THEORIES OF PSYCHOSOMATIC ILLNESS & THE LACK OF EMOTIONAL INTELLIGENCE
SUDDEN DEATH
A prolonged emergency reaction set up by continued mobilization against a
threatening environment can cause high blood pressure, and an individual
with high blood pressure may be more susceptible in the long run to death
from heart attack or stroke. What happens when a person perceives the
environment as threatening, but rather than mobilizing against the danger,
gives up? Under some circumstances, the most catastrophic of all psychosomatic
phenomena can occur, sudden death.
In 1967a distraught woman pleading for help, entered the Baltimore City Hospital
a few days be fore her 23rd birthday. She and two other girls, had been born of
different mothers assisted by the same mid wife in the Okefenokee Swamp on a
Friday the 13th.The midwife cursed all three babies, say in gone would die before
her 16thbirthday, another before her 21st birthday, and the third before her 23rd
birthday. The first had died in a car crash during her 15th year;the second was
accidentally shot to death in a nightclub fight on the evening of her 21st birthday.
Now she, the third woman, waited in terror for her own death. The hospital somewhat
skeptically admitted her for observation. The next morning two days
before her 23rd birthday, she was found dead in her
hospital bed-physical cause unknown. (Seligman, 1975, p. 5)
THE PROCESS OF SUDDEN DEATH
One sequence of events that could produce sudden death seems to be the following:
(1) perceiving a strong threat to life followed by giving up and
accepting one's fate, (2) a depressed, quiescent state; and (3) death. This
phenomenon has been explored in animals by the American physiologist
Curt Richter. Richter found that, on occasion, when he held a wild rat
tightly it would die-right there, in his hand (Richter, 1957). He hypothesized
that when animals gave up in the face of threat and entered a state of
hopelessness, they would die. To test this, he took wild rats and held them in
his (chain-mailed) gloved hand until they stopped struggling. Then he put
them in a vat of water three feet deep with a jet of water playing down on
them to stop them from floating. The rats would swim for three to five minutes,
then dive to the bottom and drown. In contrast, wild rats who had not
been restrained in the experimenter's hand until they gave up would swim
from sixty to eighty hours-vigorously trying to survive.
There were two findings that led Richter to believe that these were deaths
from hopelessness. The first was that if he took the rat and held it in his hand
until it stopped struggling, then released the rat "showing the rat there was
hope," held the rat in his hand again, released it, then held it until it stopped
struggling, and finally put it in the vat, the rat would swim for between sixty
and eighty hours. Second, if he restrained the rat in his hand until it gave up,
then put the rat in the water and waited three to five minutes until the rat
started to go down, plucked it out, released it-again "showing it there was
hope"-and then repeated the process several times, when the rat was finally
placed in the water it would swim for sixty to eighty hours.
Richter believed that this phenomenon was related to "Voodoo Death."
The American physiologist W. B. Cannon (1871-1945) had been the first
scientist to describe "Hex Death," or "Voodoo Death." Cannon had reviewed
many reports of such deaths across a variety of cultures and wrote:
A Brazilian Indian, condemned and sentenced by a so-called medicine man, is
helpless against his own emotional response to this pronouncement-and dies
within hours. In Africa a young negro unknowingly eats the inviolably-banned
wild hen. On discovery of this "crime" he trembles, is overcome by fear and dies
within 24 hours. In New Zealand, a Maori woman eats fruit that she only later
learns has come from a tabooed place. Her chief has been profaned. By noon of
the next day she is dead. In Australia a witch doctor points a bone at a man.
Believing that nothing can save him, the man rapidly sinks in spirit and prepares to
die. He is saved only at the last moment when the witch doctor is forced to remove
the charm. The man who discovers that he is being boned by an enemy is, indeed,
a pitiable sight. He stands aghast with his eyes staring at the treacherous pointer,
with his hands lifted to ward off a lethal medium, which he imagines is pouring
into his body. His cheeks blanch, and his eyes be come glassy, the expression of his
face becomes horribly distorted. He attempts to shriek but usually the sound
chokes in his throat, and all that one might see is froth at his mouth. His body
begins to tremble and his muscles twitch involuntarily. He sways backward and
falls to the ground, and after a short time appears to be in a swoon. He finally
composes himself, goes to his hut, and there frets to death. (Cannon, 1942, pp.
