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Fear and Attraction: Racial Stress

The-Pirates-AttackThe coastal populations of Mediterranean countries lived for decades, stretching into centuries, with the fear of pirates, the strange invaders suddenly appearing from the sea.  Inhabitants of regions bordering with sparsely settled or frontier territories lived in fear of the sudden appearance of “barbarians” or “savages,” variously labeled according to time and locale.  With the increased sameness of living conditions brought on by progress and technological advance, there now remain far fewer parts of the world where the fear of strange invaders is part of daily life.  But is the fear of people that are unlike us still in the background, perhaps below the threshold of full awareness, but active nonetheless in driving our reactions, and sometimes our prejudice and discrimination?

The Strange Attraction of the Strange

barbarians-at-the-gatesWithout attempting a comprehensive definition of racial diversity, at a very minimum, physical differences in appearance often appear to be the first (and sometimes the only) trigger of a psychological defense mechanism.  In most human beings, there appears to be an innate drive to self-preservation that may be activated in the presence of individuals we may not recognize as familiar to us.

Often, there appears to be an instinctive and uncontrollable stress reaction that mobilizes our psychological, and at times also physical defenses against what we perceive as a possible threat from another human being.  This is by no means a new phenomenon.  As the coastal villagers and the frontier dwellers, we know that our own survival depends on being able to accurately assess any potential threat to ourselves and to our families and possessions, and take the most appropriate action (fight, flee or do something else) toward self-protection.

Clearly, not everyone we meet who is not like us is automatically a physical or psychological threat to our well-being.  Indeed, even those who appear to be exactly like us, in race, language, culture and background, may turn out to be a severe threat.  In ensuring survival, it pays to be alert to any potential danger. As President Reagan once put, Trust But Verify is a wise policy to live by, in politics but also in business and in interpersonal relations.

In some ways, we are attracted to the strange and the unfamiliar.  Our attention is automatically directed to it, out of simple curiosity, concern or fear.  When a different physical appearance is thrown in the mix, the perceived threat may be magnified by real or imaginary thoughts of danger and risk.  Paradoxically, there is also a part of us that is attracted to risky or dangerous situations, which does nothing to simplify the cacophony of feelings that are triggered by the sudden appearance in our midst of the strange and the mysterious.

A Universal Phenomenon

racially-diverse-babiesIt appears that no particular group of human beings is immune to this type of consideration when coming in contact with strangers.  There is certainly also an economic factor that plays a role, as when the need to defend one’s income or property, ends up taking precedence over solidarity and cooperation with the stranger.  It has been observed that people down on their luck, destitute, physically ill, or in need of urgent help seem to exhibit a tendency to be far less discriminating or threatened by the stranger than those who, by their own definition, may have a lot more to lose in such encounters.  Thankfully, human solidarity seems to shed at least part of its suspicions and reservations in the face of natural disasters or man-made calamities.  There are indeed moments in time when we realize that we are all humans, that we share a common identity, and that we inhabit this small planet together, if not always at peace with each other.

Awareness Normalizes

Our God-given capacity to muster our defenses against potential threats is a powerful asset, whose importance should not be overlooked even in a world where physical danger has been greatly diminished (though certainly not eliminated) by the safeguards of civilization.  Imagine would it would be like to automatically and unthinkingly assume that everyone we meet is friendly, honest, kind and has our best interest at heart.  Unrealistic, naive?  Yes, and I would also say, definitely dangerous to our personal and collective well-being.

Being aware that we possess the gift of discriminating between the real and the perceived, the dangerous and the annoying, the severe and the trivial can help us realize that it is the way we normally are and to make the best use of it.  Racial discrimination may be caused by an overuse of this important asset.  To automatically assume that anyone not like us (by various definitions) is a dangerous threat is clearly discriminatory, exaggerated and ultimately detrimental to our own well-being.  We are societal beings, by nature, and isolating ourselves from large swatches of humanity may be an attempt at self-defense, but one that clearly exceeds the intent and the practice of reasonable threat assessment. Unreasonable fear and loneliness often travel together.

Sympathetic Muscle Tension and Stress

One of the well-known phenomena that accompany the stress response is the spontaneous and uncontrollable action of the sympathetic nervous system on the musculoskeletal structures of the body. Stress, muscular tension and pain often go hand in hand.

The Alarm or Stress Response of the Sympathetic Nervous System

bungee-jumpingWhen the sympathetic nervous system is suddenly stimulated by a stressor, there is an almost immediate increase in the body’s ability to carry out unusually vigorous muscle activity, even in individuals who would ordinarily not be capable of it.This almost prodigious increase in strength is facilitated by a cascade of physiological changes that is precipitated by stressful situations.

These changes, which take place in a matter of mere seconds, include:

  1. Increased arterial blood pressure.
  2. Increased blood flow to the muscles along with a corresponding decrease in blood supply to the gastrointestinal tract and the kidneys, which are not needed in mounting the body’s rapid response to the threat.
  3. Increased rates of cellular metabolism, which speed up the body’s rate of functioning.
  4. Increased blood glucose concentration, which provides increased levels of energy.
  5. Increased glycolysis in the liver and in the muscle, also a factor in energy supply.
  6. Increased muscle tension and preparedness to work, which increase tone and strength.
  7. Increased mental activity, which provides acuity, alertness and greater focus on the threat.
  8. Increased rate of blood coagulation, which protects the body from significant blood loss if it should sustain minor cuts and puncture.

