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

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

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

6. CAUSES OF SUICIDE 1. LACK OF SOCIAL INTEGRATION (EGOISTIC) 2. LACK OF COHERENT MEANING SYSTEMS (ANOMIC) FOCUS ON SOCIAL NOT INDIVIDUAL FOCUS ON GROUP RATES

7. II. STRESS THEORY AMBIGUITY OF “STRESS” HERE: STRESSORS = CAUSES DISTRESS = EFFECTS

8. HANS SELYE PHYSIOLOGIST STRESS RESULTED FROM DISTURBANCES OF EQUILIBRIUM STUDIED STRESS IN ANIMALS

9. 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

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

11. 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

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

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

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

18. 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

19. 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

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

21. GRADE DISTRIBUTION 90 – 100AN = 62 88B+N = 18 80 - 86BN = 59 78C+N = 17 60 - 76CN = 99 50 - 58DN = 9 44 - 46FN = 4