The patient said he fell off a roof, but the nurses were onto it. They’d seen him before, when he’d rocked up to our emergency department a few weeks earlier angling, under false pretences, for a taste of our superior brand of painkiller. As the consultant physician, I naturally took charge and diplomatically, or so I thought, raised the possibility with him that his injuries were complete bullshit.
He answered me with a fist that rose, in a perfectly defined arc, from the opposite side of his bed, greeting my jaw with sufficient force to launch it, and me, onto the little old lady berthed in the next cubicle. When my lights switched back on he’d done a runner, and my resolve to exit the profession had ratcheted up several notches.
Trauma docs do not, of course, have a monopoly on stress. Most of us, at some time or other, weigh up suffering the slings and arrows versus slipping out the side door to a gentler life. New research is, however, upping the stakes on how we deal with stress, linking it to a bunch of seriously unpleasant diseases. And it seems both the cause and the answer to it all reside largely above our necks.
In 2016 George Slavich, a stress researcher at University of California, Los Angeles (UCLA), US, published a review article that, in otherwise plain academic prose, rounded to a startling conclusion. The mere perception of being overwhelmed by life’s demands switches on the body’s system for fighting infection and injury.
Now, as any nervy public speaker will tell you, stressy gigs turn on a tap of hormones, adrenaline being the most familiar, that get you sweaty and palpitating in readiness to combat a notional foe. But the very same chemistry, it turns out, also marshals troops of the body’s immune system – white blood cells and their ilk – in preparation for a rear-guard inflammatory response.
Which is all very perplexing, until you realise it makes perfect evolutionary sense.
If your early warning system flags a marauder, there’s a good chance you’re going to get hurt, in which case having the infection-fighting and wound-healing systems on standby is just sensible housekeeping. The problem, as Hamlet reminded those of us paying attention in Form Six English, is that the mind is a prism with an infinite capacity to amplify threat. Or, as the disturbed prince put it, “there is nothing either good or bad, but thinking makes it so”.
And this, as Slavich explained in a recent interview, is a distinctively human peccadillo: “Animals only mount a biological response to stress when danger is actually present. But humans have the ability to manifest danger in their minds even when it’s not present.”
Which means that for people who feel chronically stressed the stand-down order never comes, the adrenalin tap keeps dripping, the inflammatory forces surge on, and the end-product is a swag of diseases, including heart disease, arthritis, asthma, and diabetes, that all have inflammation at their core.
And, yes, it gets worse. It seems inflammation also riles up the black dog.
Adding to a growing pile of data, a 2017 study found people with major depression had higher levels of inflammatory markers than healthy controls. This is driving research, including a trial called ASPREE-D, headquartered in Melbourne, Australia, to see if anti-inflammatory drugs such as Aspirin can beat the blues. But why would a system designed to take down infection end up taking out your good mood?
Scientists are still figuring that out, but here’s one theory to chew on. To start, be aware that social rejection and isolation are two of the most potent stressors around. They also happen to ramp up inflammation and get people really depressed. One favoured explanation is that getting booted out of your tribe makes it more likely you’ll end up predator fodder, so nature switches on inflammation to deal with those nasty gashes.
But why get all sooky?
The idea, as Miller and Raison explain in a 2016 article in the journal Nature, is that inflammation is actually causing a classic “sickness behaviour” – comprising social avoidance, irritability, lethargy and so on – that sounds a lot like depression (think duvet-diving and DVD marathons when you have the flu). And while being miserable and antisocial is no fun, it is potentially helpful – if you need to conserve precious energy for important things such a healing wounds.
The biology-bending upshot is, as Miller and Raison put it, that “the body mounts an immune response not against a pathogen, but against a threat to the subject’s self-esteem.”
All of which is exacerbated by the fact that, as a new field called “social genomics” is showing, those changes are happening right down at the gene level. Another UCLA researcher, Steven Cole, has found that chronic loneliness changes the expression of around 200 genes, many of which dial up inflammation. The obvious conclusion would be that stress is harming us at a systems level that we couldn’t possibly influence. Which would, of course, be wrong.
In 2016 Slavic’s team published a study that got people to view a video clip of a two-day-old boy crying, rather understandably, while being circumcised. Just the stress of watching brought on inflammation, but people who were better at using their thoughts to control their emotions had a smaller inflammatory response.
And in a study that appeared last July, Cole’s team found that people randomised to do (non-random) acts of kindness – writing a thank you letter, or doing someone else’s chores, for example – had reduced expression of genes that fire up your white blood cells, the infection warriors.
Add this to existing research and it looks like getting a bit of stress-busting kit on board, in the form of mindfulness meditation, yoga, or cognitive therapy – not to mention getting out and about to do a bit of cheer-spreading – doesn’t just make you feel good, but lowers your inflammatory profile, and probably your risk of chronic disease too.
So, should the conflicted worker press on against a sea of troubles, or end them by wimping out and doing something else altogether? For my two bob, I left medicine, sought renewed meaning as a philosopher, and now find myself tapping away as a try-hard journo.
Which was all fine until a (no doubt well-meaning) colleague directed me to a recent survey that ranks jobs, from one to 200, on how much they suck. Coming in last, for the third year running, was newspaper reporter, with job prospects, pay and, yes, stress levels all red-lining into the horror zone.
I guess some people never learn.
Paul Biegler is a philosopher, physician and Adjunct Research Fellow in Bioethics at Monash University. He received the 2012 Australasian Association of Philosophy Media Prize and his book The Ethical Treatment of Depression (MIT Press 2011) won the Australian Museum Eureka Prize for Research in Ethics.
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