Tami Simon: You’re listening to Insights at the Edge. Today, my guest is Martin L. Rossman. Marty is a physician and acupuncturist who has practiced holistic medicine for over 30 years. He is cofounder of the Academy for Guided Imagery and the author of the award-winning Guided Imagery for Self-Healing and Fighting Cancer from Within. With Sounds True, Marty has created several programs, including an audio program with Dr. Andrew Weil on self-healing with guided imagery, also a series of guided imagery programs on anxiety relief, stress relief, pain relief and on other topics as well.

In this episode of Insights at the Edge, Marty and I spoke about the reasons guided imagery is not more present in medical practice even with the proven data to support its effectiveness. We also talked about placebos and what the effectiveness of placebos might tell us about the mind/body connection. We talked about some of the basics of how to use guided imagery in your life, and why personal imagery can be more powerful than receiving an external image from someone else. We also talked about working with cancer with guided imagery, and finally why the use of imagery in medicine is such an enduring passion for Marty. Here’s my conversation with Dr. Marty Rossman.

Marty, when I hear something like ‘guided imagery’ in the practice of medicine, I think to myself, “Well, that’s kind of the soft stuff, right?” I mean, how effective, how powerful, how “turbo-charged,” if you will, is guided imagery?

Marty Rossman: That’s a good question Tami. And of course in a sense, it’s really the key question because it’s not that otherwise we wouldn’t really be interested in it, but guided imagery can be surprisingly powerful in some circumstances that can actually be measured. I’ll give you an example in a minute. And then there are effects that it has on people that are very difficult to measure and I’ll talk about that too.

The example that comes most quickly to mind in terms of its effectiveness is in terms of, for instance, preparing for surgery. And there’s quite a literature on guided imagery that people listening to something like a guided-imagery preparation, a 15 or 20 minute relaxation/guided-imagery preparation for surgery—there’s a number of them, we’ve made one, I’ve made one for Sounds True that you make available—that people listening to that before surgery have a tremendous reduction in complications from surgery.

There’s a study that even a simple suggestion—there was a study at UC Davis by Dr. Henry Bennett where they went into the rooms of patients in the hospital the day before abdominal surgery—those were the days when they used to put people in the hospital the day before; now you don’t have to get out of the car. But they’d go in, and of course people are very frightened usually the day before surgery; they’re very anxious. Psychologically, what happens whenever we’re really anxious or frightened is that we tend to regress a bit. We become more childlike. There’s a part of us that’s looking for somebody who’s bigger than us, smarter, more powerful to reassure us. That’s all very unconscious.

So when they went into the room the day before, they didn’t do any long preparation or any hypnotic induction or anything like that. They just said to the people, “You know, when you wake up from your surgery, you might be surprised to find that you’re thinking about some of your favorite food, and how it looks and how it might smell, and that you’re stomach may begin to churn and growl and make noises,” and so on. That’s all they did. That was the complete intervention.

In those people that they said that to, there was a 50 percent reduction in a post-operative complication called “postoperative ileus”, which is when the bowel doesn’t start up again and people don’t have bowel movements. Postoperative ileus is a very serious complication of abdominal surgery and something that surgeons fear and that we don’t really have good medical treatments for.

So with that simple suggestion made to people the day before, they cut that by half. The same research team did an interesting study where they said to people, “You know, your body is very smart. And when you’re having surgery, your body can shunt the blood away from the surgical site.” They gave them the example of, you know when you’re embarrassed how you blush, when you’re afraid your face may blanch. That’s an example of how your body opens or closes blood vessels and can move blood to or from an area.

They said, “Your body can move the blood away from the area of the surgery, so that it’s easier for the surgeon to see what they’re doing, and then afterwards it can bring the blood back to enhance the healing that can happen. And they had 40 percent less blood loss. That was just with, again, one simple suggestion, without a lot of preparation and relaxation. Now, the second [study] needs to be repeated, because in science we like data that’s replicated by different people, but the first one has been included in a lot of guided-imagery preparation CDs and methods that are fairly widely used now and seems to actually be a real finding.

So to me, that’s where the rubber meets the road. [That’s] where you see this sort of ethereal, airy-fairy guided imagery—it’s invisible, it’s something you do with your mind, it’s a nice idea—but to me when you look and you say, somebody can listen to a 15- or 20-minute preparation tape, and not only have reduced anxiety—for instance I did a study with Kaiser Permanente Cath Lab out here. They do angiograms and cardiac catheterizations and pacemaker placements for people with heart disease. And when they ask people when they go into these procedures, on a zero-to-ten scale—where zero is none and ten is the most you can handle, what’s your anxiety level, [and] the average level was eight out of ten. And they listened to a 15-minute guided-imagery preparation, which basically takes them through the procedure, tells them what’s going to happen, makes suggestions on how they can stay relaxed, how they can breathe easily, how well-qualified their doctors and nurses are, how everybody’s paying attention and everybody is there to take care of them. They listen to it once and their anxiety level goes down to less than one.