169-70)
Loss AND SUSCEPTIBILITY TO ILLNESS AND DEATH
There is more than anecdotal evidence of this sort for sudden death following
giving up in man. Loss of one's spouse by death can be an experience of
profound helplessness. Following the death of their wives, 4,500 British
widowers fifty-five years or older were identified from British records. During
the first six months of their bereavement, 213 of them died. This is 40 percent
more than the expected mortality for men of this age. Susceptibility to
death during bereavement seems to be concentrated in the first six months,
since the death rate returns to normal thereafter. Most of these men died
from cardiac problems (Parkes, Benjamin, and Fitzgerald).
These findings cause us to hypothesize that individuals who lose what is
most important to them seem more susceptible to death from a variety of
causes. The most typical sequence is this: the individual perceives a threat;
he struggles against it but gives up, becoming hopeless, depressed, and passive;
and he thereupon becomes susceptible to any of a variety of illnesses,
dangers, or pathogens in his environment, which he would normally resist
but which are now deadly to him.
There are two prospective studies that indicate such susceptibility to
pathogens following experiences of hopelessness and depression. Six
months before an influenza epidemic swept an Army base, 600 employees
had been given a battery of personality inventories. Twenty-six individuals
came down with the flu during the epidemic; of these, 12 still had the flu
three weeks later. These 12 individuals had been significantly more depressed
six months earlier than the rest of the population, and as we shall see
in Chapter 13, depression is intimately related to helplessness induced by
giving up.
One of the most insidious of all illnesses influenced by psychological factors
is cancer. There is mounting evidence that hopelessness may playa role
in susceptibility to cancer. Fifty-one women who entered a Rochester, New
York, clinic for a cancer test were interviewed upon arriving. Each of these
women had previously shown suspicious cells in her cervix which might indicate
cancer, but which could not definitely be diagnosed as cancer without
further testing. The investigators found that eighteen of these fifty-one
women had experienced significant losses in the last six months to which
they reacted with feelings of hopelessness and helplessness. The others had
experienced no such life event. Of the eighteen who had experienced hopelessness,
eleven were found to have cancer. Of the other thirty-three, only
eight had cancer. The difference between the two groups was statistically significant
(Schmale and Iker). Similarly, lack of meaning in one's life,
job instability, and no plans for the future predict who has lung cancer better
than does the amount of smoking (Horne and Picard).
ANIMAL MODELS OF HELPLESSNESS AND ILLNESS
This evidence suggests that experience with helplessness and hopelessness
may weaken the immune system, making it less able to fight off illnesses
successfully. Animal models of helplessness and hopelessness may allow us
to investigate the way in which these experiences make us more susceptible
to illness. Rats were injected with tumors, and on the following day, they
were divided into three groups. One group was given escapable shock electric
shock that the rats could turn off by bar pressing. A second group
received exactly the same pattern of electric shock, but it went on and off
independently of all the rats' actions; those in this group were helpless to
turn off the shock. The third group was not shocked at all. How did such
experience with helplessness affect the rejection of tumors? Fifty-five percent
of the animals who were not shocked rejected the tumor, and 65 percent of
the animals that received experience mastering electric shock rejected the
tumor. Only 27 percent of the animals who received helplessness experience,
however, rejected the tumor. Investigators are presently looking at
how the immune system changes in response to helplessness and hopelessness
in rats and in humans. Natural killer cells and T-Lymphocytes, cells in
the immune system that fight off foreign invaders, seem to be suppressed following
helplessness. This may provide us with some clues about how to intervene
to prevent the psychological experiences of hopelessness from
making people more susceptible to viral illness (Sklar and Anisman, 1979;
Visintainer, Volpicelli, and Seligman, 1982; Maier, 1983; Rodin, 1983).
LACK OF CONTROL IN NURSING HOMES
While giving up is a profoundly lonely and individual experience, it may be
that the structure of some institutions promotes it on a massive scale. Consider
patient care in nursing homes. When we arrange care for the elderly,
there is sometimes a tendency to try to do everything for them. On the one
hand, this seems benevolent, but on the other hand, we end up taking all of
their control away. By treating them as total patients, we undermine self care
(Bandura, 1982).