The combined effects of the mobilization of virtually all principal organs is what enables the body to perform significantly more strenuous physical activity than it is ordinarily possible. Stress of any kind, physical, emotional or mental, excites the sympathetic system, whose purpose is to provide above-normal activation of the body’s resources. Because of this stimulation, the stress response is often referred to as the sympathetic stress response.

Emotional vs. Physical Stress

The sympathetic system is activated during physical danger, but it is also and more frequently activated by many real or perceived emotional stressors. Guyton-Hall cite the example of anger or rage,

…which is elicited to a great extent by stimulating the hypothalamus, signals are transmitted downward through the reticular formation of the brain stem and into the spinal cord to cause massive sympathetic discharge; most aforementioned sympathetic events ensue immediately. This is called the sympathetic alarm reaction. It is also called the fight or flight reaction because an animal in this state decides almost instantly whether to stand and fight or to run. In either event, the sympathetic alarm reaction makes the animal’s subsequent activities vigorous.
–Textbook of medical physiology by Arthur C. Guyton & John E. Hall, 11th ed.

Chronic Stress

The same exact response can be elicited even daily in individuals exposed to multiple or repeating stressors, such as a negative environment, a dysfunctional relationship, poor working conditions, or difficult socio-economic challenges. In this case, the muscle tension and sympathetic stimulation can be so great and so frequent that the body cannot return to a normal state of relaxation, in which case a chronic stress condition can ensue.

Emotional Safety, Stress and Health

Many individuals who suffer from chronic stress report being “on edge” or “keyed up” most of the time. This near-constant state of arousal is reported at times when the person should be at rest, i.e. during normal sleeping hours, while relaxing with family or friends, or even while eating or taking a shower. Certain features appear to be common to most people who share this emotional state. Let’s look at a few of the most important ones.

Emotional Stress Often Translates Into Physical Symptoms

In most instances, psychological stress caused by real adversities or by the anticipation of adversity causes the body to react in an attempt to fight the stressor, flee from it or shut it off and away from immediate consciousness. In the process of taking these defensive measures, muscles tense, the cardiocirculatory system kicks into high gear, and many non-indispensible systems (such as the digestive and sexual systems) shut down or significantly slow their functioning. Since the stressor is often non-physical in nature, this bodily mobilization of resources never quite finds its target. Over time this may wear down certain organs of the body, which begin to manifest signs of illness. High blood pressure, irritable bowel syndrome, erectile dysfunction, muscle spams or pain, ulcerative colitis are but a few of the more or less serious physical ailments that can be directly associated with chronic anxiety and stress.

Emotional Stress Can Contribute to Mental Disorders

Frequent stress has an augmenting and, some say, even causative effect on poor mental health. In the presence of serious stressors, such as the loss of a home or a job, or a serious physical illness, or the loss of a significant relationship, many people develop symptoms that are typical of certain mental disorders. It is debatable whether the mental disorder comes first and the stress comes next, or vice versa, but regardless of whether the chicken comes before the egg, the results can be quite the same. A serious stressor may provoke depressive symptoms or acute stress disorder. What makes a difference is the individual’s proneness to manifest a psychological disturbance either in an “externalizing” manner, e.g. with visible signs of anxiety, or in an “internalizing” manner, e.g. with the shutdown of activity that is typical of depression.

Taking the other side of the equation, people who already suffer from an anxiety disorder or a depressive disorder may feel that their symptoms are aggravated by another stressor added on top of the ones they have experienced in the past. Anxious individuals will feel less prepared to meet the new psychological challenge, and even the mere anticipation of a new threat may be sufficient to produce a panic attack. Depressed individuals, who also may feel that their personal resources are inadequate to cope with a new challenge, may not show any signs of panic or heightened anxiety and will instead further retreat into the dark recesses of depression.

Emotional Stress Is Fear Under Another Name

Psychological stressors share a common characteristic: they are caused by generally unwanted and often unexpected events or situations. Regardless of their origin, negative stressors produce a reaction of surprise and, in most cases, fear. Since negative consequences usually accompany the arrival of a stressor, and since most people are quite capable of predicting a whole range of possible negative outcomes resulting from a stressful event or situation, fear (often masking as anxiety or even anger) is the naturally occurring and logical emotion. Even in the classic case of a positive stressor such as winning the lottery, fear is not too far behind the initial moment of wild elation. Even the arrival of a large sum of money can produce fears of its loss even before the unexpected windfall lands on the lucky winner’s bank account. Stories of big winnings have often culminated in poor choices, reckless decisions, broken relationships, and ultimate unhappiness.

