by Clifford Sawhney

In one of his masterpieces on shikar, hunting, the legend of Kumaon, Jim Corbett, narrates the account of a day-long excursion in the neighboring hills with a guest. They departed before the break of dawn, caught a breathtaking glimpse of the sun rising over the Himalayas, were entertained by birdsong throughout the day, and encountered quite a few denizens of the jungle.

Returning home at nightfall, they were asked how the day went. Before Corbett could wax eloquent, his companion broke into a litany of complaints of how hard the going had been, plodding uphill and downhill, getting pricked by thorns, with pesky flies and frightening jungle noises to contend with, besides close encounters with wild creatures. In short, it was a sheer waste of time, cribbed Corbett's stressed-out companion. What to the nature lover was a wonderful outing in the jungles happened to be a day of fear, worry and apprehension for the city slicker!


Stress, in a way, lies in the eye of the beholder. And with stress-related cases growing phenomenally, it's no coincidence that stress has been termed a 20th century disease. "The number of stress-related cases is about thousand times more now than it was ten years ago," reveals Dr Sanjay Chugh, a consultant psychiatrist.

The 'disease' goes back a long way in time, however. A complex concept, it has both mental and physiological components. Though some forms of stress are predominantly psychological, they trigger a variety of physiological changes, including ones in the immune function, indicating a link between the nervous and immune systems.

DEFINING STRESS

In the days when prehistoric man had not yet attained self-consciousness, he reacted to any signs of danger in two ways: he fought or he fled. This is the 'fight-or-flight' response—a term coined by W.B. Cannon in 1914. During this, the body reacts with alarm to the threat: there is a rapid increase in metabolism, with hormonal, physiological and biochemical changes taking place instantly.

The body muscles become tense and the hypothalamus activates the pituitary gland, which secretes hormones that then activate other hormone-producing centers like the adrenal glands. The release of adrenaline and other hormones sustains the alarm reaction and physiological changes occur in response to the stress stimulus. The body now needs glucose for the muscles to function properly. The liver responds by releasing some into the bloodstream. For the glucose to be transformed into energy, extra oxygen is required. The heart begins pumping blood faster to carry this extra supply, leading to a rise in blood pressure.

The amount of blood available in the body is, however, limited. In order to deliver extra blood to select areas—the muscles, heart, lungs, kidneys and the brain—there is a temporary cutoff in blood supply to non-priority areas. Consequently, the digestive system slows or stops altogether, the salivary glands stop secreting, blood vessels in the kidneys and the abdomen constrict and the immune system slows down.

These physiological effects are categorized as 'arousal'. Concomitant emotional manifestations like fear, apprehension and worry are termed 'anxiety'.

Once the Neanderthal dealt with the threat-usually an animal, which he fought off or fled from—the body's reactions quickly returned to normal. All of which was fine in the good old days of yore.


"Unfortunately," says corporate consultant Santhosh Babu, "this wonderful survival tool hasn't adapted to modern forms of stress. Today we react the same way with the boss as our ancestors reacted to a tiger-despite the fact that we have choices other than fighting or fleeing!"

If this stressful situation is not resolved (the Neanderthal could be up a tree with a saber-toothed tiger snarling below all day long!), the body goes into a second stage, the adaptation stage. This also happens when you aren't able to resolve the conflict with your boss. The changes that have occurred become chronic, that is, they take place all the time. This is the stage when the body is most prone to illness.

The third stage, according to Hans Selye (1956), was the "stage of exhaustion" which came about if the stress was constant and prolonged. Here, the body's resistance finally crumbles and death is usually the consequence.

Medically, stress is defined as a perturbation of the body's homeostasis. The common indices of stress include changes in:

(i) biochemical parameters such as epinephrine and adrenal steroids,
(ii) physiological parameters such as heart rate and blood pressure and
(iii) behavioral effects such as anxiety, fear and tension. In essence, stress is an umbrella term that encompasses physical trauma, strenuous exercise, metabolic disturbances and anxiety as they produce challenges to the body's homeostasis. The wear and tear that stressors subject our body too is termed as stress.

