Psychosomatics, psychotherapy and neuronal plasticity - how words work Johann Caspar Rüegg Institute of Physiology and Pathophysiology at the University of Heidelberg, Heidelberg, Germany Vienna Medical Weekly (2004) 154 / 15-16: 347-352 © Springer-Verlag 2004 Wiener Medizinische Wochenschrift Printed in Austria correspondence: Prof. em. Dr. med. Caspar Rüegg, Haagackerweg 10, 69493 Hirschberg, Germany. Email: Caspar.Rueegg@gmx.de Rüegg, Psychosomatics, psychotherapy and neuronal plasticity - how words affect contact and form synapses at the contact points. That now actually also in the adult brain constantly new spines and thus new synapses are formed, has been detected by fluorescence microscopy in the somatosensory cortex of the mouse brain in vivo [4] recently. The researchers used for their experiments recombinant mice, in order to unleash a gene for a green fluorescent protein ( "green fluorescent protein") has been introduced, which is expressed in the neurons of the brain. The observed through a window in the cranium green flashing Spines of the somatosensory cortex varied from day to day: Old synapses or old Spines disappeared when the test animal gained experience, but formed new, while those remained unchanged other synapses or spines. The fine structure of a mouse brain can therefore constantly changing, and that happens probably with us humans when we gather experience and learn something, even if we learning is unaware. Eric Kandel According synaptic interconnections are ever restructured with every learning process and thus also by talking, if the called party noted the call [5]. So speaks a man with another, it causes in the brain changes in synaptic connectivity of neural networks, ie structural changes. Presumably, the brain actually restructured in this way also in the course of psychotherapy or a talk therapy. And this is probably especially in a cognitive behavioral therapy, the case of there is a so-called cognitive restructuring. How can words act as healing the words of the doctor be, you knew in antiquity. Plato was in one of his dialogues Socrates say, although some remedies THAT CONDITION very good with a headache, but only if it will be administered together with the right words [6] - and with an adequate empathy, one might add. In the last century it was always Michael Balint, who pointed out how the words of a doctor, in particular to the release of his diagnosis, affect the healing process! Balint said, not the medicine bottle and tablets are decisive, but the way in which the doctor will prescribe [7], and the writer Rudyard Kipling (1865-1936) said that words are the most powerful drug use humanity. Through hypnosis - spoken words - even the immune system are affected, in particular the number of circulating in the blood T lymphocytes [8], and it is well known that the suggestive words of the doctor during a mild hypnosis also can inhibit a sharp pain. Guided Imagination, auto-suggestion or hypnosis can but inhibit not only "physical" pain, but also reduce the metabolism and blood circulation as well as the neural activity of the cerebral cortex in the cingulate gyrus, in which the pain is painfully aware. These biological effects of words and ideas on the brain has recently been determined by imaging methods PET [9]. This of course means firstly that the emotional feeling of pain also depends on what we believe and think, and then, as I said, that the metabolism and neuronal activity of our "pain center" not only by painful stimuli, but also through words and thoughts can be influenced. Under this aspect, we might also have the effect of prescribed placebos somewhat understandable that medical science is indeed still a mystery appears. If these miracle cure administered for pain by a physician with persuasive words, so about 50% of patients experienced pain relief. Currently, the United States is intensively studied and seriously Placebos and their effect and not least to help to bridge the wide gap between an orthodox, strictly scientifically oriented and an alternative or complementary medicine at prestigious research centers. So it was a major advance in the placebo research, when it first became to objectify a placebo effect by scientific methods. One of California's working group [10] succeeded it recently to improve the symptom scores of depressed patients with placebo, while the researchers in the prefrontal cortex could detect a change in the brainwaves in those depressed patients whose symptom score is improved due to an "effective treatment" placebo pills , Of course, said only half of those suffering from depression patients respond to this treatment. The remaining brain waves remained unchanged, just as with the with selective serotonin reuptake inhibitors (SSRIs) unsuccessfully treated with medication. The successfully healed with medication depressed the brain waves of the frontal lobe changed