Regardless of its origin, a significant stressor may produce quite a significant state of perceived danger. Many people feel that they can meet the challenge, but many others may not feel up to the task because of low self-esteem, a personal history of negative outcomes, low resilience, or a pessimistic outlook on life. A feeling of emotional safety is a protective condition that helps us make better decisions, enhances our judgment, and is generally good for our physical health. Conversely, the lack of emotional safety (which may range from a mild state of anxiety to the perception that a catastrophic event is about to occur) may be conducive to poor decision making, errors in judgment, inefficient allocation of personal resources or lack of adequate self-care, and may be linked to a higher probability of physical illness.

How To Tame Fear and Fight Chronic Stress

Emotional safety is one of the ingredients of good mental and physical health that, especially nowadays, appears to be in especially short supply.  How can it be increased? A good place to start is by developing better insight into our situation. Insight is the awareness not only of the content of our worries and stressors (“what” makes us feel stressed), but also of the process (the “how”) by which we attempt to manage or cope with the situation. In many cases, our coping attempts are so automatic and out of awareness that they happen without our direct control. Insight into the process can change this. There is a significant reservoir of power and energy that can be tapped by the simple act of self-observation. It is the ability to say not only, “I can’t believe this is happening to me,” but also and at the same time to be able to say, “and just look at how I am handling this right now.”

Insight into the process of coping leads to one very important moment of choice. Being able to ask the question, “Is this way of (over)reacting the only option I have right now?” constitutes a tremendous step forward from a wholly automated and fear-driven response. While it is possible that in the moment no other reaction may be possible except anxiety or depressive thoughts, the presence of insight into the process can help come up with options and alternative ways of handling the stressor. This sets up the vital, and perhaps best, way to cope with the unexpected: an initial automatic and spontaneous reaction to a stressor (which may be physical and psychological in nature, entirely human and to be expected), followed by a more intentional and not so automatic response that comes from the ability to choose between several available options.

3 Good Ways of Responding To a Panic Attack

OBriensTower_EN-US194301618A panic attack ambushes the mind, the body, and the soul. Its targets are self-esteem, a balanced self-assessment and the ability to analyze situations and expected outcomes. When panic strikes, the present becomes a bleak landscape of dangers and the future includes a (seemingly) real possibility of annihilation. In the presence of a real (or perceived) significant stressor, one’s abilities to respond to the challenging situation becomes severely impaired. For the span of the panic attack, chest pains, shortness of breath, shaking, sweating, and even nausea and vomiting can give the sensations of impeding death. Can something be done to prepare for a panic attack with any degree of success?

One: Know Thyself

A first important tool is the ability to anticipate one’s own reactions, by getting to know them well enough so that they do not become stressors in themselves. Knowing the likelihood (and thus anticipating the possibility) of the physical sensations that go with feelings of panic (chest constriction, shortness of breath, increased heart rate, and sweating) may help avoid the distress that these symptoms can cause. The very fact of knowing that these physiological reactions will take place, and allowing them to happen as a natural and understandable reaction to a threat to our well-being, can be beneficial.

Two: Know About Panic

Panic attacks are about as close to feeling imminent death as one can get, as anyone who has experienced them in all their severity will attest. A panic attack occurs without anyone else’s intervention (usually no one else is present). It can be extremely frightening even when no real physical danger exists (it can strike a person comfortably seated in his or her favorite recliner). A panic attack, by definition, occurs without any clinical danger of death and cannot by itself cause death or serious injury. A the most, when it reaches a certain level, a panic attack may trigger a loss of consciousness through hyperventilation (prolonged shallow breathing). This usually resolves the physical symptoms by momentarily taking the brain out of the picture, whereby the body can returns to homeostasis. When the person comes to, usually the panic attack is gone just as suddenly as it came. Exhaustion is not infrequent at this stage, as a panic attack can be a real workout for the heart and muscles.

Three: Manage Your Response

BearAttackA useful tool in preventing the recurrence of panic attack is stress management. Allowing the body to react, in concert with the mind, to a situation that may objectively warrant fear, sadness or worry is not only strategically sound, it is also physiologically healthier. Just as courage is not the absence of fear but simply good fear management, allowing a naturally-occurring biopsychic reaction to a stressor is simply good stress management.

Thus, the key to successful panic attack management is not in denying or attempting to prevent the stress reaction, but in what to do next (our chosen response). After the initial physical reaction ebbs and subsides and the heart rate naturally returns to near-normal levels, the real stress management response has a chance to begin. This response should first and foremost consist of addressing the stressor that is causing the panic attack to occur.

3 Good Ways of Addressing Serious Stressors

Three options usually exists in addressing significant stressors:

  1. Eliminating the stressor that caused the panic attack to occur.
  2. Removing oneself from the stressful situation, if option 1 is not available.
  3. Reducing the impact of the stressor through relaxation techniques or good coping mechanisms, when options 1 and 2 are not available.

