THE ENCYCLOPEDIA OF
STRESS AND STRESS-RELATED DISEASES Second Edition
THE ENCYCLOPEDIA OF
STRESS AND STRESS-RELATED DISEASES Second Edition Ada P. Kahn, Ph.D. Foreword by Delbert H. Meyer, M.D.
The Encyclopedia of Stress and Stress-Related Diseases, Second Edition Copyright © 2006, 1998 by Ada P. Kahn, Ph.D. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval systems, without permission in writing from the publisher. For information contact: Facts On File, Inc. An imprint of Infobase Publishing 132 West 31st Street New York NY 10001 Library of Congress Cataloging-in-Publication Data Kahn, Ada P. The encyclopedia of stress and stress-related diseases / Ada P. Kahn ; foreword by Delbert H. Meyer.— 2nd ed. p. cm. Rev. ed. of: Stress A–Z. Includes bibliographical references and index. ISBN 0-8160-5937-3 (hc: alk. paper) 1. Stress (Physiology)—Encyclopedias. 2. Stress (Psychology)—Encyclopedias. 3. Stress management— Encyclopedias. I. Kahn, Ada P. Stress A–Z. II. Title. QP82.2.S8K34 2005 616.9′8′003—dc22 2005043668 Facts On File books are available at special discounts when purchased in bulk quantities for businesses, associations, institutions, or sales promotions. Please call our Special Sales Department in New York at (212) 967-8800 or (800) 322-8755. You can find Facts On File on the World Wide Web at http://www.factsonfile.com Text and cover design by Cathy Rincon Printed in the United States of America VB Hermitage 10 9 8 7 6 5 4 3 2 1 This book is printed on acid-free paper.
CONTENTS Foreword
vii
Entries A–Z
1
Appendixes
399
Bibliography
410
Index
417
FOREWORD
T
uations fall into the category Kahn refers to as “random nuisances,” the cumulative effects on an individual can interfere with good health. As people live longer, aging becomes an increasingly contemporary stressor for the elderly, as well as their middle-aged children who themselves may also be approaching senior status and early infirmities. Debilitating illnesses and loss of capabilities are major stressors for the elderly. In many families, middle-aged children live far from their elderly parents and become long-distance caregivers. The technology of communication cannot compete with the old-fashioned comfort of personal visits, kind words, and handholding in familiar surroundings. Moving a surviving parent closer may relieve some stresses but could also create new ones. It may be difficult for the parent to make new friends in strange surroundings and for the children to have a new boarder or more immediate and demanding responsibilities. In the area of work-related stress, issues abound on a global scale. In many sectors, mergers and acquisitions may reduce the number of available jobs. Outsourcing, while creating jobs elsewhere, may reduce opportunities for work locally. Asking for service assistance by telephone can be stressful for the information seeker when connected to a technician for whom English is a second language. As the author of The Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues, Kahn has researched and described many work-related sources of stress. She has included a number of these topics in this edition of The Encyclopedia of Stress and Stress-Related Disorders. Readers will find
he topic of stress seems now to be discussed more frequently in homes, workplaces, and schools than ever before. As the world becomes more complex in terms of changing economies, organizational structure, competition, and safety, stress appears to be escalating. Issues of personal, family, and national safety arise daily. Airline travelers experience frustration waiting in lines, then again at check-in points with the many questions to answer and procedures to follow. Workers in factories and high-rise buildings must undergo elaborate safety precautions in order to enter and leave the workplace. Young people in many schools must pass through metal detectors before entering buildings. These are just a few of the everyday challenges that can cumulatively increase the stress level for people of all ages. In this edition of The Encyclopedia of Stress and Stress-Related Diseases, author Ada P. Kahn has added entries about numerous contemporary issues that contribute to stress. Many of the new terms relate to technological advancements, aging, work-related issues, family life, and mental health. Although technology has produced exciting developments in computer and telecommunications capabilities, it has also caused stress in many people. How many older folks experience exasperation when trying to use electronic gadgets that are used so facilely by younger people? How many employers now ban camera phones from company property? Telecommunication capabilities have surged ahead. But at the same time, annoyances related to recorded messages, particularly in service sectors, are overwhelming. While some of these sit-
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viii The Encyclopedia of Stress and Stress-Related Diseases entries on bullying, Employee Assistance Programs, smoking in the workplace, violence, and challenges faced by accountants, lawyers, taxi drivers, miners, and construction workers, among many others. In looking at family situations, Kahn includes topics relating to domestic violence, commuter marriages, and changing patterns of children’s activities. Are children still allowed to be children? Overscheduling of after-school activities can be a source of stress for young people and their parents. Finally, this edition of The Encyclopedia of Stress and Stress-Related Diseases includes comprehensive explanations of many mental health issues that caused 40 million people to schedule office visits with physicians in 2002. Indeed, anxiety disorders are the most common mental health concern in the United States. Kahn draws on her background of research as coauthor of three books on fears and anxieties (The Encyclopedia of Phobias, Fears and Anxieties, 2nd Edition, Facts On File, Inc., 2000; Facing Fears, Facts On File, 2000; and Phobias, Scholastic, 2003) to provide readers of this book with informative details to help differentiate fears from phobias, both of which are serious sources of stress that threaten good health. Common fears, such as earthquakes and terrorism, and specific phobias, such as public speaking and heights, are explained in order to help readers recognize their fears and phobias. They can then take steps to cope with these stressors in effective ways. Stress is inevitable in human beings. Understanding that stress can overload a person’s physical and mental systems can help us better cope with daily challenges. However, as Kahn explains, the key to healthy living is how one adapts and copes with everyday and ongoing stressors. These can range from serious situations (such as a life-threatening illness) to everyday random nuisances (such as traffic delays or telemarketing calls at dinnertime). As a physician, I see many patients whose concerns may stem from personally stressful issues.
Some people cope effectively with difficult situations, while others find that ongoing stress leads to digestive problems, headaches, difficulty sleeping, and ineffective and destructive coping methods, such as eating disorders, alcoholism, and substance abuse. I had a patient who suffered a myocardial infarction with documented cardiac muscle destruction. However, when the coronary angiograms were done, there was not a plaque or thrombosis seen, suggesting that coronary spasm was the etiology that in turn was most likely the result of an acute, very stressful event. In taking a medical history, physicians can better serve patients by including questions about their home, workplace, community, or school. Is there marital discord? Are there concerns about elderly parents? Are difficulties at work or school present? When linking the stressful challenge to the presenting symptom, a physician can also provide suggestions for relaxation rather than (or in addition to, where appropriate) anxiolytic medications. Kahn describes many strategies for relaxation, such as aromatherapy and breathing exercises, physical exercise, meditation, music, yoga, and t’ai chi. Indeed, learning to relax and to deal with everyday challenges in a calmer manner may be the best advice for many stressed individuals. Being properly informed is the key to coping effectively with daily challenges in the many areas of contemporary life that could lead to stress. To this end, Kahn’s work on this second edition of The Encyclopedia of Stress and Stress-Related Disorders is truly outstanding. The book will be useful for concerned individuals, reference librarians, employers, human resource personnel, therapists, and physicians, as well as all curious readers. —Delbert H. Meyer, M.D. University of California at Davis, Mercy San Juan Hospital
ENTRIES A–Z
A are for or against abortion, campaign for the right of a woman to make that choice. In the United States, procedures used for elective termination depend on the length of the pregnancy. In the early stages, procedures are relatively simple, involve minimal pain and discomfort, and rarely require an overnight hospital stay. For later stages, procedures are more complicated, but all of these procedures, when performed in a sterile environment by competent physicians, are safe. The key to relieving the stress of an abortion is knowing where to turn for information and counseling. If at all possible, the support of family and friends should be sought as early as possible. Organizations such as Planned Parenthood, with offices in many large cities, local health departments, women’s and other health clinics, family doctors, or local hospital gynecology staff are resources for help. While the lasting effects of an unwanted pregnancy cannot be completely eliminated, making a decision that is based on knowledge of all the options is more likely to reduce the stress. In many cases, the subject of abortion also causes stress for the fathers-to-be who may share in the decision-making process regarding continuation of the pregnancy. See also PREGNANCY.
abortion
The interruption or loss of any pregnancy before the fetus is capable of living outside the womb. However, the term usually refers to induced or intentional termination of pregnancy, while spontaneous abortion, the natural loss of pregnancy, is usually referred to as “miscarriage.” The subject of abortion is stressful to society as well as to individuals. In the early 2000s, there are issues of social pressure as well as differing religious, moral, and political points of view. Some viewpoints hold that life begins at conception and regard abortion as a criminal act. Other viewpoints hold that life begins when the baby is capable of sustaining itself beyond the womb. In 1973, the United States Supreme Court declared that under the Constitution a woman was entitled to undergo an abortion at any time during the first trimester (three months) of pregnancy; the individual states retained the right to regulate for health reasons where and by whom abortions could be performed during the second trimester. Since then, those who oppose abortion on moral and religious grounds (known as pro-lifers) have fought to reverse and limit this decision, and the issues themselves have become incorporated into political party platforms during presidential and congressional campaigns. Throughout history, many women have coped with the stress surrounding the decision to abort, and the method to use. Until the Supreme Court decision, society at large condemned women who had intercourse outside of marriage and ignored the dilemma arising from an unwanted pregnancy. The choice to abort was made secretly and often without the knowledge and support of family or the man involved. Today, however, there is a large group (known as pro-choicers) who, whether they
FOR FURTHER INFORMATION:
Planned Parenthood Federation of America 434 West 33rd Street New York, NY 10001 (212) 541-7800 http://www.plannedparenthood.org SOURCE: Kahn, Ada P., and Linda Hughey Holt. The A to Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992.
