[2] Science and the Socio-Cultural History of Stress

Welcome to Part II in my three-part series on Stress and the Medicalization of Life. Stress as a cultural model has its own socio-cultural history. This means that it has a social life and a past, like any other cultural concept. It is not simply a facet of human physiological reality – an objective fact discovered and elaborated by scientists. It is a creation specific to a culture, a place, and a time. The way we use the word stress today is of relatively recent origin; stress as a cultural model has a shallow socio-cultural history. Although the word stress was loosely associated with ill health by ordinary people during the 19th and early 20th centuries, it rarely appeared in the psychiatric and psychological literature until after W.W.II (Pollock 1988: 381). Medical historian Anne Harrington (2008) credits two men with the term stress as we use it today. The first is Walter B. Cannon (1871-1945), the Harvard physiologist best known for inventing the concepts of “homeostasis” and the “fight or flight response.” The second is Czech-born endocrinologist Hans Seyle (1907-1982), whose research and subsequent media campaign made stress the household word it is today.


 Linking Emotions, Physiology, and Illness
Walter B. Cannon

Walter B. Cannon

W.B. Cannon was interested in the physiological responses produced by our emotional reactions to experiences (Pollock 1988). This interest developed out of his research into peristalsis (how food moves through the digestive tract). Cannon discovered that peristalsis was inhibited in his subjects (mainly domestic cats) whenever they became enraged or distressed (Harrington 2008). Because of this discovery he began to question why and how emotions and digestion might be related. To find out, he developed a new experiment that involved placing cats in ‘safe cages’ and then bringing in dogs to sniff and bark at them. He found that cats threatened in this way generally had higher levels of the hormone adrenaline in their blood samples. It was already known at the time that animals injected with adrenaline showed a particular physiological response that included increases in blood pressure and blood sugar, pupil dilation, inhibited digestion, and piloerection (hair standing on end). No one understood, however, why these particular physiological changes appeared to be associated with emotional arousal (Harrington 2008: 146). To explain the connection Cannon drew on a Darwinian perspective and adaptation to develop a model he called the ‘fight or flight response’ (Pollock 1988, Harrington 2008).

Cannon theorized that all of the physiological responses induced when a cat feels threatened help it to either fight or flee its adversary. The fight or flight response involved mobilizing physiological resources to a heightened state that improved the animal’s chances of fighting or fleeing its enemy. Assuming the animal overcame the threat (and escaped being another critter’s breakfast), its physiology would return to a normative state natural to the species. Cannon termed this physiological regulatory process ‘homeostasis’.

Cannon’s next move was key to the subsequent development of the modern concept of stress: he extended his model to human beings (Harrington 2008: 146-47). Where he made his real leap was in suggesting that the daily experiences of modern life chronically stimulated the fight or flight physiological response in people, preventing the homeostatic systems from returning physiology to a resting state. Cannon speculated that chronic emotional arousal following crises, or just the everyday pressures of modern life, could be a direct cause of illness in people (Pollock 1988: 384). Yet, Cannon generally didn’t use the word stress in the way we use it today to describe the uniquely pathogenic (disease-causing) nature of modern life (Harrington 2008: 148).


Inventing the Mechanical Model of Stress
Hans Seyle

Hans Seyle

Common use of the word stress originated in laboratory research conducted in 1935 by Hans Seyle (Harrington 2008, Viner 1999, Pollock 1988). In his experiments, Seyle exposed rats to adverse environmental conditions, like temperature extremes over long periods, and then measured their physiological responses. Seyle found that if the rats survived long enough a typical combination of physiological changes would result: adrenal hyperactivity (over-production of cortisol; what today we know as the primary ‘stress hormone’), atrophy of the lymph nodes, and peptic ulcers (Seyle 1936, 1976). He believed that a common factor or force existed across the environmental conditions to which he exposed his rats and that this force accounted for the combination of physiological changes he had measured. In the model Seyle developed based on his early research, stress referred to the generalized response of the organism to environmental demands. This response is an innate physiological mechanism that prepares the organism for action in the face of threats to survival (Helman 2014).

