Long before the first glimmerings of modern science, physicians and non-physicians acknowledged that the way people feel in their minds can influence the manner in which their bodies work.

How we talk about emotions and disease has changed in the course of history, as scientists and physicians transformed medicine. Perceptive observers have regularly returned to the study of the interactions of body and mind in medicine.

Discoveries in a field of research that explores the connections between the nervous, endocrine, and immune systems confirm that emotions influence the onset and course of disease, and also show how this interaction works.

Emotions + Disease highlights achievements and turning points on a well-traveled historical road leading to a promising future that includes integrative medicine, a field incorporating science-based mind-body treatments into all aspects of medical care.

Balance of Passions

The story of Emotions + Disease begins in ancient Greece and Rome, where medicine first emerged as a secular activity.

Greek physician Hippocrates and his followers combined naturalistic clinical knowledge with ancient science and philosophy to produce the first systematic explanations of health and illness. 

These ancestors of modern biomedical scientists began to explore the solid and fluid parts of the human body for keys to unlock the hidden mechanisms of disease. They also made the first attempts to understand emotions as mental phenomena that had surprising and complex connections to the inner workings of bodily systems and their disorders in disease.

Photo of...
open book of ancient Greek and Latin text
open book of ancient Greek and Latin text

Hippocrates, Hippokratous Kōou iatrikē, Aphorismōn bibl. 8 ; Prognōstikon bibl. 3 ; Peri physios anthrōpou bibl. 1 ; Peri diaitēs oxeon bibl. 4 ; Galenou Iatrikē technē (Hippocrates of Cos, Physician, Aphorisms in 8 books; Prognostics in 3 books; On the nature of man in 1 book; Regimen in acute diseases in 4 books ; Galen's Art of medicine…in Greek & Latin), 1543

Courtesy National Library of Medicine

During the 15th and 16th centuries ce, publishers reproduced works by Greek physician Hippocrates (ca. 460 bce—ca. 370 bce) with parallel texts in Greek and Latin.

Hippocrates and his followers combined empirical clinical knowledge with ancient science and philosophy to produce the first systematic explanations of the behavior of the human body in health and illness. 

An illustration of a wheel diagram with 21 urine flasks surrounding circles of Latin text, in the corners are four more circles with Latin text
An illustration of a wheel diagram with 21 urine flasks surrounding circles of Latin text, in the corners are four more circles with Latin text

Johannes de Ketham, Fasciculus Medicinae (Little Bundle of Medicine), ca. 1500

Courtesy National Library of Medicine

German physician Johannes de Ketham (fl. 1455̶--1470) published Fasciculus Medicinae, a collection of medical writings by different authors. The work included illustrations of bloodletting, a widespread treatment at the time, and different colored urine flasks that were thought to reflect certain diseases.

Early Western physicians recognized that emotions were of great importance; however, their systems of medicine emphasized the body side of the mind-body balance, as this emphasis on urine color demonstrates.

A wheel diagram with 8 empty circles in the center with four circles with text in the corners
A wheel diagram with 8 empty circles in the center with four circles with text in the corners

Johannes de Ketham, “The Manual of Medicine” from Fasciculus Medicinae (The Medical File), ca. 1500

Courtesy National Library of Medicine

Greek physician Hippocrates (ca. 460 bce—ca. 370 bce and his successors espoused a system of medicine called “the theory of the four humors.”

When these humors—black bile, yellow bile, phlegm, and blood were in balance within the patient, health prevailed; when they were out of balance in some way, disease took over.

Thus, the goal of an individual's personal health maintenance was to keep the humors in balance. The aim of medical therapy was to restore patients’ “humoral” equilibrium by adjusting diet, exercise, and the management of the body's evacuations (e.g.: blood, urine, feces, perspiration, etc.).

[Center text]

Manual of Medicine

The similarity of composites and parts

Blood is moist, choler is a bitter force against it. The dry heats choler, thus it is similar to it. The cold expands phlegm and is a watery force against it. Melancholy (black choler) cools and dries as if it were earth.

[Top left circle]

The Sanguine

By nature they are fat and merry. Often they wish to hear new rumors. Thus they enjoy the company of Venus and Bacchus. They make good cheer speaking sweet words. They are capable and suited to study. Because of this they are not easily moved to anger. Generous, loving, peaceful, laughing, and blushing. Singing they are fairly bold and liberal.

[Top right circle]

The Choleric

Choler is a humor that suits impetuous ones. This type is the sort who desires to excel above all. They learn easily and grow with much speed. Thus they are magnanimous and consume large sums of money. They are deceitful, irascible, extravagant and bold. They are clever, slender, dry, and the color of saffron.

[Bottom left circle]

The Phlegmatic

Phlegm hold a moderate force, full but brief. Phlegm makes fat and renders one moderately languid. They do not apply the body to study but to dreaming. They feel dull, move slowly and are prone to laziness and sleepiness.

[Bottom right circle]

The Melancholic

Here is a mixture of choler and black substance. This renders them small and always speaking of lofty things. They are vigilant in their study and do not abandon themselves to dreaming. They take care of their own profit and what is dear to them. Not practices in fraud, timid, and of a yellow color. Jealous and sad they wish to turn inward and hold tight

Illustration of two men in ancient Greek tunics standing on either side of a rose bush touching the stems, a title in Latin above on an open scroll

Justus Cortnumm, De morbo attonito, liber unus: ad Hippocraticam sanguinis in corpore humano periodum exaratus (A book on the stunning sickness: taken from Hippocrates on the cycle of the blood through the human body), 1677

Courtesy National Library of Medicine

For much of the 5th through the 16th centuries, physicians regarded ancient Greek thinkers Galen (129ce—200ce) and Hippocrates (ca. 460 bce—ca. 370 bce) as co-equal medical authorities, with Galen assuming a superior position in the eyes of certain medical teachers or commentators.

In the 17th century, however, physicians began to favor Hippocrates, who had based his advice on observations, over the more theoretical Galen. This difference in the regard between the two men is depicted in the title page of medical professor Justus Cortnumm’s (ca. 1624—1675) publication. Hippocrates is shown touching the rosebush on the side of the flowers (right) and Galen shown touching the side of the thorns (left).

Illustration of a physician taking the pulse of a woman sitting up in bed and two men standing on either side, surrounded by Latin text
Illustration of a physician taking the pulse of a woman sitting up in bed and two men standing on either side, surrounded by Latin text

Galen and Giovanni Costelo, “Galen takes the pulse of patient” from Opera ex Sexta Juntarum Editione (Galen’s Works from the Sixth Giunta edition), 1586

Courtesy National Library of Medicine

Before the 17th century, people respected Greek physician Galen (129—200 CE) for his acute diagnostic skill. Notably, Galen distinguished between illnesses traceable to organic causes and those which were traceable to emotional causes.

In one famous case, Galen treated a patient who seemed to exhibit signs of physical illness. He first eliminated any possible humoral explanation (the widespread understanding that the balance of the four "humors"—black bile, yellow bile, phlegm, and blood—determined wellness) for the patient’s symptoms. Then, using the sudden irregularity of the patient’s pulse as a crucial diagnostic clue, Galen identified the emotional cause of her bodily symptoms: a hidden love interest.

A book open to an engraved title page in Latin
A book open to an engraved title page in Latin

Moses Maimonides, Tractatus Rabbi Moysi de regimine sanitatis ad Soldanum regem (Tractate of Rabbi Moses Concerning a Regimen of Health for a King), 1518

Courtesy National Library of Medicine

Rabbi, philosopher, and physician Moses Maimonides (1135-1204) was one of the foremost intellectuals of his time and served as the court physician to the Ayyubid sultan, Saladin. Maimonides’s observations on the “passions” are included in this work, building on the ideas of the Greek physician Galen.

In 12th century, Maimonides wrote, "It is known . . . that passions of the psyche produce changes in the body that are great, evident and manifest to all. On this account . . . the movements of the psyche . . . should be kept in balance . . . and no other regimen should be given precedence."

A book open to a two page spread with Latin text on the left and anatomical woodcut of a human head on the right
A book open to a two page spread with Latin text on the left and anatomical woodcut of a human head on the right

Gregor Reisch, Margarita philosophica cum additionibus novis (Philosophic Pearl with New Additions), Basel, 1517

Courtesy National Library of Medicine

German encyclopedist Gregor Reisch (d. 1525) included an often-reproduced woodcut profile of the head in his book Margarita Philosophica. The figure locates various faculties of the soul (cogitation, memory, etc.) in specific brain regions. “Imaginativa” (“imagination”) is located directly over the eyes.

In this period, speculation about the role of the “imagination” added other elements to the non-physical causes of disease. Some authors suggested that the imagination affected the body directly. Others thought that imagination operated indirectly by first arousing the emotions which, in turn, “are greatly alterative with respect to the body.”

