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332 South African Journal of Science 99, July/August 2003
Psychoneuroimmunology: from philosophy,
intuition, and folklore to a recognized science
M. Viljoen , A. Panzer , J.L. Roos and W. Bodemer
The link between physical well-being and emotions was always
intuitively known and was recognized by the medical world for
hundreds of years. The last two centuries saw belief in integrated
mind–body functioning being replaced by the dualistic approach of
the biomedical model, partly as a result of lack of empirical
evidence for the existence of pathways linking these processes.
More recent approaches such as the biopsychosocial model and
psychoneuroimmunology represent a revival in the bi-directional
interaction between mind and body. Psychoneuroimmunological
research has shown the immune system to be a super-system on a
par with the neuroendocrine system for gathering and dispersing
information throughout the body. This article briefly discusses the
interaction between the immune system and neuroendocrine-
behavioural functions and shows that psychological disposition
can act as a biological response modifier and vice versa. It also
argues that psychoneuroimmunology is providing the empirical
evidence for many associations, which were until recently seen as
mere folklore.
Introduction
The link between psychological state and disease has
intuitively been recognized for centuries. Written proof for
earlier acceptance of this kind of mind–body interaction can be
found throughout literature and it is clear that the concept of
a mutual influence between physiology and psychological
functions was taken for granted by many — despite differences
in their positions on the mind–body impasse. Ancient Greek
medicine, for instance, recognized the cause-and-effect associa-
tion between state of mind and the body’s resistance to disease.1
The belief that strong negative emotions can cause physical
disorders persisted in the medical world throughout the
medieval period and early Renaissance.2 In fact, recognition of
the mind’s potential influence on the body prevailed in medi-
cine long before the existence of psychology as a subject. The
Transylvanian physician Papai Pariz Ferenc (discussed by
Solomon4) essentially reiterated Aristotle and anticipated
psychoneuroimmunology when, in 1680, he wrote:
When the parts of the body and its humors are not in harmony, then the
mind is unbalanced and melancholy ensues, but on the other hand, a quiet
and happy mind makes the whole body healthy.3
This kind of approach, where the mind is seen as biological
response modifier, was and still is widely accepted cross-cultur-
ally and can be found in Buddhism, Huicol practices,
shamanism, the Ayurvedic approach, some Hindu-related
spiritual practices and many others. It can even be traced back to
the traditions of ancient civilizations such as the Mayan and
Aztec.5 Although glimpses of African considerations on the
mind–body paradox can be gleaned from books such as Credo
a
Department of Physiology, University of Pretoria, P.O. Box 2034, Pretoria 0001, South
Africa.
b
Department of Psychiatry, University of Pretoria.
*Author for correspondence. E-mail: mviljoen@medic.up.ac.za
Review Articles
Mutwa’s Indaba My Children6 and other writings, and despite a
vague understanding of the role of people like the sangoma and
the inyanga, there is a dire need for accessible, well-researched
documentation of the mind–body approaches of Africa. In
contrast to the traditional Western approach to medicine, where
the biomedical model became the norm, the concept of an
integration of the mind, environmental factors and physical
health had always been a consideration in Indian medicine.7
Intense interest in the influence of mind over body and vice
versa was a hallmark of certain circles over a period of about 100
years stretching from Franz Anton Mesmer (1734–1815) to
Joseph Breuer (1842–1925) and Sigmund Freud (1856–1939),
when psychophysiological studies were published claiming that
mental events such as suggestions, magnetism, mesmeric trance
states, hypnosis, trauma, catharsis and submergence of part of
the consciousness into the subconsciousness can dramatically
influence the body.8 During this period the neurological system
was seen as the only messenger between physiological and
behavioural events. However, the link between mood, cognitive
events and health can only partially be explained by neuro-
psychology. Thus, the effects of peripheral trauma, infection and
inflammatory conditions on behaviour, as well as some of the
consequences of emotions and neurological changes on physical
health, remained speculative. This partially contributed to a
dualistic approach to mind and body by psychologists and
physicians alike.
Several developments contributed to the eventual scientific
recognition of the role of the immune system in the mind–body
interaction. The first is surely the fact that immunology
advanced from simple bacteriology to the study of antibody
structure and antigen–antibody reactions, to the clonal selection
theory, to the explosion in knowledge of cytokines and the even-
tual realization that the immune system is not completely auton-
omous and self-regulating. Another indispensable contribution
was the relentless reporting by a number of individuals of ob-
served associations between mental states, personality and
stressful experiences, on the one hand, and physical disease on
the other — despite adherence in general to the biomedical
model and scorn of the psychosomatic concept.
