Emotion and Disease

An

exhibition at the

National Library of Medicine

National Institutes of Health

•

Bethesda, Maryland

Emotions and Disease

Emotions and Disease National Library of Medicine

Bethesda, Maryland

November

13,

1996

to

May

1,

1997

Emotions and Disease

An

exhibition at the

National Library of Medicine Exhibition Directors: Elizabeth Fee

Esther M. Sternberg Visiting Curators:

Anne Harrington Theodore M. Brown

Friends of the National Library of Medicine

Published

in

conjunction with the exhibition

Emotions and Disease, organized by the History of

Medicine Division, National Library of Medicine This project was made possible by the generous support of the Charles A. Dana Foundation, the

John D. and Catherine T. MacArthur Foundation, the Fetzer Institute and the National Institute of

Mental Health Copyright

©

1997 Friends of the National Library

of Medicine. All rights reserved

Printed in the Lnited States of America

Cover: (left)

YValther Ryff (d. 1548), Spiegel

und Regiment

der Gesundheyt, Frankfurt, 1555.

Graphic: Photographic reproduction of woodcut illustration.

(right)

Rudolf Yirchow (182 1-1 902), Die

Celiularpatkologu in ihrtr Eegriindung auf Pkysiologisdu unci Pathologische Gewebe/ehre, Berlin, '

1858.

Contents Exhibition Directors' Statement Emotions and Disease in Historical Perspective

Notes nu ir Checklist

page

vi

page

1

,

r

for

r

•

Emotions and Disease

Acknowledgments

A page 46

page 52 65

Exhibition Directors' Statement The

exhibition Emotions

and Disease was

initially

developed

by the History of Medicine Division of the National Library of Medicine, in conjunction with the Third International Congress of the International Society ulation

which met

November

1996.

at the

The

for

Neuroimmunomod-

National Institutes of Health

in

exhibition was intended to provide

and context for the scientific discusand presentations at the Congress and to explain to the general public the meaning and relevance of scientific developments linking neurophysiology to the functioning of our immune systems. Using the historical approach, we historical perspective

sions

we

believed

could

make

opments more accessible historical

these sophisticated scientific develto a non-specialist audience.

The

approach could also be used to show the complex

relationships

between

scientific theories,

popular ideas, and

their cultural context.

One

of the paradoxes we found was that the close between health, disease, and the emotions seemed to be more readily accepted in popular culture than within the contemporary scientific community. Why, we asked, has the close relationship of emotions to disease been so central to the long history of medical practice, yet has been regarded with suspicion by some sectors of the modern biomedical community? This exhibition evolved as a dialogue between scienrelationship

tists

and historians pursuing answers

dialogue has been

fruitful,

The The

to these questions.

although difficult

at times.

historians involved have had to learn some of the language and perspectives of the biomedical sciences, and the scientists have had to cope with the different language and per-

spectives of the historians. Working on this exhibition, we found that the collaboration across disciplines, indeed across the great divide between contemporary science and the humanities, can be a rewarding adventure for all participants and well worth the occasional linguistic, philosophical, and

The results appeal to and engage audiences from students of science and history to professionals in these fields. political struggles involved.

a variety of

vi

We a

model of

icine

would

like to

thank Dr. Sheldon Cohen, himself

work between the history of medand contemporary science, for introducing us: Elizabeth interdisciplinary

Fee, a historian of medicine, and Esther Sternberg, a neuroendocrinimmunologist. Together we developed the general outline of the exhibition and invited Anne Harrington and

Theodore M. Brown

to serve as visiting curators, responsible

for the overall intellectual

development of the exhibition and and catalogue materials.

for writing the panels, captions,

Gretchen Hermes joined us

Key

for a

summer

as assistant curator.

to the success of the exhibition

were our panel of distinguished consultants and the timely and generous support of the Charles A. Dana Foundation, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, and the National Institute of Mental Health. Also essential were the invaluable contributions of

Anne Whitaker

Lou

as collections

Storey as exhibition designer,

manager, and Patricia Tuohy

as

The acknowledgments in this catalogue recognize the many individuals who contributed to this project and to whom we are grateful. The talented people involved in the creation of this exhibition manager.

exhibition have worked together to

show how

historical

research and contemporary science, presented through creative use of visual design and in

bringing

new forms

modern media, can be

effective

of scientific understanding to the pub-

We believe that the history of science and medicine can help us understand and appreciate the frontiers of science while also demonstrating the ways in which our forebears lic.

have addressed, explored, and puzzled over the same issues that engage us today. By addressing past and current controversies in science and medicine,

we hope

to captivate public-

interest and help build awareness of the need for further hisand torical and medical research. As in the case of Emotions work can foundations private and agencies Disease, federal

together to produce attractive and instructive educational materials on health and medicine for the public. project

such

may

We

serve as an inspiration and model for

hope

many

efforts.

Elizabeth Fee, Ph.D. Chief, History of Medicine Division

National Library of Medicine

Esther M. Sternberg, M.D. Immunology and Chief, Section on Neuroendocrine National Institute of Mental Health

\ 11

this

other

Emotions and Disease

in

Historical Perspective Theodore M. Brown In the world today, science

is

about

to validate long-held

beliefs about the relationship

between emotions and disease. A new field of research, exploring the connections between the neuroendocrine and immune systems, has already produced exciting discoveries which promise to confirm, in the most modern scientific terms, the influence of emotions on the onset, course, and remission of disease. For centuries and long before the first glimmerings of modern science, physicians and non-physicians alike have acknowledged that the

way people

felt in their minds could influence the way they responded in their bodies. When prevailing medical theory denied the very possibility of such interactions, common experience and sometimes quite startling clinical encounters suggested otherwise. The relationship between emotions and disease has often been like a haunting melody that could not be forgotten, while it has sometimes surged into full chorus. It has been this way ever since the beginning of the Western scientific tradition. Although the specific terms of discussion have changed many times in the course of history and even though medicine has been transformed several

times in the process, perceptive observers have regularly returned to the study of the interactions of body, mind and

medicine. These interactions have continued

to fascinate,

even though they have never been completely understood. At times when the majority of physicians and scientists focused attention elsewhere,

a

minority refused to

the

let

Now the issues are back the convergent focus of the lay public, clinical modern laboratory science. This exhibition highlights issues die.

and center, in medicine, and

again, front

signifi-

cant achievements and major turning points on a well-travleads eled historical road which is taking a turn yet again as it into the promising but indefinite future.

1

The

Balance of Passions many other components of our Roman antiquity where medicine first

This story begins, as did so culture, in

emerged

Greek and

independent of religion. There B.C.) and his followers comknow ledge with ancient science and

as a secular activity

Hippocrates

460

(ca.

B.C.-ca.

bined naturalistic craft philosophy to produce the behavior of the ancestors of

370

first

human body

systematic explanations of the

in

modern biomedical

health and illness. Distant scientists

began

to explore

human organism for keys to hidden mechanisms of disease. They made the

the solid and fluid parts of the

unlock the Hippocrates.

This

is

Hippokratous

a Renaissance edition of works by Hippocrates,

with parallel text

in

Greek and

attempts to understand emotions as mental phenomena which had surprising and complex connections to physiological order and pathological disorder. Early Western physicians recognized that emotions were of essential significance, however, their medical systems were actually weighted more heavily on the body side of the mind-body balance. The dominant theory of Hippocrates and his successors was that of the four "humors": black bile, yellow bile, phlegm, and blood. When these humors were in balance, health prevailed; when they were out of balance or vitifirst

latrike,

Latin.

some way,

ated in ual's

disease took over.

The

goal of an individ-

personal hygiene was to keep the humors in balance,

and the goal of medical therapy was to restore humoral equilibrium by adjusting diet, exercise, and the management of the body's evacuations

Jjl|l§KiiSs3r

i

S^SSEi-Sis!

^SsS^s™~*

i

^^^^^^^ 1

Johannes de Ketham

(fl.

1455-1470). Fasciculus Medicinae, Vienna, 1495

Johannes de Ketham. a professor of medicine in Vienna, published Fasciculus Medicinae, which included illustrations on bloodletting and urine flasks showing the "resemblance of the elements and the bodily constitutions." This is an English translation of Latin text.

2

(e.g.:

the blood, urine, feces, perspira-

tion, etc.

).

1

he bcds.de scene from Walther Ryff's Spiegel und

Regiment and the diagram from Johannes de Ketham s Fasciculus Medicinae, although both from later periods, clearly illustrate these classical themes.

Emphasizing the humors gave classical medicine what modern philosophers call a "reductionist" bias— the humors were used to explain more complex phenomena like emotional states

much

simpler physical terms. For examwas melancholy, physicians assumed that his or her complicated feelings of sadness and depression resulted from the physical excess of black bile. Likewise, ple,

when

in

a patient

an excess of yellow bile was thought to make a person angry and impulsive. In the Hippocratic treatise The Sacred Disease, the author explains that "those noisy, evil-doers

and

restless,

maddened through

Cortnummius (ca. 1624-1675), Attonito Liber Unus, Leipzig, 1677

Justus

De Morbo

bile are

always doing something inop-

For

much

of the medieval

and Renaissance

periods,

portune"'; this explanation assumes that emotions are the

Galen and Hippocrates were regarded as coequal medical authorities, with Galen even assuming a

more complicated

superior position for certain medical teachers or

humoral

consequences of the simpler

and prior

causes.

mentators.

Even

more

unmistakably reductionist Hippocratic writings, however, certain emotional states appear as causal elements. In one case, a woman began to exhibit fears, in the

depression, incoherent rambling speech, and the uttering of obscenities after suffering from a "grief with a reason for

and another "without speaking pluck, scratch, pick hairs,

a

word

.

.

weep and then

.

In

com-

the seventeenth century, however, the

empirically oriented Hippocrates

came

to

be

regarded as superior to the more theoretical Galen. This distinction between the two men is depicted here

on the title page by Hippocrates touching the rosebush on the side of the flowers and Galen touching the side of the thorns.

it";

would fumble,

laugh, but

.

.

.

not speak," also "after a grief." 3 In The Sacred Disease, epilepsy is

said in certain circumstances to be "caused by fear of

the mysterious." 4

Emotional

factors played only a

minor

role in the

subsequent development of classical medical thought because authors after Hippocrates continued to rely primarily on humoral-reductionism and did not actively pursue emotional

These medical authorities worked hard and codify the humoral ideas embedded in

causal elements. clarify

Hippocrates's work.

They

to

also systematized a therapy based

on "opposition," whereby excess humors were depleted and "cold" medicines such as oil of roses countered "hot" diseases like fevers and vice versa. Some writers in late antiquity also

added important anatomical

5 medical systems. But another dimension

features to their reductionist

to

medical thought became

orienincreasingly prominent in later antiquity. This was the influstrongly tation towards emotions as causes, which was

enced by Galen (A.D. 131-201). Known for his prolific writhe was accepted in ings and essential loyalty to humoralism, coequal with or as the medieval and Renaissance periods for his diagrespected even superior to Hippocrates. Deeply celebrated for his differential diag-

nostic skill, Galen was distinguished between illnoses, especially for those which those which seemed to nesses traceable to organic causes and to emotional causes traceable actually

mimic them but were

3

^AMANTIS DIGNOT1D Galen,

Opera ex Sexta Juntarum

Editione, Venice,

1586 Galen

is

making a diagnosis of

love-sickness.

.

.

// came to t/u co/ic/usum tAat sA£y ohm rS/^erm^ro/^ on&oj '

.

/coo tAisups/: eitAer^/rom

a

e/vc trote/t/e a/tout so/?w//?//uj

Galen As quoted

in Galen

on

/tte/a/tc/to/y c/efta/c/c///

sAe cou&

— On Mental

ce/tun/tina to co/ife&&.

Disorders, Stanley

instead. In

seemed

6//f,

W. Jackson

one famous case he treated

a

young woman who who, upon

to exhibit the signs of physical illness but

closer examination, revealed

no organic pathology. After elimGalen identified

inating any possible humoral explanation,

the

real,

emotional cause of her somatic symptoms:

He

6 love interest.

a

hidden

used the sudden irregularity of her pulse

as

a crucial diagnostic clue.

Galen likewise contributed an important new in

interest

the balance not only of the humors but of what he called

the "non-naturals,"

among which he included

or perturbations of the soul."

—

7

According

the "passions

to the doctrine of the

non-naturals which was incorporated in medieval medical books alongside the humors it was important for physicians Maimonides

Regimine

(1

135-1204), Tractatus Rabbi Moysi de

Sanitatis

ad Soldanum Regem,

Augsburg, 1518

—

keep

to help patients

their

emotions

in balance, for the

of their bodies as well as their mental states.

The

sake

influence

of strong emotions on physical health and illness thus became

medical belief which grew progressively

a central tenet of

stronger in the medieval period. As rabbi, philosopher and

physician

Moses Maimonides expressed the point

twelfth century, "It

produce changes

is

known

.

.

in the

that passions of the psyche

.

body that are great, evident and maniaccount ... the movements of the psyche should be kept in balance and no other regimen should be given precedence." 8 fest to .

I

^^^^

.

all.

On

in the

this

.

.

1

Gregor Reisch 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 regions. Note that Imagmativa (imagination) is located directly over the eyes.

.

Ideas about the "balance of the passions" were popular in

the Renaissance and early

modern

One famous would become is Robert Burton's The Anatomy of Melancholy which included the

work showing how Gregor Reisch |d. 525), Margarita Philosophica cum Additionibus Novis, Basel, 1517

.

periods.

influential these ideas

following observations about the possibly disastrous role of unchecked emotions: "the mind most effectually works upon the body, producing by his passions and perturbations miraculous alterations cruel diseases and sometimes death .

.

.