The Stress of… Stress

ClareIsland_EN-US2748591595There are times in which the stress reaction and the level of anxiety caused by a stressor are so high that the body’s reactions become extreme and add to the burden. Stress becomes stressful in itself and a problem of its own. Although the stress reaction itself is normal and necessary for survival, learning and for personal growth, the body’s reaction to the increased alert level causes a predictable and rather universal set of physical changes. These include:

  • Increased central nervous system activity—a state of full awareness
  • Increased mental activity and brainwave activity—full mental alert
  • Increased secretion of adrenaline (epinephrine), noradrenaline (norepinephrine), and cortisol into the bloodstream—a state of endocrine mobilization
  • Increased heart rate, cardiac output, and blood pressure—the way in which the body prepares to meet the physical demands of the stressor
  • Increased breathing rate, breathing airways dilation—brings more oxygen into the lungs
  • Increased metabolism, oxygen consumption, oxygen to the brain—oxygen is the principal sustainer of life for brain cells and for the whole body
  • Blood is diverted away from the digestive tract and directed into the muscles and limbs—the processing of food become secondary to averting or confronting the danger
  • Increased muscle contraction, which leads to increased strength—for either fight or flight, muscle readiness is automatically brought to the highest levels
  • Increased blood coagulation (blood clotting ability)—helps the body minimize the impact of possible injuries
  • Increased circulation of free fatty acids, a source of cellular energy—contributes to the readiness of the body to greater energy expenditure
  • Increased output of blood cholesterol—makes the blood richer in nutrients to be carried to muscles and other organs
  • Increased blood sugar released by the liver, to nourish the muscles—another important source of energy for best performance and strength
  • Release of endorphins from the pituitary gland—an activating hormone that boosts alertness throughout the body
  • Pupils of the eyes dilate—increases field and acuity of vision
  • Hair stands on its end—a remnant from the time when hair covered the most vulnerable body parts
  • Blood thins—this speeds up blood circulation for faster travel from center to periphery and back
  • Sweat glands increase secretion—a well lubricated body presents a slippery surface in a fight and cools it down below dangerous heat levels
  • Increased secretion from apocrine glands resulting in foul body odor—designed to repulse enemies
  • Capillaries under the surface of the skin constrict with a consequent increases in blood pressure—blood pumping to all parts of the body is enhanced
  • Immune system is suppressed–the immune system may have energy made available for it via reduction of other activities, may change in energetically conservative ways when the protection it confers needs to be balanced with the energetic demands of other activities such as fight or flight, or may be suppressed when other activities are more important than immunity for total well-being
  • Reproductive and sexual systems stop working normally—in times of high stress, sex and reproduction take a back seat to survival and protection
  • Decreased perception of painthe analgesia system, a pain suppressing mechanism that effectively shuts off sensory transmission to the brain, so that we are permitted to go about the business of getting out of the gravest danger without the crippling sensations of pain.

Stressed_WomanNo command is needed to activate these reactions that are programmed in the genetic code. Moreover, they cannot be prevented from occurring, except to a limited extent. At best, one can learn to control what is visible to others and, in some individuals, the heart rate can be somewhat controlled.

This cascade of physical reactions is good in two ways. First, when there is a danger or threat of some sort (e.g., a bus coming straight at us) we are instantaneously aroused into action: we step out of the bus’s path without really planning to do so, automatically. In this way, we have a chance to avoid and/or survive many physical threats to our well being. This ability enabled a  physically weak human race to survive and thrive among larger and stronger animals, earthquakes, fires, and interpersonal conflict during our long history on this planet. Can we imagine surviving very long without the mobilization caused by the stress reaction alarm system?

Second, we are programmed to respond not only to physical threats but also, and more importantly in our society, to non-physical threats that are emotional, social or psychological in nature. This is of great value because most threats nowadays come from circumstances of social living, such as relationships, jobs, economics, politics, environment, and technology.

Unfortunately, the stress reaction can be so overwhelmingly strong that we become stressed by stress itself, incapable of moving beyond its mesmerizing message of danger. Changing back the focus from the stress reaction to the stressor is the key to making an appropriate use of this vitally important warning system. It is also the key to responding vs. simply reacting. Learn this, and stress becomes the alert system most useful in navigating the treacherous straits of modern life.

When Stress Matters Most, What Do You Do?

NeuschwansteinStress is the physiopsychological reaction to a challenge or a threat. It is particularly acute when the stressful event triggers the perception that one’s available resources are insufficient or poorly matched to successfully face it. Take for example our job, a purposeful activity that we engage in as a means of livelihood. On the job, our resources (finances, physical and mental abilities, time, image, and self-concept) are allocated and expended to adequately meet its demands, which carries great potential for stress. Being able to pay attention to warning signs of trouble, of which stress is certainly one of the most prominent, may make a difference in our ability to respond quickly and effectively.

Stress on the job is of the same kind as the threat of a saber-toothed tiger—not the same, but of the same kind. Should we ever find ourselves face to face with the feline, our body would instantly spring into full mobilization mode. The heart rate would go up, respiration would increase in depth and frequency, muscles would tense and pupils dilate, the stomach would contract, and adrenaline and other excitatory hormones would flood into the bloodstream. We would be faced with three possible choices: fight, flight or freeze.

