Expert View: You are as healthy as you think you are

French philosopher Rene Descartes rejected the notion that mind and body were connected and that the mind could influence physical health.

Western medicine adopted the separation proposed by Descartes. It also found it easier to fix a mechanical body without having to deal with the enigmatic mind, the “Ghost in the Machine.”

Nevertheless, physicians have been aware of the placebo effect, which is when people get better when they believe (falsely) that they are getting an effective drug. Conversely there is a nocebo effect, i.e. negative thinking about an illness or therapy, which can adversely affect health. So, in practice, mind does affect the body.

Two centuries after Descartes discarded the mind-body connection, O Henry elegantly narrated the nocebo and placebo effects in his classic short story “The Last Leaf”, which is set against the background of an epidemic of pneumonia.

Down with a nasty bout of pneumonia, the patient, a young lady, is full of gloom at the impending doom of death. The view from her window is bare and dreary. She could see a brick house around which an old ivy vine climbed up, its leaves rapidly falling in the autumn.

She keeps counting the remaining ones. This symbolises the ebbing of life from her body. The falling leaves acted as nocebo. She passively waits for death believing it will coincide with the fall of the last leaf. Her doctor gives up hope. The penultimate day arrives. Only one leaf remains. There is strong wind and heavy rain throughout the night.

An aging neighbour, a failed artist, comes to know about her. He paints a leaf on the wall across. It turns out to be the only masterpiece he has ever painted. Next day the lady sees the sole leaf standing in spite of the heavy winds and rain throughout the night. This gives her the will to fight and live. The painted leaf acts as a placebo. She recovers. But the aging artist, exposed to the elements, succumbs to pneumonia.

While O Henry in his short story may have conveyed the mind body as a work of fiction, there is emerging evidence of the mind- body connection. Fiction and fact seem to be merging.

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The concept of Salutogenesis by Antonovsky, described in his 20^th Century book, Health, Stress and Coping, suggests that life experiences help shape one’s sense of coherence, making life comprehensible, meaningful and manageable. This helps one to cope with stress. More recently, Martin Seligman distinguished between flourishing and languishing persons. Flourishing persons experience more positive feelings, while languishing persons have more negative ones.

This phenomenon not only shapes mental wellbeing, but also impacts on physical health. In the short term, stress reduces immunity to infections, while in the long run they may be risk factors for heart diseases, high blood pressure, diabetes, other endocrine disorders, autoimmune disorders, skin disorders and psychiatric illnesses.

Among students it is common to find acute stress of examinations increasing bouts of common cold, suggesting inhibition of natural immunity. Research also suggests that psychological stress increase risk of acute infectious respiratory illnesses.

Studies in the field are still evolving. They encounter difficulties as both stress and immunity are multifaceted and difficult to measure.

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Easier to understand is how stress may impact immunity and health in indirect ways. Stress as a result of prolonged panic from the pandemic may drive people to unhealthy food, tobacco and alcohol (witness the long queues at liquor shops during relaxation of lockdowns). All these while lowering immunity in the short term may increase the risk of chronic diseases. People losing their livelihoods will suffer from malnutrition reducing the immunity to infections.

The effect of panic induced stress in the present pandemic is highly detrimental to public health. The effects may be seen in the long run with higher rate of mental illness, alcoholism, substance abuse, chronic diseases while in the short run large number of people will be susceptible to infectious diseases due to low immunity.

The common strategy of most governments in the current pandemic has unfortunately been to instil fear in people. This strategy has been used in a paternalistic manner to make people compliant to “covid appropriate behaviour”. This approach may have been justified in the initial uncertain stages of the pandemic as a precautionary principle to err on the side of safety.

But this has resulted in prolonged panic in the population and mass hysteria. Short term stress has transformed into long term stress for many. Chronic stress due to suspended businesses, education, recreation and associated uncertainties will cause immense harm due to the adverse impact on mental, physical and social wellbeing of people.

While mathematical modellers are trying to predict the third wave in our country, it does not require rocket science to predict a colossal wave of chronic mental and other non-covid diseases against a background of severe malnutrition as a result of extreme measures to control an uncontrollable virus which has had an infection fatality rate of around 0.1% in India till now.

As in the Bhagvad-Gita, we need to adapt to the stages of the pandemic as it has evolved. First there was “tamas” (darkness, destruction and chaos) when nothing was known about the novel coronavirus and many fatalities were due to chaotic mismanagement; then there was “rajas” (passion, action, confusion), the passion of scientists to fight the virus at all costs, actions which were sometimes inappropriate and confusing messages from experts; while now we should move on to “sattva” (goodness, constructive action, harmony) and learn to live with the virus.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)