Epidemiology of the psychosomatic diseases.

The rise in deaths attributed to coronary thrombosis and duodenal ulcer has been widely commented upon. It has been suggested that these two conditions are merely examples of the psychosomatic diseases, the incidence of which has risen directly or consecutively with the rising mental stress associated with an increasingly complex civilization. In this paper certain epidemiological facts relating to selected examples of the psychosomatic diseases are studied, and it is shown that there are such differences in behaviour between the diseases as to suggest that modern civilization cannot adequately account for them. A study of the many published case reports and clinical investigations leaves no doubt that mental stress plays a large part in precipitating individual attacks and causing exacerbations of the illnesses. Furthermore, mental stress will cause prolonged disability to arise from an illness which in a person with less stress would cause only temporary and trivial disability. If episodes of external stress acted universally in this way, then one would expect to see fluctuations in the incidence of the psychosomatic diseases related to periods of unemployment with more marked rises in the lower social classes, in towns subjected to bombing during the war, etc. Although Swinscow (1951) showed a correlation between suicides and unemployment no such correlations have been shown with the psychosomatic diseases. For this study the following seven conditions have been selected as representative of the psychosomatic diseases: