Worried Sick
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Worried Sick

Deborah Carr

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eBook - ePub

Worried Sick

Deborah Carr

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About This Book

Comments like “I’m worried sick” convey the conventional wisdom that being “stressed out” will harm our health. Thousands of academic studies reveal that stressful life events (like a job loss), ongoing strains (like burdensome caregiving duties), and even daily hassles (like traffic jams on the commute to work) affect every aspect of our physical and emotional well-being. Cutting through a sea of scientific research and theories, Worried Sick answers many questions about how stress gets under our skin, makes us sick, and how and why people cope with stress differently. Included are several standard stress and coping checklists, allowing readers to gauge their own stress levels.We have all experienced stressful times—maybe a major work deadline or relocating cross-country for a new job—when we came out unscathed, feeling not only emotionally and physically healthy, but better than we did prior to the crisis. Why do some people withstand adversity without a scratch, while others fall ill or become emotionally despondent when faced with even a seemingly minor hassle? Without oversimplifying the discussion, Deborah Carr succinctly provides readers with key themes and contemporary research on the concept of stress. Understanding individuals’ own sources of strength and vulnerability is an important step toward developing personal strategies to minimize stress and its unhealthy consequences. Yet Carr also challenges the notion that merely reducing stress in our lives will help us to stay healthy. Many of the stressors that we face in everyday life are not our problems alone; rather, they are symptoms of much larger, sweeping problems in contemporary U.S. society.To readers interested in the broad range of chronic, acute, and daily life stressors facing Americans in the twenty-first century, as well as those with interest in the many ways that our physical and emotional health is shaped by our experiences, this brief book will be an immediate and quick look at these significant issues. View a three minute video of Deborah Carr speaking about Worried Sick.

