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Severity controlled through innate immune system
In adult mice, the block in cell proliferation caused rapid atrophy of the intestinal epithelium which led to weight loss and lethality within 8–11 d of shRNA induction.
Mice lacking phosphatase PP2A subunit PR61/B’δ (Ppp2r5d) develop spatially restricted tauopathy
the enzyme protein phosphatase methylesterase-1 (PME-1), which regulates the methylesterification state of protein phosphatase 2A (PP2A) and is implicated in cancer and neurodegeneration.
The endothelium plays a critical role in promoting inflammation in cardiovascular disease and other chronic inflammatory conditions
The search for novel therapeutic interventions for viral disease is a challenging pursuit,
Disruption of NMDAR-dependent burst firing by dopamine neurons provides ...
zonnebloem als vervanger van antidepressiva

Marion L., Washington, DC

Accompanying Documents: Testimony to the DHHS Chronic Fatigue Syndrome Advisory Committee;
Hypothesis: Chronic fatigue syndrome is cause by dysregulation of hydrogen sulfide metabolism
To the idea: Almost two years ago to the day I attended a lecture by a scientist who was able to induce a state of suspended hibernation in mice using the gas hydrogen sulfide, or H2S.
Kanker door verzuurd lichaam (te weinig zuurstof - mitochondrieën)
CFS and mitochondria dysfunction
Influence of nitric oxide synthase inhibition on vasopressin and corticosterone secretion during water deprivation in rats
Nitric oxide (NO) is a short-lived radical that functions as a neurotransmitter in the central nervous system and plays a physiological role in the regulation of hypothalamic-pituitary-adrenal axis and vasopressinergic axis.
However, in cells from DA rat strain beta-endorphin modulated both phagocytosis and NO production in a concentration-dependent manner. It could be concluded that the strain-dependent opposing effects of beta-endorphin on paw inflammation are mediated through delta and kappa opioid receptors and probably involve changes in the production of reactive oxygen species by inflammatory cells.

More than 15 years have elapsed since the authors of a nucleotide-exchange study estimated that maintenance of the actin cytoskeleton could be responsible for as much as 50% of the total ATP consumption in resting platelets (Daniel et al., 1986). One might expect the fraction of ATP consumed by the cytoskeleton to be higher in platelets than in whole cells, because platelets are enucleate cell fragments derived from megakaryocytes and have much reduced ATP-dependent biosynthetic activity. Here, we provide evidence from live neurons that supports the idea that actin dynamics are a major ATP-consuming process in bona fide cells. ...

One indication of the significance of actin for the physiology of oxidatively stressed neurons is the abundant formation of abnormal actin-containing inclusions (“rods”) within minutes of ischemic insult (Minamide et al., 2000). Rods appear in the axons and dendrites of cultured hippocampal and cortical cells and contain proteins of the actin depolymerizing factor (ADF)–cofilin family that enhance the rapid turnover of actin filaments (Bamburg, 1999).
Apoptosis and necrosis with nitric oxide in cortical cell cultures

Our findings also have interesting implications for cell biology because they allow for a new method of estimating filament length in neurons. If one assumes total ATP use of 80 μmol · l−1 · sec−1for brain tissue, which can be derived from human cerebral blood flow and metabolic rates (Sokoloff, 1996), then actin turnover is responsible for 50% of the ATP turnover,
More than 100 compounds have been identified that have, or may have, paracrine or autocrine actions. They include the neurotransmitters acetylcholine and γ-aminobutyric acid, peptides such as vasoactive intestinal peptide, galanin, endothelins, calcitonin, neuromedin B and melanocortins, growth factors of the epidermal growth factor, fibroblast growth factor, nerve growth factor and transforming growth factor-β families, cytokines, tissue factors such as annexin-1 and follistatin, hormones, nitric oxide, purines, retinoids and fatty acid derivatives.

Paracrine/autocrine actions are highly context-dependent. They are turned on/off when hormonal outputs need to be adapted to changing demands of the organism, such as during reproduction, stress, inflammation, starvation and circadian rhythms.

Specificity and selectivity in autocrine/paracrine interactions may rely on microanatomical specialisations, functional compartmentalisation in receptor–ligand distribution and the non-equilibrium dynamics of the receptor–ligand interactions in the loops.
Emerging Synergisms Between Drugs and Physiologically-Patterned Weak Magnetic Fields

The present review describes the experimental evidence for interactions between neuropharmacological compounds and the classes of weak magnetic fields that might be encountered in our daily environments. Whereas drugs mediate their effects through specific spatial (molecular) structures, magnetic fields mediate their effects through specific temporal patterns. Very weak (microT range) physiologically-patterned magnetic fields synergistically interact with drugs to strongly potentiate effects that have classically involved opiate, cholinergic, dopaminergic, serotonergic, and nitric oxide pathways.
Faraday's Law, in that "a changing magnetic field is associated with a changing electric field."
Resistance of cholestatic rats against epinephrine-induced arrhythmia: the role of nitric oxide and endogenous opioids.

This study showed that BDL animals are resistant against epinephrine-induced arrhythmia and this resistance depends on long-term NO overproduction (by LDN administration)
Meten van stikstofmonoxide bij longpatienten (pulmonale hypertensie) toont aan dat:
Bij aandoeningen waarbij de alveolocapillaire membraan verdikt is, daarentegen, nemen zowel de diffusie van koolmonoxide als die van stikstofmonoxide af.

Voorwaarde voor het kunnen uitvoeren van de diffusiemetingen met stikstofmonoxide is wel dat de industrie er brood in ziet dergelijke apparaten op de markt te brengen.
Vrouwen en auto-immuniteit
auto-immmuunziekte + cortisone + EBV = slechte combinatie
Eiwit in urine

lupus door vrouwelijke hormonen
Mu receptors are widely distributed throughout the CNS, especially in the limbic system (frontal cortex, temporal cortex, amygdala, and hippocampus), thalamus, striatum, hypothalamus, and midbrain as well as laminae I, II, IV, and V of the dorsal horn in the spinal cord.
Kappa receptors are localized primarily in the spinal cord and in the cerebral cortex.
Heterologous desensitization of opioid receptors by chemokines inhibits chemotaxis and enhances the perception of pain
Why Is Morphine Ineffective in Treating Nerve Injury Pain?

Opioid analgesics such as morphine are universally regarded as the most powerful pain-relieving drugs. Morphine acts through the μ-opioid receptor to inhibit signals that transmit pain (13). Pain that follows direct injury to a peripheral nerve is called neuropathic pain. Unfortunately, it is still not known what mechanisms underlie this prevalent pain syndrome. Neuropathic pain is an anomaly because it is insensitive to morphine as well as other opioid drugs and is currently best managed with antidepressants and antiepileptics (14). Neuropathic pain may be insensitive to morphine because damage of primary afferent nerves results in decreased expression of μ-opioid receptors on nociceptors and spinal neurons in the pain pathway, thus reducing the efficacy of morphine (15). In addition, other substances may modulate the efficacy of morphine. For example, when the neuropeptide cholecystokinin (CCK) is applied to the spinal cord, it reduces the inhibitory effects of morphine (16). At the cellular level, μ-receptors and CCK receptors are expressed in the same spinal neurons, suggesting that CCK may directly inhibit actions of morphine by means of signaling mechanisms within a given neuron (17). Furthermore, activation of μ-receptors increases release of CCK neuropeptide, which then reduces the effectiveness of morphine in a feedback manner (17). Thus, multiple mechanisms, including decreased μ-receptors and increased CCK-induced inhibition of morphine, make opioids ineffective in treating neuropathic pain.
Progesterone increases levels of mu-opioid receptor mRNA in the preoptic area and arcuate nucleus of ovariectomized, estradiol-treated female rats. Meerdere artikels onderaan:

MOR also found in the placenta. Test: Release of morphine induces immediate release of NO i the placenta.
The effects of LPS = lipopolysaccharide on inducing the up-regulation of macrophage inflammatory protein-2, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta, IL-6, nitric oxide/inducible nitric oxide synthase, and prostaglandin E(2)/cyclooxygenase 2 were inhibited by naloxone.
Mol Biol Rep. 2011 Feb;38(2):1231-6. Epub 2010 Jun 20.

The influence of opioids on matrix metalloproteinase-2 and -9 secretion and mRNA levels in MCF-7 breast cancer cell line.
Recently, a new isoform of OPRM1, MOR3, has been identified that shows an increase in the production of nitric oxide (NO) upon stimulation with morphine.
These results indicate the different roles played by nitric oxide synthesized by NOS2 = inducible or NOS1 = neuronal in the maintenance of mechanical allodynia (= not supposed to be painful , niet uitgelokt door een stimulus) and thermal hyperalgesia induced by chronic inflammatory pain as well as, in the antinociceptive effects produced by micro- and delta-opioid receptor agonists during peripheral inflammatory pain.
One of the reasons the symptoms of ME/CFS may seem to wax and wane, may have to do with the individual and the availability of the neurotransmitter dopamine in the sufferer. Some individuals actually do have to sit back and re-charge their batteries in order to keep going. Perhaps, CFS sufferers are depleted or running low, when it comes to neurotransmitter dopamine.

I came across this article on fibromyalgia and dopamine by Dr Andrew Holman and could see right way how it might apply to ME/CFS also. Almost everything measurable has been measured in patients with ME/CFS. But dopamine is not measurable, except in samples of cerebrospinal fluid. In addition, the five newly discovered dopamine receptors and their independent functions are not yet measurable.
Heroin modulates the expression of inducible nitric oxide synthase
(Natuurlijke opioiden, gluten e.d. doen hetzelfde)
uitleg pijn bij stopzetting opiaten
Characterization of the opioid receptor type mediating inhibition of rat gastric somatostatin secretion
Low Dose Naltrexone
Low dose naltrexone administration in morphine dependent
rats attenuates withdrawal-induced norepinephrine efflux in forebrain
Candida overwinnen
each human has only one of three gut ecosystems
A novel form of human neuropsin, a brain-related serine protease, is generated by alternative splicing and is expressed preferentially in human adult brain
Abnormalities of synapses and neurons in the hippocampus of neuropsin-deficient mice.
Injury induces neuropsin mRNA in the central nervous system
ldn neuropeptide nk cells
carnitine tekort kan leiden tot leververgroting of hepatomegaly (link Epstein Barr)
evidence based medicine

- Oslers Web, een kritische blik op medische ethiek
- Energy medicine and the multidimensional model
- Evidence(?)-based practice? Over valkuilen, mythes en verhalen door Inge Bramsen
- Psychotherapy versus Spiritual Therapy By Richard Schiffman
- Chronic fatigue syndrome & child abuse: Disordered patients or disordered research?

Kafka in MEdisch polderland

Ontluisterend boek over ME/cvs

Aankondiging 8 december 2010. Welke betekenis heeft een multisysteemziekte als ME/CVS voor je leven? Het antwoord is te vinden in het vandaag verschenen boek "Ik werd ziek, maar…de wereld bleek mesjokke" van Mirande de Rijke. Weinig blijft onbesproken in dit ontluisterende boek.

Mirande de Rijke werd in 1999 ziek en verloor nagenoeg alles: gezondheid, baan, zelfvertrouwen en vrienden. Ze verspeelde ook haar vertrouwen in de medische stand. Door de behandeling van prof. dr. Kenny De Meirleir uit Brussel, in oktober nog spreker tijdens het Congres Voeding & Psyche, krabbelde ze uiteindelijk uit het dal.

Allerlei aspecten komen aan de orde in dit boek. Zo ook de voor ME/CVS kenmerkende voedselallergieën. Een citaat: ‘Veel mensen met deze ziekte zijn in elk geval voor een paar dingen allergisch. Soms weten ze het niet eens doordat de darmen in hun ogen redelijk normaal functioneren en ze ook geen verband kunnen leggen tussen zich rot of extra ziek voelen en een voedingsmiddel. Ik denk, dat je wel kunt stellen dat iedere ME-er minstens een paar voedingsallergieën heeft. Ikzelf had de loterij gewonnen.’

Het boek, met een voorwoord van ORTHO-medewerker Toine de Graaf, is te bestellen via

Bron: Voeding en Psyche


Dit boek bevat hoofdzakelijk persoonlijke ervaringen. Het is duidelijk dat ik geen arts ben, maar aan de andere kant van het verhaal sta. Daar waar ik een mening uit lijk te spreken, doe ik dit slechts gebaseerd op persoonlijke visie en ervaring.

Ooit was ik een gezond mens, zoals zo velen. Helaas werd ik ziek. Toen dit gebeurde, merkte ik dat het feit van ziek-zijn op zich niet het ergste was wat ik hierdoor zou meemaken. Ik ben, in mijn ogen, onder krankzinnige omstandigheden in krankzinnige situaties terechtgekomen. Een draaikolk aan ervaringen die heftig was.

De gebeurtenissen in dit boekje hebben daadwerkelijk plaatsgevonden. Ze maken deel uit van mijn leven. Delen van dit leven heb ik hier opgetekend.

Ik spreek de hoop uit, dat het met belangstelling gelezen zal worden. Ik heb niet de wil, of de illusie, de wereld in mijn eentje te kunnen veranderen. Wel heb ik hoop, iets te kunnen bijdragen aan het persoonlijk leven van een enkeling. Wellicht door herkenning van klachten en ervaringen door mensen met een andere chronische ziekte, dan wel door mensen met dezelfde ziekte, of door het geven van iets meer duidelijkheid aan mensen die deze ziekte niet meemaken over hoe het is om hiermee geconfronteerd te worden.

Opmerking Het boek werd gedrukt in een duidelijk leesbaar lettertype op een gebroken wit achtergrond om de leesbaarheid te optimaliseren.

Oslers Web, een kritische blik op medische ethiek


"For more than a decade a devastating disease has been allowed to spread through our country--unchecked, insufficiently researched, and all but ignored, if not denied, by the medical establishment. In many circles this disease, still known as Yuppie Flu, is dismissed as a psychological aberration. For the nearly two million people who have endured its traumatic and very real debilitating physical effects, however, Chronic Fatigue Syndrome is no joke.

Journalist Hillary Johnson delivers a shocking indictment of the medical bureaucracy's unwillingness to protect the public from a disease that attacks 300 out of every 100,000 Americans (fifteen times the rate of the polio epidemic at its height).
She explodes every myth about CFS, revealing that its victims represent all income levels and backgrounds, that it may be spread through casual contact, and that less than one-fifth of CFS sufferers ever fully recover. Combining heartbreaking stories of the irreversible effects this disease has had on its victims' lives with profiles of the scientists who have dedicated themselves to finding the cause and a cure, this dramatic chronology of a modern killer offers riveting, indisputable evidence that CFS presents a very real threat and is among the most severe diseases known to man."

