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Pick up any book on the subject of stress and you will usually find a brief, authoritative-sounding definition within the first several pages. Each author begins as if:
These assumptions are part of the "stress management mentality" of our times. While they are generally accepted by most educated people, they are not really true. This chapter will show you that: a) stress is not a "thing" that exists; b) there is no such thing as "good" or "healthy" stress; and c) there is a much better way to deal with stress than learning how to manage or avoid it. In order to become a winner against stress, you must start by understanding these three points.
What Is Stress--Really?
Many experts endorse the original definition proposed by Hans Selye in 1926: STRESS IS THE NON-SPECIFIC RESPONSE OF THE BODY TO ANY DEMAND PLACED UPON IT.
Selye was an Austrian-born, Canadian physician who conducted hundreds of laboratory studies on animals and humans during the 1920's and 1930's. He was the first person to document the chemical and hormonal changes that occur with stress. He was also the first to introduce the term to the scientific community.
Selye believed that stress results whenever we are faced with external changes or demands. Such demands include variations in environmental temperature, overcrowding, painful stimuli, and loud noises. In fact, Selye believed most of life was "stressful." In the preface to his 1956 book The Stress Of Life he commented:
No one can live without experiencing some degree of stress all the time. You may think that only serious disease or intensive physical or mental injury can cause stress. This is false. Crossing a busy intersection, exposure to a draft, or even sheer joy are enough to activate the body's stress-mechanism to some extent. Stress is not even necessarily bad for you; it is also the spice of life, for any emotion, any activity causes stress. (p. vii)
Selye conceived of external demands as stressors and the internal body changes they produced as the stress response. He also reasoned that the stress response occurs whether the demands we experience are positive or negative. In other words, if you inherit a large sum of money or lose a large sum of money, your body would respond in exactly the same way. According to Selye, what matters most is how well you adapt to each new demand. He coined the term "eustress" (pronounced u-stress) to stand for good or healthy stress--i.e., to times when the adaptation process resolved itself quickly--and he chose the term "distress" to stand for bad or unhealthy stress--i.e., to times when the adaptation response was excessive or prolonged. Thus, Selye not only gave us the "external demand model" of human stress, but he also gave us the idea that two types of stress occur for human beings--1) a "good" or "healthy" type, and 2) a "bad" or "unhealthy" type.
Although Selye's ideas were widely accepted, subsequent researchers proposed other definitions. Some theorists noted similarities between the body's stress response and the "fight or flight" response, a well- known survival mechanism present in most animal species. These researchers viewed stress as AN EXCESSIVE OR INAPPROPRIATE ACTIVATION OF THE BODY'S "FIGHT OR FLIGHT" RESPONSE, which is induced by threats of danger in our environment.
In the 1960's and 1970's, other researchers began to focus upon cognitive and behavioral causes. Mental processes, such as our interpretations of events (e.g. good/bad; positive/negative), our appraisals of situations (e.g. threat/no threat; danger/no danger) and our judgements about our ability to cope with our problems successfully, were believed to activate the body's stress response. Memories of past experiences and habitual behavior patterns were also found to be important. Thus, stress became viewed as a mind- body, "psychosomatic," or psycho-physiologic phenomenon. This mind-body viewpoint is clearly expressed in the following definition, which is endorsed by many experts today:
STRESS IS A PSYCHO-PHYSIOLOGIC AROUSAL RESPONSE OCCURRING IN THE BODY AS A RESULT OF A STIMULUS WHICH BECOMES A "STRESSOR" BY VIRTUE OF THE COGNITIVE INTERPRETATION OF THE INDIVIDUAL. ( Everly, G.S., and Rosenfeld, R., The Nature And Treatment Of The Stress Response, pp. 4-5.)
Meanwhile, while scientists argued about what stress really was, members of the general public began to use the term in a variety of ways. Some people defined stress as having too many pressures, responsibilities, or demands in their lives. Some used the term to refer to internal states, such as feeling tense, nervous, tired, or exhausted. Others considered stress to be the inability to concentrate or focus mentally. Still others used the term to refer to any negative mood or emotion, such as anger, frustration, guilt, or anxiety, or to a host of stress-related physical problems, such as headaches, muscle tension, sleep disturbances, and high blood pressure.
(There are actually no "negative emotions," only emotions people consider to be negative. All emotions can have both positive and negative consequences. Fear, for example, can be devastating, while at other times it can save your life. Anger can be destructive, both individually and socially, while at other times it can be constructive for ourselves and for others.)
Humorous definitions also emerged. One of these--STRESS IS CREATED WHEN ONE'S MIND OVERRIDES THE BODY'S BASIC DESIRE TO CHOKE THE LIVING DAYLIGHTS OUT OF SOME JERK WHO DESPERATELY DESERVES IT!--frequently appears on posters, T-shirts, coffee mugs, and other novelty items.
