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A harsh early family environment is related to mental and physical health in adulthood. An important question is why family environment in childhood is associated with these outcomes so long after its initial occurrence. We describe a program of research that evaluates a model linking these variables to each other. Specifically, we hypothesize that low social competence and negative emotional states may mediate relations between a harsh early family environment and physiological/neuroendocrine responses to stress, as well as long-term health outcomes. We report evidence that the model characterizes self-rated health, cortisol responses to stress, and, in males only, elevated cardiovascular responses to stress. We discuss how the social context of early life (such as SES) may affect the family environment in ways that precipitate adverse health consequences. Perspectives on comorbidities in physical and mental health are discussed.

Self-enhancement is variously portrayed as a positive illusion that can foster health and longevity or as defensive neuroticism that can have physiological-neuroendocrine costs. In a laboratory stress-challenge paradigm, the authors found that high self-enhancers had lower cardiovascular responses to stress, more rapid cardiovascular recovery, and lower baseline cortisol levels, consistent with the positive illusions predictions and counter to the predictions of the defensive neuroticism position. A second set of analyses, replicating the "illusory mental health paradigm" (J. Shedler, M. Mayman, & M. Manis, 1993), also did not support the defensive neuroticism hypothesis. The association between self-enhancement and cortisol was mediated by psychological resources; analyses of the cardiovascular results provided no definitive mediational pathway. Discussion centers on the potential stress-buffering effects of self-enhancing beliefs.

Research has variously portrayed self-enhancement as an indicator of narcissistic defensiveness or as a concomitant of mental health. To address this controversy, the present study used multiple measures of self-enhancement along with multiple measures and judges of mental health, comprehensively assessing their relationship. The results indicated that self-enhancement is positively associated with multiple indicators of mental health and with a more favorable impact on others. Discussion centers on a reconciliation of discrepant portraits of the self-enhancer.

Twelve patients who had a large ulceration over the heel were managed with a partial calcanectomy, in lieu of a below-the-knee amputation, after unsuccessful non-operative treatment of the ulcer. Only patients who had an ankle-arm index (the ratio of blood pressure at the ankle to the brachial blood pressure) of more than 0.45, a transcutaneous PO2 of more than twenty-eight millimeters of mercury (3.7 kilopascals), a level of albumin of more than 3.0 grams per deciliter (thirty grams per liter), and a total lymphocyte count of more than 1500 were managed with a partial calcanectomy. The primary diagnosis was diabetes in seven patients, peripheral vascular disease in three, quadriplegia in one, and myelodysplasia in one. The duration of follow-up averaged thirty-three months and ranged from seven to sixty-four months. The wound healed after the partial calcanectomy in ten of the twelve patients. Nine of these ten patients maintained the level of mobility that they had had preoperatively. (One patient was unable to walk because he was quadriplegic before the operation). The wound did not heal in two patients, and those patients ultimately had a below-the-knee amputation and a decrease of one grade on the scale that was used to evaluate walking ability.