September 04, 2008

Transcript for Esther Sternberg — Stress and the Balance Within

September 4, 2008

Krista Tippett, Host: I'm Krista Tippett. Today, "Stress and the Balance Within." My guest, Dr. Esther Sternberg, works at the molecular level of the mind-body connection. She describes how the language of genes, neurotransmitters, and hormones is helping science to use knowledge that human beings have always possessed intuitively.

Dr. Esther Sternberg: The notion that stress can make you sick, that believing can make you well, all of these things the ancient Greeks knew — that the ancient Asians, the Chinese, Japanese tradition — this is known for thousands of years. And if we've known this for so long, how did we forget, why did we forget, and have we found our way back?

Ms. Tippett: This is Speaking of Faith. Stay with us.

[Announcements]

Ms. Tippett: I'm Krista Tippett. The American experience of stress has launched a multibillion-dollar self-help industry. My guest today, Dr. Esther Sternberg, is wary of that, but she says until very recently, that modern science did not have the tools or the inclination to take emotional stress seriously. This hour, she shares what science is learning at the molecular level of the mind-body connection. Why does stress make us sick while rest and music, belief, and friendship help us to heal?

From American Public Media, this is Speaking of Faith, public radio's conversation about religion, meaning, ethics, and ideas. Today, "Stress and the Balance Within."

Ms. Tippett: Esther Sternberg grew up in Canada where her father was a professor of medicine. As a child, she knew the Canadian researcher Hans Selye, who coined the medical term "stress" in the 1950s and inserted it into the vocabulary of world languages.

Today, Esther Sternberg is a leader in the field of neural-immune research, and she is internationally recognized for her discoveries about how the central nervous system and the immune system interact.

She's broken new ground in describing how the brain's hormonal stress response might contribute to diseases such as rheumatoid arthritis and depression. I sat down with her in 2005 to understand these insights she offers.

In her 2001 book, The Balance Within, Esther Sternberg explored the history of medicine to understand why, until very recently, modern science failed to treat human emotions, such as stress, seriously. She believes that this drove patients towards a mixed bag of self-help alternatives and away from some of the sophisticated insights that science can provide. Though, as Esther Sternberg approached the study that became her book, she learned how deeply she held a scientific bias.

Dr. Sternberg: The interesting thing is when I wrote the book, I tried to separate my own personal life experiences, my own illness and the stresses I was going through from the writing of the book. And it's because I was coming at it from a very scientific point of view. I was asked to write an article for the Scientific American on the science of the mind-body connection.

Ms. Tippett: And that would have been a scholarly essay …

Dr. Sternberg: That was a …

Ms. Tippett: … for other scholars.

Dr. Sternberg: … very scholarly essay. And the issue is that this field has been around for thousands of years. Right? The notion that stress can make you sick, that believing can make you well, that loving could make you well. All of these things are things that your grandmother told you, that you know in your heart of hearts. Right? That the ancient Greeks knew, that the ancient Asians, the Chinese, Japanese tradition. Go into any culture — Indian tradition — this is known for thousands of years. In every era, scientists and physicians have tried to explain these connections using their best available tools. So the question of how emotions and disease are linked were assumed in the time of Hippocrates' ancient Greece, 500 B.C., in the time of Galen, the Romans, and all through the centuries. And if we've known this for so long ...

Ms. Tippett: Right.

Dr. Sternberg: ... where did we go wrong and when did we go wrong?

Ms. Tippett: How did we forget if we once knew that?

Dr. Sternberg: Exactly. How did we forget, why did we forget, and have we found our way back to what are sort of obvious principles of health, that emotions do have something to do with disease, that disease does have something to do with emotional health, and that health lies in the balance?

Ms. Tippett: Here's how Esther Sternberg's book The Balance Within begins.

Reader: Nestled at the top of a brown, stony hill above the modern Cretan village of Lentas, at the intermingling of cool, sage mountain air and warm, salt sea breezes, are the ruins of an ancient temple to Asclepius, the Greek god of healing. It is a few meters above what was once the source of a natural spring. Ancient priests used these waters and prayer, music, sleep, and dreams to cure the sick. And the village people, who still live as one with the rhythms of the sea and sun, know, as their ancestors knew, that emotions and health are one.

As the wind and sun eroded that first ancient shrine and dried its healing source, something also happened to the world beyond the village. Our faith in the healing power of the spirit also waned; and the god of science and medicine became a much harder, more impersonal god than the fatherly Asclepius. When did we modern scientists and physicians lose the knowledge that was so much a part of these ancient teachings of medicine? And why has the road back to acceptance of this wholeness taken so many centuries to travel?