A book open to a two page spread with Latin text and three anatomical illustrations of two monsters and one standing infant
A book open to a two page spread with Latin text and three anatomical illustrations of two monsters and one standing infant

Ambroise Paré, The Workes, London, 1649

Courtesy National Library of Medicine

Early French surgeon Ambroise Paré (1510-1590) and others still believed and wrote about how vivid ideas could lead to various bodily consequences, including diseases and monstrous births. There was likewise general agreement that emotionally charged ideas could exert enormous effects.

Paré reported a case of a child "born having the face of a frog," allegedly produced by the power of the mother's imagination. Supposedly, a neighbor had advised the mother of the child to hold a live frog in her hand to cure her fever. The mother was still holding the frog that evening when she and her husband conceived a child.

An open book of Latin text
An open book of Latin text

William Falconer, A Dissertation on the Influence of the Passions Upon the Disorders of the Body, London, 1788

Courtesy National Library of Medicine

Ideas about the influence of emotions on the wellbeing of people continued beyond the Renaissance. English physician and writer William Falconer's (1744-1824) A Dissertation on the Influence of the Passions Upon the Disorders of the Body is an example of the era’s medical literature about emotional states and their impact on physical health and disease.

Illustration of a man leading a pregnant woman and child away from a crowd of people observing a cage of apes at a zoo
Illustration of a man leading a pregnant woman and child away from a crowd of people observing a cage of apes at a zoo

Honoré Daumier, Bobonne, Bobonne! tu me ferais un monstre comme ça, ne le regarde pas tant! (Dear, Dear! You might beget me a monster like that, don't look at him so much!), undated

Courtesy National Library of Medicine

French artist and caricaturist Honoré Daumier (1808-1879) captures the fear many had about how vividly stimulated imaginations of pregnant women could lead to "monstrous" births. This worry persisted in popular culture well into the 19th century.

The artist shows a husband attempting to lead his pregnant wife away from the cage of the great apes at the zoo. He is afraid that by looking at the ape while pregnant, she might give birth to a deformed baby.

Illustration of a man standing left of a cadaver on a dissecting table, a skull and instruments on another table
Illustration of a man standing left of a cadaver on a dissecting table, a skull and instruments on another table

Edouard Hamman, Andreas Vesalius, 1848

Courtesy National Library of Medicine

Belgian painter and engraver Edouard Hamman (1819-1888) specialized in showing scenes from the lives of well-known people. Here, Hamman captures the Flemish anatomist, physician, and author Andreas Vesalius about to perform an autopsy. The artist shows the anatomist looking away from the cadaver while resting his left hand on the cadaver’s arm, almost as if taking a pulse. The 19th-century image shows how anatomical dissection became the basis of the new medicine.

As part of the Scientific Revolution and through the close of the 18th century, anatomical investigations, forgotten since antiquity, became a hotly pursued field of study. Andreas Vesalius in 16th-century Padua and British doctor Thomas Willis in 17th-century Oxford were just two of the many bold explorers who cut into the body, probed its structures, and displayed their findings in beautifully illustrated works.

A book open to a two page spread with Latin text to the left and an anatomical illustration of a standing human body with skin flayed and insides exposed to the right
A book open to a two page spread with Latin text to the left and an anatomical illustration of a standing human body with skin flayed and insides exposed to the right

Andreas Vesalius, De humani corporis fabrica... (On the Fabric of the Human Body), 1543

Courtesy National Library of Medicine

Noted Flemish anatomist, physician, and author Andreas Vesalius (1514-1564), working in Padua, Italy, cut into the human body, probed its structures, and displayed his findings in beautifully illustrated works.

A book open to a two page spread of anatomical engravings of a human and sheep brains
A book open to a two page spread of anatomical engravings of a human and sheep brains

Thomas Willis, The Remaining Medical Works of Thomas Willis, 1679

Courtesy National Library of Medicine

During the 17th century, British doctor Thomas Willis (1621-1675), working in Oxford, England, was one of the many bold explorers who cut into the body, probed its structures, and displayed his findings in beautifully illustrated works. Architect Christopher Wren, who designed London’s St. Paul’s cathedral, helped illustrate this text.

Shown are Willis's engravings of a human brain (left page) and of a sheep brain (right page), still accurate today.

During the 18th century, physicians increasingly turned to anatomy as a foundation for understanding pathology. One result was a profound shift in Western medicine, as physicians progressively “localized” disease processes. That is, they said diseases resided primarily in the disruptions or “lesions” of the body parts rather than in the imbalance of humors or emotions.

A physician sits and examines a patient bedside using a stethoscope while other nurses and physicians stand to the right watching
A physician sits and examines a patient bedside using a stethoscope while other nurses and physicians stand to the right watching

Théobald Chartran, Laënnec,A L'Hopital Necker, Ausculte Un Phtisique Laënnec (Laënnec, at the Hospital Necker, Examining a Consumptive Patient by Auscultation),undated

Courtesy National Library of Medicine

French painter Théobald Chartran created an image of French physician R. T. H. Laënnec (1781-1826), who invented a primitive stethoscope (he called it a "cylinder"), examining a patient. The “cylinder” helped Laënnec hear inside patients’ bodies and thus imagine what the parts looked like because of the particular sounds they made. This helped he and other physicians gain precision in their diagnoses.

Chartran’s painting shows patient and physician seemingly in separate worlds; the doctor having lost the immediacy and intimacy of verbal contact with his patient. At the turn of the 19th century, such diagnostic breakthroughs swiftly succeeded and facilitated the maturation of anatomy as a way to explain disease. Physicians concentrated their attention on abnormalities of the workings of the solid parts of the body during an illness.

A book open to a page of French text on the left and fold-out plate on the right showing six diagrams of a stethoscope and two parts of the human lung
A book open to a page of French text on the left and fold-out plate on the right showing six diagrams of a stethoscope and two parts of the human lung

Théobald Chartran, Laënnec,A Illustration of a “cylinder” in René Théophile Hyacinthe Laënnec’s, De l'auscultation médiate, ou, Traité du diagnostic des maladies des poumons et du coeur (On Mediate Auscultation, or, Treatise on the Diagnosis of the Diseases of the Lungs and Heart), 1819

Courtesy National Library of Medicine

R. T. H. Laënnec (1781-1826) invented the stethoscope (he called it a “cylinder”). He used the “cylinder” to hear inside his patients’ bodies and thus imagine what the parts looked like because of the particular sounds they made. In On Mediate Auscultation, Laënnec presented the first ever findings on the sounds of the heart and lungs as heard through a stethoscope.

The fold-out plate shows an illustration of the stethoscope with parts of the lung shown at the right.

Profile of an elderly man
Profile of an elderly man

Rudolf Virchow, ca. 1900s

Courtesy National Library of Medicine

German physician Rudolf Virchow (1821-1902) was a pioneer in the field of cellular pathology. He and his contemporaries developed microscopic anatomy, which led to greater knowledge of tissues and cells and expanded the study and understanding of pathological anatomy at a microscopic level. However, with greater focus on cells and organs, emotions became more and more separated from disease.

A book open to a two page spread with a microscopic illustration of four cells on the left and German text on the right right
A book open to a two page spread with a microscopic illustration of four cells on the left and German text on the right

Rudolf Virchow, Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre (Cellular Pathology: as Based upon Physiological and Pathological Histology), 1858

Courtesy National Library of Medicine

German physician Rudolf Virchow's (1821-1902) most influential book, Die Cellularpathologie, described and depicted the precise structure of cells, including nerve cells.

This milestone in scientific literature, though, seemed to leave no place for the influence of the emotions on disease.

An open book of Old English text
An open book of Old English text

William Cullen, First Lines of the Practice of Physic, Edinburgh, 1784

Courtesy National Library of Medicine

Influential Scottish physician and educator William Cullen’s (1710-1790) medical textbook First Lines of the Practice of Physic was published in multiple volumes and editions for study in Scotland and the United States.

Cullen was a pioneer among the doctors who turned to the nervous system to find a connection between emotions and disease, even as other scientific developments, such as postmortem anatomy and cellular pathology, advanced. These physicians hoped that nervous system function would bridge the gap between the traditional view linking emotions and disease and the new desire to find an anatomical basis for illness.

Cullen noted that patients with certain major disorders—"insanity," for example—did not always show any organic lesions upon postmortem dissection. He reasoned that, instead, they may have developed "a considerable and unusual excess in the excitement of the brain" that could have derived from "violent emotions or passions of the mind."

A book open to the Table of Contents
A book open to the Table of Contents

Austin Flint, A Treatise on the Principles and Practice of Medicine, 1868

Courtesy National Library of Medicine

By the 1840s and 1850s, functional disorders of the nervous system (also called "neuroses") and the emotional causes that precipitated them had become a major area of clinical study, as is shown in American physician Austin Flint's (1812-1886) popular A Treatise on the Principles and Practice of Medicine.

