We are taught that the stress response is unwarranted when our brain perceives things in our environment which are not a real threat to safety. It happens when we’re in a traffic jam, struggling with tight finances, and when we have a major test coming up. These things won’t kill us and therefore the stress response that we experience from them is something unnecessary and maladaptive. This is stress theory 101. It’s what you learn within the first minute of any stress-related psychology class: sometimes the stress response is silly.
Lately I’ve found myself questioning this premise.
We know that the stress response was designed to occur in the face of some perceived danger. When we need to “fight or flight,” a body full of stress hormones prepares us. The second our brain detects a threat it is triggered. ACTH and cortisol do their thing. Epinephrine sharpens our senses, makes our heart pump faster sending blood to our organs and muscles, the lungs expand so that we can inhale more oxygen for alertness, and triggers the release of glucose so that we have more energy. This temporary systemic imbalance equips us for serious action. But sometimes it gets triggered when we don’t need to act. That’s what we’re taught.
But let’s say we’re at work and we’re stressed out about work. Let’s say we’re stressed out because we’re not passionate about what we do or we’re surrounded by assholes. No, we’re not at the immediate risk of death, but is it really true to say that this poses no real threat to us?
Obviously our needs for food, air, water, and not-being-eaten-by-a-huge-scary-animal are essential for life on Earth. The stress response undoubtedly protects us when we’re at risk in that department. But we also have an inherent need as human beings to self-actualize and to thrive. If we don’t feel that this need is being met, isn’t it rational to assume that being stressed is a legitimate response? Maybe the stress response is our body simply telling us that we are in some general situation which is not good for us and that we need to get out. Maybe it’s not a threat to our life but it is certainly a threat to our identity, our authenticity, and our wellbeing.
Who was it that decided only a select few of our needs as human beings merit our bodies responding in an attempt to help us get those needs met?
I call your attention to the multitude of research studies that have a very straightforward conclusion: psychological stress is literally a threat to our life.
- Chronic stress is associated with cardiovascular disease (CVD) and the evidence is strong (Dong et al., 2004; Gruska et al., 2005, Kawachi et al., 1995; Niaura & Goldstein, 1992; Steptoe, 2000). One study even showed that higher amounts of work stress were associated with a whopping 50% increased risk of developing coronary heart disease (CHD) (Kivimaki et al., 2006). Researchers Landsbergis and his colleagues (2001) concluded that the most consistent predictor of CVD is a particular source of this stress known as low decision latitude – in other words, having a low degree of control over your work. Considering CHD is the leading cause of death in the world, this is kind of a big deal.
- Chronic stress is associated with inflammation and other immune-related conditions like rheumatoid arthritis and autoimmune disorders such as systemic lupus erythematous (Affleck et al., 1994; Brody, 1956; Danese et al., 2007; Dube et al., 2009; Straub & Kalden, 2009).
- Chronic stress is associated with skeletal muscle conditions including headaches and bruxism (De Benedittis and Lorenzetti, 1992; Biondi & Picardi, 1993; Giraki et al., 2010; Ficek & Wittrock, 1995; Sauro & Becker, 2009; Venable et al., 2001; Waldie, 2001). Luckily, treatments for these conditions are more often aimed at addressing stress levels.
- Chronic stress is associated with gastrointestinal (GI) disorders like irritable bowel syndrome (IBS), chrons disease, ulcerative colitis, and peptic ulcers (Hertig et al., 2007; Searle & Bennett, 2001; Talley & Spiller, 2002). For this reason serotonin treatments are currently being investigated but if you are experiencing symptoms of a GI disorder your doctor will most likely just tell you to exercise more and eat enough fibre/probiotics…
- Chronic stress is associated with atopic disorders like rhinitis, asthma, and dermatitis (Chida, Hamer, & Steptoe, 2008).
- Chronic Stress is associated with type 2 diabetes (Charmandari, Tsigos, & Chrousos, 2005).
- There is even some supporting evidence that chronic stress is associated with cancer (Scherg & Blohmke, 1988; Levenson and Bemis, 1991; McKenna et al., 1999).