TS: Wow!

MR: And the reason that is significant is not only because, as human being, you relieved a huge amount of anxiety, but also your physiology changes and you don’t have all of this adrenaline and catecholamines, which the cardiologists do not want running through your system when they are doing these procedures. So we’re going to be doing follow-up studies to see if it reduces the complication rate and the post-operative adverse affect rate of these procedures too, which I think it will.

But just the fact that it reduces the anxiety level that much—it does that for surgeries, it cuts the ileus rate, it cuts the time it takes to do the surgery—I don’t understand that at all. But it cuts the time it takes for people to do the surgery. It cuts that amount of time people spend in the hospital.

A couple of years ago, I think it was Blue Cross of California, was so impressed with the dat— at that time it was back in the days when we used cassette tapes, [and] they sent out 50,000 cassette tapes to people having elective surgeries to prepare them for surgery. They studied women having hysterectomies, and they found all of those benefits that I’ve already mentioned, plus they found that they save about $800 per patient by having them listen to a $15 tape. So you reduce complications, you reduce bleeding, you reduce anxiety, the surgery goes better, you get out of the hospital faster, and the cost is reduced by a considerable amount.

The only thing that’s puzzling to me about it is, well, why isn’t that mandatory for every surgical procedure that’s done in the United States?

TS: Well, especially with these kinds of cost savings, you would think there would be all kinds of reasons people would be motivated to bring this out.

MR: Surgeons like them. Anesthesiologists like them. So I guess it’s on us—I mean if that was a drug. If that was in a pill and you had a pill that had been shown to have these benefits, it would be malpractice not to give it to everybody having a surgical procedure.

TS: OK. So help us understand the mechanisms that underlie how guided imagery works.

MR: Well, I think there’s multiple mechanisms. Basically, I think imagery is pretty well defined as thinking in sensory terms. So, an image has sort of quasi-sensory qualities and images of thought that you can imagine seeing, hearing, tasting, feeling, sometimes all of the above, in your imagination, in your mind’s eye.

Imagery is a coding language of the brain. I think the best way to understand it is that there’s two major coding languages of the human brain by which we communicate with each other and we communicate internally, and one is whatever our language happens to be. You could argue that there’s three coding languages, one being your native language, the second being mathematics, [or] ways of representing the world internally to yourself, and the third is through imagery. And imagery happens to be one that affects our mood and our physiology much more powerfully than the other two.

There are people who love mathematics so much that when they solve a mathematical problem they get ecstatic, I’m sure, but they’re fairly minor compared to people who may be involved in rituals, in prayer, in mediation, in imaging things like being connected to a source of inspiration, or being confident, or being relaxed, or having whatever quality you what to be, and letting themselves imagine that.

Just like the Olympic athletes—you know, these days we are all watching these amazing Olympic athletes, the gymnasts who do these amazing tricks and the divers and so on and so forth. Well, they don’t learn how to do those things by saying, “I’m going to contract this muscle, and I’m going to relax that muscle. I’m going to contract this muscle and I’m going to relax that muscle.” They have to get an image of what they are doing in their head before they can get their body to do that triple somersault and double twist. They do all kinds of study and practice and so on, and they look at other people. They have to be able to get that image. You see a lot of them using visualization and imagery because imagery is how we learn to do physical things. You learn to ski by watching somebody else ski and then having them guide you and help you kind of move into the internal image that you’re beginning to form. Same thing with any physical act, really—you’ve got to get a mental image of it.

One of the things we use a lot in teaching people very simple imagery and how it affects physiology is, if we ask people to salivate, you’ll find that about 20 percent of people will be able to create more saliva just by thinking about it that way. But, if you ask people to close their eyes and imagine they’re at their kitchen and they’re at a cutting board, and they’ve got a big, fat, juicy lemon. And they’ve got a big fat knife and they cut the lemon into halves and then they cut it into quarters, and they see a drop of lemon juice on the surface of the pale, yellow lemon when it’s cut, and they bring it up slowly towards their mouth, and they smell that lemony scent, and then they imagine biting into that lemon and sucking the lemon juice down their throat, you’ll get about 70 percent of people that salivate. And you’ll get a squirt of saliva from the side of your mouth.

If you have them do that with an orange, they’ll get a squirt of saliva from under the tongue, because those sublingual glands secrete saliva that breaks down sugars, whereas the parotid glands on the side of the mouth react to sour flavors, and if you do a lemon you’ll actually get it from the side of the mouth and people will wrinkle up their face. And it’s just an example of how a simple image gets a physiologic response.

