Unconscious Mental Factors in HIV Infection

c© 2008 Imprint Academic Mind & Matter Vol. 6(2), pp. 193–206
Unconscious Mental Factors
in HIV Infection
Peter B. Todd
Sydney, Australia
Abstract
Multiple drug resistant strains of HIV and continuing difficulties
with vaccine development highlight the importance of psychologi-
cal interventions which aim to influence the psychosocial and emo-
tional factors empirically demonstrated to be significant predictors
of immunity, illness progression and AIDS mortality in seropositive
persons. Such data have profound implications for psychological
interventions designed to modify psychosocial factors predictive of
enhanced risk of exposure to HIV as well as the neuroendocrine
and immune mechanisms mediating the impact of such factors on
disease progression. Many of these factors can be construed as
unconscious mental ones, and psychoanalytic self-psychology may
be a useful framework for conceptualizing psychic and immune de-
fence as well as bodily and self-integration in HIV infection. Al-
though further prospective studies and cross-cultural validation of
research are necessary, existing data suggest that psychoanalytic
insights may be useful both in therapeutic interventions and eval-
uative research which would require an underlying epistemology of
the complementarity of mind and matter.
1. Introduction
Kuhnian anomalies suggest the need for a paradigm shift in the sci-
entific understanding and treatment of HIV/AIDS. This may involve a
move beyond the traditional medical model, and towards a multifactorial,
ecological or holistic framework which highlights the potential efficacy of
psychological interventions. The anomalies in the current paradigm in-
clude multiple drug resistance to HIV, resulting in potentially serious lim-
its to a purely pharmacological approach to treatment with antiretroviral
drugs. Rambaut et al. (2004) commented that the evolutionary signifi-
cance of HIV and mutation was underestimated by those who proposed
that highly active antiretroviral therapy represented a cure for AIDS.
Commenting upon the marked genetic variability exhibited within indi-
vidual hosts, these authors referred to HIV as “one of the fastest evolving
of all organisms” (Rambaut et al. 2004, p. 56).
Mathematical modelling which had predicted the eradication of virus
from patients within two or three years has not been fulfilled. Kovalevsky

194 Todd
et al. (2006) observed that one of the most disturbing events in attempts
to counter HIV infection has been the emergence of mutations that con-
ferred resistance to all 20 FDA approved antiretroviral drugs then being
used clinically. Further anomalies include the almost insuperable difficul-
ties with vaccine development due to mutation reported by Ho (2005) and,
most recently, evidence of increased risk of seroconversion in one clinical
trial reported by Kresge (2007). Alternative biomedical approaches to sci-
entific understanding include the work of Davis (2006) and his colleagues,
exploring the immune synapse and how HIV hijacks cellular communica-
tion networks to propel itself from one cell to another, and the research
of McFadden and Al-Khalili (1999) in developing a quantum mechanical
model of adaptive or “directed” mutation.
This is particularly relevant to mutant strains of tuberculosis, which in
conjunction with HIV seropositive status constitutes a threat to the lives
of millions of people, especially in the developing world. It is in the con-
text of such anomalies in classical biomedical research that prioritizing
empirical studies into psychoneuroimmunological aspects of HIV/AIDS
and evaluating psychological interventions may need to be re-assessed and
the limitations of pharmacology recognized (Todd 2008). Such paradigm
shifts imply the need to challenge the reductionist materialist epistemol-
ogy which has characterized Western science, including medicine, for more
than 300 years.
2. Self-Psychology, Mind-Matter Anomalies, and HIV
Psychoanalytic self-psychology as outlined by psychoanalysts such as
Winnicott (1971), Kohut (1977) and Fordham (1985) provides a theoreti-
cal framework for conceptualizing both a complementarity of psychic and
immune defence and the loss of bodily and self-integration in HIV infec-
tion. In an evolutionary framework, the emergence of HIV is particularly
significant as the retrovirus poses a threat to self-continuity on both bi-
ological and psychological levels simultaneously while disguising itself so
that it is not recognized and eliminated as a “not self” pathogen by the
immune system.
Schro¨dinger’s (1992) thesis that the so-called “arrow of time” does not
necessarily deal a mortal blow to its creator is reminiscent of the concept of
timeless dimensions of the self and of the unconscious in psychoanalysis,
manifest, for instance, in dream content and archetypal symbols. Such
ideas challenge classic, mechanistic concepts of causality insofar as these
have been entangled with an apparently unbreakable spatiotemporal hold
and an epistemology of metaphysical materialism. Within the framework
of Jungian depth psychology, however, collective denial of the destructive
shadow of HIV, especially in the developing world could be construed as
a symptom of a spiritual malaise in the developed world.

