The Medicalization of Stress: Hans Selye and the Transformation of the Postwar Medical Marketplace (2015)
Markowitz, Gerald E. (Advisor)
Nasaw, David (Advisor)
Burrows, Vanessa (Author)
Markowitz, Gerald E.
New York, City University of
Nasaw, David
This dissertation employs historical methodology and public health theory to examine how critical changes in the culture and political economy of biomedical research shaped Hungarian-Canadian endocrinologist Hans Selye's concept of biological stress, guiding him to develop a highly individualistic and commercially-appealing disease model that complimented major interests of the postwar medical marketplace: the state, the corporation and the consumer. In the mid-1930s Selye proposed that the human body adapted to a diverse range of stressors—including, extreme temperatures, intoxification, surgical trauma, physical exercise and complete immobilization—by releasing adrenocortical hormones to regulate bodily functions. For the next fifty years he devoted his career to studying the mechanisms by which stress operated, using his training in histology and biological assay to identify how stress altered biochemistry at the cellular level. Selye found that while the human body maintains homeostasis and mitigates damage from stressors by altering the balance of pro- and anti-inflammatory adrenocorticoids, a prolonged imbalance of these hormones can produce "diseases of adaptation," such as arthritis, heart disease, hypertension and gastrointestinal ulceration. While this General Adaptation Syndrome (GAS) is universal, it is also highly individualized, as an individual's exposure to unique "conditioning factors" determines the type and magnitude of diseases produced by stress. Even though he complied with the reductionist methods of biomedical research, Selye's theory was a radical departure from the orthodox biomedical doctrine of specific disease etiology. However, by offering a multicausal theory of disease causation that embraced the concept of attributable risk, Selye helped to reconcile mid-century biomedicine with the contemporaneous rise in chronic disease in North America. Selye was a visionary, but was not insulated from financial and cultural pressures. In order to attract funding from philanthropies, private enterprise and the US and Canadian federal governments, he catered his research to appeal to mid-century public health priorities and the health concerns of North American patient-consumers: relief from chronic diseases and anxiety neuroses. Selye began using the term "stress" to describe the GAS at the end of the Second World War, after military neuropsychiatric research on combat stress had already given the term a medical valence. And in the early-1950s, as his controversial theory was vindicated by the therapeutic discovery of cortisone and ACTH, Selye began a vigorous public relations campaign to promote popular awareness of stress. In doing so, he appealed to the concurrent medicalization of anxiety and growing market for anxiolytic drugs, blurring the distinction between biological and psychological stress. Yet, he won validation for stress in the medical marketplace. Selye inadvertently advocated a psychosomatic perspective of stress by advancing an ethical code of "altruitistic egotism." He insisted that individuals must learn their own unique stress triggers and develop personal therapeutic strategies, especially in disrupting patterned "stress grooves" with useful "deviations," like reading a book, taking a walk, listening to music, or smoking a cigarette. While anxiolytic and adrenocoritcal medications might be useful in managing chronic conditions, to Selye will power and self-awareness were the most effective therapeutic weapons in combating stress. Stress, as Selye described it, offered patient-consumers a means of managing their own health. Yet, by advancing an individualistic and commercially-appealing theory of stress, Selye obscured ecosocial pathways of disease that distribute stress risk far beyond the control of individual interventions.
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