Self-care conversations are expanding as we seek strategies for advancing better wellness and transforming healthcare. We live in increasingly challenging, divisive times and healthcare costs continue to escalate. Drawing nurturing attention inward helps us connect daily with our humanity and corporeal presence. It seems like almost anything can qualify as self-care. My practice experience has taught me that each individual must find their own path to well-being. My advocacy work has exposed me to the music of collective steps that can remodel entire systems. Self-care energy could be animating a rhythm of hope for a better way of being human on this planet.
In theory, integrative medicine loves self-care. This multi-disciplinary genre of healing has earned a place in our lives as well as at the Academy. At my day job at Saybrook University, I get to teach and research a growing collection of practices that inspire and enhance self-care, from guided imagery to mindfulness. Various techniques and therapies, captured under the umbrella of complementary and integrative healthcare, including mind-body medicine, are increasingly supported by evidence and availability.
Ever ready to share the good news of integrative medicine and self-care, I recently gave a TV interview where I was asked to summarize my views in 5 minutes or less. Much to my surprise, I found myself stuck on the simple question, “what exactly is mind-body medicine?”. Even though I teach and champion this subject every day, I failed to deliver a cogent message. In order to enlighten and advocate, I needed to first define: What exactly is mind-body medicine? (And what does a tattoo have to do with it?)
Structure
Faced with higher costs and reduced satisfaction, patients increasingly seek solutions through what was initially termed alternative medicine (Moss, 2003). In 2015, NIH revised the lexicon and complementary-alternative medicine (CAM) became complementary and integrative health reflecting its improved acceptance into conventional healthcare systems (NCCIH, 2018). Beginning in the 1990s and continuing to today, surveys reported use of complementary therapies and practices in majority of populations and in increasing numbers (Eisenberg et al., 1993; Eisenberg et al., 2016). One assortment of complementary practices is labeled mind-body medicine.
Reflecting a sort of medical science colonialism, mind-body medicine is defined by its position in the prevailing healthcare delivery system, situated offsides in the realm of complementary therapies and practices. According to NIH, mind-body interventions remain “a large and diverse group of procedures or techniques” that are administered or taught by qualified practitioners (NIH, 2018). By logical extension, the individual can then continue to practice what they learn independently, thus perpetuating prevalence (McGrady & Moss, 2018). But the debate over what constitutes a mind-body therapy and where it sits in healthcare’s hierarchy remains under-developed.
Function
Even in the imprecise language defining complementary therapies and practices, mind-body medicine definitions are vague. Mind-body services and procedures are described by what they are not: they are not typically found in primary care physicians’ medicine bag. Researchers and clinicians, striving for a standard taxonomy, lumped together as mind-body a wide variety of interventions not otherwise connected in foundational tenets or practice conventions. Initially, these included psychotherapy, hypnosis, biofeedback, dance and movement therapies, massage and body work, mediation and prayer, biofield therapies, and homeopathic remedies (Lake, 2003; NIH, 2018). It seems like almost anything could qualify as mind-body medicine.
Gradually, some of these became elevated to sub-disciplines, such as psychotherapy, now a mostly reimbursable mental health treatment. This raises the issue of legitimacy through economic valuation or demonstrated return-on-investment. I will save this consideration for another discussion.
Mind-body medicine remedies share a common function: they initiate a change in one realm to affect a positive change in equilibrium of the whole. Thus, our mental states can affect our physiology and susceptibility to illness. Mind-body therapies and practices encompass a full spectrum of activities and all promote healing and well-being through the mechanisms of the psycho-neuro-immunological system (PNI) (Litrell, 2008). Initially understood as how the mind influenced biological functions, the PNI is now seen as a complex, bi-directional system where mind and body physiology mutually influence the whole (Yan, 2016).
Changes attributed to mind-body interactions can be viewed from every crevice of physiology, behavior, and attitude. Research now well establishes that environmentally-based perceptions are linked to illness as well as well-being. For instance, stress impacts quality of life and is also a primary factor in cardiac conditions, the foremost global disease (Kivimäki & Steptoe, 2018). Further, bodily generated effects influence the mind, e.g. research on the gut-brain axis links digestive microbes to mental states such as depression (Rieder, Wisniewski, Alderman, & Campbell, 2017). Evidence abounds demonstrating positive effects of mind-body approaches (Russo & Fortune, 2016), including mitigation of pain and addiction (Hart, 2016).
Yet aside from how mind-body interventions function in healing, and plentiful examples supported by evidence, we lack a concise definition of what exactly is mind-body medicine.
Thoughts on a Tattoo
I asked a colleague who practices as a primary care physician how he defines mind-body medicine. He referenced the PNI interactions and provided some anecdotes on related illness triggers he has witnessed. Pressed to define mind-body medicine based on mutual interconnectivity of states and systems, we agreed that mind-body practices can refer to just about anything that one undertakes on behalf of improving their well-being. For instance, I suggested that reading a good novel could trigger a positive PNI reaction. He agreed and shared his own unexpected story.
