Mind and Matter X

Quantum Physics VIIIMind over Matter VIII

We are what we think.All that we are arises with our thoughts.With our thoughts we make our world.

Dharmapada (sayings of the Buddha)

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Topics for today

• Quantum Physics VIII– Interpretations of quantum mechanics I

• Mind over Matter VII– Mental interventions in surgery – Mental factors in cancer

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Topics for today

• Quantum Physics VIII– Interpretations of quantum mechanics I

• Mind over Matter VII– Mental interventions in surgery – Mental factors in cancer

No elementary phenomenon is a real phenomenon until it is an observed phenomenon.

—John Archibald Wheeler

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1. Copenhagen

• The orthodox stance in physics • Observation creates the physical reality of the

microscopic world• But for all practical purposes we can continue to

use classical physics for the macroscopic world• And since we have mathematical equations that

work for the microscopic world we can use them for further science and engineering– And not worry about what it all means

• Short form: “Shut up and do the math!”

Review

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1. Copenhagen. Richard Henry’s comment

• The “majority” interpretation, for decades. Not really an interpretation at all, but rather a (clearly non-physical) segregation of the world into the microscopic (in which there is reality, but it is observer-created reality), and the macroscopic (which was taken to be real). A human observer is not needed; a geiger counter will do just fine. [Rosenbaum & Kuttner] correctly point out that the advance of technology now forces retreat from this increasingly untenable “interpretation”. Richard Conn Henry

Professor of Physics and AstronomyJohns Hopkins University

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2. Extreme Copenhagen

• Proposed by Aage Bohr, son of Niels Bohr, and Ole Ulfbeck• They explicitly deny the existence of the microworld– There are no atoms

• “The notion of particles as objects in space, taken over from classical physics, is thereby eliminated”

• Comment of Rosenblum & Kuttner:Accordingly, when chemists, biologists, and engineers talk of photons, electrons, atoms, and molecules, they are merely dealing with models without physical reality. No photons pass through the space between the light bulb and your eye. No air molecules bounce off the canvas sheet to push the sailboat through the water”

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3. Decoherence and Consistent Histories

• ‘decoherence’ is another term for ‘collapse’– As in “collapse of the wave function”

• This is an extension of the Copenhagen interpretation• Henry’s comment:

[Rosenblum & Kuttner] correctly paint these as ineffective evasions of the real question. Decoherence is quite popular.

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4. Many Worlds

• Accepts what quantum theory says literally• The wavefunction does not collapse after all– Into one or the other possibility

• Instead, we get both, but in different worlds• The electron (or photon or atom) is both wave and particle– But in different worlds

• The cat is alive in one world and dead in the other

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4. Many Worlds. Richard Henry’s comment

• Every observation with two possible outcomes results in the creation of an additional entire universe. Many observations have an infinite number of possible outcomes, so infinitely many universes (complete with a you in it) are made very often indeed. [Ronenblum & Kuttner] say “there is no single reality, which is essentially equivalent to no reality.” At the “Science and Ultimate Reality” meeting in 2002 in Princeton, Bryce DeWitt (the most influential advocate of this interpretation) sat down next to me at lunch, and told me that those other versions of the universe are as real as ours … and that in his opinion we will eventually communicate with them (I am not making this up). Many highly-regarded physicists accept “many worlds.”

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5. Transactional

• Proposed by John Cramer• Allows the wavefunction to evolve backward as well

as forward in time• The future thus affects the past• Cramer: “When we stand in the dark and look at a star a

hundred light years away, not only have the retarded light waves from the star been traveling for a hundred years to reach our eyes, but the advanced waves generated by absorption processes within our eyes have reached a hundred years into the past, completing the transaction that permitted the star to shine in our direction”

• Henry’s comment:A convoluted approach that “very much involves an encounter with a conscious observer.”

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6. Bohm

• Proposed by David Bohm• As in the Many Worlds interpretation, there is no

collapse of the wavefunction• Rosenblum & Kuttner: “We may find Schrödinger’s cat alive, but

the part of the wavefunction containing the possibility of the dead cat, and its owner burying it, goes on. We may ignore this part of the wavefunction, for all practical purposes, since it has engtangled with the environment. But in this interpretation it is real and, in principle at least, has future consequences.”