9

Also 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 by its immaterial agency, others itself."

that

it

which,

operated indirectly by in turn,

4

first

arousing the emotions

"are greatly alterative with respect to the

ofA&ftycAe

tAal causes

a//rivet//. Moses Maimonides (1135-1204) The Regimen of Health

Of cZMmfUrs and Tnd,g

? "'Kligr.

^^^^""dcorpo,.,^ '" "peciall, ,„

„ " ™™""°n ','"'"«

otdef„™,°, 1

^^I'lKlvlth^hlfd'^'^ "^ 1

-

T h"elo,7they,

,t

hPr''

:

It la

a

'hUdt,

™ ann eeofwale,r '"'y' l,,e

1

.

1517. in the parifh Kingf-wood, in the

forrefl

i

;u.) to die King's Engine*

1

chat plat

1

ho troubl .

died,/!

,

by

'

u

in...,', J

.-duiihhn

e

.lO.Ml.,.

l,i.J>..r,da,,dcoi

e/Mmnm t.tf ttptimli ifitt mil ttt*

E

Eareconlffaincd 10 conlelt by the event of things, tint nionfterl art bred and

foappltsKrovving upon the llraitneliofthewcaiib, gam caufledbycomto they bee put growth SRE they W*" which women hindrrd

lor the trees, if bcinto llrali \tircls, their it hlntake delight In, are from anle furthet they arektpt which ho knows not that the plana place in ? growrh bythelirUcntii of the progrcls and longer a from hindred propagation of fhtir roott,by n growing in the earth, ate theoppofitionofaant.orardeorhrtfolldbodie, and therefore in liich placet are ctaokwhere they have fret nootlfhmtnt, to bee Unit ed, flendee and weak, but on the other part, and ilrorut ) for feeing tflJt by the opinion of Natural]!! I, the place is the form of the thing that are Hut up lr t fpacetjprohibltrd of fro placed lie !• netefTarie that chofe thloR» nd lamed.

fore deed.

juft ripcnetl,

So Com whelps

W

o. P. nil births

:

The toogren

privation ofgiowthbythc :

of the

womb

:

which they thought

ih.

Ambroise Pare (151 0?-l 590J, The Workes, London,

chielefl

!

J|Herei»nodoubtbutlfariJei„|„ r i,

B

fonof »firoke,rsl| fromvti

Ll

' s.

J

«°

"worn nwith

childe, I estteod loth, child. TbVe^ Vi *" < efe occahon. B broker* ureflcd, On^tft?* a^ "-ore by the ilk, 1,'°™ " h " °>°"^ ISO °S of eh * •^Tfiux o blond, oe great lik

(_

,„

,

,',„

*^* »S »l opened or y "•wurit o(

,Wie, by which

nieanl the childe wanV-. „

S^„d altogether monllrouff

™

<

coneuir Z "ncultonof the ^'.U*cdWr,,, and thetefote

will beetmall

of all ibecaufthey

649

Speculation about the influence of the "imagination" was intense during the Renaissance period. It was widely believed that vivid ideas could lead to various bodily conseguences, including diseases and monstrous births. Pare, a famous early surgeon, reported on two cases, one of a child born with the body of a calf, and another that occurred in 1517, of a child "born having the face of a frog," produced by the power of the mothers imagination. The mother, advised by her neighbor to hold a live frog in her hand as a means to

cure her

fever,

was

still

holding the frog that evening,

when

she and her husband conceived a

child.

body.""

1

There was general agreement that emotionally-

charged ideas could exert enormous effects, as in the case of the monstrous "frog baby" produced by vivid maternal imagination, reported

by Pare.

were strongly the seventeenth and eighteenth

Intellectuals and lay people alike

William Falconer (1744-1824),

A

the Influence of the Passions of the Body, London, 788

Dissertation

Upon the

on

Disorders

committed to these ideas in centuries. While certain philosophical fashions within the medical community changed to reflect the Scientific Revolution going on around it, much medical practice remained traditional and fundamentally unaltered. Consideration of the role of the imagination and of strong emotions in the onset and course of illnesses continued into the nineteenth century. Medical literature included extensive essays and specialized monographs on emotional states and their impact on somatic health and disease." One example is

1

William Falconer's A Dissertation on 7

{

pon

the Disorders

Bobonne, Bobonne, tu me ferais un moncomme ca, ne le regarde pas tant!, Honore Daumier (1808-1879) stre

The husband wife zoo.

is

attempting to lead

his

pregnant

away from the cage of the great apes at He is afraid that by looking at the ape in

condition, she might give birth to a

baby The longstanding

the

her

deformed

belief that the vividly

stimulated imagination of pregnant

women

could lead to "monstrous" births persisted

in

pop-

ular culture well into the nineteenth century.

6

of the Body.

the Influence

of the Passions

many

In

ways, however, the close of the eighteenth new era. As part of the Scientific Revolution, anatomical investigation once undertaken in

century marked

a

antiquity had revived and study.

Andreas Ycsalius

Thomas W

illis

in

in

became

hotly pursued field of

seventeenth century Oxford were

of the man\ bold explorers structure,

a

sixteenth century Padua and

and displayed

who

just

two

cut into the body, probed

its

their findings in beautifully illustrat-

ed w orks. In the eighteenth century, physicians increasingly turned to anatomy as a foundation for pathology. As a result, disease processes were progressively "localized," that is, said to reside primarily in the disruptions or "lesions" of the solid

Andreas Vesalius Edouard

Hamman

What

is particularly notable about this scene of Vesalius about to perform an autopsy is his gaze, directed away

from the cadaver, and almost as Laennec,

if

his

hand

resting

on the

left

arm,

taking a pulse. Like the Chartran portrayal of

this

nineteenth century image strongly conveys

the anatomical basis of the

new

medicine.

QVADRAGESIMIPRIMI CAPITIS FIGVRARVM, eiufdcmq; charaftcrum Index.

Andreas Vesalius's De Humani of dissecting instruments from of anatomy, first modern work Corporis Fabrica. The De Fabrica, the 568 Venice edition. is from the plate This 543. in published Illustration

wasSly

1

1

7

Andreas Vesalius (1514-1564), Fabrica, Venice,

1

568

De Humani

Corporis

parts of the

Post

body

mortem

rather than in the imbalance of humors.

dissection

became an

increasingly

common

medical practice. 12

At the turn of the nineteenth century, diagnostic breakthroughs swiftly succeeded the maturation of gross pathological anatomy. R.T.H. Laennec invented a primitive stethoscope (he called it a "cylinder") to help him hear inside

body and thus imagine what the parts "looked" because of the particular sounds they elicited. In the

his patient's

like

process of concentrating their attention on the anatomical abnormalities of the solid parts of the body during an illness and as a result of disease, Laennec and other physicians of his

Thomas

Willis

(1621-1675),

Works of Thomas An

Willis,

The Remaining Medical

time gained precision

in their diagnoses but began to lose the immediacy and intimacy of verbal contact with their

London, 1679

achievement was Thomas Willis's Cerebri Anatome (On the Anatomy of the Brain), first published in

cal

1

664.

brain

Shown (left

13

Clearly captured in Chartran's painting of Laennec performing a physical examination is the growing communication gap between doctor and patient, each seemingly conpatients.

outstanding example of seventeenth-century anatomi-

here are Willis's engravings of the human page) and of the sheep brain (right page).

own separate world. This stands in sharp conthe scene typically depicted at the medieval bedside.

tained in his trast to

The further development of microscopic anatomy by Rudolf Virchow and others in the nineteenth century led to Laennec-style Stethoscope

In

1819, Laennec

first

described

his

powerful

new

diagnostic invention, the

The physician placed one end of the instrument on the patient's chest and his ear to the other, so he could listen to the sounds of disrupted anatomy within. cylinder-like stethoscope.

Courtesy Historical Collections, The National Forces Institute of Pathology, Washington,

Museum

D

of Health

and Medicine, Armed

C.

Rene Theophile Hyacinthe Laennec (1781-1826). De (Auscultation Mediate, ou, Traite 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), Pans, 1819

Laennec, A Hopital Necker, Ausculte Theobald Chartran 849- 907) I

(

1

1

Un

Phtisique

The stethoscope lung

shown 8

is

illustrated

at the right.

here

in

a fold-out plate with parts of the

Rudolph Virchow (1821-1902) medical

scientist of

is

regarded as perhaps the greatest

He was a pioneer in the field and pursued pathological anatomy at the tissue and

the nineteenth century.

of cellular pathology cell level.

234

ZwiSlfte Vorlesung.

Fig. 89.

in ihrer Rudolf Virchow, Die Cellularpathologie

Pathologische Begriindung auf Physiologische und Gewebelehre, Berlin, 1858 Cellularpathologie, influential book, Die precise microscopic structure the depicted and described he but seemed to leave no of ceiis-jnciudmg nerve cells— the influence of the place in the body's operation for In

Virchows most

emotions.

know ledge of tissues and cells. This development, unfortunately, also fragmented the notion of organismic unit} implicit in classical and early modern medical theory.

greater

Emotions became more and more separated from

By the mid-nineteenth

century, however,

disease. a

place was

connection with disease even as postmortem anatomy and cellular pathology advanced. Already in the eighteenth century William Cullen had noted that

secured for emotions

in

patients with certain major disorders

ple

—

"insanity," for

—did not always show the expected organic

postmortem

dissection.

He

reasoned

examupon

lesions

that, instead,

such

may have developed "a considerable and unusual excess in the excitement of the brain" and that this excitement could in turn have derived from "violent emotions or patients

passions of the mind." 15 Cullen and Robert

Whytt were two

William Cullen (1710-1790), First Lines

of the Practice of 784

Physic, Edinburgh,

Ao cornJtdcun&ofit "neurotic, "fterAafea

Aim

to "(jo

and tAen

lom& a/ul/o/ye/

tell

//,

6e inherent to tne con-

ruy//e//ees\

(jBut

Zonal ufise/s

c/// o/

Acme concrete and denwn&traS/c '

///

tie o/yonZsn?/.

Walter B.

Cannon

The Role of Emotion in Cannon (1871-1945). Bodily Changes Hunger, Fear and Rage: An Account of

Walter Bradford in Pain,

1936

Disease,

Recent Researches into the Functions of Emotional Excitement, New York, 1915 Reproduced with permission from Appleton and Lange

emotions and the onset of disease. However oretical alternatives differed,

they had in

ological orientation, in the sense that they

on notions of

holistic

human organism its

environment.

entation of these

much

common were

these thea

psychobi-

clearly based

body and mind response of the total and assaults from

to various stimuli, threats

A common new

origin explained the similar ori-

theoretical approaches, for they

some sense from

all

work of early twentieth-century Harvard physiologist Walter B. Cannon. Cannon's general program was to show how the biological derived in

the fundamental

organism automatically mobilized chemical resources by

defend

its

physiological and bio-

"wisdom of the body," to threatened assault. As an example

a built-in

itself against real or

of defensive mobilization, he explained in Bodily Changes in Pain,

Hunger, Fear and Rage, the organism responds to fear

and rage

down

as

though preparing

for fight or flight,

by shutting

energy-storing functions and activating energy-releasing

ones. In the 1940s, psychosomatic investigator Harold G.

32

Wolff and his associates

ed many of Cannon's

at

Cornell Medical School incorporat-

ideas."'

Wolff then moved from

of organismic self-defense directly borrowed from a

a

model

Cannon

to

generalized notion of "stress and disease," according to

w hich disease w

as the "inept" version of a

tective reaction pattern" that allowed the

normally "apt pro-

human organism

to

51 mobilize against stressful situations or events.

became

Stress

theory in the 1950s and

known and most

a

leading new idea in psychosomatic Hans Selye emerged as its best

effective proponent. Selye was a Vienna-

born, Prague-trained physician and biochemist

who

settled in

the 1930s and w rote the leading endocrinology

Montreal

in

textbook

in 1947. In

1950 he published

a

1,025-page mono-

graph entitled The Physiology and Pathology of Exposure to Stress, in which he elaborated ideas he had been developing since

Hans

Selye,

The Physiology and Pathology of

Exposure to

Stress, Montreal,

1

950

52 1936 on what he called the "General Adaptation Syndrome."

was

Selye's theory

that various "stressors" (cold, heat, solar

"nervous stimuli") produce a generalized, stereotyped response in the biological organism as it works to "perform certain adaptive functions and then to reestablish radiation, burns,

normalcy." As the organism automatically mobilizes its defense mechanisms, the hypothalamus (a nerve center

base of the brain)

is

effects, the adrenal

excited

first.

at

the

Later, after a chain of

glands produce "corticoid" hormones.

Corticoid hormones cause a characteristic set of somatic reactions including the development of gastrointestinal ulcers.

Due swept

largely to their synthetic scope, Selye's ideas and exerted an enormous influence. As F.L.

the field

theory of stress and the dismedical thinking and permeated has adaptation] of eases land, probably more every in research medical influenced and more intensely than any other theory of disease

Engel noted

in 1956, "[Selye's

Readers Digest, February 1957 Courtesy Ghilta Sternberg. Reproduced with permission

Readers Digest

rapidly

The "stress syndrome" became even more of its and widely known in the sixties, partly because

ever proposed.""

popular discredited appeal as a replacement for older, increasingly and partly psychoanalvtically-based psychosomatic theories published He due to Selye's charisma and prodigious output. of course the in books and over 1,700 scientific papers forty

mediSelye was frequently quoted throughout to spread fame his fields, and cine, nursing, and other health by cultivated deliberately the wider culture, a reputation he his career

^4

reader as The Story of the publishing such books for the general Life (1956 and 1976), Adaptive Syndrome (1952), The Stress of by the 1970s there was and Stress Without Distress (1974). Yet research as Selye conceived it. discord in the field of stress riddled theory and experGrowing confusion and controversy for having caused a great iment. Some critics blamed Selye inconsistences and his shitting deal of it with his conceptual contradictory formulations."

and sometimes stress model One major alternative challenged the Engel and George popularity. during the height of its initial Center Medical Rochester of his

^leagues

at the

University

33

American Journal of Nursing, March 1965 Publishers Used with permission of Lippincott-Raven

"conservation-withdeveloped a theory they ultimately called focused on psydrawal." Like Selye, Engel and his associates But instead well-being. threats to an individual's chobiological

elicited defensive of considering threats as "stressors" that organism, the hyperaroused and protective behaviors from the of these important most Rochester group conceptualized the caused that "deprivations" behaviors in terms of "losses" and shutand depressed the organism to become withdrawn, 56 The Rochester group was generally attuned to psydown n.

preserving a choanalytic theory and remained committed to medicine. psychosomatic place for it even in post-Alexandrian terms in of framed scheme thus developed a complex

They

"helpdisrupted relationships between individuals, affects of "conservationof state a and lessness" and "hopelessness," withdrawal" in which physiological function was depressed to the point of creating a "final

common pathway"

to illness

and

death.

