CAN STRESS CAUSE DISEASE - REVISITING THE TUBERCULOSIS RESEARCH OF HOLMES,THOMAS, 1949-1961

The increasing emphasis in medicine on treating the whole patient has focused attention on the association between emotions and disease. How ever, physicians have long studied the connection between mind and bod y. One particularly interesting researcher in this area was Thomas Hol mes, a charismatic and iconoclastic Seattle physician who studied the association between stress and tuberculosis in the 1950s. Although lac king the sophistication of modern biostatistics, several of Holmes' st udies suggested that persons who had experienced stressful situations, such as divorce, death of a spouse, or loss of a job, were more likel y to develop tuberculosis and less likely to recover from it. Holmes c onsciously used the same scientific methods as his peers, devising a n umeric scale that quantified stressful events and doing prospective st udies with control groups. Yet, he also emphasized the need to underst and each patient's story and to view his or her tuber culosis as the c ulmination of a life of emotional hardship. Although Holmes' work was rudimentary, his basic supposition may have been correct. Recent resea rch, benefiting from advances in both immunology and biostatistics. su ggests that stress may lead to decreased immune function and thus to c linical disease. As studies of stress and disease become more statisti cally sophisticated, it will be important to retain Holmes' emphasis o n understanding the lives of individual patients.