JCO Interviews Dr. C. Norman Shealy on Holistic Health, Part 1

DR. GOTTLIEB Norm, I think our readers ought to know your background.

DR. SHEALY At age 16 I knew that I was going to be a neurosurgeon. My plan was to be a professor of neurological surgery and do research on the brain. I did graduate from Duke University Medical School, took a general surgery residency for a year, and then had five years of neurological residency at Massachusetts General Hospital in Boston, and was involved with basic neurophysiologic research. In 1965, I theorized that we could control pain by stimulating the dorsal column of the spinal cord, and this actually revolutionized pain therapy in this country. From dorsal column stimulation, I very quickly moved into transcutaneous electrical stimulation, and I was really responsible for a huge surge of interest in controlling pain with electrical stimulation. In 1971, I realized that 94% of the people I was seeing, who were invalids with chronic pain, were not candidates for a surgical procedure. That's when we started the Pain and Health Rehabilitation Center in La Crosse. We started off using behavior modification and anything else that seemed safe. Gradually, we evolved a system of management of these patients which includes the use of acupuncture, transcutaneous electrical stimulation, physical exercise, nutritional education, a tremendous amount of psychological counselling and biofeedback training, and a systematic way of using the mind to train the physiology of the body, which I have called Biogenics, which is just a synthesis of a lot of other people's concepts. We have worked with about 2500 patients in this way.

DR. GOTTLIEB How long does this therapy and training take?

DR. SHEALY We ordinarily work all day every day for 11 of the 12 days that patients are with us at the Center. We take people who, on the average, have been invalids for six years and, after six months, 72% of those who have gone through our program are improved 50-100%. Ninety percent of them are off drugs; physical activity is markedly improved; mood is improved; pain is reduced. I don't know a better set of statistics anywhere in the country in dealing with chronic pain. As we began having good success with the Biogenics approach in 1973, we found that patients' high blood pressure, angina, asthma, and other symptoms began to come under control at the same time. So, I became interested not just in pain, but in chronic disease and the stress that creates chronic disease. My work now is just as much in stress management as in pain management. I quit doing surgery around 1974, because I found that I just didn't see enough people for whom surgery was justified. I felt that what I was doing was more important, because at that time no one else was doing an adequate job in managing chronic pain. So, I have evolved from being an absolutely traditional neurosurgeon into a comprehensive holistic clinic for management of chronic pain, chronic illness, and chronic stress.

DR. GOTTLIEB How do you define holistic health?

DR. SHEALY We've defined holistic health as a state of being in which body, mind, emotion, and spirit are in harmony with the environment. That's similar to the definition that the World Health Organization has given to health. They don't mention spirit, but they emphasize that health is more than the absence of disease, which is what most people have thought of as health.

DR. GOTTLIEB That may be because disease symptoms are a measure of lack of health.

DR. SHEALY Only about two people in a thousand in America have no symptoms. That is a fascinating fact, because everyone is born well. Those that are not born well usually don't live. So, 99% of people are born rather healthy. By the time an individual is 30, symptoms are rather prevalent. In fact, they begin in the teens. I've been looking at it from what I call Total Life Stress. After age 30, the higher the total chemical, physical, and emotional stress that a person has, the greater the chance that they will have a number of symptoms; and, in general, when they exceed 50 points on the Total Life Stress Scale, the chances are very high that they will have well over 20 symptoms on the Cornell Medical Index, which is a well-known symptom analyzer.

DR. GOTTLIEB What is the Total Life Stress Scale?

DR. SHEALY It is something that we developed to analyze physical, chemical, and emotional stress. I must add the spiritual, because we are finding that what is missing from a spiritual point of view is an important factor in the stress reactions of the chronically ill. We are also developing a Human Development Potential Scale, meaning the personality characteristics that most people would accept as being goals toward which human beings should work. Psychologists have not looked at this from the right perspective. Basically, it isn't that a person has meanness or somerather disagreeable personality trait. They have a lack of development of some of the higher human characteristics such as tolerance, charity, forgiveness, love, etc.

DR. GOTTLIEB Wilson and other sociobiologists influenced by Wilson say that such traits are genetically related.

DR. SHEALY I must say that I almost totally disagree with the idea that those things are genetic in origin. They are environmental.