1
2 absenteeism absenteeism
Absenteeism or frequent absence from work may be related to employees’ stress on the job and/or in their personal lives. Another source of stress for employees is the need to balance time for work, family, and self. This stressor can lead to health problems, decreased productivity, and employee turnover. It can be expected to remain a major factor since the hours spent by men and women in the workplace are increasing. Employees experiencing stressors may exhibit persistent physical symptoms such as irregular sleep patterns, fatigue, anxiety, and weight change. There is also evidence that these employees may be more subject to colds, flu, headaches, gastric upsets, and other illnesses, all of which lead to an increase in absenteeism. The high rate of absenteeism among the nation’s workers results in high losses for business and industry. Many corporations have undertaken preventive efforts, such as health examinations, health risk appraisals and employee assistance (EAPs) and wellness programs for weight control, smoking cessation, exercise, and stress reduction. Because there is a positive correlation between absences and the attitudes of employees to their superiors, some employees have introduced programs aimed at job enrichment, career ladders, and worker participation. See also EMPLOYEE ASSISTANCE PROGRAMS; MARITAL THERAPY; PRESENTEEISM; SCHOOL; WORKING MOTHERS; WORKPLACE. STRESSFUL FACTORS AT WORK THAT MAY CAUSE ABSENTEEISM • • • • • • • • • • • • •
Lack of recognition by superiors Role conflict (particularly with peers) Deadlines Job unsuitability or unpreparedness Concerns about job security and career paths Environmental discomforts (“sick building syndrome”) Sexual concerns Marital difficulties Concerns about children/grandchildren Concerns about elderly parents Financial problems Health problems (self or family members) Other family pressures
FOR FURTHER INFORMATION:
American Industrial Hygiene Association (AIHA) 2700 Prosperity Avenue, Suite 250 Fairfax, VA 22031 (703) 849-8888 http://www.aiha.org
abuse
See
ADDICTION; DOMESTIC VIOLENCE.
accident
An unexpected, unintentional, chance happening. These stressful undesirable events or mishaps occur in homes, schools, workplaces, while traveling, in water, or many other places. Some accidents may result in injuries; others are merely inconveniences. The stress caused by an accident disrupts one’s schedule and, depending on its seriousness, may affect family members, employers, or insurance companies. In homes, falls and burns are common accidents. In workplaces, machinery accidents and eye injuries are common accidents. According to the Centers for Disease Control and Prevention, injuries are a leading cause of death for Americans of all ages, regardless of gender, race, or economic status. Many of these injuries are the result of accidents. For many, the injury causes temporary pain and inconvenience, but for some, the injury leads to the ongoing stress of disability, chronic pain, and a profound change in lifestyle. The best way to cope with the stress of accidents is prevention. In homes, attention should be given to loose rugs, electrical cords and other objects on which a person may trip. In workplaces, adherence to safety standards of the specific industry is a primary way to prevent accidents and their stressful aftermaths. See also ELECTRICITY; FALLING MERCHANDISE; INDUSTRIAL HYGIENE; PERSONAL PROTECTIVE EQUIPMENT; SLIPS, TRIPS, AND FALLS.
accountants
Accounting is a very stressful field of employment. Accountants begin their careers with great expectations. At some stage, they may start an independent practice with a new sense of freedom and many misgivings, worries, and fears. A large part of accountants’ self-esteem is involved in the success or failure of the accounting practice. There is also the stress of making enough money to pay the bills and
acculturation 3 working long hours at risk of becoming a workaholic. A support system sometimes exists in a corporate environment if partners or team workers share feelings, hopes, and disappointments. However, in private practice, an accountant may feel isolated and even overwhelmed. Whether an accountant experiences the stress of burnout depends on his or her tolerance for frustration and boredom. It also depends on the social connections and creative outlets the accountant has in his or her life. A poll of accountants in England found 82 percent of respondents working more than 40 hours a week and 30 percent working 45 hours or more. Many also take work home. However, more than half believed accountancy gave them a good worklife balance, and that the rewards made the sacrifices worthwhile. One firm said “There’s little doubt that accountancy is a more demanding environment today than it has ever been. Events such as 9/11 and the Enron scandal, and the ensuing increase in regulation have put finance professionals right in the firing line.” Tips for Accountants to Avoid Stress SmartPros Ltd., a provider of accredited professional education for accounting and finance professionals, has some tips for accountants to avoid stress: • As you build or expand your accounting practice, do not neglect friends. • If you have a spouse, significant other, children, or pets, set aside a time of day that belongs to them alone. • Join professional support organizations that serve the dual functions of helping you develop your accounting business and giving you a social outlet. • Take a vacation. Leave the business at home. • Develop a nonbusiness hobby that provides you with a creative outlet, such as community theater or stand-up comedy. FOR FURTHER INFORMATION:
SmartPros Ltd. 12 Skyline Drive Hawthorne, NY 10532 (914) 345-2620
SOURCE: Fox, Jack. “Accountants Can Learn to Overcome Burnout and Stress,” SmartPros Web site. Available online. URL: http://accounting.smartpros.com/x26464.xml. Downloaded on August 22, 2005.
acculturation The process of adjusting to a new culture. In situations where there are linguistic or cultural communication barriers or an individual’s expectations are not congruent with what takes place, stress can be heightened. The stress of adjusting to an unfamiliar culture may lead to behavior changes, such as increased alcohol and tobacco consumption. Furthermore, when various family members become accustomed to the new culture at different rates, conflicts can arise between the generations, contributing to tensions within the family. There are many community service programs available in cities in the United States designed to help acquaint newcomers to the country with customs, costs, and ways to locate needed services. Many are geared to helping newcomers learn the language, while others emphasize the sociocultural aspects of relocating. Local public libraries are a good source of such programs. Frequently, ethnic groups welcoming newcomers in their communities will help them learn how to shop in local markets, find good merchandise at a discount, and obtain legal services and medical care. Health Care Needs of Immigrants Many immigrant patients in the United States do not use the Western medical model. Some of these patients see Western medicine as one of many healing systems. Cultural expectations can cause stress for these individuals as well as the physicians who treat them. For example, some East Indian women will not allow pelvic examination by male physicians, even those from their own culture. Because such procedures can be construed as grounds for divorce, a relatively simple physical examination becomes both a cultural and a medical issue. Health care professionals should address the clinical issues surrounding folk beliefs and behaviors in a culturally sensitive manner, according to an article in The Journal of the American Medical Association (March 1, 1994). Lee M. Pachter, D.O., St.
4 acne Francis Hospital and Medical Center, Hartford, Connecticut, wrote: “A culturally sensitive health care system is one that is not only accessible, but also respects the beliefs, attitudes and cultural lifestyles of its patients. It is a system that is flexible and acknowledges that health and illness are in large part molded by variables such as ethnic values, cultural orientation, religious beliefs and linguistic considerations.” Dr. Pachter explained that most medical folk beliefs and practices are not harmful and do not interfere with biomedical therapy. Under these circumstances the clinician should not attempt to dissuade the patient from these beliefs, but instead
TIPS TO REDUCE STRESS OF MEDICAL ENCOUNTERS WITH IMMIGRANT PATIENTS • Become aware of the commonly held folk medical beliefs and behaviors of the patient’s community. • Assess the likelihood of a particular patient or family acting on these beliefs during a specific illness episode. • Arrive at a way to successfully negotiate between the two belief systems. • Be aware of your own cultural biases. • Determine whether language will be an issue during office visits. • Develop an office guide for immigrant patients, including typical questions asked during an examination, needs for disrobing, and types of examinations and testing procedures and their importance. • Prepare a list of local agencies that are available to help with multicultural issues. • Encourage patients to share their culture and life-style with you so that you have information for accurate diagnoses and appropriate therapy. • Ask before going ahead with any procedures. By seeking permission and explaining the procedures you remove the mystery and patients become partners in the activity rather than objects of scrutiny. Compliance improves with understanding. • Take advantage of opportunities for cross-cultural learning in group discussions with other professionals from different cultural backgrounds.
educate him or her as to the importance of the biomedical therapy in addition to the patient-held belief. Any ethnomedical practice that has the potential for serious negative outcome needs to be discouraged, but this must be done in a sensitive and respectful way. Replacing dangerous practices with alternatives that fit into the patient’s ethnocultural belief system is often met with acceptance. As reported in an editorial in Canadian Family Physician (October 1995), the stress of the acculturation experience is especially severe for individuals whose future residency status is in question, such as those entering a new country as a student, or those hoping to find work and remain on a permanent basis. Local community agencies can help relieve some of the stresses these individuals encounter. See also ALTERNATIVE THERAPIES; MIGRATION; PERSONAL SPACE. SOURCES: Cave, Andrew, et al. “Physicians and Immigrant Patients.” Canadian Family Physician 41 (October 1995): 1,685–1,690. Pachter, Lee M. “Culture and Clinical Care: Folk Illness Beliefs and Behavior and Their Implications for Health Care Delivery.” Journal of the American Medical Association 271, no. 9 (March 1, 1994): 690–694.
