By Matt Irwin
"The most extensive of all the morbid mental conditions which reflect themselves so disastrously in the human system is the state of fear. It has many degrees of gradation, from the state of extreme alarm, fright, and terror, down to the slightest shade of apprehension of intending evil. But all along the line it is the same thing -- a paralyzing impression upon the centers of life which can produce, through the agency of the nervous system, a vast variety of morbid symptoms in every tissue of the body."
-- Dr. William H. Holcomb (Omkar 1998)
I. The Power of Belief
There have been a number of groundbreaking studies that suggest just how powerful beliefs can be in causing or healing illness. Many were performed several decades ago, while others have been published quite recently. These studies reveal how dangerous the current beliefs about HIV and AIDS can be, and support the possibility that the diagnosis itself can bring about a self-fulfilling prophecy because of the powerful negative beliefs it creates. The great majority of this essay will use examples from the medical literature to support this argument. The last portion of this essay will present documented cases of "voodoo hexing" which have been written about in the medical literature, and will include many extended quotes. There will also be descriptions of how stress, social isolation, and negative beliefs can create the same type of immunodeficiency that is commonly blamed on HIV.
Before beginning with our review of the medical literature, however, I would like to highlight two news articles that serve as an introduction.
The first article comes from the Washington Post on June 18, 2001 (De Young 2001). The article was entitled "A Deadly Stigma in the Carribean: As AIDS Rate Soars, Infected Are Shunned". The following quote comes from its opening paragraphs:
"Port Antonio, Jamaica -- "By then, everyone else in her village, perched in the steep blue mountains overlooking this coastal town, knew it too (that she had been diagnosed HIV-positive).
"Pretty, quick-witted Claudia, then 28, suddenly became known as the "AIDS lady," shunned in the place where she had been born and had lived nearly all her life. Her mother, son, and siblings stopped speaking to her and threw her out of the family home. When she moved into her protesting grandfather's two-room cottage, he shouted insults and refused to go near her. She was poor, and costly treatment was beyond reach. "By the last Saturday in May, about 18 months after her last test, Claudia lay alone in the crumbling, dimly lit Port Antonio General Hospital. Her eyes, glazed and unfocused from morphine, seemed unnaturally large in her gaunt face, and she was having trouble breathing. But Claudia wanted to talk -- about her children, Ainsworth, 14, and Felicia, 12; about whether a visitor could bring some Immodium to the hospital for her diarrhea; and about her coming birthday on June 5.
"Two-thirds of those diagnosed with the AIDS virus in the Carribbean are dead within two years, and Claudia was no exception. She died on June 4, 2001" (page A1).
This article shows how devastating the social isolation and negative beliefs created by the diagnosis can be and also suggests that helping people re-establish social ties and creating positive beliefs about their health could solve their health problems, even if they have been diagnosed "HIV-positive". Another news article, this time from an Indian newspaper, suggests that recreating health in this way is a real possibility. This article was entitled, "AIDS Cocktail":
"A large number of people from within the general population, that is, those not part of the "high-risk groups" enjoy good health despite testing HIV positive a decade ago. In Mumbai, the "AIDS capital of India", counseling groups such as Salvation Army and CASA (Counseling and Allied Services), who attend to HIV-positive people from this segment of the population say there is strong evidence to show that the damage caused to the immune system can be reversed.
"This happens when people change their habits of substance abuse, eat nutritious food, involve themselves in community service, practice discipline and hygiene, receive regular counseling, family and social support. Such persons emerge stronger and healthy, says Arun Meitram, a counselor at the Salvation Army clinic. Incidentally, Salvation Army counselors recall only 15 deaths have occurred among the 900 patients they have been following over the past decade. In most cases the cause of death is related to malnutrition or TB.
"Says Nagesh Shirgoppikar, a medical consultant to Salvation Army, 'Our experience in treating HIV positive persons over the past decade shows that all the components of comprehensive psychological, emotional, physical and conventional medical treatment are very important. If a person is treated wholly, he is fine. Our patients have remained asymptomatic for up to ten years, and enjoy perfect health without anti-retroviral drugs.' " (Chinai 2001)
The rest of this paper will focus on controlled studies and articles from the medical literature that add further evidence to the arguments presented above. People diagnosed HIV-positive may remain healthy indefinitely if they retain positive beliefs and healthy social ties, something that the diagnosis, "HIV-positive" makes difficult.
Two Studies on the Power of Placebo
The first two studies to be reviewed here were never followed up, to my knowledge, in spite of their potential implications. The first was published in 1962 by two Japanese researchers, Dr.'s Ikemi and Nakagawa (Ikemi 1962). In Japan there is a tree whose leaves produce a rash similar to a poison ivy rash. These researchers had noticed that some people developed a rash if they thought they had touched the tree, even when no such contact had occurred. They thought that maybe the power of suggestion was at work, and decided to test this hypothesis with a controlled study. They took 57 school boys, selected only the ones who reported being allergic to the trees in question. They then performed a simple experiment. On each boy, they brushed one arm with harmless chestnut leaves, and the other with poisonous leaves. They told the boys that they had done just the opposite, however, so that the boys thought the benign leaves were poisonous and vice-a-versa. Within minutes the "placebo" arm reacted in many cases with a bright red rash with raised boils, while in the majority of cases the arm brushed with the poisonous leaves did not react at all. Thus it was shown that a perfectly harmless substance could produce a specific physical reaction through the power of suggestion, and that the physical symptoms produced could match perfectly with the symptoms that were suggested. It was also shown that the reaction to a toxic substance could be prevented, even in highly susceptible individuals, if they were convinced that the toxic substance was actually a harmless one.
The second study to be reviewed was performed in the United States in 1950, about ten years prior to the Japanese study. In this study a bold experiment was performed, one that might not be allowed today because it involved lying to the participants. The author of the study, Dr Wolf, gave a group of women a toxic substance called syrup of ipecac that causes nausea and vomiting. He lied to the women, however, telling them it was actually a drug that would cure nausea and vomiting. The women in the study were already suffering from chronic nausea and vomiting of pregnancy, and so they gladly took the syrup of ipecac. In most cases their symptoms ceased entirely. Objective evidence of their improvement was also measured by Dr. Wolf, who had the patients swallow small tubes to measure the amount of muscle contractions in the stomach, contractions that occur with the heaving which occure when one vomits. After taking the toxin, the contractions subsided. This second study shows that, at least in the short term, a drug that is highly toxic can actually cure the very subjective and objective symptoms that it normally causes - if the power of belief is working in it's favor.
This second study shows that, at least in the short term, a drug that is highly toxic can actually cure the same subjective and objective symptoms that it normally causes. One probable explanation is that the power of belief is working in its favor, but there are other explanations. Homeopathic medicines are said to work by stimulating the body's own healing response, which is done by giving an extremely diluted dose of a toxin. The diluted toxin is matched carefully to the symptoms of the person who is ill, and the toxin chosen is one that would actually cause these symptoms if it were given to a healthy person. Even these extremely dilute homeopathic remedies can become toxic, however, if they are given repeatedly for a long period of time. Although many conventional medical practitioners are skeptical about homeopathy, over 100 double-blind placebo-controlled trials of homeopathic remedies have been performed, and a meta-analysis of these trials was published in the Lancet, a leading medical journal (Linde et al 1997). The meta-analysis found a significant positive effect from the remedies.
Whatever the explanation, this study appears to demonstrate that the short term use of a toxic substance when given with the belief that it will cure the very illness that it causes, can actually cure the illness.
The idea of relying exclusively on "placebo-controlled, randomized, double-blind" studies evolved from reviewing studies like these. These studies have become the gold standard of scientific research, but there are some serious doubts about how well they actually eliminate the potential for placebo-like effects. Double-blind studies are supposed to distill out the "truly effective" drugs from those that are "only placebos", but it has been shown repeatedly that people participating in double-blind studies can usually tell whether they are getting the placebo or the active substance.
Participants and researchers in placebo-controlled studies are naturally curious as to whom is getting the real drug and who is not. Especially for the participants, it is likely to be a question that is repeatedly on their minds while they take their daily regimen of pills. This has been supported by research studies designed to look at this question which have found that patients and physicians involved in "double blind" studies can correctly guess who is getting placebo and who is not about 70% to 80% of the time (Greenberg and Fisher 1997). This opens up a Pandora's box of questions regarding the effectiveness of most drug treatments and may explain why studies like these have not been followed up. If the placebo effect can be so powerful it becomes a serious threat to people who have invested their time and energy into drug treatments.
II. Can AIDS Be Caused By Stress, Social Isolation, and Negative Beliefs?
HIV is claimed to cause a wide variety of symptoms in people who test positive on the HIV antibody test, but even for the most common symptoms, like immunosuppression and low CD4 T-cells, there is continued difficulty and disagreement in understanding the mechanism involved (Balter 1997), a fact that has led the original discoverer of HIV, Luc Montagnier, to state that he does not think HIV can cause AIDS without other unidentified cofactors (Balter, 1991).
Studies of both animals and humans have shown that severe, chronic stress results in a syndrome remarkably similar to AIDS, and some of the proposed mechanisms are easily reproduced in animal and test tube models (Benson 1997, Binik 1985, Campinha 1992, Cannon 1957, Cecchi 1984, Cohen 1988, Eastwell 1987, Golden 1977, Kaada 1989, Meador 1992, Milton 1973, Uno 1994). The effects of stress are mediated at least in part by the hormones cortisol and epinephrine, which cause a state of immunodeficiency characterized by a reduction of the number of T-cells. The CD4, helper T-cells are selectively depleted, exactly as is seen in people diagnosed HIV+ (Antoni 1990, Castle 1995, Herbert 1993, Kennedy 1988, Kiecolt-Glaser 1991, Laudenslager 1983, Kiecolt-Glaser 1988, Pariante 1997, Stefanski 1998).
