By Rick Leskowitz MD

Overview
We live in a time of great polarization, when our societys attention seems to be focused on what divides us rather than what unites us. And the Covid story is the primary forum where this divisiveness is playing out. Theres no consensus on any given aspect of Covid, so people will have diametrically opposite opinions on each of these elements, whether its the politics of public health measures, the scientific research underlying these policies, or the hidden agendas motivating public figures. Weve all experienced first-hand how difficult it can be to have a conversation about these issues, with people becoming defensive, judgmental, and even more fixed in their points of view at the drop of a hat, with just a few poorly-chosen words. Its become much easier to avoid than to engage.

With that in mind, Ive found that my background in holistic medicine is helpful. Bitter experience has taught me how to communicate far out ideas to people in the world of academic medicine, and Ive noticed that strategies from that arena can at least increase the odds that any given communication about Covid will be constructive rather than destructive. Ideally, bridges could be built rather than burned. None of these approaches is new, as they come from such well-established traditions as non-violent communication, deep listening, mindful inquiry, and simple respect for the Other. They all spring from the idea that we have each adopted our own POV for reasons that may make sense to no one but ourselves. And thats how it should be.

So the goal in these conversations isnt to change someones mind, but to learn how they got where they are, and why an idea makes sense to them. In the course of this exchange, however, hidden beliefs and assumptions may surface that surprise the holder, leading to a re-examination. Or maybe not – its not the primary purpose, though it can be a welcome side-effect. Resources outlining these approaches are readily available (see Resources), but some key pointers are clear: Avoid trigger phrases and judgmentalism or
self-righteousness. Use words aligned with the jargon of the person youre talking to (ie, my med school mentor said I should talk to skeptics about magnetic fields instead of auras, and it made a huge difference). Be willing to explore whats being triggered in you, because everybody has issues, not just Them. This is a chance to find yours (ie, the need to always be right, the wish to be in control, etc.).

And finally, since data and science are at the core of much of the Covid debate, Ill include two examples of how Ive used these principles to present a more holistic view of Covid. The viewpoint is not anti-vaxx or pro-vaxx, but hopefully has something of value for both sides: both/and, not either/or. What follows are two Op Ed commentaries Ive written for a local newspaper (The Greenfield (MA) Recorder) over the last two years. Theres no groundbreaking information here, but they were written with my neighbors in mind – non-clinicians who are vaguely aware of the world of holistic health and integrative medicine and are curious but confused about whats going on in America today.

Self-care for two viruses (5/24/20)

Its been a stressful few months for our planet, as we humans try to figure out how to deal with the coronavirus pandemic. The ongoing uncertainties about the situation make it even harder for us to cope, so Id like to offer a perspective based on my 25 years as a psychiatrist working with chronic pain patients. Even when our current pain is more psychological than physical, the same principles apply.

Self-management was the key tool for our patients we taught them how to take charge of their nervous systems by using stress management techniques to become more functional in their lives. A major hurdle was their tendency to turn little aches and pains into medical catastrophes. But they gradually learned to get calmer and become comfortable with the feedback from their body: in the jargon, they stopped catastrophizing. Were all doing something similar with COVID. Our news media has always specialized in catastrophizing, and its become even more evident with their coverage of COVID.

Will one million Americans really die? Will we be in lock-down for another two years? No one really knows yet, but worst case scenarios are the specialty of the house on TV news. Its as though the media is spreading another virus: fear. And its an easy virus to fall prey to, so here are some suggestions for resisting that bug.

We can get so focused on the externals that we lose the context. Remember virus particles are in the air everywhere, all the time. Our immune systems have evolved to take care of that, and theyre good at it. So unless youre in one of the medically high risk groups (i.e., the tragedy at the Holyoke Soldiers Home), or arent following public health measures like masking and social distancing and get coughed on by an infected carrier, your natural defense mechanisms will most likely serve you well and develop protective antibodies. The virus is not like plutonium low exposure levels can be tolerated by most healthy people.

Bacteria and viruses only flourish when the terrain is favorable. External factors like malnutrition, overcrowding, poverty and especially with a lung disease like Covid air pollution make a huge difference. But the intangibles can be just as important its well known that immune function is damaged by stress in particular, by the loss of social connections and by loneliness. So COVID has a Catch-22 the same public health measures that cut down our exposure to the virus can also break down our social cohesion and impair our resilience.

Thats why its important to be able to feel empowered in these tough times, aided by whatever positive emotions you can access. Here are some suggestions. If you already have a stress management practice exercise, meditation, yoga youre well on the way. Cultivate your own approaches, anything that takes your mind off the thoughts of worry and What if? Nows a good time to start up your veggie garden, take your dog for a walk, sing in the shower, listen to the breeze rustling in the trees outside.

And some things are worth cutting down on: for example, eating Big Macs and drinking Diet Cokes impair immunity (a recent Boston Globe Op-Ed was entitled The link between coronavirus deaths and those French fries). And TV news should be limited to small, infrequent doses to avoid insomnia.

Its also time to be kind to yourself. A very effective way to boost your resilience is to put aside self-criticism and judgment, and to just accept that youre doing the best you can. Youd give that extra kindness to a loved one in a rut so why not extend that same kindness to yourself? Notice when you get caught in a negative train of thought, and follow that observation with a feeling of self-acceptance: Im an OK person even though some negative thoughts just came to mind. And that sigh of relief tells you that youve hit the spot and released another bit of stress.

So lets not hold our breaths while we wait for a vaccine. We can empower ourselves and our immune systems with meditation apps, Zoom calls to friends, acts of kindness to ourself and others, and time spent outdoors in our beautiful Pioneer Valley. Taking care of the fear virus will help us better handle the coronavirus.