• Bohm and Hiley: “…the intuition that consciousness and quantum theory are in some sense related seems to be a good one.”

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6. Bohm. Richard Henry’s comment

• [Rosenblum & Kuttner] bring out that Bohm did consider a role for consciousness. There is a “quantum potential” that has no role other than to allow this interpretation in which there is “a physically real, completely deterministic world.”

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7. Ithaca

• Proposed by David Mermin of Cornell University• “Correlations have physical reality; that which they

correlate do not.”• Example 1: twin-state photons

– They have no particular polarization– But they have the same polarization– Only the correlation of their polarization

• The polarizations themselves are not real

• Example 2: the position of two entangled atoms– Their separation is a reality– The position of each atom is not a reality

• Rosenblum & Kuttner: “The encounter with consciousness is not denied. Ithaca assigns consciousness to a ‘reality’ larger than the ‘physical reality’ to which physics…should be restricted.”

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8. GRW.

• Proposed by Ghirardi, Rimini & Weber• The Schrödinger equation is modified to make the

wavefunctions collapse randomly every now and then. For things as small as atoms, a collapse occurs only every billion years or so

• But there are so many billions of atoms in Schrödinger’s cat that at least one of them would collapse very soon, and since it would be entangled with all the others in the cat, the whole cat would soon be either dead or alive after having been in the superposition state only briefly

• Not supported by any experimental evidence

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8. GRW. Henry’s comment

• Not an interpretation, as it proposes a change in quantum mechanics. Such a change could be tested, and it should be! But, don’t invest your own money in such tests. [Rosenblum & Kuttner] quote Steven Weinberg, “the one part of today’s physics that seems to me likely to survive unchanged in a final theory is quantum mechanics” and state that they share his intuition. Well, his was no “intuition!” Weinberg once attempted to change quantum mechanics, but Polchinsky showed him that it couldn’t be done.

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9. Quantum Logic

• Quantum logic “resolves” the enigma by revising the rules of logic to fit quantum theory

• But since any conceivable observations can be ”explained” by adopting rules of logic to fit, this hardly provides a comfortable resolution of the quantum measurement problem

• “As a resolution of the quantum enigma, this assumption is, to use John Bell’s words…, ‘more mind boggling’ than the enigma it presumes to resolve” (Rosenblum & Kuttner)

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Topics for today

• Quantum Physics VIII– Interpretations of quantum mechanics I

• Mind over Matter VII– Mental interventions in surgery – Mental factors in cancer

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Topics for today

• Mind over Matter VII– Mental interventions in surgery – Mental factors in cancer

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Mental interventions in surgery

• There is a huge literature– Hundreds of studies, thousands of patients – Yet largely unknown to majority of doctors and health-care systems

• Wide variety of different kinds of surgery• Simple mental interventions before surgery– Comforting words– Information about the surgical procedure– Instructions– Hypnotic suggestion – Guided imagery

• There are also tapes/CD’s for use before and during surgery

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Mental interventions in surgery: Outcomes

• Studies cover a wide variety of different kinds of surgery

• Results/Outcomes:– Less pain medication after surgery– Less loss of blood– Timely return of bowel motility– Fewer surgical complications– Shorter hospital stays

• Good both for patient and hospital

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Relaxation techniques alone are not effective

• Much of mind-body medicine relies heavily on relaxation techniques

• Such techniques produce limited and mixed results in surgery• Possible partial explanation:– Surgery is unlike other producers of stress– Better to address actuality and meaning of the surgical

experience

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Mental interventions and length of hospital stay

• Most studies use comparisons with control group– Control group: similar surgery, no prior mental

intervention• Length of hospital stay– Psychological intervention group, avg. 2.4 days

less than control group– (N.B.: huge cost savings for hospitals)

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Blood loss during surgery

• Suggestions given before surgery Dreher 306UL

• Results (spinal cord surgery):– Treatment group

• Average blood loss of 500 cc – Control group (patients not receiving mental intervention)

• Average blood loss about 900 cc

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Return of gastro-intestinal motility

