Psychosomatic symptoms,stress, and modernization: A model

The quantity of research on the effects of stress on disease has increased substantially in recent years, but little effort has been devoted to examining the effects of cultural influences in the stress process. A model is proposed in this paper in which cultural context exerts a modifying influence on the relationship between sociocultural stressors and psychosomatic symptoms, specifically in the context of modernization. In change situations involving increasing modernization there is increased differentiation in systems of social stratification within a community, due to increased potential for upward social mobility. The individuals who are upwardly mobile adopt a particular style of life, involving the acquisition of western consumer goods, as symbolic of their success. Lower class individuals strive to attain this same style of life as a claim to a higher status social identity, but their lower economic condition results in stressful incongruities and higher psychosomatic symptoms. Individuals who are successful in upward mobility are confronted by a different set of stressors that are primarily intrapsychic in nature. Events and circumstances perceived as threats to their self-identity are related to more psychosomatic symptoms. Thus, the meaning of specific stressors changes depending on the sociocultural context of the individual, and this meaning serves as a bridge between environmental circumstances and physiological outcomes. This model receives substantial empirical support in two field studies. Limitations of the model and implications for future research are discussed.Research in St. Lucia was supported by the Connecticut Research Foundation and the University of Connecticut Health Center. Research in the U.S. was supported by Research Grant MH 33943 from the Center for the Study of Minority Group Mental Health, National Institute of Mental Health. Drs. Arthur Kleinman, Lee Badger, H. B. M. Murphy, James Bindon, and Laurence Watkins kindly commented on previous drafts of this paper. Dr. Michael Murphy deserves a special note of gratitude for reading several drafts of the paper and for patiently sitting through several lengthy discussions of it. I alone am responsible for the errors and shortcomings.