Coping with stress and illness


  • Health
  • Sunday, 22 Jan 2006

LIFE is full of incidents, each with variable potency to cause stress (and illnesses). Even the absence of occurrences can be stressful – picture the clerk not having anything on the “in-tray”, quite under-utilised and soon experiencing the stress of boredom.  

More commonly, we associate stress with excessive responsibilities, often over a period of time, or a sudden overwhelming dose of angst. Examples include the sudden loss of a spouse in an accident, or the vexatious tribulations brought on by long standing marital disharmony, or bringing up a delinquent teenage child. Not to mention difficulties at work (with traffic jams, cranky bosses, supersensitive colleagues, backstabbing peers in the corporate corridors) plus domestic worries (overdue mortgages with escalating interests, maid servants who run away, difficult in-laws, etc).  

Then there are global issues such as earthquakes, tsunamis and hurricanes, an increasingly unsafe environment with rapes, snatch thieves and burglaries, terrorism, and an increasingly unpredictable business and political climate. And ? the good family doctor just informed you that you have diabetes and explained to you the consequences if left untreated. 

The environment can be an unwitting contributor to your stress levels. Remember the last time you were caught in traffic?

With all these, do you still wish you were born? No wonder old man Job once said: “May the day of my birth perish...”  

But hold on, all is not lost. With an appropriate approach, things can turn out to be a lot better. And many can tread life as a journey with a more positive outlook, and thereby reap its rewards. This approach to effectively cope with stress is lumped up in the flexible package called “stress management strategies”. 

 

Stress management 

The first step in stress management is to be aware of the stress signals or symptoms in you. (Space constraints unfortunately do not give me the opportunity to deal with stress in corporate organisations). The intensity of these symptoms may be mild to severe. Early detection allows for prompt remedial action, preventing any snowballing effect thereby minimising any harmful consequences.  

Symptoms in the individual are varied and include psychological (nervousness, anxiety, fear and irritability), physiological (dry mouth, giddiness, cold sweaty palms, palpitations, breathless sensation, bloated abdominal sensation), physical (tension headaches, nervous diarrhoea, etc), altered biological functions (sleep disturbances, appetite loss to eating binges, lack of drive and changed libido) and increased use of caffeine, nicotine and liquor. Lest we include everyone, the identification feature is symptom intensity, chronicity and its marked difference compared to the good old yesteryears. 

The busy individual needs to be vigilant of these signals. More often than not, it subtly emerges and persists or gradually and insidiously escalates. No wonder some call “stress” a form of silent killer. We recall “the frog that died while sitting innocently on a plate of water which was slowly warmed to boiling point”. Stress is like that. The unknowing victim thinks little of his increasing dose of cigarettes/coffee/beer as he “successfully” struggles through week after week. He is quite exhausted by Friday evening (TGIF – thank god it’s Friday).  

The cognisant and savvy will sense an impending scenario of burnout where the stress symptoms are signalling that the individual’s existing stress management strategies are slowly decompensating with the current circumstances. There is an immediate need for re-evaluation and enhancement of strategies. Continued denial or postponement of remedial actions will be foolhardy, resulting in deleterious outcomes. 

And what are these deleterious outcomes? From a loose cluster of stress symptoms, it may coalesce into the myriad forms of depressive conditions or anxiety states or addiction problems.  

Along the way it affects your quality of life, disturbs your handling of your present relationships, and jeopardises your work performance. And the nail in the coffin was hammered in in the recent December issue of the Journal of Experimental MedicineStress does make you sick. The Australian research scientifically documented emotional stress effecting hormonal release (neuropeptide Y). This hormone not only affects blood pressure and heart rate, but also undermines the body’s immune system. Illnesses linked to stress include rheumatoid arthritis, multiple sclerosis, Crohn’s disease, diabetes and lupus. 

 

Recognising stress 

Stress signal recognition must go together with the recognition of the pathogenetic factors of stress. Two levels are noted: the direct precipitating factors and the predisposing contributing factors.  

The direct stressors include those found at work, home, the environment and also includes personality factors. Work stressors come as work overload, work mismatch, work unappreciated, under-utilisation and unemployment. Not to forget that your lofty ambitions (appropriate or otherwise) may not always be good for you.  

The work of a housewife should not be underestimated. It involves a balancing of limited resources – time, money and energy – as she markets, cooks, cleans and chauffeurs the kids to tuition and the ailing mother-in-law to the doctor. On top of that she may have to pander to the male chauvinist spouse who claims to be stressed out after his work, demanding her immediate attention.  

Learn to relax … a lazy afternoon in the pool can do you wonders.

Heaven forbid if the woman has to do both a full-time job as well as the house minding duties, with little help at all. 

Home stressors centre largely on relationships. Marital discord, sibling rivalry, parent-child problems (generation gap, rebellious adolescence, etc) and in-law issues are some potential headaches. Hopefully your neighbours are friendly and do not turn on their hi-fi to “twin-tower” levels. 

