The Yale Journal for Humanities in Medicine

Bio/psycho/social/tecnho/spiritual Considerations
Regarding the "Human Stress-strain System"
in Chronic Disease Processes

Michael Basso, Jr.
cthha1@ix.netcom.com

Excessive and non-productive stress is one of the most important public health issues on our planet, costing more than 200 billion dollars annually (5) in the US alone. More than 50 percent of all medical visits (2), about 80 percent of all workplace accidents (10), and millions of lost workdays have been attributed to excessive stress. Nearly 100 million people in the US take medication for stress and the lost opportunities attributed to excessive stress are socially and ethically relevant to the highest degree.

In this brief article, I plan to share some of my views on the neuro-pathophysiology of maladaptive stress and some related social ramifications. Excessive stress can be caused by social factors, while it may also lead to social problems. I think that the healthcare provider of the present, as well as future providers, can find no area of study to be more important to her/his practice than  ‘stress leadership.’ Of course, a leader is someone that people are voluntarily willing to follow, is focused upon prevention, and is often perceived as a teacher.

The ‘stress leader’ / physician of the future will be adept at not only preventing stress-related illnesses, but will have a keen grasp on both it’s etiology and morphology. I think that this humanitarian of the highest degree will, if trained properly, follow a bio/psycho/social/techno/spiritual model and his/her patients will benefit greatly from this approach. The ‘human side of healthcare quality’ will be a broad-based approach where psychological and social factors will be duly considered along with the biological ones. Intelligent uses of science and technology can be important aspects of multi-factorial stress leadership designs. However, inclusion of spiritual considerations will provide well-rounded approaches towards stress related disease processes and the human beings impacted.

I believe that human based practices can be the only effective ones, and that a deep understanding of underlying human pathophysiology is an important part of the equation. A multi-dimensional system can be the only true holistic one and would include factors with are both genetic and environmental in nature.

The humanitarian / stress leader will need to know how and why initial sympathetic excitation can readily escalate to pituitary-mediated release of adrenal stress hormones in an attempt to ‘prepare for battle’ or take flight. I think that a clear understanding of the biochemistry, physiology, and pathology of chronic disease associated with prolonged stress is well worth the effort.

From the psychobiological perspective, the curiosity of a healer-scientist cannot be better exercised than by understanding stress-related pathophysiology. Some may be intrigued by the intricate connections between sensory inputs and both cortical and sub-cortical structures within the ‘stress cascade.’

I am certain that a deep understanding of hippocampal and amygdala based memory systems could shed light on many new and important steps in our understanding of stress related trauma and how to deal with its effects. The importance of memory formation occurring during severe trauma, including the ‘surgical memory,’ can shed insights of considerable social relevance. 

The successful physician of the future will also understand stress-related relationships between the immune system and the nervous system. I suspect that the important field of psychoneuroimmunogy (8) has yet to reach its full potential in our understanding of neoplastic (cancer) and infectious disease processes and their progression. What greater understanding can those with this mindset have than to truly understand the reciprocal relationships between the neuron and the cells of the immune system?

For example, it is now known that both neurons and immune calls have receptor sites for neuropeptides and neurotransmitters. A pragmatic understanding of how and why excessive stress hormones may weaken immune function is of considerable social relevance. Conversely, secretions from immune system leukocytes have influenced the growth of neuronal structures and may even play a role on how we ‘remember’ our illnesses at very deep levels.

The biological and psychological aspects broached are only part of the ‘human stress-strain system.’ Thwarted intrinsic motivation, coupled with a variety of social complications, may be the missing link to a considerable amount of baffling and chronic disease processes, including some gastrointestinal (3) and endocrine ones. The stresses produced by these often-overlooked factors can produce life-threatening strain within the human organism. Meditation, fitness, and exercise are rapidly becoming the treatments of choice, among even the most conventional of practitioners. But these wonderful approaches are not enough!

Maslow’s hierarchy of needs, while being simplistic in nature, illustrates another piece of the broad-based stress-strain system that ALL responsible practitioners would surely be interested in. We all have needs, beginning with the most basic such as for food, shelter, and security. Once these basic motivators are fulfilled, our social needs become paramount, followed by those associated with self-esteem. Finally, at the top of the hierarchy, is our need for self-realization.

When any of these needs are thwarted along the way, there is a dissonance between what we perceive that we ‘need’ and the fulfillment of those needs. This stress scenario can become much more complicated when our expectations are not realized. In my opinion, these unfulfilled needs can cause SEVERE and even life threatening stress when we perceive that we are being treated inequitably. Even the most powerful drugs, or the most well meaning ‘pseudo-holistic’ stress management regimes, may not be enough.  This is part of what cardiovascular disease and cancer live on, while ironically being the least understood aspects of the stress-strain system! In the worst case scenario, the complications of unresolved extrinsic conflict can potentially bring the patient over the edge.