Dr. Sternberg: Those temples were built at tops of hills overlooking the Aegean or the Mediterranean with beautiful views, always near a freshwater source. The ramps to these temples to Asclepius were built in a long, low slope so that people who could not walk would be able to be helped up these slopes easily. But more important than anything else, there were social interactions, rich social interactions. So these places were places of healing, and they're like modern-day spas in a way.

Ms. Tippett: Mm-hmm.

Dr. Sternberg: I guess I should start then, go back to the Scientific American article on how I got to the temples to Asclepius. I was editing it by my mother's bedside when she was dying of breast cancer. And so I would be sitting there with my laptop on the armchair in the room, and every time she'd wake up, she'd look at me and ask me what I was writing about and engage me in these very animated discussions. She was a very feisty lady, and she would not let go of the topic. She asked me why am I just focusing on stress and disease. 'Why aren't you putting something in there about belief and healing?'

Ms. Tippett: What did she mean when she used the word belief?

Dr. Sternberg: Well, so it's very interesting, because, when I was young, she didn't really practice Orthodox Judaism in any way. My grandmother was very Orthodox. But after my grandfather died and then after my grandmother died, and certainly after my father died, my mother became more and more observant, going back to the way she'd been raised and lighting the candles every Friday night on the Sabbath and, I think, praying in her own way, although it wasn't really overt and open. And then the other funny thing about this is it happened that her nurse in the hospital was a Hasidic Orthodox-practicing Jewish lady, and the two of them would gang up on me while I was writing this article. And the Hasidic nurse, of course, knew all the scriptures and came out with all sorts of arguments why I should be including belief and healing in it, and my mother was on the emotional side. And I would take the scientific side that this is not proven, that this is not something I can put in this article. And I was very, you know, stern about it. And so I published the article my own way, which was talking about stress and illness. Now, really, in large part, it's because when I was writing it, which was 1996, this field was still not accepted. We're not even talking about belief and healing; we're talking about stress and illness.

Ms. Tippett: What's fascinating is that in such a short time, the field has just opened up and exploded.

Dr. Sternberg: Well, and I think it's because the research, the scientific research, has opened up and exploded. And that's really what happened. I mean, coming back to that very first question and asking have we found our way back? We have, but we found our way back through the language of science.

Ms. Tippett: Right, which also is fascinating, that it's science that forgot or that couldn't incorporate emotions. Right? And belief …

Dr. Sternberg: That's right.

Ms. Tippett: … into what was measurable and real?

Dr. Sternberg: Yes, exactly.

Ms. Tippett: And it's also science that has now established that connection.

Dr. Sternberg: Right. Well, so one of the conclusions that I came to in the book, and actually, in part, also by working on an exhibition at the National Library of Medicine, I learned a lot from that about where this break came, what happened exactly. Scientists need evidence. We need measurable proof. That started in, you know, with Descartes in the 1600s. And at that time, 400 or 500 years ago, science didn't have the tools to measure something as ephemeral and not concrete as abstract as an emotion.

You know, you can measure disease. Disease is an abnormality of anatomy. So with the anatomists of the 16th century, when they started to dissect the human body, they discovered that when there was a pneumonia, there was a hole in the lung. You know, there was a problem in the liver, there was an anatomical problem in the liver. So the assumption became that disease is associated with an abnormality of anatomy, which allowed huge advances in medicine. You know, Laennec, in the 19th century, when he developed the stethoscope, developed it so that you could hear problems in the lung. Right? Without seeing them, you could actually hear them. And so that's concrete; that's easy to understand.

But we didn't have the tools until now, until very recently, to see the living human brain at work with neuroimaging. We didn't have the tools to see into how the nerve cells function, the biochemistry, the chemicals that change, the nerve chemicals that are released, the electrical activity that changes. We couldn't see into the genes that make these cells function until very, very recently.

Ms. Tippett: Dr. Esther Sternberg.

Ms. Tippett: Dr. Esther Sternberg.

I'm Krista Tippett, and this is Speaking of Faith from American Public Media. Today, we're exploring the relationship between emotional stress and physical health. Read the original article Esther Sternberg published on this subject in Scientific American at speakingoffaith.org. We're also featuring more of her writing, including excerpts from her book The Balance Within: The Science Connecting Health and Emotions. Here's another passage from that book.

Reader: Illness can be teased apart into its discreet components: fever, fatigue, sleepiness, weakness, sadness, loss of interest in the environment, loss of appetite for food and sex, and an overwhelming desire to be still. Each of these feelings can be explained by the effects on the brain of various molecules released from immune cells during an infection. But we usually describe all these components with one parsimonious phrase: 'feeling sick.' These two words compactly convey the notion that our awareness of being ill has a sensory component, such as pain, and an emotional component, such as feeling sad.

