Monday, June 6, 2005

Dr. Sharon Montes uses two diagnostic manuals to describe patient conditions that involve both the mind and the body. Trained in Western medicine, which, she says, separates the mind and the body, Dr. Montes also includes the ideas of psychoneuroimmunology in her clinical work.

“Everything is chemistry, and everyone can change their chemistry through their thoughts and feelings. When you change your chemistry, you change your body,” says Dr. Montes, a physician and assistant professor at the Center for Integrative Medicine at the University of Maryland School of Medicine. The center is at the Kernan Hospital Mansion in Baltimore.

Psychoneuroimmunology focuses on the interaction of the immune, nervous and endocrine systems with the brain, says Alfonso Campbell, professor of psychology at Howard University in Northwest. The immune system does not operate independently of the nervous and endocrine or hormone systems, as previously thought, he says.

“Now there appears to be a bidirectional communication network that allows these … systems to communicate with each other,” says Mr. Campbell, who holds a doctorate in psychology.

The communication, in other words, is not one way from the brain to the body, but back and forth.

The immune system’s function is to identify and rid the body of any foreign materials, such as viruses and bacteria. When encountering a psychosocial stressor, such as a work deadline or an insult from another person, the immune system, in response to signals from the brain, may release chemicals called cytokines to signal the presence of the stressor.

“The body attempts to maintain a state of homeostasis, or stability, across all its physiological systems when presented with a stressor,” Mr. Campbell says. “Success in coping with this stressor can influence health outcomes. Stress, of course, causes a fight-or-flight kind of response, depending on the nature of the stressful stimulus.”

In situations of danger or stress, the brain signals the immune system to release, in addition to cytokines, anti-inflammatory chemicals, such as endorphins, in anticipation of an injury and to relieve any pain, says James Olds, professor of computational neuroscience and director of the Krasnow Institute for Advanced Study at George Mason University in Fairfax.

“That was good for caveman days and is not applicable for modern-day stress,” says Mr. Olds, who holds a doctorate in neuroscience. “It turns out anti-inflammatory agents weaken the immune system and make it more vulnerable.”

The brain signals the release of stress hormones that mobilize the body to react to danger, causing the heart rate, blood pressure and breathing rate to increase.

If the “danger” is prolonged or the stress becomes chronic, the brain produces too much of the stress hormone cortisol, Mr. Campbell says.

“The brain may be overwhelmed by the amount of cortisol, causing a negative inhibitory feedback pathway — which usually shuts down further production of cortisol — to fail,” he says.

Cortisol, which suppresses the immune system, also fails to keep the pro-inflammatory cytokines in check.

Continual exposure to cortisol may contribute to the emergence cardiovascular disease, hypertension, arthritic conditions, diabetes and abdominal obesity, Mr. Campbell says.

Negative emotions, such as depression, anxiety, anger, jealousy and hate, also may compromise the immune system and contribute to the emergence or progression of these diseases, he says. Positive emotions can be beneficial in some situations, he says.

“The complexity of the stressful event seems to determine that,” Mr. Campbell says, adding that when a positive outlook fails, frustration or disappointment may result.

“The immune system, then, may be compromised by disappointment, which is a negative emotion,” he says.

A person’s personality, age, gender, health status and genetics help determine how that person’s immune system will respond to different events and situations, says Mary Gregerson, director of research and development in health, environment and performance anxiety at the Family Therapy Institute of Alexandria and a member of the American Psychological Association health and media psychology divisions.

“Only for some people is there a tight connection between what happens in their mind and what happens in their body, like their immune system,” says Mrs. Gregerson, who holds a doctorate in clinical psychology. “If you have a tight mind-body connection, what happens in your mind tends to affect what happens in your body.”

Psychologists have identified the tight mind-body connection in a variety of ways, including a person’s hypnotic suggestibility, absorption ability and sensitization/repression ability. Absorption ability is a heightened physiological response to what is going on in the mind, such as imaging a favorite food and then producing saliva in the mouth. Sensitization/repression ability is becoming aroused and responsive to physiological cues, or ignoring those cues.

“The status of the research right now is that we have accepted a connection between the mind and the body’s health, and for some people, that connection is stronger than for others,” Mrs. Gregerson says.

Sleeping and eating poorly, exercising less, and drinking and smoking more also have adverse effects on the immune system response, says Janice Kiecolt-Glaser, professor and director of the Division of Health Psychology at the Department of Psychiatry at Ohio State University College of Medicine.

Ms. Kiecolt-Glaser, who holds a doctorate in clinical psychology, is a member of the Psychoneuroimmunology Research Society, an international organization for researchers.

“Close personal relationships are associated with strong immune function,” she says. “When people are isolated or going through events like divorce or bereavement, immune function tends to get disregulated.”

The idea that the body is closely entwined with the mind is not new, says Candace Pert, research professor at the Department of Physiology and Biophysics at Georgetown University’s School of Medicine in Northwest. She holds a doctorate in pharmacology.

“What’s new is a theory to explain it: Endorphins and other molecules of emotion shared throughout the head and body form a psychosomatic network which controls healing and regenerative processes,” she says.

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