~ Psychoneuroimmunology ~
chemicals, the neuropeptides and their receptors, are the actual biological
underpinnings of our awareness, manifesting themselves as our emotions,
beliefs and expectations, and profoundly influencing how we respond to
and experience our world.
- Deepak Chopra,
Around 200 AD, the Greek author Galen wrote that
melancholic women are more susceptible to breast cancer than sanguine women.
He was among the many physicians who have recognized through the years
the importance of psychological factors in the prognosis of disease. 
The fact that the mind can affect the course of illness has generally been
accepted as fact by both physician and patient. Proving the mind-body connection
scientifically took until the end of the 20th century before the knowledge
and technology progressed far enough to conduct the research. Researchers
in the fields of medicine, neuroscience, microbiology, psychology and social
science are making great progress to prove that the connections between
emotions and disease, the brain and the immune system, the mind and the
body, are real.
The relatively young science of Psychoneuroimmunology,
with slightly more than 20 years of study, is now scientifically establishing
the interconnectedness of the mind, nervous, endocrine and immune systems.
PNI views the body as a complex integrated circuit. When healthy, the brain,
the blood, the glands and the nerves all work cooperatively to guard against
disease. They work together through constant communication to mobilize
and modulate each other’s power in combating disease and maintaining balance.
[3,4] New molecular and pharmacological tools have made it possible for
scientists and researchers to identify the components of this intricate
network that exists between the various systems and the brain; this network
allows the systems to signal each other continuously and rapidly. Chemical
signals, Cytokines, produced by immune cells reach the brain, and the brain
in turn sends its own chemical signals, neuropeptides to influence the
immune system. The nervous, immune, and endocrine systems are in constant
biochemical communication via this web of chemical signals. These same
chemical signals can also affect behavior and the response to stress. Disruption
of this communication network in any way, whether inherited or through
drugs, toxic substances or surgery, exacerbates the diseases that these
system guard against: infectious, inflammatory, autoimmune and associated
mood disorders. [3,5]
The three traditionally
separated fields of neuroscience, endocrinology and immunology, with their
various organs—the brain, the glands, the spleen, bone morrow, and lymph
nodes—are actually joined to each other in a multidirectional network of
communication, linked by information carriers known as neuropeptides.
To understand the term Psychoneuroimmunology
one can start by breaking it into and defining the component parts:
Psyche - the mind component or study of
psychology, the cognitive and emotional processes involving mood states.
Various Definitions of Psychoneuroimmunology:
Neuro - the neurologic connections e.g.
neurotransmitters and neuroendocrine secretions, or study of neurology
Immunology how the immune system e.g.
the cellular and humoral components is impacted, or the study of immunology.
The study of the interaction of behavioral, neural,
and endocrine factors and the functioning of the immune system. 
The study of interactions, bidirectional communication
occurring between behavior, brain, the immune and endocrine systems. 
The best working definition is the one below:
An interdisciplinary science that
studies the interrelationships between psychological, behavioral, neuroendocrine
processes and immunology.
Different Emotional States on the Mind-Body System
A considerable and growing body of evidence is
demonstrating that life stress can alter immune function, thus impacting
the body's ability to ward off disease and maintain health. Life stressors
such as bereavement, marital separation, academic examinations, or caregiving
of a spouse with Alzheimer have all been shown to impact the immune function.
Stress, the Immune System and the Impact on
Chronic activation of cortisol, the body's response
to stress, can produce unhealthy physiological outcomes. Some of these
Other effects of stress shown in various studies
Increased blood pressure
Bone Resorption (Osteoporosis)
Chronic stressors, lasting over periods of one or
more years, not only increase the risk for depression but also are likely
to alter the immune function. Compared to age-matched controls, family
caregivers of Alzheimer patients are more likely to be psychologically
distressed. Their bodies manifest this stress with significantly higher
antibody titers to EBV and reduced percentages of total T lymphocytes and
T helper cells, the body's main immune fighting components. 
Chronic increased streptococcal infections.
Psychological stress can increase vulnerability to
upper respiratory infections.
Increased incidence of mononucleosis in military
cadets under increased academic pressure.
Medical students decline of natural killer cells
reduction of lymphocyte proliferation and alterations in the regulation
of Interleukin-2 and Interleukin-2 receptors around time of final exams.
Diminished antibody and immune cell response in medical
students with more anxiety, higher stress and less social support.
Loss of few hours of sleep can temporarily depress
the immune system.
Decreased Natural Killer activity with in those reporting
In general, caregivers who report caregiving strain
have higher levels of depression symptoms and have worse health practices
than noncaregivers or caregivers who report no strain. Caretakers for spouse
or parent with Alzheimer’s disease were more likely to have more severe
colds than those without such responsibilities. In addition, following
the death of their spouse, strained caregivers had improved health practices
and no further increases in depression symptoms, antidepressant medication
use or significant weight loss. This indicates that the the death of a
spouse among strained caregivers represents a significant reduction in
burden, reducing the stress load, rather than further tax the bereaved
spouse's ability to cope. 