… The central principle of medical teaching that for 1,000 years linked emotions and disease was the balance of the four humors: blood, yellow bile, black bile, and phlegm. These visible secretions were physicians' only window into the workings of the body. Imbalances in them were equated not only with disease, but also with emotions. Vestiges of the concepts are buried in the words we still use to describe emotional types: sanguine, melancholy, phlegmatic, choleric.

Ms. Tippett: Modern scientists know genes, hormones, and neurotransmitters to be as real and measurable as blood and bile. They know that what we call feelings, both physical and emotional, are caused by myriad biochemical connections. The brain as we can see and explore it now, Esther Sternberg says, is not so much one organ as a number of interconnected organs. For example, the human instinct to be alert and vigilant in an unknown environment is controlled by two very different parts of the brain: the hippocampus that controls memory, and the amygdala that controls anxiety and is also known as the fear center. Both of these have connections to the brain's stress center. As Esther Sternberg relates, the complex feeling we know commonly as stress was first named in the mid-20th century.

Dr. Sternberg: Well, in the 1950s, '40s and '50s, physiology was really reaching its peak, and the technologies were available to measure electrical inputs or outputs and physiological responses of the blood vessels and the heart and also hormones. People were — scientists were beginning to discover hormones. So Hans Selye was a physiologist who really borrowed the word "stress" from the physicists and used it in the biological sense that we know today.

Ms. Tippett: Oh. OK.

Dr. Sternberg: OK? And he was a very colorful character, and I …

Ms. Tippett: Now, didn't you know him?

Dr. Sternberg: Yes. My father and he were professors at the University of Montreal in the Department of Medicine. And I put my memories together with also talking to his students and colleagues and asked about his, you know, his theories of stress, which were very revolutionary at the time. And his concept was that stress is the body's nonspecific response to any demand. And he had it mapped out that there was the hypothalamus, the pituitary, the adrenal glands, and even he put in the immune system at that time. So he proposed that there were hormones that came out of the hypothalamus, the pituitary gland, and the adrenal glands that would have an effect on how the immune system worked.

Now, you know, people have asked me, so what's different about that? What have we learned in 50 years that Hans Selye didn't say before? Well, we've learned a number of things. First of all, in those days, people who thought about this system stopped at the hypothalamus, which is a very deep structure. It's a structure that's present in all animals. It's a very ancient structure. It's a reflex response, just like your knee jerk. It's kind of a — you don't have to think when you're stressed, Right?

Ms. Tippett: OK.

Dr. Sternberg: I mean, this is a good thing because if you're driving down the street and a car comes out of nowhere, you don't have time to write a thesis to say, 'Am I going to put my foot on the brake or not.' Right?

Ms. Tippett: Right.

Dr. Sternberg: You have to do this in a millisecond.

Ms. Tippett: So that's a positive function of stress.

Dr. Sternberg: Right. Now, there's something very important that happens between the bad thing that happens to you, the stressful event, and your physiological response that you recognize as stress. And the thing that happens is perception, your perception of that event as stressful. Now, going back to Hans Selye, because that's what we were talking about, the physiologists of the 1950s didn't have the tools to really understand how the rest of the brain was working, and so they focused on those deeper parts of the brain, those structures like the hypothalamus and the adrenalin-like nerves, and how they affected the rest of the body. We have advanced to the point where we can really understand much, much better how those inputs, those signals from the outside world, get interpreted by the brain, by all these different parts of the brain, and get the overlay of memory on it, so that your memory of certain events can color whether you perceive an event as stressful or threatening or happy or not.

Ms. Tippett: And that gets into the life you've lived, the habits you have. Right?

Dr. Sternberg: Everything, yeah.

Ms. Tippett: How healthy you are mentally.

Dr. Sternberg: Right. And that's the part we can hope to change. I want to just say one other thing about Hans Selye, because it's interesting that he coined the word, as I said, "stress." And he went around the world getting that word into the dictionary of virtually every country. So that when I was in Japan last year, I asked this audience of mostly Japanese speakers, 'How do you say stress in Japanese?' And they said. 'Stress.' So I said, 'Well, I guess I speak Japanese.' But it's in every dictionary. And he was very aggressive in doing this. And the sad thing about it was, he also talked to the lay public a lot, and the lay public, of course, loved this. And as a result, his colleagues really disparaged him, because in those days and up until very recently, scientists talking to the lay public was considered …

Ms. Tippett: And this is sort of mid century, 1950s?

Dr. Sternberg: Yes, mid century. Right, 1940s, 1950s.

