A Critical Review of the Concept of Stress in Psychosomatic Medicine

A CRITICAL REVIEW OF THE CONCEPT OF STRESS IN PSYCHOSOMATIC MEDICINE ROBERTD. MARTIN* Stress is simultaneously a very popular word and a very difficult concept . It can be a colloquialism or a poetic reference. In physics, biology, psychology, and the social sciences, it is both a metaphor and a term which aspires to be scientific. There are many words in our language which bridge philosophical, scientific, aesthetic, and social worlds. One is tempted to simply eschew diem and search for new alternatives. Perhaps a Greek word can be found as a substitute, or the issue can be defined mathematically widi signs taking the place of the term. To me, these alternatives prove awkward. Despite dieir tendency toward clarity and elimination of ambiguity, they often cause special kinds of problems in comprehension. My choice widi a concept such as stress is to explain what I am talking about as completely as possible widi many different examples to clarify die meaning. In this inductive fashion, the term gradually acquires limits in its meaning. This distinguishes it from other words or even from itself used in different contexts. As one might expect, diis concept of stress is not widiout controversy. Mason [1] concluded, after reviewing its history, diat, despite difficulties, its continued popularity suggests there must be somediing of importance in it somewhere. Hinkle [2], by contrast, makes a very critical argument against it. He indicates diat it is a single idea of questionable merit, it probably covers too large a territory, it can never be die ". . . sole and sufficient cause of disease," it is an overworked noun, and few authors can agree on what they are talking about anyway. There remains , nevertheless, a nagging feeling diat, widi diis concept, somediing very important is being grasped. If the idea of stress has any merit, it may then represent a fundamental framework with which psychosomatic processes can be clarified.»Psychiatrist in charge, Psychosomatic Clinics, Long Island Jewish-Hillside Medical Center, New York. Address: 14 Buckingham Place, Great Neck, New York 11021.© 1984 by The University of Chicago. AU rights reserved. 003 1-5982/84/2703-0381$01 .00 Perspectives inBiology andMedicine, 27, 3 · Spring 1984 | 443 Of particular interest here is an understanding of illness onset, especially how stimuli influence human functioning. A stimulus is viewed as any activity in an environment which can elicit any kind of response in a human. Within environment, humans function by the continuation of their body processes in a living state. In a theoretical steady-state surround , the human organism will use the available air, moisture, light, and so on in a predictable way dependent on the already activated physiological and biochemical systems. Any change in that environmental medium is extremely likely to cause a reaction in the body processes. The change in this environmental medium is a stimulus; the change in the body processes is a reaction. So far in the discussion, the concepts put forth have a wide acceptability . The only slighdy unusual emphasis is on the high degree of sensitivity ofthe human organism to even the smallest changes in life space. My opinion, expressed in this paper, is that this has to be the paradigm for any concept of stress. This stimulus-response idea is the skeleton, the framework around which the discussion of the stress must occur. In figure 1 an illustration of this idea is superimposed on a Venn diagram. The entire picture is enclosed in a box. This box is meant to Ö I KbWW Fig. 1.—A Venn diagram illustrating stress as die process of stimulus, interaction, and response. 444 I Robert D. Martin · Stress in Psychosomatic Medicine represent the idea of stress; that is, stress is not to be understood as either stimulus or response but as the entire process in which stimulus and response occur. This does away with the need to "identify the outside stress" or to define the stress as the response—both positions frequentiy taken in the stress literature. Certainly, understanding a stimulus, the way in which it is perceived, and the overall result of its interaction widi die organism is essential to research and clinical work. But the comprehension of what is under way is dependent...