Hepatitis: In both Who Gets Sick? and A Different Kind of Health, you talk about people who speak of themselves as being well, although they are often chronically or terminally ill. Will you discuss the effect that their attitude has on their lives, not only the quality of their lives from the subjective point of view, but in terms of the actual physiological changes that can sometimes occur because of a person’s belief system?

Blair Justice: I use a stress model because stress is not only psychological and emotional, but also physical. There are definitions of disease that say that disease is a response to stress when it is defined as physical stress. This would include viruses, genes that go wrong, chemicals in the atmosphere, chemicals that people ingest, as well as stress that is induced by how we perceive events. Such events include the stress of having life-threatening diseases such as hepatitis C or cancer.

So, using that kind of model, you can see that the biological pathways have common features. We activate a stress response regardless of which category it falls into. We activate two major pathways: one (the easy way) is called the SAM (sympathetic adrenal medullary) system. The other is called H-PAC (hypothalamic adrenal cortical) system.

Those two pathways are involved in elevating chemicals that we all need but abuse. We are here — in terms of survival — at the top of some evolutionary scheme, I guess you could say, because we have chemicals in us to energize ourselves in an instantaneous moment, a characteristic very necessary if you were facing a saber-toothed tiger.

But today we live in a symbolic world, certainly in the western world, and our stresses are nonphysical. They include things like loss, criticism, rejection. All of those things equally elevate cortisol and norepinephrine, just as much as getting a diagnosis of hepatitis or cancer, where you not only have to deal with the emotional impact of hearing those words, but you’re contending with some aberration of cells. And when you have an aberration, it’s stressful on the body. The same pathways are elevated. So we want to do anything that we can do to reduce the level of those stress chemicals. Usually if we get something that is very biological, the only thing that we have to work on is the psychological and emotional and how we respond to it. But that is very powerful stuff. It isn’t mystical.

Hepatitis: Then you are clearly changing something physiologically?

Justice: You are changing neurotransmitters and these chemicals. The conduction starts from these neurotransmitters, which then impact these two major systems — one is the neural system and the other is the endocrine system.

Hepatitis: How does that apply to what people call the "placebo effect?"

Justice: There is a placebo effect in every transaction, in terms of a patient and healer, because you don’t go to a healer without some expectation, and that’s what the definition of a placebo is — an expectancy — a positive one.

Hepatitis: So when we go into an experience expecting something positive to happen, we are initiating a placebo effect? Even if it is only coming from ourselves and our own positive attitude about whatever it is that we are bringing to the table, whether it is a changed diet or changed expectations about what we can do for ourselves in altering the way that we are living?

Justice: It isn’t just a Polly-annaish outlook. It is recognizing that good and bad can coexist. So if I acknowledge that I’ve got hepatitis C or AIDS or cancer or heart disease, that doesn’t negate the fact that I can still find benefit in the experience. Well, the body benefits because instead of reacting by keeping these stress chemicals high — and also keeping one’s serotonin low — it can do just the opposite. Because stress does have an effect on serotonin and on dopamine, which is the pleasure chemical. It can elevate those neurotransmitter levels if given the right kind of input. You can raise your serotonin and dopamine levels simply by hugging your spouse or watching a sunset or playing with your dog. If you’re sick, it makes sense to seek something about which you can say, that’s a value, and do more of these things that raise dopamine and serotonin levels.

Hepatitis: Talk to us a little about how people respond differently to treatment for hepatitis C. Let’s say that we have two people, Jack and Peter, and they’ve both been diagnosed with hepatitis C, and they’ve both been typed and both have the same genotype and both have been given the same course of treatment for 48 weeks. Jack has been very, very sick. He can’t work, he can’t really go out, and is basically unable to do much of anything at all. Peter doesn’t feel all that great, but he’s also able to do some work from time to time. He can do some yard work, some house work and maybe attend a support group every once in a while. Why do two people with the same illness and the same genotype have such a different experience of the same course of therapy?

Justice: It’s kind of difficult really, even with the advances today in genomics, to know that people have identical genetic input. Now, if you took two identical twins and made that hypothetical case, you’d come closer to it, but even then, the immune system still has a lot of mystery to it.

Viruses are so tricky. They hide. When you start talking about being a carrier, which we do in hepatitis, this is now what is being found in AIDS. There is some mystery so far, but it will be unraveled eventually. There is something that seems to occur in the early stages, and now they are testing the hypotheses. The idea is to try to outwit the virus. So maybe in hepatitis we will find that it is much the same thing.

