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The whir of the washing machines, down at a local laundromat, keeps tempo as the words for this article unfold. Patrons busy themselves in solitary worlds, each wrapped up in thoughts of their own, quietly unloading, folding, and organizing clean clothes as the unexpected beat of laundromat “silence” provides: patterns of people performing tasks in a repetitious fashion. Closely I watch. Its inherent rhythm is catching, my toe neatly tapping onto the linoleum floor. Part of me thinks that any minute now a Bjork song-and-dance will take place, each non-descript citizen flamboyantly breaking into a charismatic, heartfelt musical performance.

This is not the case; in fact, this scenario takes place solely in my head, front and center, as I decide how to begin a complex description of where music meets creativity, and the fine line of where genius infiltrates the fatty tissues of the brain.

The ability of the brain to make sense out of nonsense is truly an art form. Musicians are able to interpret a vast sea of information; immaterial thoughts, ideas, and imagination and then weave it into the material world in the form of a musical composition. Neuroscientists are refining and defining where creativity and genius reside within the brain, literally pin-pointing where an insight hits plain view sight. Here’s what the brainy kids have discovered so far….

Musicians interpret the structured aspects of music like a language; aware of inflections, reading the underlying musical harmonics, the structure and stepping stones based upon hours of practice (Neuhaus, 2006)(Limb 2006)(Sieborger 2007). The areas of the brain, which become active in improvisational jazz pianists, are the same that light up when complex language is used (Limb 2006). It’s like a conversation between people only, rather than words, instruments and notes are the medium of dialogue. The vibraphonist for Portland’s Point Juncture Washington, Victor Nash, reiterates this feeling. “Music has nothing to do with sound, body, function, technique, style, (or) anything concrete…. It’s a feeling that is somehow translatable between people independent of musical language or visual cues.”

The artists who most reshape our perceptions of the world tend to be unconventional rebels and out-of-the-box believers who constantly seek new frontiers. Scientists confirm this tendency within the confines of the skull: where the areas in the brain responsible for employing rules, regulation, or the societal cues that keep us “normal” are down regulated during improvisational performances (Robertson 2008). Scientists surmise that a tuning down of the dorsolateral prefrontal cortex allows musicians to tune out the distractions - those regulatory cues where feelings of failure originate - allowing creativity to flow more easily and thoughts to become less constrained by rules and regulations (Limb 2008). Moreover, artists aren’t afraid to tread upon new ground, define boundaries in the chaos of musical notes. This makes sense because areas of the brain reflective of this dance, the prefrontal cortex, have greater electrical activity during moments of creativity and improvisation (Limb 2008).

Some ascribe musicians as philosophers, taking the abstract and formulating musical patterns from its chaos. According to James Lincoln Collier, author of “The Making of Jazz”, jazz is essentially a musical experiment, in search of the new and striking discoveries, adding and subtracting on top of existing permutations (Collier 1978). The language of music is built upon two factors: structure and potential. Psychologists argue that geniuses have a common thread, knowing the rules, and creating unique ways to break them.

So what functions within the brain constitute a musical genius? The verdict is still out on this one, yet in the meantime, whet your whistle with this. Genuine music gets to you. It grips you in the heart, makes you stop what you’re doing, stare into space… and truly listen, not just passively absorb the external collage of sounds. Genuine music is a primal, emotive force scripted with thought-provoking notes. Most importantly, it has the potential to knock you upside your head and make you stop… and listen… body and soul. This is when you know you’re inside the musician’s head, reading his thoughts, following his narrative. You are being steered, lead by your ears, on a ship of undulating emotion as it takes you on a fantastic voyage. Nash expresses a similar notion,

“your body is completing tasks that have been rehearsed on the subconscious level, but your mind is elsewhere—I’ve heard it described as picking up a transmission, that the music exists on a higher plane, you just tune into it like a program already in progress.”

Tuning my attention back to my external surroundings, the fuzziness of laundromat world comes into view. Each movement ticks in precision with the circular 12-hour metronome overhead. It’s a crazy world that we live in, kudos to the musical artists that successfully harness the chaotic, universal patterning, and best wishes to the scientists in pursuit of the illusive muse. Both are noteworthy expeditions.

Limb CJ, Kemeny S, Ortigoza EB, Rouhani S, Braun, AR. Left hemispheric lateralization of brain activity during passive rhythm perception in musicians. The anatomical record. 2006. Volume 288A; Issue 4; p 382-389.

Limb CJ, Braun AR. Neural substrates of spontaneous musical performance: An fMRI study of Jazz improvisation. PLoS One. 2008. 3(2): e1679.