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Chapter 1. Introduction: What Is Stress?
  • Naomi, a fifty-nine-year-old mother of five grown children, spent ten difficult years caring for her husband, Raymond, who was slowly dying from chronic liver disease. At the same time, Naomi worried about her mother, Marguerite, who was in the final stages of congestive heart failure and dementia. Just months after Ray and Marguerite died, Naomi suffered a transient ischemic attack (TIA) or “mini-stroke.”
  • Rob, a forty-seven-year-old copy machine repairman, was one of millions of Americans who lost his job during the recent recession. He went back to school for an associate’s degree in computer science, developed new skills, and searched high and low for a new job—to no avail. After more than a year of fruitless job hunting, Rob shot and killed himself, leaving behind his devastated wife and teenage daughter.
  • Marisol is a twenty-year-old dynamo who attends college full time, volunteers as a translator at her local hospital, works thirty-five hours each week at a fast-food restaurant to earn tuition money, and helps her single mother care for two younger sisters. An A- student majoring in Spanish and biology, Marisol was so run down by the end of the semester that she fell sick with the flu, and had to take incompletes in two of her courses. She is worried that her grades may suffer, and that she won’t be accepted into medical school.
We all know a Naomi, Rob, or Marisol. Each of us has witnessed a friend, coworker, or family member who tried to “do it all,” yet ended up exhausted, sick, or depressed. Maybe you’ve faced your own struggles, whether a divorce, a bankruptcy, or a troubled relationship that pushed you to drink more than you usually would. Maybe you have a stressful job, and try to calm your nerves by smoking cigarettes or eating your favorite comfort foods. That stressors—large and small—affect our health is a truism. Laments like “I’m worried sick” convey the conventional wisdom that being “stressed out” will harm our health. Literally thousands of academic studies reveal that stressful life events (such as a job loss), ongoing strains (such as burdensome caregiving duties), and even daily “hassles” (such as persistent traffic jams on the commute to work) affect nearly all aspects of our physical and emotional well-being.
Yet we have all experienced stressful times—maybe a major work deadline, or relocating cross-country for a new job—when we came out unscathed, feeling not only emotionally and physically healthy, but better than we did prior to the crisis. This experience is not unique; dozens of academic studies also provide support for the rallying cry “that which doesn’t kill us makes us stronger,” which suggests that we may grow more resilient and resourceful with every challenge. But how can stress be a source of both compromised health and resilience? And why do some people withstand tremendous adversity without a scratch, while others fall ill or become emotionally despondent when faced with even a seemingly minor hassle?
Worried Sick answers these and other questions about how stress makes us sick and depressed and even shortens our life spans. I will also show how and why some people are resilient and seemingly immune to such health woes—even in the face of unimaginable stress. Figuring out our own sources of strength and vulnerability is an important step toward developing personal strategies to minimize stress and its unhealthy consequences. Yet I will also challenge the notion that merely reducing stress in our lives—doing deep-breathing exercises or venting to our best friend—will help us to stay healthy despite our increasingly hectic lives as workers, parents, students, and caregivers. By focusing on repairing the stressors in our lives and trying to find quick-fix solutions (a good babysitter, a new job, an antidepressant), we’re missing the larger picture. Many of the stressors that we face in everyday life are not our problems alone; rather, they are symptoms of much larger, sweeping problems in contemporary U.S. society.
For instance, what might have benefited Rob most? A visit with a therapist? A prescription for an antidepressant? An economy that provided full-time jobs with benefits to all qualified workers? A culture that encouraged men to talk about their fears and insecurities, rather than keeping their feelings bottled up? And while Marisol’s college advisor told her to get more sleep and attend stress-reduction workshops at her university health center, might a better solution have been programs to help first-generation college students to fund their education? Although the self-help guides lining the shelves of bookstores give us tips on how to manage our stress, and prescription medications to “cure” our anxiety are just a doctor’s visit away, more sweeping solutions may be necessary.
Overview of Chapters
The following chapters delve into the concept of stress: defining what it is; explaining how it affects our emotional and physical health; identifying the biological, psychological, and economic factors that protect against (or exacerbate) the consequences of stress; and showing what can be done to minimize its impact on our everyday lives. In this first chapter, I provide a brief overview of the history and concept of “stress,” and describe the diverse forms that stress may take. Although we often use the term “stress” as a catch-all to describe the many nerve-jangling experiences in life, we will see that stress can take many forms: stressful events, such as a house fire or job loss; chronic stressors that persist over time, such as marital conflict or a long-term illness; daily hassles, such as traffic jams or a misbehaving pet; and network events, or those stressors bedeviling others that may affect us, such as a spouse’s work troubles or a child’s difficulties at school. I also show how stress exposure varies based our personal characteristics, including gender, race, age, and social class.
In Chapter 2, “Sweating the Small (and Big) Stuff: How and Why Stress Affects Our Mental Health,” I describe how our mental health is affected by the stress in our lives. Feeling sad, anxious, lonely, depressed, or suicidal is rarely something that is just “in our heads.” Symptoms of sadness and depression often can be traced back to a chronic or acute stressor, whether profound, such as the death of a loved one, or fleeting, such as being rejected by one’s first-choice college. Yet the extent to which a stressor affects our mental health varies based on important characteristics of the stressor, such as whether it was expected or unanticipated; whether our peers are also experiencing a similar stressor; and the events that precede, co-occur with, or follow the main stressor. I summarize classic and contemporary theories on stress and mental health, and provide evidence from scientific studies showing precisely how and why stressors of modern life can overwhelm our ability to cope.
Chapter 3, “Under Our Skin: How and Why Stress Affects Our Physical Health,” shows how stress affects our physical health, including our susceptibility to colds, how quickly our wounds heal, and how long we live. Early research on stress, conducted by endocrinologist Hans Selye (1956), viewed physical distress as an automatic response to any environmental stressor. In the six decades since the publication of Selye’s path-breaking work, scientists working in fields ranging from genetics to psychophysiology to neuroscience have identified multiple biological pathways linking stress to physical health conditions. Social and behavioral scientists have contributed by identifying the coping tactics and health behaviors that link stress to health, such as smoking or overeating. Social scientists also have explored the ways that structural and economic factors related to stress (such as job loss and thus loss of health benefits) can indirectly affect one’s health. Taken together, this research sheds light on why some health conditions, especially heart disease, are particularly susceptible to stress.
