All in your mind

How often have you heard this? Maybe you’ve said it to a friend or companion when they have expressed worry over a physical symptom or discomfort for which no one has found a cause.

Or perhaps, it’s been said to you in such an instance… or at a time, when you felt physically different and uneasy, maybe nauseous or dizzy… for no obvious reason.

And then someone suggests that maybe it’s stress. Perhaps you agree. What is the thought that follows that one? Do you then make a decision to identify and eliminate those sources of stress in your life? Or do you tell yourself to “…suck it up”; ‘…shake it off”; “,,,put your big girl panties on” (if, in fact, you have some); or simply “…get over it!”

I’ve heard all of those things, and have even said a few of them myself. While those philosophies encourage us to have and demonstrate grit, they also suggest that much of what we are experiencing is imaginary or hypochondriacal; and that acknowledging these discomforts means that we just aren’t being strong enough. And maybe from time to time, that is the case.

However, during the vast majority of those times, we are NOT imagining things; these vague and often times recurrent symptoms are not figments of our imagination. In fact, there is indeed a physical process which is taking place in response to a stressful encounter, experience or (God forbid), lifestyle.

Yes. All too often, our stress and responses to stress are not due to one simple event, concern or person. Instead many of our responses are related to different elements in our everyday lives which impact and create our lifestyles. And we are often unaware of the most frequent offenders.

So let’s discuss stress.

What is that? How do YOU define it? Please consider that.
Take a look at one definition by Merriam-Webster:

I love this definition as it relates to disease and overall well being, or lack thereof.

This particular definition lets us know that it isn’t simply in our minds; that it, in fact, may represent a true physical response; and that chronicity of this response may have a detrimental effect on our well being.

What is important to understand is that having responses to stress are normal and healthy. We were given these reactions and responses in order to stay alive under adversarial conditions. In fact the fear-stress axis is believed to be an evolutionary adaptation, as important and impactful as the physical traits that allowed ancient man to escape any variety of predators, at least long enough to reproduce and pass their genes along.

While we no longer have to fear saber-tooth tigers, giant predatory kangaroos or giant hyenas, the adaptation of fear and the stress-response that follows it have been our inheritance.

The difference, however, is that we probably experience the stress response more frequently than did our ancestors and in response to less threatening stimuli. It is the frequency of this response that lays the foundation for disease and physical dysfunction.

In order to see the correlation, it is first key to understand why a response to stress is necessary in the first place. The simple answer is that it keeps us alive. Our awareness of stress, particularly as it relates to a perceived threat prepares us to fight or flee. Both of these responses are fundamental components of self-preservation.

So, what happens when our stress response is engaged?

The stress response is designed to give us optimal preparation to survive whatever is in our path. This is one of the very remarkably efficient things that our bodies do.

What, do you suppose, you would need to happen in order for you to successfully engage an attacker, for instance? Would you need your gastrointestinal system to kick in and start doing its thing? Might this be a good time for your kidneys and bladder to do what they do best? You have probably already realized that these organ systems will be of little benefit to you if you are fighting for your life.

What is needed is optimization of your heart, lungs, muscles and skeletal system. These will be our lifesavers. These organs will respond by an increase in their rate of work and efficiency. As a result, our hearts beat harder and faster; our blood pressure rises; our respiratory rate increases; blood flow to our muscles increase for optimum speed and strength; and our eyes dilate so that we can take in more light for visual acuity.

As our perception of stress mounts, our bodies will prepare themselves by shunting (redirecting) blood flow from organs that are non-essential in this process to the organs that will need it most. That means that our gastrointestinal, genitourinary, integumentary (skin, nails and hair) and immune systems will receive less blood, and our heart, lungs, muscles and bones will receive the lion’s share. This makes sense, as they will be doing most of the work involved in preserving our immediate health and well being.

This can only happen when the mind becomes aware of a stressor. Once that occurs, a part of the brain called the hypothalamus will signal the Autonomic Nervous System which will control most of the organs in your body. Neurotransmitters like noradrenaline (norepinephrine) will signal our bodies to begin the cascade of events in “fight or flight”. These hormones will redirect blood and oxygen from non-vital organ systems to the life-saving ones.

At some point during all of this, cortisol production by the adrenal glands increases in response to the brain releasing Corticotropin Stimulating Hormone. Cortisol helps us to mobilize fat and stored sugar so that sufficient calories and energy are available for a strong defense.

Now… imagine that with every stressful event, the above functions are occurring. It is not uncommon for us to experience stress multiple times throughout the day. Let’s consider some of the many instances that we may perceive as stressful:

• rush hour traffic;
• a deadline or presentation at work;
• that annoying co-worker;
• a passive-aggressive or controlling boss;
• getting to the dry-cleaner before it closes;
• marital conflict;
• challenges of parenting; the list goes on.