Severe stress has also been linked to increased incidences of specific illnesses and symptoms that are officially considered "AIDS defining conditions", including pneumonia, tuberculosis, dementia, wasting, and death. Stress has been demonstrated in both animals and humans to cause brain damage and neuronal atrophy, resulting in a dementia that mirrors "HIV dementia", with the same changes in the brain that are often observed in people who die of AIDS (Axelson 1993, Berent 1992, Brooke 1994, Frol'kis 1994, Gold 1984, Jensen 1982, Lopez 1998, Magarinos 1997, Momose 1971, Sasuga 1997, Sapolsky 1990, 1996, Starkman 1992, Uno 1989,1994). Severe, chronic psychological and social stress has also been linked to increased death rates due to illnesses like pneumonia and tuberculosis (Kennedy 1988, Luecken 1997, Russek 1997), and has been found, in animals, humans, and non-human primates, to cause a fatal wasting syndrome that is remarkably similar to AIDS. These studies will be reviewed in detail later in this paper, but here is a brief quote from one study of captured wild monkeys:
"Wild-caught vervet monkeys... occasionally showed a syndrome of cachexia associated with persistent diarrhea, anorexia, and dehydration that usually proved fatal. Those animals appeared to be socially subordinate and to have suffered an atypically high rate of social harrassment and attack from their peers. Two animals died as early as one month under such conditions, and others died after six months to 4 years in captivity... The fatal outcome, caused by severe prolonged social stress, induced classic pathology associated with stress, including gastric ulcers and adrenal hyperplasia. In these animals we also found unique insidious degeneration and resultant depletion of neurons in the hippocampus (the area of the brain that controls learning and memory)... Similar degeneration was also found in cortical neurons." (Uno 1994, page 339)
Most people have heard of Voodoo hexing, where a hexed individual succumbs to a chronic illness that often results in death, exactly as predicted. Most people are not aware, however, that some of medicine's leading researchers and physicians have studied this phenomenon. In addition, most people have not considered how this might relate to AIDS.
A number of reports, mostly by Western physicians working in traditional societies, have appeared in medical journals over the years. The phenomenon has been called "Voodoo death", "root work" and "bone pointing" (Benson 1997, Binik 1985, Campinha 1992, Cannon 1957, Cecchi 1984, Cohen 1988, Eastwell 1987, Golden 1977, Kaada 1989, Meador 1992, Milton 1973). A similar phenomenon occurring in modern, "developed" societies has also been described, where people have died after receiving terminal diagnoses from their physicians, but before the pathology has spread enough to cause death. This has been called "unexplained death", "self-willed death", "the given-up-giving-up complex", and "the nocebo effect" (Benson 1997, Engel 1968, Milton 1973). As one small example of what will be presented in that section of this paper, Meador (1992) reported on two men given voodoo hexes by very different medicine men, one modern, and one traditional.
"The first patient, a poorly educated man near death after a hex pronounced by a local voodoo priest, rapidly recovered after ingenious words and actions by his family physician. The second, who had a diagnosis of metastatic carcinoma of the esophagus, died believing he was dying of widespread cancer, as did his family and his physicians. At autopsy, only a 2 cm nodule of cancer in his liver was found." (page 244)
Another comparison between these two phenomena had been provided twenty years before by the Australian physician G.W. Milton (1973) in a special article to the Lancet, a top medical journal. The following is a quote which also suggests that such deaths can occur in Western societies as well.
"There is a small group of patients in whom the realisation of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')." (page 1435)
Because of the controversy surrounding this topic, as well as its possible significance in AIDS, this subject will be reviewed with extensive quotes in the final portion of this paper.
In addition to the severe stress of living with such a devastating prognosis, people diagnosed HIV+ also often face severe social rejection and isolation. The groups of people primarily affected by AIDS, male homosexuals and IV drug users, already experience this kind of rejection, often by members of their own families. This isolation is made much worse by being diagnosed HIV positive, in spite of efforts by caring family, friends and health care workers. Tragically, these same friends and loved ones may unintentionally perpetuate the social isolation because of fear of infection. Social isolation has been shown to be an independent risk factor for immunosuppression and to lead to low levels of CD4 T-lymphocytes. Socially isolated people, when compared to people with high levels of social support, have been found in over eight studies to have between double and triple the death rates (Berkman 1979, House 1988, Ornish 1997). A recent study found that people diagnosed HIV positive were two to three times more likely to "progress to AIDS" if they were socially isolated and under high levels of stress (Leserman 1999). Here are some quotes from the abstract of their paper:
"Faster progression to AIDS was associated with more cumulative stressful life events (p<0.002),>
Other studies have looked at this question, but every one, including the one quoted above, suffers from a fundamental oversight which is critical to the argument of this paper. None of them take into account the severe stress and feelings of isolation associated with being diagnosed "HIV positive", but instead only examine other major stressors. A study focusing on the stress of an HIV-positive diagnosis would be challenging to design, or perhaps even impossible, without breaking people's right to be fully informed about their own medical diagnoses, but this does not solve the quandary. Similar problems exist with a number of other studies of HIV that would shed light on this issue.
III. Severe, Chronic, Psychological Stress: A Painful and often Terminal Disease
Severe, chronic psychological stress and social isolation can have health effects that are nearly identical to AIDS, especially when combined with physical stress or illness. Stress causes a state of immunodeficiency characterized by a reduction of the number of T-lymphocytes, with special targeting of CD4, helper T cells. There is also a reduced CD4:CD8 ratio, with a relative increase in CD8, suppressor/cytotoxic T cells (Antoni 1990, Bonneau 1993, Castle 1995, Herbert 1993, Kennedy 1988, Kiecolt-Glaser 1988, 1991, Laudenslager 1983, Pariante 1997, Stefanski 1998). Both of these immunological changes are considered characteristics specific to AIDS. Since being diagnosed with AIDS carries with it a high level of psychological stress and social isolation, low CD4 counts are likely caused, at least in part, by stress.
A marked increase of the hormone cortisol, which is released during times of stress, appears to be one of the primary causes of these immune changes. Catecholamines like epinephrine, which are also released, have also been implicated but to a lesser degree. Multiple studies have found that people diagnosed HIV positive have chronically elevated cortisol levels (Azar 1993, Christeff 1988, 1992, Coodley 1994, Lewi 1995, Lortholary 1996, Membreno 1987, Norbiato 1996, Norbiato 1997, Nunez 1996, Verges 1989). It is important to note, however, that chronic stress can induce immune suppression even when cortisol and epinephrine are not elevated (Bonneau 1993, Keller 1983), so that the mechanisms by which stress affects health and immunity are not at all completely understood.
Severe stress has also been shown to cause brain damage and neuronal atrophy, especially in the hippocampus, the area of the brain that controls learning and memory (Axelson 1993, Bremner 1995, Brooke 1994, Frol'kis 1994, Gold 1984, Gurvits 1996, Jensen 1982, Lopez 1998, Magarinos 1997, Sapolsky 1990, 1996, Sasuga 1997, Sheline 1996, Starkman 1992, Uno 1989,1994). This results in decreased mental function similar to what is often called "HIV dementia". The most chilling research, however, is research that has demonstrated that severe social and psychological stress can cause a fatal wasting syndrome in animals, humans, and non-human primates that is very similar to AIDS (Benson 1997, Binik 1985, Campinha 1992, Cannon 1957, Cecchi 1984, Cohen 1988, Eastwell 1987, Golden 1977, Kaada 1989, Meador 1992, Milton 1973, Uno 1994), a topic that will be covered in detail later in this paper.
Being diagnosed HIV-positive is perhaps one of the greatest stressors one can imagine. Not only does it raise the constant and extreme fear of a relentless deterioration and death, but it also creates a social isolation that pervades all aspects of people's lives. To make matters worse, many of the people diagnosed with AIDS already suffer from social isolation and rejection. Social isolation, alone, has been associated with a 100% to 200% increase in mortality in several large prospective studies, and the increase in mortality is equal to the increase associated with smoking (Berkman & Syme 1979, House 1988). The amount of psychological stress in people diagnosed HIV positive is likely to be much greater than the stress in the people in these studies.
III A. The Effects of Stress and Social Isolation on T-lymphocytes
The reduction of CD4 cells in people diagnosed HIV+ has been called the "hallmark of the disease" (Balter 1997), and it has been claimed since the initial discovery of HIV that it selectively targets these cells, creating a CD4/CD8 ratio with a value less than one, referred to as an "inverted" ratio. The mechanisms by which it might do this have not yet been uncovered, in spite of vast sums of money spent on HIV research. Other research has shown that CD4 cells become depleted in a wide variety of ways and that low CD4 counts is an incredibly non-specific finding which is common in many people suffering from all types of physical and psychological stress (Bird 1996, Carney 1981, Feeney 1995, Junker 1986, Kennedy 1988, Lotzova 1984, Pariante 1997, Zachar 1998). Low CD4 counts are even relatively common in people with no illness (Bird 1996). All of these findings raise the possibility that low CD4 counts in people diagnosed HIV-positive may not be caused by HIV at all, but rather by one of the many other factors present in these people. For a complete review of this topic see the author's comprehensive review of the literature, which shows that low CD4 counts and other immune system changes claimed to be specific to HIV commonly occur when a person's system is under nearly any kind of physical or psychological stress (Irwin 2001).
Low CD4 Counts in Chronic Illness
In 1981 a group of researchers looked at CD4 and CD8 counts in ten consecutive patients with acute mononucleosis, and compared their counts with those of ten healthy volunteers (Carney 1981). At this time CD4 counting was a newly discovered technique, as was the idea of looking at CD4/CD8 ratios. The CD4 counts in the healthy volunteers were 73% higher than those found in people with mononucleosis. The CD8 cells in people with mono were increased, resulting in an inverted CD4/CD8 ratio in every single patient. The average ratio was only 0.2, compared to the normal average of 1.7 found in controls. Of the nine patients whose CD4 counts were measured, the three with the lowest CD4 counts had 194, 202 , and 255 cells/mm3. People who are HIV positive with less than 200 CD4 cells are immediately diagnosed with AIDS, and the assumption is made that HIV is attacking their T-cells. This assumption that seems ill-advised in light of findings like this one.
More recently another group of researchers looked at CD4 counts in HIV negative people, this time in 102 consecutive Intensive Care Unit (ICU) patients who were admitted for a variety of reasons (Feeney 1995). Fully 30% of these patients had CD4 counts less than 300. They do not discuss how many were below 200, the level diagnosed as "AIDS" in people with a positive HIV antibody test. They also did not find that low CD4 counts were linked with poor health, nor were they linked with a poor prognosis. Here are the author's comments on their findings.
