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

4. ASSUMPTIONS (CONT.) 2. CURRENT ENVIRONMENT MOST IMPORTANT 3. GROUPS HAVE DIFFERENT EXPOSURE TO STRESSORS AND RATES OF DISORDER 4. FOCUS ON COMMUNITY POPULATIONS NOT CLINICAL CASES

5. 5. DISTRESS IS OFTEN COLLECTIVE AND NOT INDIVIDUAL

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

10. CAUSES OF SUICIDE 1. LACK OF CONNECTION TO SOCIAL GROUPS AND MEANING SYSTEMS - EGOISTIC (ALTRUISTIC) 2. LACK OF CONSTRAINT OVER BEHAVIOR – ANOMIC (FATALISTIC) FOCUS ON SOCIAL NOT INDIVIDUAL

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

12. 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

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

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

15. 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

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

17. HANS SELYE

18. PHYSIOLOGIST STUDIED STRESS IN ANIMALS STRESS RESULTED FROM DISTURBANCES OF EQUILIBRIUM - CHANGE

19. 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

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

23. 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

24. H+R LIFE EVENTS RELATED TO BOTH MENTAL AND PHYSICAL HEALTH (NON-SPECIFIC) LESS THAN 150 - FEW HEALTH PROBLEMS OVER 300 - 80% HAVE PROBLEMS OVERALL MODERATE CORRELATION WITH HEALTH PROBLEMS

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

26. GRADE DISTRIBUTION 90 – 100AN = 65 88B+N = 17 80 - 86BN = 75 76 - 78C+N = 21 60 - 74CN = 64 50 - 58DN = 11 32 - 48FN = 4

27. GRADE DISTRIBUTION 90 – 100AN = 45 88B+N = 15 80 - 86BN = 69 76 - 78C+N = 36 60 - 74CN = 65 50 - 58DN = 20 32 - 48FN = 11