Psychosocial Processes and “Stress”: Theoretical Formulation

Despite widespread belief that psychosocial processes may be important in disease etiology, attempts to document the role of such factors in epidemiologic studies have led to conflicting and often confusing results. It is the thesis of this paper that this is largely a result of inadequacies in our theoretical framework. The point of view is presented that this stems from an uncritical subscription to and often erroneous interpretation of “stress” theory, a failure to recognize that psychosocial processes are unlikely to be directly pathogenic (in the way that, for example, a microorganism is) and unlikely to be unidimensional. An alternative point of view with data from animal and human studies is presented, and the implications for research strategy and the delivery of health care are discussed.