August 2014

Introduction to PNI

Introduction to Psychoneuroimmunology

 



Definition of PNI

 

Psychoneuroimmunology, often referred to as PNI, is the study of interactions between ones perception of the world around them, their behavior, the way their brain functions, and their immune system. The field of PNI studies the measurable interaction between psychological and physiological processes. The psychological portion is the Psycho aspect, the central nervous system aspect is the Neuro aspect, there is an endocrine system aspect, and the body's defense against external infection and aberrant cell division is the Immunology aspect.


The Dualistic Medical Systems

 

Today the immune system is no longer regarded as autonomous and separated from the mind and external events. With the emergence of PNI we begin to see the rise of a new paradigm relating to the practice of medicine. This new paradigm for the first time integrates the previously dualistic concepts of mind and body. It introduces a new concept where mind and body interact as one,each affecting the other. To date, evidence regarding this mind-body-immune system interaction has been collected with regard to the role of nerve fibers in lymphatic tissues, the sympathetic and parasympathetic nervous systems, the effects of brain lesions on the immune system, the interplay of neurotransmitters, hormones and immunotransmitters. It is being used in research and treatment of AIDS, cancer and bacterial and viral infectious processes. Other researchers are looking at its effects in classic learning and conditioning, the development of the immune system, the impact of experimental and naturally occurring stressors on the immune system, the immune modulating effects of personality characteristics, life style and psychodynamic processes. In the future,research will likely be extended into many new areas including psychotherapy, pregnancy, illness prevention and healing to name only a few.

 

PNI appears to go beyond the present narrow biological perspectives of illness to consider behavioral components as an integral part of health and disease. The conceptualization of the role of human behavior and how it interacts with the central nervous system and the immune system are central issues. Psychoneuroimmunology is thus an arena in which questions about the mind,body and person in context of each other come to the fore.

 

Research is often driven by attempts to define the extremely complex (and non-linear)relationships between behavioral and biological dimensions of 'immune system.' Today researchers operate under disciplinary, institutional, and funding constraints, which tend to work against PNI research. These tend to maintain the status quo, as well as inhibit the development of competing and radical models within the field psychoneuroimmunology itself. This slows research down and tends to keep it out of the mainstream of medicine.

 

PNI is a new field having begun in the late 1960's. Over the last 30 years, the body of knowledge in PNI has emerged and in the last 10 years has flourished. PNI is still in its infancy. It is by no means proven as a fact, yet there is growing evidence that it is and will continue to be an important new discipline.



The Dualistic Medical System


Bidirectional Feedback Loop

 

Disciplines as diverse and different as anatomy to psychology have demonstrated that the immune system is the target of signals from both the brain and the endocrine system. Findings also suggest that a bidirectional feedback loop exists between the brain, the body, its tissues, the stress mechanism and the immune system. This means that ultimately our past experiences, our present behavior, what we think and believe all have impact on the body, and its immune system and vice versa.

 

The existence of this bidirectional communication pathway between the brain, the body and the immune system is maintained by neuron activity, neurochemicals, hormones and various other molecules such as peptides, endorphins, enkephalins and cytokines. They carry messages from the brain to the immune system and from the immune system back to the brain.



Bidirectional Feedback Loop


Characteristics of PNI

 

The overall implications are that processes can alter immune functions and that events that occur as part of immune responses can modulate our behavior. Evidence for influences in both of these directions is presently being collected and evaluated. The psychological modulation of immunity generally focuses on classical conditioning and stress, whereas that of immune modification of behavior highlights behavioral effects produced by substances released from the immune system. The ultimate implication of this work suggests that we are due for a major shift in the way we think, and the practice medicine and the healing arts.

 

In the time allotted it would be impossible to present a detailed discussion of this burgeon field.Instead, my intention is to present an overview of this new field for the generalist, whether in the medical, psychological, social or behavioral realm. PNI either is already affecting you or will in then ear future.


Neuroendocrine Interaction with the Immune System

 

One of the primary areas of study is the relationship between stress and the immune, defensive,repair and healing systems of the body. It is this area which is probably best understood at this time.

 

When we get angry, our entire body responds, it instantaneously becomes tense and we move toward Fight or Flight. When we are happy, our entire body becomes happy.

