DEC 1998


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD

Staying Positive About Being Positive

This article has been published in Colorado's award winning AIDS newsletter, Resolute!
It cannot be re-printed for publication in any other form without the permission of the author.

AIDS has long been described as a disease of casual "co-factors." We still don't have an adequate knowledge of what those factors are, specific to HIV. But we do have a body of knowledge about the psychology of wellness.

For a long time this approach was considered on the fringe of medical respectability. Such things as massage and meditation seemed more indicative of a Boulder cult life style than science. However, a new field, "psychoneuroimmunology" (PNI) is adding respectability to the ideas of holistic health advocates. PNI has shown that our brains control our immune system, that for instance, mice can be given Pavlovian conditioning to suppress or increase their own immune systems. Further, that at a cellular level such things as depression can make lymphocytes move sluggishly; a "lower lymphocite mitogen response" as they call it

Hippocrates was cognizant of the particularly fuzzy line between psyche and soma when he said, "I would rather know what sort of person has the disease than what sort of disease has the person." That sentiment is echoed in studies by psychologists Marjorie and Claus Bahnson who have developed a personality questionnaire that is 88% accurate in identifying women who turn out to have biopsy-confirmed cancer. Breast cancer in women is not AIDS, but much of the research on who gets sick with any illness demonstrates that they often vary in personality, outlook, and life events from those who remain healthy. For instance. George Valliant in a thirty-year study of two hundred Harvard Graduates, found that those who were extremely satisfied with their lives had one-tenth the rate of serious illness and death of those who were very dissatisfied. Another study of industrial absenteeism reflected these results with 12 times the number of minor respiratory illnesses among the most dissatisfied with life.

Similar studies have isolated the following psychological factors which can reasonably be concluded serve to suppress the immune system:

Psychological Immunosuppressants:

1. Chronic Stress/Anxiety

2. Major Life Changes

3. Depression/Life Dissatisfaction

4. Bereavement

5. Being Unassertive/Unexpressive

6. Social Isolation

Stress is such a commonly accepted compromiser of physical as well as mental health it needs little discussion. From ulcers to eczema, from heart disease to asthma, stress is recognized as a casual cofactor in disease. I was particularly impressed by the work of Vernon Riley in Seattle who could vary the cancer rate in mice from 7% to 92% depending upon the amount of stress he introduced into their environment

Major life changes, as a source of stress and illness, was demonstrated by the work of Holmes and his associates in the mid-sixties. What these researchers found was that life events, either good or bad, made us more susceptible to disease. 80 percent of the high scorers who by number of changes occurring over a short period of time were, by definition, experiencing a "major life crisis" got sick, while the lowest scorers had no significant health problems. The Schedule of Life Events contained everything from the "death of a spouse" (100 pts.) to a vacation.

Depression, a sense of hopelessness, a lack of desire to live, a sense of being a victim in life--at the mercy of outside forces, and a general life dissatisfaction all produce weak immune systems, inviting diseases of all kinds. The number of helper and suppresser cells reduce proportionately with the severity of depression. This is most evident in cases where the cause of depression is loss. The Albert Einstein College of Medicine found 31 of 33 children with leukemia they studied had experienced traumatic loss within two years of diagnosis. It is commonly known that widows and widowers are much more likely to die themselves within two years of the death of their partner.

Although largely anecdotal to date, the same has been found with AIDS. This makes the lovers of people with AIDS, who themselves are positive, particularly vulnerable. Bartrop and colleagues have demonstrated in their research that mitogens, the chemicals which stimulate lyphocytes to respond to a foreign body or infection are compromised in the bereaved.

Such a life crisis is only exacerbated by an inability to express the wide range of feelings involved with grief. Men in our culture are renowned for their John Wayne approach to emotions. They are supposed to be strong, self-sufficient hide their vulnerabilities, and to be "good (stoic) little soldiers." However, such a stiff upper lip philosophy leads to internal physical problems. As Boris Pasternak said it in Doctor Zhivago: "Your health is bound to be affected if, day after day, you say the opposite of what you feel. Our nervous system isn't just a fiction, its a part of our physical body, and our soul exists in space and is inside us. like the teeth in our mouth. It can't be forever violated with impunity."

