Stress:
All together now … breathe
Think you are stressed out?
Try being Emma Nance.
It must have been a bizarre sight — a 64-year-old woman confronting a man in a grocery store, yelling and screaming about a parking space he allegedly “stole” from her.
“I went inside the store and tracked him down,” she recalls. “I had to let him know.”
Nance admits she was short-tempered and prone to erupt at even the smallest provocation. It got to the point where Nance didn’t even recognize herself. She finally concluded, “That’s enough.”
Stress is a curious thing. It triggers what Walter Cannon, a physiologist at Harvard Medical School, called the “fight or flight” response. Present in all humans since the beginning of time, the automatic response refers to the physiological transformation that occurs when a person is faced with imminent danger — real or perceived.
The threat causes certain hormones, such as adrenaline and cortisol, to flood the bloodstream. The heart pumps faster; the blood pressure increases; the pupils dilate to improve vision; the impulses quicken; the muscles are engorged with blood for increased strength and endurance; glucose abounds for additional energy; the immune system is suppressed — all in the name of survival.
The changes are not necessarily a bad thing. Some actually perform better under stress. Athletes welcome the “adrenaline rush” to increase their efficiency, while others flourish under deadline pressure.
But stress is one thing; being able to handle it is another, and stress is clearly winning the battle in America. In a 2001 newsletter, the American Institute of Stress reported that stress accounts for more than $300 billion a year due to absenteeism, turnover and reduced productivity, as well as medical, legal and insurance expenses.
Dr. Ronald Dixon, an internist at Massachusetts General Hospital Beacon Hill, admits that many of his patients complain of stress.
“Stress is ubiquitous,” he says. “It’s a part of living. But how you handle it can affect your health.”
Dixon says that some of his patients are not always able to make the connection between their stress and their physical complaints.
“A person might present with palpitations,” he explains. “They know that they are under stress because they lost their home, for example, but are unaware that the palpitations are often a result of the stress.”
Dixon warns that if a person tends to internalize things and not share or has no outlets, stress can build up and begin to negatively impact life.
Uncontrolled stress can take a heavy toll.
“People lose behavioral discipline,” Dixon says. “Some people self-medicate and turn to drugs or alcohol.” Similarly, smokers who have kicked the habit can fall off the wagon.
The trick is to know when the stress is out of control.
“When stress hampers relationships with loved ones or the person loses control of things that he or she could previously manage,” Dixon says, “the stress is getting out of hand.”
By any objective standard, Emma Nance should have been stressed out.
She has four grown children, 22 grandchildren and 24 great-grandchildren. Most of them have her telephone number. Taking in her two foster brothers was something she says she had to do.
Her generosity comes, in part, from her deeply rooted Christian faith; it also comes from her inability to say “no.” Making the problem worse was Nance’s desire to keep her feelings to herself.
“I’ve had to keep a clear head for everyone,” she says. “Everything was on me.”
Nance is happy to be alive. Six years ago, she was diagnosed with inoperable lung cancer. She was given five months to live. She survived, but tragedy still found her. A few years ago, she lost a daughter to AIDS a week before Christmas. A short time later, her mother died.
It is somewhat understandable, then, that Nance was likely to explode sooner or later.
The problem is that the body responds the same whether it’s reacting to a life-threatening situation or an argument with a child. The aftermaths are different, however. Once the life-threatening situation — like a near-miss car accident — has passed, the body returns to its normal state. But the day-to-day stressors or problems — psychological and emotional — are another story. If there is no outlet for the stress, it becomes chronic.
“… When the stress response goes on for too long,” explained Dr. Esther Sternberg of the National Institute of Mental Health in a recent published interview, “… hormones weaken the immune system’s ability to fight disease. That’s when you get sick.”
Not only can stress cause backaches and headaches, it can also prolong wound healing, decrease response to vaccines, and increase the frequency and severity of upper respiratory infections. It also aggravates existing health problems, such as asthma, acid reflux and irritable bowel problems.
But backaches are the tip of the iceberg. Research has indicated a link between chronic stress and heart disease. The relationship is not clear; it is possible that stress itself is a risk factor of heart disease, or that it worsens other risk factors, such as high cholesterol or high blood pressure. Studies also link stress to blood clots that increase the threat of heart attack.
In addition, unresolved chronic stress can result in anxiety and depression, which require more intense psychological intervention.
Stress does not result from only unpleasantness. Major life changes — good or bad — such as the birth of a baby or marriage can rev up the hormones.
In 1983, Time Magazine cited stress as “America’s number one health problem.” At the time the article was written, 55 percent of those surveyed said they were under great stress every week. Thirteen years later, a similar survey found that 75 percent cited great stress at least one day a week.
The problem has increased over the years. The American Institute of Stress estimated more than 10 years ago that 75 to 90 percent of all visits to primary care physicians are related to stress. It’s safe to assume that the percentage remains high today.
For some, stress has become a never-ending way of life with long-term consequences. In a recent study conducted at the University of California at Los Angeles, the researchers concluded that repeated responses to discrimination may be a factor behind higher rates of hypertension, diabetes and obesity in blacks.
When a person experiences discrimination — real or perceived — the body sets into motion a protective response very similar to the physiological changes triggered by stress. The repeated influx of these chemicals can damage systems in the body that are associated with disease and obesity, the researchers explained.
Although it is not always possible to prevent stress, the good news is that it is possible to control our reaction to it.
Diana Freeland is a licensed clinical social worker and conducts stress management techniques for major corporations. Freeland offers a few hints on how to recognize and manage stress.
“Know where your shoulders are,” she says. “If your shoulders are hiked up to your ears, that’s a sure sign of stress.”
Freeland advises her clients to practice deep breathing, even during business meetings.
“Place a hand over your stomach as you breathe in,” she explains. “Your stomach should rise. That’s diaphragmatic breathing. If your stomach does not rise, your breathing is shallow.”
And a symptom of stress.
But if none of these measures work and people are unable to devise a strategy that works for them, it is best to seek professional help.
That’s what Emma Nance did. She started talking to a therapist.
She learned to not overextend herself. She remembers the first time she could bring herself to say no to one of her grandchildren. “It felt so good,” she said.
And singing has been a boon to her. She sings in the choir at Union Baptist Church in Cambridge.
“If I can’t sing, I’m lost,” she says. “It’s a great medication for me.”
She also does liturgical dancing, a Christian expression of prayer or worship through body movement.
Nance says she has seen results. Her temper is now a thing of the past.
“That has gotten so, so, so much better,” she says. |
| The death of loved ones and excessive demands on her time overwhelmed Emma Nance. She addresses her stress through liturgical dancing, a Christian expression of prayer through body movement. |
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Ronald F. Dixon, M.D.
Internist
Associate Medical Director
Massachusetts General Hospital Beacon Hill
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