The same thing is true, you know, for guys: I just talk about sexual fantasy. I say [to] just remember the last time you had a sexual fantasy. And it’s not only for guys, but it’s very prominent for men. Men are very tuned into sexual fantasy, and when they sexually fantasize, they get big responses in their body from those images in their brain. That generally makes it very clear how imagining something can affect other areas of your physiology. That’s why [imagery] is important: it just seems to be the coding language that prompts the strongest responses from the body.

TS: So you know, interestingly—I started off by asking you, you know—guided imagery is considered sort of soft, and even a little “woo woo” when it comes to a medical response to a problem, but now after listening to you give these descriptions, and feeling into how powerful imagery is to evoke physiological responses, I have the absolutely opposite question coming up, which is, why has guided imagery and the use of imagery for healing been excluded so much from medical practice, given its effectiveness? Why isn’t it more integrated into medicine today?

MR: Another excellent question. I do a talk that’s called the called “The Art and Science of Mind/Body Medicine,” and I typically do that when I go to hospitals, or if I’m invited to do grand rounds and address a group of my colleagues. Over the years, I developed a presentation, and it was just full of data and statistics and studies, because there is a huge literature on mind/body medicine.

When you look at it, it goes back 40 years. And when you really look at it carefully, it almost all involves imagery and guided imagery, again because imagery is the basic coding language of the psycho-physiologic pathway. As our colleague Ken Pelletier says, there is more evidence and more studies on mind/body effects than any other effect, not only in alternative medicine but also just in conventional medicine. There are thousands and thousands of studies.

So I would put them together in an impressive PowerPoint [presentation] and so on and so forth, and I’d kind of gird up, ready to kind of do battle with my colleagues in my mind, who I often perceived as skeptical and maybe not interested in it. Then about 10 years ago, I was at a hospital down in central California. There were about 100 doctors there, community doctors. And before I started my talk, I said, “I just want to do something that I’ve never done before.” I said, “How many of you think that mind/body effects, the effects of your patient’s attitude, the way that they use their mind, are a critical factor in their health and healing?”

And you know how many people raised their hands? One hundred. All of them, instantaneously, with no hesitation, no looking around to see who else raised their hand. Every single one of them just shot their hand right up. And then I said, “How many of you have ever hand any training or education in how to use these, how to teach mind/body skills to patients?” Two people raised their hands.

So I think it’s kind of the same thing as nutrition, which is another big deal in integrative medicine, which I practice. We used to call it holistic medicine. It’s just not taught in the curriculum, so most doctors don’t feel like it’s their business. It’s not part of medical training; it’s something you have to learn. If your doctor is knowledgeable in either nutrition or mind/body medicine, it’s because he or she has a special interest in it, and they went out of their way as a postgraduate to somehow get trained or certified, or educated in how to use that, even though they all understand and all pay lip service and honor to the fact that in humans, the mind/body connection is, I think, undoubtedly the strongest force in all of medicine. It’s what makes human medicine different than veterinary medicine. You know, in veterinary medicine, you can just treat the body, although they have to treat the owner as well.

TS: [Laughs]

MR: [Laughs]

TS: But you’re saying that you think that point of leverage is in medical training, or one of the points?

MR: Yeah. I think medical training—it’s not part of the curriculum. It’s always mentioned in modern medical schools, [but] I think there’s a little bit more attention paid to the doctor/patient interaction, the importance of stress and relaxation. But you know, when I go talk to doctors, Tami, it’s astounding, even when I talk about the simple basics of stress physiology and relaxation physiology, and the axis between the hypothalamus, the pituitary, the adrenal glands, which is such a basic thing to understand—it’s just amazing how many doctors don’t pay any attention to it.

They are really just drilled and trained—and it’s gotten worse in the modern day because of the economic pressures, which are basically pressing more doctors to see more and more patients in less and less time. The meaning of medicine—to me, medicine has a big “M” on it. It’s more medicine in the way that our Native American forebears thought of medicine. Medicine was really anything that affected you, affected your spirit, your body, and your life. It could be chants, or rituals, or prayers, or your know, beads or rocks or bear claws or herbs or whatever— [they all] could be big medicine words. Prayers could be big medicine.

Medicine, in America, almost equates to drugs and procedures. The medicine of the mind, the medicine of the spirit, just does not have the place that it deserves and it needs. I think it’s a huge loss for everybody, because it takes a lot of the soulfulness out of medicine. So I think one [problem] is, it’s not a focus of education. We learn; you know you go to school to learn how to be a doctor. Well, if they teach you 10,000 hours of one thing, and two hours of another thing, guess what you’re going to be doing?

TS: Right. But just to go under the surface one more level, I mean, who is deciding upon these medical curriculums, the training program, and how does that shift?