Ms. Tippett: I mean, I spent a lot of the '80s in Germany, and I remember, as I read your book, I remember der stress.

Dr. Sternberg: Yes, yes, der stress.

Ms. Tippett: And that's very stressy.

Dr. Sternberg: True.

Ms. Tippett: But I guess also what's fascinating to me about that is that human beings experienced what we now call stress forever.

Dr. Sternberg: Oh, yes.

Ms. Tippett: I mean, we know this biochemically, but we also just know that in the nature of being human, but we didn't have a word for it in any language?

Dr. Sternberg: Well, it was called different things. So in the 19th century, it was called nervousness. OK? And, actually, there was a quote that George M. Beard in the 1880s said that the principal cause of nervousness in modern civilization, there are five causes: "the periodical press, the telegraph, the steam railroads, the sciences, and the mental activity of women." So people have perceived things as stressful for a very long time and actually, this is a really — it's not being facetious, but what he was describing was the stress of the Industrial Revolution. And you could transpose all of those pieces to today.

Ms. Tippett: Right. Fill in the blanks.

Dr. Sternberg: Right. The media — sorry about that — the Internet, a constant connection with cell phones. And I think what he was talking about, and the sciences, because there's all this unknown, there's fear of advance …

Ms. Tippett: And all of these sort of ethical dilemmas being presented by cutting-edge science that people are facing in a doctor's office.

Dr. Sternberg: Right same thing, exactly. And the mental activity of women, I think what he was talking about is the social change that comes along with technological change, especially rapid technological change. And so it's, really, we're living in an information age. Now, but why is it these things are stressful? Because change, novelty, is one of the most potent triggers of the stress response. And that's a good thing because when an animal finds itself in a new environment — so if a field mouse wanders into a new field, if it didn't have a stress response, if it wouldn't suddenly sit up and look around and become vigilant and focused and ready to fight or flee, if it just went to sleep, it would get eaten by the next cat that came along. Right?

So you need your stress response to survive. And novelty must, therefore, trigger the stress response. So the problem happens when the stress response goes on too long, when it's active when it shouldn't be active, when you're pumping out these hormones and nerve chemicals at max. And that's when you get sick, and that's when these chemicals and hormones have an effect on the immune system and change its ability to fight disease.

Ms. Tippett: Dr. Esther Sternberg.

Some of her most important work has been in determining when stress moves from good to bad as far as the immune system is concerned. If a stressful stimulus or environment is sustained over time, stress hormones and chemicals such as cortisol flood the body. Stress changes us as our minds and bodies, the nervous system, and the immune system communicate and interact. This interaction is too complex, Esther Sternberg believes, to be adequately addressed by the culture of self-help that Americans have embraced. At the same time, she says, new science is driving the medical profession to take popular convictions about the mind-body connection far more seriously.

Ms. Tippett: It's not just that — and I think this is maybe the way a lot of us have internalized it — stress makes you sick.

Dr. Sternberg: Right. It's not the stress that makes you sick. It's that the stress response, those hormones and nerve chemicals, go to the immune system through the blood stream, through the nerve endings, that then hit immune cells that are nearby and change how immune cells work.

Ms. Tippett: So that same response that calms you down or that is a byproduct of this whole cascade of stress response is also dampens your immune system?

Dr. Sternberg: Well, no it doesn't calm you down, because you're pumping out all these hormones.

Ms. Tippett: Yeah.

Dr. Sternberg: That activates you.

Ms. Tippett: Right.

Dr. Sternberg: That's giving you the stress response. That's making you fight or flee, it's giving you the energy. But if you're — but that cortisol, that hormone from the adrenal glands, is the most potent anti-inflammatory drug that our body makes. Now why do I say drug? Because Cortisone, the pharmacological form of cortisol, which is what your adrenals make — the Nobel Prize was given in 1950 for the discovery that that could be used as a drug, that Cortisone could be used as an anti-inflammatory drug for arthritis. It didn't occur to scientists and physicians at that time that that wasn't just a drug; that was the body's own way of tuning down the immune response so it didn't go out of control.

Ms. Tippett: OK. So something like arthritis is, in fact, an overactive immune system?

Dr. Sternberg: Correct. Arthritis, Crohn's disease, inflammatory bowel disease, lupus — these are all overactive immune responses. You need your immune cells to be active, to create inflammation to fight bacteria, to chew up the bugs, take them away, get rid of them. But then the immune system has to turn off. It has to have an exit strategy; it has to go back to sleep. So there has to be an on/off switch. And there are on/off switches within the immune system, but it turns out that the nervous system plays a very important role in this on/off switch. And there are actually certain nerve chemicals that turn immune cells on, and there are certain ones that turn immune cells off. And cortisol happens to be one that turns immune cells off very powerfully.

