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Influence of social and cultural patterns on psychosomatic diseases.

The author surveys the mechanisms by which socio-cultural factors can produce or modify psychosomatic disease via education and the opportunities which the structure and cultural norms of society allow and prescribe for the acting-out of reactions to conflicts and frustration. The hypothesis is offered that every society or culture (like biological organisms) tends to preserve its homeostasis by feed-back mechanisms, which consist in the psychosocial interactions of the members of its cultural and social subgroups. This homeostatic tendency preserves a dynamic equilibrium in the society, although in the long run both biological and social organisms do not succeed in their tendency toward self-preservation but are involved, evolutionarily and sometimes revolutionarily, in progressive or regressive change. This changing process in the society is itself a more or less stressful situation which requires from the members adaptative responses to cope with it. Depending on whether their responses are adequate, the members of the subgroup may remain healthy or fall victim to deviant behaviour or disease. The so-called psychosomatic disorders are markedly culture-induced. Support for this thesis is derived from clinical trans-cultural experience and from observations during World War II in Holland and in the concentration camps. Present observations among the affluent and poor classes in Western countries and in developing areas, as well as among new immigrants, also illustrate the determination of diseases and behaviour patterns by socio-cultural circumstances. It appears that the socio-cultural stressors prevalent in affluent social groups increase the risk of certain psychosomatic illnesses of which coronary heart disease is the most prominent example. Poverty and overcrowding, which are prevalent in the lower social strata of both the affluent and developing countries, appear to increase the tendencies to aggressive and deviant social behaviour. The loss of family, community and tribal cohesion, and support, both in the home and in the work situation and in other social cultural groups, is the most noxious stressor in both poor and well-to-do groups in our days. The emancipation of women and children in the western culture has improved their situation but has deprived many males of the support they derived from their previous authority. The effects of these stresses need urgent study. It appears that individuals who are supported by love and secure family and community bonds can cope much better with stressful psychosocial situations than individuals who are deprived of such support. These concepts can serve as guiding lines for government policies, public and mental health programmes, and can form a basis for a fruitful cooperation of doctors, biologists, psychologists, educators, and sociologists. This is not only necessary in the western culture. The same process is also beginning to take place in other countries, which used to be technically underdeveloped but are already participating in the western ways of life with its stresses and diseases.