Energy Medicine and the Multidimensional Model

by Debra Greene

Debra Greene, PhD, is the founder of Inner Clarity (IC), an energy-based healing modality, and author of the acclaimed book Endless Energy: The Essential Guide to Energy Health. She lives on Maui Island in Hawaii; her website is

According to Einstein’s famous formula, E=MC2, energy and matter are interchangeable. Matter can be converted into energy, and energy into matter. Indeed, when physicists looked deeply into matter to find what we are made of, they discovered that matter is not solid but consists of subatomic particles comprised of mostly empty space. In turn, when they looked into the “empty space,” physicists determined that it was not so empty after all, that it is teaming with energy, effervescing, a quantum froth. This energy is at the core of everything in existence.

One does not have to stretch far to see the parallels between this underlying energy-essence that connects everything and the notion of unifying oneness that weaves its way through many spiritual traditions. One of the places where science and spirituality intersect comfortably is in the emerging field of energy medicine. Here ancient methods find their home in modern practitioners’ offices and in research laboratories.

The question then arises: If everything is energy, what constitutes the legitimate domain of energy medicine? In attempting to answer this question, I found a useful model that is shared by modern science and many ancient traditions. It accounts for the diversity in the field of energy medicine and helps to explain a vast array of energy-based phenomena. This theoretical model holds that a human being consists of multiple layers, or dimensions, that coexist simultaneously. Although individual models based on this principle differ slightly in terms of the number of layers and their labels, there is general agreement about four main dimensions: the physical-etheric, the emotional, the mental, and the spiritual. According to the ancients, the soul is encased in these successive layers.

Versions of the multidimensional model have been discussed over the years at annual conferences of the International Society for the Study of Subtle Energies and Energy Medicine (ISSSEEM), the leading organization for the scientific study of energy medicine. Elmer Green, the organization’s cofounder, a pioneer in biofeedback and psychophysiology research, used the model as a basis for his work (for more information on ISSSEEM and recordings from its conferences, go to The most substantiated version of the multidimensional model has been advanced by William Tiller, professor emeritus at Stanford University and former chair of the Materials Science department. Tiller’s contribution is significant because, after 34 years in academia, his feet are firmly planted in conventional science. His stated mission is to build a reliable bridge that seamlessly joins conventional science with the various subtle domains of inner reality and the domain of spirit. He calls his approach psychoenergetic science, and he has made important strides in revealing, in quantitative detail, how human consciousness interacts with physical reality.

Rich in heuristic value, Tiller’s multidimensional model was used by Richard Gerber, a practicing physician trained in internal medicine and devoted to researching vibrational healing. Gerber became a definitive authority on energy medicine with the publication of his seminal contribution Vibrational Medicine, which used the multidimensional model as its foundation. Meticulously researched and backed by the science of the day, the book was essentially the first energy medicine textbook of its kind. Former professor and analytical chemist Charles Krebs used the same model in his groundbreaking work on energy kinesiology (A Revolutionary Way of Thinking), and I also made use of the multidimensional model in my recent book on energy health (Endless Energy).

What Is the Multidimensional Model?

According to the multidimensional model, human beings consist of a spectrum of energy frequencies. These layers or “energy bodies” – the physical-etheric, emotional, mental, and spiritual – comprise distinct yet overlapping frequency domains. They represent the “equipment” through which we experience various dimensions of reality. Consciousness is the great mediator that connects the energy bodies and holds us together so that we function as a whole person (actions, feelings, thoughts, and volition) with continuity from day to day.

The slowest or lowest frequency domain is the physical plane, which we occupy by virtue of the fact that we have a physical body. Bones, organs, tissues, blood, glandular secretions, nervous system, and DNA all fall within the purview of the physical body. As well, the five senses of seeing, hearing, tasting, touching, and smelling belong to the physical body. But the gross physical body needs a power supply, a life force, in order to function. This life force is called the etheric body, and it is responsible for our vitality.

According to the model, the dense physical body and the etheric body must be understood as inseparably woven together, as two sides of the same coin. That’s why the physical-etheric is typically referred to as one body and not two. Without the etheric body to animate it, the physical body is a corpse. That Western medical science developed primarily through the study of cadavers helps explain how the etheric body was missed in conventional medicine.

The etheric body is the inner substantial form, the “internal scaffolding,” upon which the dense physical body is built. It consists of a vitality-rich energy that goes by several names: for example, chi in China, ki in Japan, prana in India, or mana in Hawaii. The martial arts from a variety of cultures are based on this energy, as are the healing systems of Traditional Chinese Medicine, acupuncture, Ayurveda, yoga, Tibetan Medicine, and kahuna healing, to name a few. The ancients knew this energy well and developed their healing practices accordingly.

Moving up the frequency spectrum, the remaining energy bodies that comprise our basic human constitution are the emotional, mental, and spiritual. The emotional body is responsible for our emotions and feelings, while the domain of the mental body is our thoughts and intellect. The spiritual body, which is the highest or fastest frequency domain, allows us to have spiritual experiences. We humans occupy these multiple levels of existence simultaneously. That’s what makes us so wonderfully complex. Most of us are familiar with the emotional, mental, and spiritual aspects of ourselves, but the etheric body, the foundational component of energy medicine, remains more of a mystery.

The Etheric Body

Although the U.S. medical world has been resistant to recognizing the etheric body, mainstream culture has embraced numerous practices based on its underlying principles. You don’t have to look far today to see the popularity of yoga, acupuncture, meditation, and the martial arts. These practices emerged from ancient cultures dedicated to the complex and systematic study of the etheric body, which led to a scientific understanding of human energy anatomy. Successful medical systems based on their findings followed. This knowledge and these practices are now being validated by Western scientific methods.

According to the ancients, the etheric body is a complex energy/information matrix that interpenetrates the dense physical body and extends beyond it for several inches. The etheric body powers the physical body through a sophisticated network of energy centers, distribution lines called meridians in Chinese medicine, and the branching of smaller and smaller energy capillaries called nadis, a Sanskrit term for “channels.” This network has been validated by a number of modern scientific methods, includingmagnetic resonance imaging(MRI). The energy centers are often referred to as chakras, a Sanskrit word that means round or wheel. These, too, have been experimentally verified with electrostatic measurements as well as electromyography (EMG). It’s likely that ancient scientists and practitioners had the capacity to see these wheel-like energy centers and named them accordingly. People today who claim to see these energies have described them as looking like spinning wheels or vortices that range in size from about two to several inches in diameter, depending on their stage of development.

Chakras are like electrical power plants where high voltage energy is transformed and distributed through a convergence of power lines. The etheric body interfaces with the physical body through these power distribution lines, these meridians. This energy network corresponds to the physical nervous system. When several meridians intersect, which happens at the major nerve centers in the physical body, they become even more potent, teeming with life-force energy.

