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But can self-esteem itself lead to excesses?
Cynicism
A danger inherent in excessively high self-esteem is seen in behaviour involving cynical mistrust. This is characterized by a collection of attitudes which involves suspicion and the denigration of the motives and behaviour of others, and this has been shown to be a risk factor in the development of coronary heart disease (A. Fontana et al, ‘Cynical mistrust and the search for self-worth’ Journal of Psychosomatic Research (1989), Vol. 33, No. 4, pages 449–56.)
Interestingly, this research also showed that such people who are prone to self-criticism if they fail to reach the high standards they set themselves, who score high in assessment of their own self-worth in social comparisons as well as displaying cynical mistrust of others, also scored high in assessment of their degree of dependency on others for validation that they were deserving of being loved.
Self-esteem can therefore be seen to be a two-edged sword, especially where these other elements are found (cynical mistrust and strongly self-critical tendencies). I will return to cynicism in later chapters, and will also examine a splendid psychotherapeutic tool (Voice Dialogue) which allows the therapist to help you become aware of the ‘sub-personalities’ which make up all of us, and which can be involved in these excesses of critical and self-critical behaviour.
In summary: self-esteem, in its healthiest expressions, is a major stress-proofing factor, and conversely excessive self-esteem, especially when linked with cynicism, is a stress factor in its own right, as is low self-esteem.
Basic Emotions
The range of possible stress factors is almost endless, and the possible permutations of reaction to them equally so. It has been said that there are only two basic emotions: ‘like’ and ‘dislike’. All other emotions stem from variations and degrees of these prime feelings. The amazing differences in people, tastes, likes, dislikes and so on, makes it obvious that there is seldom any intrinsic quality in an event, object or situation, which guarantees it being universally liked or disliked (one man’s meat is patently another man’s poison). It is also worth noting that at different stages in life and under different conditions, the same person’s ‘likes’ and ‘dislikes’ will vary.
The conclusion may be drawn that a person can possibly be taught to like what was previously disliked, and vice versa. Thus, if, because of degrees of ‘liking’ or ‘disliking’, a person’s behaviour gives rise to a more stressful existence and more problematic relationships than are desirable, reduction of stress is possible only through a basic change in attitudes.
Just as type A must change from a fast-moving, fast-talking, fast-acting, fast-eating individual to one with more deliberate habits, so must the individual who says ‘that’s how I am, I can’t change!’ be made to understand that change is not only possible but desirable, and that self-interest dictates that it should be so. Changing habits and attitudes is merely a matter of understanding and recognizing them for what they are, followed by modifications in behaviour. This is easily said and, obviously, not as easily achieved. However, as will become clear, the alternatives to such behavioural modification may often be serious illness.
The Importance of Changing Your Automatic Response
In setting about behavioural modification – the changing of habitual attitudes and ways of responding – it is important to be aware that whenever you behave in a particular manner, you reinforce the belief that lies behind that form of behaviour. If there is always an angry tantrum in response to real or imagined criticism, then your belief that this is the appropriate response will be reinforced with each outburst.
To alter the underlying belief calls for an altered response. By substituting a less stressful, less provocative reaction, the belief will develop, and be reinforced, that the new reaction is correct and appropriate. Obviously, in interpersonal relationships, two such modified responses may be needed, and this is not easy to arrange.
Once you realize the role that habit plays in reinforcing undesirable modes of behaviour, it is possible to begin to change. By acting in a manner in which the other person is dealt with as you would wish to be dealt with yourself, and by expressing whatever needs to be said honestly and calmly, the opportunity will grow for a less stressful relationship. Such behaviour changes often spark changes for the better in the other half of the relationship.
It is worth noting that no-one and nothing makes you angry. You do it all on your own. Such feelings are always self-generated, and this is true of most emotions. You choose to be angry, jealous, guilty or bitter and, equally, you choose to be happy, giving, loving etc. Your attitudes and behaviour can be self-modified, and most experiences present a choice of response – one negative and stressful, and the other positive and, potentially, offering the opportunity for growth and self-knowledge – that choice always being yours, and the extent of attention you pay to the stress-reducing measures presented later in this book will be an indication of the extent to which you are prepared to accept responsibility for your life and actions.
Stress is Cumulative
Whilst, in early life, most people can cope with a great deal of emotional and physical trauma, this ability tends to diminish as life progresses. There are, of course, inherited characteristics which have an influence on our capacity for coping. And, there are other factors which will also, to varying degrees, determine to what extent stress can influence our physical and mental health. Among these are nutritional considerations, structural factors, exercise patterns, general fatigue, and the sum total – long-term and in the recent past – of stress. The effects these influences have will become clearer in subsequent chapters. At this stage, it is worth noting that stress is the spur that moves us to action, and that, if responses are not appropriate, it can also become the boulder that crushes.