Rochester groups work grew at the juncture on such diseases as leukemia and between experiment on an infant, naturalistic and colitis' a ulcerative "Monica," who was fortuitously admitted to Rochester's SK Strong Memorial Hospital during the course of their work.

The

clinical studies 7

Monica had been born with a blockage in her esophagus, which required that two surgical openings be made, one in her neck to drain anything she took by mouth and one in her Monitoring Monica's gastric (stomach) secretions, Engel and his associfound that physiological activity increased sharply, not only in the presence of food, but in the course of Monicas interactions with other,

ates

trusted

human

beings. Joyful reunions following separation

ciated with especially copious secretions. At the

same

Monica emotionally disengaged and withdrew

for

presence of a stranger logical activity. In

were

asso-

when

— example, the —there was a pronounced shutdown of physio-

a sense, the body "withdrew"

conserve resources.

time,

also, as

in

if

trying to

stomach through which she could be fed. Monica did not do well and was admitted to the hospital at fifteen months in a dangerous condition. While she was being nursed back to health, Engel and his associates designed a study in which they measured her gastric secretion continuously and correlated their observations with Monicas moods. They found that Monica's physiological activity increased w hen she was engaged with the members of the group, whether joyfully or angrily, and especially on reunion after separation. By conher gastric secretion ceased entirely, and even

trast,

became

histamine (which normally stimulates gastric secretion), w hen she withdrew physically and emotionally

unresponsive

from

to

who

stranger

a

physiological

shutdown

mic resources.

It

members

replaced the familiar

group. Monica's behavior

also

made sense

of the

and

as a psychological

that served to conserve her organis-

helped put into perspective the sepaon patients who articulated feel-

rately collected clinical data

up" or being "given up" shortly before the

ings of "giving

onset or exacerbation of a variety of somatic diseases. 59

By the 1970s the psychosomatic of

new

field thus

had

a pair

concepts, one emphasizing stress-induced hyper-

arousal and the other deprivation-caused hypoarousal.

Dismissal

Howard

A

major achievement of the next decade was the merger of

this

one model of socio-environmental challenge and response and the connection of that model with other streams of w ork focused on "life change events" (divorce, bereav ement, and job loss) and "social stressors" (high intensity living and work situations and major social dislocations from normal support networks).'" The seventies were also notable for the application of progressively more sophisticated pair of ideas into

The shock trust

is

(or)

Taft

Pink Slip

Lorenz

to the system

starkly

captured

Courtesy National Institution, transfer

caused by

in this

WPA

loss

and broken

painting by Lorenz.

Museum of American Art, Smithsonian from Museum of Modern Art

biostatistical techniques and more rigorous epidemiological study designs/' Striking landmarks were Sidney Cobb and Robert M. Rose's study of "Hypertension, Peptic Ulcer, and 1

Diabetes

in Air Traffic Controllers," the

New York

1973 conference

in

City on "Stressful Life Events," John Frost Lecture of 1976 at the American Public Cassel's

Wade Hampton

Health Association on "The Contribution of the Social Environment to Host Resistance," and David Jenkins's report in

the

New England Journal of Medicine

the

same year of sub-

A" stantial evidence confirming the significance of the "Type 62 disease. artery coronary for behavior pattern as a risk factor Although there w ere

critics

of

some of

new w ork

this

in psy-

chosomatic medicine, the strong consensus in the 1970s— sciboth w ithin the psychosomatic field and more broadly in

—was

on the relationship disease onset were sigand between social support, life stress, It was well estabfuture." the for nificant and very promising ence and medicine

that studies

5

stress of modern lished in the popular imagination that the devastating tragedy and anxiety, life, work-related tension and

accompanied by the

loss

of

community could

lead to very

severe health consequences. translation of Also notable in the seventies was the 35

Kent Houston and C.R. Snyder, editors, Type Behavior Pattern: Research, Theory, and Intervention, New York, 988 B.

A

1

Reproduced with permission from John Wiley and Sons,

Inc.

o/ rieroousn&s& (

from

c&

ancient

mot/em />//

fteriocucalftre&&y tAe at tioitu

cloi/ization/,

coAccA

c&

(&&tifwuu&Aecl

tAe&&froe cAa/victeri&tccs/: steanybocoer, tAe

and tAe mental

tAe &cience&,

/c/cyrafi/t,

of co om n t

George M. Beard American Nervousness,

new

Its

Causes

and Consequences, 1881

theoretical insights into practical intervention strategies,

sometimes actively promoted by the researchers themselves. Thus, Meyer Friedman and Ray Rosenman, the physicians

who lar

initially

defined the Type

book which included

engineer" one's daily

life

A

concept, published a popu-

practical chapters

and develop

on how

to "re-

"drills" to replace old

and harmful habits." Similarly, Harvard's Herbert Benson promoted a simple, "noncultic" technique to elicit the "relaxation response" as a counter to the stress-induced "emergency response." He showed that physicians could teach the relaxation response to patients as either a preventive or therapeutic strategy.'" Several other investigators introduced

"biofeedback" techniques Saratoga Spa,

N.Y., ca.

A vacation life,

!

950s

"in the country, " away from the routines of remains a tried-and-true remedy for "stress."

Courtesy Ghilta Sternberg

variables such as heart rate

which various physiological and muscle tension were dis-

(in

played to the patient) as practical clinical methods for managing hypertension and a variety of other conditions."" In work settings, employers introduced timeouts for stress-reducing exercise sessions and even redesigned the production process itself. Of course, the time-honored "vacation in the country" or "stay at the spa" remained popular outlets for people's

accumulated tension. But in a period sensitive to the importance of loss as well as overload, health practitioners intro-

duced newer interventions to affiliate isolated and vulnerable people with one another through support groups, to provide them with beloved objects of affection, and to encourage shared group solidarity of great symbolic and emotional significance. If stress and deprivation could cause disease, relaxation and reconnection may be able to cure it or, at least mitigate

its

effects.

36

CATBERT, OUR EVIL DIRECTOR OF HUN\AN RESOURCES, WILL DESCRIBE OUR MEW CUBICLE PLAN.

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BUT

COE DID LOWER fAORALE.

J

WITH THE PATENTED] "HEAD CUBICLE

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Dilbert, Scott

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©

1

Adams, September

5,

1

996

Adams, creator of the popular comic

996 United Feature

Volvo Assembly

,n

1

„87

,he

Line,

VCvo

strip

Dilbert, has updated the idea of "office stress" for the economically insecure

1

990s.

Syndicate, Inc.

Sweden

True,

Corporal Mdated

a

s,

g ni,can«

^ ^^^Z^^^^^^^ STE- — an.

employees decreased and morale increased. Powertrain Division. Skovde, Sweden Courtesy Volvo Truck Corporation.

37

ep,ne^e MlS ,

o,

,e

Frontiers of the

Mind

Two

of the most compelling features of the last twenty years have been dramatic achievements in the laboratory and striking advances in biomedical technology. Together, they have literally

extended the

emotions

frontiers of the

mind by embodying

the biology of the brain more successfully than ever before and by creating the possibility of identifying the in

intricate interconnections

between brain-based emotions and

the functioning of the neuroendocrine and

Spectacular developments

in laboratory

immune

systems.

science and visualiza-

technology have been essential components of the explodevelopment of neuroscience, a field which has quickly become one of the most respected, exciting and actively pur-

tion

sive

sued

in medicine.""

Within the neurosciences an area various-

"psychoneuroimmunology" and "neuroimmunomod68 ulation" has recently emerged which seems on the verge of tracing the pathways between emotions and disease whose connections had long been glimpsed in clinical contexts by physicians ranging from Galen to Freud and from Maimonides to Alexander. The modern grounding of emotional expression in the biology of the brain began with the work of the American neuroanatomist James Papez. In 1937, Papez argued from anatomical and clinical evidence that an "ensemble of strucly

called

tures" in the lower, subcortical areas of the brain constituted

the "anatomic basis" and "harmonious

mechanism"

for the

elaboration and expression of emotions. Rejecting the possi-

magic product," Papez insisted that is "a physiologic process which depends on an anatomic mechanism." 6 " Papez's ideas were effectively promoted by Paul MacLean, a physician and neurophysiologist. In 1949, MacLean proposed a hypothesized "visceral brain" as an anatomical and functional system intermediate between the bility that

emotion

is

"a

it

"intellectual" cortex and the "discharging" hypothalamus. This system was "largely concerned with visceral and emotional functions."

70

In the 1950s,

MacLean

generalized his

ideas into a theory of the "limbic system," an integrated set

of subcortical structures in the brain including the hippocampus and amygdala whose precise role in emotional expression

and modulation he explored through the electrical and chemistimulation of specific anatomical regions and structures." Other investigators added human clinical evidence and the results of surgery on the brains of laboratory animals, which cal

also

pointed to the role of the limbic system

in the

expression

of emotions. Interest in the limbic system remained strong through recent times, although in the last several years neuroscientists have raised questions about the looseness of some

of the earlier theoretical assumptions and anatomical constructs. They are still interested in the neural substrates of

39

The organs of the immune system (thymus, spleen, and lymph nodes) and the organs of the neuroimmune system (adrenal gland, hypothalamus, and the cortical and subcortical brain).

emotion within the brain bur have shifted their attention to the hemispheres of the cerebral cortex and to the interactions between cortical and subcortical regions. In the 1070s, neuroseientists began to concentrate on the right cortical hemi73 most interesting locus of emotional control. Roger Sperry's award of the Nobel Prize in 1981 for his work on "cerebral laterality" (the differences between the "left"

sphere

as the

and the "right" brain and

their behavioral significance) rein-

forced this trend, but respected neuroseientist R.W. Doty indicated in a 1989 review article that "any idea of emotion in

mammal

an intact

circuitry

is

being played out purely

an unsustainable abstraction.

the evidence

is

On

via subcortical

the other hand,

unequivocal that subcortical structures are

essential for the expression of the

more

'primitive' emotions,

and can support such expression in the absence of the neo74 cortex." Current work is verifying the integrative functioning of cortical and subcortical areas (especially the amygdala) in

the organism's response to primitive emotional experiences

such

as fear.

75

Powerful

new imaging techniques have supported

and made possible the recent emphasis on the anatomical substrates of emotion. The most impressive techniques are computer assisted tomography (CAT scans), magnetic reso7 ''

nance imaging (MRI), positron emission tomography

REGIONAL BRAIN ACTIVITY DURING TRANSIENT HAPPINESS

"

" «.

(PET

REGIONAL BRAIN ACTIVITY DURING TRANSIENT SADNFSS

NCREASED ACTIVITY

& front

Look-throuc

Left Anterior Cingulate.

Medial Prefrontal Cortex

5* DECREASED ACTIVITY

ejections

Increased Activity front

-eft =r- e frontal. 3 latera Anterior Cingulate Hvsotnaia-nus. Infero-medial Prefrontal Cor-tex)

Temporo-parietal

Bilateral

:

Right Prefrontal Cortex

Using PET scans, Courtesy Mark Charleston

S

scientists are in

the

Diffuse Limbic Structure

in

first

stages of relating different emotional states

—pleasure, sorrow—

to different patterns of brain activity.

George, Medical University of South Carolina,

PET scans of people who have been asked to look at. listen speak or think about a word. Different parts of the brain become active, depending on how the word signal is

to.

received Courtesy Marcus E Raichle. Washington University.

St.

Louis.

Missouri

Thinking About Words

40

emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI). The breakthrough technology was computer assisted scans), single-photon

tomography, developed Allan

in the

1960s and 1970s, for which

Cormack and Godfrey Hounsfield

Prize in 1979.

The

of a three-dimensional

taken

received the Nobel was the computer synthesis

basic principle

image from

a series of

two-dimension-

multiple angles (tomography) of some nal aimed at or emanating from the patient and detected

al

"slices"

at

outside his or her body. This principle was applied

sig-

first to

CAT scans

where the measured property was an x-ray attenuation coefficient. The same principle was then applied to MRI imaging and PET scans, where the measured property was natural magnetization density in the first case and the concentration of an intravenously injected radioisotope in the second.

77

The newer fMRI

is

based on the tomographic

construction of images formed by the signal differences

between MRIs taken of the brain and non-activated

now widely used in cerebral

78

in functionally activated

CAT scans

and MRI images are determine anomalies and fMRI are valuable

in clinical settings to

anatomy.

tools, at this

to

states.

point

SPECT, PET

employed primarily

in research settings

determine physiological and biochemical variations

in

Functional magnetic resonance imaging, or fMRI,

is

new

technology that can detect the living brain at work. This is a computer-enhanced fMRI scan of a person who has been asked to look at faces. The

another

image shows increased blood flow

in

the part of the

visual cortex that recognizes faces.

brain activity, including anatomically-localized alterations

metabolism and neurochemical functioning which are 79 visualized as they occur. Many of the achievements in the neurosciences have come at the intersection of this new imaging technology with 80 recent breakthroughs in neurochemistry. As one of neuroin

chemistry's leaders,

Solomon Snyder, has

has brought together findings from so

said,

many

"The

plines into a coherent concept of brain function

Indeed the revolution

is

more

glue that

different disciis

chemistry.

precisely characterized as a rev-

olution in 'molecular neuroscience.'"

