Social Assets and Vulnerabilities influence the Distribution of Illness.
In my third year of Medical School I became interested in following a career of stress and illness research influenced by my contact with Thomas H. Holmes, M.D. Dr. Holmes, trained in Internal Medicine, was hired as a Professor of Psychiatry because of his background training in life stress and illness research. I was fascinated by lectures he presented to our class. He was famous for starting a lecture with a statement that would arouse dismay and disbelfief. For example, he started one lecture stating: “A life crisis” in needed in order for women to become pregnant." Soon the woman, and many men, in the audience to groan loudly and even shout: "Nonsense!" He now had everyone's attention!
He went on the review results form a study done by one of his previous medical student trainees comprised of unwed young women living at a charity facility that provided free room and board throughout their pregnancies. The majority of women interviewed gave a history of just such a pregnancy-preceding life crisis. They had often run away home in their early teenage years, experienced severe financial and job problems, encountered legal difficulties, reported frequent changes in residence, and had problems finding stable relationships with men. Frequently these women said that shortly before becoming pregnant they had begun seeking “meaning in their lives.” Dr. Holmes would summarize by saying that: "Heterosexual intercourse is a necessary, but not by itself sufficient, cause of pregnancy."
Among his memorable presentations were his generalizations regarding the distribution of illness in a population. I have listed eight generalizations below. See if you don't find wisdom in reading them.
Some of the People have most of the illness
Persons in the health care profession are extremely familiar with patients who encounter an astounding number of illnesses. As medical students we used to weigh a patient's medical records as an index of their "heavy" past medical history. Studies of groups of persons' lifetime illness experiences have shown that 30% of the people experience 70% of all the illnesses.
Some of the people have most of the health
We all know persons who are never sick. They seem to be "immune" to illness and accidents. These individuals are the converse of persons alluded to above, showing that another 30% of the people have 70% of all the health.
To be sick successfully you must choose your parents carefully
Only Dr. Holmes would ever have labeled persons with multiple illnesses throughout their lifetimes as being "sick successfully?" However this concept becomes clear from information concerning genetics and early learning playing important roles in our susceptibilities to illnesses.
To be sick successfully you must start early
This generalization relates to the one above. Adults developing multiple illnesses very frequently report similar high illness rates, including accidents, during their childhood and adolescence.
When you get sick you get sick all over
A generalization that is one of my favorites. I often see new patients stating a single problem – such as a recent heart attack, or recent trauma. They are not aware, initially, of other possible concomitant illnesses issues until I ask about a possible concurrent sleep disorder, digestive problems, psychological depression, headaches, muscle tension, and so on.
Illness is a byproduct of failures to adapt
Life stress is experienced by all of us. Most often these life stresses are managed successfully over the following months. What if all attempts to solve these stresses failed? What would be then mind and body consequences? Most likely they would include a lowering of bodily resistance to illness and accidents.
Stress makes any illness bigger, stronger, and longer-lasting
I adapted this generalization from one of Dr. Holmes’ stress and illness examples - hay fever. He would say that if you are suffering from hay fever and then your mother-in-law comes to visit, you may well develop "bigger hay fever, better hay fever, and longer hay fever." I've seen such stress related enhancements of an illness occur with a number of different illnesses. So I generally tell my patients that stress may not have caused their illness, but if unmanaged it will likely make the illness more difficult to overcome.
Stress can bring an illness forward in time
This interesting conceptualization regarding the timing of onset for an illness was brought to my attention by George Brown, PhD. I have seen a possible applications of this concept dealing with patients following a heart attack. They generally show many of the "physical risk factors" for heart disease - such as being overweight, high blood pressure, and elevated blood fats. But several patients were only in their late 30s or early 40's when they experienced their heart attack. Typically their recent life stresses were extremely high plus they also reported few coping skills. it appeared to me their disease may well have been brought forward in time from these "precipitating" stresses and minimal coping.
