The course will explore the interface between consciousness and clinical medicine; how consciousness affects the body -- in health, disease and the intervening transitional states. For example, mind/body interventional techniques (such as biofeedback, electronic entrainment devices, visualization, neurolinguistic programming and cognitive therapy) are known to bring about an alteration of the disease.
In scientifically scrutinizing those areas in clinical medicine where the issue of the nature and role of consciousness plays a significant role, the course shall critically study existing credible scientific models of consciousness that try to account for relevant phenomena. Where none exist, the aim will be to empower students to propose plausible models with underlying scientific reasoning, including testable criteria.
Time: W: 1.30 P.M.- 4.30 P.M.
Venue: #207, Bhaktivedanta Institute
Instructor: Dr. S. Nagarkatti, M.D.
- General Class room participation (10 marks)
- The students will be called upon to make presentations in the class, or give comments. The students are also encouraged
- Quizzes: For each sub-module there will be a 30-minute quiz, each of 10 marks. Total obtained will be normalized to 15 marks.
- Reading Assignments (15 marks)
- At the end of each class, material for reading for the next week will be assigned. The students must read and submit a one-page summary on any of the ideas that they have encountered in their weekly reading assignment. Substantial, critical and insightful presentations expected, not just verbatim quotes from the readings. Each submission is worth 10 marks, which will be normalized to 20 marks.
- At the end of each major module, there will be a 3-hour essay type examination, each contributing 10 marks towards the final grade.
- Final comprehensive: 3-hour examination (30 marks)
Number of classroom hours: 42
Module 1: General Introduction [Lectures 1-3]
Overview of Mind Body Medicine and its importance in Consciousness studies. Outline of the modules to be covered in this semester. Methods of study, research and evaluation of student performance. What is Mind-Body Medicine? Between the Mind and Body : Stress, Emotions, and Health.
- Doleman D. and Gurin J. (eds.) (1993) Mind- Body Medicine Chapters 1, 2 and 13
- von Uexkull and Pauli G.H. (1986) The Mind-Body Problem in Medicine, Advances, Vol. 3. No. 4
- Cunningham A.L. (1995) Pies, Levels and Languages: Why the Contribution of Mind to Health has been underestimated, Advances, 11 (2): 4-11
- Dafter R.E. (1996) Why “Negative” Emotions Can Sometimes Be Positive: The Spectrum Model of Emotions and Their Role in Mind-Body Healing, Advances 12 (2): 6-19
- Eisenberg D.M. et al (1993) The Scope and Challenge of Unconventional Medicine, Advances, 9 (3): 4-11
- Cassidy C.M. (1994) Unraveling the Ball of String: Reality, Paradigms and the Study of Alternative Medicine, Advances, 10 (1): 5-31
- Bennett H.L. (1993) The Mind during Surgery: The Uncertain Effect of Anaesthesia, Advances, 9 (1), p. 5-16
- Pincus T. and Callahan L.F. (1995) What Explains the Association between Socio-economic Status and Health: Primary Access to Medical Care or Mind-Body Variables?, Advances, 11 (1), p. 4-36
Module 2: The Psychobiology of Mind-Body Interaction [Lecture 4-12]
2.1 Stress [Lectures 4-12]
1) Basic Physiology
a) Functional organization of the human body and control of the internal environment.
b) Organization of the Nervous System: Basic function of synapses and Transmitter substances.
c) The Cerebral Cortex: Intellectual Functions of the Brain and Learning & Memory.
d) Behavioural and Motivational Mechanisms of the Brain — The Limbic System and the Hypothalamus
e) States of Brain Activity — Sleep; Brain Waves; Epilepsy Psychoses
f) Autonomic nervous system; the Adrenal Medulla
g) Cerebral Blood Flow
2) Models of Stress
a) Walter Cannon & Hans Selye’s Model of Stress
b) Alternative models of stress (Nuernberger)
3) Aetiology of Stress
a) Relationship of Psyche to Soma
b) The Genesis and Stages of Psycho-Somatic Diseases
c) Models of Stress resulting primarily from
iii) External threat
d) Models of stress resulting primarily from internal perception rather than above factors
i) Emotional Stress
ii) Role of Consciousness in perceiving Stress
4) Psychobiology of Consciousness–Body Communication
a) Role of the Limbic System as a TRANSDUCER of Consciousness generated impulses
b) Limbic Hypothalamic System and Endocrine Axis. Its role in generating the stress response
c) Limbic Hypothalamic System and Autonomic Nervous System axis. It s role in generating stress response
5) Overview of interventional mind-body techniques for reduction of Consciousness generated stress responses.
