stress

Worried Sick: How Stress Hurts Us and How to Bounce BackGuest poster Deborah Carr is professor and chair of the Sociology department at Rutgers University. Her latest book is Worried Sick: How Stress Hurts Us and How to Bounce Back (Rutgers University Press, 2014). I was curious to hear her thoughts on stress and the academic summer, and here’s what she had to say!

For many, summer is a time to exhale, take it easy, and enjoy lazy days at the beach, when one’s toughest decision is whether to read a guilty-pleasure novel or to catch up on back issues of the New Yorker. At least that’s how it looks in the movies. In reality, the gentle breezes of summer often are accompanied by overly ambitious “to do” lists that will never be achieved, and unrealistic (and ultimately disappointing) expectations for family time. Summer is unwittingly a pressure cooker for stress, when our lofty dreams are far removed from reality.

For academics, summer is viewed as the time to finish one’s magnum opus that got left untouched during the school year. Ask an academic what they’re doing this summer, and a nontrivial number will say “finishing my new book.” Although that may be the dream, many (especially working parents) know that uninterrupted work spells can be a rarity, when other duties of summer – like home repairs, child care, and caring for aging parents – emerge. For others, the much anticipated high point of the summer is a family vacation. Despite visions of songs around the campfire and late-night heart to hearts, most of us will experience family vacations in precisely the way we’ve experienced every other family visit – the good, the bad, and the ugly. And as our family members grow older, they simply become amplified versions of their earlier selves. Although the “good news” is that kind and supportive family members grow more so, the bad news is that the cranky control freaks become even more intense.

Mental health researchers have long recognized that it’s not just the presence of negative – illness, job loss, marital spats, traffic accidents – that can impair our psychological health. It’s also the absence of positive, or experiencing less positive than we had earlier hoped for. As far back as 1890, philosopher William James wrote that self-esteem is a result of the balance between one’s actual successes and what one hopes to achieve. More recently, psychologist Alex Michalos’ “multiple discrepancy” theory says that gaps between what we have and what we want are distressing. Psychologist E. Tory Higgins’ “self-discrepancy” theory argues that when there’s a gap between our “actual self” (who we are) and our “ideal self” (who we want to be), depression can result. Yet when there’s a gap between our “actual self” and “ought self” (who we think we should be), guilt and anxiety may emerge. That partly explains the fleeting (though inevitable) feeling of failure when summer ends, and we have not completed our book manuscript, or the long-awaited herb garden remains a dirt mound, or we never made it past the “couch” phase of our “Couch to 5K” fitness dream.

Yet research also shows that most of us overestimate how fun, rewarding, or scintillating an experience will be. The reality simply can’t live up to the dream. Harvard professor Dan Gilbert has documented that most adults are bad at “affective forecasting,” or predicting how happy (or sad) a future event will make them. Even if the long-awaited family trip to the Grand Canyon is joyous, it won’t likely live up to the boundless euphoria we had anticipated. This tendency to overestimate some future encounter is so common that The New York Times Magazine gave it its own name: “tadventure,” or an exciting adventure that doesn’t quite pan out.

Is it inevitable that come Labor Day, we’ll be disillusioned, disappointed, and too despondent to rev up for the upcoming school year? Not necessarily, but it takes some cognitive energy to maintain a positive sense of self. First, avoid social comparisons, or comparing your own accomplishments with others. Many people, especially ambitious types, compare themselves with those at the top of the achievement hierarchy; when we compare ourselves with those at the top, a feeling of self-doubt is inevitable. Second, shed the tendency to “ruminate.” Rumination is continually replaying the disappointing experience in our minds and stewing in our own sadness. Ruminators often intensify their anxiety by fixating on all the things they feel they did wrong.

Third, “just say no” when asked to take on another task that might put you over the edge. Turning down invitations gives us more time to work on the tasks at hand. Saying “no” to an opportunity may lead to that opportunity being passed along to another person who may want or benefit from it more. By “paying forward” a potentially rewarding opportunity, we might also bring ourselves a short-term mood boost.

