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Visceral Prescription
ASSISTED LIVING COLUMN
Karen Love
Visceral Prescription Karen Love There is an aspect of human physiology that is infrequently addressed in health care yet plays an important role in overall well-being. The limbic system, an area of the brain located on top of the brainstem and under the cortex, is known as the body’s emotional brain and stores emotional or “visceral” memories. The limbic system, which controls visceral feelings such as pleasure, affection, happiness, anxiety, sadness, pain, fear, and grief, consists of the amygdala, hippocampus, hypothalamus, and thalamus. Visceral responses and stored memories are involuntary physical reactions. The purpose of this article is to familiarize nurse leaders with the powerful effects of visceral experiences to general health and well-being. A visceral response can be triggered when a memory of a certain smell, sound, sight, or feeling is encountered. For example, the smell of an apple pie baking may stir a pleasant visceral memory of family events. Some smells, sights, and sounds, such as the smell of baking bread, seeing a puppy or kitten, and the sounds of holiday music, activate almost universal positive emotional responses. Other smells, sights, and sounds can activate fearful or unhappy emotional responses; these include the sound of a dentist’s drill, the sight of a hypodermic needle, and the smell of antiseptics and disinfectants. Hospice and palliative care programs are designed to include multidisciplinary people on care teams with an understanding of the dynamic of the body’s emotional response to an experience. The best hospice and palliative care practices recognize that the emotional experience is as important as the medical treatment. It turns out that not only is this a good practice to promote health and well-being, it also fosters savings in health care costs. A 2008 study published in the Archives of Internal Medicine found that people who received palliative care
Geriatric Nursing, Volume 32, Number 5
consultations in hospitals cost between $1,696 and $4,908 less per admission.1 Emergency departments are beginning to realize the positive effects that can be achieved for overall health outcomes when the emotional response generated by the limbic system is also addressed. An emergency department nurse at the Stanford Hospital and Clinics in Palo Alto, California, that had been incorporating palliative care principles, recognized the signs of emotional distress in an elderly woman brought in as a result of a fall during her 91st birthday party. The nurse saw that the woman’s emotional response over missing the party was having a negative health effect, so a birthday cake was ordered from the dietary department to “complete” the birthday celebration. The nurse noted that “it’s some of these small interventions that you might not think are significant, but they have a big effect on psychological and emotional well-being.”2 There is a biological basis for the physical effects generated by positive feelings. Happy, positive experiences induce the release of oxytocin. Oxytocin is, a hormone produced mainly in the hypothalamus. Oxytocin has been shown to induce a general sense of well-being, including calm, reduced fear, reduced blood pressure, and increased pain thresholds, and it also promotes healing.3 Oxytocin can be released through numerous types of sensory stimulation, such as touch, warmth, food smells, sounds, and light. Positive social interactions of daily life as well as a positive environment have also been shown to activate the release of oxytocin.4 Consider the feelings of happiness and joy one can experience with, for example, a new purchase, an achievement, and a new love. These feelings are part of the body’s biological response to emotional experiences. An emergency department physician in New Jersey, David Adinaro, has an unusual way of
363
stimulating positive feelings in his patients. He personally brings them a heated blanket. This simple act of kindness and compassion helps soothe the individual and fosters a sense of trust. Although it might take a couple of precious minutes to provide the heated blanket, the positive effects it has on the individual makes it more than worth the time, according to Dr. Adinaro.5 Additionally he notes that it helps him better connect with the individual. Nursing homes evolved from the hospital model with its focus on medical care. People don’t actually “live” in hospitals, so using the same model for an environment where people do “live” can generate unintended negative visceral responses for its residents. For example, the sight of staff wearing scrubs, the lack of food cooking smells, and noise and lights at night are some elements that trigger visceral feelings of “institutional” living instead of “home” that ultimately can contribute negatively to residents’ well-being and quality of life. Green Houses and other transformed models of nursing home care are based on a different modeldone of providing a home environment first and health care services and supports second. These models also intentionally incorporate elements that stimulate general pleasant visceral feelings by cooking meals in the living environment, turning lights off at night, not using a public address system, and having gardens and providing other ways to experience the outdoors pleasantly, among many other elements.
364
The information that has been gleaned about the correlation between positive visceral emotions and well-being has mainly been obtained through anecdotal observations. Because the stimulation of positive emotional experiences to help support well-being in elders is virtually cost-free, has no adverse side effects, has the potential to reduce blood pressure, increase pain thresholds, and promote healing, and can also foster positive effects for those providing the stimulation, research studies to provide empirical evidence is sorely needed.
