Of Washington, Stress, and the Mind

b_800_600_16777215_0_stories_immagini_Inverno_Alba_sul_primo_piazzaleThe way we perceive a situation, and decide whether it is positive or negative, is an active, continuing process of appraisal of the risks, costs, and likely gains of our
possible responses. Three individuals may be stuck in traffic at the same time and each may perceive and appraise the situation quite differently. “OMG,” one may say, “late again, my boss will be furious!” The second may think, “I’m going to be late, but my boss will understand how unpredictable this traffic really is.” The third may settle in, turn on the radio and say, “It’s a good thing I left a little early, I can’t speed this up so I’ll just catch up on the news.”

Depending on this cognitive appraisal of a situation, the stress reaction will mobilize the body to action. The greater the anxiety generated by the situation, the higher the level of physical and psychological arousal. Sometimes, overt behavior will be produced directly by the mobilization of impulses, drives, or wishes. One specific and frequent set of behaviors is likely to occur most frequently, as a behavioral inclination to act in a certain way due to our background, beliefs and available resources. Depending on the content of our thoughts about the situation, the behavioral inclination may be a desire to withdraw (flight), attack (fight), approach, or avoid (freeze). The emotions corresponding to these inclinations are anxiety, anger, affection, and sadness, respectively. The ultimate response to a stressor can be conceptualized as a structure of the mind, where a set of beliefs about one’s self, the world, and the outcome activates and controls the behavioral inclination and the emotional response.

Life’s stressors, especially if significant to our physical, psychological and social well-being can disrupt the normal activity of the mind. In addition to almost immediate loss of the ability to concentrate, recall, reason and control impulses, a severe and unexpected stressor produces a relative increase in instinctive, more primitive, and less rational processes. Instinctive reactions are usually paired to specific stimuli. These almost mandatory reactions are characteristic to the specific sensitivity of each individual. They can give way to inappropriate or excessive behavioral reactions. For example, the need for a stiff drink, reaching for a cigarette, crying, or being unable to breathe or move can be automatic, with little insight and thus virtually unstoppable.

The wide differences between people in their specific sensitivities explains why an event that is an almost unbearable stressor for one person may be an annoying or even benign situation for another. The seasoned public speaker may still get butterflies in the stomach, but is able to carry on and deliver an excellent presentation, whereas another may be terrified at the very idea of speaking before an audience.

Core differences in one’s personality also account for the wide variations in individual
sensitivities to stressors. The independent and somewhat misanthropic personality will not be sensitive to the same stressor as the individual who craves human connection and feels dependent on it for validation. Excessive or ineffective reactions to stressors, such as hostility, anxiety, and depression, also result from specific behavioral inclinations, personality structure, and specific sensitivities.

Finally, reactions to stressors may be dictated primarily by one’s internal motivations, with no apparent connection to the events or circumstances of the outside world. For example, the belief that the only road to happiness is through total success is characteristic of achievement-oriented individuals who are therefore extremely vulnerable to excessive and ineffective reactions at the slightest doubt of failure—regardless of evidence to the contrary.

Obama & Boehner at Stresshacker.comStressful interactions with other people who may be equally as stressed, albeit for different reasons, produce a mutually reinforcing cycle of excessive and ineffective reactions. Specific psychological mechanisms, such as an egocentric approach, negative framing, and polarization, increase the level of arousal experienced by each individual and, consequently, to higher and higher levels of collectively shared stress. This cycle seems to be in evidence at this time in Washington, as the executive and legislative powers appear to be locked in a mutually reinforcing cycle of excessive and ineffective reactions to each other.

Mental Health USA: An Inconvenient Truth

aaWyeth_1946_WinterIn 2009, almost 20% of the adult population in the United States (19.9% or 45.1 million people) had a mental illness of some kind during the prior twelve months. Those with a serious mental illness were 4.8% of the adult population, or 11 million people.

These are the sobering results of the latest National Survey on Drug Use and Health (NSDUH), a report presenting estimates on the prevalence of mental disorders and mental health services utilization among adult Americans.

The results showed that adult women were more likely than men to have a mental illness of any kind (23.8 vs. 15.6%) or a serious mental illness (6.4 vs. 3.2%). An estimated 8.4 million adults, or 3.7%, had serious thoughts of suicide, 2.2 million (1%) had made suicide plans, and 1 million (0.5%) had attempted suicide within the past year.