The Interface Effect

Chakras and meridians form the basis of a variety of established energy-based healing modalities and have been linked to physical, emotional, and mental health. One explanation for this is “the interface effect” of the etheric body. It is believed that the etheric body acts as an interface between the physical body and the other energy bodies (emotional, mental, and spiritual). In the clothing world, an interface performs important function –, for example, making the collar of a man’s dress shirt stiff so it can stand up. The purpose of an interface is to reinforce or add substance to whatever it is sewn into. It is usually stitched onto the inside of an outward-facing piece of fabric. This makes it invisible when the garment is completed because the interface is concealed between layers of fabric.

So it is with the etheric body. This energy body is woven onto the inside of the physical body and is “invisible” from the outside. As an interface, the etheric body reinforces the physical body, providing the energetic substance that holds the physical body together and helps it function as an integrated unit (for example, your liver stays in place and your heart beats without you having to think about it). Like a collar without an interface, if the physical body were without its etheric body “backing,” it would be limp and unsubstantiated, unable to stand up.

As an interface, the etheric body also acts as a gateway between the physical body and the three remaining bodies – the emotional, mental, and spiritual – creating reciprocity between them. Any of the bodies can be accessed through the etheric body. This is why healing modalities that specifically involve the etheric body (such as classical homeopathy, acupuncture, therapeutic touch, Reiki, Emotional Freedom Technique, Touch for Health, and other kinesiologies, to name a few) usually help with physical ailments as well as emotional and psychological issues.

The Blueprint Effect

In addition to being an interface, the etheric body serves another important function. The conventional wisdom is that genes provide the blueprint for the physical body. However, groundbreaking research in molecular biology over the last couple of decades suggests otherwise. Although genes play a fundamental role in determining our physicality, the new field of epigenetics (epigenetic means “above the gene”) has revealed another influence beyond the genes that determines whether or not a gene is used.

According to epigenetics, our genes are more like building materials than blueprints. They are the lumber, nails, Sheetrock, and fixture choices that may or may not end up being included in the physical structure. Something outside of the gene helps determine whether it becomes part of the building (or rebuilding) process. Mechanisms that potentially influence whether or not a gene gets “expressed” include such nonphysical factors as emotions, thoughts, and states of consciousness. In light of the interface effect, this is the domain of the etheric body as it provides a gateway to the physical, emotional, mental, and spiritual bodies.

It could be that the true blueprint for the physical body is the etheric body, which may contain the energy/information instructions that determine what goes into the physical body’s formation. It may also be that all aspects of the physical body, including illness and disease, preexist in the etheric body. The physical body is an exact replica of the etheric body; the etheric body is the “original.” This helps explain why energy-based healing modalities are able to produce physical effects simply by balancing the energies of the etheric body. It appears that they may be working at the level of the blueprint.


Taken together, the blueprint effect and the interface effect of the etheric body profoundly impact the physical body, from its shape and size to its ongoing health and vitality. The important energy activity happens behind the scenes, in the internal realms; the physical body displays the aftereffects. In essence, the physical body is the stage where emotions, thoughts, and spiritual energies play out their ultimate expression.

The multidimensional model, and the etheric body in particular, help explain why there’s such a high incidence of relapse with conventional medical approaches. One can fall sick with any number of illnesses, get treated, and then become sick again. The illness may not be truly healed because addressing only the physical aspect potentially leaves the “energetic signature” of the illness intact. Indeed, the energy bodies may hold the key to complete healing.

Recognizing and working with the energy bodies may also provide an accurate early detection system. Since, in this model, any physical ailment preexists in the etheric body before it manifests on the physical level, we don’t have to wait for an illness to show up in the physical body before correcting it. We can be pro-active by focusing on the energy bodies first, keeping them healthy and balanced. This is something that can largely be accomplished with education and self-care – a much more cost effective and much less invasive approach than medical interventions on the gross physical level.

Energy medicine is an idea whose time has come. Recognition of the energy bodies is what defines energy medicine and sets it apart from allopathic approaches. As far as we know, every healing system on the planet recognizes the existence of these types of energy except for one, conventional Western medicine. But as the therapeutic effects of energy-based healing methods continue to be substantiated, this is bound to change. It’s time to put the soul back into medicine.

Hard copy

Evidence(?)-based practice? Over valkuilen, mythes en verhalen

In het boek "Praktijkgericht onderzoek in de praktijk, een spraakmakend project" vindt men een interessant hoofdstuk terug van Inge Bramsen die eerder het artikel "Onderzoek naar medisch onverklaarde klachten is strijdig met basale wetenschappelijke en ethische principes." schreef. In deze bijdrage presenteert zij haar visie, op de betekenis van ‘verhalen’ voor het handelen van professionals in de gezondheidszorg. Deze visie is geïnspireerd door haar opleiding en werkervaring als gezondheidspsycholoog en methodoloog. Sinds enkele jaren kan zij hieraan toevoegen: ervaringsdeskundigheid als chronisch zieke. Hieronder vindt u enkele relevante passages met betrekking tot de valkuilen in het onderzoek naar ME/cvs.

Evidence(?)-based practice? Over valkuilen, mythes en verhalen

Valkuilen bij het ver talen van onder zoeksresultaten naar de praktijk Valkuil 1: reductie van de werkelijkheid

(...) Een ander knelpunt dat uit de gereduceerde onderzoekswerkelijkheid voort kan komen is dat bepaalde theorieën ongemerkt een eigen leven gaan leiden, terwijl zij niet voldoende bewezen zijn. Soms verliest men uit het oog dat een score op een vragenlijst niet hetzelfde is als een klinische diagnose. En soms gaat een begrip een eigen leven leiden, terwijl de validiteit onvoldoende is. Een goed voorbeeld hiervan is het lastig te operationaliseren begrip ‘somatisatie’.

Met ‘somatisatie’ wordt meestal bedoeld dat mensen lichamelijke klachten en ongemakken presenteren die in feite een uiting zijn van (veronderstelde) onderliggende psychische problematiek. De behandeling van de psychische stoornis zou de klachten doen verdwijnen (Bridges & Goldberg, 1985). In de praktijk wordt vooral indien er sprake is van lichamelijke klachten die de arts niet kan verklaren, overwogen of er sprake is van somatisatie of zelfs van een somatoforme stoornis.

Hiermee komen we op het omstreden karakter van de definitie van de somatoforme stoornissen in het psychiatrische classificatiesysteem DSM-IV (APA, 1994). Deze definitie is gebaseerd op negatieve criteria, namelijk de afwezigheid van organische bevindingen, in plaats van op positieve criteria, bijvoorbeeld de aanwezigheid van een heldere en eenduidig omschreven psychiatrische problematiek (Janca, 2005; Kroenke, Sharpe & Sykes, 2007). (...)

Deze definitie is problematisch, omdat het nu eenmaal niet vanzelfsprekend is dat lichamelijke klachten waarvoor een dokter geen onmiddellijke verklaring heeft, automatisch psychisch van aard zouden zijn. Er zijn grenzen aan de medische kennis. Bovendien zijn sommige aandoeningen zeldzaam en/of moeilijk te diagnosticeren. Hierdoor kan een al te gemakkelijke toepassing van de diagnose ‘somatoforme stoornis’ leiden tot medische missers.

In wetenschappelijk onderzoek wordt het verschijnsel ‘somatisatie’ meestal gemeten met een vragenlijst, bijvoorbeeld de schaal Lichamelijke Klachten van de Symptom Checklist (SCL-90; Arrindell & Ettema, 2003). Hierop geven cliënten aan in welke mate zij in de afgelopen week last hadden van een aantal lichamelijke klachten, zoals hoofdpijn, duizeligheid en pijn. De handleiding van de SCL-90 vermeldt dat een feitelijke lichamelijke aandoening nooit is uitgesloten en dat daarom een hoge score niet automatisch gelijk kan worden gesteld aan ‘somatisering’. Toch wordt dit vaak gedaan. (...)

