Feature

Recite Your Mantra and Call Me In the Morning

All of the big six teaching hospitals have respected social-work and “liaison psychiatry” departments that offer support groups and counseling to patients. But beyond those services, mind-body medicine has been available only via what Steve Horowitz, chief of Beth Israel’s cardiology division, and a longtime proponent of mind-body medicine, calls the tchotchke principle. “Leaders of the hospitals don’t buy into complementary medicine. Then they suddenly look around at other people doing it and think, We should have something like this,” says Horowitz. “So they store one on a shelf like a tchotchke -- it’s not incorporated into the mainstream design of the house, but it’s there when someone asks if you have it.” At New York Hospital- Cornell Medical Center, for example, only one clinician, Dr. Robert Allan, primarily treats the emotional fallout from heart disease with relaxation training and cognitive therapy. At Mt. Sinai, the Behavioral Medicine Program is geared to patients with psychiatric disturbances, not people experiencing the normal distress associated with a serious medical diagnosis. Richard Grossman, a Beth Israel- affiliated physician, thinks of these programs, which he wholly supports, as “strange little dents in the body troglodyte.”

At his stress-disorder clinic, NYU’s Moskowitz uses emotion-focused psychotherapy to treat patients with stress-related conditions and works with one biofeedback trainer. Moskowitz credits NYU for its decade-long support of his program, but his work seems strangely disconnected from the life of the institution. He sees patients in his small, private office 60 blocks north of NYU Medical Center, and though he gets referrals from NYU doctors, many stressed-out medical patients will never hear about his service. “Even within NYU, many respected physicians don’t know about this program,” says Moskowitz.

The medical world’s reluctance to endorse these alternatives baffles some scientists. “It’s considered radical to send someone to a modified Dean Ornish cardiac program,” marvels Stephen Josephson, an assistant professor of psychology at Cornell Medical College. “But to crack their chest open to do a bypass, that’s considered conservative.”

Barron Lerner, a physician and historian at Columbia University’s Center for the Study of Society and Medicine, believes that several cultural factors have produced New York medicine’s embrace of the one-cause, one-cure philosophy that disregards the role of the mind in health and healing. To start, the city has a singular conglomeration of major academic institutions -- there’s so much competition that no one can risk the one potentially false move. Lerner cites the contrasting example of Case Western Reserve in Cleveland, noted for its progressive medical education: “If you’re the only game in town, you are going to be more comfortable experimenting.”

But why would the city more closely identified with psychiatry and psychoanalysis than any other, save Vienna, be resistant to principles of mind-body interaction? Lerner explains that the antipathy between medicine and psychiatry, between psychiatry and psychoanalysis, and, in particular, between medicine and psychoanalysis has prevented the cross-disciplinary communication needed to develop integrated mind-body programs. He adds yet another wrinkle: The psychiatrists and analysts who might otherwise champion mind-body medicine may actually see it as a competitive threat. Finally, theorizes Steve Horowitz, New Yorkers “who feel they have to be productive every moment” may not provide the ideal market for, say, meditation.

Sloan-Kettering is one hospital that has long had a tradition of encouraging group or individual therapy for cancer patients. Jimmie Holland, the formidable chairman of the Department of Psychiatry and Behavior Sciences, is considered, in fact, a founder of the field of psycho-oncology. But the hospital’s mind-body offerings are spotty: Its Evelyn Lauder Breast Center has solid support services and one psychotherapy group that offers relaxation techniques and cognitive therapy, but there are few support groups for patients suffering from other, rarer kinds of cancer. And the more prevalent counseling programs are targeted to patients experiencing severe psychological difficulty; the cancer patient who is merely terrified but not clinically depressed may not always be alerted to resources. Holland has been criticized by therapists in the mind-body community for being too wary of judgments by peers at her hospital who view meditation or hypnosis as borderline quackery. But Holland -- who stresses that she’s involved in psychological counseling, not “mind-body” medicine -- says she simply feels that her role is to focus on quality of life rather than to push healing techniques that haven’t been clinically proven. “Group psychotherapy is certainly going to make you feel better, but we still don’t know whether it extends life,” says Holland, who points out that some key encouraging studies have yet to be replicated. “And I’m concerned about patients who feel, ‘I didn’t get to the group, so I’m going to do myself in.’ “

Still, Sloan-Kettering, the city’s standard-bearer of conventional biomedicine for cancer, plans to open the Program for Integrative Oncology early next year. Housed in a ne bvnm,cw facility on East 53rd Street, it will offer relaxation techniques, stress management, group therapy, art therapy, and pastoral counseling as well as nutrition and physical therapy. Dr. Sidney Winawer, the hospital’s soft-spoken gastroenterology chief, has been named the program’s director, while Jimmie Holland will provide the psychosocial components. Winawer acknowledges that with the consolidation of mind-body medicine at Memorial will come “resistance on the part of the physicians,” but, he says, “it’s normal for physicians to be skeptical.” Helping to overcome that resistance is the full-throttle support of philanthropist and holistic-medicine advocate Laurance Rockefeller, who has committed between $5 million and $10 million to the project, sources close to the hospital say. But development has been slowed by institutional caution. Says Abby Bloch, coordinator of clinical research for Sloan-Kettering’s Gastrointestinal and Nutritional Service and one of the program planners: “We need to satisfy the concerns of people in the center who want to be certain we can support what we are doing with evidence and scientific rationale.”

