1. Cummings, N. A., and N. Van den Bos, "The Twenty Year Kaiser Permanente Experience with Psychotherapy and Medical Utilization : Implications for National Health Policy and National Health Insurance," Health Policy Quarterly 1 (1981) : 159-175 ;
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2. Grossarth-Maticek, R., and H. J. Eysenck, "Self-Regulation And Mortality From Cancer, Coronary Heart Disease and Other Causes : A Prospective Study," Personality And Individual Differences 19 (1995) : 781-795.

3. Pharmacy Times, "Top ten drugs of 2001," 68 (4) (2002) : 10, 12, 15.

4. Antonuccio, D., D. D. Burns, et al., "Antidepressants : A Triumph of Marketing Over Science ?" Prevention & Treatment 5, Article 25, posted July 15, 2002.

5. Langer, G., "Use of Antidepressants is a Long-term Practice," www.abcnews.com (2000).

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7. Gabbard, G. O., J. G. Gunderson, et al., "The Place of Psychoanalytic Treatments within Psychiatry," Archives of General Psychiatry 59 (2002) : 505-510.

8. Kramer, P., Listening to Prozac (New York : Viking, 1993).

9. Flint, A., and S. Rifat, "Recurrence of First-Episode Geriatric Depression after Discontinuation of Maintenance Antidepressants," American Journal of Psychiatry 156 (1999) : 943-945 ;
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10. Viguera, A., R. Baldessarini, et al., "Discontinuing Antidepressant Treatment in Major Depression," Harvard Review of Psychiatry 5, no. 6 (1998) : 293-306.

1. Mayer, J. D., P. Salovey, A. Capuso, "Models of Emotional Intelligence," in Steinberg, R. J. (ed.), Handbook of Intelligence (Cambridge : Cambridge University Press, 2000).

2. Goleman, D., Emotional Intelligence (New York : Bantam Books, 1995).

3. Mayer, et al., Handbook of Intelligence, 396-420.

4. Vaillant, G., Adaptation to Life (Boston : Harvard University Press, 1995).

5. Felsman, J. K., and G. Vaillant, "Resilient Children as Adults : A 40-Year Study," in The Invulnerable Child, eds. E. J. Anderson and B. J. Cohler (New York : Guilford Press, 1987).

6. Broca, P., "Anatomie Compar�e des Circonvolutions C�r�brales. Le Grand Lobe Limbique et la Scissure Limbique dans la S�rie des Ammifi�res," Revue Anthropologique 2 (1878) : 385-498.

7. Servan-Schreiber, D., W. M. Perlstein, et al., "Selective Pharmacological Activation of Limbic Structures in Human Volunteers : A Positron Emission Tomography Study," Journal of Neuropsychiatry and Clinical Neurosciences 10 (1998) : 148-159.

8. LeDoux, J. E., The Emotional Brain : The Mysterious Underpinnings of Emotional Life (New York : Simon & Schuster, 1996).

9. Levitt, P, "A monoclonal antibody to limbic system neurons," Science 223 (1984) : 299-301.

10. Damasio, A., The Feeling of What Happens (San Diego : Harcourt, 1990). In his most recent book, Damasio explores the consequences of this notion further, and attributes the discovery of the connection between emotions and physiological reactions in the body to the great 17th-century philosopher Benedict (Baruch) Spinoza ;
- Damasio, A., Looking for Spinoza : Joy, Sorrow and the Feeling Brain (San Diego : Harcourt, 2003).

11. Mehler, J., G. Lambertz, et al., "Discrimination de la Langue Maternelle par le Nouveau-n�," Comptes Rendus de l’Académie des Sciences 303 (1986) : 637-640.

12. Arnsten, A. F., and P. S. Goldman-Rakic, "Noise Stress Impairs Prefrontal Cortical Cognitive Function in Monkeys : Evidence for a Hyperdopaminergic Mechanism," Archives of General Psychiatry 55, no. 4 (1998) : 362-368.

13. Regier, D. A., and Robins, L. N., Psychiatric Disorders in America : The Epidemiology Catchment Area Study (New York : Free Press, 1991).

14. Ochsner, K. N., S. A. Bunge, et al., "An MRI study of the cognitive regulation of emotion," Journal of Cognitive Neuroscience (2002).
- See also the theory of Drevets and Raichle, who describe the relationship of reciprocal inhibition between the cognitive and emotional brains and the confirmation of that theory in a recent study at Duke University with MRI by Yamasaki and LaBar : Drevets, W. C., and M. E. Raichle, "Reciprocal Suppression of Regional Cerebral Blood Flow During Emotional Versus Higher Cognitive Processes : Implications for Interactions between Emotion and Cognition," Cognition and Emotion 12 (1998) : 353-385 ;
- Yamasaki, H., K. S. LaBar, et al., "Dissociable prefrontal brain systems for attention and emotion," Proceedings of the National Academy of Sciences 99, no. 17 (2002) : 11447-11451.

15. Macmillan, M. B. (1986), "A wonderful journey through skull and brains : The travels of Mr. Gage’s tamping iron," Brain and Cognition, no. 5 (1986) : 67-107.

16. Damasio, H., T. Brabowski, et al., "The Return of Phineas Gage : Clues about the Brain from the Skull of a Famous Patient," Science 264 (1994) : 1102-1105.

17. Eslinger, P. J., and A. R. Damasio, "Severe Disturbance of Higher Cognition after Bilateral Frontal Lobe Ablation : Patient EVR," Neurology 35 (1985) : 1731-1741.

18. Levenson, R., et al., "The Influence of Age and Gender on Affect, Physiology, and their Interrelations : A Study of Long-Term Marriages," Journal of Personality and Social Psychology 67 (1994).

19. Csikszentmihalyi, M., Flow : The Psychology of Optimal Experience (New York : Harper & Row, 1990).

1. Harrer, G., and H. Harrer, "Music, Emotion and Autonomic Function," Music and the Brain, M. Critchley and R. A. Hanson eds. (London : William Heinemann Medical, 1977) 202-215.

2. Grossarth-Maticek, R., and H. J. Eysenck, "Self-regulation and Mortality from Cancer, Coronary Heart Disease and Other Causes : A Prospective Study," Personality and Individual Differences 19, no. 6 (1995) : 781-795 ;
- Linden, W., C. Stossel, et al., "Psychosocial Interventions for Patients with Coronary Artery Disease : A Meta-Analysis," Archives of Internal Medicine 156, no. 7 (1996) : 745-752 ;
- Ornish, D., L. Scherwitz, et al., "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease," Journal of the American Medical Association 280, no. 23 (1998) : 2001-2007.

3. Frasure-Smith, N., F. Lesperance, et al., "Depression and 18-Month Prognosis after Myocardial Infarction," Circulation 91, no. 4 (1995) : 999-1005 ;
- Glassman, A., and P. Shapiro, "Depression and the Course of Coronary Artery Disease," American Journal of Psychiatry 155 (1998) : 4-10.

4. Armour, J. A., and J. Ardell, Neurocardiology (New York : Oxford University Press, 1994) ;
- Samuels, M., "Voodoo Death Revisited : The Modern Lessons of Neurocardiology," Grand Rounds, Department of Medicine, University of Pittsburgh Medical Center, Presbyterian/ Shadyside Hospital, 2001.

