Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping

by Robert M. Sapolsky

Many experts are skeptical about the studies behind these characterizations, however. The first reason harks back to a caveat I aired early in the book: a diagnosis of “psychogenic” anything (impotency, amenorrhea, abortion, and so on) is usually a diagnosis by exclusion. In other words, the physician can’t find any disease or organic cause, and until one is discovered, the disorder gets tossed into the psychogenic bucket. This may mean that, legitimately, it is heavily explained by psychological variables, or it may simply mean that the relevant hormone, neurotransmitter, or genetic abnormality has not yet been discovered. Once it is discovered, the psychogenic disease is magically transformed into an organic problem—“Oh, it wasn’t your personality after all.” The area of repeated aborting seems to be one that is rife with recent biological insights—in other words, if so many of last decade’s psychogenic aborters now have an organic explanation for their malady, that trend is likely to continue. So be skeptical of any current “psychogenic” label.