By accident, he discovered that receiving a tattoo initiated for him a state of deep relaxation, with a subsequent ripple effect of improved well-being. Recent studies have linked the practice of tattooing with non-suicidal self-injury (NSSI) behavior (Solís-Bravo et al., 2019). Findings indicate that NSSI activities relieve tension and induce positive feelings. He was aware of research linking tattoo-ing with risk of self-injury and assured me that he did not present with such indications. However, he was equally certain that the process of receiving a tattoo induced a deeply healing state on a physical and possibly a spiritual level: Tattoo Medicine.
Theoretically, the experience of tattoo medicine could be a mind-body intervention. In the anecdote provided, it sits in the structure of non-conventional approaches. Functionally, it appears to have invoked the relaxation response and triggered PNI reactions. In addition, the exact symbol used in the tattoo could have influenced the experience if it conveyed emotional or spiritual meaning. Clearly, more research is indicated about the prevalence of this phenomenon and its place in the collection of mind-body medicine practices.
Implications
When considering the possibility that tattoo practice is a mind-body intervention, perhaps defining mind-body medicine is ultimately all about intentions. Alternatively, the mismatched components and practices now termed “mind-body” might simply be in a taxonomy holding-space, awaiting more informed and sophisticated knowledge systems to define, examine, and apply more precise terms. If practices as apparently unconnected as tattoos and meditation can be grouped together for the greater good, what indeed is in a name. Certainly, healthcare and well-being can use an incentive to empower uncommitted individuals to step into their own self-care path.
Based on popularity and the potential to infuse self-care with creative options, the practice and research of mind-body medicine is timely. Proponents need to be articulate and clear about applications and relevance, even if that includes acknowledging that the definitions are still under construction. Under any name, better tools for health and wellness are needed now.
So, scholars and practitioners can roll up our sleeves and get to work on this. In the meantime, consider a recent statement from the World Health Organization calling for quality self-care: adopting evidence-based practices that the individual undertakes with or without the support of a healthcare professional. Consider also how NIH recently defined mind-body medicine as large collection of procedures and techniques that are administered or taught by qualified practitioners to affect healing (NIH, 2018). Self-care and mind-body medicine seem like a perfect match, even minus the tattoo.
References
Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine, 328(4), 246-252.
Eisenberg, D. M., Kaptchuk, T., Post, D. E., Hrbek, A. L., O’Connor, B. B., Osypiuk, K., … & Levy, D. B. (2016). Establishing an integrative medicine program within an academic health center: Essential considerations. Academic Medicine: Journal of the Association of American Medical Colleges, 91(9), 1223-1230.
Hart, J. (2016). Chronic pain, addiction and complementary therapies. Alternative and Complementary Therapies, 22(3), 117-119. https://doi.org/10.1089/act.2016.29058.jha
Kivimäki, M., & Steptoe, A. (2018). Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology, 15(4), 215.
Littrell, J. (2008). The mind-body connection: not just a theory anymore. Social Work in Health Care, 46(4), 17-37.
Lake, J. (2003). Complementary, alternative, and integrative medicine. In D. Moss, A. McGrady, T. Davies, & I. Wickramasekera (Eds.), Handbook of mind-body medicine for primary care, (pp. 57-68). Thousand Oaks, CA: Sage.
McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Cham, SZ: Springer.
Moss, D. (2003). Mind-body medicine, evidence-based medicine, clinical psychophysiology, and integrative medicine. In D. Moss, A. McGrady, T. Davies, & I. Wickramasekera (Eds.), Handbook of mind-body medicine for primary care, (pp. 3-18). Thousand Oaks, CA: Sage.
National Center for Complementary and Integrative Health (NCCIH). (2018, July). Complementary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health
Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: a review. Brain, behavior, and immunity, 66, 9-17.
Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM J Community Med, 2(2), 1018.
Solís-Bravo, M. A., Flores-Rodríguez, Y., Tapia-Guillen, L. G., Gatica-Hernández, A., Guzmán-Reséndiz, M., Salinas-Torres, L. A., … & Albores-Gallo, L. (2019). Are tattoos an indicator of severity of non-suicidal self-injury behavior in adolescents?. Psychiatry investigation, 16(7), 504.
World Health Organization (WHO) (2019, April 2). Self-care can be an effective part of national health systems. Retrieved from https://www.who.int/reproductivehealth/self-care-national-health-systems/en/
Yan, Q. (2016). The translation of psychoneuroimmunology into mind–body medicine. In Psychoneuroimmunology: Systems biology approaches to mind-body medicine (pp. 121-129). Cham, SZ: Springer.
Embodied Living: by Luann Fortune, PhD, LMT 