Zij veronderstellen dat bij deze ‘modeziekten’ culturele en psychologische factoren een hoofdrol spelen. Deze visie wordt ook uitgedragen in een recent Nederlands promotieonderzoek (Buitenhuis, 2009). Volgens dit onderzoek zou de naam van de ziekte van doorslaggevende invloed zijn op het beloop, en zou het daarom beter zijn bepaalde ziekten niet meer bij de nu gangbare naam te noemen. (...)

Dergelijke metaforen en mythes moedigen de zieken aan ‘om te geloven dat ze ziek worden, omdat ze dit (onbewust) willen, en dat zij zichzelf kunnen genezen door hun wil te mobiliseren’ (p. 57). Zij laat zien hoe dit soort psychologische theorieën de zieken de schuld geven en hen daarbij ook nog opzadelen met het gevoel dat ze hun ziekte verdiend hebben. (...)

Bovengenoemde voorbeelden bij de gereduceerde onderzoekswerkelijkheid laten een spanningsveld zien tussen verhalen van patiënten en wetenschappers. (...)

Valkuil 2: schijnexactheid

Iedere vorm van wetenschappelijk onderzoek, dus ook de meest geavanceerde Randomized Controlled Trial, is kwetsbaar voor verstorende elementen (bias) die kunnen leiden tot vertekende resultaten en verkeerde conclusies. (...)

Verschillende onderzoeken hebben laten zien dat vooral positieve onderzoeksresultaten gepubliceerd worden en negatieve resultaten niet of vertekend, alsof het toch positieve resultaten zijn. Hierdoor, betoogt zij, wordt het gunstige effect van antidepressiva in de dagelijkse praktijk sterk overschat. Ook dringen verhalen van patiënten of nabestaanden over vervelende en soms heel ernstige bijwerkingen nauwelijks door. (...)

Valkuil 3: voorbarige causale conclusies

Als twee verschijnselen met elkaar samenhangen, betekent dit niet automatisch dat er sprake is van een oorzaak-gevolgrelatie. Zo kan bijvoorbeeld een derde variabele die de gemeten samenhang verklaart, eenvoudig gemist worden, en wordt een interventie gericht op het verkeerde doel.

Een voorbeeld: Huibers et al. (2003) vonden in een onderzoek onder vermoeide werknemers een correlatie tussen het hebben van een ‘somatische attributie’ en een slechte prognose. Zij vonden dat vermoeide werknemers die menen dat er voor de vermoeidheid een lichamelijke oorzaak is, bijvoorbeeld een virusinfectie, na een bepaalde periode vaak niet waren hersteld, terwijl mensen die dachten aan een psychische oorzaak, bijvoorbeeld werkstress, vaak wel herstelden. Deze onderzoeksbevinding wordt door sommigen gezien als ondersteuning voor het idee dat cliënten met het chronisch vermoeidheidssyndroom (CVS), ook wel myalgische encephalomyelitis (ME) genoemd, met behulp van cognitieve gedragstherapie (CGT) anders moeten leren denken (Bleijenberg, Prins & Bazelmans, 2003; Verhoeven & Bieleman, 2005). Zij zouden moeten stoppen met te denken dat zij lichamelijk ziek zijn, want dit zou ertoe leiden dat zij langer ziek blijven.

Anderen hebben erop gewezen dat deze conclusie problematisch is, en wel om twee redenen (Jason, Fennel & Taylor, 2003).

1.In de eerste plaats is hier vermoedelijk een derde moeilijk te beïnvloeden variabele in het spel, namelijk dat chronische vermoeidheid verschillende oorzaken kan hebben, bijvoorbeeld een depressie of een burn-out, maar ook een organische ziekte. Patiënten die denken dat zij lichamelijk ziek zijn, kunnen dus een correcte inschatting of attributie hebben gemaakt omtrent de oorzaak van hun ziekte, en om die reden niet zo gemakkelijk herstellen als patiënten die een psychische oorzaak zien voor hun vermoeidheid. En als zij voldoen aan de criteria voor ME/CVS gaat het bovendien om een neurologische ziekte (zie de ICD-10, code G93.3; WHO , 2005) waarvoor artsen nog geen behandeling hebben, hetgeen de kans op herstel vanzelfsprekend nadelig beïnvloedt (Carruthers et al., 2003; Jason, Fennel & Taylor, 2003).

2.In de tweede plaats is de oorzaak-gevolgredenering van de onderzoekers gebaseerd op de aanname dat chronische vermoeidheid niet fundamenteel verschilt van ME/CVS. Deze aanname is niet in overeenstemming met internationaal gangbare criteria voor ME/CVS (Fukuda et al., 1994; Carruthers et al., 2003). Carruthers et al. (2003) definiëren als belangrijk kenmerk van ME/CVS dat geringe inspanning leidt tot een abnormaal verlies van lichamelijk en geestelijk uithoudingsvermogen, snel afnemende spiersterkte en cognitieve vaardigheden, malaise en/of vermoeidheid en/of pijn na inspanning. Er is een pathologisch lange herstelduur, gewoonlijk 24 uur of langer (dagen/weken/maanden). Verder kan inspanning leiden tot verergering van andere verwante symptomen zoals een niet-verkwikkende slaap, hersenmist, instabiele lichaamstemperatuur en een plotseling gejaagde hartslag. In bovengenoemde studie had geen van de vermoeide werknemers een diagnose ME/CVS, terwijl de onderzoekers de uitkomsten wel, en zonder hieraan een discussie te wijden, generaliseren naar deze groep.

Doordat men zich niet houdt aan stringente criteria voor ME/CVS wordt het doen van onderzoek onder grote groepen mensen veel gemakkelijker, maar dit gaat wel ten koste van de validiteit van de conclusies. Ook leidt deze handelswijze tot een enorme toename van het aantal mensen dat deze diagnose krijgt, waardoor de oorspronkelijke, veel kleinere doelgroep uit beeld dreigt te raken (Jason, Najar, Porter & Reh, 2008). Een groot optimisme over de gunstige effecten van cognitieve gedragstherapie bij ME/CVS lijkt eveneens het gevolg van deze handelwijze. Het is waarschijnlijk dat een brede en weinig specifieke dan wel een stringente afbakening van de doelgroep van cruciale invloed is op de resultaten van wetenschappelijk onderzoek (Carruthers et al., 2003; Jason & Richman, 2008).

Verhaal 4: Negatieve ervaringen met cgt – het verhaal van Louise

De 15-jarige Louise moest voortdurend hoesten en was erg snel moe. Na een halfjaar werden sporen van Pfeiffer in haar bloed aangetroffen. Inmiddels had ze ook veel hoofdpijn, pijn in haar gewrichten en concentratieproblemen.

Ze ging nog maar drie dagen per week naar school. Na ongeveer een jaar wordt zij doorverwezen voor een CGT -behandeling: ‘Ik ging er gewoon voor.