5. Armour, J. A., ed., "Anatomy and Function of the Intrathoracic Neurons Regulating the Mammalian Heart," Reflex Control of the Circulation (Boca Raton, FL : CRC Press, 1991) ;
- Gershon, M. D., "The Enteric Nervous System : A Second Brain," Hospital Practice (Office Edition) 34, no. 7 (1999) : 31-32, 35-38, 41-42 passim.

6. Carter, C. S., "Neuroendocrine Perspectives on Social Attachment and Love," Psychoneuroendocrinology 23 (1998) : 779-818 ;
- Uvnas-Moberg, K., "Oxytocin May Mediate the Benefits of Positive Social Interaction and Emotions," Psychoneuroendocrinology 23 (1998) : 819-835.
- The Quebec researchers, Cantin and Genest, after discovering the ANF (atrial natriuretic factor), were among the first to describe the heart as an actual hormonal gland in their article : Cantin, M., and J. Genest, "The heart as an endocrine gland," Clinical and Investigative Medicine 9, no. 4 (1986) : 319-327.

7. Stroink, G., "Principles of Cardiomagnetism," Advances in Biomagnetism, S. J. Williamson et al. eds. (New York : Plenum Press, 1989) 47-57.

8. Coplan, J. D., L. A. Papp, et al., "Amelioration of Mitral Valve Prolapse after Treatment for Panic Disorder," American Journal of Psychiatry 149, no.11 (1992) : 1587-1588.

9. Gahery, Y., and D. Vigier, "Inhibitory Effects in the Cuneate Nucleus Produced by Vago-Aortic Afferent Fibers," Brain Research 75 (1974) : 241-246.

10. Akselrod, S., D. Gordon, et al., "Power Spectrum Analysis of Heart Rate Fluctuation : A Quantitative Probe of Beat-to-Beat Cardiovascular Control," Science 213 (1981) : 220-222.

11. Umetani, K., D. Singer, et al., "Twenty-Four Hours Time Domain Heart Rate Variability and Heart Rate : Relations to Age and Gender over Nine Decades," Journal of the American College of Cardiology 31, no. 3 (1999) : 593-601.

12. Tsuji, H., F. Venditti, et al., "Reduced Heart Rate Variability and Mortality Risk in an Elderly Cohort. The Framingham Heart Study," Circulation 90, no. 2 (1994) : 878-883 ;
- Dekker, J., E. Schouten, et al., "Heart Rate Variability from Short Term Electrocardiographic Recordings Predicts Mortality from All Causes in Middle-Aged and Elderly Men. The Zutphen Study," American Journal of Epidemiology 145, no.10 (1997) : 899-908 ;
- La Rovere, M., J. T. Bigger, et al., "Baroreflex Sensitivity and Heart-Rate Variability in Prediction of Total Cardiac Mortality after Myocardial Infarction," The Lancet 351 (1998) : 478-484.

13. Carney, R. M., M. W. Rich, et al., "The Relationship between Heart Rate, Heart Rate Variability, and Depression in Patients with Coronary Artery Disease," Journal of Psychosomatic Research 32 (1988) : 159-164 ;
- Rechlin, T., M. Weis, et al., "Are Affective Disorders Associated with Alterations of Heart Rate Variability ?" Journal of Affective Disorders 32, no. 4 (1994) : 271-275 ;
- Krittayaphong, R., W. Cascio, et al., "Heart rate variability in patients with coronary artery disease : differences in patients with higher and lower depression scores," Psychosomatic Medicine 59, no. 3 (1997) : 231-235 ;
- Stys, A., and T. Stys, "Current clinical applications of heart rate variability," Clinical Cardiology 21 (1998) : 719-724 ;
- Carney, R., K. Freedland, et al., "Change in Heart Rate Variability During Treatment for Depression in Patients with Coronary Heart Disease," American Psychosomatic Society 62, no. 5 (2000) : 639-647 ;
- Luskin, F., M. Reitz, et al., "A Controlled Pilot Study of Stress Management Training in Elderly Patients with Congestive Heart Failure," Preventive Cardiology 5, no. 4 (2002) : 168-172.

14. McCraty, R., M. Atkinson, et al., "The Effects of Emotions on Short-Term Power Spectrum Analysis and Heart Rate Variability," The American Journal of Cardiology 76, no.14 (1995) : 1089-1093.

15. Barrios-Choplin, B., R. McCraty, et al., "An Inner Quality Approach to Reducing Stress and Improving Physical and Emotional Well-Being at Work," Stress Medicine 13, no. 3 (1997) : 193-201.

16. Watkins, A. D., "Corporate Training In Heart Rate Variability : 6 Weeks and 6 Months Follow-Up Studies," Hunter-Kane, London (2002).

17. Katz, L. F., and J. M. Gottman, "Buffering Children from Marital Conflict and Dissolution," Journal of Clinical Child Psychology 26 (1997) : 157-171.

1. McCraty, R., ed., Science of the Heart : Exploring the Role of the Heart in Human Performance (Boulder Creek, CA : Institute of HeartMath, 2001).

2. McCraty, R., M. Atkinson, et al., "The Effects of Emotions on Short-Term Power Spectrum Analysis and Heart Rate Variability," The American Journal of Cardiology 76, no. 14 (1995) : 1089-1093.

3. Luskin, F., M. Reitz, et al., "A Controlled Pilot Study of Stress Management Training in Elderly Patients with Congestive Heart Failure," Preventive Cardiology 5, no. 4 (2002) : 168-172.

4. Barrios-Choplin, B., R. McCraty, et al., "An Inner Quality Approach to Reducing Stress and Improving Physical and Emotional Well-Being at Work," Stress Medicine 13, no. 3 (1997) : 193-201.

5. Baulieu, E., G. Thomas, et al., "Dehydroepiandrosterone (DHEA), DHEA Sulfate, and Aging : Contribution of the DHEA Study to a Sociobiomedical Issue," Proceedings of the National Academy of Science 97, no. 8 (2000) : 4279-4284.

6. Kirschbaum, C., O. Wolf, et al., "Stress and Treatment-Induced Elevation of Cortisol Levels Associated with Impaired Declarative Memory in Healthy Adults," Life Sciences 58, no. 17 (1996) : 1475-1483 ;
- Bremner, J. D., "Does Stress Damage the Brain ?" Society of Biological Psychiatry 45 (1999) : 797-805 ;
- McEwen, B., The End of Stress as We Know It (Washington, DC : National Academic Press, 2002).

7. McCraty, R., B. Barrios-Choplin, et al., "The Impact of a New Emotional Self-Management Program on Stress, Emotions, Heart Rate Variability, DHEA and Cortisol," Integrative Physiological and Behavioral Science 33, no. 2 (1998) : 151-170.

8. Rein, G., R. McCraty, et al., "Effects of Positive and Negative Emotions on Salivary IgA," Journal for the Advancement of Medicine 8, no. 2 (1995) : 87-105.

9. Cohen, S., D. A. Tyrrell, et al., "Psychological Stress and Susceptibility to the Common Cold," New England Journal of Medicine 325, no. 9 (1991) : 606-612.

10. McCraty, R., ed., Science of the Heart : Exploring the Role of the Heart in Human Performance (Boulder Creek, CA : Institute of HeartMath, 2001).

