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Stress! Why is this word giving us the tremors, setting our hearts racing and our lungs panting harder? In day-to-day life, stress comes from a number of sources, for example, worries about situations beyond our control, fears of illness or financial ruin. Most of the factors that cause stress are unavoidable, and knowing what they are and how they work can reduce their strength.

Take, for instance, 30-year-old Mr D in the prime of his life, an executive in a multinational company and a soon-to-be father. One day, he presents with symptoms of giddiness and blurred vision, and it turned out to be hypertension. This was due to the fear of being retrenched because of the recent merger of his company with a bigger one.

Mr K was leading a happy married life. He happened to befriend a woman and as time went on, the relationship grew very intimate. He now went to great lengths to please her, to the extent of even sacrificing his foreign assignments in order to be with her. Subsequently, he realised that his so-called friend had a dark and questionable side. What do you think was the impact on him? A total nervous breakdown. A closer look at his family showed that his wife and father, who were aware of the entire situation, had very high stress levels too

In the instances cited above, ‘stress’ was the major destructive power wreaking havoc in their lives. Stress comes in all shapes and sizes and has become so pervasive it seems to permeate everything and everybody. It is hard to get through the day without hearing or reading something about stress.

It is a common misconception that stress is due to a bad change and is most often correlated with negativity in life. However, the truth is that anything ‘good’ or ‘bad’ that causes a change in life is stressful. It may be what is called ‘eustress’ or ‘distress’. For instance, events such as a promotion at work, marriage, pregnancy, and so on, which usually mark welcome changes in one’s life, can cause stress. It is not the acute tension that does the actual harm, but its accumulation over a prolonged period. International researchers have proved that overall, individual life stress has increased by 45% over the past 40 years.

One of my favourite researchers in Stress Medicine is Dr Robert S Elliot, Director of the Institute of Stress Medicine, Nebraska. In his book, From Stress to Strengthhe explains how he realised the fact that stress by itself can kill and the importance of effective stress management. Despite being a cardiologist and having tested negative for possible coronary artery disease, he suffered from a totally unpredictable heart attack. It was then that he realised that coronary artery disease is not the only cause of heart attacks; he had been what he now calls a typical ‘hot reactor’ for a period of more than 20 years prior to the attack. “Hot reactors,” he says, “are those individuals who exhibit extreme cardiovascular arousal in response to standardised stress test.”

Here are some excerpts from the book, which will help the reader realise that stress is a silent killer:

In 1968, when Dr Robert Elliot was asked to be a Consultant to the National Aeronautics and Space Administration at Cape Canaveral, he discovered a fatal side-effect to the space programme. Strong and healthy aerospace engineers and scientists, mostly aged between and 35 years, were dropping dead for no apparent reason. His task was to investigate the puzzling rise in the numbers of people suffering from sudden cardiac death (SCD) at the space centre. A look at their medical histories revealed nothing to explain the high rate of SCD. He then began analysing the autopsies of the former space workers. Though their coronary arteries were rarely blocked, mysterious microscopic lesions appeared in the fibres of the heart muscle themselves. He then wondered if these lesions could have led to electrical short circuits and fatal heart rhythms.

Years later, his theories were confirmed when he discovered that large doses of adrenaline, such as chemicals normally released during stressful situations, could produce these lesions, now called ‘contraction bands’. When he broadened his search for the risk factors, he discovered that environmental instability was the only factor all the workers had in common. Further analysis showed that for most of the SCD victims, the greatest source of instability came from the worksite. At this time, the customary procedure at NASA was to reduce staff levels drastically as soon as a rocket programme cycle was completed. Typically, 15% of those specialised aerospace workers who had made the launch possible were laid off. The technical expertise these engineers possessed was of no value outside the space programme. In order to feed their families, they were forced to move from their area, take up mundane, lower paying jobs with the hope of catching a ride on the next space programme. This sense of impending personal catastrophe, coupled with the rigours of the workplace itself, meant that these engineers and scientists were living in a work environment characterized by a loss of control. Anxiety, depression, anger and a sense of helplessness were their daily companions. Both those laid off and the managers who had to do the firing were dying from stress.

Death due to stress is as old as civilisation. Quoting a typical example from the popular Indian history of Kannagi and Kovalan, the glorious ruler of the Pandya kingdom, Nedunchezian and his wife Koperum Devi collapsed the minute they realised they had convicted an innocent man. It was not the deed of the gods but sudden cardiac death due to stress by guilt.

Have you heard of the stirring tale of the professor who was held in high esteem for his knowledge and dedication and was hailed by his students as a paragon of virtue? Unfortunately, he fell into the clutches of a nightclub singer and became her willing slave. Soon after marriage, she started to debase him and the stunned professor became nearly insane and went back to college to recapture the past. He died in a vacant classroom thinking of his past glory. This is the well-known classic movie The Blue Angel, which catapulted Marlene Dietrich to fame in the 1930s. This is a classic example of how repeated negative and stressful thoughts can act as slow poison, finally leading to death.

We can now test-ride the heart under conditions of mental stress by challenging a person to a series of mild stressors. The new Cardiac Performance Lab (CPL) developed at the Institute of Stress Medicine consists of three stages: the mental arithmetic challenge, the competitive video game and the cold pressure test.

“Don’t add the fear of stress to the stresses in your life,” says the American Heart Association (AHA) and the American Cancer Society, in Living Well, Staying Well. Stress is a perfectly normal aspect of the human condition experienced by us all. “Stress isn’t necessarily a bad thing – it is more of how you handle it.” The anxiety-relieving strategies and solutions based on the AHA protocols are called positive coping techniques, consisting of progressive muscle relaxation, deep breathing exercises and meditation.

An important study by Herbert Benson and Dean Ornish has clearly demonstrated that meditation and relaxation can be important, not only in reducing blood pressure and reversing arteriosclerosis but also in enhancing the quality of your life and performance. Meditation and relaxation are strong antidotes for the fight-or-flight (alarm) reactions. They produce a reduction in physical levels of adrenaline-like substances and relaxation of muscle tension. The blood vessels open and blood pressure drifts down.

Good health is more than just the absence of illness. Rather, it is a robust state of physical and emotional well-being that acknowledges the importance and inseparability of mind and body relationships. It is important for all of us to join the pursuit of learning how to harness stress and make ourselves more productive rather than self-destructive.

Stress is an unavoidable part of life but it does not have to be a disabling one. The more we know about how it affects us, and why, the less opportunity it has to take hold of us, and the more opportunity we have to either circumvent it altogether or put it to work on our own behalf. We can change our situation. We can change the way we view it.

The author is a Senior Consultant & HOD of the Department of Rehabilitation Medicine at MGM Healthcare.

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