There is indeed a point at which our body’s capacity for adjustment and adaptation in the face of stress becomes inadequate. When this occurs, health begins to break down in obvious ways. I will cover this in greater detail in the next chapter, but it is important to note that this very noticeable deterioration in health is itself a potent stressor. Anxiety in the face of changes in function and the onset of pain quickens the downward spiral. If you wait for this stage before taking reforming action you may have waited too long. It is, though, possible to regain health from this point, but only with great effort.
There are extrinsic factors which are outside our control, but there are also many aspects of the picture that we can control. There are, of course, states of mind which generate stress, which are outside our conscious control. There are many deep-seated anxiety states and depressions, in which only skilled psychotherapy and counselling can enable us to achieve insights and understanding and, ultimately, a resolution of the problem. Such forms of treatment lie outside the scope of this book, but it is suggested that the general principles here outlined, and the techniques described, can only be of help, even in such cases. However, no-one who is receiving psychotherapy should attempt self-treatment without first consulting his or her practitioner.
CHAPTER 2
The Physical Effects of Stress
Stress is an essential and constant part of life. It is the spur that drives humankind to all achievement, but, when excessive, it can destroy. All the ages and stages of life are transitional; from baby to toddler, from schoolchild to young adult, from active worker to retired pensioner, and so on. Each change has potential stress implications which, when overlayed upon the external and internal stresses of living, are constantly affecting our minds and bodies.
A definition of stress, coined by the great researcher into this ubiquitous phenomenon, Dr Hans Selye, is simply ‘the rate of wear and tear on the body’. All change calls for adaptation. If we go from a warm room into the freezing cold outdoors, adaptive mechanisms immediately become operative to help the body to maintain its equilibrium.
Adaptive processes take place in response to all changes and stressors, whether these are physical, such as heat and cold; chemical, such as polluted air and water, and drugs; or self-generated emotions, such as anger, grief or joy. Anything that is perceived as threatening the mind or body arouses a response of an adaptive or defensive nature instantly.
Homoeostasis
This ability to attempt to maintain the safe equilibrium of the body is known as homoeostasis. It is, for a variety of reasons, not always successful. The biochemistry of the body may be inadequate for the task, perhaps through poor nutrition – and this and other possible factors, including structural integrity, will be considered later. If the response is inadequate, or if perception of threats is inaccurate, then unbalanced and faulty body adjustments may occur with harmful consequences.
The normal stress reaction is seldom the result of the outside agency, but rather it is the system’s reaction to it. Whether the stressor is physical, such as sudden exposure to cold; or psychological, such as an unexpected crisis or a change of responsibility at work, or unpleasant news, the body begins to make biochemical changes in response to its perceived needs. Such changes take place to a greater or lesser degree almost constantly throughout life.
If a stressor is prolonged, continuous or extreme in its nature, then the defensive mechanisms of the body become even more active. In response to intense heat, changes take place in the blood chemistry and circulatory system in order to cool the body by means, for example, of extra fluid loss and evaporation through the skin. Should this fail to achieve the desired effect, then an even greater defensive effort might involve fainting and temporary unconsciousness, in order to reduce all bodily functions to a minimum. Such homoeostatic efforts, though, fall short of being actual stress reactions, unless prolonged.
Fight or Flight
In response to any stress or extreme the body undergoes a series of changes which Selye has grouped under the heading of the ‘fight or flight’ reaction. Quite logically, the response to being confronted with real physical danger, such as the appearance of a man-eating animal, would be to attack it or to escape from it. Whichever was the choice, the body would require instantly available energy, strength and concentration. There would be no time for slow deliberation or stages of progressive arousal, for by that time the adversary would be beginning its meal! If an appropriate response (fight or flight) to the stressor were forthcoming, then the biochemical and other changes triggered by the initial shock, would be utilized, and no ill-effects would be felt.
Today, people are seldom faced with such life and death stress situations. However, the mind and body may feel threatened in many other ways than by a man-eating tiger. Any perceived (accurately or not) threat or danger to the mind or body will produce a similar ‘fight or flight’ reaction, and there may be ways of producing an appropriate response to these. For instance, someone might say something which is perceived as being insulting and hurtful. The stress reaction, which includes a tensing of the muscles as well as biochemical (hormonal and other) changes, could simply be ‘bottled up’ and remain as an extra degree of muscular tension. If a suitable verbal and/or physical response were to be found, however, then again the preparation for action would have been expressed and used, and no ill-effects would result.