11. Ibid.

1. Rauch, S. L., Van der Kolk et al., "A Symptom Provocation Study of Posttraumatic Stress Disorder Using Positron Emission Tomography and Script-Driven Imagery," Archives of General Psychiatry 53 (1996) : 380-387.
- There have been several other brain imaging studies of PTSD since then that have pointed to a number of other brain regions possibly being involved in PTSD. This remains an active area of research with the usual disagreements and controversies over the interpretation of findings. I chose to illustrate the neural correlates of PTSD with this older study because it captures so well—at the neurological level—the essence of what we see as clinicians : strong emotions, vivid visual images, and impaired verbal expression.

2. Breslau, N., R. C. Kessler, et al., "Trauma and Posttraumatic Stress Disorder in the Community : The 1996 Detroit Area Survey of Trauma," Archives of General Psychiatry 55 (1998) : 626-632.

3. Shapiro, F., EMDR Treatment : Overview and Integration. EMDR as an Integrative Psychotherapy Approach (Washington, DC : American Psychological Association, 2002).

4. LeDoux, J. E., "Brain Mechanisms of Emotions and Emotional Learning," Current Opinion in Neurobiology 2 (1992) : 191-197.

5. Pavlov, I. P., Conditioned Reflexes (London : Oxford University Press, 1927).

6. Quirk, G. I., "Memory for Extinction of Conditioned Fear is Long-Lasting and Persists Following Spontaneous Recovery," Learning and Memory 9, no. 6 (2002) : 402-407 ;
- Morgan, M. A., L. M. Romanski, et al. "Extinction of Emotional Learning : Contribution of Medial Prefrontal Cortex," Neuroscience Letters 163, no. 1 (1993) : 109-113.

7. LeDoux, J. E., L. Romanski, et al., "Indelibility of Subcortical Emotional Memories," Journal of Cognitive Neuroscience 1 (1989) : 238-243. LeDoux, J. E., The Emotional Brain : The Mysterious Underpinnings of Emotional Life (New York : Simon & Schuster, 1996).

8. See the neural network of this phenomenon developed by Jorge Armony in LeDoux’s lab in collaboration with my own laboratory at the University of Pittsburgh : Armony, J., D. Servan-Schreiber, et al., "Computational Modeling of Emotion : Explorations Through the Anatomy and Physiology of Fear Conditioning," Trends in Cognitive Sciences 1, no. 1 (1997) : 28-34.

9. Solomon, S., E. T. Gerrity, et al., "Efficacy of Treatments for Posttraumatic Stress Disorder," Journal of the American Medical Association 268 (1992) : 633-638.

10. Wilson, S., L. Becker, et al., "Eye Movement Desensitization and Reprocessing (EMDR) Treatment for Psychologically Traumatized Individuals," Journal of Consulting and Clinical Psychology 63 (1995) : 928-937 ;
- Wilson, S., L. Becker, et al., "Fifteen-Month Follow-Up of Eye Movement Desensitization and Reprocessing (EMDR) Treatment for Posttraumatic Stress Disorder and Psychological Trauma," Journal of Consulting and Clinical Psychology 65 (1997) : 1047-1056.

11. Antibiotics are successful in 90 percent of outpatient cases of pneumonia but only 80 percent of patients who require hospitalization. Those cases, of course, are more serious. Fine, M., R. Stone, et al., "Processes and Outcomes of Care for Patients with Community-Acquired Pneumonia," Archives of Internal Medicine 159 (1999) : 970-980.

12. Shapiro, F., Eye Movement Desensitization and Reprocessing : Basic Principles, Protocols and Procedures, 2nd ed. (New York : Guilford, 2001) ;
- Stickgold, R., "EMDR : A Putative Neurobiological Mechanism," Journal of Clinical Psychology 58 (2002) : 61-75.

13. Cyrulnik, B., Les Vilains Petits Canards (Paris : Odile Jacob, 2001).

14. Van Der Kolk, B., "Beyond the Talking Cure : Somatic Experience and the Subcortical Imprints in the Treatment of Trauma," in EMDR as an Integrative Psychotherapy Approach, F. Shapiro, ed. (Washington, DC : American Psychological Association, 2002) ;
- Shapiro, F., Eye Movement Desensitization and Reprocessing : Basic Principles, Protocols and Procedures (New York : Guilford, 2001).

15. Rumelhart, D. E., and J. L. McClelland, Parallel Distributed Processing : Explorations in the Microstructure of Cognition (Cambridge, MA : MIT Press, 1986) ;
- Edelman, G. N., Neural Darwinism : The Theory of Neuronal Group Selection (New York : Perseus Publishing, 1987).

16. The title of one of Bessel van der Kolk’s early papers on this issue used a quote from one of his multiply traumatized patients, "The Body Keeps the Score . . ." : van der Kolk, B. A., "The Body Keeps the Score : Memory and the Evolving Psychobiology of Posttraumatic Stress," Harvard Review of Psychiatry 1 (1994) : 253-265.

1. K�bler-Ross, E., On Death and Dying (New York : Touchstone, 1969).

2. Chemtob, C. M., J. Nakashima, et al., "Brief Treatment for Elementary School Children with Disaster-Related Post-Traumatic Stress Disorder : A Field Study," Journal of Clinical Psychology 58 (2002) : 99-112.

3. Van Etten, M. L., and S. Taylor, "Comparative Efficacy of Treatments for Post-Traumatic Stress Disorder : A Meta-Analysis," Clinical Psychology & Psychotherapy 5 (1998) : 126-144 ;
- Spector, J., and J. Read, "The Current Status of Eye Movement Desensitization and Reprocessing (EMDR)," Clinical Psychology & Psychotherapy 6 (1999) : 165-174 ;
- Sack, M., W. Lempa, et al., "Study Quality and Effect-Sizes : A Meta-Analysis of EMDR-Treatment for Post-Traumatic Stress Disorder," Psychotherapie, Psychosomatik, Medizinische Psychologie 51, no. 9-10 (2001) : 350-355 ;
- Maxfield, L., and L. A. Hyer, "The Relationship Between Efficacy and Methodology in Studies Investigating EMDR Treatment of PTSD," Journal of Clinical Psychology 58 (2002) : 23-41.

4. Herbert, J., S. Lilienfeld, et al., "Science and Pseudoscience in the Development of Eye Movement Desensitization and Reprocessing : Implications for Clinical Psychology," Clinical Psychology Review 20 (2000) : 945-971.
- A detailed reply to this criticism was published by two American psychoanalysts in 2002 : Perkins, B. R., and C. C. Rouanzoin, "A Critical Evaluation of Current Views Regarding Eye Movement Desensitization and Reprocessing (EMDR) : Clarifying Points of Confusion," Journal of Clinical Psychology 58 (2002) : 77-97.

5. Stickgold, R., J. A. Hobson, et al., "Sleep, Learning, and Dreams : Off-Line Memory Reprocessing," Science (2001) : 1052-1057.

6. Stickgold, R.,"EMDR : A Putative Neurobiological Mechanism," Journal of Clinical Psychology 58 (2002) : 61-75.

7. Wilson, D., S. M. Silver, et al., "Eye Movement Desensitization and Reprocessing : Effectiveness and Autonomic Correlates," Journal of Behavior Therapy and Experimental Psychiatry 27 (1996).