When we remove the last vestiges of control over the environment from
human beings already weakened by age, we put them in a helpless situation,
one without purpose. Some give up and die. Conversely, if we bring choice
and control into geriatric wards, we may be able to prolong life. Ellen
Langer and Judith Rodin divided nursing home residents of equal health
into two groups. One group was given enhanced choice and control over
small things at the nursing home. They were encouraged to decide how they
would spend their own time, they were given the choice of what night to attend
a movie, and they were given the opportunity to select a plant for their
room and to take care of it themselves. Those in the comparison group were
told about all the good things that were available to them, they were told on
what day they would see a movie, and they were given a plant (no choice)
and told that the nurse would care for it. The comparison group was treated
very much like ordinary geriatric patients. Although they experienced some
positive events, they exerted little or no control over their life. Eighteen
months later, 30 percent of the comparison group (thirteen out of forty-four
patients) had died, while only 15percent (seven of forty-four patients) of the
group that had control and responsibility had died. These differences were
statistically significant (Langer and Rodin, 1976; Rodin and Langer, 1977).
In conclusion, how much control one exerts over the important things in
one's life may affect one's susceptibility to illness and even death itself. We
have much more to learn in this area, but it does seem that when an individual
perceives a major threat, tries to control it, and fails, he or she will become
hopeless, depressed, and passive. Thereupon any of a variety of
pathogens in the environment that are normally resisted may become life
threatening.
THEORIES OF PSYCHOSOMATIC ILLNESS
We have now had a detailed look at three physical problems that are influenced
by psychological factors: stomach ulcers, high blood pressure, and
sudden death. In addition to these three, many other diseases are often
thought to have psychosomatic components: migraine headaches, arthritis,
chronic pain, and asthma, among others.
Let us now look at the different principles that recur through explanations
of the cause and the alleviation of these psychosomatic disorders.
There are four theories, and they correspond to four of the schools of abnormality:
biomedical, psychodynamic, behavioral, and cognitive. All are compatible
with the diathesis-stress perspective.
ASTHMA IN CHILDREN AND FAMILY SEPARATION
Asthma is a condition in which the air passages of the bronchia narrow, swell,
and secrete excess fluid to a variety of stimuli. This results in wheezing, which in its
worst form can be severe and can produce a convulsive struggle for breath.
Asthma can be caused by infection, by allergy, or by psychological factors. It has
been estimated that each of these plays the dominant role in about a third of the
cases (Weiner, 1977). Put differently, asthma stems from psychological sources in
only a minority of cases. In this minority, the personal relations between parents
and the asthmatic child have long been suspected to be the major source of psychological disturbance.
Anecdotes indicated that when European children with asthma were sent off by
their parents to spas "to take the waters" they cheerfully ignored their parents'
long lists of instructions, showed few signs of asthma, and seemed to be
psychologically improved as well. To test the possibility that separation from parents might
alleviate asthma, Dennis Purcell and his colleagues chose twenty-five chronically asthmatic
school children who lived with their families (Purcell, Brady, Choi, Muser, Molk, Gordon, and Means).
They divided these children into two
groups-those in whom emotional factors had usually preceded past attacks of
asthma at home, and those in whom emotional factors seemed irrelevant to the
onset of past attacks. The first group was expected to benefit from separation, but
not the second.
The parents and siblings were removed from the home and sent to a motel for
two weeks, while the child continued to live in his home environment. A surrogate
parent was provided, and the child continued normal attendance at school and
normal play activities. After two weeks of not seeing their child, the
parents returned to the home and life went on as usual.
As predicted, the effects were beneficial for the group suspected of emotionally
induced asthma. Their medication during separation was reduced by half during
daily physician checks, and on top of this the number of asthma attacks and
amount of wheezing was reduced by half as well. When the parents returned,
wheezing, number of attacks, and amount of necessary medication all increased.
Beneficial effects of separation on asthma did not appear for the group in which
emotional factors had been judged unimportant.
So, for some children, emotional factors are probably irrelevant to asthma. For
others, however, family stresses may set off or worsen asthmatic attacks. In these
cases, if the family members learn more effective and less stressful ways of dealing
with each other, the child's asthma may get better.
