An Introduction to Stress & Health

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Hymie Anisman

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    Acknowledgements

    For Simon, Rebecca, Jessica and Max Contrary to what your sibs say, Max, I love all of you unconditionally and equally. BTW, I sent you that coat of many colors by courier.

    Acknowledgements

    ‘We are like dwarfs on the shoulders of giants, so that we can see more than they, and things at a greater distance, not by virtue of any sharpness of sight on our part, or any physical distinction, but because we are carried high and raised up by their giant size.’ This comment, that has been attributed to Bernard of Chartres (almost a thousand years ago), was subsequently made more famous by Isaac Newton with his statement ‘If I have seen further, it is by standing on the shoulders of giants’.

    My source for all information, Wikipedia, has told me that a form of this phrase also appeared in the works of Rebbe Isaiah di Trani (c.1180–c.1250), a Jewish tosaphist (a tosaphist is a highly educated and wise scholar who wrote commentaries on the Talmud), in one of his comments regarding our (his) audacity in contradicting an earlier scholar: ‘Should Joshua the son of Nun endorse a mistaken position, I would reject it out of hand, I do not hesitate to express my opinion, regarding such matters in accordance with the modicum of intelligence allotted to me. I was never arrogant claiming ‘My Wisdom served me well’. Instead I applied to myself the parable of the philosophers. For I heard the following from the philosophers. The wisest of the philosophers asked: ‘We admit that our predecessors were wiser than we. At the same time we criticize their comments, often rejecting them and claiming that the truth rests with us. How is this possible?’ The wise philosopher responded: ‘Who sees further a dwarf or a giant? Surely a giant for his eyes are situated at a higher level than those of the dwarf. But if the dwarf is placed on the shoulders of the giant who sees further? … So too we are dwarfs astride the shoulders of giants. We master their wisdom and move beyond it. Due to their wisdom we grow wise and are able to say all that we say, but not because we are greater than they.’

    As I was writing these acknowledgements I again realized how lucky I've been. There are so many people who hoisted me onto their shoulders to give me a wonderful view. I'm grateful, not only for their influence in preparing this book, but also for so many other choices I've made. I've been very lucky right from the start in having great mentors, Jane Stewart, Norm Braveman, Gary Waller and Doug Wahlsten, who pointed out the view. I've also been gifted with many, many wonderful collaborators who made research fun and offered a shared perspective. The gang included Zul Merali and Kim Matheson, my oldest collaborators and BFFs, as well as Sandy Livnat, Arun Ravindran, Alex Kusnecov, Robert Zacharko, Dan Stewart, Bruce Pappas, Dan McIntyre, Shawn Hayley, Mike (Fabio) Poulter, Steve Ferguson, David Park, Alfonso Abizaid, John Stead, Matt Holahan, Kim Helleman, and the Montreal affiliate gang members Joe Rochford, Dominique Walker and Alain Gratton, and those who've been teaching me about social psychology, Cath Haslam, Michael Wohl, and Nyla Branscombe. Alex Haslam, particularly, has given me some wonderful perspectives of social interactions and identity.

    I've also been blessed by several wonderful post docs; Shlomit Jacobson, Marie Claude Audet, Pasto Wann, Maia Miguelez, Vincent Roy, Beth Tannenbaum, Tom Borowski, Zheng (James) Wu Lu, and Pardeep Ahluwalia did all sorts of heavy lifting, and made sure that the graduate students were all OK and provided shoulders for them as well.

    I've had a bunch of really terrific kids receive their PhD in my lab, who've gone on to establish their careers in universities, medical practices or as clinical psychologists. Larry Kokkinidis, Gary Remington and Lawrence Sklar comprised that first cohort that paved the way to make it easier for those who came later: Jilly Irwin, Angela Corradini, Chris Prince, Nola Shanks, Steve Zalcman, Marliee Zaharia, Sue Lacosta, Nick Turrin, Jenna Griffiths, Shawn Hayley, Owen Kelly, Kathy Michaud, Kerry Sudom, Jullie Gibb, Kate Raspopow, Amy Bombay, Kelly Christie, Sheena Taha, and Miki Talebi. There are also several about to get their PhDs and will soon be off: Robyn McQuaid, Opal McInnis, and Rob Gabrys.

    There have also been some pretty terrific students in our group that limited themselves to a Master's degree. Some went to other universities to obtain a PhD (or another degree), some went to medical school or clinical psychology programs, whereas others took positions directly in research venues: Margaret Hamilton, Carolyn Szostak, Venera Bruto, Maxine Morrison, Brenda Hahn, Wayne Bowers, Jason Kotsopoulos, Jamie McIntyre, Karen Lacey, Karen Brebner, Leslie Drummond, Leslie Kerr, Maralyn Kasian, Anna-Marie Danielson, Reno Ghandi, Effie Helis, Priya Parkash, Mark Turcotte, Kelly Brennan, Alexandra Fiocci, Laura Ziebold, Caroline Wayne, Heather Soberman, Ashley Mulligan, Ashlee Charbonneau, Valerie Repta, Andrea Perna, Jeff Scharf, Katlyn Chambers, Adam Neufeld, Faisal Al-Yawer and Jesse Howell. I was also lucky to have Tom Connor in my lab for a spell, although technically he wasn't one of my students.