"Our results demonstrate that acute illness alone, in the absence of HIV infection, can be associated with profoundly depressed lymphocyte concentrations. Although we hypothesized that this depression would be directly related to the severity of illness, this was not seen in our results. The T-cell depression we observed was unpredictable and did not correlate with severity of illness, predicted mortality rate, or survival rate. This study was consistent with prior studies that have shown similar decreases in T-cell counts in specific subsets of acutely ill patients. These subsets included patients with bacterial infections, sepsis, septic shock, multiple organ system failure, tuberculosis, coccidioidomycosis, viral infections, burns, and trauma patients. Most of these studies reported decreases in lymphocyte populations, some of which were severe and included CD4/CD8 ratio inversions...
"In the largest study to date of hospitalized patients, Williams et al (1983) evaluated T-cell subsets in 146 febrile patients with serious acute infections... with 19 of 45 patients having a CD4 count of less than 300 per microliter." (page 1682-3)
"We also found that CD4 counts were linearly related to total lymphocyte concentrations, as Blatt et al. (1991) reported in HIV-positive patients." (page 1683)
Curiously, although these researchers did find the low CD4 cell counts as seen in AIDS, they did not find that such counts were very good measures of immune function. One major double-blind study of AZT use in over 2000 HIV positive people found the same result. AZT increased the number of CD4 T-cells, but in spite of this people who received AZT earlier died at a faster rate (Seligman 1994). This study was the major reason AZT fell out of favor as the sole drug used on HIV positive people, but it also seriously questioned the value of CD4 T-cells as a marker for immune health.
Stress, Cortisol and CD4+ T-lymphocytes
In contrast to the confusion over how HIV affects the immune system, the mechanism for the immunosuppression during states of chronic physical and psychological stress is comparatively well understood. One of the major changes during times of stress is an outpouring of the hormones epinephrine and cortisol, which lead to a dramatic reduction in the number of T-lymphocytes. The strength of the correlation between decrease in T-cells, also called "lymphocytopenia", and excess cortisol is so strong that low T-cells is one of the diagnostic criteria for identifying excess cortisol.
Here are some quotes on this topic, from a basic textbook on physiology used in most medical schools (Guyton 1996).
"Almost any type of physical or mental stress can lead within minutes to greatly enhanced secretion of ACTH and consequently cortisol as well, often increasing cortisol secretion as much as 20-fold" (p.966).
"Cortisol suppresses the immune system, causing lymphocyte production to decrease markedly. The T lymphocytes are especially suppressed." (p.964)
"Cortisol decreases the number of eosinophils and lymphocytes in the blood; this effect begins within a few minutes of injection of cortisol and becomes marked within a few hours. Indeed, a finding of lymphocytopenia or eosinopenia is an important diagnostic criterion for overproduction of cortisol by the adrenal gland. Likewise, the administration of large doses of cortisol causes significant atrophy of all the lymphoid tissue throughout the body... This occasionally can lead to fulminating infection and death from diseases that would otherwise not be lethal, such as fulminating tuberculosis in a person whose disease had previously been arrested" (p.965).
This description of death from infections that "would otherwise not be lethal" sounds identical to a description of the symptoms usually blamed on HIV.
Many studies have linked cortisol levels with CD4 depletion, and some have linked epinephrine, as well. These are the two major hormones released during times of stress, and when injected into humans and laboratory animals, immune suppression results (Crary 1983a, 1983b, Tornatore 1998). Tornatore (1998), for example, found reductions of 70% in the number of CD4 cells in both young and elderly people after a single injection of a synthetic analogue of cortisol called methylprednisone. After the single injection, it took 8-12 hours for the numbers of lymphocytes to return to normal.
It is important to note that studies have found that these are not the only mechanisms. The adrenal glands are the source of both cortisol and epinephrine, but when rats have their adrenal glands removed they still have reduced T-cell number and function when subjected to stress (Bonneau 1993, Esterling 1987, Keller 1983).
People diagnosed HIV+ have been found in a number of studies to have elevated levels of cortisol, and some have reduced cortisol responses when artificially stimulated, which indicates the presence of chronic stress as well as chronically overactive cortisol production (Membreno 1987, Christeff 1988, 1992, Verges 1989, Azar 1993, Coodley, 1994, Lewi 1995, Lortholary 1996, Nunez 1996, Norbiato 1996, Norbiato 1997). Norbiato et al. (1997), for example, compared patients with AIDS with healthy, HIV negative controls. They placed the AIDS patients into two groups, those with normal cortisol receptor affinity (AIDS-C) and those with low cortisol receptor affinity (AIDS-GR), and compared both these groups to HIV-negative controls. When comparing urinary free 24 hour cortisol levels, they found that patients with AIDS-GR had 451 micrograms/24hr, while control subjects had only 79 micrograms/24hr. People with AIDS excreted nearly six times as much cortisol as normal controls. AIDS-C patients had levels of 293 micrograms/24hr, 3.7 times higher than normal. Plasma cortisol levels were also increased, with levels nearly three times as high in AIDS-GR patients as in normal controls. Their comments on their findings are revealing:
"In HIV disease, the normal interaction between hypothalamic/pituitary axis is altered, thus producing an oversecretion of cortisol, resulting in immune suppression. In most patients, this trend continues throughout the course of the disease." (page 3262)
These levels are compatible with levels of cortisol commonly found in patients with Cushing's Disease, a disease of cortisol overproduction that results in severe immunosuppression, opportunistic infections, neuropsychiatric abnormalities, muscle wasting, weakness, and fat deposits in the upper back, face, and belly (Britton 1975, Momose 1971, Robbins 1995, Starkman 1992).
Several studies have linked high stress with a selective depletion of CD4 helper T-cells, often with increased CD8 cells. One of the problems in comparing the immunsuppression due to stress with that in people with AIDS, however, is that most researchers do not consider CD4 counts to be a good measure of immune function, and therefore most studies do not measure CD4 counts. Instead, lymphocyte responsiveness is preferred, which is nearly always reduced in states of chronic psychological stress (Antoni 1990, Kiecolt-Glaser 1988). There are studies that look at T-cells in times of stress, however, and these will be focused upon here. The results to be reviewed first will be from a study of non-human primates, followed by several human studies.
Social Isolation and Cortisol Levels in Non-Human Primates
A study by Sapolsky et al. (1997) looked at the effects of social isolation and social subordination on cortisol levels in twelve wild baboons. They found basal cortisol levels four times as high in the six more isolated baboons, when compared with the six more socially connected baboons, an astounding and statistically significant difference. Here are some excerpts from their report:
"Hypersecretion of glucocordicoids (excess cortisol production) can have deleterious effects on immune defenses, metabolism, reproductive physiology, tissue repair, and neurological status...
"Detailed data about adult male social behavior were collected by one of us (S.C.A.) during the two months prior to darting for anesthetization. These data were collected as part of a larger multi-year study of adult male baboon social behavior and presented an opportunity to examine social correlates of hypercortisolism (excess cortisol production)." (pages 1137-8).
"Socially isolated males had significantly higher basal cortisol concentrations than males that were well-connected socially (the six more isolated baboons averaged 850 mmol/L compared to only 213 mmol/L in the six more socially connected baboons)." (page 1141, figure 1)
"In a previous study with a wild population of baboons, we observed that among dominant males, those with the lowest rates of grooming with females and social interactions with infants had markedly elevated cortisol levels... These studies cannot reveal whether there is any causality to this link. However, studies with rodents and captive primates demonstrate the power of social proximity or affiliation to blunt the cortisol response to various stressors, suggesting that these baboons are hypercortisolemic because they lack the stress-reducing advantages of social affiliation... This association echoes the classic finding in behavioral medicine that social isolation represents a highly notable mortality risk factor across a wide range of maladies in humans (House 1988). A key finding in those studies was that no particular form of social affiliation (spouse, friend, or community group) was more protective than the others, but that the association instead emerged from the aggregate of social connections. Simlarly, we did not observe any 1 of the 8 measurements of social connectedness to predict adrenocortical status; instead, it was their aggregate that was highly predictive." (pages 1141-1142)
Some of the studies mentioned by Sapolsky et al above were analyzed by Coe (1993). He reviewed the research that examined the effect of psychosocial factors on the immune systems of non-human primates. Many studies showed that when young, captive monkeys were separated from friends or from their mothers, their T-cells showed markedly impaired function. Researchers also tried to assess why some monkeys were more affected than others, and found that many subtle variables such as the timing of the separation, the age of the monkeys, and the way the separation was created, could all have a significant effect. Thus measuring the effects of social support is a complex task, as is measuring psychological stress. The influence of subtle factors related to the social environment and to the person's internal coping mechanisms may have significant mediating effects.
A review by Levine et al. (1996) looked at research showing that social relationships significantly buffered the effects of stress in a variety of animal studies. Here are some of the authors' comments.
"Our initial studies of squirrel monkey adrenocortical activity showed that social separations of mother and infants produce striking increases in cortisol in both mothers and infants... We also showed that the magnitude of this physiological effect is at least partly dependent on the degree of social support available to the infants. In the company of mothers and/or familiar peers, social buffering of stress-induced increases in cortisol is apparent. Dramatic increases in cortisol occur during maternal separations when infants are placed in novel environments... Long-lasting increases in cortisol also occur in subadults and adults..." (page 211)
"Social separations can induce long-lasting increases in cortisol, whereas companionship can result in social buffering... From 1 to 21 days post separation, however, cortisol remains elevated above pre-separation controls." (page 216)
One section of this review applies particularly to people diagnosed HIV positive. The authors discuss the effects of creation of newly formed social groups on stress and cortisol levels, along with the effects of major changes.
"Novelty, uncertainty, and lack of predictability are all psychogenic factors known to activate the HPA-axis in a variety of animals, and increased cortisol levels have previously been reported in newly formed squirrel monkey groups. Recent evidence suggests, however, that group formation-induced changes probably depend on a monkey's prior social-psychological state." (Page 218)
This applies to the members of the gay community, where AIDS still concentrates, who had recently created a new community in San Francisco as well as a few other cities. It also applies to people for whom many social contacts are disrupted or eliminated as a result of their HIV positive antibody test.