Says Dr Chugh: "Stress is how people react to demands placed on them and arises when there is worry about one's capacity to cope. Seventy-five to 90 per cent of adult visits to primary care physicians are for stress-related problems."

For the lay person, however, the word stress has mental rather than physiological connotations. As Anandi Iyer, Deputy Director at German Technical Cooperation (GTZ) says: "Stress occurs when you are incapable of handling a given situation. For instance, for soldiers constantly at the border, the situation is no longer so stressful. But for others, it would be."

According to Janki Chopra, associated with the Delhi center of the Vedanta Institute: "Stress is an agitated mind, a state that's caused by unfulfilled desire. Stress has nothing to do with an external situation."

PRIME CAUSES

A stress-free existence is, perhaps, a mirage. Hans Selye aptly commented: "Complete freedom from stress is death!" The pressures of modern living ensure that stress is always lurking in the background. It is generally assumed that adverse life events or challenges called stressors cause stress. If this stress becomes very intense or chronic, it leads to stress-related diseases.

However, this phenomenon is not as simplistic as it sounds. Different individuals subjected to the same stressful event may react differently, with responses ranging from extreme to mild to absent.

Although the causes of stress are myriad, we could loosely categorize these into common and uncommon stressors. Common stressors comprise disease, academic stress (heightened during examinations), marital discord, separation or divorce, career stress, bereavement and unemployment.

The uncommon ones include overcrowding, commuting, sleep deprivation, shifts (home, school, career), malnutrition, drug abuse, phobias, excessive exercise, noise pollution, et al.

It isn't just adults who fall prey to stress. Modern lifestyles are exacting a toll on impressionable kids and unsuspecting teenagers too. In the words of Dr Chugh: "A fairly large number of children have stress problems related to studies and unrealistic parental expectations. And there are huge numbers of stressed teenagers. These are cases related to academics, relationships, parental expectations, drug and alcohol abuse and even sexual experimentation that backfires. Examination stress is phenomenally high, especially during board exams."

Frustration through sexual deprivation, social or peer pressure to conform, and the struggle for professional advancement all cause stress. It was Sigmund Freud (1856-1939) who pointed out that if psychic energy is unable to meet its original objective, it fixes upon an alternative. This impulse leads to sublimation. It can also lead to stress. While the individual adapts to the situation, if pressures become unbearable or persistent, he may enter a state of chronic stress.

Most of these stressors can ultimately impair immune functions.

INSIDIOUS EFFECTS

As early as the 2nd century AD, the deleterious effects of stress were recognized. In his treatise on tumors, De Tumoribus, the Greek physician Galen noted a greater tendency for development of breast cancer among melancholic women than those with sanguine traits.

Earl Wilson drove this point home laterally in his pithy observation on hypertension: "One way to get high blood pressure is to go mountain climbing over molehills."

Stress can be the culprit in palpitations, heart attacks, migraine and tension headaches, eating disorders, ulcers, irritable bowel syndrome, colitis, diabetes, backache, chronic fatigue syndrome, dermatitis, allergies, colds and coughs, asthma, insomnia, stammering, phobias, depression, premature aging…

The list is endless.

In many illnesses, however, there may be multiple pathways by which symptoms occur, and stress may act as a predisposing, precipitating, and/or sustaining factor. Not surprisingly, many of these ailments are associated with immune alterations. The influence of stress may also be complex and indirect. In his study of gout, H. Weiner (1977) discovered that exacerbation were connected to dietary habits. Flare-ups typically occurred during periods of stress when patients exhibited less dietary control, guzzled greater amounts of alcohol, took medication less regularly and got insufficient sleep.

Can stress really cause illness? The ecumenical belief holds that an individual's emotional state can directly affect his well being. Empirical evidence demonstrates that a variety of personality traits and stressful life events are correlated with both the provocation and the increased incidence of many psychosomatic disorders, including cancer.

