Biological basis of stress-related mortality

It is believed in primitive society that physical health depends on harmonious social relations and that sickness follows social disruption. The mortality patterns of adults in modern society support this view, but its biological basis is not widely appreciated. This essay reviews the mechanisms by which chronic psychological arousal produces chronic physiological arousal and, in turn, specific biological pathology. The brain sets for the body a broad pattern of physiological and metabolic activity and enforces it by control over the autonomic and endocrine systems. Under conditions of arousal the brain sets a pattern of catabolism, mobilizing all the mechanisms that produce energy for "coping" and suppressing the mechanisms that store energy or use it for growth, repair, and surveillance against pathogens. As part of this adaptive response the brain mobilizes cardiac, vascular, and renal mechanisms to raise blood pressure. When arousal is chronic, the high pressure causes damage which, in interaction with a variety of arousal-induced chemical changes, leads to endstage diseases such as coronary heart disease, stroke, and kidney disease. The biological causes of cancer and diabetes are not fully known but seem to be powerfully influenced by arousal-induced endocrine patterns. Treatment of arousal pathology at the end stages has been highly technological, of limited success, and very expensive. The leading alternative has been an attempt to prevent endstage disease by treating mild hypertension on a mass scale (23-60 million patients in U.S.) with potent drugs. As drugs block peripheral pressor mechanisms, the brain drives them to compensate and to require blocking by additional drugs. Over the decades of prophylaxis for which drugs are intended, their cumulative iatrogenic effects are likely to be serious. Psychosocial treatments for mild hypertension (including placebo, relaxation techniques, and social support) appear to be quite effective. These treatments appear to work by reducing chronic arousal, and tend not to evoke compensatory or iatrogenic responses. The extraordinary sensitivity of the brain and the neuro-endocrine system to psychosocial intervention suggests that in modern, as in primitive society, these are the treatments that will prove safest and most effective.