- This list does not even include the annoying problems like weight gain, obesity, hormonal imbalance, and mental illnesses which can also be triggered by stress.
The pathways involved between these illnesses and stress are irrelevant and even deterring to the point. Here’s the thing…
The conclusions in the literature tend to reflect this pattern: chronic stress is associated with illness because of the stress hormones themselves wreaking havoc on our bodies over a prolonged period of time. Shortened telomeres, depleted vitamins, androgens, backed up livers, etc. are to blame. In other words, the problem is a malfunction of our BIOLOGY and if only we could just handle uncomfortable situations without experiencing a stress response then we would be just fine. We “can’t avoid” stressful events so we just need to meditate more often or develop better coping strategies.
Literature like the article “Too Toxic to Ignore” by Blackburn & Epel (2012) suggests that we focus on medical treatments or help people change certain maladaptive behaviours in order to address the the issue of stress.
But, what if instead of blaming ourselves and our biology we blame our shitty system which forces us to do things that don’t feel good in order to survive? Are we being inadvertently brainwashed to ignore something serious that our bodies are trying to tell us?
Low socioeconomic status (SES) is one of the strongest and most consistent predictors of disease and mortality and stress is a key mediator (Cohen, 2007; Kristenson et al., 2004); the lower you are on the social ladder, the poorer the health you can expect. Very few diseases are an exception to this fact. It makes sense – low SES individuals tend to face unhealthier living conditions and more stress.
In response to this, a lot of people will say “But look at all of the opportunities we have! We can go to university, or get a better job! We are free to choose whatever path we want! If someone is stuck in a shitty situation, it’s their fault for being lazy and not working harder to get out of it.” If you fall into this category, I’m afraid you’re a victim of the postmodern brainwashing. Getting out of a low SES bracket is incredibly difficult – so difficult in fact, that staying in the situation is sometimes healthier than going through the amount of stress required to get out of it. Ergo, low SES individuals DO NOT have true autonomy. Try getting good grades when you also have to work 25 hours a week and come home to cooking, cleaning, and possibly even caretaking everyday. Add a dance class, a modest beauty regimen, a workout, a meditation, and an occasional evening out on top of that. Good luck. Try getting a better job when you show up to the interview looking like shit because you had to take a 2-hour public transit trip in extreme heat, after running 10 other errands, going to class, doing a shift at your other job, and by the time you finally get there you’re so tired you can’t even respond properly to the interview questions so you’re perceived as “unmotivated.” This is the shit that the middle class will never understand. To them it sounds like bitching. That’s what they’ll think as they read this, probably sitting in an uber on their way to an avo toast brunch.
And the government, who so devotedly caters to the middle class, designs initiatives to address the issue of psychological stress by targeting individuals who are already suffering. They develop campaigns to reduce stigma, crisis support lines, support centres, and training programs for employers to help them support mentally ill employees. There are also wellness workshops and educational programs to teach people how to reduce stress and live healthier. But what the hell does enhancing education do when poor people still can’t afford to buy fresh produce or relax in a car ride home after a stressful day? What if you don’t have the time to meditate because you need to work for 12 hours a day to make ends meet? And if you think about it, this approach is kind of ironic because the very act of participating in such programs means more things added on to an already-stressed-out person’s to-do list.
In Canada, leaders are attempting to implement such “organizational changes.” The Mental Health Strategy for Canada outlines the initiatives. Nowhere does it talk about addressing the mental health crisis by increasing autonomy. Essentially, it talks about how we can improve the lives of those already living with mental illness. In a way we are being force-fed the idea that low autonomy is a fact of life and if you’re faced with it then you basically just gotta learn to deal with it and get support.
As Jordan Peterson put it, “Everything improves when the poor get richer. We need to make them richer as fast as possible.” I agree. Money is a resource which can buy you time therefore increasing autonomy and giving you the freedom to pursue your passions. And it has been well theorized just how amazing and prosperous this world would be if we could all pursue our passions.