MR: Another excellent question. I think it’s something like between 65 and 70 percent, maybe even a little bit higher, of all the research that’s done in all the medical schools in America, is funded by pharmaceutical companies. And over 80 percent of all the postgraduate medical education done for doctors is funded and presented by pharmaceutical companies. And they have ways of, you know, doctors have to reveal any business interactions they have with pharmaceutical companies. There has to be, you know, they have to reveal those kinds of things.

If you talk about the treatment of a certain condition, you can’t just go up there and sell a new drug that you’ve been doing research on for that pharmaceutical company, but because they’re paying your way there and they’re paying your fee, you do that, and you talk about the older drugs as well. But people, very, very, very rarely talk about alternatives to drugs. They don’t talk about nutrition, they don’t talk about lifestyle, and they don’t talk about mind/body things. It’s medicine equals pharmaceuticals.

That’s their business. And they pay for the education of doctors and they provide the education for doctors and they provide the research budgets. It used to be the NIH provided a significant part of the budget, but their funding is way down and has been for quite a while now. So you go to a medical school, and they’re largely funded by pharmaceutical companies. And they’re interested in finding pharmaceuticals.

And the other part of it that is really so interesting is that it has permeated the practice of medicine so deeply that—and we see this in alternative or integrated medicine all the time—when people say “Well, where are the double-blinded, placebo-controlled studies that can prove that acupuncture or guided imagery or nutrition can have effects like that?” Well, they’re few and far between, partly because they’re extremely expensive, a), and b) this gold standard—which is the double-blinded, randomized placebo control study—that’s considered the gold standard for proving that an intervention actually has an effect, and the problem with it is that it’s only applicable to things like pharmaceuticals.

TS: Hmmmm.

MR: So think about this. You have to double-blind the study. In other words, the patient can’t know whether they’re getting the real pill or the placebo pill that is supposedly filled with inactive ingredients. The reason you have to blind the study is because there’s huge literature that shows that if the patient thinks that they’re getting an active medicine, there’s a big effect of that. Half of them will get better, if they think they’re getting a medicine. Is that not guided imagery?

TS: Yeah!

MR: Alright. Then, they found that even if the person giving the patient the pill knows whether it’s the real pill or the real injection, or the real infusion or not, that affects the outcome, even though they don’t say anything. Think about that one, that’s pretty interesting. So they have to go to all that trouble. And these studies cost a couple hundred million dollars to do these studies, by the time you get enough people, enough centers to research it. So you know, are you and I going to do studies that cost a couple a hundred million dollars in order to prove that a 15-minute guided imagery that we sell for $11 is going to help surgical complications? It’s ridiculous!

Plus, we can’t blind it. There’s no way to blind it. There’s no equivalent placebo. But the most startling fact about all of that, to me, is that if you look at it and you see, well, look at the extremes that we have to go to make sure that it’s not the effect of somebody’s expectations and beliefs and images, that are causing the healing effect.

TS: Your point here is that the placebo effect itself is demonstration of the power of the mind in healing.

MR: Exactly. Exactly. You have to go those extremes to get it out of the equation.

TS: We have to take the human out of the testing process.

MR: Yeah, you have to take the human out. You have to take the mind/body element out of the equation. And that’s right and proper. I don’t object to that because a lot of these pharmaceuticals that they’re studying have toxic effects as well. They’re not just beneficial. They’re not clean enough yet. Maybe someday we’ll get to a place where pharmaceuticals are just really sparkling clean and they’ll have a pill that you can take and you get happy and healthy and wealthy and wise. And there are no downsides and no side effects. I’ll be first in line to take it. You know, once I’m convinced that that’s true.

But the powerful medicines that we use these days—some of the immune system modulators, some of the chemotherapy medications, some of the really powerful medications that have big-time effects on the body—they do have some very positive upsides for people with difficult diseases that we previously haven’t been able to help. So you have to give credit where credit is due. But they also typically have big-time downsides and significant risks, and are not easy drugs to take. You know—the kinds of medicines that people take for cancers or for autoimmune diseases or transplants, or so on and so forth. They have significant toxicity. And we always, as doctors, have to weigh the risks to the benefits. We always have to look [at] what’s the potential benefit here, what are the potential risks. The higher the benefit in relation to the risk, the easier it is to use that intervention.

Imagery has a huge benefit to risk ratio. There’s almost no risk, an extremely low risk, and often a very significant benefit. And so it’s something that should be used routinely, the same as improving somebody’s nutrition, the same as interventions like hands-on healing or massage or acupuncture. The risk/benefit ratio is tremendously in favor of the patient. These things should be used routinely for patients that will accept them. And, you know, wait on riskier things until later on.

TS: Let’s talk for a moment, Marty, about the ‘do’s and don’ts’ of using imagery for self-healing. Like, what are the ways that I want to approach it, if I have, you know, the kinds of normal things people have—we can get into maybe more how you would use guided imagery with more disease processes, but for the beginning here, just, “I have a backache. I have a headache. My stomach hurts.” What are the do’s and don’ts of how I might use imagery in a situation like that?