Seyle’s model, which he termed the General Adaptation Syndrome (GAS), clearly built upon the fight or flight response and homeostasis concepts developed earlier by Cannon (Harrington 2008). In the GAS model, Seyle used the term “stressors” to refer to any environmental influence that produces a combination of physiological changes in the rat body, which he called “the stress response.” In his experiments, stressors included things like exposing rats to temperature extremes, forced exercise in mechanical wheels over long periods, and sewing their eyelids open and then subjecting them to continuous bright light (Harrington 2008). The GAS model laid out the stages in an organism’s physiological response to stressors. The first stage of the response (the alarm reaction) included the initial physiological response to the stressor or force applied to the organism. In the second stage (the resistance or adaptation stage), the organism adjusted to the physiological condition and used this response to cope with the stressor (to fight or flee in the wild). Also, in this stage, the physiological reaction reversed and the body returned to normal (homeostasis), assuming the stressor was removed. The organism also recovered with increased resistance to the original stressor. The third stage (the exhaustion stage) occurred only if the stressor was continuous. If the stressor persisted, the organism’s physiological reaction to the stressor would also persist. If homeostasis was not restored the organism would develop pathologies (disease) and ultimately suffer a premature death (Harrington 2008, Helman 2014, Pollock 1988).

Although they may seem quite similar, there are some important differences between the models developed by Cannon and Seyle. Cannon’s model was about the way emotion mediates between an organism’s physiological response to threats in the environment and illness. Seyle’s model was about a mechanical, non-specific physiological response to an external common factor (any kind of physical damage). Seyle’s stress response did involve emotion, but it wasn’t defined by it (Harrington 2008: 148). His model was much more mechanistic than Cannon’s. Seyle intentionally borrowed the mechanistic approach to stress common in physics and engineering at the time and translated it into the world of biology (Pollock 1988).

test-214185_640Like Cannon before him, Seyle could not resist the urge to apply the GAS model to the experiences of modern humanity. He believed that his experiments explained the prevalence of many illnesses broadly considered the ‘plagues’ of modern life in Western societies. They included heart disease, arthritis, various mental illnesses, and high blood pressure (Harrington 2008). These modern ills had become so frequent, yet were so different, Seyle reasoned that they must be explainable by a non-specific common factor. By 1950, Seyle had coined the term stress to designate this factor and speculated that it was the cause of a whole host of physical and mental illnesses associated with modern life (Harrington 2008: 150).

When Seyle published his model, it was not well received by other endocrinologists, including Cannon. Seyle’s detractors noted that stress was unobservable, immeasurable, too flexible as a concept, and thus not amenable to scientific hypothesis testing (Viner 1999: 396). His leap from the environmental stressors (physical damage) he applied to rats to the human organism’s response to the pressures and complexities of modern life (economic and social) entailed yet another problematic conceptual leap. This leap involved speculation that the ‘stressors of modern life’ were analogous to the mechanical physical forces he applied to rats. He assumed that stressors in the human social world would cause the same nonspecific physiological response (the stress response), which would in turn result in pathogenesis in humans. Presumably, emotion and cognition would both mediate between stressors and the stress response and between the stress response and pathogenesis in humans. But how and to what extent was not elaborated in Seyle’s model. His rat-human analogy included a kind of sleight of hand wherein physical stressors were replaced by the social, emotional, and psychological stressors experienced by humans.


Stress as a Household Word

Seyle quickly decided not to bother with trying to convince other scientists of the validity of his theory through further experimentation. Instead, he launched his own media campaign to get his ideas out to the public and professionals working in other fields. He wrote magazine articles for publications like The Reader’s Digest and gave public lectures. He reached out to special interest groups, to medical clinicians dealing with psychosomatic illnesses, and particularly to military psychiatrists dealing with shell-shocked WW II veterans (Harrington 2008). Seyle sold stress to the public and the medical profession through force of will rather than through an accumulated body of verifiable research.

His strategy worked. Harrington notes that, “As early as 1956, one commentator opined that Seyle’s ideas had ‘permeated medical thinking and influenced medical research in every land, probably more rapidly and more intensely than any other theory of disease ever proposed’” (ibid: 151-52). His ideas also had a profound impact beyond medicine. For example, the Merriam Webster Collegiate Dictionary definition of stress changed from an engineering-based definition referring to the strain caused by external forces in 1949 to a human-centered definition in the 1965 edition. The later definition referred to physical, chemical, and emotional states that can cause bodily or mental tension and may even result in disease (see Young 1980: 133). Today Seyle’s notion of a universal non-specific reaction to an external common factor is accepted in most forms of human discourse in the West and many fields of study, such as epigenetics, psychoneuroimmunology, and psychology, use it as a unifying concept (Viner 1999: 391).