81

Twenty years ago, Snyder was among those neurochemists who succeeded in identifying opium-like molecules the brain (variously called "enkephalins," "endorphins," or sometimes just "endogenous opioids") that helped regulate in

the sensation of pain.

Endogenous opioids

rotransmitter," a long-studied class of

are a type of "neu-

biochemical substances

convey messages from nerve fiber endings to other biological receptors, whether nerve, muscle or gland. Neurothat

chemists were able to identify specific opiate "receptor sites" where the endogenous opioids normally attach but at which they are sometimes displaced by exogenous competitors such

morphine. Using photographic techniques that take pichigh tures of samples incorporating radioactive materials and as

power microscopy,

scientists

found large concentrations of

these receptor sites in areas of the brain (in the limbic system) specifically associated with pain perception and other 82 forms of emotional regulation. More recently and with the scan and fMRI technology, neuroscientists have help of

PET

41

Courtesy

VP

Ungerleider,

Clark, K. Keil,

J.

Ma. Maisog,

and J.V Haxby, National

S.

Courtney, L.G. Mental Health

Institute of

optical imaging camera allows scientists to peer even more deeply into the brain, making pictures of nerve cells working together in ensembles. A bright light shone onto the brain reflects back

The

nerve cell activity (measured through changing colors water content, cell size, and amount of oxygen in the blood). These are then turned into colorful images.

changes Optical imaging camera.

in

related to

Courtesy Photometries

Courtesy Ehud Kaplan and Richard Everson,

New

Mount

Sinai

School of Medicine,

York

Computerized imaging microscopes combined with molecular biology techniques for staining tissue show activated genes in the hypothalamus at the site they are expressed (in situ hybridization). Courtesy Miles A. Herkenham, National

New

technologies,

like

computerized photomicrographic

imaging, are bringing even the microscopic world of

and genes more

fully into

Courtesy Leica Inc

Deerfield.

.

cells

the light of day. Illinois

The scanning electron microscope allows scientists to see lymphocytes, red blood cells, macrophages and monocytes. Courtesy Bruce Wetzel and Harry Schaefer. National Cancer

Institute

Institute of

Mental Health

been able tors in

to confirm the dense distribution of opiate recepthe structures of the limbic system and especially in

the amygdala. Neuroscicntists thus seem to be closing in on both the biochemical mechanisms and the anatomical architecture of emotional expression in specific structures

of the brain. In perhaps the most exciting development of

new

field has

emerged which

is

the neurosciences with the latest in

in

the scientific basis for understanding relationships

emotions and disease once explored only

Not yet possessing been able

all, a

combine the latest immunology to provide

starting to

between

in clinical settings.

agreed upon name, this new demonstrate previously unsuspected but now verifiably direct connections between the immune system and the neuroendocrine system. The field developed in two waves. The first wave, rising in the late seventies

field has

a generally

to

and early eighties, was generally called "psychoneuroimmunology (PNI). Its roots could in some sense be traced back to the pioneering studies of the Russian immunologist ,

'

Metal'nikov

S.

at

the Pasteur Institute in Paris in the 1920s

and 1930s and to the considerable work in the Soviet Union from the 1920s through the 1950s on psychologically conditioned immunobiological effects.

The

field really

began

to

take shape around 1980 under the

combined leadership of the Americans George Solomon, Novera Herbert Spector and Robert Ader, the Swiss

Hugo Besedovsky, and

the Russian

Elena A. Korneva. 85 Although each of these leaders came from

and contributed different specific expertise (Ader, for example, was an experimental psychologist, Solomon was a psychiatrist and Besedovsky was an endocrinologist), they all agreed on the need to break down the barria

different discipline

then had artificially separated immunology as a from endocrinology and the neurosciences. As Ader and

ers that until field

his colleagues

put the point

in 1987, "In

integrated adaptive processes

and

is,

restricting paradigm."

Beginning

in

in its

extreme form,

a restric-

84

the late 1980s, the second wave was

marked by the recruitment of molecular neuroscientists. This phase does not yet have a fixed name, although "neuroimmunomodulation" (NIM) is widely accepted, while some leaders prefer simply

"neuro-immune

interactions."

Some

of

the scientists recruited to the field during this phase were wary of PNI and remained skeptical until they were persuad-

ed by "harder" evidence that the

immune and neuroen-

docrine systems are in fact in close and bi-directional communication and, indeed, "talk" to each other all the time. A short

of discoveries early in the second wave includes the following: demonstration of direct microanatomical contacts between the nervous and the immune systems; discovery that list

anatomical lesions in or the electrical stimulation of parts of

43

your brain share information and

and

electricity. Chemicals 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

involves both chemistry

called neurotransmitters are

in

the receiving

cells,

chemical release

our view, the

attempt to understand immunity as an adaptive process that is independent of and can be studied in isolation from other

tive

Different parts of

organize plans for action through a code system that

all

that starts the

over again.

whole process

of

Activation of

T

The Immune System and the Nervous System

Cells

y^~^v

H«ic*r

CUM

Brain

Ted ntoaotor

II

Neuroendocrine

Immunotransmitters

and Autonomic Pathways

(feedback, regulation

and

modulation)

Bone Marrow

'ooo

TCon

c

o

'OC._ O Cf.0

LymphoWn©sc°C 1

Macrophage

When system

(T and B cells) and macrophages. Receptors on the surfaces of these cells recognize and bind to the invader. The binding process triggers the production of chemical signals called interleukins Interleukins allow immune cells to

make

antibodies

-

~c

6

a foreign toxin or bacteria, called an antigen, enters the body, immune cells race to the site of invasion. These cells are called lymphocytes

mature, communicate with each other, and to

*

Monokines

BCdl

At the

same time

that interleukins (sometimes called

lymphokines and monokines) allow immune cells to signal one another, they also allow immune cells to signal

and other

substances that remove the invader.

the brain

—and vice versa.

the brain influence antibody production in the spleen and

lymph nodes; identification of receptor sites for neuroendocrine hormones and neurotransmitters on cells of the immune system. The "clincher" was the repeated proof in several different animal models that interruptions of these communications on

a genetic, surgical, or

basis, lead to increased susceptibility to

eases like that too

arthritis.

much

enhanced

The

converse

is

now

pharmacological

inflammatory also

dis-

being shown,

responsiveness of these systems leads to

susceptibility to infection.

particular molecules of the

Now

it is

immune system

certain that

(cytokines or

interleukins) signal areas of the brain directly as well as exert

influences on peripheral parts of the nervous system such

vagus nerve. This rigorously demonstrated "cross-talk" between the immune and neuroendocrine systems

as the

won over neuroscientists and gained converts among the immunologists themselves. Even more important, it provides

has

the scientific basis for understanding

emotions can

—

at

long

last

in fact influence the onset, course,

— how

and remis-

sion of disease.

Two already

very different signs of enthusiasm and "arrival" 1990s: the inclusion of an entry on

mark the

"Neuroendocrine Regulation of Immunity" in the 1992 Encyclopedia of Immunology and the featuring of psychoneuro-

immunolgy 44

as a central

theme

in Bill

Moyers's 1993 best

sell-

cr.

Healing

of the

and flic Mind." The

new

field

first

indicated the acceptance

within the mainstream of previously resistant

immunology and the second demonstrated popular fascination with the emerging inter-discipline. Moyers and many of his readers seized upon the new field as seeming to validate long-suspected but frequently denied connections between emotions and disease. A spate of high-level international scientific conferences marked by unusual energy and bold proclamations have added to the sense of excitement. The in 1994 as volume "Hans Selye Symposia on Neuroendocrinology The editors of the Selye volume capture the cur-

proceedings of one of these was published three of the

and Stress." rent

mood:

The interaction of the nervous, endocrine only

now

and immune systems

being considered seriously. This field represents

Even

multidisciplinary approach in Biological Sciences.

name

of the field has not been settled as yet

going on with regards

to the

in this

is

novel,

the

and there are debates Modern

proper term

equipped with powerful research tools which

advance quickly

a

make

complex multidisciplinary

science is

it feasible to

field,

with the

aim of understanding the whole organism, rather than trying

to

analyze restricted areas. The developments are spectacular, indeed,

and the new

insights

gained

our understanding of certain human

mune

.

.

.

have already advanced

diseases, such

disease, in flammatory diseases,

nervous

as autoim-

and endocrine

abnormalities and the influence of behavioral factors

aging on the

immune

response

volume will contribute this

to

and of

and disease. We sincerely hope this and acceptance of

the understanding

brave new area of scientific enquiry.

area" will finally validate long that we in the West held beliefs about emotions and disease grappling with for at least two millennia. It

may be

that this "brave

new

have been

45

Notes Sec. for example, Vivian Nutton, "Humoralism,"

1.

Roy

Porter, eds..

Companion

in

Encyclopedia of the History

W.F.

(London: Routledge, 1993), pp. 281-291 and Lawrence Tie Western Medical Tradition (Cambridge:

Bynum

and

ofMedicine, Vol. I.

Conrad,

Cambridge University

I

et. a!.,

Press,

1995).

W.H.S. Jones, K.T. Withington and Paul Potter, eds.

2.

Hippocrates, Works, 6 vols.

1923-88), Vol.

II,

&

trans.,

(London: Loeb Classical Library/Heinemann.

p 177. 283.

3.

Hippocrates, op. at.. Vol.

4.

Hippocrates, op.

5.

Sec. for example, Heinrich von Staden, Herophilus: The Art of Medicim

in

Early Alexandria (Cambridge: Cambridge University Press, 1989).

6.

Stanley Jackson, "Galen

Vol.

tit..

p.

II, p.

167.

—On Mental Disorders," Journal of

the History

Behavioral Sciences, 5 (1969): 366.

of the

L.J. Rather,

7.

I,

"The

'Six

Things Non-Natural,'"

Clio Medica,

3

(1968):

337-347; Saul Jarcho, "Galen's Six Non-Naturals," Bulletin of the History of Medicine, 44 (1970): 372-377. \ncl Bar-Sela,

8.

Two

Hebbel

Hoff and

E.

"Moses Maimonides'

Elias Farus,

Regimen of Health,"

Treatises on the

Transactions of the Anient an

Philosophical Society, ns, 54 (1964), Part 4: 25.

Robert Burton, The Anatomy ofMelancholy (1621

9.

(London: George Bell and Sons, 1893), 10. L.J.

Rather,

vol.

I,

p.

"Thomas F lenus (1567—1631)

of the Imagination as Cause and

),

ed. A.R. Shilleto

288.

Dialectical Investigation

Cure of Bodily Disease,"

Bulletin of the

History of Medicine, 41 (1967): 356. 1 1.

E rvvin H. Ackerknecht,

"

The History of Psychosomatic Medicine,"

Psychological Medicine, 12 (1982): 17-24. 12.

Russell C. Maulitz,

Morbid Appearances: The Anatomy of Pathology in the Cambridge University Press, 1987).

Early Nineteenth Century (Cambridge: 13. Joel

Stanley Reiser, Medicine

Cambridge University 14.

Leland

J.

Rather,

and the

Reign of 'Technology (Cambridge-

Press, 1978).

Mind and Body

in Eighteenth

Century Medicine

(Berkeley: University of California Press, 1965). 15.

William Cullen, First Lines of the Practice of Physic (Edinburgh: C.

Elliot 16.

& T.

Cadell, 1784), Vol. 4, p. 149.

Sander L. Gilman

et. al.,

Hysteria Beyond Freud (Berkeley: University

of California Press, 1993) and

Mark

S.

Micale, Approaching Hysteria

(Princeton: Princeton University Press, 1995). 17.

Francois

M. Mai and Harold Merskey, "Briquet's Treatise on

Hysteria," Archives of General Psychiatry, 37 (1980): 1401-1405;

Mai and Merskey, "Briquet's Concept of Hysteria: An Historical Perspective," Canadian Journal of Psychiatry, 26 ( 1981 ): 57-63.

46

18.

Christopher G. Goetz, Michel Bonduelle, Toby Gelfand, Charcot:

Constructing Neurology (Oxford:

Oxford University

19.

Quoted

20.

Kenneth Levin. Freud's Early

ibid., p.

Psychology of the Neuroses (Pittsburgh:

University of Pittsburgh Press, 1978), 21.

p. 46.

Martin Stone, "Shellshock and the Psychologists,"

Roy Porter and Michael Shepherd, (London: Tavistock. 1985),

Vol.

in

II,

and English

Culture,

1X30-1980 (New

Penguin Books. 1985), pp. 167-194.

York:

Harold

I.

Kaplan and Helen

S.

Kaplan, "An Historical Survey of

Psychosomatic Medicine," Journal of Nervous and Mental

546-568 and John C. Burnham,

(1956):

Physician (Chicago: University of 23.

Jelliffe:

Diseases,

1

24

American Psychoanalyst and

Chicago Press, 1983).

Martin Grotjahn, "Georg Groddeck and His Teaching About Man's

Innate 24.

Bynum,

W.F.

Anatomy ofMadness pp. 242-271 and Elaine Showalter, eds., The

The Female Malady: Women, Madness

22.

Press, 1995).

197.

Need

for Symbolization," Psychoanalytic Review,

Theodore M. Brow

n,

"Man Gregg and

32 (1945): 9-24.

the Rockefeller Foundation's

Support of Fran/. Alexander's Psychosomatic Research," Bulletin of the History of Medicine, 61 (1987): 155-182. 25.