DR. GOTTLIEB Wilson based this point on the idea that altruism frequently found in humans, is contrary to the basic instincts of self-interest such as survival; and he extended it to other reactions like rage and anger.

DR. SHEALY But rage and anger can be created with poor nutrition. I think I could create almost any personality state by manipulation of diet and nutrition. There are genetic predispositions. There is no doubt about that; and each person is born with a certain stress reserve. Those who choose their parents wisely may have a greater stress reserve. As long as they don't use up that stress reserve with bad nutrition, with chemical habits like smoking, and with physical inactivity, they will tolerate a tremendous amount of emotional stress; but, once that stress reserve is used up, they become ill.

DR. GOTTLIEB Can they reverse the process?

DR. SHEALY Yes; They can reestablish homeostasis without even dealing with the emotional stress, if they start exercising and eating well. While there may be an aspect that is genetically determined, my strong suspicion is that it is more environmental than genetic.

DR. GOTTLIEB Is stress reserve related to what we call will, such as the will to live?

DR. SHEALY Viktor Frankel, who was in a German concentration camp and later wrote about it in one of my favorite books, "Man's Search for Meaning" states that more important than nutrition, starvation, or anything else, is the will to live. I suspect it is strongly genetically determined, but I am equally convinced that it can be altered by environment.

DR. GOTTLIEB Can it be measured?

DR. SHEALY How do you measure positivity? There are some scales available. Abraham Maslow, one of the founding fathers of humanistic psychology, developed a Personal Orientation Inventory, which is a scale of self-actualization. To Maslow, a self-actualized person is an individual who can make choices between good and bad, mature and immature, and who can make rational moral decisions without being judgmental. That's the kind of thing that I am considering as spiritual development. Not something mystical, but just practical, common sense, intelligent community living.

DR. GOTTLIEB Do you make that evaluation on your patients?

DR. SHEALY Actually, we do a lot of psychological testing. We also interview patients, and use intuition, I suppose, more than anything. We find that chronically ill patients have a lot of unresolved fear and anger, which often leads them to become guilty and depressed. Basically, there is only one negative emotion, and that is fear. Franklin D. Roosevelt was right when he said that the only thing we have to fear is fear itself. Sometimes, people are not aware of what they are afraid of, when they are really afraid of losing life, health, money, love, and as my wife helped me add, moral values. There is nothing else that gets people into trouble other than fear of loss of life, health, money, love, or moral values. All human problems come from those five fears. Sometimes, people react to the threat of loss of one of these with anger. "How dare that SOB try to take away my life, my health, my money, my love, my moral values." Sometimes, they get so angry that they begin conniving to destroy the individual they think is threatening them. This often leads to guilt, because they know that you aren't supposed to murder anyone. You have the Ten Commandments, after all, and almost all human beings recognize the Ten Commandments as common sense ways of getting along with other people. Now, sometimes, when individuals become overwhelmed by fear or guilt, they become depressed. They feel that it is hopeless, that there is no way of overcoming this fear. That is a time when they may lose the will to live. Depression of a significant degree is present in 90% of people who are chronically ill.

DR. GOTTLIEB Is the same mechanism occurring occasionally in persons who are not chronically ill?

DR. SHEALY Yes. I think so.

DR. GOTTLIEB Is the practice of holistic health preventive medicine for them?

DR. SHEALY Preventive medicine has dealt more with environment and habits, more recently with life styles. Preventive medicine ignored one important aspect of holistic medicine and that is confronting the patient with the concept that they have got to get in touch with their own spiritual ideals. We are telling our patients as subtly as possible that we believe that virtually all human beings, except perhaps for psychopaths, have moral values; and they don't believe in killing people, maiming people, getting even with people. It is learning to make choices in harmony with one'sspiritual ideals.

DR. GOTTLIEB Does every practitioner of holistic health become a physician?

DR. SHEALY No. Of course not.

DR. GOTTLIEB I mean without a license.

DR. SHEALY Ah. Well, if you look at a popular book that was published some years ago entitled "We Are All Healers" in a sense we are all our own physician.

DR. GOTTLIEB General dentists deal with disease to a much lesser extent than physicians, but to a much greater extent than orthodontists. Orthodontists feel that the people they are treating are not diseased, but suffer from morphological problems.