Aside from Seyle’s media campaign, why was the stress model so readily accepted in science and popular culture? Seyle’s earliest allies were physicians, psychiatrists, and psychologists interested in psychosomatic medicine (Viner 1999: 395). They embraced his work, despite his failure to adequately integrate social, emotional, and psychological factors into his experiments and his mechanistic, biological model of stress. Military researchers in the 1950s and 1960s did more than any other group to expand its application from the laboratory into real world circumstances (Harrington 2008: 153). These experiments involving human beings were fundamentally different from those Seyle conducted on rats. Military and other stress studies on human subjects rarely involved physical damage of any kind. Rather, these studies involved psychological and emotional hardship. Reminiscent of Cannon’s original theories, stress was transformed into a physiological response influenced by a person’s emotional and cognitive ability to cope with many different kinds of social and environmental demands.

alone-61043_640Once Seyle’s theory entered the arena of psychosomatic research, stress as a concept became heavily psychologized (Pollock 1988). In human studies, stress shifted from a mechanical biological model to a cognitive model. Human cognition and its entanglement with emotion became the most important part of the equation, because researchers assumed that the stress response in humans was mediated through meaning and perception. People experience situations as stressful or not based on their perceptions of experiences, the meanings they attach to them, and their emotional responses. Pollock (1988: 385) calls this shift from a mechanical model of stress in biology to a cognitive model of stress in the medical, psychological, and social sciences ‘incongruous’ and ‘unfathomable’. The cognitive model of stress and its relationship to illness is fundamentally incompatible with the more concrete and mechanistic biological model developed by Seyle. Notwithstanding the incongruities, the biological model served (and continues to serve) as the underlying source of legitimacy for the social and psychological models of stress that have developed over time (Pollock 1988: 387), as well as for the relationship of stress to illnesses in humans.


The Changing Etiology of Stress

The essential difference between the biological and cognitive models of stress becomes clearer when we consider them for what they are – etiological theories. Anthropologists classify etiological theories based on the types of ultimate causes of illness identified by the theories. As discussed in Part I in this series on Stress and the Medicalization of Life, an etiological theory can usually be classified into one of four areas of causes: natural, personal, social, or supernatural. Socio-cultural groups tend to emphasize either the first two types of causes (naturalistic theories of the causes of disease) or the latter two (personalistic theories). Seyle’s biological model is a naturalistic theory. The ultimate cause of illness is physical damage due to prolonged exposure to adverse environmental conditions (like temperature extremes). The physical environment (natural cause) and biological variation (individual cause) are both naturalistic causes of pathology. When Seyle attempted to apply his model to humans and sold it to researchers interested in psychosomatic medicine, however, the ultimate cause of illness shifted, and so did the nature of the etiological theory.

In the cognitive model of stress (the one so prevalent today), illness originates in social situations that elicit the stress response – stressful life events, like divorce, job loss, and war. Physical damage is by no means a necessary ingredient in stress. Instead, the stress response is mediated by the human ability to appraise and interpret situations, emotional coping skills, and, perhaps, genetic variation. Here we see a hybrid mix of etiologies. The ultimate cause of illness due to stress is social, which makes it a personalistic etiological theory, but biological variation (individual, naturalistic factors) may also play a role in whether stress ultimately results in disease in a person. The stress etiological theory is the ‘poster child’ of mind-body dualism; stress research is the perfect venue to elaborate the mind’s influence on the body. This is one reason it is so popular.

It is vitally important that we recognize the cultural model of stress for what it is – a psychosomatic model of illness. In fact, stress is a personalistic theory of disease parading as a naturalistic theory. It is cloaked in science, but based in beliefs about contagious, indeterminate forces that can get inside of us, make us sick, and even kill us. Stress matters, not because it is a scientific ‘reality’, but because we actually live and die by our etiological theories. Such theories not only constrain perception; they are embodied and affect well-being. This is the topic of Part III of my series on Stress and the Medicalization of Life.


References:

Harrington, Anne. 2008. The Cure Within, A History of Mind-Body Medicine. New York: W.W. Norton & Co.

Helman, Cecil G. 2014. Culture, Health and Illness, Fifth Edition. Boca Raton: CRC Press.

Pollock, Kristian. 1988. On the Nature of Social Stress: Production of a Modern Mythology. Social Science and Medicine. 26(3): 381-92.

Viner, Russell. 1999. Putting Stress in Life: Hans Seyle and the Making of Stress Theory. Social Studies of Science. 29(3): 391-410.

Young, Allan. 1980. The Discourse on Stress and the Production of Conventional Knowledge. Social Science and Medicine, 14B: 133-46.

Seyle, Hans. 1976. Forty Years of Stress Research: Principal Remaining Problems and Misconceptions. Canadian Medical Association Journal. 115: 53-7.