The survey results estimate that among the over 45 million adults with any mental illness in the past year, almost 9 million had substance dependence or abuse. Among the 11 million adults with a serious mental illness, almost 26% also had substance dependence or abuse.

Only 17 million people with any mental illness received mental health services, whereas 28 million neither sought or received any treatment. Six in ten adults with a serious mental illness received mental health services, while almost 4.5 million received no treatment at all.

aaWyeth_1948_ChristinasWorldThe survey is conducted each year by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services using computerized interviewing. The 2009 results were extrapolated from screening completed at 143,565 addresses, and 68,700 completed interviews. In this survey, the category any mental illness includes the presence of a diagnosable mental, behavioral, or emotional disorder in the past year (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The category serious mental illness includes a diagnosable mental, behavioral, or emotional disorder resulting in substantial impairment in carrying out major life activities.

You can see the complete results of the 2009 survey, published a few days ago, on the OAS-SAMHSA web site by following this link.

How Owning a Dog Extends Your Life

Puppy_1-21-09Human interactions have a biochemical signature that is most evident in what happens between a mother and her baby. A study presented at the 12th International Conference on Human-Animal Interactions that took place this summer in Stockholm offers convincing evidence that the same biochemical process plays a role in the bond between dogs and their owners. Researchers Linda Handlin and Kerstin Uvnäs-Moberg of Sweden’s Karolinska Institute believe oxytocin is the “bonding hormone” that is released in humans and in dogs during mutual interactions. To test their theory, blood samples were taken from dogs and their owners before and during a petting session. “We had a basal blood sample, and there was nothing, and then we had the sample taken at one minute and three minutes, and you could see this beautiful peak of oxytocin,” said Uvnäs-Moberg in an interview on PBS. “The fascinating thing is, actually, that the peak level of oxytocin is similar to the one we see in breastfeeding mothers.”

The hormone oxytocin has a powerful physiological effect. It can reduce blood pressure, increase tolerance to pain, and reduce anxiety. Research indicates that owning a dog could even extend your life. “If you have a dog, you are much less likely to have a heart attack, and if you have a heart attack, you are three to four times more likely to survive it if you have a dog than if you don’t,” added Uvnäs-Moberg.

Oxytocin: The Baby-love Puppy-love Hormone

Oxytocin is a polypeptide hormone that has long been known to stimulate the contraction of the uterine muscles and the release of milk during breast-feeding. It is now recognized as an important modulator of the stress response. Stored in and released from neurons in the posterior pituitary as well as in the brain, oxytocin is synthesized in cell bodies of the magnocellular neurons located principally in the paraventricular nucleus of the hypothalamus. However, oxytocin is more ubiquitous as it is also synthesized in neurons that are widely distributed within the central nervous system. Oxytocin facilitates mother–infant interactions and tends to facilitate behaviors that oppose classic fight-or-flight behavioral responses to stress.

The Study: Dogs Have Feelings of Love, Too

Mother and childHandlin and Uvnäs-Moberg sought to establish a correlation between levels of oxytocin and those of the stress hormone cortisol during interactions between dog owners and their dogs. Ten female dog owners were asked to evaluate the quality of their relationships with their dogs via a standardized questionnaire. They were also asked to interact with them, stroke them and talk to them for one hour. The owners’ oxytocin levels correlated significantly with questionnaire items indicating positive feelings and closeness to the dog, while cortisol levels were significantly correlated to items regarding negative feeling towards their dog. The dog’s oxytocin and cortisol levels also correlated significantly with the owners’ answers to items regarding their attitude toward the dog. The scientists concluded that hormones in both human and animal were related to the owners’ perception of their relationship with the dog. “A short-term sensory interaction between a dog and its owner [can] influence hormonal levels in both species,” says Uvnäs-Moberg. “The dogs’ oxytocin levels displayed a significant rise just three minutes after the start of the interaction. There was also a significant positive correlation between the dogs’ and the owners’ oxytocin levels after 15 minutes.”

Crying: Public, Political, and Private

BoehnerCryingDespite the popular (and clinical) consensus that emotional tears are beneficial, dating back to ancient history, the benefits of crying to one’s physical health and its effectiveness as stress reliever turn out to be unexpectedly controversial. Scientific evidence is inconsistent at best, owing in part to the difficulty in measuring the effects of crying on the body and on the psyche in a valid, reliable and reproducible way. Crying remains a poorly understood phenomenon whose physiology is not a mystery but whose product, human tears, appears to stir controversy when analyzed for composition and function.