References 1. Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Int Med 2008;168:1783-90. 2. Andrews M. Hospitals focus on patients’ piece of mind amid emergency departments’ chaos. The Washington Post July 26, 2011;E5. 3. Ishak WW, Kahloon M, Fakhry H. Oxytocin role in enhancing well-being: a literature review. J Affect Disord 2011;130:1-9. 4. Uvnas-Moberg K, Petersson M. Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother 2005;51:57-80. 5. Adinaro D. Connecting with my patients. Available at www.thisibelieve.org/essay/6087. Cited May 18, 2011. KAREN LOVE, President, Center for Excellent in Assisted Living (CEAL), Falls Church, VA. 0197-4572/$ - see front matter Ó 2011 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2011.07.007
Geriatric Nursing, Volume 32, Number 5
Karen Love
Visceral Prescription Karen Love There is an aspect of human physiology that is infrequently addressed in health care yet plays an important role in overall well-being. The limbic system, an area of the brain located on top of the brainstem and under the cortex, is known as the body’s emotional brain and stores emotional or “visceral” memories. The limbic system, which controls visceral feelings such as pleasure, affection, happiness, anxiety, sadness, pain, fear, and grief, consists of the amygdala, hippocampus, hypothalamus, and thalamus. Visceral responses and stored memories are involuntary physical reactions. The purpose of this article is to familiarize nurse leaders with the powerful effects of visceral experiences to general health and well-being. A visceral response can be triggered when a memory of a certain smell, sound, sight, or feeling is encountered. For example, the smell of an apple pie baking may stir a pleasant visceral memory of family events. Some smells, sights, and sounds, such as the smell of baking bread, seeing a puppy or kitten, and the sounds of holiday music, activate almost universal positive emotional responses. Other smells, sights, and sounds can activate fearful or unhappy emotional responses; these include the sound of a dentist’s drill, the sight of a hypodermic needle, and the smell of antiseptics and disinfectants. Hospice and palliative care programs are designed to include multidisciplinary people on care teams with an understanding of the dynamic of the body’s emotional response to an experience. The best hospice and palliative care practices recognize that the emotional experience is as important as the medical treatment. It turns out that not only is this a good practice to promote health and well-being, it also fosters savings in health care costs. A 2008 study published in the Archives of Internal Medicine found that people who received palliative care
Geriatric Nursing, Volume 32, Number 5
consultations in hospitals cost between $1,696 and $4,908 less per admission.1 Emergency departments are beginning to realize the positive effects that can be achieved for overall health outcomes when the emotional response generated by the limbic system is also addressed. An emergency department nurse at the Stanford Hospital and Clinics in Palo Alto, California, that had been incorporating palliative care principles, recognized the signs of emotional distress in an elderly woman brought in as a result of a fall during her 91st birthday party. The nurse saw that the woman’s emotional response over missing the party was having a negative health effect, so a birthday cake was ordered from the dietary department to “complete” the birthday celebration. The nurse noted that “it’s some of these small interventions that you might not think are significant, but they have a big effect on psychological and emotional well-being.”2 There is a biological basis for the physical effects generated by positive feelings. Happy, positive experiences induce the release of oxytocin. Oxytocin is, a hormone produced mainly in the hypothalamus. Oxytocin has been shown to induce a general sense of well-being, including calm, reduced fear, reduced blood pressure, and increased pain thresholds, and it also promotes healing.3 Oxytocin can be released through numerous types of sensory stimulation, such as touch, warmth, food smells, sounds, and light. Positive social interactions of daily life as well as a positive environment have also been shown to activate the release of oxytocin.4 Consider the feelings of happiness and joy one can experience with, for example, a new purchase, an achievement, and a new love. These feelings are part of the body’s biological response to emotional experiences. An emergency department physician in New Jersey, David Adinaro, has an unusual way of
363
stimulating positive feelings in his patients. He personally brings them a heated blanket. This simple act of kindness and compassion helps soothe the individual and fosters a sense of trust. Although it might take a couple of precious minutes to provide the heated blanket, the positive effects it has on the individual makes it more than worth the time, according to Dr. Adinaro.5 Additionally he notes that it helps him better connect with the individual. Nursing homes evolved from the hospital model with its focus on medical care. People don’t actually “live” in hospitals, so using the same model for an environment where people do “live” can generate unintended negative visceral responses for its residents. For example, the sight of staff wearing scrubs, the lack of food cooking smells, and noise and lights at night are some elements that trigger visceral feelings of “institutional” living instead of “home” that ultimately can contribute negatively to residents’ well-being and quality of life. Green Houses and other transformed models of nursing home care are based on a different modeldone of providing a home environment first and health care services and supports second. These models also intentionally incorporate elements that stimulate general pleasant visceral feelings by cooking meals in the living environment, turning lights off at night, not using a public address system, and having gardens and providing other ways to experience the outdoors pleasantly, among many other elements.
364
The information that has been gleaned about the correlation between positive visceral emotions and well-being has mainly been obtained through anecdotal observations. Because the stimulation of positive emotional experiences to help support well-being in elders is virtually cost-free, has no adverse side effects, has the potential to reduce blood pressure, increase pain thresholds, and promote healing, and can also foster positive effects for those providing the stimulation, research studies to provide empirical evidence is sorely needed.
References 1. Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Int Med 2008;168:1783-90. 2. Andrews M. Hospitals focus on patients’ piece of mind amid emergency departments’ chaos. The Washington Post July 26, 2011;E5. 3. Ishak WW, Kahloon M, Fakhry H. Oxytocin role in enhancing well-being: a literature review. J Affect Disord 2011;130:1-9. 4. Uvnas-Moberg K, Petersson M. Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother 2005;51:57-80. 5. Adinaro D. Connecting with my patients. Available at www.thisibelieve.org/essay/6087. Cited May 18, 2011. KAREN LOVE, President, Center for Excellent in Assisted Living (CEAL), Falls Church, VA. 0197-4572/$ - see front matter Ó 2011 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2011.07.007
Geriatric Nursing, Volume 32, Number 5