And each time that we experience these very ordinary and often mundane, but frequent challenges, we may be engaging the same stress response that our Homo Sapien ancestors did when trying to outrun a cave lion or giant jaguar. And when we undergo this reaction multiple times a day, on a regularly occurring basis, we chronically deprive certain organs of oxygen; we chronically elevate our blood pressure, heart rate and blood sugar. Is there any wonder that disease can be the result of chronic stress?

And did I mention that we can experience the stress response in response to things that we enjoy or that make us happy? Consider your child’s high school graduation; your best friend’s birthday party; a trip abroad. While these are fun and exciting events, the autonomic response is indistinguishable from that which occurs with a negative stressor.

Our bodies cannot tell the difference between “good” and “bad” stress. Excitement that we feel results in the same physiologic changes as does fear and anxiety.

So, is it surprising that we might develop organ dysfunction and disease from the recurrent oxygen deprivation that occurs with stress?

Stress has been attributed to various and sundry maladies. Let’s name a few: peptic ulcer disease; irritable bowel syndrome; migraine headaches; tension headaches; hypertension; heart disease; decreased libido; insomnia. The list goes on.

Now that you know that the effects of stress start in your head, but are not “… all in your head…”, you might be wondering what can be done about it.

I will tell you that clinically, a diagnosis of a stress-related illness, can be very frustrating as there are no easy answers, magic potions or quick fixes. And, in fact, the solution to stress typically involves interventions that will present us with solutions through delayed gratification, as success only occurs with regular and consistent lifestyle changes.

Generally, we diagnose a stress-related malady only after we have done the “million dollar workup” and have found no other pathology or medical problem that would account for a patient’s symptoms or complaints.

At this point, we generally tell you something really helpful, like,

the average population of American women, particularly those who have already started a family, the failure to rest and rejuvenate is a common shortcoming. I believe that in the role of family and nurturer, and in a society where we are constantly encouraged to do more and to be more productive, women will often put their emotional needs last. They will rest or observe a pastime “when they get time”, which means almost never.

This deficit becomes obvious when I ask a question about their hobbies or interests and they answer me by saying, “shopping”. Activities like shopping and cleaning do not count. Cooking does not count as a hobby either, unless you routinely cook for those outside of your immediate household, participate in competitions and/or attend classes and workshops to master new recipes and skills. Do not rationalize this by saying,

“I like cooking for other people”.

This means that your hobby is taking care of and nurturing others… which is not a hobby at all.

Some women have no idea what they like or what interests them because they have forgotten that it was important to cultivate these things. Generally, by this point in the conversation, I give my patient an assignment challenging her to come up with a list of interests or hobbies that she might enjoy.

Next on the list of “must-dos” is the acquisition of quality rest. In order for this to have maximum impact, it really must be done daily. There is no way that we can ever reclaim lost sleep or missed opportunities to rest. The lack of regular and effective rest, in and of itself, can lead to certain disease states. One of the most loving things that we can do for ourselves is to treat our bodies gently, and this always includes rest and the opportunity for rejuvenation.

We often maintain lifestyles that compel us to feel guilty if we slow down for a while; if we endeavor to take things easy. Certainly, there are times in our lives where our responsibilities require us to be in high gear. We must ascertain when this state of being is necessary and when it can be foregone.

I remind myself that, on the seventh day, even God rested. If He required rest and He is divine, then I don’t stand a chance with out it.

Finally, there are times when the above things that I mentioned seem impossible to accomplish because something else always seems to “… come up…”. If we are waiting for the optimum time, when all of our obligations are met and we can give ourselves permission to nurture our bodies and spirits, this moment will never arrive. It’s one that we must seize for ourselves. We must make this aspect of our health a priority. Whether it’s time to engage in a hobby, to rest or to pray and meditate, there should be essential time within our schedules to do this.

This means that we might have to schedule time to ourselves. In other words, place it on your calendar with regular dates of occurrence. Keep this “meeting” with yourself and hold it in the same regard that you would a meeting with your boss. Short of an emergency, nothing ought interfere with or preclude this.

This requires a big paradigm shift for some. There are those who will feel guilty that if they routinely allocate time for themselves, they are being selfish. I believe that this is untrue. My perspective on the matter is that this is self-preserving behavior, not selfish.

Selfish is when we take on too much, and for too long, because we tell ourselves that without us certain things will never get done. This is a very egomaniacal view of things. Many things in our lives can and will be done by others if we give them a chance to help out or an opportunity for them to take care of things on their own.

If we fail to nurture our bodies and spirits on a regular basis, we cannot be strong sources of support for others.

So, the next time that someone tells you that your discomforts are “…all in your head…”, reply by saying,

“You are absolutely right! They certainly are!”