Psychosomatic medicine in a changing society: Some current trends in theory and research

Psychosomatic Some Current

M e d i c i n e in a C h a n g i n g S o c i e t y : Trends in Theory and Research Z, J . ' L i p o w s k i

H E s c o p e o f p s y c h o s o m a t i c medicine has b r o a d e n e d to a point w h e r e people begin to w o n d e r what the limits of its b o u n d a r i e s a r e . A puzzled o b s e r v e r asks: " H a s p s y c h o s o m a t i c m e d i c i n e a n y limits.'? If so, w h a t and why? If not, h a s the t e r m outlived its u s e f u l n e s s , being n e i t h e r definable nor even d e s c r i b a b l e ? " l T h e s e a r e valid q u e s t i o n s . T h e r e is j u s t i f i c a t i o n in t a l k i n g about the second phase o J ' d e v e l o p m e n t o f o u r discipline, ~ o n e whose growing diversity m a k e s a t t e m p t s at i n t e g r a t i o n difficult but n e c e s s a r y if we a r e to m a i n t a i n its i d e n t i t y and sense o f d i r e c t i o n . T h i s w r i t e r has f o r m u l a t e d a c o m p r e h e n s i v e definition o f p s y c h o s o m a t i c m e d i c i n e reflecting both its scientific and clinical a s p e c t s , z It e x p r e s s e s a conception of o u r field a s one whose main goal is twofold: to strive for a unified t h e o r y of m i n d - b o d y - e n v i r o n m e n t i n t e r r e l a t i o n s ; and to apply w h a t k n o w l e d g e we gain to i m p r o v e the c a r e of the sick, to help p r e v e n t s o m e illness, and u l t i m a t e l y to e n h a n c e t h e q u a l i t y o f h u m a n existence. We do not need to be too c o n c e r n e d with s h a r p d e l i m i t a t i o n o f t h e b o u n d a r i e s o f o u r field. To do so m i g h t lead to prem a t u r e closure on m a n y promising lines of u n o r t h o d o x thought. It would m e a n missing an o p p o r t u n i t y and t h e i n t e l l e c t u a l c h a l l e n g e of c o n s t r u c t i n g a unified t h e o r y from e l e m e n t s supplied by d i s p a r a t e m e t h o d s of o b s e r v a t i o n and e x p l a n a tory s y s t e m s . T o m e e t this challenge, however, an ecologicalperspective m u s t be added to the t r a d i t i o n a l focus o f o u r discipline. As Dubos :~ e x p r e s s e d it, " ' P s y c h o s o m a t i c medicine, c o n c e r n e d p r i m a r i l y with the c a u s a t i o n of o r g a n i c d i s e a s e by m e n t a l d i s t u r b a n c e s , was an o u t g r o w t h of the e n l a r g e m e n t of t h o u g h t b r o u g h t about by the F r e u d i a n r e v o l u t i o n . " He goes on to say t h a t the o b s e r v a t i o n t h a t w h a t h a p p e n s in the mind affects the body and vice v e r s a m a k e s it "'misleading to single out c e r t a i n diseases as having p s y c h o s o m a t i c o r i g i n . . . T h e u n d e r s t a n d i n g and control o f d i s e a s e requires t h a t t h e b o d y mind c o m p l e x be studied in its r e l a t i o n s to e x t e r n a l e n v i r o n m e n t . " "Fhis is also t h e thesis o f the p r e s e n t article. It does not call for rejection of w h a t w a s achieved in the first p h a s e of p s y c h o s o m a t i c medicine, b u t s t r e s s e s a b r o a d e n i n g of t h e whole conception o f the l a t t e r , to include e n v i r o n m e n t a l v a r i a b l e s into o u r t h e o r e t i c a l f r a m e w o r k and r e s e a r c h p r o j e c t s to a m u c h g r e a t e r e x t e n t t h a n b e f o r e J

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P S Y C H O S O M A T I C M E D I C I N E A N D THE S O C I A L E N V I R O N M E N T

It is often a s s e r t e d t h a t f a c t o r s i n h e r e n t in the social e n v i r o n m e n t are no less r e l e v a n t to t h e wall-being o f individuals, to issues of h e a l t h and disease, t h a n t h e b i o l o g i c a l a n d p h y s i c o c h e m i c a l c h a r a c t e r i s t i c s o f the p h y s i c a l e n v i r o n m e n t . T h e validity o f this a s s u m p t i o n is being t e s t e d by r e s e a r c h ,relating specific social factors to p s y e h o p h y s i o l o g i c a l p r o c e s s e s of indi~:iduals and m o r b i d i t y of various social groups. T h i s calls for both individual-oriented and epidemiological studies. From the Department o f Psychiatry, Dartmouth .41edical School. Darmlouth. N. 1f. Z. J. Lipowski, M.D.:.Professor, Departnlent o f Psychiatry. Dartmouth zih,dical School. tlanover. N. H. 03755 © 1973 byGrune & Stratton, Inc. Comprehensive Psychiatry, Vol. 14, No. 3 (May/June), 1973

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P s y c h o s o m a t i c m e d i c i n e has often ignored social variables. In m a n y psychosom a t i c studies the main e m p h a s i s has been on p s y c h o d y n a m i c e x p l a n a t o r y concepts, such as i n t r a p s y c h i c conflicts o f the a p p r o a c h - a v o i d a n c e type a n d the related emotions; a t t i t u d e s ; ego defenses; and a t t e m p t s a t regressive, n o n v e r b a l c o m m u n i c a t i o n utilizing a u t o n o m i c n e r v o u s p a t h w a y s instead o f l a n g u a g e and g e s t u r e . T h e s e p s y c h o l o g i c a l c o n c e p t s h a v e then been causally r e l a t e d to part i c u l a r m o d e s of physiological dysfunction and disease. When t h e social environm e n t was considered by p s y c h o s o m a t i c i n v e s t i g a t o r s , it was o f t e n in a g e n e r a l sense as a source o f d e p r i v a t i o n , t e m p t a t i o n , loss, o r d a n g e r , which elicits specific e m o t i o n a l r e s p o n s e s and their physiological c o n c o m i t a n t s . F u r t h e r , psychosom a t i c r e s e a r c h s e l d o m v e n t u r e d beyond the.f.amilY e n v i r o n m e n t . R e l e v a n t e x p l a n a t o r y h y p o t h e s e s have r e v o l v e d a r o u n d inhibited expression o f d e p e n d e n t needs and c o n s e q u e n t intensification o f i n t r a p s y c h i c conflicts over impulses to express disavowed desires and e m o t i o n s , especially aggression. This methodological a p p r o a c h has yielded i m p o r t a n t o b s e r v a t i o n s but it n e e d s to be s u p p l e m e n t e d by inclusion into our i n q u i r y and t h e o r e t i c a l f o r m u l a t i o n s o f the influence of a whole range o f social variables on psychophysiological processes. W e c a n n o t view c u r r e n t l y p r e v a l e n t p s y c h o d y n a m i c c o n c e p t i o n s as i m m u t a b l e laws o f h u m a n behavior. I n t r a p s y c h i c conflicts, for e x a m p l e , which p l a y e d such a p r o m i n e n t role in p s y c h o s o m a t i c h y p o t h e s e s o f A l e x a n d e r and his followers, m a y well u n d e r g o significant c h a n g e s u n d e r the influence o f c h a n g i n g values and t h e i r i m p a c t o n p s y c h o l o g i c a l d e v e l o p m e n t o f children. C e r t a i n impulses, sexual, dep e n d e n t , o r aggressive, m a y be losing their p e j o r a t i v e c o n n o t a t i o n and the conseq u e n t need for t h e i r ~repression and o t h e r d e f e n s e s against their i n t r u s i o n into consciousness, if not t h e i r o u t w a r d expression. T h u s the most often p o s t u l a t e d unconscious a p p r o a c h - a v o i d a n c e conflicts m a y g r a d u a l l y cease being unconscious, and the expression o f r e l e v a n t impulses m a y lead to conscious, i n t e r p e r sonal conflicts, or even no conflicts at all. And y e t physiological d y s f u n c t i o n s and specific diseases p u r p o r t e d l y d e p e n d e n t on the existence o f such u n r e s o l v e d conflicts continue to develop with no p e r c e p t i b l e c h a n g e in t h e i r incidence. Further, o t h e r psychosocial variables, such as a p p r o a c h - a p p r o a c h , choice and decision conflicts,~ value conflicts, s t a t u s incongruity,'L~ increased r a t e o f social change, d i s s o n a n c e b e t w e e n e x p e c t a t i o n s and g r a t i f i c a t i o n , and a host o f o t h e r c u r r e n t l y prevailing f a c t o r s m a y well s u p e r s e d e the previously m e n t i o n e d p s y c h o d y n a m i c variables as p o t e n t i a l sources o f psychic distress, physiological d y s f u n c t i o n and disease. T h e i r influence may be expressed by non-specific g e n e r a l susceptibility to a n y physio- and p s y c h o p a t h o l o g i c a l processes. It is psyc h o s o m a t i c research in all its aspects- e x p e r i m e n t a l and clinical, h u m a n and a n i m a l , epidemioiogical as well as t h a t focused on unique subjective r e s p o n s e s o f individuals- which should t h r o w light on these questions. T h e f o u n d a t i o n s for this broad a p p r o a c h were laid in t h e m i l e s t o n e s o f p s y c h o s o m a t i c l i t e r a t u r e . "-I~ THE E C O L O G I C A L

