How tightly are emotions and diseases linked to each other? Can someone actually die from loneliness? Is it really possible to become sick with fear?
When the great French Impressionist painter Renoir suffered from both severe
arthritis and bouts of depression, his contemporaries gave only passing thought
to the possibility that his two problems might in some way be connected. But
today there are so many examples of tie-ins between the workings of the brain and
the reactions of the body--stressed executives who die of heart attacks during
fiery board meetings, survivors of wars, earthquakes, and floods who subsequently
experience severe physical disabilities, and widows and widowers who become ill
themselves soon after their spouses have died--that the question has changed
from "are emotions and diseases related?" to "how are the two related?"
These issues and questions are the subjects of Emotions and Disease, a museum exhibit (1) that examines the evolution of scientific, medical, and public understanding of the links between health and strong emotions like anger, love, stress, and fear. Two powerful and changing variables--the tools of the day and the philosophies of the times--shape and influence understanding of these relations.
In the 18th and 19th centuries, when it became possible to listen to the sounds
of the heart with a stethoscope and look at cells and tissues with microscopes,
doctors found they could account for most of the diseases of their patients with
concrete examples of changes in anatomy or physiology--the numbers of white cells
in the bloodstream would definitely increase in response to infections, the heart
would beat much too rapidly when a patient experienced episodes of lightheadedness
or breathlessness, and so on. Because they could point to such "evidence," most
doctors were skeptical that emotions "could have much to do with disease."
But there was always the rare patient who had a serious illness for which no "organic" cause could be found or measured. These patients were said to have "functional neuroses," problems that in some vague way had to do with their nervous systems.
At the end of the 19th century, the French neurologist Jean-Martin Charcot set
his large boxy accordion-sized camera to the study of hysterical patients.
Charcot's photographs captured the "fits" of his patients and thereby
demonstrated that hysteria was no different from the organic diseases: it too was
associated with distinguishing symptoms. "The camera did not lie." Although
Charcot's pictures showed what was happening, they did not come close to
explaining why.
Enter Sigmund Freud and his colleague Josef Breuer. Their approach -- "less in looking and more in listening" -- was known as psychoanalysis. It involved intensive probing over many months, years, or even decades into past events in patients' lives that may have led to the patients' current problems. Their slant was that physical symptoms could have "emotional causes and biographical meanings."
A landmark book called Emotions and Bodily Changes was published in 1935. The author, Helen Flanders Dunbar, was both a doctor and a theologian, and her book and her ideas--that spiritual, emotional, and physical suffering were inextricably linked--inaugurated a new field, psychosomatic medicine. It applied the Freud-Breuer psychoanalytic approach to medical problems in general and not just to the puzzling neuroses.
Psychosomatic medicine was highly controversial from the start. Some doctors
argued that, if seriously ill patients relied too heavily on curing their diseases
with positive thoughts, they might jeopardize their chances of benefiting from
established therapies that worked best if started early in the course of a
disease. Others worried that patients might blame themselves if they could not
get well. Still, many patients found that "the power of positive thinking" was
strong and that they were helped by relaxation, meditation and similar self-help
techniques.
By 1950, psychosomatic illness and medicine were so deeply embedded in popular culture that they had found their way to Broadway. In the musical Guys and Dolls, which premiered that year, Adelaide sings, ". . . just from worrying whether the wedding is on or off, a person can develop a cough . . ."
Adelaide was suffering from what Hans Selye, a physician in Montreal, had labeled a "stress syndrome." And she was not alone. Stress seemed to be an increasing fact of life. Selye said that, under certain circumstances, it was right for people and other animals to respond with stress responses to dangerous and frightening stimuli. He identified three stages to the response. The first was the "alarm reaction" during which bodily defenses are mobilized to the stressful situation; the second was the "stage of resistance" in which the person adapts to the situation that is causing stress, and the third was the "stage of exhaustion" in which the stress response dies out (2). When a person sees a tiger, for example, there is initial shock but then flight. And when tiger and person no longer share the same turf, the stress response appropriately ends.
