The Psychology of Physical Symptoms

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1 The Psychology of Physical Symptoms

2 James W. Pennebaker The Psychology of Physical Symptoms Springer-Verlag New York Heidelberg Berlin

3 James W. Pennebaker Department of Psychology Gilmer Hall University of Virginia Charlottesville, VA With 4 Figures Library of Congress Cataloging in Publication Data Pennebaker, James W. The psychology of physical symptoms. Bibliography: p. Includes indexes. 1. Medicine, Psychosomatic. 2. Symptomatology. 1. Title. RC49.P '2' by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1st edition 1982 All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, U.S.A. The use of general descriptive names, trade names, trademarks, etc., in this publication, even ifthe former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Typeset by Ms Associates, Champaign, IL ISBN-13 : DOT: / e-isbn-13 :

4 To Ruth

5 Preface Physical symptoms are fascinating phenomena to examine. We all experience them, use them as signals to guide our behavior, and usually assume that they accurately represent underlying physiological activity. At the same time, we implicitly know that bodily sensations are often vague, ambiguous, and subject to a variety of interpretations. It is not surprising, then, that there is often a disparity between what we think is going on in our bodies and what is objectively occurring. In short, phenomena such as physical symptoms are the stuff of psychology. My own research into physical symptoms started by accident several years ago. In a hastily devised experiment dealing with the effects of noise on behavior, I had to write a post-experimental questionnaire that would be long enough to allow the experimenter time to calibrate some equipment for a later portion of the study. I included some physical symptoms on the questionnaire as fillers. The experiment was a total failure, with the exception of the symptom reports. People's perceptions of symptoms were easily influenced by our manipulations, even though their actual physiological state had not changed. And so began the present inquiry. Despite the pervasiveness, importance, and sheer amount of time and money devoted to discussing and curing common physical symptoms and sensations, very little empirical work has been devoted to examining the psychological and perceptual factors related to sensory experience. Occasional papers have tested a specific theory, such as cognitive dissonance, wherein physical symptoms served as an interesting dependent measure. Similarly, clinical researchers have often studied symptoms as tools with which to affect biofeedback training. Most others who have examined them have simply considered them a necessary problem in attempting

6 viii Preface to understand the more basic physiological processes they supposedly represent. This book is the culmination of several years of research aimed at understanding the nature of physical symptoms among relatively normal and healthy individuals. What psychological processes are implicated in the perception of sensations? What is the link between perceived and actual physiological activity? What roles do developmental, personality and cultural differences play in the perception and cognitive organizations of body state? In an attempt to answer these questions, my students and I have uncovered a number of intriguing and often unanticipated answers. By the same token, we have also stumbled across a number of additional questions that have yet to be addressed. This is a book of theories, data, and speculations. In attempting to understand physical symptoms, we have devised a number of theories and mini-theories that represent a general cognitive-perceptual perspective. Because of the complexities of the topic, we have also drawn on several seemingly unrelated approaches ranging from learning theory to psychoanalytic models. The dozens of experiments that we have conducted have forced us gradually (and, on occasion, abruptly) to alter and update our theoretical framework. Any explanatory schemas that are presented in this book, then, will undoubtedly be modified by us and others in the future. Nevertheless, we hope that this project will serve as a departure point for future investigations related to the psychology of physical symptoms. A research project such as this has relied on dozens of people. Among those that have contributed their time and energy in conducting many of the experiments, I am especially indebted to Andy Skelton, Linda Gonder-Frederick, Greg Brittingham, David Epstein, Claudia Hoover, Cobie Hendler, Ginny Maycock, Ella Harbour, Terry Kerler, Herb Stewart, and Melissa Conrad. My thinking on symptoms has been influenced particularly by Darren Newtson, whose insight and" breadth of perception will always be appreciated. I also wish to thank the many others with whom I have spent literally hundreds of hours discussing the research topics in this book, including Audrey Burnam, Bella DePaulo, Tim Wilson, Rob Roberts, Billy Barrios, and Dan Cox; and a number of people who have read versions of this book and have made extremely helpful comments: Mihalyi Csikszentmihalyi, Bella DePaulo, Andy Skelton, and Dan Wegner. Finally, I wish to thank Debbie Mundie for her invaluable aid in typing the multiple drafts of the manuscript. August 1982 James W. Pennebaker

7 Table of Contents Chapter 1 Introduction and Overview... 1 Boundary Conditions Surrounding Symptom Reporting... 2 Demographic and Cultural Comparisons... 5 Experimental and Theoretical Approaches Plan of This Book Chapter 2 Perceptual Processes I: Competition of Cues The Perceptual Process Orienting and Competition of Cues Concluding Remarks Chapter 3 Perceptual Processes II: Schemas, Selective Search, and Inference Selective Monitoring of Specific Sensations Selective Monitoring of Categorical or Higher Order Body States Inference of Physical Symptoms Generality of Schema-Directed Search Implications and Conclusions Chapter 4 Accuracy of Perception Relative to Physiological State 59 Measurement of Accuracy: Between-Subjects Versus Within-Subject Approaches Situational and Dispositional Factors and Accuracy... 68

8 x Contents Is Accuracy Unidimensional? Conclusions and Future Directions Concerning Accuracy Chapter 5 Cognitive Organization I: Emotions Symptoms and Emotions: Perceptual Specificity Causal and Temporal Relationships Between Symptoms and Emotions Physiological Search for the Symptom - Emotion Link Toward an Understanding of the Emotion-Symptom Link Summary Chapter 6 Cognitive Organization II: Blood Pressure and Blood Glucose Blood Pressure and Blood Glucose Research Projects Bases of Cognitive Organization: Through the Looking Glass Conclusions and Implications Chapter 7 Personality and Developmental Correlates Measurement and Construct Validity of Symptom Reporting Personality Correlates of Symptom Reporting Habits and Daily Behaviors of the Symptom Reporter Developmental Issues in Symptom Reporting Composite Picture of the Symptom Reporter Chapter 8 Summary and Conclusions Adaptive and Functional Bases of Symptoms Applications of Symptom Research Current Problems and Future Directions Appendix A Symptom/Emotion Checklist: A State Measure Sample Symptom-Emotion Checklist Measurement Parameters of Checklist Appendix B The PILL: A Trait Measure The Pennebaker Inventory of Limbic Languidness Measurement Parameters of the PILL References Author Index Subject Index

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