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May 27, 1974


Author Affiliations

Fredericksburg, Va

JAMA. 1974;228(9):1097. doi:10.1001/jama.1974.03230340013007

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To the Editor.—  Dr. Kassel's letter (227:941, 1974) emphasizes that smoking not only is a physical handicap, but a psychological one as well. That an individual selects this method as an adaptive measure in handling the stress of life is significant for two reasons. The basic element is general conformity, although many people (including teen-agers) employ this means as an alternative, finding tobacco smoke aversive only when not smoking. One may refer to Freudian theory in assuming a deterministic position relative to oral fixation.Yet it is possible to regard smoking, if viewed in a more existential context, as conscious, willful behavior. Given the human's more fully developed cerebral cortex, and his generally assumed superiority over lower animals, it is reasonable to expect a decision process to effect itself—in the negative.