DIMENSION

OF P S Y C H O S O M A T I C S

H u m a n ecology has been defined as the study o f the relations b e t w e e n m a n and his envi'ronment, both as it affects him and as he affects it. H To be m e t h o d o l o g i cally useful, however, the ecological dimension o f p s y c h o s o m a t i c s needs to be defined in m o r e specific terms. Both physical and social e n v i r o n m e n t is r e l e v a n t

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to p s y c h o s o m a t i c relationships in f o u r o v e r l a p p i n g ways: (I) as a source of stimulus and i n f o r m a t i o n input; (2) as an i n s t i g a t o r o f g o a l - d i r e c t e d t h o u g h t and action; (3) as a source of stimuli which give rise to s o m a t i c p e r c e p t i o n s ; (4) as a source of f a c t o r s which a l t e r c e r e b r a l .function a n d s t r u c t u r e and thus i m p a i r adaptive c a p a c i t i e s of the individual. Each of t h e s e four a s p e c t s m a y influence psychophysiologicai functioning o f m a n and lead to b e h a v i o r s which i n turn modify the e n v i r o n m e n t . T h e r e is thus a d y n a m i c i n t e r p l a y in t h e m a n - e n v i r o n m e n t s y s t e m w h o s e detailed study is the aim of p s y c h o s o m a t i c r e s e a r c h . Each o f these a s p e c t s of the e n v i r o n m e n t needs f u r t h e r e l a b o r a t i o n for t h e s a k e of clarity. First, e n v i r o n m e n t c o n c e r n s us as a source of i n f o r m a t i o n input in a broad sense. As H i n k l e ~ states: "'A m e a n i n g f u l h y p o t h e s i s about the relation of a m a n to his social and i n t e r p e r s o n a l e n v i r o n m e n t , and the effect of this upon his h e a l t h , m u s t t a k e into a c c o u n t t h e inJbrmation t h a t he receives from this e n v i r o n m e n t , and the way t h a t he evaluates i t " (italics mine). T h u s , the key i n t e r v e n i n g variable h e r e is a cognitive one, n a m e l y subjective i~teaning. T h i s w r i t e r h a s proposed t h a t we m a y distinguish tbur m a j o r c a t e g o r i e s of subjective m e a n i n g of perceived events, situations, and objects. T h e y are: threat, loss, gain (or its promise), and insignificance. ~~ T h e s e c a t e g o r i e s a r e not n e c e s s a r i l y m u t u a l l y exclusive. T h e evaluation and m e a n i n g a r e both conscious and unconscious, and the two m a y be at v a r i a n c e with each o t h e r . It is especially in uncovering the unconscious m e a n i n g o f i n f o r m a t i o n for the individual t h a t p s y c h o a n a l y t i c m e t h o d and t h e o r y c o n t i n u e s to play an i n d i s p e n s a b l e role in p s y c h o s o m a t i c s . T h r e a t , loss and gain a r e classes of m e a n i n g of key i m p o r t a n c e for p s y c h o s o m a t i c r e s e a r c h and theory. T h e y a r e so by virtue of their power to evoke e m o t i o n a l , behavioral, and physiological responses. T h e y a r e also c e n t r a l to the c o n c e p t of psychological s t r e s s and its c o n s e q u e n c e s , w h e t h e r d e s i r a b l e or p a t h o g e n i c . G a i n is linked conc e p t u a l l y with appetitive drives, hopeful anticipation, striving, p l e a s u r e and satiety. T h e r e are o t h e r f e a t u r e s of i n f o r m a t i o n input relevant to p s y c h o s o m a t i c s . T h e y include quantity, novelo', clariO', consistent.r, and attractiveness of inf o r m a t i o n as experienced by its recipients. T h e s e c h a r a c t e r i s t i c s have a t t r a c t e d increasing scientific i n t e r e s t only r e c e n t l y . W h a t c o n c e r n s a p s y c h o s o m a t i c i n v e s t i g a t o r is the p s y c h o p h y s i o l o g i c a i effects of t h e s e variables. W e are especially i n t e r e s t e d in such effects when t h e r e is p e r s o n a l l y e x p e r i e n c e d i n f o r m a t i o n underload or overload, when i n f o r m a t i o n is novel, d i s c r e p a n t o r a m b i g u o u s , or when it elicits appetitive drives beyond the individual's c a p a c i t y for c o n s u m mation. All these situations a r e p o t e n t i a l sources of i n f o r m a t i o n - d e r i v e d s t r e s s with its varied psychological and s o m a t i c c o m p o n e n t s . S e c o n d , social e n v i r o n m e n t i n s t i g a t e s activity at both cognitive and m o t o r levels. This is the d o m a i n of i n t e r p e r s o n a l relationships, of p r e v a l e n t values and n o r m s of behavior, of c o m p e t i t i v e striving and its goals, of f e e d b a c k in the f o r m of r e w a r d s and p u n i s h m e n t s . T h e r e is a growing n u m b e r o f studies a t t e m p t i n g to relate these social v a r i a b l e s to p s y c h o p h y s i o l o g i c a l responses.~'~- ~r T h i r d , e n v i r o n m e n t is a source of s o m a t i c p e r c e p t i o n s . T h e l a t t e r c o n s t i t u t e an internal, s o m a t i c i n f o r m a t i o n input which m a y be endowed with p e r s o n a l meaning. F r o m then on the four c a t e g o r i e s of m e a n i n g m e n t i o n e d e a r l i e r c o m e into play.