acne Very common skin condition; occurs on the face but can also occur on the back, chest, shoulders, neck, and buttocks. It consists of blackheads, whiteheads, pimples, and deeper, boil-like lesions called nodules and can be a source of extreme stress for the sufferer. It has been estimated that 80 percent to 90 percent of teenagers suffer from acne at one time or another, and about one in every five young people visit a dermatologist because of acne. The prevalence of the problem is no comfort to the high school student who feels that the blemishes will keep him or her from being socially accepted. Although primarily a disease of adolescence, acne occurs among older persons as well. In many cases untreated acne clears up after several years; however, it can leave lifelong scars that affect the person’s self-image. Coping with Acne In addition to seeking help from a dermatologist, a person who has acne might relieve some of his or
acquired immunodeficiency syndrome 5 her stress by joining a peer support group at school or at a local community center, or visiting a psychotherapist who counsels adolescents. Parents can be particularly helpful to their son or daughter who has acne by being supportive, offering encouragement for treatment, and contributing to the young person’s self-esteem. In cases of extreme scarring a plastic and/or reconstructive surgeon’s opinion on treatment might be sought. Diagnosis and Treatment Dermatologists recommend that sufferers not pick, scratch, pop, or squeeze pimples, which may lead to additional inflammation and scarring. However, when treating acne, the dermatologists may open pimples or remove blackheads and whiteheads. Depending on the type of acne, a dermatologist will recommend different therapies. In some cases, an acne-like rash is due to another cause, such as makeup, lotions, or medications. When visiting a dermatologist, it is important to provide a history of relevant habits. For milder cases of acne, many non-prescription lotions and creams may be helpful. If used too often, however, many of them lead to excessively dry skin. Dermatologists advise that when buying makeup, people should choose noncomedogenic or nonacnegenic products. Noncomedogenic means that using the cosmetic should not result in the formation of whiteheads and blackheads. Topical preparations in cream or lotion form are sometimes prescribed by dermatologists to help unblock the pores and reduce the bacteria. In more severe cases, female-type hormones and other medications that decrease the male-type hormones are used. Another oral medication, isotretinoin (Accutane), is sometimes used to treat acne that has not responded to other treatments. However, frequent visits with the dermatologist are necessary to monitor and control the side effects; the drug can cause severe birth defects if taken during pregnancy. Self-Care to Relieve Acne There is no instant or permanent cure for acne, but it can be controlled and sufferers should be encouraged to follow appropriate care and treatment to prevent permanent scars. Washing the face with soap and warm water no more than twice a day is
a good routine to follow. Men with acne who shave and prefer using a safety rather than an electric razor have particular concerns. They should soften the beard thoroughly with soap and warm water. To avoid nicking pimples, they should shave as lightly as possible, and shave only when necessary, always using a sharp blade. Dermatologists have differing opinions on the importance of diet in managing acne. Some people however, find that their acne becomes worse when they eat certain foods, such as chocolate, milk products, or nuts. Individuals can often determine what foods cause their acne and learn to avoid them. FOR FURTHER INFORMATION:
American Academy of Dermatology P.O. Box 4014 Schaumburg, IL 60168 (847) 330-0230 http://www.aad.org SOURCE: Acne. Schaumburg, Ill.: American Academy of Dermatology, 1993.
acquired immunodeficiency syndrome (AIDS) AIDS is a deficiency of the IMMUNE SYSTEM due to infection with HIV (HUMAN IMMUNODEFICIENCY VIRUS). As yet, there is no curative treatment and no vaccine for AIDS; however, in many individuals, symptoms and complications respond in varying degrees to antiviral agents, antibiotics, radiation therapy, and anticancer drugs. AIDS is considered by many the “plague” of the 20th century. No other disease in modern times has had such an impact on the world. It is a source of stress for those who are infected, for all who fear acquiring it, and for family and friends of AIDS patients. Nearly 5 million people across the world contracted the virus that causes AIDS in 2003, more than in any year previously recorded, according to a United Nations report released in July 2004. According to the report, estimates are that 38 million people were living with HIV across the world in 2003, up from 35 million in 2001. Of the 20 million people who have died of AIDS since 1981, when the disease was first reported, 5.6 million died since 2002.
6 acquired immunodeficiency syndrome In the United States and western Europe, infections have risen since 2002. According to the U.S. Centers for Disease Control and Prevention, about 950,000 people are now living with HIV and AIDS in the United States, up from 900,000 in 2001; half of all those who are newly infected are African Americans. In western Europe, 580,000 people have the virus, a rise from 540,000 two years before. Since the early 1980s, 500,000 Americans have died from AIDS. While the death rate has gone down, the rate of new infections is increasing. In 2003, the estimated number of diagnoses of AIDS in the United States was 43,171. Adult and adolescent AIDS cases totaled 43,112, with 31,614 cases in males and 11,498 cases in females. Also in 2003, there were 59 AIDS cases in children under age 13. How the Virus Is Transmitted The virus is transmitted through body fluids—usually semen or blood, but also through saliva and tears. AIDS is also transmitted from mother to infant in utero or via passage through the birth canal or via infected breast milk. More rarely, doctors and nurses exposed to infected patients have caught the virus. There have also been isolated case reports of infection through organ donations, artificial inseminations, and exposure to infected dentists. In the early 1980s, when AIDS was first recognized as a syndrome and the full extent of the disease acknowledged, most of the patients were homosexual males and intravenous drug users or their partners. Within a few years, there was recognition that the disease was also spreading into the heterosexual population, and that women and children were dying of AIDS. In many developed countries, public health measures have helped to level off the rate of AIDS. For example, donated blood and semen samples are screened for AIDS. Also, guidelines have been developed for “safe sex” between partners in risk groups. “Safe sex” eliminates the exchange of body fluids through such means as using condoms, avoiding oral intercourse, and limiting to a single, steady partner. Western medical centers advise “universal precautions,” which mean carefully covering any body surfaces that might be exposed to an infected person’s body fluids.
Stresses of HIV on Mental Health Individuals at high risk for developing the disease live in fear and have concerns about acquiring the disease through casual contact. Death from AIDS has touched many families in the United States. For most, it has meant recognizing their children’s homosexual behavior as well as facing their illness and death in their 20s, 30s, and 40s. The period of time after learning that a person is infected with the HIV virus is characterized by anxiety and stress stemming from his or her own DENIAL, family reactions, the homophobia of both family and friends, and employment and insurance concerns. HIV patients need nonjudgmental, forward-looking sources of support, people skilled in LISTENING carefully, letting them speak their fears, and dealing with their physical symptoms. SUPPORT GROUPS, helping the person maintain as much CONTROL as possible, counseling them in legal decisions before dementia sets in, and identifying referral programs, are extremely helpful. Stresses on Health Care Professionals There is enormous personal stress among many health care professionals who work with AIDS patients. There is the medical complexity of the disease, as well as the stigma of AIDS and AIDS risk behaviors. Some health care workers fear contracting the disease from the patients, while some inwardly rebel against caring for people whose concepts of behavior differ so radically from theirs. Pediatric AIDS Pediatric AIDS causes special stresses for the infected child and his or her family. Many infected children require foster care because of parental inability to provide the needed care. Unfortunately, many AIDS-infected children do not live long, and parents must face grief after watching the child suffer. Although it is controversial, most communities have accepted the opinion of the Centers for Disease Control that infected children in a normal classroom would not pose a hazard to their classmates. However, the reality is that few infants or young children with AIDS live long enough to be in school for very long. Meanwhile, schoolchildren with AIDS live with the stresses of being different and have difficulties maintaining the grade level because of frequent treatment. In
acupressure 7 many cases, they are cut off from teachers and other students, which leads to FRUSTRATION, despair, and DEPRESSION. Runaway adolescents, many of whom subsist through prostitution, are especially vulnerable to HIV infection. These teenagers have few support systems, are usually school dropouts, and have severed family connections. AIDS in the Aging Population HIV/AIDS is increasing among people age 50 and over. According to the U.S. Centers for Disease Control and Prevention, 17 percent of new cases since 2002 are among Americans 50 and older, up from 15 percent from 1991 through 2001. Older Americans “are probably the least educated group about AIDS,” according to Nathan Link, an AIDS researcher at the University of Illinois at Chicago. Additionally, most physicians do not ask elderly patients about their sex lives or drug use, nor do they routinely test them for HIV/AIDS. AIDS and Pregnancy Recommendations by the Centers for Disease Control included testing of pregnant women for the HIV virus who acknowledge having engaged in high-risk behavior. More recently, researchers have suggested that HIV screening be routinely offered to all pregnant women. See also CHRONIC ILLNESS. FOR FURTHER INFORMATION:
AIDS-Hotlines National AZT Hotline (800) 843-9388 CAIN (Computerized AIDS Information Network) San Francisco AIDS Foundation 54 Tenth Street San Francisco, CA 94103 (415) 864-4368 Centers for Disease Control and Prevention/American Social Health Association (800) 341-AIDS National Prevention Information Network (NPIN) Centers for Disease Control P.O. Box 6003 Rockville, MD 20849 (800) 458-5231
Physician Link (List of MDs with expertise in AIDS treatment and research) (800) 344-5500 SOURCES: Andre, Pierre. People, Sex, HIV & AIDS: Social, Political, Philosophical and Moral Implications. Huntington, W. Va.: University Press, 1995. Donovan, Catherine A., and Elizabeth Stratton. “Changing Epidemiology of AIDS.” Canadian Family Physician 40 (August 1994). Epstein, Steven. Impure Science: AIDS, Activism and the Politics of Knowledge. Berkeley: University of California Press, 1996. Gifford, Allen. Living Well with HIV & AIDS. Palo Alto, Calif.: Bull Publishers, 1997. Goldfinger, Stephen E., ed. “AIDS: A Glimmer of Hope.” Harvard Health Letter 20, no. 9 (July 1995). “Panel Backs New AIDS Drug.” Chicago Tribune, November 7, 1995.
acrophobia
A fear of heights. It is one of the most common PHOBIAS and is a source of stress to phobic individuals. The fear, which may include being on top of mountains, on high floors of skyscrapers, or even of riding to a high floor in an elevator is usually out of proportion to the real danger. There is a high level of stress and anxiety even when these individuals approach overlooks or bridges. Some individuals who experience acrophobia may also fear being injured or falling, which are related phobias. See also ANXIETY DISORDERS.
