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If you close your eyes and think about it for a while, as philosophers have done for centuries, the world of the mind seems very different from the one inhabited by our bodies. The psychic space inside our heads is infinite and ethereal; it seems obvious that it must be made of different stuff than all the other organs. Cut into the body, and blood pours forth. But slice into the brain, and thoughts and emotions don't spill out onto the operating table. Love and anger can't be collected in a test tube to be weighed and measured.

Rene Descartes, the great 17th century French mathematician and philosopher, enshrined this metaphysical divide in what came to be known in Western philosophy as mind-body dualism. Many Eastern mystical traditions, contemplating the same inner space, have come to the opposite conclusion. They teach that the mind and body belong to an indivisible continuum. In the past, doctors and scientists have tended to dismiss that view as bunk, but the more they learn about the inner workings of the mind, the more they realize that in this regard at least, the mystics are right and Descartes was dead wrong.

Mind and body, psychologists and neurologists now agree, aren't that different. The brain is just another organ, albeit more intricate than the rest. The thoughts and emotions that seem to color our reality are the result of complex electrochemical interactions within and between nerve cells. The disembodied voices of schizophrenia and the feelings of worthlessness and self-hatred that accompany depression, although they seem to be based on reality, are no more than distortions in brain electrochemistry. Researchers are learning how these distortions arise, how to lessen their severity and, in some cases, how to correct them.

Scientists are also learning something else. Not only is the mind like the rest of the body, but the well-being of one is intimately intertwined with that of the other. This makes sense because they share the same systems—nervous, circulatory, endocrine and immune. What happens in the pancreas or liver can directly affect brain function. Disorders of the brain, conversely, can send out biochemical shock waves that disturb the rest of the body. The pages that follow, our annual special report on health, take you to the cutting edge of mind-body research, where scientists, having left Descartes's great mistake far behind, are exploring how the brain works, how it malfunctions, and what can be done when it goes awry.

How Stress Takes Its Toll
Like its more severe cousin depression, ordinary stress is harmful to the body as well as the mind. Stress comes in two forms, each with its own biochemistry.

ACUTE
A response to imminent danger, it turbocharges the system with powerful hormones that can damage the cardiovascular system.

CHRONIC
Caused by constant emotional pressure the victim can't control, it produces hormones that can weaken the immune system and damage bones.

1 A stress response starts in the brain...

When the brain detects a threat, a number of structures, including the hypothalamus, amygdala and pituitary gland, go on alert: they exchange information with each other and then send signaling hormones and nerve impulses to the rest of the body to prepare for fight or flight.

2 ...and the body unleashes a flood of hormones...

Adrenal glands react to the alert by releasing epinephrine (adrenaline), which makes the heart pump faster and the lungs work harder to flood the body with oxygen.

The adrenal glands also release extra cortisol and other glucocorticoids, which help the body convert sugars into energy.

Nerve cells release norepinephrine, which tenses the muscles and sharpens the senses to prepare for action. Digestion shuts down.

3 ...that can cause significant damage

When the threat passes, epinephrine and norepinephrine levels drop, but if danger comes too often they can damage the arteries. Chronic low-level stress keeps the glucocorticoids in circulation, leading to a weakened immune system, loss of bone mass, suppression of the reproductive system and memory problems.

We've come a long way from Freud's couch. The big breakthrough arrived in the late 1980s with the advent of safer and more widely effective drugs, like Prozac. According to Dr. Bruce Cohen of Harvard's McLean Hospital, we're on the cusp of a new era in treatment as the search for a single magic pill for depression gives way to a broad spectrum of therapies.

Drugs
TODAY'S TREATMENTS
Most antidepressants work by tweaking levels of various neurotransmitters, the chemicals that carry signals from one neuron to another. Prozac, Paxil, Zoloft and the other SSRIs slow the absorption of serotonin. Effective antidepressants that act on both serotonin and norepinephrine include Effexor and Remeron. Drugs like Wellbutrin work in a similar way but probably on the neurotransmitters norepinephrine and dopamine. The tricyclic antidepressants (such as Elavil and Tofranil) also blocked the absorption of neurotransmitters, especially norepinephrine, but the drugs had significant side effects. Another class of first-generation drugs, the monoamine oxidase inhibitors (MAOIs) such as Nardil and Marplan, can be effective but can also produce dangerous side effects. A transdermal patch just approved by the Food and Drug Administration will give new life to MAOIs by reducing the side effects they sometimes caused when taken orally.

