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And we are the national educational radio network presents special of the week from Yale University from its series called Yale reports. More and more the relationship between mental stress and physical disease becomes apparent. The suburbanite the city dweller and the ghetto resident are all victims of today's stressful life each in his own way staying alive. Part three looks at the stress in today's lifestyles and the effects upon our health. Dr. Richard Weinerman professor of medicine and public health. Dr. Adrian M. us felde chairman of the Department of Epidemiology and public health and Richard Sennett assistant professor of sociology discuss questions of stress and disease. Dr. Weinerman. What is it that makes a certain kind of stress and up with a certain kind of disease. I'm fascinated by this relationship of what we sort of glibly call stress on the one hand and disease manifestation on the other
because there must be some mediating mechanism in between and that's what interests me. I don't think any of us could claim that current modern society has a monopoly on stressful life. I'm sure other people had to survive from day to day in the jungles in the primitive people had enormous stresses that we don't even know about and we switch our one button for heat and another button for a light and so on but that they were apparently different kinds of stresses and they had different kinds of effects the stresses we see today. I think there's evidence would you agree I agree and it's beginning to be pointed up is mediated through changes in the function of the body that we can study and that those changes end up in the disease patterns we see. There are only a couple of mechanisms really that link the receiving station of the brain with the rest of the body. The nervous system the chemical or Harman system and the vascular system. And in the years that I was in medical practice I'll just say this much and ask
for your reactions. I began to develop a feeling about these three different kinds of stress relationships and I have no real data to go whether there was some day I'd like to compile it. But just watching patients over many years there seemed to be a type of stress that was essentially affecting the arteries of the system and basically making them contract and then in response over expand abnormally. There was a type of stress that seemed to have its major AFACT on the hollow organs of the body like the stomach and intestine with peptic ulcers or the bronc tubes with asthma or the lower gut with ulcerative colitis and that seemed to be one type of stress and one type of person. And thirdly there were there was a type of stress that seemed to be manifest through the what we call the autonomic nervous system of the body which produced an overreaction of the nervous system and fainting smells and things we call
hypoglycemia and over breathing and so on. At any rate at what I was when i'm trying to do is put the emphasis on the kind of stress because a psychiatrist than putting a lot of emphasis on the kind of person and I don't think it's only the person and the three examples I have in mind is this. And and what's much too long a speech that the. The kind of stress which is a person on against himself for performance. I began to correlate with the ulcer type of disease of somehow involving the viscera of visceral response the kind of stress that was a stress against time against the externally imposed limitations like the very busy general practitioner running around. It wasn't hard necessarily to do is work. He just couldn't cram it all in in the time he had. That seemed to be much more a vascular type of stress with the coronary kind of outlet. And then there was the stress of
frustration maybe of boredom essentially the Housewives kind of stress of a life in a normal healthy intelligent often educated woman doing very routine and simplistic and restrictive things. And the self deprecation and the boredom leading to a kind of reaction that was manifest with things like migraine. Now I know I do and that you have been involved with a great deal of these things on a much more serious epidemiologic level. I wonder if you have any feelings about the relationship between the type of stress as well as the type of person and some of these. I think that your individual experience Dick is at least insofar as I can tell started leading it down the right path. I think maybe I can point this up a little bit more by talking about a single illness that I've had some experience looking at high blood pressure for instance just does not exist among primitive peoples.
You can go in this kind of work you will be able to do it for very much longer because you're putting you know jet strips all over. But the Australians and New Zealanders fortunately have gone into islands in the South Seas and surveyed a whole island people missing nobody. And there simply are no high blood pressures. And then if you go to islands which are in a state of very rapid social change and in a state of rapid cultural and social transition you find a lots of high blood pressure. And interestingly enough again if you go to urban industrialised countries you find that the disease starts to disappear again so that there appears to be some correlation between social and cultural instability and change and this disorder. But it's striking that all of the all of the stresses you mention essentially suffered by middle class people do you have any sense of this for say patients who would you know work and people who do very very routine.