It is some relief to weep; grief is satisfied and carried off by tears.- Ovid

Perhaps the best known and most controversial theory on the function of crying continues to be the 1985 research published by Dr. William Frey, who hypothesized that emotion-triggered tears may simply be an excretory process. Like other bodily waste, the primary function of emotional tears may be to remove ACTH, prolactin, endorphins, toxic substances and hormones that accumulate during emotional stress. Frey reported that emotional tears, at least those he studied in his laboratory, appeared to contain higher concentrations of some hormones. Frey also reported differences between the protein content of emotional and irritant tears. These results have proven difficult to interpret and duplicate, making it unclear whether this difference has any clinical relevance. Frey’s critics contend that the amount of tears shed by humans is generally so small that it is unreasonable to presume that this process would have any physiological benefit.

ClintonCryingA recently published book by Tom Lutz, Crying: A Natural and Cultural History of Tears offers plenty of insights into the history of public crying, but few scientific explanations for the phenomenon. Lutz, a professor of creative writing at UC Riverside offers interesting anecdotes about the political value of public tears. Says Lutz, “Men cried openly and often in the upper classes in the 18th century. Lincoln and Douglas both cried on the stump. And men cry more openly now than they did 50 years ago. Issues of ‘control’ are always in relation to these changing social norms. Bob Dole cried in public exactly twice before his 1996 campaign. But in the early 1990s, Bill Clinton had transformed the political meaning of crying; it tracked very well with women voters. All of a sudden Bob Dole couldn’t control his crying and did it often.”  As to the reasons for public crying, “We do so for a number of reasons,” he says. “For emphasis (this is so important I give myself permission to break the rules); for self-definition (I don’t care how I’m supposed to act; this is who I really am); to ward off criticism (he’s too upset for me to challenge him); to suggest intimacy (he feels so comfortable with me he will break the rules in front of me); and so on.”

The BBC lists the following as the ten most frequent reasons people cry in public:

  1. Making one’s parents proud. For men, this most often refers to Dad, as many movies having this theme can attest, e.g. Field of Dreams.
  2. The birth of a first child or grandchild.
  3. The suffering of a loved one.
  4. Letting a loved one down.
  5. Saying I’m sorry.
  6. Letting yourself down.
  7. Being dumped.
  8. Being beaten in a hard-fought game.
  9. Winning a hard-fought game. Most recently famous is Iker Casillas, the goalie of the Spanish soccer team who just couldn’t stop crying after winning the 2010 World Cup.
  10. These aren’t emotional tears. It’s just bits of dust.

ronaldo-cryingPsychologically, crying appears to perform a valuable interpersonal function. Tears can be a powerful way to get what we want.  And there is some evidence to suggest that a process of natural selection favors infants whose cries are most alarming.  This bit of psychology appears intuitively to make sense when we think about how babies get attention — they cry. And so do Bill Clinton, John Boehner, Hillary Clinton, TV preachers, and countless others on baseball, football, soccer fields and TV sets everywhere. And they get attention.

Forced to Lie About Stress

aaDelacroix_1852_LaMerADieppeA full 36% say it’s stomach upset, 13% that it’s a cold; 12% claim to have a headache, 6% a medical appointment; 5% blame it on a bad back. The rest cite a variety of reasons, from housing problems to the illness of a loved one or the death of a beloved relative, for not showing up for work. None of it is true. What’s going on? In most cases, nothing more than an intense stress reaction forces 19% of workers to call in sick, yet as many as 93% feel compelled to lie to their boss and coworkers about the real reason for missing work.

Although employees are willing to go to great lengths to cover up their dangerously high stress levels, the vast majority do not like having to lie: 70% say that they long to be able to discuss stress with their employers. While some try, most can’t seem to find the courage to bring it up and remain hopeful that their boss will make the first move and approach them directly when they show signs of strain. Few employers do.

Millions of people experience unmanageable stress at work, and the fact that so many people feel forced to lie about it rather than finding a solution should be a major concern for our businesses. If employees don’t feel they can be honest about the pressures on them, problems that aren’t addressed can quickly snowball into low morale, low productivity and high sick leave. We’d urge employers to encourage a culture of openness at work so they can solve problems now, rather than storing up problems for the future.–Paul Farmer, Mind Research

These sobering statistics were published in a study released by the British mental health research group Mind, an organization which campaigns vigorously to promote and protect good mental health and advocates that people with experience of mental distress are treated fairly, positively and with respect.

Not being able to come clean clean on workplace stress claims its toll: 62% of employees feel their bosses aren’t doing enough to look after the well-being of their staff and resent this apparent neglect. One in five becomes physically ill from stress, but only 10% seek help from their doctor or from a counselor on specific issues of stress. Doctors and therapists are often told a different reason, at least initially, for the symptoms the individual may be experiencing.

Stress-related symptoms still appear to carry a stigma in the workplace, as stress may be associated, at least in Western cultures, with a negative perception of one’s ability to manage a heavy workload. In this day and age, the fear of being perceived as a stressed out (and therefore unproductive) worker may have the power to trump honesty and reasonable self-care.

The Vote: Fear, Anger and Resignation?

IVotedLest Stresshacker be labeled left, right or center, this post is about the prevailing psychological states of US voters that may have prompted the choices made yesterday at the polls in the midterm election. The brief moment in the voting booth when each voter was about to punch, press or pull on the input device was as always the point of real decision, along a continuum of choice either matured over a long and careful analysis of the options or arrived at on the spur of the moment. The vote was either reaction or response, instinct or deliberation. In any case, this vote was a blend of rationality, emotion and convenience, a culminating of feelings that translates into a choice.

Americans voted not only with their minds and hands, but also and perhaps mostly with their hearts. They voted for or against their congressman, their senator, Congress in general, and president Obama. Former speaker Tipp O’Neill said famously that all politics is local, meaning that in his view decisions are made at the polls mostly on the record of the local incumbent and challenger. The advent of 24/7 news access and the impact of social media may have changed this to the point where those who lost or won their seat may have been helped or hindered, more than used to be the case, by a broader and more macroscopic view.

Voters, interviewed extensively by news media as they exited their polling stations, reported not liking the way the President is doing his job, and they sounded even angrier at Congressional Democrats, which may explain why they gave the House back to the Republicans. Given the magnitude of the shift, it also appears that Obama policies passed through the filter of voter anxiety, as voters looked back at a decade of economic decline. And this, only two years after “the audacity of hope” propelled Mr. Obama into the White House, is remarkable in itself.

senateThat this was the most expensive midterm election campaign in the nation’s history, when a record $3.8 billion was spent in all races big and small, only confirms the perception by contributors and recipients of this sizable amount of money that this election reflected more than rational choice—it expressed a mood, a feeling, an emotional reaction pointing to prevailing psychological states that range from simple malaise, to frustration, overt anger and underlying fear. Nothing can focus the mind and the pocketbook like justified fear for one’s present and future situation.

And the situation in the United States appears indeed grim, although it may not be as bad as reported, due to the well-known axiom that good news does not sell newspapers, online clicks or TV commentaries. If there is good news about the economy, it may not be reported with the same alacrity (and a bit of schadenfreude) as the bad. It is therefore not surprising that the interviews with voters conducted for the National Election Pool, a consortium of television networks and The Associated Press, show a majority of Americans saying that the country is headed in the wrong direction. Almost 90% said they were worried about the economy and more than 40% said their family’s situation had worsened in the last two years. Enough to worry and be angry about.

School Bullying Is Much More Than ‘Just What Kids Do’

aaMondrian_BroadwayIs school becoming an increasingly dangerous place for our children’s mental and physical health? A study of 43,321 high school students confirms that student-on-student bullying has become a serious problem in public and private schools across the United States. Its behavioral, health and social consequences are lowered academic achievement and aspirations, increased anxiety, loss of self‐esteem and confidence, depression and PTSD, general deterioration in physical health, self‐harm and suicidal thinking, feelings of alienation in the school environment such as fear of other children, and absenteeism from school. In response to recent high-profile bullying cases, the U.S. Department of Education has sent this letter to over 15,000 school districts across the country, in which school officials are reminded of their responsibility and legal obligation to protect the civil rights of all students, regardless of their nationality, race, sex or disability status.

The study, conducted by the Josephson Institute of Ethics, was released on Tuesday and is the largest ever undertaken of the attitudes and conduct of high school students. The truly sobering results show that 50% of all high school students admit they bullied someone in the past year, and 47% say they were bullied, teased, or taunted in a way that seriously upset them in the past year. 33% percent of all high school students say that violence is a big problem at their school, and 24% say they do not feel safe at school. 52% admit that within the past year they hit a person because they were angry. 10% of students say they took a weapon to school at least once in the past 12 months, and 16% admit that they have been intoxicated at school. The study clearly shows that there is almost no difference between public, religious private and non-religious private schools in the students’ perceived safety, or in the percentage of perpetrators and victims of bullying.

In the press release accompanying the results, Institute Director Michael Josephson said, “If the saying, ‘sticks and stones will break my bones but names will never harm me’ was ever true, it certainly is not so today. Insults, name calling, relentless teasing, and malicious gossip often inflict deep and enduring pain. It’s not only the prevalence of bullying behavior and victimization that’s troublesome. The Internet has intensified the injury. What’s posted on the Internet is permanent, and it spreads like a virus – there is no refuge. The difference between the impact of bullying today versus 20 years ago is the difference between getting into a fist fight and using a gun. The combination of bullying, a penchant toward violence when one is angry, the availability of weapons, and the possibility of intoxication at school increases significantly the likelihood of retaliatory violence.”

Deflation: Chronic Stress on a National Scale

Palmyra_EN-US856764098"The economy isn’t recovering fast enough." One of the principal reasons is that sales of anything, from houses to double no-foam lattes, are down or flat across the board. American consumers are worried about their personal financial health, their jobs (or lack thereof), their families’ future, the sorry state of the economy, gridlock in Washington, and the fear of another bank/mortgage/stock market crash.

The piling up of this real heap of trouble over the last couple of years has caused most Americans to go into stress reaction mode: fight, flight or freeze. The evidence is mounting that most are choosing to freeze. Businesses that sell goods and services report flat or lower sales to fewer buyers. In a so far vain attempt to get the consumer economy moving again, prices have been and continue to be reduced through special offers, discounts, two-fers and other creative ways meant to entice more buyers.

As consumers refuse to take any risk, either because of their worries or simply waiting for prices to fall further, deflation may now be setting in. Deflation is the opposite of inflation and defines a situation when prices are mostly falling, sales stagnate or fall, with "lower business profits, which lead to layoffs and lower consumer spending and further price declines. [Deflation] makes it more difficult to pay off debt because the value of debt rises relative to income. It provokes hoarding, as consumers, businesses and banks hold on to cash, expecting that prices will keep falling," as characterized by the New York Times. In short, the paralysis of freeze

So it is that unending economic turmoil since 2008, record-high job losses, stagnating or falling employment, and the double-whammy mortgage/foreclosure crisis appear to be provoking one of the most severe stress reactions in generations, in individuals, families, and businesses across the nation. While a few are now fighting to get the economy moving again, a significant number may have left the fight and given up trying, and many more still could be just frozen in place, unable to move forward with their decisions, investments, and major purchases.

As understandable as it may be, this nationwide stress reaction is just what it is, a reaction. It is not a formulated response against a severe and persistent set of stressors, which would require the exercise of sound judgment, decision-making and risk-taking. Instead, the risk to the US economy is that this reaction may become chronic and take years before progressing toward an effective response.

The red lights are flashing and the alarm bells are ringing, urging meaningful action that will address the emergency. Not much appears to be happening. Until the paralysis of freeze is overcome and a real response begins, the alarm bells will continue to ring, while deflation takes hold. Chronic stress, on a national scale.

Army Suicides Highest Ever and Rising

aaCarignano_CrimeaThe number of suicides among active duty US soldiers is very high and it is rising at a faster rate: 125 Army soldiers have taken their own lives in the first eight months of this year. If suicides continue at this pace they will exceed the total for 2009, when there were a record 162 suicides. The trend shows little sign of abating, despite a now 20-month-old suicide prevention program and work aimed at removing the stigma of psychological counseling, the New York Times reports

Medical corps Army officers familiar with the situation have identified several factors that may be involved in the rising rate of suicides. While there is a widespread belief that repeated deployments are the principal cause of suicides, Army records show that 80% of soldiers who killed themselves were deployed in combat zones only one time or not at all. A significant number of the soldiers had experienced serious problems in their marriage. Many had sought counseling from Army psychologists for anxiety and posttraumatic stress symptoms. Interviews with family members indicate that in many cases, the soldiers believed that a diagnosis of posttraumatic stress disorder would ruin their careers. Additionally, many believed that their counselor or psychologist would not treat their condition as confidential, but would convey up the chain of command what the soldiers reported in private counseling sessions.