MR: The most prominent and almost only ‘don’t’ that I know of, Tami, is that you want to make sure that you don’t have something that needs to be treated otherwise. So if you get shot, it wouldn’t be a bad idea to know how to relax while you’re waiting for the ambulance or while you’re in the ambulance on the way to the hospital, but you should also go to the hospital.

TS: That’s why you’re a good doctor Marty, you know.

MR: Well, it’s true.

TS: Yeah.

MR: You know, if you’ve got a backache for a couple of days, it’s very likely that guided imagery, relaxation, breathing, guided imagery is going to help, because muscular tension and stress are a component of a huge amount of the typical common symptoms that we all have—the pain in the butt, the pain in the neck, the headache, all those things, the upset stomach and so on and so forth. Relaxation and imagery help a lot of those things.

If they go away fairly quickly, then you’re fine. But if you have a terrible pain in your gut and it’s with you for more than several days in spite of taking antacids and doing self-help things and doing relaxation and guided imagery and so on and so forth, you should go get that checked out and make sure that it’s not something that could be treated more definitively. Or, if you’ve got a pain in your gut and you’ve had it for three months and you’ve lost 25 pounds, you may want to get that checked out as opposed to having intermittent kinds of irritable bowel symptoms, which typically do respond very well to relaxation and imagery.

So the main ‘don’t’ is, don’t ignore the fact that there may be things that happen to you physically that can be helped medically, or a good health professional may be able to help diagnose and treat you. If you don’t ignore that, then there’s very, very little risk. The only other risks for guided imagery that I’m really aware of is if somebody has a history of psychosis, has a history of mental hospitalization, has trouble knowing the difference between their imaginary world and the outside world.

In imagery we go into our inner world. For most people, we know whether we’re in our inner world or our outer world. People who have a tendency to become psychotic may not be able to tell that, and they need to be a little careful with guided imagery and need to work with people who know how to work with them on that. But that’s a small percentage of the population.

The do’s are: get knowledgeable about it. You know, years ago, Tami, you helped Andrew Weil and I make a really nice guided imagery set, I think it’s called Self-Healing with Guided Imagery, and one CD has us talking for about an hour about guided imagery, and why it works and how it works, and how people can use it; and the other CD has what I consider the three fundamental relaxation and guided imagery skills that I found to be most useful over the 40 years that I’ve practiced, and other people have found to be most useful. So that’s a really nice introduction and way to begin to experiment and just experiment yourself.

On that level it can be very simple, easy, [and] safe. There are other conditions— maybe if people have a very complex or difficult kind of psychological issues or woundedness, people who have been abused as young people, and have wounds or scars from that, those are places where it’s usually best to work with a health professional that has been well-trained in guided imagery and who can help them work with it safely.

TS: But when it comes to how I might approach a symptom, like a back pain or a stomachache, with guided imagery, do I want to come up with whatever image occurs to me? Do I want the image to be big and strong or soft and gentle? How do I know what imagery will be the most effective?

MR: Well, I think the way that I like to work with that and the way that I teach people to work with imagery is to first go through some sort of a relaxation process, whether it’s a simple breathing or muscular relaxation; go to a place in your mind that’s beautiful and peaceful and safe, so that you’re relaxed but you’re still awake, and you’re aware. What I like to do is have people focus directly on the symptom itself, which is exactly what we usually don’t do. Right? If we have a headache we just want it to go away. If we have a backache we just want it to go away.

That makes sense. I’m in that club too: we just want to pain to go away. We want to kill pain. We want to take a painkiller. You know, the thing that we miss by doing that, Tami, is that pain and other symptoms can really be feedback to us.

They’re probably better seen as the equivalent of an oil light on a car. So your car has a light that, when it comes on, it’s telling you there’s a problem. It needs more oil. You wouldn’t ignore that oil light. If you do, you ignore it to your risk—you’re probably going to blow the engine up and it will cost you several thousand dollars. So, most people, when the oil light is on and it stays on, they take it to the gas station or to the mechanic.

When they take it to the mechanic, they don’t say “Put a piece of tape over that oil light because it’s bugging me,” or ”Why don’t you take that light out, because it’s annoying me, it’s making me nervous.” But that’s kind of what we ask our doctors to do, in a way. And sometimes the doctors often need to just treat people symptomatically, because we don’t know where that’s coming from.

With imagery, you have the opportunity to kind of look ‘under the hood’—and that doesn’t meet that it’s a deep, dark psychological issue. It just may mean that that headache or backache or neck pain—a lot of times these things are from an accumulation of stress and tension. There’s muscular tension. You get decrease in blood flow in the area. The area becomes inflamed and painful. It may be pinching on a nerve. And when you take the time to physiologically relax, a lot of symptoms improve just from the relaxation.

