Editor-in-Chief, Encyclopedia of Stress, 2e Director, Mental Health Research Institute, Parkville, Victoria, Australia	January 2007
	We have some fascinating articles on the use of suicide in terrorism, and what factors are involved in what causes people to become suicide bombers. All articles are relevant, and all articles are apolitical written by scholars in the area who are trying to analyze factors involved in the most objective way possible.

Where did you grow up?

I grew up in Melbourne, Australia. I was actually born in Vienna, but arrived here at the age of three. So all of my schooling was in Melbourne, and then I got a scholarship to Oxford.

What was your childhood like? How did you become interested in science?

I’ve actually been interested in science since I was a kid. As far back as six years old, my favorite books were about discovery and science. I don’t know what stimulated that. My father was a chemist, so there was a bit of scientific talk in the house, but not a great deal. It seemed to be a spontaneous interest, and I was determined from about twelve or so to do medicine. I wanted to become a medical doctor.

And you did become a medical doctor through Melbourne University.

Yes, I qualified in medicine, and then I got distracted by medical research.

You are a neuroendocrinologist and a neuropharmacologist?

That’s correct.

How do you diagnose stress? Are there specific biological tests?

There are several ways of assessing stress. There are clear cut biological markers. If we focus on the human, they include increased heart rate, changes in blood pressure, changes in skin color, temperature, and perspiration, which is a very common feature for people who are stressed.

Are those also features for long-term stress?

The cardiovascular (heart) effects are likely to continue, like increased heart rate, increased pulse rate, and increased blood pressure. One will also see behavior changes which reflect anxiety and/or stress-induced depression, such as increased or inappropriate movements, disturbed or lack of sleep and changes in mood. Those are the relatively easy clinical markers. There are hormonal measures as well, such as an increase in hormones secreted by the adrenal glands called glucocorticoids (such as cortisol) and also epinephrine and nor epinephrine.

When people go in for a check up because they are concerned about their stress level, do most doctors do specific tests using technology, or is it more a matter of getting their history and talking with them?

Well, it’s a mixture and it depends on the patient’s symptoms and which doctor the patient goes to. The most important thing is the history of the patient. If the doctor is thorough, he/she will certainly take a detailed history from the patient. The patient will very likely tell them that they feel anxious and will describe what the stressors are. It may be as simple as having neighbors next door who are rowdy or noisy, or something more serious like racial tensions, traumatic conditions of war or conflict, or any of the constant pressures that people feel. In terms of actually measuring stress, one of the essential features of any physical examination is to check the blood pressure, pulse rate and so on. The doctor won’t necessarily take the hormone levels. The patients do not complain about the hormones, they complain about their feelings.

Has technology changed much in measuring stress? Technology doesn’t seem to be as important in treating stress as it is with other medical conditions.

Seeing the doctor and having a straight-forward examination is probably standard procedure, even nowadays with increased technology. The major leap in technology is of course the sequencing of the genetic code – the human genome. That has led to the identification of genetic factors that make people susceptible to stress, and on the other hand, make other people more resistant to stress.

Is there any evidence to show that there is a specific gene that predisposes an individual to stress or depression?

Yes is the answer to that. We have articles in the Encyclopedia on this which demonstrate the fact that there are certain genes and particular changes in the genes that predispose certain individuals and make them more susceptible than others to stressful stimuli. It is still the early days, but so far there seem to be at least two main genes involved. There is still a lot more work to be done on that.

Is technology as important as a doctor’s knowledge or experience when treating stress?

At the end of the day, in terms of the patient, it is very much the doctor’s knowledge that is still paramount. However, in the future, genetics will certainly offer a way in which people will have a better understanding of stress and so perhaps that will enable intervention to prevent or reduce stress in people who are susceptible to it.

How do you cover post-traumatic stress disorder in the Encyclopedia?

We have a whole series of articles specifically dedicated to post-traumatic stress disorder. In addition, numerous articles mention the disorder where appropriate. It is probably one of the largest single areas that we have included in this edition. We have probably doubled the amount of information on it since the first edition. We deal with all sorts of different factors such as post-traumatic stress response to experience in concentration camps, wars, terrorism, and specifically 9/11. We have really covered a good deal. The articles cover the situations that cause the post-traumatic stress disorder, what the symptoms are, and what the biological markers are. The biology of post-traumatic stress disorder appears to be somewhat different from that of acute stress. We also cover abuse of children, spouses, partners and so on.

