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Emergence of Disease in the Absence of Pathology
 within the Elderly

Permission graciously given by the author to reproduce this paper

The Emergence of Disease in the Absence of Pathology
 Within the Elderly and Very Elderly Populations

G. Chikazawa-Nelson

What is the power of the mind and its ability to induce illness? What are the physical outcomes that emerge from our thoughts? And, how does our emotional states interact with those thoughts? Questions that cause one to pause, and hopefully, rethink the mind-body dichotomy, challenge the standard belief system, and to view the interrelationship and bidirectional communication that exists between our mental and physical being. 

The challenge resides in our understanding and connotation of the phrase, psychosomatic illness. Until recently (i.e., past 20 – 30 years), psychosomatic illness carried a pejorative meaning where the person labeled as having such an illness, really had a mental condition, and thus, he or she was a patient of psychiatry and the mental health field. To be sure, this belief system has not left our collective unconscious, and there are many individuals trapped in this world receiving substandard (or no) clinical care. Diseases such as, fibromyalgia and irritable bowel syndrome are examples where the absence of organic pathology places them into question under the biomedical model. 

While the symptoms experienced by the individual struggling with are “real”, for example, pain, uncomfortableness in their body due to inflammation, general feeling of malaise, etc., the medical community tends to function from the perspective that the individual is causing the symptoms, and any exacerbation/flare-ups of those symptoms. Research and work in the field of biopsychosocial medicine does not assume that psychological, emotional, and psychosocial aspects may contribute to the development and/or exacerbations of disease, as does the biomedical model. Rather, the biopsychosocial model views these components as vital to the development and maintenance of pathology. Therefore, through the lens of the biopsychosocial model, a redefining of the psychosomatic concept is occurring and could be viewed as a synonym of the mind-body perspective.

As the body ages, and the individual (unfortunately) accepts the inevitability, and thus, authors their physical decline, the concepts of psychogenic disease and psychosomatic illness start to become more prevalent and applicable to the this [aging] population. Research has found that one’s personality has profound effects on health (Smith & Zautra, 2002). In particular, personality types can influence the individual’s sensitivity and reaction to stress and stressful events. For example, neuroticism, defined as having a greater tendency to experience negative affects (Smith & Zautra, 2002), has been positively correlated to increased interaction with stressful experiences, and that those found to be high on the scale of neuroticism tend to maintain a heighten level of stress days after the [stressful] event has passed. Smith and Zautra also reported that these same individuals experienced more interpersonal conflicts than individuals who scored low on neuroticism measures. Finally, their study produced data that individuals high in stress, as a result of high neuroticism, reported more disease activity. In this case, the disease under study was rumathorid arthritis –an autoimmune disease that is intimately linked to psychological and psychosocial stressors.

Over the past few decades, research has continued to produce data that partners and spouses of individuals with chronic illness experience more physical health problems than among partners and spouses of healthy individuals (Bigatti & Cronan, 2002). Due to the psychological and emotional investment partners and spouses have to the relationship and to their significant other dealing with a chronic illness, there becomes a high probability that physical symptoms emerge as a result of this investment. Indeed, Bigatti and Cronan’s findings show a strong correlation between emotional distress and physical symptoms; for example, backaches, arthritis, acute and chronic pain, insomnia, ulcers, and high blood pressure, to name a few from a long list. Given that these conditions are reported more often in the geriatric population (Verhaeghen, Borchelt & Smith, 2003; Yonan & Wegener, 2003), would assigning the concept of “growing old” be accurate in its origins, or could it be that the investment places this population in a higher risk category? If the latter is true, than susceptibility becomes intimately linked to psychological and emotional factors, and as such, creates legitimately to one’s symptoms as a true illness in the absence of tangible evidence. Thus, the gap between structural and functional diseases begins to close.

Another area being generated in current research within the elderly population that surrounds a possible psychogenic development of illness involves the role of cognitive decline on the development of somatic disorders (Verhaeghen et al., 2003). Specifically, Verhaeghen et al. report that, after the age of 70, there is an increase in somatic disorders, for example, cardiovascular disease and diabetes that coincide with a decline in cognitive functioning (e.g., perceptual speed, memory, fluency, and knowledge). While their work found that, after controlling for age, SES, sex, and dementia status, cognitive factors were negatively associated with the development of disease, there was a strong link between cognition and health status. One possible explanation for this is that cognitive functioning affects health status through psychological and psychosocial factors, with the potential of the reverse also occurring. Specifically, and particularly in the aging population, psychosocial stressors could contribute to the decline in cognitive functioning which, in turn, would lead to a decline in overall health and [positive] health behaviors and thus place the individual at a higher risk for the development of somatic diseases.

The brief examples above begin to challenge deeply ingrained cultural and societal beliefs surrounding the idea that a true disease occurs only in the presence of identifiable pathology. A challenge in our understanding of health status within the elderly and very elderly population should also be occurring when one considers the fact that a decline in health does not arise out of a determined path, but rather, the decline emerges from a set of psychological and social factors that are possibly appraised incorrectly by the aging individual. To be sure, this appraisal is grounded and reinforced through the ingrained cultural and societal beliefs, and that this process has been occurring over the length of the individual’s lifespan. 


Bigatti, S. M. & Cronan, T. A. (2002). An examination of physical health, health care use, and psychological well-being of spouses of people with fibromyalgia syndrome. Health Psychology, 21(2), 157-166.

Smith, B. W. & Zautra, A. J. (2002). The role of personality in exposure and reactivity to interpersonal stress in relation to arthritis disease activity and negative affect in women. Health Psychology, 21(1), 81-88.

Verhaeghen, P., Borchelt, M. & Smith, J. (2003). Relation between cardiovascular and metabolic disease and cognition in very old age: cross-sectional and longitudinal findings from the Berlin again study. Health Psychology, 22(6), 559-569.

Yonan, C. A. & Wegener, S. T. (2003). Assessment and management of pain in the older adult. Rehabilitation Psychology, 48(1), 4-13.