acupressure
Sometimes referred to as ACUPUNCwithout needles, acupressure embraces the same concepts of energy flow and point stimulation as the original science but uses the pressure of the therapist’s fingers for point stimulation. Acupressure is used by many people for relief of physical and psychological stresses. It is thought to combine the science of acupuncture with the power of the healing touch and has been most widely used for pain control. In Oriental medicine, acupressure is helpful in conditions where the body’s energy balance has been upset by a variety of physical and/or emotional stresses. Because it is an extremely gentle technique, acupressure is sometimes used by the therapist with individuals who are fearful of needles. See also ALTERNATIVE MEDICINE; SHIATSU. TURE
8 acupuncture acupuncture A technique used to relieve stress for many people. It has been used for thousands of years as a component of Chinese medicine, and is based on the theory that the body’s “vital energy” (chi) circulates through “meridians” along the surfaces of the body. The ancient theory holds that illness and disease result from imbalances in vital energy, which can be remedied when therapy is applied to “acupuncture points” located along the meridians. The goal of acupuncture is to rebalance the flow of energy, promoting health and preventing future imbalance. The points are believed to have certain electrical properties, which when stimulated can alter chemical neurotransmitters in the body and bring about a healing response. Practitioners of acupuncture insert hair-thin stainless steel needles into the patient’s body surfaces at acupuncture points. In addition to stress reduction and relaxation, many people have used acupuncture for a variety of conditions, including osteoporosis, asthma, back pain, painful menstrual cycles, and migraine headaches. Research with Acupuncture Over the last two decades in the 20th century, acupuncture became one of the most intensively studied medical procedures, said Dr. Bruce Pomeranz, professor of medicine, University of Toronto Medical School. He reported to the Toronto Star (September 10, 1995) that scores of scientifically rigorous animal experiments and clinical studies allowed researchers to uncover a mechanism to explain how acupuncture controls chronic pain. Evidence points to a similar mechanism accounting for acupuncture’s success in treating addictions to alcohol, cocaine, and opiate, he said. The acupuncture points on the body and ear correlate to sites where there are unusually large concentrations of nerves. The needles stimulate the nerves, which send an electrical message to the brain. Dr. Pomeranz explains that the brain releases endorphins (morphine-like brain chemicals), which block pain messages from getting through and take away the emotional components of pain. Further, the endorphin system is linked to a system that releases cortisone, a chemical that alleviates inflammation in the body. Heroin and cocaine
addicts suffer from depressed endorphin levels. Their bodies compensate for the high levels of narcotics in their blood by producing less of the naturally-occurring substance. The agonies of withdrawal result from low levels of the painblocking endorphins. Stimulation of the endorphin system through acupuncture gets it going in a natural way, said Dr. Pomeranz. He also pointed out that acupuncture has been successful in treating alcoholism. Increasing Acceptance of Acupuncturists In the early 2000s, acupuncture is permitted in all 50 states. In some states, only physicians are permitted to practice acupuncture, while other states allow the procedure to be performed by lay acupuncturists under medical supervision or by unsupervised laypersons. In the United States, an estimated 3,000 medical doctors and osteopaths have studied acupuncture and use it in practice, up from 500 a decade before. Additionally, some 7,000 nonphysicians use acupuncture for a wide array of problems, sometimes in conjunction with massage, herbal therapies, and other traditional Eastern techniques. In 1990, the U.S. secretary of education recognized the National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine as an accrediting agency. However, the Food and Drug Administration considers acupuncture needles to be investigational devices and has not approved the use of acupuncture for any disease treatment. Choosing an Acupuncturist Individuals choosing a therapist to perform acupuncture should be examined by their physician first. Some conditions are beyond the scope of acupuncture treatment and demand immediate medical attention. However, many physicians may agree to have their patients undergo acupuncture along with traditional treatment. In some cases they will agree that a patient try acupuncture first, if postponing traditional treatment will not be injurious. When arranging to meet with an acupuncturist, follow the suggestions on page 9. See also ACUPRESSURE; ADDICTION; ALTERNATIVE MEDICINE. SOURCES: Martyn, Peter. “Acupuncture Successful in Treating Addictions.” The Toronto Star, September 10, 1995.
addiction 9 TIPS TO AVOID STRESS WHEN USING ACUPUNCTURE • Discuss your expectations with the acupuncturist. Ask how long until you can expect to see a change in your condition. Be suspicious of promises of a quick cure, especially if you have had your problem for some time. If you don’t see progress after six to eight treatments, reevaluate your choice of treatment and the practitioner. • Check the credentials of the acupuncturist you are considering. Ask whether he or she is certified by the National Commission for the Certification of Acupuncturists. To become certified, an acupuncturist must pass both a written and practical exam. To be eligible to take the exam, he or she must be licensed, have at least two years of training at an acupuncture school, or must have worked as an apprentice acupuncturist for at least four years. • If your prospective acupuncturist is a physician, ask whether he or she belongs to the American Academy of Medical Acupuncture, which requires at least 200 hours of acupuncture training for membership. Approximately 500 of the 3,000 physicians practicing acupuncture in the United States belong to the AAMA. • Discuss the costs of the procedure. Depending on the area of the country, and whether or not the acupuncturist is a physician, fees vary. Usually the first visit is considerably higher than subsequent visits. • Weigh the risks of acupuncture. There have been reports of serious complications attributed to acupuncture needles. However, most acupuncturists use sterile, disposable needles that come in a sealed package.
Weiss, Rick. “Medicine’s Latest Miracle.” Health, January/ February 1995.
addiction Usually refers to psychological or physical dependence on a chemical substance or behavior. Some individuals develop addiction to alcohol, tobacco, drugs, food, and sedatives prescribed by physicians. Others are addicted to activities such as dieting, exercising, GAMBLING, and sex. An addiction is often the result of stressful situations and the inability of the individual to cope
with them. Once addicted, he or she suffers from new stresses, including the physical or mental symptoms of the addiction or obtaining the money for his or her habit. In the meantime, family, friends and employers also suffer from stress, which can lead to situations such as DIVORCE, low job productivity or loss of job. Criteria for addiction are a compulsive or obsessive craving leading to persistent substance use or repeated actions; a need to increase the substance dose or level of activity as the addict’s tolerance increases; and, with certain drugs (alcohol, narcotics, barbiturates, etc.), possibly acute withdrawal symptoms if the drug is reduced or withdrawn abruptly. Withdrawal symptoms alone do not necessarily imply addiction. However, physical dependence can develop with prolonged use of a drug (e.g., morphine for pain). Psychological dependence can involve a loss of control of the substance use, and a tendency to orient behavior or life priorities toward obtaining the drug or pursuing the addictive behavior. Recognizing an Addiction Warning signs of drug or alcohol addiction include withdrawal from responsibilities; deterioration of family relationships, school or work performance; negative personality changes, such as depression; changes in sleep patterns, such as insomnia or sleeping too much; and legal problems, such as shoplifting or stealing money. Overcoming Addictions To overcome an addiction the addict must recognize that it exists and acknowledge his or her responsibility for the situation. Once the addict has confronted his/her problem, relief from addictions is usually best accomplished with a multidimensional approach. This may include psychological, medical, and spiritual therapies. Additionally, ALTERNATIVE MEDICINE, such as MEDITATION and GUIDED IMAGERY, may be of use. The addict also needs help from family members and an outside support group. Many self-help organizations exist to help recovering addicts and can be located through local public health departments or libraries. Groups are available to help the addicts themselves as well as spouses and children, who will also experience anxiety and stress
10 adolescence because of the addict’s behaviors. In many cases, relief from certain stressors, such as work pressure and family problems, can help an addict recover from his or her dependency. Addiction Severity Index The addiction severity index is a tool that mental health professionals generate from a questionnaire that gathers information about an individual’s stressors leading to or resulting from the addiction, as well as social, legal, employment, drug and alcohol use, and other habits. Using the index, the mental health professional can assess the individual’s function and level of stress in each dimension independently at the beginning of treatment and later, after treatment interventions. See also AGING; ALCOHOLISM AND ALCOHOL DEPENDENCE; ANXIETY; BEHAVIOR THERAPY; PSYCHOTHERAPIES. FOR FURTHER INFORMATION:
American Society of Addiction Medicine 4601 North Park Avenue Upper Arcade #101 Chevy Chase, MD 20815 (301) 656-3920 http://www.asam.org SOURCE E’Archangelo, E. “Substance Abuse in Later Life.” Canadian Family Physician 39 (September 1993): 1,986–1,993.
adolescence adoption
See
PUBERTY.
When individuals take by choice a child of other parents as their own child. Couples or singles choose to adopt for various personal reasons; some are unable to have children and may have undergone a variety of tests and treatments to no avail. Adopting a child is a stressful process and with each step new anxieties appear to replace previous ones. Planning for adoption puts stress on personal relationships. Referring to emotional highs and lows, the book Adopting Your Child suggests, “Most adoptions are roller coaster rides. There are long straight stretches, sudden lurches upward, and swooping plunges to the ground. There are people for whom adoption seems to go like clockwork, but
they are in the minority. Because there are so many areas over which you have no control, you cannot plan your way to a certain result.” Next, the avenue of adoption must be chosen and the many players involved in aiding and approving adoptive parents identified. Adoptive parents have many choices to make: private channels versus public agencies versus adoption through intermediaries, adoption directly from birth mother, or domestic versus international. Furthermore, far more adoption litigation is taking place today, in courtrooms in the United States, and far more stories of birth parents changing their minds permeate our media than in earlier times. Other issues that could arise include disqualification after a study of the adoptive home by a social worker, refusal of a child that is referred, and court denial of the adoption. Finally, once adoption occurs, there will be the many stresses that are the norms of parenthood. However, for adoptive parents other stressful events may lie ahead: deciding how and when to tell children they are adopted, dealing with the anxiety this information may bring to them at various stages of their lives, and recognizing the possibility that when they are older they may want to find their birth parents. See also COMMUNICATION; INFERTILITY; PARENTING. FOR FURTHER INFORMATION:
National Adoption Center 1500 Chestnut Street, Suite 701 Philadelphia, PA 19102 (800) TO-ADOPT (toll-free) http://www.adopt.org SOURCE: Reynolds, Nancy Thalia. Adopting Your Child: Options, Answers, & Actions. Bellingham, Wash.: Self-Counsel Press, 1993.
adrenaline A catecholamine (also known as epinephrine) produced and released by the adrenal medulla in response to stimulation from the nervous system, such as stressful events. Regulated by the sympathetic nervous system, it is a potent stimulator of the organs and may play a role in controlling certain aspects of immune functions. Adrenaline produces an increase in heart rate, rise in blood pressure, and contraction of abdominal blood vessels. These
affective disorders 11 sympathetic changes can be reversed by activation of the parasympathetic system. See also IMMUNE SYSTEM; NEUROTRANSMITTERS; STRESS.
advance directives
See
DEATH; END-OF-LIFE CARE.
