What about stress?

An estimated three fourths of all visits to family physicians are related in some way to stress.

It was the morning after. The morning after her visit to the emergency room, that is. She was 27 years old, an attractive young woman who appeared in my office at 9:14 a.m. seeking an explanation for her symptoms. Now quite composed, she told me that she had experienced an episode of severe chest pain with shortness of breath and a terrifying feeling of numbness in her hands and fingers on the previous evening. She had been rushed to the ER for evaluation and treatment, and later, feeling somewhat better, released with instructions to follow up with her family doctor.

"Have you been under unusual stress or tension lately?" I asked. "No, nothing out of the ordinary."

"How are things at home? Any family problems?"

"No, the man I'm with is good to me, not abusive like my former husbands."

"How many times have you been married?" "Four."

As we talked, a story of incredible coping emerged. She told how she was attending night school but finding it difficult to study in the daytime because of her mother's recent hospitalization, which left her with the responsibility of caring for her younger brother. Neither she nor her husband (who had just been arrested for shoplifting) was employed, and the landlord was threatening eviction. She had undergone two major surgeries in recent years, and was a heavy user of caffeine and tobacco.

Her body was trying to tell her what she was unable to understand or accept on a conscious level- that she was under severe stress and in need of relief. Admittedly, her story, while entirely true, is unusually dramatic. Most of us aren't faced with the multitude of challenges confronting this young woman. But we all must deal with stress, and the manner in which we cope has far-reaching implications for our health and happiness.

What is stress?

Stress has been defined as an activity or condition that requires coping. Physical causes of stress, or stressors, may include an element as uncontrollable as the weather, noxious noise, pollution, or disease-causing bacteria and viruses. A broken romance, financial disaster, and the death of a loved one are serious social stressors. Even positive experiences, such as marriage and childbirth, require significant coping. And the emotions connected with stressful times--anger, frustration, joy, grief, fear, happiness, embarrassment --are sources of psychological stress.

Individual responses to stress vary greatly. Aging seems to make some people more vulnerable, or perhaps less resilient, when stressed. Certain occupations are perceived to be inherently stressful. And some lifestyle factors, such as use of alcohol and caffeine, are thought to compromise coping ability. Perhaps the single most significant determinant of the stress response, however, is one's attitude toward life.

Stress and the body

Dr. Robert Eliot, a noted heart specialist, has studied the physiological effects of stress. He identifies two types of people, "hot reactors" and "cold reactors," based on the way the body responds to artificially induced stress. He states unequivocally that one cannot remain a hot reactor indefinitely without suffering unwanted consequences.

He should know. Dr. Eliot experienced a heart attack at the age of 44. He was then chairman of the Department of Cardiology at the University of Nebraska, working energetically, even frantically, to achieve his goals and establish a national reputation. Administrative delays and detours only caused him to push harder, but not without frustration, aggravation, anger, and fatigue. At the end of a particularly difficult day, while lecturing on how to prevent heart attacks, he experienced the chest pain of his own heart attack.

Upon recovering, Dr. Eliot began serious investigation into the effects of stress on the body. He learned that stress initiates the flow of powerful biochemical substances, including epinephrine, cortisone, and cholesterol, into the bloodstream. The nerves and blood vessels of the body respond to this potent concoction by preparing the body for battle--the heart rate goes up, while the pressure against which the heart must work (peripheral resistance) increases as well. It's not unlike placing a clamp on the garden hose, then turning on the water full force. Sooner or later, the weakest point in the hose will pop.

When the "hose pops," some organ or system of the body has simply lost the ability to recover spontaneously, and illness is the result. Dr. Eliot and the young woman from the emergency room have a lot of company. An estimated three fourths of all visits to family physicians are related in some way to stress.

The symptoms of stress-induced illness may suggest disease in any part of the body. And patients often express multisymptoms, including various combinations of the following: nervousness, sweating, trembling, fatigue, faintness, indigestion, headache, neck pain, back pain, shortness of breath, and chest pain. These symptoms may reflect real disease. A heart attack is a real, life-threatening disease. And indigestion may represent peptic ulcers, very real sores in the stomach or duodenum.

How to cope

We are assaulted by stressors every day. The economy is uncertain, the world political scene is volatile, our cities are crime-ridden, and our homes are often fragmented. Are we simply to be victimized by stress, to await in anxious anticipation the day that the "hose pops"? Or is there something we can do? Can we become more effective managers of the unavoidable stress that characterizes our lives, and reduce the inevitable deleterious impact of stress on our bodies?

Recognition is the first step in coping. We must learn to listen to our bodies and understand the meaning of body signals. A headache may be the initial warning of undue stress for one person, while another may experience abdominal pain and indigestion. To ignore or minimize these messages is unwise and can be dangerous.

Equally important is conscious acceptance of the possibility that our symptom or symptoms are stress-related. The young woman knew she was sick--she was frightened enough to go to the emergency room--but she was unable to accept the possibility that her illness was directly related to stress. Recognize your symptoms and accept their relation to stress.

Now, just cool down. Yes, cool down! It may not be easy at first, but it's essential. Dr. Eliot's hot reactors are individuals distinguished by characteristics of hostility, impatience, and competitiveness--a truly lethal combination. When you feel the tension begin to build, step back mentally, take a deep breath, think about something soothing, and allow yourself to relax a bit.

A balanced diet, comprised of a wide variety of nutritious foods, helps prepare your body to cope with stress. Fresh fruits and vegetables, along with nuts, grains, legumes, and dairy products, provide all the essential nutrients required for energy,growth, and body upkeep.

Aerobic exercise induces the production of biochemical substances within the body that help resolve the strain of stress. Thirty minutes of walking, jogging, cycling, or swimming, enjoyed three to four times weekly, produces an invigorating "training effect," toning the muscles, strengthening the cardiovascular system, and calming the nerves.

Just as important as vigorous physical activity is adequate rest and sleep. The body's physiological "batteries" require the periodic recharging that takes place during sleep. Sleep disturbances may contribute to decompensation caused by stress and may likewise be among its first recognized symptoms. An occasional long holiday or vacation may be necessary to allow sufficient opportunity for needed rest.

Friends can be a big help when you are confronted by difficult or stressful circumstances. A listening ear, a shoulder to lean on, or a reassuring smile may be just what is needed to restore hope and provide incentive to face life's challenges productively.

Feelings, attitudes, and beliefs are increasingly recognized as major determinants of the state of health. It naturally follows that the ability to manage stress constructively depends on a healthy emotional state, a positive mental outlook, and a belief that life has transcendent meaning. Trust in God, accompanied by meditation, prayer, and worship, can provide relief from the anxieties and burdens of life when all other remedies and techniques prove inadequate.

Uncontrolled stress, with its progeny of illness and unhappiness, is a serious problem for many in today's world. But it can be managed effectively when it is recognized, accepted, and approached with the "good sense" application of proven techniques for successful coping.

Ted Hamilton, M.D., is a family physician living in the Atlanta area.

Stress Toil

According to the American Institute of Stress, anywhere from 75 to 90 percent of all visits to primary-care physicians are for stress-related disorders.

These include headache, backache, insomnia, anxiety, depression, arthritis, herpes, gastrointestinal and skin problems, obesity, alcoholism, and drug abuse complications. Stress also plays a prominent role in heart attacks, hypertension, cancer, and the aging process.

The American Institute of Stress is a nonprofit educational clearing house for information on stress. For more information, write the institute at 124 Park Avenue, Yonkers, New York 10703; or call (914) 9 63-1200.