Unconscious Mental Factors in HIV Infection 195
These notions, however, are not only consistent with the concepts
of timelessness and meaningful coincidence in psychoanalysis. They are
also implicitly spiritual, with intimations of a numinous dimension of the
evolutionary process in which humanity participates. This includes the
idea that an evolving God becomes conscious through and is completed
by humankind in a process theology which regards the numinous as being
both immanent and transcendent.
Atmanspacher (2007, p. 133) has noted contributions to spirituality
which involve concepts of mind which “transcend the individual in a
transpersonal sense” so that near-death experiences may become subjects
for scientific study. Perhaps diseases in which unconscious mental phe-
nomena are demonstrably predictive of outcome and mortality could be
regarded usefully as examples of such “anomalies”. Unconscious defences,
negative emotions, denied and split off parts of the self, which the Jun-
gian analyst Fordham (1985) has referred to as “de-integrates” and the
awakening of a sense of meaning in confronting mortality have already
been implicated in psychoneuroimmunological research as predictors of
immunity and disease progression in HIV seropositive persons.
Psychological interventions and evaluative research may be enriched
by such insights, particularly those concerning the significance of uncon-
scious psychosocial factors to immunity and disease progression. As I
shall argue further, an unconscious investment in a materialist epistemol-
ogy of science remains a source of resistance to such insights as well as
psychoanalysis with its therapeutic aims of self-transformation and mak-
ing the unconscious conscious. Such an investment is also inimical both
to concepts of spirituality and conceptualizing disease psychosomatically
in a new “enlightenment” in which science and religion are re-integrated,
as complementary rather than antagonistic perspectives..
The banishment of anything personal, including psyche and conscious-
ness, from classical mechanistic science, could be construed as a one-sided
development so that recognizing a complementarity of mind and matter as
well as a numinous dimension of evolutionary becoming would represent
the restoration of a lost wholeness. A dual-aspect notion of reality would
replace monist reductionism in either a materialistic or an idealistic form.
Schro¨dinger (1992) had noted that nothing personal, including numinos-
ity, would be found subsequent to its strangulation by the spatiotemporal
hold, itself a construct of creative mind. In this meaningful connection,
HIV might be construed as a retroviral messenger delivering a figurative
summons to humanity to recognize a metaphorical entanglement between
the developed and developing worlds with a geopolitical holism which
transcends the confines of nationalism in collectively responding to a truly
global, evolutionary challenge. Such a response would imply a spiritual
transformation in the collective consciousness of humanity.

196 Todd
3. The Unconscious and Prevention
Psychological interventions aim to facilitate the modification of per-
sonality, stress, emotional and behavioral factors which enhance the prob-
ability of exposure to HIV as well as immunosuppression and disease pro-
gression once infection has occurred. In conjunction with education pro-
grams and biomedical measures demonstrated by empirical evidence to
reduce the risk of infection, such measures fall into the domain of primary
prevention. The assumption that simply providing information about be-
haviors resulting in a high risk of exposure to HIV is a sufficient primary
prevention measure has been known to be flawed since the early 1980’s
(McKusick 1983, Todd 1992). Nevertheless, the errors which have histori-
cally characterized attempts to modify behavior patterns related to cancer
and heart disease keep being repeated (Todd and Magarey 1978). The of-
ten complex and unconscious motivations of such high-risk behaviors must
also be taken into account. Similar considerations apply to behavioral and
lifestyle factors such as substance misuse which are likely to impact upon
immunity and disease progression once infection has occurred.
Evidence-based psychological interventions are potentially highly rel-
evant to immunosuppression (and enhancement) as well as disease pro-
gression in persons who are already seropositive to HIV (Solomon 1987,
Solomon et al. 1991, Todd 1992, Cole and Kemeny 2001, Kiecolt-Glaser
et al. 2002a). Empirical data concerning these issues fall into the do-
main of secondary prevention and much of the research on psychoneu-
roimmunological aspects of HIV/AIDS concerns quantified psychosocial
factors predictive of immunity and disease outcome. Psychoanalysis can
provide a good explanatory fit for such data, as Todd and Magarey (1978)
suggested in an empirical study of psychosocial aspects of breast cancer
in which psychoanalytic concepts including ego-defences and unconscious
affects were subject to rigorous operational analysis and measurement.
Defensive denial and depression were especially salient predictors of de-
layed presentation for diagnosis in a context of potential object loss.
In the remainder of this paper I shall review empirical studies relevant
to both primary and secondary prevention as well as the implications for
psychological interventions in considerable detail, with various perspec-
tives upon the so-called “psychophysical problem” elucidated. Histori-
cally, many studies have evaluated the relevance of one or few psychosocial
factors instead of exploring the possible predictive significance of multiple
variables with respect to immunity, illness outcome and AIDS mortality.
4. The Psychophysical Problem and HIV
One conceptual obstacle to the acceptance of psychoneuroimmunolog-
ical research into HIV/AIDS has been a perhaps unconscious, narcissis-
tic investment in a materialist epistemology of science which banished