Stress and Lymphocytes in Humans, Non-human Primates, and Other Animals
A group of researchers led by Robert Sapolsky has done a great deal of work observing the effects of psychological stress on baboons and other primates. Most of their work has focused on neurotoxicity, which will be reviewed in a later section of this paper. In one study, however, they measured total lymphocyte counts and cortisol levels in a group of baboons that were invaded by a highly aggressive young male baboon, whom they named Hobbs (Alberts 1992). Hobbs was particularly threatening to females in the group, and was apparently attempting to use fear, physical intimidation, and abuse to increase his chances of successful mating. Cortisol levels in the group nearly doubled after Hobbs joined the group, with a slightly greater increase among females. T-lymphocytes plummeted in the group, from a pre-Hobbs level of 67 per 10,000 red blood cells (field conditions prevented them from determining the number of lymphocytes per microliter of blood, or from measuring CD4 cells) to a level of about 39, a drop of 42%. When looking at only the levels in baboons who were victims of Hobbs' aggression, the levels fell even more steeply, to only 29 per 10,000 RBC's, a drop of 55%. Interestingly, Hobbs, himself, had the lowest number of lymphocytes in the group, and the highest cortisol level, suggesting that his behavior may have been taking an even greater toll on his system than it did on the victims of his aggression. The authors comment on their use of lymphocyte counts instead of more sophisticated methods:
"Whereas most studies of the effects of stress upon immunity examine functional indices of immune competence (e.g. mitogen stimulation tests, antibody generation, cytokine responsiveness), our field conditions limited us to this rather crude quantitative measure of numbers of cells." (Alberts 1992 page 174)
It is notable that these researchers also agree that T-cell function tests are the best way to measure immune competency, something supported by earlier reports that question the value of CD4-cell counting (Feeney 1995, Seligman 1994).
Pariante et al. (1997) measured the CD4 helper T-cells and CD4/CD8 ratio of people who were under chronic stress due to being caregivers of severely handicapped family members. They found that the caregivers had "significantly lower percentages of T cells, a significantly higher percentage of T suppressor/cytotoxic cells, and a significantly lower helper:suppressor (CD4/CD8) ratio." Another study of caregivers, this time of people caring for people with late-stage Alzheimers, also found decreased CD4/CD8 ratios, in addition to impaired T-cell function (Castle 1995).
A study in rats compared the effect of three weeks of chronic stress in rats who either had normal pre-natal experiences, or who were exposed to ethanol in utero. Males were especially affected, and ethanol exposed rats had significantly more lowering of CD4 counts when placed in a stressful environment than non-exposed rats (Giberson 1995). This suggests that chemical insults can increase the susceptibility to stress-induced immunodeficiency, especially if the exposures occur in utero, a finding that is especially significant to childhood AIDS cases as many of them are born to women who are IV drug users.
It is important to note that short-term stress can have very different effects from long-term stress. For instance, one study compared the effects of two hours of social stress in rats with the effects of 48 hours of stress. After two hours, there were decreases in the number of T-cells, but an increase in the CD4/CD8 ratio. After 48 hours of the same social stress, however, the CD4/CD8 ratio had lowered to the normal range, while T-cell numbers remained reduced (Stefanski 1998).
The effects of stress also show a lot of individual variance, which may be due to factors like coping strategies and social support. Several studies have found that isolated people have more immune dysfunction than people with high levels of social support (Kennedy 1988, Kiecolt-Glaser, 1984, 1991). These studies will be reviewed in the next section of this paper. Another mediating factor appears to be the amount of control that one has over the source of stress. Rats who were given some measure of control over the source of stress showed normal lymphocyte responses, while rats who had no control showed impaired responses, even though the amount of external stress producing events (electric shocks) were equal (Laudenslager 1983). A review of relevant studies from 1988 examined some of these variables, with the following comments:
"Data are given which document immunosuppressive effects of commonplace, short-term stressors, as well as more prolonged stressors, such as marital disruption and caregiving for a relative with Alzheimer's disease. Immune changes included both quantitative and qualitative changes in immune cells, including changes in herpes virus latency, decreases in the percentages of T-helper lymphocytes and decreases in the numbers and function of natural killer cells. These effects occurred independently of changes in nutrition. Psychological variables, including loneliness, attachment and depression were related to the immune changes. The data are discussed in a framework in which quality interpersonal relationships may serve to attenuate the adverse immunological changes associated with psychological distress, and may have consequences for disease susceptibility and health." (Kiecolt-Glaser 1988).
Another review article (Antoni 1990) has several discussions of this topic, including some discussion of the effects of stress in people with AIDS. Following are some of the author's statements regarding effects on T-cells:
"Animals subjected to uncontrollable stressors, for instance, have been noted to display... immune system decrements such as thymic involution, decreased NK cell cytotoxicity, suppressed lymphocyte proliferation, and decreased helper/suppressor cell ratios." (page 41)
"In research using naturally occuring uncontrollable stressors in human subjects... (there were) decreases in total T-lymphocyte number, total macrophage number, and total number of CD4 cells." (page 41-42)
"Other recent work has noted that a high stress level, increased depressive symptoms, dissatisfaction with social support, and limited use of coping strategies predicted decreased CD4 cell number and increased CD8 cell number." (page 42).
Several different types of stressors led to these immune system changes, including loneliness, lack of social support, and bereavement, all three of which have a high prevalence in people diagnosed with AIDS. A final quote from this article (Antoni 1990) discusses the impact of HIV diagnosis on immune function.
"Indeed, we have observed discrete and significant psychological and immunological changes among asymptomatic gay men across the anticipatory period preceeding HIV-1 antibody testing and during the impact period following news of diagnosis. Furthermore, we have noted significant benefits of behavioral interventions on psychological and immunological functioning among asymptomatic, HIV-1 seropositive and seronegative gay men." (page 46)
It is notable that these two reviews (Antoni 1990, Kiecolt-Glaser 1988), and also a meta-analysis (Herbert 1993) of studies looking at the effects of stress on immune function consistently find CD4 helper T cells selectively reduced in people subjected to chronic stress together with a decrease in CD4/CD8 ratio. If found in someone who is HIV positive, these effects would unquestionably be blamed on HIV, and the effects on immunity of the extreme stress of living with an HIV positive diagnosis would be ignored.
III B. Stress-Induced Dementia
Multiple studies have found that chronic psychological stress, and the resultant hypercortisolism, induces brain damage characterized by atrophy of cortical neurons, especially in the hippocampus, the region of the brain that controls learning and memory. Another reported finding is enlargement of the ventricles in the brain (Axelson 1993, Brooke 1994, Frol'kis 1994, Gold 1984, Jensen 1982, Lopez 1998, Magarinos 1997, Mimose 1971, Ohl 1999, Sapolsky 1990, Sasuga 1997, Starkman 1992, Uno 1989,1994). Dementia is a classic finding in people diagnosed with AIDS, and similar changes in the brain have been reported.
A commonly recognized example of how severe stress impairs mental function is the gaps in memory that people often have in relation to periods of prolonged trauma, as occurs in many cases of childhood sexual abuse, for example. Most people are not aware, however, that chronic stress actually causes atrophy of the brain tissue.
A quote from Uno et al (1994), in the introduction to this paper, discussed the cases of stress-induced fatal wasting syndrome in monkeys. The authors also indicated that they found atrophy of cortical neurons in the hippocampus, as well as in other areas of cortex. This phenomenon was observed both in wild-caught animals subjected to severe social stress by their peers, as well as in animals injected with synthetic analogues of cortisol.
This phenomenon has also been observed in humans. Jensen et al reported in 1982 that torture victims showed long-term signs of dementia, as well as other problems, and described their findings in five such victims:
"Examination of torture victims throughout the world has revealed a high incidence of late physical and neuropsychiatric sequelae. The most prominent mental and neurologic symptoms are impaired memory and ability to concentrate, headache, anxiety, depression, asthenia (loss of strength), sleep disturbances, cerebral asthenopia (aching and burning of the eyes), and sexual dysfunction. These conditions are present in other conditions in which brain atrophy or intellectual impairment or both are frequent findings.
"We recently examined five young men subjected to to various forms of torture years earlier. These previously healthy young men (mean age 31 years) had all been tortured severely for from two to six years. Similar mental and neurologic symptoms developed in all of them immediately or shortly after torture; these symptoms persisted unaltered until examination (an average of four years later)... Computerized axial tomography (CT scans) showed definite cerebral atrophy that was cortical in four men and central in one...
"The symptoms and signs in the present cases were in many ways comparable to those seen in survivors of World War Two concentration camps. Although the social and mental complications in concentration camp survivors were initially considered to be transient, later follow-up studies showed that signs of dementia occured in a high proportion of cases 10 to 20 years after detention (Thygesen 1970). The same long-term effects with signs of irreversible brain damage may occur in today's torture victims..." (Rasmussen 1980, page 1341).
Alzheimer's patients have also been found to have hippocampal atrophy whose severity correlated with high cortisol levels (DeLeon 1988), and people with depression have been found to have enlarged ventricles and greater cognitive impairment if their cortisol levels were elevated.
Starkman et al (1992) studied the effects of chronic excess cortisol on brain function and hippocampal atrophy. They found hippocampal atrophy that was correlated with the amount of cortisol in the patient's blood, just as was found in Alzheimer's patients (Starkman 1992). In their conclusions they briefly discuss these effects as observed in various studies:
"Significant correlations between elevated cortisol levels and severity of hippocampal atrophy have been reported in patients with Alzheimer's disease, as well (De Leon 1988). In a broader context, it should be noted that the role of cortisol in cognitive dysfunction likely extends beyond its specific effects on the hippocampus. For example, CT scans revealed ventricular enlargement and cortical atrophy in patients with yhypercortisolism due to Cushing's disease (Momose 1971). In primary depressive disorder, patients with abnormally high cortisol were more likely to have larger ventricles, as measured by ventricle to brain ratios (VBRs), and those patients with large VBRs demonstrated greater global cognitive impairment." (page 764)
Cortical atrophy and ventricular enlargement are two characteristics commonly found in what is called "AIDS Dementia Complex" (Robbins 1996). Patients with Cushing's Disease have also been found to develop meningitis, due to cortisol-mediated immunosuppression, which is another common neurological complication in people diagnosed HIV positive (Britton 1975).