So what if the source of much illness is not within the people but in system that enslaves them? Despite the wealth of opportunity that capitalism has brought us, things are still imperfect. But is the lack of autonomy solely to blame?
Earlier this month, fashion designer Kate Spade made the decision to end her life. She was a highly successful, wealthy entrepreneur with a significant level of autonomy. Those who were close to her knew that she suffered from depression and a great source of it was relational. She and her husband had been living quite separate and unaffectionate lives and he eventually wanted a divorce. Being a family oriented woman, she didn’t. That was the very reason why she left the company in 2006 – to raise her daughter and focus more on the family. According to her sister, Spade didn’t even care that much for her massive fame and success. It stressed her out more than anything.
Spade is far from alone. I draw your attention back to the fact that we are in the midst of a mental health crisis, particularly with respect to depression. It makes sense given that depression is a mental illness which is often attributed to a perceived lack of control over one’s life – and in our current society, many of us are forced to put aside our passions in order to make a living at jobs where we are told what to do. What the death of Spade shows us however is that lacking control over your own life isn’t just about being held back from expressing yourself or achieving personal goals.
Suicide is now the second leading cause of death for people aged 15-34 (Millennials) in Canada, with depression being the most common illness among those who die (Statistics Canada, 2017). Coincidentally this is also a pivotal phase of life for developing long lasting intimate relationships. It’s when people tend to think the most about dating, love, and marriage. Erik Erikson’s famous theory of psychosocial development calls this the stage of Intimacy vs. Isolation, where the biggest psychological conflict that individuals are faced with is the task of forming loving relationships. Successfully making it through this stage results in fulfilment, whereas failure results in isolation and depression.
Among the suicide statistics, we do see that married people in this age range have a much lower death rate than those who are single, widowed, or divorced. It is theorized that the companionship and social support offered by marriage are the factors which decrease the risk of suicide (Kposowa, 2000). Keep in mind that these are fatalities, not attempts (women attempt suicide two to four times more often than men. Men are more successful because they tend to use more aggressive means [Krug, 2002]). Also worthy of noting is that cohabitation without marriage does not tend to show similar benefits. I will discuss this further in a separate article.
Back in 1983, Dr. Aaron Beck and colleagues presented a theory which suggested that there are two personality styles which make a person vulnerable to developing depression. More specifically, individuals with a high need for belonging, or those high in sociotropy, would likely become depressed when their social needs are not met, and individuals with a high need for autonomy would likely become depressed when their needs for personal achievement are not met. With this theory, they created the sociotropy-autonomy scale which was designed to predict a person’s likelihood of developing depression. Sato & McCann’s (2000) study used this scale and found that sociotrophy was in fact a risk factor for depression.
I would also like to emphasize however, that sociotropy is not a psychological disorder or symptom but a personality trait and it simply indicates a natural desire to connect with others which is higher than average. In other words, it is not, in itself, something maladaptive, or “wrong.”
Fast forward to today. Not only are we in the midst of a mental health crisis, we are also in the midst of a social crisis. Under the influence of postmodernism, we are being taught that autonomy is the be-all end-all of our existence. Traditional values of family and belonging go ignored, even shamed. To feel the need to belong is considered “needy” in our current culture. We see it everywhere – just go on any dating app and read a few profiles. The most sought after qualities in a woman are “a mind of her own,” “ambitious,” and “strong and independent.” Dependency is the most feared quality with very few people caring whether you’re mean or apathetic. Marriage is seen as outdated and relationships as transient.
Of course those who feel the need for connection are depressed! They are stuck in a situation that they have little to no control over due to the fact that they live in a society which makes them feel like their need for belonging IS NOT OKAY. Furthermore, it is a need that cannot be achieved through personal development – it can only come through positive relationships with other people. We can do our best to make relationships work, but ultimately we are not in control over the decisions that other people make. We cannot control whether our dates call us back, whether our family abandons us, or whether our partner asks for a divorce.
