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Emotions and Disease

The National Library of Medicine recently redesigned the online presentation of its exhibition Emotions and Disease. Held in the Library’s building in Bethesda, MD, 25 years ago, the exhibition explored the intersection of the mind and body. Circulating Now interviewed Esther Sternberg, MD and Ted Brown, PhD about their work on the original exhibition and the continued relevancy of its message today.

Circulating Now: Dr. Brown, we heard from you a couple of years ago on the subject of the World Health Organization (WHO) Alma-Ata Declaration of 1978; it’s nice to have you back. Will you tell us a little about what you’ve been working on lately?

An older white man speaks to a class in front of a chalkboard.
Photo courtesy Brandon Vick/University of Rochester

Ted Brown: I’ve been doing some more work related to the WHO narrative history I had worked on with Liz Fee and Marcos Cueto that was published by Cambridge University Press in April 2019. I will have a chapter on the history of international health regulations (which WHO now oversees) in a book Oxford University Press is planning to publish. I am also working with Marcos Cueto and with a Danish scholar Niels Brimnes on a biography of Halfdan Mahler, who was WHO Director General from 1973 to 1988 and the driving force behind the Alma Ata Declaration. More directly relevant to the Emotions and Disease exhibition, I have also begun to work again on the history of American psychosomatic medicine and biopsychosocial approaches to clinical practice.

Circulating Now: Dr. Sternberg, you’ve had a long association with the NLM and it’s great to reconnect with you, but we haven’t had the honor of talking to you here on Circulating Now. Would you tell us a little about yourself?

An older white woman poses outdoors in an Arizona desert landscape.Esther Sternberg: I grew up in Montreal, and received my MD and trained at McGill University as a rheumatologist. A single patient, who had developed an autoimmune disease while being treated for a brain disorder, inspired me to go into research to try to figure out the connection between the brain and immune system at a time when most scientists and physicians didn’t believe that connection. I loved the detective work that’s involved in research and knowing that the work I do makes a difference in people’s lives.  My research took me to the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH) and eventually led me to become Research Director at the Andrew Weil Center for Integrative Medicine and Founding Director of the University of Arizona Institute on Place, Wellbeing & Performance.  Much of my work involves carrying out research, writing scholarly papers, giving talks and interviews, and advising a wide variety of organizations. Over the last twenty years, I’ve been using wearable devices to study the impact of the built environment on health and well-being, specifically how workspace affects stress levels. That topic suddenly became critically relevant in the wake of COVID-19, as so many workers begin returning to the office and/or working from home.

CN: How did you both become involved in the curation of Emotions and Disease and what were your perspectives on the project?

ES: I was putting on a conference, the Third International Congress of the International Society for Neuroimmunomodulation, which met at the National Institutes of Health in November 1996 in a new building on the NIH campus just across the street from the National Library of Medicine. Initially, we planned to hold a reception at the Library to show visiting scientists the physical building that houses PubMed, but the idea grew rapidly into a plan for an exhibition. We wanted to provide historical perspective and context for the scientific presentations at the Congress and to explain to the general public the meaning and relevance of scientific developments linking neuroscience and immunology—the science of the mind-body connection.

This was my first time working with the Library other than for literature research. I first met Dr. Elizabeth Fee, then Chief of the History of Medicine Division, in her office during a snowstorm, we were so eager to get the project started. She was an amazing collaborator and colleague. She suggested the title of the exhibition to help make the science accessible to a general audience, and she guided and shaped the exhibition from beginning to end, including hiring the right team of advisors and curators, like Ted Brown and Anne Harrington, who could think about these issues in a multi-dimensional way. I learned a lot from Liz about how to think about science in the context of history. Dr. Donald A.B. Lindberg, then NLM director, was so supportive as we worked to put on this popular exhibition. I’m forever grateful.

An open book showing an illustration of a man's head in profile with regions mapped in a band around the head.
Margarita Philosophica cum Additionibus Nouis by Gregor Reisch, 1517.
Gregor Reisch included an often-reproduced woodcut profile of the head in his book Margarita Philosophica. The figure locates various faculties of the soul for cogitation. memory, etc.) in specific regions. Note that Imaginativa (imagination) is located directly over the eyes.
National Library of Medicine #2282006R

TB: Liz Fee knew of my deep interests in the history of psychosomatic medicine and invited me to become involved in the “Emotions and Disease” project. I worked on it with Anne Harrington of Harvard, another historian with interests in the history of psychosomatic medicine and related topics, and with Esther, who was a leading researcher in neuroendocrinology and neuroimmunology at the NIMH at the time.

ES: The whole thing was a whirlwind, put together in just nine months.  We realized that we needed a project manager to keep us on track on our very tight timeline so we brought in Patricia Tuohy, who later became Head of the Exhibition Program at NLM. As soon as we had her skilled and expert management of all aspects of the exhibition, things came together and moved along apace. I learned a lot from Patti about making executive decisions—she gave us our marching orders and didn’t take any waffling from any of us!

CN: The project was a collaboration between scientists and historians. What were some of the discussions you had about how to shape the narrative of the exhibition?

TB: Anne, Esther, and I complemented one another very well and enjoyed working together. My focus was the history of psychosomatic medicine to about 1950, Anne’s was on developments since 1950, and Esther gave us a contemporary scientific understanding of the relationships that Anne and I traced through historical sources.