Almost all those who developed cancer in a 30 year study of 1,300 medical students were, throughout their lives, restricted in expressing emotions, particularly when it came to getting their own needs met They were givers and "nice guys." Jeff Leiphart a Bay area psychotherapist found similar characteristics in people with AIDS. They all had a "Mr. Likeable defense against feelings of anger and an avoidance of confrontation.

Having no one to vent those feelings to also has been shown to increase one's vulnerability to illness. A nine year study of Alameda County residents in California found those with the fewest social contacts had a two and-one-half times higher incidence of disease than those with the most social contacts. "Social supports," as defined for the purposes of research is, "information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations."

The bottom line is that the more of these qualities and circumstances are present in conjunction with the HIV virus, the more likely you are to progress to AIDS. This is not a proven fact mind you, but well enough established to be foolish to ignore.

At this point I am sure I have offended some readers. It will be argued that I am saying PWAs are responsible for their illness; that if they had just done everything "right" they would be healthy today. I don't believe this is true. If you take this line of reasoning further, the best way to avoid illness is to never be close enough to one person to care deeply if they leave, and thereby avoid the immune risk of bereavement. On the other hand, such a strategy would put you at risk for becoming devoid of a social support network You would also have to become a total couch potato to avoid stress. However, doing this runs the risk of creating a depressive state which leads to more immune problems.

On the other hand, to conclude that we are powerless, that it is hopeless, has in itself been shown to hasten death. There are many dramatic examples of people who die shortly after losing all hope. It was a common phenomenon in the Nazi death camps, documented by the famous psychiatrist Victor Frankl. Hopelessness was also shown to be a predictor of who had cancer. Aurther Schmale was able to pick out 36 of the 51 women he tested who had a malignancy by looking for a sense of hopelessness and a recent emotional loss.

Being HIV can be a positive growth experience by its very nature as a crisis. It can make us pay attention to things we should have all along. The reality of our vulnerability can motivate us to reorder our priorities so we deal more with what is really important in life, and less with those things that are stress-inducing. Stress, after all, is an internal response to external stimuli. It is a response we have the power to control This sentiment is no better expressed than by Paul Dague, a psychologist who died of AIDS in January, 1984:

Impending death is a reality for us all. But to me it has become far less important to dwell on that fact than to address the tragedy of living life burdened with the fears, ties or indifference in all the stunning variety of forms that these take--like perpetuating a negative self-image, doing a job that one hates, or making ones self hostage to the rules of the jungle at the expense of all else in life.

Since contracting AIDS. I've been trying not to accept my unconsciousness as I did before. In fact I'm trying to see everything I say or do in light of the underlying truth or lie I'm creating for myself--because I can't afford the cost of allowing anything but that reality to guide me now.

A life which involves healthy physical and emotional growth also involves risk, which. in turn, causes stress. Everyone has to decide for themselves what priorities one sets for their lives to be at their best What is really important in life may be harmful to your immune system, and worth the risk. Avoiding death is no way to live. We all die. Two hundred thousand people died on this planet today, and every day of the year.

I believe that we have some control over our destinies, including our health. That is common sense. No judgment needs to be put on that fact There is no reason for guilt over being sick You haven't caused your illness. But if you are HIV positive, I believe some of what I suggest here might help your drug cocktail keep your viral load down. If you are diagnosed with AIDS, I believe these things might increase the quality of your life, your risk of opportunistic infections, and ultimately your longevity. What is suggested here might just turn your life around, an important step whether you die in the end or not

So what can you do about these immune vulnerabilities? Some things are obvious from the foregoing discussion, and all may involve a change in your lifestyle:

1. Increase Your Support Network:

Organized HIV support groups are available through the Colorado AIDS Project, B-CAP and other agencies, and through this author. They serve as one springboard to a personal support system of people with similar concerns. Simply making one's friends a higher priority in your life can help; putting more time and energy into sharing your life with those close to you, cultivating friends from acquaintances, and overcoming the blocks to intimacy with your own family. Having a lover also helps, although too many men I see as clients view "Mr. Right as the total answer to all their needs for affection and intimacy.

