Social Causes of Illness
by Richard Totman
Pantheon, 263 pp., $10.00
The first, and perhaps the most important, thing to be said about this book is that its title is misleading. Social Causes of Illness is not about whether social habits, customs, conditions, or structures cause illnesses—or whether social changes are reflected in changes in the incidence of illnesses. It is about the theoretical and epistemological implications of the fact that many physical illnesses seem to occur shortly after a significant event in the patient’s life, particularly after one which has changed his style of life. “Recently,” Dr. Totman writes,
a considerable body of evidence has accumulated which suggests that many serious illnesses, as well as being related to acknowledged physical causes, occur with some regularity following particular types of life experience. The significance of this evidence is not to be under-estimated. For if it is true that specific circumstances can render a person susceptible to illness, we are forced to recognize a degree of control over health prior to the point at which the accredited physical “causes” can exert any influence.
The physical aspects of a disease—the organic manifestations we have come to regard as the disease itself—may, in fact, represent a comparatively late stage in an “underlying” dysfunction. If this is the case, then treating illness by conventional methods (with drugs, surgery, radiation, etc.) is merely scratching the surface of the problem. Physical intervention may be attending to the symptoms of the basic affliction rather than to the real cause.
Dr. Totman’s book is, in fact, an essay on the theory of psychosomatic disease—not a contribution to the sociology or politics of medicine. It is an attempt to formulate a structuralist theory of mind which would make it possible to conceive how a social, psychological event, e.g., marriage, divorce, bereavement, retirement, could act as the cause of a physical illness, e.g., cancer, heart disease, or hypertension, and how there can be such a thing as “a degree of control over health prior to” the moment at which physical causes begin to operate.
At this point it must be stated that Dr. Totman is a clinical psychologist not a physician, a PhD not an MD, and that, therefore, the experience which has persuaded him of the reality of psychosomatic illness must be very different from that of those physicians and medically qualified psychoanalysts who introduced and popularized the concept during the early years of this century. They would, I imagine, have based their conviction of the reality of psychosomatic illness on their clinical experience, or perhaps on their philosophical position. Totman bases his on his familiarity with the accumulating statistical evidence provided by papers written, mostly, by psychologists, notably by R.H. Rahe and G.W. Brown, both of whom have developed sophisticated interviewing techniques for assessing the incidence and quantifying the impact of disturbing life events.
This evidence is, indeed, most impressive and it has, I think, to be taken as fact that human beings are at greater risk of developing …