One of the most important things to know about stress is that two people may respond very differently to the exact same stressor; one person may become depressed or suicidal, while another may just accept it and move on. What accounts for these vast differences? In Chapter 4, “Why Some Crumble and Others Bounce Back: Risk and Resilience in the Face of Stress,” I show how some people bounce back from—and even thrive—in the face of stress and challenge, whereas others may become debilitated. In the past two decades, stress researchers have paid particular attention to “gene-environment interactions,” or the ways that our genetic makeup renders us particularly resilient (or vulnerable) when faced with stress. I describe the biological, psychological, interpersonal, and socioeconomic factors that help some people to bounce back from stress, while others break under the pressure. I draw primarily on “stress process” theories developed by sociologists, which focus on resources such as personality, coping style, and interpersonal relations that shape how we respond to stress.
Literally thousands of scholarly studies show how stress hurts, so what can we do about it? In Chapter 5, “Paths to Healing: Strategies for Overcoming Life’s Stressors,” I review strategies to minimize the health-depleting consequences of stress, and highlight which ones work and which ones don’t. It is impossible to turn on the television or pick up a magazine today without seeing at least some tips to “battle stress.” The past decade has seen an explosion of popular books, magazine articles, and television programs focused on reducing stress, but which ones work? And how do they work? I review the results from rigorous scientific studies and highlight those interventions, pharmaceutical treatments, or programs that have been identified as effective for battling stress-related health woes. I also show that we often cannot battle stress on our own; I highlight sweeping social factors that contribute to the stress levels of many Americans, and suggest policies to help minimize both exposure to stress and its health-depleting consequences.
What Is Stress?
A Brief History
Before we focus on the specific ways that stress affects health, it is important to first understand the basic history of and core concepts in stress research. Stress or a stressor refers to any environmental, social, biological, or psychological demand that requires a person to adjust his or her usual patterns of behavior. The notion that stress makes us sick, anxious, or depressed traces back to the 1956 classic book The Stress of Life, in which endocrinologist Hans Selye wrote that any harmful environmental stimulus would trigger adverse biological reactions. Selye borrowed the term “stress” from scientists in the field of engineering, who described stress as the forces that can put strain on a physical structure. For example, a scientist could exert physical force on a piece of metal in such a way that the metal could bend or even shatter like glass when it met its stress threshold. The notion that objects (and people!) can either bend or break when their stress levels reach a certain point has since been a recurring theme in research. In his early studies, Selye exposed lab animals, typically mice, to a physically distressing condition such as extreme cold or physical pain and then documented the organism’s physical response. A guiding assumption of his work was that the consequences of stress were “nonspecific”; that is, regardless of what the specific stressor was (e.g., extreme cold versus starvation), it would have similar effects on the lab animal’s physical response.
Although Selye was an endocrinologist who studied animals, his ideas and research set the foundation for the first wave of social science research on human responses to stress. One of the earliest social studies of stress was conducted in the 1960s by psychiatrists Thomas H. Holmes and Richard H. Rahe. They developed one of the first instruments to measure social stressors, or the types of interpersonal stressors that humans experience in everyday life. This instrument, the Social Readjustment Rating Scale (SRRS), was a questionnaire that asked people to indicate which of several dozen stressful life events they had experienced in the past twelve months. As figure 1.1 shows, life events are ranked on a scale from 0 to 100 “life change units (LCU),” meaning that some events are more serious than others, and thus may put one at more severe risk for illness or disease. An individual’s self-report of stress in the past year could then be examined in relation to one’s physical health symptoms, as a way to understand the association between stress and health. After subjects checked off all of the events that they had experienced in the past year, and summed up the total number of LCUs associated with those events, they could then estimate their risk of illness. For example, those with total scores of 300 or more would have an 80 percent risk of falling ill, whereas those with scores lower than 150 would have just a 30 percent risk of illness.
Just as Selye argued that the consequences of stress were “nonspecific,” Holmes and Rahe also presumed that any change in one’s social environment could overwhelm one’s ability to cope, and increase vulnerability to ill health. For example, figure 1.1 shows that the “death of a spouse” rated 100 LCUs on the SRSS, whereas an “outstanding personal achievement” rated 28 LCUs. However, the SRSS did not consider that the former is almost always interpreted by the bereaved spouse to be a sad, devastating, and life-altering event, whereas the latter is typically interpreted as a pleasant and desired experience. Rather, the assumption stood that each life change would have a health-depleting effect, and that the events merely differed with respect to the magnitude of their effects. As Holmes and Rahe wrote, “change in one’s life requires an effort to adapt and then to regain stability. This process probably saps energy the body would ordinarily use to maintain itself, so susceptibility to illness increases.” In other words, all changes were viewed as potentially harmful, regardless of one’s interpretation of change (e.g., was it desired or not?), how long the stressful period lasted, and a range of other conditions that could make the transition more or less distressing.
Contemporary Concepts and Measures
Contemporary research on stress has abandoned the assumption that “all change is harmful,” and instead recognizes tremendous variation in how we might experience, interpret, and respond to stress. First, researchers have moved away from using the general term “stress” and instead consider the specific forms that stress takes. The main subtypes identified are life events, chronic strains, daily hassles, and network events.
Life events are acute changes that require adjustment within a relatively short time period, such as being laid off from one’s job, the death of a spouse, or losing one’s home in a fire. Life events often signify a transition between two statuses or roles, such as the movement from spouse to widow, worker to ex-worker, or able-bodied person to disabled. One particular subtype, traumatic life events, such as experiencing a sexual assault, have especially harmful and long-lasting effects on health. In general, the health impact of a stressful life event depends on its magnitude (i.e., how serious is it?), desirability (i.e., was the change desired or not?), expectedness (i.e., was it anticipated or was it a surprise?), and timing (i.e., how old were you when it occurred?). In general, events that are unexpected are particularly distressing. For example, if one loses their job suddenly and without warning, it may be a jarring “shock to the system,” and one may be ill-prepared to find a new job. However, if one sees his or her colleagues being laid off, that worker might start looking for a new position to help prepare for the inevitability of one’s own job loss.

