The Stress Protection Plan

The key to such a change is awareness of where the key to improving things lies, to a realization that there are other ways of seeing things, that these may be more life/health enhancing than our current approaches, that we need to challenge our present attitudes and beliefs. As you alter your attitudes so will your feelings change, and this is because it is your thoughts which govern your emotions. If you can learn to see your emotions as a mirror of your thoughts, and if you are aware that your emotions are in turmoil, or that they lead you to inappropriate responses, you can see that it is the way you think which needs to be addressed before changes will come in your emotions and stress-coping skills.

If you can begin to see that a repetitive cycle occurs in which life stresses are poorly coped with, and that the end result of this is depression, and the risk of mental and physical ill health, the need to gain control of the underlying causes becomes clear. Control of the emotions comes through understanding and awareness that negative feelings can be replaced with positive ones.

It is no simple or easy task to make such changes, and it may well require professional counselling, for it is not enough to simply superficially ‘blot out’ negative emotions with an overlay of positive thinking. What is called for is a more fundamental change in which you come to understand your way of thinking, the place where your attitudes were born. The start of this process towards an upwards positive spiral is recognition of what is necessary, followed by the use of a method which leads to greater understanding or insight. This can be achieved by attending workshops or group therapy sessions, or one-to-one counselling with a therapist, whether the method involves psychosynthesis, voice dialogue, neurolinguistic programming, or any other humanistic psychotherapy tool.

In all of these methods, judgements are avoided, and understanding and awareness is encouraged. Once you come to understand and accept yourself, and learn why you think (and, therefore, behave) as you do, change comes naturally.

There are a number of defensive tricks which the mind can play in response to any challenge or stress. These include repression of thoughts and memories which might prove stressful, as well as ‘rationalization’, in which the individual makes up an account of his or her behaviour in response to stress, the true explanation of which would produce anxiety. Such common defences, if producing anxiety states or personality changes, require professional psychotherapy to provide insights into, and resolution of, the problem.

It is self-evident, then, that what is to one individual a major stress factor may to another be only a minor irritant. Recall the student doctors who I referred to earlier. Some became ill and some did not when confronted by the same exam stresses. It was their coping skills and attitudes which determined who would become ill and who would not. In a well-documented study (M. Linn, ‘Stressful events, disphoric mood and immune responsiveness’, Psychological Report (1984), Vol. 54, pages 219–22) it was shown that the psychological response to a stressful event can alter the ability of the immune system to function adequately. In particular, men who reported the most depression after bereavement or serious family illness had the greatest reduction in immune efficiency. Such changes are not confined to depressive illness, but may result in a variety of responses to unpleasant life events.

Now, it is clear that life-events are common to us all. We all experience many, or even most, of the sort of events which are listed below, and yet they do not provoke a negative effect in everyone. Dr Norman Cousins, writing in the American Journal of Holistic Medicine (March/April 1986, pages 1–20) gives his view of the remedy which saves so many from stress-induced illness.

‘If negative emotions like panic can create disease, what is the role of positive emotions – love, hope, faith, laughter, playfulness, creativity? I’ve come to the conclusion that the function of the positive emotions is to interrupt the negative ones. The positive emotions protect the body against the bolts of fear, anger, worry and despair. They are the blockers, magnificent blockers … blocking as they can the disease of panic, which can intensify virtually any underlying illness. It is not possible to entertain two contrary feelings. The positive emotions drive out the negative. You cannot panic and laugh at the same time.’

The difference lies in a person’s attitude towards the cause of stress. For one person, for example, the meeting of a deadline, the need to be at a particular place at a fixed time, is of vital importance, and the prospect of being late, of failing to meet the deadline, generates a great deal of tension and anxiety. To another person, such deadlines are mere guidelines, and no particular worry is felt at their being missed.

Attitudes depend upon a person’s concept of reality. The world as they see it is their own reality, and when this comes into conflict with the external environment stress results. To some extent, all change represents stress. Anything that calls on us to adjust or change from what is normal represents stress. Our concept of what is normal, what is right, how things ought to be is, therefore, the sounding board on which the external environmental factors operate. Beliefs and attitudes often determine the degree of stress, anxiety etc. experienced. For example, the death of someone close is undoubtedly a major stress factor, and yet to someone whose beliefs include a certainty of an after-life or a reincarnation, the death will be seen as part of a continuous process, not an end, and therefore the amount of stress will be minimized. Clearly, what you believe, what you think, and how you see both major and minor events, is linked to your learned responses, which in turn derives from your upbringing and the attitudes and beliefs of those who guided your early years, modified by all that has happened to you since then.