When face to face with a job challenge of a serious nature (loss of a major client, a sudden promotion, the loss of the job itself, a major breakthrough), we are alerted to a threat and our body instantly springs into full mobilization mode, with the same biological changes as when in a close encounter with the wild cat. The threat or challenge may be very different, with linoleum under our feet instead of savanna grasses, but the body doesn’t care—a threat is a threat. We are faced with the same three possible choices: fight, flight or freeze.

Even when we know we are not going to suffer physical harm, the body can’t help but to prepare for the worst. Our chances of being killed by wildlife or to compete with the tiger for our lunch are abysmally small. The last saber-toothed tiger became extinct sometime between the Oligocene and the Pleistocene epoch. Yet, we humans continue to be instinctively and instantly mobilized when we perceive a threat of any kind. Which is a good thing.

The usefulness of stress throughout or history is undeniable. Many more of our ancestors would have been killed had they not perceived the appearance of predators as a possible threat. A great many probably did get killed when they chose the option to freeze. Others, owing to inadequate weapons, got killed while exercising their option to fight. And still others were not fast enough to take full advantage of the opportunity to flee. To be sure, one hundred percent of those who saw no threat in the approaching tiger and lingered to consider the size of her teeth, or in other words, those who felt no stress in the situation, were swiftly eliminated from the genetic pool by a process of natural selection.

Fast forward to the present, and General Motor and Chrysler executives must have felt pretty safe from the saber-toothed tigers of competition and market change, because up until the last minute they felt no real stress from their falling sales (except for SUVs) and dwindling customer base (except for SUV buyers). How many people lost their job in the current recession and never saw it coming? Or saw it coming and froze? Or didn’t flee soon enough, or did not fight for change? Stress told Ford executives to come up with a plan, a better plan as it turns out. One wishes that GM and Chrysler executives had felt a little bit more stressed out, a bit more mobilized into action, less complacent and relaxed. Stress is a bright amber light on the dashboard of our life that simply says, something requires our attention—NOW. More often than not, the light is right.

A New Stressor: FOMO

Sm-bandwagonThe power of communication has been unleashed on the Internet as never before. It is now possible to know almost instantly what is happening around the world, to broadcast one’s ever-changing “status” to real or virtual friends and acquaintances, to express oneself endlessly in 160-character increments, to blog multiple times a day one’s erudite or inane musings to an audience that can number in the tens of thousands. Everyone has the power to become a “brand” and many have done so to great lengths, baring their life and its inspiring or sordid details without regard for privacy, confidentiality or simple reserve. With this phenomenon, new stressors are born, old ones are better overcome, and still others morph into more or less ominous sources of anxiety.

Take for example the ability to know, via Facebook, Twitter, Foursquare and Instagram, the whereabouts and activities of our immediate and extended social network. It is possible to know, just by virtue of swiping the screen of a smartphone, who’s out, who’s dining with whom and where, who’s at the club or the sports arena—often with photos and videos of the event as it unfolds in some sort of electronic play by play. Truly fascinating glimpses of reality in some cases, not so interesting and even banal in many others.

One of the newest stressors originated by this type of instant access is “fear of missing out,” or FOMO. It is a bizarre reversal of social anxiety, the particularly debilitating condition which causes people to reluctantly withdraw from interpersonal contact due to stress overload. In FOMO, the stress comes from the anxiety provoked in recipients of instant messages by the awareness that others are socially involved at that very minute, while they are supposedly missing out on something fun and interesting. In other words, being at home, at work, or otherwise “not there,” not doing the things others are doing and that are being portrayed in the photo or video or described in the message, is sufficient to produce anxiety, which perhaps could be referred to as non-social in nature.

texting-while-drivingFOMO is a close cognate of that other need to be connected at all times, for which there may already be an acronym of which I am not aware, yet. Being “out of touch” means not having 24×7 access to email, IM, social media—and that’s simply too horrible to contemplate. Voice calls are becoming an endangered species, as people seem to prefer, in increasingly greater numbers, to text or post. The stress of not having access, no rhyme intended, can be fiercely acute. Its excesses bear on the ridiculous, and increasingly more often, on the tragic—as in the train operator in the San Fernando Valley who wrecked his passenger train while texting to his friends. For the growing number of car accidents caused by this technological distraction there is already an acronym, TWD or texting while driving.

Ultimate Stressors: Public Drama, Private Pain

charlie-sheenRecently televised interviews with Mr. Charlie Sheen appear to have focused attention on the symptoms and manifestations of the manic phase of bipolar disorder. A public display of inflated self-esteem or grandiosity, profuse talkativeness, increase in goal-directed activity, psychomotor agitation, and the excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish investments) are the textbook criteria for a manic episode. More privately, the individual in the grip of mania also experiences a decreased need for sleep, flight of ideas or racing thoughts, and distractibility. When this disturbance is sufficiently severe, it can cause marked or total impairment in occupational functioning, usual social activities and relationships with others and may necessitate hospitalization to prevent self-harm or harm to others. Episodes of mania, whose symptoms are the opposite of those denoting depression, are rarely seen alone. Usually, the manic state is preceded and followed by depressive periods in an alternating fashion, with each state lasting from many months to a few weeks, the latter being described as ‘‘rapid cycling.’’