also, but in a somewhat different way than in a placebo-treated: The neuronal activity took namely, not from, as in the case of placebo treatment. It is therefore possible to distinguish objectively in the treatment of depressive between placebo and drug response. This is relevant because allegedly 50-70% of a therapeutic effect of antidepressants must be attributed to a "placebo effect". but is very remarkable also obtained by the experiments realization that placebos, or the belief in the curative effect, not only subjective, but actually have an objectively ascertainable effect by causing a persistent and characteristic biological change in the brain and its brainwaves can. Such effects have but presumably not only placebo, but as I said also suggestive words. C. G. Jung reported that he was able to free a client just by a short talk by the psychogenic fever [11]. Words can not only heal, but also to offend - and this in two senses of the word, they can make you sick. Everyone knows how much a word said in anger can hit and injure a person and certainly stuck in my memory. Stress words or even frightening threatening words solve psychogenic stress out - also anger and fear - and (unresolved) Stress weakens the immune system [12]. 348 Rüegg, Psychosomatics, psychotherapy and neuronal plasticity - therefore how words affect Chronic stress increases the morbidity and mortality from infectious diseases enormously. [13] But act hurtful words on the brain? Stress words have strong neurolinguistic effects - by leaving their material traces in memory, or in the brain: they invade us - up in the area deep in the temporal lobe amygdala (amygdala), which are known to process our emotions, especially fear and aggression. This has recently been demonstrated by imaging methods PET: Stress threatening words or words caused an activation of both the right and the left amygdala [14]. Particularly sensitive and sustainable but responded Depressive or people who once before went through a depression, as demonstrated using functional magnetic resonance imaging [15]. The amygdala of formerly depressed individuals answered in these experiments to emotionally negative loaded words such. As murder, death, suicide, or cancer with a long-lasting hyperactivity. The subjects studied were so to speak, their negative feelings do not get rid of as quickly, which were triggered by the depressing buzzwords. Apparently the earlier undergone depression had altered neural networks in the amygdala, they sensitized to a certain extent for depressing or frightening words. For the never depressed control subjects responded to the depressing emotive words with only lasts a few seconds activation of the amygdala. This might be activated only at the mere sight of depressed or anxious faces distorted [16]. The amygdala evaluates our disposal, from the sense organs messages regarding their meaning character, danger, for example, and if necessary shall very quickly appropriate emotional reactions associated with activation of the sympathetic nervous system and the hypothalamic-pituitary system. The stress hormones adrenaline and cortisol are released, increase heart rate and blood pressure. On the other hand, also the springing in the brainstem nerve vagus be activated and therefore fall in blood pressure, particularly when a "fright heart nearly resting" as the saying goes. An example: As a young doctor diagnosed Thure von Uexküll in clinical lecture a patient with a seemingly harmless enlargement of the spleen before, but instead of speaking of spleen, he used the medical jargon "splenic" without considering that the word "tumor" also is used for "cancer". but the patient had startled and frightened by this word. It was a stress word for him. For him that meant itself harmless word tumor "cancer" and he had therefore seen as a death sentence and is still faint broken during the investigation with a circulatory collapse together [17]. Such fainting (syncope) are as I said from the brain through the mediation of a cranial nerve, namely the vagus nerve, triggered by its activity inhibits release of acetylcholine the heartbeat, in extreme cases up to cardiac arrest. And: Such effects can also be conditioned as demonstrated animal experiments. Conditioning of emotions and the body's own defenses When rabbits are afraid or frightened, so they remain somewhat heart stopped and her blood pressure falls. The American psychologist Bruce Kapp succeeded the conditioning of this effect on the cardiac rhythm [18]: Every time the guinea pigs heard a buzzing sound, they received a slightly painful electric shock, the frightened and the pulse slowed. Over time, however frightened the animals alone at the sound of the tone, her pulse slowed dramatically and the blood pressure fell because they unconsciously associate the tone with electric pain. Kapp rabbit got something of a "sound phobia" or