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How do you know when you are sick? Sometimes the situation is obvious, but at other times you wonder and worry about the meaning of undifferentiated symptoms you may experience. This experience – the stressful reactions we feel and the emotions, including fear and uncertainty, that arise – is mediated by the brain. What do we know about the interaction of the immune, endocrine and nervous systems? How do these systems work together to create patterns of behavior, in particular those arising when we are ill or when we think we might be ill? This Medical Center Hour reviews how the immune system communicates with the brain and presents evidence that sickness symptoms such as fatigue, depression and "cognitive fuzziness," rather than coming from debilitation, result from an active inhibition of brain regions involved in arousal, mood and emotion. Thus, these sickness symptoms seem to provide an adaptive advantage, at least in the short term. Delineation of the precise mechanisms underlying these sickness symptoms may allow targeted intervention to improve the quality of life for the sick.
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