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The neuroscience of stress management.

These days it seems everyone is stressed. Studies in most countries seem to (similarly) report that almost a third of populations report feeling stress. Covid restrictions, cost-of living crises, and crime appears to be taking its toll everywhere. Record number of people are also leaving healthcare workforces such as medicine that already struggles with lack of personnel. What is stress? What does it do to us and how do we develop resilience?

Mental health receives more attention these days, even if we still don’t have the answers. However, we know that what is going on in our minds—real or imagined—has complex and substantial implications. As I wrote in my book, The Genetics of Health (Simon and Schuster, NYC):

“…Before a trip to Washington, DC, several years ago, I was invited to dinner by the US ambassador in New Zealand, and I asked for some travel advice regarding my destination. “DC has a lot of crime,” I was told. “Stay at a hotel around Dupont Circle, and if you take the Metro, stick to the blue line; avoid the red line. Even areas around the White House can be unsafe at night.” I made some mental notes.

Once I reached Washington, I enjoyed my time in DC. Per square mile, Dupont Circle must have the highest density of independent bookstores. Bookstores are a good hangout—even better when they have a brasserie attached as a bookstore I found did. I found Steven Pinker’s book, The Better Angels of Our Nature, in which Pinker argues that even with terrorist threats and greater migration, we live in the safest of times. He can’t be right, I thought. After all, even the American ambassador had advised me to avoid Washington, DC, Metro’s red line after dark. 

Pinker’s book compares recorded homicide rates: in fourteenth-century London, the murder rate was about 100 per 100,000 people; now it is about 2 per 100,000. In late sixteenth century Rome, it ran between 30 and 70 per 100,000 people; now it is closer to 1. In 2014, in Washington, DC, there were 15.9 murders for 100,000 people—still much safer than Rome or London in the fourteenth and sixteenth centuries. If we live in the safest of times, why are we so anxious about danger? George Bernard Shaw once said, “There is always danger for those who are afraid.”

I have been in medical practice for 36 years and have run my own practice for 26 of them. My publishers told me that I was the only person ever to have written works of literary fiction, non-fiction, poetry, and medical textbooks. Many a newspaper article has asked if I was New Zealand’s busiest man? But annoyingly for my staff –on a Monday morning, or even at the end of a long day—I always approach every day with a “bring it on” positivity. Until Covid-19 affected me for a few days in 2022, I had never had a sick day due to illness in my 35 years in medicine which was considered some kind of a record. Was it my attitude towards my work, and only doing things I am passionate about the secret to good health?

Medicine can be stressful as a career as there are always unexpected diagnoses, and results to deal with. Medical school has a relatively high dropout rate if one considers the investment one has made in time and money. Doctors and dentists top suicide rate charts for professions. It is, in my view, because we are not taught to handle stress.

Stress causes you to produce adrenaline (epinephrine), noradrenaline, and cortisol in that order. Essentially it triggers a fight-or-flight response, and in understanding this physiology one can harness its power. There is a distinction between acute (short-term) stress and chronic (longer-term) stress; the former may indeed be beneficial. After all, the stress response is an evolutionarily learned response to a particular memory, and many of the chemicals secreted help us cope with danger and adapt. Animal studies have shown that significant but brief stressful events cause stem cells in the brains to produce new brain cells and improve performance. In contrast, when one is under stress for long periods, the chronic stress elevates glucocorticoid stress hormones levels, and these steroids over time suppress our immune system. However, low doses of the stress hormones in short bursts can help protect from infections. Short term stress stimulates interleukins that boost our immunity and protect against illnesses; chronic stress, in contrast lowers immunity and increases inflammation.

I have always found the best way to deal with stress is to work algorithmically and divide stress into things you can control, and things you cannot. Things you can control are your actions, the jobs you choose, or people you hang out with. The things you cannot control are what others think about you, envious or malicious comments, and what others do (if your child or family members do not listen to your advice for example). If things are within your control, don’t whinge but act. If things are outside your control, there is no point fretting anyway. 

The benefits of acute or mild stress are well known. Even in pregnancy. A study done at Johns Hopkins followed 137 women from mid-pregnancy to their children’s second birthdays. The study found that babies born to women who experienced mild to moderate stress during pregnancy had better developmental skills by the age of two when compared to those kids whose mothers had no stress. But too much stress on a daily basis can be bad. Chronic stress has been shown to increase all-cause mortality independent of if one had a family history or not.

It now transpires that how we think about stress makes all the difference. I have often written about skin being our only universal organ, the only organ all creatures have. Starfish have no hearts, sea squirts have no brains, but everyone has skin! For the first 1.5 billion years, all life forms had only one cell, but they still needed a semipermeable membrane enveloping them for life. At a basic level we are all covered by skin which envelopes a whole bunch of organs, each with its own liquid flows, and cells with chemicals all over the place. So if stress is nothing but a change in dynamics, so why should we take it personally, or consider it individually dangerous, right?

Therefore even faced with the same bad situation, if you think stress is bad for you, then it becomes so. If you think stress will not cause you harm, it turns out that this positivity can help you develop resilience. A landmark study found that it is indeed all in the mind. Specifically, the study found that if you reported feeling stressed and thought that stress affected your health a lot, it increased the risk of premature death by as much as 43%! In contrast, if you underwent the same stress, but felt it would not affect your health, it did not affect your lifespan at all. There you go. These people faced the same stress but opined that it could not hurt their health. And it didn’t!

Stress responses evolve to protect us from danger. But even when there is no threat, we use our human imagination to good effect. Hormones, chemicals, and biofeedback mechanisms are all algorithms to sort the human condition—actually every animal’s problem—of how to survive for long and be healthy. Happiness is not evolutionary. Survival is. This is the key to understanding the problem that at once is both edifying and also humbling: stress. The secret to handling pressure is almost Shakespearean. When faced with stress, even when it is something you cannot control, the best option for good health and a long life is to think of it as much ado about nothing. Cellular choreography about imagined hazards that no longer need the site-specific, hormone-driven, and biological system-driven seething that shatters our calm. In changing our thinking that it cannot damage us, then stress –like the panic that bubbles underneath our psyche—ends up powerless and defeated. 

Many years ago, I used to run an independent bookstore café, Baci Lounge. I remember seeing a book called ‘Living with A Black Dog’ — Matthew and Ainsley Johnstone’s illustrated book referring to depression. If one were to consider stress as a brown dog, the trick to dealing with it is in realising that it may have a bark but no teeth to bite you. So, don’t worry. Be happy.

THE END.