Benjamin

V.

White. Stanley Cobb: A Builder of the Modern Neurosciences

(Boston: Francis A.

Countway Library

of Medicine, 1984), pp. 212,

245-246. 26.

Gerald N. Grob. From Asylum

Community: Mental Health

to

Policy in

Modern America (Princeton: Princeton University Press, 1991),

N athan (New

G. Hale, The Rise and Crisis of Psychoanalysis

in the

p.

17 and

United States

York: Oxford University Press, 1995), pp. 187-202. 282.

27. Gail

Thain Parker, Mind Cure

University Press of Medicine

New

and American

in

New England

1

1

Ianover

NH:

England, 1973) and Robert C. Fuller, Alternative

Religious Life

(New

York: Oxford University Press,

1989). 28.

William James. The

Varieties

Longmans, Green, and Co.,

of Religious Experience

(New

York:

1902), p. 94.

29. Ibid., p. 122.

30.

Quoted

in

Rennie

B. Schoepflin, Lives on Trial: Christian Science

Healers in the Progressive

Era

(University of Wisconsin Doctoral

Dissertation: Madison. 1995), p. 210. 31.

Donald Meyer. The

Positive 'Thinkers

(New

York:

Pantheon Books,

1980), p. 168. 32.

Ernest Kurtz, Not-God: A History of Alcoholics Anonymous (Center City,

MN: 33.

Hazelden, 1979).

Meyer,

34. See, for

op. at., pp.

177-194, 259-289.

example, Norman Cousins, Anatomy of an

WAV. Norton, 1979) and Head First: The

Illness

Biology of Hope

(New

(New

York:

Dutton, 1989).

47

York:

E.P

35.

James Harvey Young, The Toadstool Millionaires: A

Social II is/on of

Patent Medicines in America Before Federal Regulation (Princeton: Princeton

University Press, 1961) and The Medical Messiahs: \ Social History of Health Quackery in Twentieth-Century America (Princeton: Princeton

University Press, 1967). 36. Paul Starr, The Social Transformation of American Medicine

(New

York:

Basic Books, 1982), pp. 127-134. 37.

Daniel Hack Tuke, Illustrations of the Influence of the Mind

Body

in

Henry 38.

T

I

pon

the

Health and Disease, Second American Edition (Philadelphia: C. Lea's Son

& Co.,

1884), p. 439.

O.H. Perry Pepper, "A Note on the Placebo," American Journal of

"The Placebo

Pharmacy, 117 (1945): 409^412 and Arthur K. Shapiro, Effect in

the History of Medical Treatment," American Journal of

Psychiatry, 116 (1959): 298-304.

39.

Lewellys

F.

Barker, "Psychotherapeutics," Transactions of the

Association oj American Physicians, 23 (1908): 478.

40. C.

Macfie Campbell, "Psychiatry and the Practice of Medicine,"

Boston Medical and Surgical Journal, 190(1924): 1058. 41.

W.R. Houston, "The Doctor Himself

Annals of Internal Medicine,

example,

42. Sec, for

as a

Therapeutic Agent,"

11 (1938): 1418.

Thomas

Findley,

"The Placebo and

the

Physician," Medical Clinics of North America, 37 (1953): 1821-1826 and

Louis Lasagna,

et. al.,

"A Study of the Placebo Response," American

Journal of Medicine, 16 (1954): 770-779. 43. Louis Lasagna, "Placebos," Scientific American, 193 (August, 1955):

68-71. 44.

Henry

Byerly, "Explaining

Perspectives in Biology

and Exploiting Placebo Effects,"

and Medicine, 19

(1976): 423^136.

Grevert and Avram Goldstein, "Placebo Analgesia,

45. Priscilla

Naloxone, and the Role of Endogenous Opioids,"

in

Leonard White,

Bernard Tursky, and Gary E. Schwartz, eds., Placebo: Theory, Research, ami Mechanisms 46.

Chase

(New

P.

York: Guilford Press, 1985), pp. 332-350.

Kimball, "Conceptual Developments in Psychosomatic

Medicine: 1939-1969," Annals of Internal Medicine, 73 (1970): 307-316; Z.J.

Lipowski, "Psychosomatic Medicine

Current Trends

in

in a

Changing

(1973): 203-215; Z.J. Lipowski, "Psychosomatic

Seventies:

Society:

Theory and Research," Comprehensive

Some

Psychiatry, 14

Medicine

in

An Overview," American Journal of Psychiatry, 134

the (1977):

233-244 47.

Nathan G. Hale, The

States

(New

Rise

and Crisis of Psychoanalysis

in the United

York: Oxford University Press, 1995), p. 322.

323-324; 326-327; 449, n. 43; 451-453, n. 3-8; 13-16. See also Robert Aronowitz and Howard M. Spiro, "The Rise and Fall of the Psychosomatic Hypothesis in Ulcerative Colitis," Journal Clinical

48. Ibid., pp. 312;

of

Gastroenterology, 10 (1988): 298-305.

48

49. Eliot Slater,

"Diagnosis of 'Hysteria,'" British Medical Journal,

1

(1965): 1399.

Mittelmann and Harold G. Wolff, "Emotions and

50. Bela

Gastroduodenal Function," Psychosomatic Medicine, 4 (1942): 5-61 and Harold G. Wolff, "Protective Reaction Patterns and Disease," Annals of Internal Medicine, 27 (1947): 944-969. 51.

Harold G. Wolff,

Thomas, 52.

Stress

and Disease

(Springfield IL: Charles C.

1953).

Montreal: Acta, Inc., Medical Publishers, 1950. See also Hans Selye,

"The Evolution of the

Stress Concept," American Scientist, 61 (1973):

692-699. 53.

Quoted

Part

54. S.

in

John W. Mason, "A Historical View of the Stress Field,"

Journal of Human

\,

1

(March, 1975):

"The Creative and Productive

Szabo,

Review of His Major 564-567 and

Stress,

V.

10.

Life of

Hans

A

Selye:

Scientific Discoveries," Experienria, 41 (19X5):

Tache, "A Tribute to the Pioneering Contributions of

Hans Selye: An Appraisal Through His Books,"

Experientia, 41 (1985):

567-568. 55.

John W. Mason, "A Historical View of the Stress Field," Part

Journal of Human Stress 56.

1

II,

(June, 1975): 22-36.

Arthur H. Schmale, "Relationship of Separation and Depression to

Disease," Psychosomatic Medicine,

Engel,

ns.,

"A Life Setting Conducive

20 (1958): 259-277; George L.

to Illness," Annals of Internal Medicine,

69 (1968): 293-300; George L. Engel and Arthur H. Schmale,

"Conservation-Withdrawal:

A

Primary Regulatory Process

Homeostasis," in Physiology, Emotion

Foundation Symposium

8,

for

& Psychosomatic Illness,

Organismic

Ciba

ns (Amsterdam: Elsevier-Excerpta Medica,

1972), pp. 57-85. 57.

William A. Greene,

Jr.,

"Psychological Factors and

Reticuloendothelial Disease," Psychosomatic Medicine, 16 (1954): 220-230

and George L. Engel, "Biologic and Psychologic Features of the Ulcerative Colitis Patient," Gastroenterology, 40 (1961): 313-317. 58.

George L. Engel, Franz Reichsman, and Harry L. Segal, "A Study of

an Infant With a Gastric Fistula," Psychosomatic Medicine, 18 (1956):

374_398 and George L. Engel and Franz Reichsman, "Spontaneous and Experimentally Induced Depressions Fistula,"

in

an Infant With

a Gastric-

Journal of the American Psychoanalytic Association, 4 (1956):

428-452. 59. in

A.H. Schmale, "Giving

Health," in Z.

J.

Up

Lipowski,

as a Final

Common

Pathway

ed., Psychosocial Aspects

to

Changes

of Physical Illness

(Basel: Karger, 1972), pp. 20^10. 60.

George L. Engel, "The Need

Challenge Engel,

for

"The

Biomedicine,"

for a

Science,

New

Medical Model:

A

196 (1977): 129-135 and George L.

Clinical Application of the Biopsychosocial Model,"

American Journal of Psychiatry, 137 (1980): 535-543. 61. Z.J.

Lipowski, "Psychosomatic Medicine:

An Overview," Modern

Trends in Psychosomatic Medicine, 3 (1976): 1-20.

49

Cobb and Rose, JAMA. 224 (1973): 489-492; Barbara Sncll Dohrenwend and Bruce P. Dohrenwend, eds., Stressful Life Events: Their Nature and Effects (New York: John Wiley & Sons, 1974); John ( lassel,

62.

"The Contribution

Environment

of the Social

Host Resistance,"

to

Jenkins, American Journal of Epidemiology 104 (1976): 107-123; C. David "Recent Evidence Supporting Psychologic and Social Risk Factors foi

Coronary Disease," New England Journal of Medicine, 294 (1976): 1033-1038. 63.

and Evelyn L. Goldberg and George W. Comstock, "Life Events Illness." American Journal of Epidemiology, 104(1976);

Subsequent

146-158; Sidney Cobb, "Social Support as

a

Moderator of Lite

Stress."

Rabkin and Elmer Psychosomatic Medicine, 38 (1976): 300-314; Judith G. L. Struening, "Life Events, Stress,

and

Illness," Science, 194 (1976):

1013-1020. 64.

Meyer Friedman and Ray Rosenman, Type A Behavior and Your Heart

&

(Nev, York: Alfred A. Knopf, 1974), Chapts. 16 65.

Herbert Benson, The Relaxation Response

example, Lee Birk,

66. See, for

York:

Crime and Stratum,

67. Francis (). Schmitt,

History," in Fred

17.

(New

York: Morrow. 1975).

ed.. Biofeedback: Behavioral Medicine

(New

1973).

The Neurosciences Research Program: A Brief

"

Samson and George Adelman,

eds., The Neurosciences:

Baths of Discovery II (Boston: Birkhauser, 1992), p. 15, points out that the Soc iety for Neuroscience,

200, had

membership of 68.

George Adelman,

which was founded

grown

to 13,500

in

1970 with an

members

initial

by 1989.

ed.. Encyclopedia of Neuroscience (Boston:

Birkhauser, 1987), pp. 798-799 and 1001-1004. 69.

James W. Papez, "A Proposed Mechanism of Emotion," Archives of

Neurology 70. Paul

and Psychiatry, 38

(1937): 725-743, esp. 743.

D. MacLean, "Psychosomatic Disease and the 'Visceral Brain,'"

Psychosomatic Medicine, 11 (1949): 338-353, esp. 351. 71.

Paul D.

MacLean and

Jose M.R. Delgado, "Electrical and Chemical

Stimulation of Frontotemporal Portion of Limbic System

Animal." Electroencephalography and

in

the

Clinical Neurophysiology, 5

Waking

1953):

(

91-100 and Paul D. MacLean, "Chemical and Electrical Stimulation of

Hippocampus

in

Unrestrained Animals," Archives of Neurology

and

Psychiatry. 78 (1957): 113-142. 72.

Antonio R. Damasio and (JAY. Van Hocsen, "Emotional

Disturbances Associated with Focal Lesions of the Limbic

Lobe,"

in

Kenneth Heilman and Paul

Human Emotion (New 73.

Sat/., eds..

f rontal

Neuropsychology of

York: Cuilford Press, 1983), pp. 85-1 10.

Norman Ceschwind,

"Specializations of the

Human

Brain," Scientific

American, 241 (September, 1979): 192. 74.

R.W. Doty,

in

Guido Gainotti and Carlo Caltargirone,

and the Dual Brain 75.

eds.,

Emotions

(Berlin: Springer- Verlag, 1989), pp. 56-82.

Joseph E. LeDoux, "Emotion,

Memory and

the Brain," Scientific

American, 270 (June, 1994): 50-57. 76. See, for

50

example, John C. Mazziotta and Michael E. Phelps,

"Metabolic Evidence of Lateralized Cerebral Function Demonstrated by Positron Emission

Tomography

in

Disorders and Normal Individuals," Zaidel, eds.. The

D. Frank Benson and Kran

Dual Brain (New York: Guilford

181-192 and Frank B.

Neuroimaging,"

Patients With Neuropsychiatric

in

in

Wood

et. al.,

Press, 1985), pp.

"Cerebral Laterality

in

Functional

Frederick L. Kitterle, ed., Cerebral Laterality: Theory

and Research (Hillsdale NJ: Lawrence Erlbaum Associates,

1991), pp.

103-115. 77.

Nancy C. Andreasen,

Brain Imaging: Applications

ed..

in Psychiatry

(Washington: American Psychiatric Press, 1989). 78. Jeffrey R.

Binder and Stephen M. Rao.

"Unman

Functional Magnetic Resonance Imaging," Localization

and Neuroimaging in

Press, 1994), pp.

in

Neuropsychology (San Diego:

"Functional Magnetic Resonance Imaging."

in

7 l ».

Marcus E. Raichle. "Visualizing the Mind,"

For

ith

Academic

(St.

William W. Orrison,

et.

Louis: Mosby, 1995), pp. 239-326.

Functional Brain Imaging

80.

Mapping w

Kertesz, ed..

185-212 and John A. Sanders and William W. Orrison,

al..

(April, 1994):

Brain

Andrew

American, 270

Scientific

58-64.

a lively

account of neurochemistry

Levinthal, Messengers of Paradise: Opiates

in the 1970s,

see Charles

and the Brain (New

F.

York:

Anchor/Doubleday, 1988), esp. pp. 70-109. 81.

Solomon H. Snyder, "Drugs, Neurotransmitters, and the

Brain," in

Pietro Corsi, ed., The Enchanted Loom: Chapters in the History of Neuroscience 82.

