Contained hostility in rheumatoid arthritis

Abstract

Containment or suppression of hostile Le continimento o suppression de imimpulses emerges as a sensible syn-pulsos de hostilitate se revela como un thesis of the known psychosocial factors synthese plausibile del cognoscite facin rheumatoid arthritis. An unusual case tores psycho-social in arthritis rheumaprovides a n opportunity to present a toide. Un caso inusual provide le opporreview of the literature. This is an tunitate de presentar un revista del important area for further research. litteratura. Isto es un importante area pro recercas additional.OR THE LAST hundred years the literature on rheumatoid arthritis F has presented occasional references to the importance of psychologic and social factors. The frequency of such reports is growing geometrically and a sample of American rheumatologists recently queried about the most important areas for research on this disease consistently indicated that the psychosocial area should get primary a t t e n t i~n .~~ Many interesting aspects of this problem were pointed out by King,la in his review of the literature. However, to date the known facts have not been marshalled in such a meaningful array that one could say that there is one dominant influence in this disease. In the course of studying the case here presented, a possible synthesis around a central concept of contained hostility became apparent. Therefore, this case is presented with a review of the pertinent literature. Following the example of Nemiah,27 the patient was selected for study because he suffered from two interesting diseases,27 rheumatoid arthritis and duodenal ulcer, and because of his intelligence, his powers of observation and his willingness and ability to communicate. The relationship established between the patient and the investigator was purely for research purposes. At no time did the investigator assume any therapeutic responsibility for the patient beyond friendly concern and occasional simple advice. CASE HISTORYDr. A. is a scientist in his early fifties, who was born the youngest of four sons in a small country town where his father was the minister. His mother was a vigorous woman, who before her marriage had been a school teacher, and who, at the age of 91, was still said to have more energy than any of her sons. The older two siblings, aged 66 and 64, are teaching school. The third boy, now aged 61, is, like the patient, a scientist, and it is interesting to note that he also had a peptic ulcer which ultimately led to gastrectomy. The only rheumatism reported in his family was in his father. This appears to have come on in the seventies and to have been mild, certainly never disabling.A. is nine years younger than his next older sibling. He repeatedly identifies himself as being like his mother and her side of the family. His father is conspicuous by the fact that he was never mentioned in the interviews beyond being identified as the Presbyterian

Physical Limitation and Anger

“…and aggressive inclinations” (p. 502). Consistent with this view, prior research demonstrates that individuals who experience chronic physical pain report higher levels of anger than those who do not and that anger increases as physical discomfort increases (Cobb 1959; Summers et al 1991).…”

“…Simply experiencing physical discomfort or pain—a frequent corollary of physical limitation—may elicit anger. Several studies have shown that pain is associated with the experience of anger (Cobb 1959; Summers et al 1991), and additional evidence indicates that the propensity for anger is elevated among people with physical limitations who experience chronic pain (Burns et al 1996; Greenwood et al 2003; Okifuji, Turk, and Curran 1999).…”

A Dynamic Conceptual Framework of Generalized Adaptation to Stressful Stimuli

“…W e have departed from the strict phenomenological perspective that the individual creates his own reality, although we recognize the individual's integral and active role in influencing environmental events, and have postulated a process of environmental demand-stress-mediating factor-response which runs parallel with but at times independent of the individual's perceptions and evaluations of environmental events. W e believe that response to environmental events may, at times proceed unrecognized and unperceived by the individual and that there is sufficient literature to warrant this conclusion, especially in the area of psychosomatic reactions to stress (4,5,6,10,14,22). W e believe that future research must identify which types of stressor events lead to what types of adjustive responses relative to coping and defense, given certain types of internal and external mediating conditions.…”

Rational/antiemotional behaviors in interpersonal relationships and the functional prognosis of patients with rheumatoid arthritis: a Japanese multicenter, longitudinal study

“…For centuries, clinicians have been impressed by the role of psychosocial factors on RA, and in the 1950s and 1960s, RA came to be viewed as one of the classical psychosomatic diseases [ 8 , 9 ]. Particular personality factors that possibly relate to the onset and course of RA have received considerable attention [ 10 ], and a personality characterized by an inability to express aggressive feelings, e.g., “contained hostility” [ 11 ] was the one on which many researchers agreed [ 12 ]. The nature of these earlier studies included a cross-sectional design, and they were repeatedly criticized, with reviewers concurring on the necessity for prospective studies that allow better causal interpretations [ 5 , 9 , 13 , 14 ].…”