Social Stress

Sol Levine

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138533028
• eBook ISBN: 9781351489485
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Physicians are not alone in their concern with stress. Other professionals, such as psychologists and social workers, invoke stress to explain social pathology, for example, alcoholism, suicide, and drug abuse. They are joined by additional individuals in implicating stress in the development of disease. Indeed, conventional wisdom has long noted that to worry, be tense, or take things hard, is to increase one's vulnerability to disease.

Sol Levine and Norman A. Scotch argue that whether the focus upon stress is in its origins and its management, or upon its relationship to individual pathology and behavior, it is necessary to appreciate its complexity and its various dimensions. In particular, they discuss and answer the following common questions: To what extent do various work and organizational settings engender stress for various occupants? To what degree does upward and downward social mobility create stress? What are the effects of family disruptions—death, divorce, or desertion—upon the psychological state of the individual?

This book presents a clear and comprehensive picture of the phenomena encompassed within the conceptual rubric of stress and to explicate such specific levels or dimensions as the sources of stress, its management, and its consequences. The contributors are top researchers from the fields of sociology, anthropology, psychology, and medicine. They include Sydney H. Croog, Edward Gross, Barbara Snell Dohrenwend, Bruce P. Dohrenwend, Richard S. Lazarus, Andrew Crider, John Cassell, E. Gartly Jaco, James E. Teele, Robert Scott, and Alan Howard. The work concludes with a statement by the editors summarizing the data and themes that are presented throughout the work. This work should be read by all individuals. In particular, it will be invaluable for sociologists, psychologists, and professional social scientists.

PART ONE
Introduction

1. Social Stress

Sol Levine and
Norman A. Scotch

WHEN a man suffers a coronary heart attack or other acute life-threatening episode, the alert physician providing medical care almost invariably attempts to collect a social as well as a medical or physical history. In particular the physican is interested in any evidence that the patient has experienced “unusual psychological trauma or distress.’ But he is rarely quite sure what to do with such information. Should the patient recover, the physician may very likely caution him to “try to avoid” psychological upsets in the future, even though both physician and patient know how difficult it is to avoid the stress so often built in to the lives of members of modern society. Even in the absence of reliable, systematic data, many distinguished physicians believe that some sort of social or psychological threat or insult, which for the moment we may term stress, contributes to the risk of developing heart disease, and indeed any number of other serious and trivial diseases. While there are some physicians who maintain considerable skepticism regarding stress, few rule it out altogether as important in contributing to disease.

Sol Levine is chairman and professor, and Norman A. Scotch is professor, Department of Behavioral Sciences, The Johns Hopkins School of Hygiene and Public Health. They are co-editors of this volume.

Physicians are not alone in their concern with stress. Other professionals, such as psychologists and social workers, invoke stress to explain social pathology, for example, alcoholism, suicide, and drug abuse. They are joined by many lay people (whatever their experience or sophistication regarding health and illness) in implicating stress in the development of disease. Indeed, conventional wisdom includes the notion that to worry, or to be tense, or to take things hard, is to increase one’s vulnerability to disease.

The Nature of the Evidence

At least five major kinds of evidence can be identified that support the notion that stress is related to and even contributes to physiological dysfunction, disease, mental disorder, and socially pathological behavior. The five types of supporting evidence are: (1) clinical impressions, (2) laboratory studies, (3) variation in prevalence of the “disorder,” (4) empirical, epidemiological studies, and (5) “logic and common sense.” Let us briefly examine each of these.

1. Clinical impressions. From time immemorial, it seems, physicians have observed that patients suffering from different diseases appear to have special life histories, peculiar vulnerabilities, or distinctive personalities. In addition, episodes of physical illness often seem preceded by situational “shocks,” such as the loss of a job or the death of a loved one. These same histories, vulnerabilities, and personalities have also been noticed among the mentally ill and the socially deviant. These observations have led some to take the next step and to study and record these special characteristics. The medical literature is filled with retrospective case studies of patients suffering a particular disorder and possessing this or that personality characteristic. Much of this literature has been based on small numbers of patients, often less than twenty or even ten.

Despite the insights and suggestive value of some of these studies, by far the majority fail to pass the minimal requirements of scientific inquiry. Rudimentary scientific procedures—sampling, controls, etc., —are nearly always violated. It would not be easy to dispose quickly of decades of observations by thoughtful and intelligent men, were it not that these observations are often at odds with one another, and the characteristics alleged to be associated with one disease by one practitioner are conspicuously ignored by another. At best, this class of evidence remains suggestive.