The discovery that I made is that there can be an actual problem in that circuit that predisposes to developing arthritis. It doesn't mean that stress is causing arthritis. It's that the on/off switch is not working right. It's either stuck in the on position or stuck in the off position. In the case of arthritis, it's stuck in the off position because you can't pump out enough of those hormones to shut off inflammation when you need to shut it off.

Ms. Tippett: OK.

Dr. Sternberg: Now, the other side of the coin is when you're chronically stressed — and this is work by the Glasers at Ohio State, Jan Kiecolt-Glaser and Ron Glaser. They've shown that in chronic caregivers of Alzheimer's patients or in people undergoing marital stress, where you're chronically stressed and you're chronically pumping out these stress hormones that are anti-inflammatory, your immune cells are going to be bathed in this anti-inflammatory milieu and will be therefore less able to fight infection.

Ms. Tippett: OK.

Dr. Sternberg: OK? So then if you're exposed to a flu bug, a virus or a, you know, bacteria, you're less able to fight that and you're more likely to get sick from infections, you're less able to make antibodies when you get vaccines, and it takes twice as long for wounds to heal. So there's no question that when these connections are out of balance, that's when you get sick.

Ms. Tippett: So does all of this knowledge then kind of reduce us to a mass of chemicals or does it give us more control?

Dr. Sternberg: Well, that's a very good question. Well, I think it, for me, it gives me more control. And I actually think, I think when I, you know, go around speaking to general audiences, I've asked people that. You know, we don't have all the answers now, certainly, to various diseases, but at least we know this is real. Is that good enough? And I think people are relieved to know that all these feelings that they've had are real, you know, that we can explain it with nerve chemicals and nerve pathways and hormones and so on. It's not all in your head. You're not crazy if you say that 'stress made me sick.'

Now, that doesn't mean you shouldn't, you know, follow the latest advances in medicine. Of course you should. But understanding these principles, I think, allows you to give yourself the permission. For instance, if you're a caregiver of an Alzheimer's patient, if you understand that by pushing yourself to the max, you're going to really have physiological burnout, not just psychological burnout, that you yourself will get sick, I think it should be easier to then not feel so guilty about …

Ms. Tippett: Giving yourself a break.

Dr. Sternberg: … giving yourself a break, getting help, getting social support, taking a vacation.

Ms. Tippett: Or not saying, 'I shouldn't be feeling this way.'

Dr. Sternberg: Right. These things are real. And also to know that it's your biology. If you can't overcome stress — I mean, this is another problem with the self-help movement is that I think people feel if they can't fix it on their own, then they've failed and they feel bad about themselves. And to know that there's a biology to it and if you come to the point where you really are in such distress, you really do need to seek professional help from somebody who knows how to treat all aspects of stress-related illness.

Ms. Tippett: You say something interesting that someone like you, that all of us, really, with the new vocabulary of science, that we can talk about emotions and disease, each of these things as real, and still, that we need different languages or that we possess different languages for talking about them, for describing them.

Dr. Sternberg: Well, I mean, the language of science, when I say the language of science, I mean that scientists need evidence. We need hard evidence, data. We have to be able to measure something to know that it's real. So you know, going back to the anatomists, their view of it is if you couldn't see it, it wasn't real. Actually, until very recently, if you couldn't see it, it wasn't real. But we have different ways of, quote, "seeing" things.

Ms. Tippett: I interviewed Dr. Esther Sternberg at a 2005 week on the brain, at The Chautauqua Institution. I also interviewed Dr. Sherwin Nuland there. In our program "The Biology of the Spirit," Dr. Nuland speaks about one of his favorite subjects — the wisdom of the body — and his emerging new sense of the human soul from what science is learning about the brain. We offer several ways of listening to both of these programs at your convenience through our Web site, podcast, and e-mail newsletter. That's where I write about my personal response to my interviews. Look for links on our homepage, speakingoffaith.org.

As Esther Sternberg delved into her research, she herself became chronically stressed and developed a form of the illness she studies, arthritis. After a short break, we'll hear her medical and personal reflections on turning the science of stress towards healing.

I'm Krista Tippett. Stay with us. Speaking of Faith comes to you from American Public Media.

[Announcements]

Ms. Tippett: Welcome back to Speaking of Faith, public radio's conversation about religion, meaning, ethics, and ideas. I'm Krista Tippett. Today, "Stress and the Balance Within."