Bereavement, the Immune System and the Impact
on the Body
Psychological response to bereavement, not merely
the event, appears to contribute to the immune changes in this severe life
stress. Individuals undergoing bereavement show alterations of cellular
immunity including suppression of lymphocyte responses to mitogenic stimulation,
reduction of NK cell activity, and alterations of T-cell subpopulations,
generally indicators of reduced immune function. Women who's husbands had
died showed increased plasma cortisol levels resulting in immunosuppression.
Widowed noncaregivers had increased depression symptoms and antidepressant
medication use, significant weight loss, but no change in overall health
to Impact the Body with the Mind
Several recent investigations have suggested
that psychiatric interventions that reduce psychological distress may have
beneficial effects on cancer survival, indicators of the mind's ability
to impact the body. Patients with advanced breast cancer who used self-hypnosis
for pain control not only improved their quality of life but had a longer
life expectancy. Other types of cancer patients demonstrated psychological
and immunological by participating in psychosocial group therapy. [4,9]
Candice Pert Ph.D., one of the early researchers
in the field of what is now known as psychoneuroimmunology, define "emotions"
in scientific terminology to explain the science behind mind-body. She
offers the following explanation of the molecules of emotions: 
neuropeptides and receptors, the biochemicals of emotion are the messengers
that carry information to link the major systems of the body into one unit
that we can call the body-mind. Emotions are cellular signals that are
involved in the process of translating information into physical reality,
literally transforming mind into matter. Emotions are at the nexus between
mind and matter, going back and forth between the two and influencing both.
There is growing evidence that emotions of the mind
influence the body. Substantial envidence now suggests that chronic hostility,
depression and repression along with their acompanying negativity influence
physical health and impeed recovery from illness. Sometimes the influence
is positive e.g. when the immune system is enhanced to combat diseases,
other times the influence is negative e.g. when heart disease (and the
immune system) is negatively impacted by the effects of stress. Physiological
disturbances such as high levels of cortisol, unhealth behaviors including
substance abuse or increased risk-taking can also negatively impact health.
Staying depressed, having a negative outlook may depress the immune system,
whereas feeling up beat, maintaining a positive attitude may help to strengthen
the immune system. These mind-body disturbances interact with environmental
factors e.g. high fat diets, low exercise, smoking and hereditary predisposition
to certain diseases e.g. cancer, heart, diabetes. Many believe it is not
the stress per se, but rather chronic negative emotion combined with poor
life-style choices that lead to a disruption of life's harmony which causes
The current research in the field of psychoneuroimmunology
makes it difficult for the health care profession to continue ignoring
the impact of the mind, the emotions or the spirit on the health or well-being
of the body or on the disease and healing processes.
Since the times of the Greeks conventional medicine
has traditionally utilized the biomedical model. This model focuses on
dualism involving the mind and the body interactions. This model does not
include the spirit. The biomedical model treats disease as a pathology
that occurs within the person. The doctor's function is to control the
pathology, repair the body and restore health. The limitation of this model
is that it excludes any psychological, social or ecological factors. 
Traditional Biomedical View
The traditional religious view also involves a
dualism, but this one foccuses on the spirit-mind, ignoring the impact
that either have on the body.
Traditional Religious View
In contrast, the humanistic model utilizes a pleuralistic
approach considering interactions and the interconnectedness between the
mind, the body and the spirit when treating "dis-ease" within a person.
The psychoneuroimmunology view is a pluralistic one that considers mind,
body and spirit. [1,17]
Psychoneuroimmunology, Humanistic View
The current research in the field of psychoneuroimmunology
is demonstrating the inter- connections of the mind, the body and the spirit.
One is no longer able to focus on the mind as an abstract phenomenon that
is separate from the processes of the body and the emotions. The health
or well-being of the body can no longer ignore the impact of the mind,
the emotions or the spirit on the process. [1,17]
of the Healer on the Patient
It is more important to
know what sort of person has a disease
than to know what sort
of disease a person has.
We are entering an era where it is becoming
important to restore the "humanism" in medical care, where the focus is
on a plurualistic view that includes the body, the mind and the spirit.
One way of doing this would be by creating physician-healers, following
the saged advice of Hippocrates where the physician gets to know (and has
the time to get to know) the person that has the disease, not just concentrating
on the disease process. 
The impact of the physician or other health care
provider on their patients or clients is a central aspect of the therapeutic
effectiveness. Simple, basis, humanistic techniques can have very powerful
impacts. Some useful techniques include: [19-21]
These techniques often rely upon the placebo response
as their mechanism of action which relies heavily upon the relationship
between the doctor and the patient. The placebo is believed to work because
the subjectively pleasurable and meaningful stimuli associated with a healer
is based on hope, trust and expectations objectively stimulates the patient's
pleasure system, aiding in the healing process. Psychoneuroimmunology can
also be used to explain the placebo effect, by understanding the interactions
between the mind and the body; this very powerful biological effect can
be used judiciously to help the healing process. Dr. Herbet Spiegel reminds
us that "medical practice consists not only of diagnosis and treatment,
but also of the careful tending of a patient's expectations and the unabashed
willingness to comfort." [19-21]
Mere presence, listening to and being present for
Use of Touch.