ON THE HORIZON
Researchers are exploring two related molecules, gaba and glutamate, that are responsible for 90% of chemical signaling in the brain. Because they control so much of the brain's activity, the trick is to fine-tune their levels in ways that relieve depression but don't affect other brain functions. Other targets of drug development: the sex hormone testosterone (a transdermal patch proved effective in a recent clinical trial for men); the stress hormone cortisol, which researchers are trying to regulate with the abortion drug RU 486 and compounds called CRF antagonists; the dynorphins (the evil twins of feel-good endorphins); and a chemical called substance P, involved in pain pathways closely related to depression.

Electrical and Magnetic
TODAY'S TREATMENTS
Electroshock therapy, despite its unsavory reputation, is actually quite effective, especially for patients who don't respond to drugs and seniors for whom drug interactions pose problems. The treatment today uses a small current to trigger a mild seizure — a rhythmic firing of neurons — that can push a depressed brain out of its rut.

ON THE HORIZON
Researchers are exploring a similar technique that sends an electrical current through the vagus nerve — a major conduit wiring the heart and intestines — which then delivers it to the brain. Another approach, called regional transcranial magnetic stimulation, uses an electric coil shaped like a figure eight to create a magnetic field inside the pre-frontal cortex, which plays a key role in mood regulation.

Talking Cures
TODAY'S TREATMENTS
Most research today is focused on the physiology of depression, yet clinicians find that approaches combining medical and psychological treatments are still the most effective. Freud's techniques have been adapted and streamlined, but analysts still try to get patients to probe the unconscious roots of their problems.

Newer techniques like cognitive therapy, by contrast, teach patients to recognize destructive patterns in their lives and develop practical steps for changing bad mental habits.

ON THE HORIZON
Meditation, mindfulness training and biofeedback have long been championed as proven stress relievers. Now proponents believe these techniques may also provide relief to people with depression by lowering levels of cortisol.

Alternative Therapies
TODAY'S TREATMENTS
More patients today help themselves to over-the-counter aids, from St.-John's-wort to ginkgo biloba and soybean extracts. But herbs, like prescription drugs, can have side effects, and researchers are investigating their efficacy. The popular supplement DHEA, for example, has been linked to an increased risk of cancer.

ON THE HORIZON
Omega-3 fatty acids (in fish oils) are good for the heart and also may be good for the brain by promoting the health of nerve-cell membranes. Studies are under way.

Effects of Depression and Anxiety on Canadian Society

Experience with Depression or Anxiety

Effect of Depression or Anxiety

Treatments for Depression and Anxiety

CMHA/Compas Survey

CMHA/Compas Survey finds an astounding 91% of Canadians say maintaining mental health is very important.

The Canadian Mental Health Association engaged COMPAS to undertake a national, representative survey among 500 Canadians to explore public experiences and perceptions relating to stress and depression. In some instances, the report presents findings from questions that COMPAS first tracked on behalf of the Canadian Mental Health Association almost a decade ago.

Some key findings of fact are:

Read the full report. (This link will open it into a new browser window.)

Ot Yet?

I did my nurse's training at a hospital in Liverpool, England. My fellow students and I had little money for meals, so we ate the awful food provided at the hospital complex.

We often took our breaks in the kitchen, and sometimes kindly visitors would give us some of the treats they had brought for patients who had not wanted to eat them.

One night a woman brought a pie to the kitchen and said to me, "Would you eat this up, love?"

Another student and I devoured every delicious crumb!

Soon our benefactor returned, however, and asked, "Is me 'usband's pie 'ot yet, dearie?"

Philosophy Exam

An eccentric philosophy professor gave a one question final exam after a semester dealing with a broad array of topics.

The class was already seated and ready to go when the professor picked up his chair, plopped it on his desk and wrote on the board: "Using everything we have learned this semester, prove that this chair does not exist."

Fingers flew, erasers erased, notebooks were filled in furious fashion. Some students wrote over 30 pages in one hour attempting to refute the existence of the chair. One member of the class however, was up and finished in less than a minute.

Weeks later when the grades were posted, the rest of the group wondered how he could have gotten an "A" when he had barely written anything at all. His answer consisted of two words:

"What chair?"

Bad Language

The little boy was caught swearing by his teacher.

"Jeffrey," she said, "you shouldn't use that kind of language. Where did you hear it?"

"My daddy said it," he responded.

"Well, that doesn't matter," she explained, "you don't know what it means."

"I do, too," Jeffrey corrected. "It means the car won't start."

For more information on this and other subjects go to Interventions Archive. 

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