It sounds very comprehensive. Did post-traumatic stress disorder become a recognized disorder after the Vietnam War?

Yes. It was only the pressure from Vietnam veterans that finally led to an action mandated by Congress that led to recognition by the American Psychiatric Association of post-traumatic stress disorder as a formal psychiatric disorder, and its inclusion in the Association’s Diagnostic and Statistical Manual of Mental Disorders ( DSM). This handbook is used widely for recognizing, classifying and diagnosing mental disorders. From that it grew very rapidly as people recognized that it was certainly not limited to Vietnam veterans but extended to victims of concentration camps, victims of any genocide, or victims of any personal criminal trauma that occurs on the streets of any city.

Has the treatment changed much?

No, there isn’t any magic new technology that has improved the treatment. It is all very much based on different forms of either psychotherapy or behavioral therapy which all focus on ways to get the person to express their fears and anxieties with the hope that that will somehow relieve or reduce the post-traumatic stress disorder and/or get them to think positively whenever they get it. The latter approach has been systematized in “cognitive behavioral therapy”. An important point is that people are starting to accept that there is no stigma attached to it. It is an illness the same as having the flu or arthritis. This is a mental illness. It’s very difficult to treat, to be honest.

How long has stress been linked to disease and illness?

It’s been accepted since about the middle of the 20th century. There have been observations linking stress to disease and illness that go back into the 19th century. Even the ancient Greeks made the point that stress had adverse effects on bodily functions and can completely block reproduction, for example. However, in terms of formal documentation and acceptance, it was about the middle of the last century due in large part to the seminal contributions of Walter Cannon and Hans Selye.

How has drug therapy changed in the last several years with treating stress and different ramifications of stress?

There has been a significant improvement in the treatment of the outcomes of stress. The drug treatment for depression has improved significantly in the last twenty or thirty years with the development of more selective drugs. There has also been a new generation of drugs that have made a significant improvement in our pharmacological armor to treating schizophrenia, which does not appear to be a consequence of stress, but can be exacerbated by stress. The big breakthrough, which is now about thirty to forty years old, is the development of what are called benzodiazepines. Valium is the most commonly known drug in that series for the treatment of anxiety, which again is definitely stress provoked, if not caused. Valium and its modern derivatives is the main prototype for treating anxiety. Prozac is the main prototype for treating depression. About 20% of people in the population have a major depressive event at some stage in their life, and we all have anxiety to one extent or another. The benzodiazepines have made a major impact on being able to moderate that level of anxiety. With other conditions, like schizophrenia and bipolar disorder, similar developments have occurred in the last thirty years to provide pharmacological treatment for these conditions.

Are most prescriptions for Prozac for an extended period of time?

Most people who are treated with Prozac continue on it for quite some time. In the human it takes about two to three weeks of treatment before it actually becomes effective.

Do children suffer from depression?

Children actually can suffer from quite severe depression. That has only been recognized formally in the last ten years or so. In many cases, it would reflect abuse in the home or at school.

You are a Director at the Mental Health Research Institute at Victoria. Can you tell me about what you do there?

Our institute is comprised of about one hundred staff. We have two main research thrusts, one is into Alzheimer’s Disease, and the other is into schizophrenia and related disorders such as bipolar or manic depressive disorder. Our predominant interest is very much biological genetic molecular work. We ask questions as to what causes Alzheimer’s and can we develop a method for treating it, and the same applies to schizophrenia. A lot of our work is based on studies on the human brain, from people who have died from Alzheimer’s or schizophrenia. In addition, a lot of our work is based on brain imaging, studying it with functional magnetic resonance imaging and positron emission tomography. These are sophisticated new methods for brain imaging in the human. That is some of what we do in a nutshell.

What are you most interested in or knowledgeable out? For example, are you more of an expert in Alzheimer’s or schizophrenia?

My personal interest is very much on the molecular side, although I am clinically qualified. Most of my work following my Ph.D at Oxford has been very much at the bench and focused on the mechanism of chemical transmission in the brain (neurochemistry and neuropharmacology) and neuroendocrinology – the way the brain controls hormones and hormones control the brain. During the past 20 years, my personal research interest has been on the way in which sex hormones, such as estrogen and testosterone, effect the expression of certain genes in the brain related to behavior, mental state and mood. This work has relevance for our understanding of schizophrenia as well as mood disorders.

How do you keep up with literature in your field?

With great difficulty!

I can’t imagine how any one person can keep up with research around the world.

Usually nights and weekends are spent reading all the literature. It’s all online.

