In the recent past, the questions that face a comprehensive psychosomatic medicine have been defined. These questions refer to the context in which disease begins, the timing of the onset of the disease, the role of previous social experience in predisposing to disease, and the choice of the particular disease. It is suggested that a study of bereavement may be paradigmatic in answering these four questions: Bereavement has been cited as a factor in a large variety of disease. However, bereavement may produce discriminated responses of grief; helplessness, hopelessness, and giving-up; and pathological mourning. Pathological mourning in turn may be associated with autoimmune disease. There is evidence that separation and bereavement produces changes in immune function but there is as yet no evidence that it produces distortions of the immune process. There are many factors that affect the timing of disease onset, including maturational ones. Many social experiences have been shown to alter behavior and bodily function and predispose to disease. The question of the choice of disease is determined not only by the effects of bereavement and early experiences, and age, but also by a multiplicity of predisposing ones some of which have been specified.
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