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Z. J. L t P O W S K t

Fourtll and last, e n v i r o n m e n t a l f a c t o r s m a y c a u s e c;hanges in the b i o l o g i c a l s u b s t r a t e o f psychic p r o c e s s e s and t h e r e b y a l t e r a p e r s o n ' s h a b i t u a l m o d e s o f perceiving, t h i n k i n g a n d feeling. This is a class o f e n v i r o n m e n t a l f a c t o r s which m a y influence p s y c h o s o m a t i c r e l a t i o n s h i p s without t h e i n t e r p o s i t i o n o f s y m b o l i c stimuli. A p p l i c a t i o n o f this s c h e m a to a c o n c r e t e e x a m p l e o f an i m p o r t a n t c o n t e m p o rary p r o b l e m m a y help to clarify it f u r t h e r . Let us c o n s i d e r pollution o f the physical e n v i r o n m e n t . It m a y affect individuals a n d be r e l e v a n t to psychosom a t i c s in t h e following ways: F i r s t , it gives rise to social c o m m u n i c a t i o n s which a l e r t individuals to the noxious a s p e c t s o f pollution and m a y m a k e t h e m view the e n v i r o n m e n t as p e r s o n a l l y t h r e a t e n i n g . T h e a l e r t e d subject m a y then n o t i c e and i n t e r p r e t c e r t a i n sensory cues, such as color o f the w a t e r o r smell o f t h e air, as subjectively m e a n i n g f u l d a n g e r signals. T h e s e in t u r n m a y m a k e him view his physical e n v i r o n m e n t as alien and p o t e n t i a l l y lethal. It should be feasible to design r e s e a r c h to d e t e r m i n e how this type o f i n f o r m a t i o n affects individuals p s y c h o l o g i c a l l y and physiologically. S e c o n d , i n f o r m a t i o n a b o u t pollution leads to t h e f o r m u l a t i o n o f values, n o r m s and p r o b l e m - s o l v i n g actions r e l a t e d to t h e quality o f the e n v i r o n m e n t as well as to r e l e v a n t social i n t e r a c t i o n s , c o o p e r a t i v e o r hostile. Third, noxious biological, c h e m i c a l , o r physical p o l l u t a n t s m a y c a u s e t i s s u e c h a n g e s . T h e s e in turn m a y give rise to s o m a t i c p e r c e p t i o n s , e.g., o f impaired b r e a t h i n g o r d i a r r h o e a , which b e c o m e endowed with symbolic m e a n i n g in t e r m s of t h e c a t e g o r i e s d e s c r i b e d above. Such a m e a n i n g m a y be both conscious and u n c o n s c i o u s and e v o k e e m o t i o n a l responses with t h e i r physiological conc o m i t a n t s , t h u s giving r i s e to m o r e s o m a t i c p e r c e p t i o n s which in t u r n m a y be int e r p r e t e d as t h r e a t e n i n g . This is an e x a m p l e o f positive f e e d b a c k which magnifies the e m o t i o n a l response to the original s o m a t i c p e r c e p t i o n . F o u r t h , s o m e p o l l u t a n t s m a y bring a b o u t c h a n g e s in the p h y s i c o - c h e m i c a l milieu o f t h e brain and a l t e r its function. It is c l e a r t h a t each o f t h e s e a s p e c t s o f pollution m a y affect a p e r s o n ' s psychophysiological functioning and t h e study of t h e effects of pollution on h u m a n s would be i n c o m p l e t e if any o f t h e s e a s p e c t s was ignored. This m a y serve as a p a r a d i g m o f the p s y c h o s o m a t i c a p p r o a c h to c e r t a i n a s p e c t s o f the physical envir o n m e n t , o r o f the ecological di .rnension o f p s y c h o s o m a t i c s . SOME RELEVANT SOCIAL VARIABLES Information Inputs

It is difficult to d e m a r c a t e s h a r p l y the social and n o n h u m a n e n v i r o n m e n t since the l a t t e r is i n c r e a s i n g l y modified and shaped by h u m a n activity. As t h e above e x a m p l e o f e n v i r o n m e n t a l pollution i l l u s t r a t e s , m a n - m a d e i n f l u e n c e on t h e envir o n m e n t results in s y m b o l i c and physical stimuli both o f which, though by m e a n s o f different p a t h w a y s , m a y result in psychological and physiological c h a n g e s . O u r p r i m a r y c o n c e r n in this section is with the symbolic stimuli, o r information inputs, emaniating from t h e social e n v i r o n m e n t . O n e a s p e c t o f i n f o r m a t i o n r e l e v a n t to p s y c h o s o m a t i c s is quantity of inf o r m a t i o n o r stimulus input. O f m o r e p a r t i c u l a r i n t e r e s t a r e c o n d i t i o n s o f inf o r m a t i o n u n d e r l o a d and o v e r l o a d b e c a u s e o f t h e i r p o t e n t i a l l y d e t r i m e n t a l psy-

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chophysiological effects. A g r e a t deal h a s b e e n l e a r n e d a b o u t s u c h effects o f i n f o r m a t i o n u n d e r l o a d , usually referre~t to as sensory deprivation. K n o w l e d g e a b o u t its effects has been a d m i r a b l y s u m m a r i z e d in a v o l u m e edited by Z u b e k . TM O n e o f the m a j o r t h e o r e t i c a l f o r m u l a t i o n s a t t e m p t i n g to a c c o u n t for the p h e n o m e n a o f s e n s o r y u n d e r l o a d and o v e r l o a d is Z u c k e r m a n ' s t h e o r y o f o p t i m a l level o f stimulation. ~'~ T h e k e y p o s t u l a t e o f this t h e o r y a s s e r t s t h a t every individual has" c h a r a c t e r i s t i c o p t i m a l levels o f s t i m u l a t i o n and a r o u s a l for cognitive and m o t o r activity and positive affective tone. It follows t h a t deviations from the o p t i m a l level for the given individual at the given point in his life cycle a r e likely to result in subjectively u n p l e a s a n t e x p e r i e n c e and some p a t t e r n o f p s y c h o p h y s i o logical d e r a n g e m e n t . T h e s e experiential, b e h a v i o r a l , and physiological r e s p o n s e s m a y be s u b s u m e d u n d e r the t e r m s t r e s s . For s o m e reason studies o f i n f o r m a t i o n o v e r l o a d have lagged behind those o f sensory d e p r i v a t i o n , d e s p i t e t h e i r obvious relevance to the c o n t e m p o r a r y envir o n m e n t in t e c h n o l o g i c a l societies. Miller, ~° a pioneer in this field, d e s c r i b e s m e c h a n i s m s o f a d j u s t m e n t to i n f o r m a t i o n input o v e r l o a d and suggests t h a t it m a y have p s y c h o p a t h o l o g i c a l c o n s e q u e n c e s . He p o s t u l a t e s , for e x a m p l e , t h a t c e r t a i n conditions, such as infection o r t r a u m a , may e x a c e r b a t e s c h i z o p h r e n i c s y m p t o m s as a result o f lowering o f c h a n n e l c a p a c i t y for the inflow o f inf o r m a t i o n , a c a p a c i t y p e r h a p s a b n o r m a l l y low in schizophrenics to s t a r t with. Spitz ~ p r o p o s e d t h a t surfeit of e m o t i o n a l stimuli in i n f a n c y m i g h t have p s y c h o p a t h o g e n i c effects in l a t e r life. Ludwig ~.z:~ r e p o r t s p r e l i m i n a r y results o f the first m a j o r r e s e a r c h project on the effects o f sensory o v e r l o a d on h u m a n subj e c t s . He d e s c r i b e s a l t e r e d s t a t e o f c o n s c i o u s n e s s ( " p s y c h e d e l i c " effects) in 40% of n o r m a l v o l u n t e e r s subjected to two and o n e - h a l f h o u r s o f o v e r l o a d vcith two types of sensory input: light and sound. T h e s e findings seem to s u p p o r t L i n d s e y ' s e a r l i e r a s s u m p t i o n o f c o m m o n f a c t o r s in s e n s o r y deprivation, d i s t o r t i o n and overload, z~ W h a t is still missing, is the study o f selected physiological variables, along with the b e h a v i o r a l and experiential ones, in states o f s e n s o r y overload. Exp e r i m e n t s in which rats were exposed to i n t e n s e sound, light, and m o t i o n stimuli C ' s t r e s s o r s " ) c o n s i s t e n t l y p r o d u c e d significant i n c r e a s e s in s y s t o l i c blood pressure, h y p e r t r o p h y o f the left v e n t r i c l e and evidence o f h y p e r f u n c t i o n o f the a d r e n a l cortex, z-' R e l e v a n c e o f these findings for h u m a n s is u n k n o w n . A most r e c e n t c o n t r i b u t i o n to this field is a study o f G o t t s e h a l k et al. z" It differs in details o f design a n d psychological indices used from L u d w i g ' s s t u d y , but it also p u r p o r t s to i n v e s t i g a t e the effects o f visual and a u d i t o r y s t i m u l u s overload on h u m a n s . T h e significant findings include i n c r e a s e in social aliena t i v n - - p e r s o n a l d i s o r g a n i z a t i o n scores and cognitive i m p a i r m e n t a f t e r e x p o s u r e to o v e r s t i m u l a t i o n . T h e cognitive i m p a i r m e n t c o r r e l a t e d with p r e e x p o s u r e field d e p e n d e n c e scores suggesting g r e a t e r susceptibility o f f i e l d - d e p e n d e n t subjects to cognitive d i s o r g a n i z a t i o n u n d e r sensory, o v e r l o a d . Both Ludwig and G o t t s c h a l k et ai., r e f e r to t h e i r respective e x p e r i m e n t s as involving "'sensory o v e r l o a d . " This t e r m raises the question o f the difference, if any, between c o n c e p t s o f stimulus and i n f o r m a t i o n o v e r l o a d , respectively. T h e f o r m e r c o n c e p t implies q u a n t i t y , the l a t t e r , m e a n i n g . It is q u e s t i o n a b l e , however, if a n y type, intensity, o r p a t t e r n i n g o f sensory stimuli is a n y t h i n g but v a r i a t i o n o f i n f o r m a t i o n input. Even a p p a r e n t l y " ' m e a n i n g l e s s " stimuli, such as white noise o r