And as a result of this lack of control we seek love in manipulative ways – evident by the hoards of mainstream dating advice which are essentially different spins on how to play hard to get. They’re not wrong – people are wired to want more of what they can’t have. But what is the social cost of normalizing this behaviour? We are all suffering. We play these games to achieve power and control and in the process we leave others in a position of lacking control over aspects of their own life. Great relationships suffer, fail, or perhaps never even start because people are too afraid to be vulnerable.
The praise for autonomy is also reinforced by almost every higher education advertisement. Every other poster on the subway tells us to “Be a Leader!” and go to such-and-such university because we’re “Born to Make a Difference.” This advertising plants subconscious beliefs in people’s minds that it’s not good enough to be who they already are and want what they want. If anything it perpetuates the mental health crisis. It’s annoying at best and harmful at worst. What if I don’t really care about making a difference in the world? What if I am happy as a barista, or a mom, or a hairdresser? If I feel like being a “leader” I will fucking google nearby MBA programs. I don’t need someone else to tell me how I “should” be living my life…
Disney movies, TV shows, media – it used to be about saving the world or finding love. Now it’s all about finding yourself. As a rude awakening, get over “yourself.” Newsflash: We are SO much more similar than we are different!
Autonomy is incredibly valuable but it isn’t the whole story. As humans, we also need to feel connected to others. Abraham Maslow acknowledged this back in the 1940s when traditional family-oriented values were not only socially acceptable but something to be proud of. In his model the need for belonging was represented as being even more important than our autonomous needs:
And we all know this model is legit.
Honestly though, how many stories have you heard about someone achieving great success only to become depressed because they realized they had no one special to share it with? Or someone who was so ambitious that they lost the love of those around them and ended up regretting it? They were looking at their needs backwards.
We are suffering because our society is suffering. We want to love and to be loved, and we also want to pursue our passions, but we are held back from those things because of the false widespread beliefs that a) it’s not okay to need others, and b) you need to work for a living and sometimes that means getting a job you don’t like.
So essentially, we have a mental health crisis as the result of imbalanced social values and we are addressing the problem with band-aid mental health programs targeted to individuals and their behaviour. We are praising autonomy while simultaneously refusing to address the fact that so many of us simply don’t have it. We are also devaluing belongingness while simultaneously ignoring that it is a massive buffer against stress and mental illness.
Back to the topic of disease – this problem goes beyond the social and psychological. We aren’t just depressed and naive. People are literally physically ill and dying as a result of illnesses which can be attributed to the stress caused by unfilfilment and a perceived lack of control over one’s life.
So what can we do about this?
Part 1 of the solution is balancing our values. We need to see the merit in both autonomy and belongingness. I believe that having personal autonomy and the freedom to pursue what you are passionate about is absolutely integral to health and wellness. However, I also believe that we need to start acknowledging the fact that we are social creatures with a deep need for connection, who need each other, and who can’t always do everything on our own. Not only that, but there is no real reason why we should have to. We evolved as homo sapiens because we learned how to work together. We are wired for it. Deep down, we all want (and need!) love and connection. It’s time we start acting and talking like it. Just as autonomy acts as a buffer in the stress-illness relationship, so does social support (in fact to an even higher degree). And if there is anything I’ve learned from psychology, it’s that we need to know when to ask for help. I’d add on that we also need to learn when and how to ask for love.
Part 2 of the solution is changing how we encourage people to contribute to society. Notice I didn’t say “work.” That’s because I don’t believe it should be work. We should be pursuing something that we are so passionate about it’s akin to breathing. I’ve met CEO’s, engineers, hairdressers, and mom’s who all loved what they do for a living and they were perfectly content – all except those who couldn’t afford to live decently. Why aren’t people working at jobs that give them purpose and fulfillment? Why don’t they have access to them? Why are only some jobs considered socially desirable? Why do more difficult and laborious jobs often pay less? Why do artists have to struggle? And more importantly, how can we change this?