    I've also had a great many research assistants over the decades, but over the past fifteen years Jerzy Kulzcycki and Marzena Szieckos have been my right and left hand, and Diane Trenouth has provided all sorts of help.

    I'm exceptionally appreciative of Michael Carmichael, Keri Dickens, and Imogen Roome at SAGE who did the heavy work of shepherding this book through the many steps it went through, and for patiently guiding me through this processes.

    Simon and Helen were, without question, most important in every imaginable way. Of course, if not for Maida, the early experiments that Dan Stewart and I conducted would have been a flop (at least that's her story). Simon, Rebecca, Jessica and Max have been the best. We've taken turns standing on each other's shoulders; I hope the view from my shoulders was a good one.

    Finally, I'm particularly indebted to the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Foundation for Innovation (CFI) for providing funding for my research, and to the Canada Research Chairs (CRC) program and the Ontario Mental Health Foundation (OMHF) for personal support over many years.

    OttawaApril, 2013

    About the Author

    Hymie Anisman received his PhD in 1972 (University of Waterloo), and has been a Professor at Carleton University, Ottawa, since that time, while also holding an adjunct appointment with the Institute of Mental Health Research (Royal Ottawa Hospital). Professor Anisman was a Senior Ontario Mental Health Research Fellow (1999–2006), is a Fellow of the Royal Society of Canada, and has held a Canada Research Chair in Neuroscience since 2001. The principle theme of his research has concerned the influence of stressors on neurochemical and neuroendocrine systems, and how these influence psychological (anxiety, depression) and physical (immune-related and neurodegenerative) disorders. His work has spanned animal models to assess stress-related pathology as well as studies in humans to assess stress, coping and appraisal processes. In this regard, he has assessed the impact of chronic strain emanating from discrimination and stigmatization on well-being, depression and posttraumatic stress disorder (PTSD) among refugees from war-torn regions and among Aboriginal groups that suffered childhood traumatization, distress associated with abusive relationships and life transitions, as well as the transmission of trauma effects across generations.

    In addition to sitting on the editorial boards of several journals and on numerous grant panels, Professor Anisman has published more than 350 peer-reviewed journal papers and book chapters as well as several review papers within neuroscience and psychology journals, and has edited two books, one dealing with stress processes and the second concerning psychoneuroimmunology. A mainstay of his research program has been the training of students. More than 20 PhD and 50 MA/MSc students have graduated from his laboratory. His research has been funded by the Canadian Institutes of Health Research (CIHR), The Natural Sciences and Engineering Research Council of Canada (NSERC), the Ontario Mental Health Foundation (OMHF), the Canadian Foundation for Innovation (CFI) and the Canada Research Chairs program (CRC).

    Preface

    There's a poem by Edward Arlington Robinson about a character, Richard Cory, who was later made much more famous by the captivating rendition sung by Simon and Garfunkel. It seems that Richard was

    Born into society, a banker's only child,

    He had everything a man could want: power, grace, and style.

    Clearly, he was the type of person that everyone envied, and might have wished that they could trade places with him, until we learn of his fate at the end of the poem;

    So my mind was filled with wonder when the evening headlines read:

    ‘Richard Cory went home last night and put a bullet through his head’.

    Sure, there are those people with seemingly charmed lives, who appear to float from situation to situation untouched by the chaos and distress affecting others. However, look a little deeper and you'll find that they aren't immune from stressors, despite the outward appearances. To turn to an old cliché, ‘nobody gets out of this alive’, and odds are that there are few, very few, who don't have some scars earned along the way. We're not entirely sure what was ailing Richard Cory. However, it is clear that he was far from ‘happy with everything he's got’.