- Guyton and Hall (1996) Textbook of Medical Physiology, Chapter 1, Chapter 57, Chapter 59, Chapter 60 and Chapter 74: p. 3-9, 733-747, 761-768, 769-781,957-970
- Nuernberger P. (1981) Freedom from Stress, Part One: p. 3-101
- Ross E.L. (1985) The Psychobiology of Mind-Body Healing, Chapter 4, Chapter 7 and Chapter 8: p. 57-67, 105-124, 125-148
- Schulkin J. (1999) Neuroendrocine Regulation of Behavior, Cambridge University Press, Chapters 4, 5 and 6, p. 116-213
2.2 Placebo Effect
1. Definitions of the Placebo Effect
2. Suggested Mechanisms of the Placebo Effect
3. The Objective and Subjective Effect of Placebos
4. The Doctor-Patient Relationship
5. The Placebo Effect and the Immune System
6. Clinical Implications
- White L. (ed.) (1985) Placebo: Theory, Research and Mechanisms, Guilford Press, New York
- Beecher H.K .and Boston M.D. (1955) The Powerful Placebo, The Journal of American Medical Association, 159 (17), p. 1602-1606
- Ader R. and Cohen N. (1975) Behaviourally Conditioned Immunosuppression, Psychosomatic Medicine, 37 (4), p. 333-340
- Benson H. et al (1975) The Placebo Effect – A Neglected Asset in the Care of Patients, The Journal of American Medical Association, 232 (12), p. 1225-1227
- Wolf S. (1949) Effects of Suggestion and Conditioning on the action of chemical agents in human subjects - the pharmacology of placebos, Journal of Clinical Investigation, p. 100-109
- Evans J.K. (1984) Unravelling the Placebo Effects, Advances, 1 (3), p. 11-20
- Berland W. (1995) Unexpected Cancer Recovery: Why Patients Believe they Survive?, Advances, 11 (4), p. 5-19
- Bollentino R.C. and Leshan L. (1995) Cancer Patients and Marathon Psychotherapy: A New Model, Advances, 11 (4), p. 19-35
- Leshan L.L. and Worthington R.E. (1995) Loss of Cathexes as a Common Psychodynamic Characteristics of Cancer Patients: An Attempt at Statistical Validation of a Clinical Hypothesis, Advances, 11 (4), p. 20-34
- Holmes C.L. and Stolbach L. (1995) The Experience of Cancer and the Course of Cancer, Interview In Advances, 11 (4), p. 35-39
2.3 Pyschoneuroimmunology [Lectures 13-21]
1. Stress and Immunosuppression.
2. Effect of psychological and emotional factors on the immune system.
3. Transformation or transduction of information as the basic mechanism of psychobiology and hypnotic healing.
4. The Limbic – Hypothalamic System: The major mind-body information transducer.
5. The Reticular Activating System: The Awakening, Novelty Seeking and Dreaming Mind.
6. The Cerebral Hemispheres – The Logical And Metaphorical Minds.
7. The mind as a process of self-reflective information transduction.
8. The State Dependent Theory of Mind – Body Medicine (The limbic-hypothalamic system as t he major anatomical link between mind and body)
9. Application of the Theory to clinical cases.
10. Based on The State-Dependent Theory of the Mind – The Mind Modulation of the Immune System. Case Studies.
11. The Immune System, Information and Consciousness.
12. Subconscious Mediation of pscyhoneuroimmmunological activity.
13. Subtle signals in psychoneuroimmunology and their biological detection.
- Locke S. et al (eds.) (1985) Foundations of Psychoneuroimmunology, Aldine Publishing Co.