Stress and Changes in Lifestyle

It has been possible to grade the potential of events or changes in our life. In the following chart, scores have been allotted to each event so that the degree of susceptibility to the effects of stress can be estimated. This can be valuable in alerting us to pay extra attention to dealing with those elements of health maintenance which are within our control. Some such methods are explained in Chapter 5.

The stress scale is based on the work of T.H. Holmes and R.H. Rahe (Journal of Psychosomatic Research (1967), No. 11) and is meant as a guide to the assessment of measurable stress resulting from having to adjust to change. There are many other causes of stress, but it is true to say that a high score on this chart (300 or more) over a short period of time (six months or so) is a strong indicator (affecting 80 per cent of us) that a major illness may follow. If the score is relatively high (anything from 150 to 299) about 50 per cent of us may become ill soon afterwards, and if under 150 points are scored, fewer than 30 per cent become ill. The higher the score the greater the need for stress-proofing.

Changes in lifestyleScaleDeath of spouse100Divorce73Marital separation65Jail sentence or being institutionalized63Death of close member of family63Illness or injury53Marriage50Loss of job47Reconciliation with marriage partner45Retirement45Health problem of close member of family44Pregnancy40Sex problems39Addition to family39Major change at work39Change of financial status39Death of a friend37Change in line of work36Change in number of marital arguments35Large mortgage taken out31Mortgage or loan foreclosed30Responsibility change29Child leaves home29In-law problems29Personal achievement realized28Wife starts or stops work26Starting a new school26Leaving school26Change in living conditions25Change in personal habits24Trouble with employer23Change in working hours20Change in residence20Change in recreation19Change in church activities19Change in social activities18Small mortgage taken out17Change in sleeping habits16Change in number of family get-togethers15Major change in eating pattern15Holiday13Christmas12Minor violation of the law11

It is known that these scores and the position on the scale of some of the incidents vary in different cultures. Different belief systems place the stress of marriage higher in Europe, for example, than in Japan. It can also be seen from the list that stress factors are not always confined to unpleasant events. A holiday, for instance, is seen as a cause of stress. Change itself, pleasant or unpleasant, has a potential for stress. But, even in high-scoring people 20 per cent do not become ill soon afterwards because it is our response, our attitudes, beliefs and underlying health status, that are the real determining factors in whether or not we are badly affected by stress. The list can be used as a guide, but it should be coupled with thoughts on the most appropriate responses, and these responses should then be cultivated.

Anticipated problems

There is another element in life which can often produce even more stress than events and changes which actually take place. This is the highly charged area of anticipated problems or events. Whilst losing a job is indeed a high-scoring stress factor, the anticipation of such a loss presents potentially greater stresses by virtue of the time-scale involved. Once a job has been lost, the reality of the situation determines that the person concerned does something about it. Looking for a new job, making practical arrangements regarding finance etc. are all stressful, but they are positive responses to the event. If, however, there are rumours of possible redundancies, and the anxiety and uncertainty continues for months or years, then the stress induced may be far greater. It is, nevertheless, worth remembering that, in such a case, there are practical steps which can be taken to minimize the effects of the stress once it is realized what is happening.

So, apart from actual changes in life being potentially stressful, the anticipation of such changes also creates stress. It is true, too, unfortunately, that much stress relates to an inability to resolve events which are in the past. Guilt, self-pity, brooding over events gone by – real or imagined – present another major potential for stress generation. Not only does such dwelling on the past produce stressful changes in the body, but it greatly diminishes our ability to function well in the present.

As well as anticipated or remembered unpleasant events, stress can build up from the environment in which we find ourselves. We may have to work amongst a lot of noise, or in very hot or cold conditions. All these things, including the effects of change, are termed ‘stressors’, and of course their potential for harm will depend upon our attitudes, emotions and personality characteristics. The strain, conflict and pressure resulting from such stressors may produce anxiety states which can be short-lived or long-term. Since it is not possible, in the main, to protect oneself against the major changes in life, it should be thought of as desirable and necessary that attitudes should be cultivated which will minimize the effects of the inevitable vicissitudes of life.

External stressors, whilst easy to identify, are less easy to measure and control. These might include difficult working conditions, boring repetitive occupations, and commuting on an unreliable transport system, or having to drive in heavy traffic for hours every day. Our bodies respond to all such stressors in a predictable pattern of internal changes. Stress is, however, cumulative, and a relatively minor event, when added to a large existing stress load, will often prove to be more than the body’s adaptation process can cope with. To a large extent the breaking point can be avoided by taking care of that aspect of the stress jigsaw puzzle most easily alterable, i.e. your personal habits and lifestyle. A change in attitude can dramatically alter the potential for damage created by externally generated stress, but such a change is far more difficult to achieve than, for example, a healthier pattern of rest and exercise, or a change in the food you eat.