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colored lights, m a y a n d a p p a r e n t l y do e v o k e associative t h o u g h t s and i m a g e s in the subject and are, in this sense, p e r s o n a l l y m e a n i n g f u l i n f o r m a t i o n , h o w e v e r i d i o s y n c r a t i c the l a t t e r m a y be. This view m a d e the w r i t e r include this experim e n t a l work u n d e r the h e a d i n g "'information o v e r l o a d . " T h e t e r m s "'inf o r m a t i o n " and " ' s t i m u l a t i o n " h a v e been used i n t e r c h a n g e a b l y here. T h e p o t e n t i a l i m p o r t a n c e o f this budding field of inquiry lies in its r e l e v a n c e to e n v i r o n m e n t a l p s y c h o l o g y , especially p r o b l e m s o f u r b a n e n v i r o n m e n t . T h e l a t t e r has been s t a t e d to c o n s t i t u t e "'a c o n t i n u o u s set o f e n c o u n t e r s with overload, and of r e s u l t a n t a d a p t a t i o n s . ''e7 T h e r e a r e o t h e r situations w h e r e a t l e a s t some individuals will e x p e r i e n c e overload. T h e y include o v e r c r o w d i n g , ~ driving conditions, zs certain o c c u p a t i o n s , ~' e x p o s u r e to various c o m m u n i c a t i o n media, etc. E x p e r i m e n t a l animal r e s e a r c h on the e f f e c t s of crowding led W e l c h z'J to p r o p o s e a t h e o r e t i c a l principle related c o n c e p t u a l l y to t h a t derived from work on s e n s o r y deprivation: t h a t every e n v i r o n m e n t e x e r t s its own c h a r a c t e r i s t i c m e a n l e v e l o f s t i m u l a t i o n which is largely d e t e r m i n e d by social i n t e r a c t i o n and e m o t i o n a l inv o l v e m e n t . T h e m e a n level is reflected in r e t i c u l a r a c t i v a t i o n and e n d o c r i n e secretions, and influences the a n i m a l ' s r e s i s t a n c e to disease, z'J Cassel, a° rev'iewing epidemiological studies o f h u m a n p o p u l a t i o n s , suggests that i n c r e a s e d p o p u l a t i o n density e n h a n c e s the i m p o r t a n c e o f the social environm e n t as a s o u r c e o f stimuli which e v o k e physiological responses influencing g e n e r a l susceptibility to disease. Q u a l i t y o f social i n t e r a c t i o n s and position within the g r o u p seem to be i m p o r t a n t , in addition to the s h e e r q u a n t i t y and novelty o f stimuli. W e thus have converging lines o f evidence which m a y be t e n t a t i v e l y s u m m e d up in the following h y p o t h e s e s : (1) Each individual is c h a r a c t e r i z e d by an o p t h ~ l u m l e v e l o f stimulus o r inf o r m a t i o n input which he can t o l e r a t e and process. This level m a y f l u c t u a t e over time a n d a p e r s o n ' s life-cycle. (2) Each individual has a for him c h a r a c t e r i s t i c and e n d u r i n g stimulus o r inf o r m a t i o n need. This need acts as m o t i v a t i o n a l f a c t o r in seeking o r avoiding (or oscillation between both) a s t i m u l u s level which is c o n s o n a n t with pleasure. T h e r e is s o m e evidence t h a t this need is g r e a t e r in e x t r a v e r t s t h a n i n t r o v e r t s , a°~ (3) Each social e n v i r o n m e n t is c h a r a c t e r i z e d by the m e a n l e v e l o f s t i m u l a t i o n which will affect different individuals a c c o r d i n g to t h e i r individual s t i m u l u s t o l e r a n c e and need. (4) E x t r e m e deviations o f stimulus input result in excessive a u t o n o m i c and cortical a r o u s a l leading to cognitive disorganization, u n p l e a s a n t feelings, and obj e c t i v e d e c r e m e n t in cognitive a n d / o r m o t o r p e r f o r m a n c e . T h i s s t a t e is a form o f p s y c h o l o g i c a l s t r e s s , o n e elicited by excess o r deficiency o f symbolic stimuli. (5) C o n t e m p o r a r y t e c h n o l o g i c a l society provides n u m e r o u s o p p o r t u n i t i e s for a r o u s a l o f stimulus need, its satisfaction, as well as for i n f o r m a t i o n overload. (6) Such r e p e a t e d o r sustained a r o u s a l m a y lead to physiological c h a n g e s as well as b e h a v i o r s e n h a n c i n g t h e s u b j e c t ' s g e n e r a l s u s c e p t i b i l i t y to illness. T h e specific form and severity o f the l a t t e r will be c o - d e t e r m i n e d by intra-individual specific s o m a t i c vulnerability as well as c u r r e n t e n v i r o n m e n t a l noxae. T h e s e h y p o t h e s e s await testing t h r o u g h multidiseiplinary r e s e a r c h . T h e question o f their validation has obvious social and clinical relevance. O n e notes,