- Solomon G.F. (1985) The Emerging Field of Psychoneuroimmunology, Advances, 2 (1), p. 6-19
- Ader R. et al (1991) Psychoneuroimmunology, Academic Press
- Ader R. and Cohen N. (1975) Behaviourally Conditioned Immunosuppression, Psychosomatic Medicine, 37 (4), p. 333-340
- Pelletier K.R. and Herzing L.D. ( ), Psychoneuroimmunology: Towards a Mind-Body Model, Advances, 5 (1), p. 27-56
- Booth R.J. and Ashbridge K.R. (1993) A Fresh Look at the Relation between the Psyche and Immune System: Teleological Coherence and Harmony of Purpose, Advances, 9(2), p. 4-23
- Schwartz C.E. (1994) Introduction: Old Methodological Challenges and New Mind-Body Links in Psychoneuroimmunology, Advances, 10 (4), p. 4-7
- Hall et al (1994) Transformation of Personality and the Immune System, Advances, 10 (4), p. 7-15
- Wakesman B.H. (1994) Can Psychoneuroimmunology Help Explain Disease? The Example of Multiple Sclerosis, Advance, 10 (4), p. 16-20
- Mohynian J. (1994) Stress Induced Modulation of Immunity: Animal Models and Human Implications, Advances, 10 (4), 23-28
- Stern R. (1994) Neuropsychological Aspects of HIV, With a Note on Psychoneuroimmunology, Advances, 10 (4), p. 28-31
- Fauzy L.F. (1994) Immune Effects of a Short-Term Intervention for Cancer Patients, Advances, 10 (4), p. 32-33
- Spencer F. (1994) Exploring Brain Interactions With the Immune System: Corticosteroids and Their Receptors, Advances, 10 (4),p. 33-40
- Arcus D. (1994) Biological Mechanisms and Personality Evidence from Shy Children, Advances, 10 (4), p. 40-50
- Miller D.W. (1995) Instincts, Feelings and Homeostasis: A Psychological Model of Cancer, Advances, 11 (2), p. 58-76
2.4. Spontaneous Remission
Module 3: Altered states of Consciousness and their role in Mind-Body interaction
3.1. Relaxation Response. [Lecture 22]
3.2. Hypnosis and Trance States [Lectures 23-24]
3.3. Visualisation. [Lectures 25-26]
3.4. Anaesthesia [Lectures 27-28]
3.5. Near Death Experience. [Lecture 29]
Module 4: Mind-Body Interventional Techniques
4.1. Biofeedback [Lectures 30-35]
1) Historical Overview of the field of Biofeedback - Major trends that have influenced the development of the field of biofeedback:
a) Instrumental Conditioning of autonomic nervous system responses
c) Behaviour therapy and behavioural medicine.
d) Stress Research and stress-management strategies.
e) Biomedical Engineering.
f) Electromyography (EMG), diagnostic EMG and single unit motor control.
g) Consciousness, altered states of consciousness and EEG feedback
i) Cultural Factors
j) Professional Developments
2) Explanations Offered and Suggested Models to explain Biofeedback
3) The Central Focus of Biofeedback
a) Monitoring Correlates of Psycho-physiological Arousal.
b) Three physiological processes associated with over arousal: skeletal muscle tension, peripheral vasoconstriction and electrodermal activity.
4) Biofeedback Instrumentation
a) Tasks of Biofeedback Instruments
b) Gaining access to the three psycho-physiological processes associated with arousal: Electromyography, Finger Phototransmission and Skin Conductance Activity.
c) Theoretical Principles and Working of different biofeedback instruments: The EMG Instrument, The Temperature Biofeedback Instrument and The Electrodermal Biofeedback Instrument
5) Baseline data in biofeedback techniques
a) The importance, justification and advantages of reliable symptom baselines and careful interviews.
b) Obtaining baseline data in different phases of physiological arousal: Resting, Tension and Arousal, Reactivity to Stress, Post-Stress Recovery and Relaxation phases: Rationale, Methods of measurement used in obtaining baseline data, Review of studies done and clinical implications of these techniques
6) Lower physiological arousal
a) The importance of cultivating lower physiological arousal
b) Factors involved in increased physiological arousal and techniques used to lower arousal:
i) Dietary Factors - Review of influence of various dietary agents on pathological conditions, case study of migraine.
ii) Hyperventilation – Methods and tests for diagnosing hyperventilation, Breathing Therapies - Techniques used induce relaxed breathing: Review of non-biofeedback and biofeedback based techniques.
7) Problems with Relaxation and Biofeedback–Assisted Relaxation and its Management
8) Use of Audiotapes for Relaxation and Patient Education
a) Advantages of using audiotapes: Professional advantages, practical considerations and patient considerations
b) Different considerations in audio taped relaxation
c) Taped vs. Live Relaxation
9) Use of Biofeedback in treatment of headaches, hypertension and diabetes mellitus
10) Emerging fields of applications of biofeedback-based treatments.
- Schwartz M.S. et al (1995) Biofeedback – A Practitioner’s Guide, Guilford Press, New York, Chapters 1, 4, 7, 10, 11, 12, 13, 14, 15, 18, 19, 32, 35 and 37
4.2. Physical techniques that alter Consciousness [Lecture 36]
i) Progressive Muscular relaxation (ii) Autogenic training (iii) Yoga (iv) Aerobic Exercise
4.3. Non Physical techniques that alter Consciousness [Lectures 37-42]
i) TM ii) Cognitive Therapy (iii) Mindfulness (iv) Meditation (v) Body Scanning (vi) Visual Imagery (vii) Neuro Linguistic Programming