Is it stress? Or is it life?

Fifteen years ago, if I suggested to a patient that marital or job difficulties might be contributing to his headaches or abdominal pains, the patient might have been insulted, as if I were minimizing physical symptoms or even suggesting that these symptoms were imaginary. Now I find that patients themselves often bring up the idea that emotional stress is affecting their health. Far from making them feel neglected or written off as hypochondriacs, being asked to talk about the particular circumstances of their lives actually makes most patients feel better understood as people (rather than just diagnoses) and thus better cared for.

Yet, as patients have become more receptive to the idea that stress may be causing or worsening physical symptoms, the meaning of the term “stress” has become more and more nebulous. Sometimes when I ask patients about the stress in their lives they tell me about truly awful family conflicts, bosses from hell, legal problems, and — especially these days — looming financial disaster. But sometimes the “stress” is a basically happy event that simply is keeping the patient busy — like planning a wedding or moving into a new home — or even nothing in particular, just the ebb and flow of life — raising children, caring for elderly parents, earning a living.

The term “stress” was borrowed from the physical sciences in the mid-twentieth century by endocrinologist and physiologist Hans Selye. Originally stress was simply a measurement, in pounds per square inch, of the impact of some external force on an object or material — say, a hammer hitting and denting a piece of metal. In the 1930s, Selye began researching animals’ responses to noxious stimuli. He and other researchers found that in animals — and in humans as well — unpleasant or painful physical or emotional experiences activated the “fight or flight” response. This response is a series of hormonal and nervous reactions that animals have evolved to deal with predators: pupils dilate to broaden the field of vision so as to better see the attacker, muscles tense to enable running or striking back, and respiratory rate, heart rate, and blood pressure all increase to supply oxygen to those muscles. Digestion and sex drive, which aren’t needed during these times of physical threat, are reduced during the fight or flight response.

This is a very useful system to have available if you are a cave man or woman and may suddenly find yourself being chased by tigers. But in modern life most of the threats to which we respond aren’t “tigers.” In fact, they aren’t physical at all, but, rather, subjective perceptions and even projections of a threat. “I might be late to work and lose my job,” “My spouse might not love me anymore,” etc. Even when the threats are real — bankruptcy, divorce, serious illness, etc. — the “fight or flight response,” which has evolved so we can deal with physical dangers, isn’t helpful. And yet, many of us walk around all day in a state of physical tension and, compounding the problem, trying to calm ourselves down by overeating, smoking, drinking too much alcohol, and engaging in other activities that further compromise our health already damaged by chronic stress.

So what is a stressful event? It’s something that evokes the fight or flight response. In some people, contemplating a move might do this. Other people would find organizing a move exciting, and while they may feel busy and crunched for time, they wouldn’t technically feel stressed unless the physical tension was there.

Some stress can be reduced or even eliminated.  And, for the rest, it may be possible to change how you respond to make it easier to take. Here are three steps to consider:

1. Change your environment. .We can’t always alter our living conditions to reduce stress but we underestimate our power to do so. Can you shorten or eliminate your commute by working from home once a week? Extricate yourself from draining relationships? Decrease your spending so you don’t need to work quite as hard or can consider switching to a less well paid but more satisfying job? De-clutter and keep TVs and radios off or on low to make your home more of a haven?
2. Change your mind. Since most threat is perceived rather than actual, it is worth trying to adjust your perceptions. Sometimes simply stopping, taking a deep breath and asking “Is this really so terrible?” or “Is this really worth being upset about?” can help. If you find certain situations unusually stressful, counseling may be useful to help understand the root of your response. That understanding, in itself, often reduces stress.
3. Make yourself more stress resistant. Just as some materials are less likely to crack under pressure, some people are more stress hardy than others. Exercise, relaxation practices such as yoga and meditation, healthy diet, adequate sleep, and nurturing social relationships all make our fight or flight systems less “trigger happy.”
   

Dr. Suzanne Koven practices internal medicine with a special interest in weight issues at Massachusetts General Hospital in Boston, and teaches at Harvard Medical School.

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