Rick Leskowitz is a Buckland resident who worked for many years at Spaulding Rehabilitation Hospital in Boston.

Covid: The germ or the terrain? (11/2/21)

The germ theory of disease was developed by the French scientist Louis Pasteur in the late 19th century. His idea that invisible bacteria and viruses cause disease is now a cornerstone of Western medicine, as weve developed a large array of medicines to fight back against these invaders (thats why we pasteurize milk as heating it kills the germs). Surprisingly, though, on his deathbed, Pasteur renounced his theory in favor of a rival approach the terrain theory of disease.

In this model, the key feature was not the presence or absence of germs, but the innate health status of the person (what are called host factors in modern medicine). In other words, the body was the terrain, the internal environment, the soil in which bacterial seeds tried to sprout and take root. Not everyone who is exposed to a pathogen gets sick: if the body is healthy, bacteria cant thrive, but a weakened body can be overwhelmed by invisible invaders.

Its an important distinction for several reasons. Though neither Pasteur nor his rival, Claude Bernard, knew about immunology, we now realize that the immune system is a key factor in determining health. Bacteria and viruses have always been present in our environment, and over the past several hundred thousand years, humanity has generally been resilient enough to bounce back from other plagues. So what, if anything, is different this time around with the COVID pandemic?

Our public health policy has strongly focused on the germ theorys approach, aiming to vaccinate all Americans, even beyond the original 70-80% target that would bestow herd immunity and cause the virus to wither on the vine. So Americans are encouraged to rely on an external agent to bring them health, without any direction on how they could also improve their terrain.

But optimizing host factors could make it harder for viral guests to enter our bodies through the open door of ill health: a healthy immune system can shut that door. And thanks to advances in the field of psychoneuroimmunology (PNI), we know how to do this. So here are several key approaches that boost our own immune resilience, as a complement to what vaccines do. These are cheap, effective and empowering, giving people a sense of influence and agency over their own health.

The first area PNI investigated was the role of stress in impairing immune function. It was a controversial idea when first proposed by Hans Selye in the 1950s, but its now widely accepted. So one key step in dealing with COVID easier said than done is to learn how to manage stress effectively. Thats a topic worthy of another essay, but everything from meditation to socialization, from walking in the woods to listening to music, can help boost your immunity; it also increases your sense of empowerment and decreases any sense of helplessness.

Several other factors are very specifically related to COVID, and emerged from analyzing the characteristics that COVID-related deaths share. The factor most strongly correlated with poor COVID outcomes is the amount of Vitamin D in the bloodstream. That might seem an odd connection, but Vitamin D is a key booster of the immune system, and its levels tend to be low in Americans in general, perhaps because we spend more time absorbing light from our computer monitors than from the sun, which our bodies use to make Vitamin D; annual winter spikes in colds and flu are related to shorter days with less sunshine. Yet there has been almost no public health messaging about this factor, or even free distribution of this inexpensive vitamin supplement to at-risk populations.

Another risk factor is obesity, which not only impairs pulmonary health but also sets the stage for the over-active inflammatory response that does so much damage to COVID-infected lungs. So wheres the publicity about weight loss to prevent COVID, or infomercials about decreasing our bodies chronic low-level inflammation via so-called anti-inflammatory diets?

Exercise is another key preventive factor whose value is not widely known. A recent study showed that, among people who developed COVID symptoms, those who had practiced regular exercise before they became ill had almost three times the chance of avoiding hospitalization, while those who rarely exercised were much more likely to end up in the ICU or to die.

So in summary, I think our approach to COVID should be based on both the germ theory of disease (vaccines, masks, social distancing) and the terrain theory of disease (self-care measures like stress management, Vitamin D supplementation, weight loss, and exercise). In other words, lets use both models, rather than choosing just one, as the best way to get through this crisis.

Summary

One of my neighbors read these Op Eds and told me that I should run for the open position on our local Board of Health. I took this feedback as a sign that the essays had resonated with her, but I declined the invitation to run for office because the political arena is not for me – I might have to come down from my ivory tower into the trenches, to really walk the talk and practice what I preach!

Resources
My Turn Op Eds are reprinted by permission of The Recorder, Greenfield MA https://www.recorder.com/Self-care-for-two-viruses-34342721 https://www.recorder.com/my-turn-leskowitz-CovidGermVs-Terrain-43231658

Non-violent communication:
Rosenberg, M. Nonviolent Communication: A Language of Life: Life-Changing Tools for Healthy Relationships (Foreward by Deepak Chopra), PuddleDancer Press, Encinitas CA, 2015
The Center for NVC: www.cnvc.org.

Deep listening: Oliveros, P. (2005). Deep Listening: A Composer’s Sound Practice. New York: iUniverse, Inc. ISBN 978-0-595-34365-2.
www.deeplistening.org

Radical acceptance:
Brach, T. Radical Acceptance: Embracing Your Life with the Heart of a Buddha, Random House, 2004

Mindful self-compassion:
Germer, C and Neff, K. The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive, Guilford Press, NY, NY, 2018.
www.centerformsc.org

Strategies to boost immune resilience:
Li, C. How to strengthen your inner shield. https://www.dailygood.org/story/2483/how-to-strengthen-your-inner-shield-science-based-integrative-strategies-for-a-healthy-immune-system-during-a-pandemic-cynthia-li-md/

Bio: Rick Leskowitz, MD, is a retired psychiatrist and Buckland resident who worked for many years in a holistically oriented pain management program at Spaulding Rehabilitation Hospital in Boston. email: rick.leskowitz@gmail.com