A prolonged emergency reaction set up by continued mobilization against a
threatening environment can cause high blood pressure, and an individual
with high blood pressure may be more susceptible in the long run to death
from heart attack or stroke. What happens when a person perceives the
environment as threatening, but rather than mobilizing against the danger,
gives up? Under some circumstances, the most catastrophic of all psychosomatic
phenomena can occur, sudden death.
In 1967a distraught woman pleading for help, entered the Baltimore City Hospital
a few days be fore her 23rd birthday. She and two other girls, had been born of
different mothers assisted by the same mid wife in the Okefenokee Swamp on a
Friday the 13th.The midwife cursed all three babies, say in gone would die before
her 16thbirthday, another before her 21st birthday, and the third before her 23rd
birthday. The first had died in a car crash during her 15th year;the second was
accidentally shot to death in a nightclub fight on the evening of her 21st birthday.
Now she, the third woman, waited in terror for her own death. The hospital somewhat
skeptically admitted her for observation. The next morning two days
before her 23rd birthday, she was found dead in her
hospital bed-physical cause unknown. (Seligman, 1975, p. 5)
THE PROCESS OF SUDDEN DEATH
One sequence of events that could produce sudden death seems to be the following:
(1) perceiving a strong threat to life followed by giving up and
accepting one's fate, (2) a depressed, quiescent state; and (3) death. This
phenomenon has been explored in animals by the American physiologist
Curt Richter. Richter found that, on occasion, when he held a wild rat
tightly it would die-right there, in his hand (Richter, 1957). He hypothesized
that when animals gave up in the face of threat and entered a state of
hopelessness, they would die. To test this, he took wild rats and held them in
his (chain-mailed) gloved hand until they stopped struggling. Then he put
them in a vat of water three feet deep with a jet of water playing down on
them to stop them from floating. The rats would swim for three to five minutes,
then dive to the bottom and drown. In contrast, wild rats who had not
been restrained in the experimenter's hand until they gave up would swim
from sixty to eighty hours-vigorously trying to survive.
There were two findings that led Richter to believe that these were deaths
from hopelessness. The first was that if he took the rat and held it in his hand
until it stopped struggling, then released the rat "showing the rat there was
hope," held the rat in his hand again, released it, then held it until it stopped
struggling, and finally put it in the vat, the rat would swim for between sixty
and eighty hours. Second, if he restrained the rat in his hand until it gave up,
then put the rat in the water and waited three to five minutes until the rat
started to go down, plucked it out, released it-again "showing it there was
hope"-and then repeated the process several times, when the rat was finally
placed in the water it would swim for sixty to eighty hours.
Richter believed that this phenomenon was related to "Voodoo Death."
The American physiologist W. B. Cannon (1871-1945) had been the first
scientist to describe "Hex Death," or "Voodoo Death." Cannon had reviewed
many reports of such deaths across a variety of cultures and wrote:
A Brazilian Indian, condemned and sentenced by a so-called medicine man, is
helpless against his own emotional response to this pronouncement-and dies
within hours. In Africa a young negro unknowingly eats the inviolably-banned
wild hen. On discovery of this "crime" he trembles, is overcome by fear and dies
within 24 hours. In New Zealand, a Maori woman eats fruit that she only later
learns has come from a tabooed place. Her chief has been profaned. By noon of
the next day she is dead. In Australia a witch doctor points a bone at a man.
Believing that nothing can save him, the man rapidly sinks in spirit and prepares to
die. He is saved only at the last moment when the witch doctor is forced to remove
the charm. The man who discovers that he is being boned by an enemy is, indeed,
a pitiable sight. He stands aghast with his eyes staring at the treacherous pointer,
with his hands lifted to ward off a lethal medium, which he imagines is pouring
into his body. His cheeks blanch, and his eyes be come glassy, the expression of his
face becomes horribly distorted. He attempts to shriek but usually the sound
chokes in his throat, and all that one might see is froth at his mouth. His body
begins to tremble and his muscles twitch involuntarily. He sways backward and
falls to the ground, and after a short time appears to be in a swoon. He finally
composes himself, goes to his hut, and there frets to death. (Cannon, 1942, pp.
