STRESS THE KISS OF DEATH OR?

Distinguishing between "stress" and "stressor"

When dealing with stress, most of us already have two things against us beforehand. The very language we typically use to describe stress diminishes our ability to deal with it in the most effective way. Most people define stress by what they are faced with – the problems and worries they need to deal with. Such understanding makes us victims of what is happening around us. However, a large amount of research indicates that it is not what we have to deal with but how we deal with it that determines the severity of stress in our lives. Simply put, in order to begin to understand the most basic aspects of stress, we need to understand a key difference: the difference between "stressor" and "stress." "Stressors" mean external forces, which represent problems and worries that we have to deal with in life. The term "stress" refers to a person's response to these stressors. Some examples of stressors are shown in Table 1.

Table 1. Examples of stressors

- Pollution

- Deadlines

- The heat

- Overload

– Family relations

– Finances

- Death

- Diseases

The first stressor on the list is air pollution. Suppose you move from the countryside to a heavily polluted city. Almost immediately you will start coughing as a specific physical response to the physical stressor of air pollution. In addition to physical stressors, there are also mental stressors. These can be in the form of deadlines or money problems. The social environment presents its share of stressors; they can occur at home, at school, at work, or in the neighborhood. There are also spiritual stressors. They especially arise when our external circumstances or internal decisions conflict with our goals, values or religious beliefs.

Dr. Phillip Rice described the mental and social effects of long-term work-related stress. 1 His observations are generally applicable to any mental stressor present. His descriptions of the mental and social effects of such stress in an adapted and modified form are presented in Tables 2 and 3. It is evident that prolonged exposure to a stressor can produce a range of mental and social effects. Being aware of the whole range of ways that stress can take its toll can help us be more understanding when we or people close to us are faced with the effects of stress. All the mental and social effects of stress represent red flags that must be interpreted as indicators that stage 3, i.e. the level of exhaustion, could follow. In fact, some of the more dramatic manifestations that I have highlighted such as depression, or loss of control, may even indicate that the third phase has been reached. In such cases, quick action is necessary to effectively deal with stressors. If you find yourself in such a situation, carefully consider your top ten stressors. You need to deal with it as soon as possible.

Table 2. Mental effects of the present stressor

– Mental fatigue with loss of spontaneity and creativity

– Confusion, including forgetfulness and difficulty making decisions

– Anxiety, including feelings of panic

– Tension, frustration, irritability and anger

- Depression

- Feeling of low self-esteem

– Decreased intellectual functioning

- Boredom

Table 3. Social effects of the present stressor

– Procrastination, avoiding important work and household responsibilities

– Lack of concern for others and deterioration of relationships

- Decreased effectiveness in communication, including the inability to listen to others

- Emotional hypersensitivity with a tendency to overreact to others, or a feeling of isolation and alienation with a tendency to suppress feelings

– Loss of control, sudden temper, aggressiveness

– Increased tendency to take risks, including gambling

– Increased use of drugs and abuse of other substances

The physical effects of stress can play out invisibly, beneath the surface, only to explode into an acute illness or dramatic life-threatening event. Some of these chronic effects are related to the weakening of the immune system. Others may be related to the acceleration of atherosclerosis (hardening of the arteries). There are many indications that chronic stress can cause disease, that it is a factor in worsening an existing disease, or that it makes recovery from disease difficult. However, there are no scientific measurements, such as blood tests, that can confirm or measure a person's stress level. All stress level indicators are subjective. As a result, a person can never be sure in any particular case that the disease was caused by stress or that stress was even a factor in causing the disease or hindering recovery from the disease. However, I have seen certain cases where there are definite indications pointing to stress as the cause of the disease. I have seen other cases where stress seemed to be one of several causes, and still others where stress seemed to prevent recovery from illness. On the other hand, I've seen patients with cardiovascular disease for example, and stress didn't seem to be involved. A classic example of this is a person who leads a low-stress life in all respects, but still smokes, doesn't exercise and eats unhealthy. A heart attack can occur for obvious reasons, without the visible involvement of stress. Many times when a heart attack is detected, the patient asks: "Did stress cause it?" I answer that stress can contribute to a heart attack. I also point out that even when stress is a factor, it usually does not act alone. Typically, other underlying factors such as partially blocked arteries, an unhealthy diet, and possibly elevated blood pressure and/or elevated cholesterol are at play. Uncontrolled anger or other reactions caused by stress can cause a heart attack. However, it is unlikely that such an emotional response would have caused a heart attack if the heart's arteries were free of cholesterol blockages. It is known that stress affects many diseases. The main ones are listed in table 4 in the left column. 2 I have seen many cases of heart disease and cancer in people who were faced with great stresses in life. It has been established that after the death of a loved one, the surviving spouse has a higher risk of heart attack, especially within 6 months of the loss. 3

Table 4. Illnesses related to stress

Stress affects the onset, treatment or recovery of the following diseases and conditions:

Major diseases

– Cardiovascular diseases (e.g. heart disease and stroke)

- Cancer

- Depression

– Angina pectoris

– Diabetes mellitus

– Tubeculosis

– Rheumatoid arthritis

– Hypertension

- Ulcers

- Aids

Other diseases

– Muscle-related conditions (e.g. tension headaches, body aches)

– Allergies (asthma, hives, hay fever)

– Premenstrual tension syndrome

- Nipples

- Itchy skin

- Loss of hair

- Hair sits, dandruff

- Gout

- Herpes

Similarly, in the context of a loss, a survivor may develop a fatal cancer—probably because the stress weakened his or her immune system. The research I found on this issue followed over 1.5 million married people in Finland over a 5-year period. . 4 The researchers concluded: "The results agree with the hypothesis that increased mortality after the death of a spouse is partly caused by stress." Diabetes is sometimes more difficult to control in stressed patients. 5 Infectious diseases such as tuberculosis are more likely to spread and dominate the body if the immune system is weak; such weakened immunity can occur if the patient is unable to cope with stress. 6 In addition to major diseases, other diseases are also related to stress. They are listed in the right column of Figure 5. You don't have to be under too much stress to get any of these ailments. However, stress appears to be sufficient to increase the risk of these conditions or at least accelerate their onset in those who are genetically or environmentally predisposed.

Source: Positive by Neil Nedley MD

Literature:

1 Rice PL. Stress and Health: Principles and Practice for Coping and Wellness. Pacific Grove, CA: Brooks/Cole Publishing Company, 1987 pp. 209-211.

2 The American Institute of Stress. Stress—America's #1 Health Problem. Internet: http://www.stress.org/problem.htm (2/4/97).

3 Martikainen P, Valkonen T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health 1996 Aug;86(8 Pt 1):1087-1093

4 Martikainen P, Valkonen T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health 1996 Aug;86(8 Pt 1):1087-1093.

5 Gonder-Frederick LA, Carter WR, et al. Environmental stress and blood glucose changes in insulin-dependent diabetes mellitus. Health Psychol 1990;9(5):503-515.

6 Sheridan JF, Dobbs C, Brown D, Zwilling B. Psychoneuroimmunology: stress effects on pathogenesis and immunity during infection. Clin Microbiol Rev 1994 Apr;7(2):200-212.