(New

York: Oxford University Press, 1991),

Solomon H. Snyder, "Opiate Receptors and

Scientific

American, 236 (March, 1977): 44-56;

Chemistry of the Brain,"

Scientific

cf.

p. 299.

Internal Opiates,"

Leslie L. Iversen,

"The

American, 241 (September, 1979):

146-148. 83.

For

a brief historical

overview, see Ruth Lloyd, Explorations

For

a collection

see Steven

(New

of the

Locke

critical

et. al., eds.,

York: Aldine, 1985).

in

& Stratton,

1987), Chapt.

papers that helped shape

the discipline,

Psychoneuroimmunology (Orlando, FL: Grune

1.

Foundations of Psychoneuroimmunology

The

seminal book that contained major

review articles by the leading Figures and that most dramatically

launched the York: 84.

field

Academic

was Robert Ader.

ed..

Psychoneuroimmunology

Press, 1981).

Robert Ader, Nicholas Cohen, David L. Felten, "Editorial: Brain,

Behavior, and Immunity," Brain, Behavior, 85.

(New

Bryan M. Gebhardt and

Regulation of Immunity,"

J.

in

Edwin

Ivan

M.

Encyclopedia of Immunology (London:

and Immunity,

1

(1987):

5.

Blalock, "Neuroendocrine Roitt and Peter

Academic

J.

Delves, eds.,

Press, 1992), pp.

1145-1149. 86. Bill

Movers, Healing and the Mind (New York: Doubleday, 1993) pp.

213-237. 87.

Edited by Istvan Berczi and Judith S/elenyi, Hans Selye Symposia on

Neuroendocrinology

and Stress (New

York:

Plenum

Press, 1994).

88. Ibid., p. vii.

51

Checklist for Emotions In the

list

and Disease

numbers) have been

that follows, classmarks (call

provided only for items from the collections of the National Library of Medicine. All measurements,

given

in

The

when

available, are

centimeters unless otherwise noted.

Balance of Passions

Walther Ryff

(d. 1548), Spiegel

and Regiment der Gesundheyt,

Frankfurt, 1555. Graphic: Photographic reproduction of wood-

cut illustration, (illustrated page

viii)

A Long Tradition Johannes de Ketham (fl. 1455-1470), Fasciculus Medicinae, Vienna, 1495. Book: 31 (h) x 43 (open width) WZ240 K43f Galen.

Opera ex Sexta Juntarum

Editione, Venice,

1495. (illustrated page 2)

1586

Description of the Humoral system. Graphic: Photographic-

reproduction of illustration with English translation of the original Latin text.

Based on an original

illustration in

Fasciculus Medicinae. (illustrated page 2)

Hippocrates

(ca.

latrike, Basel,

H667

460

B.C.-ca.

370

B.C.),

Hippokratous

1543. Book: 15 (h) x 21 (open width).

.

.

.

WZ240

1543. (illustrated page 2)

Galen (131-201), Opera ex Sexta Juntarum Editione, Venice, 1586. Book: 36.5 (h) x 48.5 (open width). 240 G153L 1586 v. 1. (illustrated page 52)

WZ

Johann Engel (1463-1512). Astrolabium Planum Tabulis Ascendens, Augsburg, 1488

in

Galen (131-201), Opera

ex Sexta

Juntarum Editione, Venice,

1586. Graphic: Photographic reproduction of illustration of a lovesick maiden taken from title page illustration, (illustrated

page 3)

Johann Engel (1463-1512), Astrolabium Planum in Tabulis copy 1. Book: 25.5 (h) x 37.5 (open width). WZ230 A585a 1488 c.l. (illustrated page 52)

Ascendens, Augsburg, 1488,

Gregor Reisch (d. 1525), Margarita Pkilosophica cum Additionibus Novis, Basel, 1517. Book: 21.5 (h) x 36 (open width). WZ240 R375m 1517. (illustrated page 4) Gregor Reisch (d. 1525), Margarita Pkilosophica rum Additionibus Novis, Basel, 1517. Graphic: Photographic reproduction of illustration of profile of head, (image unavailable Robert Burton (1577-1 640), Melancholy, Oxford. 632

The Anatomy of

for catalogue)

1

52

Moses Maimonides (1135-1204), Tractates Rabbi Moysi de Regimine Sanitatis ad Soldanum Regem, Augsburg, 1518. Book: 20 (h) \ 28 (open width).

WZ240 M911tL

1518. (illustrated

page 4) Justus

Cortnummius

(ca.

1624-1675

m.),

DeMorbo

Attonito

Liber Unus, Leipzig, 1677. Book: 21 (h) x 33 (open width).

WZ250 C8298dm

1677. (illustrated page 3)

Ambroise Pare (1510P-1590), The Workes, London, 1649. Book: 33 (h) x 45.5 (open width). WZ250 fP227E 1649. (illustrated page 5)

Honore Daumier (1808-1879), Bobonne, Bobonne, tu me ferais monstre com me fa, ne le regarde pas tant!, 1860s. Lithograph:

tin

These mechanical bloodletting devices were used by physicians

33 (h) x 25 (w). (illustrated page 6)

even

Robert Burton (1577-1640), The Anatomy of Melancholy, Oxford: Printed for Henry Cripps, 1632. Book: 29 (h) x 37.5 (open width).

WZ250 B9745a

Passions

Upon

20.5 (h) x 27

the Disorders

(open width).

the nineteenth century an indication of

after the partial eclipse of

in

medicine,

humoral theory

in

the

seventeenth century.

1632. (illustrated page 52)

William Falconer (1744-1824), the

in

the long persistence of humoral practice

.4

Dissertation on the Influence of

of the Body, London, 1788. Book:

WZ260 F179d

1788. (illustrated

page 6) Bloodletting lancet, 19th century. Lancet: 1/2" (h) x 1" x (w) 2"

(1).

Courtesy Historical Collections, The National

and Medicine, Armed Forces Institute Washington, D.C. (illustrated page 53) Health

Scarificator, 19th century. Scarificator: 2" (h)

Courtesy Historical Collections, The National Medicine,

Armed

(illustrated

x 1" (w) x 2"

Museum

of Health

(1).

and

Forces Institute of Pathology, Washington, D.C.

Historical Collections,

Armed

(illustrated

of

page 53)

Artificial leech, 1879.

Medicine,

Museum

of Pathology,

Leech: 5"

(h) x 1" (dia). Courtesy

The National Museum of Health and

Forces Institute of Pathology, Washington, D.C.

page 53)

(fl. 1455-1470), Fasciculus Medicinae, Vienna, 1495. Graphic: Photographic reproduction of illustra-

Johannes de Ketham

tion of bloodletting sites, (illustrated

page 53)

Johannes de Ketham (fl. 1455-1470), Fasciculus Medicinae, Vienna, 1495.

.S3

The Challenge

of Anatomy

Humani Corporis Fabrica, Vndrcas Vcsalius (1514-1564), De width). WZ240 (open 45 x (h) Venice, 1568. Book: 32.5 fV575d 1568.

(illustrated

page

7)

Andreas Vesalius (1514-1564), De Humani Corporis Fabrica, reproduction of illustraVenice, 1568. Graphic: Photographic page 7) tion of autopsy/dissection tools, (illustrated

Thomas

Joseph ing

Woodward used

work

light

this

as a microscopist

from a

microscope

The mirror

window through

in his

pioneer-

scientists

features of

(h) x 46.5 (open u 167 a. (illustrated page 8)

London. 1679. Book: 54

Willis,

width).

WZ250 fW35phE

reflected the

the microscope

and

onto a photoplate. thereby allowing Woodward other

Willis (1621-1675). The Remaining Medical Works oj

Thomas

—or

—to photographically capture certain

Rudolf Virchow (1821-1902), Die Cellularpathologie in ihrer Begrundung auf Physiologische und Pathologist Gewebelehre, Berlin, 1858. Book: 22 (h) x 29.5 (open w idth). QSA V813c

cells.

1858. (illustrated page 9) Courtesy Historical Collections. The National

and Medicine. Armed Forces

Museum

of Health

Institute of Pathology.

Rudolph L.K. Virchow. Photograph:

Washington. D.C.

16.5 (h) x 11 (w). (illus-

trated page 9)

Rend Theophile Hyacinthe Laennee (1781-1826), De VAuscultation Mediate, ou, Traitedu Diagnostic des Maladies Poii dioiis et (hi

Coeur (On Mediate Auscultation,

Diagnosis of the Diseases of the Lungs

and

Book: 21 (h) x 26 (open width with (illustrated

page

Heart), Paris, 1819.

illustration).

WF

L158de.

8)

Un

Postcard of Laennee, A I'Hopital Necker, Ausculte original painting

des

Treatise on the

or.

Phtisique,

by Theobald Chartran (1849-1907).

Postcard: 15.7 (h) x 12 (w). (illustrated page 8)

Laennec-style stethoscope. Stethoscope: 10" Courtesy Historical Collections, The National Medicine,

Armed

(illustrated

page

x 1.5" (dia).

Museum

of Health

Forces Institute of Pathology, Washington,

D

and C.

8)

Microscope, 1864. 11" (h) x 16" Historical Collections, National

Armed

(1)

(1)

x 9.5"

Museum

(d).

of Health

Forces Institute of Pathology, Washington,

Courtesy

and Medicine,

D

C. (illustrated

page 54)

Alexandar Levy, Woodward Working in the Laboratory, ca. 1952. Graphic: Photographic reproduction of illustration, (image unavailable for catalogue) 1845 shows instruments more refined than those of the sixteenth century, although

This

autopsy

their basic

kit

from

design

is

ca.

not

much

Autopsy/dissection

kit, ca.

altered.

1845. 1" (h)x 3" (w) x 7"

closed. Courtesy Historical Collections, National Courtesy Historical Collections. The National Medical History. Armed Forces Washington. D C.

Museum

Institute of Pathology.

of

and Medicine, Armed Forces

D

C. (illustrated

S4

page 54)

Museum

Institute of Pathology,

(1)

of Health

Washington,

Hamman

Edouard

(1819-1888), Andreas

Vesalius, ca.

1848.

Lithograph: 31.2 (h) 40.2 (w). (illustrated page 7) Lucia Rosetti, The University of Padua, An Outline of Its History, Trieste, 1983. Courtesy Esther Sternberg, (image unavailable tor catalogue)

The Compromise William Cullen (1710-1790). FirstLines of the Practice of Physic,

WZ260 C967f 1784.

Edinburgh, 1784.

(illustrated

page 10)

Robertv Whytt (1714-1766). Observations on the Nature, Causes, and Cure of Those Disorders Which Have Been Co mm only Called Nervous, Hypochondriac, or Hysteric, Edinburgh, 1765. Book: 20.5 (h)

x 28 (open width),

Austin Llint (1812-1886),

(illustrated

.4

Treatise

on the Principles and

Practice of Medicine, Philadelphia, 1868.

trated

page 55)

WB

F623t 1868.

(illus-

page 11)

Psychosomatic Medicine:

The "Puzzling Leap" Robert Whytt (1714-1766), Observations

Andre

Brouillet,

UneLegon

CUnique a

la Sa/petriere, 1887.

Graphic: Photographic reproduction of painting. B4519.

(illus-

trated page 12)

Camera,

1900.

ca.

Camera: 16"

Historical Collections,

Medicine,

Armed

(illustrated

(h) x 16" (w)

The National Museum

x 42"

of Health

(1).

Courtesy

and

Forces Institute of Pathology, Washington, D.C.

page 14)

Desire-Magloire Bourneville

(b.

1840) and Paul Regnard,

1877-1880. Iconographie Photograph ique de la Salpetriere, Paris, Photographic reproductions of two patients Graphics: Two with hysteria, (illustrated page 14)

Honore Daumier (1808-1879), Le malade

imaginaire, 1860s.

page 13) Lithograph. Courtesy Penny Herscovitch. (illustrated

Freud (1856-1939), Josef Breuer (1842-1925) and Sigmund York, 1957. WM173 B846s 1957. Studies on Hysteria,

New

(illustrated

page 15)

Berggasse 19,

The Sigmund Freud s Home and Office, Vienna 1938, CC2656. Edmund Engelman, Chicago, 1976.

Photographs of

(image unavailable for catalogue)

55

on the

Nature, Causes, and Cure of Those Disorders Which Have Been Commonly Called Nervous, Hypochondriac, or Hysteric, Edinburgh, 1765

Sidney Chafetz, Portrait of Sigmund Freud, 1964. Etching: 69 (h) \ 56 (w). (illustrated page 15) H. Flanders Dunbar (1902-1959), Emotions

and Bodily

Changes: A Survey of Literature on Psychomatic Interrelationships, York, 1935. Book: 24.5 (h) x 35.5 (open 1910-1933,

New

width).

WM90

D898e 1935

Psychosomatic Medicine.

Wl

page 18)

(illustrated

September-October 1959.

P582. (illustrated page 18)

Smith Ely

Jelliffe

(1866-1959), "Psyche-pathology and

Organic Disease," Sketches 1939.

Wl NE211

in

Psychosomatic Medicine,

New

York,

no.65 1939. (image unavailable for cata-

logue) It, New Wl NE21 v.

Georg Groddeck (1866-1934), The Book of the 1928. Book: 23 (h) x 32.5 (open width). (illustrated

1

York, 49.

page 17)

Franz Alexander (1891-1964), Psychosomatic Medicine, York. 1950. Book: 22 (h) x 31.5 (open width).

New

WM90 A375p

1950. (image unavailable for catalogue)

Franz Alexander (1891-1964), Psychosomatic Medicine,

New

York, 1950. Graphic: Photographic reproduction of schematic-

representation of specificity in the etiology of the peptic ulcer, (illustrated

page 19)

Helen Lundeberg (1908-

),

Double Portrait of the Artist

in Time,

1935. Graphic: Photographic reproduction of oil painting.

Courtesy National

Washington,

D

Museum

of

C. (illustrated

Roy Grinker (1900-1993

)

American

Art,

Smithsonian

institution,

page 56)

and John

P.