The degree of stress imposed on the body will vary with your perception of what constitutes a threat – one person would laugh and shrug off an insult, another would reach for a gun! It will also vary with your ability to respond appropriately. One might calmly but firmly state their views and inform the ‘villain of the piece’ of their feelings. Another might bluster and fluster and add fuel to the fire, and in doing so fail to obtain psychological release from the hurt and anger within. The stress factor, therefore, cannot be seen as the main determinant of the degree of ‘fight or flight’ reaction, but only as its potential trigger. The harm done to your body by prolonged, repeated arousal, is largely an outcome of your beliefs, attitudes, personality and ability to see objectively what constitutes real, and what constitutes imagined danger, physically or mentally.
The ‘Chain Reaction’ of Stress
The actual processes that take place during arousal and ‘fight or flight’ reactions are quite amazing to contemplate. It is possible to extrapolate these immediate changes and to see their potential for major physical damage if they are repeated or prolonged. The following process occurs instantly within the body in response to stress:
The muscles tense in preparation for activity; the hypothalamus (part of your brain) co-ordinates a number of hormonal changes; the pituitary gland is activated, and among other results of this is the production by the adrenal glands of the hormones, adrenaline and noradrenaline. As a result, a vast number of bodily changes occur; the pupils of the eye dilate – no doubt to see more clearly; the heart pumps more rapidly to service the extra requirements of the tense muscles, and this increases the blood pressure; the extra blood for the muscles requires extra oxygen, and the respiratory rate quickens to cope with this, as well as to help expel additional waste products resulting from increased activity. Blood being diverted to potential muscular activity requires the shut-down of some other functions, including reduction in blood through the kidneys, as well as the ceasing of digestive functions. To this end, saliva dries up and the intestines and stomach stop working. The body’s need for additional energy is met by the liver releasing stored glucose into the bloodstream, where the oxygen changes it into readily available energy. In anticipation of extra activity, the skin cools the body down by opening its pores to encourage perspiration. Since blood is being diverted to the muscles, there is a tendency for the skin to become paler. There may be involuntary urination or defecation, due to an over-reaction of that part of the nervous system responsible for restoring the status quo (the parasympathetic nervous system); normally, however, the sphincters controlling these functions close to prevent any further activity until the crisis is past. Other aspects of the body’s defence capability, the immune system, become less active during such arousal. This makes infection more likely at such a time. Since the muscles are tense, they will be producing lactic acid break-down products, which have the effect of reinforcing the anxiety and tension felt.
This listing of the chain reaction set up by stress is by no means fully comprehensive, but it gives an idea of what a devastating effect prolonged stress can have on normal body functions.
General Adaptation Syndrome
In the initial stages of arousal, most systems adapt to and accommodate such changes. After arousal there is a return to the status quo, especially if the response is adequate. However, if arousal is repeated over and over again, then some of the changes mentioned above stop being temporary and become chronic. The term employed to describe this process is the General Adaptation Syndrome (GAS). As your body adapts to repeated and constant stress factors, and as chronic symptoms become an accepted part of life, the general level of health declines. Such symptoms include headaches, dizziness, insomnia, blurred vision, swallowing difficulties, aching neck and shoulder muscles, high blood pressure, heart problems, circulatory problems, palpitations, asthma, allergies, indigestion, ulcers, backache, skin rashes, excessive sweating, colitis, sexual problems, depression, phobias and irritability.
Disturbances occur in the blood-sugar balance, giving rise to wild swings in energy levels and mood. If this is accompanied by the excessive use of sugar in the diet, and of stimulants such as tea, coffee and chocolate, the body’s ability to maintain a normal blood-sugar level can be severely damaged. (Some researchers see this as a major cause of diabetes.) There is often a tendency to underperform; self-doubt and insecurity become apparent, and there is a tendency for the defence mechanism to break down, making allergies and infections more likely. Personal relationships may become strained, libido often disappears, and all these changes lead to further anxiety and stress. A vicious circle of declining health, resulting from stress, is the bleak picture which is all too familiar in modern society.
Accompanied, as it often is, by poor nutrition, lack of exercise, and the debilitating habits of drinking (tea and coffee as well as alcohol) and smoking, the formula for disaster is well under way. Treatment by drugs and other medication results in nothing but a possible alteration of superficial symptoms. Indeed, by neglecting the underlying causes, symptomatic treatment may well do further harm. Masking and disguising a problem will never provide an answer to it.
This adaptation stage is critical in as much as most, if not all, of the symptoms are still reversible if the underlying stress factors are dealt with, and attention is paid to nutrition, exercise and structural integrity. How long this stage lasts depends upon many variables, including inherited factors, as well as the degree of stress, basic health habits, and the degree of emotional support available.