 

In our old system of thinking such responses were thought to start off as electrical impulses from the brain to various parts of the body. That is, instructions in the form of electrical impulses were sent by means of the nervous system to innervate various tissues. It was, and in fact, still is believed that the nerve ending or synapse played the largest role in this process by releasing chemicals which are ultimately responsible for all changes which occur in anatomy and physiology.

 

While this concept has not really changed, PNI has added to it. We now know that the process is more complex then this alone. Besides electrical stimulation there is also release of neurochemicals that travel along nerve tissues, other neurochemicals are released into the blood stream, our hormonal system also plays a significant role, and other chemical and yet undetermined messengers appear to have specific tasks of carrying messages to every part of the body.

 

To simplify the language, since I do not have time to go through all of the various ways that the body can communicate with itself. I will refer to all of the various mechanisms as messenger pathways and messengers regardless of what these processes or pathways are.

 

These messengers and their specific pathways have some important properties that tell us that something quite remarkable is occurring. We know that they are not simply "neutral actions." That is, these messengers are not simply general messengers that bring chemical or electrical stimulation from one place to another.

 

They are quite specific. There are messengers which transmit happiness, joy and positive feelings and there are messengers that transmit fear, activate the Stress Mechanism, or create depression.The old model of too much of one chemical or another causing a particular effect will likely be replaced by a more complex model of interaction between the various stimulating and inhibiting messengers.

 

In a sense the body, mind and psychology are the result of a symphony, and not simply a three or four-piece ensemble. This concept was known by the ancient healers who talked about it in the form of spirits, of various shades of good and evil.

 

It can also be seen clearly in the humoral concept of that held sway on the healing arts for hundreds of years. Man was seen as responding to interaction of various humors. They accounted for changes in emotion, for anger, rage, for love, caring, melancholia and depression, for humor and for illness. Almost anything could happen when the humors were out of balance. While these humors did not entirely answer what we needed to know, they were an attempt to understand how and why we acted the way we did. In a sense they were not entirely wrong, for we are a blending of the interaction of many chemical, electric and other processes that ultimately make us the sum total of who and what we are.

 

We have come along way since belief in the humoral concepts of healing, yet as things often have a tendency to make complete circles we are now once again recognizing that we are not linear but rather a more integrated or Holistic, as many people are now calling it, construction.


Responding To Our Environment

 

To understand this better lets look at this concept on the macro level. While we can choose just about any organ system as an example, I think that most people associate PNI with the interaction of mind, brain, body and the Stress Mechanism.

 

Let's look at an example:

 

You are out shopping late at your local mall you are supposed to meet a friend. You are waiting at the predetermined site when you see a shadow moving toward you. Simultaneously you may feel joy that your friend is coming and fear that it could be a stranger who means harm to you. In this case messengers of joy or happiness are being released and messengers of fear are also being released. The stress mechanism is also activated, while at the same time your positive expectations create a sense anticipation. All of these feelings and sensation can be happening simultaneously.You experience waves of positive, negative or neutral, and sensations of anxiety and anticipation.

 

While all this is going on, it is no coincidence that you are also thinking. You may at first feel relieved your friend is coming, "Oh, there he is, he is late!" You may have doubts, "Is that my friend?" "If not, who could it be?" The figure is the right size and shape so you reassure yourself,"That's him, I am sure." But he is walking slowly and you would think that your friend would be moving faster or calling out to you. "Maybe that's not him." "If it is not him, who could it be?"

 

The interaction of mind, our thoughts and the sense of how we think it is supposed to be, I will call this our "picture of the experience," come together along with body chemistry to create us to be what we are at any given moment. In this example, I am mixing positive, negative and neutral simply to be able to introduce these concepts all at the same time. In real life, however, most of what we experience is a combination of these three types of emotions.

 

Generally, there are two ways this works:

 

1) An external event occurs ---> Through our memories of the past, prior decisions and beliefs we have already created a picture of the way we expect things to be. When the external events either support or conflict with this picture which we have already accepted as real ---> Positive or negative messengers are released to inform the entire body ---> There is a physical, mental,emotional and possibly even spiritual response to these events which is mediated by our past experience, what we think and what we believe.