It’s not hard to read journals or books from a laptop?

No, I can do it pretty easily. It may be from training. I used to print out reams of paper. In the last six or seven years I read everything online. I have several search engines running for me where I get weekly updates. There are fabulous tools now. There isn’t a day that passes without a new thing coming up. My staff get very frustrated with me because over weekends I go through probably about fifteen or twenty journals and I shoot out papers to relevant members of staff so they come in on Monday morning and find they have email!

Someone has to keep up, right?

Yes, and I actually enjoy it enormously. I feel fully briefed on all advances in psychopharmacology, neuropharmacology, neuroendocrinology, and the whole area of neuroscience. The tools are fantastic! I may have five items, searches or articles, open at one time on the computer.

When was the last time you visited a library?

It was not so long ago. I was writing an article on stress for another Elsevier publication (the new Encyclopedia of Neuroscience), and that took me right back to articles in the 1930’s. That was the first time in three years that I had carried out a serious literature search in a Biomedical library.

You were the Editor-in-Chief of the first edition of the Encyclopedia of Stress?

That’s right. It was actually my little concept conceived in a slightly inebriated state at an Academic Press reception in Washington in November 1996.

How did that happen?

I was simply talking to Erica Conner, a production editor in the major reference works division. We got to talking about possible new titles and I said what Elsevier really needed was an encyclopedia of stress. I thought since it was such a difficult term to define with so many different components that an encyclopedia was needed to cover all the different aspects. Such a work might help to consolidate and clarify our understanding of the stress phenomenon or syndrome.

So Erica followed up on that conversation?

Yes. She actually gave me a call and said it was a good idea! I was doing a sabbatical at the time at The Rockefeller University in New York. Academic Press had offices in New York so we had a meeting there. Christopher Morris, the guru of major reference works at Academic Press flew out from the San Diego office for the meeting. It took off from there. It was great fun!

Great idea! How is the second edition different from the first?

The second edition differs in a number of ways. On the human clinical side we have a lot more coverage of post-traumatic stress disorder, the adverse mental effects of stress, the interaction between stress and disease and the impact of socioeconomic stressors on health and well-being. There is also more coverage on conflict, obviously triggered by the events of 9/11. We have some fascinating articles on the use of suicide in terrorism, and what factors are involved and what causes people to become suicide bombers. All articles are relevant, and all articles are apolitical written by scholars in the area who are trying to analyze factors involved in the most objective way possible. Also, at the time of the first edition the human genome had not been published yet. So we have a whole slew of new articles on the genetics and genomics of stress in this edition. Further, the biology revolution, triggered by quantum leaps in molecular biology have made a step difference to the rigor of the Encyclopedia’s large number of biomedical articles. The total number of new articles in the second edition is over one hundred and forty.

Are there general biological mechanisms that underlie the stress response?

Yes – in vertebrates there are two brain-controlled mechanisms that mount the response to stress – the hypothalamic–pituitary–adrenal system and the autonomic nervous system. Both mechanisms bring about rapid changes, such as increased blood glucose, heart rate and blood-flow to limb muscles, which enable the animal to fight or take flight, as appropriate. At a cellular level, protection against stress is provided by the rapid generation of specific molecules, and especially the “heat-shock proteins”. The heat-shock protein response to stress, first discovered in the fruit fly (Drosophila melanogaster), appears to be common to all species from bacteria to man. These phenomena are of course given prominence in the Encyclopedia.

What would you like librarians to know about this four volume set?

I would say, quite arrogantly, there is nothing in the area of stress that is comparable to it. We have five hundred and forty seven separate articles in four volumes that cover almost every conceivable aspect of stress and its causes. It is written by stars in the field for the widest possible audience of people who are interested in any aspect of stress, from the latest advances in our understanding of the molecular mechanisms involved, the role of stress in the causation of cardiovascular, mental and other stress-related disorders, stress at the work place, socioeconomic factors and stress, post- traumatic stress disorder and the genetics of stress. Further, while not a “do it yourself” book, the Work explains neuroendocrinological and psychological tests of stress, and the nature of psychopharmacological drugs and psychoanalytical methods used in the management of stress and stress related disorders.

What would you like to accomplish or discover before you retire?

That’s a good question. I would really like to discover what one might call the mother molecule for running the stress response. I would like to discover what the central mechanism is in the brain that triggers the stress response. I would feel happy with discovering that.

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This article by Jacqui Tavis
j.tavis@elsevier.com