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Stress might not typically be thought of as a mental illness, but consider these facts from the American Psychological Association: 43 percent of adults suffer adverse health effects from stress; 75 to 90 percent of all physician office visits are for stress-related complaints; and in terms of lost hours due to absenteeism, reduced productivity and workers' compensation benefits, stress costs American industry more than $300 billion annually. Stress also wrecks our health and our relationships and robs us of our happiness. In the first part of this ongoing InteliHealth series on mental illness, Michael Clark, M.D., M.P.H., assistant professor of psychiatry for the Johns Hopkins Medical Institutions, helps us understand stress; in the second installment, he offers stress management tips.
InteliHealth: Virtually everyone today is "stressed out". How can you tell
when you’ve crossed the line into mental illness?
Dr. Clark: That’s a
good question. Stress in part involves what we call "the realm of meaning."
That’s a fancy phrase for saying that one person’s stress is another’s
challenge. For example, one individual gets the news that their father has died,
and it’s a disaster. They loved their father. They were close. But if another
father was a violent, abusive alcoholic, the news of his death might be a cause
for celebration. Both people experienced the same event. They received the news
with the same words. But it had totally different meanings. This is where we
have to start when considering the effects of stress. Now everybody says, "I’m
stressed out," but stress is not really a cause of mental illness. Research has
shown that environmental stress can activate mental illness - like schizophrenia
or bipolar disorder. But these are diseases of the brain. You have a weak or
broken part in your brain, and the stress is going to have an impact on that,
but it’s not going to actually cause the mental illness.
IH: How does stress cause problems?
Dr. Clark: Stress can overwhelm
people. It’s kind of like an assembly line. If you have to make one widget every
10 minutes, you’re not too bad off. But if you have to do one widget every
minute, and then they tie your hand behind your back and tell you to stand on
one foot, you’re in trouble. The setting now acts on your vulnerabilities. But
if you were to go back to making one widget every 10 minutes, you’d be fine. Now
you can rely on your skills or strengths. Stress becomes a problem when it
provokes your weaknesses or vulnerabilities.
IH: What are the symptoms of stress?
Dr. Clark: You don’t have the
energy you normally have. Your sleep is disrupted. Your appetite is thrown off.
You may have a variety of physical symptoms, like an upset stomach, diarrhea,
heart palpitations, excessive sweating and shaking. The psychological symptoms
include feeling anxious, worried, or depressed.
IH: How does stress impact on relationships?
Dr. Clark: Whenever
anyone is sick or not doing well, that will have an impact on other
relationships. The biggest worry is that the true cause of a strain won’t be
recognized. Problems arise when the other person interprets the person under
stress as being angry with them. The relationship itself is mistakenly seen as
the problem. Then someone says, "I can’t take the way you’re treating me," and
the relationship deteriorates further.
IH: Are there times when stress is more prevalent? At holidays?
Anniversaries?
Dr. Clark: For individuals with mood disorders, fall and
spring are the worst, and that probably has to do with the change in available
sunlight. Although life has many stresses, holidays, special events and
anniversaries are rich with meaning. So, if it’s the anniversary of the death of
a spouse, or if you’ve recently been widowed, or if holidays bring back memories
of great times you’re no longer having, they will be stressful. If Christmas is
when you always get into an argument with your family, you’re not going to look
forward to Christmas.
IH: What is the difference between short-term stress and chronic or
prolonged stress?
Dr. Clark: With short-term stress, you’re pretty sure
it’s going to end soon. People like predictability, not mystery. If I tell you I
want you to immerse your hand in freezing water for as long as you can, or if I
tell you I want you to put your hand in freezing water for three minutes, you
are much more likely to do the latter successfully. You won’t if I just say, "as
long as you can." If your boss says, "This is going to be an awful week," and
you stay up all night Wednesday and Thursday, you’ll get through it because you
know you’ll be able to sleep next week. But, if your boss says, "We’re in
trouble here and there’s no end in sight," that’s much more stressful. That’s
one reason why downsizing is so stressful. Management says, "Well, we’re going
to lay off 5 percent of our people, and if that doesn’t work, then maybe we’ll
lay off another 5 percent." It’s like you’ve got a guillotine hanging over your
head.
In part two, Dr. Clark explores how he diagnoses and treats severe stress.
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