[...] Toen de therapie begon, moest ik vroeger opstaan en diverse keren per dag vijf minuten een ommetje lopen. Toen dat al te veel was, moest ik toch vroeger opstaan en langer lopen. Maar ik kon nog geen twintig meter lopen zonder buiten uitgeput op de grond te gaan zitten. Toch zei mijn therapeute dat ik het kon als ik maar wilde! Fysiek ben ik enorm achteruitgegaan door de therapie. [...] Er werd ook niet naar me geluisterd als ik zei dat ik iets niet kon. [...] Na een tijdje besloot de therapeute te stoppen met cgt . “Dit heeft geen zin”, zei ze op een niet al te vriendelijke manier. Ze gedroeg zich alsof het aan mij lag. [...] Ik kon door de vermoeidheid nog amper volgen wat ze zei, maar dan verhief ze haar stem. Gelukkig zat mijn moeder er soms bij om me te steunen.’ 5

5 Ontleend aan: Van Tuyll, E. & Van Ormondt, F. (december 2008). ‘Ik heb er nog steeds last van’. Uitvallen bij de Nijmeegse variant van CGT . Lees ME (Nummer 6, pp. 14-15). Een uitgave van de ME/CVS-vereniging.

Verhaal 4 en 5 beschrijven de verschillende ervaringen van twee cliënten met de diagnose ME/CVS met cognitieve gedragstherapie, die het gevolg lijkt van de op dit terrein ontstane spraakverwarring. Bij de eerste patiënte lijkt sprake te zijn van inspanningsintolerantie en een terechte diagnose ME/CVS : haar toestand verslechtert in ernstige mate als gevolg van de inspanning die door de therapie wordt opgelegd. Bij de tweede patiënte lijkt eerder sprake van een vorm van chronische vermoeidheid die niet aan de criteria voor ME/CVS voldoet: zij kan zonder problemen de hoeveelheid inspanning verhogen en geeft ook expliciet aan dat haar moeheid niet gekoppeld is aan inspanning. En wat te denken van de patiënte in de groep die al elf jaar ME/CVS heeft? Zal de ziekte bij haar kunnen worden ‘weggetraind’?

Verhaal 5: Positieve ervaringen met CGT – het verhaal van Monique

De 39-jarige Monique was begin 2007 chronisch vermoeid. De eerste klachten waren vaag, niet goed te verklaren. Ze scheidde van haar man en bleef met drie kinderen achter. Dat was geen gemakkelijke tijd. [...] Eerst dacht ze nog dat ze daardoor steeds meer last kreeg van vermoeidheid. Dat uitte zich in verzuring van haar beenspieren. Niet nadat ze had gelopen of gewerkt, maar juist als ze niets had gedaan. [...] Ze kon wel aan het slapen blijven, er kwam geen einde meer aan haar behoefte aan rust. [...] Toen ze voor de zoveelste keer naar de huisarts ging, raadde deze haar aan met de baas te gaan praten en een paar weken rust te nemen. [...] Eenmaal thuis bereikte ze het dieptepunt. Ze wordt doorverwezen naar de GGZ: ‘Ik wilde eerst voorzichtig kennismaken met die therapie.’ Het werd uiteindelijk het begin van haar herstel.

[...] De behandeling was helemaal geweldig [...]: ‘Ze hebben me weer een normaal slaapritme aangeleerd. En ik ben door hen weer gaan wandelen, iedere dag een minuutje langer. Nu doe ik al een tijdje aan nordic walking. [...] In de groep zaten ook mensen die waren ontslagen. Die konden er niets aan doen, moesten gewoon eerst zien dat ze hun CVS de baas werden. Een van hen was daar al elf jaar mee bezig.’6

6 Ontleend aan: Ed Sluis, Monique kon alleen nog maar slapen, Algemeen Dagblad, dinsdag 10 juli 2007

Deze voorbeelden van omstreden causale conclusies illustreren wederom dat het beoefenen van wetenschap een actieve rol van de onderzoekers vereist. Bij het onderzoeken van de werkelijkheid wordt deze tevens gemanipuleerd en deels geconstrueerd. Dit sluit aan bij de eerder genoemde observaties van de wetenschapshistoricus Kuhn (1969). Kuhn constateerde dat het kiezen tussen twee concurrerende theorieën soms niet mogelijk is, omdat de onderzoekers onvergelijkbare begrippenkaders hanteren en hierdoor verschillende scheidslijnen hanteren, waardoor zij de werkelijkheid ook op een verschillende wijze waarnemen. Dit noemde hij de incommensurabiliteitsthese.

Wetenschappelijke teksten versus verhalen van de patiënten Aan de ‘evidence’ die ontleend kan worden aan de ervaringsdeskundigheid van mensen met een whiplash of met me /cvs wordt in de praktijk wellicht te veel voorbijgegaan. Soms door hierbij een al te smalle definitie van evidencebased practice te hanteren of door wetenschappelijk onderzoek niet op een evenwichtige manier te vertalen en te interpreteren, soms ook door onoordeelkundig gebruik van de statistiek (zie voor een voorbeeld hiervan Bramsen & Roelofs, 2009).

Onvoldoende historische kennis (= ‘evidence’) verhindert dat lessen worden getrokken uit fouten en misstappen uit het verleden. Maar al te vaak is bij onvoldoende ‘bewijs’ voor ziekten als multiple sclerose, migraine, posttraumatische dystrofie (Beerthuizen, 2008), epilepsie (Chaudhuri & Behan, 1999), syndroom van Gilles de la Tourette (Draaisma, 2006) en colitis ulcerosa (Aronowitz & Sprio, 1988) gezocht naar verklaringen op het terrein van de persoonlijkheid, psychische trauma’s, stress of falende coping, waarbij onvoldoende gewicht werd toegekend aan de deskundigheid van de patiënten.

Wetenschappelijke teksten en de vorming van de professional

Om volgens de principes van evidence-based practice te kunnen handelen is het nodig dat de professional teksten over wetenschappelijk bewijs kan beoordelen.(...)

Conclusie Wetenschappelijke kennis is feilbaar, (...)

(...) van cruciaal belang dat onderzoekers, professionals, patiënten en anderen beseffen dat er grenzen zijn aan de kennis, en dat zij onder ogen durven zien dat op sommige terreinen onzekerheid bestaat of verschil van mening.

Psychotherapy versus Spiritual Therapy

Spiritual Wisdom Confronts Psychology: Faith Based Psychotherapy By Richard Schiffman

Does psychotherapy work? The answer--if one has the patience to plow through the morass of often contradictory research--is a resounding "maybe." Ever since London psychiatrist H. J. Eysenck published his controversial study in 1957 purporting to show a negative correlation between psychotherapy and psychological healing (the more therapy one received the lower the recovery rate!) a debate has raged about how effective Freud's talking cure actually is.

The world of modern psychology, of course, has moved well beyond its founder's theories. The past century has witnessed an explosion of often contradictory forms of treatment: Jungian archetype work, Adlerian therapy, Reichian orgone boxes, behavior modification a la B.F. Skinner, the Logotherapy of concentration camp survivor Viktor Frankl--to name just a few of the diverging branches of practice that have grown from the Freudian trunk. The cure rates reported for these varied approaches are mostly lackluster, and, surprisingly, they differ little from one therapeutic regimen to the other. Even more dismaying to the professional psychological community is the conclusion reached in a recent study by professors Andrew Christensen and Neil Jacobson that therapy delivered by untrained nonprofessionals--folks without big offices and fancy credentials tacked on to their names--is just as effective, if not more effective than the far pricier work performed by academically qualified psychiatrists and psychologists.