169-70)
Loss AND SUSCEPTIBILITY TO ILLNESS AND DEATH
There is more than anecdotal evidence of this sort for sudden death following
giving up in man. Loss of one's spouse by death can be an experience of
profound helplessness. Following the death of their wives, 4,500 British
widowers fifty-five years or older were identified from British records. During
the first six months of their bereavement, 213 of them died. This is 40 percent
more than the expected mortality for men of this age. Susceptibility to
death during bereavement seems to be concentrated in the first six months,
since the death rate returns to normal thereafter. Most of these men died
from cardiac problems (Parkes, Benjamin, and Fitzgerald).
These findings cause us to hypothesize that individuals who lose what is
most important to them seem more susceptible to death from a variety of
causes. The most typical sequence is this: the individual perceives a threat;
he struggles against it but gives up, becoming hopeless, depressed, and passive;
and he thereupon becomes susceptible to any of a variety of illnesses,
dangers, or pathogens in his environment, which he would normally resist
but which are now deadly to him.
There are two prospective studies that indicate such susceptibility to
pathogens following experiences of hopelessness and depression. Six
months before an influenza epidemic swept an Army base, 600 employees
had been given a battery of personality inventories. Twenty-six individuals
came down with the flu during the epidemic; of these, 12 still had the flu
three weeks later. These 12 individuals had been significantly more depressed
six months earlier than the rest of the population, and as we shall see
in Chapter 13, depression is intimately related to helplessness induced by
giving up.
One of the most insidious of all illnesses influenced by psychological factors
is cancer. There is mounting evidence that hopelessness may playa role
in susceptibility to cancer. Fifty-one women who entered a Rochester, New
York, clinic for a cancer test were interviewed upon arriving. Each of these
women had previously shown suspicious cells in her cervix which might indicate
cancer, but which could not definitely be diagnosed as cancer without
further testing. The investigators found that eighteen of these fifty-one
women had experienced significant losses in the last six months to which
they reacted with feelings of hopelessness and helplessness. The others had
experienced no such life event. Of the eighteen who had experienced hopelessness,
eleven were found to have cancer. Of the other thirty-three, only
eight had cancer. The difference between the two groups was statistically significant
(Schmale and Iker). Similarly, lack of meaning in one's life,
job instability, and no plans for the future predict who has lung cancer better
than does the amount of smoking (Horne and Picard).
ANIMAL MODELS OF HELPLESSNESS AND ILLNESS
This evidence suggests that experience with helplessness and hopelessness
may weaken the immune system, making it less able to fight off illnesses
successfully. Animal models of helplessness and hopelessness may allow us
to investigate the way in which these experiences make us more susceptible
to illness. Rats were injected with tumors, and on the following day, they
were divided into three groups. One group was given escapable shock electric
shock that the rats could turn off by bar pressing. A second group
received exactly the same pattern of electric shock, but it went on and off
independently of all the rats' actions; those in this group were helpless to
turn off the shock. The third group was not shocked at all. How did such
experience with helplessness affect the rejection of tumors? Fifty-five percent
of the animals who were not shocked rejected the tumor, and 65 percent of
the animals that received experience mastering electric shock rejected the
tumor. Only 27 percent of the animals who received helplessness experience,
however, rejected the tumor. Investigators are presently looking at
how the immune system changes in response to helplessness and hopelessness
in rats and in humans. Natural killer cells and T-Lymphocytes, cells in
the immune system that fight off foreign invaders, seem to be suppressed following
helplessness. This may provide us with some clues about how to intervene
to prevent the psychological experiences of hopelessness from
making people more susceptible to viral illness (Sklar and Anisman, 1979;
Visintainer, Volpicelli, and Seligman, 1982; Maier, 1983; Rodin, 1983).
LACK OF CONTROL IN NURSING HOMES
While giving up is a profoundly lonely and individual experience, it may be
that the structure of some institutions promotes it on a massive scale. Consider
patient care in nursing homes. When we arrange care for the elderly,
there is sometimes a tendency to try to do everything for them. On the one
hand, this seems benevolent, but on the other hand, we end up taking all of
their control away. By treating them as total patients, we undermine self care
(Bandura, 1982).
