Stressed to kill

Only in the past 20 years or so has science arrived at the no-longer-startling conclusion that stress can make you sick

Only in the past 20 years or so has science arrived at the no-longer-startling conclusion that stress can make you sick. The New England Journal of Medicine in 1998 went so far as to declare that "managing the long-term effects of the physiological responses to stress is critical to survival." Stress may contribute to 85 % of all medical problems, says Connie Tyne, executive director of the Cooper Wellness Program in Dallas, which counsels executives on stress reduction. Fifty-two % of executives will die of diseases related to stress, according to Tyne. That's partly because stress affects nearly every major system in our bodies, creating a laundry list of health problems -- among them diabetes, high blood pressure, stroke, allergies, asthma and colitis.

The clearest sign that there's a stress epidemic can be seen in heart disease statistics. For example, a recent study found that people who get less than five hours of sleep twice a week or more are 300 % more susceptible to heart attacks. Their overall rate of developing heart disease doubles.

Not surprising, stress has been on the rise in the past few years. With the economy gone bad, unemployment rising and the increased threat of terrorism, most Americans report feeling more stress today. It's even worse for executives.

Constant stress does more than damage your health. It destroys your judgment and distorts your decision-making process. Constant stress has been shown to shrink the hippocampus, a region of the brain that controls memory and concentration. "We all know anecdotally that when someone is under stress they don't have the clearest vision," says Tyne. "They don't have the patience to work through a complicated decision. They will have a tendency to abdicate or jump into a decision prematurely."

Business executives don't like to talk about how stress affects them. They are taught that stress is to be accepted, swallowed whole and its effects ignored. Admitting to, or worse, displaying stress is a sign of weakness, an admission of failure. Unfortunately, this belief is widely shared, at least at work.

"You have to carry off the position with dignity and a show of strength in public," says Jim Quick, professor of organisational behavior at the University of Texas at Arlington. "You have to reflect the strength and power of the organisation even if as an individual you're feeling somewhat vulnerable."

This means that businesspeople need to deal with stress on their own -- a lonely and difficult struggle that few choose to face. Denial is easier. But denial inevitably extracts its own toll in health, relationships with family and friends, careers, and even lives.

The Science of Stress

The reason that stress, and our response to it, has so much power over us has to do with evolution, which as far as stress reaction goes, stopped 30,000 years ago when modern man replaced the Neanderthal. Our earliest human ancestor, Cro-Magnon man, needed to control his environment in specific ways to avoid starving or being eaten by predators. To survive, he needed help holding off saber-toothed tigers or bringing down a woolly mammoth for dinner--so evolution favored those who felt uncomfortable alone and sought out the company of others. Knowing the guy in the next cave increased one's survival chances, as did the drive to control one's environment by, say, developing a mental map of the hunting grounds nearby, or by stacking a pile of clubs and rocks near the cave's entrance for protection. Cro-Magnon man learned to hate uncertainty because in his world, surprises were usually lethal.

Today, we hate uncertainty every bit as much as our ancestors did. Read the headlines about September 11, the postwar chaos in Iraq, kidnapped children or even that memo from the CEO cutting the security budget (again), and you'll experience the same reactions that our caveman had when he noticed that the tigers had moved from their usual lair: sweaty palms, an elevated heart rate. No doubt the caveman's worries and stress were nearly constant, but he rarely lived long enough to develop stress-related pathologies such as heart disease.

We do. And science is now linking the daily anxieties and worries that cavemen felt to a much more powerful, primitive reaction to stress -- the "fight-or-flight response," as researcher Walter Cannon dubbed it in the early 1900s. This is the biological process designed to help a caveman out of serious jams such as a saber-tooth suddenly showing up at the door of the cave. The process is extremely effective for its intended purpose: fighting the tiger or running away.

First, the sight of the tiger signals the brain's speed regulator, the locus coeruleus, to shock the rest of the brain into a state of hyperactivity and alertness. The brain then causes a chemical called norepinephrine to be released into the autonomic, or involuntary, nervous system -- turning up the dial on blood pressure and respiration. Simultaneously, cortisol, known as the stress hormone, shoots through the bloodstream to vital systems, turning off those that don't play an immediate role in survival (such as digestion and the immune system) while supercharging others (such as the liver) to provide extra sugar to fuel the brain and muscles. Meanwhile, adrenaline turns up the heart rate and blood flow. It's like gunning the accelerator at a stoplight. The body is revving itself up for what, in the caveman days, was very likely to follow: a life-or-death struggle or a frantic escape.