Well I do because. Well two things One is that I think the overwhelming physical and biological and deprivation stresses of the poverty groups in our population often overshadow these more individual psychological one of us. There you are. If you're suffering from nutritional deficiency and from infections that you get because the city doesn't collect your garbage and the rats accumulate and so on. Maybe you don't have as much time to worry about being bored. But I do feel that factory worker type of stress and routinized productive line production lines can be comparable to the housewives type of stress that I was talking about in that it's a fun challenging routine boring and the pressures of other kinds of workers who have to make deadlines or who are on piecework where they get paid by the pressure of the clock that these can be very similar to the professional who is racing
around with more to do than he has time for and people and all kinds of economic classes. Candy can be fighting against themselves in various ways which is why I thought of originally as that but also that I because I don't see Dr S from a no statistics on this. I don't see class differentials anymore in the distribution of these kinds of diseases. Brancaccio asthma and optic ulcer. Migraine whereas we used to see class differential it was in diseases that were directly related to economic status romantic fever gastric carcinoma. But these kinds of older diseases are giving way in a sense to the new ones which I think I must more related to either the stresses or the general pollutants like smog and cigarette smoking that affect all classes. I think what you do find is that there's a relationship
between social and economic status. And what we call the natural history of disease I think there is good reason to believe for coronary heart disease which is a major health problem of our time that this is the case. The upper echelon management people when they get a new coronary heart disease for the first time it's manifest among this group in a much more mild way what we call angina pectoris which is a pain in the chest with physical activity that goes away when you stop work. These upper echelon people either notice this and see a physician about it while a blue collar worker doesn't or there really is some fundamental difference in the way the disease appears. The blue collar guy when he first experiences it either keels over and has had it or he has a heart attack very seldom does he have these warning attacks of Nanjing of Petra's for years and years.
This is I think this is now all clear beyond a reasonable doubt and it helps to establish or helps to rationalize and understand a lot of conflicts in the literature about this. You hear the story on the one hand that the upper echelon business guy is a man who gets a lot of heart disease. The blue collar worker is free of it. When people have studied it they found that exactly the opposite is true. That the blue collar man gets much more of it than the upper echelon man but the truth of the matter is that they haven't studied in a broad enough way. They're only looking at Frank heart attacks or sudden death from heart disease as as a manifestation the problem. If you look at the whole problem of coronary heart disease and all the ways in which it can occur there still is more of it you know upper echelon business people than there is among blue collar workers. I think this in part could be related to the sudden Taare life factor. Do you believe with so many others that there is a relation and coronary disease between
activity and lack right and the upper echelon business people are more physically active or more FAS Yes. Because I would guess there they weren't there. There are no more high energy jobs the housewife who scrubs floors or washing windows what a terrible state FISC is just putting out much more work than the average shift factory worker now. So how does this tie in with the our interest. And I mean I just did and I said I wonder if some of this differences don't have to do with that. I would let So the capacity for vocalisation of the stress of expressing it would exist in a middle class household versus lower class household and whether some of these elitist kinds of stresses that you're talking about are things that the people undergoing themselves might have a chance to to vocalize more into it to get out of their system a little more than a man that's faced in his job all the time with media time
that these so-called diseases do not have a differential economic class incidence. This is what interests me. Some of the old diseases. Very definitely for example cancer of the stomach was related to social blindness but also air peptic ulcer of the small of the part just below the stomach duodenal ulcer is not related to social class. Can some diseases like tuberculosis of the lungs were obviously related to social class but procmail asthma is not the all of this I already met How do you explain the rheumatic heart disease was coronary heart disease is not. Well I'm looking for the explanation in the combination of what I dreamed was saying about the nature of this of the stress and the physical activity and so on plus some of the more sort of material factors like. That are now equally
pervasive in all economic classes. We all breathe the polluted air. The incidence of cigarette smoking is pretty equal in any social class. Whatever is happening to our saturated unsaturated fat diet and take is not class developed very closely so I think whatever the cold logic mix of factors that produces these new diseases is people in different economic strata are pretty equally exposed to them at the same time I get there. There are more explain how to say this carefully. They get more of the diseases in total because the intensity of the exposure is often higher but the relationship is this time. What about your studies in migraine of these class Derived you know. I don't know. I don't think that what I did in that area would be enough really to make any assessments about how they're distributed by social class but if I can
