Death from heart attacks and coronary artery disease is often associated with over-achieving, high-flying executives, but this is not necessarily so. In a study of the civil service (The Whitehall Study) over a ten-year period, it was found that death rates from coronary disease were lowest in the administrative grades and highest in the lowest grade. The researchers found that people on higher grades felt more in control of their work and better supported by friends and colleagues so that, although their lives appeared more stressful, they were able to cope. These people had more hobbies arid interests outside work. Whilst not suggesting that stress or the lack of it was the only factor contributing to these deaths during working life, it must be assumed that it played an important part. Other studies have confirmed that people who are employed in positions where they have job satisfaction and enjoy a certain amount of control have a better health record. For example, a review carried out by the Medical Officer of the British Institute of Directors showed that chairpersons of companies rarely suffer heart attacks whilst in office.

We will see later that stress manifests itself in many different ways, but it originated in antiquity. The "flight or flight" syndrome was seen in our ancestors who, when faced by marauding enemies or wild animals, had only two choices either to stay and fight or to run away. Both choices required an increase in energy which the body provided through release of adrenaline.

In modern life we are not very likely to be faced with these alternatives, but we may still feel angry because of a very difficult customer, or fear when (unjustifiably) we are 'put on the carpet' by our boss, or frustrated by non-recognition of our work. In these circumstances, adrenaline is released but, because we are unable to use it (i.e. to fight), it remains as a harmful substance in the body. One of the effects of this is a chemical reaction with 'good' cholesterol converting it to 'bad' cholesterol. This, in turn, causes a hard waxy substance to build up on the inner walls of arteries, the reduced bore of the blood vessels increasing the blood pressure, or hypertension. In some Japanese companies they have rubber models of bosses in the company's gymnasium so that, having to stand and take a telling off by the boss, they may later visit the gymnasium and knock the 'living daylights' out of the rubber model! It has been found using up of the adrenaline has a profound effect in restoring normality to the situation.

It is useful to look at the physiological pathway of fear and anger.

• fear causes an increase of adrenaline
• anger causes an increase of noradrenaline.

Together they equip us for emergency action. They contract the arteries; the heart beats faster to supply more blood which is drawn back from the skin in order to make more available. In addition, the blood clotting time is quickened and the liver is stimulated to release more glycogen for muscle energy.

Body physiology requires time to adjust to environmental changes and the following timetable shows why we currently have problems;

• in the Stone Age, humans had 10 000 years to adjust
• in the Bronze Age, they had 1000 years to adjust
• in the Iron Ag,e they had 100 years
• in our age, we have had 50 years to adjust to nuclear energy and molecular biology, and 20 years to adjust to genetic engineering and lap-top computers.

The speed of change has been accompanied by a number of other factors which contribute to stress:

• a lifestyle of constantly meeting deadlines/constant hurry
• noise in a service test, 75 per cent of soldiers who had been subjected to high noise - level (9 dc) doubled their margin of visual error for one hour afterwards.
• frustration - Experiments on rats showed deformation of adrenals, thyroids, hearts and lungs.
• pollution - and its effects especially on the respiratory system
• increasing number of cars - which combine the four factors above.

Medical Symptoms of Stress

Harmful stress shows itself in a number of medical symptoms: apprehension, generalized feelings of anxiety, tense headaches, unusual fatigue, frigidity, impotence, poor concentration, decreasing ability to make decisions, hyperventilation, increased irritability eating/drinking/smoking too much.

Types of Stress

There are three fundamental stresses:

• mortal combat - Today films, videos and TV keep the idea alive.
• fight for survival - Today it is to keep up with the Jones' - or overtake them.
• fear of death - This appears to be more obvious today with the decreasing role of religion.

Characteristics of Stress

There are three elements involved in stress:

• psychological, e.g. a feeling of inadequacy or inferiority
• physical, e.g. tension in muscles of neck and shoulders
• emotional, e.g. hate and love/guilt. Stressed persons normally experience at least two of these and more often all three.

Causes of Stress

Stressors, things which causes stress, may be:

• environmental, such as unsuitable working conditions, hunched over a computer or word processor
• chemical, such as working in a smoke or other polluted atmosphere
• workload-related, such as pressure to complete on time.
• financial.

The above extract is from "Principals and Practice of Physical Therapy" by William Arnould-Taylor. It is published by Stanley Thornes, Cheltenham, England, GL50 1YW. (ISBN 0-7487-2998-4)

Why not take our simple stress test to see how much stress you are under.