Our understanding of the stress processes of the brain has been impressive, especially since the emergence of brain CRH systems as a central regulator of the stress response. Not only is the CRH receptor now a prime target for drug development, but a host of other neuropeptide systems have been identified that participate in the stress response. This knowledge is percolating through all research areas interested in the etiology of stress-related psychiatric disorders as well as the nature of basic emotional and motivational systems (Chapter 21).
Considering the increasingly well-documented effects of stress on the body and the effects of chronic stress on a host of disease vectors (Booth et al., 2001; Mayer and Saper, 1999), there is an increasing acceptance of the interdependence of brain-mental and body-physical processes (Uchino et al., 1996). Social attachments are a powerful modulator of physiological stress responses (Feeney and Kirkpatrick, 1996; Hennessy, 1997), and our growing understanding of the brain mechanisms of social bonding (and hence mother-infant love) have implicated oxytocin, prolactin, and the endogenous opioids as prime movers of social attachments (Carter, 1998; Insel, 1997; Nelson and Panksepp, 1998). Females are generally more responsive to social support than males (Kirschbaum et al., 1995), as they are to the effects of prosocial hormones and stress (Cusing and Carter, 2000; DeVries et al., 1996). Couples who are better able to soothe each other's stress responses are more likely to remain married than those who tend to intensify each other's stress-related autonomic arousal (Gottman et al., 2002).
This recognition, as well as the "emotion revolution" that has been sweeping through psychology and other social science disciplines, has helped create a robust, scientifically based positive health movement that characterizes key factors that promote disease, while also identifying those that can facilitate a more positive spectrum of health. New composite measures of long-term bodily stress, such as the "allostatic load" and a variety of new concepts and hypotheses, are emerging (e.g., Ryff and Singer, 1998). The preliminary fruits of this movement have recently been harvested into a compendium of progress (Snyder and Lopez., 2002). When the aspirations of such mind-body initiatives are eventually established on a more solid empirical foundation, we may find that a host of new and milder psychotropic medicines could be developed (e.g., see Chapter 21).
The development of these medicines will require new types of research paradigms that are willing to evaluate the long-term effects of certain agents not only in traditional disease-targeted ways, but in the context of positive psychosocial support systems that may interact in beneficial ways with new medicinal agents that may only have rather modest effects on their own (Sachser et al., 1998; Taylor et al., 2000). For optimal efficacy, such agents may also require investments in new and more sophisticated views of depth psychology (e.g., Solms and Turnbull, 2002). In short, it is once again time in psychiatry to triangulate more completely between the molecular aspects of the brain, the behavioral symptoms of psychiatric disorders, and the intervening neuropsychological processes that comprise mental experience.
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