Introduction

The theme underlying this set of readings is the role played by personality factors, behavior patterns and coping styles in vulnerability to illness. The idea that personality is relevant to disease aetiology has a long history in psychosomatic medicine, beginning with psychodynamic conceptualisations in which psychic conflicts or specific attitudes were thought to increase risk for particular disorders (Alexander, 1950; Grace and Graham, 1952). These formulations were based predominantly on retrospective assessments using poorly standardised measures, so doubts were raised about consistency, reliability and bias. More recently, hypotheses about specific personality types being linked with particular disorders, as in the ‘cancer-prone personality’ suggested by Temoshok (1987), have been developed using more systematic approaches. It has also been suggested by Friedman (Friedman and Booth-Kewley, 1987) that there might be a ‘disease-prone personality’, a constellation of negative affective traits such as anxiety, depression and hostility that increase disease risk in a general fashion across different medical problems.

Biomedical scientists have remained sceptical of these hypotheses, and this is perhaps not surprising given the inconsistencies in the literature and the failure to link personality and behaviour patterns with credible psychobiological mechanisms. One of the major difficulties has been teasing out cause and effect relationships, since many studies of psychological factors have been carried out on diagnosed groups of patients. The presence of a serious medical condition may lead to changes in psychological factors as the individual faces threats to his or her well-being and the prospect of a curtailed lifespan.