This constellation of symptoms was known, until a few years ago, as manic-depressive disorder. Nowadays, it goes by the somewhat more cryptic label of bipolar disorder. The neurochemical basis of bipolar disorder is not exactly known. One of the most valid hypotheses regarding the neurochemical mechanisms of bipolar disorder is the synergy between two neurotransmitters that determine mood states, whereby a lower than normal release of norepinephrine produces a disordered mood (significantly higher or lower than the normal range), while the levels of serotonin determine the direction the symptoms will take, i.e. downward toward depression or upward toward mania.

What Bipolar Disorder Feels Like

The subjective experience of these intense mood swings ranges from abject despair and hopelessness to not entirely distressing and almost pleasurable. Depression produces a pervasive
and relentless sense of gloom, inadequacy, rumination, guilt, and worthlessness. No logic, willful effort or remembrance of wellness seems capable of dispelling these cognitive and emotional experiences, often for prolonged periods.

Mania reverses and accelerates upward from the disappearance of depression, through a state of well-being that can be considered a normal mood state. Normality soon becomes exuberance, enters into a state of unexplained euphoria, and finally culminates into a chaotic state of racing, incomprehensible, disconnected thoughts, and bizarre behaviors. Given a choice, the individuals so affected report that they much prefer the state of mania, in which they experience a release from inhibitions, a hedonistic focus, and a pursuit of pleasure and gratification that can be nearly devoid of accountability or restraint. Self-medication with alcohol and illegal drugs is often present in the manic phase, which sets up a circular relationship that exacerbates its symptoms and impedes treatment and recovery.

An individual in a state of mania can be frightening, annoying, or amusing to the casual observer. It is perhaps easy to overlook the nature of the behavior, especially when there is an assumption of intent. In most cases, however, the individual has virtually no control over thoughts, words and behaviors and little if any insight into their bizarre, provocative, and sometimes dangerous presentation. The loss of reality testing, judgment and moral restraint of bipolar disorder is sure to cause psychological pain to the people who experience it and to the people who love them. Mr. Charlie Sheen has been variously portrayed as victim and perpetrator, and variously diagnosed by experts and entertainment reporters.

Bipolar Disorder: A Brief History

The first connection between a manic state and depression as belonging to the same neurochemical disorder was established in 1686 by the French physician Theophile Bonet, who observed individuals who appeared to cycle between high and low moods, and described their presentation as ‘‘manico-melancolicus.’’ In the middle of the 19th century, two other French researchers, Falret and Baillarger, who had independently observed the same cycling of moods in their patients, arrived at the same conclusion that the symptoms must be two different presentations of the same illness. Falret described the disorder as ‘‘circular insanity’’  and hypothesized a hereditary component to the disorder. In the late 1800s to early 1900s, German psychiatrist Emil Kraepelin elaborated the description and classification for manic–depressive illness that is considered the standard presentation that we see today.

It was John F. J. Cade, a doctor in the Mental Hygiene Department of Victoria, Australia, who introduced and promoted the belief that manic–depression was a biological disorder of the brain. On the basis of his research on neurochemistry, Cade administered a lithium salt preparation to several highly agitated manic patients and observed a remarkable reduction in symptoms, with a near return to a normal mood state. Lithium is currently the standard of care for the pharmacological treatment of bipolar disorder, and still the most effective in the management of its symptoms.

The Ultimate Stressor: Being Mark Madoff

MarkMadoffThe sudden, sad news of Mark Madoff’s suicide at the age of 46 while embroiled in as many as nine lawsuits against him and his family was not entirely unexpected and also somewhat unsurprising. From a clinical point of view, Mr. Madoff was at moderate to high risk for suicide or self-inflicted injury, but also benefited from several “protective factors” that could have made his choice of suicide less likely.

Nonetheless, the barrage of news that portrayed him as under investigation for being his father’s accomplice (without any indictment), his having become virtually unemployable, the shame of being a Madoff in a world where the surname has become a synonym for a crime of epic proportions eventually proved too much to bear. Mr. Madoff’s options progressively narrowed to one single choice which he exercised alone in his Manhattan apartment in the early hours of a Saturday morning: death by suffocation.

The pressure of the last two years weighed on him enormously… He was deeply, deeply angry at what his father had done to him — to everybody. That anger just seemed to feed on itself… That’s why I never believed he knew about the fraud. He was always a nervous wreck. He could never have stood it — keeping a secret like that would have torn him apart. –- Statements by Mark Madoff’s friends to the New York Times

Was the last straw his wife Stephanie’s application to the courts to have her last name and that of her two children changed to “Morgan”? Was there an early sign in his October 2009 disappearance, when he was eventually located at the Soho Grand Hotel, in a single room, alone with his thoughts and, some say, a weapon nearby?