The Wages of Stress

We've come to accept stress as a normal part of our lives, but there's nothing normal about lighting up our brains with chemicals and shutting down half the systems in our bodies while flooding the bloodstream with sugar. Today, our bodies don't get much of a break from the stress response, which was designed to be an occasional event, not a constant condition of existence. "We've all come to believe that occasional headaches or muscle tension from stress is normal, but it isn't normal," says Tyne. "A normal body doesn't have headaches."

Stress sends a constant flow of sugar into the bloodstream to feed fleeing muscles, but with our less active modern lives, the sugar doesn't get burned up. "Having high levels of sugar in the blood is like having rust in your gas tank," says Tyne. "It flows into every part of the engine." The body responds by releasing insulin to regulate the sugar, but over time the insulin reaction degrades and the excess sugar can cause diabetes and kidney and circulation problems.

The long-term effects of cortisol aren't much better. Our metabolism slows and fat cells, particularly those around the gut, open up to receive more fat -- the body's most storable source of energy. In other words, stress makes us fat. Since cavemen used all that extra sugar by fighting or fleeing, the brain evolved to react to elevated cortisol levels by craving more food, according to leading stress expert Pamela Peeke. And not just a carrot and a rice cracker. Stress wants a burger with fries -- lots of fats and carbohydrates -- so that you'll have the energy stored to run next time. A trip to Mickey D's a survival response? Absolutely. Your body, after all, doesn't know the difference between a tiger on the prowl and a CFO's email. Fight or flight has become "stew and chew," as Peeke calls it.

Indeed, researchers found that Americans surveyed after September 11 said their initial reaction was to avoid food (stress hormones initially suppress appetite so that our caveman wouldn't get distracted while running from the tiger) followed by a tendency to overeat (the cortisol effect).

Not that stress makes it any easier to digest the food you crave. Since eating doesn't have much to do with getting away from the tiger, stress steers blood away from the digestive tract, leading to indigestion, ulcers and more. Similarly, survival is more important than attacking a cold bug, so resources are shifted away from the immune system, increasing the susceptibility to everything from the trivial (colds and allergies) to the tragic -- cancer, multiple sclerosis and lupus, to name a few.

But the most dramatic impact of stress is on the circulatory system. Stress runs the heart harder than a 16-year-old drives a car. The combination of stress hormones such as cortisol and adrenaline keeps the heart running at a high idle. "Emergency room doctors use a shot of adrenaline to get a heart attack patient going again," says Tyne. "Imagine what that does to your heart when it's flowing constantly." But unlike a car, your heart doesn't begin to leak oil or emit the telltale odor of burning bushings as it runs down. It just stops.

For 50 % of the people who get cardiovascular disease, death is the first symptom, according to the American Heart Association.

Stress and Its Antidotes

Though the evidence is still being assembled, many scientists now believe that learning how to short-circuit the fight-or-flight response may be as important to our health as exercise and diet. For example, a recent Duke University study of about 100 heart disease patients divided them into three groups. The control group just had regular medical checkups, another had supervised aerobic exercise classes three times a week for four months, and the third group received stress reduction education once a week for 90 minutes during the same period. After five years, the first group had experienced 12 heart attacks, the second had seven, and the third had three. Results such as those are slowly convincing doctors to take a hard look at the mental state of their patients.

The best antidote to stress is exercise. And viewed in the context of the chemistry of the fight-or-flight response, that makes sense. Exercise is simulated flight -- a chance for all the sugars and hormones in the bloodstream to be used for their intended purpose. Exercise also feeds our brains some feel-good drugs such as dopamine and beta-endorphin -- evolution's reward for safely escaping the tiger.

Avoiding the stress response itself -- feeling less stress in the first place -- is a lot harder. To understand how to control stress, you have to think yourself back to the caves. Three major psychological factors made cavemen's stress hormones flow: lack of control, fear and isolation. All three have modern correlatives.

The CSO role is tailor-made for feeling out of control. Something can go seriously wrong at any moment, CEOs can change their minds and stop funding your work, businesspeople can resist your risk assessments for no good reason. CSOs have a vast amount of responsibility but little authority for controlling outcomes. This is what psychologists call low decision latitude.

"This creates a sense of chronic powerlessness," says Scott Stacy, clinical program director for the Professional Renewal Centre, which counsels executives on stress. "You can't have an effect on what you need to have an effect on to generate a sense of (internal) calm." This leads directly to health problems. According to a 1997 study of about 3,000 Canadian public-service executives, those with low decision latitude saw their risk of illness increase anywhere from 30 % to 1,700 %.