Despite resistance, a number of approaches by individuals
from both the humanities and the biomedical sciences seriously
attempted to bring the psychosocial and biomedical aspects
together under the same rubric. The biopsychosocial model and
psychoneuroimmunology represent such approaches. The
biopsychosocial model should be mentioned as it was the first of
the two to be included in the curriculum of health psychology
and in certain medical courses. The biopsychosocial model, as
proposed by Engel9,10 and modified by others, was intended as a
holistic model where social, biological and psychological factors
comprise a complex system of interactions which determines the
individual’s health and vulnerability, as well as reactions, to
disease. The biopsychosocial model challenged the single
domain approach of the biomedical paradigm.
The essence of the model is the premise that a disease does not
influence only one organ or system but that the organism as a
whole is involved with multidirectional interactions among
Review Articles South African Journal of Science 99, July/August 2003
biological, psychological and social factors. Health, or for that
matter disease, is therefore seen as the product of perpetual
interactions among biological, psychological and environmen-
tal influences. The onslaught on health can therefore be from
various entry points or even from various interactions. Interven-
tions can similarly, within obvious limits, be performed at any of
the interacting domains or even from a combination of entry
points. The effectiveness of the interventions will vary from
person to person and even at different times for the same indi-
vidual.
The biopsychosocial model, which started out as a change in
perspective from the traditional biomedical model,11 rather than
from a scientifically evidenced domain, evoked strong contro-
versy when first introduced. From the medical perspective, the
implied influences of mental state, personality and emotions on
health outcome were openly condemned as mere folklore by
eminent medical journals as recently as 1985.12 From a psycho-
logical perspective, the reactions were equally restrictive.
Despite the inclusion of the biopsychosocial model in the
curriculum of health psychology, the practical acceptance of the
biological mechanisms, underlying and modified by the holistic
interactions, was, and often still is, largely denounced as physi-
ology without integral value for the psychological disposition.
From the initial construct of the biopsychosocial model as a
change in perspective, several workers have subsequently
shown its practical applicability through systematic research.
However, empirical evidence on the neuroimmunological
mechanisms was required to give the proposed interactions
scientific credibility.
Psychoneuroimmunology (PNI) and neuroimmunomodu-
lation provided the necessary evidence. The realization that
neural and immunological structures have receptors in common
and that the immune system can produce neuroendocrine trans-
mitters and neural structures can secrete immunologically com-
petent substances like cytokines, supported the idea of some
kind of interaction between the two systems.13,14 Initially, how-
ever, the identification of immunological cell surface molecules
on neural structures and the neuroendocrine receptors on im-
mune cells were, in some circles, seen as remnants of an evolu-
tionary process, a view articulated in the Darwinian approach to
the psychoimmune interaction.15
The Darwinian view of the psychoimmune relationship states
that the immune system and the neural system, somewhere in
distant phylogeny, used to be one and the same system. This
approach could, in theory, explain the similarities in receptor
expression, adhesion molecules and secretory ability between
immune and brain cells. It was, from this point of view, argued
that the immune-associated receptors on brain cells and the
neural receptors and secretions of immune cells are actually of a
vestigial nature, and therefore of no functional significance. This
concept was refuted, amongst others, by observations that
immune stimulation can alter central nervous system (CNS)
neural activity and turnover of those neurotransmitters com-
monly associated with behavioural functions and that cerebral
lesioning can modulate the immune response.13 Psychoneuro-
immunological studies have since shown that the structures and
secretions shared by the neurological and immunological sys-
tems are indeed of great importance for the regulation of
neuropsychological and immunological function.
PNI is the study of the interactions between behaviour, the
brain, the endocrine system and the immune system. It is
therefore sometimes referred to as psychoneuroendocrino-
immunology (PNEI). However, as the neurological system is
largely in control of the endocrine system, the interactions can
be seen as being among behaviour, the brain, and the immune
333
system. The knowledge of these interactions went a long way to
fostering understanding of the bi-directional influence between
physiological and psychological functioning.