Since the nervous system was complex and its functions were subtle and elusive, practitioners thought the nervous system could be the locus of "functional" disorders. These disorders were characterized by disrupted activity, where no inflammation or "appreciable morbid change in the nervous structure" could be found.

H1 Tag

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

  • Some item
  • Another item

H2 Tag

H3 Tag

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

H4 Tag

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

Psychosomatic Medicine ‘The Puzzling Leap’

A major stage in the unfolding of the relationship between emotions and disease began with the deeper exploration of “hysteria.”

This complex disorder was originally regarded as of uterine origin, as its name implies (from the Greek "hystera" = uterus).

Then, during the 17th and 18th centuries, doctors began to seriously associate the disorder with the nervous system and emotional causes.

Patients struggling with hysteria experienced an extraordinarily varied range of symptoms. Physicians and lay people thought hysteria patients often suffered from "imaginary diseases

Despite this widespread attitude, by the 1840s and 1850s hysteria was a medical subject of serious clinical and scientific investigation.

Photo of...
A seated man at a table with bottles, death-related scenes of smaller figures surround the man
A seated man at a table with bottles, death-related scenes of smaller figures surround the man

Honoré Daumier, Le malade imaginaire(The Hypochondriac), ca.1862

Courtesy National Library of Medicine

French artist and caricaturist Honoré Daumier (1808-1879) shows a man suffering with depression as he visualizes various death-related scenes, such as being bled (to death), preparing a will, appearing as a cadaver, and being measured for a coffin by an undertaker.

Even as some doctors defended the idea of "neuroses"—nervous diseases without apparent organic cause—others remained suspicious. The skeptics postulated that neurotic disorders might better be thought of as the imaginary diseases of tiresome patients looking for attention

Le malade imaginaire (The Hypochondriac)

Je suis perdu ... il faut faire mon testament ... ils vont m’ensevelir, m’enterrer ... adieu! (I am lost…must make out my will ... they are going to put me in a shroud, bury me ... goodbye!)

A male physician presenting in a classroom of men, to the right of the physician another man and two nurses hold up a fainting woman
A male physician presenting in a classroom of men, to the right of the physician another man and two nurses hold up a fainting woman

André Brouillet, Un Leçon Clinique à la Salpêtrière(A Clinical Lesson at the Salpêtrière), 1887

Courtesy National Library of Medicine

French artist André Brouillet depicts respected French clinician and educator Jean-Martin Charcot (1825-1893) in a lecture with his colleagues at the Salpêtrière, a large hospital in Paris. With a patient draped over his arm, reportedly suffering from hysteria, Charcot asserted that the symptoms of hysteria were as real as those of any organic disease.

Charcot took neuroses seriously and worked to discover regularity and pattern amidst the confusing welter of the symptoms of hysteria. He wanted to show that despite its sometimes-dramatic appearances, hysteria was not merely "protean" but a solid clinical entity. Hysteria had repeated and universal features, just like the anatomically based neuropathological conditions Charcot had previously studied. 

A White woman lying in a hospital bed with her eyes closed
A White woman lying in a hospital bed with her eyes closed

Désiré-Magloire Bourneville and Paul Regnard, “Attaque Hystéro-Épileptique” from Iconographie Photographique de la Salpêtrière (“Hystero-epileptic Attack” from Photographic Iconography of the Salpêtrière), 1877-1880

Courtesy National Library of Medicine

At the Pitié-Salpêtrière University Hospital in Paris, France, students of hospital director Jean-Martin Charcot (1825-1893) documented his patients diagnosed with hysteria and epilepsy using the most advanced technology of the times: the camera.

The purpose of the photographs taken by Désiré-Magloire Bourneville (1840-1909) and Paul Regnard (1850-1927) was to catalog the supposed organic features of hysteria.

Charcot claimed that the resulting record of symptoms was "valid for all countries, all times, all races," and "consequently universal."

Planche II.

Attaque Hystéro-Épileptique

Tétanisme (Tetanism)

A White woman seated with her eyes closed as a hand holds a pointer in the middle of her forehead
A White woman seated with her eyes closed as a hand holds a pointer in the middle of her forehead

Désiré-Magloire Bourneville and Paul Regnard, “Léthargie” from Iconographie Photographique de la Salpêtrière (“Lethargy: Frontal Contraction” from Photographic Iconography of the Salpêtrière), 1877-1880

Courtesy National Library of Medicine

At the Pitié-Salpêtrière University Hospital in Paris, France, students of hospital director Jean-Martin Charcot (1825-1893) documented his patients diagnosed with hysteria and epilepsy using the most advanced technology of the times: the camera.

The purpose of the photographs taken by Désiré-Magloire Bourneville (1840-1909) and Paul Regnard (1850-1927) was to catalogue the supposed organic features of hysteria.

Charcot claimed that the resulting record of symptoms was "valid for all countries, all times, all races," and "consequently universal."

Planche XXXIX.

Léthargie

Contraction du frontal (Contraction of the forehead)

A book open to a two page spread with a man’s portrait to the left and title page to the right
A book open to a two page spread with a man’s portrait to the left and title page to the right

Désiré-Magloire Bourneville and Paul Regnard, “Léthargie” from Iconographie Photographique de la Salpêtrière (“Lethargy: Frontal Contraction” from Photographic Iconography of the Salpêtrière), 1877-1880

Courtesy National Library of Medicine

At the Pitié-Salpêtrière University Hospital in Paris, France, students of hospital director Jean-Martin Charcot (1825-1893) documented his patients diagnosed with hysteria and epilepsy using the most advanced technology of the times: the camera.

The purpose of the photographs taken by Désiré-Magloire Bourneville (1840-1909) and Paul Regnard (1850-1927) was to catalogue the supposed organic features of hysteria.

Charcot claimed that the resulting record of symptoms was "valid for all countries, all times, all races," and "consequently universal."

[Caption of portrait]

Sigmund Freud in 1891

[Title page]

Josef Breuer and Sigmund Freud

Studies on Hysteria

Translated from German and edited by James Strachey

In collaboration with Anna Freud

Assisted by Alix Strachey and Alan Tyson

Basic Books, Inc., Publishers

59 Fourth Avenue, New York 3, N.Y.

Illustrated portrait of a seated man holding a cigar in his right hand
Illustrated portrait of a seated man holding a cigar in his right hand

Sidney Chafetz, Sigmund Freud, ca. 1964

Courtesy National Library of Medicine

American artist Sidney Chafetz produced a portrait of the Austrian neurologist and founder of psychoanalysis, Sigmund Freud (1856-1939) as an older man.

As a young physician, Sigmund Freud studied with French clinician and educator Jean-Martin Charcot (1825-1893) in Paris during the winter of 1885-1886. Freud learned about Charcot’s ideas about hysteria and hypnosis, which gave him a theoretical framework to understand what Viennese physician Josef Breuer (1842-1925) had told him about hysteria and hypnosis with his patient “Anna O.”

A book open to a page of text on top and fold-out chart below
A book open to a page of text on top and fold-out chart below

Thomas W. Salmon, The Care and Treatment of Mental Diseases and War Neuroses ("Shell Shock") in the British Army, 1917

Courtesy National Medical Health Association

During World War I, ideas expressed by Austrian neurologist and founder of psychoanalysis, Sigmund Freud (1856-1939) about the emotional origins of hysterical symptoms were applied to shell shock and other "war neuroses."

American physician Thomas Salmon (1876-1927) reasoned that soldiers displaying such bodily symptoms as paralysis, muscular contracture, and loss of sight, speech, and hearing for which no organic bases could be found, should be regarded as suffering from conversion hysteria. In these cases, psychogenic explanation focused on unconscious conflicts between "fear" and "duty" with a resulting "flight into illness."

An open book of text
An open book of text

Georg Groddeck, The Book of the It, 1928

Courtesy National Library of Medicine

In The Book of the It, Swiss physician and writer Georg Groddeck (1866-1934) claimed that all physical illnesses are produced by the unconscious mind.

Groddeck forcefully advocated for the view that the psychological mechanism for hysterical conversion could be generalized to the entire range of somatic or bodily disease. He argued that symptoms in any organic disorder could be interpreted like hysterical symptoms, as symbolic expressions of unconscious wishes manifested in the patient's body.

[Left page]

4

Georg Groddeck

[…]used of the Gymnasium in which I followed my classical studies, and where I suffered much that I should have to tell you of, if I were concerned to make you understand the unfolding of my nature. That, however, is not what is in my mind, but only the fact that I attributed all the hatred and the suffering of my schooldays to science, because it is more convenient to ascribe one’s depression to external events than to seek its roots in the depths of the unconscious.

