SYSTEMIC LUPUS ERYTHEMATOSUS IN AFRICAN-AMERICAN WOMEN: COGNITIVE PHYSIOLOGICAL MODULES, AUTOIMMUNE DISEASE, AND STRUCTURED PSYCHOSOCIAL STRESS

Examining elevated rates of systemic lupus erythematosus in African-American women from perspectives of immune cognition suggests the disease constitutes an internalized physiological image of external patterns of structured psychosocial stress, a 'pathogenic social hierarchy' involving the synergism of racism and gender discrimination, in the context of policy-driven social disintegration which has particularly affected ethnic minorities in the USA. The disorder represents the punctuated resetting of 'normal' immune self-image to a self-attacking 'excited' state, a process formally analogous to models of punctuated equilibrium in evolutionary theory.Thus disease onset takes place in the context of a particular immunological 'cognitive module' similar to what has been proposed by evolutionary psychologists for the human mind. Disease progression involves interaction of the hypothalamic-pituitary-adrenal axis, which we also treat as a cognitive physiological submodule, with both immune cognition and an embedding pathogenic social hierarchy, a structured psychosocial stress which literally writes an image of itself on the course of the disorder. Both onset and progression may be stratified by a relation to cyclic physiological responses which are long in comparison with heartbeat period: circadian, hormonal, and annual light/temperature cycles.The high rate of lupus in African-American women suggests existence of a larger dynamic which entrains powerful as well as subordinate population subgroups, implying that the wide ranging programs of social and economic reform required to cause declines in disease among African-American women will bring significant benefit to all.