BASIC ASSUMPTIONS 1. EXTERNAL ENVIRONMENT LEADS TO MENTAL CONDITION LIFE EVENTS, CHRONIC STRAINS, SOCIAL ROLES 2. CURRENT ENVIRONMENT MOST IMPORTANT

ASSUMPTIONS (CONT.) 3. GROUPS HAVE DIFFERENT EXPOSURE TO STRESSORS AND RATES OF DISORDER 4. FOCUS ON COMMUNITY POPULATIONS NOT CLINICAL CASES

I. DURKHEIM SUICIDE (1897) SUICIDE RATES VARY SYSTEMATICALLY WITH SOCIAL CONDITIONS

CAUSES OF SUICIDE 1. LACK OF SOCIAL INTEGRATION (EGOISTIC) 2. LACK OF COHERENT MEANING SYSTEMS (ANOMIC) FOCUS ON SOCIAL NOT INDIVIDUAL FOCUS ON GROUP RATES

II. STRESS THEORY AMBIGUITY OF “STRESS” HERE: STRESSORS = CAUSES DISTRESS = EFFECTS

HANS SELYE PHYSIOLOGIST STRESS RESULTED FROM DISTURBANCES OF EQUILIBRIUM STUDIED STRESS IN ANIMALS

SELYE (CONT.) ENVIRONMENTAL CAUSES – TEMPERATURE, FOOD, CROWDING STRESSORS CAUSE PROBLEMS BY WEAKENING IMMUNE SYSTEM GAS - GLOBAL ADAPTATION SYNDROME ANY DISTURBANCE OF EQUILIBRIUM CAN LEAD TO GAS

III. MILITARY PSYCHIATRY LESSONS OF WWI HUGE PROPORTION OF PSYCHIATRIC CASUALITIES LED TO PRESCREENING OF ALL DRAFTEES IN WWII

MILITARY PSYCHIATRY HUGE PROPORTION OF PSYCHIATRIC CASUALTIES IN WWII OVERALL 25%; OVER 70% FOR LONG STRETCHES AVERAGE SOLDIER WOULD BREAKDOWN AFTER 80 DAYS OF CONTINUOUS COMBAT

EFFECT OF COMBAT HIGHLY PRESCREENED NO INDIVIDUAL PREDISPOSITIONS PREDICTED BREAKDOWNS WHAT DID? LENGTH OF COMBAT BEST PREDICTOR CAUSE WAS ENVIRONMENTAL NOT INDIVIDUAL

EFFECT OF COMBAT TREATMENT NEAR UNITS 2/3 RETURNED TO UNITS WITHIN 2 DAYS MINORITY MORE LASTING PROBLEMS (PTSD)

MAJOR REORIENTATION ENVIRONMENT CAUSE OF MUCH DISORDER - “EVERYONE HAS THEIR BREAKING POINT” FOCUS ON ENTIRE POPULATION NOT JUST TREATED CASES TREATMENT SHOULD BE IN COMMUNITY NOT HOSPITALS

HOLMES AND RAHE MILITARY PSYCHIATRISTS TRANSLATE STRESS THEORY AND WWII TO CIVILIANS STARTED WITH SAILORS MANY OTHER GROUPS SRRS IN 1968

HOLMES AND RAHE SRRS STANDARDIZED SCORE NEGATIVE - DEATH, DIVORCE, JAIL AND POSITIVE - MARRIAGE, HAVE CHILD, XMAS BOTH CAN DISTURB EQUILIBRIUM FOCUS ON CHANGES SUM NUMBER AND GET SCORE

H+R LIFE EVENTS RELATED TO BOTH MENTAL AND PHYSICAL HEALTH (NON-SPECIFIC) LESS THAN FEW HEALTH PROBLEMS OVER % HAVE PROBLEMS OVERALL MODERATE CORRELATION WITH HEALTH PROBLEMS

CRITICISMS OF SRRS IGNORES CONTEXT AND MEANING ONLY NEGATIVE ARE STRESSFUL WHAT IS CAUSE AND EFFECT? NOT UPDATED IGNORES DIVERSITY OF RESPONSES

GRADE DISTRIBUTION 90 – 100AN = 62 88B+N = BN = 59 78C+N = CN = DN = FN = 4