perhaps a "cardiac phobia", since the heart rhythm was disturbed. This acquired by associative learning (conditioned) fear response did not materialize when Kapp injured parts of the amygdala by surgery before conditioning. As can be concluded from these experiments, that the amygdala obviously plays a central role in learning the anxiety and its effects on the heart and circulation. Joseph LeDoux and employees have demonstrated in rats that the neural networks of the amygdala to be restructured in learning the fear in such a way that a synaptic connection of the auditory pathway is paved to the amygdala [19]. They discovered namely in the amygdala neurons that (only) reacted to the fear conditioning both sound stimuli and to pain stimuli and thus a buzzer with pain associated [20]. Such restructuring requires the acquisition of fears chemical processes, in particular a formation of proteins, since stronger or even new synapses have to be made. Namely, the gene expression of proteins is inhibited, finds a fear conditioning not occur [21]. How far can be, however, the above-described animal experiments on the mechanism of conditioned fear responses transmitted to the clinical conditions? I think they are relevant to the psychosomatic, especially for understanding the development of phobias, such as fear of heights, claustrophobia or heart phobias. Attempts to fear conditioning of animals, however, are also useful for understanding the origin of post-traumatic stress disorder. If such, then known for years after the previous traumatic experience by certain cues physical fright and fear response evoked that is learned because of the traumatic experience, namely palpitations, shortness of breath and trembling, in short, an alarm response. For example, unit of suffering from posttraumatic stress disorder war veteran with a cannon in a panic because he characterized (unconsciously) is reminiscent of his war trauma. The fears of posttraumatic incriminated are so learned through conditioning - just like phobias or the fear reactions conditioned animals. All these fears and phobias are organic changes in the brain, namely neuroplastic restructuring 349 Rüegg, Psychosomatics, psychotherapy and neuronal plasticity - how words function in the amygdala and other brain structures underlying means of which previous traumatic experiences in the (implicit) have dug memory [ 22]. Maybe effected a successful Verhaltensbzw. Psychotherapy that sickening associative neural links dissolved in the nervous system again, so to speak, "remelted" [23]? Restructuring of neural networks in the brain are probably also based on the conditioning of the immune system, which established the Psycho € immunology paradigm. How conditioning experiments proved humans and animals can learn to change the reactions of their own immune system [24]. By conditioning test animals could even teach you to endure a blood infection with bacterial endotoxins better [25], but this therapeutic goal could also by stimulation of the 10th cranial nerve (vagus nerve) can be achieved [26]. In this context, the American Psychoimmunologe Kevin Tracey recalls that even hypnosis - that spoken words - vagus activate the nerve and thus probably can also affect the immune system [27]. Pain diseases Some pain diseases can be seemingly ever find no organic findings, and it is usually called, the suffering is just "psychosomatic". Consider, for. Example, to chronic back pain without physical findings or phantom pain, which are stored in so-called pain memory and are therefore often be felt for years after an amputation of the leg or arm. But now you know recently that even accompanied such psychosomatic pain with materially tangible fine structural changes in the nervous system, which adequately explain the pain occurring. This enabled the Heidelberg pain researcher Herta Flor, in patients with phantom pain pain-related changes of cortical structures - 1 to 2 cm large shifts in the neuronal "maps" of the somatosensory cortex! - Detect, and could these changes by certain behavioral interventions do (a perception training) reversed, whereupon the pain improved [28]. In the somatosensory cortex, so in the cortex of the dentate gyrus, the body surface is known to be reduced as represented on a map. The representation of the hand is the face directly adjacent. After an amputation of a hand, however, a drastic reorganization of the mental map takes place: The amputated hand should really no longer be sents repre- the somatosensory cortex. Surprisingly, however, there is still a hand-representation in the cerebral cortex, but less space than before the amputation. For the hand region expands directly adjacent area for the representation of the face; it invaded it were in the hand region and penetrates them, so that they almost melts on the cortical map with the face area. Consequently, feels the pain patient response