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A Piece of My Mind
December 25, 2002

Not Guilty

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2002;288(24):3084-3085. doi:10.1001/jama.288.24.3084

Recently I've been having a discussion with Susan, a patient who has bipolar disorder. She tells me she is afraid her illness is her fault. She believes that if she were a stronger person, she would be able to overcome this illness, that if she were a better person, she would perhaps never have gotten it in the first place. This morning she told me she sometimes worries that God is punishing her with this illness.

Susan is certainly not the first person I've encountered with such beliefs. I practice family medicine. Perhaps because my first job after residency was in a clinic that served Salvadoran refugees—war survivors—and because I saw how frequently the stress of trauma and homesickness took a toll on their bodies, I have long been interested in connections between mind and body. And I have benefited from the legacy of those who have elaborated on these connections. The Hippocratic writings include many references to interrelationships between soma and psyche.1 Hans Selye2 began to elucidate for us the mechanisms of stress and illness. Herbert Benson3 began the study of the relaxation response. I think most persons would agree now that stress tends to contribute to illness and can play a role in both its onset and its aggravation. Reducing stress tends to make people feel better.

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