advertising Propaganda for commercial purposes, designed to influence the consumer in making decisions to buy by emphasizing advantages of one particular product over its competitors. Choosing from the wide array of products and services available in the marketplace today can be an extremely stressful experience. Advertising is just one part of a complicated process of marketing that includes determining what goods and services should be created for a specific segment of customers, finding suitable pricing structures and methods of distribution, and influencing prospective purchasers. In an ideal world, consumers would be educated and use technical guidelines and consumer guides to help in making purchasing decisions. Unfortunately, there are few educated consumers and most live their lives prey to the pressures and stresses of advertising. Children, particularly, can be victims since they are unable to discriminate between what is real and what is unreal, what is good and what is bad. In turn, children may place demands on parents for products that can be unhealthy or poorly made, and which the parents cannot afford. Direct mail and telemarketing, are playing an increasingly important role in the advertising process. Both tend to apply greater pressure in their selling messages and often produce a great deal of stress for potential customers in the form of unwelcome mail and telephone calls both at the office and at home. Advertising campaigns are usually a combination of print ads and radio and TV commercials. They nudge, tease, scold, amuse, prod, and provoke potential customers in order to get them to try and then buy. Often, the campaign is centered not on the product itself, but on surrounding issues—how or where it is being used or who is using it. Techniques used to accomplish this include testimonials by well-known spokesper-
sons, often athletes or movie stars who are paid to lend their names or faces as an endorsement for products. In many cases, products are merely repackaged and promoted as new and improved. Advertising campaigns are usually directed to women, who have, since the turn of the century, accounted for more than 80 percent of all consumer spending. Until recently, Madison Avenue in New York City, long the center of the advertising business, was dominated by males, and the images of women in the advertising they created reflected their fantasies and fears. Advertisers have told consumers what they should and should not be and/or do, and advertising has spun pictures of perfection that often reminded consumers of their many shortcomings. Advertising, at its best, reflects styles and values. But it also can be overbearing when it takes the lead, sets the agenda, and attempts to dictate consumer behavior. See also MONEY; SHOPAHOLISM. FOR FURTHER INFORMATION (INQUIRIES AND COMPLAINTS):
Federal Trade Commission Pennsylvania Avenue 600 NW Washington, DC 20580 (202) 326-2222 http://www.ftc.gov
aerobic activities
See
EXERCISE.
affective disorders An individual who has an affective disorder (also known as mood disorder) may have feelings of extreme sadness or intense, unrealistic elation with corresponding disturbances in mood that are not due to any other physical or mental disorder. It is stressful enough for the individual as well as those around him or her at work or at home to warrant professional attention. Affective disorders differ from thought disorders; schizophrenic and paranoid disorders are primarily disturbances of thought, although individuals who have those disorders may also have some distortion of mood or affect. The death rate for individuals with chronically depressed moods is about 30 times as high as that for the general population because of the higher incidence of SUICIDE. Manic individuals also have a
12 affective disorders high risk of death, which can be attributed to their tendencies to exhaust themselves physically, to neglect their health, and to have accidents (often alcohol related). Types of Affective Disorders Affective disorders can be subcategorized as major depression and bipolar disorders. These disorders can be acute or chronic; both show symptoms by changes in the biological, psychological and sociological functioning of the individual. In some individuals, bipolar disorders and DEPRESSION occur according to a seasonal pattern, with a regular cyclic relationship between the onset of the mood episodes and particular seasons. A mood syndrome (depressive or manic) is a group of associated symptoms that occur together over a short duration. For example, major depressive syndrome is defined as a depressed mood or loss of interest, of at least two weeks’ duration, along with several associated symptoms, such as difficulty in concentrating and sleeping, fatigue, hopelessness, loss of pleasure, and weight loss or gain, with suicidal thoughts sometimes present. A mood episode (major depressive, manic, or hypomanic) is a mood syndrome not due to a known organic factor and not part of a non-mood psychotic disorder such as schizophrenia, schizoaffective disorder, or delusional disorder. Psychiatrists diagnose a mood disorder by the pattern of mood episodes. For example, the diagnosis of major depression, recurrent type, is made when an individual has had one or more major depressive episodes without a history of a manic or hypomanic episode. Manic episodes are distinct periods during which the individual experiences a predominant mood that is either elevated, expansive, or irritable. Such individuals may have inflated self-esteem, increased energy, accelerated and loud speech, flight of ideas, distractibility, grandiose delusions, and decreased need for sleep. The disturbance may cause marked impairment in working, social activities, or relationships; an episode may require that the affected person be hospitalized to prevent his harming himself or others. There may be rapid shifts of mood, with sudden changes to depression or anger. The mean age for the onset of manic episodes is in the early 20s, but many new cases appear after age 50. Hypomanic episodes are mood disturbances less severe than mania, but they may be severe enough
to cause several symptoms: marked impairment in judgment; financial, social or work activities associated with increased energy and busyness; exaggerated self-confidence; hypertalkativeness; euphoria or increased sense of humor. Often not recognized as illness by others, these behaviors are nevertheless associated with what are known as hypomanic episodes. Hypomanic episodes may be followed by depressions of moderate to great severity. Major Depressive Episodes Major depression affects approximately 10 percent of the adult population. A major depressive episode includes either depressed mood (in children or adolescents, sometimes irritable mood) or loss of interest or pleasure in all, or almost all, activities for at least two weeks. Associated symptoms may include feelings of worthlessness or excessive or inappropriate guilt, difficulty in concentrating, restlessness, appetite disturbance, change in weight, sleep disturbance, decreased energy, an inability to sit still, pacing, hand-wringing, and recurrent thoughts of death or of attempting suicide. Depressive episodes are more common among females than among males. The average age of onset of depressive episodes is the late 20s, but a major depressive episode may begin at any age. Bipolar disorders (episodes of mania and depression) are equally common in males and females. Bipolar disorder seems to occur at much higher rates in first-degree biologic relatives of people with bipolar disorder than in the general population. Cyclothymia involves numerous periods of hypomanic episodes and numerous periods of depressed mood or loss of interest or pleasure that are not severe enough to meet the criteria for bipolar disorder or major depressive episode. Dysthymia involves a history of a depressed mood for at least two years that is not severe enough to meet the criteria for a major depressive episode. This is a common form of depression, and the person who has this condition may have periods of major depressive episodes as well. Causes of Affective Disorders There are many explanations for affective disorders, including the psychoanalytic, interpersonal, cognitive, behavioral, learned helplessness, biologic, and genetic theories.
affective disorders 13 All these theories have common points of focus that can be roughly categorized as biological, psychosocial, and sociocultural. Personality characteristics of some individuals, such as lack of self-esteem and negative views of themselves and their future, predispose them to affective disorders. A stressful life event can also activate previously dormant negative thoughts. Individuals who become manic generally are ambitious, outgoing, energetic, care what others think about them, and are sociable before their episodes and after remission. However, depressive individuals appear to be more anxious, obsessive, and self-deprecatory. They often are prone to feelings of self-blame and guilt. Depressed individuals tend to interact with others differently from the way manics do. For example, some manic individuals dislike relying on others and try to establish social roles in which they can dominate others. On the other hand, depressed individuals take on a role of dependency and look to others to provide support and care. Feelings of a loss of hope and helplessness are central to most depressive reactions. In severe depression, “learned helplessness” may occur in which the individual sees no hope and gives up trying to cope with his or her situation. Biologic factors also play an important role. There was considerable research during the 1970s and 1980s to explore the view that depression and manic episodes both may arise from disruptions in the balance of the levels of brain chemicals called biogenic amines. Biogenic amines serve as neural transmitters or modulators to regulate the movement of nerve impulses across the synapses from one neuron to the next. Two such amines involved in affective disorders are NOREPINEPHRINE and 5hydroxytryptamine (SEROTONIN). Some drugs are known to have antidepressant properties and to biochemically increase concentrations of one or the other (or both) of these transmitters. In many individuals, psychosocial and biochemical factors work together to cause affective disorders. For example, stress has been considered as a possible causative factor in many cases. Stress may also affect the biochemical balance in the brain, at least in some predisposed individuals. Some individuals experience mild depression following significant life stresses, such as the death of a family member. Other major life events, especially those
involving reduced self-esteem, physical disease or abnormality, or deteriorating physical condition, may precipitate changes in mood. Treatment of Affective Disorders A variety of treatments including pharmaceutical medications and BEHAVIOR THERAPY are used to treat affective disorders. Some behavioral approaches, known as cognitive and cognitive-behavioral therapies, include efforts to improve the thoughts and beliefs (implicit and explicit) that underlie the depressed state. Therapy includes attention to unusual stressors and unfavorable life situations, and observing recurrence of depression. Prescription medications used to treat affective disorders include antidepressants, tranquilizers, and antianxiety drugs. Lithium carbonate, a simple mineral salt, is used to control manic episodes and is also used in some cases of depression where the underlying disorder is basically bipolar. For many individuals, lithium therapy is often effective in preventing cycling from depressive to manic episodes. Support groups for the affected individuals as well as their families are available in many areas. See also AGORAPHOBIA; ALCOHOLISM AND ALCOHOL DEPENDENCE; MANIC-DEPRESSIVE DISORDER; PHARMACOLOGICAL APPROACH; PSYCHOTHERAPIES; SEASONAL AFFECTIVE DISORDER SYNDROME (SADS). FOR FURTHER INFORMATION:
Depression and Bipolar Support Alliance 730 North Franklin Street, Suite 501 Chicago, 60610 (312) 642-0049 http://www.dbsalliance.org National Institute of Mental Health Office of Scientific Information Public Inquiries Section 5600 Fishers Lane, Room 15C-17 Rockville, MD 20857 (301) 443-4513 National Mental Health Association 2001 North Beauregard Street, 12th Floor Alexandria, VA 22311 (703) 684-7722 SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
14 age discrimination age discrimination Usually refers to adults ages 55 to 65 and older who are often the first workers to be let go in company downsizings and MERGERS and are overlooked as potential employees when applying for new jobs. Both of these factors of age discrimination are a source of stress. Although Congress banned age discrimination with the Age Discrimination in Employment Act of 1967, discrimination has continued and there have been increasing numbers of unemployed adults. Polls conducted by the Commonwealth Fund, a New York–based foundation, showed that there are 6 million unemployed Americans older than 55, half of whom are women who want to continue working. Despite the fact that there has been much research to disprove the stereotypes attributed to aging, they continue to influence judgments made concerning employment. Statistics have shown that workers age 40 and older take less time off than any other age group and are less accident-prone than younger workers. Members of this age group have also experienced more massive changes in technology over their lifetime than any past generation and are no less—if no more—adept at learning and using technology than those who are younger. For those older adults in the age 55 to 65 and older range, loss of work may also mean loss of health insurance and/or pension benefits at a time when they need them most. These losses and the efforts older adults make to seek new employment are sources of great stress. Corporations who have ignored the stereotypes and made a point of hiring older workers have said it pays. For a decade, Travelers Corporation, an insurance company, has operated an in-house temporary service staffed mainly by its retirees who need little training and are highly productive because of their knowledge of the company. See also AGING; JOB SECURITY. FOR FURTHER INFORMATION:
National Institute on Aging National Institutes of Health Department of Health and Human Services Building 31, Room 5C27 31 Center Drive, MSC 2292 Bethesda, MD 20892 (800) 222-2225
ageism
See
AGE DISCRIMINATION.