While cortisol has been studied the most, epinephrine, the other major hormone released in times of stress, also causes brain atrophy and impaired brain function, as has been indicated by controlled animal experiments. Gold (1984) performed such an experiment using epinephrine injections:
"a single injection of epinephrine results in long lasting change in brain function... The findings suggest that some hormonal responses may not only regulate neuronal changes responsible for memory storage but may also themselves initiate long-lasting alterations in neuronal function." (p. 379)
There are also likely other mechanisms by which this brain damage occurs that are not yet understood, but no matter what the mechanism, the effects appear to be swift and often irreversible.
Robert Sapolsky authored an article published in Science that reviewed the literature on the effects of stress in the brain (Sapolsky 1996). A number of direct quotes from this review follow:
"Glucocordicoids (GCs) like cortisol, along with epinephrine and norepinephrine, are essential for surviving acute physical stress (evading a predator, for example) but they may cause adverse effects when secretion is sustained.
"Excessive exposure to GCs has adverse effects in the rodent brain, particularly in the hippocampus, a structure vital to learning and memory (McEwen 1992, Sapolsky 1994)... Over the course of weeks, excess GC reversibly causes atrophy of hippocampal dendrites, whereas as GC overexposure for months can cause permanent loss of hippocampal neurons. Although studies suggest that similar effects can occur in the brains of primates (Magarinos 1996, Sapolsky 1990, Uno 1989), until recently there has been no evidence (except perhaps Jensen et al, 1982) for GC induced damage in the human. Some new exciting studies present such evidence.
"A first example by Sheline and colleagues concerns major depression (Sheline 1996). Approximately half of depressed patients studied secrete abnormally high amounts of GCs... The authors of the new study report MRIs with far more resolution than in previous studies and have excluded individuals with neurologic, metabolic, or endocrine diseases. They have found significant reductions in the volume of both hippocampi... The authors ruled out alcohol or substance abuse, electrocunvulsive therapy, and current use of antidepressants. Remarkably, there was a significant correlation between the duration of the depression and the extent of atrophy.
"A similar relation was seen in patients with Cushing's syndrome (where) there is bilateral hippocampal atrophy (Starkman 1992)... The extent of GC hypersecretion correlated with the extent of hippocampal atrophy, which also correlated with the extent of impairment in hippocampal dependent cognition...
"In Vietnam combat veterans with post traumatic stress disorder (PTSD), Bremner et al (1995) found a significant 8% atrophy of the right hippocampus, and near significant atrophy in the left. In (another study) Gurvits et al. (1996) also examined Vietnam veterans with PTSD and found significant 22 and 26% reductions in volumes of the right and left hippocampi. Finally, in another study... Bremner et al (1996) found a 12% atrophy in adults with PTSD due to childhood abuse... These studies controlled for age, gender, education, and alcohol abuse... In the studies by Bremner.. there were nearly as large (but non-significant) reductions in volumes of the amygdala, caudate nucleus, and temporal lobe...
"How persistent are these changes? Although the Cushingoid atrophy reverses with correction of the endocrine abnormality (excess cortisol/GC production), in the PTSD and depression studies, the atrophy occurred months to years after the trauma or last depressive episode... Thus, these changes could represent irreversible neuron loss." (Sapolsky 1996, pages 749-750)
III C. Stress and Social Isolation's Effects on Mortality
Large, prospective clinical trials of the general population have found that people with low levels of social support have between double and triple the death rates of people with the highest levels of social support (House 1988, Berkman & Syme 1979). In addition, socially isolated people have reduced numbers of T-lymphocytes (Kennedy 1988, Kiecolt-Glaser 1984, 1991), as do socially isolated non-human primates (Sapolsky 1997). These types of results are extremely consistent and go back for decades in the medical literature. In 1956, for instance, socially isolated people were found to have much higher rates of tuberculosis, even when they lived in wealthy neighborhoods (Holmes 1956). It is worth noting that tuberculosis is an "AIDS defining illness", so these people would have been diagnosed with AIDS if they tested positive on the HIV antibody tests.
The effects of social support on survival of cancer has been examined by many researchers, as well. In all eight prospective studies found by this author in which levels of social support were compared among cancer patients, increased survival was observed in people with higher levels of social support. These increases were statistically significant in seven of the eight studies (Cassileth 1988, Colon 1991, Eli 1992, Goodwin 1987, Maunsell 1995, Reynolds 1990, 1994, Waxler-Morrison 1991). Similar results for heart disease have also been found in a large number of studies (Ornish 1998).
Perhaps the most tragic findings regarding social support and human contact involve childhood development. Infants raised in severely understaffed Romanian orphanages have been found to have extremely high rates of developmental disorders and very high death rates (Carlson & Earls 1997, Rosenberg 1992).
Social Support and Survival of Cancer
Cancer patients with high levels of social support have as much as double the survival rates as those with low levels of social support (Berkman & Syme 1979, Colon 1991, Reynolds 1994), Every prospective study looking at this issue found higher survival rates for cancer patients with higher levels of social support (Cassileth 1988, Colon 1991, Eli 1992, Goodwin 1987, Maunsell 1995, Reynolds 1990, 1994, Waxler-Morrison 1991). Social support interventions were also found to increase survival in two of three studies where a group of cancer patients receiving a social support intervention was compared to a control group (Fawzy 1993, Gallert 1993, Spiegel 1989). Further weight was added to these results by the fact that the two studies with statistically significant results (Fawzy 1993, Spiegel 1989) were also those that used randomized group selection, giving them much more external validity than the other, nonrandomized study by Gallert et al. (1993). Siegel et al. (1989) found that women with late stage breast cancer randomized to receive social support group interventions lived nearly twice as long, and Fawzy et al (1993) found that only three of 34 melanoma patients randomized to receive group education and support intereventions died after seven years compared to ten of 34 who did not. there was also a trend for decreased recurrence, with seven recurrences in the group receiving group interevention compared to thirteen in the control group.
III D. Social Support, Human Contact, and Childhood Development
One of the great tragedies of the 20th century has been the suffering of children in Romanian orphanges that occurred under the rule of Nicolae Ceausescu. Two different teams of researchers have studied these children and come to heart rending conclusions. The children have suffered extremely high rates of developmental delay, mental retardation, delirium, and death. Because these children received adequate food, clothing, shelter, and medical care when sick, the researchers concluded that these children suffered and died because of lack of physical and emotional contacts during their infancy. The first quotes are from a letter published in JAMA in 1992 (Rosenberg 1992).
"Since the downfall of Nicolae Ceausescu's communist regime in Romania in December 1989, several almost barbaric institutions for children have been discovered throughout the country. Because of draconian probirth policies implemented by Ceausescu coupled with Romania's status as one of the poorest countries in Europe, children were frequently abandoned by their parents and placed in state-run orphanages. As a result, approximately 40,000 abused and neglected children languish in these orphanages...
"Prior to 1989, it was estimated that 35% of these children died every year. During September of 1991 we conducted a neuropsychiatric assessment of the entire population of one of these orphanages. One hundred and seventy patients resided in this institution, and all had been declared 'irrecuperable'.
"The orphanage was severely understaffed... This understaffing resulted in such minimal child-staff interaction that 75% of the children did not know their own name or age... It should be noted, however, that the director and many of the attendants had a true desire to help these children but did not have the means, or the training, to do so... 85% of the children had no family contact whatsoever." (page 3489)
The researchers report the results of their neurospychiatric assessment in table 1 on page 3489. They found that fully 94% of the children had developmental language and speech disorders, 40% were mentally retarded, 26% had muscular atrophy, 22% were "completely immobile", 14% suffered from delirium, 12% had epilepsy, 10% had autism, and 4% had psychosis.
Another description of these children is given by a husband and wife team from Harvard Medical School and School of Public Health, Mary Carlson and Felton Earls (Carlson & Earls 1997). Their analysis is both moving and comprehensive, and extended quotes from their work follow.
"The situation of infants and children living in state-operated residential institutions in Romania provides a setting in which the consequences of severe social deprivation can be examined. These children experience a form of social care in which their medical and nutritional needs are met, but but their social and psychological needs are not. We believe it is scientifically and ethically imperative to analyze the developmental deficits of such children within the context of the social and material resources available to them... Study of the defecits or capacities of the decontextualized child can lead to invalid attributions of intrinsic causation within the child (eg. genes for temperament or IQ)...
"Studying children in a situation of extreme deprivation provokes such a strong reaction that pursuing an ethical voice to govern one's work would seem crucial. We intend to... become advocates for these children at the same time that we assess the consequences of their living conditions...
"The demonstration of direct relation between tactile modality and social deprivation was established in the laboratory of Henry Harlow where it was shown that... tactile (but not visual or auditory) deprivation was a critical determinant of the autistic-like behavioral syndrome that resulted from early social deprivation. These studies were continued by Mason and many others, including one of the authors of this article." (pp. 419-420)
The authors go on to give a detailed account of the mechanisms by which touch induces healthy responses in brain neurotransmitters, receptors, and neuronal development, and go on to describe how increased cortisol (glucocorticoids) can inhibit this process. They then describe the condition of these children, and outline a small program that successfully reversed much the damage that had been done.
"The muteness, blank facial expressions, social withdrawal, and bizarre stereotypic movements of these infants bore a strong resemblance to the behavior of socially deprived macaques and chimpanzees. Most of the children... had experienced severe tactile/social deprivation due to the high child:caretaker ratios and custodial rearing practices... we discovered an early enrichment program..., organized by an American psychologist, Joseph Sparling. In this program, two groups of 2-9 month old infants were randomly assigned to either a social/educational enrichment program with child:caretaker ratio of 4:1 or left in standard depriving conditions with a child:caretaker ratio of 20:1...