8. Pessah, M. A., and H. P. Roffwarg, "Spontaneous Middle Ear Muscle Activity in Man : A Rapid Eye Movement Sleep Phenomenon," Science 178 (1972) : 773-776 ;
- Benson, K., and V. P. Zarcone, "Phasic Events of REM Sleep : Phenomenology of Middle Ear Muscle Activity and Periorbital Integrated Potentials in the Same Normal Population," Sleep 2, no. 2 (1979) : 199-213.

9. Servan-Schreiber, D.,"Eye Movement Desensitization and Reprocessing : Is Psychiatry Missing the Point ?" Psychiatric Times 17, no. 7 (2000) : 36-40.

10. Chambless, D., M. Baker, et al., "Update on Empirically Validated Therapies, II," The Clinical Psychologist 51, no. 1 (1998) : 3-16.

11. Chemtob, C. M., D. Tolin, et al., "Eye Movement Desensitization and Reprocessing (EMDR)," in Effective Treatments for PTSD : Practice Guidelines from the International Society for Traumatic Stress Studies, E. A. Foa, T. M. Keane, and M. J. Friedman, eds. (New York : Guilford Press, 2000) : 139-155, 333-335.

12. United Kingdom Department of Health, "The Evidence Based Clinical Practice Guideline" (2001).

13. Bleich, A., J. Berstein, et. al., "Guidelines for the Assessment and Professional Intervention with Terror Victims in the Hospital and in the Community," a position paper of the National Council for Mental Health, Ministry of Health, Israel (2002).

14. CREST, "The Management of Posttraumatic Stress Disorder in Adults" (Belfast, Ireland, Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, 2003).

15. Kirsch, I., A. Scoboria, et al., "Antidepressants and Placebos : Secrets, Revelations, and Unanswered Questions," Prevention & Treatment (2002) ;
- Thase, M. E., "Antidepressant Effects : The Suit May Be Small, but the Fabric is Real," Article 32, Prevention & Treatment (2002) ;
- Khan, A., R. Leventhal, et al., "Severity of Depression and Response to Antidepressants and Placebo : An Analysis of the Food and Drug Administration Database," Journal of Clinical Psychopharmacology 22, no. 1 (2002) : 50-54.

16. Yehuda, R., A. C. McFarlane, et al., "Predicting the Development of Post-Traumatic Stress Disorder from the Acute Response to a Traumatic Event," Biological Psychiatry 44 (1998) : 1305-1313.

1. Cook, F. A., "Medical Observations Among the Esquimaux," New York Journal of Gynecology and Obstetrics 4 (1894) : 282-296, cited in Rosenthal, N. E., Winter Blues : Seasonal Affective Disorder—What It Is and How to Overcome It (New York : Guilford Press, 1998).

2. Haggarty, J. M., Z. Cernovsh et al., "The Limited Influence of Latitude on Rates of Seasonal Affective Disorder," Journal of Nervous and Mental Disease 189 (2001) : 482-484.

3. Avery, D. H., D. N. Eder, et al., "Dawn Simulation and Bright Light in the Treatment of SAD : A Controlled Study," Biological Psychiatry 50, no. 3 (2001) : 205-216.

4. Personal communication of e-mail sent Don Romero of Pi-Square, Inc., Seattle, Washington.

5. Parry, B., S. Berga, et al., "Melatonin and Phototherapy in Premenstrual Depression," Progress in Clinical & Biological Research 341 B (1990) : 35-43 ;
- Lam, R. W., E. M. Goldner, et al., "A Controlled Study of Light Therapy for Bulimia Nervosa," American Journal of Psychiatry 151, no. 5 (1994) : 744-750 ;
- Satlin, A., L. Volicer, et al., "Bright Light Treatment of Behavioral and Sleep Disturbances in Patients with Alzheimer’s Disease," Amercian Journal of Psychiatry 149, no. 8 (1992) : 1028-1032 ;
- Levitt, A., R. Joffe, et al., "Bright Light Augmentation in Antidepressant Nonresponders," Journal of Clinical Psychiatry 52, no. 8 (1991) : 336-337.

6. In-Young, Y., D. Kripke, et al., "Luteinizing Hormone Following Light Exposure in Healthy Young Men," Neuroscience Letters 341, no. 1 (2003) : 25-28.

1. Soulie de Morant, G. I., L’Acupuncture Chinoise (Paris : Maloine �diteurs, 1972).

2. As analyses of all the clinical studies registered by the American Food and Drug Adminstration suggest : Kirsch, I., A. Scoboria, et al., "Antidepressants and Placebos : Secrets, Revelations, and Unanswered Questions," Prevention & Treatment (2002) ;
- Thase, M. E., "Antidepressant Effects : The Suit May Be Small, but the Fabric is Real," Prevention & Treatment Article 32 (2002) ;
- Khan, A., R. Leventhal, et al., "Severity of Depression and Response to Antidepressants and Placebo : An Analysis of the Food and Drug Administration Database," Journal of Clinical Psychopharmacology 22, no. 1 (2002) : 50-54.

3. British Medical Association, Board of Sciences, Acupuncture : Efficacy, Safety and Practice (London : Harwood Academic, 2000).

4. Ulett, G. A., S. Han, et al., "Electroacupuncture : Mechanisms and Clinical Applications," Biological Psychiatry 44 (1998) : 129-138.

5. Hechun, L., J. Yunkui, et al., "Electroacupuncture vs. Amitriptyline in the Treatment of Depressive States," Journal of Traditional Chinese Medicine (1985) : 3-8 ;
- Han, J.-S., "Electroacupuncture : An Alternative to Antidepressants for Treating Affective Diseases ?" Journal of Neuroscience 29 (1986) : 79-92 ;
- Polyakov, S. E., "Acupuncture in the Treatment of Endogenous Depression," Soviet Neurology and Psychiatry 21 (1988) : 36-44 ;
- Thomas, M., S. V. Eriksson, et al., "A Comparative Study of Diazepam and Acupuncture in Patients with Osteoarthritis Pain : A Placebo Controlled Study," American Journal of Chinese Medicine 2, no. XIX (1991) : 95-100 ;
- Jin, H., L. Zhou, et al., "The Inhibition by Electrical Acupuncture on Gastric Acid Secretion is Mediated Via Endorphin and Somatostating in Dogs," Clinical Research 40 (1992) : 167A ;
- Li, Y., G. Tougas, et al., "The Effect of Acupuncture on Gastrointestinal Function and Disorders," American Journal of Gastroenterology 87 (1992) : 1372-1381 ;
- He, D., J. Berg, et al., "Effects of Acupuncture on Smoking Cessation or Reduction for Motivated Smokers," Preventive Medicine 26 (1997) : 208-214 ;
- Cardini, F. W., Huang, "Moxibustion for Correction of Breech Presentation," Journal of the American Medical Association 280, no. 18 (1998) : 1580-1584 ;
- Montakab, H., "Akupunktur und Schlaflosigkeit [Acupuncture and insomnia]," Forschende Komplementarmedizin 6 (Supplement 1) (1999) : 29-31 ;
- Timofeev, M. F., "Effects of Acupuncture and an Agonist of Opiate Receptors on Heroin Dependent Patients," American Journal of Chinese Medicine 27, no. 2 (1999) : 143-148 ;
- Wang, S.-M., and Z. N. Kain, "Auricular Acupuncture : A Potential Treatment for Anxiety," Anesthesia and Analgesia 92 (2001) : 548-553 ;
- Paulus, W. E., M. Zhang, et al., "Influence of Acupuncture on the Pregnancy Rate in Patients Who Undergo Assisted Reproduction Therapy," Fertility and Sterility 77, no. 4 (2002) : 721-724.