In sum, the stress response is telling us something very important. We feel out of control, not only because we lack autonomy in a society that glorifies it, but we also lack the freedom to reach out and ask for love in healthy ways. Our needs as human beings are going unmet to the extent that premature death is sometimes the result. In the meantime there is a wealth of research on society and its impact on health. Maybe we should start talking more about that.
- Affleck, G., Tennen, H., Urrows, S., & Higgins, P. (1994). Person and contextual features of daily stress reactivity: Individual differences in relations of undesirable daily events with mood disturbance and chronic pain intensity. Journal of Personality and Social Psychology, 66(2), 329-340. doi:10.1037/0022-35188.8.131.529
- Alford, B. A., & Gerrity, D. M. (1995). The specificity of sociotropy‐autonomy personality dimensions to depression vs. anxiety. Journal of Clinical Psychology, 51(2), 190-195. doi:10.1002/1097-4679(199503)51:23.0.CO;2-S
- Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy, 1(1), 1-16.
- Biondi, M., & Picardi, A. (1993). Temporomandibular joint pain dysfunction syndrome and bruxism: Etiopathogenesis and treatment from a psychosomatic integrative viewpoint. Psychotherapy and Psychosomatics, 59, 84-98.
- Blackburn, E. H., & Epel, E. S. (2012). Too toxic to ignore: A stark warning about the societal costs of stress comes from links between shortened telomeres, chronic stress and disease. Nature, 490(7419), 169.
- Brody, S. (1956). Psychological factors associated with disseminated lupus erythematosus and effects of cortisone and ACTH. The Psychiatric Quarterly, 30(1), 44-60. doi:10.1007/BF01564326
- Charmandari, E., Tsigos, C., & Chrousos G. (2005). Endocrinology of the stress response. Annual Review of Physiology, 67, 259-284.
- Chida, Y., Hamer, M., & Steptoe, A. (2008). A bidirectional relationship between psychosocial factors and atopic disorders: A systematic review and meta-analysis. Psychosomatic Medicine, 70(1), 102-116. doi:10.1097/PSY.0b013e31815c1b71
- Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease.Jama, 298(14), 1685-1687. doi:10.1001/jama.298.14.1685
- Danese, A., Pariante, C. M., Caspi, A., Taylor, A., & Poulton, R. (2007). Childhood maltreatment predicts adult inflammation in a life-course study. Proceedings of the National Academy of Sciences of the United States of America, 104(4), 1319-1324. doi:10.1073/pnas.0610362104
- De Benedittis, G., & Lorenzetti, A. (1992). The role of stressful life events in the persistence of primary headache: Major events vs. daily hassles. Pain, 51(1), 35-42. doi:10.1016/0304-3959(92)90006-W
- Dong, M., Giles, W.H., Flitti, V.J., Dube, S.R., Williams, J.E., Chapman, D.P., & Anda, R.F. (2004). Insights into causal pathways for ischemic heart disease: Adverse childhood experiences study. Circulation, 110, 1761-1766.
- Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., & Croft, J. B. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243-250. doi:10.1097/PSY.0b013e3181907888
- Ficek, S. K., & Wittrock, D. A. (1995). Subjective stress and coping in recurrent tension-type headache. Headache, 35(8), 455-460. doi:10.1111/j.1526-4610.1995.hed3508455.x
- Giraki, M., Schneider, C., Schäfer, R., Singh, P., Franz, M., Raab, W. H. M., & Ommerborn, M. A. (2010). Correlation between stress, stress-coping and current sleep bruxism. Head & Face Medicine, 6(1), 2-2. doi:10.1186/1746-160X-6-2
- Gruska, M., Gaul, G. B., Winkler, M., Levnaic, S., Reiter, C., Voracek, M., & Kaff, A. (2005). Increased occurrence of out-of-hospital cardiac arrest on mondays in a community-based study. Chronobiology International, 22(1), 107-120. doi:10.1081/CBI-200041046
- Hertig, V. L., Cain, K. C., Jarrett, M. E., Burr, R. L., & Heitkemper, M. M. (2007). Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome. Nursing Research, 56(6), 399-406. doi:10.1097/01.NNR.0000299855.60053.88
- Kawachi, I., Colditz, G. A., Stampfer, M. J., Willett, W. C., Manson, J. E., Speizer, F. E., & Hennekens, C. H. (1995). Prospective study of shift work and risk of coronary heart disease in women. Circulation, 92(11), 3178-3182. doi:10.1161/01.CIR.92.11.3178
- Kivimäki, M., Virtanen, M., Elovainio, M., Kouvonen, A., Väänänen, A., & Vahtera, J. (2006). Work stress in the etiology of coronary heart disease—a meta-analysis. Scandinavian Journal of Work, Environment & Health, 32(6), 431-442. doi:10.5271/sjweh.1049
- Kposowa AJ. Marital status and suicide in the National Longitudinal Mortality Study. Journal of Epidemiology and Community Health. 2000;54:254-61.