After a period of years (ten, twenty or more) the exhaustion stage of the GAS may be reached, and at this time the body simply ceases to be able to cope, and there is a collapse into one or other disease state. Break-down finally occurs, when even minor stress factors are not dealt with satisfactorily. At this point there may be collapse into a catastrophic illness, such as coronary heart disease, cancer, etc.
Knowledge of the signs and symptoms of stress, and of some of the ways in which the body copes with stress, can be seen as a necessary step towards understanding the enemy. Without being able to recognize and become aware of stress, it is possible to delude oneself that ‘it just won’t happen to me’.
The combination of prolonged stress and chronic fatigue has been put forward by some researchers (Drs Poteliakhof and Carruthers, in their report: Real Health: the III Effects of Stress and their Prevention) as a major factor in the cause of such conditions as rheumatoid arthritis, asthma and hypertension. Lack of sleep, persistent overwork and chronic anxiety is thought to result in hormonal imbalance, notably adrenal exhaustion or sluggishness. This is thought to interact with constitutional and inherited factors to determine the type of disease which develops.
Heart Disease
In the field of heart disease, research by Dr Peter Nixon at London’s Charing Cross Hospital (detailed in Stress and Relaxation by Jane Madders) has shown contributory causes to be sustained and inappropriately high levels of arousal. This is mainly the result of the following factors, he suggests:
1 Pressures exerted by people from whom there is no escape.
2 Unacceptable time pressures, deadlines, etc.
3 Sleep deprivation.
4 A high score in the lifestyle changes list (see page).
Dr Nixon states that drugs are unsatisfactory in the treatment of hypertension, since the underlying causes are not dealt with.
Neurological Disease
Among other stress-induced conditions are those that mimic more serious conditions. ‘Symptoms suggesting serious neurological disease are common in patients suffering from anxiety states, or depressive illness, partly, or wholly, attributable to the effects of stress’, states Dr Richard Godwin Austin, consultant neurologist of Nottingham General Hospital. ‘The most common example seen in the neurological out-patient clinic is the patient suffering from recent onset headaches … Patients under physical or psychological stress, frequently develop tension headaches. These may occur in the setting of a depressive reaction, with symptoms of agitation or phobia. The headache often fails to respond to any form of simple analgesic.’
Cancer
There has also been a good deal of research into stress and its relationship to the onset of cancer. The German researcher Dr W. Herberger has noted that chronic anger, disappointment, fear and inability to cope with misfortune often play a role in its development. It has been found that the majority of cancer sufferers have a tendency to dwell on past misfortunes, real or imagined, and they have little sense of the future. Dr Hans Moolenburg, a noted Dutch physician, has described cancer patients as people who have been ‘battered by fate’. It has also been noted that in the U.K., where six out of ten members of the general public acknowledge some belief in God or some spiritual agency, that nine out of ten cancer patients had no such belief. Cancer might therefore be described as, in part, a disease of ‘spiritual deficiency’.
Load, Strain and Stress – Harmful and Helpful Factors
Before looking at some of the conclusions that have been come to concerning the relationship between personality traits and disease states, I want to touch on the possibly surprising healing potentials of some aspects of controlled stress. First, I want to be sure that you truly understand what is, and what is not stress.
Any reaction of your body or mind in response to an environmental or psychological demand is commonly termed a stress reaction. However, the total process of adaptation can be divided into three major phases, termed load, strain and stress.
Load is that part of the process in which an interaction takes place between you and any factor (physical, chemical or psychological) which is capable of disturbing you, or which demands a response from you. Strain is the term applied to the change(s) which result in your body/mind after the application of that load. It is the defensive (healing or normalizing) phase which follows on from the strain, in which an attempt is made to restore the situation to balance, which, strictly speaking, should be termed stress.
Stress can therefore often be seen to represent a positive, normalizing effort, something which can only be considered good, helpful and desirable. It is this self-healing process upon which we rely for survival, and in fact upon which all healing methods depend. For example, cut yourself (load and strain) and stress follows as the wound heals. This is homoeostasis in action.
Many other symptoms which we commonly try to ‘cure’ are, in fact, nothing more than evidence of the body putting things right. One good example of this is that of the fever which occurs during an infection. The infecting agent (load) has led to local or general problems, leading in turn to a ‘stress’ reaction (adaptive response) on the part of the immune system, which involves elevation of the body’s temperature (the fever). Under normal conditions this is a self-limiting process which causes no harm (except to the invading virus or bacteria) and which effectively gets rid of the infecting agent.
Such a stress reaction can actually be said to be life-saving, and yet – in many instances – the first objective of most people seems to be to try to over-ride this self-healing process and to take or do something to bring down the temperature! Such an action is clearly counterproductive, and not in the best interests of the body as a whole, unless the fever is of life-threatening proportions.