to painful stimulation of his face not only the painful cheek, but he means the pain in the (defunct) to feel hand. Flor suspected that such a reorganization of mental map of the somatosensory cortex is the actual cause of phantom pain, because their strength was correlated with the degree of neuronal restructuring. What could be more than an attempt to make this neuroplastic change somehow reversed in order to reduce phantom pain? The pain researcher achieved the desired cortical reorganization by a behavioral training, in which the ability of the so-called sensory discrimination ability of the phantom stump was trained, and then disappeared the pain. Such psychosomatic pain are therefore not just "imaginary" (as laymen sometimes think), but they have a tangible neurobiological cause: a change in the brain, and behavior therapy to cure by turn changes the brain! So can pain patients 'forgotten' by restructuring their plastic brain their chronic pain, erase her memory of pain to a certain extent, and this could be done perhaps by way of a cognitive restructuring, ie for example by autosuggestive soliloquies and thoughts? Thinking, cognitive restructuring and neuroplasticity Everything we talking, even in therapeutic conversation, record, and consciously or unconsciously store in memory, changing our neural networks, because based on such mechanisms, as stated our memory. But not only talking with others lead to medium and long-term changes of synapses and spines in neural networks of the person addressed, we can also talk to ourselves and act upon ourselves, by our own thoughts and ideas, even by our faith, as teach the different auto-suggestion techniques. What happens in the brain when we think? If we think and "verbal" in terms, it is often as if we were talking quietly to ourselves? and we can also notice such thoughts. I postulate, therefore, that also by verbal thinking influenced analogous to speak the synaptic connections between the neurons of the brain and restructuring [29]. Our thoughts sit down in our brains fixed as opinions and beliefs and fixed in an extreme case even as Idée, and this especially when constantly recur the same thoughts and impose the consciousness. It would follow that if we were to change through our minds, but also by our faith, the complex material structures of our brain, the neural "Ensembles" capable. Similar thoughts expressed already the physiologist and Nobel laureate John Eccles in a conversation with Karl Popper, who brought it to the point: The I seal his brain, he said. [30] The neural networks between neurons would undoubtedly otherwise altered by positive beliefs and positive thoughts than negative thoughts circles as for depression and Zwangsneuro- 350 Rüegg, Psychosomatics, psychotherapy and neuronal plasticity - is typical sen How do words. Depressed my in her circling thoughts z. B. repeatedly that they were not able to reach their destination, and therefore they do not achieve it. And thus they feel confirmed in their thinking and are more depressed. Negative thinking, wrong thinking and belief structures are therefore often psychosomatic disorders based and therefore the therapist tried to change the ways of thinking, such. As by cognitive restructuring or cognitive behavioral therapy and he conveys by hope. In this neural network are changed. Positive thinking and the principle of hope has been demonstrated to reduce stress reactions and pain. So it is for. B. not least depend on our mental attitude, how strongly we feel a pain or how we deal with stress, and with post-traumatic stress. Psychophysical interactions of this type are almost a paradigm for change how mental processes, self-experience and our faith the body and brain, thus also for a psychosomatic Done. Conclusions and perspectives In recent years it has become increasingly clear, as changeable as plastic are the neural structures of the brain throughout our lives. We have also learned the crucial role of neuronal plasticity both in the formation and in healing psychosomatic illnesses, and we have seen how very words, and probably our own thinking, affecting the neural networks of the brain, and even restructure can. So we can understand the power of words for the health and lives of people on a neurobiological level, and I think the acceptance of psychosomatic cures by a strictly scientifically oriented medicine is likely to be higher so in the future, the better it is possible neurobiological plausible model concepts and to develop mechanisms through psychophysical interactions. Thanksgiving Mrs. A. Ebling I thank for the revision of the manuscript and the Fonds der Chemischen Industrie for helpful assistance.
在弘一法师身上，有许多个“想不到”，这样一位奇人和畸人（他和苏曼殊被称为“南社两畸人”），居然会不小心投胎世间，可能连造物主也感觉意外吧。想不到，他是第一个将西洋油画、音乐和话剧引入国内的人；想不到，他在东京的舞台上演出过《茶花女》，扮演的不是阿芒，而是女主角玛格丽特；想不到，他是才子，是艺术家，本该落拓不羁，却偏偏是个最严肃、最认真、最恪守信约的人；想不到，他在盛年，三十九岁，日子过得天好地好，却决意去杭州虎跑寺削发为僧……
