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Editorial |

Healing Words:  Emotional Expression and Disease Outcome

David Spiegel, MD
JAMA. 1999;281(14):1328-1329. doi:10.1001/jama.281.14.1328.
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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 depression.6,7

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