By all current standards of risk for self-injury or suicide, Mr. Madoff was a danger to himself. The risk factors for suicide, according to the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention are:

  • A family history of suicide
  • A family history of child maltreatment
  • Previous suicide attempt(s)—was the Soho Hotel episode a precursor?
  • A personal history of mental disorders, particularly clinical depression—Mr. Madoff was reportedly prone to depressive mood swings and physical ailments, including stomach troubles; also, Mr. Madoff had always seemed sensitive to criticism and tended to take his grievances too much to heart
  • Alcohol and substance abuse
  • Feelings of hopelessness—unsurprising given the relentless drumbeat of negative news, the literal and figurative loss of identity that had beset Mr. Madoff for the last several years
  • Isolation, a feeling of being cut off from other people
  • Impulsive or aggressive tendencies—Mr. Madoff was said to be deeply, deeply angry at his father and at everyone else
  • Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)
  • A local epidemic of suicide
  • Barriers to accessing mental health treatment
  • Loss (relational, social, work, or financial)—Mr. Madoff had lost his job, the only one he had ever had, when his father’s firm was shut down and had no prospect to find employment
  • Physical illness
  • Easy access to lethal methods—Mr. Madoff first tried the vacuum cleaner cord, which broke, then his dog’s leash, which proved to be sufficiently strong
  • Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

On the other hand, the protective factors that can make suicide a less likely choice are:

  • Effective clinical care for mental, physical, and substance abuse disorders
  • Easy access to a variety of clinical interventions and support for help seeking—after the Soho Hotel episode Mr. Madoff had obtained counseling, which seemed to have steadied him
  • Family and community support (connectedness)—Mr. Madoff was happily married and had two small children, in addition to two children from a previous marriage, and was well-connected with a network of childhood, school and business friends
  • Support from ongoing medical and mental health care relationships
  • Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
  • Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

Clearly, a diagnosis of Mr. Madoff’s true mental state and whether he benefited from any of these protective factors and to what extent he may have been at risk is impossible to make by reading news reports and at a distance. His death makes a specific statement that trumps all other assertions of low risk or protective factors. As well-connected and potentially as well-supported as Mr. Madoff was, ultimately he found himself literally alone to face the only choice that to him seemed to offer an escape from a life that had lost its meaning and its anchoring points of identity and hope for the future.

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.”

Beyond Reaction: An Intelligent Response to Stressors

aaAltdorfer_SusannaElternA stress reaction that gets “stuck” into alarm mode and never progresses toward a resolution of the stressor can develop into chronic stress or depression. The latter can be conceptualized as turning inward, shutting off the world and avoiding all but the most necessary contact with the stressor. It is a rather primitive and ultimately ineffective way of coping with stressful events and situations (for better ways of defending against stress see this post), but it is undeniable that it works at reducing the level of incoming inputs and the effort required to respond. When stress causes anxiety, what follows is a semi-permanent state of arousal (which can have dangerous health consequences). When the response is depression, what follows is a significant reduction in functioning—to the extent that the person is not anxious but apathetic, withdrawn, and unresponsive even to positive stimulation.

The Coping with Stressors Inventory

Adapted from the Coping Styles Questionnaire (CSQ) by Roger, Jarvis, & Najarian, (1993), this is a simple way to determine our instinctive and preferred ways of managing stressors as they appear in our lives. These are ways that are characteristic of our behavior and are most likely to be used under conditions of severe stress.

Instructions: Mark as many as apply, but make sure to choose only the ones that you are most likely to use or have definitely used in coping with severe stressors.

When I am confronted with a severe or continuing stressor:

1. I ignore my own needs and just work harder and faster.
2. I seek out friends for conversation and support.
3. I eat more than usual.
4. I engage in some type of physical exercise.
5. I get irritable and take it out on those around me.
6. I take a little time to relax, breathe, and unwind.
7. I smoke a cigarette or drink a caffeinated beverage.
8. I confront my source of stress and work to change it.
9. I withdraw emotionally and just go through the motions of my day.
10. I change my outlook on the problem and put it in a better perspective.
11. I sleep more than I really need to.
12. I take some time off and get away from my working life.
13. I go out shopping and buy something to make myself feel good.
14. I joke with my friends and use humor to take the edge off.
15. I drink more alcohol than usual.
16. I get involved in a hobby or interest that helps me unwind and enjoy myself.
17. I take medicine to help me relax or sleep better.
18. I maintain a healthy diet.
19. I just ignore the problem and hope it will go away.
20. I pray, meditate, or enhance my spiritual life.
21. I worry about the problem and am afraid to do something about it.
22. I try to focus on the things I can control and accept the things I can’t.

Results Evaluation: Even-numbered ways of coping are more constructive, while the odd-numbered ones are less constructive tactics for coping with severe or continuing stressors. Checking more even-numbered items indicates a better approach to stressors that takes into account the need for self-care, emphasizes the seeking of support, and confronts the stressor in effective ways. If more odd-numbered items are checked, this may indicate an attempt to cope with stressors by avoidance, smothering the stress reaction with chemical means, and generally retreating into tactics that may temporarily reduce the symptoms of stress but fail to address the causes.

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.