"In the 9 month period necessary to obtain funding, this intervention program lost its support. Thus, after 13 months of enrichment, children in the intervention group were once again living in the depriving conditions. The children in the intervention group had shown significantly accelerated physical growth and mental/motor development compared to the control group during the enrichment period, but 6 months after the program ended they were no longer superior to the control children (as measured on the Denver Development Screening Test). Measures of weight and height, head, triceps and chest circumference, and mental and motor performance (using the Bayley Scales of Infant Development) revealed that the intervention group had lost the advantage gained from the enrichment experience. At this same time, we measured cortisol levels using the non-invasive method of saliva sampling to determine its level, diurnal variation (cyclic daily variation), and its reactivity to a stressful event... The control group levels can be seen (Fig 2) to rise significantly at noon, compared to intervention group levels. Significant correlations were found between levels of cortisol and physical growth (Denver Developmental Scale) as well as mental and motor performance (Bayley Scale)." (pp. 422-424)
The authors later provide a brief description of other studies showing memory loss and brain damage (neuronal death and shrinkage of the hippocampus) in adults who were victims of prolongued stress, and discuss chronically elevated cortisol as a possible cause.
"This study of psychologically deprived and stressed young children not only carries implications for deficient learning and memory, but also may convey a life-long vulnerability to certain psychiatric disorders. The results of this research will be compared to clinical studies of psychiatric conditions in adults that reveal similar factors of HPA (hypothalamus-pituitary axis) dysregulation, hippocampal neuron degeneration, and declarative memory loss...
"The most profound similarity with the work in rodents is the finding of significant hippocampal shrinkage in patients with post-traumatic stress disorder. The presence of shrinkage is strongly associated with declarative memory deficits... Both changes in hippocampal volume and verbal memory loss have been associated with the degree of cortisol elevation in adults with Cushing's disease. Elevated levels of cortisol associated with memory impairment are seen in depressed adults and adolescents, and elevated levels of exogenous glucocordicoids administered for control of asthma have been shown to produce memory deficits and other cognitive changes in children." (p 426)
Finally, Carlson and Earls provide the following comparison to conditions in the United States, where child neglect is also present.
"Although this research undoubtedly has implications for the nature of affiliative relations in Romanian society, we are increasingly concerned about the consequences of the growing numbers of children under age 5 who live in poverty in this country (a rate that has increased from 15% to 26% over the past 20 years). When this reality is coupled with the increasing rates of maternal unemployment, which is the objective of "workfare", and the insufficient supply of satisfactory child care services, the enduring negative effects on child well-being for a large segment of American society should be appreciated." (page 426)
IV. Voodoo Hexing, Root Work, Bone Pointing, and AIDS
We have seen how stress and social isolation can cause immune deficiency that resembles AIDS, and also how they can cause dementia and increased rates of chronic and often fatal illnesses. The most dramatic syndrome caused by stress, however, is a fatal wasting syndrome that results when a "voodoo hex", is cast in certain traditional societies. Physicians observing this phenomenon postulate that the power of such a hex is derived from the group beliefs of the person, their family and their society. Such syndromes are not limited to humans, however.
Stress-Induced AIDS in Wild-Caught Baboons
A study that looked at the effects of severe stress on the health of monkeys found that some monkeys who had been subjected to severe social harrassment and attack from their peers showed a relentless wasting syndrome that usually proved fatal. The authors comments were quoted at the beginning of this paper, but bear repeating:
"Wild-caught vervet monkeys... occasionally showed a syndrome of cachexia associated with persistent diarrhea, anorexia, and dehydration that usually proved fatal. Those animals appeared to be socially subordinate and to have suffered an atypically high rate of social harrassment and attack from their peers. Two animals died as early as one month under such conditions, and others died after six months to 4 years in captivity...
"The fatal outcome, caused by severe prolonged social stress, induced classic pathology associated with stress, namely gastric ulcers and adrenal hyperplasia (adrenal hyperplasia is caused by chronic excess cortisol secretion). In these animals we also found unique insidious degeneration and resultant depletion of neurons in the hippocampus... Similar degeneration was also found in cortical neurons." (Uno 1994, page 339)
This description resembles the syndrome that is called "AIDS", as do some of the descriptions in the articles on voodoo hexing which follow. It is the author's hope that by seeing how much damage negative beliefs can cause, our readers of this article will help people reintroduce healthy beliefs, such as people diagnosed HIV-positive.
The Voodoo Hex in the Medical Literature
Walter Cannon, the renowned professor of physiology at Harvard School of Medicine who first described the hormonal effects of the "fight or flight" response, was also the first to publish a review of the phenomenon that he called "Voodoo death". He compiled reports from a number of Western-trained physicians who lived in areas of the world where native inhabitants believed in, and practiced, this phenomenon (Cannon 1957). These physicians attempted to rule out other explanations for the deaths, such as poisoning. Here are a number of excerpts from this classic article:
"Dr. S.M. Lambert of the Western Pacific Health Service wrote to me that on several occasions he had seen evidence of death from fear. In only one case was there a startling recovery... When Dr. Lambert arrived at the mission (in Mona Mona in North Queensland, Australia) he learned that Rob (the chief helper at the mission) was in distress and that the missionary wanted him examined... He was impressed by the obvious indications that Rob was seriously ill and extremely weak. From the missionary he learned that he had had a bone pointed at him by Nebo (a local medicine man) and was convinced that he must die. Thereupon Dr. Lambert and the missionary went for Nebo, threatened him sharply that his supply of food would be shut off if anything should happen to Rob. At once Nebo agreed to go with them. He leaned over Rob's bed and told the sick man that it was all a mistake, a mere joke-indeed, that the bone had not been pointed at him at all... That evening Rob was back at work, quite happy again, and in full possession of his physical strength. (page 183)
"Dr. Lambert (also) wrote to me concerning the experience of Dr. P.S. Clarke. One day a Kanaka (a local native resident) came to his hospital and told him he would die in a few days because a spell had been put upon him and nothing could be done to counteract it. The man had been known by Dr. Clarke for some time. He was given a very thorough examination, including an examination of the stool and of the urine. All was found normal, but as he lay in bed he gradually grew weaker. Dr. Clarke called upon the foreman to come to the hospital to give the man assurance, but on reaching the foot of the bed, the foreman leaned over, saying, "Yes, doctor, he will soon die". The next day at 11 o'clock in the morning he ceased to live. A postmortem examination revealed nothing that could in any way account for the fatal outcome." (pages 183-184)
"Dr. J.B. Cleland, professor of Pathology at the University of Adelaide, has written to me that he has no doubt that from time to time the natives of the Australian bush do die as a result of a bone being pointed at them, and that such death may not be associated with any of the ordinary lethal injuries... In his letter to me he wrote, 'Poisoning is, I think, entirely ruled out in such cases.' " (page 184).
Cannon also provides the following eloquent description of how the reaction of the hexed person's community and family combine to multiply the force of the words of the medicine man. These words emanate from the early part of this century into ours with prophetic power. The description is chilling in its similarity to what often happens in people diagnosed HIV positive.
"Now to return to the observations of W.L. Warner regarding the aborigines of northern Australia. There are two definite movements of the social group, he declares, in the process by which black magic becomes effective on the victim of sorcery. In the first movement, the community contracts; all people who stand in kinship relation with him withdraw their sustaining support. This means everyone he knows -all his fellows- completely change their attitudes towards him and place him in a new category... The organization of his social group has collapsed, and, no longer a member of a group, he is alone and isolated. During the death illness which ensues, the group acts with all the outreachings and complexities of its organization and with countless stimuli to suggest death positively to the victim, who is in a highly suggestible state. In addition to the social pressure upon him, the victim, himself... through the multiple suggestions which he receives, cooperates in the withdrawal from life. He becomes what the attitude of his fellow tribesmen wills him to be. Thus he assists in committing a kind of suicide.
"Before the death takes place, the second movement of the community occurs which is to return to the victim in order to subject him to the fateful ritual of mourning... The effect of the double movement in the society, first away from the victim and then back, with all the compulsive force of one of its most powerful rituals, is obviously drastic. Warner (1941) writes:
"'An analogous situation in our society is hard to imagine. If all a man's near kin, his father, mother, brothers, sisters, children, business associates, friends, and all other members of the society should suddenly withdraw..., refusing to take any other attitude but one of taboo and looking at the man as already dead, and then after some little time perform over him (death rituals), the enormous suggestive power of this two-fold movement of the community can be somewhat understood by ourselves.'" (page 185)
Perhaps an analogous situation is not so hard to imagine occurring in our society, after all, given the similarities between what is described above and what is experienced by someone diagnosed "HIV positive". A study of the effects of curses and hexes on family dynamics was published in the American Journal of Psychiatry in November, 1970 (Raybin 1970). The author provided detailed case histories of four families in which a member of the family had been "cursed" or "hexed", focussing on the emotional and psychological affects of these curses on the individuals. These hexes often resulted in severe emotional despair and repeated suicide attempts, as well as disruption of social ties. He states in his conclusion that:
"The four clinical vignettes have illustrated family mythology in general, and curses and prophecies in particular, whether they be direct or implied. These communications can effectively disrupt or devastate a family, or they can serve to maintain a precariously balanced equilibrium... The dynamic issues involved in myths and curses vary with the individual family." (p. 620)
A more recent article by Meador appeared in the Sothern Medical Journal in 1992. Dr. Meador gave case histories of two people who received death-hexes from medicine men. The two men had very different outcomes, apparently due to the ability of one of their physicians to alter the belief structure of the patient. One of the most astounding elements of his case histories is that one of the men was a Haitian given a death hex by a medicine man, while the other was an American given a death hex unintentionally because of a false positive liver scan which appeared to indicate widespread metastatic cancer, when in actuality there was none. The "medicine man" who placed this second hex was Dr. Meador, himself, the author of the article.
"The first patient, a poorly educated man near death after a hex pronounced by a local voodoo priest, rapidly recovered after ingenious words and actions by his family physician. The second, who had a diagnosis of metastatic carcinoma of the esophagus, died believing he was dying of widespread cancer, as did his family and his physicians. At autopsy, only a 2 cm nodule of cancer in his liver was found." (page 244)
The actions of the physician whose patient made a dramatic recovery were truly remarkable, and involved something more akin to theatre, rather than medical treatment:
"The patient had been ill for many weeks and had lost a large amount of weight. He looked wasted and near death. Tuberculosis or widespread cancer was considered the likely diagnosis. The patient refused to eat and continued a downward course despite a feeding tube.
"He soon reached a stage of near stupor, coming in and out of consciosness, and was barely able to talk. Only then did his wife ask to speak with Dr. Daugherty privately... The wife told him that about 4 months before hospitalization, the patient had an argument with a local voodoo priest. The priest summoned him to a local cemetery late one night, and... annonced that he had "voodooed" him, that he would die in the very near future.