Unconscious Mental Factors in HIV Infection 197
spirit from matter. Consciousness and mental processes (including un-
conscious ones) have often been viewed as epiphenomenal and causally
inefficacious by-products of events in the brain. Such a position either
denies causal significance to psychological factors or regards mentalistic
terms as a linguistic shorthand for the description of neurophysiologi-
cal processes. Historically, this has been one influential solution to the
so-called “psychophysical” or mind-matter problem, providing an episte-
mological foundation for conceptualizing disease exclusively within a clas-
sical, mechanistic medical model from which considerations of the mental
were intentionally excluded, partly due to the received wisdom of a posi-
tivist philosophy of science.
On empirical grounds, HIV can be construed as contributing to certain
“mind-matter anomalies” (Atmanspacher 2007). Examples to be consid-
ered are the demonstrated correlations between measured unconscious
psychological factors influencing disease progression and AIDS mortality
via the neuroendocrine and immune systems which maintain bodily as
well as psychic self-integration and continuity. A relationship of comple-
mentarity between psychic and immune defence would be a particularly
interesting case of a complementarity of mind and matter. In this mean-
ingful connection, HIV is destructive not only to the immune system, but
also to the brain, causing AIDS dementia complex in seropositive persons,
while being a threat to psychic and immunological self-integration and
survival. Psychosocial HIV research might thus be viewed as constitut-
ing one possible model in the exploration of mind-matter anomalies with
significant epistemological as well as pragmatic treatment implications.
The contributions of such neuroscientists as Eccles (see Popper and
Eccles 1990) and Pribram (2004) have challenged materialism, conclud-
ing that Popper’s “three worlds” of brain, culture and mind (Popper and
Eccles 1990) are indispensably necessary for the achievement of conscious-
ness. The three worlds interact in a feedback loop, so that consciousness
or mind program the brain to evolve culture which in turn stimulates
mental development. Pribram’s position was “hostile” to an eliminative
materialist approach, an attitude expressed pithily in his remark that “the
more reflex the reflex, the less does mind accompany it” (Pribram 2004,
p. 21). Rather, mind and matter have a common ontological foundation
which transcends spacetime.
Pribram rejects the idea that consciousness is an epiphenomenal by-
product of brain processes, noting that it is a psychological process, math-
ematics, which describes mind-matter relationships. On his account, the
cultural world is spiritual insofar as conscious experience is drawn to “in-
formational patterns” which transcend humankind’s immediate daily con-
cerns. Results and ideas of quantum physics, neuroscience, depth psychol-
ogy and religious belief systems may awaken a phenomenological sense of
transpersonal meaning.