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however, t h a t i n v e s t i g a t o r s often c u l t i v a t e their r e s p e c t i v e g a r d e n s while ignoring w h a t goes on o u t s i d e t h e i r t e r r i t o r i a l fence. T h e r e is a host o f s t u d i e s pertainir~g to t h e t o l e r a n c e o f a n d need for s t i m u l a t i o n from e a r l y i n f a n c y to old a g e which await m e a n i n g f u l c o n c e p t u a l i n t e g r a t i o n . K o r n e r at s u m m a r i z e s o b s e r v a t i o n s on n e o n a t e s wla~ch r e v e a l individual differences in the r e s p o n s i v e n e s s to and s y n t h e s i s of s e n s o r y stimuli. T h u s s o m e infants readily b e c o m e o v e r w h e l m e d by o v e r s t i m u l a t i o n u n l e s s a m o t h e r i n g person provides a "'stimulus b a r r i e r . " O t h e r s , by c o n t r a s t , d i s p l a y high s e n s o r y t h r e s h o l d s to all s e n s o r y stimuli and need a g r e a t deal of s t i m u l a t i o n for o p t i m a t d e v e l o p m e n t . K o r n e r p o s t u l a t e s t h a t the m o s t e n d u r i n g c h a r a c t e r i s t i c s o f an individual d e r i v e from his c a p a c i t y to cope with sensor)' stimuli and his individual s t i m u l u s needs. S h e p r o p o s e s t h a t t h e r e a r e two basic r e g u l a t o r y s t r a t e g i e s for dealing with o v e r s t i m u l a t i o n : one a i m e d at d i m i n i s h i n g the s e n s o r y input; t h e o t h e r e m p l o y i n g m o t o r or affective d i s c h a r g e and e x p e r i e n c i n g s t r o n g excitation as ego-syntonic. T h e s e two basic coping s t r a t e g i e s a r e linked to specific ego d e f e n s e s and cognitive s t y l e s which m a y be r e g a r d e d as t h e i r e n d u r i n g c h a r a c terological derivatives. T h e s e basic s t i m u l u s needs and coping s t y l e s m a y be reflected in l a t e r life in behavioral d i s p o s i t i o n s r e f e r r e d to as s t i m u l u s - s e e k i n g , :~ reducing o r a u g m e n t i n g s e n s o r y inputs, :~z i m p u l s i v e n e s s or r e f l e c t i v e n e s s , field d e p e n d e n c e or i n d e p e n d e n c e , as well as o p t i m a l level of s t i m u l a t i o n . T h e s e individual d i f f e r e n c e s m a y also c o - d e t e r m i n e the m o d e s in which d i f f e r e n t s u b j e c t s cope with s t i m u l u s or i n f o r m a t i o n overloads. "~:~-:~W h a t r e m a i n s to be i n v e s t i g a t e d is the physiological r e s p o n s e s which a c c o m p a n y these d i f f e r e n t m o d e s o f coping with o v e r s t i m u l a t i o n and their relevance, if any, to g e n e r a l o r specific d i s e a s e susceptibility. This m a y well e m e r g e as a m a j o r t a s k of p s y c h o s o m a t i c r e s e a r c h in the coming y e a r s . It m a y be a r g u e d t h a t the c o n c e p t of q u a n t i t y of i n f o r m a t i o n is m o r e c o g e n t for e n g i n e e r i n g t h a n psychology. W h e n applied to h u m a n s , q u a n t i t y o f i n f o r m a t i o n can h a r d l y be t e a s e d a w a y from its o t h e r a t t r i b u t e s , e s p e c i a l l y the meanh~g of inf o r m a t i o n for t h e recipient as well as its novelty, c o n s i s t e n c y , etc. T h u s when we talk of i n f o r m a t i o n a l u n d e r l o a d a n d o v e r l o a d we m u s t c o n s i d e r t h e effects o f t h e s e l a t t e r c h a r a c t e r i s t i c s in addition to s h e e r q u a n t i t y . T h e y will be d i s c u s s e d briefly. Novel stimuli i n d u c e the o r i e n t i n g r e a c t i o n . A c c o r d i n g to Sokolov :~-" this reaction includes n u m e r o u s a u t o n o m i c a r o u s a l responses, such as d i l a t e d pupils, i n c r e a s e d blood s u p p l y to t h e head, r e s p i r a t o r y i r r e g u l a r i t y , etc. O n e m a y postul a t e t h a t t h e r e is an o p t i m a l level for such a r o u s a l and t h a t its e x c e s s is stressful. I n c o n s i s t e n c y or a m b i g u i t y o f i n f o r m a t i o n m a y reflect social c h a n g e or, m o r e specifically, the s p r e a d o f d i s c r e p a n t values and g u i d e l i n e s for choice and action. T h e r e is s o m e e x p e r i m e n t a l evidence t h a t i n c o n s i s t e n t o r conflicting i n f o r m a t i o n m a y have a high p h y s i o l o g i c a l l y a r o u s i n g p o t e n t i a l : ~'; P r e v a l e n t v a l u e s influence people's e x p e c t a t i o n s , g o a l s and striving. T h e y influence the q u a l i t y o f i n t e r p e r sonal r e l a t i o n s h i p s a n d have a decisive effect on which social e v e n t s a n d s i t u a t i o n s will m e a n t h r e a t , loss, o r gain, a c h i e v e m e n t or failure, for the individual, and thus p a r t l y d e t e r m i n e t h e p s y c h o p h y s i o l o g i c a l r e s p o n s e to i n f o r m a t i o n received or action u n d e r t a k e n . T o t h e r a'~ gives an o u t s p o k e n a c c o u n t o f the c u r r e n t value crisis in technological societies and the related choice and decision conflicts. T h e

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l a t t e r are closely r e l a t e d to this w r i t e r ' s t h e o r y o f a t t r a c t i v e s t i m u l u s overload. "~ T h e c o n c e p t of " ' a t t r a c t i v e n e s s " in t h i s c o n t e x t r e f e r s to t h e c a p a c i t y o f inf o r m a t i o n to a r o u s e an a p p e t i t i v e s t a t e a n d a p p r o a c h t e n d e n c i e s in t h e recipient. It is p o s t u l a t e d t h a t a t t r a c t i v e i n f o r m a t i o n o v e r l o a d is a h a l l m a r k of affluent s o c i e t i e s with p e r v a s i v e social, p s y c h o l o g i c a l a n d one m a y p r e d i c t , p h y s i o l o g i c a l c o n s e q u e n c e s . O n the o n e h a n d t h e r e is an o v e r a b u n d a n c e o f i n f o r m a t i o n a n d stimuli a r o u s i n g d e s i r e for c o n s u m m a t i o n , at both m a t e r i a l a n d s y m b o l i c levels. T h i s s u r f e i t coupled with a wide range o f a v a i l a b l e o p t i o n s for choice as well as d i s c r e p a n t value s y s t e m s r e s u l t s in a p p r o a c h - a p p r o a c h a n d decision conflicts. S e v e r a l b e h a v i o r a l coping s t r a t e g i e s with this p r e d i c a m e n t h a v e been d e s c r i b e d ? :~ T h e y a r e aimed at a v o i d a n c e or r e d u c t i o n of s t i m u l a t i o n , o r a r e c e a s e l e s s , r e p e a t e d a t t e m p t s at a p p r o a c h a n d c o n s u m m a t i o n . T h e p o o r e x p o s e d to this f o r m o f o v e r l o a d a r e a r o u s e d and e x p e c t a n t b u t u n a b l e to a p p r o a c h t h e p r o f f e r e d a t t r a c t i v e goals for e c o n o m i c r e a s o n s and a r e f r u s t r a t e d . T h o s e e n d o w e d with the e c o n o m i c m e a n s a r e o f t e n h a m p e r e d by p s y c h o l o g i c a l and t e m p o r a l l i m i t a t i o n s for a p p r o a c h b e h a v i o r a n d c o n s u m m a t i o n . F o r t h e m , the decision and choice conflicts a r e a p o t e n t i a l s o u r c e o f f r u s t r a t i o n and d i s c o n t e n t . T h e s e h y p o t h e t i c a l f o r m u l a t i o n s await e x p e r i m e n t a l validation t h r o u g h p s y c h o s o m a t i c r e s e a r c h . T h e only r e l e v a n t s t u d y to d a t e is M a s s e r m a n ' s e x p e r i m e n t ? 7 H e s u b j e c t e d n o r m a l m o n k e y s to i n c r e a s i n g l y difficult choices b e t w e e n n e a r l y e q u a l l y d e s i r a b l e food. A f t e r ten d a y s in the difficult-choice s i t u a t i o n , t h e a n i m a l s d e v e l o p e d n e u r o t i c d i s t u r b a n c e s , such as tics, a g i t a t i o n , d i s t r a c t i b i l i t y , a n d ~ d e s t r u c t i v e n e s s . T h e s e effects w e r e s i m i l a r to those i n d u c e d by a v e r s i v e conflicts. SOCIAL