We're exploring how science is coming to a new understanding of the interaction between the brain and the body during emotional stress and how we all might use this knowledge. My guest, Dr. Esther Sternberg, is a leading biomedical researcher in the field of neural-immune connections. Here's a passage from her book The Balance Within: The Science Connecting Health and Emotions.

Reader: Emotions are always with us, but constantly shifting. They change the way we see the world and the way we see ourselves. Diseases come and go but on a different time scale. And if they change the way we see the world, they do it through emotions. Could something as vague and fleeting as an emotion actually affect something as tangible as a disease? Can depression cause arthritis? Can laughing and a positive attitude ameliorate, even help to cure disease? We all suspect that the answers to these questions are yes, yet we can't say why and certainly not how. Indeed, entire self-cure industries have been built on this underlying assumption. But physicians and scientists, until recently, dismissed such ideas as nonsense because there did not appear to be a plausible biological mechanism to explain the link.

"… Part of the reason for this is that scientists and lay people speak different languages — but so do emotions and disease. Poetry and song are the language of emotions; scientific precision, logic, and deductive reasoning are the language of disease.

Ms. Tippett: Esther Sternberg has been describing how science is now learning to treat emotional stress seriously because it's acquired the language of molecules and nerve pathways, electrical impulses and hormonal responses. Such insights grew from a scholarly article she wrote while her mother was dying of cancer. Esther Sternberg's mother pressed her at that time to take her knowledge a step further. If we know that stress can make us sick, she asked her daughter, can we understand why loving and believing can help us live well? But Esther Sternberg resisted those questions on a personal level until stress took a physical toll on her.

Dr. Sternberg: So maybe I should go back to my own experience in this. I was very focused on these very endocrinological, molecular neuroscience studies and analyzing all the different nerve pathways that are involved in the stress response and so on, and the differences in these arthritis-prone rats and arthritis-resistant rats. But the converse of that, the corollary of that, is that if you understand how breaking the connections can make you ill, then perhaps you can figure out how you can fix those connections. Right? Well, if you're pumping out too much of those stress hormones, so if you're chronically stressed and your immune system is tuned down, what are the things that you can do intuitively to reduce that, to get that back to balance? And these are the things that are being worked on now and are certainly being worked on increasingly. But you can begin to think about taking yourself off line so you're not chronically stressed.

Ms. Tippett: What do you mean by that analogy?

Dr. Sternberg: The analogy that I often give when I'm speaking is when your computer is jammed up, when your e-mail is jammed up with spam, what do you do? You shut down and reboot. Right? We know this about computers. We don't seem to know it about our bodies and ourselves. So shutting down and rebooting is a really important thing to do. So if you're working 24/7 on a deadline and you're exhausted, if you're a chronic caregiver of an Alzheimer's patient, taking yourself away from that situation as much as you can. I mean, you may not be able to, but there are things you can do to remove yourself. A vacation is one. So in my own case, when I was writing that article by my mother's bedside, and in the last throes of her illness flying up to Montreal all the time and under a huge amount of stress, and then after she died, you know, going through the grieving process, around that period, I became sick myself. I developed an inflammatory arthritis. And, you know, of course there were the genes in the family, you know, these diseases don't just come from stress. There has to be some predisposition. But the question is, why did I develop it at that moment in time? Why didn't I develop it five years before or five years later? And I believe there's no question and there's evidence to support the notion that being chronically stressed can be associated with triggering these sorts of diseases from burnout.

Ms. Tippett: Did it help you, as that happened to you, because you knew something of the biochemistry?

Dr. Sternberg: I guess what happens when you understand the anatomy and physiology of the system is that you can stand back and become an observer of your own situation. So you can, to a certain extent, treat yourself as the patient and dissociate yourself from yourself. But then there's the patient's side of you that really doesn't feel great.

Ms. Tippett: It doesn't go away.

Dr. Sternberg: It doesn't go away. And you may not do the right things. So, knowing all this stuff, I didn't stop. You know, I just burnt myself out, effectively.

Ms. Tippett: Biomedical researcher Esther Sternberg. In the midst of exhaustion and illness, compounded by a move, she received a surprise invitation from new neighbors to stay with them on the Greek island of Crete. Esther Sternberg found herself at the site of the ancient temple of the Greek god of healing, Asclepius. He and his daughters, Hygieia and Panacea, symbolize the timeworn human insight that health lies in balance. This experience changed and framed the conclusions Esther Sternberg ultimately drew, both medically and personally.