Expectant Mother Stress and the Unborn Child

JapaneseGarden_EN-US1668112966Stress during pregnancy is usually discussed in negative terms and fear and anxiety seem to be the rule in explaining its possible consequences. A recent and soon to be published study by Janet Di­Pietro suggests that, at least in part, the contrary may be true. DiPietro, an internationally recognized leader in the field of child development, is credited with having described for the first time the ontogeny of human fetal brain–behavior relations throughout gestation, the associations of maternal and fetal characteristics with the neurobehavioral maturation of the fetus, and the fetal neurobehavioral origins of individual differences in infant physiology and behavior. Her latest study shows that 2-week-old infants of women who experience relatively more stress during pregnancy showed faster neural conduction, “evidence of a more mature brain.” Thus, maternal stress during pregnancy may actually stimulate the unborn child’s brain development, suggesting that the dreaded nefarious effects of stress on the child may be simply a matter of degree.

In her other studies, DiPietro outlined evidence to support the notion that the effects of maternal stress on the unborn child are actually quite modest in magnitude, pointing out that the placenta breaks down the stress hormone cortisol in the woman’s blood, preventing most of it from reaching the fetus. However, she is also careful to note that maternal stress may directly influence the developing fetal nervous system; that these effects on brain development may be aggravated over time by various characteristics of postnatal development; and that existing research on the effects of maternal prenatal/perinatal stress on child development lacks conceptual and methodological consistency and scientific rigor.

[amtap book:isbn=0743296621]

Science writer Anne Murphy, author of the recently published new book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, classifies prenatal stress as belonging to the “profoundly unsatisfying” category of “it depends.” While describing her second pregnancy, Paul traces the developing literature on fetal origins, which has been called the staging ground for well-being and disease in later life. In her chapter on stress, she cites the existence of 200 industrial chemicals that can be found in babies’ umbilical cords, the link between low birth weight and later cardiovascular disease, and raises the possibility that a dietary supplement might one day protect future children from cancer.

Her focus on how expectant mothers can minimize harm to their unborn child during pregnancy makes Paul’s book a fascinating read that will help understand and put into perspective the opportunities and dangers of this fascinating period. It is the Stresshacker Recommended book for this week.

ADHD Breakthrough: Not Just Bad Behavior

IntlSpaceStation_EN-US2825695802 Attention-deficit/hyperactivity disorder (ADHD) is a genetic, neurodevelopmental disorder and not just a behavioral problem. In a study published online in the Sept. 30 issue of The Lancet, investigators from the University of Cardiff in the United Kingdom say their findings show that ADHD has a genetic basis. In the genome-wide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls without the condition were included. Researchers found that compared with the control group without ADHD, children with the disorder were twice as likely — approximately 15% vs. 7% — to have copy number variants (CNVs). CNVs are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).

The breakthrough results of this study should help in the controversy as to whether ADHD is a "real disorder" or simply the result of bad parenting, in shifting public perception about ADHD and promoting further research into the biological basis of the disorder with a view to developing better, more effective therapies for affected individuals.

A Woman’s Stress Relief: Tend-and-befriend

ElGreco on Stresshacker.com Reaching out vs. retreating appears to be what distinguishes the instinctual reaction to stress between men and women. For women, the choice between fight or flight in the presence of a stressor applies less frequently than tend-and-befriend.

Whereas the typical male is more likely to narrow his response to stress down to a decision whether to fight the stressor directly and aggressively or retreat from it by way of an emotional withdrawal, most women choose to turn to family and friends by tending to or cultivating connections. Forming a network of support appears to be an innate characteristic of females also among primates, intended as a form of protection for themselves and their offspring. Clearly, the assumption is that there is more safety in numbers than in trying to make it alone in potentially dangerous situations.

Most women naturally construct a more intimate and complex social network than men do, and when they are stressed, in danger, or in times of change, they can turn to this network for support. Thus, they are more likely to seek out the company of other women and less likely to flee the stressor by withdrawing or isolating or to fight it directly and single-handedly, as most men appear to do.

This natural response to the stress reaction, moderated by a support system such as tend-and-befriend, might help explain why women live an average of five years longer than men. Men are also capable of creating complex social networks (now enormously facilitated by technological connectivity), but male-created social networks may lack the necessary level of intimacy or remain underutilized as a coping mechanism.