6. Cho, Z. H., S. C. Chung, et al., "New Findings of the Correlation Between Acupoints and Corresponding Brain Cortices Using Functional MRI," Proceedings of the National Academy of Sciences 95 (1998) : 2670-2673.

7. Han, op. cit. ;
- Luo, H. C., Y. K. Jia, et al., "Electroacupuncture vs. Amitriptyline in the Treatment of Depressive States," Journal of Traditional Chinese Medicine 5 (1985) : 3-8 ;
- Lou, H. C., Y. Jia, et al., "Electro-acupuncture in the Treatment of Depressive Psychosis," International Journal fo Clinical Acupuncture 1 (1990) : 7-13 ;
- Luo, H. C., Y. C. Shen, et al., "A Comparative Study of the Treatment of Depression by Electroacupuncture and Amitriptyline," Acupuncture 1 (Huntington, NY : 1990) 20-26.

8. Wang, op. cit. (2001).

9. Hui, K., J. Liu, et al., "Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain : Evidence from MRI Studies in Normal Subjects," Human Brain Mapping 9 (2000) : 13-25.

10. Chen, L., J. Tang, et al., "The Effect of Location of Transcutaneous Electrical Nerve Stimulation on Postoperative Opioid Analgesic Requirement : Acupoint Versus Nonacupoint Stimulation," Anesth Analg 87 (1998) : 1129-1134 ;
- Lao, L., S. Bergman, et al., "Evaluation of Acupuncture for Pain Control after Oral Surgery : A Placebo-Controlled Trial,"Archives of Otolaryngology—Head and Neck Surgery 125 (1999) : 567-572.

11. Haker, E., H. Egekvist, et al., "Effect of DSensory Stimulation Cacupuncture) on sympathetic and parasympathetic activites in healthy subjects," Journal of the Autonomic Nervous System 79, no. 1 (2000) : 52-59.

12. Pert, C. B., H. E. Dreher, et al., "The Psychosomatic Network : Foundations of Mind-Body Medicine," Alternative Therapies in Health and Medicine 4, no. 4 (1998) : 30-41.

1. B�gedahl-Strindlund, M., and K. Monsen B�rjesson, "Postnatal Depression : A Hidden Illness," Acta Psychiatrica Scandinavica 98 (1998) : 272-275.

2. Hibbeln, J. R., "Long-Chain Polyunsaturated Fatty Acids in Depression and Related Conditions," Phospholipid spectrum disorder, M. Peet, I. Glen, and D. Horrobin (Lancashire, U.K. : Marius Press, 1999), 195-210.

3. Hornstra, G., M. Al, et al., "Essential Fatty Acids in Pregnancy and Early Human Development," European Journal of Obstetrics, Gynecology, and Reproductive Biology 61, no. 1 (1995) : 57-62 ;
- Al, M., A. C. van Houwelingen, et al., "Long-Chain Polyunsaturated Fatty Acids, Pregnancy, And Pregnancy Outcome," American Journal of Clinical Nutrition 71 (2000) : 285S-291S.

4. Hibbeln, J., "Fish Consumption and Major Depression," The Lancet 351 (1998) : 1213.

5. Barton, P. G., and F. D. Gunstone, "Hydrocarbon Chain Packing and Molecular Motion in Phospholipid Bilayers Formed from Unsaturated Lecithin," Journal of Biological Chemistry 250 (1975) : 4470-4476 ;
- Sperling, R. I., A. I. Benincaso, et al., "Dietary Omega-3 Polyunsaturated Fatty Acids Inhibit Phosphoinositide Formation and Chemotaxis in Neutrophils," Journal of Clinical Investigation 91 (1993) : 651-660.

6. Bourre, J. M., M. Bonneil, et al., "Function of Dietary Polyunsaturated Fatty Acids in the Nervous System," Prostaglandins Leukotrienes & Essential Fatty Acids 48, no. 1 (1993) : 5-15.

7. Frances, H., P. Drai, et al., "Nutritional (n-3) Polyunsaturated Fatty Acids Influence the Behavioral Responses to Positive Events in Mice," Neuroscience Letters 285, no. 3 (2000) : 223-227.

8. Bang, H. O., J. Dyerberg, et al., "The Composition of Foods Consumed by Greenland Eskimos," Acta Medica Scandinavica 200 (1976) : 69-73.

9. This concerns primarily dopamine, the neurotransmitter responsible for the euphoria and surge of energy associated with cocaine and amphetamines. Chalon, S., S. Delion-Vancassel, et al., "Dietary Fish Oil Affects Monoaminergic Neurotransmission and Behavior in Rats," Journal of Nutrition 128 (1998) : 2512-2519.

10. Olsen, S. F., and N. J. Secher, "Low Consumption of Seafood in Early Pregnancy as a Risk Factor for Preterm Delivery : Prospective Cohort Study," British Medical Journal 324 (2002) : 447-451.

11. Naturally, the difference in IQ may be explained by other factors as well, such as a better emotional connection with the infants among mothers who breastfed for a longer period, etcetera. However, there is a consensus among researchers about the importance of an adequate supply of omega-3 fatty acids for brain development in the newborn : Mortensen, E. L., K. F. Michaelsen, et al., "The Association Between Duration of Breastfeeding and Adult Intelligence," Journal of the American Medical Association 287 (2002) : 2365-2371.

12. Hibbeln, J., "Seafood consumption, The DHA Content of Mothers’ Milk and Prevalence Rates of Postpartum Depression : A Cross-National, Ecological Analysis," Journal of Affective Disorders 69 (2002) : 15-29.

13. Stoll, A. L., W. E. Severus, et al., "Omega 3 Fatty Acids in Bipolar Disorder : A Preliminary Double-Blind, Placebo-Controlled Trial," Archives of General Psychiatry 56 (1999) : 407-412.

14. Stoll, A. L., The Omega-3 Connection : The Groundbreaking Omega-3 Antidepression Diet and Brain Program (New York : Simon & Schuster, 2001).

15. A preliminary study of the effects of an esterified extract of fish oil on stage III of Huntington’s disease—the most advanced stage of the illness—shows an improvement of symptoms over a few months compared to the group taking an olive oil placebo. It also shows a rebuilding of cortical tissue as opposed to the steady withering of cortex in the control group. This suggests an inversion of the pathological processes in the brain underlying the illness.

16. Zanarini, M., and F. R. Frankenburg, "Omega-3 Fatty Acid Treatment of Women with Borderline Personality Disorder : A Double-Blind, Placebo-Controlled Pilot Study," American Journal of Psychiatry 160 (2003) : 167-169.

17. Maes, M., R. Smith, et al., "Fatty Acid Composition in Major Depression : Decreased w3 Fractions in Cholesteryl Esters And Increased C20:4 Omega 6/C20:5 Omega 3 Ratio in Cholesteryl Esters and Phospholipids," Journal of Affective Disorders 38 (1996) : 35-46 ;
- Peet, M., B. Murphy, et al.,"Depletion of Omega-3 Fatty Acid Levels in Red Blood Cell Membranes of Depressive Patient," Biological Psychiatry 43, no. 5 (1998) : 315-319.