To see the theory in action, just ask a top CSO if he would like to report to, say, the head of audit instead of to the CEO. Put in stress terms, reporting to the head of audit reduces a CSO's control over the environment because it puts someone between him and the ultimate influencer over the company. CSOs also feel increasingly out of control as their workload grows and affects more people. That's more people the CSO can't control. Users don't have to do anything the CSO asks.

The control-related stress conditions CSOs face are shared by another C-level player: the CIO. Joe Gagliardi is the CIO at Unisa, a distributor of women's shoes and accessories. When a custom manufacturing resource planning project he was overseeing at Unisa had its funding withdrawn earlier this year, Gagliardi not only lost control over his project but also over the expectations of users. "I had a bunch of half-developed applications and a bunch of half-trained developers, and I tried to deliver what I could, but it wasn't working out," he says. Disappointed departments began criticizing. So Gagliardi changed everyone's expectations, including his own. "I said we're going to stop the project and go into maintenance mode on the legacy applications until times improve," he says. "Now when my developers manage to deliver something new, it's a pleasant surprise for everybody, and they're happy to get it."

Gagliardi says that since engineering this attitude adjustment, his stress level has gone way down. Psychologically, he achieved the control over his environment that he needed to turn off his primal sense of anxiety -- and his physiological fight-or-flight response.

Stress in Isolation

It's much harder for CSOs to escape the isolation that cavemen learned to dislike so much. CSOs who show the signs of stress send it rippling through their staffs like a rock thrown into a pond. Worse, those who confide in their employees about the stress they feel risk having it used against them. "You need for your staff to know that you're human; you don't need your staff to know that you're weak," says the University of Texas's Quick.

Joining a networking group can help relieve the loneliness, as can a deep discussion with your spouse. But neither of these palliatives can change a CSO's reaction to stress or offer ways to relieve it.

Indeed, CSOs who feel isolated tend to alienate those around them who could offer support. "No one understands what I'm going through, so there's no use in talking about it" is a refrain that Lee Smithson, a psychologist and executive coach for consultancy RHR International, hears a lot from executives she works with.

For one of Smithson's clients, who requested anonymity, stress on the job and stress at home marched in lockstep. "He was constantly having to bargain with his wife for time, and he canceled two vacations with her and their children," Smithson says. "His wife had become hardened to the whole situation." When his company merged with another, he told his wife that he wanted to apply for a higher paying but more demanding position at the new company. "She hit the roof," says Smithson. The man's wife wasn't the only unhappy one. The new company told him that unless he revamped his approach to work and the way he handled stress, he wouldn't get the job. "He was functioning as the consummate problem-solver," says Smithson. But his obsession with controlling his stress by doing everything himself had alienated him from his employees, who wished he would delegate more often, and from his superiors, who could never track him down for important meetings. And when he did attend, he was so distracted that he usually sat in silence.

It all came out when the new company's management asked the man to submit to a 360-degree performance review. He was stunned with the results. He was far from being appreciated -- the 12-hour workdays he was putting in and the evenings he spent sifting through the email that had arrived while he was off putting out fires were viewed as a problem. "He had never gotten that kind of feedback before," says Smithson. "They said he wasn't strategic and therefore wasn't qualified for the job."

Like many hard-charging professionals, this man was in denial. He had become withdrawn. Ironically, while attempting to project strength, he was actually advertising his weakness. Alone in his office cave, he had doomed himself to become some tiger's lunch.

Fortunately, spurred by the review, he and Smithson were able to create a plan for him to distribute responsibility among his staff and become more involved in business strategy. Ultimately, he got the job he coveted.

And last spring, he took his wife and two kids to Disney World -- along with a cellphone.


12 Warning Signs That You're Stressed Out

1. Your stomach hurts; your head aches; you catch colds frequently.

2. You feel emotionally numb.

3. You snap at people: colleagues, your spouse, your kids.

4. People tell you they're worried about you.

5. You feel that if you take on one more task, you're going to blow.

6. You feel like quitting your job. Often.

7. You feel helpless, out of control.

8. You know that whatever you do, things are bound to go wrong.

9. And you know that when they do, you'll be the only one who cares.

10. You feel guilty about taking a vacation.

11. You know the problem: It's everybody else.

12. You can't stop thinking about your work. Ever.

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