198 Todd
However, even sophisticated brain imaging techniques such as fMRI
do not permit the prediction of the phenomenological content of con-
sciousness. The brain process, as Pribram points out, does not look like
what we are experiencing mentally in consciousness, whether reflecting
upon patients’ fantasies and symbolic dream content about HIV or the
global challenge created for humanity. Similarly, such neuropsychoana-
lysts as Turnbull and Solms (2007) have argued that neural reductionism
can only be seriously challenged by demonstrating that subjective ex-
perience (including unconscious mental processes) generates robust and
useful scientific predictions, including those relevant to understanding the
outcome of HIV infection.
Heelan’s (2004) argument for research into the “quantum structure of
the kind of physical embodiment that makes consciousness and cognition
possible” utilizes the concepts of complementarity and entanglement. Ac-
knowledging his debt to the philosopher Husserl and more recent thinkers,
including Primas and Pribram, Heelan’s thesis is that, on phenomeno-
logical grounds, consciousness possesses a structure isomorphic with or
analogous to quantum mechanics (Heelan 2004, p. 81). Phenomenology,
in Heelan’s framework, is to be regarded as a tool for exploring mind
and matter. This is central to psychoanalytically oriented research and
therapies, as Todd and Magarey (1978) have pointed out in eliciting data
about subjective states and meanings as well as unconscious ego-defences
and affects in women with symptoms of breast cancer.
The treatment of the psychophysical problem by the depth psycholo-
gist Jung and the physicist Pauli with their notion of the archetypes as
timeless, cosmic ordering and regulating principles creating a bridge be-
tween mind and matter in a relationship of complementarity, corresponds
to the notion of active information, fulfilling this function in the dual-
aspect position adopted by Bohm (2002) or Hiley and Pylkka¨nen (2005).
Whatever position one may prefer concerning the psychophysical prob-
lem, it will inevitably exert an overt or covert influence on the funding
and conduct of psychosomatic or psychoneuroimmunological research into
such illnesses as cancer and HIV/AIDS.
5. Foundations of Psychoneuroimmunological Research
The eminent scientist and pioneer Solomon is credited with coining the
term “psychoimmunology” in 1964. Solomon and Engel (1977), who had
called for a revolution in medicine, had seriously challenged the Jenner-
Pasteur model of infectious disease as well as traditional medical model
concepts of such immunologically mediated and resisted illnesses as cancer
and autoimmune disorders. Early correlational studies beginning in the
1930’s on the basis of largely psychoanalytic hypotheses into the impact

Unconscious Mental Factors in HIV Infection 199
of repressed conflicts in “object relations” or attachments, loss, depres-
sion and inward-turning anger as well as the symbolic meanings of specific
organ systems (such as the breast) had laid the foundations for psycho-
somatic research which, however, did not permit causal inferences to be
made on the basis of data collected (Menninger 1938, Grinker 1973). The
possible causal significance of unconscious defences, intrapsychic conflicts
and emotions could be assessed only when the biological mechanisms me-
diating the impact of such variables on disease onset and outcome could
be elucidated and quantified.
Psychoneuroimmunology was born when both immunological and neu-
roendocrine pathways were identified and became susceptible to empirical
measurement. A landmark study was that of Bartrop et al. (1977), an
Australian physician who demonstrated depression of T lymphocytes af-
ter bereavement, a finding replicated by Schleifer et al. (1983). Higher
mortality rates in partners within six months of bereavement were ob-
served.
The explanatory theoretical framework provided by the psychoanalyst
Bowlby (1989), in his work on Attachment and Loss, has been a useful
source of hypotheses about the impact of bereavement and separation (or
object loss) upon immunity and illness including HIV/AIDS. Bereave-
ment resulting in guilt and self-reproach is not only emotionally toxic,
but deleterious to the prognosis of HIV seropositive persons as I shall
point out in discussing data on psychosocial factors as predictors of HIV
progression and AIDS mortality. As I have already intimated, HIV repre-
sents a threat to self-continuity with respect to immunological and psychic
defence systems. Not only does the retrovirus disguise itself from the im-
mune system so that it is not eliminated as a “not-self” pathogen, one of
its primary modes of transmission utilizes the sexuality which ensures the
continuity, biological identity and immortality of the human species. The
evolutionary significance of HIV encompasses mind, matter and culture
in a genuinely transpersonal meaning.
Solomon (1987), Ader et al. (1991), and Todd (1992) have provided
detailed reviews of the nature and history of psychoneuroimmunology,
including early studies of HIV/AIDS within this conceptual framework.
Specifically, empirical research on psychosocial factors as predictors of
behavior patterns associated with the risk of infection with HIV, im-
mune status and the onset of AIDS spectrum disorders in seropositive
individuals were reviewed. I shall now turn to the psychosocial factors
demonstrated to be predictors of immunosuppression, illness progression
and AIDS mortality. Such evidence exemplifies the application of a dual-
aspect solution of the psychophysical problem to a multifactorial under-
standing of illnesses, including HIV/AIDS. Unconscious psychosocial fac-
tors have demonstrated significance for secondary prevention, that is to
say, to influencing immunity, illness and AIDS related mortality even sub-

