Clinical Review

Fortnightly review: Stress, the brain, and mental illness

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7107.530 (Published 30 August 1997) Cite this as: BMJ 1997;315:530
  1. J Herbert, reader in neuroendocrinologya
  1. a Department of Anatomy and MRC Cambridge Centre for Brain Repair, University of Cambridge, Cambridge CB2 3DY

    Introduction

    Not for the first time, medicine is beginning to accept what folklore has been saying for some time—in this case, that stress causes illness. Causation is most comfortably accepted in medicine when it relates to definable physical events: bacteria cause infection, radiation can cause cancer; exposure to toxic chemicals can cause blood abnormalities, and so on, though we know that even these relations are not simple. How can stress cause anything?

    Method

    In a cross disciplinary and wide ranging paper such as this, it seems useful to give most references to books or reviews that summarise current evidence or opinion. However, the factual statements are based on the primary literature, which I accessed in the usual way: from personal collections of reprints, from databases (such as BIDS and Medline, using keywords such as “stress” or “depression” coupled with other keywords such as “adrenal steroids,” “corticoids,” “serotonin,” etc), from reviews (some cited in this paper), from scanning key journals, and from contact with colleagues.

    What is stress?

    Stress is a general, not a specific, term and refers to any demand (physical or psychological) that is outside the norm and that signals a disparity between what is optimal and what actually exists. Since this is the stuff of life, some form of stress is commonplace: Selye thought that “stress ceases only at the moment of death.”1 However, there are episodic events that most people would recognise as unusually stressful. Haemorrhage is a stress; so is discovering infidelity. The two are not the same, and they require different sets of responses, though some may overlap. Coping is the process of recognising, evaluating, and adapting to persistent and adverse stress.

    A particular stress will not hold the same importance for everybody—for example, an examination is likely to be viewed less severely by someone who is well prepared …

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