Stress

Dr. Mahesh Rajasuriya

Dr. Rajasuriya is at present a Senior Lecturer at the Department of Psychological Medicine, Faculty of Medicine, University of Colombo as well as a Consultant Psychiatrist at the University Psychiatry Unit, Ward 59, National Hospital of Sri Lanka, Colombo.

Translated into English by Dr. Geshan Kalupahana

Q

What do the words stress, tension and anxiety actually imply? Are we confused by all these terms?

A

Maybe we’re just a little confused. The three words tension, stress and anxiety have clear-cut scientific meanings. Once we have learned about these words our confusion is certain to resolve.

Q

Which word do we start with?

A

Stress. Before I go into its definition, let me throw in two more terms: ‘stressor’ and ‘reaction to stressor’.

A stressor is an incident which is likely to cause discomfort, pressure or harm in a person, be it mentally, physically or in both ways. Examples include the loss of a job or the death of a loved one. Likewise, stumbling over a rock while walking, getting into an argument with a bus conductor, preparing for an exam or failing one, or even simple hunger and thirst, are stressors.

Things which may seem positive or constructive at first glance could also be stressors. Marriage is a good example, as are starting a new job or getting a promotion. Other more neutral experiences too fall into this category; a visit to the doctor’s, getting ready to board a train, talking and leaving home for work too qualify as stressors. Even one’s own thoughts generate stress; worrying that you left your house key in the keyhole, or that you forgot to turn the electric iron off on the way to work, or worrying about the future for example. Although these thoughts often do not reflect reality, the mental distress they cause makes them stressors.

Q

It seems to me that practically everything we do and anything that happens to us are stressors.

A

Yes, in a way. Asking these questions are as much stressors to you as they are to me providing answers! Reading this post is a stressor to the reader.

What is important however is that most of these are minor and insignificant stressors. More powerful and consequential stressors include losing a job, the death of a loved one, failing a key exam, marriage, divorce and childbirth.

Q

So that’s about stressor. ‘Reaction to stressor’ is next in line isn’t it?

A

Yes. The moment a stressor arises we tend to react to it either consciously or unconsciously, usually the latter. In the example of failing an exam, one individual would shut him/herself up in a room and cry for days while another would go to a post office to dispatch the application for the next exam. Of these two reactions, the second at face value would appear to be beneficial to the person while the first would not.

Accordingly there are two kinds of reactions to stressors, namely appropriate or adaptive reactions and inappropriate or maladaptive ones. In some cases, such as postponing sitting for the exam for one year, it would be difficult to comment on the appropriateness/ adaptiveness of the reaction at first glance.

Q

But isn’t crying an inappropriate reaction?

A

Not necessarily. Crying helps provide a certain amount of dilution to states such as sorrow. Shouting and screaming while jumping up and down may bring a little relief to the anger and pain experienced by someone who has stubbed his toe on a rock, yet in the event of a serious injury to the toe, rushing to see a doctor would seem a more adaptive reaction than cursing the stone-thrower. Shutting oneself up in a room and weeping for days on end would likewise appear to be a maladaptive response to failing an exam.

Q

I would appreciate more input on inappropriate responses together with a few more illustrations.

A

Well, here you go: Showing others how dejected lovers make their lives alcohol fuelled miseries along the lines of silly characters in novels, films and teledramas is a good example of an inappropriate response. So is becoming bait to the tobacco industry by taking up cigarette smoking as a supposed remedy for mental stress. Causing harm to oneself or to others, exhibiting infantile behaviour while taking on a childish façade of helplessness, burdening someone else with your load and washing your hands off it and taking out one’s anger on others are quite often maladaptive responses too.

Sometimes you find people suffering from conditions such as high blood pressure and diabetes feigning an exacerbation of their illness when faced with a stressor. Take the mother who clutches her chest saying ‘My pressure has gone up!’ on learning from her son that he is seeing an objectionable girl; isn’t she reacting inappropriately? Another mother would face the same situation differently. ‘I can see that my son has become an independent adult. It’s just that the girl is unsuitable’, she would initially tell herself, and later react more appropriately possibly achieving her own objective in the process.

Q

Is that an appropriate response? The mother is scheming to break up a love affair isn’t she?

A

I am using the terms ‘appropriate/ adaptive’ and ‘inappropriate/ maladaptive’ based on whether or not the reaction is beneficial to the individual and his/her development, and whether or not it would bring good results. From this angle the mother appears to have made an adaptive response as far as she herself is concerned.

Q

From that point of view, yes I would agree with you. It would also be a subtle, intelligent and far-reaching step would it not? I’d like to learn this method too one day!

A

Exactly. This method is called ‘reappraisal of stressor’. To do it consciously for the benefit of oneself as well as others is a true skill. It is a technology that could be taught and should be acquired, and is invariably inbuilt to a certain extent within us all.

Q

Now it’s time to go back to the beginning. We now understand the stressor and the reaction to it. Is stress itself something different?

A

No. Stress is actually the sum of both of these. Sounds a bit confusing doesn’t it? I will say it again: The stress generator namely the stressor, taken together with the reaction to it, is referred to as stress. Think about it.

Q

I need to make a clarification. Do you mean that to define stress its root cause alone is not sufficient?

A

Spot on. Sometimes the reaction to a stressor is more important than the stressor itself. The degree of stress could depend on this.

Q

For example…?

A

Think of the two people who failed their exams. One stays inside a room and cries for days while the other goes to the post office to send an application for the next exam. Same stressor, different responses.

Even physical health would deteriorate in the person who weeps for days on end; Nothing constructive happens towards the exam; No inquiries are made into options besides the exam either. It’s almost as if the individual’s life has come to a standstill, with no good but harm coming of it to anyone. Clearly there is greater stress in this instance.

Maybe the second person too cried to begin with but it’s clear to us that he/she is now working towards an apparent goal. Couldn’t we surmise therefore that besides the lower stress levels in this situation, the individual has also channeled stress in a productive manner?

Q

True. So stress is not really as straightforward as we thought it was. We have the ability to regulate stress too.

A

Precisely. Not just an ability but a responsibility as well I would say. Some people make themselves a nuisance by constantly bombarding others with their stresses and problems. It may be that the listener has even greater stresses in his life.

Q

This is indeed an important message. It even reminds me of someone I know. His little problem seems to be bigger than anything else, and we find ourselves listening wearily for hours on end. OK, let’s go back to the beginning. Tension, stress and anxiety. Stress down, what’s next?

A

Rather than the other two, let’s talk about the features of stress. Namely what we would experience when we’re under stress, or rather when we’re under greater stress since I suppose there is never really a time when we are stress-free.

Q

Do you mean symptoms of stress?

A

No. We need to be wary about this opinion as to whether stress is an illness, because it is not classified as a disease under any categorization of mental pathology. It is in fact something normal. Only excessive or inapropriate stress has been described as a disease. In day-to-day usage there are no symptoms of stress, but only features of stress.

Q

Now I understand. Stress is in fact a part of life. Let’s discuss the features of stress on another page.

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