Thus, as we enter the 1990's, we are faced with a multitude of definitions of stress, both popular and scientific. Unfortunately, all of these definitions ignore one major fact. This fact is emphasized in the definition I use and also encourage my patients to adopt:
Dr. Orman's Definition
STRESS IS JUST A WORD!
While the same could be said about any term in the English language (or any other language), there are several important advantages to thinking of stress in this way. One advantage is that this definition will remind you that stress does not exist. It also can remind you that it is not really possible to cope or deal with your stress directly.
These two points are intimately connected. The reason neither you, nor I, nor anyone else can cope with stress directly is because STRESS DOESN'T TRULY EXIST IN THE WORLD. It is not some "thing" that occurs in space or time or that "afflicts" us like a disease. It is merely a word that we use--an abstract linguistic device--that stands for hundreds of specific problems and difficulties which do really exist and which trouble us from time to time.
Stress = Problems In Our Lives
Why do I say that stress is just a word? I do so because that's what it is--an abstract concept that has no real existence outside of human language. Selye himself admitted this point. In The Stress Of Life (1956), he acknowledged that stress is an abstraction, but that it is necessary to have some operational definition in order to study it scientifically:
If we are to use this concept in a strictly scientific manner, it is important to keep in mind that stress is an abstraction; it has no independent existence. (p. 43.)
Unlike Selye, however, most of us confuse the abstraction (stress) with the reality (problems), and this leads to a great deal of confusion and misunderstanding.
Stress = Problems Inside And Outside Our Body
Whenever I conduct a seminar or workshop on this subject, I start by asking participants to name some of the problems they are having whenever they say they are suffering from "stress." Within minutes, each group generates a list that fills an entire blackboard. Here are some of the items almost every group includes:
WHAT DOES THE WORD "STRESS" MEAN TO YOU?
_________________________________________________________________ Feeling nervous Too much work Upset stomach Feeling anxious Too many responsibilities Tension headaches Tense muscles Too little time Noisy neighbors Rapid heart beat Feeling hopeless Traffic jams Family problems Feeling bored Inconsiderate people Money problems Feeling trapped Feeling angry _________________________________________________________________
As you can see, each of these problems is highly specific. Despite this, each is generally referred to by the same general term: "stress." Also, all of the problems listed above can be divided into two major sub- groups:
Thus, "stress" is a word that stands for problems and conflicts that occur either outside or inside our bodies. Whenever I use the word "stress" in this book--whether or not it appears in quotations-- substitute the word "problems" instead.
NOTE: Problems that occur outside our bodies clearly affect what goes on inside and vice versa. Most types of stress, however, can usually be divided into internal and external components.
A larger list of problems included under the general heading of "stress" is shown in Figure 1-2. Take a few moments to review this list. Check off any problems that might be bothering you right now. (If you are concerned that someone else might look at your list, write down your responses on a separate sheet of paper.)
______________________________ __________________________________ Things That Happen Things That Happen OUTSIDE Your Body INSIDE Your Body _______________________________ __________________________________
SITUATIONS/EVENTS THOUGHTS _ Relationship conflicts _ Trouble concentrating _ Job changes _ Compulsive ruminating _ Stock market fluctuations _ Being overly critical _ Illness in a loved one _ Thinking negatively _ Divorce or separation _ Awfulizing _ Being sued _ Catastrophizing _ Losing a job _ Going to the doctor/dentist FEELINGS _ Failures/mistakes _ Feeling tired _ Retirement _ Feeling trapped _ Overcrowding _ Feeling irritable _ Disasters _ Feeling tense or nervous _ Death of a loved one _ Diminished libido
DEMANDS MOODS/EMOTIONS _ Deadlines _ Acute anxiety (Fears/phobias) _ Competition _ Chronic anxiety _ Tests/Examinations _ Anger _ Time pressures _ Sadness _ Family/children problems _ Frustration _ Financial pressures _ Worry _ Too many responsibilities _ Guilt _ Public speaking _ Impatience _ Public performances _ Depression _ Caring for others _ Resentment _ Dieting _ Hostility _ Quitting smoking _ Hopelessness _ Powerlessness OTHER EXTERNAL PROBLEMS _ Resignation _ Inconsiderate neighbors _ Despair _ Unappreciative boss _ Boredom _ Traffic jams _ Apathy _ Construction problems _ Economic recession OTHER BODY RESPONSES _ Business problems _ Muscle aches/tension _ Employee problems _ Teeth grinding _ Travel problems _ Jaw clenching _ Car problems _ Cold hands/cold feet _ House problems _ Rapid heart beat _ Crime _ Headaches _ Vandalism _ Neck pains _ Harassment _ Back pains _ Prejudice/discrimination _ Upset stomach _ Lack of resources _ Diarrhea _ Lack of opportunities _ High blood pressure _ Lack of education/training _ Skin rashes _ Bureaucratic hassles _ Increased appetite _ Social unrest _ Decreased appetite _ Unexpected crises/changes _ Sleeping problems _ Corporate takeovers _ Sexual problems
Again, while all of these problems are highly specific, they are commonly referred to by the very same word--"stress." This is why there is so much confusion about stress today. When people use this word in everyday speech, they can be referring to any one of the problems in Figure 1-2. They can also be referring to either external or internal problems or even to unwanted consequences of these problems, such as illness, burnout, interpersonal conflicts, and the like. Thus, as Dr. Paul Rosch, M.D., founder and President of the American Institute of Stress, points out: "Stress, in addition to being itself, can also be the cause of itself and the result of itself."