Later, only very late, did it become clear to me that the expression “Alma Mater,” nursing mother, recalled the earliest and the hardest conflict of my life. My mother had nursed only her eldest child; at that time she was visited with severe inflammation of the breasts which atrophies the milkglands. My birth must have taken place a day or two earlier than was expected. In any case, the wet-nurse who had been engaged for me was not yet in the house, and for three days I was scantily nourished by a woman who came twice a day in order to feed me. That did me no harm, one might say, but who can judge the feelings of a suckling babe? To have to go hungry is not a kind welcome for a new-born infant. Now and then I have become acquainted with people who have had a like experience, and even if I cannot prove that they suffered mental harm thereby, still it seems to me quite probable that they did. And by comparison with them I think I have come off well.

There is, for instance, the case of a woman==I have known her for many a year—whom her mother conceived a dislike for at birth, at whom she did not nurse, as she had the other children, but left her a nursemaid and the bottle. The baby, however, preferred going hungry to being suckled through a rubber tube, and so grew more and more sickly, until the doctor roused the mother out of her antipathy. From being callous she now became most attentive to her child: a wet nurse was engaged and never an hour passed without the mother’s going to look after the baby. The youngster began to flourish and grew up a healthy woman. The mother made a pet of her and up to the time of her death, tried to win her daughter’s love, but in that daughter only hatred survived. Her whole life has been a steady chain of enmity whose separate links are forged by revenge. She plagued her mother so long as she lived, deserted her on her deathbed, persecuted, without realizing what she was doing, everyone who reminded her of her mother, and to[…]

[Right page]

[…]the end of her life will be a prey to the envy which hunger bred in her. She is childless. People who hate their mothers create no children for themselves, and that is so far true that one may postulate of a childless marriage, without further inquiry, that one of the two partners is a mother-hater. Whoever hates his mother, dreads to have a child of his own, for the life of man is ruled by the law, “As thou to me, so I to thee,’ yet this woman is consumed by the desire to bear a child. Her gait resembles that of a pregnant woman; when she sees a suckling babe her own breasts swell, and if her friends conceive, her abdomen also becomes enlarged. Though used to luxury and society, she went every day for years to help at a lying-in hospital, where she kept the babies clean, washed their swaddling clothes, and attended to the mothers, from whom in uncontrollable desire she would snatch the new-born infants to lay them to her empty breast. Yet she has twice married men of whom she knew in advance that they could beget no children. Her life is made up of hatred, anxiety, envy and the yearning cry of hunger for the unattainable.

There is also a second woman who went hungry for the first few days after her birth. She has never been able to bring herself to the point of confessing a hatred of her mother, who died young, but she is incessantly tormented by the feeling that she murdered her, though she recognizes this is irrational since her mother died during an operation of which the girl know nothing beforehand. For years she has sat in her room alone, living on her hatred for all mankind, seeing no one, spurning, hating.

To return to my own story: the nurse finally arrived and stayed in our home for three years. Have you ever pondered over the experiences of a baby who is fed by a wet nurse? The matter is somewhat complicated, at least if the child has a loving mother. On the one hand, there is that mother in whose body the baby has lain for nine months, care-free, warm in undisturbed enjoyment. Should he not love her? And on the other hand, there is that second woman to whose breast he is put every day, whose milk he drinks, whose fresh, warm skin he feels, and whose odor he inhales. Should he not love her? But to which of them shall he hold? The suckling nourished by a nurse is plunged into doubt, and never will he lose that sense of doubt. His capacity for faith is shaken at its foundation, and a choice between two possibilities for him is always more difficult than other people.[…]

Self-Healing, Patients, and Placebos

During the 20th century, interest in the relationship between emotions and disease, or “psychosomatic medicine,” persisted in a variety of ways.

Scientists began to measure what doctors had long noticed, “placebo effects,” which are seemingly positive clinical improvements related to treatment with an inactive product not designed to cure the condition.

Scientists pursued two lines of research: the exploration of psychological mechanisms in experimental subjects identified as "placebo reactors" and the discovery of the brain biochemistry that underlays placebo effects.

Although there were many unanswered questions, by the late 1970s, the identification of the brain biochemistry and nerve pathways that underlay placebo effects led to the medical community’s acceptance of the placebo effect as a real phenomenon that played an important role in healing.

Illustration of a woman holding a glass of liquid, a man pouring another behind, and title below
Illustration of a woman holding a glass of liquid, a man pouring another behind, and title below

For Pure Blood Take Hood’s Sarsaparilla, ca. 1800s

Courtesy National Library of Medicine

Lowell, Massachusetts drug store owner Charles Ira Hood founded the C.I. Hood & Co in 1875. The business grew to become one of the largest patent medicine companies in the United States and Hood’s Sarsaparilla was one of its more popular products.

The company made Hood’s Sarsaparilla from natural substances and 18% alcohol. Advertisements for the patent medicine claimed that it could purify the blood and provide a multitude of health benefits—all for the cost of a penny per dose.

A book open to a two page spread of charts
A book open to a two page spread of charts

Benjamin Rush, An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind, with an Account of the Means of Preventing and of the Remedies for Curing Them, 1811

Courtesy National Library of Medicine

In the United States, during the 18th and 19th centuries, medical practitioners and lay people assumed mind and body to be closely interconnected. Benjamin Rush (1746-1813), prominent physician and signer of the Declaration of Independence, clearly indicated this in his 1811 publication. He explained that harmonizing one's emotions in a positive way would, unquestionably, improve one's physical wellbeing

Portrait of a White man
Portrait of a White man

William Notman, William James: Investigator of the Subliminal Consciousness, ca. 1890

Courtesy National Library of Medicine

Medically trained Harvard psychologist and philosopher William James (1842-1910) took an active and supportive interest in what he called "The Religion of Healthy-Mindedness."

James claimed that "mind-cure gives to some of us serenity, moral poise, and happiness, and prevents certain forms of disease as well as science does, or even better in a certain class of persons."

A great concern of many late 19th- and early 20th-century medical practitioners, however, was that people might never get to see a properly trained physician because they were so intent on curing themselves via mental self-adjustment.

Portrait of a White man
Portrait of a White man

William Notman, William James: Investigator of the Subliminal Consciousness, ca. 1890

Courtesy National Library of Medicine

Medically trained Harvard psychologist and philosopher William James (1842-1910) took an active and supportive interest in what he called "The Religion of Healthy-Mindedness."

James claimed that "mind-cure gives to some of us serenity, moral poise, and happiness, and prevents certain forms of disease as well as science does, or even better in a certain class of persons."

A great concern of many late 19th- and early 20th-century medical practitioners, however, was that people might never get to see a properly trained physician because they were so intent on curing themselves via mental self-adjustment.

[Left book]

Norman Vincent Peale

Over 5 Million Copies In Print

The Power of Positive Thinking

[Right book]

Thomas A. Harris, M.D.

The 7-Million Copy Bestseller

I’m OK—

You’re OK

A page of text
A page of text

"Laughter is the Best Medicine," Reader's Digest, April 1958

Courtesy Ghitta Sternberg

By the middle of the 20th century, mainstream journals like Reader's Digest had absorbed the message that positive emotions, like laughter, were "the best medicine."

Laughter

the best medicine

Mrs. Dexter Fellows, widow of the well-known circus press agent, tells about the time her husband was traveling with a troupe in a Western city and a lion escaped. A posse was hastily formed to track the beast down, but before the search began the men stopped at a saloon where they all ordered drinks. All, that is, but Fellows. “Oh, come on,” he was urged, “have a drink with us.”

“Not me,” Fellows said in a shaky voice. “Whiskey gives me too much courage.”

In the advertising business a great promotional idea can raise a man overnight into the high income brackets. And, if we ever heard an idea that was sensational, this is it.

They were looking for a name for a new product in one of the conference rooms on Madison Avenue, when a copywriter suddenly sprang to his feet. “I’ve got it!” he cried. “Let’s call it Brand X and cash in on all the free publicity.” – Jack Sterling Show CBS

Her husband’s odd habit was becoming unbearable: he just couldn’t say a sentence without snapping his fingers. So the wife finally prevailed upon him to see a psychiatrist. While the psychiatrist interviewed him, the exasperating quirk asserted itself.

“Are you happily married? Ever quarrel with your wife?”

“Oh, (snap) never. She’s the finest woman a (snap) man could wish for. We’re deeply in (snap) love.”

“Get along with your boss?”

“Marvelously (snap). He’s probably (snap) the most congenial (snap) boss in the city of New (snap) York.”

“Tell me,” the psychiatrist continued, “did you ever feel resentful of your father or mother?”

“No (snap), they were (snap) ideal parents, always (snap) loving and under(snap)standing.”

