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Rabkin, J.G. Struening, E.L. (1976). Social Change Stress and Illness: A Selective Literature Review. Psychoanal. Contemp. Sci., 5:573-624.

(1976). Psychoanalysis and Contemporary Science, 5:573-624

5 Adaptation and Stress

Social Change Stress and Illness: A Selective Literature Review

Judith Godwin Rabkin, Ph.D. and Elmer L. Struening, Ph.D.

The object of this paper is to review the research literature concerning observed relationships between social change, stress, and the onset of illness. The framework within which these findings are considered represents an integration of components derived from Freud's early considerations of external trauma and reactive illness, later psychosomatic formulations, and contemporary stress theory.

It has long been recognized that changes in the social environment often heighten the person's vulnerability to stress and stress-related diseases. Even when existing social conditions are difficult, their alteration, especially when rapid, frequently generates stress. As Hippocrates observed, “Those things which one has been accustomed to for a long time, although worse than things which one is not accustomed to, usually give less disturbance.”

Despite recognition of the role of social factors in the onset of illness, adequate documentation was limited for many years. Even today questions about selective vulnerability remain unanswered, such as why some people become ill when exposed to difficult social events whereas others do not, and why some groups are more susceptible than others to illness in the presence of social change.

Until recently in the history of medicine, considerations about selective vulnerability were secondary in importance to the need to account for and control the infectious diseases that were the major causes of mortality. The illness model generated by the germ theory in the nineteenth century led to the diligent search for a single etiological factor and a specific antidotal cure or “magic bullet.”

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