B.H. Fox (1978) hypothesizes two primary cancer-causing mechanisms. The first, 'carcinogenesis', involves an agent or mechanism which produces cancer by overcoming the body's natural resistance. The second, 'lowered resistance to cancer', permits a potential carcinogen normally insufficient to produce cancer to do so due to a weakened emotional state, for example.

Researchers like D.M. Kissen (1969) have argued that the stress of adverse circumstances and the loss of a loved one can lead to cancer by psychological mechanisms of "despair, depression and hopelessness".

Some researchers have linked the theory of learned helplessness to health. Helplessness has been defined as "the psychological state that frequently results when events are uncontrollable". It is used interchangeably with hopelessness, describing a feeling that a situation is without solution. Hopelessness has often been associated with early relapse and mortality in cancer studies. Examining survival rates of patients post-surgery and 10 years after a psychological interview, S. Greer (1985) found telling conclusions. Those displaying a helpless attitude or a stoic acceptance had recurrent disease or died earlier than those responding with 'denial' or a 'fighting spirit'.

In the 1950s, Dr Franz Alexander of Chicago found that strong but inhibited aggressive impulses led to increased muscle tension, a contributing factor in rheumatoid arthritis. Along with anxiety, it raised blood pressure, as though the body "were constantly in preparation for a fight which never takes place". Dr Alexander showed that high blood pressure is rare among African blacks, but frequent in American blacks-an incontrovertible proof of the damaging effects of a more stressful environment. An American study in the 1970s discovered that 20 out of 25 new diabetics had suffered the loss of a loved one or a severe setback shortly before the symptoms developed.

EMOTIONS AND AILMENTS

Surprisingly, emotions can have an effect on diseases that might seem beyond the power of the mind to influence. Cholera is a classic example, first recognized by Dr A.T.W. Simeons, a British physician who practiced for some time in India. In his book, Man's Presumptuous Brain (1960), Dr Simeons pointed out that in a cholera epidemic the very old and the very young survive. Though endowed with greater powers of resistance, those in the prime of life are the chief victims.

The explanation illustrates the awesome power of mind over matter.

The cholera bacillus flourishes in an alkaline medium that, when taken into the body, is normally killed by stomach acids. But fear and worry can alter the rate of acid secretion in the stomach. In a cholera epidemic, young people worry the most, being the breadwinners. Tragically, the worry created by their sense of responsibility alters the acid content of their stomachs, allowing the cholera bacilli to slip through into the alkaline haven of the small intestine. Babies who are oblivious to their illness and the aged who aren't bothered about whether they live or not, survive because their stomachs continue to secrete acid normally.

Reviewing the relationship between personality, stress and death from cancer and heart disease, H.J. Eysenck (1988) found that stress was a potent cause of death-stressed individuals having a 40 per cent higher death rate than non-stressed ones.

Response to stress is not static. It fluctuates and changes as the person interacts with and responds to the stressor. At the workplace, stressed people could be prone to 'desk rage'-flinging whatever comes to hand at colleagues, across the room or on their tables.

"Stress can be subdivided into constructive stress and destructive stress. The former is positive and a good motivator. It increases productivity and efficiency, besides providing stimulation. Destructive stress is counterproductive and detrimental to both psyche and body," Dr Chugh elaborates.

Needless to say, stress affects a negative person's performance in a well-defined manner. This effect is referred to as the Yerkes-Dodson law, which states that as arousal increases, performance improves, and with further increase in arousal, performance drops. Stress also effects their behavior by boosting the activity level. Besides, the individual attempts to engage in coping behavior.

STRESS AND GENDER

Does stress tend to affect the male of the species more than the female? Opinions vary, since there are differentiating factors between the sexes. All parameters being equal, however, the preponderant view is that women are more adept at handling stress, thanks to better coping mechanisms.

"Statistics don't really bear this out though my personal and professional opinion is that females handle stressors better than men do," opines Dr Chugh.