We are now finding, in this 20th year of AIDS, going back to these people who have had HIV infection for years, that there is something in the very early stages that the immune system on the molecular level does in terms of activating a particular type of T-4 cell. The T-4 cell then commands the killer cells and the other protectors to go to work, versus the person who doesn’t have this particular type of T-4 cell, and therefore, the troops don’t get marshaled. This is just now being discovered. But this seems to be very important in terms of explaining how people start out differently in treatment when you’re dealing with viruses.

The easy answer to your question of course, would be that these two people are affecting the immune system. One, by strengthening it in terms of how he lives and looks upon life, and the other one is depressing it. Because you can do that. The immune system is pretty easily influenced. We know this from Pennebaker’s work and now from all the data that’s being shown on what happens when people write about their pain.

Hepatitis: Could you talk about that?

Justice: Writing has measurable advantages if people will do it, but it requires discipline. You must first, in effect, sign up for it — doing it at least five days a week for at least 15-20 minutes a day, but the second assignment is that you must be very self-disclosing. And, even when people know that they are the only audience, some people still can’t be self-disclosing. Those who are self-disclosers and who really do write about their deepest thoughts and feelings in what their biggest pain in life is are going to get an increased immune competence, and it’s likely to occur within six months. The immune system doesn’t react immediately. You have to track it. But at the end of six months, they are going to have a higher immune functioning.

Hepatitis: In what way?

Justice: They will have fewer visits to a primary care physician. They’ll have fewer respiratory ailments — things that people get every year, and they will spend less time away from work because they’re sick. And, they will feel better.

Hepatitis: So basically, because people are not talking about or writing about or unburdening themselves to anyone, including themselves, they are trapping these feelings inside and in some way making themselves sick?

Justice: You see, that’s what stress is about. It is stressful to, in effect, put in a closet what you know happened and what you feel. Stress is defined as imbalance between demand and resources. In this case, stress is an imbalance between what we are willing to acknowledge to ourselves, and what actually exists, what we deny and what actually exists.

So denial is a stressful kind of posture. I’m talking physiologically stressful. Once you stop that denying and become self-disclosing — and you’re not doing the disclosing to anybody else but yourself — the body benefits. Just from the simple fact that you’re expressing what has been bottled up; you get a response.

Hepatitis: And that is a measurable response?

Justice: Oh yes, it’s hard data. And it’s such an opportunity for people. But again, many people will not be that self-disclosing, even if their life depends on it.

Hepatitis: Naomi Judd wrote the introduction to the second edition of your book, A Different Kind of Health. What special strengths do you think that she has that have become her greatest allies in terms of her fight against hepatitis C?

Justice: Naomi is a strong-willed person who raised two daughters on her own and did a good job of it. She was disciplined enough to go through nursing school and then become a practicing nurse. More than that, she then recognized that she had a talent in music, and then really developed that talent, not only in herself but also in her two daughters. One of them, of course, has now become an accomplished actress (Ashley Judd), while her daughter Wynonna continues the singing career that she and her mother began as a duo. All of these things are powerful in people’s lives.

Naomi was also spiritual from the beginning — a powerfully spiritual person. So she knew how to do things, once she read the evidence about what she could do for herself. It benefited her, and it continues to benefit her. She now goes around giving inspirational talks for corporations, and she may be back on the circuit, I don’t know. She told me that she did join her daughter, Wynonna, after she got that virus-free outcome on the test.

Hepatitis: So she is well?

Justice: The physicians would say that she is in remission. Well, if you are in remission for the rest of your life, is that well?

Hepatitis: That sounds pretty good to me. So, Naomi Judd is a good example of someone who is technically ill, who has a chronic illness, who says, "I’m well," and when you measure it…

Justice: It wasn’t just through positive thinking. That must be emphasized. She did dietary management. She did stress management. She learned techniques and had the discipline to follow through on them, and she already had her faith. But she didn’t stop taking interferon, and she paid attention to what her physician said, too. So that’s just another example of how you want to pay attention to what you can do for yourself, but there is a balance. You don’t just get to sit down and say, "I’m going to fight this thing and I’m going to lick it. I don’t care anything about learning techniques." She didn’t do that. Naomi Judd is a good example of someone who used the best of both medicines and the so-called alternative or complementary techniques to recover from hepatitis C and get on with her life. hep

Sheri Nelson Maclean is a free-lance writer living in Houston, Texas.