When we remove the last vestiges of control over the environment from
human beings already weakened by age, we put them in a helpless situation,
one without purpose. Some give up and die. Conversely, if we bring choice
and control into geriatric wards, we may be able to prolong life. Ellen
Langer and Judith Rodin divided nursing home residents of equal health
into two groups. One group was given enhanced choice and control over
small things at the nursing home. They were encouraged to decide how they
would spend their own time, they were given the choice of what night to attend
a movie, and they were given the opportunity to select a plant for their
room and to take care of it themselves. Those in the comparison group were
told about all the good things that were available to them, they were told on
what day they would see a movie, and they were given a plant (no choice)
and told that the nurse would care for it. The comparison group was treated
very much like ordinary geriatric patients. Although they experienced some
positive events, they exerted little or no control over their life. Eighteen
months later, 30 percent of the comparison group (thirteen out of forty-four
patients) had died, while only 15percent (seven of forty-four patients) of the
group that had control and responsibility had died. These differences were
statistically significant (Langer and Rodin, 1976; Rodin and Langer, 1977).
In conclusion, how much control one exerts over the important things in
one's life may affect one's susceptibility to illness and even death itself. We
have much more to learn in this area, but it does seem that when an individual
perceives a major threat, tries to control it, and fails, he or she will become
hopeless, depressed, and passive. Thereupon any of a variety of
pathogens in the environment that are normally resisted may become life
threatening.
THEORIES OF PSYCHOSOMATIC ILLNESS
We have now had a detailed look at three physical problems that are influenced
by psychological factors: stomach ulcers, high blood pressure, and
sudden death. In addition to these three, many other diseases are often
thought to have psychosomatic components: migraine headaches, arthritis,
chronic pain, and asthma, among others.
Let us now look at the different principles that recur through explanations
of the cause and the alleviation of these psychosomatic disorders.
There are four theories, and they correspond to four of the schools of abnormality:
biomedical, psychodynamic, behavioral, and cognitive. All are compatible
with the diathesis-stress perspective.
ASTHMA IN CHILDREN AND FAMILY SEPARATION
Asthma is a condition in which the air passages of the bronchia narrow, swell,
and secrete excess fluid to a variety of stimuli. This results in wheezing, which in its
worst form can be severe and can produce a convulsive struggle for breath.
Asthma can be caused by infection, by allergy, or by psychological factors. It has
been estimated that each of these plays the dominant role in about a third of the
cases (Weiner, 1977). Put differently, asthma stems from psychological sources in
only a minority of cases. In this minority, the personal relations between parents
and the asthmatic child have long been suspected to be the major source of psychological disturbance.
Anecdotes indicated that when European children with asthma were sent off by
their parents to spas "to take the waters" they cheerfully ignored their parents'
long lists of instructions, showed few signs of asthma, and seemed to be
psychologically improved as well. To test the possibility that separation from parents might
alleviate asthma, Dennis Purcell and his colleagues chose twenty-five chronically asthmatic
school children who lived with their families (Purcell, Brady, Choi, Muser, Molk, Gordon, and Means).
They divided these children into two
groups-those in whom emotional factors had usually preceded past attacks of
asthma at home, and those in whom emotional factors seemed irrelevant to the
onset of past attacks. The first group was expected to benefit from separation, but
not the second.
The parents and siblings were removed from the home and sent to a motel for
two weeks, while the child continued to live in his home environment. A surrogate
parent was provided, and the child continued normal attendance at school and
normal play activities. After two weeks of not seeing their child, the
parents returned to the home and life went on as usual.
As predicted, the effects were beneficial for the group suspected of emotionally
induced asthma. Their medication during separation was reduced by half during
daily physician checks, and on top of this the number of asthma attacks and
amount of wheezing was reduced by half as well. When the parents returned,
wheezing, number of attacks, and amount of necessary medication all increased.
Beneficial effects of separation on asthma did not appear for the group in which
emotional factors had been judged unimportant.
So, for some children, emotional factors are probably irrelevant to asthma. For
others, however, family stresses may set off or worsen asthmatic attacks. In these
cases, if the family members learn more effective and less stressful ways of dealing
with each other, the child's asthma may get better.
EMOTIONAL INTELLIGENCE THERAPY APPLIED TO PSYCHOSOMATIC DISORDERS HAS BEEN PROVEN SUCCESSFUL.
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