Even though Freud demonstrated the role of psychological factors in illness, the medical field has still focused upon the biological roots ofillness and has still largely rejected or ignored the role of emotions and personality. Nevertheless, the ascending line of thought can be described as a biopsychosocial view of illness, which begins with the basic assumption that health and illness result from an interplay of biological, psychological, and social factors. This view provides a conceptual framework for incorporating human elements into the scientific paradigm. A man who suffers a heart attack at age thirty-five is not conceptualized simply as a person who is experiencing the effects of cellular damage caused by purely biological processes that are best treated by surgery or the administration of drugs. The victim, instead, is viewed as a person who also has engaged in practices that adversely affected his health. In addition to drugs and surgery, therefore, treatment for this man might include changing his views on the relative value of work and family as well as emphasizing the importance of daily exercise and diet. If he smokes, he will be encouraged to quit smoking. He might receive training in stress management and relaxation techniques.
Few people today would argue with the proposition that stress is a fact of life. Most have far more experience with stressors—those events that humans find stressful—than they would willingly choose for themselves. Stress is one of the major causes of psychosomatic disorders. Stressors are often assumed to be external events, probably because stressful external events are so easily identified and recognized. Many stressors, however, come from within oneself. For example, an individual alone often sets strict standards for himself or herself and, in failing to meet those standards, often makes harsher personal judgments than anyone else would make. Especially since the late 1970's and early 1980's, cognitive psychologists have focused attention on the internal thinking processes, thoughts, values, beliefs, and expectations that lead people to put unnecessary pressure on themselves that results in the subjective sense of stress.
Another contribution made by cognitive psychologists was the realization that a situation can be a stressor only if the individual interprets it as stressful. Any event that people perceive as something with which they can cope will be perceived as less stressful than an event that taxes or exceeds their resources, regardless of the objective seriousness of the two events. In other words, it is the cognitive appraisal of the event, coupled with one's cognitive appraisal of one's ability to deal with the event, rather than the objective reality of the event, that determines the degree to which one subjectively experiences stress.
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