Challenge and Control: The Element of Choice

All the changes and challenges in your life require that you adapt to or deal with them, often on a level where you are acting instinctively. Such challenges of life might involve any of the seemingly mundane stressors referred to above, or such things as:

 Time pressures (deadlines, appointments, responsibilities, tasks, tests, meetings)

 Other people’s behaviour (abusive, unkind, unreliable, contradictory, demanding, spiteful)

 Situations (job or home pressures, expectations of others)

 Self-imposed stresses (excessively high standards of performance in job, and even leisure activity; unduly self-critical)

 Life events beyond your control (as listed on pages 24 and 25) or the prospect of these

The question of whether or not damaging stress will result from any of these or other challenges and demands hinges upon the type of response which is forthcoming. Are the challenges seen as something to be overcome, to be dealt with, to grow through, offering a spur towards an improved future, triggers for potential growth, opportunity for change for the better? Or are they viewed as insurmountable, never-ending, overwhelming, crushing, beyond any personal control, negative with no redeeming features at all? To a large extent the degree of stress-induced damage which occurs is dependent upon which answer is forthcoming to these questions.

It is the ‘hardy’ response which is health-promoting with quite the opposite effect deriving from the opposite choice. Hardiness carries with it a sense of being in control, the view that the sort of events and situations described above offer a challenge and not a threat, and finally a sense of involvement and commitment rather than of detachment and isolation. And, in all of these hardiness elements, whether or not you feel it likely at this stage, you have a large degree of choice.

Choice? Yes indeed, for we can learn to choose how we will respond to life’s inconsistencies, demands and challenges, and this represents a major element in stress-proofing yourself. Even your believing the possibility of that statement being correct involves choice.

From childhood onwards, stress provides a spur and an incentive to development. The will to please others and to satisfy inner drives are responses to needs, desires and targets or goals, set by authority, society, family, self, and so on. This aspect of stress is vital to human survival and development. It is when there are inappropriate responses to such drives that stress becomes potentially harmful.

Whether considering early childhood development, schooling, family life, courtship, marriage, higher education, work or retirement, life presents a kaleidoscope of stressful events, challenges, obstacles, pitfalls and sometimes tragedies. The ground on which these events fall is the personality and make-up of the person, and since the avoidance of all stressful events and stages in life is not possible, it is the ground, the personality and belief system, that presents the main opportunity for modification, and consequent lessening of the impact of the many stressors that beset us.

‘Type A’ and ‘Type B’ Personalities

Cardiologists, Friedman and Rosenmann, have described the ‘Type A’ personality who is predisposed to heart disease. The Type A individual moves, walks, talks and eats quickly. He finds it difficult to relax, sets himself deadlines, often undertakes more than one task at a time; he fidgets and is ambitious. The ‘Type B’ person, much less prone to heart disease, is in direct contrast. This type moves, talks and eats slowly, is able to relax, is unambitious and avoids pressure and deadlines. None of this is too surprising, but what is exciting is that, when motivated (often by an early coronary) the Type A can turn into a Type B by altering their behaviour and copying Type B behaviour until it becomes habitual. There is a consequent drop in the likelihood of coronary disease following such a modification. Type A will have then adopted more desirable and appropriate responses to the needs of life, and will have enhanced his chances of long-term survival.

Living in the present lessens the tendency to dwell on past events or to worry about anticipated future events, and a further aspect of this is that the nearer our concept of reality is to actual life the less stress will be created. Reality may not always be the same for all people, but in many daily situations the stress felt by people is the direct result of their ‘fantasy’ of how things should be, being at odds with reality. My ‘fantasy’, for example, is that when people make appointments they ought to keep them, and what is more, they ought to be on time. In reality, however, this is often not the case. The annoyance and stress which is generated every time an appointment is missed or someone is late, could be avoided if I could bring my fantasy closer to real life, i.e. anticipate that people will, by the nature of things, be late for or will actually forget to keep their appointments from time to time.

‘If Only …’

In terms of attitudes to life and events, such thoughts or utterances as ‘if only …’ or ‘it should have been like …’, or ‘wouldn’t it have been nice if …’ indicate a failure to accept reality, or an unwillingness to accept what has actually happened. This type of ‘fantasy’ may appear harmless, but it is as potentially stressful as dwelling in the past or future. It is, in fact, another facet of that same tendency. ‘Be there now’ is the best piece of advice for such a person to bear in mind. Life is in the ‘here and now’. In the past, the future and the ‘if only’ lie shadows, demons and stress.