200 Todd
sequent to the introduction and use of antiretroviral drugs, especially in
the developed world.
6. Psychosocial Predictors of HIV Progression
Hypotheses about psychosocial factors likely to be relevant to the onset
and progression of HIV/AIDS were deduced initially from research stud-
ies of the role of factors in other immunologically mediated and resisted
diseases including cancer, autoimmune disorders and infections such as
Epstein-Barr, cytomegalovirus and herpes simplex. This work had been
published in such sources as the volume of Ader et al. (1991) on psy-
choneuroimmunology. Viral causation of certain cancers had been consid-
ered probable even prior to the onset of the HIV/AIDS pandemic during
the early 1980’s. Solomon (1987) and other members of the Biopsychoso-
cial AIDS Project at the University of California, San Francisco (including
Todd (1986, 1992)) formulated hypotheses about psychosocial factors as
predictors of immunity and illness progression as well as the role of such
factors as determinants of behavior patterns resulting in a high risk of
exposure to HIV.
Solomon (1987) reported the results of pilot studies in the United
States. Summed up briefly, the early hypotheses concerned the possi-
ble significance of such psychosocial factors are (a) coping and defence
mechanisms, (b) loss of significant persons through bereavement or sep-
aration, (c) depression manifest as hopeless/helpless reactions to trauma
and threat, as distinct from grief, (d) integration or acceptance of sexual
identity, (e) inward-turning or suppressed anger, (f) social support, and
(g) resilience associated with a sense of meaning in life. Psychoanalyti-
cally oriented studies (Todd and Magarey 1978) were a significant source
of these hypotheses.
The pilot studies and early research reported by Solomon (1987, 1991)
and Todd and Burcham (1986) provided some significant data in sup-
port of these hypotheses. However, the need for prospective, longitudinal
studies and controlling for possible confounding factors such as substance
misuse and for optimizing statistical power with larger sample sizes was
noted as an important direction for future research as well as more rig-
orous hypothesis testing (Solomon 1991, Todd, 1992, Cole and Kemeny
2001). Extensive reviews of studies on psychosocial determinants of im-
mune status and the progression of HIV infection since 1991 have been
provided by Cole and Kemeny (2001) and Kiecolt-Glaser et al. (2002a).
Analyses focussing upon reactions to highly traumatic and personally
salient events such as diagnosis of HIV seropositive status and bereave-
ment have identified relationships with both immunological and clinical
indices of HIV progression. Kemeny et al. (1994) found that measures of

Unconscious Mental Factors in HIV Infection 201
grief uncomplicated by depression predicted reductions in immune func-
tion over a two-to-three-year period in a group of seropositive homosexual
men. This finding was replicated by Kemeny et al. (1995) in which guilt
and self-reproach or blame as an aspect of grief following bereavement
predicted CD4+T cell declines during an 18 month period.
However, other research indicated that actively confronting such trau-
mas as bereavement or the threat of mortality and finding a sense of
meaning could mitigate immunosuppression and mortality. For instance,
Bower et al. (1998) found that those who discovered meaning experienced
a slower decline in CD4+T cell levels over two to three years and had an
enhanced survival time during four to nine years. Such data support the
notion that a sense of meaning and spirituality have important health
implications in the populations studied (Todd 1992, 2008).
Defensive denial of seropositive status (Ironson et al. 1994) and shame-
based concealment of homosexual identity were associated with immuno-
suppression and heightened risk of progression to AIDS during a two year
follow up. These findings confirmed those of the earlier studies which had
demonstrated significant associations between high-risk sexual behavior,
immunosuppression and disease progression while linking acceptance of
sexual identity with a lower probability of exposure to HIV and a more
favorable prognosis. This is a matter of serious concern for health profes-
sionals working in the HIV/AIDS field (Todd 1992).
Cole et al. (1996, 1997) investigated concealment of homosexual iden-
tity as a model of what they termed “psychological inhibition”, finding
accelerated times to a critically low CD4+T cell level as well as AIDS
onset and mortality among so-called “closeted” members of a sample of
initially healthy homosexual men followed up for a period of nine years.
These closeted individuals were assessed as particularly sensitive to per-
ceived social rejection, this factor being an even stronger predictor of HIV
disease progression than concealment per se. Such data seem to fit well
with the notion of internalized homophobia, associated with shame and
self-hatred resulting in both concealment and, perhaps through such de-
fence mechanisms as denial, splitting and projection, observed hypersen-
sitivity to rejection by others. Psychoanalysis may be particularly well
suited to the working through of such defensive and affective processes
while perhaps promoting self-integration, inner transformation and the
awakening of a sense of transpersonal purpose in confronting mortality
and loss in HIV seropositive persons generally.
The factors which can be considered to be potential foci for psycholog-
ical interventions include: (a) depression, (b) bereavement, (c) grieving
responses to bereavement such as guilt and self-reproach (identified by
Freud (1917) in his paper on “mourning and melancholia” as repressed
feelings towards the deceased), (d) sustained denial of traumatic realities
such as seropositive status, bereavement and mortality, (e) stigma and