PUFAs-Inflammation-Stress: The Axis of Evil

Nighttime at Stresshacker.comIn a prior post on the benefits of fish oil in preventing stress-related illness, the subject of inflammation—the principal cause of stress-related illnesses—was touched upon briefly. It is of such importance, however, that we return to it today and discuss further the connection between inflammation, stress and low polyunsaturated fatty acids (PUFAs) intake.

The Problem: Too much ALA, Not Enough LA

In most industrialized countries, including the United States, we now consume five to 20 times as much proinflammatory omega-6 fatty acids than anti-inflammatory omega-3s. What’s the difference between the two, where do these fatty acids come from, and why is this happening?

Omega-6 and omega-3 are the two major types of PUFAs, contributing between 95 and 98% of dietary PUFA intake. Omega-3’s principal component is linoleic acid (LA) and omega-6’s is a-linoleic acid (ALA). LA is abundant in corn, sunflower, soybean oils, and their margarines. ALA is found in green vegetables, soybean and rapeseed oils, nuts, flaxseed and flaxseed oil. The availability of LA in Western countries increased greatly in the second half of the 20th century, following the introduction and marketing of long-shelf-life cooking oils and margarines. This changed pattern of consumption has resulted in a significant increase of bad-PUFA omega-6 intake vs. good-PUFA omega-3.

Why Do We Need PUFAs?

PUFAs are important in the membrane protein function of human cells, in maintaining
membrane fluidity, in regulating cell signaling and gene expression, and in overall cellular
function. It is through the interactions of fatty acids that anti-inflammatory agents in the bloodstream can pass through blood vessel walls and reach the site where their intervention is needed.

Inflammation can be caused by a physical pathogen (an insect bite, a burn, or a traumatic injury), or by a stressful event that triggers the body’s defensive mechanisms and causes the release of inflammatory agents such as norepinephrine and cortisol in the blood stream. PUFAs are active in facilitating the removal of inflammation induced by either a physical pathogen or by stress.

Which PUFAs Reduce Stress?

Omega-6 and omega-3 PUFAs play different roles in facilitating anti-inflammatory responses. Research indicates that it is the ratio between these fatty acids that is most important in preventing or reducing the severity of stress-induced diseases such as rheumatoid arthritis, asthma, and inflammatory bowel syndrome. A favorable ratio of LA (eating foods rich in omega-3) vs. ALA (eating less food that contains omega-6) appears to produce the best anti-inflammatory effects.

Foods Rich in Omega-3 Fatty Acids

  • Nuts: walnuts.
  • Vegetables: kidney beans, navy beans, tofu, winter and summer squash, broccoli, cauliflower, green beans, romaine lettuce, and collard greens.
  • Fruits: raspberries and strawberries.
  • Meats: free-range beef and poultry.
  • Fish: herring, mackerel, sturgeon, salmon, and anchovies.

Oil Spill Causing Stress Symptoms in Gulf Coast

More than a third [of the Gulf residents surveyed] report children with new rashes or breathing problems, or who are nervous, fearful or “very sad” since the spill began. And even though the gusher of oil has been stanched, almost a quarter of residents still fear that they will have to move.

These are some of the findings of the first major survey of Gulf Coast residents conducted since the BP oil well was successfully capped. The survey, conducted from July 19 to 25 by the National Center for Disaster Preparedness at Mailman School of Public Health at Columbia University, suggests that the spill’s effects have not been contained along with the oil itself. The NYTimes article is at After Spill, Broad Anxiety Among Gulf Resident, Survey Finds – NYTimes.com.

All of the above, plus other reported symptoms such as a persistent and overwhelming level of anxiety, a substantial level of psychological stress, concerns about children’s mental health, more insecurity, and mysterious rashes that can become infected, point to a widespread stress reaction to the oil spill and to its economic and environmental consequences.

Is Stress Entertainment?

Avatar at Stresshacker.com The rep is that stress is to be avoided. The reality is otherwise. Stress is avidly watched, read, and heard because, contrary to what we think we believe about it, stress is entertaining. Why?

The truth is, stress sells—in movies, books, quiz shows, talent shows, and crime scene dramas. Not always and not for everyone, to be sure, but in vast numbers of book plots, screenplays, TV storylines, in radio plays, and theater plays, stress reigns supreme.

The surface reason is that stressful situations, when they are happening to someone else as in most forms of entertainment, hold our attention. Peaceful, restful, and relaxing situations, when we watch them happening to someone else, generally do not. There is not much fun in reading about someone having a really quiet day when nothing much is happening, but isn’t it great to watch a-thrill-every-second action on the big screen? Indeed, there is a deeper, genetically programmed reason why stress can be fun.

What’s the Fun in Stress?

To understand what’s happening, we must step back and consider the mechanics of stress. When we perceive a threat (a risk, a danger, a challenge), our mind is instantly alerted by the stress reaction that we experience in the body. Most often, this consists of increased heart beat, elevated blood pressure, muscle tension, and a release of excitatory hormones into the blood stream (cortisol, epinephrine, adrenaline), plus a host of other biological changes that very quickly get us ready for action. Now, what is interesting here is that, in addition to mobilizing the body, the excitatory hormones also generate a certain amount of pleasurable sensations. Is this nature’s little joke, or what?

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