- Kristenson, M., Eriksen, H. R., Sluiter, J. K., Starke, D., Ursin, H., Östergötlands Läns Landsting, . . . Hälsouniversitetet. (2004). Psychobiological mechanisms of socioeconomic differences in health. Social Science & Medicine, 58(8), 1511-1522. doi:10.1016/S0277-9536(03)00353-8
- Krug, Etienne G. (2002). World Report on Violence and Health. World Health Organization. p. 191. ISBN 9789241545617.
- Landsbergis, P.A., Schnall P.L., Belkie, K.L., Baker, D., Schwartz, J., & Pickering, T.G. (2001). Work stressors and cardiovascular disease. Work, 17, 191-208.
- Levenson, J. L., & Bemis, C. (1991). The role of psychological factors in cancer onset and progression. Psychosomatics, 32, 124-132.
- McKenna, M. C., Zevon, M. A., Corn, B., & Rounds, J. (1999). Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychology, 18, 520-531.
- Niaura, R., & Goldstein, M. G. (1992). Psychological factors affecting physical condition. cardiovascular disease literature review. part II: Coronary artery disease and sudden death and hypertension. Psychosomatics, 33(2), 146.
- Sato, T., & McCann, D. (2000). Sociotropy-autonomy and the Beck Depression Inventory. European Journal of Psychological Assessment, 16, 66-76.
- Sauro, K. M., & Becker, W. J. (2009). The stress and migraine interaction. Headache, 49(9), 1378-1386. doi:10.1111/j.1526-4610.2009.01486.x
- Searle, A., & Bennett, P. (2001). Psychological factors and inflammatory bowel disease: A review of a decade of literature. Psychology, Health & Medicine, 6(2), 121-135. doi:10.1080/13548500120035382
- Scherg, H., & Blohmke, M. (1988). Associations between selected life events and cancer. Behavioral Medicine, 14, 119-124.
- Statistics Canada. (2017, June 16). Suicide Rates: An Overview. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-624-x/2012001/article/11696-eng.htm.
- Steptoe, A. (2000). Stress, social support and cardiovascular activity over the working day.International Journal of Psychophysiology, 37(3), 299-308. doi:10.1016/S0167-8760(00)00109-4
- Straub, R. H., & Kalden, J. R. (2009). Stress of different types increases the proinflammatory load in rheumatoid arthritis. Arthritis Research & Therapy, 11(3), 114-114. doi:10.1186/ar2712
- Talley, N. J., & Spiller, R. (2002). Irritable bowel syndrome: A little understood organic bowel disease? The Lancet, 360(9332), 555-564. doi:10.1016/S0140-6736(02)09712-X
- Venable, V. L., Carlson, C. R., & Wilson, J. (2001). The role of anger and depression in recurrent headache. Headache: The Journal of Head and Face Pain, 41(1), 21-30. doi:10.1046/j.1526-4610.2001.111006021.x
- Waldie, K. E. (2001). Childhood headache, stress in adolescence, and primary headache in young adulthood: A longitudinal cohort study. Headache: The Journal of Head and Face Pain, 41(1), 1-10. doi:10.1046/j.1526-4610.2001.111006001.x