Although the term ‘psychoneuroimmunology’ was already
coined by Solomon et al.16 in 1964, very little progress was made
in the following twenty years. However, many scientists in a
variety of sub-disciplines subsequently contributed to the rapid
conversion of psychoneuroimmunology from a speculative field
to that of a recognized science. Robert Ader*, David L. Felten†
and Nicholas Cohen‡ should be mentioned in particular, not
only for their research but also for publishing three editions of
important books on PNI. A short chronological overview of
some of the important scientific milestones in the development
of psychoneuroimmunology into a recognized discipline can
be found in a paper by Ader,17 that describes events such as the
realization that the immune system can be conditioned, the
appearance of the first edition of the book Psychoneuroimmunol-
ogy in 1981, the effect of brain lesioning on the immune system,
that stress can change susceptibility to infections, the link
between autoimmune diseases and psychological disposition,
the influence of immunologically competent substances on the
brain, the effect of the autonomic nervous system on lymphoid
tissue, the studies that subsequently confirmed that psychologi-
cal stress can influence the immune system of humans, as well as
the central role of the autonomic nervous system and hypo-
thalamo-pituitary-adrenocortical axis in the psychoneuro-
immunological interaction.
Psychoneuroimmunology looks at behaviour as a biological
response modifier and vice versa. The immune system, previ-
ously seen as an independent, closed, self-regulating system,
driven by antigenic stimulation and regulated by cytokines and
other soluble immune cell-derived substances, is now known to
be involved in bi-directional communications with the neuro-
endocrine system. It is becoming more and more clear that the
immune system can in turn act as neuroendocrine modulator.
The immune system has been described by Blalock18 as a sixth
sense organ informing the brain about peripheral events. The in-
fluence of the immune system on the brain is, however, much
more than that of a sensory organ. It has, in addition to its short-
term effects on neuroendocrine function, been shown to induce
long-term anatomical changes with subsequent behavioural
effects. This bi-directional influence between the immune and
neuroendocrine systems starts before birth when normal
neuroendocrine development is necessary for normal immuno-
logical development and vice versa.19–21 It speaks for itself that
interactions between the psychological functions and the two
main physiological regulatory systems, the neuroendocrine and
immune, would influence the total individual — mind as well as
body.
The idea of the psychoneuroimmunological interaction being
a recent concept is wrong. All that is new is the name and the
scientific credibility afforded to the existence of the interactions
— this as a result of the intense research by accredited scientists
of recent times. From an academic point of view, it is obvious that
psychoneuroimmunology evolved from observations that a
connection exists between psychological stressful events and
*Editor-in-chief of Brain, Behavior, and Immunity, editor/co-editor of all three editions of
Psychoneuroimmunology, past president of the American Psychosomatic Society, the
International Society for Developmental Psychobiology and the Academy of Behavioral
Medicine Research, and founding member of the Psychoneuroimmunoloical Society.
†
Past director of the Neurosciences Graduate Program and associate director of the Center
for Psychoneuroimmunological Research at Rochester University, co-editor of Psycho-
neuroimmunology 2nd and 3rd editions, associate editor of Brain, Behavior and Immunol-
ogy, and present director of the Center for Neuroimmunology at the Loma Linda University
School of Medicine.
‡
Professor of Microbiology and Immunology, associate director for Psychoneuroimmuno-
logical Research, past councilor of the Psychoneuroimmunological Research Society and
co-editor of the 2nd and 3rd editions of Psychoneuroimmunology.
334 South African Journal of Science 99, July/August 2003
disease. Psychoneuroimmunology can rightfully be seen as an
outflow of the stress paradigm. Direct empirical evidence in
support of the psychoneuroimmunological interactions are,
however, also derived from a sub-discipline of the biological
sciences, that is, neuroimmunomodulation.
Practical implications
In the psychoneuroimmunological interaction, the neuro-
endocrine system, as would be expected, constitutes the link
between psychological phenomena and the immune system.
This interaction is not merely present in isolated situations and
disorders, but present as pervasive occurrences, influencing and
influenced by all other events — psychological as well physio-
logical. Published examples of conditions and phenomena
where psychoimmunological interactions occur include condi-
tioning, the stress response, infections and tumour develop-
ment, autoimmune diseases, therapeutic interventions, bio-
feedback mechanisms, the placebo effect, behavioural phenom-
ena, brain damage, neurological diseases and virtually all classes
of psychiatric disorders. What is important to realize is that the
psychoneuroimmunological interaction is not merely a stress or
pathology-related phenomenon, but that it also forms part of the
normal homeostatic regulatory processes. The bi-directional in-
teractions between the immune system and neurobehavioural
functions have significant implications for health — physical as
well as psychological, in humans as well as in animals.
