Author Affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.
We have been closet Cartesians in modern medicine, treating the mind as though it
were reactive to but otherwise disconnected from disease in the body.
Although medical science has productively focused on the
pathophysiology of disease, such as tumor biology, coronary artery
disease, and immunology, it has done so at the expense of studying the
body's psychophysiological reactions to these disease processes. These
reactions are mediated by brain and body mechanisms, including the
endocrine, neuroimmune, and autonomic nervous systems. While a large
portion of the variance in any disease outcome is accounted for by the
specific local pathophysiology of that disease, some variability must
also be explained by host resistance factors, which include the manner
of response to the stress of the illness. For example, in a series of
classic experiments in animals, Riley1,2 showed that
crowding accelerated the rate of tumor growth and mortality. In a
recent authoritative review of human stress literature,
McEwen3 documented the adverse health effects of cumulative
stressors and the body's failure to adapt the stress response to them.
Activation of the hypothalamic-pituitary-adrenal axis (HPA) is an
adaptive response to acute stress, but over time, in response to
cumulative stress, the system's signal-to-noise ratio can be degraded,
so that it is partially "on" all the time, leading to adverse
physiological consequences, including abnormalities of glucose
metabolism,4 hippocampal damage,5 and
Spiegel D. Healing Words: Emotional Expression and Disease Outcome. JAMA. 1999;281(14):1328–1329. doi:10.1001/jama.281.14.1328
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.