Life events that happen “off-time,” meaning earlier or later than is typical, also are considered particularly harmful. For example, having a baby may be a source of great joy, yet the changes that new parenthood impose may have harmful consequences for one’s emotional and physical health. Sleep deprivation, worries about caring for a baby, changes in one’s daily routines, and a renegotiation of one’s marital roles can take a personal toll. Yet for someone who undergoes the parenthood transition earlier than expected, such as the teen moms featured on “reality” shows like MTV’s 16 and Pregnant or Teen Mom, the transition may be particularly stressful. The young mother typically is not prepared for her role, may not have a group of peers who can support her, and may even face stigmatization and the loss of social support of friends and teachers who feel that teenagers should not become parents. As a result, the transition to parenthood may be more stressful for those who experience the life event “off-time.”
The health effects of stressful events involving a transition out of a social role, such as loss of a job or a marriage, are contingent on one’s role history or on the qualitative aspects of the role one is exiting or entering. Divorce from an abusive spouse or being fired from an intolerable job may actually enhance one’s happiness and self-esteem. By the same token, the loss of a particularly cherished role, such as forced retirement from a job one loved, may be especially distressing.
Scholars have recently proposed that individuals might also experience distress because of an event or role transition that they anticipated but that never came to fruition. The concept of a “nonevent” is fairly new but is one that most of us can relate to. Imagine being passed over for a much-desired promotion at work. Or think about forty-five-year-old Dawn. Although she always dreamed of finding the perfect husband, buying a home with a white picket fence, and having an adorable child or two, Dawn is now single, childless, and has few romantic prospects in the rural town where she works as a schoolteacher. She struggles daily with sadness, loneliness, and worries of “growing old alone.” Researchers are only starting to investigate the ways that not experiencing an event that one had desired can take a toll on health and well-being. Preliminary evidence suggests that not experiencing a family transition—such as a marriage or first birth—within a few years of the “typical” age for doing so can heighten one’s feelings of depression.
Whereas life events are generally thought of as single point-in-time transitions, chronic strains are persistent and repeated demands that require us to adapt, often over long periods of time. Think about being trapped in an unhappy marriage, having a stressful job, or living in a dangerous crime-ridden neighborhood; each of these conditions stays with us, day after day. That’s partly why chronic strains are considered more harmful than life events; they are constant and often reflect situations that we cannot easily change or escape.
Researchers tend to classify chronic strains into three types: status, role, and ambient strains. Status strains arise out of one’s position in the social hierarchies that are present in all societies. For example, in the United States, a history of racial stratification and discrimination has created a hierarchy in which African Americans tend to have less political and economic power than whites. Similarly, for much of U.S. history, women have held less power and had fewer resources than men. Belonging to a socially or economically disadvantaged group may create daily challenges that threaten our health.
Role strains are conflicts or demands related to social roles, such as juggling work and family responsibilities. Sociologists often write about role overload, or the ways that our multiple responsibilities may pile up and t...

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