Neuhaus c, Knosche TR, Friederici AD. Effects of musical experience and boundary markers on phrase perception in music. J. Cognitive Neuroscience. 2006. March; 18(3): 472-93.

Robertson P. What is a Musical Genius? Clinical Medicine. 2008. 8:178-81.

Sieborger FT, Ferstl EC, Cramon DY. Making sense of nonsense: An fMRI study of taks induced inference processes during discourse comprehension. Brain Research Vol 1166. 29 August 2007, p77-91.

On a sunny day last week, a group of Helfgotters took a road trip to Seattle to check out a conference hosted by our colleagues at Bastyr University. This conference, titled Collaborative Research in CAM: Making Studies Relevant to Clinical Practice, highlighted a number of research efforts between Bastyr, the University of Washington, and other institutions, and illustrated the complexities of studying CAM therapies. The two main speakers for the conference demonstrated the diversity and possibilities inherent in CAM and helped to facilitate a healthy discussion of potential next steps in natural medicine research.

Lynne Shinto, ND, MPH, from Oregon Health and Science University, described her work in evaluating a naturopathic whole practice approach to multiple sclerosis. In naturopathic medicine, treatment plans are usually highly individualized and typically consist of multiple therapies, including botanicals, diet changes, stress reduction techniques and so forth. These qualities make the medicine complicated to study, and nearly impossible to accurately test the efficacy of each separate component on its own. Dr. Shinto’s study is one of the first clinical trials that evaluated naturopathic treatment for MS as a whole, rather than a single naturopathic therapy.

Bill Lafferty, MD, from the University of Washington, and Leanna Standish, PhD, ND, LAc, from Bastyr University, presented a study they completed on CAM care at the end of life. In this trial, they randomized patients in hospice care to one of three treatments: massage, meditation, or having a friendly visitor twice a week. This study brought up an interesting notion about patient choice of treatment and the corresponding efficacy of that treatment. In this study, patients were surveyed about what group they preferred to be randomized to, with meditation being the least popular. While statistically, patient choice did not have an effect in this study’s results, we realized that for our future trials, it will be important to survey participants to see if being randomized to a preferred group can change outcomes.

In our effort to avoid I-5 traffic snarls heading back to Portland, we weren’t able to catch the post doctoral presentations or a plenary session focusing on herbal medicine research challenges. However, we left full of ideas and plans for possible future Bastyr/Helfgott collaborations. Not only did we have a good time visiting with our friends up north, but we acquired a lot of valuable information that we can use in our own work.

Part of the fun of working at the Helfgott Research Institute is being able to hang out with and learn from all of the talented scientists who spend their days trying to unravel the mysteries of natural medicine. One of these scientists, Agatha Colbert, MD, is directing a program of research at Helfgott that focuses on electromagnetic fields and how they influence the body to heal itself.

Dr. Colbert completed her medical training at the University of the West Indies, her specialty training in Physical Medicine and Rehabilitation at Ohio State University, and her NIH post doctoral research fellowship at the Oregon Center for Complementary and Alternative Medicine. Her interest in electromagnetic fields began when she studied acupuncture with Kiiko Matsumoto in Boston in the mid 1990s. During her training, she became acquainted with magnetic therapy researchers, and heard about a new magnetic mattress pad that she thought might be good for fibromyalgia patients. Because it was a relatively untested practice, Dr. Colbert decided to conduct a small clinical trial to see if the mattress pad would work for these patients. She got funding from a magnet manufacturer, recruited 25 people with fibromyalgia, and found that there were some small improvements in sleep and pain. In the meantime, Dr. Colbert was using magnets on acupuncture points in her practice for pediatric rehabilitation patients, was seeing results, and wanted to know why. The convergence of these events got her hooked on research, and when she moved to Portland, Oregon she quickly obtained a post-doctoral position at the Oregon Center for Complementary and Alternative Medicine at the Kaiser Permanente Center for Health Research.

Since then, Dr. Colbert’s research has expanded to include a wide range of scholarly pursuits. As a post-doctoral fellow, she studied skin impedance (impedance is defined as the opposition to the flow of current in a circuit) at acupuncture points as a potential biomarker for acupuncture. This project expanded, and Dr. Colbert and her team recently obtained NIH funding to develop an instrument that will measure skin impedance at multiple acupuncture points simultaneously. Dr. Colbert hopes to use this instrument to test the theory that acupuncture points are linked by connective pathways, or meridians. She hypothesizes that these connections are electrical in nature and will test this theory by placing electrodes on meridians, then stimulating a theoretically related acupuncture point to see if changes in impedance occur that are unique to the point being stimulated.