18. Adams, P. B., S. Lawson, et al., "Arachidonic Acid to Eicosapentanoic Acid Ratio in Blood Correlates Positively with Clinical Symptoms of Depression," Lipids 31 (1996) : S157-S161.

19. Edwards, R., M. Peet, et al., "Omega-3 Polyunsaturated Fatty Acid Levels in the Diet and in Red Blood Cell Membranes of Depressed Patients," Journal of Affective Disorders 48, no. 2-3 (1998) : 149-155.

20. Tanskanen, A., J. Hibbeln, et al., "Fish Consumption, Depression, and Suicidality in a General Population," Archives of General Psychiatry 58 (2001) : 512-513.

21. Tiemeier, H., H. van Tuijl, et al., "Plasma Fatty Acid Composition and Depression Are Associated in the Elderly : The Rotterdam Study," American Journal of Clinical Nutrition 78 (2003) : 40-46.

22. Chamberlain, J., "The Possible Role of Long-Chain, Omega-3 Fatty Acids in Human Brain Phylogeny," Perspectives in Biology and Medicine 39, no. 3 (1996) : 436-445 ;
- Broadhurst, C., S. Cunnane, et al., "Rift Valley Lake Fish and Shellfish Provided Brain-Specific Nutrition for Early Homo," British Journal of Nutrition 79, no. 1 (1998) : 3-21.

23. Stoll, A. L., and C. A. Locke, "Omega-3 Fatty Acids in Mood Disorders : A Review of Neurobiologic and Clinical Applications," Natural Medications for Psychiatric Disorders : Considering the Alternatives, D. Mischoulon and J. Rosenbaum (Philadelphia : Lippincott Williams & Wilkins, 2002), 13-34.

24. I borrowed this graphic metaphor from Jeanette Settle. Settle, J. E., "Diet and Essential Fatty Acids," Handbook of Complementary and Alternative Therapies in Mental Health, S. Shannon (San Diego : Academic Press, 2001) 93-113.

25. Weissman, M. W., R. Bland, et al., "Cross-National Epidemiology of Major Depression and Bipolar Disorder," Journal of the American Medical Association 276 (1996) : 293-296 ;
- Hibbeln, J. (1998).

26. Stordy, B., and M. Nichol, The LCP Solution : The Remarkable Nutritional Treatment for ADHD, Dyslexia, and Dyspraxia (New York : Ballantine Books, 2000).

27. Klerman, G. L., and M. M. Weissman, "Increasing Rates of Depression," Journal of the American Medical Association 261, no. 15 (1989) : 2229-2235.

28. Endres, S., R. Ghorbani, et al., "The Effect of Dietary Supplementation with n-3 Polyunsaturated Fatty Acids on the Synthesis of Interleukin-1 and Tumor Necrosis Factor by Mononuclear Cells," New England Journal of Medicine 320, no. 5 (1989) : 265-271 ;
- Simopoulos, A.,"Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases," Journal of the American College of Nutrition 21, no. 6 (2002) : 495-505 ;
- Stoll, A. L., and C. A. Locke, "Omega-3 Fatty Acids in Mood Disorders : A Review of Neurobiologic and Clinical Applications," Natural Medications for Psychiatric Disorders : Considering the Alternatives, D. Mischoulon and J. Rosenbaum (Philadelphia : Lippincott Williams & Wilkins, 2002), 13-34.

29. Rudin, D. O., "The Dominant Diseases of Modernized Societies as Omega-3 Essential Fatty Acid Deficiency Syndrome," Medical Hypotheses 8 (1982) : 17-47 ;
- Simopoulos, A. P., and J. Robinson, The Omega Diet (New York : Harper Collins, 1998).

30. Liu, K., J. Stamler, et al., "Dietary Lipids, Sugar, Fiber, and Mortality from Coronary Heart Disease—Bivariate Analysis of International Data," Atherosclerosis 2 (1998) : 221-227.

31. Weissman, M. W., R. Bland, et al., "Cross-National Epidemiology of Major Depression and Bipolar Disorder," Journal of the American Medical Association 276 (1996) : 293-296.

32. De Lorgeril, M., S. Renaud, et al., "Mediterranean Alpha-Linolenic Acid Rich Diet in Secondary Prevention of Coronary Heart Disease," The Lancet 343 (1994) : 1454-1459.

33. Christensen, J. H., and E. B. Schmidt, "N-3 Fatty Acids and the Risk of Sudden Cardiac Death," Lipids 36 (2001) : S115-118 ;
- Leaf, A., "Electrophysiologic Basis for the Antiarrhythmic and Anticonvulsant Effects of Omega-3 Polyunsaturated Fatty Acids," World Review of Nutrition & Dietetics 88 (2001) : 72-78 ;
- Brouwer, I. A., P. L. Zock, et al., "Association Between n-3 Fatty Acid Status in Blood and Electrocardiographic Predictors of Arrhythmia Risk in Healthy Volunteers," American Journal of Cardiology 89, no. 5 (2002) : 629-631.

34. Smith, R. S., "The Macrophage Theory of Depression," Medical Hypotheses 35 (1991) : 298-306 ;
- Maes, M., and R. S. Smith, "Fatty Acids, Cytokines, and Major Depression," Biological Psychiatry 43 (1998) : 313-314.

35. Crawford, M. A., "Fatty-Acid Ratios in Free-Living and Domestic Animals," The Lancet (1968) : 1329-1333 ;
- Crawford, M. A., M. M. Gale, et al., "The Polyenoic Acids and Their Elongation Products in the Muscle Tissue of Phacochoerus Aethiopicus : a Re-Evaluation of Animal Fat," Journal of Biochemistry 114 (1969) : 68P ;
- Crawford, M. A., M. M. Gale, et al., "Linoleic Acid and Linolenic Acid Elongation Products in the Muscle Tissue of Syncerus caffer and Other Ruminant Species," Journal of Biochemistry 115 (1969) : 25-27.

36. Simopoulos, A. P., and N. Salem, "Omega-3 Fatty Acids in Eggs from Range-Fed Greek Chickens," New England Journal of Medicine (1989) : 1412.

37. Renaud, S., M. Ciavatti, et al., "Protective Effects of Dietary Calcium and Magnesium on Platelet Function and Atherosclerosis in Rabbits Fed Saturated Fat," Atherosclerosis 47 (1983) : 189-198.

38. Simopoulos, A. P., and J. Robinson, The Omega Diet (1998), op. cit.

39. Weill, P., et al., "Enriching Diets with Omega-3 Fatty Acid : Impact of Various Sources," Nutrition, Metabolism, and Cardiovascular Diseases (in press).

40. Marangell, L., J. Martinez, et al., "A Double-Blind, Placebo-Controlled Study of the Omega-3 Fatty Acid Docosahexaenoic Acid (DHA) in the Treatment of Major Depression," American Journal of Psychiatry 160, no. 5 (2003) : 996-998.

