Tuesday, July 19, 2005

Stress - Some Basic Definitions by Dr Kamath

In order for the reader to process the information in this guide, he must first understand basic definitions of certain terms used in it. This would ensure that both the reader and the author are “tuned in” with each other. This is important because the reader brings into this learning process his own meaning of certain terms, which might not be consistent with their true meaning. For example, the term “stress” might mean different things to different people. When asked, “What is stress?” the often heard incorrect replies are, “Anxiety?” “worry?” “out of control?” “overwork?”

1. What is a symptom?

A symptom is an uncomfortable sensation in the mind or the body indicative of some problem with one’s health. We experience one symptom or another on a daily basis: headaches, aches and pains in the joints, cough, stomach ache, heartburn, sleeplessness, etc. Vast majority of television advertisements are on drugs meant to help alleviate these common bodily symptoms: sleeping aides; pain medications, constipation medications, etc. Most symptoms we experience on daily basis are transient.
As we read before, when symptoms become persistent, we visit doctors. When the doctors do not find any physical cause for our persistent symptoms they conclude that we now have a stress-related symptom. For example, if I keep feeling exhausted all the time and the doctor can not find anything to explain it, he would tell me it is stress-related.

2. What is stress?

Simply put, stress means getting upset about something. Peace of mind is gone. Sense of tranquility is gone.
This simple definition of stress often baffles people who are already down with a stress-related disorder such as depression or anxiety, as evidenced by their statement, “I am not upset about anything except this disorder itself!” This is because they are not aware of the role of various stressful events and problems that upset them prior to the onset of their disorder. It is the job of the psychiatrist to help them connect the dots.
[By the way, drugs that seemingly bring back our sense of peace and tranquility are called tranquilizers. Almost all psychotropic (“mind-altering”) drugs such as antidepressants, mood stabilizers, anti-anxiety drugs and anti-psychotic drugs have this effect on the mind.]

3. What does “getting upset” mean?

Human beings are endowed with the ability to experience hundreds of emotions. Most of them are negative or painful emotions. Positive emotions are precious few: joy, happiness, contentment, ecstasy, peacefulness, etc. Of the hundreds of negative or painful emotions, I have listed here thirty five as the most important in our understanding of stress. I made up this list after carefully listening to thousands of stressed-out patients. When upset for whatever reason, we experience one or more of these thirty five painful, potentially toxic emotions in our mind:

Fear, hurt, anger, sadness, guilt, shame, disappointment, frustration, helplessness, hopelessness, humiliation, hate, bitterness, resentment, envy, jealousy, terror, horror, disgust, embarrassment, rage, exasperation, insecurity, despair, dejection, remorse, regret, worthlessness, hostility, vengefulness, dread, sorrow, sinfulness, despondency, uselessness.

It is these painful, potentially toxic emotions in the mind and the brain that make us feel and look upset, cause changes in the brain chemicals and make various stress symptoms to appear. If we can make these painful emotions go away from the mind, the brain chemicals go back to their normal state, and stress symptoms disappear. The simplest way to look at this is to imagine the mind as a balloon. When we are calm, the balloon/mind is empty of painful emotions and so it can be seen as “deflated”. When we are upset, the mind/balloon is inflated with painful emotions, and stress symptoms appear immediately. If we can somehow make the painful emotions disappear from the mind/balloon again, it deflates again, the brain chemicals go back to their normal position, and symptoms disappear immediately.

Here is a gross example. As you step into your bathroom, you see a six foot long cobra in the bathtub. Scared, your balloon inflates immediately, your brain chemicals change and you experience many stress symptoms: fast heart beat, shortness of breath, trembling of hands, anxiety, sweating, etc. Your first response is to get away from the bathroom. After mustering some courage (the antidote to fear) you decide to prod the snake with a long stick. It does not move. You get a little closer and discover that it is just a real-looking rubber cobra put in the bathtub by your kids as a prank. You get a good laugh at this innocent prank. Your balloon shrinks, your chemicals go back to normal and your stress symptoms disappear promptly.
This inflating and deflating of the balloon/mind happens continually day in and day out in response to various upsetting events and problems we face in life. Even when we dream in sleep, our balloon could become inflated and we could experience various stress symptoms such as fast heart beat, shortness of breath, sweating, etc., in response to the danger we perceive in it. If you dream of being chased by a ferocious bear, you would feel very stressed. When you wake up and realize it was merely a dream, your balloon would shrink and you would feel calm once again.
Those of us who are able to keep our balloon shrunk on a daily basis live free from stress. Of course, there are appropriate and inappropriate ways of accomplishing this. If for whatever reason one is not able to keep his balloon shrunk, his stress symptoms would become persistent, get worse over time, and he would need a shrink to do the shrinking for him. Now you know why we psychiatrists are called shrinks!
In small to moderate doses these painful emotions are very useful for normal emotional growth and maturation, just as a small dose of fertilizer is essential for plants to grow to their full potential. In large doses, however, these emotions could become toxic and damage normal growth and maturation of people, no different than a large dose of fertilizer ruining the health of plants. This is especially true if one mishandles these emotions. A 16 years old boy involved in a fender-bender car accident could benefit from this scary experience, and learn to be a better driver. A total car wreck with loss of several lives could, on the contrary, leave permanent emotional scars on the same 16 year old, resulting in life-long suffering, especially if he did not deal with this tragedy promptly and in an appropriate manner.

