The 10% Solution For A Healthy Life, Chapter 8: The Mind-Body Connection
March 6, 2002
I understand that stress plays an important role in the development of disease.
It is an important issue, although not a simple one.
None of these issues is simple.
The dietary principles-10 percent calories from fat and similar guidelines for cholesterol, sodium, and other nutrients-are reasonably simple, although the scientific evidence justifying them and the means of implementing them in our lives are more complicated. Articulating the essential role of stress in our health and well-being is more difficult
Perhaps that just reflects the state of our knowledge in this area. Nutrition can also seem confusing if you are lacking the right road map.
That is very well put. The difficulty is that we cannot simply say that stress is bad for you. In certain circumstances, some forms of stress can be very damaging to one’s health. In other situations, circumstances that we would consider very stressful may not be damaging or can even be energizing. Consider the example I cited in Chapter l: the experience of the European populations during World War II-populations hiding in subway tunnels while their homes were firebombed, other populations fleeing their homes when caught between opposing armies. Yet the rate of heart disease did not increase during those terrible years. The only impact that has been noted was the dramatic decrease in heart disease in those countries in which food rationing was imposed during the exact period of time in which rationing was in effect. And we know that the principal consequence of the rationing was the limitation of precisely those foods that are high in fat and cholesterol, meat, eggs, cheese, butter, milk, cream, and cooking oils.
On the other hand, there are many examples of life situations, and perhaps most important, our reactions to them, that appear to have a profound effect on our ability to resist or overcome disease. Many studies have shown that certain types of chronic stress can contribute to disease. Conversely, studies have shown the ability of the mind to assist in both resisting and overcoming disease through such methods as meditation and other relaxation techniques.
Just what is stress?
Essentially, stress is the arousal of the body and mind to demands and challenges that present themselves.
That doesn’t sound like a bad thing.
Stress is not necessarily harmful. We need a certain amount of challenge to avoid apathy and boredom. Even positive changes in our lives represent stress. The term eustress refers to our reaction to constructive change: a job promotion, an award, getting married, even going on a vacation. The type of stress that appears to be harmful to our health is the excessive activation of our fight-or-flight response.
Fight or flight?
Fight or Flight
That refers to the primitive origins of this mechanism. When our paleolithic ancestors confronted a menacing foe, whether animal or human, they had the choice of confronting the danger or fleeing; thus the term fight or flight. The process starts with our pattern recognition and cognitive faculties perceiving danger. Once that judgment is made, the rest is automatic. A perception of danger triggers a chain reaction of neural and hormonal changes that puts the body into a state of readiness for action. The hypothalamus signals the pituitary gland, which produces a hormone, which in turn stimulates the adrenal cortex to produce cortisol. Cortisol is carried in the bloodstream and causes a dramatic but temporary increase in metabolism. A spinal reflex signals the adrenal glands to produce adrenaline and noradrenaline, also known as epinephrine and norepinephrine. These hormones have a dramatic effect on the body, including nearly halting the digestive process and increasing blood pressure, blood sugar, cholesterol levels, and breathing and heart rates. Other effects include dilation of the pupils, the activation of blood clotting mechanisms to prepare for the possibility of injury, and the mobilization of internal energy stores for the possibility of extreme physical exertion.1
I take it that these changes are harmful.
Not necessarily. We need the fight-or-flight mechanism to survive, otherwise we would not have the capacity to respond appropriately to danger. A problem arises when this mechanism is overutilized. It is chronic stress that is harmful. It’s as if your body is in a constant state of emergency. Then the temporary effects, such as increased blood pressure and cholesterol and decreased blood flow to the liver and digestive organs, can become permanent.
Does this have to do with the type A personality?
The Type A Personality Revisited
The so-called type A personality gained publicity in the mid-1970s and is described as a person who is hard driving, overly ambitious, impatient, competitive, aggressive, always working to a deadline, and generally possessing the traits of a workaholic. In contrast, type B personalities are described as relaxed, easygoing, accepting, and complacent. These early studies suggested that having a type A personality was a risk factor for the development of heart disease. More recent studies have cast doubt on the type A personality as a risk factor, at least as it was originally defined. The contemporary research indicates that of all the aspects that make up the classic type A pattern, the only ones that appear to be related to an increased risk of heart disease, are those involving anger, cynicism, and hostility.2 People with hot tempers and/or suspicious, angry, hostile natures are more likely to die from heart disease. Other type A characteristics, such as competitiveness, ambition, even workaholism, were not found to be risk factors.