Reponding to Our External Environment-1

When this process relates to an event which is external to us, and when it is negative, we refer to it as a stressor. This stressor can also come from within and be an internal stress or such as a thought, a remembrance, a fear or a faulty belief system. Remember, stress can be both positive and negative so a reaction can also arise from something that is happening to us that is positive. For example, a pleasurable feeling, getting what we desire or even an internal joke.

 

We hold a significant number of specific and general pictures, sets of belief systems, of how we desire or expect things to be. When an event (or stressor) occurs we will likely react to it in either positive or negative way or somewhere in between. Our mind/brain and not the actual event,makes the decision as to what the unfolding event means to us and then tells our body how to respond to it. In the example, the question was whether the shadowy figure was or was not a friend. When you thought the figure to be a friend, positive messengers were released. When you thought the figure to be a menace negative messengers were released and the Stress Mechanism was activated. In any case, the entire body was being informed about what was happening and it was waiting, as you and I were, to find out who the figure really was.

 

 

2) The picture of the way we expect things to be already exists ---> an event occurs and depending upon whether the event is positive or negative ---> it causes the release of messengers ---> there is a physical, mental, emotional and spiritual response to the event.   

 

Resonding To Our External Environment-2  

 

In the first case presented the event occurred randomly without our being ready for it. It just happens. In the second case, we were already expecting something to happen and we had a preconceived notion of what we wanted to happen. In both situation what happens, happens and we are left to deal with it through already set pathways using the PNI mechanism and at times the Stress Mechanism, if it is perceived as a threat.  

 

Responding to Our External Environment-3 

 

What then is actually happening? To understand this process lets look at one more schematic of the events:

 

Our past experiences and memories ---> Cause us to create beliefs or a picture of the way we expect things to be ---> this affects our ultimate mind/brain interaction ---> and hence our mind,body response.


Responding to Our Internal Envirornment-1



Now when an event occurs: ----->


Responding to Our Internal Environment-2


Responding to Our Internal Environment

 

We respond to it depending on our beliefs and memories. When the event is perceived as a threat,we experience fear, apprehension and the Stress Mechanism may be activated. If the event is perceived as positive, we experience an entirely different set of feelings, emotions and body responses. The key point to remember here, is that the immune system is also simultaneously affected. The immune system is turned on and off, activated and deactivated depending on the variables we have already outlined. When messages are mixed the response of the immune system,may well also become mixed and its ability to respond, confused.


Systems Involved

 

We have already discussed most of the systems involved in this process. At this point I want to direct your attention to item #5.

  1. Nervous System (Brain, Memories, Past Experiences, Future Projections, Belief Systems)
  2. Neurochemical System (Neuro-peptides, Neurohormones, Endorphins, Signaling Neurotransmitters, Neuroreceptors)
  3. Hormonal/Endocrine System (Entire Hormonal/Endocrine System - Principally Corticosteriods)
  4. Immune, Repair and Healing Systems (Stress Mechanism, Primary, Secondary and Tertiary defensive Systems)
  5. Adequate Nutrition and Normal Body Chemistry: We know that when there is inadequate nutrition, illness, mental instability, or chemical imbalances this can affect the process described above and create faulty responses at all levels including within the immune system. Our state of physical being can affect the direction of these interactions and the end result of what is perceived and how we act.
  6. Feedback from Body Tissues, Cells and Organs (Cytokines, Met-Enkephalin. Lymphokines,Pyrogens)


What is Stress and How Does It Relate To the PNI Process?

 

One of the focal points of this fledgling branch of science is its ability to link stress and disease.We can now begin to pinpoint changes in hormonal flow as well as the various messengers and messenger pathways within the body to and from immune system cells. We can also associate these phenomena with specific responses involved in both the creation and healing of many illnesses. The stress hormones can change immune cell behavior and the activity of the entire immune system. The immune system cells actually have receptors which as Margaret Kemeny a Professor of Psychiatry at UCLA says, "hear" the signals and allow nervous, endocrine and immune systems to "talk" with each other and the rest of our body.


What is Stress?