If Sloan-Kettering’s major mind-body effort has been launched largely with the gift of a single outside donor, and Columbia-Presbyterian’s has been willed into existence by a team of two, Beth Israel Medical Center has come to its latest initiative more organically, through widespread support from administration, doctors, its CEO, and its unusually open-minded 65-member board of trustees. Already in place at Beth Israel is a project directed by Steve Horowitz, the Samuels Planetree Model Hospital Unit. On this spalike hospital floor, the patients, mostly there for cardiac care, are offered access to their medical charts, meditation sessions, massage, and musical concerts. And through Beth Israel’s Program for Humanistic Health Care, a five-year-old effort to educate the center’s health-care providers about complementary care, the hospital now hosts workshops, training programs, and weekend retreats that stimulate the staff’s interest in alternative therapies.

The board of trustees generously subsidized the Humanistic Health Care program, which also relies on foundation grants. Now about ten select members of that board are personally bankrolling Beth Israel’s Center for Integrative Healthcare, a freestanding facility scheduled to open this fall. The center, says CEO Matt Fink, will include not only internal medicine, OB/GYN, and pediatrics but also acupuncture, hypnosis, meditation, imagery, and psychological support. The supportive trustees are providing most of the program’s $2 million annual budget for its first two years of operation. Among those trustees most devoted to the project are William Sarnoff, former chairman of Warner Publishing, and Beatrice Renfield, the Broadway producer behind the original productions of Carousel and Brigadoon.

And it was a board member whose connections brought the Dalai Lama to Beth Israel this week. Attorney Alan Abramson, who lost a son to brain cancer seventeen years ago, now serves as the board liaison to INN. Through a friend who knows Columbia University’s chair of Indo-Tibetan studies, Robert Thurman -- the academic who gets equal billing for being Uma’s father and the Dalai Lama’s friend -- Abramson extended an invitation to the Dalai Lama to attend the conference, which quickly became the hot ticket for neuroscientists nationwide.

“I don’t want everyone to just have a meeting where we walk away saying, ‘What a wonderful experience,’ and everyone forgets it. I want to come out with a plan to implement a number of concepts of the Tibetans in our environment,” says Fred Epstein, director of INN and the country’s leading pediatric neurosurgeon. “I have a wonderful teenage patient who is terminally ill. He has a brain tumor, but he has all his cognitive function. Is there something in the techniques of the Buddhist tradition that will help him die peacefully?” The doctors are also hoping to get the Dalai Lama’s blessing, so to speak, for a number of studies of Tibetan meditation techniques.

Carole Carlson, 57, was diagnosed with advanced ovarian cancer almost two years ago, and she is still fighting for an elusive “complete remission.” Carlson, a patient at NYU, likes her doctors but says, “I never got any support at the medical center.” Although NYU has support groups run by social workers, no one told her about them. There is no program of stress management or meditation specifically for people with cancer. Instead, she finds those services at Gilda’s Club, a downtown mecca named for the late comedian Gilda Radner that offers meditation, yoga, and group support to people with cancer. “That place has brought me back to life,” she says. The best thing she can say about NYU’s psychological services: “I found the brochure for Gilda’s in the oncology waiting room.”

Carlson says that in an ideal world, most hospitals would offer the services that Gilda’s does. (Even Columbia has yet to establish in-house support groups for cancer patients.)

“The important thing here for all hospitals -- and I think Beth Israel has realized it earlier and in a more aggressive way -- is that these services are going to be driven by the consumer, the patient,” asserts Beth Israel trustee Sarnoff. “They’re going to demand it as time goes by because it does work.”

Sarnoff, no stranger to market forces, may be right. “I said to my oncologist, ‘Shouldn’t I be in a support group or something?’ “ recalls one 25-year-old patient at Mt. Sinai who has battled Hodgkin’s disease since she was 14. Her doctor’s response: “Why? You’re not an addict.” She says that after attending Mt. Sinai on and off for the past eleven years, she’s now considering seeking care somewhere with better support services. (Mt. Sinai does have a well-respected hypnosis program for pediatric patients.) “I have no confidence that I’ll beat this thing if it’s treated strictly as a biological condition. And the worst part about hospitals is when doctors don’t treat you like a person,” she says. “Why wouldn’t I go somewhere that’s willing to treat me not just as a patient with platelet counts but as a person?