For example, a long-term study was conducted on a group of 118 lawyers who had taken the Minnesota Multiphasic Personality Inventory, a standard personality test, 25 years earlier, while in law school.3 Those who had higher scores for hostility had a death rate from heart disease that was more than four times higher over the subsequent 25 year period than those with low scores for hostility.
Another dramatic study was a 25-year follow-up study of 255 physicians.4 Here the hostile physicians were 6 times more likely to die than the group who scored low on the hostility characteristic.
Hostility and anger. Are those the only personality traits linked to disease?
Researchers have discovered a similar link between “suspicious” personalities and increased mortality rate, although suspiciousness is linked to hostility and anger. A study reported in 1987 at Duke University followed 500 men and women with an average starting age of 59 for a period of 15 years.5 Men who were characterized as having a suspicious personality were twice as likely to die as their more trusting peers. The suspicious women were 29 percent more likely to die than their more trustful peers. There are other studies that demonstrate the healthful benefits of a positive and trusting outlook on life.
So the original idea of the type A personality was not accurate.
The Four Cs: Challenge, Commitment, Curiosity, and Creativity
It was only partially correct. The health implications of having characteristics we associate with being competitive and ambitious depend on why the person has those characteristics. There are, after all, constructive reasons why a person might be eager to achieve a set of goals. These can be characterized by the four Cs: challenge, commitment, curiosity, and creativity. A challenge is a goal that, while difficult to achieve, is worthwhile and meaningful to that individual. Commitment is the ability to place an overriding priority on attaining a challenging goal, to see progress toward a goal as more important than sacrifices that may be required. Curiosity is a desire for knowledge and an openness to life’s wonders. Creativity is the ability to create knowledge, to harness one’s curiosity to discover new wonders. People who are characterized by the four Cs often appear to be type A in that their high level of commitment and willingness to take on challenges cause them to appear driven and hardworking. But their work is rooted in a strong sense of self and purpose. The negative type A pattern is driven by something different-by cynicism, anger, and hostility, by a persistent sense of being treated unfairly and a need to be aggressive to get what is due.
Meyer Friedman, a cardiologist and one of the originators of the type A concept, has spent the past thirty years studying the research on the link between behavior and personality and heart disease. Friedman describes the negative type A as a one-dimensional personality, someone with a profound absence of spiritual life.
You have to be religious to avoid heart disease?
By spiritual life, Friedman is not referring specifically to a life with strong religious beliefs, but rather a life that has meaning, that attaches importance to human relationships and to other social and cultural concerns that enrich our lives.6 If the hard work and apparent impatience of the type A person emerges from concerns and beliefs that are deeply rooted in their own structure of values, then this commitment to achievement is supportive of cardiac health. If the pattern is the result of the “erosion of personality” that results from chronic suspiciousness, then it is destructive. You might say it has to do with whether or not our energy is directed out toward the world in a constructive fashion or directed inward in a destructive fashion.
This perspective sheds light on why the years of World War II, as stressful as they may appear, did not cause an increase in heart disease. The populations in these wars were not passive bystanders. In previous centuries, war was an activity engaged in primarily by professional armies. But in this century, war has been a struggle of entire societies. The first two Cs, challenge and commitment, certainly characterized the attitude of these populations in that circumstance. And since we might regard war as the father of invention and a major impetus to the creation of technology, we can include creativity as well.
Still, it is hard to avoid stress in our society.
The Stress Scale
True, stressful change is a part of life, particularly in the rapidly changing technology-oriented society we live in. Researchers Thomas Holmes and Richard Rahe studied five thousand individuals-the events in their lives and their reactions to them. They developed a stress scale ranking various events ranging from Christmas to the death of a spouse. They found that the higher your total stress score in any particular year, the more likely you were to become ill.
Based on what you said earlier, it would seem that different people would experience different levels of stress when faced with these events.