Stress: The hidden adversary PDF
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STRESS The hidden adversary To my Mother and in loving memory of my Father STRESS The hidden adversary Clifford B. Dobson MSc, PhD, LCP, ABPsS, FRSH ~.~~' ,t-'i~. :"-"':--. MTPPRESS LIMITED' LANCASTER' ENGLAND International Medical Publishers Published by MTP Press Limited Falcon House Lancaster, England Copyrigh t© 1982 Clifford B. Dobson Softcover reprint of the hardcover 1st edition 1982 All rights reserved. No part oft his publica tion may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the pu blishers. Bri tish Library Cataloguing in Pu blica tion Data Dobson, C. B. Stress. 1. Stress (Physiology) 2. Stress (Psychology) I. Title 616.8 BF575.S75 ISBN 978-94-010-9800-7 ISBN 978-94-010-9798-7 (eBook) DOl 10.1 007/978-94-010-9798-7 Typesetting by Robert MacLehose & Co. Limited, Renfrew CONTENTS Preface Vll 1 The nature and sources of stress 2 Personality and stress 35 3 Stress and the self-concept 73 4 Physiological and psychological responses to stress 97 5 Mental illness in response to stress 139 6 The physical and behavioural effects of stress 169 7 Stress and medical disorders - I 201 8 Stress and medical disorders - II 225 9 Stress and social pathology 263 10 Occupational stress 287 11 Stress in education 323 12 Stress in young people 359 13 The control of stress 393 Appendix A 419 Appendix B 421 Author index 425 Subject index PREFACE This book is intended as an introductory text on stress and is aimed principally at students in the medical, para-medical and nursing professions, and for students of psychology and the social sciences. Additionally, students preparing for other 'caring' professions whose chief concern is with helping people in distress should find the book informative and instructive. Stress is a complex subject and the book will provide students with the opportunity to become acquainted with a multiplicity of topics cur rently in vogue which are subsumed under the general heading of stress. The book should also enable readers to gain some insight into the symptoms of stress in those whom they are seeking to help, and to empathize with them. A secondary objective of the book is to help readers to understand and come to terms with their own personal stress experiences, especially those which arise in connection with their professional work. The book begins by examining the nature and sources of stress, and highlights the difficulties inherent in attempting to formulate an adequate definition of the concept. There follows a survey of some of the conceptual models of stress which have been produced by researchers in the field, and a related section is also devoted to anxiety. Not all stress is harmful, and its motivational aspects are discussed. Nevertheless, a comprehensive study of the research evidence suggests that stress is detrimental to the organism's well-being, and various general causes of stress are mentioned. Why does one person react to stressful stimuli when another person does not? Individual differences are important and the book goes on to examine the concept of personality and the instruments which have been devised to measure it. The works of Eysenck and Cattell feature prominently, and their respective concepts of extraversion-introversion and exvia-invia are related to stress. This leads on to the notion of the self-concept and the stress which can arise when dissonance occurs between the 'real' self and the 'ideal' self, and between the ways in Vll Vlll STRESS which we see ourselves and the ways in which we are evaluated by others. The book then looks at the ways in which we respond to stress. The physiological and psychological responses to stress are considered in some detail and the section concludes with some examples of defence mechanisms. This is followed by a discussion of mental illness in response to stress, and various types of mental illnesses are described with illustrative case-studies. The effects of stress on the organism are considerable, and the next part of the book deals with the physiological effects of stress (tension headaches, respiration, blood pressure) and the psychological effects (anger, resentment, fatigue). Two chapters are devoted to stress and medical disorders, the first of which deals entirely with stress and heart disease. The second chapter examines a selection of stress-related ailments. There is also a chapter on stress and social pathology which inspects some of the empirical evidence on such variables as alcoholism, drug abuse, crime and suicide. The emphasis of the book shifts to occupational stress and a few of the more stressful occupations have been selected to emphasize some of the problems. There is mounting evidence to proclaim that stress is taking its toll in educational institutions where it is affecting administrators, teachers and pupils. A chapter has been devoted to this acute problem. Stress is often treated in the literature as something to be found solely within the adult world, and to dispel this notion a chapter has been included which deals with young people and stress. Among the topics presented are: adoption, family disruption, illness and hospitalization, bereavement and certain constitutional disorders. The book concludes with a section on the control of stress and incorporates material on relaxation and meditation, psychotherapy, behaviour modification, and self-instructional methods (biofeedback). In summary, the book attempts to answer the following questions: What is stress? How do we respond to stress? What are the effects of stress? Do young people experience stress? Where do we encounter stress