Diet, exercise, and relaxation processes can do wonders when intrinsic and extrinsic conflict is managed simultaneously. Either approach by itself is only a partial solution, considerably less effective than the sum of both approaches working in harmony.

I think that any doctor, nurse, or allied health care professional can benefit tremendously by understanding the social dynamics of the human stress-strain system.

From a broad based ‘technical’ perspective, the human stress-strain system can be only be managed in ways that are suitable for the unique patient, including practitioner- patients in question. For example, those who need to be cooped up inside may benefit greatly from important contributions within the living environment itself. Full-spectrum lighting (1) and natural light transmitting windows and skylights can do wonders during the winter months. Innovative uses of art, color and music can be among the most important considerations in minimizing environmental aspects of stress. For some folks, the creation of art itself may do much to relieve tension. In fact, I think that pursuing these activities may even help to strengthen our immune systems in ways yet to be discovered!

Proper air ionization (the electrical charge present in the air itself) can also do wonders for overworked patients (9). The abundance of negatively charged air is one of the reasons we feel so great in pine forests (negative charges are emitted through sharp points like those found in pine needles), on mountaintops, and at the seashore. Negative ion generators, indoor water falls, and even properly placed plants can change the electrical characteristics of the air itself towards harmonious human existence.

I think that the stress-strain system, including its underlying neural structures and biochemical cascades, can only be understood completely by understanding multicultural diversity and spiritual aspects of the overall human system. For example, the well meaning and innovative clinician can even cause significant stress by prescribing diets that are not in alignment with the individuals cultural and religious background. Even the choice of the practitioner her/himself may be contribute in a variety of ways to stress of the patient if social and cultural aspects are not carefully considered (6).

From another angle, hope, trust, and a sense of being in alignment with something of spiritual significance can do much to prevent or alleviate stress. At a deeper level, all of the stress and strain management considerations discussed may have focal points of interest within the human system itself. For example, I think that the little understood ‘Godspot’ within the medial temporal lobe of the brain (7) may have much to do with how we process many stress-relieving approaches discussed. This includes art, music, meditation, biofeedback, and prayer. Even our perception of cozy and inspiring architecture may help us to feel ‘de-stressed’ when this spot vibrates at lower brainwave frequencies.

I believe that even the choice of literature and poetry, including that with spiritual significance, can have significant and even perhaps measurable impact regarding its impact on the human stress-strain system. There is a vast area of untapped potential between the areas of neuroscience and the arts and humanities that can do much to alleviate stress related disease.

I strongly believe that ‘stress-strain’ related mechanisms are behind great many chronic diseases. Broad-based considerations for intrinsic and extrinsic conflict are major factor in much of this disease.

Ethical and valid uses of the sciences, technology, and spirituality will provide great benefits if framed within the context of multicultural diversity and human value systems. Innovative uses of the arts and the humanities are sure to play significant roles as our understanding of human stress and strain continues to evolve!

References

1.) Basso. Jr., M.R. (2001). Neurobiological Relationships Between Ambient Lighting and the Startle Response to Acoustic Stress in Humans. International Journal of Neuroscience vol. 10   F

2.) Calandra, Bob (Mar, 2003). Be a Stress Buster: Workshops on Dealing with Emotions in the Workplace can Reveal Anxiety-reducing Secrets. The Scientist. V17 i6 p52(2)  

3.) Folks, D.G. (2004). The Interface of Psychiatry and Irritable Bowel Syndrome. Curr Psychiatry Rep. 2004 Jun;6(3):210-5. E

4.) Frazer, Nicole (2002). Family History of Hypertension is Related to Maladpative Beharioral Responses as Well as Exaggerated Physiological Reactions to Stress, According to Study. APA press releases, May 12.

5.) Heeg, Theresa (Oct, 2003). Don’t Let Stress Make Your Workplace Unhealthy. Aspen Publishers: Patient care management.  v19i10p5(2)

6.) Linnard-Palmer L, Kools S. (Jan, 2005). Parents' refusal of medical treatment for cultural or religious beliefs: an ethnographic study of health care professionals' experiences. J Pediatr Oncol Nurs. 2005 Jan-Feb;22(1):48-57.

7.) O’connor, Joe. God and the Brain. Is Belief a Psychological Condition? A collection of great articles on the subject. http://atheistempire.com/reference/brain/main.html

8.)  Quinlan, Jay. Psychoneuroimmunology. http://www.nfnlp.com/psychoneuroimmunology_quinlan.htm#intro

9.)  Ryushi, T. et al (1998). The Effect of Exposure to Negative Air Ions on the Recovery of Physiological Responses after Moderate Endurance Exercise. Int J Biometeorol. 1998 Feb;41(3):132-6.

10.)  Safety Compliance Letter. (Aug, 2003). Creating a Safe and Stress-free Workplace. Aspen Publishers. i2431 p5(2)

Published: February 5, 2005