2. Laboratory studies. Dating back to Selye’s brilliant and trail-blazing studies of the effects of stressful stimuli on laboratory animals, there have been hundreds of inventive experiments on human and animal subjects demonstrating that both the threat and the actual use of either psychic or physical stressors produce physiological reactions in vital organs. Indeed, it was Selye who first brought the concept of stress and its concomitant general adaptation syndrome (GAS) into prominence (Selye, 1956). It is simple to alter the vital signs of a human being (e.g., blood pressure, heart beat) in the laboratory; the stimuli necessary range from relatively mild physical stimuli such as electric shocks and immersion of hands in ice water to psychological fear of failure or group disapproval. Indeed, almost every physician has observed that the simple psychological “threat” of the taking of blood pressure of a patient “causes” the pressure to rise. Almost invariably, as the patient becomes more familiar with the experience and presumably less threatened, there is a subsequent drop in pressure reading as it is taken at five-minute intervals. Accordingly, the second reading is generally lower than the first, a third lower than the second, until a plateau is reached.

Closely related to this class of data are the findings that have emerged from studies of natural disasters. Studies conducted of soldiers entering combat (Ehrstrom, 1945) have revealed increases in blood pressure and other vital signs associated with Selye’s GAS, and other studies indicate that the prevalence of hypertension increases for civilians under war-time conditions (Graham, 1945).

All of these studies offer consistent support to the belief that both artificial and real stresses lead to alterations in body state involving preparation for “fight” or “flight.” Nevertheless, a number of questions remain unanswered. There is the problem, for example, of to what degree artificial laboratory stresses tend to be milder than those encountered in real life. To overcome laboratory distortion, sophisticated monitoring devices are currently being developed to track changes in bodily functioning of the individual as he carries on his “normal” daily activities.

One general question posed by both laboratory and natural disaster studies is, “How permanent are bodily changes that are caused by temporary stresses?” Very little is known in this area. More specifically, “What is the relation of temporary rises in blood pressure to the development of hypertensive heart disease?” Theories abound but factual data are scarce.

3. Variations in prevalence. The distribution of virtually all physiological or behavioral “disorders” varies by social as well as biological characteristics. It is difficult to think of a single disorder —from cancer and asthma to drug addiction and juvenile delinquency —that does not distribute unequally among different segments of the population. Even seemingly pure biological criteria for grouping populations such as age and sex have powerful psychological and social concomitants. Thus cancer, heart disease, tuberculosis, juvenile delinquency, suicide, alcoholism, and homosexuality vary by country, region, ethnic group, religion, age, sex, social class, and other social parameters.

Differential prevalence of a disease or differential distribution among various social groups should provide some general clues for ascertaining etiology and the possible effects of stress. For example, when we find that economically deprived persons suffer from an unusually high prevalence of nutritional disorders, it is easy to hypothesize that lack of money leads to lack of food, or that persons without money are often without education and are therefore unlikely to be familiar with the notion of a balanced diet. In the case of chronic diseases, similar reasoning may be employed. If we find among a group of high-level business executives that those with only a high school education have a higher prevalence of coronary heart disease than those with a college education we have to ask, “Why the discrepancy?” (Hinkle and others, 1968). An answer might be postulated in terms of the stresses associated with “role incongruence,” implying that a high degree of social mobility entails considerable psychological costs. Executives who have only a high school education often have to deliberate whether their behavior is correct (are they using the proper fork at dinner? are they talking correctly to the president of a firm?, etc.), unlike the college graduate who has presumably learned his etiquette at an earlier age and finds it and all aspects of life at the top considerably less disruptive and threatening.

