The science of brain-immune communications bridges clinical medicine and the intangible but essential input of emotion
BY: Esther M. Sternberg, M.D.
If we are to make the leap into the next era of science, we must also include a look outward from each scientific discipline, and a re-integration of them all. As C.P. Snow described in his essay "The Two Cultures," we must drop the arrogance and walling off that comes with increasing technological specialization--and we must try to understand how the technologies and approaches to solving problems of one scientific discipline can be applied in order to solve the problems of another.
The science of brain-immune communications is by its very nature a field that does this. It looks inward to the most detailed level of body chemistry, and at the same time it looks outward to the larger concerns of health and emotion. It applies technologies that analyze molecules and genes, and technologies that image functioning of whole organs. It bridges specialized disciplines of basic science, such as immunology and neurobiology, and it bridges specialized fields of medicine, such as psychiatry and rheumatology. It bridges the basic sciences with clinical medicine and both of these with the intangible but essential input of feeling and emotion. The end result is to make the body and mind whole again.
Probably it was necessary to go through the exercise of increasing specialization in the previous era, from the time of Descartes and Bacon until the middle of this century, to achieve the level of detailed medical understanding that we have today. But so overwhelmed with detail is each scientific discipline that in the domain of health at least, sometimes the whole has been lost in favor of the parts. Perhaps in response to scientists' preoccupation with what seems to be minutiae, disillusioned with the medical community's enthusiasm for shiny technological toys at the expense of human interaction, the popular culture has turned away to seek more seemingly controllable, less alienating ways to health. Herbs and Zen meditation, acupuncture, spas and crystals-"alternative" forms of healing--are sought and paid for by the public with out-of-pocket billions, approaching or even exceeding traditional health care costs. How much of any benefit from these cures is placebo, how much are the desperate hopes of vulnerable people taken advantage of by clever salesmen? How much is real?
Perhaps the greatest future contribution of this new-old science will be to bring these two poles together once again. In fact, this field is not so much a bridge as a meeting point between science and the popular culture.
The way this emerging science can accomplish such a difficult reunion is by convincing both sides of the value of their view. For scientists, the totality of experimental observation, brought together from all sorts of studies--in genes and cells, animals and humans--can lead to a finer and more detailed definition of the intricate workings of connections between the nervous and immune systems. Ultimately through such knowledge, the conundrums of the mechanisms of illness will be uncovered, and so open up new avenues for previously unthought-of treatments for disease.
This process has already begun, especially in areas of this new science that have been most explored. Thus, knowing that immune molecules can kill neurons has led to a search for such molecules in brains of dementia victims--people whose memory slowly disappears in Alzheimer's, AIDS, and because of stroke. Finding these immune molecules at sites of nerve degeneration has led to testing of drugs that block cytokines, like the interleukin-1 receptor antagonist, to prevent the nerve-cell death that occurs in stroke. And since this treatment works, it proves to the skeptical scientist in yet another way that such connections are real and do play a role in health and in disease. To the patient or caregiver of such patients, it provides a new source of hope that some of their pain and suffering may soon be cured.
The principles underpinning this new science also provide a basis for physicians and health professionals to step back and hear their patients, to recognize that emotions do play a very important role in health and in disease. And this in turn may help physicians spend more time listening to what the patient has to say. It may help them think of the patient as a whole and treat with words and with compassion before so quickly pushing limb and head and belly through computerized diagnostic tools. And if really listened to and heard, the public may be more willing to accept these otherwise alienating technologies that do help diagnose and cure disease.
At the same time, we can use the technology-driven science of this field to help us begin to think of illnesses previously thought to be unrelated as connected, at least in some aspects, by a common thread. Inflammatory illnesses like rheumatoid arthritis, allergic diseases like asthma and dermatitis, fatigue conditions like chronic fatigue syndrome and fibromyalgia, mood disorders like depression and seasonal affective disorder, all show some perturbation of the hormonal stress response. And so, this understanding could lead to development of new treatments for these illnesses.
If new mind-body science accomplishes one thing, it will be to force us to learn to listen and to speak to one another in each other's languages. It will cause scientists and physicians to learn the languages of their colleagues' disciplines. It will help medical specialists think of the person as a whole--one single body with one single soul. By focusing on the minute connections between each part, and at the same time looking outward to the emotions and beyond, scientists and physicians will be able to work out in intricate detail how the cogs and wheels fit together in an interlocking, time-defined pattern, which, when functioning harmoniously, is the basis of "feeling well."