Michael Bond, consultant
Ignoring stress's social background puts the burden of change on the poor (Image: Steve Liss/Polaris/Eyevine)
Two opposing strategies for dealing with the stress of modern life have been put forward by Dana Becker and Marc Shoen, but which is best?
STRESS is the epidemic of our age, or so it seems: a disfiguring consequence of modern life that we all succumb to from time to time. Yet it is hard to know what it really is, other than a miscellany of physical and psychological symptoms covering everything from anxiety to hypertension. The original medical definition, which, as its derivation from mechanics suggests, is concerned specifically with an organism's response to external pressures, has all but vanished from view.
The effect of the external environment is central to some of the most telling scientific studies on stress, such as those exploring links between wealth inequalities and brain development. But this is not how most of us - or indeed most scientists - talk about stress. The focus has now turned inward, from environmental causes to medical solutions and what individuals should do to cope.
The result of this recalibration, initiated partly by the discovery that stressful experiences affect people's immune systems in different ways, is a vast market for biomedical and psychological interventions. In the scramble for drugs and therapy, the social and developmental context of stress and stress-related disease is conveniently ignored. Children with chronic behavioural issues, for example, are diagnosed with "conduct disorder", a label that pathologises their shortcomings and disregards the deficiencies in care and upbringing that are likely to have contributed to them.
In One Nation Under Stress, Dana Becker argues that the medicalisation of stress and the current infatuation with neurobiology is a disaster for societies, and particularly for women. The problems women face daily in balancing work and family, for example, are so strongly shaped by social attitudes that they have most to lose when social conditions are ignored.
Ignoring the social background to stress, she says, puts the burden of responsibility on vulnerable people to change themselves - to solve their own problems - and it condones the external conditions that lead to their suffering. It allows us to avoid the larger problems. The upshot, writes Becker, is that it becomes "far easier to talk about the 'stressed' African American single mother, say, than to think about the effects of de facto school segregation in our cities, or the effects of discrimination on employment opportunities, or the shortage of affordable childcare".
Becker is a family therapy specialist at Bryn Mawr College in Pennsylvania with a long interest in cultural and historical attitudes to illness. She is a sharp observer of the social and cultural implications of modern attitudes to stress, such as the tendency of researchers and the media to exaggerate the incidence of post-traumatic stress disorder among both civilians and soldiers.
One Nation Under Stress reads like a manifesto against the current order, and few areas of medicine emerge unscathed. Becker sounds angry and occasionally bitter, which can make for a difficult read. She is convincing but also frustrating, for she offers few solutions, short of the need to "make substantive structural changes in our society", such as reducing inequalities.
Here, she makes the radical and clever suggestion that poverty should be viewed (by researchers and funders presumably) as a direct cause of illness and death, since it is well established that poverty leads to a greater risk of hypertension, depression, heart disease and other life-threatening conditions. But she fails to show how that could affect how science is carried out. Does she want money diverted from biomedicine to social sciences? Should we just give up on trying to discern individual differences in the way people deal with environmental and social pressures?
Marc Schoen's Your Survival Instinct is Killing You, on the other hand, offers to "retrain your brain" to better cope with the stresses of modern living. It looks like just the kind of approach Becker hopes to banish.
Schoen is a clinical professor of medicine at the University of California, Los Angeles, and a strong believer in the ability of the mind to influence the body (he's been hypnotising people since he was 16). He identifies what he perceives as a growing intolerance of discomfort as a major factor behind many disorders from insomnia to obesity. The modern world puts us on edge, which triggers maladaptive behaviours that then become entrenched.
He suggests ways to correct this distorted response to stress. Some make good sense, though are easier said than done: wind down before trying to sleep, stop procrastinating, delay your need for gratification, use a breathing meditation, learn to experience discomfort without reacting to it.
Others, such as "take a technology time out", seem dubious because they are predicated on the notion that modern technologies are bad for us. Where's the evidence that using computers leads to "a lower tolerance for ambiguity" and makes us less inclined to tolerate human imperfections?
Such self-help solutions are alluring for the reasons that grieve Becker most: we have so little control over the things dictating our health that the best we can do is adapt and survive. Her enduring point is this is not a level playing field, since those whose living conditions make them more susceptible to stress have the least access to tools that would help.
She hails a much-needed revolution, but until it arrives (or is at least signposted) people are likely to grab at anything that offers help and researchers will no doubt strive to provide it.
This article appeared in print under the headline "Get off my back!"
Book information
One Nation Under Stress: The trouble with stress as an idea by Dana Becker
Oxford University Press
$35Your Survival Instinct is Killing You: Retrain your brain to conquer fear, make better decisions, and thrive in the 21st century by Marc Schoen
Hudson Street Press
$25.95
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