• After gastro-intestinal surgery, complete cessation of peristaltic action of stomach and intestines– Patients cannot take food by mouth– Are fed intravenously

• 1993 study (Bennett et al.) – 20 patients in suggestion group: 5 minutes of mental suggestion– “Your stomach will churn and growl, your intestines will pump

and gurgle, and you will be hungry soon after your surgery”– They were also asked to identify their favorite foods, thoughts of which

could lead to stomach growling– 20 patients in control group: 5 minutes of instructions on clearing lungs

• Time to return of gastro-intestinal motility– Suggestion group: Average 2.6 days, average hospital stay 6.5 days– Control group: Average 4.1 days, average hospital stay 8.1 days

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Naparstek tape: guided imagery before surgeryBelleruth Naparstek

• Variety of types of surgery• Guided imagery D 312L • Results

– Blood loss• Imagery group: average 200 cc• Control group: average 350 cc

– Length of hospital stay after surgery• Imagery group: average 92.5 hours• Control group: average 121 hours

• Others have also produced tapes– Don’t get such good results– Why is Naparstek’s tape better? D 315B, 317T-M

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Topics for today

• Mind over Matter VII– Mental interventions in surgery – Mental factors in cancer

• Psychosocial interventions for cancer patients• Mental and emotional factors in cancer development

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Types of mental intervention in cancer patients

I. Imagery– Impressive anecdotal evidence but

no good controlled studies yet

II. Music therapy– No good controlled studies yet

III. Group psychotherapy – (“psychosocial intervention”)

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Examples of psychosocial interventionI: Research of David Spiegel, beginning in 1980’s

• Metastatic breast cancer patients with grim prognoses• Program of group psychotherapy

– Patients shared their emotional distress– Gave emotional support to one another– Confronted the existential issues of life-threatening illness

• Patients were also taught mind-body skills– Mainly self-hypnosis

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Spiegel’s expectations and results

• Study included 86 patients, randomized to– 1) study group– 2) controls– Both groups received standard therapy– All were in advanced stage of breast cancer, grim prognosis

• Spiegel’s expectations for participating patients:– Less distress– More expression of emotion– Better ability to obtain social support– Better able to confront the reality of their situation

• Spiegel’s results– Control group patients survived average 19 months– Study group patients survived average 38 months

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Examples of psychosocial interventionII: Fawzi I.Fawzi, early 1990’s

• 68 melanoma patients, randomized into– Treatment group– Control group

• Treatment techniques (treatment group)– Relaxation techniques– Cognitive therapy to cultivate active coping– Psychological support

• Results, after six years of follow-up:– Death-rate for treatment group: 9%– Death-rate for control group: 29%

• more than three times that of the treatment group– Treatment group had one-half the recurrence rate

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Examples of psychosocial interventionIII: Two studies without positive outcomes for treatment groups

• Why no significant improvement over controls?• The treatment: – Patients were “seen regularly by a counselor”– (Lynn et al. 1982)

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Biological results of psychosocial intervention (Fawzi 1990)

• Immune enhancement• Specifically, significant increase in – natural killer (NK) cells– large granular lymphocytes– ability of interferon to augment NK cell activity

• All these are associated with control of metastatic spread of cancer

• Other biological mechanisms are under study• Consequences:

– Less aggressive tumors– Longer survival

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Evaluating psychosocial intervention

• Appropriate standards for comparison: – New pharmacological treatments for immune enhancement– New chemotherapy drugs– Other new and standard and treatments

“If you proceed on the basis of the published literature, there is better evidence right now that group therapy extends survival time with breast cancer than there is similar evidence for bone marrow transplantation.”

