The Medicalization Of Stress: Hans Selye And The Transformation Of The Postwar Medical

455 Pages·2017·3.31 MB·English

by  Vanessa L. Burrows

City University of New York (CUNY)
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The Medicalization of Stress: Hans Selye and the Transformation
of the Postwar Medical Marketplace
Vanessa L. Burrows
Graduate Center, City University of New York
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THE MEDICALIZATION OF STRESS: HANS SELYE AND THE
TRANSFORMATION OF THE POSTWAR MEDICAL MARKETPLACE

BY
VANESSA BURROWS

A Dissertation submitted to the Graduate Faculty in History in partial fulfillment of the
requirements for the degree of Doctor of Philosophy, The City University of New York
2015
© 2015
VANESSA BURROWS
All Rights Reserved
ii
This manuscript has been read an accepted for the
Graduate Faculty in History in satisfaction of the
dissertation requirement for the degree of Doctor of Philosophy.

Gerald Markowitz

_______________ ____________________________________
Date Chair of Examining Committee

Helena Rosenblatt
_______________ ____________________________________
Date Executive Officer

David Nasaw____________________________________________
Gerald Oppenheimer______________________________________
Nick Freudenberg________________________________________
David Rosner____________________________________________
Supervisory Committee

THE CITY UNIVERSITY OF NEW YORK
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Abstract

THE MEDICALIZATION OF STRESS: HANS SELYE AND THE
TRANSFORMATION OF THE POSTWAR MEDICAL MARKETPLACE
By
Vanessa Burrows
Advisor: Gerald Markowitz
This dissertation employs historical methodology and public health theory to examine how
critical changes in the culture and political economy of biomedical research shaped Hungarian-
Canadian endocrinologist Hans Selye’s concept of biological stress, guiding him to develop a
highly individualistic and commercially-appealing disease model that complimented major
interests of the postwar medical marketplace: the state, the corporation and the consumer. In the
mid-1930s Selye proposed that the human body adapted to a diverse range of stressors—
including, extreme temperatures, intoxification, surgical trauma, physical exercise and complete
immobilization—by releasing adrenocortical hormones to regulate bodily functions. For the next
fifty years he devoted his career to studying the mechanisms by which stress operated, using his
training in histology and biological assay to identify how stress altered biochemistry at the
cellular level. Selye found that while the human body maintains homeostasis and mitigates
damage from stressors by altering the balance of pro- and anti-inflammatory adrenocorticoids, a
prolonged imbalance of these hormones can produce “diseases of adaptation,” such as arthritis,
heart disease, hypertension and gastrointestinal ulceration. While this General Adaptation
Syndrome (GAS) is universal, it is also highly individualized, as an individual’s exposure to
unique “conditioning factors” determines the type and magnitude of diseases produced by stress.
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Even though he complied with the reductionist methods of biomedical research, Selye’s
theory was a radical departure from the orthodox biomedical doctrine of specific disease etiology.
However, by offering a multicausal theory of disease causation that embraced the concept of
attributable risk, Selye helped to reconcile mid-century biomedicine with the contemporaneous
rise in chronic disease in North America. Selye was a visionary, but was not insulated from
financial and cultural pressures. In order to attract funding from philanthropies, private
enterprise and the US and Canadian federal governments, he catered his research to appeal to
mid-century public health priorities and the health concerns of North American patient-
consumers: relief from chronic diseases and anxiety neuroses.
Selye began using the term “stress” to describe the GAS at the end of the Second World
War, after military neuropsychiatric research on combat stress had already given the term a
medical valence. And in the early-1950s, as his controversial theory was vindicated by the
therapeutic discovery of cortisone and ACTH, Selye began a vigorous public relations campaign
to promote popular awareness of stress. In doing so, he appealed to the concurrent
medicalization of anxiety and growing market for anxiolytic drugs, blurring the distinction
between biological and psychological stress. Yet, he won validation for stress in the medical
marketplace.
Selye inadvertently advocated a psychosomatic perspective of stress by advancing an
ethical code of “altruitistic egotism.” He insisted that individuals must learn their own unique
stress triggers and develop personal therapeutic strategies, especially in disrupting patterned
“stress grooves” with useful “deviations,” like reading a book, taking a walk, listening to music,
or smoking a cigarette. While anxiolytic and adrenocoritcal medications might be useful in
managing chronic conditions, to Selye will power and self-awareness were the most effective
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therapeutic weapons in combating stress. Stress, as Selye described it, offered patien-tconsumers
a means of managing their own health. Yet, by advancing an individualistic and commercially-
appealing theory of stress, Selye obscured ecosocial pathways of disease that distribute stress
risk far beyond the control of individual interventions.