Dr. Sternberg: The more I thought about it, the more I thought that there are a lot of indirect pieces of evidence that one can piece together to construct a logical argument that believing — we're not talking about what you're believing in or who you're believing in — but the act of feeling spiritual, maybe that's what I really mean, that that feeling of wonder and awe that one gets when one is in a spiritual place, that, you know, thrill of seeing a sunset — when my sister and I were small, we lived at the base of Mount Royal, which is a hill in Montreal, and whenever it looked like there was a beautiful sunset, we would drop everything — we were washing the dishes, we were having dinner, whatever — we'd pile into the car, drive up to the University of Montreal, which was on the top of one of the hills, and look at the sunset.

And I guess I assumed that everybody used to do this as a child. But what that did is it inspired in us the sort of awe of nature and life and beauty. In part, I think, because my parents were — they had been through the war. They had been both born in Romania, and my father had been in a, probably what was a kind of starvation, concentration camp in Russia. He was a physician; he managed to get out. And my mother had gotten out before the war. But I think, for them, it was very palpable. Life and peace meant a lot to them. I remember sitting on summer mornings on the terrace at home with my father, early in the morning, and having breakfast, and he would look up — he used to read a lot — and he'd look up and he'd say, "Stop, listen. Listen to the sounds of peace." You know, you'd hear the birds chirping and the dog barking and the tennis balls on the tennis court across the way. And I think all those things were, I guess, became part of me to understand that you can find a place of peace if you stop and look and listen. And I think that's what happened to me in Crete. So when I went with my neighbors to Crete, to their little cottage, and I did bring my laptop, but unfortunately, the …

Ms. Tippett: Voltage?

Dr. Sternberg: Yes, voltage — you got it. I had the converter, whatever, for the voltage, and it blew on the first paragraph, and so they never forgave me because they said, 'I thought you were going to be writing your book.' But I wrote it in my mind, and I enjoyed the place. And what happened is I would swim every day in these warm, wonderful waters of the Mediterranean. And at first I couldn't walk very well, but by the end of the time, and it wasn't that long that I was there, I was able to climb up these hills of sort of scrabbly rock and …

Ms. Tippett: Despite your arthritis.

Dr. Sternberg: Yes, because of my arthritis, I couldn't. And then I would climb up to the top of the hill above the town, which had this ruins of the temple to Asclepius, the Greek god of healing, and on top of the temple site, as is pretty typical, there was a Byzantine church. And then on top of that, there was a tiny little Greek chapel that was modern, but I think it was about 300 years old. And there were all these icons and the candles to the icons. And it was just the most amazing peaceful place. And I would sit out there and look at the ocean and just stay for hours and crawl around the ruins and look at these amazing things. And it gave me a sense of peace, and it was really a sense of spirituality of place and time. And when I came back to Washington, I didn't need to go into hospital.

Now, you could argue, and the physician side of me says, well, I had been put on high-power medications before I left.

Ms. Tippett: OK. It may have clicked in?

Dr. Sternberg: It took some time to kick in. They don't kick in right away; it took some time to kick in. But just as I asked before, why did I get sick at that very moment when I was stressed, Why not five years before or five years later? You've got to assume that the stress response had something to do with it. Why did I get better in such a relatively short time after I had this period of rest and social support, healthy diet, beginning gradually to exercise more and more? Why did I get better then and not a month later? I think what was happening was I was allowing those medications to kick in, because I wasn't forcing my body to work against them.

Ms. Tippett: Right. You don't see the efforts that we can make to manage stress as an alternative to medicine but as a partner to medicine?

Dr. Sternberg: Oh, absolutely not. A partner, absolutely, no, yeah.

Ms. Tippett: You know what this makes me think, though? I mean, even when you tell the story about your parents and them helping you appreciate a peaceful moment or a beautiful sunset, we don't all have that. And it seems like even though there are these ways to use this knowledge we have about what's happening in our bodies and how that's connected with our emotions, we come to this knowledge with different wounds and weaknesses and different degrees of damage from our families. You talked about how memory plays a role in this and how we've been traumatized by memories differently. I don't know, how do you think about this? Because it seems like a sort of built-in inequity in terms of how we can use the knowledge.

Dr. Sternberg: Well, I think that the memories can go both ways. So you can have positive memories that trigger positive emotional responses and a flood of positive nerve chemicals, endorphins, you know, those dopamine reward chemicals, and you can have negative memories that trigger the stress response. And you know, again, a week vacation isn't going to do it for everybody. You know, it depends on how deep the wounds are, at what stage you are in the grieving process, your genetic makeup, whether you have the genes that predispose to depression or not, whether these kinds of wounds then trigger a biological depression that just can't be fixed with a vacation. This sort of thing needs to be fixed with fixing the imbalance and the nerve chemicals with antidepressant drugs together with psychotherapy and cognitive behavior therapy, working on those memories. That's what psychotherapy is about, digging deep into those memories. You can't do it overnight.

