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 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. Both onset and progression of disease may be stratified by a relation to cyclic physiological responses which are long in comparison with heartbeat period: circadian, hormonal, and annual light/termperature cycles.