Agent Orange An herbicide used during the Vietnam conflict between 1962 and 1971 to remove unwanted plant life and leaves that provided cover for enemy forces. The effects of Agent Orange have been a cause of stress for individuals and their families because shortly following military service in Vietnam, some veterans reported health problems and concerns that many attributed to exposure to Agent Orange or other herbicides. Some of the illnesses included chemical acne, non-Hodgkin’s lymphoma, Hodgkin’s disease, soft-tissue sarcoma, prostate cancer, or peripheral neuropathy, a degenerative nerve disorder. Agent Orange contains varying amounts of dioxin, a known carcinogen. According to the U.S. Veterans Health Administration, more than 105,000 veterans or their survivors filed claims. Afflicted veterans brought a class-action suit against manufacturers of Agent Orange that was settled out of court. A fund was established to compensate them and their families for any disabilities. The Department of Veterans Affairs developed a program to respond to these medical problems and concerns. The program includes health care services, disability compensation, scientific research, and education. Veterans need not prove they were exposed directly to Agent Orange. Service anywhere in Vietnam is presumed as sufficient exposure and qualifies veterans for benefits. aggression
A general term for a variety of behaviors that appear outside the range of what is socially and culturally acceptable. It includes extreme selfassertiveness, social dominance to the point of producing resentment in others, and a tendency toward hostility. Individuals who show aggression may do so for many reasons including stress, frustration, as a compensatory mechanism for low SELFESTEEM, lack of affection, hormonal changes, or illness. Aggression may be motivated by ANGER, overcompetitiveness or a need to harm or defeat others. Aggression is stressful for the victim of the aggressor as well as for the aggressor him- or herself. An individual with an aggressive personality may behave unpredictably at times, causing stress
aging 15 for those around him or her. For example, such an individual may start arguments inappropriately with friends or members of the family and may harangue them. The individual may write letters of an angry nature to government officials or others with whom he or she has some quarrel. In addition to stressful circumstances, hormonal imbalances may account for some aggression. Excessive androgens, the male sex hormones, seem to promote aggression (e.g., the use of androgenic steroids to promote development of muscle mass in athletes has been known to make the user more aggressive). Individuals who are continuously aggressive may show changes in brain wave patterns in electroencephalograms (EEG). The term passive aggression relates to behavior that seems to be compliant, but in which “errors, mistakes, or accidents” for which no direct responsibility is assumed result in difficulties or harm to others. Patterns of behavior such as making “mistakes” that harm others are considered “passive aggressive.” (“Gee, I’m sorry, I didn’t mean to ruin all your work.”) SOURCE: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
aging
The aging process begins the day one is born, but for many individuals, stress related to aging increases as the years go by. Anxieties about the health status, financial capabilities, standard of living, and surviving loved ones mount as one grows older. Additionally, the aging process often brings with it a decrease in the body’s ability to adapt to stress. Consequently, there is an increase in the body’s vulnerability, often resulting in more susceptibility to colds, headaches, and minor gastrointestinal upsets. Stress also affects a person’s likelihood of developing more serious diseases in older age, including high blood pressure, heart disease, arthritis, ulcers, and possibly cancer. Stress has also been shown to worsen diseases such as diabetes in people who already have them. Some characteristics associated with aging can be slowed down by regular exercise programs. Exercise strengthens the body while improving one’s mental outlook and widening one’s social
COPING WITH THE STRESSES OF AGING • Maintain friendships and relationships with others. • Keep physically and intellectually active. • Make constructive use of time. • Eat a proper diet with a reasonable amount of fiber. • Reduce intake of salt and cholesterol. • Avoid smoking and excessive alcohol intake. • Do a reasonable amount of exercise. • Protect skin from the sun. • Undergo periodic health examinations. • Examine risk factors; determine necessary lifestyle changes.
contacts. Older adults are now jogging, walking, bicycling, and swimming. These exercises improve the condition of the heart and lungs, aid in weight control, and decrease many stress factors. Planning for retirement helps one stay active. In a study by the American Association of Retired Persons, members ranked BOREDOM as one of the most serious problems of retirement. Many healthy people move into RETIREMENT communities or buildings during their later years so that they will have companionship as well as available health care nearby. Among the concerns of the aging population are the ability to continue managing one’s own affairs, the desire to remain independent and not be a burden to children or society, and the dread of living out one’s last years in a nursing home. Mental Health in an Aging Population The prevalence, nature, and course of mental disorders in older adults may be very different from those in other adults. Assessment and diagnosis of later life mental disorders are challenging because of several distinctive characteristics of older adults. Clinical presentation of mental disorders may be different from that of other adults, making detection of treatable illness more difficult. For example, many older individuals present with somatic complaints and experience symptoms of depression and anxiety that do not meet the full criteria for depressive or anxiety disorders.
16 aging Detection of mental disorders in older adults is complicated further by high comorbidity with other medical disorders. Symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more difficult. Additionally, older individuals are more likely to report somatic symptoms than psychological ones, leading to further underidentification of mental disorders. Stereotypes about normal aging also can make diagnosis and assessment of mental disorders in later life challenging. For example, many people believe that senility is normal and therefore may delay seeking care for relatives with dementing illnesses. Similarly, patients and their families may believe that depression and hopelessness are natural conditions of older age. Depression is strikingly prevalent among older people. According to the surgeon general’s report, 8 to 20 percent of older adults in the community and up to 37 percent in primary care settings experience symptoms of depression. Depression is a major risk factor for suicide in older adults. Older people have the highest rates of suicide in the U.S. population; suicide rates increase with age, with older white men having a rate of suicide up to six times that of the general population. Medication-Related Concerns in the Aging Population As people age, there is a gradual decrease in gastrointestinal motility, gastric blood flow, and gastric acid production. This slows the rate of absorption, but the overall extent of gastric absorption is probably comparable to that in other adults. The aging process is also associated with a decrease in total body water, a decrease in muscle mass, and an increase in adipose tissue. Drugs that are highly lipophilic, such as neuroleptics, are therefore more likely to be accumulated in fatty tissues in older patients than they are in younger patients. Pharmacodynamics, or the drug’s effect on its target organ, also can be altered in older individuals. An example of aging-associated pharmacodynamic change is reduced central cholinergic function contributing to increase sensitivity to the anticholinergic effects of many neuroleptics and antidepressants in older adults. Prevention of medication side effects and adverse reactions is an important goal of treatment-related
prevention efforts in older adults. Comorbidity and the associated polypharmacy for multiple conditions are characteristic of older patients. Many older patients require antipsychotic treatment for management of behavioral symptoms in Alzheimer’s disease, schizophrenia, and depression. Body sway and postural stability are affected by many drugs. Minimizing the risk of falling, therefore, is another target for prevention research. Falls represent a leading cause of injury deaths among older persons. In addition to the effects of aging on how medications work and the increased risk of side effects, older individuals are also more likely than other adults to be medicated with multiple compounds, both prescription and nonprescription. Older adults (over the age of 65) fill an average of 13 prescriptions a year (for original or refill prescriptions), which is approximately three times the number filled by younger individuals. Drug interactions are of concern, both in terms of increasing side effects and decreasing efficacy of one or both compounds. Compliance with the treatment regimen also is a special concern in older adults, especially in those with moderate or severe cognitive deficits. Physical problems, such as impaired vision, make it likely that instructions may be misread or that one medicine may be mistaken for another. Cognitive impairment may also make it difficult for patients to remember whether or not they have taken their medication. See also CAREGIVERS; DEPRESSION; ELDERLY PARENTS; MENTAL HEALTH; RETIREMENT; SUICIDE. FOR FURTHER INFORMATION:
American Association of Retired Persons 601 E Street NW Washington, DC 20049 (202) 434-2277 SOURCES: Hyman, Steven E., M.D. “Mental Health in an Aging Population,” American Journal of Geriatric Psychiatry. Available online. URL: http://www.ajgp.psychiatryonline. org/cgi/content/full/9/4/330. Downloaded on June 20, 2005. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Mental Health: A Report of the Surgeon General. Available online. URL: http://www.surgeongeneral.gov/ library/mentalhealth/home.html. Accessed January 24, 2006.
agoraphobia 17 aging parents
See
AGING; CAREGIVERS; ELDERLY
PARENTS.