– 1936. A Syndrome Produced by Diverse Nocuous Agents. Nature. 138: 32.

 


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[1] Stress as a Cultural Model

Welcome to Part I in my series on Stress and the Medicalization of Life. In this series of three posts, I’ll be writing about how stress as a cultural concept has contributed to the creation of diseases and disease-like states, or medicalization, in Western societies. Why do I need a series of posts to communicate about stress? The concept of stress has become so important to our experiences of health, illness, and healing that there’s a lot to cover. First, it takes time to break down the common assumption that stress is primarily a scientific ‘reality’. It takes time to understand stress as a cultural model, rather than simply an objective, measurable physiological response. This is the goal of Part I of the series. Secondly, the concept of stress has a specific socio-cultural history. Understanding the origin of stress in the scientific knowledge base illustrates why and how the concept has become so popular in biomedical research, in the popular media, and in our everyday lives. This is the topic of Part II of the series. Finally, stress contributes significantly to the process of medicalization. The concept is so flexible that non-specialists use it all the time to explain their health complaints. It has also been used by researchers working in many areas to transform the complexity of our life experiences into a single physiological response. This is the topic of Part III of the series. All of these views on stress are necessary to put stress in its place. Read on to learn about stress as a cultural model…


 

punch-316605_640STRESS is a word we’re exposed to quite frequently in modern Western societies. We use it in conversation, experience it at work, and read about it in the media. We especially relate stress to health and believe that it is the root cause of many conditions and diseases. We get the message all the time that if we’re “stressed out” and don’t do something to “relieve the stress” we’re going to get sick. Doctors and medical researchers also tell us that stress and how we manage it can make us more susceptible to getting everything from the flu to cancer. But what is stress, really, and why does it have so much power over our lives?

The concept of stress is part of a large and pervasive theory about the origins of diseases and conditions – it is a theory about what makes us sick. This is what Western medical researchers and practitioners refer to as etiology. Etiological theories tend to be shared by the members of a socio-cultural group. Everyone everywhere possesses such theories, but there is great variation from one socio-cultural group to the next in what people consider the ‘real’ causes of illness. Scientists believe that stress produces a series of physiological responses that, if continuous and persistent, can cause disease. But all etiological theories, including stress, are actually cultural models that help us to elaborate the causes of misfortune in our lives.

What is a cultural model? Cultural models are really about cognition, our ability to learn, think, and understand the world through concepts acquired in the early months and years of life. Cultural models are based in cognition and composed of the interrelated concepts we use to make sense of the world. We embody such models through processes of enculturation and socialization. Cultural models support our taken-for-granted notions about what is ‘natural’ and thus support assumptions (like the distinction between biology and psychology) that few of us reflect on in conscious, critical ways. Such notions simply feel right to us so we assume that they are a part of the nature of reality.

Most of us make sense of our experiences surrounding health and healing on the basis of cultural models that tell us what causes illness in the first place. These models constrain the ways we experience and explain illness because they provide the interrelated concepts we use to perceive the world and interpret our experiences. A socio-cultural group’s models about the causes of disease and illness link particular illness experiences to wider theories of knowledge (what the world is like and how it is best known). Etiological theories necessarily influence how we conceive of illness and determine the healing therapies we consider effective. Cross-cultural comparison of etiological theories by anthropologists revealed that they tend to fit within one of four categories of causes: 1) the individual; 2) the natural world; 3) the social world; and 4) the supernatural world (Foster and Anderson 1978).

In practice, cultural groups often combine two or more of these kinds of causes in their explanations of illness. Most healing systems emphasize either both individual and natural causes OR both social and supernatural causes. Those theories that emphasize the individual body and the natural environment tend towards what anthropologists call naturalistic theories of illness causality, while those that emphasize the social and supernatural tend towards personalistic theories of illness causality (Erickson 2008). In naturalistic systems, the cause of an illness is usually thought to be impersonal and believed to affect the individual through its anatomical and/or physiological impact on the body. Biomedicine is based on naturalistic theories, but so are many other systems, like traditional Chinese medicine and homeopathy (both of which conceive of health as a balance of substances in the body). In personalistic systems, the causes of illness are more personal and often involve direct aggression from other beings, like other people (witches or sorcerers), spirits, or gods. But these theories are also intertwined with the notion that social discord in a person’s life can cause illness. Even when an actual pathology is present from a biomedical point of view, in personalistic systems, the ultimate cause of the illness is located in the social or supernatural worlds.