Willingness to cry with the patient.
Maintaining continued trust in the physician.
Availability over time.
messengers act with intelligence by communication information,
orchestrating a vast
complex of conscious and unconscious activities at any one moment.
In the last decade the technology in immunology
and neuroscience has been developed to prove that the connections between
emotions and disease, between the brain and the immune system, the mind
and the body, are real, measurable and in some instances quantifiable.
The current research in the field of psychoneuroimmunology is demonstrating
the interconnections of the mind, the body and the spirit. Knowing how
these interactions occur will help treat diseases and lead to development
of new treatments for such illnesses based on stimulating various parts
of the immune, neuro or endocrine systems to enhance healing. [19,20]
One is no longer able to focus on the mind as
an abstract phenomenon that is separate from the processes of the body
and the emotions. The health or well-being of the body can no longer ignore
the impact of the mind, the emotions or the spirit on the processes of
disease or maintaining health. [1,17]
1. Pert CB. Molecules of
Emotion: The Science Behind Mind-Body Medicine. New York, N.Y.: Touchstone,
1997, p. 9.
2. Dunn AJ. Interactions
Between the Nervous System and the Immune System: Implications for Psychopharmacology.
Part of The Fourth Generation of Progress On-Line Edition. American
College of Neuropsychopharmacology, 2000. Available at: http://www.acnp.org/G4/GN401000069 .
3. Weil A. Immunity, 2000.
Previously available at: http://www.drweil.com/database/display/0,1412,69,00.html
when accessed in July 2001.
4. Hammerschlag CA. Silverman
HD. Healing Ceremonies: Creating Personal Rituals for Spiritual, Emotional,
Physical and Mental Health. New York, N.Y.: A Perigee Book: 1997. p. 3.
5. Sternberg, EM. Gold, PW.
The mind-body interaction in disease. Scientific American, 1997 Special
Issue The Mind, Vol. 7 Issue 1, p8, 8p, 8c
6. Pert CB. Molecules of
Emotion: The Science Behind Mind-Body Medicine. New York, N.Y.: Touchstone,
1997, p. 184
7. The American Heritage
Dictionary of the English Language: Fourth Edition. Houghton Mifflin Company:
2000. Available at: http://www.bartleby.com/61/59/P0635950.html .
8. Maier SF, Watkins LR,
Fleshner M. Psychoneuroimmunology: The Interface between behavior, Brain
and Immunity. American Psychologist. 1994;49;1004-17.
9. Irwin M. Psychoneuroimmunology
of Depression. Part of The Fourth Generation of Progress On-Line
Edition. American College of Neuropsychopharmacology, 2000. Available at:
10. Sadek N, Nemeroff CB. Update
on the Neurobiology of Depression. Medscape: Psychiatry and Mental Health
Updates. August 2000.
11. McDaniel JS. Psychoimmunology:
Implications for Future Research. Southern Medical Journal 1992;85:388-96.
12. Eichner ER. Calabrese LH. Immunology
and Exercise: Physiology, Pathology, and Implications for HIV Infection.
Med Clinics of N America 1994;76:377-87.
13. Ballieux RE. The Mind and the
Immune System. Theoretical Medicine. 1994;15:387-95.
14. Schulz R, Beach SR, Lind B.
et.al. Involvement in Caregiving and Adjustment to Death of a Spouse: Findings
From the Caregiver Health Effects Study. JAMA. 2001;285:3123-3129.
15. Friedman HS, VandenBos GR.
Disease-Prone and Self-Healing Personalities. Hospital and Community Psychiatry.
16. Achterberg J, Dossey B, Kolkmeier
L. Rituals of Healing: Using Imagery for Health and Wellness. New York,
N.Y.: Bantum Books, 1994, p. 21.
17. Tamm ME. Models of health and
disease. British Journal of Medical Psychology. 1993;66:213-228.
18. Novack DM, Epstein RM, Paulsen
RH. Toward creating physician-healers: fostering medical students' self-awareness,
personal growth, and well-being. Academic Medicine 1999;74:516-520.
19. Lehrman NS. Pleasure Heals:
The role of Social Pleasure-Love in its Broadest Sense-in Medical Practice
Arch Intern Med. 1993;153:929-34.
20. Levin JS. Religion and Health:
Is there an association, is it valid, and is it causal? Soc Sci Med 1994;38:1475-82.
21. Sternberg, EM. Does Stress
Make You Sick and Believing Make You Well? The Science Connecting Body
and Mind. Opening Ceremony Talk, March 26, 2000 for Stress et Immunite.
Available at: http://psydoc-fr.broca.inserm.fr/colloques/cr/Stressimmunite/Sternberg.html .
This article is based on information
originally prepared as part of the syllabus and lecture for the "Somatic
Aspects of Loss & Grief," taught in August 2001 at the University of
California Berkeley Extension as part of the Professional Program in the
Study of Loss and Grief.
Patients carry their
own doctor inside. They come to us not knowing that truth.
We are at our best when
we give the physician who resides within each patient a chance to go to
See the Emergency
911 Page for links to immediate resources
if you are feeling helpless,
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