An amassing body of data demonstrates further the growing importance to medicine of the recognition that, for man, reactions to threats in the form of symbols, especially when sustained, may be more important than response to assaults. Certainly, many aspects of cardiovascular disease may be looked upon as functions of man's goals, his methods of achieving them, and the conflicts they engender. In this paper the importance of life stress to the cardiovascular system in various conditions is

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... ussed; case examples demonstrate the relationship between stressful situations and circulatory efficiency, faulty exercise tolerance in patients with or without structural heart disease, the hypodynamic response, cardiac arrhythmias, electrocardiogram, blood pressure, hypertension and renal blood flow. THE N ATURE OF STRESS FOR MAN THE STRESSES to which man is exposed include assaults by many living forms that aim to invade as parasites or to destroy; by meteorologic and climatic crises that pass sometimes predictably and often whimsically over the earth's surface; by mechanical, electrical and thermal forces that operate upon man merely in terms of his structure, mass and volume; and by elements of the earth's crust which man often dangerously manipulates for his comfort and delight or to fulfill his passion for destruction. But constituted as he is, man is further vulnerable because he reacts not only to the actual existence of danger but to threats and symbols of assaults experienced in his past. These call forth reactions little different from those to the assault itself. Also, since he is a tribal or group creature, he depends for his very existence upon the aid, support and encouragement of other men. Indeed, he lives his life so much in contact with men and in such concern about their expectations of him that perhaps to him the greatest threat of all is his doubt about his ability to live the life of a man. He is threatened by those very forces in society upon which he is dependent for nourishment and life. He must be part of the tribe and yet he is driven to fulfill his own proclivities. When these goals are diver-From the New York