bounce something off you dicks on it. It seems to me that if we leave out the in our thinking for a moment the problems of the black community you know that among the white American society the differences in different social classes in terms of diet physical activity hobbies are pretty well washed out. Can a blue collar factory worker have a wife who also works in between and they make $12000 a year 20000 You know so that you know this is going to you know is one of the most strange things in the word to really describe it aspects of development both in the American suburb and non ghetto aspects of the inner city. There are a lot of non ghetto aspects of the inner city you know enormous and growing all the time you know. As a matter of fact I would be willing to predict predict although I would like to be pinned down to it in ten years that within about 15 or 20 years the whole
ecology of the city will have reversed itself and that some factories are now locating out on the outskirts of large metropolitan areas that get a workers who are employed in those factories will have moved out to the fringes the urban area and at what used to be the classic pattern of ecological distribution of the population will re-establish itself that the closer into the center of town you can the higher the economic status of the people who live there. I think what we've gone through as a result of this black migration. You know after the Second World War. To some extent after the First World War as a sport. But let me come back to your original question one of the things that as a sociologist fascinates me in this. Is the extent to which cultural differences between different economic classes have in the United States largely played themselves out. And the last 15 20 years that is the availability of more money for people who are
supposedly working class or blue collar means they can do all sorts of white collar things. And there may be some parallel I don't know how one would draw it between this non class aspect of the diseases that you're talking about and effect cultural style of the population and what the part of the population uses its wealth becoming fairly homogenized in terms of classes. Not everybody is doing the same thing while I just want to register something I come back to later that all of this is except for the 20 odd percent at the bottom of this and really black urban core because I think they're outside of these generalizations about the marginalization of the rest assured. You know I mean when you accept you know get a residence then you see very. But there were let me just one other moment I throw back you there we're still seeing gross nutritional defects infant mortality beginning to go back up after
coming down. So as Adrian already mentioned venereal infections and even tuberculosis and other infections beginning to reappear there we're still seeing primitive health patterns as well as primitive lifestyle patterns and that's what interested me when you talked about the changing of the ecology of the city because in one of our per previous discussions I think it was Mr. Sears who was pointing out that the inner city ghetto area has no longer any ecological or economic functional reason for being. How is it people trapped in it in a sense are not needed and maybe even not wanted by this society and this economy. Their and their labor power is not needed and in an automated economy when out there there is no immediately discernable outlets for them to move up and out to chase after the factories and the suburbs.
If indeed they're not considered essential to the economic ecology and the social policy that goes with this now if this is true then it seems to me that just as much a chance for them to be sealed in and a kind of ACORN isolated as some of our physical redevelopment projects would make them in a little nubs in the heart of the city with all the rest of the life of the city going on around them and they're getting sort of subsistence welfare but no real employment sociologic cultural relationship to the rest unless we bang it open with a brand new social policy. I'm well I think that's that's half true I there are. There are the potential for a lot of semi skilled jobs in the new supposedly new industries like electronics for instance you know automation really doesn't do away with all the workers in effect or it does away with just a particular
kind of worker that is the very skilled worker who essentially assembles the OT the automated factory with one man pulling the lever I think is is is is not just around the corner. I think Sears is right to a certain extent that many ghetto residents are being frozen out of some of the things that now can be done mechanically but there still is a very is a very very large market for some ice if it can only be trained semi skilled labor to work in a new kind of factory situations that are developing. And I don't think it's going to be quite this dire I think the problem is to open up the flow between the sections of the city. If you want to talk about stresses of the city itself as an organism this would seem to me to be a major problem now that not only is a question of stress from young people moving out of the suburbs back in. And what that means in terms of the way their parents live and
so on and the conflicts you have there. But economically opening up the channel so that the people. Who live in ghettos don't for instance as they do in Chicago often have to commute an hour and a half an hour and 45 minutes each way to a job. And this seems to me to be critical. You know if we're to avoid exactly the kind of situation. Bring up. I see some dangers too even if it goes more happily and the way you suggest. I've always suspected that there were stresses in suburbia that are different than the ones maybe we can identify in the slums. You know that's what I like you. Well I think they come to the surface in the question of the relations between the generations and split in the lifestyle from people who are young people who have essentially the same economic orders there as their parents. But you know despite the work of people like her brigands and he ork who study of
Levittown has just been published. A good deal of evidence to suggest that such that the very simplicity of that environment was a stress people. People don't the emptiness of blandness is sort of you know sense of there's not really very much that's unexpected. How do we get a handle on the stress thing that has some health implications. These are communities organized around childrearing if you don't have children you have zero social role and what happens within what happens when the children get a ward because by the time they're 14 or 15 there are no kicks in hanging around Walgreen's drugstore on Sunday afternoon you know you want to go in the Chicago where the action is it was something about the organic composition of the city. That's right totally gone. It's set up that attracts these youngsters like a light attracts monsters. Also because it is disorganized that's part of what makes it seem