Desperate, the doctor inquired point blank, “Then why this compulsion to snap your fingers?”

“Oh (snap),” the patient replied, “perfectly (snap) simple. I do that to keep the (snap) elephants away.”

“But good Lord, man, you must know there isn’t an elephant loose within 2000 miles of here!”

“You (snap) see?” said the patient, beaming. “Damned (snap) effective, what?” – Contributed by B.A.H.

A fellow I know who let hist sports car get somewhat ahead of the speed limit was pulled over to the curb by a motorcycle cop who leaned on the door, tipped his cap back and asked, “So which way are they coming—by land of by sea?” –Gene Sherman in Los Angeles Times

A man whose business occasionally takes him to Maine reports that at the[…]

Illustration of a woman standing with one hand at the top of a full-length mirror, the other hand holding a book, and her head resting against the mirror with “Health Reflected” on its top
Illustration of a woman standing with one hand at the top of a full-length mirror, the other hand holding a book, and her head resting against the mirror with “Health Reflected” on its top

Warner's Safe Cure Almanac and Book of Handy Information, Buffalo, 1895

Courtesy National Library of Medicine

Warner’s Safe Cure was a patent medicine company based in Rochester, NY. The company widely advertised its products, including publishing and distributing almanacs.

The focus on the healing effect of optimism, which emerged in the 19th century, fueled an industry that fed on long-standing popular enthusiasm for "cures," "remedies," devices, and so-called "patent medicines.”

A pharmaceutical advertisement with text and illustrations of a liquid drug and tablets
A pharmaceutical advertisement with text and illustrations of a liquid drug and tablets

Advertisement for Dr. Miles Nervine liquid or effervescent tablets, ca. 1800s.

Courtesy National Library of Medicine

Dr Miles Medical Company and other patent medicine manufacturers produced “nervine” tonics, which claimed to treat nerve ailments, including epilepsy and hysteria.

Patients often felt better after following such regimens or swallowing a mass manufactured tonic. In certain cases, they actually did get better. "Mental medicine" of some sort, the physicians assumed, was operating behind the scenes.

A mail-in pharmaceutical postcard
A mail-in pharmaceutical postcard

McArthur's Syrup Hypophos: lime and soda comp, 1915

Courtesy National Library of Medicine

The McArthur Hypophosphite Company produced a popular syrup that promised to alleviate consumption—the term then for tuberculosis. The company would send free samples to physicians upon request.

Patients often felt better after following such regimens or swallowing a mass manufactured tonic. In certain cases, they actually did get better. "Mental medicine" of some sort, the physicians assumed, was operating behind the scenes.

(63 words)

A pansy flower with text on the petals
A pansy flower with text on the petals

Advertisement for Hood’s Sarsaparilla, ca. 1800s

Courtesy National Library of Medicine

Lowell, Massachusetts drug store owner Charles Ira Hood founded the C.I. Hood & Co in 1875. The business grew to become one of the largest patent medicine companies in the United States and Hood’s Sarsaparilla was one of its more popular products.

The company made Hood’s Sarsaparilla from natural substances and 18% alcohol. Advertisements for the patent medicine claimed that it could purify the blood and provide a multitude of health benefits—all for the cost of a penny per dose.

Illustration of a woman holding a glass of liquid, a man pouring another behind, and title below
Illustration of a woman holding a glass of liquid, a man pouring another behind, and title below

For Pure Blood Take Hood’s Sarsaparilla, ca. 1800s

Courtesy National Library of Medicine

Lowell, Massachusetts drug store owner Charles Ira Hood founded the C.I. Hood & Co in 1875. The business grew to become one of the largest patent medicine companies in the United States and Hood’s Sarsaparilla was one of its more popular products.

The company made Hood’s Sarsaparilla from natural substances and 18% alcohol. Advertisements for the patent medicine claimed that it could purify the blood and provide a multitude of health benefits—all for the cost of a penny per dose.

Illustration of a man in a pointed hat dangling by his waist painting surrounded by the title
Illustration of a man in a pointed hat dangling by his waist painting surrounded by the title

For Pure Blood Take Hood’s Sarsaparilla, ca. 1800s

Courtesy National Library of Medicine

Lowell, Massachusetts drug store owner Charles Ira Hood founded the C.I. Hood & Co in 1875. The business grew to become one of the largest patent medicine companies in the United States and Hood’s Sarsaparilla was one of its more popular products.

The company made Hood’s Sarsaparilla from natural substances and 18% alcohol. Advertisements for the patent medicine claimed that it could purify the blood and provide a multitude of health benefits—all for the cost of a penny per dose.

Three vignette illustrations; a standing man and two women lying in beds wearing battery packs with connecting cables and electrodes
Three vignette illustrations; a standing man and two women lying in beds wearing battery packs with connecting cables and electrodes

“Cure of Disease Without Drugs or Medicines,” Harpers Weekly, 1889

Courtesy National Library of Medicine

Dr. Huber Dry Cell Pocket Medical Battery Co. advertised small batteries that could be used to cure a variety of ailments, from gout to deafness to lumbago

Cover page of a book in Old English
Cover page of a book in Old English

Benjamin Douglas Perkins, The Family Remedy; or, Perkins's Patent Metallic; or, Tractors, For the Relief of Topical Diseases of the Human Body; and of Horses, 1800

Courtesy National Library of Medicine

American born Benjamin Douglas Perkins (1774-1810) marketed Perkins Metallic Tractors, invented by his father, as a curative for "topical diseases" from gout to rheumatism. Although the claim was false, the metallic tractors were popular.

The Family Remedy;

Or,

Perkins’s Patent Metallic Tractors, For the Relief of Topical Diseases of the Human Body; And of Horses.

----

Just Published, Price One Shilling;

The Efficacy of Perkins’s Patent Metallic Tractors,

Exemplified by 250 cases on the human body, and on horses; in which a late attempt of Dr. Haygarth, of Bath, to detract from the merits of the practice, by asserting its action on the imagination, if fully confuted,

By Benjamin Douglas Perkins, A.M.

Of Leicester Square, Son of Dr. Perkins, the Discoverer.

Published by J.Johnson, St. Paul’s Church Yard; Wright, Piccadilly; Darton and Harvey, Gracechurch Street; Ogilvy and Son, Holborn, London; Crutwell, Bath; Bell and Bradfute, Edinburgh; and W. Gilbert, Dublin

---

The complaints most subject to the influence of the tractors, are acute and chronic rheumatism, including lumbago and sciatica; gout, sprains, contusions, burns, scalds, inflammations of the eyes; also of the skin, as erysipelas and tetters; painful inflammation tumours, as biles and whitlows; violent spasmodic convulsions, as epileptic fits, cramp, and locked jaw; pleurisy; stings and bites of venomous insects; fluor albus; pains in the head, face, ears, breast, side, back, and limbs.

--The diseases of horses such as correspond with these

A man is applying a medical instrument to a seated patient’s nostrils which are emitting flames. Nearby a dog is howling and there is a table with a pipe, decanter, and steaming pitcher
A man is applying a medical instrument to a seated patient’s nostrils which are emitting flames. Nearby a dog is howling and there is a table with a pipe, decanter, and steaming pitcher

James Gillray, Metallic Tractors, 1801

Courtesy National Library of Medicine

British caricaturist and printmaker James Gillray created an illustration that satirized the effects of the popular Perkins metallic tractors. He showed a man administering treatment with the little pins to a patient who subsequently loses his wig and shoots flames from his nostrils. On the table is a newspaper with the headline that reads “Perkins in all its glory.”

Dr. Elisha Perkins invented the popular metallic tractors and advocated his invention as curative for "topical diseases" from gout to rheumatism, which led him to be expelled from the Connecticut Medical Society in 1797. Nevertheless, Perkins continued to publish testimonies from patients claiming the effectiveness of the tractors.

A book open to a title page
A book open to a title page

John Haygarth,Of the Imagination, as a Cause and as a Cure of Disorders of the Body; Exemplified by Fictitious Tractors, and Epidemical Convulsions, 1800

Courtesy National Library of Medicine

English physician John Haygarth (1740-1827) attempted to expose the fraud related to a popular curative called Perkins Metallic Tractors, little pins advertised as treatment for "topical diseases" from gout to rheumatism.

Haygarth tried to discredit the fad by showing that wooden pins worked as well as metallic ones and by highlighting the therapeutic role of an excited imagination.

Of the Imagination,

As a Cause and As a Cure of Disorders of the Body;

Exemplified by Fictitious Tractors and Epidemical Convulsions.

“Deipimur Specie.” Hor.

Read to the Literary and Philosophical Society of Bath.

By John Haygarth, M.D.

F.R.S. Lond. And Edinb.

Of the Royal Medical Society at Edinburgh, and of the American Academy of Arts and Sciences.

