The Daily Apple™© Volume 2, Number 1
From Dr. Mike & Infinity Health Solutions
www.ihealsolutions.com
January 22, 2013 PGY 40 Day #206
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| Chilling Waters Fall |
In keeping with our promise to “use The Stress Management Workbook, to help maintain order and perspective in what has become an extraordinarily complex and fragmented “business of medicine” we now bring you back to The Stress Management Workbook. Keep this December 2, 2012 Addendum in mind as you use the book. Please review the December 2 blog post (The Daily Apple™© Volume 1, Number 2) to get the details of the first few pages and contact me if you have any questions, or problems with the post.
NB: Please read this book carefully and use in conjunction with your trusted Family Doctor. This book is not intended to treat any medical emergencies and is not a substitute for your doctor or any other healthcare provider. The Stress Management Workbook is designed to help you take The Best Possible Care™© of yourself, and to help you achieve optimal health & wellness. It takes time to reprogram; to bust a lifestyle that breeds pathology and to build a lifestyle that breeds health, wellbeing and wellness. Be patient. Be strong. You can do it.
This is a reiteration of the Preface for those who do not want to go back to the December 2, 2012 Blog Post
Preface
The twentieth century has been marked by tremendous advances in
the theory and practice of medicine. Phenomenal scientific and technological
discoveries have found their way into medical practice. People have grown
to expect certain seemingly miraculous results from the institutions and providers
of medical care, and often, the expectation is that the "impossible" can be achieved.
There is, however, increasing popular awareness that modern medicine
cannot perform miracles despite the available science and technology. Professionals
and laymen alike are learning that advances in medicine, however dazzling, cannot
make up for life styles that breed pathology. Life ·style is now being recognized as
a major factor in the development of many of our modern medical problems. General
attitude and behavior are clearly linked to the individual's health status. Moreover,
most medical problems seem to occur more frequently with increasing stress, and
environmental exposure appears to be a factor in most illnesses. Expectations
appear to have an effect on health and well-being. Such varied problems as cancer,
cirrhosis of the liver, malnutrition, pancreatitis, ulcers, high blood pressure,
headache, food poisoning, voodoo deaths, and others appear to be influenced by both
internal and environmental factors, both emotional and physical.
Professionals and laymen are beginning to realize and teach that the
individual has a great responsibility in the promotion of his own health and the
prevention of his own disease. The concept of self-care is steadily gaining acceptance.
People are beginning to realize that they have control over certain factors that affect
their health and wellbeing. But although these concepts are being accepted more
readily, the methods for their application and general use have not been widely available.
THE STRESS MANAGEMENT WORKBOOK is designed for the
individual who takes the concept of self-care seriously and wants to do whatever
he* can to promote his own health and well-being, as well as take advantage of the
best that modern medicine has to offer. Although the book can be read rather quickly,
the material is designed to be implemented gradually and thoughtfully in conjunction
with advice from your personal physician. It is expected that your initial planned
changes may take up to two years or more to institute.
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*Throughout the book we have used such constructions as "the individual ... he" solely for the economy of language.
Our usage of personal pronouns is not, in any way, intended to imply any connotation of sexual role discrimination.
Now we will skip ahead to Chapter 1, Page 1 of The Original Stress Management Workbook. I will preface some of the pages with page numbers, as the blog pages do not line up with the original text and my comments are also added to the original text.
1
Introduction to
Stress
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Stress is frequently used today as a derogatory term referring to social and psychological factors that adversely affect modern man. For purposes of this book, however, stress is defined as any internal or environmental, real or imagined condition, event, or agent that elicits a physical or psychological response in a person. This is a very general biological definition of stress and is deliberately vague. The important aspect of the definition is that for a condition, event, or agent to be a stress, it must elicit a response in the person. No response means no stress. Each agent, event, or condition that has the ability to elicit a response in the organism is called a stressor. The effects of stress on the individual are determined by the magnitude of the stressor and the preexisting condition of the individual.
Stress is a normal part of our daily lives. We have all experienced varying degrees of stress during different times of our lives. The amount of stress that we experience varies from hour to hour, day to day, week to week, and year to year. And each of us reacts to stress in different ways. Each of us also has a different ability to deal with stress. It is true, however, that no matter how great our ability to cope with stress, we each have our limits. If we consistently exceed our limits of stress tolerance, loss of well-being and/or illness will result. The problem is that most of us have no idea how much stress we are tolerating, how much stress we are capable of tolerating, how we can reduce our stress load, and how we may increase our stress tolerance. Moreover, few of us realize that we have the power to control much of the stress in our lives. In this chapter, we will examine some of the basic research showing the relationship between health and stress, and we will provide you with a basic model that explains the relationship between stress and health and demonstrates which factors can be influenced or controlled.
The relationship between stress and health has been chronicled at least since the beginning of this century. In 1910, Sir William Osler pointed out the relationship between coronary chest pain and stress. In 1927, Walter Cannon published material indicating some details of the body’s response to stress. He recognized a general discharge of the sympathetic nervous system as a preparatory bodily response to an actual or perceived threat to the individual. This response to maintain internal conditions of the body and prepare it for self-defense (for survival) was observed as a reaction to strong muscular exercise, asphyxia, hypoxia (low levels of oxygen in the blood), pain, emotional
Page 2
excitement, hypoglycemia (low blood sugar), and rage. In 1936, Hans Selye further defined this response to stress and termed it the general adaptation syndrome.