The second thing is, if there’s still a symptom left, you can focus your attention on it in that relaxed state and can ask your unconscious mind for an image; what we say is let an image appear that can represent that symptom. To people’s surprise, an image will typically pop into mind, and sometimes it’s sort of anatomical and physiological, but more often than not, it’s a symbolic image or it’s an image that people didn’t expect; people may be focusing on a pain in the stomach and they get an image of a fire.

And then I’ll just ask them, if the fire represents this symptom, the pain, kind of play ‘fix the picture’ like they used to have in the Sunday comics. They’d have a ‘what’s wrong with this picture?’ You’d look at a picture and you’d see what’s out of place. So in your image, if the fire is the symptom, I would typically say, “If that represents the symptom, what would it look like if it was all better?” Or, “What would you imagine bringing into this image that would help to relieve the symptom, or soothe it?” Most people would think, in that kind of instance, of water—of watering it or bringing a fire hose, or a stream or a creek or a river. And they very often find that they get nice symptomatic relief.

And if it’s a simple, temporary kind of a problem, that may be all people need to do. Sometimes, if the symptom keeps coming back, it may be a knottier problem or an issue that really needs to get addressed and resolved. There are lots and lots of examples of people getting images that I even encourage them to have a conversation with. You know, ask the image why it’s there? Where did it come from? What’s it there for? What does it want from you? What does it have to offer you if you give it what it wants?

It sounds a little wacky in some circles, to be carrying on imaginary conversations with yourself. But if you think of it as that your brain, focusing on the image, comes up with a representation of it, your brain is obviously intelligent. It knows what’s going on in your body. It gives you an image that symbolizes the process that’s going on and you can have that conversation between the two parts of your brain: one, the part of you that you ordinarily identify with, and the part that’s represented by the symptom. You can often get a lot of information about not only what’s going on, but also about how you might be able to resolve the issue.

TS: Have you found it more effective for people to come up with their own personal imagery, just whatever image arises versus a doctor or a book telling someone what to imagine?

MR: I do. I’m biased and in favor of that. I find that when people are able to do that process, it’s using the receptive aspect of imagery, Tami. I think when a lot of people think of guided imagery or visualization, they think of it as a mind over matter, kind of situation: I’m going to use my mind to overcome this pain or symptom or illness. And there’s a certain utility to that, you know, I want to use my mind to tell my body what to do. But I think that it’s more powerful to first listen to your body and see if there’s something that it need from you or wants you to pay attention to and then respond to it, than it is to just try to overcome it.

I think a lot of the symptoms that we have come from asking things of our body that are really not normal for it. We overwork and over-stress our bodies habitually in our culture. We don’t live like our more primitive ancestors [did] and there’s many advantages to that, but there’s also disadvantages.

Natural-living people have a much more relaxed rhythm of life, even though they may be scrapping for survival and have to hunt out in the jungle or have wild animals around them and things like that. But they typically have relatively short periods of stress, like if they’re hunting or they’re at war, or dealing with some sort of a crisis, interposed by often fairly long periods of non-stress, of just doing ordinary day-to-day things, socializing with their family and their tribe, napping, playing games, hanging out with their children. You know, just doing the normal everyday kinds of things. Whereas in modern life, we tend to be wound up and busy and focused and stressed, and have relatively little downtime.

The downtime is important for health, because that’s when the body is able to do what I call, ‘paint up, clean up, fix up.’ It’s able to concentrate without distraction on just bringing things back into balance, rather than that feeling that you’re always busy and you’re always fighting, and there’s always too much to do and there’s always decisions to make. That kind of chronic, long-term stress—stress researchers call it Type II stress—that is a major risk factor for almost all the leading diseases that we have in modern life: heart disease, high blood pressure, strokes, diabetes, even cancer. It’s a huge, huge risk factor.

So just breaking into that, and breathing and relaxing and kind of punctuating that, helps with a lot of symptoms, and also, it’s in that quiet time when you can step back from your life that you might see, hey, there’s something over there that needs your attention—either something in you, or doing something with somebody who’s important to you that needs your attention.

The only way that the body—in a sense, you know your body is run unconsciously. So if you think that your mind is much bigger than your conscious mind: your unconscious mind. Your body’s run unconsciously; one of the ways that your unconscious can get your conscious mind to pay attention is to signal through the body. Again, if we just approach it by saying, “Oh, let’s just make this pain go away,” we may lose the signal value of that, to where it becomes indecipherable. Whereas, if we take a little time, let it speak to us, and let it speak through creating its own image, you get some very, very interesting and precisely proper images for the person.