41. Whereas daily vitamins have long been scorned by conventional medicine, they have recently made a significant comeback when a panel of experts published their conclusions in the Journal of the American Medical Association. After reviewing a large number of studies, the preeminent authors of this article were forced to acknowledge that daily vitamin intake (particularly vitamins B, E, C, and D) reduces the risk for a whole array of chronic illnesses and of serious diseases. Fletcher, R. H., and K. M. Fairfield, "Vitamins for Chronic Disease Prevention in Adults : Clinical Applications," Journal of the American Medical Association 287, no. 23 (2002) : 3127-3129.

42. Stoll, A. L.,The Omega-3 Connection (New York : Simon & Schuster, 2001).

43. Baillie, R. A., R. Takada, et al., "Coordinate Induction of Peroxisomal Acyl-Coa Oxidase and UCP-3 by Dietary Fish Oil : A Mechanism for Decreased Body Fat Deposition," Prostaglandins, Leukotrienes & Essential Fatty Acids 60, no. 5-6 (1999) : 351-356.

44. Kris-Etherton, P. M., W. S. Harris, et al., "AHA Scientific Statement : Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease," Circulation 106 (2002) : 2747-2757.

1. McDonald, D. G., and J. A. Hogdon, The Psychological Effects of Aerobic Fitness Training : Research and Theory (New York : Springer-Verlag, 1991) ;
- Long, B. C., and R. van Stavel, "Effects of Exercise Training on Anxiety. A Meta-Analysis," Journal of Applied Sport Psychology 7 (1995) : 167-189.

2. DiLorenzo, T. M., E. P. Bargman, et al., "Long-Term Effects of Aerobic Exercise on Psychological Outcomes," Preventive Medicine 28, no. 1 (1999) : 75-85.

3. Kasch, F., "The Effects of Exercise on the Aging Process," The Physician and Sports Medicine 4 (1976) : 64-68 ;
- Palone, A. M., R. R. Lewis, et al., "Results of Two Years of Exercise Training in Middle-Aged Men," The Physician and Sports Medicine 4 (1976) : 72-77.

4. LaPerri�re, A., M. H. Antoni, et al., "Exercise Intervention Attenuates Emotional Distress and Natural Killer Cell Decrements Following Notification of Positive Serologic Status of HIV-1," Biofeedback and Self-Regulation 15 (1990) : 229-242.

5. Greist, J. H., M. H. Klein, et al., "Running as Treatment for Depression," Comprehensive Psychiatry 20, no. 1 (1979) : 41-54.

6. Beck, A., Depression : Clinical, Experimental and Theoretical Aspects (New York : Harper & Row, 1967) ;
- Beck, A., Cognitive Therapy and the Emotional Disorders (New York : International Universities Press, 1976) ;
- Burns, D. D., The New Mood Therapy (1999).

7. Babyak, M., J. A. Blumenthal, et al., "Exercise Treatment for Major Depression : Maintenance and Therapeutic Benefit at 10 Months," Psychosomatic Medicine 62, no. 5 (2000) : 633-638.

8. Blumenthal, J., M. Babyak, et al., "Effects of Exercise Training on Older Patients with Major Depression," Archives of Internal Medicine 159 (1999) : 2349-2356.

9. Paffenbarger, R. S., I. M. Lee, et al., "Physical Activity and Personal Characteristics Associated with Depression and Suicide in American College Men," Acta Psychiatrica Scandinavica 377 (1994) : 16-22.

10. Wise, S. P., and M. Herkenham, "Opiate Receptor Distribution in the Cerebral Cortex of the Rhesus Monkey," Science 218 (1982) : 387-389.

11. Panksepp, J., M. Siviy, et al., "Brain Opioids and Social Emotions," The Psychobiology of Attachment and Separation, M. Reite and T. Field (New York : Academic Press, 1985).

12. Thoren, P., J. S. Floras, et al., "Endorphins and Exercise : Physiological Mechanisms and Clinical Implications," Medicine & Science in Sports & Exercise 22, no. 4 (1990) : 417-428 ;
- Sher, L., "Exercise, Well-Being, and Endogenous Molecules of Mood," The Lancet 348, no. 9025 (1996) : 477.

13. Jonsdottir, I. H., P. Hoffmann, et al., "Physical Exercise, Endogenous Opioids and Immune Function," Acta Physiologica Scandinavica 640, suppl.(1997) : 47-50.

14. Furlan, R., D. Piazza, et al., "Early and Late Effects of Exercise and Athletic Training on Neural Mechanisms Controlling Heart Rate," Cardiovascular Research 27 (1993) : 482-488.

15. George, M., Z. Nahas, et al., "Vagus Nerve Stimulation Therapy : A Research Update," Neurology 59, no. 6, suppl. 4 (2002) : S56-61.

16. Lawlor, D., and S. Hopker, "The Effectiveness of Exercise as an Intervention in the Management of Depression : Systematic Review and Meta-Regression Analysis of Randomised Controlled Trials," British Medical Journal 322, no. 7289 (2001) : 763-767.

1. Observatoire National des Prescriptions et Consommations des Medicaments. Etude de la Prescription et de la Consommation des antidepresseurs en Ambulatoire. Paris, Agence du M�dicament—Directions des Etudes et de l’Information Pharmaco-Economiques (1998).

2. Gupta, S., "If everyone were on Prozac . . ." Time 81 (January 20, 2003).

3. Hirigoyen, M.-F., Stalking the Soul : On Emotional Abuse and the Erosion of Identity (Helen Marx Books, 2000).

4. The cingular cortex is the oldest and the most "primitive" region of the neocortex, whose tissue is closer to that of the emotional brain than to that of the neocortex. Mesulam, M. M., Principles of Behavioral Neurology (Philadelphia : F. A. Davis, 1985).

5. Schanberg, S., "Genetic Basis for Touch Effects," Touch in Early Development, T. Field (Hillsdale, NJ : Erlbaum, 1994) : 67-80.
- The remarkable research of Dr. Tiffany Field on growth of preterm babies preceded the explanation of Dr. Schanberg by several years : Field, T., S. M. Schanberg, et al., "Tactile/Kinesthetic Stimulation Effects on Preterm Neonates," Pediatrics 77 (1986) : 654-658.

6. Spitz, R., "Hospitalism : An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood," Psychoanalytic Study of the Child I (1945) : 53-74.

7. Hubel, D., "The Visual Cortex of Normal and Deprived Monkeys," American Scientist 67, no. 5 (1979) : 532-543.

8. Chugani, H. T., M. E. Behen, et al., "Local Brain Functional Activity Following Early Deprivation : A Study of Postinstitutionalized Romanian Orphans," Neuroimage 14, no. 6 (2001) : 1290-1301.

9. Hofer, M. A., "Early Social Relationships : A Psychobiologist’s View," Child Development 58 (1987) : 633-647.
- I wish to thank the remarkable book of Tom Lewis, Fari Amini, and Richard Lannon, A General Theory of Love, for bringing this experiment to my attention.

10. Katz, L. F., and J. M. Gottman, "Buffering Children from Marital Conflict and Dissolution," Journal of Clinical Child Psychology 26 (1997) : 157-171.

11. Murray Parkes, C., B. Benjamin, et al., "Broken Heart : A Statistical Study of Increased Mortality among Widowers," British Medical Journal 646 (1969) : 740-743.