Fourth, take solace in knowing that as we get older, we’re better able to roll with the punches and each perceived slight or failure takes less of an emotional toll than it did in our younger years. “Emotional reactivity,” or how strongly we feel the slights in our lives, diminishes with age. With age also comes the wisdom that the key to happiness doesn’t lie in adding another publication to one’s CV, or another half-marathon medal to one’s collection. Happiness comes in the process of the pursuit, rather than the end goal.

But changing our thought processes isn’t the panacea. Summer stressors are rooted in major societal problems. Employers forced to run “mean and lean” are demanding more and more work from their employees, under shorter and shorter deadlines. Those lucky enough to have stable jobs often find that their responsibilities spill over into nights, weekends, and vacations. Lack of affordable elder and childcare in the U.S. deprives millions of the safety net that Europeans have long enjoyed. And all the while, the media continue to uphold images of those who “have it all,” and do it all effortlessly. Recognizing that we’re doing the best we can, and focusing on what we’ve accomplished (rather than what we’re still hoping to do) may bring some joy back to our summer breaks.

Welcome to the first official post for Bedside Manners. As a sexual health researcher and book author, I receive a lot of emails from women and men who are dealing with sexually transmitted diseases. Yesterday, I replied to Liza, a 25 year-old married, monogamous woman who had just been diagnosed with a serious cervical HPV infection and treated via LEEP. She could not understand how this had happened, since she had been getting pap smears during her annual gynecological exams for the past 10 years, and her husband had never been diagnosed with genital warts. Her doctor told her it was “bad luck,” and now she is worried about the possibility of having an oral HPV infection, wondering whether her cervical infection is cured, and trying to figure out how to this will affect her marriage.

By getting annual pap smear exams, Liza has been doing the right thing. Unfortunately, most medical practitioners don’t explain that pap smears only sample a small area of a woman’s cervix. So, it is possible to receive a “normal” pap smear result when there are HPV-infected/abnormal cell changes in other portions of the cervix.

With Liza’s husband as her only sexual partner, it’s key for him to get thoroughly examined for HPV/genital warts. If HPV-infected cells are found, then he should have them removed via one of several treatment options. Once both of their bodies have healed from treatments, the couple should strongly consider using condoms during sex (note: condoms reduce but do not eliminate the risk of HPV transmission).

 

Given Liza’s concern about oral HPV, a ‘HPV test’ can determine the specific strain of the virus. HPV 16 has been linked to cervical cancer and to oral/head/neck cancers. So, an important follow-up exam after receiving a genital HPV diagnosis is to see a dentist: I encouraged her to share that she’s been exposed to HPV orally and request a thorough exam.

 

As I concluded my reply to Liza, I realized that I needed to address the stress that she was clearly experiencing. Medical sociologists have often written about how disease can cause dis-ease, an illness often causes a patient to lose her sense of wellbeing. In the case of socially stigmatizing and medically incurable infections, like HPV, stress is almost unavoidable for newly diagnosed patients. In my book, Damaged Goods?, I detail specific strategies for handling the variety of stressors that come with a genital HPV or herpes infection, but I’ve decided to wrap up today’s post with a general note about stress.

 

The Inner Game of Stress: Outsmart Life's Challenges and Fulfill Your Potential

 

I was fortunate to attend a talk last night by the authors of a new book, The Inner Game of Stress. Tim Gallwey has teamed up with two physicians, who practice a patient-centered approach to integrative medicine, to combine medical research with his executive coaching techniques. The result is a thoughtful self-help approach to stress management that encourages readers to be assertive patients. As a medical sociologist, I have written about the health impacts of practitioner-patient interactions and was familiar with the body of research showing how stress can weaken a person’s immune system.

 

 

For people, like Liza, who are battling a virus, it is important to not only empower yourself with knowledge about your particular illness but also to strategize how to strengthen your immune system. In addition to the obvious recommendations of decreasing unhealthy behaviors and increasing healthy ones, I encouraged her to find sources of emotional and social support. Some who are facing a stigmatizing illness may find comfort by talking with trusted friends, while others may prefer the neutrality of a therapist, and many may find empowerment in a book.