Dr. Colbert is also the principal investigator on another NIH-funded study on the effects of magnet therapy for carpal tunnel syndrome. This is a dose-ranging study to determine which strength magnet is likely to give a therapeutic benefit. This study is still recruiting for participants, and is expected to reach target enrollment in late September of this year. Additionally, Dr. Colbert has produced a number of literature reviews, including a joint paper with Harvard researcher Andrew Ahn, MD, that reviewed the literature on electrical properties of acupuncture points, and a paper on the use of magnets on acupuncture points.

As if this doesn’t keep her busy enough, Dr. Colbert is also working on establishing a psychophysiology lab at the Helfgott Research Institute. Her goal is to have a fully equipped lab to use to initiate studies of autonomic nervous system changes associated with giving and receiving CAM interventions including acupuncture, magnet therapy, and Reiki.

The Birth of a Student Researcher

“Healing begins in the imagination,” Dawn Thompson, a program coordinator for Write Around Portland, said this to me in a meeting last Thursday morning. I love this statement. It ripples with meaning and holds some intuitive truth.

Dawn and I were meeting to discuss curriculum design for a pilot study being developed by a group of researchers at the Helfgott Research Institute. The project proposes to examine “writing in community” as a means of transformative change for people diagnosed with Fibromyalgia and Chronic Fatigue Syndrome.

Why Writing?

Excellent question. And, I will add one, what does “writing in community,” mean? The idea for the study came from an experience I had before moving to Portland, Oregon. I was then practicing massage in a small rural community that was a Petri dish of sorts. I saw my clients at the grocery store, the café, and out in the mountains. In a sense we lived together. But the community didn’t come together for many things. I created the Mt. Shasta Writers Series and invited regional poets, whose work related to rural living, to come to town and give readings. People turned out in droves, sixty to eighty folks to a poetry reading. Out of that grew a monthly poetry open-mic. Somewhat unintentionally, we had fomented a cultural movement. People from different walks of life were gathering to hear live culture born from their home ground. I like to think this strengthened the weave of our connection with one another. One client’s case in particular stuck out. She was working hard towards change but was stuck. I came to work one day after a reading and open-mic and there was a long message on my voice mail. The event had catalyzed a change in her perception of her situation. From that moment she began initiating changes in her circumstances.

If healing begins in the imagination, how can this be delivered to people feeling decidedly unimaginative and stuck, like my client? Writing is particularly well suited to answer this question. However, most often we consider writing to be a solitary activity, the pensive writer alone with a cup of coffee or tea, gazing forlornly out as streaks of rain run down the fogged window. There’s nothing wrong with this picture – sometimes that’s me and I relish the time to be there like that with my thoughts.

It has been well documented just what social creatures we humans are. Before we gathered at cafes or bars to hear the latest news we were gathering around the campfire. In pre-history it was around the fire that stories were told and these stories were essential to continuing the fabric of the tribe. I think we are hardwired to like to tell and hear stories. Something changes when a story moves from words on the page to words in the air – somebody hears you. Things change.

And this is what I wanted to research when I approached the staff at Helfgott – not just writing, but sharing writing out loud, listening to one another’s stories. Using the inherent power in this medium to allow people to catalyze change in their lives.

What Next?

Thus began my odessey as a student researcher. It’s not all fun. There are hours at the computer reading dry and densely written research studies with impenetrable layers of statistics and conclusions. It was another language. This process, called the literature review actually bore fruit. I began to learn the language for one (though am still hopelessly poor at understanding all the statistical numbers). More important, two threads emerged. There was existing research on what is called “expressive writing” though none on a community-writing model. Second, I came to understand something of the struggles encountered by people with Chronic Fatigue Syndrome and Fibromyalgia (and the struggles of the medical community attempting to help them).

Anecdotes abound when it comes to the power of writing but anecdotes don’t generate NIH funding. Nor do they pave the way to real understanding at how well something like this might work and what exactly will it offer people.

Interesting Background Research

There is a history of research on writing in a medical setting. It is generally termed “expressive writing.” The pioneer of this work is James Pennebaker from the University of Texas. His model involves short periods of solitary writing about a specific traumatic event, repeated over a few days. The results were favorable and studies have corroborated his findings. The other interesting bit of research done on the writing process has examined the effects of writing poetry on medical students. It was found to help them become more empathic towards their patients and be better listeners. Poetry writing has become a mainstay in many medical school programs.