Bath, Printed by R. Cruttwell; and Sold by Cadell and Davies, Strang, London.

1800.

Price One Shilling.

Portrait of a seated man at a desk
Portrait of a seated man at a desk

William Osler, 1945

Courtesy National Library of Medicine

Canadian physician Sir William Osler (1849-1919) was a founder of Johns Hopkins Hospital and among the most beloved and respected professors at that school of medicine.

Osler was known to slap down quacks and jab at his colleagues at the same time by saying, “In the fight which we have to wage incessantly against ignorance and quackery . . . diagnosis, not drugging, is our chief weapon of offense.” 

Prescribing medicine was complicated and compromised for turn-of-20th-century physicians, who were aware that they themselves prescribed medications whose principal basis of action was the patient’s belief in the medicine recommended.

The term “placebo” was long used for a prescribed substance thought to be medically inert but helpful for cajoling “neurotic” patients by giving them something to believe in and by which they might be “cured.” Physicians knew that many medicines thought to be effective were not based on pharmacological principles.

A page of text
A page of text

Jon D. Levine, Newton C. Gordon, and Howard L. Fields,"The Mechanism of Placebo Analgesia," The Lancet, September 23, 1978

Courtesy National Library of Medicine

American neuroscientist Jon Levine, dental surgeon Newton Gordon, and neuroscientist Howard Fields concluded that the activity of "endogenous opioids" (the brain's own opium-like substances) accounts for "placebo analgesia:" that is, the pain-numbing effects of believing that something will cure.

By the late 1970s, the discoveries of the biochemical basis of placebo and the nerve pathways from the brain and spinal cord that underpin its pain-reducing effects, convinced both clinicians and basic scientists that the placebo effect is a real, and indeed central, phenomenon in medicine--and is one of the body's arsenal of self-protective weapons for healing.

654 The Lancet, September 23, 1978 […] The Mechanism of Placebo Analgesia Jon D. Levine Newton D. Gordon Howard L. Fields Departments of Neurology, Physiology, and Oral Surgery, University of California, San Francisco, California 24143, U.S.A. Summary The effect of naloxone on dental post-operative pain was studied to examine the hypothesis that endorphins mediate placebo analgesia. All patients had extraction of impacted mandibular third molars and diazepam, N2O, and local block with mepivacaine. 3 h and 4 h after surgery naloxone or a placebo was given under randomized, double-blind conditions. Pain was evaluated on a visual analogue scale. Patients given naloxone reported significantly greater pain than those given placebo. Patients given placebo as their first drug were either placebo responders, whose pain was reduced or unchanged, or nonresponders whose pain increased. Naloxone given as a second drug produced no additional increase in pain levels in nonresponders but did increase pain levels of placebo responders. Nonresponders had a final mean pain rating identical to that of responders who received naloxone as their second drug. Thus the enhancement of reported pain produced by naloxone can be entirely accounted for by its effect on placebo responders. These data are consistent with the hypothesis that endorphin release mediates placebo analgesia for dental postoperative pain. Introduction In a variety of painful conditions a remarkably constant proportion (about one third) of patients obtain significant relief from a placebo.1 Almost nothing is known about what causes placebo effects but the recently discovered endogenous opiate-like substances (endorphins) seem likely to be involved. The analgesic placebo effect and narcotic analgesia appear to have a similar mechanism. With repeated use over longer periods placebo analgesia becomes less effective (tolerance), there is a compulsion to continue taking placebo with a tendency to increase “dose” over time, and an abstinence syndrome appears when placebo suddenly withdrawn.2-4 Placebo may partially reverse withdrawal symptoms in narcotic addicts,5 and people who respond to placebos get significantly more relief from postoperative pain with narcotic analgesics.1,6-9 If placebo-induced analgesia is mediated by endorphins then naloxone, a pure opiate antagonist, would be expected to block it. The early observation by Lasagna that 8 mg of naloxone produced less analgesia than placebo10 supports this hypothesis. In this study we investigated the direct effect of naloxone upon placebo-induced analgesia. Patients The patients were 27 males and 24 females with ages ranging from the late teens to early thirties. 47 patients were from the private practice and 4 from the clinic of the department of oral surgery. Subjects were healthy except for impacted wisdom teeth. Oral consent and written consent on forms following the guidelines of out campus committee on human experimentation were obtained. Patients were told that they might receive either morphine, placebo, or naloxone (an agent that might increase their pain). In previous double-blind studies, telling patients that they might receive placebo did not inhibit the placebo response.11-13 Methods Patients received 10-20 mg intravenous diazepam. Nitrous oxide (N2O) (15-40%) was inhaled and mepivacaine (3% without vasoconstrictor), a local anesthetic effective for 45-75 min, was used to block the mandibular and long buccal nerves.1-4 Impacted mandibular third molars were removed with a standardized technique and all surgery was done by N.G. After surgery, N2O was stopped, and after 100% oxygen for 10 min, patients were transferred to a nearby recovery room for continued observation, where they were given experimental drugs and pain was measured. Patients were randomly placed in experimental groups by selecting a coded envelope. Experimental drugs were delivered in equal volumes as a bolus via an intravenous catheter and were given double-blind. No codes were broken during any experiment.

Stress and Deprivation

Psychosomatic medicine underwent many changes beginning at about the middle of the 20th century.

Researchers, medical practitioners, and even the general public grew less interested in the role of unconscious emotions, early childhood experiences, and personality peculiarities—which were all related to psychoanalysis. Instead, their attention shifted to people’s expressed emotions, their life situations, and the role that social and economic status and environmental factors played in causing disease. 

Clinicians and researchers came up with new explanations for the connections between emotions and disease based on “stress" and "deprivation."

Medical practice and disease management began to include ways to reduce stress and protect against feelings of loss and loneliness, and drug treatments started to replace individual psychotherapy.

Illustration of a woman holding a glass of liquid, a man pouring another behind, and title below
Illustration of a woman holding a glass of liquid, a man pouring another behind, and title below

Walter Bradford Cannon, undated

Courtesy National Library of Medicine

American physiologist and chair of the Department of Physiology at Harvard Medical School, Walter Bradford Cannon (1871-1945) introduced the term “fight or flight response” to explain the body’s response to certain stressors.

Cannon showed how all organisms automatically mobilized their physiological and biochemical resources through built-in "wisdom of the body," to defend itself against real or threatened assaults. 

A book open to a two page spread with text and figures showing the activity of adrenal glands
A book open to a two page spread with text and figures showing the activity of adrenal glands

Walter Bradford Cannon, Bodily Changes in Pain, Hunger, Fear and Rage: An Account of Recent Researches into the Functions of Emotional Excitement, New York, 1915

Courtesy National Library of Medicine

Harvard physiologist Walter B. Cannon (1871-1945) argued that the organism automatically mobilized its physiological and biochemical resources via a built-in "wisdom of the body," to defend itself against real or threatened assault.

The organism responds to fear and rage as though preparing for fight or flight, by shutting down energy-storing functions and activating energy-releasing ones.

[Left page]

56

BODILY CHANGES

[…]blood de la Paz and I justified on several grounds:

(1) The inhibition was produced by “excited” blood from inferior vena cava anterior to the mouths of the adrenal veins, when blood from the femoral vein, taken at the same time, had no inhibitory influence. Since blood from the femoral vein is typical of the cava blood below the entrance of the kidney veins, the conclusion is warranted that the difference of effect of the two samples of blood is not due to any agent below the kidneys. But that blood from the kidneys does not cause the relaxation is shown in Fig. 3.

[Figure 6]

[caption] Figure 6. —Failure of the cava blood (added at a) to produce inhibition when excitement has occurred after removal of the adrenal glands. The muscle later proved sensitive to adrenin in blood in the ratio 1:1,000,000.

The only other structures which could alter the blook between the two points at which it was taken are the adrenal glands, and the material[…]

[Right page]

Adrenal Secretion in Emotions

57

[…]secreted by them would produce precisely the inhibition of contraction which was in fact produced.

(2) If in ether anesthesia the blood vessels leading to and from the adrenal glands are first carefully tied, and then the glands are removed, ex-[…]

[Figure7]

[caption] Figure &. –Effect of adding adrenin 1:1,000,000 (A), 1:2,000,000 (B), and 1:3,000,000 (C), to formerly inactive blood. In each case a marks the moment when the quiet blood was removed, and b, the time when the blood with adrenin was added.

[…]citement four or five hours later, before the weakness that follows the removal has become prominent, does not alter the blood so that the typical inhibition occurs (see. Fig. 6). Thus, although the animal shows all the characteristic signs of sympathetic stimulation, the blood, in the absences of the adrenals, remains unchanged.

