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The Role of the Brain in Physical Disease: Title and subTitle BreakFolklore, Normal Science, or Paradigm Shift? FREE

Redford B. Williams, MD
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Reprint requests to Box 3926, Duke University Medical Center, Durham, NC 27710 (Dr Williams).


JAMA. 1990;263(14):1971-1972. doi:10.1001/jama.1990.03440140097038
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That the brain can exert profound effects on the body is by no means a new idea. The Bible contains an early description (Acts 5) of stress-induced sudden cardiac death: on being severely chastised by Peter for holding back part of a gift intended to support the early church, both Ananias and his wife Sapphira "fell down and gave up the ghost." In modern times such anecdotal reports have been supplemented by more systematic research, including, for example, laboratory studies documenting decreased myocardial perfusion during acute mental stress1 and epidemiologic studies making the case that mental states are involved in the long-term development of coronary heart disease.2

There is still skepticism, however, that mental states— and, hence, the brain—play an important role in physical illness, with some in positions of authority consigning such a notion to the realm of "folklore."3 This skepticism stems in part from the

REFERENCES

1. Deanfield JM, Kensett, Wilson RA, et al.  Silent myocardial ischaemia due to mental stress . Lancet. 1984;;2:1001-1004.
Dembroski TM, MacDougall JM, Costa PT, Grandits GA.  Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial . Psychosom Med. 1989;;51:514-522.
Angell M.  Disease as a reflection of the psyche . N Engl J Med. 1985;:312:1570-1572.
Kuhn TS. The Structure of Scientific Revolutions . 2nd ed. Chicago, Ill: University of Chicago Press; 1970;.
Schnall PL, Pieper C, Schwartz JE, et al.  The relationship between 'job strain,' workplace diastolic blood pressure, and left ventricular mass index: results of a case-control study . JAMA. 1990;;263:1929-1935.
Devereux RB, Pickering TG, Harshfield GA, et al.  Left ventricular hypertrophy in patients with hypertension: importance of blood pressure response to regularly recurring stress . Circulation. 1983;;68:470-476.
Theorell T, Knox S, Svensson J, Waller D.  Blood pressure variations during a working day at age 28: effects of different types of work and blood pressure level at age 18 . J Human Stress. 1985;;11:36-41.
Frankenhaeuser M.  Coping with stress at work . Int J Health Serv. 1981;:11:491-510.
Suarez EC, Williams RB.  Situational determinants of cardiovascular and emotional reactivity in high and low hostile men . Psychosom Med. 1989;;51:404-418.
Hamburg DA.  Frontiers of research in neurobiology . Science. 1983;;222:969.

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1. Deanfield JM, Kensett, Wilson RA, et al.  Silent myocardial ischaemia due to mental stress . Lancet. 1984;;2:1001-1004.
Dembroski TM, MacDougall JM, Costa PT, Grandits GA.  Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial . Psychosom Med. 1989;;51:514-522.
Angell M.  Disease as a reflection of the psyche . N Engl J Med. 1985;:312:1570-1572.
Kuhn TS. The Structure of Scientific Revolutions . 2nd ed. Chicago, Ill: University of Chicago Press; 1970;.
Schnall PL, Pieper C, Schwartz JE, et al.  The relationship between 'job strain,' workplace diastolic blood pressure, and left ventricular mass index: results of a case-control study . JAMA. 1990;;263:1929-1935.
Devereux RB, Pickering TG, Harshfield GA, et al.  Left ventricular hypertrophy in patients with hypertension: importance of blood pressure response to regularly recurring stress . Circulation. 1983;;68:470-476.
Theorell T, Knox S, Svensson J, Waller D.  Blood pressure variations during a working day at age 28: effects of different types of work and blood pressure level at age 18 . J Human Stress. 1985;;11:36-41.
Frankenhaeuser M.  Coping with stress at work . Int J Health Serv. 1981;:11:491-510.
Suarez EC, Williams RB.  Situational determinants of cardiovascular and emotional reactivity in high and low hostile men . Psychosom Med. 1989;;51:404-418.
Hamburg DA.  Frontiers of research in neurobiology . Science. 1983;;222:969.
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