Just last week I came across an article on the New York Times website citing a study conducted by the Lombardi Comprehensive Cancer Center in Washington, D.C. They were using a writing model based on Pennebaker’s research. Patients were asked to write in the waiting room of a cancer care clinic. The researchers concluded that their research “provide(s) support for future efforts to move beyond efficacy studies of expressive writing into community- and clinic-based effectiveness trials.” This study was published in the February issue of “The Oncologist” and can be read online. Strangely enough writing has yet to break out of these two models. That’s where we hope to come in!

Why People with Chronic Fatigue Syndrome and Fibromyalgia?

The short answer is because that’s what Dr. Heather Zwickey, Director of the Helfgott Research Center, said. I think the real answer is longer than that – she just wanted me to discover it for myself. I think I’m getting there. I could bore you now with those impenetrable layers of statistics, but I wont. Quite simply the available and effective care for people suffering from these diseases is limited. There are: medications, cognitive behavioral therapy (CBT) and support groups, exercise programs and, alternative medicine interventions such as acupuncture and/or naturopathy. Most patients end up trying some mixture of these with the goal often being managing their symptoms and trying to improve their quality of life. Success is varied if it comes at all. This is not to say that people don’t get better, some do. The quote below was taken from the NIH website discussing the challenges facing people with these diseases.

“Providing social support and education about one’s disease or disorder has been shown to be an effective means for improving the health care status of individuals with chronic diseases. Studies are currently underway focusing on patients with fibromyalgia to advance understanding of how social support and education interventions may be helpful to these patients as well. (Source: excerpt from Fibromyalgia Research Challenges and Opportunities: NIAMS)”

There is a lot of interest on figuring out effective ways to work with these diseases. We are hoping to add something meaningful to the discussion.

The Model is the Key…

I mean the curriculum model that we use. Now this part of the process has been fun!

In the well publicized surveys of CAM usage, the National Center for Complementary and Alternative Medicine (NCCAM) released some interesting statistics. The percentage of people who use CAM is 36%. But when the use of prayer is included, the figure skyrockets to 62%. Such an obvious statistical variance begs the question of whether prayer should be considered CAM after all.

As a stanch follower of an undisclosed religion (ok, it’s Anglo-catholic) with a graduate degree in a non-health related field (ok, it’s Indo-Tibetan Buddhism), I am a person who would likely respond no to the question “Do you use CAM?” but might very well respond yes to the question “What if we sweetened the pot and included prayer?” I am an example of the statistic in question. As such, I would like to informally posit some thoughts about these results.

I say I might have responded yes to the question- do I pray for my own health or the health of others- because it feels right to say so. It has a certain truthiness. Of course I pray for the health of my loved ones. Hell, who doesn’t? But if pressed upon my beliefs, and I dare say the beliefs of most of the positive responders, I do not believe that prayer is CAM.

Prayer is neither a treatment against disease nor a practice to prevent disease, partially because with prayer there is no such intention. To define prayer as medicine is removing it from the sacred context that gives it meaning. From a religious perspective, meditation and prayer very well may have health benefits but they are more likely to be the secondary outcomes of relaxation, mindfulness and breathing techniques. No causal connection exists between the petitionary action of prayer and a physical result. As often as not, people’s prayers simply are not answered. It is a reality with which virtually all religion is comfortable. To the penitent, the point of prayer is the communion with the divine itself, not the possible health benefits. Everyone who prays understands this. We can not quantify where, how, or when a prayer causes a positive health outcome. Undoubtedly, prayer has health benefits and, of course, any religion would affirm that sometimes prayers are answered. But this does not make it medicine.

Prayer lives within a religious (or, I say begrudgingly, a spiritual) context. Truthfully, I am not advocating for any particular system but what I am advocating is that we leave prayer intact within those contexts. Redefining religion as your own personal health plan or attempting to isolate some variable of prayer for medical research will open up religion to exactly the sort of questions it was never meant to answer. Applying scientific method to prayer is patently absurd. It is not that religion and science do not have anything to say to each other. Lord knows they should talk more. But religion and medicine are attempting to accomplish very different goals. Physical and spiritual health are rarely at cross purposes but they are different sorts of endeavors entirely.

If CAM did decide to infringe on the intellectual property of religious studies departments (yeah, I said it!) and attempted to study prayer meaningfully, it would need to answer a library’s worth of preliminary questions before it could administer questions, monitor progress, or interpret results. Who is praying? To which God are they praying? Does denomination matter? How do we quantify the piety of the people praying? What is the dosage of prayer? Does temporal or geographic proximity matter? How do we even know if a prayer is answered, or when? How do we possibly account for coincidence? Is CAM willing to take the intellectual not to mention the political and social fall-out of attempting to establish religious ‘best practices’?

My advice? Back up slowly, CAM. Nice and easy.