Nowhere is this more evident than in personal relationships, whether this be at work or in the home environment. Much stress results from an inability to express feelings clearly, without becoming upset. If feelings are expressed inadequately, then hostility and anger will often develop. Once again, many such stresses relate to differences of opinion as to what is, and what is not reality. Interpersonal relationships require that we express our feelings clearly and in a non-hostile manner, and that we are then prepared to listen to a similar expression of the other person’s views, without feeling ‘got at’ or under attack.

This is the ideal, of course, and it may be difficult to achieve because of long-held attitudes and firmly-rooted personality traits, but it is, undoubtedly, the way to ensure non-stressful relationships. Seeing reality in the present, the ability to deliver unbiased, non-hostile expressions of opinion, and the ability to listen are, then, qualities to be cultivated.

In personal relationships much tension is generated as a result of unfulfilled expectations. If one party anticipates a gesture or form of recognition (such as a birthday card or telephone call) which does not materialize, a tense and resentful attitude may ensue. Again, an ability to communicate can defuse such a situation. Errors or sins of omission are just as potentially stressful as sins of commission; i.e. non-events as opposed to actual events. If bottled up and nursed, such feelings can produce stress out of all proportion to the importance of the actual incident.

Self-Esteem and Cynicism

Into the huge equation of stress factors and their interaction with the mind/body complex which makes up each of us, we need to add ‘self-image’. How do you see yourself in relation to others, society at large, your friends and family? How accurately (and how harshly) do you judge your own strengths and weaknesses? Above all, what is the degree of your self-esteem, and how important is that anyway?

An important leading article appeared in the Lancet (22 October 1988, pages 943–4) which addressed the question of self-esteem. This explained the complex way in which we come to a value judgement, in which we weigh ourselves, deriving our standards partly by comparing ourselves with others. Do we, however, compare ourselves with those who are better off or those who are worse off than ourselves?

Modern American adolescents compare themselves with their fellows, judging by such yardsticks as popularity, degree of influence over others, school and other results and their self-awareness of such concepts as honour and virtue. Out of those assessments comes a self-esteem judgement which can profoundly influence the person’s stress-coping abilities.

In adult life we use similar yardsticks, but we add to it factors such as how good we feel we have been at being parents, husbands or wives, as well as experiences of success and failure in many of life’s tasks and the world in general. One common tactic in maintaining self-esteem is the awarding to ourselves of the credit for all that goes well, and to others (or circumstances) the blame for all that goes wrong.

Additional reinforcement for feelings of self-esteem (and the opposite) derives from other people’s opinions of us, as we perceive them. To that we have to add the degree of respect, attention, approval, praise, affection and love (or the opposite of any of these) we receive. Our self-esteem, therefore, has a lot to do with how we see our value reflected in the eyes of those around us and of society, and this starts in childhood.

Freud summed it up by saying: ‘A man who has been the indisputable favourite of his mother keeps for life the feeling of a conqueror.’ Imagine also the opposite, the sense of rejection and failure which children derive and carry with them into adult life from a parental attitude of indifference, or worse. Of course, life is seldom as simple as any of these models suggest. Some children are much loved by their parents, but rejected by their peers (or the other way around); some people regard themselves as superior, having a high self-esteem, despite little evidence that anyone else agrees with them.

Is Self-Esteem Important Anyway?

It is known that poor self-esteem is linked to illness such as depression, anxiety states and a host of psychosomatic disorders. It has also been linked to delinquency, child abuse and prejudice. It is even suggested, with strong research evidence, that our measuring of self-esteem has echoes in biological evolution. Many animals have displayed what is called ‘resource holding potential’ (RHP). This relates to the animal’s sense of degree of ability to fight and defend itself when it compares itself with other animals. When a low RHP is assessed by an animal it actually alters its internal physiological state, characterized by excretion of higher levels of certain hormones, changes in skin colour and behaviour patterns which indicate submission rather than a desire to assert itself. This sort of behaviour is clear to anyone who has kept groups of animals in which some dominate and others seem willing to adopt submissive roles (the pecking order in a chicken run is a good example.)

In a human setting this means that hardiness, self-esteem, the ability to deal with life’s vicissitudes, could be linked to the primeval pattern noted in our animal example, and that we unconsciously take on the role of the weak and vulnerable based largely on our self-image, our degree or lack of self-esteem, and that this has profound implications in health terms. Unlike chickens, we are not legally permitted to assert ourselves by pecking and fighting, and we should look for other ways of raising self-esteem. This has to be one of the major challenges of stress-proofing. And, what is the ideal? To be healthy, it is suggested, you should be neither unmoved by success nor indifferent to it. You should also be using every means possible to increase awareness in yourself of these self-imposed limitations, so that you can blossom into the full potential which life offers, even with all its challenges and hardships.