 

 

  1. Stress is an inborn biologic mechanism which exists in all living creatures. Its purpose is to protect the organism and to ensure its survival and the survival of our species.
  2. The Stress Mechanism, also thought of as the survival instinct, operates through a concept which is often referred to as Fight or Flight.
  3. When threatened the individual may have little or no time to think or plan. Nature understood this and gave us the ability to either turn and fight the threat, or to run from it.
  4. In our modern society threats are everywhere, however, we are rarely able to attack or run.
  5. Hence, we most often respond by creating what we think of as stress and now we know that stress can and does affect our body and our immune system in both positive and negative ways.


Selye General Adaption Model

 

The term stress was first coined in response to the work of Hans Selye and his General Adaption Model. Selye had noticed that when humans were stressed for prolonged periods of time they demonstrated characteristic internal responses affecting the hormonal system and the stomach,thymus glands, lymphoid tissues and white blood cells. These are the organs of stress. Notice the similarity between Selye's General Adaption Model and what we have talked about PNI so far.The only difference is that PNI tells us that these organs and cellular components communicate back with the brain.

General Adaption Model

The Stress Cascade

 

There are three major aspects to stress.

 

 

  1. First, is the stressor event which poses a real or imagined threat to our internal or external well-being. The event can be life threatening or can instead be only interpreted by the individual as life threatening. That is, it is interpreted as a threat to our picture of the way we see our life. For example, a pile of bills can act to be threatening to the way an individual sees his or her future.
  2. Second, there is a complex series of internal chemical, neurologic and hormonal changes that are automatically set in motion which I like to refer to as the Stress Cascade. Again, notice the similarity to what we have already discussed.
  • These events occur below the level of our control and result in physical, emotional and mental alterations which are directed at preparing the individual for self defense.

     

  • Once initiated, this process can only be stopped by eliminating the threat. Only then can the Stress Mechanism be released come to a natural conclusion.

     

  • The Stress Mechanism can also be released when the individual is able to recognize that the events in question are no longer or never were life threatening.  
  •  

    The Stress Cascade 

     

    Since the overall goal of the Stress Mechanism is to ensure our survival, when any event (threatening or not) occurs in our direct life space, the very first thing our body/mind does is to check all past experiences, including our genetic codes (our species specific and collective unconscious memories) and our personal learned experiences to determine whether the event occurring is a threat. If it is threatening in any way, the Stress Mechanism is triggered. If it is not,we may never even know that the event took place. I have named this action the Survival Center.This may be where all PNI phenomena begin and ultimately end.

     

    The neuro/electric/hormonal/biochemical aspects of the Stress Mechanism are the same as those of the PNI response. You could essentially say, they are the same mechanism.

     

    Stress Hormones

     

    To support this lets look for a second, at the stress organs, and their hormones. Once again, notice the similarities to the PNI mechanism.

     

    The Stress organs are the Hypothalamus and Pituitary gland, Adrenal Glands, Thyroid, Thymus and Reproductive glands. They communicate through hormonal feedback systems and there is sympathetic and parasympathetic nervous system involvement.

    Stress Hormones

    The Adrenal Cortical Hormones:

     

    1. Specifically, the Stress Hormones, Adrenalin (epinephrine) and Cortisol:
    2. They prepare the individual for Fight or Flight
    3. They are responsible for the Primary Stress Response
    4. Adrenalin turns on the Inflammatory System, the Defensive Systems and Immune Systems of the body to prepare it for external invasion and possible injury. The inflammatory mechanism is the first step of repairing any injury that might occur should an injury result from Fight or flight.
    5. Cortisol, on the other hand, stimulates the Anti-Inflammatory mechanism which turns off the Inflammatory mechanism once healing and repair are in process.
    6. These two hormones also affect sugar metabolism and the blood clotting mechanisms of the body.
    7. They also have an effect on the blood pressure control mechanisms of the body, cholesterol manufacturing, renal function, blood flow to the digestive and muscular systems, as well as many cardiovascular functions including blood pressure, heart rate and rhythm.

    External  Manifestations of Stress



    They affect the primary systems which are responsible for the creation of illness, healing, repair and housekeeping activities of our body.


    The Simonton's Work

     

    While there are now literally thousands of studies and case histories regarding PNI that could be presented at this point, none is as dramatic as is the work of Dr. O. Carl Simonton and his wife Stephanie Matthews-Simonton.