12. Medalie, J. H., and U. Goldbourt, "Angina Pectoris among 10,000 men. II. Psychosocial and Other Risk Factors as Evidenced by a Multivariate Analysis of a Five Year Incidence Study," American Journal of Medicine 60, no. 6 (1976) : 910-921.

13. Medalie, J. H., K. C. Stange, et al., "The Importance of Biopsychosocial Factors in the Development of Duodenal Ulcer in a Cohort of Middle-Aged Men," American Journal of Epidemiology 136, no. 10 (1992) : 1280-1287.

14. Reynolds, P., P. T. Boyd, et al., "The Relationship Between Social Ties and Survival among Black and White Breast Cancer Patients. National Cancer Institute Black/White Cancer Survival Study Group," Cancer Epidemiology, Biomarkers & Prevention 3, no. 3 (1994) : 253-259.

15. Levenson, R., L. L. Carstensen, et al., "Long-Term Marriage : Age, Gender, and Satisfaction," Psychology and Aging 8, no. 2 (1993) : 301-313.

16. Graham, C. A., and W. C. McGrew, "Menstrual Synchrony in Female Undergraduates Living on a Coeducational Campus," Psychoneuroendocrinology 5 (1980) : 245-252.

17. Lewis, T., F. Amini, et al., A General Theory of Love (New York : Random House, 2000).

18. Friedman, E., and S. A. Thomas, "Pet Ownership, Social Support, and One-Year Survival after Acute Myocardial Infarction in the Cardiac Arrhythmia Suppression Trial (CAST)," American Journal of Cardiology 76 (1995) : 1213-1217.

19. Siegel, J. M., "Stressful Life Events and Use of Physician Services among the Elderly : The Moderating Influence of Pet Ownership," Journal of Personal and Social Psychology 58 (1990) : 1081-1086.

20. Rodin, J., Langer, E. J., "Long-Term Effects of a Control-Relevant Intervention with the Institutionalized Aged," Journal of Personality and Social Psychology 35 (1977) : 897-902.

21. Siegel, J. M., F. J. Angulo, et al., "AIDS Diagnosis and Depression in the Multicenter AIDS Cohort Study : The Ameliorating Impact of Pet Ownership," AIDS Care 11 (1999) : 157-169.

22. Allen, K., and J. Blascovich, "The Value of Service Dogs for People with Severe Ambulatory Disabilities : A Randomized Controlled Trial," Journal of the American Medical Association 275 (1996) : 1001-1006.

23. Lockwood, R., "The Influence of Animals on Social Perception," New Perspectives on Our Lives with Companion Animals, vol. 8, A. H. Katcher and A. M. Beck (Philadelphia : University of Pennsylvania Press, 1983) : 64-71.

24. Allen, K., B. E. Shykoff, et al., "Pet Ownership, but Not ACE Inhibitor Therapy, Blunts Home Blood Pressure Responses to Mental Stress," Hypertension 38 (2001) : 815-820.

25. Allen, K., and J. L. Izzo, "Social Support and Resting Blood Pressure among Young and Elderly Women : The Moderating Role of Pet Ownership" (in submission).

26. Simon, S., "Sarajevo Pets," Weekend Edition Saturday with Scott Simon, Washington, National Public Radio (1993).

1. Hocker, J. L., and W. W. Wilmot, Interpersonal Conflict (Dubuque, IA : William C. Brown, 1991).

2. Chang, P. P., D. E. Ford, et al., "Anger in Young Men and Subsequent Premature Cardiovascular Disease : The Precursors Study," Archives of Internal Medicine 162 (2002) : 901-906.

3. Gottman, J., Why Marriages Succeed or Fail (New York : Simon & Schuster, 1994) ;
- Gottman, J., and N. Silver, The Seven Principles for Making Marriage Work (New York :Random House, 1994).

4. Levenson, R., L. L. Carstensen, et al., "Long-term marriage : Age, gender, and satisfaction," Psychology and Aging no. 8 (1993) : 301-313.

5. Gottman, J., What Predicts Divorce (Mahwaw, NJ : Lawrence Erlbaum Associates, 1994) : 84, cited in Goleman, D., Emotional Intelligence (New York : Bantam Books, 1995) : 135.

6. Rosenberg, M. D., Non-violent Communication (Puddle Dancer Press, 1999).

7. Harvey, O. J., Conceptual Systems and Personality Organization (New York : Harper & Row, 1961), cited in Rosenberg, M. D., op. cit.

1. Stuart, M. R., and J. A. Lieberman, The Fifteen Minute Hour : Applied Psychotherapy for the Primary Care Physican (Westport, Conn. : Prager, 1993).

2. Coulehan, J. L., and M. R. Block, The Medical Interview : Mastering Skills for Clinical Practice, 4th ed. (F.A. Davis Company, 2000).

3. Thank you to my friend and colleague Jo Devlin, M.S.W., for teaching me this metaphor about the benefits of briefly sharing the patient’s burden of pain.

1. Cherlin, Marriage, Divorce and Remarriage (Cambridge : Harvard University Press, 1992).

2. Klerman, G. L., and M. M. Weissman, "Increasing Rates of Depression," Journal of the American Medical Association 261, no. 15 (1989) : 2229-2235.

3. Wilson, E. O., Sociobiology : The New Synthesis, 25th anniversary ed. (Cambridge : Harvard University Press, 2000).

4. Walsh, R., Essential Spirituality : The Seven Central Practices to Awaken Heart and Mind (New York : John Wiley & Sons, 1999).

5. Damasio, A., Looking for Spinoza : Joy, Sorrow and the Feeling Brain (San Diego : Harcourt, 2003).

6. Myers, D. G., and E. Diener, "The pursuit of happiness," Scientific American 274 (1996) : 70-72 ;
- Argyle, M., The Psychology of Happiness, 20th ed. (New York : Routledge, 2001).

7. Durkheim, E., Le Suicide. Une �tude sociologique (Paris : Alcan, 1897).

8. Zuckerman, D. M., S. V. Kasl, et al., "Psychosocial Predictors of Mortality among the Elderly Poor," American Journal of Cardiology 119 (1984) : 410-423.

9. House, J. S., K. R. Landis, et al., "Social Relationships and Health," Science 241 (1988) : 540-545.

10. Frankl, V. E., Man’s Search for Meaning : An Introduction to Logotherapy (New York : 1976).

11. Mother Teresa quoted in Walsh, R. (1999), op. cit.

12. Abraham Maslow quoted in Walsh, R. (1999), op. cit.

13. McCraty, R., M. Atkinson, et al., "The Effects of Emotions on Short-Term Power Spectrum Analysis and Heart Rate Variability," American Journal of Cardiology 76, no. 14 (1995) : 1089-1093.

1. Aristotle, Nichomacean Ethics.

2. I wish to thank Dr. Scott Shannon, of the American Association of Holistic Medicine, for having pointed out the connection between Aristotle, Jung, and Maslow—across a span of 2,500 years—in the introduction to his book on natural methods in mental health. Shannon, S., Integration and Holism. Handbook of Complementary and Alternative Therapies in Mental Health, S. Shannon, ed. (San Diego : Academic Press, 2001) : 21-42.

3. McCraty, R., M. Atkinson, et al., "The Effects of Emotions on Short-Term Power Spectrum Analysis and Heart Rate Variability," American Journal of Cardiology 76, no. 14 (1995) : 1089-1093 ;
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