From Clinical Experience to Tested Hypothesis: The Role of Psychosocial Factors in Coronary Heart Disease

Abstract

The influence of psychosocial factors in the development of coronary heart disease has been suspected for many years by family practitioners and physicians like William Osier. The clinical impression that myocardial infarction preferably strikes a certain type of person and frequently occurs after a shattering life event was supported by more systematic clinical observations made from 1935 to 1955, although these observations lacked the support of control groups (Arlow 1945; Dunbar 1943; Dreyfuss 1959; Gildea 1949; Russek and Zohman 1958; Raab 1964). Our first systematic studies took place between 1956 and 1965 and were based on long biographies of 24 successive male, married patients (Groen et al. 1965; 1968 a) who were admitted to the Wilhelmina Gasthuis in Amsterdam. Psychosocial factors were found to precede the onset of disease in all of the patients. Based on these systematic clinical observations, we formulated the hypothesis (Van der Valk et al. 1967) that myocardial infarction seems to occur as a result of a constellation of three factors:

• 1. Certain personality characteristics determined by heredity, maturation, and previous experiences), which seem to predispose certain individuals more than others to become involved in

• 2. a certain type of interhuman conflict situation, which serves as a more immediately precipitating “stressor”

• 3. certain types of behavior through which the individual, because of his personality, responds to this conflict.