The Science Behind Tend-and-befriend

Research being conducted at UCLA under a grant by the National Science Foundation on Biopsychosocial Bases of Social Responses to Threat indicates that, in times of danger, most people seek positive social relationships that may provide safety for themselves and their offspring.  This and prior research by Dr. Shelley Taylor at UCLA’s Social Neurosciences Lab suggests that the hormone oxytocin and other opioid peptides produced in the body stimulate these responses, most especially in women. Oxytocin in particular appears to function as a social thermostat that monitors the availability of social resources and prompts the seeking of additional connections when needed.

The Rising Cost of War: Military Sexual Trauma

RioAlseseca_EN-US608673953 The latest research on the long-term health consequences of Operation Enduring Freedom in Afghanistan (OEFA) and Operation Iraqi Freedom in Iraq (OIFI) suggests that US veterans are bringing home a significant number of psychological problems. The most recent study published in August by the American Journal of Public Health estimates that 19% to 42% of returning veterans have one or more clinically-diagnosable mental health conditions.

Returning servicemen and women are turning to the Veterans Health Administration (VHA) for health care in record numbers, with nearly 40% enrolled as of the end of July. In addition to posttraumatic stress disorder, depression, anxiety and stress disorders, and sleep impairment, another (somewhat overlooked until now) contributor
to this burden of mental illness is exposure to sexual assault or harassment during service. The newly categorized disturbance is referred to in military lingo as military sexual trauma.

This is not a new phenomenon, as military sexual trauma had been documented in veterans of previous wars. What is different this time, though, is that OEFA and OIFI veterans are the first generation of VHA users to return from a large-scale deployment and have access to comprehensive screening and treatment services.

The most recent study was conducted at the National Center for Posttraumatic Stress Disorder and the Center for Health Care Evaluation, VA of Palo Alto, California. It was the  first comprehensive assessment of the mental health profile associated with a history of military sexual trauma among Iraq and Afghanistan veterans.

The results show high rates of postdeployment mental health conditions among all OEFA and OIFI patients. Women and men who reported military sexual trauma were significantly more likely than those who did not to also be diagnosed with posttraumatic stress disorder (PTSD), other anxiety disorders, depression, and substance use
disorders.

Additionally, and not surprisingly, the study shows that the co-occurrence of military sexual trauma and PTSD is substantially more frequent among female soldiers than among males, suggesting that military sexual trauma may be a particularly relevant gender-specific clinical issue in PTSD treatment settings.

Mild to Deadly: Stress At Work

CloudToGround_EN-US2741696585 Stress at work can take many forms and range in severity from mild annoyance to burnout. It may be relatively easy to tell if co-workers appear to be under severe stress by observing the appearance and persistence of certain characteristic behaviors. It may not be so easy to diagnose dangerous levels of stress in ourselves, however, especially when other considerations of self-esteem, personal ambition to succeed, economic pressure, deadline requirements, and career goals may interfere with a sound and unbiased self-diagnosis.

Mild vs. Severe Stressors: It’s About Control

The first consideration is the severity of the stressors. Are they mild and can they be addressed by making appropriate adjustments? Stressors such as a noisy environment, not knowing one’s job objectives, and skipping meals can be (although not always) addressed by closing the door, asking for clarification, and committing to take lunch and snack breaks as needed.

The second consideration is whether or not the stressors are under our control. The presence or lack of control creates an internal vs. external locus of control situation, with important psychological consequences (see this post on the difference between internal and external locus of control).

Stressors that are beyond our control are far more difficult to address, as for example when there are too many things to do and not enough resources to get them done. Its opposite, the situation when there is hardly anything to do at all, is also stressful and may not have an easy solution.

Other relatively difficult stressors that may not have a solution within our control is not enjoying the job, and not knowing what else one could be doing or being in a situation where a change of job is just about impossible. In the current job market, this may not be an uncommon situation, as jobs that used to be good have become more stressful and jobs that were bad to begin with have not gotten any better.

Another difficult stressor where external control may be an issue is the experience of being caught between conflicting demands, often with insufficient information or resources to address them appropriately. Not feeling appreciated or under-appreciated while putting in long hours and hard work can also create a considerable level of stress.

On the other hand, many stressors can be successfully addressed because they do fall within our control. The most common are interruptions and how they are handled (the well-known inability to say “no”). Another is poor delegation skills, or not sharing work responsibilities with others. These are two examples of stressors that, although not easily eliminated, at least can be controlled and limited in their impact by making changes that are well within our possibilities.  