Given the less than inspiring success rates, the daunting length of treatment (often years, if not decades on the couch), and the prohibitive cost of traditional psychotherapy (at least when the insurance company is not footing the bill), many sufferers are now opting for alternative forms of treatment--everything from self medication with herbal remedies, to encounter groups, to deep massage and therapeutic touch--to help allay their anxieties and relieve their depression. I recently got a taste of the dazzling variety of new techniques that are out there at the annual conference of the Association for Spirituality and Psychotherapy in New York City, where I joined over two hundred working therapists as they wandered wide-eyed through a veritable bazaar of workshops, panel discussions, and shamanistic rites. There were past-life therapists, Yoruba ritualists, psychic healers, Course in Miracles gurus, and practitioners of recently developed technologies like psychosynthesis and neurolinguistic programming--all of them smiling effusively and proffering their wares with missionary zeal. I left the weekend extravaganza with head spinning, chakras throbbing, and mind opened to the exhilarating new vistas on psychology's Wild West frontier.

But I also left with some nagging questions about the efficacy of methods whose scientific virginity has not yet been violated by a double-blind study or statistical analysis. Will the new "spiritual" approaches be any more (or perhaps less) successful in relieving mental anguish than old-fashioned psychotherapy? Not that I am a skeptic, mind you. As a spiritual writer who spent several years chasing enlightenment in Hindu India and Buddhist Asia, I have experienced time and again how spiritual practice can open up the deepest layers of one's own psyche, the numinous realm which pre-moderns called "the soul." What remains to be demonstrated, however, is whether practices taken out of the context of the living traditions of which they are a part and applied more or less indiscriminately toward purposes they were never intended to serve will do the trick.

A dash of Yoruba ancestor worship and a dollop of Hindu kirtan to chase away an urbanite's midwinter blues? No more strange, I suppose, than lying prostrate on a leather couch and prattling on about one's toilet training, or free-associating about last night's dreams. And arguably no less "scientific" either, if by "scientific" we mean "consistently proven to be effective." Every culture has developed its own ways and means to banish the inner demons that assail its members. Psychotherapy--underneath its high-gloss scientific veneer--may turn out to be a form of modern day shamanism, no better and no worse than shaking a rattle to clear one's aura, or burning effigies to exorcise offending spirits. What heals, in any event, may not be so much a particular therapeutic regimen, as the relationship of trust forged with a healer in whose caring presence one feels free to release one's burdens. Sometimes just being heard is enough.

Nevertheless, an even deeper question remains: What are we looking for when we seek psychological help? Are we seeking the revelatory--and invariably stormy and disruptive--journey of deep soul work, or are we simply trying to get through our days in one piece? If all we want is to feel better, then I am not sure that we need to ransack the treasure house of world mysticism. A little Prozac and access to a sympathetic ear may well do the trick. But many of us today are yearning for a more radical (in its original sense of striking directly at the root) transformation than orthodox therapy is likely to provide. We don't just want to feel better, we want to know who we are, and what we are here on earth to accomplish.

I do not mean to disparage those who want to feel better. Who doesn't? The real question from the spiritual standpoint is: can mental suffering be radically relieved--not just masked or somewhat alleviated and made bearable? Psychotherapy aims to return its patients to a semblance of psychological normalcy--whatever that might mean. The great mystical traditions, on the other hand, are unanimous in declaring that the normal human condition is shot through with illusion, suffering, and unease. Yet all alike hold out the hope that this misery can be substantially transmuted--if not perhaps eliminated entirely--through time-tested sacred practices like forgiveness, compassion for self and others, profound meditation, self inquiry, and surrender to a Higher Power. When we know who we are in the greater scheme of things, we will be happy. Not before.

The goal of psychotherapy is more modest. It was founded on the assumption that by ferreting out the childhood causes of our present-day neurotic patterns of thought and behavior we would become free of them. Experience demonstrates, however, that merely understanding the origins of one's malaise intellectually is not enough. Understanding how I came to develop low self-esteem as a child, for example, will not magically make me feel better about myself as an adult. Something more needs to be added to the equation--namely faith and intention. The challenge of spiritual therapy is to provide effective techniques for helping believers and nonbelievers alike to reconnect with their own innate will to believe in themselves and in the larger possibilities of the world around them. Faith heals.

But how exactly do we develop faith in ourselves? The answer that the wisdom traditions give is counterintuitive. They tell us that we do not develop faith in ourselves by focusing on the self, its symptoms, and healing, as psychotherapy does. Just the opposite: we uplift ourselves by looking away from the self and its narrow orbit of concerns and toward the mysterious existence of the Other--God, our neighbors, the greater society, the universe itself. We possess ourselves most fully, ironically, when we give ourselves away selflessly to the greater-than-self, and not when we pander to the ego and its insatiable need to "feel better."

This "turning toward the Other" is radical medicine indeed, and not at all what Freud and company had in mind when they developed the introverted practices of psychoanalysis at the beginning of the twentieth century. Yet there is surprising new evidence that cultivating a devotional attitude toward life may be the best antidote for the infirmities that plague the postmodern soul. In his keynote address to the conference on spirituality and psychotherapy, David Lukoff, an expert on spiritual issues in clinical practice, quoted a variety of studies which demonstrate that religious believers as a class are healthier than nonbelievers, that they are less prone to substance abuse, that they are four times less likely to commit suicide, and that they are more likely to recover, and to recover more quickly, from heart surgery than their agnostic counterparts. He also cited the growing body of research that shows prayer is a powerful aid in both physical and psychological healing. Lukoff went on to assert that lack of religious belief is a risk factor equivalent to tobacco and alcohol abuse for a wide assortment of illnesses of the body and the mind.

Still, the professional psychological community has been slow to integrate these findings into its practice. Freud's famous antipathy to religion, which he viewed as an essentially infantile search for the unbounded love and protection we experienced in earliest childhood, still colors the thinking of many psychotherapists. This view is articulated by Barry Farber, the Chair in Clinical Psychology at Columbia Teacher's College, who says that spirituality is often used "in the service of denying death, disallowing the inherent complexity of life, and avoiding hard work on oneself and relationships." Farber quotes the lyrics of Billy Joel: "Some people hope for a miracle cure, some people see the world as it is."

Yet I wonder if the real divide is, as Barry Farber suggests, between a head-in-the-sand spirituality, which pretends that everything is perfect or about to become so, on the one hand, and an unblinking psychological realism, on the other hand. Far from denying suffering and death, genuine spirituality (as opposed to the spirituality-lite that is indeed endemic today) forces us to confront the transience and unsatisfactory state of our lives head on. It tells us that our suffering comes from the ego's misguided effort to perpetuate itself as an isolated entity separate and apart from the greater life beyond our skins. The ego's attitude of "me against the world" leads inevitably to conflict in all its myriad forms. Spiritual practice means fearlessly challenging this fundamental division between self and not-self.

And this is, of course, where psychology and spirituality part ways. Psychology takes as its mission shoring up the ego-self and defending its boundaries, whereas spirituality wants to knock those walls down and return us to a conscious oneness with all things. Does this fundamental divergence of purpose doom the efforts of those who are trying to bring about a marriage between these two seemingly antithetical disciplines? I don't think that it does. But achieving a synthesis will require a radical rethinking of the very nature of the self that psychotherapy aims to heal. The science of psychology will need to move beyond the reigning model of "fixing" the self toward a new paradigm of transcending the small self and selfishness, which lies at the root of all our human problems.