    Some of the negative events that we encounter might constitute the usual minor unpleasantries, but some may be traumatic, life-threatening events or experiences that suck the soul right out of your head/body, and leave you shattered. We all know of people who have experienced particularly distressing events or multiple horrible events, and we're left wondering how these people survive and even be cheerful at times, and we shake our heads muttering ‘there but for the grace of God go I’. Most of us also know people who seem to get stressed-out far too often. Those people who seem to panic over every minor event, and end up stressing everyone around them. The fact is that there are huge differences in how people react to stressors, who deals well and who deals poorly, who succumbs to the effects of stressors and who becomes stronger in the face of adversity. There's no easy solution to getting rid of stressors, and there's similarly no easy way to make yourself invulnerable; however, there are ways to improve your resilience and to limit the damage that might otherwise be engendered by stressors. This book doesn't describe (or prescribe) some form of anti-kryptonite to help you ward off distressing events, and it isn't a self-help book to make you tough. Instead, it aims to provide information, based on empirical research, about the stress process and the factors that generally facilitate stress resilience. However, along the way, some guidance will also be provided that may (or may not) influence your ways of dealing with bad events, and also help you to help others. However, each individual, as you'll see, is very different, and so this book is about stress in general, and not about you in particular. Michelangelo observed that every block of marble has an angel inside it that it is the sculptor's job to set free. I'm certainly no Michelangelo. Nevertheless, with the methods and insights of neuroscience and psychology as my chisel I hope to help you understand how the general processes of stress impact on each of us in different ways, and indeed how our very individuality is a consequence of those processes.

    As the reader goes through the chapters of this book it will become clear that there is a simple logic concerning its construction. However, in the hope of the reader getting the most from it, there are some simple considerations on how to use this book. The successive chapters build on one another to offer the reader an integrated perspective regarding stress and its relation to well-being and pathology, and the methods that can be used to diminish distress and its pathological consequences. The initial two chapters are meant to inform the reader about the various factors that determine the extent to which stressors might have adverse effects. Among other things, these chapters cover a series of variables that are related to the stressor itself, individual difference factors that govern vulnerability to stressor effects, and processes related to appraisal and coping. Having described these multiple contributions to the stress process, the next three chapters outline some of the biological consequences of stressors, focusing on hormones (Chapter 3), neurotransmitters, growth factors (Chapter 4) and immune processes (Chapter 5). In doing so, every effort was made to demonstrate that these systems are interrelated to one another and thus jointly protect us from pathology, and conversely, that pathology may involve disregulation involving multiple systems. In addition, these biological changes are considered in the context of the variables described in Chapter 1 and 2 that influence the potency of stressors. With an understanding of the biological consequences of stressors and the variables that moderate these outcomes, the next two chapters are concerned with the influence of stressors on physical illnesses, notably immune-related illnesses (Chapter 6) and heart disease (Chapter 7). This is then followed by the analyses of stressors on psychological disturbances, particularly depressive disorders (Chapter 8), anxiety disorders (Chapter 9) and addictions (Chapter 10). In discussing the physical and psychological disorders, the text repeatedly returns to the information concerning what makes stressors more or less potent, our stressor appraisal and coping processes, and the biological sequelae of stressors. Chapter 11 takes a slight detour from the preceding chapters and could well have been included much earlier. This chapter deals with the intergenerational effects of stressors, and includes a consideration of developmental factors, including prenatal and early postnatal stressors, as well as biological processes that might contribute to the effects of adverse experiences being transmitted across generations. Having detailed some of the consequences of stressors, Chapter 12 deals with methods to diminish distress, which go hand-in-hand with methods to diminish psychological disturbances and some features of physical illnesses that might be secondary to the associated distress. Finally, although few texts concerning Health Psychology include a chapter on discrimination and stigma, it is clear that these are exceptionally powerful insults, and failure to seek help owing to self- and other-stigma is likely one of the main blocks to alleviating mental illness. Thus, not including such a chapter would have been counterproductive. One last point regarding the information in these chapters needs to be made. The initial version of this book contained more than five thousand citations to specific articles. However, including all of these would have resulted in the cost of the book being excessive, and thus sharp scissors had to be taken to this aspect of the book. I apologize to the researchers whose very important work was mentioned in the text, but was not specifically attributed to them. Of course, there are several important topics that were not covered in the book (the issue of sleep is the first to come to mind), and I have no excuse for these ommisions.

    As we all know, learning and remembering complex sets of information are less difficult when they are appropriately contextualized. In writing this text I made a considerable effort to simplify some of the material and make it practically relevant, particularly the sections that were related to biological processes. This was done by repeatedly placing this information in the context of pathology, most often depressive and anxiety disorders, but other illnesses as well. A case was also made for individualized treatment of psychological disturbances. That is, treating individual patients on the basis of the specific symptoms presented together with biomarkers that might inform treatment strategies and prevention of illness recurrence. Admittedly, this can only be repeated so often before it begins to sound like a broken CD, and there were times when I felt this intensely. In reading this book, or for instructors teaching from it, I would encourage returning to the information in Chapters 1 and 2 when considering the effects of stressors on biological systems, and likewise when dealing with pathologies to put this in the perspective of the information related to behavioral and biological processes. This might sound a bit preachy or patronising, especially as its likely being said to many good teachers as well as their students, but this is how I envisioned the book being used as I composed the different chapters. This approach has worked well for me as I taught the material, and I hope it does for you as well.

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