agoraphobia
An ANXIETY DISORDER; it is a complex syndrome characterized by extreme ANXIETY about being in situations from which escape may be difficult or embarrassing or in which help may not be available in the event of having a PANIC ATTACK. Agoraphobia includes fears of losing control of oneself and of developing embarrassing or incapacitating symptoms, such as dizziness, fainting, or sudden illness. Typically, the anxiety leads to a pervasive avoidance of situations that may include being alone outside or in the home; being in a crowd of people; traveling in an automobile, bus, or airplane; or being on a bridge or in an elevator. According to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, some individuals are able to expose themselves to the feared situations but endure these experiences with considerable dread. Often an individual is better able to confront a feared situation when accompanied by a companion. Agoraphobia causes stress for the sufferer as well as for family members and friends. Individuals’ avoidance of situations may impair their ability to travel to work or to carry out homemaking responsibilities, such as grocery shopping and taking children to the doctor. Agoraphobia can be socially disabling. Many agoraphobics refuse invitations or make excuses for not going out. Thus, adjustments are necessary to compensate for the agoraphobic’s lack of participation in family life and activities outside the home. Prevalence Agoraphobia usually occurs in adults; the ratio of agoraphobia in women vs. men is three to one. Shy, anxious women form the group of individuals most prone to agoraphobia. Many agoraphobics are indecisive, lack initiative, feel guilty because they are unable to get out of situations themselves, and may gradually withdraw into a restricted lifestyle. The majority of agoraphobics are married at the time they come for treatment. In most cases involving agoraphobics, spouses seem well-adjusted and integrated individuals. Agoraphobia may strain a marriage because the agoraphobic person may ask
the spouse to take over chores that require going out, such as shopping or picking up children; spouses often must fulfill social obligations without the companionship of their mates. Spouses are additionally stressed by having to be “on call” in case anxiety attacks occur that require an emergency trip home to soothe the agoraphobic. Thus, a couple that may have been happy may be driven apart by the disorder, with each blaming the other for a lack of understanding. The husband may think that the wife is not trying to overcome her phobic feelings, and the agoraphobic wife may think that her husband does not understand her suffering. The wife may become so preoccupied with fighting her daily terrors that she focuses little attention on their marital relationship and her husband’s needs. However, in cases where the agoraphobic has an understanding, patient, and loving spouse, this support can be an asset in overcoming the agoraphobic condition. The spouse can attend training sessions with the therapist, attend group therapy sessions, and act as the “understanding companion” when the agoraphobic is ready to venture out. Symptoms Many agoraphobics were formerly active, sociable, outgoing persons; however, when they seek treatment, they are often in a constant state of extreme stress. Typically, the agoraphobic admits to being generally anxious and expresses feelings of helplessness and discouragement. In some cases, agoraphobics abuse alcohol and drugs. Characteristic symptoms in addition to general anxiety include an intense fear of dizziness or falling, loss of bladder or bowel control, vomiting, palpitations, and chest pain. There may be a fear of having a heart attack because of the rapid heart action, of fainting if the anxiety becomes too intense, and of being surrounded by unsympathetic onlookers. The individual then develops a fear of the fear, which brings about anxiety in anticipation of a panic reaction, resulting in avoidance of the feared situation. Occasionally, depersonalization occurs; depersonalization is a change in the perception or experience of the self so that the feeling of one’s own reality is temporarily lost. Often in agoraphobia there is a history of panic attacks; however, agoraphobia may occur with or without a history of panic attacks.
18 agoraphobia Many agoraphobics have episodes of DEPRESThe first episode may occur within weeks or months of the first panic attack. Individuals complain of feeling “blue,” having crying spells, feeling hopeless and irritable, lacking interest in work, and having difficulty in sleeping. Agoraphobia is often aggravated during a depressive episode. The increased anxiety may make individuals less motivated to work hard at tasks (such as going out) that they previously did without difficulty. Some agoraphobics are also claustrophobic. Usually CLAUSTROPHOBIA is present before the agoraphobia develops. The common factor between the two phobias is that escape is blocked, at least temporarily. Symptoms of the phobic anxiety in agoraphobia may include many physical sensations that accompany other anxiety states, such as dry mouth, sweating, rapid heart beat, hyperventilation, faintness, and dizziness. Many women report that generalized anxiety and panic in agoraphobia tends to be worse just prior to and during MENSTRUATION. Some agoraphobics experience obsessions, which are persistent and recurrent ideas, thoughts, impulses, or images that occur involuntarily and invade the consciousness. Obsessional behavior is usually present before an individual develops agoraphobia. Individuals may develop obsessional thinking about certain places, situations, or objects that might stimulate their fear reaction. Obsessional thinking is difficult to control, often distorts or exaggerates reality, and causes much anticipatory anxiety. Individuals may develop compulsive behavior in an attempt to reduce obsessional thoughts and resultant stress and anxiety. SION.
Causes of Agoraphobia Agoraphobia frequently results from panic attacks, which are attacks of overwhelming anxiety, leading the victim to fear a fatal heart attack or loss of mental control. After repeated panic attacks, sufferers avoid crowds, enclosed places (tunnels, airplanes, large groups of people, even leaving home) for fear that a repeat panic attack might occur. Some individuals regard the world as a dangerous place because of learned experiences. Many agoraphobics had at least one agoraphobic parent and many have had at least one parent who is somewhat fearful. In some cases, they received mixed messages from their parents. While they
were encouraged to achieve, they were not well prepared to deal with the world, either because they were overprotected and taught that home is the only safe place, or underprotected, having to take on too much responsibility at an early age. Additionally, there may be a genetic predisposition to panic disorder; it may be as much as 10 times more frequent in the biological relatives of those with panic disorder as among those without such a family history. The biological basis for panic attacks and resultant agoraphobia is being researched, and there are many theories. For example, symptoms of panic attacks, such as palpitations, sweating, and tremulousness, have lead to a theory that they are the result of massive discharges from the adrenergic nervous system (part of the autonomic nervous system, which controls activities of organs, blood vessels, glands and many other tissues in the body). Treatments for Agoraphobia Treatment for agoraphobia is usually directed toward several aspects of the agoraphobic syndrome: agoraphobia, panic attacks and anticipatory anxiety. A variety of treatments are often used for the same individual, sometimes in sequence or combination. BEHAVIOR THERAPY includes educating individuals about their reactions to anxiety-producing situations, and teaching BREATHING exercises to help overcome HYPERVENTILATION. In many cases, three to six months of behavior therapy is effective, and subsequent supportive and behavioral techniques reduce the anxiety level and help individuals master fears of recurrent attacks in specific situations. Many treatments for agoraphobia are based on varieties of techniques known as exposure therapy. Typically, treatment involves exposing the agoraphobic to situations that are commonly avoided and frightening in order to demonstrate that there is no actual danger. Treatment may include direct exposure, such as having the individual move away from a safe place or person, or enter a crowded shopping center in a structured way. Indirect exposure is also used; this may involve use of films with fear-arousing cues. Systematic desensitization is a procedure characterized by exposure (either in imagination or in “real life”) to the least reactive elements of a situation or object until the anxiety response no longer occurs. Another imaginal proce-
agoraphobia 19 dure for anxiety treatment includes flooding, or continuous presentation of the most reactive elements of a situation until anxiety reduction occurs. Facing the fearful situation with appropriate reinforcement may help an individual undo the learned fear. For example, some therapists set progressive goals for the patient for each week, such as walking one block from home, then two and three, and taking a bus. In the early stages of treatment, many therapists accompany their patients as they venture into public places, and in some cases spouses or family members are trained to accompany them. Other therapists recommend structured group therapy with defined goals and social skill training for agoraphobics and their families. Involvement of spouses and family members usually produces better results than treatment involving the agoraphobic alone. Home-based treatment, where individuals proceed at their own pace within a structured treatment program, produces fewer dropouts than the more intensive, prolonged exposure or pharmacological treatments. Some agoraphobics develop ways to live more comfortably with their disorder. For example, those who go to church or a movie theater may prefer aisle seats so that they can make a fast exit if they experience a panic attack. Having a telephone nearby is another comfort. Pharmacological Approach The treatment of choice today for agoraphobia involves use of both behavior therapy and pharmaceutical medication, with the latter withdrawn as progress is made. Particularly for those who have panic attacks, drug therapy initially seems to enhance results of exposure-based treatments. In many cases, drugs are used for three to six months and then discontinued once the individual has some control over bodily sensations. Some individuals never experience recurrence of attacks, while others experience a return months or years later. When attacks recur, a second course of drug therapy is often successful. Agoraphobia and Alcoholism Some agoraphobics use alcohol in an unsuccessful attempt to avoid anticipatory anxiety and panic attacks. However, alcohol may exacerbate panic by bringing about a feeling of loss of control both men-
tally and physically. Also, use of alcohol may interfere with effective treatment of the agoraphobia, as central nervous system depressants in alcohol reduce the efficacy of exposure treatment. However, some agoraphobic people believe that alcohol helps to calm them before they venture out into public. There is some evidence that both agoraphobics who abuse alcohol and agoraphobics who don’t may have histories of disturbed childhoods that include familial ALCOHOLISM and depression. Also, children whose early attachments to caretakers were non-supportive as well as frightening or dangerous may fail to develop a sense of trust and security. Such individuals may be particularly vulnerable to later psychopathology, including panic attacks and agoraphobia; alcoholism may be one mode of coping for such individuals. The clinical picture of both agoraphobia and alcoholism often involves depression. Agoraphobics who are alcohol abusers may also be more socially anxious than their non-alcoholic peers. High rates of SOCIAL PHOBIA have been noted among inpatient alcoholics, and major depression has been found to increase both the likelihood and intensity of agoraphobia and social anxieties. Self-Help Groups for Agoraphobics As recovery from agoraphobia is a long-term process, self-help groups can provide valuable support. Participating individuals share common experiences and coping tips, and have an additional social outlet. Some agoraphobic SUPPORT GROUPS get together for outings, help take each other’s children to and from school, arrange programs, and retrain themselves out of their fears and anxieties. See also PHARMACOLOGICAL APPROACH; PSYCHOTHERAPIES. FOR FURTHER INFORMATION:
American Psychiatric Association Division of Public Affairs 1000 Wilson Boulevard, Suite 1825 Arlington, VA 22209-3901 (703) 907-7300 http://www.psych.org Anxiety Disorders Association of America 8730 Georgia Avenue, Suite 600 Silver Spring, MD 20910 (240) 485-1001 http://www.adaa.org
20 AIDS SOURCES: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994. Frampton, Muriel. Agoraphobia: Coping with the World Outside. Wellingstorough, Northamptonshire, England: Turnstone Press, Ltd., 1984. Kahn, Ada P. “Panic Attacks.” Chicago Tribune, June 23, 1991. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
AIDS
See
ACQUIRED
IMMUNODEFICIENCY
SYN-
DROME; HUMAN IMMUNODEFICIENCY VIRUS.
