On chronic stress

This Jonah Lehrer piece from Wired is a long look at the work of Robert Sapolsky, a Stanford scientist who has focused on the stress and its role in human health. His conclusions are that stress is really bad for you...

Chronic stress, it turns out, is an extremely dangerous condition. And not just for baboons: People are as vulnerable to its effects as those low-ranking male apes. While stress doesn’t cause any single disease — in fact, the causal link between stress and ulcers has been largely disproved — it makes most diseases significantly worse. The list of ailments connected to stress is staggeringly diverse and includes everything from the common cold and lower-back pain to Alzheimer’s disease, major depressive disorder, and heart attack. Stress hollows out our bones and atrophies our muscles. It triggers adult-onset diabetes and is a leading cause of male impotence. In fact, numerous studies of human longevity in developed countries have found that psychosocial factors such as stress are the single most important variable in determining the length of a life. It’s not that genes and risk factors like smoking don’t matter. It’s that our levels of stress matter more.

Furthermore, the effects of chronic stress directly counteract improvements in medical care and public health. Antibiotics, for instance, are far less effective when our immune system is suppressed by stress; that fancy heart surgery will work only if the patient can learn to shed stress. As Sapolsky notes, “You can give a guy a drug-coated stent, but if you don’t fix the stress problem, it won’t really matter. For so many conditions, stress is the major long-term risk factor. Everything else is a short-term fix.”

... and that stress is caused by being of subordinate in social or career rank or status...

...While doctors speculated for years that increasing rates of cardiovascular disease in women might be linked to the increasing number of females employed outside the home, that correlation turned out to be nonexistent. Working women didn’t have more heart attacks. There were, however, two glaring statistical exceptions to the rule: Women developed significantly more heart disease if they performed menial clerical work or when they had an unsupportive boss. The work, in other words, wasn’t the problem. It was the subordination....
The British civil service comes with one...feature that makes it ideal for studying the health effects of stress: It’s hierarchical, with a precise classification scheme for ranking employees (in other words, it’s the human equivalent of a baboon troop). At the bottom are messengers, porters, and security guards. Just above them are the clerical officers, followed by staff scientists and other professionals. This last group implements the policies dictated by powerful administrators who run the governmental agencies. Marmot wanted to investigate how differences in status “in people who are neither very poor nor very rich” might lead to measurable differences in health.

The differences are dramatic. After tracking thousands of civil servants for decades, Marmot was able to demonstrate that between the ages of 40 and 64, workers at the bottom of the hierarchy had a mortality rate four times higher than that of people at the top. Even after accounting for genetic risks and behaviors like smoking and binge drinking, civil servants at the bottom of the pecking order still had nearly double the mortality rate of those at the top....

The same effect applies even to the rich and famous. A few years ago, Donald Redelmeier, an epidemiologist at the University of Toronto, led a study of Academy Award-winning actors. His hypothesis was that having an Oscar gave people more control over their stressful careers. Instead of being forced to accept bad roles or work on mediocre movies just for the money, these stars could pick and choose their parts. This creative control, in turn, would lead to improved health outcomes. Redelmeier compared the award winners to two groups: (1) actors who had appeared in the same film as a nominated actor and didn’t get a nomination and (2) actors who had been nominated for an Academy Award but never won. The results were clear: People with Oscars lived, on average, four years longer than their less-successful peers, which represented a 28 percent reduction in death rate. As Redelmeier notes, this longevity boost is roughly equal to the effect that would come from “curing all cancers in all people for all time.”

Interesting stuff, offering more than a little insight into how stress can lead to anxiety disorders, why anxiety disorders can get worse over time, and why learning to manage your stress is key to managing anxiety disorders.