Psychoneurological influence on immunity
Many of the effects of psychological stress on the immune
system are mediated via the so-called main stress axes, that is,
the hypothalamo-pituitary-adrenocortical axis (HPA axis) and
the sympatho-adrenomedullary axis (SAM axis). The limbic
system plays an important central role in these neuroimmuno-
modulatory interactions.22 It should, however, be remembered
that the role of these stress axes is primarily that of homeostatic
regulators and that psychologically induced alterations of
neuroendocrine function with subsequent immunological
alterations therefore represent a new adapted homeostasis
intended to cope with the initial threatening stimulus. It is only
in the chronic form or with overwhelming responses that it
becomes a pathological phenomenon.
Although stress is generally seen as immune suppressive, there
are indications that acute stress may in certain circumstances
enhance immune function.23 The raised immunoreactivity of
acute stress forms part of the adaptational homeostasis in
response to an acute stressor and can increase the resistance
against infections and the development of mutation-related
cancer. There are, however, also disadvantages in this acute
increase in immune activity as it can predispose to the develop-
ment of autoimmune disorders and exacerbate inflammatory
conditions such as rheumatoid arthritis.23 This hyperrespon-
siveness may, in addition, lead to intensification of delayed type
hypersensitivity and contact allergies.24 Transient immune
suppression can, however, also occur with relatively mild to
severe acute stressors such as examination stress, or emotional
disabling experiences where it may suppress seroconversion
upon vaccination, delay wound healing and increase the vulner-
ability to infectious complications.23,24 This paradoxical situation,
where acute stress could lead to either immune enhancement or
suppression, probably depends on the basal reactivity of the
immune regulatory neuroendocrine systems such as the HPA
axis and the SAM axis.
The immune suppression associated with chronic stress is
known to increase the vulnerability of predisposed individuals
to the development and progression of cancers and infectious
Review Articles
complications.23 Typical chronic stressors include work stress,
care giving of family and friends with chronic physical or mental
illness, unemployment, hostile environments, imprisonment,
destructive close relationships and almost any factor that is
perceived as threatening or uncontrollable. It is important to
note that acute stressors can be the cause of chronic stress if they
are followed by recurrent negative thoughts and feelings of a
loss of control. Negative emotions such as anxiety, depression,
hostility and anger have been described as among the main risk
factors that contribute to deterioration of physical well-being,
including the development of osteoporosis, arthritis, type 2
diabetes, cardiovascular disease, periodontal disease, several
neurocognitive disorders, cancer, certain lymphoproliferative
disorders and delayed wound healing, as well as premature
ageing and other debilitating conditions.2,23 Although some of
these effects are mediated through stress-induced alterations of
neuroendocrine systems like the HPA axis and the sympathetic
nervous system, negative emotions are also known to stimulate
the production of pro-inflammatory cytokines, a phenomenon
known to play a role in many chronic inflammatory and other
conditions.2,25 Of interest is that the influence of the neuro-
endocrine system on the immune system varies, depending not
only on the duration and strength of the stressor, but also on
cognitive and emotional characteristics of the individual such as
coping style and abilities, the perception about the stressor, the
ability to relax after a stressful experience and almost any factor
that can influence the rate at which the stress-induced changes
in neurohormonal activity will return to baseline values.2 It is,
for instance, known that the so-called ‘high stress responders’
show more significant immunological changes than low stress
responders. A practical example can be found in socially inhib-
ited individuals, who are said to be physiologically hyper-
responsive, where augmentation of the DTH skin response may
occur upon intense social interaction.24,26
As it is well established that the immune system, and by impli-
cation health, is influenced by stressful life experiences, one
would intuitively expect positive experiences to have a benefi-
cial effect on the immune system, as well as the possibility that
psychological intervention could be of value. In general very
few investigators concern themselves with the testing of positive
experiences and health is commonly considered to be merely the
absence of disease or emotional distress.27 There are, however,
indications that laughter, optimism, positive coping styles and
other factors that contribute to positive emotions could have
beneficial effects on neuroimmunological activity.2,28 Various
degrees of success in the manipulation of the immune system
have also been reported with psychological interventions
such as hypnosis, self-hypnosis, relaxation therapy, condition-
ing procedures, self-disclosure, group psychotherapy, support-
ive group therapy, guided imagery, and biofeedback tech-
niques24,29–31 and it is known that in certain cases a sustained
period of months of intervention is needed to obtain the
required effects.
