Monday, November 26, 2007

Stress:Causes and Effects!!

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.


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