Spiegel,

War Neuroses

in

North Africa: The Tunisian Campaign (January-May, 1943). Prepared and distributed for the Air Surgeon, Army Air

Forces by the Josiah Macy, Jr. Foundation, New York, September 1943. Book: 23 (h) x 15 (w). WM184 G867w (illustrated

Roy Grinker (1900-1993 Stress,

Double

Portrait of the Artist in

Psychosomatic medicine traced the diseases suffered as to the developmental dramas and trau-

an adult back

of early childhood.

Courtesy National Institution,

Museum

Washington.

and John

P.

Spiegel,

Men Under

WM184

1945. (illustrated page 18)

Time

Helen Lundeberg

mas

)

Philadelphia, 1945. Book: 33 (h) x 23 (w).

G867m

1943.

page 18)

of American Art. Smithsonian

Thomas W. Salmon (1876-1927), The Care and Treatment of Mental Diseases and War Neuroses ("Shell Shock") in the British Army. War Work Committee of the National Committee for Mental Hygiene, New York, 1917. Book: 24.5 (h) x 46.5 (open width with illustration). US 629 S172c 1917. (illustrated page 16)

DC

56

Frank Loesser (1910-1969), "Adelaide's Lament," Guys and © 1950, 1978 Frank Music Corporation. Sheet

Pharmacy

Dolls, 1950.

music and

lyrics.

Donated by Lou

Storey,

(image unavailable

for

Bottle.

Courtesy Elaine and Arthur Shapiro.

catalogue)

Self-Healing, Patents, and Placebos, Pharmaceutical Era, February 1889. Graphic: Photographic

reproduction of illustration of pharmacy designed and built by

C.H. Bangs, (illustrated page 21)

Pharmacy

Bottle. Bottle: 26" (h) x 6" (dia). Courtesy Elaine

Arthur Shapiro, (illustrated

and

page 57)

Benjamin Rush (1746-1813), .4// 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, New York, 1811. Book: 17 (h) x 21.5 (open width). WZ270 R952i 1811. (illustrated page 21) Albert Vernon, Correspondence Course of Instruction in the Science of Psych ratism or Prowess of the

York,

The Vernon Academy

Human

Vernon Sanatorium, 1900. Book: 17.5 BF Y539c 1900. (illustrated page 57) Julia

Mind, Rochester,

of Mental Sciences and (h) x 53.5

Anderson Root, Healing Power of Mind: A

Mind-Cure, with Original Views on the Subject

New

The

(open width).

Treatise on

and Complete

and Self-Treatment, Peoria, Illinois, 1886. R806h 1886. (illustrated page (w).

Instructions for Practice

Book: 20.5 (h) x 32.5

WM

22)

Albert Vernon,

Correspondence Course of

Instruction in the Science of Psychratism or

Prowess of the Human Mind, Rochester, New York, The Vernon Academy of Mental Sciences and The Vernon Sanatorium, 900 1

Notman, William James, Graphic: Photographic reproduction of a photograph. B15230. (illustrated page 22)

frame (with Emile Coue quote), ca. 1920. Courtesy Elizabeth Fee. (image not available for catalogue)

Mirror with

gilt

Fremont Winbigler (1857-1925), How to Heal and 1916. Help One's Self or a New Outlook on Life, Los Angeles, Charles

Book: 20 (h) x 14 (w).

QT180 W758h

1916. (illustrated

page 57)

Nervous John Kearsley Mitchell (1859-1917), Self Help for Expenditure, Women: Familiar Talks on Economy in Nervous M675s 1909. Philadelphia, 1909. Book: 20 (h) x 14 (w).WM

page 57)

(illustrated

How

to Charles Fremont Winbigler (1857-1925), Outlook on Heal and Help One's Self or a

New

Life, Los Angeles,

April 1958. the Best Medicine," Reader s Digest, (illustratSternberg, Magazine: 7" (h) x 10" (w). Courtesy Ghilta

"Laughter

is

1916

Help for Nervous Women: Familiar Talks on Economy in Nervous Expenditure, Philadelphia, 909

John Kearsley

Mitchell (1859-1917), Self

1

ed page 23) 57

Dale Carnegie (1888-1955),

New

Living,

York, 1985,

©

How

to

Stop Worrying

and Stan

1944. Book: 6" (h) \ 4" (w

).

(image

unavailable for catalogue)

—

New

York, You're OK, A. Harris (1913- ), I'm Okay 1973, ©1967. Book: 7" (h) \ 4" (w). (illustrated page 23)

Thomas

Norman Vincent Thinking,

New

Peale

(

1889-1994), The Power of Positive ©1952. Book: 7" (h) x 4" (w ).

York. 1992,

page 23)

(illustrated

Perkins's Metallic Tractors, late 18th century. Tractors: .V x 1/2" (w

).

Health and

Courtesy

Historical Collections,

Medicine,

Armed

D

Washington,

(I)

The National Museum

of

Forces Institute of Pathology,

C. (illustrated

page 25)

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

and

Epidemical Convulsions, Bath, 1800. Book: 21.5 (h) \ 27.5 (w).

WZ260

1

14210 1800. (illustrated page 25)

Benjamin Douglas Perkins (1774-1810), The Family Remedy; Perkins's Patent Metallic 'inn tors, For the Relief of Topical

or,

Disease of the (h) \ 14.5 (w

Human ).

Unicorn horn.

WBC I

lorn:

Body; And of Horses, 1800. Pamphlet: 22.5

P448e 1801.

(illustrated

page 25)

73" (h) x 4" (dia). Courtesy Elaine and

Arthur Shapiro, (illustrated page 24)

Kickapoo Oil: Relief from Aches and Pains. Courtesy and Arthur Shapiro, (illustrated page 24)

Nerve

&

Bone Liniment. Courtesy

(illustrated

Elaine

and Arthur

Elaine

Shapiro,

page 24)

Dr. Pierce's Favorite Prescription. Courtesy Elaine Shapiro, (illustrated

and Arthur

page 24)

Hood's Sarsaparilla, Gentian and Bitter Orange Compound. Courtesy Elaine and Arthur Shapiro, (illustrated page 24) Bliss

Native Balsam. Courtesy Elaine and Arthur Shapiro,

(illus-

trated page 24)

Swamp

Root. Courtesy Elaine and Arthur Shapiro, (illustrated

page 24) Milks Emulsion Natures Remedy. Courtesy Elaine and Arthur Shapiro, (illustrated page 24) Krso Anti-Bilious Bitters. Courtesy Elaine and Arthur Shapiro, (illustrated page 24) 58

Pastor Koenig's Nervine for Nervous Aliments. Courtesy and Arthur Shapiro, (illustrated page 24)

Goldine Tonic and Nervine. Courtesy

Elaine

and Arthur

Elaine

Shapiro,

page 24)

(illustrated

Ads Compound Syrup Hypophosphites (Hear. Courtesy and Arthur Shapiro, (illustrated page 24) Dr. Pierce's

Golden \ledieal Discovery. Courtesy

Elaine

Elaine

and

Arthur Shapiro, (image unavailable for catalogue)

Powered unicorn horn. Courtesy

Elaine

and Arthur

Shapiro,

page 24)

(illustrated

Four Batteries. Batteries: 1"

(dia) to 1" (dia). Courtesy Elaine

and Arthur Shapiro, (illustrated page 25)

Humphrevs' Remedies Elaine

and Arthur

Warner's Safe Cure 1895. Buffalo,

sign. Sign: 16" (h) x 12" (w). Courtesy

Shapiro, (illustrated

page 24)

Almanac and Book of Handy Information York. Book: 22 (h) x 15.5 (w). W6 P3 no.

New

7475. (illustrated page 24)

Portrait of

William Osier. Graphic: Photographic reproduction

of painting. 20142. (illustrated

page 26)

Milk Sugar. Bottle: 5" (h) x 2"

(dia).

Shapiro, (illustrated

Courtesy Elaine and Arthur

page 28)

Antilirium Placebo. Bottle: 4" (h) x 2" (dia). Courtesy Elaine

and Arthur Shapiro, (illustrated page 28)

Cebocap No.

1.

Bottle 2" (h) x 1" (dia). Courtesy Elaine and

Arthur Shapiro, (illustrated

Cebocap No.

2.

Bottle 2" (h) x 1" (dia). Courtesy Elaine and

Arthur Shapiro, (illustrated

Cebocap No.

3.

page 28)

page 28)

Bottle 2" (h) x 1" (dia). Courtesy Elaine and

Arthur Shapiro, (illustrated

page 28)

Nardil Placebo. Courtesy Elaine and Arthur Shapiro, (illustrated

page 29) Placebo for Elavil HC1. Courtesy Elaine and Arthur Shapiro, (illustrated

page 29)

Placebo for Stela/ine. Courtesy trated

Elaine

and Arthur

Shapiro, (illus-

page 29)

59

Placebo

fon

Valium. Courtesy Elaine and Arthur Shapiro,

tor

(illus-

page 29)

trated

I).

Levine,

Mechanism

Newton

C. Gordon,

Howard

"The September 23, LA453. (illustrated L. Fields,

of Placebo Analgesia," The Lancet,

1978. Book: 28 (h) x 38 (open width).

Wl

page 29) "Pain Pathways." Graphic: Photographic reproduction of

illus-

tration. Courtesy Alfred Mansour, Mental Health Research Institute.

University of Michigan,

(image unavailable

for catalogue)

and Deprivation

Stress

Peter Gridley, Long Island Expressway. Graphic: Photographic

reproduction of photograph, (illustrated page 30)

Chris Todd, "Noise Pollution." Audio recording.

Walter Bradford Cannon. Graphic: Photographic reproduction of photograph. B30295. (illustrated page 32)

Walter Bradford

Cannon (1871-1945),

Bodily Changes in Pain,

Hunger, Fear and Rage:

An Account of Recent Researches into the Functions of Emotional Excitement, New York, 1915. BF511

G266b

1915. (illustrated page 32)

Walter Bradford

New

Cannon (1871-1945), The Wisdom

V,„k, 1939.

QT104 C226W

of the Body,

1939. (image not available

for catalogue)

1

lans Selye (1907-1982), The Physiology

Exposure to width).

Stress,

and Pathology

of

Montreal, 1950. Book: 24.8 (h) x 39.5 (open

QZ140 S469p

1950. (illustrated page 33)

American Journal of Nursing, March 1965. trated page 34)

Wl AM495.

(illus-

Readers Digest, February 1957. Magazine: 19 (h) x 27 (open width). Courtesy Ghilta Sternberg, (illustrated page 33)

How ard Taft Lorenz, Dismissal (or) Pink Slip, 1940. Graphic: Photographic reproduction of oil painting. Courtesy National Museum Museum

of

American

of

Modern

Art,

Smithsonian

Art. (illustrated

Institution, transfer

Excerpts from Monica Study, 1950s. Video. Courtesy Engel.

60

from

page 35)

Dr.

George

Monica, 1950s. Graphic: Photographic reproduction of original

photographs of Monica. Courtesy

(illustrated

George

Dr.

six

Engel.

page 34)

2/26/54 Applegate, Histamine laboratory "flowsheets."

Graphic: Photographic reproduction of original laboratory notes. Courtesy

B.

Dr.

George Engel.

Kent Houston and C.R. Snyder,

Pattern: Research, Theory,

Book: 24 (h) x 36 (w).

and

page 34)

(illustrated

editors. Type

Intervention,

WG300 T991

New

A Behavior

York, 1988.

1988. (illustrated

page 35)

Robert Dantzer, The Psychomatic Delusion,

New

York, 1993.

1993 A261. (image unavailable for catalogue) Defuse Stress, Health Dynamics Poster Program. ©1988 Clement Communications, Inc. Poster: 56 (h) x 43.2 (w). A25395 (image unavailable for catalogue)

Kai T. Erickson, Everything in

Donated by Lou Barry

J.

Storey,

Its

Path,

New

(image unavailable

York, 1976.

for catalogue)

McCallum, Richard

Marshall, Richard W.

L.

Guerrant, editors, Helicobacter Pylori in Pept'n Ulceration Gastritis,

for

Boston, 1991. YYI310

H475

and

1991. (image unavailable

catalogue)

Scott

Adams,

Dilbert,

September

15, 1996.

Photographic reproduction of cartoon.

©

Graphic-

1996 United Feature

Syndicate, Inc. (illustrated page 37)

Volvo Assembly Line, Sweden,

ca. 1987.

Graphic:

Two

photo-

graphic reproductions of the assembly line. Courtesy Volvo Truck Corporation, Powertrain Division, Skovde,

Sweden,

(illustrat-

ed page 37)

Betty

White with Thomas

Pet-Love:

How

J.

Watson, Betty White's

Pets Take Care of Us,

New York,

1983

Saratoga Spa, N.Y., ca. 1950s. Postcard: 3" (h) x 5". Courtesy Ghilta Sternberg, (illustrated page 36)

Some

hospitals, hospices

and nursing homes have

covered that patients feel calmer and the presence of a loving, furry friend

less

dis-

depressed

in

—some may even

Betty White with

Thomas

J.

Watson, Betty

Take Care of Us, New York, 1983. Book: (open width). DD8254. (illustrated page 61)

How Pets

Pecome more

White's Pet-Love:

21.5 (h) x

30

in

from the NAMES Project, New York, 1988. Courtesy Nola (image unavailable for catalogue)

61

Heffner.

more

"pet therapy."

Photograph

Cindy Ruskin, photographs by Matt Herron, The Quilt: Stories

stable physiologically or recover

quickly from their illness as a result of their involvement

credits

(I

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.

