Life Events and Illness

Book excerpt: The role of factors outside the province of the physical and biological sciences in the onset of illness has long been a source of speculation. While early efforts in psychosomatic medicine focused on the relationship between mental states and illness, the effects of personal status and social circumstances on physical health are only now receiving the attention they merit. By integrating current theory, methodology, and research, this ground-breaking volume advances the study of life events and disease to a new stage. George Brown and Tirril Harris are ideal editors for such an undertaking. George Brown has long been known for his path-breaking work on intensive clinical assessment and designing measures that capture the real complexity of social situations, assigned meanings, and personal response to crisis. He brought to light the importance of ``expressed emotion,' the differential role of life events in schizophrenia and depression, and most recently, produced a seminal work on the social etiology of depression with Tirril Harris. As David Mechanic notes in his Foreword, the defining characteristics of these efforts, which are also reflected in this volume are a ``sensitivity to clinical material and capitalizing on serendipity; self-consciousness about methods and methodological advances; and focus on theory with careful efforts to specify intervening processes and the links between macro events and personal meanings.' Along with their collaborators, these eminent editors bring together an impressive range of theoretical thought and empirical study organized around the Life Events and Difficulties Schedule (LEDS). Their examination of the origins of life events and difficulties and the notion of ``conveyor belts' to continuing adversity capture the immutable uncertainties of life and help to link concerns with life events and disease to larger issues of human development. The authors' innovative approach to establishing the relationship between ``attitudes' and psychiatric and physical disorders fully utilizes the wealth of data elicited by the LEDS, and demonstrates how the comprehensiveness of this data matches the sophistication and complexity of the theoretical ideas it serves. Addressing fundamental questions on the whether the specific nature of life events and vulnerability factors differ in different disorders, the authors conclude by providing a perspective on psychodynamic etiology which emphasizes the specificity of crucial links. It integrates social, psychological, and biological factors around the notion that specific types of cognitive-affective experience are linked to specific types of illness. While significantly advancing our understanding of how individuals define and deal with adversity, LIFE EVENTS AND ILLNESS also fosters a greater appreciation of the methodological tools available for examining these processes. For all clinicians, researchers, and students in the behavioral sciences, this timely work not only provides a comprehensive review of the literature and a critical examination of current research models but also points the way for future investigations.