4. Evolutionary roots of stress symptoms

Why do we have stress symptoms? The fundamental function of the mind is self-preservation. At the most primitive level the mind’s basic tasks are to decide what is bad for it (a function of thinking); fear that which is bad for it (a function of feeling), and to flee from it or fight back (a function of action). Fear is the most fundamental painful emotion which we share with all animals. The main purpose of fear was self-preservation as we struggled for survival, and evolved into the socially oriented modern man over hundreds of thousands of years in the wilderness of Africa.
Self-preservation boiled down to one of two responses to threats posed by other animals or fellow beings: either fight back or flee. Either way, the body must be quickly prepared for action when man faced grave threat to his personal safety. That meant rapidly turning on various vital organs of the body: heart, lungs, muscles, etc. to flee or fight back. Bursts of hormones into the blood circulation and chemical messages sent rapidly via a vast network of nerves connecting the brain to the body organs ensured sudden increase in blood supply to these organs for this purpose. These changes in the body organs manifested themselves as stress symptoms: Fast heart beat to ensure increased volume of blood; heavy breathing to increase supply of oxygen; blood pressure rise to increase rate of supply of blood; rushing of blood into to the tense muscles to take action; increased blood supply to the skin to cool the blood by means of sweating, etc. The increased blood supply to the whole body made it feel very hot. Once the threat was over, fear went away, brain chemicals went back to their normal or slightly altered state, and the man calmed down once again. The modern man experiences these very symptoms in panic disorder without any identifiable external threat. We will study later how this could happen.[By the way, we use the term “cold-blooded” to describe those who are not stressed at all when they commit a horrible, violent crime, and the term “hot blooded” to describe those who are quick to temper, meaning, they get stressed easily.]
The degree to which the primitive man became “emotionally charged” depended upon the perception of the level of danger posed by the threat. The primitive man’s stress response was appropriately different when he encountered a mosquito than when he came across a poisonous cobra, or a charging lion. Whereas the mosquito was seen as a nuisance, the cobra was best dealt with through avoidance. The lion, however, was seen as extremely dangerous as it was a predatory animal. The humans of other tribes were also perceived as extremely dangerous.

5. How did emotions come to play greater role in modern man’s life?

Self-preservation forced the primitive man to become a social being. As man evolved into even more complex social being over hundreds of thousands of years, he came to acquire more and more emotions in his new environment: the human society. They served as important tools to communicate good as well as bad feelings in his interaction with his fellow beings, his allies in the struggle for survival. No wonder, absence of social support system makes one vulnerable to serious stress.
As the functions of the primitive man’s mind became increasingly complex, his brain enlarged, and his face became the most important part of communication with others. Long before he learned to communicate verbally, he could express his feelings to fellow beings by facial expressions using dozens of facial muscles, no different than children do before they learn to talk.
Naturally, the blood supply to the brain and face gradually increased enormously to facilitate expression of emotions. That is why when really upset the face turns red, eyes become blood-shot, nose becomes stuffy, veins in the neck engorge and the head feels like it is about to explode. No wonder, headache is one of the commonest symptoms of stress. Blushing, which happens when we are bashful, embarrassed or humiliated, is an example of mildly increased blood flow to the face. We often describe emotional faces with such phrases as “red with rage,” “green with envy,” “ashen white with fright,” “dark with despair” etc. “Poker-faced,” “bald-faced,” “bland-faced,” “mask-faced” are some of the pejorative terms we use to describe people who effectively hide their true emotions.
As millennia after millennia passed, man learned to express his emotions to fellow beings by means of speech, crying, sobbing, sighing, moaning, groaning, squalling, bawling, grunting and other sounds and motions of face and the body. Copious flow of salty tears served the purpose of reducing not only the volume of blood flow into the head but also the inner emotional tension. Shedding tears of sadness is such an important mechanism for reducing inner emotional tension as well as the blood flow into the head that now those who are unable to do so are condemned to suffer from severe headaches and other psychiatric and psychosomatic pain disorders later in their lives.
Even though we have come a long way from the dangerous environment of the African savanna, we are still wired to suffer stress symptoms whenever we experience fear and other painful emotions in our daily dealings with others. We might not be too fearful of losing our lives on a daily basis like the primitive man did, but we do constantly fear losing various other things we have come to believe are essential for our security and self-preservation in the society of people: love, liberty, acceptance, respect of others, relationships, livelihood, money, property, etc. When we lose these, or are threatened with the loss of these, our sense of security is threatened, we get upset or stressed, and we experience stress symptoms no different than our prehistoric ancestors did when they were attacked by a charging lion in the African savanna. The modern man’s brain is still wired like that of primitive man of a million years ago even though he has been “civilized“ for five thousand years. We can see evidence of primitive thinking in our everyday behavior.
As the primitive man became more and more civilized, free expression of painful emotions came to be frowned upon, especially in western societies. To maintain order, decor, peace and harmony in the society, subtle and overt restrictions were put on people as to how they could express their emotions. Normal expression of grief has come to be branded as “creating a scene.” Overt display of sadness nowadays mean being “hysterical.” Crying over something is now called “maudlin.” Complaining about something is now known as “whining.” Gradually, being civilized has come to mean holding a stiff upper lip when the mind is full of swirling emotions. Whenever I attend funerals, I am struck by the jovial mood of the family of the dead person. No moist eyes here. Most are either drunk or drugged. The remaining are busy being strong for others, or celebrating their good fortune!
Inability or unwillingness to deal with painful emotions is the foundation of all stress-related disorders. Unexpressed emotional pain, unshed tears, unresolved grief and conflicts- all have a price to pay in the long run: stress-related disorders. Understanding the nature of our emotions is absolutely essential for healthful life. Emotional Quotient (E. Q.), -savvy in dealing with one’s own emotions and in tuning in with others’- is more important than Intelligence Quotient (I. Q.) -general knowledge about the world- in successful life management. Indeed, it is rare to find both these attributes in the same person. Most of my clients score very low on their E. Q. Explains why they are in the predicament they find themselves in.