DR. SHEALY I know of one dentist who believes that to a significant extent orthodontic problems are nutritional.

DR. GOTTLIEB The influence of nutrition on growth and development?

DR. SHEALY Right.

DR. GOTTLIEB On eruption of teeth?

DR. SHEALY Exactly. Some people may inherit an inadequate jaw through a distorted growth pattern, but several times as many may be created through poor habits. My belief system, which I cannot necessarily prove, says that almost any disease, illness, or physical abnormality is created by multiple factors. Forbus, a great pathologist of some years ago, wrote about the reaction of the body to injury and emphasized that there are a limited number of ways in which the body can react. There may be a dominance of infection, but Pasteur himself supposedly stated on his dying bed, "I was wrong. It is not the germ that causes the disease. It is the culture medium upon which it falls" Weknow that there are people in every great plague and every infectious epidemic who are exposed to it, but don't come down with it. Why? Because their immune system is strong, because their stress reserve is greater. Some of that stress reserve is affected by genetic predisposition, but a big part of it is created by attitude. The ultimate factor that determines if a person is optimally balanced physically, mentally, emotionally, and spiritually is attitude. Without the right attitude, people won't choose the right habits. They won't choose to think straight or eat straight; and these are just as intertwined as body and mind are.

DR. GOTTLIEB Body, mind, and spirit has become body, mind, emotion, and spirit. How did spirit come to be divided into emotion and spirit?

DR. SHEALY There is truly no separation of emotional and spiritual, even though it has happened. Emotions are physiologic reactions in the body to mental attitudes. In other words, an emotion is not a mental abnormality and it is wrong to speak of people being emotionally disturbed. They are attitudinally disturbed, and mental disturbances of attitude are spiritual.

DR. GOTTLIEB Spiritual in holism is a belief in a divinity, is it not?

DR. SHEALY Yes. I think that it would be impossible to consider oneself holistic if one denied the existence of the soul and of God.

DR. GOTTLIEB You cannot be three-fourths holistic?

DR. SHEALY Not very easily, although there are excellent scientists who deny there is such a thing as God or a soul because they haven't been proven scientifically, but who themselves are highly evolved spiritual beings, whose attitudes, behavior, and treatment of other people is what I would call highly spiritual.

DR. GOTTLIEB Can you intellectualize belief in that way? Does not religion require blind belief?

DR. SHEALY Now I think we may be on the verge of it. You introduced the term "religion" Religion and spirituality are totally different. Religion is largely a man-created or woman-created belief system with a large amount of dogma associated with it. Spiritual belief is a knowing, an absolute belief in and certainty of the existence of something that is beyond body, mind, and emotion. Certain things transcend religion, although they are universal in the great religions of the world. Such things as generalized love and the Golden Rule, religions have made into Commandments; but a true thinker accepts these not as Commandments, but as truths which become the basis for a personal spirituality.

DR. GOTTLIEB In order for a person to influence another to holistic health, would he have to be holistic himself?

DR. SHEALY Yes and no. To do an optimal job, absolutely yes. To do a better than average job, not necessarily. For instance, there are psychologists, psychiatrists, and other counsellors who have terribly messed-up personal lives, who nevertheless--and perhaps because they have messed-up lives--can pass out good advice to other people. But, to do it optimally, we must be examples of what we are preaching and teaching. For instance, a physician who tries to get a patient to stop smoking, but himself smokes, is not going to convince very many people.

DR. GOTTLIEB What are the rewards for living a holistic life?

DR. SHEALY Number one would be happiness.

DR. GOTTLIEB Someone who lives a healthy, holistic life is automatically happy?

DR. SHEALY Oh yes. Contributing to happiness with a sense of well being, a sense of responsibility, a sense of purpose, and a sense that one is doing something good for other people. Hans Selye has put it very well, "being an altruistic egotist", doing something to help other people because it makes you feel good and helps you enhance a purpose in life. A person who is greedy, selfish, or immature is going to have a hard time optimizing the rewards of life. Life is not easy. It is not a rose garden, but it is more of one if one lives one's life in concert with inner ideals. You could substitute the word "ideals" for the word "spiritual" The extent to which one lives up to ideals ultimately determines health, because those ideals are reflected in one's attitudes.

DR. GOTTLIEB Is this where the concept comes from that you can be diseased of body, but well, and that wellness d