ES: I was looking at it like a scientist: look at all the shiny new tools we’ve developed—brain imaging, molecular biology, immunology.  At NIH, I had discovered that the brain’s stress center was important in susceptibility to inflammatory diseases in rats. Others were studying different aspects of the brain-immune connection and together our evidence proved the importance of that connection for health and disease. There was some push and pull between the scientist’s perspective of discovering new answers that will change the world and the historical perspective tracing where all this came from and how today’s ideas come from a long history of medical understanding and social context.

TB: Esther and I developed a very fruitful collaboration, not only because we were both eager to learn from one another but because Esther had deep interests and was very well read in history. The only tough issue we had to sort through was related to the language—how to refer to certain ideas in the past, with Esther having a slight tendency to use modern terminology applied in retrospect while I had a contrary tendency to use the language of the past and to translate it into modern idiom only on occasion.

CN: The physical exhibition at the Library opened just over 25 years ago. What has changed since then?

TB: I think most of the themes and issues identified in the exhibition are still current and, indeed, Esther is still exploring them in her clinical and scientific work. Historians also remain interested in these topics and in my own work I have written about how “stress” formulations began to compete with and then displace psychoanalytically-based formulations of emotion-disease connections in the 1940s and 1950s. I intend to continue this work into the 1960s and 1970s and also look at new developments that were synthesized in Herbert Weiner’s pathbreaking 1977 book, Psychobiology and Human Disease.

ES: In 1996, scientists and physicians were still skeptical of the idea that the brain and the immune system could communicate. The exhibition asked the questions: Why did we in Western medicine lose sight of the brain-body connection and why did it take centuries to come back to that understanding?  The answer is that we have come back, through the language of science—scientists don’t believe something unless we know how it works.  Back then, brain imaging, fMRI, was just in its infancy and the human genome was yet to be elucidated. Now we have a lot more very specific and detailed knowledge to prove those many brain-immune connections at a genomic, molecular, cellular, and whole brain and body functioning level. As more evidence has accumulated the idea has become fully accepted.  We’re seeing much more research and greater understanding of issues we looked at in the exhibition like PTSD, the placebo effect, and environmental stress. We know more now but the information the exhibition presented then is still all true.

Functional magnetic resonance image (fMRI) of brain activity of a person looking at faces. Courtesy VP Clark, K. Keil, J. Ma. Maisog, S. Courtney, L.G. Ungerleider, and J.V Haxby, National Institute of Mental Health
In Emotions and Disease Catalog National Library of Medicine #100891324

CN: What do you recall most clearly about your work on this project? Does any person, story, or item from the exhibition stand out for you?

ES: We were able to mount the exhibition so quickly because the Library’s historical collections were so rich, and extensive, and right there to work with. There were many early texts about the four humors and concepts of the emotions, as well as later materials, like Rudolf Virchow’s book showing the first precise drawings of nerve cells.

A book open to a detailed illustration of a neuron.

Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre by Rudolf Virchow, 1858
National Library of Medicine #OB13568

We were also able to work with NLM’s sister institution, the National Museum of Health and Medicine.  I remember spending a wonderful day with Liz among their collections discovering a range of medical instruments to complement the books. I remember we realized that the first four sections of the exhibition were full of books while the final, contemporary section had none. Of course, this was because of the way modern scientists do most of their background lit searching work now—through fast-paced journal publications. So, we decided to put a PubMed terminal in that section of the exhibition, to highlight the central role of online searching in how science was—and is—done.

Just before the drop-dead deadline for production, I came across a Dilbert comic showing the reduction of the size of workspaces to “Head Cubicles” that perfectly spoke to connections between space and morale in the workplace. I reached out and Scott Adams gave us permission to put it in the show!

TB: The single most compelling part of my work on the exhibition was my collaboration with Dr. George L. Engel on the “Monica” story in the Stress and Deprivation section of the exhibition. Dr. Engel had been the original investigator of the “natural experiment.” He and his associates observed an infant, “Monica,” who had been born with an esophageal blockage that required a surgical opening in her stomach. They collected and measured her gastric secretions and compared the amount collected with Monica’s moods. They showed that the infant Monica’s gastric juices increased when she was lively and engaged with the group but stopped completely when she withdrew around strangers. Dr. Engel still had some of the photos and clinical notes in his possession. He was living in a retirement community in Rochester, NY, at the time of the exhibition, and we enjoyed several long conversations in his apartment there as I learned more about his work and its significance, and received the original material from him for delivery to Bethesda.

Detail of a panel in a book with photographs of a child, a data table and explanatory text.
The “Monica” study in the Emotions and Disease Catalog
National Library of Medicine #100891324

ES: On opening night, The Washington Post sent a museum reviewer. We were on tenterhooks as we waited for the review to come out in the paper but were relieved and delighted to find that it was very well received and that was a great feeling. After the project, I continued to be associated with NLM, I advised on other exhibitions, served on the LISTRC panel and Board of Regents, and then chaired the BOR. Working with the Library was like a sabbatical from the hurly burly of working in the lab at NIMH. It was always calming and restorative to come to NLM. I really felt like I was part of the NLM family.

Explore the online presentation of its exhibition Emotions and Disease and view the catalog of the original physical exhibition in NLM Digital Collections.

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