6. What is an “emotional cascade” ?

Sometimes, when we experience just one of the above painful emotions in
response to a serious stressful situation, a cascade of painful emotions follows. For example, if I felt hurt or humiliated by someone’s nasty comment, after a while I might begin to experience a cascade of emotions: bitterness, resentment, anger, rage, hate and vengefulness. An angry outburst at the loved one could be followed by guilt, shame, embarrassment, remorse, regret, sorrow, worthlessness, etc. This chain reaction is very common after one has received a serious emotional or physical injury by negligent or deliberate action of another person. Behind every lawsuit there is a cascade of painful emotions with a need to exact revenge or to gain compensation. Do not believe any suing person who says, “It is not revenge or money that made me sue!”

7. What do these emotions mean?

1. Fear means being scared in response to something perceived as dangerous or offensive. Not only do we fear getting hurt physically and emotionally, we also fear losing things that we are attached to emotionally: people, job, money, power, title, love, respect, etc. Fear can be conquered with faith, courage, reassurance and prayer.
2. Hurt means one’s feelings are injured. It is a form of mental pain. Solace is antidote to hurt.
3. Anger means one experiences sudden, very adverse, antagonistic emotions against someone or something. It is an extreme form of displeasure. Anger usually follows hurt. Forgiveness is antidote to anger.
4. Sadness means one is feeling emotionally down or depressed. Sadness is prominent in grief, that is, when you lose someone or something you are very fond of. Happiness cancels-out sadness.
5. Guilt is what one feels when he has done something that is not consistent with his own conscience, or values he learned from his parents or parental figures. Guilt makes us downgrade ourselves in our own eye. People without guilt become antisocial in behavior. Thieves, rapists, murderers, mafia, etc. feel no guilt. Guilt is countered with compensation, repentance, begging forgiveness or offering apology.
6. Shame is what one feels when he thinks others around him, whose opinion he values, disapprove his behavior. In shame we feel downgraded in others’ eyes. This emotion is fast disappearing in the United States. Shame is overcome with public exposure and confession.
7. Disappointment means one feels let down by the turn of events or by the people he trusted. One an overcome this by acceptance of human frailty.
8. Frustration is what one feels when he is not making headway with his goal in spite of his best efforts. Patience might help us to deal with this emotion.
9. Helplessness is what one feels when he is completely at the mercy of a dangerous situation or person. A woman being raped at the point of a loaded gun is a classic example of helplessness. Rage often follows helplessness. Doing something to deal with the situation can counter feelings of helplessness.
10. Hopelessness is what one feels when he faces a situation which is getting steadily worse and he is at a loss what to do. Being told that one has terminal cancer is an example. Faith and prayer often counter this emotion.
11. Humiliation means one is belittled or humbled by another person, usually in the presence of others. Hurt, anger and rage often follow this emotion. Tolerate it with dignity.
12. Hate is an powerful emotion of aversion or extreme dislike directed toward someone or something. Hate makes one avoid the hated person and wish him ill. Hate often hurts the person who harbors it for long. Hate can be overcome with love.
13. Bitterness is an extremely distasteful feeling one has about a particular incident. Counter it by letting go.
14. Resentment is a simmering, low grade anger one feels towards those one dislikes for some hurt suffered from them in the past. Forgive and move on.
15. Envy is a feeling of discontent or resentment over others’ possessions or accomplishments. Be content with what you have.
16. Jealousy is what we feel when we fear being pushed aside by others, or we are made to feel insecure by another person’s accomplishment or possessions. This is a sign of insecurity. Improve your self-esteem to get over this.
17. Terror is what we feel when we face a sudden and serious life threatening event. It is an extreme form of fear. Face it with fortitude.
18. Horror is the shock we feel when we witness a frightening and dreadful event around us. Face it with outrage.
19. Disgust is what we feel when we experience loathing or sickening feeling in response to an offensive event or situation. Deal with this by walking away from it.
20. Embarrassment is what we feel when we are uncomfortable or disconcerted in a situation. Try to see humor in it.