Further supporting evidence for the influence of the brain on
the immune system comes from observations in patients with
cerebral damage. Brain injury, including surgery, ischaemic
damage, stroke, cerebral tumours and chronic neurodegenerative
diseases can influence not only cerebral immune responses, but
also systemic immune function. The injury-induced cerebral
immune stimulation may contribute to further brain damage,
but it can also play an important role in processes such as the
development of post-injury plasticity.32–34 Cerebral injury often
suppresses important systemic immune responses and may
render the individual more vulnerable to infections and the
development of sepsis.34
Review Articles South African Journal of Science 99, July/August 2003
Influence of the immune system on neurological function
and on behaviour
It is by now scientifically well accepted that mood and cogni-
tion can change the immune system. The reverse is, however,
also true. The immune system’s main messengers that influence
the brain are the immune-cell-derived cytokines.
The role of the immune system in psychopathology has been a
subject of intense research for the last few years and examples of
immune involvement can be found in all classes of the DSM-IV
(4th edition of Diagnostic and Statistical Manual of Mental Disor-
ders). Major depression is probably the best-investigated distur-
bance associated with immune alterations. The immunological
changes that can exist in major depression were well reviewed
by Maes.35 Direct evidence for the presence of an inflamma-
tory response in mood disorders comprises findings such as
increases in circulating monocytes and neutrophils, raised
neopterin and prostaglandin levels, activation of the acute
phase response, and increases in pro-inflammatory cytokines
such as IL-1$, IL-6 and IFN(.35 Pro-inflammatory cytokines
would, not only in depression but in general, appear to be the
main neuromodulatory factors through which the immune
system can influence neurobehavioural function, and pro-
inflammatory cytokines such as IL-1, IL-2, IL-6 and TNF" have
repeatedly been shown to alter the functioning of the dopa-
minergic, serotonergic, cholinergic, noradrenergic, cortico-
tropin-releasing factor and other CNS systems.36
Strong support for the influence of cytokines on the brain is
also derived from human cytokine therapy and experimental
work that demonstrates the ability of cytokines to cause
neurobehavioural disturbances ranging from mild constitu-
tional symptoms (fatigue, chills, headaches, fever, etc.) to serious
behavioural problems such as major depressive moods, anxiety,
hallucinations, disorientation, delirium and psychosis.25 Of great
practical importance is the fact that pro-inflammatory cytokines
produced anywhere in the body as a result of inflammation,
infection or simply any form of tissue injury, can influence the
central nervous system and behaviour. This can initiate the
condition known as ‘sickness behaviour’.
Sickness behaviour can be defined as a combination of coordi-
nated behavioural and physiological changes that develop in
response to infection, inflammatory conditions or any physical
trauma that initiates the inflammatory response. The symptoms
of sickness behaviour can include any combination of the
following: fever, fatigue, hyperalgesia, somnolence, anhedonia,
loss of appetite, loss of interest in social and sexual interaction,
decreased concentration and other cognitive abilities, decreased
locomotor and body-care activities, as well as feelings of depres-
sion, hopelessness, irritability, anxiety, worthlessness, guilt and
the reorganization of perceptions and coping strategies.25,37
Understanding that sickness behaviour, in contrast to illness
behaviour, is primarily physiologically induced and that the
mood disturbances seen with chronic inflammatory and long-
term infectious complications, or even just the common cold,
may partially result from the production of pro-inflammatory
cytokines, rather than being merely reactive in nature, should
change our attitude to behavioural disturbances such as depres-
sive moods in the physically ill patient. Of interest is that there
are indications that antidepressants could be of benefit by
suppressing the production of pro-inflammatory cytokines and
by acting as analgesics.25,38
An important aspect of the psychoneuroimmunological
interaction is that both the neurological and the immune system
can be primed by early life experiences to a high stress vulnera-
bility, as well as to suppression of the regulatory negative feed-
back mechanisms — traits which could, depending on the
335
nature of the neurological, immunological and feedback
alterations, predispose, in later life, to either physical disease,
psychological disorders or to both.25,39 There are even indications
that alterations of basal neuroimmunological function due to
adverse early life experiences, with subsequent non-termination
of the sickness-induced production of pro-inflammatory
cytokines, could trigger the development of mental disorders.25
Impact of psychoneuroimmunology
The impact of the knowledge that neither the immune system,
nor any part of the nervous system, is autonomic and that the
neuroendocrine system has a regulatory influence on the
immune system, and vice versa, is far-reaching. It is now well
established that immune changes are not, as previously thought,
specific correlates of individual mental disturbances.25,40 It is
realized that there are flaws in our concept of the brain as
a so-called ‘immune privileged organ’, that peripherally
produced cytokines can influence the brain,41,42 that the brain can
produce its own cytokines,41,42 that an interplay exists between
central nervous system and peripheral immune responses43 and
that cerebral function is influenced at many levels by the
immune system, including normal memory processes and the
plasticity that develops after cerebral injury.32,33,41,42
Scientific insight into the mechanisms that underlie the
adverse effects of negative thoughts on health gives credence to
what has long been intuitively suspected and a paradigm shift is
occurring in the biological sciences where the magnitude of the
influence of environment, lifestyle, perceptions, coping style,
positive as well as negative relationships and a host of other
psychological vulnerability and resilience factors on physical
health is being recognized.2,29,43 At the same time, the physiologi-
cal processes through which cognition and emotion can be
influenced by peripheral infections, inflammation, trauma and
almost any kind of tissue injury are becoming clear, and it is
realized that these behavioural symptoms cannot be seen as
reactive only in response to disability and pain.25 Consideration
should be given to the possibility that such symptoms can reflect
a combination of the psychological response to disability and
pain, and the effect of cytokines on the brain.