     

    While working with cancer patients who were considered to be incurable and terminal, the Simonton's started a program which educated them and helped them reduce their fears and stress about cancer. They instructed these patients that cancer is really a weak and malleable process, and not the strong overwhelming process that the medical profession and the general public usually think it to be.

     

    They taught them a process of positive visual imagery in which they "saw" their immune system attacking and destroying cancer cells. This activated their immune systems and caused the natural defense of the body which had apparently been "turned off" or "impaired"to be reactivated and attack and destroy their cancer cells.

     

    The Simonton's presented their patients with a new model for recovery and winning over their cancer. Using this new model many were successful in overcoming their cancers and other health problems.

     

     

    Three important breakthroughs occurred:

     

    1. Patients who were previously told that they were incurable, by using the Simonton program were able to stimulate their immune systems to reverse their cancer and in many cases eliminate them entirely.

       

    2. We now better recognize the role of beliefs, thoughts and emotions especially negative thinking, resentment, anger and rage in causing cancer and how resolving conflict or changing it to a positive, can promote reversal of illness and healing.

       

    3. We have established that the body's defense mechanisms can be activated and that white blood cells, lymphocytes, killer cells and other messenger factors associated with the healing response can be stimulated to act against cancer and other illnesses.

    Factors Involved in Health

    Why Is this So Important?

     

    While PNI has not been entirely proven, it is clear that what is known is merely the tip of the proverbial iceberg. This research and the way that it is changing medicine is important to all of us.Fritjov Capra in his book The Turning Point suggested that we are now in process of changing from the presently accepted paradigm, which we refer to generally as Modern Western Medicine,to a new paradigm. This new paradigm, while yet without a name, is fueled by movement away from the concepts involved with the Cartesian-Newtonian construct that underlies present medical thought. The new paradigm is based on the present new understanding of the universe laid down by Albert Einstein, Werner Heisenberg, Nils Bohr, David Bohm and many others.

     

    It is based in Systems Theory which suggests that everything is interconnected, and that there is an interrelatedness and interdependence of all phenomena. While the Newtonian-Cartesian paradigm suggests that to understand something we had to break it into its component pieces and separate them one from the other, the new paradigm tells us that Systems, such as the human body a reintegrated wholes whose properties cannot be reduced to smaller units. While we can look at each component separately, we cannot in reality separate one from the other. They are dependant upon each other and their interrelatedness is integral to their ability to function appropriately. It emphasizes basic principals of organization. Hence, we are in a sense one and the same as our environment and we respond to it based not only on how we work, but also on how it works.

     

    This is entirely consistent with the evolving concepts of PNI as well as with the way we now seethe endocrine, stress and immune systems operating.

     

    We are now seeing a major directional shift in the way the general public is thinking and how they feel about the old paradigm. There is now an increasing interest in Holistic concepts, a conspicuous increase in interest in Alternative medicine and a movement away from drugs and surgery. There is a resurgence of interest in Eastern and ancient healing practices, such as shamanism, native American healing, Huna and almost anything that is not related to modern or establishment medicine.

     

    Truthfully, there is no more thing called Establishment medicine. Physicians are now integrating concepts of acupuncture, biofeedback, nutrition, prayer work, religion, spirituality and magnetics into their medical practices. Not always because they totally believe in it, often because economic pressures are pushing them toward this new paradigm.

     

    Many practitioners are becoming involved in new paradigm type processes for other reasons.

     

     

    1. Some because it something new to explore.
    2. Others because it is a new way of looking at what they are doing professionally.
    3. Some because their patients want answers to questions that are not answerable by the older establishment medical model.
    4. Some become involved in the process of supporting the growing movement toward the patients' right to control his or her own destiny. Or because they believe that the patient must be actively involved in their own process of healing and recovery.
    5. It is also an opportunity to add a valuable new dimension to their diagnostic, intuitional and treating skills or to how they practice our art.
    6. Possibly as has happened with me, a recognition that what I was doing was not working. That simply treating patients with medications and surgery, and ultimately ignoring their need to be whole and fully actuated, was not enough. That wellness and healing could be accomplished using other modalities, which were less dangerous and even more effective.
    7. Lastly, because many have found that these methods can ultimately mean providing better and more productive care for their patients.