As we increasingly tap into this more spacious self, healing happens. Healing in this way does not mean "suppressing" our self, as Barry Farber implies, or (as some spiritual salesmen suggest) ending our mental suffering once and for all time. What healing does mean is becoming whole. As we are guided to become aware of our own big heart and vast spirit, the so-called problems that once loomed large are placed in proper perspective. We find out that we are so much greater than our problems, indeed greater than anything that life can throw at us. We are enabled to cope with life's inevitable pain (as well as joy) no longer as an embittered and embattled ego, but from a position of inner confidence and strength born of spiritual self knowledge.

Spiritual therapy shares the age old mystical insight that the way to access the greater self is by developing a devotional attitude toward the greater-than-self, which religious believers call variously "God," "Allah," "Buddha Nature," "Jesus," and "the Brahman." Most spiritual therapists, however, are reluctant to preach any particular religious system to their clients. They see their role as facilitators whose task is not to impose belief, but rather to uncover the will to faith and meaning that already exists latent within those who come to them.

With some religiously inclined clients this may include talking about God, prayer, and the great issues of life and death. But spiritual therapy is based on the conviction that all people, and not just religious believers, are motivated to lead rich inner lives. All of us want to feel intimately connected to the Greater Life, whatever we may choose to call it, and to find meaning in our existence. The art of spiritual therapy is to finding out how our own souls are already uniquely striving to awaken, and to support them in their efforts.

Does spiritual therapy trespass on the territory of religion? I don't think so. Religion provides the fundamental moral and mystical principles which are the basis for living a healthy life. Psychology in the years ahead can provide the scientific rigor to test out and develop effective methods to apply these principles to the task of healing. As my visit to the conference on psychotherapy and spirituality showed me, we have a long way to go before the techniques of spiritual therapy--or orthodox psychotherapy, for that matter--are placed on a genuinely scientific basis.

And maybe the whole model is wrong. Maybe what we need is not more studies and a new scientific theory on healing, but a humble acknowledgment that what makes people get better is not so much the expertise of the therapist as the therapist's love and empathetic concern; not so much the psychological knowledge generated in the client as the will to become free; not so much the eradication of the symptoms as the clear seeing that looks beyond the symptoms to the innate wholeness that underlies them.

Readers who would like to explore further the burgeoning field of spiritual therapy can contact: the Association for Spirituality and Psychotherapy (, the Association for Transpersonal Psychology (, and the Association for Humanist Psychology (

Richard Schiffman is a freelance journalist whose work is heard on National Public Radio and a spiritual writer whose latest book is Mother of All: A Revelation of the Motherhood of God in the Life and Teachings of the Jillellamudi Mother, published by Blue Dove Press.

Leer Amma kennen, moeder van alle mensen.

Hard copy

Chronic fatigue syndrome & child abuse:
Disordered patients or disordered research?
Are chronic fatigue patients victims of child abuse or research abuse?

Published on January 13, 2009

Last week Emory University issued a press release that reverberated in newspapers and media throughout the world:

Childhood trauma is a potent risk factor for development of chronic fatigue syndrome (CFS), according to a study by researchers at Emory University School of Medicine and the Centers for Disease Control and Prevention (CDC). The study is published in the Jan. 5, 2009 Archives of General Psychiatry.

Results of the study confirm that childhood trauma, particularly emotional maltreatment and sexual abuse, is associated with a six-fold increased risk for CFS. The risk further increases with the presence of posttraumatic stress disorder symptoms.

Somehow the news that so many people with chronic fatigue syndrome had been subject to child abuse struck me as outrageous --could this really be? Having come through the Lyme wars, where patients are routinely mislabeled "psychiatric," this kind of assertion is always a red flag to me.

For some perspective, I contacted Hillary Johnson, author of Osler's Web: Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic --the investigative tour de force that laid out an extensive body of scientific evidence for the biological origins of physical dysfunction of what many patients and scientists now call chronic fatigue and immune dysfunction syndrome (CFIDS) or, in Great Britain, Myalgic Encephaloyelitis (ME).

Johnson told me that the CDC -and the Emory study it funded-- had broadened the definition of the disease to include not just those with the actual immune syndrome, but also people who were, well ...simply fatigued. "That is why, in their paper, they call the disease simply chronic fatigue syndrome, or CFS," she says.
This broader group muddied the waters on the true etiology of the specifically-defined syndrome to which other research refers. "The CDC has created a definition that does not match any disease entity, much less the disease they claim to be studying. They have essentially medicalized ‘fatigue,' defining ‘fatigue' as a specific disease," Johnson states.

As for alternative studies, Johnson says "there are dozens of scientific papers published about the actual chronic fatigue syndrome every month in more distinguished journals, all of them worthy of being covered in the mainstream media, but the only research on this disease that gets covered comes out of the CDC. Why is that? For one thing, its because the agency pays a ton of money to a PR newswire to publicize their papers on CFS worldwide. This is part of a long-time strategic effort to promote the agency's longstanding propganda that M.E. is a personality disorder. It's the latest in a continuum of miguided, money-wasting research by epidemiologists who aren't really qualified to be undertaking basic research into such a complicated and serious disease," Johnson states.

She is disturbed that the study uses healthy controls when the true measure should be other disease states. "The correct controls would have been people disabled with MS, or Parkinsons, ALS, Alzhimers, congestive heart failure, or other infectious diseases like AIDS and Hep C." Then the study could have asked whether disease in general is more likely in those facing trauma -or just this "disease" alone.

She also explains that "trauma and abuse are very vague, very subjective. This is simply not acceptable science from a major American health agency. This is pushing your agenda forward. It's sick, it's cruel and it's hurting millions of people around the world whose lives have been utterly and permanently shattered by this illness." Indeed, she is critical that the study was done at all. "It is a waste of public funds, given the fact that there are over 5,000 research papers demonstrating CFS is a serious neurological and imuunologic disease --papers that the press has ignored," she states.

Perhaps the most notable thing about the Emory study, Johnson points out, is that it fails to cite a study performed in 2001 that asked the identical question. That study demonstrated that people with CFS actually have a lower incidence of childhood abuse and trauma than controls.

It's doubtful that the patients in the CDC study even have chronic fatigue syndrome as defined by scientists elsewhere --but even if they did, why look at them through the prism of childhood abuse and trauma," Johnson asks. "Why not study something about the disease that is actually quantifiable? Why not investigate why gray matter atrophies and blood perfusion in the brain is remarkably reduced? Or why spinal fluid has protein in it? Or why so many people with this disease get lymphoma? Or have virulent, active HHV6 and HHV6-A infections? Or have severe Natural Killer cell deficiencies? Or are dying in their 40s and 50s? All are topics with a significant body of scientific publications behind them --papers that were authored by academic scientists greatly more credentialed than the group that has put out the child abuse theory now.

"If there was any doubt before, this paper suggests the agency's research program on CFS should simply be shut down because it's hurting more than it's helping," Johnson contends.

Pamela Weintraub is senior editor at Discover Magazine and author of Cure Unknown: Inside the Lyme Epidemic, St. Martin's Press, 2008