Selye speculated that, in western cultures, people are bombarded with constant noise, constant danger, relentless feelings of powerlessness and hopelessness, and unremitting pressures at home and at work--what cartoonist Scott Adams has been capturing in his popular character Dilbert. Simply stated, stress never ends, and the stress response remains stuck in the 'on' position for days, months, even years, tipping the balance away from health toward stress syndromes that can have both physical and emotional components.
Selye's insights and hypotheses came unintentionally from his laboratory experiments with rats. He had not been studying stress at all. He was not adept at handling the rats and often bungled an experiment by dropping an animal while he was trying to give it an injection. Over the course of the experimental period, many of Selye's rats developed ulcers, shrunken immune tissues, enlarged glands and other physical signs and symptoms that were in no way associated with the substances he was injecting. He concluded that the animals' physiologic problems must be "due to the strains of life in his laboratory."
If the pace of everyday life could cause stress responses in animals and people, then it came as no surprise that crises--wars and other traumatic situations-- could produce even more dramatic stress responses and stress-associated diseases. In fact, roughly 20% of the disabled soldiers from World War II were classified as "shell shocked" or suffered from "combat neuroses."
In a fascinating documentary film made after World War II by Hollywood director John Huston, a soldier with paralyzed legs is helped onto a hospital bed by two attendants. The doctor in the film hypnotizes the soldier, taking "a shortcut to his unconscious mind" by injecting him with the drug sodium amytal. Doctor and patient discuss the soldier's inability to walk, the nature of his "neuropsychiatric problem," why and how the paralysis began two days earlier, and what sorts of stresses he has encountered at home since he returned from the battleground. The film ends with the hypnotized soldier moving his legs, getting up off the table, and then rapidly regaining his ability to walk as a result of the doctor's "suggestion" and verbal encouragement. Days later, the soldier is playing a vigorous game of baseball, hitting a home run, and sprinting around the bases.
Few psychiatric symptoms and illnesses are "solved" as easily as were the
problems of the film's soldier. (Few strictly medical ones are either.) But,
the movie graphically illustrates the point that health is "a state of the whole
brain and body."
Today "a critical mass of solid sophisticated scientific research" documents the mind-body connection, notes exhibit co-director (3) Dr. Esther Sternberg and these data are being accepted by "researchers in the hard-core biological disciplines." Sternberg commented that at a recent meeting of brain-immune interactions (4) that included researchers in numerous fields--psychiatry, neurobiology, neurology, endocrinology, immunology, neuroimaging, rheumatology, psychology -- "scientists all along the spectrum were learning the language of other disciplines and finding ways to interact."
Among the most valuable new tools for studying emotions and disease are "imaging"
devices, like PET and MRI scanners, which record brain activities as they are
taking place. These cutting-edge technologies were, says exhibition manager
Patricia Tuohy, the most challenging parts of the exhibit to develop and present.
"Everyone can relate to feeling withdrawn, to feeling anxiety. But making
science accessible to the public was the hardest part. We had a big chunk of
science to deal with, but we still had to talk about 'me' and what happens to
my body. This most sophisticated science is all brand new." Commented one guest
at the opening of the exhibit: "Scientists have instincts; technology is letting
them prove them."
New model systems--knockout and transgenic mice--have also boosted understanding
and given insights into the roles of individual genes in various diseases. Says
Sternberg: "Part of how stress affects disease severity depends on you and your
genes. Genes affect susceptibility and resistance to inflammatory and infectious
diseases. You have to look at it as a package. But with strong enough stresses,
even the most tuned-down system will respond." She comments that it may be most
accurate to say that "stress is not what happens to you but how you respond to it."
Ancient physicians understood disease as an imbalance of four fluid "humors" in the body--phlegm, blood, black bile, and yellow bile; a person could become healthy only when the balance was restored. Scientists today also talk about achieving a balance. This time around, the balance is understood in molecular terms, involving circulating molecules called interleukins, neurotransmitters, and hormones that send signals to each other and make people sick or well.
Strong, painful emotions trigger these chemical messengers in ways that tip the balance toward disease. Good health represents a different molecular balance. Laughter may thus actually be, as the saying goes, "the best medicine."
