In our two previous columns we have shown that having the body’s response to stress continually turned on is like living in a mosquito infested swamp. Stress may not give you malaria, but having the stress-response turned on all the time can make the body vulnerable to a number of diseases. We reviewed how the stress-response affects our cardiovascular system, metabolism, digestion, growth, and sex. In this final installment we would like to review how the stress-response affects our immune system, memory, and aging. Additionally, with these facts before us and given that our profession creates disease risk conditions, we will discuss what changes we may need to make in order to stay healthy.
Some of the first research into the effect of the stress-response on the body’s immune system occurred almost 60 years ago. Since then, our knowledge about the importance and potency of the effect of the stress-response on the immune system has grown. Immune defenses are brought about by a complex array of circulating cells called lymphocytes and monocytes. The release of glucocorticoids halts the formation of new lymphocytes in the thymus and indeed can cause lymphocytes to actually be extracted from the circulatory system. In addition to this well-established, immune disabling effect, recent experiments have shown that stressors can suppress immune system function in other ways independent of glucocorticoid secretions.
One of the newer areas of research is that of the effect of stress on memory. Memory is not monolithic. There are several different types of memory, most notable short term, long term, and remote memory. Just as there are different types of memory, different parts of the brain are involved in memory storage and retrieval. Memory is not stored in specific neurons, but in the patterns of excitation of vast arrays of neurons.
We know that initially stress heightens mental acuity as well as energy. More oxygen is delivered to the brain (as well as the muscles to be used in fight or flight). The difficulty is in the extended stress response. While the initial release of glucocorticoids is mildly helpful to the brain, the extended release of glucocorticoids causes the array of neurons that form memory to actually shrivel and atrophy. New evidence also shows that glucocorticoid exposure may also compromise the ability of neurons to survive neurological disease. Among humans who have had a stroke, the higher the glucocorticoid levels at the time the person comes into the ER, the more neurological damage and memory loss there ultimately is.
The same research that suggests that the stress response can damage our memories also suggests that it may affect aging by accelerating aging of the brain. In addition, the older one gets, the longer it takes the body to reestablish its normal equilibriums. As we get older we become less flexible physiologically as well as psychologically. Cardiac muscle gets stiffer. The system becomes less able to tuck and roll when stress comes along. Aged organisms not only have trouble turning off the stress response after the stressor is removed or has ended, but they also secrete more stress-related hormones even in their normal, nonstressed state. Although there is limited research with humans, animal research suggests that glucocorticoid neurotoxicity can, under certain circumstances, accelerate aging.
We have now taken a look at the various bodily systems in which the stress response can lead to disease and dysfunction. Know also that, while the repeated stress of complex trial work may make one person a great lawyer, in another attorney it may create the conditions for illness. One of the hugely variable factors is personality. The level of stress we are under and the nature of our personalities affect the context in which disease arises at the cellular level.
Some folks are good at modulating the effects of stress and others are not. Those that are good do so because of natural tendencies in their personality to do the sort of things that we know psychologically decrease the effects of the stress-response. While we have learned that stress causes the heart rate to go up and glucocorticoids to be secreted, our subjective experience of stress is usually that we feel frustration. Good outlets for frustration are an excellent way to decrease the negative effects of the stress-response. Physical exercise is one of the best ways to metaphorically sweat out the increased glucocorticoids in your system. We are all familiar with inappropriate frustration responses, when you get home from a stressed day at the office and yell at your spouse and kick the dog.
Social support is another proven important way to reduce the impact of the stress-response. Social support comes when you are in relation with other people, those with whom you can discuss exactly what is going on with you and be heard without judgment. This can occur in both structured and unstructured settings. Studies have also shown that people who are socially isolated have overly active sympathetic nervous systems. This leads to the likelihood of higher blood pressure and increased risk of heart disease to go with the risk from the stress-response.
A third important personality trait is how one deals with unpredictability. Those who need greater predictability are less able to moderate the effects of the stress-response. If your control needs are high over areas of your life in which you have no control, then the stress-response will often remain stuck in the on position. At the core of 12-step programs is development of a way to moderate control needs, to adjust to the ultimate reality that everything always changes.
Conversely, the ability to have control over certain things, to have a passion in life, to have a purpose is also an important psychological factor in ameliorating the stress-response. Somehow the stressful things of life take less of a toll when there is a course set, especially a flexible one, for one’s life direction.
The good news then is that there are psychological ways of being that one can have by natural predisposition, or that one can develop, that lessen the impact of the stress-response, e.g. attitude toward exercise, tendency to emotionally isolate or not isolate, and attitude toward unpredictability. The bad news is that these psychological factors are so powerful that they can trigger a stress-response on their own or make another stressor much more stressful. The research of Redford Williams, a Duke University physician, has shown that one of the biggest internal stressors is hostility. Connected to hostility as a stressor is the sense of being time pressured.
In our profession, our lawyer culture and technology have created many of the stressors that surround our lives. The first step is to be aware of them and our own reactions to them. What are our strengths and weaknesses for coping with them? For those that are problematic we can develop strategies so that the effect of the stress-response doesn’t dominate our lives. Once we have had a cardiac arrest, once a tumor has metastasized, once our brain has been badly deprived of oxygen, little about our psychological outlook on stress is likely to help.
– by Don Carroll and Ed Ward
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