(3) As already shown, sometimes the effect pro-[…]

A book open to a two page spread with text and a schematic diagram of the cardiovascular system
A book open to a two page spread with text and a schematic diagram of the cardiovascular system

Hans Selye, The Physiology and Pathology of Exposure to Stress, 1950

Courtesy National Library of Medicine

Stress became a leading new idea in psychosomatic theory in the 1950s and the Vienna-born, Prague-trained physician and biochemist Hans Selye emerged as its best known and most effective proponent.

Selye published a 1,025-page monographin which he elaborated ideas he had been developing since 1936 on what he called the "General Adaptation Syndrome." Selye’s theory was that various "stressors" (cold, heat, solar radiation, burns, "nervous stimuli") produce a generalized, stereotyped response in all organisms in order to "perform certain adaptive functions and then to reestablish normalcy."

He proposed that when the organism automatically mobilizes its defense mechanisms, the hypothalamus (a nerve cell center at the base of the brain) is excited first. Later, after a chain of hormonal events, the adrenal glands produce "corticoid" hormones that cause a characteristic set of bodily reactions including the development of gastrointestinal ulcers.

A two page spread with text, two advertisements on either side, and a full face photograph of a man
A two page spread with text, two advertisements on either side, and a full face photograph of a man

Reader's Digest, February 1957

Courtesy Ghitta Sternberg

During the 1950s, stress became a leading new idea in psychosomatic theory, replacing the older, increasingly discredited psychoanalytically based theories. Partly due to his charisma and prodigious output, Vienna-born, Prague-trained physician and biochemist Hans Selye emerged as its best known and most effective proponent, which embedded stress in the popular culture, as this ad in Reader’s Digest illustrates

A two page spread with text and a portrait of a man
A two page spread with text and a portrait of a man

"The Stress Syndrome,” American Journal of Nursing, March 1965

Courtesy National Library of Medicine

The American Journal of Nursing published an article about the Vienna-born, Prague-trained physician and biochemist Hans Selye’s theory of stress and disease adaptation. Stress became a leading new idea in psychosomatic theory, replacing the older, increasingly discredited psychoanalytically based theories, during the 1950s.

A set of six photographs of a baby in a bed observed by a man in a lab coat
A set of six photographs of a baby in a bed observed by a man in a lab coat

Monitoring MonicaMonica

Courtesy George Engel

American internist and psychiatrist George Engel, with Dr. Franz Reichsman and colleagues, developed the “conservation-withdrawal” theory.

Instead of considering threats as "stressors" that brought about defensive and protective behaviors—as outlined in physician and biochemist Hans Selye’s “stress syndrome” model, they framed threats as "losses" and "deprivations" that caused an organism to become depressed and withdrawn.

Engel and his associates observed an infant, "Monica," who had been born with an esophageal blockage. They collected and measured her gastric secretions from a surgical opening in her stomach and compared the amount collected with Monica’s moods. They found that Monica’s gastric juices increased when she was lively and engaged with the group but stopped completely when she withdrew around strangers.

They proposed that Monica’s psychological and physiological responses shut down to conserve her resources, explaining clinical observations on patients who expressed feelings of resignation shortly before the onset or worsening of illness.

A blue chart recording statistics
A blue chart recording statistics

Monitoring MonicaMonica

Courtesy George Engel

American internist and psychiatrist George Engel, with Dr. Franz Reichsman and colleagues, developed the “conservation-withdrawal” theory.

Instead of considering threats as "stressors" that brought about defensive and protective behaviors—as outlined in physician and biochemist Hans Selye’s “stress syndrome” model, they framed threats as "losses" and "deprivations" that caused an organism to become depressed and withdrawn.

Engel and his associates observed an infant, "Monica," who had been born with an esophageal blockage. They collected and measured her gastric secretions from a surgical opening in her stomach and compared the amount collected with Monica’s moods. They found that Monica’s gastric juices increased when she was lively and engaged with the group but stopped completely when she withdrew around strangers.

They proposed that Monica’s psychological and physiological responses shut down to conserve her resources, explaining clinical observations on patients who expressed feelings of resignation shortly before the onset or worsening of illness.

Painting of a seated man holding up a pink paper while a woman behind with two children are crying, in the background is a table with an empty glass bottle
Painting of a seated man holding up a pink paper while a woman behind with two children are crying, in the background is a table with an empty glass bottle

Howard Taft Lorenz, Dismissal (or) Pink Slip, 1940

Courtesy National Museum of American Art, Smithsonian Institution, transfer from Museum of Modern Art

American actor and bon vivant turned struggling Washington Projects for the Arts painter, Howard Taft Lorenz (1906-1956) depicts the shock to the system caused by loss and broken trust. In Dismissal (or) Pink Slip, Lorenz portrays in the starkest terms the devastation a job loss or “pink slip” causes an unfortunate worker and his family.

It was well established in the popular imagination that the stress of modern life, work-related tension and anxiety, and devastating tragedy accompanied by the loss of community could lead to very severe health consequences.

A book open to a two page spread with text and a chart
A book open to a two page spread with text and a chart

B. Kent Houston and C.R. Snyder, Type A Behavior Pattern: Research, Theory, and Intervention, 1988

Courtesy National Library of Medicine

In their book, American psychologists B. Kent Houston (ca. 1939-1995) and Charles R. Snyder (1944-2000) explored the popular idea that ambitious, anxious, and perfectionistic tendencies increased risk for cardiovascular disease.

By the 1970s, the psychosomatic field had two concepts: one emphasizing stress-induced excitement, or “hyperarousal” and the other, deprivation-caused withdrawal, or “hypoarousal.”

This pair of ideas merged into one model of social and environmental challenge and responses to them, and joined with other streams of work focused on "life change events" (divorce, bereavement, and job loss) and "social stressors" (high intensity living and work situations and major dislocations from normal support networks). Researchers used progressively more sophisticated statistical techniques and more rigorous epidemiological study designs to prove the theories.

In the 1970s—experts in the psychosomatic field and more broadly in science and medicine—agreed that studies on the relationship between social support, life stress, and disease onset were important and promising for the future.

A man stands in a factory at a conveyor belt full of automobile parts
A man stands in a factory at a conveyor belt full of automobile parts

B. Kent Houston and C.R. Snyder, Type A Behavior Pattern: Research, Theory, and Intervention, 1988

Courtesy National Library of Medicine

In their book, American psychologists B. Kent Houston (ca. 1939-1995) and Charles R. Snyder (1944-2000) explored the popular idea that ambitious, anxious, and perfectionistic tendencies increased risk for cardiovascular disease.

By the 1970s, the psychosomatic field had two concepts: one emphasizing stress-induced excitement, or “hyperarousal” and the other, deprivation-caused withdrawal, or “hypoarousal.”

This pair of ideas merged into one model of social and environmental challenge and responses to them, and joined with other streams of work focused on "life change events" (divorce, bereavement, and job loss) and "social stressors" (high intensity living and work situations and major dislocations from normal support networks). Researchers used progressively more sophisticated statistical techniques and more rigorous epidemiological study designs to prove the theories.

In the 1970s—experts in the psychosomatic field and more broadly in science and medicine—agreed that studies on the relationship between social support, life stress, and disease onset were important and promising for the future.

A group of workers sit at a table in a factory surrounded by automobile parts, equipment, and machinery
A group of workers sit at a table in a factory surrounded by automobile parts, equipment, and machinery

Volvo Assembly Line, Sweden, ca. 1987

Courtesy Volvo Truck Corporation, Powertrain Division, Skövde, Sweden

In 1987 the Volvo Truck Corporation initiated a significant effort to improve the environment of its factories and alter the assembly process. Scientists documented blood pressure, stress hormones and attitudes of workers before and after restructuring the way car and truck engines were put together and found that after the changes, perceived stress, blood pressure and epinephrine (adrenalin) levels of the employees decreased, and morale improved.

A book open to a two page spread with four photographs of patients in hospitals, hospices, and nursing homes being visited by animals
A book open to a two page spread with four photographs of patients in hospitals, hospices, and nursing homes being visited by animals

Betty White with Thomas J. Watson, Betty White's Pet-Love: How Pets Take Care of Us, 1983

Courtesy National Library of Medicine

Photograph credits (l to r): Courtesy of People-Pet Partnership Program; Flossie Stowell; Courtesy of People-Pet Partnership Program; Courtesy of People-Pet Partnership Program. Used by permission of William Morrow & Co., Inc.

Some hospitals, hospices, and nursing homes have discovered that patients feel calmer and less depressed in the presence of a loving, furry friend--some may even become less stressed and recover more quickly from their illness as a result of their involvement in "pet therapy."

Frontiers of the Mind

Biomedical and technological advancements have helped to explain the effects of emotions on disease. With brain imaging, we can now “see” the anatomical and biochemical basis of emotions.