I don’t think it’s near as powerful to read a book and say, okay, if you have a headache, then image this happening and image that go away. I think it can help some people, but if you learn how to use your imagination to be receptive to your unconscious, especially the what I think of as the helpful, the guiding parts of the unconscious, which I think you can access through imagery by imagining that in your quiet place, there’s a loving friend or guide, and you have a talk with that figure about your symptoms. It’s often astounding what kinds of information people will get. It goes way beyond a book that tells you what your dream meant or what image you should use for that particular problem.

TS: Now, I know this is an area where you’ve done a lot of work, which is working with patients who have cancer with imagery. I’m curious to know, in those instances, is working with imagery that we’re going to fight the cancer cells? Is that the right type of imagery to work with, versus more peaceful, we’re going to make friends with the cancer cells? Or is it whatever the body of that person comes up with?

MR: Well, it depends what level we’re talking about. On the level of what’s more effective? Nobody knows, I think. You just don’t find cancer patients where the only thing they are doing is guided imagery, you know? And you couldn’t find, take 1,000 cancer patients and they’ll imagine blowing up their cancer with nuclear weapons, and let’s take 1,000 cancer patients and they’ll imagine making peace with their cancer and transforming them into nice cells.

I don’t think we’ll ever have that kind of study, but as a clinician, as somebody who works personally with people at a level of depth where they do bring [in] their own unconscious imagery, what I would say is that for some people, one is better, and for some people, the other is better. I’ve worked with people where the imagery has been important and helpful to them who have done both kinds of imagery.

I thought a lot about that when I wrote a book called Fighting Cancer From Within, which is about how to use imagery and mind/body approaches to help yourself get through cancer and its treatment. I spent a long time thinking about, “Is it fighting cancer from within, or is it healing cancer from within?” I can argue both sides of it. I decided to use the word ‘fighting,’ because when I really looked at all the cancer patients I’ve worked with, all the cancer patients I’ve talked to [and] communicated with, the vast majority of them experience it as a fight. There’s a battle.

Maybe that’s because that’s our cultural approach to medicine. Medicine is filled with military terms. We have a medical armamentarium. We actually call it that. We think of it as a fight. “We’re going to beat the big ‘C.’” “We’re going to fight this thing.” You see that stars and celebrities go on TV, and they always talk about how they’re going to fight it, and they’re going to beat it, and they’re not going to let it beat them, and it’s a fighting spirit. There’s something to say for that. There are certain studies on people whether they use guided imagery or not where it looks like a fighting spirit is a good thing to have in response to a life-threatening disease like cancer, but it’s not the only response. But it’s the majority response.

Even going through the treatments—chemotherapy, surgery, radiation therapy—even if you’re a peace-loving person, there’s often a fight or a battle: to make those decisions, to get yourself to treatment, to put up with the side effects, and so on and so forth. So I decided to call it’ fighting,’ but it’s not the only way.

I have worked with people who have survived cancer—and again, they don’t just do guided imagery. Nobody just does guided imagery that I know of. They typically have conventional medical treatment. They often have complementary and integrative treatments as well. And they use their mind/body connection. I’ve had people where they dialogue with the cancer cells. They make deals with them. They make a peace with them. They ask if there’s something that it’s trying to tell them. And that’s how they imagine it to go. Not everybody’s willing to do that. As a matter of fact, most people are not, but the ones who are, I’ve seen some very moving kinds of things.

There are some issues with the healing of it, Tami; the main one that I see is when people are very loving—talking to their cancer cells, they’re imagining their cancer cells becoming benign and rejoining the community of cells, and making peace with it and being very loving—and I do believe in love as a very potent, healing force. But then, they’re doing chemotherapy at the same time. You know what I mean?

TS: Yeah.

MR: So there’s a cognitive, there’s a dissonance there. Like, here I’m being all lovey-dovey in my imagery, and then I’m taking cellular poisons that are aimed at killing the cancer cells. So with some people you have to—I think if you’re actually working with people to be really honest and have them be doing whole-hearted healing, you have to address that issue somehow. Interestingly enough, they’re not truly incompatible. I learned this from a patient of mine who was very oriented towards healing through love and yet was going through very aggressive chemotherapy, and we had a number of talks about how he put that together, and it was an issue.

He came in one day, very excited. We have a wonderful natural history museum up here in San Francisco. I’d been to it many times, and he said that he had gone this one weekend. And they have these dioramas, these models of humanity through history, and different cultures that you go through. He had seen this one diorama, which was an Eskimo, an Inuit in furs and so on, standing on the ice next to a seal which it had just killed for food. You know, there’s blood on the seal and so on.

The plaque on the display said that the Inuit needed to hunt for food, they had to survive, but like most native cultures, when they went hunting, they would always pray to the spirit of the animal that they were hunting. And when an animal presented itself, they felt that it was an offering on the part of the spirit of the animal. And they would kill the animal, but they would thank its spirit, and they would pray for its spirit to go on to the next world, which they believed was there.