situations? How can we control stress? The book is illustrated, contains a wealth of references to empirical research and has a useful index. Since no chauvinistic overtones are PREFACE IX intended, the reader is asked to accept that the use of masculine pronouns throughout the book is purely to facilitate the mechanics of writing, and that they should be sensibly applied to 'embrace' the female sex. I wish to acknowledge my indebtedness to the many scholars in this country and abroad, especially those in the USA, who have so generously made their research findings available to me. My thanks must also go to students and colleagues for their helpful comments and assistance. lowe to my typists, Mrs Elma Parkin and Mrs Shirley Hinchcliffe, a special debt of gratitude for producing uncomplainingly (to me at least!) a fine manuscript from illegible drafts. My special thanks must go to family and friends who encouraged me and suppressed their own needs for my time during the writing of this book. Clifford B. Dobson Bradford, 1982 Chapter 1 THE NATURE AND SOURCES OF STRESS WHAT IS STRESS? Stress is a familiar concept to us since it is an inescapable part of life. We feel we know what stress is because we experience it in its various forms in everyday life. We recognize it when we are faced with the prospect of having to pay an overdue bill, have an argument with another motorist, become frustrated with the boss, anticipate surgery at the dentist's, or await a driving test. We speak of stress in general terms because it incorporates so many areas of our lives. Moreover, the concept is understood by professionals and laymen alike. Company directors experience it, and so do teachers, actors, airline pilott', govern ment officials, sportsmen, soldiers in combat, housewives, students, and so on. The list is inexhaustible. A glance on the shelves of university libraries will reveal a wealth ~ printed material on stress in different fields such as medicine, biology, biochemistry, sociology, psychology, psychiatry, physiology, anthropology, ergonomics, etc. Several types of studies have been undertaken into the subject of stress and have made distinctive con tributions to the literature. Three research areas in particular which have proved invaluable in helping us understand stress are studies con cerned with anxi~ty subJects, investigations into life-stress events, and laboratory experiments involving induced stress. We shall look at some ofthese studies and their findings in this and later chapters. In spite of the abundance of available written material, it would be difficult to present an adequate definition of stress - one which would be acceptable to all. The concept remains vague and ambiguous and any definition must of necessity reflect the interests, methodologies and 2 STRESS subject-matter of the disciplines which attempt to study it. A search of the literature reveals that there are over 300 definitions of stress and words which are semantically akin to it. It may be helpful to regard it as a situation-specific word, i.e. a word which assumes various meanings according to the particular situation or context in which it is used. Richardson has a~so referred to the generality of the concept of stress and has suggested that for the concept to have any specific usefulness '. . . it should be further differentiated into a set of elements or compo nents germane to the phenomenon under study. . .' The term probably derives from the Latin stringere (strictus) which means to draw tightly or bind. It was certainly used in Old French (estrece) and in Middle English where it appeared as 'stres', 'straisse', or with other similar spellings. The original connotation of the word 'stress' referred to hardships or adversity, but by the eighteenth century it came to denote a force. Any attempt to resist this force by change or distortion became known as 'strain'. Indeed, a definition of stress which dates from 1843 introduces the related term strain - 'strain upon a bodily organ, or a mental power'. This same idea is to be found in the Shorter Oxford English Dictionary - 'to subject (a material thing, a bodily organ, a mental faculty) to stress or strain'. The term 'stress' was introduced into the physical sciences where it referred to the external force or pressure applied to an object, and' strain' was the change or distortion which took place within the object when stress was applied. More precisely, engineering sciences refer to the external force as the load, the internal force is the stress, while the change, distortion or breaking of the object is the' strain'. When we apply this information to the human situation, the Concise Oxford English Dictionary shows a close affinity between the words 'stress', 'distress', and the 'fatigue' which follows exertion or strain. Underlying these definitions there would seem to be an implicit model of stress which proposes that it is an excessive force which acts upon the individual, causing him to respond to it and cope with it in such ways that strain ensues. Osler (1910) associated stress with working too hard, and strain with worry. His concern was that these conditions, if allowed to continue unchecked, could result in physical or mental illness for the individual. More recently, Levi (1972) has suggested that 'stress is one of the mechanisms suspected of leading under certain circumstances to disease. ' Lazarus, writing in the International Encyclopedia of the Social Sciences (1968), notes that 'Stress suggests excessive demands made on man and animals, demands that produce disturbances of physiological, social
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