There are strong signs that what is true at Bell Labs augurs for the future of all corporate life, a tomorrow where the basic skills of emotional intelligence will be ever more important, in teamwork, in cooperation, in helping people learn together how to work more effectively. As knowledge-based services and intellectual capital become more central to corporations, improving the way people work together will be a major way to leverage intellectual capital, making a critical competitive difference. To thrive, if not survive, corporations would do well to boost their collective emotional intelligence.
11
Mind and Medicine
"Who taught you all this, Doctor?"
The reply came promptly:
"Suffering."
—ALBERT CAMUS, The Plague
A vague ache in my groin sent me to my doctor. Nothing seemed unusual until he looked at the results of a urine test. I had traces of blood in my urine.
"I want you to go to the hospital and get some tests . . . kidney function, cytology . . . ," he said in a businesslike tone.
I don't know what he said next. My mind seemed to freeze at the word cytology. Cancer.
I have a foggy memory of his explaining to me when and where to go for diagnostic tests. It was the simplest instruction, but I had to ask him to repeat it three or four times. Cytology —my mind would not leave the word. That one word made me feel as though I had just been mugged at my own front door.
Why should I have reacted so strongly? My doctor was just being thorough and competent, checking the limbs in a diagnostic decision tree. There was a tiny likelihood that cancer was the problem. But this rational analysis was irrelevant at that moment. In the land of the sick, emotions reign supreme; fear is a thought away. We can be so emotionally fragile while we are ailing because our mental well-being is based in part on the illusion of invulnerability. Sickness—especially a severe illness—bursts that illusion, attacking the premise that our private world is safe and secure. Suddenly we feel weak, helpless, and vulnerable.
The problem is when medical personnel ignore how patients are reacting emotionally, even while attending to their physical condition. This inattention to the emotional reality of illness neglects a growing body of evidence showing that people's emotional states can play a sometimes significant role in their vulnerability to disease and in the course of their recovery. Modern medical care too often lacks emotional intelligence.
For the patient, any encounter with a nurse or physician can be a chance for reassuring information, comfort, and solace—or, if handled unfortunately, an invitation to despair. But too often medical caregivers are rushed or indifferent to patients' distress. To be sure, there are compassionate nurses and physicians who take the time to reassure and inform as well as administer medically. But the trend is toward a professional universe in which institutional imperatives can leave medical staff oblivious to the vulnerabilities of patients, or feeling too pressed to do anything about them. With the hard realities of a medical system increasingly timed by accountants, things seem to be getting worse.
Beyond the humanitarian argument for physicians to offer care along with cure, there are other compelling reasons to consider the psychological and social reality of patients as being within the medical realm rather than separate from it. By now a scientific case can be made that there is a margin of medical effectiveness, both in prevention and treatment, that can be gained by treating people's emotional state along with their medical condition. Not in every case or every condition, of course. But looking at data from hundreds and hundreds of cases, there is on average enough increment of medical benefit to suggest that an emotional intervention should be a standard part of medical care for the range of serious disease.
Historically, medicine in modern society has defined its mission in terms of curing disease —the medical disorder—while overlooking illness —the patient's experience of disease. Patients, by going along with this view of their problem, join a quiet conspiracy to ignore how they are reacting emotionally to their medical problems—or to dismiss those reactions as irrelevant to the course of the problem itself. That attitude is reinforced by a medical model that dismisses entirely the idea that mind influences body in any consequential way.
Yet there is an equally unproductive ideology in the other direction: the notion that people can cure themselves of even the most pernicious disease simply by making themselves happy or thinking positive thoughts, or that they are somehow to blame for having gotten sick in the first place. The result of this attitude-will-cure-all rhetoric has been to create widespread confusion and misunderstanding about the extent to which illness can be affected by the mind, and, perhaps worse, sometimes to make people feel guilty for having a disease, as though it were a sign of some moral lapse or spiritual unworthiness.
The truth lies somewhere between these extremes. By sorting through the scientific data, my aim is to clarify the contradictions and replace the nonsense with a clearer understanding of the degree to which our emotions—and emotional intelligence—play a part in health and disease.
THE BODY'S MIND: HOW EMOTIONS MATTER FOR HEALTH
In 1974 a finding in a laboratory at the School of Medicine and Dentistry, University of Rochester, rewrote biology's map of the body: Robert Ader, a psychologist, discovered that the immune system, like the brain, could learn. His result was a shock; the prevailing wisdom in medicine had been that only the brain and central nervous system could respond to experience by changing how they behaved. Ader's finding led to the investigation of what are turning out to be myriad ways the central nervous system and the immune system communicate—biological pathways that make the mind, the emotions, and the body not separate, but intimately entwined.
In his experiment white rats had been given a medication that artificially suppressed the quantity of disease-fighting T cells circulating in their blood. Each time they received the medication, they ate it along with saccharin-laced water. But Ader discovered that giving the rats the saccharin-flavored water alone, without the suppressive medication, still resulted in a lowering of the T-cell count—to the point that some of the rats were getting sick and dying. Their immune system had learned to suppress T cells in response to the flavored water. That just should not have happened, according to the best scientific understanding at the time.
The immune system is the "body's brain," as neuroscientist Francisco Varela, at Paris's Ecole Polytechnique, puts it, defining the body's own sense of self—of what belongs within it and what does not.1 Immune cells travel in the bloodstream throughout the entire body, contacting virtually every other cell. Those cells they recognize, they leave alone; those they fail to recognize, they attack. The attack either defends us against viruses, bacteria, and cancer or, if the immune cells misidentify some of the body's own cells, creates an autoimmune disease such as allergy or lupus. Until the day Ader made his serendipitous discovery, every anatomist, every physician, and every biologist believed that the brain (along with its extensions throughout the body via the central nervous system) and the immune system were separate entities, neither able to influence the operation of the other. There was no pathway that could connect the brain centers monitoring what the rat tasted with the areas of bone marrow that manufacture T cells. Or so it had been thought for a century.