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Acknowledgements

I have been extremely fortunate to receive the help and support from a number of people
as I researched and wrote this dissertation. I am deeply grateful to Jerry Markowitz and Gerald
Oppenheimer for helping to conceive and guide this project, for their encouragement, for their
wisdom, for being inspirational scholars and people, and for shaping the way I understand health
and history. I would also like to thank David Nasaw, Nick Freudenberg and David Rosner for
generously devoting their time to reviewing this manuscript and for their expert scholarly advice.
This research depended on the invaluable help of a number of archivists. I would like to
thank Arlene Shaner and Johanna Goldberg at the New York Academy of Medicine; Scott
Podolsky and Jack Eckert at the Center for Medicine of the Harvard Countway Medical Library;
Monique Voyer at the University of Montreal Library; Janice Goldblum at the National
Academy of Sciences Archives; Elizabeth Shepherd at the Medical Center Archives of New
York-Presbyterian/Cornell Weill; Marisa Shaari at the Oskar Diethelm Library; Gilles Bertrand,
Kathy Chow, George de Zwaan, Patrick Osbourne, Nelly Savova, Stephanie Speroni and Megan
Butcher at the National Library and Archive of Canada; Bethany Antos at the Rockefeller
Archive Center; Patrick Kerwin and Jeffrey M. Flannery at the Library of Congress; Wilbert
Mahoney and Amy Schmidt at the National Archives and Records Administration at College
Park; Richard Earle at the Canadian Institute of Stress, and Milagros Salas-Prato of the Hans
Selye Foundation. I would also like to thank the Harvard Countway Medical Library, the
Advanced Research Collaborative, and the Graduate Center for financial support in conducting
this research.
I would like to thank the Graduate Center for supporting my graduate studies in
numerous ways, and for cultivating an atmosphere of collegiality and intellectual curiousity. In
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particular, I would like to thank Helena Rosenblatt, Carol Berkin, Clarence Taylor, Josh Freeman,
Tim Alborn, Thomas Kessner, Jonathan Sassi, Andrew Robertson, Joseph Dauben and Judith
Stein, as well as Marilyn Weber and Betty Einerman. I am grateful to my fellow students at the
Graduate Center for challenging me intellectually and for countless generative conversations.
Thank you Kathleen Brennan, Rachel Burstein, Benjamin Persky, Lauren Santangelo, Mariel
Isaacson and Ben Hellwegge.
I would also like to thank the Hunter College History Department for giving me a strong
foundation to pursue my graduate work, and for welcoming me as an adjunct lecturer and
Writing-Across-the-Curriculum Fellow. I would especially like to thank Bernadette McCauley
for inspiring me to pursue graduate studies in the History of Medicine and Public Health, and for
her continued support and guidance. I would also like to thank Rick Belsky, Angelo Angelis,
Jean Mills, Dennis Paoli and Trudy Smoke.
I am grateful to Michelle Fine and David Surry for their pedagogical and scholarly advice,
and for being good friends and neighbors. Thank you Cindy Molloy for your support and
kindness, and for showing me how to graciously balance professionalism and compassion.
Thank you Barbara Berney for believing in me, for valuing my work and for being a model
scholar-activist.
I am blessed to have supportive, intelligent, and admirable parents who take a genuine
interest in my work. Thank you mom and dad. And thank you Kathryn, Sam, Vincent, Gwen
and Terry for your love and patience. Most of all, thank you Geoff for your heart, for your mind,
for Charlotte and Ysela and for our future together.
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Table of Contents

List of Tables…………...………………………………………………………………………....x
List of Illustrations…………...………………………………………………………………...…xi
Introduction…………...…………………………………………………………………………...1
Chapter 1: Discovering Biological Stress….…………………………………………………….36
Chapter 2: World War II and the Transformation of Stress Research…………..……………….99
Chapter 3: Stress, Multicausal Disease and the Health of the Public…….…..………………...164
Chapter 4: The Professionalization of Stress…………………………………………………...234
Chapter 5: Stress in the Postwar Medical Marketplace………………………………………..284
Chapter 6: Naturalizing Individualism and Politicizing Stress Research.……………………...347
Conclusion………………………………..……………………..……………………………...398
Appendix A: Glossary of Abbreviations....……………………..……..……………………..…405
Appendix B: The Etiological and Nosological Development of Selye’s Stress Research…..…406
Appendix C: Selye’s Funders and Grants..……………………………………………..………411
Bibliography………………………………...……………..…………………………...………420
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