It is frequently found that there are demographic variations in the prevalence of disorder. Urban areas often exhibit a higher prevalence of a particular condition (e.g., hypertension) than rural areas. A frequent interpretation of this phenomena is to assume that stress is associated with the development of hypertension, and then to reason that stress is associated more with urban than with rural living. It is not difficult to make a convincing argument and to conclude tautologically that stress increases hypertension. Example: more hypertension in the city. More stress in the city; evidence: overcrowding, noise, greater competition, etc. Therefore: more stress, more hypertension. The trouble with this kind of reasoning is that it is often just as easy to “prove” the opposite. Example: “We found a mistake in our data. Actually the prevalence of hypertension is higher in rural than in urban areas.” Long pause. “Well,” it will then be argued, “there is actually more stress in rural areas.” Evidence: great social isolation in the country, anxiety brought about by the lack of medical care facilities, lack of anonymity and privacy, and the punitive nature of gossip and social control. Only a lack of an imagination limits the extent to which social conditions found to be associated with a disorder can be interpreted as being stressful. One conspicuous example in this regard is the higher prevalence of hypertension among Negroes (Comstock, 1957; Geiger and Scotch, 1963; Scotch and Geiger, 1963). It can easily be reasoned that since Negroes have greater stress than do whites, they therefore experience higher prevalence of hypertension, but closer examination enables us to take a more circumspect position on the kinds of possible relationships that may actually exist between social stress and a particular disorder. It has been found consistently that Negroes do, indeed, have a higher prevalence of hypertension than do whites. The question that immediately must be posed is: In what ways do Negroes differ from whites? Heredity, diet, constitution, and the “quality” of their lives are primary differences. Finding differences between the races means that the epidemiologist must collect data that will permit more refined observations and, it is hoped, testable hypotheses. In comparing the lives of Negroes with whites, it is hard to refute the observation that Negroes do indeed suffer from greater stress than whites. Differential treatment and experience of Negroes in a whole range of American institutions would tend to support this. We can agree that Negroes suffer from more stress experiences and also have a higher prevalence of hypertension. Unfortunately it is at this point that epidemiologists —at least until recently—have failed to pursue the question and to test the relationship of stress experiences to the development of hypertension, or to demonstrate a dynamic association between the two.

The hypothesized relationship between stress and hypertension, then, may be a promising starting point, but it is only a starting point. If an investigator could devise measures of stress applicable to a Negro population and then determine whether or not highly stressed Negroes had significantly more hypertension than those with less stress, especially if constitution and diet could be held constant, the proposition that stress is related to hypertension would be supported. The same type of investigation should, of course, be conducted for whites, or for specific ethnic groups. In addition, we should have to distinguish between types of stress (e.g., episodic versus chronic) or between life areas in which stress may be present (e.g., work, family, social relations) and ascertain whether variations in stress have differential relationships to hypertension. Only by pursuing the leads presented by differential prevalence can real progress be made.

4. Epidemiological studies. Epidemiological studies attempt to go beyond the casual observation and impressionistic interpretation of gross relationships; they are more purposively designed, more systematically executed, and more rigorously analyzed. In the past few years there has been a small but growing number of epidemiological studies that have produced on accumulating body of evidence linking stress to disorder. For example, studies of accountants at tax deadlines, students at examination time, and Pentagon officials about to testify before congressional committees indicate significant changes in blood pressure, cholesterol values, and blood-clotting time. Among the various other investigations that form an increasing body of evidence in this area are the studies of heart disease among lawyers, the studies of personality and heart disease by Jenkins, Rosenmen, and Friedman (1968), and others by Rosenmen and associates (1968), and the work by Syme and others on social mobility and hypertension.

These studies represent a significant advance over previous studies in that they begin to offer specific clues to the dynamic relationship between stress and disease. They provide some information concerning the differential “power” of stress, as indicated by personality and social group membership, in affecting the status and behavior of human populations.

5. Logic and common sense. For some observers the question should not be, “Does psychosocial stress lead to disorder?” To them the existence of a relationship is obvious. Who has not under moments of considerable stress experienced a pounding heart, a racing pulse, perspiration, or the urge to urinate? If a person experiences stress chronically or frequently, will not his heart “pound” and his pulse race more than others? How long can this continue without causing physiologic alterations and, finally, morbidity and mortality? Proponents of this position do not feel impelled to demonstrate that a relationship does indeed exist.

If membership in particular social groups with particular cultural beliefs and practices influence how people behave, what they think and what they perceive, it stands to reason, those who hold this position argue, that social events will have some effect on physiology, whether or not this will be mediated through mental processes. The position is exemplified in the following statements from students of different fields.

Disease and its treatment are only in the abstract purely biological processes. Actually such facts as whether a person gets sick at all, what kind of disease he acquires and what kind of treatment he receives depend largely upon social factors (Akerknecht, 1947).

Religion, philosophy, education, social economic conditions—whatever determines a man’s attitude towards life —will also exert great influence on his individual disposition to diseases and the importance of these cultural factors is still more evident when we consider the environmental causes of disease” (Sigerest, 1943).

If it is granted that physical, social and cultural factors combine to make a man a whole person, it is equally imperative to consider their potential effects in his undoing, whether this takes place through illness, accidents, or other illfated happenings” (Simmons and Wolff,...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Table of Contents
• Publisher’s Note
• Preface
• PART I. INTRODUCTION
• PART II. SOURCES OF STRESS
• PART III. CONSEQUENCES OF STRESS
• PART IV. CONCLUSIONS AND IMPLICATIONS
• Index