CHANGE

AND

HEALTH

Dubos:' a s s e r t s t h a t social c h a n g e m a y be a c a u s e of d i s e a s e and t h a t p r e v a l e n t c h r o n i c n e o p l a s t i c and d e g e n e r a t i v e d i s e a s e s a r e "'diseases of civilization," in s o m e way r e l a t e d to affluence. T h i s is a v a g u e g e n e r a l i z a t i o n w h o s e validity m a y only be t e s t e d by i d e n t i f y i n g a n d s t u d y i n g those social f a c t o r s which c a n be related to social c h a n g e in specific a r e a s o f living and linked c a u s a l l y to affluence. H y p o t h e s e s p r e s e n t e d above a r e an a t t e m p t at j u s t such identification o f s o m e r e l e v a n t social v a r i a b l e s . T h r e e m a j o r r e s e a r c h a p p r o a c h e s a t t e m p t i n g to r e l a t e social f a c t o r s to m o r b i d i t y have e m p l o y e d epidemiological, p s y c h o d y n a m i c (individual), and e x p e r i m e n t a l a n i m a l a p p r o a c h e s , r e s p e c t i v e l y . T h e s e a p p r o a c h e s a r e c o m p l e m e n t a r y r a t h e r t h a n m u t u a l l y exclusive. R e p r e s e n t a t i v e e x a m p l e s of t h e s e s t u d i e s a r e provided by t h e w o r k of H i n k l e , H o l m e s , R a h e , a n d o t h e r s on t h e relation b e t w e e n life c h a n g e and g e n e r a l susceptibility to disease; as'~'J t h e w o r k by Engel, S c h m a l e a n d t h e i r c o l l a b o r a t o r s on t h e g i v i n g - u p - - g i v e n - u p c o m p l e x as a c o m m o n s e t t i n g for t h e o n s e t of a n y illness; a" and t h e s t u d i e s by H e n r y et al., o f e f f e c t s o f social s t i m u l a t i o n on h o r m o n a l a n d c a r d i o v a s c u l a r f u n c t i o n s in mice. ~ O n e m a y a r g u e t h a t t h e f o r m e r two t y p e s o f s t u d y reflect the i m p a c t o f the social e n v i r o n m e n t on t h e i n d i v i d u a l ' s value s y s t e m and h i s c o n s e q u e n t e v a l u a t i o n o f life e v e n t s which are, in p a r t at least, an e x p r e s s i o n o f his i n t e r a c t i o n with, s u b j e c t i v e e v a l u a t i o n of a n d his coping with his social e n v i r o n m e n t . T h e i n f o r m a t i o n a l f e e d b a c k f r o m t h e social environm e n t h a s a crucial i n f l u e n c e on m a n ' s s e t t i n g of his g o a l s , definition o f his social role a n d s t a t u s , his a c t u a l b e h a v i o r , a n d his e v a l u a t i o n of h i m s e l f a n d his actions.

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T h e s e f a c t o r s a r e c l o s e l y r e l a t e d to subjective m e a n i n g of social e v e n t s , to w h a t c o n s t i t u t e s social s t r e s s , 4~ to s f z , ~ i n t e g r a t i o n , ~ and o t h e r social v a r i a b l e s w h o s e c a u s a l r e l a t i o n s h i p to affective r e s p o n s e , physiological d y s f u n c t i o n and d i s e a s e h a s been p o s t u l a t e d . R e v i e w s o f the rote of t h e s e f a c t o r s :in two p r e v a l e n t c a u s e s of ,morbidity and mortality., i.e., e s s e n t i a l h y p e r t e n s i o n ~:~ a n d c o r o n a r y h e a r t d i s e a s e r illustrate" this. O n e m a y p o s t u l a t e , for e x a m p l e , t h a t p a r t i c u l a r pers o n a l i t y d i s p o s i t i o n s leading to a behavior p a t t e r n c h a r a c t e r i z e d by u p w a r d social m o b i l i t y and c e a s e l e s s striving in a c o m p e t i t i v e e n v i r o n m e n t offering an overab u n d a n c e o f o p t i o n s and i n c e n t i v e s for striving, m a y r e p r e s e n t a c o n s t e l l a t i o n o f p s y c h o s o c i a l f a c t o r s conducive to t h e d e v e l o p m e n t of c o r o n a r y a r t e r y d i s e a s e . THE ROLE OF N I E D I A T I N G

PHYSIOLOGICAL MECHANISMS

H o w do social stimuli arid t h e p s y c h o l o g i c a l r e s p o n s e s to t h e m d i s t u r b h o m e o s t a t i c m e c h a n i s m s o f the h u m a n o r g a n i s m ? W h a t a r e the physiological p a t h w a y s which i n t e r v e n e b e t w e e n symbolic stimuli a n d c h a n g e s in body cells, t i s s u e s and o r g a n s ? In o t h e r w o r d s , by w h a t m e c h a n i s m s does the i n f o r m a t i o n input from the e n v i r o n m e n t bring a b o u t s o m a t i c c h a n g e s which m a y c o n t r i b u t e to t h e dev e l o p m e n t of d i s e a s e ? T h e s e q u e s t i o n s a r e t h e s u b j e c t of r e s e a r c h c u t t i n g a c r o s s m a n y biological disciplines. U n t i l t h e above q u e s t i o n s a r e a n s w e r e d , p s y c h o s o m a t i c h y p o t h e s e s will r e m a i n only plausible guesses. Y e t p r o g r e s s is e v i d e n t in this difficult a r e a , o n e which h a s c o m e to o c c u p y the c e n t e r of the s t a g e in c u r r e n t p s y c h o s o m a t i c res e a r c h . It would be beyond t h e scope of this a r t i c l e to s u m m a r i z e the vast n u m b e r o f r e l e v a n t studies. O n l y t h e m o s t p r o m i n e n t and p r o m i s i n g lines of investigation will be r e f e r r e d to. T h e m o s t intensive r e s e a r c h a c t i v i t y has c e n t e r e d on n e u r o e n d o c r i n e m e c h a n i s m s , e s p e c i a l l y the role of the h y p o t h a l a m u s , r e t i c u l a r a c t i v a t i n g s y s t e m , the limbic s y s t e m , and t h e . p i t u i t a r y - a d r e n a l axis. T h e r e a d e r is r e f e r r e d to relev a n t c o m p r e h e n s i v e review,;. ~4-53 S o l o m o n h a s p u r s u e d p r o m i s i n g r e s e a r c h on the influence of p s y c h o l o g i c a l s t r e s s on i m m u n e r e a c t i o n s . ~ A r e l a t i o n s h i p between social class a n d a c h i e v e m e n t and striving tbr it on t h e o n e h a n d a n d s e r u m u r a t e levels on the o t h e r , has been proposed. 5~ T h e m a j o r i t y o f the s t u d i e s in question have focussed on p h y s i o l o g i c a l c o r r e lates o f s t r e s s and emotion. Both t h e s e c o n s t r u c t s are not free o f a m b i g u i t y , alt h o u g h L a z a r u s m u s t be c r e d i t e d with bringing s o m e o r d e r into s e m a n t i c c h a o s s u r r o u n d i n g t h e m . 5a O f p a r t i c u l a r i n t e r e s t to our t h e s i s t h a t s y m b o l i c s t i m u l i m a y affect physiological function,; is t h e finding t h a t t h o s e stimuli which a r e subjectively s t r e s s f u l can be d i s c r i m i n a t e d on t h e basis of E E G t r a c i n g s . 54 A N I~TTEMPT A T I N T E G R A T I O N

