The science of psychoneuroimmunology

I am deeply grateful for Dr Janet Dollin’s positive review¹ of my book, When The Body Says No: The Cost of Hidden Stress, which discusses mind-body unity and the stress-disease connection. I disagree, however, with Dr Dollin’s comment that “our ability to validate this science has not kept pace with this avant-garde thinking.” The new science of psychoneuroimmunology has more than validated age-old human wisdom about the unity of mind and body, showing that the emotion-processing centres of the brain are inextricably linked with the nervous system, the immune system, and the hormonal apparatus. As the pioneering researcher Candace Pert has written, “the conceptual division between the sciences of immunology, endocrinology, and psychology/neuroscience is a historical artifact.”²

There are large-scale prospective studies showing that self-repressing emotional patterns are major risk factors for cancer and other diseases, and many retrospective and prospective studies demonstrate the link between stress and a whole range of illnesses, from rheumatoid arthritis to multiple sclerosis, ulcerative colitis, Crohn disease, amyotrophic lateral sclerosis, asthma, diabetes, and almost any chronic condition that exists. While the exact mechanisms of pathogenesis remain to be worked out for each particular disease, there is little doubt that they involve chronic imbalances of the hypothalamic-pituitary-adrenal axis. The most recent examples of such research are the “broken heart syndrome” reported in the New England Journal of Medicine,³ and the study presented on February 17 at the Second International Conference on Women, Heart Disease, and Stroke in Orlando, Fla, and published in Circulation,⁴ showing that unhappily married women who bottle up their feelings are four times more likely to die early than unhappily married women who express their emotions. When The Body Says No makes reference to many such studies. It is no longer the advocates of a unified mind-body approach but the skeptics who need to be asked to justify their position on scientific grounds.

The book’s bestseller status in this country and its publication in eight languages on five continents attests to the public’s intuitive yearning for medicine that goes beyond the narrow boundaries of a pseudo-scientific separation of mind and body. The challenge is to adapt in medical practice what people have always known and what science has now proven—a task for which we, as family physicians, are ideally suited.