"Dr. Daugherty spent many hours that evening pondering... what he could do to save this moribund man. The next morning he gathered 10 or more of the patient's kin at the bedside; they were trembling and frightened to even be associated with this doomed man. Dr. Daugherty announced in his most authoritative voice that he now knew exactly what was wrong. He told them of a harrowing encounter at midnight the night before in the local cemetery where he had lured the voodoo priest. Dr. Daugherty reported that he had... choked the priest against a tree nearly to death until the priest described exactly what he had done. Dr. Daugherty announced to the astonished patient and family "That voodoo priest made some lizard eggs climb down into your stomach and they hatched out some small lizards. All but one of them died leaving a large one which is eating up all of your food and the lining of your body. I will now get that lizard out of your sustem and cure you of this horrible curse." With that he summoned the nurse, who had, on prearrangement, filled a large syringe with apomorphine (a powerful emetic for inducing vomiting). With great ceremony, Dr. Daugherty squirted the smallest amount of clear liquid into the air and lunged towards the patient, who by now had gathered enough strength to be sitting up wide-eyed in the bed. Although he pressed himself against the headboard trying to withdraw from the injection, Dr. Daugherty delivered the entire dose of apomorphine. With that he wheeled about, said nothing, and dramatically left the ward.
"Within a few moments the patient began to vomit. When Dr. Daugherty arrived at the bedside the patient was retching, one wave of spasms after another. His head was buried in a metal basin. After several minutes of continued vomiting and at a point judged to be near its end, Dr. Daugherty pulled from his black bag, carefully and secretively, a live green lizard. At the height of the next wave of retching, he slid the lizard into the basin. He called out in a loud voice, "Look what has come out of you. You are now cured. the voodoo curse is lifted."...
"The patient's eyes widened and his mouth fell open. He looked dazed. he then drifted into a deep sleep within a minute or two, saying nothing. The sleep lasted until the next morning. When he awoke, he was ravenous for food. Within a week the patient was discharged home, and soon regained his weight and strength. he lived another 10, or more, years, and died of an apparent heart attack. No one else in the family was affected...
"I reflected on this case for many years. I could make no sense of it until I read Walter Cannon's classic paper, "Voodoo Death"." (pages 244-245)
Dr. Meador goes on to describe Cannon's paper, and summarizes the aspects necessary to cause a voodoo hex to succeed, including deep belief in the hex by the victim, the family, and the community, as well as initial social isolation followed by expectant preparations for death. Before describing the American man who died after a false liver scan, he asks the following question:
"Even if such a strongly held belief could cause death, most Westerners think of hexing as a bizarre superstitious practice limited to ignorant people. It has no pertinence to modern Western society... does it?" (page 245).
This patient died with only a small patch of pneumonia and a small nodule of cancer in his liver. His wasting syndrome was unresponsive to antibiotics, and he died "thinking that he was dying of cancer, a belief shared by his wife, her family, his surgeons, and me, his internist" (page 246).
Meador asks yet another question of the reader:
"If the first patient was cured of a hex, did the second die of a hex?".
Some of the descriptions of the first patient's illness bear remarkable resemblance to AIDS. The patient "had lost a large amount of weight". He looked "wasted and near death". Tuberculosis or widespread cancer was considered the likely diagnosis, and tuberculosis is one of the most common "AIDS-defining illnesses". Several types of cancer are also considered AIDS-defining. The patient "continued a downward course depsite a feeding tube", showing that malnutrition alone did not explain his demise. He also suffered from severe dementia.
Kaada (1989) presents a review of research into the opposite of the placebo effect, dubbed the "nocebo" effect. This is the negative effect on health associated with harmful beliefs and psychological stressors. He comments on voodoo hexing and the ability to resist its power as follows:
"In its most extreme, nocebo-stimuli may cause death, as in voodoo-death in primitive societies, an example of the fear-paralysis reflex. Whether the outcome is positive or negative is determined, inter alia, by the subject's possibility of coping with the situation."
This could explain why some people live for years after an HIV diagnosis with no ill health, while others succomb in much shorter time.
Also quoted in the introduction of this paper was a brief quote from a special article to the Lancet (Milton 1973). Dr. Milton was an Australian physician who commented as follows:
"There is a small group of patients in whom the realisation of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ("pointing the bone")...
"Throughout questioning his answers are minimal, and as soon as the questions stop he is silent... He does not have the obvious signs of extreme anxiety or fear. Blood pressure, pulse, and respiration remain normal... Within a month of the onset of this syndrome the patient will almost certainly be dead. If a necroscopy is carried out, ... there will often appear to be no adequate explanation for the cause of death.
"A similar syndrome is associated with the custom of "pointing the bone" in primitive societies... Pointing the bone is essentially a magic spell cast by a witch-doctor into the spirit of the victim. The Australian aborigines believe that all disease is the result of disharmony of the spirit. If the spirit can be disturbed by such spells, illness should follow... Any hope of escape becomes unthinkable, and, provided the victim holds the necessary beliefs, death follows the witch-doctor's spell. Obviously, the method is ineffective against those who do not hold the necessary beliefs...
"The Melanoma Clinic at Sydney hospital (where Dr. Milton worked) often admits patients with incurable melanoma who are beginning to show all the features of self-willed death. As soon as the patient feels that something can be done to help him, ... his mental attitude improves. This improvement may be so dramatic that there is danger of the medical staff believing that various treatments offered ... have prolonged the patient's life by an organic effect." (pages 1435-1436)
This last description could explain the widely propogated belief that new protease inhibitor "cocktails" are prolonging people's lives, especially since controlled clinical trials do not show reduction in death rates. This topic will be addressed in a later section.
Another paper on hexing appeared in the Journal of the American Medical Association in 1975 (Cappannari 1975). This case was different from other in that it occurred in the United States, and did not involve a professional "witch doctor" but rather a woman considered to have magical powers. The person hexed was the woman's duaghter-in-law, which adds a new dimension to the classic tension between mothers and women who marry their sons. It all began when the woman in question found she was pregnant and her mother in law, who "did not like her" told her that her baby would be born dead.
"The patient maintained that she did not worry about this threat, in spite of her mother-in-law's reputation in the community as being a "bad lady" who "cast spells".
"In September the baby was born dead at full term. that evening the patient experienced abdominal pain, nausea, vomiting and diarrhea. In November (with persistence of her symptoms) she went to a local hospital and a diagnosis of sickle cell trait was made (which ordinarily produces no symptoms). Continued symptoms precipitated the first admission to Vanderbilt University Hospital in January 1972, when regional enteritis was diagnosed on the basis of findings on x-ray and biopsy. In addition to treatment with corticosteroids and sulfonamides, therapy with isoniazid was begun.
"In June, the patient and her husband separated. She noted that "he was tired of me being sick all the time"... He said that "he didn't want to leave, but something had power over him and was making him do it". In September (one year after the still-birth) the patient was readmitted because of weight loss. Dosages of corticosteroids were increased, and she was tube-fed. When she left the hospital her weight was 47kg (105 lb) compared to her normal range of 63 to 68kg (140 to 150 lb) before pregnancy. (p. 938)
"The patient learned formally that a hex had been placed on her by her mother-in-law, and went to an "herb doctor" who told her to "throw away all she owned of her husband and his mother's possessions in order to free her of the hex" (p. 938) Unfortunately this did not work and she "began to doubt that the hex was gone". Soon she learned of a new hex placed on her.
"In July, (nearly two years after the still-birth) her husband served her with divorce papers and said "I must do this... I'm under another power, and besides, you will die in January anyway." He repeated this prophecy to her before remarrying in December, when he disappeared from her life. (According to the patient's mother his present wife is said to be losing weight). This dire prophecy was given additional weight by a physician who told the patient she would always have her disease and that it would eventually "kill" her.
"Since her weight had fallen to 33 kg (72 lb - about half of her normal weight) and she had begun to look as if she might die, she was readmitted to the hospital. At that time a psychiatric opinion was requested. She was laconic (spoke little), appeared depressed, but was not anxious or psychotic. Concerning the hex, she said "I don't know if I am going to die or not, but I believe my stomach trouble was caused by her spell."... She would not participate in the interview, but let her mother answer questions. It was clear her mother believed in the hex and in the validity of the gypsies as much or more than her daughter... But then she added with emotion, "She will not die until the Lord is ready for her. His power is the greatest of all."...
"The psychiatric consultant suggested that a fundamentalist black Baptist minister (who was also involved in voodoo) talk with the patient. He briefly interviewed the patient and informed her that the hex was "all in her head". Then he read biblical passages concerning the casting out of devils, whereupon she entered a hypnoid-like state from which she later emerged, saying that she felt better. The next day she said that she had "forgotten" about the hex and did not wish to be reminded of it... Her mother said she was angry about people bringing up "things which were upsetting her"...
"She gained weight. Her spirits improved greatly after February 1 (she was predicted to die in "January"), although she continued to have abdominal cramping... She observed that her hex was never real, that she only had "regional enteritis," and concluded "anybody can be fooled". (pp. 938-939)
The authors provide some brief comments:
"It seems clear that this patient and her omnipresent mother were torn between two distinct systems of belief: one, the supernatural, including especially a belief in hexing.., and the other, involving contemporary allopathic medicine...
"It is pertinent that the mother-in-law had a reputation for casting spells and was viewed in the community as a "bad-lady"... This case is complicated by the patient's having regional enteritis. Although there is some controversy about the psychosomatic aspects of this disease, there is evidence that it is related to psychosocial stress and that psychodynamic factors are of etiological importance. Several independent reports emphasize the role of emotional stress in the precipitation of symptoms." (p. 940)
There was evidence of psychosocial stress with the chaotic and disruptive marital situation, as well as severe object loss with the birth of the dead infant... Thus, the clinical picture is also consistent from a psychosomatic viewpoint even out oif context of the hex, which in itself may be looked on as a form of psychic stress.
One evidently adverse suggestion by a physician to the patient to the effect that she would not recover was all too similar to her husband's prophecy that she would die in January. It constituted a blatane example of the inadvertent hexing sometimes performed by physicians...