Research in immunology has revealed the many molecules by which the immune system signals the brain. Advances in neuroscience and neuroendocrinology have identified the brain’s hormones, nerve chemicals, and nerve pathways through which it affects the immune system.

These scientific discoveries have helped us come full circle, to include mind-body treatments within the armamentarium of conventional medical care. This new field of clinical medicine is called “integrative medicine” and incorporates mind-body therapies for treatment of disease and for disease prevention.

Physicians throughout history had long glimpsed the mind-body connection’s impact on health but we now have a clear scientific basis for its effects.

Digital image of a human brain that has been cut in half to show where the amygdala is located
Digital image of a human brain that has been cut in half to show where the amygdala is located

An illustration of a section of the human brain showing an overactive amygdala, ca. 1996

Courtesy National Library of Medicine

In 1949, Paul MacLean, a physician and neurophysiologist, proposed that several areas deep within the brain, which he called the "visceral brain," linked the "intellectual" cortex – the thinking part of the brain, and the "discharging" part of the brain ­– the brain’s stress center, the hypothalamus. He proposed that this system was "largely concerned with visceral and emotional functions."

In the 1950s, MacLean generalized his ideas into a theory of the "limbic system," a connected grouping of deep brain structures. This system includes parts of the brain called the hippocampus and amygdala. MacLean used electrical and chemical stimulation of specific anatomical regions and structures to learn their precise roles in emotional expression and modulation.

Digital image of a human body showing the thymus, spleen, lymph nodes, adrenal gland, hypothalamus, and the cortical and subcortical brain highlighted in blue, yellow, and red
Digital image of a human body showing the thymus, spleen, lymph nodes, adrenal gland, hypothalamus, and the cortical and subcortical brain highlighted in blue, yellow, and red

Illustration highlighting the organs of the immune system (thymus, spleen, bone marrow and lymph nodes) and the organs of the neuro-endocrine system (adrenal gland, hypothalamus, and the cortical and subcortical brain), ca. 1996

Courtesy National Library of Medicine

The modern grounding of emotional expression in the biology of the brain began with the work of the American neuroanatomist James Papez (1883-1958).

In 1937, based on anatomical and clinical evidence, Papez argued that an "ensemble of structures" in the lower, subcortical areas of the brain constituted the "anatomic basis" and "harmonious mechanism" for the expression of emotions.

Rejecting the possibility that emotion is "a magic product," Papez insisted that it is "a physiologic process which depends on an anatomic mechanism."

Digital image of a human body showing the thymus, spleen, lymph nodes, adrenal gland, hypothalamus, and the cortical and subcortical brain highlighted in blue, yellow, and red
Digital image of a human body showing the thymus, spleen, lymph nodes, adrenal gland, hypothalamus, and the cortical and subcortical brain highlighted in blue, yellow, and red

PET scans of brain activity, ca. 1996

Courtesy Mark S. George, Medical University of South Carolina, Charleston

The limbic system continues to be recognized as an important part of the brain’s emotional responses but it is now understood that many parts of the brain work together and that these integrated networks of higher (cortical) and deeper brain regions (especially the amygdala), in concert, create the organism’s response to primitive emotional experiences such as fear.

[Image 1]

Regional Brain Activity During Transient Happiness

Increased Activity

front

Left Anterior Cingulate,

Medial Prefrontal Cortex

Decreased Activity

front

Bilateral Temporo-parietal

Right Prefrontal Cortex

[Image 2]

Regional Brain Activity During Transient Sadness

SPM look-through projection

front

front

Medial views

front

front

Lateral Cortical Projections

Increased Activity in Diffuse Limbic Structures

(Left Prefrontal, Bilateral Anterior Cingulate

Hypothalamus, Infero-medial, Prefrontal Cortex)

A patient lying on a flat examination table in front of the center of a large medical imaging device resembling a doughnut-like shaped machine
A patient lying on a flat examination table in front of the center of a large medical imaging device resembling a doughnut-like shaped machine

PET Scanner, ca. 1996

Courtesy GE Medical Systems

Positron Emission Tomography or PET scanning—one of several relatively new imaging techniques—tracks the course of high energy, very short-lived radioactive compounds through the brain. In this way, a "map" is created of the brain's changing blood flow and chemistry as a person thinks and feels.

Digital scan of the profile view of a human head and brain in blue showing increased blood flow in yellow to red colors
Digital scan of the profile view of a human head and brain in blue showing increased blood flow in yellow to red colors

Functional magnetic resonance image of brain activity of a person looking at faces, ca. 1996

Courtesy V.P. Clark, K. Keil, J. Ma. Maisog, S. Courteny, L.G. Ungerleider, and J.V. Haxby, National Institute of Mental Health

Functional magnetic resonance imaging, or fMRI, is a technology that detects the living brain at work.

This is a computer-enhanced fMRI scan of a person who has been asked to look at faces. The image shows increased blood flow in the part of the brain’s visual center, which recognizes faces.

An optical imaging camera
An optical imaging camera

Optical imaging camera, ca. 1996

Courtesy Photometrics, Ltd.

The opticalimaging camera allows scientists to make pictures of the brain’s nerve cells working together in ensembles. A bright light shone onto the brain reflects back changes in nerve cells’ activity (measured through changing colors related to water content, cell size, and amount of oxygen in the blood). These colors are then turned into images.

Digital image of the brain as a multicolored mass with some parts higher and lower than others
Digital image of the brain as a multicolored mass with some parts higher and lower than others

Image created by optical imaging camera, ca. 1996

Courtesy Ehud Kaplan and Richard Everson, Mount Sinai School of Medicine New York

The changing colors of the image created with an optical imaging camera represent nerve cells’ activity. The varying colors relate to water content, cell size, and amount of oxygen in the blood.

A computerized photomicrographic microscope
A computerized photomicrographic microscope

Computerized photomicrographic imaging microscope, ca. 1996

Courtesy Leica Inc., Deerfield, Illinois

Technologies, like computerized photomicrographic imaging, are making more visible the microscopic world of cells and products of genes.

Computer generated images of nerve synapse and neurotransmitters
Computer generated images of nerve synapse and neurotransmitters

Illustration showing how eurotransmitters work, ca. 1996

Courtesy National Library of Medicine

Different parts of the brain share information and organize plans for action through a code system that involves both chemistry and electricity.

Chemicals called “neurotransmitters" are emptied from tiny sacs into the space between nerve cells. These chemicals cross that space and bind to receptors on other nerve cells. The binding process triggers an electrical stimulus in the receiving cells that starts the whole process of chemical release all over again.

A diagram of the cycle of T cells, in blue, from antigen to mature help T cell, against a yellow background
A diagram of the cycle of T cells, in blue, from antigen to mature help T cell, against a yellow background

Activation of T-cells, ca. 1996

Courtesy National Library of Medicine

When a foreign substance, called an antigen, enters the body, immune cells race to the site of invasion. The first to arrive, called macrophages, gobble up the foreign substance and spit out bits and pieces of it that then bind to receptors on the surface of other immune cells called “lymphocytes” (T and B cells). The binding process triggers the production of chemical signals called “interleukins.” Interleukins allow immune cells to mature, communicate with each other, and make antibodies and other molecules that remove the invader.

[Title] Activation of T cells [1] Antigen Macrophage Class II MHC-encoded Protein [2] Antigen Being Processed [3] Processed Antigen and Class II Protein [4] Helper T-cell Receptor (Recognizes Processed Antigen Plus Class II Protein) Immature Helper T Cell [5] Interleukins [6] Mature Helper T cell
A diagram of the brain with labels, connecting lines, and illustrations of different cellular components and parts of the immune system
A diagram of the brain with labels, connecting lines, and illustrations of different cellular components and parts of the immune system

The Immune System and the Nervous System, ca. 1996

Appearing by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Nature Reviews Immunology (Neural regulation of innate immunity: a coordinated nonspecific host response to pathogens, Esther M. Sternberg), Copyright 2006

When foreign toxins or bacteria enter the body, immune system cells race to the site of invasion. These cells are called “lymphocytes” (T and B cells) and “macrophages.” Receptors on the surface of these cells recognize and bind to the invader. The binding process triggers the production of chemical signals called “interleukins.”

At the same time that interleukins (sometimes called “cytokines”) allow immune cells to signal one another, they also signal the brain and change brain function, turning on the brain’s stress response and affecting memory and even mood. This completes the two-way communication between the brain and immune system, where brain hormones and nerve chemicals affect immune system function and immune molecules, in turn, change brain function. This explains how emotions can affect health and how disease can affect emotions.

Stressors

CNS cytokines

Hypothalamus

Corticotropin-releasing hormone

Pituitary gland

Vagus nerve

Adrenocorticotropic hormone

Adrenal gland

SNS

Cytokines

Glucocorticoids

PNS

Immune cells

Thymus

Spleen

Bone marrow

Lymphnode