(Dr Rosch attributes this quotation to a British observer, who commented more than 40 years ago about the tremendous amount of confusion the term "stress" has generated. Everly, G.S., A Clinical Guide To Treatment Of The Human Stress Response, p. 6.)
Human Beings Never Suffer From "Stress"
Since "stress" is a word that stands for problems and conflicts in our lives, it is these specific problems--not the abstract concept called "stress"--that we truly want relief from. Thus, whenever we say we are "suffering from stress," we are really suffering from problems or conflicts that are painful or troubling to us.
NOTE: Even though stress does not exist, I will continue to use the term throughout this book. I have elected to do this for two reasons. First, the term is not going to go away, no matter how much confusion and misunderstanding it produces. Second, you need to begin training yourself to listen to it in a different way. Thus, sometimes I enclose this word in quotations ("stress"), while other times I intentionally leave the quotations out (stress) so that you have to remember to supply them yourself.
I am continually amazed at how often we fail to appreciate that stress is just a word. For example, people will come to me with complaints such as: "I'm having trouble coping with stress," or "I've got too much stress in my life right now," or "is there anything you can do to help me get rid of my stress?" As I listen to them speak, I know these people are struggling with many serious problems in their lives. But the specific nature of these problems is often hidden--both from me and from them--as long as they think they are suffering from "stress."
The following example illustrates this point. Paul, a 36-year-old management executive, was referred to me for treatment. A portion of our initial conversation is reproduced below:
Dr.O: Can you tell me what you mean by "being under stress?"
Paul: Well, I've recently been transferred to a new department and my boss is riding me pretty hard. I've got many new responsibilities and not enough time to learn how to handle them all.
Dr.O: Is there anything else going on that makes you say you are under stress?
Paul: Yes. I'm not sleeping very well and I've become overly preoccupied with my performance at work. I felt confident and secure in my old position, but now I don't have any self-confidence at all. I'm worried that if I don't increase my productivity, I'm going to get fired.
Dr.O: Anything else?
Paul: No, that's it. Oh, yes, there's one more thing. I've been so concerned about work lately that my sex drive has diminished, and my wife is beginning to pressure me.
From this brief exchange, you can see how Paul contributed to his own lack of success by failing to recognize that stress is just a word. In truth, he had seven specific problems that were troubling him: 1) a relationship conflict with his new boss; 2) adjusting to new job responsibilities; 3) poor sleep; 4) loss of self-confidence; 5) fear of being fired; 6) reduced sexual desire; 7) increasing pressure from his wife. Instead of treating him with medication, relaxation exercises, or other stress management techniques, my first goal was to help Paul forget about dealing with "stress" per se and focus instead upon the specific problems he was facing. Once he did this, we were able to examine and solve each of these problems successfully.
NOTE: Each specific problem or conflict we experience has specific underlying causes. Knowing how to "win" against stress means knowing how to identify and deal with these causes effectively.
All Other Definitions Of Stress Are Incomplete Or Misleading
Failing to recognize that stress is just a word can also cause you to underestimate the amount of stress (i.e. problems) you have. If you operate from a definition that is too narrowly focused--i.e. which includes certain problems but leaves out many others--you will only consider yourself to have "stress" if you meet your specific criteria. Other problems could exist in your life that don't fit your definition, and you may not take these problems seriously even though they could be harmful to you.
I see this quite often in my medical practice. People will come in to see me because of a stomach ulcer, high blood pressure, migraine headaches, or some other "medical" condition. When I ask if they have any "stress" in their life, they frequently respond "No, not at all." On further questioning, however, I find that many of these people have serious family, relationship, or work-related problems that are not included in their personal definition of "stress." They often have a loved one or family member who is not doing well, or they are about to be fired from their job, or they are feeling angry, frustrated, worried, or depressed.