Discussion
Psychoneuroimmunology is a developing interdisciplinary
field that deals with the interactions between behaviour, the
interconnected neurological functions, and the related immuno-
logical processes.43 Unlike previous approaches to the mind–
body paradox, it introduces the immune system into the equa-
tion. Although initial papers on PNI were speculative, we have
now moved beyond the point of folklore, speculation and
intuitive knowledge to where the convergence of many sub-dis-
ciplines from the biological sciences and humanities led to the
emergence of its present status, that is, an interdisciplinary field
where body and mind are seen as one functional unit.43
Psychoneuroimmunology developed and scientifically supports
the concept of the immune system as major sense-cum-control
organ — on a par and interacting with the neuroendocrine
system.14,18,42 Psychoneuroimmunology, considered by some to
be a post-modernistic approach to the mind–body problem and
by the uninitiated as some form of a quasi-medical concept,
should surely be seen as a major contributor to a more integra-
tive understanding of the way psychological and physical
aspects operate in unison. In a sense psychoneuroimmuno-
logical research provided the scientific credibility for certain
assumptions made by the biopsychosocial model, by earlier
approaches of mind–body unity, and in general by intuitive
knowledge among the general public on the way our thoughts
336 South African Journal of Science 99, July/August 2003
and emotions can influence our health and vice versa.
Why then, the procrastination in the practical implementation
of treating mind and body as one, despite the intuitive knowl-
edge of the holistic concept and despite solid empirical evidence
for the mutual influence? Several major barriers are probably
involved. In the first place, it requires a rather drastic mind-shift
for professionals from the humanities and the biomedical
sciences and, although many are convinced that they are indeed
treating patients from a holistic point of view, most are still
operating within the mind set indoctrinated by their primary
training. A willingness of patients to be treated in this way,
naturally contributes to the perpetuation of this one-domain
approach. Although a mind-shift appears to be developing
among large parts of the general population, it is speculative
whether popularization by the press and non-scientific writers
of the mind’s power to heal the body, and vice versa, may not
perhaps be doing the holistic concept more damage than good.
Another impediment to a more holistic approach is the wide-
spread tendency to see everything in terms of a linear cause-
and-effect model — a mode of thinking that requires far less
energy, effort and knowledge and which minimizes information
overload and self-doubt in the practitioner or scientist. Still
another deterrent, probably the one major barrier to implemen-
tation of the holistic approach, lies in the lack of appropriate
knowledge and insight. This paucity of a proper understanding
of the mechanisms underlying the multiple interactions can
probably be ascribed to career-directed training and to the mass
of new information that every professional has to master within
his or her own field of specialization alone.
There can be no doubt that PNI brings us one step closer to the
understanding of the total interconnection of body and mind. It
is, however, essential to stress that the psychoneuroimmunological
approach does not in any way detract from the value of existing
biological or psychological approaches to health or its distur-
bances. Rather, the validity of opposing theories is in certain
cases strengthened by the link psychoneuroimmunology
provides between more reductionist biological and environ-
mental approaches. The pervasiveness of the psychoneuro-
immunological interaction does indeed necessitate a paradigm
shift in our approach to illness, be it primarily physical or mental
in presentation. It would at this stage, nevertheless, be a disser-
vice to the field and to the health profession to try and explain
every disease or disorder primarily in terms of the psycho-
neuroimmunological interaction.
Received 25 May. Accepted 14 August 2003.
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