Ms. Tippett: Another way to think about how then — we haven't talked about psychotherapy, but how psychotherapy fits into this kind of whole picture of what's going on with us when we're not functioning as well as we could or as healthy as we could be.

Dr. Sternberg: Well, I think — my way of thinking about it, and now we're getting more into speculation than into science, but when you think about meditation, because that's another thing that changes the way the brain works.

Ms. Tippett: Mm-hmm, and we can measure that and see that.

Dr. Sternberg: We can measure that, right. And when you look at Richie Davidson and the University of Wisconsin has done this with meditating monks, those sort of Olympic meditators, and there are different parts of the brain that become active and different parts that shut down. And meditation is a state, just like being awake or being asleep, but it's a different state than being awake or being asleep. And so we don't fully understand exactly what happens when one is meditating. But clearly, there are different nerve chemicals that are released in those states. And there's evidence to believe now that meditation can change how your immune system works, probably through these nerve chemicals. So meditation is one, psychotherapy is another, Yoga, exercise, when you have a runner's high. When you're — I swim, and after, it's probably about 10 or 15 minutes of swimming, you get into this peaceful zone. Now, I think what's happening in all of these settings is you're relearning how to perceive that stressful event. So, you know, if you think of learning how to ride a bicycle, the first time you get on a bicycle when you're a kid, you fall off. Right? You need to get on about 50 times. OK? It's known that if you're going to learn something, you have to do it repetitively about 50 times. That's why your mother told you to practice piano every day, right?

Ms. Tippett: OK, OK. And you're saying the same thing that happens in your brain when you practice piano that you finally get it, it's like what can happen after …

Dr. Sternberg: You finally get it. There's an "aha" moment, yes.

Ms. Tippett: … your perception, just your response to stress.

Dr. Sternberg: And psychotherapy, you can go over and over and over again, those same loops, and your therapist can tell you, which many of them don't because they're trained not to tell you consciously what's going on there, but you need to come to it yourself after going over and over and over it about 50 or maybe more times, and then you suddenly get it.

Ms. Tippett: Rheumatologist and biomedical researcher Esther Sternberg. I'm Krista Tippett, and this is Speaking of Faith from American Public Media. Today, "Stress and the Balance Within."

As you look around the world we live in, the culture, our culture, American culture, knowing what you know — I mean, having named the word stress or invented it, we now probably overuse it. Everyone I know feels overwhelmed by stress. So do I — what would you wish for us? What are some simple things that you would like to see happening that you think could make life feel more manageable?

Dr. Sternberg: Well, first of all, I think you're right, that we do live in an era now that is not only filled with very rapid technological change, so in that way, it's like the Industrial Revolution that I described before. But we also live in a fearful world, which for Americans, is a relatively new thing. It always used to be over there, and since 2001, September 11th, it's come here. You know, the rest of the world has lived with this for many, many centuries, and we've had the privilege to not have to deal with the fear of the unknown day to day. But I think there's no question that when I speak to audiences, there is a lot of fear and stress out there. And it may not always be possible, but I do think we need to find, each one of us, our place of peace and try to go there every day. You know, we take our cars in to be serviced every 5,000 miles or whatever it is, but we don't do that with ourselves. And I'm sure it's different for every person. Some people may find it through meditation, some through prayer, some through yoga, some through exercise, some through music, some through reading, some through art, you know, whatever it is that does it for you. And any amount of time that you can devote to going off line in whatever way you find, will help.

Ms. Tippett: Esther Sternberg's book is The Balance Within: The Science Connecting Health and Emotions. She is currently working on a book on the science of place and well-being.

Part of the fun of producing each week's program is making connections between seemingly unrelated perspectives. Although Esther Sternberg's understanding of stress is rooted in science, she says we must also acknowledge our intuition about the connection between health and emotions. Popular spiritual teacher Eckhart Tolle, whom I interviewed recently, sees emotional pain manifest itself physically in what he's dubbed the pain body. What do you think? Listen to both of these programs and my complete unedited conversations with Esther Sternberg and Eckhart Tolle. That's on our Web site at speakingoffaith.org.

And for an upcoming program, we'd like to hear if you've found restoration and balance through the practice of yoga. Share your stories and visuals with us. Find the Share Your Story link at speakingoffaith.org. We'd love to hear from you.

The senior producer of Speaking of Faith is Mitch Hanley, with producers Colleen Scheck, Shiraz Janjua, and Rob McGinley Myers. Our online editor is Trent Gilliss, with Web producer Andrew Dayton. Kate Moos is the managing producer of Speaking of Faith, and I'm Krista Tippett.

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is a rheumatologist, researcher, and author of The Balance Within.