—L. Crain Henderson, UCSF

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Comparison with conventional (physical) treatments

• New chemotherapy protocol for advanced ovarian cancer– Taxol and cisplatin

• Average survival time: 38 months– Previous standard treatment: cyclophosphamide and cisplatin

• Average survival time: 24 months– Improvement in survival time: 14 months, 58%– On the basis of this study (1996), the new treatment was elevated

to “first line of treatment”

• Spiegel study, psychosocial intervention for breast cancer– Control group patients survived average 19 months– Study group patients survived average 38 months– Improvement in survival time: 19 months, 100%

• Fawzi study, psychosocial intervention for melanoma – Death-rate after six years for treatment group: 9%– Death-rate after six years for control group: 29%

• More than three times that of the treatment group

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Topics for today

• Mind over Matter VII– Mental interventions in surgery – Mental factors in cancer

• Psychosocial interventions for cancer patients• Mental and emotional factors in cancer development

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Psychological traits of successful cancer survivorsTemoshok & Dreher (1992)

• Fighting spirit• Emotional expression

– Ability to freely express emotions• i.e., absence of suppression

• Active or assertive coping

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Mind and Cancer: An ancient observation

Galen (2nd century Greek physician): Breast cancer occurs far more often in women with a “melancholic” temperament than in women with a “sanguine” temperament

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Mental and emotional factors in cancer developmentA good source in information: Henry Dreher, Mind-Body Unity (2003)

• The mind influences the strength of the immune system– A wealth of studies

• The immune system attacks cancer cells– Natural Killer (NK) cells, T cells– They (1) recognize (2) destroy cancer cells

• More effective in early-stage cancer• But even metastatic cancer is some cases

– Recent pharmaceutical developments also work by strengthening the immune system

• Mind also affects gene expression, DNA repair, apoptosis of cancer cells

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The “Type-C” Personality

• Descriptions (from Dreher, Chapter 4)– “serious, over-nice, apologetic, …” 160U

• Prebiopsy psychiatric test (Greer&Morris 1975)– 160 women with suspicious lumps – 69 had cancer– Most important psychological difference:

• More likely to be suppressors of anger (about 50%)• Extreme suppressors: “had never or not more than twice during

their adult lives openly shown anger”• Over 50% were also suppressors of sadness, anxiety• Of those without cancer, only 15% were “anger suppressors”

• Hopelessness 161TM• Unable to express either negative or positive emotions

Timoshok & Dreher (1992)

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Psychological factors and non-factors

• Psychological factors without significant cancer effect:– Anxiety– Depression– Introversion– Extroverson

• Psychological factors with significant cancer effect:– Felling of hopelessness– Denial– Repressive coping– Anger repression– Non-expression of emotions– Compliance– Self-sacrifice– Passive response to stress– Stoicism

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“Positive” and “negative” emotions

• Suppression of negative emotions also suppresses the positive• The ability to express and cognitively process negative

emotions ultimately reduces distress and makes positive emotions: joy, hope, fighting spirit—more accessible

David Spiegel et al. (1989), Turner-Cobbs et al. (2001)

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Social support and emotions

Social support also slows cancer suppression: ”expressors of negative emotion are more likely to seek social support; those who remain non-expressive, stoical, passive, or self-sacrificing (Type C-like) may be less inclined to turn to their social networks, worrying more about others than about themselves.”

—Dreher 177

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Type C personality and biological processes

• Psychological state:– Hopeless– Feeling of helplessness– Unable to engage in positive assertion on behalf of self

• Resulting biological imbalances:– Endocrine disruptions– Deficits in neurotransmitter systems– Improper regulation of immune system by nervous system

• Consequences:– Weakened immune defenses– Reduction in tumor-invading lymphocytes– Reduced NK cell activity

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Hope (I)Lawrence LeShan

• Cancer can be a turning point rather than a breaking point• When the patient seeks the help of loved ones, as well as

knowledgeable and compassionate clinicians, he or she may find the strength to transform one of life’s most dreadful challenges into an enriching and life-affirming experience

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Hope (II)

• Coping responses can and do change – They do not have to remain static under pressure– Type C behavior can be changed

• Lydia Temoshok– Director of The Behavioral Medicine Program, University

of Maryland Medical School– Co-Author, The Type C Connection: The Mind-Body Link

to Cancer and Your Health– “I’ve described the experience of cancer as a crossroads

in your life, when you’re confronted with both danger—and opportunity…..What changes you make turn this experience from what (at first) may seem like a prison sentence into an opportunity for healing and a better life.”

– http://www.healingcancer.info/ebook/lydia-temoshok– D 195TU

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T h a t ‘ s i t f o r t o d a y !