Most societies, including American society, tend towards one model or the other. Of course, Americans generally share naturalistic theories of illness causality, but there is great diversity in our theories, so we also sometimes incorporate personalistic theories in with our naturalistic ones. Many of us raised in Western contexts dominated by biomedicine feel at some level that the illnesses we experience are not always reducible to naturalistic causes. Indeed, one of the most pervasive characteristics of our notions of health has been “a lingering faith in a causal system outside science” (Blaxter 2004:36, quoted in Erickson 2008:42). Most of us have experienced illness and interpreted those experiences in ways that are inconsistent with the biomedical disease model. We believe that illnesses, and even diseases, like cancer, are caused by phenomena that are neither strictly natural nor attributable to the individual alone. We embrace theories that better capture the complexity of our experiences and the place and time in which we live.

Why has stress as a cultural model become so popular? The answer to this question lies in the flexibility of stress as a concept. Stress encompasses both naturalistic and personalistic theories. Many people (ordinary people and scientists) use stress to explain how environmental conditions can cause disease – conditions like climate, natural disaster, and toxins in the environment. Many people use stress to explain why some people living under the same conditions experience disease while others do not, because individual ability to cope with stress varies from person to person. Many people use stress to explain how social situations, like unhealthy relationships or job loss, can cause illness. And many people use stress to explain how spiritual crises, like loss of faith, can cause illness. To understand why we use stress in all these ways, we have to consider the origin and history of stress as a cultural model, the subject of Part II of my series on Stress and the Medicalization of Life.

References:

Blaxter, Mildred. 2004. Health. Cambridge, UK: Polity Press.

Erickson, Pamela I. 2008. Ethnomedicine. Long Grove: Waveland Press, Inc.

Foster, George M. and Barbara Gallatin Anderson. 1978. Medical Anthropology. New York: John Wiley & Sons.


 


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What Is Embodiment?

Welcome everyone! This is my inaugural post on my new Embodiment and Healing (E&H) blog. I’ve established this blog as a platform for presenting some of the ideas in my forthcoming book, Healing the Embodied Self, Understanding Our Innate Ability to Heal due out in June, 2014. I will use this blog in equal measure to comment on new research in areas such as biomedicine, epigenetics, and neurology from the point of view of cultural analysis and the Embodied Self model of health, illness, and healing presented in my book. I’m going to begin by explaining a little bit about the process of embodiment.

My definition of embodiment draws on those used in several fields, primarily anthropology, but also embodied cognition and neurology. I specifically ground embodiment, however, in the material substrate of the human body to help people understand that cultural beliefs and practices, symbols and metaphors, also have a material existence in our bodies. Most people understand that components in the environment, such as foods and toxins, impact anatomy and physiology. Fewer realize, I think, that meanings are also stored in our sinews, tissues, and biochemical processes.

I define Embodiment as a universal, dynamic process that blends experience, context, and time together and embeds them in human biology. Embodiment is how experience ‘gets under our skins’ and shapes anatomy and physiology. Embodiment happens because most of the structures and functions in our bodies are malleable, they have plasticity, which means they alter naturally in response to our experiences. We are thus equally the products of both nature and nurture, biology and culture.

The embodiment paradigm as I use it in my research undermines the mind-body dualism, psychology-biology divide, and other dichotomies that structure the biomedical disease model still so prevalent in Western contexts, and which is spreading rapidly into non-Western contexts. Embodiment is not about somatization or psychosomatic illness, because the cultural model of ‘the mind’ so prevalent in the Western philosophical tradition is made obsolete. Instead, the self, as the totality of everything we are, physically, psychologically, culturally, socially, and environmentally is fully embodied, inseparable from the body, and an emergent property of the human organism as a complex system. The self, is our self-organizing principle, implicated in everything from homeostasis to sense of self to self-representation. In fact, we cannot exist as human beings minus the self and its organizing functions. The self struggles for coherence and integrity even when embodied in pathological physiological/anatomical states.

Focusing on the embodied self radically alters the way we can conceive of disease, illness, and healing. It posits the self as an organic entity and implicates the self in all forms of pathologies, whether we commonly consider them physical or mental. In fact, in this model there is no distinction between the two. Diseases are embodied and correspond with dissonances in the self. All diseases are also what anthropologists refer to as ‘culture-bound syndromes’, varying in mode, progression, symptoms, and therapeutic response with socio-cultural context. Since how the self is embodied varies both individually, and in space and time, so does the expression of disease. Herein lies a clue to how the self is implicated in innate healing. More to come…


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