For that matter, simply being touched by another person helps. Since the Rene Spitz studies in WWI I, a lack of touching has been recognized as a cause of "failure to thrive" and subsequent death in infants. Pavlov was struck by the fact that of all the stimuli that affected the dog he taught to so famously salivate, none was more powerful than human contact The same has been demonstrated with humans, even when in a coma Thus, professional masage can be an especially helpful adjunct to the touching of close relationships, especially for the single person.

2. Learn to Express Your Feelings and Accept their Existence Within Yourself:

Emotional release through the sharing of confidences with a close friend, or psychotherapy, personal growth workshops, or support groups all work to bolster the immune system. John Wayne may have lived a long and full life, but many who followed in his footsteps died being heros in Viet Nam and now are dying from dodging emotional bullets.

Even keeping a journal has been shown to help one's immune system in blood tests done by James Pennebaker, especially if people reported both the facts and the feelings involved in traumatic, problematic events.

3. Pay Attention to Your Unconscious:

Other emotional outlets can come from focusing inside. Paying attention to what is going on with our unconscious mind can make us healthier by making more of our life a conscious process. As surgeon Bernie Siegel says, "The light is better in our conscious minds, but we must look for healing in the dark unconscious."

The royal road to the unconscious, Freud believed, was dreams. It is relatively easy to develop a memory for our dreams by writing them down as soon as we wake up, and by simply giving them the attention they deserve. Any activity which engages our right brain will serve a similar function, such as abstract drawing and guided imagery.

4. Meditate Regularly, Visualizing Yourself as Physically & Emotionally Strong and Healthy.

A related inner activity of similar, possibly greater significance is meditation and the positive imaging suggested by Carl Simonton. Louis Hay uses a similar technique in her audio tape, "A Positive Approach to AIDS," which was quite popular among my clients in the eighties. The basic idea is to imagine while meditating that your Helper-T Cells are, for instance, vicious white dogs which vigorously attack invaders.

Simonton's methods increased the survival time of cancer patients by two-and-one-half times, and one in ten remain disease free after five years. These clinical results have been reinforced by the PNI research by Nicholas Hall and his colleagues. They found "relaxation, and aggressive mental imagery can cause cancer patients' lymphocytes to multiply and fight tumors more successfully." Similar findings have been discovered by researchers with the V.A. Hospital in La Jolla, California, and by Albert Villoldo at San Francisco State College.

Although the Simonton positive visualization methods are particularly helpful, it is also useful to learn the altered states of mind provided by different types of meditation. Everyone has to find his own pathways inside. For some it may be through TM, for others the isolation "float to relax" tanks, for still others it will be self hypnosis. All these roads lead in the same direction, as well as deep muscle relaxation, yoga, environmental audio tapes, and biofeedback.

5. Develop a Sense of Mastery through a Healthy Regimen.

The activities suggested here can be justified for reasons other than a greater sense of being in charge and in control. However, they all have that characteristic in common. It is better to do something--anything (as long as it is not potentially harmful--than to feel at the mercy of forces outside yourself, like a virus. Just the sense that one is not a victim can be important for one's spirit As described before, there are many examples of people who die soon after they give up all hope.

The activities I refer to here are any regimen for health: diet exercise, vitamins, adequate sleep, and drug free life styles. On the last point it is worth noting that in a study of the drug use of 87 people with AIDS, 97% had used poppers, 93% marijuana, 65% speed, and 66% coke. More than one out of two had used several drugs (5 or more).

6. Take Stock of Your Life:

The reality of dying forces the issue of living. What are we really doing here? What is the meaning and purpose of life? These questions become more relevant and urgent to address. For many men this is a spiritual quest often with inquiries such as the Course in Miracles, or metaphysical beliefs. For others, it may involve a resurgence of interest in their own religious backgrounds.

For many of the gay men I encounter in my practice, it involves a reexamination of their own homophobia They go through the throws of self-doubt and depreciation, as if they were in the process of coming out for the first time. The previously hard-won road to self-acceptance and gay pride can be found to be full of potholes. Take some comfort in the usualness of this reaction, and talk it out with someone you trust and respect.

The initial version of this article was published in Out Front, April 10, 1987 and was originally the content of a conference presentation to the Colorado Psychological Association that same month. I believe it is significant that this material remains so relevant after so many years: even the latest triple drug combinations aren't the total answer to surviving and thriving.



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.