An a p p r o p r i a t e l y s c e p t i c a l and c a u t i o u s viewpoint widely held a m o n g psyc h o s o m a t i c r e s e a r c h e r s is tha:t to a t t e m p t i n t e g r a t i o n o f p s y c h o s o m a t i c relationships at this s t a g e is both p r e m a t u r e and d o o m e d to failure. T h e r e is y e t a c o g e n t a r g u m e n t t h a t such a t t e m p t s , h o w e v e r i n a d e q u a t e and t e n t a t i v e t h e y m a y be, a r e o f value as t h e y point to m e a n i n g f u l r e l a t i o n s h i p s not noticed b e f o r e and pinpoint g a p s in o u r k n o w l e d g e which s t i m u l a t e f u r t h e r r e s e a r c h . W i t h o u t t h e o r i z i n g , o u r field could h a r d l y a d v a n c e and would likely d i s i n t e g r a t e into a m a s s o f u n r e l a t e d

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o b s e r v a t i o n s and h y p o t h e s e s . T h u s , its p o t e n t i a l for developing a/unified t h e o r y of h u m a n b e h a v i o r as well as its clin'ical applicability would be impeded. T h e following a t t e m p t at an i n t e g r a t i v e s u m m a r y o f the precedm~g d~scussion may serve as a c o n c e p t u a l f r a m e w o r k , t e n t a t i v e and i n c o m p l e t e , br(hging t o g e t h e r the p s y c h o s o m a t i c and e c o l o g i c a l d i m e n s i o n s o f h u m a n p s y c h o b i o l 6 g y . M a n s social e n w r o n m e n t ~s a source o f s y m b o l i c stlmuh,/that is, e v e n t s and situa.tions which impinge o n individuals as i n f o r m a t i o n . T h e l a t t e r is p r o c e s s e d at t h e psychological level o f o r g a n i z a t i o n and endowed with ~ u b j e c t l v e : m e a n i n g , conscious and unconscious. T h e n a t u r e o f the m e a n i n g i T d e t e r m i n e d by the p e r s o n ' s individual c h a r a c t e r i s t i c s , i n n a t e and learned, endui-ing a n d c u r r e n t . Dep e n d i n g on the way in w h i c h =information is evalua.ted by t h e subject, it sets off affective and p s y c h o m o t o r r e s p o n s e s as well as physiological c h a n g e s which p r o v i d e f e e d b a c k m o d i f y i n g the cognitive processes wh;ereby i n f o r m a t i o n is e v a l u a t e d . T h e s e activities a r e studied by p s y c h o l o g i c a l o b s e r v a t i o n m e t h o d s and expressed in s t a t e m e n t s , descriptive and t h e o r e t i c a l , c o u c h e d in the l a n g u a g e o f psychology, the person language. All these p r o c e s s e s ~are s u b s e r v e d by t h e activity of the c e n t r a l n e r v o u s s y s t e m . E x t e r n a l stimuli ul,~dergo s c r e e n i n g at the level o f the reticular a c t i v a t i n g system which serves an akousing f u n c t i o n for cerebral c o r t e x a n d p r e p a r e s it for r e c e p t i o n o f specifier s t i m u l u s input and its processing. S o m e o f the incoming stimuli m a y set off impulses t r a n s m i t t e d f r o m the cell assemblies in t h e r e t i c u l a r a c t i v a t i n g s y s t e m to the limbic s y s t e m and the h y p o t h a l a m u s , and by a c t i v a t i n g t h e s e s t r u c t u r e s b r i n g / a b o u t e m o t i o n a l a n d aut o n o m i c arousal. T h e l a t t e r results in affective t o n e a~s well as n e u r o e n d o c r i n e activities which lead to a h o m e o s t a t i c c h a n g e whose p a t t e r n is p a r t l y d e t e r m i n e d by individual and p a r t l y by s t i m u l u s - b o u n d r e s p o n s e sFJecificity. Affective and aut o n o m i c a r o u s a l a p p e a r s to be achieved by both cortical and s u b c o r t i c a l activity which function as an i n t e g r a t e d whole. A s y m b o l i c / s t i m u l u s may t h u s lead to affective and physiological c h a n g e s both t h r o u g h evdluative, cognitive p r o c e s s e s o f the c e r e b r a l cortex, and by the d i r e c t outflow of:impulses from the r e t i c u l a r a c t i v a t i n g s y s t e m to neural s t r u c t u r e s controlling/hil bodily processes. T h e pattern o f physiological c h a n g e s induced by the c e n t r a i n e r v o u s s y s t e m ' s i n t e g r a t i v e activity m a y give rise to s o m e s t h e t i c perception~s, t h a t is f e e d b a c k which in turn a u g m e n t s o r inhibits the activity of cortical and s u b c o r t i c a l n e u r a l s t r u c t u r e s . T h e result at the psychological level o f a b s t r a c t i o n involves modification o f the inf o r m a t i o n processing, planning o f action a n d readiness .for and d i r e c t i o n o f t h e m a n i f e s t behavior. T h e s o m e s t h e t i c p e r c e p t i o n s elicited by t h e m o t o r and secretory activity provide s o m a t i c i n f o r m a t i o n input which m a y be endowed with a n y o f t h e subjective m e a n i n g s m e n t i o n e d before. Both e x t e r n a l a n d s o m a t i c inf o r m a t i o n inputs a r e e v a l u a t e d in the light of individual's a c c r u e d learning, his values, goals and m o i i v e s . T h e s e c o n t r i b u t e the third i n f o r m a t i o n i n p u t in the form o r m e m o r i e s , i m a g e r y , fantasies, and d i r e c t e d t h o u g h t s . T h e o u t c o m e , o f the processing o f these i n f o r m a t i o n inputs, t h e i r respective subjective m e a n i n g s and related affeetive ¢ , , c o m i t a n t s , is a p a t t e r n o f physiological a r o u s a l m e d i a t e d by n e u r o e n d o c r i n e re:~ ",ting m e c h a n i s m s . I f such an a r o u s a l exceeds, by v i r t u e o f its i n t e n s i t y a n d / o r d u r a t i o n , the p e r s o n ' s a d a p t i v e c a p a c i t y , then a s t a t e o f g e n e r a l ~;usceptibility to illness m a y ensue. This s t a t e m a y be viewed as t h e final c o m m o n path for psychological stress. W h e t h e r an illness follows and what form it t a k e s , frill then d e p e n d on additional factors, i n h e r e n t in the person and his en•

