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Hans Selye and the Transformation of the Postwar Medical Marketplace City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 5-2015 The Medicalization of Stress: Hans Selye and the Transformation of the Postwar Medical Marketplace Vanessa L. Burrows Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/877 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] 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 iii 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. iv 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 v therapeutic weapons in combating stress. Stress, as Selye described it, offered patient-consumers 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. vi 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 vii 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. viii 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
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