The environment may offer real or subtle stressors, enough to strain your nervous system. If you have not had your handbag snatched before, then your address in SS2 Petaling Jaya is questionable. Neighbourhoods hire local security guards to help reduce adrenalin and neuropeptide Y levels at night. The traffic jams become increasingly predictable as the national policy (of automobile industry versus public transport) becomes increasingly unpredictable. Then there is bird flu, terrorism, global warming. Sigh! 

Many stress therapists deem personality factors as a main contribution (predisposing) to stress susceptibility. What is viewed as a dreadfully unpleasant stressful situation can be viewed in a totally different way, seen as a challenging event, and hence an opportunity of growth. It is all in the mind they say. So often with unsuitable thinking/attitudinal styles, events are seen negatively as dreadful stressors, thereby straining your nervous system. 

Another high risk factor is loneliness. The absence of social support predisposes the individual to perceiving a load to be more burdensome. Many hands make a task lighter. 

I need to highlight the still-relevant work of Holmes and Rahe in stress events. Too many things happening do result in overload, even if they are pleasant events. Consider this – moving to a newly bought house, younger son getting married and daughter giving birth; all happening within weeks of each other. That’s what happened to my patient! 

 

Coping techniques 

This leads us to the actual techniques of coping. It starts with determining the right amount of stress in your life. Too little, you “die” of boredom; too much, you are overwhelmed and burnt-out. The optimum amount allows for peak performance. This calls for greater sensitivity to your body’s stress signals and greater honesty to your own self. Don’t take in too much. Pace yourself. Postpone it if there are too many things happening. Remember time management. A simple diary works wonders. 

Live a lifestyle appropriate to your means. Don’t keep up with the Jones’! Those who go along the fast lane risk a lot more. Is it worth it? Don’t over-commit yourself to a house, another car, more insurance, another holiday trip. Cut your coat according to your cloth. 

Remember patience. It goes with diligence if you are ambitious. Try to shoot too high, and you will attract unnecessary attention and stress. Be wary of the additional demands due to your lofty ambition. Avoid unnecessary stress, skip the midnight movies, the Premier League matches, the “teh tariks”. If your nicotine, caffeine or liquor intake is rising, then you may need to cut down on your responsibilities to reduce these “stimulants”. 

Regular physical exercises does wonders in cutting out the nervous strain in your system. A minimum of three to four times a week is advised. Brisk walks, jogging or aerobic exercise is as good as any gym workout.  

Another technique is to learn to relax – to slow down and unwind the system. Relaxing hobbies like reading, listening to soothing music, yoga, massage and so on can do wonders for the body and soul. Never forget how therapeutic a lazy afternoon high tea with your neighbours and friends can be. Specific relaxation exercises can be taught by counsellors. 

 

Support system 

This leads us to the need to have good social emotional support, someone whom we can confide in. It can be your spouse, your sibling, your colleague, your counsellor and of course your god. One can never overestimate the immense influence your religion has in buttressing you from the traumas and vicissitudes of life. For many, it really helps to believe in a life hereafter and in a divine being. 

Closely related will be the mental outlook of life and the way (attitudinal style) we perceive events and situations, a kind of self-talk that goes on in our minds all the time. It determines if an event is either an unpleasant stress or a challenging opportunity. You feel dreadfully disheartened when your boss just walks past you without acknowledging your smile, thinking it betokens a bad appraisal report. In actual fact, he is too occupied with his new car that was just dented by a passing motorcyclist.  

This calls for a change in your habitual inappropriate self-talk modes of thinking, which may be weighing you down, causing unnecessary stress. Skilled counsellors can be of great help here to help you to refashion your cognitions. 

Connected to this is the need to accept that life is never a bed of roses. There are many thorns, and often, more thorns and few flowers. Be philosophical about it and you will find life more meaningful. This will greatly contribute to mental toughness! 

Another area to pay attention to is your own needs for affirmation, what transactional analysts call “strokes”. Most of us need strokes (like pats on the back), obtained from appreciated work or grateful colleagues. Excessive reliance from one source is risky. Sudden corporate reshuffles may leave you sidelined, “strokeless” and miserable. Diversify your stoke sources. Join the Rotary club, the neighbourhood Rela, the mosque sub-committee, and so on. 

I do not need to elaborate on the mandatory assets of social skills, delegation skills, budgeting and other technical skills needed for your social intercourse and work. 

And of course should we be afflicted with any physical ailment, take it in stride. It is part and parcel of mortality. Even machines need fixing and regular servicing. Resistant conditions may need additional assistance. They may come in the form of patient support groups. Help is also available from lay counsellors, social workers and other professional counsellors. Many NGOs offer useful inexpensive assistance. 

How can I end but by saying you can cope better than you think with a better understanding of stress and yourself. Extra help is quite easily available when needed. Happy living! 

 

  • This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.  

    The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Assoc Prof Khoo Ee Ming, primary care physician. For more information, e-mail starhealth@thestar.com.my 

    The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. 

    The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. 

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