The ecology of suffering: developmental disorders of structured stress, emotion, and chronic inflammation

Abstract

'Punctuated equilibrium' models of cognitive process, adapted from the Large Deviations Program of probability theory, are applied to the interaction between immune function and emotion in the context of culturally structured psychosocial stress. The analysis suggests: (1) Chronic inflammatory diseases should be comorbid and synergistic with characteristic emotional dysfunction, and may form a collection of joint disorders most effectively treated at the individual level using multifactorial 'mind/body' strategies. (2) Culturally constructed psychosocial stress can literally write an image of itself onto the punctuated etiology and progression of such composite disorders, beginning a trajectory to disease in utero or early childhood, and continuing throughout the life course, suggesting that, when moderated by 'social exposures', these are developmental disorders. (3) At the community level of organization, strategies for prevention and control of the spectrum of emotional/inflammatory developmental disorders must include redress of cross-sectional and logitudinal (i.e. historical) patterns of inequality and injustice which generate structured psychosocial stress. Evidence further suggests that within 'Westernized' or 'market economy' societies, such stress will inevitably entrain high as well as lower stutus subopulations into a unified ecology of suffering.