Sukhdeepak Malvai, a corporate consultant, firmly believes that: "Men seem to be more stress prone. They are more likely to get into other things that add to stress-like alcoholism or smoking. Of course, I'm not implying that women don't indulge in these. Women are better equipped to deal with emotional issues. Men find it difficult to express anxiety and sorrow; women are more apt to do so. On the other hand, women undergo a lot more stress of another kind as they have to constantly prove they are as good as their male peers."

Agrees D.D. Rajdev, the CEO of Fibcom India Ltd: "I feel women are much better at handling stress, with a higher level of tolerance. Most men end up expressing stress in some other way."

Ex-journalist Anandi Iyer echoes similar sentiments: "Women tend to have more stress because they have to manage two worlds, home and career. So they are stretched and stressed a little more. But women manage to balance both worlds and have more tenacity. Men tend to flap, while women deal with stress more rationally."

Malvika Joshi, a general manager at Fibcom India, thinks otherwise: "I feel men handle stress equally well as women. Men are more composed and don't show stress. Women show it." But Janki Chopra perceives no gender benders: "Whoever has a mind that's not within control will have stress. Only the areas of stress will differ. Assuming that the level of desires between both sexes is the same, the stress will be the same."
COPING STRATEGIES

Understanding stress-causing attitudes is crucial to determining the coping mechanisms to use. Perfectionism, idealism and control could be major causes of stress not only for an individual but also for people around him. It is imperative to replace a stress-building attitude with a stress-busting one. This can be done by asking yourself: Under stress, are your thoughts alarming or reassuring? You can reduce stress by talking to yourself in a reassuring way, which is an excellent stress-buster for starters.

If you constantly seek to control the situation and achieve a 'perfect ten', don't. Delegate tasks to subordinates. Strive for excellence, not perfection. Excellence is a positive aspiration. Except in a high-precision industry, perfectionism can be a very negative attribute that induces stress in oneself and others.

A positive attitude can dramatically reduce stress and transform an individual's life. Ask Anandi Iyer. "A perfectionist who couldn't tolerate any imperfection, I was always crabby and snapping at everyone. I had a short tolerance level. All this made my job stressful and affected me physically. I had constant headaches.

"A year ago I came across C.B. Satpathy who showed me the path to Shirdi Sai Baba," says the lady, smiling and indicating, with an expansive wave of her arm, Sai Baba's pictures all over her cabin. "After the spiritual connection began, realization dawned and my life changed. Now I'm more relaxed. I realize that stress occurs when you are incapable of handling a given situation. Of course, I'm still a workaholic and find it difficult to take leave. But I've developed a positive outlook. Earlier, I could blast the staff if my printer didn't work. I don't anymore. Life offers choices. Nothing is the ultimate. Earlier, I wanted everything to be perfect. Today, I'm more tolerant and less stressed."

To lead a more or less stress-free existence, Dr Sanjay Chugh has a practical recipe: "Redefine priorities, reassess abilities and potential, have realistic and flexible expectations, regular exercise, a healthy lifestyle and a balanced diet."

According to Joe Rodrigues, the Director of Breakthrough Communication Services in Mumbai: "The pillars of stress management are meditation, physical exercise and proper eating habits. I hold a three-day workshop on stress management which takes a body-mind-spirit approach to handling stress."

In daily life, people use two kinds of coping strategies-positive or negative. Positive coping includes time management, proper nutrition, healthy relationships and social support, regular exercise, recreational activities, sufficient sleep, vacations, meditation, relaxation techniques, a sense of humor, auto-suggestion, self-hypnosis, creative visualization, massage and yoga, to name a few.

Negative coping includes smoking, drinking, drugs, food, tranquilizer and stimulants like tea and coffee.

At the fag end of this piece, we wouldn't labor the point as to which strategies a reader should use. The choice is yours. And if making choices is a stressful activity for you, learn to view things backwards. Remember: STRESSED spelt backwards is DESSERTS! Happy distressing!