If this case were classic of hexing, with total belief by the patient (and mother) in magical powers of the mother-in-law, the patient should have died as scheduled... A person may, of course, subscribe to more than one belief system at a time, even when such systems are logically or empirically contradictory. Most of the medical literature on voodoo deals with voodoo death. The mechanisms that cause death are still under discussion, but the full acceptance of witchcraft by the victims is characteristic in these reports. In this case, the persons involved subscribed in part to two differing systems of disease causation and cure. Indeed, this vacillation may have prevented this patient's death.
While it is certainly possible that "hexing" had nothing to do with this patient's illness. The fact that her symptoms began improving immediately after a spiritual intervention induced a "hypnoid-like state" and then again after she outlived her predicted date of death, however, suggests otherwise. The physicians involved in her care evidently agree, as their comments make clear.
In this case the hex was more vague, and death did not result. Instead, a period of severe chronic illness was created, that lasted over two years.
Campinha-Bacote provided an excellent overview of "voodoo illness" in an article in the journal, Perspectives in Psychiatric Care in the winter of 1992 (Campinha-Bacote 1992). He also describes, in much more detail than the other authors cited so far, what the voodoo religion is like and who practices it.
"Voodoo illness involves a belief that illness or death may come to an individual via a supernatural force. Other terms for this illness include "root work", a "hex", "conjuring", a "trick", "black magic", "conjure illness", "hoodoo", "voodoo", "witchcraft", or a "spell". Voodoo illness is classified as a culture-bound syndrome, that is, as an illness that varies from culture to culture...
"Voodoo is derives from the word vodun, which means "spirit". In the African Haitian belief system, God or "Gran-Mat" is acknowledged as creator of heaven and earth. this Gran Met delegates certain spirits ... to serve as intermediaries between God and man. The voodoo priests or priestesses practice sorcery and conjuring, as well as the voodoo religion, in an attempt to maintain harmony with these spirits. the priests are expected to be knowledgable about black magic in order to counteract malignant forces."
The author then goes on to describe how the voodoo religion affected and interacted with the culture of African slaves in America, and how this has affected current day beliefs in some members of African American communities. After this, she describes common symptoms of "voodoo illness".
"Conjure doctors and folk healers report that symptoms typically fall into two broad categories: gastrointestinal and behavioral. Gastrointestinal symptoms include diarrhea, nausea, vomiting, food not tasting right, and "falling off" (unexplainable weight loss). Behavioral symptoms include bizarre behavior, delusions and hallucinations...
"Generally, the victim believes in the power of the person who administered the hex, and realizes he/she has been hexed or at least suspects it.
"Left untreated, voodoo illness can progress to voodoo death. While voodoo death is not surprising to the folk healers who understand the belief system that victims hold, to Western health workers such death is a shocking and mystical phenomenon... (In the United States) hexing practices are no longer restricted to rural isolated communities ... Nor is a belief in voodoo illness restricted to the poor, uneducated, or lower socioeconomic classes. Indeed, the Western health worker is more likley to encounter (this phenomenon) than ever before.
"Generally speaking, Western medicine treats these individuals as having either psychological or physiological problems. The spiritual and cultural dimensions of the client's presenting problem are often overlooked, except by the folk medicine practicioner, who sees no distinction between the mind, body and spirit... Western medicine classifies voodoo illness under the heading of psychiatric disorders, listing diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 3d ed., Revised (DSM-III)."
Campinha-Bacote also provides a brief description of several proposed mechanisms.
"Western medicine has posed several different etiological explanations for voodoo death. As early as 1942, Cannon (1957) explained magical death in terms of the response of the autonomic nervous system to extreme emotion; in such cases death was thought to be caused by the exhaustion of the sympathetic nervous system. In contrast, Richter (1957) believe death was due to the excessive response in the parasympathetic nervous system, which was a result of extreme feelings of helplessness. Lex (1974) proposed that voodoo death involves stimulation of both the parasympathetic and sympathetic nervous systems. Other explanations of voodoo death have included the power of suggestion and pharmacological poisoning."
The next study to be reviewed documents similar types of severe, chronic illnesses, which the author feels were caused by a voodoo hex and the powerful beliefs that were generated.
Golden (1977) provided a description of voodoo hexing that he observed while serving as a peace corps volunteer. His article was published in the American Journal of Psychiatry. Although the author is not a physician, he provides perhaps the best research summary of all, as well as an excellent discussion comparing the "hexing" that occurs in a traditional society with similar phenomena that occur in Western society. He describes both the practice of hexing as he observed it, as well as the effects of such a curse on someone he knew quite well, his landlady.
"As a Peace Corps volunteer teacher I spent two years in West Africa. There I lived in an area where the voodoo cult originated, and where cursing and hexing were actively practiced. Vodu in the Ewe dialect of the West african village where I lived means "one to be feared"...
"Disobedience of tribal custom is punished by fines, disgrace, banishment, or, when the infraction is particularly serious, by curse death, which means certain death to the victim. My landlady was fatally affected by such a curse... For a year or so she had been suffering from severe and acute attacks of abdominal pains. She had had exploratory surgery performed by European doctors ... Towards the end of my Peace Corps tour I noticed that she was losing weight and saw her less and less often. When she died, she was buried at the outskirts of the cemetery. When I asked a friend of mine why, I was told that she had been cursed by one of the yehwe, one of the major cults of the village, because she had been an adulteress.
"For the curse to be successful, the victim has to be made aware that he or she has been cursed... Death comes slowly but surely over a period of months. When the curse becomes known, the victim's family and friends as well as the entire community withdraw their support. The victim becomes an outsider to the few cohesive and organized activities of the village ...
"Feeling Hopeless and helpless, the victim withdraws, thus furthuring his or her isolation ... Although the threat to life is not acute, the emotional strain of feeling hopeless is evident over an extended period of time. The victim fatigues easily in order to conserve the energy needed to protect threatened resources from the emotionally overstressful situation. The victim remains in a state of chronic fatigue and melancholia, and ... he or she simply dies.
"Unlike the curse death in this village, curse deaths in other parts of Africa have been reported to occur immediately after the curse has been placed... When cursed with all the drama of the ceremony, the victim dies suddenly. Many physicians have speculated on the physiological basis of such curse death as well as other types of death caused by emotionally stressful situations...
"In the village I lived in, belief in the power of such hexes is wholehearted. In areas where the belief is weaker, the victim seems more amenable to treatment... when curses and hexes are effective, overdependency and a feeling of powerlessness also occur...
"Furthur, psycho-physiological forms of giving up are often seen in (Western) hospitals. Patients ... told of their imminent death have been known to react by withdrawing, eating and drinking poorly, and socially isolating themselves; at times these reactions result in premature death." (pp. 1425-1426)
A Likely Explanation for the "Course" of AIDS
Based partly on this evidence, a compelling argument can be made that much of what we call AIDS is a self-fulfilling prophecy which might happen as follows:
a) The severe, acute psychological stress of being diagnosed "HIV Positive" is quickly transformed into a severe, chronic psychological stress of living with a prediction of a horrifying decline that could start at any time. This causes a suppression of the immune system, with selective depletion of CD4 T-cells. In addition, people are more likely to be tested for HIV when there is already some health problem present, so that the psychological stress adds to significant stress due to the illness already present. These illnesses are often severe and chronic in nature. It is not necessary, however, for prior illness to be present. These factors have been studied in healthy people where they create the very same immunosuppression and immune dysregulation that may later be called "AIDS".
b) After testing positive, people are often put on a variety of powerful medications as a preventative measure and/or for treatment of actual infections. These include long-term regimens of the most potent broad-spectrum antibiotics, as well as "antiretroviral" agents like AZT, ddI, ddC, and protease inhibitors. Although the toxicities of the "antiretrovirals" have been outlined elsewere, antibiotics also often have debilitating side effects which are easily blamed on HIV, including immune suppression. Perhaps more significantly, they lead to a complete disruption of the normal microbial flora present in the gastrointestinal system. The healthy balance of flora in the gastrointestinal tract and elsewhere in the body is one of the most important protectors against infection (8). If this is not enough, these antibiotics also often lead to the development of multidrug-resistant strains of bacteria, fungi, and viruses, which can later ravage a person's system, especially if their immune system is not functioning very well.
c) Once the immune system starts to crack under the strain of the emotional stress, previous health problems (if there were any), and disrupted natural defenses, the diagnosis of AIDS is made. If not already on "antiretrovirals", then the person will now definitely be started on them, with all of the toxic effects.
d) The new "cocktails" are to be given until the patient dies, with no exceptions, if possible. This is because of the theory that mutant, drug resistant, HIV will flourish if they go off of their treatment. Patients who abandon "antiretroviral" treatment would then, theoretically, be a public health threat because they might infect others with their superpowerful, mutated "HIV". Thus, aside from considering their own health, the patient has a larger social responsibility to stay on the "cocktail", no matter how debilitating the "side effects" are. It is heavily stressed that the patient must not miss a single dose, if at all possible. When the patient's health begins to fail, the failure is blamed on the effects of this "mutated HIV", possibly due to the patients poor compliance. Rarely are the drug toxicities and complications caused by the treatment held responsible.
Some people seem to respond well (at least temporarily) to these "antiretroviral" regimens. The reasons for this are unclear, but may be related to:
1) Direct actions of the drugs on many possible pathogens including, possibly, HIV.
2) Toxic substances have been observed to stimulate the release of T cells from the bone marrow, before eventually exhausting the supply and causing immune cell depletion and anemia. The initial rise in CD4 counts seen in this case would be interpreted as improved immune function when it is actually the beginning of immune exhaustion.
3) Relief of the severe psychological stress due to the powerful belief that these drugs are "life-saving". This is often reinforced by rising CD4 counts and falling "viral load", which are doubtful and non-specific markers of actual health.
Matt Irwin MD is a family practice resident who wrote several literature reviews on HIV and AIDS while attending medical school at George Washington University. He also holds a Master's degree in social work from the Catholic University of America. In addition to his interest in alternative views of HIV and AIDS, he specializes in health promotion with nutritional, psychological, social, and spiritual interventions, as well as classical homeopathy. He has a practice near Washington, D.C. The above article was extracted from a draft of his book on AIDS, and updated by the author in Feb. 2002.