In the previous article (Ishikawa, 1992), six different hypotheses about the life-stress process were presented. They were a) Victimization hypothesis, b) Stress-strain hypothe-sis, c) Vulnerability hypothehypothe-sis, d) Additive burden hypothehypothe-sis, e) Chronic burden hypothesis, and f) Event proneness hypothesis.
Since severely stressful life events such as combat and concentration camps are not included in this study, the suitability of the victimization hypothesis can not be discussed by the data presented here.
The chronic burden hypothesis which proposes stable personal dispositions and social conditions alone causing adverse health change is hardly acceptable from the facts that
a) there were no significant differences among the subject groups in terms of the number of Type A's and the number of external locus of controllers (Table 11 and Table 13 in Study I), and b) there was no strong tendency that the social conditions of the patient groups were worse than those of the control subjects. Only "regular occupation" and
"social group membership" contributed to the two health status indexes in common (Table 15 in Study I).
Although the percentages of Type A's and of the external locus of controllers among the neuropsychiatric patients were slightly higher than those percentages among other groups and the mean scores of these measures for the neuropsychiatric group is significantly higher than those scores for other groups, this evidence should be interpreted as follows:
Personal dispositions such as Type A-B behavior pattern or Locus of Control do not cause physical and mental ailments but· they exaggerate symptoms or complaints. The results that Type A's and External locus of controllers among the neuropsychiatric patients reported more symptoms or complaints compared to Type B's and Internal locus of controllers among the psychiatric patients seem to support the above inference.
If personal dispositions or social supports have some function in the life stress process, the event-proneness hypothesis is not adequate. The hypothesis proposes that the presence of a disorder leads to stressful life events which in turn exacerbate the disorder. The hypothesis was supported by a study of chronic mental patients (Fontana et al., 1972) but not by a study of neurotics (Tennant and Andrews, 1978). Furthermore, the data of the peptic ulcer, asthma and otorhinological patients in this study did not support this hypothesis. There were almost no differences in the number and the kind of symptoms or complaints by the different types of personal dispositions in these three patient groups.
The stress-strain hypothesis is the same as the traditional scheme of S-0-R in psychol-ogy. This hypothesis is very useful and convenient to explain the life stress process, but it does not clarify the functional relationships between stressful life events and psy-chophysiological strain, and between the strain and adverse health changes in a workable fashion.
Thus, the vulnerability hypothesis or the additive burden hypothesis remains as a best fit to the life stress process. The former hypothesis indicates that stressful life events, moderated by preexisting personal dispositions and social conditions that make the individual vulnerable to the impact of life events, cause adverse health changes, while the latter hypothesis proposes that, rather than moderating the impact of stressful life events,
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personal dispositions and social condiHons add to the impact of stressful life events.
The facts that the Type A's and the External locus of controllers showed more psychophysical symptoms or complaints than the Type B's and the Internal locus of controllers among the neuropsychiatric patients in this study, and that such a tendency was not seen among other patient groups and the control subjects seems to support the latter hypothesis.
With respect to the function of social conditions or social support to the life stress process, as mentioned earlier, the conditions of "regular occupation" and "social group membership" contributed to the two health status indexes in common. In case a health status index is the control-patients dichotomy, two more conditions of "annual income more than 6 million yen" and "education above junior college" showed a significant association. On the other hand, the variable of "existence of mental supporter" had an association with the health status measured by the number of symptoms. From both these results and the results of reporting number and the kind of life events by subject group, it may be said that although both life events and social supports are significantly related to a variety of psychophysical symptoms, the interaction between these variables is not necessarily related to psychophysical symptomatology. That is, life events and social supports exert their effects rather independently. A recent study of depressed inpatients by Overholster et al. (1990) also showed similar results and they argued against the vulner-ability hypothesis in favor of the added burden hypothesis.
However, the additive burden hypothesis can not explain the fact that about 40% of the control subjects reported experiencing more than three stressful life events but they did not report illness symptoms.
Therefore, we may conclude that the vulnerability hypothesis would be best fit to explain the life process for the control subjects, while the additive burden hypothesis would be more applicable for the patients of stress-induced illnesses, particularly for the neuropsychiatric patients-.
The results of this study seem to enhance the position that when all three variables of life events, personal dispositions and social conditions are considered, the discriminative power between sick and healthy persons is greatly increased. However, the functional relationships between these three variables can not yet be clarified. Further work in this direction appears destined to markedly increase our capabilities to more completely understand the significance of recent life change events in the history of illnesses.
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