Frontiers of the Mind low Emotions Matter

1

scanner). Graphic: Positron Emission Tomography (PET Medical Systems (illusGE Courtesy Photographic reproduction. trated page 38)

1996. Video, Emotions and Disease: The Delicate Balance, with Medicine of Library National Produced by the and Emotions exhibition the for Inc. Multimedia Software Disease.

Graphic: Photographic in the wild (including close-up). reproduction from Emotions and Disease video. Courtesy for cataNational Geographic Television, (image unavailable

Tiger

logue)

Fear-response system. Graphic: Photographic reproduction of

Emotions and Disease video illustration. Illustrated by Bob loward Computer Graphics, (image unavailable for cataI

logue

)

Neurotransmitters. Graphic: Photographic reproduction from

Emotions and Disease Computer Graphics,

video. Illustrated by (illustrated

Bob How ard

page 43)

Optical imaging camera. Camera: 14.4 (h) x 13.21 (w) x 21.9 (d).

Ltd. (illustrated

Courtesy Photometries,

Image created by

optical

page 42)

imaging camera. Graphic:

Photographic reproduction of imaging camera output. Courtesy

Ehud Kaplan and Richard Everson, Mount

New

PET

York, (illustrated

Sinai

School of Medicine,

page 42)

scans of brain activity during transient sadness and hap-

piness. Graphic: Photographic reproductions of

Courtesy Mark

S.

Charleston, (illustrated

PET look

PET

scans.

George, Medical University of South Carolina,

page 40)

scans of brain activity of people w ho have been asked to

think about or speak a word. Graphic: Photographic reproduction of PET scans. Courtesy Marcus Raichle, Washington University, St. Louis, Missouri, (illustrated at, listen to,

E.

page 40) Functional magnetic resonance image (fMRI) of brain activity a person looking at faces. Graphic: Photographic reproduc-

of

tion of fMRI. Courtesy S.

VP

Clark, K. Keil,

Courtney, L.G. Ungerleider,

Mental Health, (illustrated

2

J.

Ma. Maisog,

and J.V Haxby National page 41

Institute of

Activation of T-cells. Graphic: Photographic reproduction of illustration, (illustrated

page 44)

Molecular structure of interleukin-1. Graphic: Photographic reproduction of illustration. Courtesy. Angela Gronenborn, National Institute of Diabetes Illustrated

and

Digestive

and Kidney

Diseases.

by Bob Howard Computer Graphics, (image

unavailable for catalogue)

The Immune System and

the Nervous System. Graphic: Photographic reproduction of illustration, (illustrated page 44) Physician examining

a sick child.

reproduction. Courtesy National Diseases,

Graphic: Photographic

Institute of Allergy

and

Infectious

((image not available for catalogue)

Computerized photomicrographic microscope. Graphic: Photographic reproduction. Courtesy Leica (illustrated

Inc.,

Deerfield,

Illinois,

page 42)

In situ hybridization. Graphic: Photographic reproduction of

imaging microscope output. Courtesy

Miles A.

National Institute of Mental Health, (illustrated

Herkenham,

page 42)

Normal circulating human blood. Graphic: Photographicreproduction of scanning electron microscope output. Courtesy Bruce Wetzel trated

and Harry

Schaeffer, National

Cancer

Institute, (illus-

page 42

Researcher and

DNA sequencing gel.

reproduction. Courtesy National Disease,

Graphic: Photographic

Institute of Allergy

and

Infectious

((image not available for catalogue)

A Dynamic Balance Overactive hypothalamus. Graphic: Photographic reproduc-

Emotions and Disease video illustration. Illustrated by Bob Howard Computer Graphics, (image not available for tion of

catalogue)

An

overactive amygdala. Graphic: Photographic reproduction

and Disease video Howard Computer Graphics,

of Emotions

illustration. Illustrated

(illustrated

by Bob

page 40)

Interruption of the brain/immune system communication.

and Disease Bob Howard Computer

Graphic: Photographic reproduction of Emotions

video illustration. Illustrated by

Graphics, (image not available for catalogue)

63

Immune system

stuek

in

the on position. Graphic:

and Disease video Howard Bob Computer Graphics, by

Photographic reproduction of Emotions tration. Illustrated

(image not available

Imbalance

in

for catalogue)

the chemical transmission

between neurons.

Photographic reproduction of Emotions and Disease video tration. Illustrated

by Bob Howard Computer Graphics,

(image not available

64

illus-

for catalogue)

illus-

Acknowledgments made possible by the generous support of Dana Foundation, the John I), and Catherine

This project was the Charles A. r.

MacArthur Foundation, the Fetzer Mental Health.

Institute,

and the

National Institute of

Project Staff Esther M. Sternberg,

M.D.

National Institute of Mental Health Exhibit'io a Dit n to r

Elizabeth Fee, Ph.D. National Library of Medicine Exhibition Dit i < tor

Anne Harrington, Ph.D. Harvard University, Cambridge

MA

Visiting Curator, Exhibition Script Writer

Theodore M. Brown. Ph.D. University of Rochester, Rochester Visiting Can/tor,

NY

Exhibition Catalogue Essay Author

Gretchen Hermes, Washington Curator

DC

Assistant

Patricia

Tuohy, Washington

Exhibition Manager;

DC

Managing Editor, Catalogue

Anne Whitaker National Library of Medicine Collections

Manager

Edwina Smith, Washington

DC

Exhibition Coordinator

Mary Parke Johnson National Library of Medicine Conservator

Margaret Kaiser Elizabeth Tunis

National Library of Medicine Proofreaders

Roxanne Beatty National Library of Medicine Invitation Coordinator

65

William Leonard National Library of Medicine Audiovisual Coordinator

Joe Fitzgerald National Library of Medicine Chief of Graphics

Troy

Hill

National Library of Medicine

Graphic Designer

)csign and Production

I

Lou Storey Red Bank NJ Exhibition

I )> 'signt

r

Multimedia Software,

Inc.,

Frederick

MD

Emotions and Disease: A Delicate Balance ideo Producer

1

Exhibits Unlimited, Inc., Alexandria Exhibition

Technical / igfiting .

VA

and Graphic Fabricator Vrtistry,

New

York

NY

Designer

Donors and Lenders

to the

Exhibition

George L. Engel Elizabeth Fee Mary Garofalo Nola Heffner Penny Herscovitch Historical Collections,

The National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington DC Photometries Ltd, Tucson AZ Elaine and Arthur Shapiro Esther Sternberg

Ghitta Sternberg

Lou Storey

66

Exhibition Photographs and Graphics Scott V.P.

Adams

Clark, K. Keil,

J. Ma. Masog, S. Courtney, L.G. Ungerleider, andJ.V. Haxby, National Institute of Mental Health George L. Engel GE Medical Systems, Milwaukee Wl

Mark

S.

George, Medical University of South Carolina, Charleston

Peter Gridley/FPG

Angela Gronenborn, National Institute of Diabetes and Digestive and Kidney Diseases Miles A. Herkenham, National Institute of Mental Health

Ehud Kaplan and Richard Everson, Mount Sinai School of

Medicine

Leica, Inc., Deerfield IL

Alfred Mansour. University of Michigan,

Ann Arbor

National Cancer Institute

National Institute of Allergy and Infectious Diseases National Geographic Television

Museum of American Art, Smithsonian Institution Marcus E. Raichle, Washington University School of Medicine. St. Louis United Media, New York NY Volvo Lastvagnar. Skovde, Sweden Bruce Wetzel and Harry Schaefer, National Cancer Institute National

Let There Be Light video excerpts Production Brian

Matthews

National Library of Medicine Editor

Open

captions and laser disk provided by Audiovisual Hill National Center

Program Development Branch, Lister for Biomedical Communications,

NLM

67

Story video excerpts

Mon nd

Video and Images Courtesy Dr. George L. Engel Monica Archives Committee, University of Rochester,

Rochester

NY

Production

Tim Shea I

)epartment of Psychiatry fniversity of Rochester Medical School

I

'isual

1

Brian

Consultant

Matthews

National Library of Medicine Editor

Open

captions and laser disk provided by Audiovisual

Program Development Branch, Lister for Biomedical Communications,

Hill National

Center

NLM

Emotions and Disease: A Delicate Balance video Video and Images

The V.P

Arthritis (

Foundation

Hark, K. Keil,

J.

Ma. Maisog,

L.G. Lngerleider, and

S.

J.V.

Courtney,

Haxby, National Institute

of Mental Health "Digital Anatomist"

team

at

University of Washington

including: Dr. Cornelius Rosse, Dr.

John Bolles, John W. Sundsten, Dr. James Brinkley, Draig Eno, Jeffery Prothero, Roger Williams Dr.

The National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington DC

Historical Collections,

History of Medicine Division, National Library of Medicine

Mark

S.

George, Medical University of South Carolina, Charleston

Miles A. Herkenham, National Institute of Mental Health Ehud Kaplan and Richard Everson, Mount Sinai

School of Medicine National Institute of Allergy and Infectious Diseases National Institute of Mental Health National Institute of Mental Health/DART National Institute of Diabetes and Digestive

and Kidney Diseases National Cancer Institute National Geographic Television

"Luncheon of the Boating Party" Reproduced courtesy oi he Phillips Collection, Washington DC I

68

Production Esther M. Sternberg, M.D. National Institute of Mental Health Executive Producer, Script Writer

Mare Montefusco Multimedia Softw

are, Inc.

Producer

Bob Howard Computer Graphics Art Direction, Animation, Digital Video Editing

and Special Effects Paul Rose

Charizmah, Inc. Composer, Original Score

Special Advisors

Michelle Trudeau National Public Radio, Irvine

CA

James Louie, M.D. Division of Rheumatology, Harbor-ICLA Medical Center Dr. C. Liana Bolis World Health Organization

Dr.

Rex Cow dry

National Institute of Mental Health

Dr. Scott

Durum

National Cancer Institute

Dr.

Suzanne Felten

University of Rochester

Dr. Jonathan Fritz

National Institute of Mental Health

Dr.

Angela Gronenborn

National Institute of Diabetes and Digestive

and Kidney Diseases

Henkart Institute Cancer National Dr. Pierre

Dr. Steven

Hyman

National Institute of

Mental Health

69

Ehud Kaplan Mount Sinai School of Medicine Dr.

LeDoux

Dr. Joseph

Ncm Dr.

York University

Ludise Malkova

Health National Institute of Mental

McKwen

Dr. Bruce

Rockefeller University

Mortimer Mishkin National Institute of Mental )r.

I

Dr. Jon

I

lealth

New som

Library of Congress >r. Stanley Pillemer National Institute of Arthritis and Musculoskeletal and Skin Diseases 1

)r.

I

Marcus

E. Raichle

Washington University School of Medicine Dr. Harry Z.

(

Rami

Museum

National

lonsulting Panel

C. Liana Bolis, I

of American Art

)i\

ision of

M.D.

Mental

1

lealth

World Health Organization Ary Goldberger, M.D.

Beth

Israel

Hospital

Harvard Medical School, Boston

Lynn

(i.

MA

Gordon, Ph.D.

Fetzer Institute, Kalamazoo

MI

Vyacheslav Ivanov, Ph.D. University of California, Los Angeles, Institute of

CA

World Culture, Moscow University

Ehud Kaplan. Ph.D.

M ount

Sinai School of Medicine,

New

Joseph LeDoux. Ph.D.

New

York University,

70

New

York

NY

York

NY

William R. Lovallo, Ph.D.

Mind-Body Network. Chicago IL MacArthur Foundation, Chicago IL Bruce

McEwen, Ph.D.

Rockefeller University,

New

York

NY

Socierv for Neuroseience, Washington

DC

Declan Murphy, Ph.D. Management Group, halls Church VA

DMR Jon

Newsom, Ph.D.

Library of Congress, Washington

DC

Marcus E. Raichle, M.D. Washington University School of Medicine.

St.

Louis

MO

Harry Z. Rand. Ph.D. National

Museum

of American Art. Washington

DC

Douglas Smith, Ph.D. Boston

Museum

of Science, Boston

Fred Steiner, Ph.D. Composer, Santa Fe

MA

NM

71

Thanks

Special

Donald A.B. Lindberg, M.D., Director, National Library of Medicine Jules Asher, National Institute of

Maggie

Bartlett,

Mental Health

National Cancer Institute

Rick Becker, Department of Psychiatry, University of Rochester Medical School Lois

Ann

Colaianni, Associate Director for

Library Operations, National Library of Medicine

Rex W. Cowdry, Acting Deputy Director, National Institute of Mental Health Isabel Davidoff, National Institute of Mental Health/DART Kathleen Gardner Cravedi, Special Expert, Office of Public Information, National Library of Medicine Daniel Garrett, National Institute of Diabetes

and Digestive and Kidney Diseases \h

in

Harris,

Deputy Chief, Office of Administration,

National Library of Medicine

Steven E. Hyman, Director, National Institute of Mental Health Joy Jackson,

NIH

Video Unit

Karlton Jackson, Staff Photographer, National Library

of Medicine

)onna Kerrigan, National Cancer Institute Karen Leighty, National Institute of Allergy I

and Infectious Diseases Robert Mehnert, Chief, Office of Public Information, National Library of Medicine Pamela Meredith, Head, Public Services Division, National Library of Medicine Elizabeth G. Rosso, Assistant Administrative Officer, National Library of Medicine

Kent A. Smith, Ph.D., Deputy Director, National Library of Medicine Patricia Williams, Administrative Officer, National Library

of Medicine

Theodore

E. Youwer, Chief, Office of Administration, National Library of Medicine

Additional

Thanks

\brams, Bethesda MD, print broker Litho Impressions, VA, brochure printer Frame of Mine, Washington DC, framing Jeff Watts, Staff Photographer, Infinite Color, Arlington VA, catalogue photography \l

Chroma

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Graphics, Inc., Largo

MD,

catalogue printer