He was very excited, because he felt like he could do the same thing with his cancer cells, that he could—in his own words, he felt like “I’ve gotten a lot out of this cancer. I found out who loves me. I found out who are my friends. It’s slowed me down. It’s made me think more about what I want to do with my life,” and all these sort of things—what some people call “terrible gifts of serious illness.” People often do get benefits from them.

He said, “I can thank my cancer for having that. I can pray for its spirit to go on and live in another dimension, and at the same time, it has to be removed from my body.” It kind of resolved that fighting/healing kind of dissonance inside him. A long-winded answer to your question.

TS: Yeah. A good answer. You know, what’s really running through our conversation for me, as a felt sense, is your incredible passion and dedication to people becoming more aware of the power of imagery and healing. I’m curious: for you, this is now four decades of your life that you’ve dedicated to teaching this material and working directly with patients. What’s your own understanding [of] why this is such a passion for you?

MR: Hmm. You know, I think, ever since I was very little, I’ve been interested in human consciousness. It seems to me that—maybe we’re fooling ourselves—but it seems like consciousness is what differentiates the human from other life forms that we know. At least our particular kind of consciousness. And its seems to be such a remarkable gift: the ability to remember the past, the ability to imagine the future, the ability to make decisions that can potentially change the course of not only your own life, but of the lives of people around you and in some cases, the lives of hundreds of millions of people around you, [and] the ability to invent and create things that haven’t existed before.

These seem to be unique to the human being, and it’s such a powerful gift. And at the same time, I also think it’s a huge responsibility that we have, in order to use it well. I don’t know that we’re wise enough to use it, and I think that maybe for that reason, most of us, for a great part of our lives, live unconscious lives, and maybe don’t feel adequate to meet that challenge of having the potential power that’s there in consciousness, you know. At the same time, what a waste that is.

We live in a world where the major threats to our existence have been created by the human mind. You know, the climate change, the threat of over-population, the unbalanced distribution of resources, the imagined differences that come from what religion, what god you worship, and—to me—the perverted conclusion that because you worship a god that’s different than me, that you’re an infidel and not worthy of living, and you’re frightening, and we want to eradicate you from the earth, and the weaponry that is now available that still has the potential to eradicate huge numbers of not only the human but all the living population of the earth. All of those things are created by a poor use of imagination, by an unconscious use of our creative abilities.

As a doctor, on a day-to-day level, certainly I saw it in my family and in my community; I would just, from a very young age, see people creating problems for themselves that didn’t actually exist outside of their perception and outside of their imagination. You know, whether you call it anxiety or worry or stress, it’s just [that] we’re very good at creating problems for ourselves. And I think it’s a misuse of this incredible power we have of creative imagination. It’s a poor handling of a powerful thing. And it seems to me that we would all be better off if people, including myself, learn how to use this more consciously. We could learn how to use it to solve problems instead of create problems.

And it shows up every day in my medical practice. Just as a medical doctor, as a primary medical doctor, everybody’s in agreement that somewhere between 50-70 percent of all the problems that are presented to primary care doctors are directly related to anxiety, stress, worry, and their consequences. When I talk to other doctors, you know, really you could say that the job of the primary care doctor is to determine what is not anxiety and stress, you know? Just sort [it] out. Most of it is anxiety and stress and the symptoms it presents, but we have to be careful to try to sort out if there’s something else going on that we need to treat in a different manner.

So I see it in my practice. I see it in my students. I see it in myself. It’s hard to be conscious. There are ways in which it’s easier to be unconscious, but ultimately, I think it’s harder. We create more problems for ourselves and others. So somehow that just got me on this bandwagon, and there’s something inside of me that says, “Look, we’ve got this. We bit into the apple on the Tree of Knowledge and we got kicked out of the Garden of Eden.” And that bite out of the apple is that we found out that we have creative abilities.

And we can be co-creators, to some degree: sometimes a small degree, sometimes a large degree, in our lives and the lives of others. And there’s something in me that just feels strongly that we should be morally responsible for stepping up to that potential.

TS: I’ve been speaking with Dr. Marty Rossman, and Marty, with Sounds True, has published many guided-imagery audio programs, including a program with Dr. Andrew Weil, which teaches the basics of self-healing with guided imagery. He’s also published with Sounds True a program using guided imagery to prepare for surgery and to prepare for childbirth, and a guided imagery program for headache relief, pain relief, stress relief and anxiety relief.

Marty, it’s always great to hear your voice. I have to say I find it deeply relaxing just listening to the sound of your voice, as well as hearing your heart and intelligence through the sound. So it’s wonderful to speak with you.

MR: Likewise Tami, I appreciate it.

TS: SoundsTrue.com. Many voices. One journey. Thanks for listening.