Since then, many researchers have defined the physiology of the body’s response to stress. Current research indicates the body’s response to stress is far more complicated than the early research indicated. Recent investigations by James Henry and Daniel Ely indicate at least two physiological response patterns to stress depending on the organism’s perception of the stimulus. If the stress is a perceived threat to control, the general adaptation syndrome is elicited. If the stress is perceived as a loss of control, a depressive response (passive behavior, withdrawal) results. In 1958, Dr. Lawrence Hinkle and Dr. Harold Wolf, two industrial physicians, published material indicating an association between psychological stress and human disease. Their research was based on the data accumulated prospectively over a 20-year period. These two industrial physicians found that illness “peaked” every 7 years in American blue-collar workers and every 3 years in Chinese blue-collar workers. That means that illnesses occurred most frequently at these times. Illness peaks in both groups of workers corresponded to life circumstances that were considered intolerable and unchangeable by the individuals involved. Moreover, Hinkle and Wolf showed that a majority of illness occurred in a minority of the population being evaluated. Since the 1960s, Dr. Thomas Holmes has been publishing the results of his research, and much of his work has recently been popularized in the lay press as the Social Readjustment Scale. (This scale appears in Chapter 5.) His research allows quantification of psychosocial stress through use of a scale of life events and has shown that the likelihood of illness increases with increasing stress. Richard Rahe has demonstrated increased mortality from heart attacks (myocardial infarctions) with increased stress.
The research touched upon here is only a small part of the available, convincing information. In summary, research indicates that stress of sufficient quantity and duration contributes to an individual’s ill health and lack of well-being. If the individual’s preexisting condition is good, lack of well-being or minor illness may result.
Stress is a confusing term. Its meaning is not clear even among those who have studied it closely. The researchers previously mentioned have selected their own definitions of stress, and the popular definition of the word varies with time. Common usage today defines stress as some “bad” environmental force that must be avoided at all costs. Stress becomes a problem when it adversely affects our ability to feel well and function normally. Abnormally prolonged or frequent response to stressors does appear to have adverse effects.* By the same token, minor responses to minor stresses in a debilitated person may be the final factor in causing a major illness. Are all responses detrimental? No, but all responses are potentially detrimental depending on the prior condition of the individual. The prior condition is determined by prior stress load and existing state of health. What is stressful and detrimental to you may be stressful and beneficial to another. Running (within limits) is stressful but beneficial for a healthy person, but it is potentially lethal for a person with coronary artery disease or congenital heart disease. A baseball game may be relaxing although stressful and exciting for a healthy person, but a grand slam home run can be a lethal dose of excitement for a coronary-prone individual.
* Some people refer to these adverse effects as strain.
Page 3
There are three basic components of the Integrated Model: internal factors, environmental factors, and time. The interaction of the factors varies over time and determines the overall functional ability of the individual.
Are you a person who can benefit from certain stressors but should avoid others? How can you change your attitude and behavior to improve your stress tolerance? How can you improve your attitude in order to reduce adverse stress? To explore these and other questions more fully, we have developed a theoretical model that incorporates many of the known stressful factors that impinge upon our lives (see the above figure).
The interaction of the individual with the environment determines that individual’s overall functional ability and sometimes results in disease or pathology. Pathology in the individual may, in turn, result in a temporary or permanent reduction in functional ability.
As can be seen by examining the model, individuals are exposed to environmental and internal stressors and supporters. Some of the stressors are alterable and some are unalterable. These variables change over time, and their interaction determines an individual’s overall stress tolerance and well-being at any given time. Internal pathology (disease or abnormality) plays a large role in determining stress tolerance. In this book, we will be discussing primarily alterable factors, factors that you can change to promote your health and well-being. The following figure gives examples of factors that can be affecting your health at any given time (see Figure 2 Below).
The following figure (on page 5 of the original text) represents how a real patient with pneumonia might look from the perspective of the Integrated Model. This person’s stress tolerance would probably be low at this time. The expectation is that the patient would probably recover over time with or without treatment because of internal and environmental supporters. However, excessive stress on environmental support might be devastating; for example, withdrawal of family support during the delusions of a high fever might result in this person’s injuring himself.
The individual’s stress tolerance is limited. Psychosocial stress could result from loss of family support and might be devastating unless some other support system, such as a hospital, was available. Excessive or prolonged increased stress would be intolerable and could possibly result in death or permanent disability. This is just one example. We are all experiencing thousands of environmental and internal stressors and supporters at all times. Many of the alterable factors will be examined in more detail in the following chapters. The following analogy further explains the relationship between stressors and supporters and your level of functioning.
A pickup truck is designed to perform certain functions. It has built-in load-carrying limits, speed capabilities, engine rpm limits, and terrain limits. It must be maintained properly and must get proper fuel. If the design limits are exceeded without appropriate accommodating design changes, the vehicle will not function properly and may be damaged. A one-ton pickup truck can carry one and one-half tons for a short distance at slow speed over level ground, probably without damage. If the driver speeds on rough terrain with a heavy load, however, damage will probably result. If the truck has heavy-duty suspension installed, the load capacity may be doubled from one to two tons without damage on all reasonable road conditions and at all but excessive speeds.
Man is similar to this pickup truck. The load is the accumulation of his stressors; the design is his stress tolerance; and the suspension is the sum of his supporters. Man differs in that he must learn his own capacity to tolerate stress: His capacity changes with age, time, and attitude, and he must develop his own support system. In the chapters that follow, you will be taught how to increase your feeling of well-being and to reduce your chances of major illness by learning how to identify your excess stress, how to identify stressors, how to avoid excess stress, and how to increase your stress tolerance.
(Sorry I am unable to upload the diagram at this time ... I will get it in and reiterate in the next blog post.)
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It should be noted that certain “unalterable” environmental factors can be altered through industrial and/or governmental action, but usually not through individual behavioral change.
To be continued
Join us. StepWisely® & Go to Health™© Michael F. Mascia, MD, MPH
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