engage in risky behaviors after becoming infected, especially if they do not show outward signs of disease. Students should also be educated in how to recognize distress in chronically ill patients. For example, HIV-infected individuals who exhibit signs of persistent depression have been shown to have increased rates of mortality (Ickovics et al., 2001; Mayne et al., 1996), and stressful life events have been shown to cause a faster progression from HIV-positive status to AIDS (Leserman et al., 2000).

Psychological and Social Aspects of Human Development That Influence Disease and Illness

Human development is the product of the elaborate interplay of biological, psychological, and social influences (U.S. DHHS, 1999), and disease and illness can be understood more fully when the combined effects of these factors are considered at different life stages (Hertzman and Power, 2003; Power and Hertzman, 1997). Exposure of the developing brain to severe or prolonged stress, for example, may result in anatomical and biological changes that can have profound effects lasting throughout the individual’s life (Charmandari et al., 2003; Weinstock, 1997). Abnormalities may appear in childhood, adolescence, and adulthood as excessive fear and addictive behaviors, dysthymia and/or depression, and symptoms of metabolic X syndrome (Charmandari et al., 2003; Tsigos and Chrousos, 2002).

Life-cycle theories of Sigmund Freud, Jean Piaget, Erik Erikson, John Bowlby, and others on human development through infancy, toddlerhood, middle childhood, adolescence, adulthood, and old age help physicians understand the process of maturation from a variety of perspectives. Medical students should be exposed to these theories, as well as to their basic underlying principle—the Epigenetic Principle of the Lifecycle Theory—which states that the foundation for each step along the path to maturity is laid by the conditions and events that precede it (Kaplan et al., 1994). This is one of the compelling theories and approaches to adult development, and may fit well into the behavioral and social science portion of a medical school curriculum.

Psychosocial Aspects of Pain

Pain is the most common reason that people consult a physician (HBCC, 1993). There has been growing recognition that pain is a complex perceptual experience influenced by a wide range of psychosocial factors that can include emotions; social and environmental conditions; sociocultural background; personal experiences, beliefs, attitudes, and expectations; and biological factors (Turk and Okifuji, 2002). There is evidence that many physicians undertreat pain (Cleeland, 1998; Portenoy and Lesage, 1999). Furthermore, physician biases may



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