When Stress at Work Is too Much: Burnout

There are times when the symptoms of stress are just too severe, too persistent and too intractable to be dismissed. They interfere not only with productivity and efficiency on the job, but they also have important negative health consequence in addition to being detrimental to interpersonal relationships at work and at home. The resulting complex cluster of psychological, physical and behavioral symptoms is defined as occupational stress or, for short, burnout.

The emotional exhaustion of burnout can result in diminished interest in work, fatigue, and detachment. Hopelessness is common: we "give in," "numb out," and "march like robots through the day."

The depersonalization of burnout, or the defensive distancing from the surrounding world, can result in diminished contact with coworkers and the public, withdrawal of psychological investment, self-absorption, and an overall negative attitude toward others.

The dissatisfaction of burnout, or the perception of unsatisfactory personal accomplishment, can result in feelings of failure, fatalism, diminished competence, and incapacity to respond to further job, personal and environmental demands.

Early Warning Signs of Work Stress

One of the first noticeable signs that stress is beginning to have a behavioral impact is irritability. Fellow workers will notice this first. They may or may not be able to point it out, but if they do, it is worth paying attention to their feedback and asking ourselves a few questions.

The second sign is fatigue. Even though it is hard to miss, fatigue very often goes unchecked not because it isn’t visibly affecting us but because we may refuse to acknowledge it. Pushing harder can become a mantra, a repetitive “principle-driven” set of behaviors that pushes rest and relaxation aside, with potentially serious health consequences.

Difficulty concentrating and forgetfulness are also early signs of severe stress. Sometimes, stress affects memory in such a severe manner that, by evening time, we can’t remember what we did all day, or what we ate for breakfast.

Sleep ceases to be a safe haven for regenerating and recharging and becomes a place of torture. Lack of sleep is linked to so many health consequences, and to stress itself, in a circular causality pattern. Less sleep means more vulnerability to stress, which leads to more stress by the time we get to bed, with even less chances of getting a good night’s sleep. A potentially deadly vicious cycle!

The body complains about stress, too. Its messages take the form of bowel irritation, chronic fatigue, asthma and other respiratory ailments, headaches, rashes, tics, cramps, and many more pains and problems that appear to come out of nowhere and stubbornly refuse to go away.

Finally, withdrawal and depression may raise their ugly head. Burnout has arrived. It may take a few years to get here, or maybe just a few months of severe stress. In any case, burnout may be the end game of one very simple losing strategy: ignoring the obvious, steaming through the warning signs and hoping that stress will just go away by itself.

Get Away From the Maddening City—Now!

Blackwell at Stresshacker.com Incidence of schizophrenia and other psychoses is greater in urban than rural areas, but the reason remains unclear. Various studies have found the link between living in the city and severe mental illness, and none have determined a specific cause. A new study claims to have the explanation. The study examined a group of over 200,000 people born between 1972 and 1977 whose medical history was cross-referenced with demographic, school, municipality, and county information.

The study, published this month in the Archives of General Psychiatry examined whether individual, school, or area characteristics could be associated with psychosis and whether the effects of individual characteristics on risk of psychosis varied according to location.

The incidence of psychosis was significantly higher among people living in urban settings as compared to those living in the country.  Further data analysis showed that psychosis appears to be a reflection of the increased social fragmentation that has become a feature of city living.

The principal researcher, Dr. Stanley Zammit of the Center for Neuropsychiatric Genetics and Genomics of Cardiff University, said that previous studies had found that the severity of schizophrenia risk depends on the context of the living situation, with increased risk found for those living in an area with few people of their own ethnicity.

Of this study, Dr Zammit says that "it was somewhat surprising that we found this sort of context-dependent effect across a range of characteristics: ethnicity, social fragmentation, and deprivation. Although it makes sense that such an effect would not be restricted to ethnicity but to potentially any characteristic that might define someone as being different from their peers as they grow up."

With the caution that is characteristic of studies that avoid the presumption of absolute revelation, the researchers point out that much more investigation is needed before it could be said (if ever) that living in the city causes schizophrenia. What can be said from this and other similar studies, however, is that there is a greater risk of developing a severe mental illness such as psychotic disorder for people who live in a predominantly urban setting. Is this enough to make you want to live in the boonies? Maybe not. But this may be another consideration for a move to the more distant ‘burbs.