EXAMPLE: One young man came to me because he was having either a cold, sinus infection, or lung infection three out of every four weeks for several months in succession. After a thorough medical evaluation revealed no major problems, he vehemently denied having any type of stress in his life. This was because he defined stress as "having more work to do than a person can handle." Since he didn't have this particular problem, he concluded he didn't have any "stress." On further questioning, however, I found out that: a) he was the owner of a small retail business which had not been doing well for more than a year; b) his two key employees were his wife and his sister; c) he was not very happy with their performance at work, but he was reluctant to express his displeasure; and d) he and his wife were having serious conflicts about how they should raise their children.
Needless to say, while this man did not think he had stress according to his narrow definition of the term, he did have problems that could have contributed to his physical difficulties. As we tackled each of his problems successfully, and as he learned to improve his relationships with his wife and sister, his colds, sinus infections, and lung infections became much less frequent. (While this does not prove a cause-effect relationship between "stress" (i.e. problems in his life) and his physical symptoms, I have seen so many similar cases that I find it hard to reject this hypothesis.)
Since all other definitions except:
STRESS = PROBLEMS
will in some ways be exclusive, they are all either incomplete or misleading. Thus, instead of saying "I've got stress," you should say to yourself "I'VE GOT PROBLEMS IN MY LIFE THAT ARE PAINFUL OR TROUBLING TO ME."
There Is No Such Thing As "Good" Or "Healthy" Stress
Another reason we fail to address certain problems in our lives is because we have been taught to believe that some degree of stress is "good" or "healthy" for us. This confusion also results from failing to appreciate that stress is just a word.
Do you really believe it is good to have unwanted problems in your life? Are you usually delighted to feel frustrated, angry, irritable, or depressed? Do you consider yourself fortunate because you have relationship conflicts, or because you're business is failing, or because you're having trouble meeting your deadlines?
There are many times, of course, when we intentionally seek out situations that make us feel fearful, exhilarated, or otherwise aroused. Getting passionately excited about your favorite sports team, getting physically or emotionally "psyched up" for your own athletic performances, or experiencing the emotional ups and downs of a powerful movie or play are just a few examples. But these are all instances of desired problems. (Just because a problem or feeling is desired does not mean it is necessarily "good" or "healthy" for you.) They are not at all similar to the unwanted problems, conflicts, and other types of "stress" we would prefer to do without.
And while we can label happy moments, joyous moments, and other positive aspects of life as "good stress" if we want, they have nothing to do with stress at all--at least in the sense in which most people use the term. For instance, no one has ever walked into my office and said, "Doc, I've got too much happiness and excitement in my life. Is there anything you can do to help me get rid of these?"
The notion that "stress" can sometimes be healthy for us is also largely a myth. While being active, challenged, and stimulated in our daily endeavors may indeed be good and healthy for us, these things also have little to do with "stress." Anyone who believes that a certain amount of anger, frustration, anxiety, guilt, or other problems improves their health and well-being is ignoring the fact that these emotions can lead to illness, depression, and sometimes even death in human beings. And while some negative emotions or other types of problems can at times be useful to us, this doesn't mean they are "good" or "healthy," nor does it mean that we necessarily need to experience them.
Thus, while you might think I have been harping on a trivial semantic point, there are very real dangers in believing that some types of "stress" are good or healthy for you. Such beliefs can lead you to endure a great number of unhealthy problems in your life, many of which you could learn to prevent or eliminate.
How Do You Benefit From Remembering "Stress Is Just A Word"?
In summary, there are several ways you benefit from remembering stress is just a word. First, it will help you better understand what stress is and what stress is not. Second, it will make you cautious about assuming you know what other people mean when they use this term in everyday speech. Third, it may make you skeptical about programs and treatment approaches that encourage you to deal with your "stress" directly. And fourth, it will force you to become more specific about the individual problems and conflicts that are troubling you. Once you do this, you will then be in position to recognize and deal with their underlying causes.
Thus, by consciously reminding yourself that stress is just a word, you will be taking the first important step toward learning how to win against it.
DAY 1: EXERCISES
1. List three major problems that are bothering you right now.
2. Is each problem listed above located outside your body, inside your body, or both? (If your response is "both," see if you can separate the problem into internal and external components.)
A _ OUTSIDE _ INSIDE _ BOTH
B _ OUTSIDE _ INSIDE _ BOTH
C _ OUTSIDE _ INSIDE _ BOTH
3. Ask at least three different people what the word "stress" means to them. Write down the answers you receive.
4. What definition of stress were you using, either consciously or unconsciously, before you read this chapter?
5. List three types of problems your previous definition excludes.
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