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q i r o n m e n t . T h e s e f a c t o r s i n c l u d e specific i n d i v i d u a l p r e d i s p o s i t i o n , i n n a t e o r acq u i r e d , to r e s p o n d with d y s f u n c t i o n o f a g i v e n o r g a n o r t i s s u e a s well as o n t h e p r e s e n c e , o f p h y s i c a l , c h e m i c a l o r biologic~/t n o x a e w i t h i n t h e o r g a n i s m o r i m p i n g i n g o n it f r o m o u t s i d e . A n a d d i t i o n a l set o f d e t e r m i n a n t s i n c l u d e s t h e effectiveness of the subject's psychobiological defense mechanisms and the degree of s u p p o r t h e r e c e i v e g f r o m his social m i l i e u . It" biological., p s y c h o l o g i c a l , a n d social d e f e n s e s a n d s u p p o r t s fail, o r t h e i n d i v i d u a l e n g a g e s in b e h a v i o r i n c r e a s i n g his illness s u s c e p t i b i l i t y , an o r g a n i s m i c s'tate c a l l e d d i s e a s e follows. T h e l a t t e r , implies f a i l u r e o f a d a p t i v e c a p a c i t y at s o m e level o f o r g a n i z a t i o n f r o m t h e m o l e c u l a r to t h e s y m b o l i c . O n c e d i s e a s e d e v e l o p s , a n e w set o f p s y c h o s o c i a l a n d .physiol o g i c a l p r o c e s s e s is set into m o t i o n w h i c h i n f l u e n c e t h e course.~and o u t c o m e - o f e v e r y d i s e a s e . It i s a t th~s p o i n t t h a t a c o m p r e h e n s i v e diagnosi's':a~nd m a n a g e m e n t w h i c h t a k e c o g n i z a n c e o f ' t h e p a t i e n t ' s p s y c h o l o g i c a l , social a n d b i o l o g i c a l liabilities, s t r a i n s a n d s t r e n g t h s m a y b e a p p l i e d in t h e Service o f o p t i m a l r e c o v e r y a n d r.eh a bilita tion. T h e t a s k o f p s y c h o s o m a t i c m e d i c i n e is t h r e e f o l d : F i r s t , t o b r e a k d o w n t h e e n o r m o u s c o m p l e x i t y o f t h e a b o v e p r o c e s s e s into c o n c e p t u a l l y t r a c t a b l e a n d resea:rchable i n t e r r e l a t i o n s h i p s a m o n g s e l e c t e d social, p s y c h o l o g i c a l a n d b i o l o g i c a l v a r i a b l e s . This is a n a n a l y t i c a p p r o a c h . S e c o n d , t o i n t e g r a t e t h e d i v e r s e e l e m e n t s o f e m p i r i c a l k n o w l e d g e to f o r m u l a t e h i g h e r o r d e r g e n e r a l i z a t i o n s a b o u t e n v i r o n m e n t - m i n d - b o d y t r a n s a c t i o n s . This is a s y n t h e t i c a p p r o a c h . A n d t h i r d , to t r a n s l a t e t h e k n o w l e d g e so g a i n e d i n t o g u i d e l i n e s for clinical a c t i o n : p r e v e n t i v e , t h e r a p e u t i c , a n d r e h a b i l i t a t i v e . T h i s is t h e a p p l i e d , p r a c t i c a l a p p r o a c h o f d i r e c t r e l e v a n c e to m e d i c i n e . N e i t h e r o f t h e s e t h r e e a p p r o a c h e s c a n b e d i s p e n s e d w i t h if . p s y c h o s o m a t i c m e d i c i n e is to r e m a i n a v i a b l e a n d p r a c t i c a l l y useful field o f knowledge. ,CONCLUSIONS

T h i s a r t i c l e c o n t i n u e s t h e s e r i e s o f p a p e r s in w h i c h t h e w r i t e r h a s a t t e m p t e d to d e l i n e a t e s a l i e n t i s s u e s in c o n t e m p o r a r y p s y c h o s o m a t i c m e d i c i n e : i n v e s t i g a t i v e , clinical a n d t h e o r e t i c a l , e- ~4..~.~-zr T h e focus o f t h e presenii: p a p e r is o n a r e l a t i v e l y n e g l e c t e d asrmct o f t h e field, o n e w h i c h m a y b e c a l l e d its ecological dimension. M o r e specifically, a set o f p o s t u l a t e s is p u t forth to u n d e r s c o r e t h e v a r i o u s asp e c t s o f i n f o r m a t i o n o r s t i m u l u s o v e r l o a d as a class o f v a r i a b l e s l i n k i n g c o n c e p t u a l l y m a n ' s social e n v i r o n m e n t with his p s y c h o p h y s i o l o g i c a l f u n c t i o n i n g . I n f o r m a t i o n is s e e n as a h e u r i s t i c a l l y u s e f u l c o n c e p t for p s y c h o s o m a t i c f o r m u l a tions a n d r e s e a r c h o n t h e i m p a c t o f social e v e n t s a n d c h a n g e o n p s y c h o l o g i c a l a n d p h y s i o l o g i c a l p r o c e s s e s c o d e t e r m i n i n g h e a l t h and illness. It is a t e n t a t i v e a t t e m p t t o a d d a n e w p e r s p e c t i v e to p s y c h o s o m a t i c t h e o r y a n d i n t e g r a t e it into t h e m a i n b o d y o f its h y p o t h e s e s r e l a t i n g t h e p s y c h o l o g i c a l a n d biological f a c t o r s w h o s e int e r p l a y d e t e r m i n e s h u m a n b e h a v i o r a n d f u n c t i o n s at all l e v e l s o f o r g a n i z a t i o n , f r o m t h e m o l e c u l a r to t h e s y m b o l i c . N o c l a i m is m a d e t h a t i n f o r m a t i o n is t h e o n l y r e l e v a n t v a r i a b l e . T h e a u t h o r d o e s a s s e r t , h o w e v e r , t h a t it h e l p s to i d e n t i f y specific a s p e c t s o f o u r social e n v i r o n m e n t a n d l e n d s i t s e l f to f o r m u l a t i o n o f t e s t a b l e h y p o t h e s e s . T h e i r u l t i m a t e r e s u l t is h o p e d to l e a d to g u i d e l i n e s for p r a c t i c a l a c t i o n a i m e d at p r e v e n t i o n o f s o m e p o t e n t i a l l y p a t h o g e n i c a s p e c t s o f a t e c h n o l o g i c a l s o c i e t y w h i c h e x e r t t h e i r e f f e c t s on t h e i n d i v i d u a l s t h r o u g h t h e m e d i u m o f s y m b o l i c , m a n - m a d e stimuli.

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Z, J. LIPOWSKI

SUMMARY

This article f o r m u l a t e s the ecological dimension o f psychosomat,ic m e d i c i n e and s t r e s s e s its indispensability for a c o m p r e h e n s i v e conception and further development o f the latter. S p e c i a l e m p h a s i s is laid on various a s p e c t s o f information input overload as a paradigm o f current s o c i a l c h a n g e relevant ~o psychophysiological functioning o f individuals in technological societies and to issues o f health and disease. An a t t e m p t is also m a d e to outline a c o m p r e h e n s i v e theoretical framework integrating growing diversity o f trends in research, e x p e r i m e n t a l and clinical, pertinent to the central concern o f p s y c h o s o m a t i c s : the interrelations h!l~s o f psychological, biological and social variables .as they influence health .and d i s e a s e . It is argued that this integrationist approach e n h a n c e s t h e dual social role o f psychosomatics: to strive for a unified theory o f man in a changing social e n v i r o n m e n t , and to work out practical guidelines for preventive and remedial action applicable :to medical practice. REFERENCES

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