so organic. Oh a lot. And vaguely vaguely threatening sort of obscenely attractive i sexy at the same time. Well I I would. Or maybe start with the fact that it has content. There's an emptiness aspect to the suburbs which isn't the same as organization of disorganization you can't organize something if it's not there. And I get a little bit of the feeling except around the childbearing business life is empty as against being at least having a wide range of choices in the core. I think it is particularly for the women and children the women are chauffeured still when we go into the core anything that women are chauffeurs really that's all they do. Drop off Daddy and pick him up at the station they show for the kids to music lessons and little league games. Daddy gets into the action for eight hours but he comes home and he doesn't know what I want to know what's going on. Course there's a question in all that is to you know it's very easy to talk about the M.S. in the
suburbs and people like Krugerrands Wendell Bill who at Yale found that in fact the people themselves don't overtly perceive some of these. These stresses I'm struck by what you're saying that the critical element in this is really a defect or a feeling board and that's that's a stress that doesn't have a handle for the people who feel it a person who's feels bored doesn't articulate the reasons for it. You know in any of this is in the very defined way all of the mistrust phenomenon in the suburbs is to be thought of at least largely as being the stress of boredom or emptiness blandness. What about the other side of the coin because I have a feeling a little bit that we might be idealizing the center of the city. What about the stresses of the ghetto of the slum of the core. Well I and there are health implications of for example Dr. Ostrum that we know a good
deal more about I think if somebody were to point a finger at me and saying what are the precise health implications both psychologically and bodily where the precise health implications of living in suburbia I would have one hell of a time being very specific. But I do think we have a good deal of information about the health implications of living in inner city. Well you know one thing that strikes me is that. They use that suburban young suburban kids are those. It's not a growing number of people from suburbs who are moving back into cities make of the inner city is not the same areas ecologically that are used obviously but get a residence no point. I think we should focus for a moment on the ghetto residents themselves and not just the inner city as a refuge for the suburban kids. Well here I think the the health implications of ghetto living are you might say the ecological
aspects of ghetto residents I think we do know something about it. In the 19th century and early 20th century of course the big problems were primarily tuberculosis and venereal disease and tuberculosis. We know it's now somewhat less of a problem than it was in that period venereal disease is having a comeback but there are a whole new set of chronic diseases that appear to be associated with a ghetto life. One of the finest studies I know was done by a man named Harburg who is at Wayne State and University of Michigan. And he simply took all of the data from the Detroit area survey and identified those parts of Detroit which had the highest divorce rates crime rates illegitimacy rates. Relief roll rates and so forth. And another area which did not have any of these aspects
for both whites and blacks and it was about four times as much high blood pressure in the so-called high stress areas with these from our white middle class point of view undesirable. Four times as much hype or tension in those areas as compared to low stress areas. And if there is more high blood pressure this means a more coronary disease heart disease it also means more strokes. And I'm one of the major public health problems of our time as white as the black man have so much more trouble with high blood pressure north and south rural and urban men and women young and old. But he does. I think you're reflecting to add economic poverty to cultural poverty does even more than double the problem. Sure. So in terms of health it's good to have money. I don't how do you see it going. Well it's awfully hard to tell I don't I don't see any clear patterns emerging yet but again I don't have any
special expertise. There's no question that the trends are toward urbanization and toward the formation of megalopolis. And I think the health effects of these we can know a little bit about some people in the North Carolina School of Public Health had a fascinating opportunity to find out what being removed from a rural valley and Appalachian to a large factory town would have on health and nature and the government providing them with a first rate experimental design by moving all of people on one side of the lake into a North Carolina town so that a dam could be built there and leaving people on the other side of the lake intact and they were able to look at the health of the people who remained in the valley. And the health of the people who were in effect forcibly removed to an urban setting. And they found that the amount of serious mental illness in the form of schizophrenia the amount of
tuberculosis and the suicide rates were very much higher in the people who were moved to the newer been setting as compared to their relatives who remained behind. Similar to the concept of the culture of poverty which a lot of us talked about in relation to many very poor groups that have a rich cultural organizational setting in which to live. It's Money isn't everything in terms of the organic interconnections of people's lives in relation to each other and the environment. Which brings us back now to our whole original definition of ecology which is that human well-being is related to the way he interacts with his fellow organisms and his physical cultural and biological environment. I think perhaps we've identified some of these problems but we sure have a long way to go to solve them. Dr. Richard Weinerman professor of medicine and public health. Dr. Adrian M. us
Special of the week
Issue 18-1969
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