202 Todd
shame associated with sexuality, (f) a sense of meaning or transpersonal
purpose in life in the face of the threat of self-disintegration and mortality.
Psychoanalytic theories, especially those of Jung, Kohut and Winnicott
would permit a more profound understanding of the role of unconscious
defences and negative emotions, factors known to be linked with immuno-
suppression and hence to loss of bodily and self-integration as well as
providing frameworks for evaluating spiritual transformation.
7. Mindful Interventions
Kiecolt-Glaser et al. (2002b) have provided a review of psychoneu-
roimmunological studies relevant to the understanding and treatment of
cancer and autoimmune disease as well as HIV/AIDS. With respect to
HIV, the authors paid specific attention to the potential benefit of psy-
chological interventions as diverse as hypnosis, cognitive behavior ther-
apy, self-disclosure and existential approaches concerned with the quest
for meaning in confronting such highly traumatic events as bereavement
and mortality. In general terms they noted that the narrower the scope
of a behavioral intervention and the shorter its time course, the smaller
and less enduring would be its impact either psychologically or immuno-
logically. Longer follow-up periods would be desirable in future evaluative
research.
Such research, therefore, might be enriched through the application of
insights from psychoanalytic self-psychology, including the notions of de-
fence and self-integration, in longer term therapeutic approaches including
groups, particularly given the apparent complementarity between psychic
and immune defence in maintaining integrity, self-continuity and biolog-
ical survival. Similarly, several randomized clinical trials had suggested
that psychological interventions addressed, for instance, to bereavement,
grief and shame may influence indices of disease progression (Cole and
Kemeny 2001).
While Kiecolt-Glaser et al. (2002b) observed that intervention work
with HIV seropositive persons had produced some “promising results”,
this conclusion appears to have been based as much upon the mounting
evidence that psychosocial factors are significant predictors of behavior
exposing people to HIV infection and both immunity and disease progres-
sion, as the results of well controlled intervention studies. Future research
would need to establish more empirical evidence for psychological inter-
ventions as well as clarifying those with greater efficacy in reducing mor-
bidity and mortality in evaluation studies. Specifically, studies focussing
upon the effects of self-transformation and the awakening of meaning upon
immunity and disease outcome might be a fruitful direction for research
which addresses both the unconscious and the self in its personal and
archetypal or transpersonal aspects.

Unconscious Mental Factors in HIV Infection 203
8. Conclusions
In conclusion it may be useful to highlight the need for sophisticated
studies of multiple variables in psychosomatic research, permitting the
use of such multivariate techniques as hierarchical logistic regression and
discriminant function analyses, unresolved methodological issues and fu-
ture directions for research. The need for further prospective, longitudinal
studies and controlling for such confounding variables as substance mis-
use and stage of illness at the commencement of research, with the larger
sample sizes necessary to optimize statistical power than those in cross-
sectional and pilot work has been noted as important for more rigorous
hypothesis testing and the provision of a solid evidence basis for psycho-
logical interventions (Solomon et al. 1991, Todd 1992, Cole and Kemeny
2001). The simultaneous analysis of psychosocial factors, biological medi-
ators (neuroendocrine and immune) and HIV disease progression remain
important questions for research.
Well designed evaluation studies could be vital to creating an empir-
ically solid case for properly funded psychological intervention programs,
independently of antiretroviral drug treatment. Cross-cultural validation
of research conducted in the developed world to developing nations would
permit generalization of results, given that HIV/AIDS is a globally salient,
human issue affecting millions of people, including children. How the re-
lationship between mind and matter is conceptualized is likely to be a
determinant of scientific and medical as well as societal attitudes and
research into such diseases. HIV/AIDS as a psychosomatic phenomenon
might be considered to be one “mind-matter anomaly” the study of which
might help to elucidate this relationship. Psychosocial and spiritual fac-
tors are relevant not only to mental health in seropositive persons, but
also to treatment and disease outcome (Todd 2008).
Acknowledgement
I wish to thank Harald Atmanspacher for his careful reading and crit-
ical remarks in helping me to revise an earlier version of this paper.
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206 Todd
Received: May 23, 2008
Revised: December 19, 2008
Accepted: December 22, 2009
Reviewed by Axel Holm and another, anonymous, referee