21. Rage is a sudden and extreme form of anger in which we are almost out of control. Control yourself before you hurt someone.
22. Exasperation is what we feel when we feel aggravated, annoyed or infuriated by a difficult situation or person. Do something to change the situation.
23. Insecurity is what we feel when we are in a situation which makes us feel vulnerable to danger of some sort. Actions of others could also make us feel insecure. Listen to your instinct. Do whatever you need to to ensure your safety.
24. Despair is what we feel when we have given up all hope. Find solace in prayer.
25. Dejection is what we feel when we are disheartened by bad news or turn of events. Don’t give up hope.
26. Remorse is what we feel when we admit to doing something bad that was injurious to others. Apologize.
27. Regret is what we feel when we realize that we missed out an opportunity or did something wrong. Forgive yourself and do not make the same mistake again.
28. Worthlessness is an emotion we feel when we have repeatedly failed to accomplish what we set out to. It is an extreme form of low self-esteem. Reexamine your goals and methods.
29. Hostility is the adverse feeling against those we dislike or hate. Give it up and move on. Hostility creates more hostility.
30. Vengefulness is what we do when we feel a need to get back at someone whom we perceive as having done us wrong. Leave it to God to punish those that have hurt us.
31. Dread is what we feel when we are anticipating something terrible to happen. Courage.
32. Sinfulness is what we feel when we have done something that we think is wrong as per our religious or spiritual belief. Renew your Faith; repent; ask for forgiveness.
33. Sorrow is the grief we feel when we have lost someone or something we are emotionally attached to. Express it. Accept the loss. Move on.
34. Despondency is what we feel when we are very discouraged, or when we experience hopelessness about a situation. Seek spiritual strength.
35. Uselessness is what we feel when others around us treat us as though what we think, feel and do does not matter at all. Recognize that there is no such thing as useless person. Only, his time has not come.

8. What factors determine how much upset we get?

How much upset we get is directly related to 1) severity of painful emotions and 2) the number of painful emotions we experience in response to a stressful event. If you were very scared about something, you would be a lot more upset than if you were slightly scared. If you experience several powerful painful emotions all at once, such as fear, hurt, anger, sadness, etc., you would be feeling a lot more upset than if you experienced only
one of these emotions. For example, a woman’s emotional reaction to discovering her spouse’s unfaithfulness would be infinitely greater than her reaction to his forgetting her birthday.
As to exactly what, how many and how severe emotions we experience when upset depends upon the nature of the event or the problem at hand. A close friend’s death might cause one to feel profound sorrow. Betrayal of trust by another close friend could cause him to feel hurt, anger, sadness, disappointment and many other emotions.
Because we are all different from one another in the way we respond to stressors by virtue of our differing genes, innate temperament, emotional sensitivity, past experiences and cultural influences, each of our reaction to a given situation is also different. What upsets one very much might not upset another at all. In fact, what is outrageous to one might be hilarious to another. For that matter, what might upset us today might not upset us a year from now as, by then, our thinking might be quite different. Therefore, it is inappropriate to generalize stress response and designate a severity number to a given stressful event: death of a spouse: 100; divorce: 98, etc. Breakup of a relationship could devastate one and relieve another. Death of a spouse could cause one person’s balloon to pop and make another person open a Champaign bottle. All depends on one’s state of mind at the given moment.
That is why one person might see a glass as half full and another as half empty. One might become very upset when the price of a stock goes down, and another might become ecstatic, because he sees an opportunity to make some money. One might see you as a great person and another might see you as the worst person on earth. One might judge a person as terrorist and another might declare him a freedom fighter. Everything depends on one’s perception. Changing perception is one of many tools in coping with stress as we will study later.

1 comment:

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