AIDSinfo A free reference service for health care providers as well as people living with HIV disease. The service, which began in 1995, is sponsored by the U.S. Department of Health and Human Services (HHS). The service resulted from the merger of two previous HHS projects: The AIDS Clinical Trials Information Service (ACTIS) and the HIV/AIDS Treatment Information Service (ATIS). The mission of AIDSinfo is to offer the latest federally approved information on HIV/AIDS clinical research, treatment, and prevention, and medical practice guidelines for HIV/AIDS patients, their families and friends, health care providers, and researchers. Specialists answer questions about the latest treatment options, provide customized database searches, and link inquirers to other HIV/AIDS information resources. Information seekers can obtain copies of the latest federally approved treatment guidelines, including recommendations for HIV counseling and voluntary testing for pregnant women, guidelines for prevention of opportunistic infections in persons infected with HIV, and study results concerning antiHIV therapy that lowers risk of AIDS and death in patients with intermediate-stage HIV disease. Evaluations of clinical trials using experimental drugs and other therapies for adults and children at all stages of HIV infection are provided. Information can be obtained about Food and Drug Administration (FDA)–approved anti-HIV medications. Links to literature citations and clinical trials are provided for each of the FDAapproved medications.
AIDSinfo maintains an extensive Web site useful for information seekers. AIDSinfo developed the Glossary of HIV/AidsRelated Terms to help people understand the technical terms related to HIV, its associated treatments, and the medical management of related conditions. See also HUMAN IMMUNODEFICIENCY VIRUS. FOR INFORMATION:
AIDSinfo P.O. Box 6303 Rockville, MD 20849-6303 (800) 448-0440 (toll-free) (301) 519-6616 (fax) (888) 480-3739 (TTY) http://aidsinfo.nih.gov
airplanes Many individuals are phobic about flying. Estimates indicate that one of every six adults is afraid to fly. Some people choose to spend days traveling by train or experience the stresses of highway travel in place of flying. Anticipation of taking an airplane flight is a major source of stress for many people. Some are fearful of being in an enclosed place (CLAUSTROPHOBIA), while others fear being out of CONTROL or becoming ill, and are just generally anxious about all the safety and weather factors associated with traveling by air. Many common phrases related to flying in airplanes, such as “terminal,” “final boarding,” “final approach,” and “departure lounge,” have a morbid connotation and produce stress. These terms are augmented by oxygen masks, life jackets, emergency exits, crash procedures, and other reminders of adverse consequences of flying. In addition, news reports of air crashes and television and movie productions centering on trouble on airplanes can contribute to the ANXIETY. Reasons for Stress There are two major areas of stress relating to flying. One is anticipating the situation and the other is the flying situation itself. Anticipatory anxiety occurs when one makes a commitment to fly by making the reservation, purchasing the ticket, and telling people about the trip. People experiencing anticipatory anxiety usually feel dread, rapid pulse, body sensations such as tension and warmth, and have fear-producing images and thoughts.
air pollution 21 The anticipatory fear is usually not of the airplane itself but of uncontrollable outcomes such as fear of losing control of oneself in the plane, embarrassing oneself in public, fear of separation from loved ones, fears of relinquishing control to the pilot, or thoughts of falling from the sky and dying in a crash. People who fear flying can learn to become less fearful. Flying can be viewed as an opportunity to begin overcoming this fear. Skills can be acquired to visualize flying comfortably, and relaxation techniques can be learned to help cope with the fears. One can practice desensitization; this involves going to the airport, watching planes take off and land and imagining feeling comfortable in the planes being watched. Finally, one can make a tape to relax with reminders and ideas to help cope while flying. With preparation, practice, and more flying, this fear can be diminished. Since September 11, 2001, stress associated with airline travel has increased significantly because of security and fears of terrorism. Baggage cannot be locked except with special locks that security agents can open. Baggage is X-rayed and, at many airports in the United States, often searched before one boards the plane. In many cases, people undergo a body search with a wand that can detect metal or explosives, or with a pat-down of their body. Pat-down procedures have been controversial when pat-downs of women are performed by male security personnel. At times passengers are chosen randomly for these more thorough searches. Additionally, passengers are often asked to remove their shoes while going through the final security checkpoint. After exiting the checkpoint, passengers must remove their baggage from the conveyor belt and then find a chair on which to sit while they tie their shoes. However, although still stressful for many people, by 2005, this routine became habit for most travelers. Treating Stresses and Fears Surrounding Airplanes Treatments for the stresses involved in airplane travel includes behavior therapies, particularly exposure therapy, HYPNOSIS, RELAXATION techniques, and use of some pharmacological approaches. Propranolol and ALPRAZOLAM are two drugs commonly used for fear of flying. They are both fast-acting and produce relatively few side effects.
Many people turn to alcohol to relieve their stresses and fears related to flying. While alcohol reduces autonomic arousal, it tends to produce anxiety-like sensations including dizziness, loss of balance, mental confusion, and lack of control of perceptual-motor functions, which in turn can trigger more stress and an anxiety response. There may also be stress related to feelings about a place or person the individual associated with either the point of departure or of arrival. See also AIRPORT SCREENING MACHINES; ALCOHOLISM AND ALCOHOL DEPENDENCE; BEHAVIOR THERAPY; PHOBIAS; PHARMACOLOGICAL APPROACH; POST-TRAUMATIC STRESS DISORDER. SOURCE: Kahn, Ada P., and Ronald M. Doctor. Encyclopedia of Phobias, Fears, and Anxieties. New York: Facts On File, 1989.
air pollution
An air quality that is a source of stress because it contributes to lung disease, including respiratory tract infections, asthma, and lung cancer. People who have health problems such as asthma, heart disease, and lung disease may also suffer more when the air is polluted. The extent to which an individual is harmed by air pollution usually depends on the total exposure to the damaging chemicals, the concentration of the chemicals, and the duration of exposure. Short-term air pollution can aggravate medical conditions of those who have asthma and emphysema. Short-term effects include irritation to the eyes, nose, and throat, and upper respiratory infections such as bronchitis and pneumonia. Other symptoms can include headaches, nausea, and allergic reactions. Long-term effects can include chronic respiratory disease, lung cancer, heart disease, and even damage to the brain, nerves, liver, or kidneys. Types of Air Pollution There are many types of air pollution, including smog, particulate matter, smoke, and acid rain. The exhaust from burning fuels in industries and automobiles is a major source of pollution in the air. For example, diesel smoke contains particulate matter; this type of pollution is sometimes referred to as “black carbon” pollution. The release of noxious gases into the air, such as sulfur dioxide, carbon monoxide, nitrogen oxides,
22 airports and chemical vapors, is another type of pollution. These substances can take part in further chemical reactions once they are in the atmosphere, forming smog and acid rain. Indoor air pollution may be caused by biological pollutants such as molds, bacteria, viruses, pollen, dust mites, and animal dander. In large buildings, heating, cooling, and ventilation systems are frequent sources of biological substances that are inhaled, leading to breathing problems. “Secondhand smoke” is also a major indoor air pollutant. It contains about 4,000 chemicals, including 200 known poisons, such as formaldehyde and carbon dioxide, as well as 43 known carcinogens. Estimates are that environmental tobacco smoke (ETS) causes 3,000 lung cancer deaths and 35,000 to 50,000 heart disease deaths in nonsmokers in the United States each year. The release of formaldehyde into the air may cause health problems, such as coughing; eye, nose, and throat irritation; skin rashes; headaches; and dizziness. Formaldehyde is a common chemical found primarily in adhesive or bonding agents for many materials used in buildings, including carpets, upholstery, particleboard, and plywood paneling. Asbestos fibers can be inhaled into the lungs and cause asbestosis (scarring of the lung tissue), lung cancer, and mesothelioma, a relatively uncommon cancer of the lining of the lung or abdominal cavity. Roofing and flooring materials, wall and pipe insulation, heating equipment and acoustic insulation products are a potential problem indoors if the asbestos-containing material is disturbed and becomes airborne. Carbon dioxide in the air can impede coordination, worsen cardiovascular conditions, and produce fatigue, headaches, confusion, nausea and dizziness, depending upon the amount present. Very high levels can cause death. Nitrogen dioxide is a colorless, odorless gas that irritates mucous membranes in the eyes, nose, and throat and causes shortness of breath after exposure to high concentrations. Prolonged exposure to high levels of nitrogen dioxide can damage respiratory tissue and may lead to chronic bronchitis. Research into the health effects of air pollution is ongoing. Medical conditions arising from air pollution are expensive in terms of health care. See also ASTHMA.
FOR FURTHER INFORMATION:
American Lung Association 61 Broadway, Sixth Floor New York, NY 10006 (800) LUNG USA (212) 315-8872 (fax) SOURCE: Kahn, Ada P. The Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
airports
See
AIRPLANES;
RANDOM
NUISANCES;
VACATIONS.
airport screening machines
X-ray screening machines are used to search carry-on and checked baggage for possible explosives and dangerous objects. Passengers experience stress while waiting in lines at checkpoints and when officials open their luggage and view its contents. Employees find working with the machines stressful because of the tedium of the activity. They might also have concerns about possible radiation exposure from working with the cabinet X-ray system. The cabinet is intended to protect the public from the X-rays. In November 2001, Congress enacted the Aviation and Transportation Security Act (ATSA). Under ATSA, the responsibility for inspecting persons and property carried by aircraft operators and foreign air carriers was transferred to a newly formed agency, the Transportation Security Administration (TSA). In March 2003, the TSA requested that the National Institute for Occupational Safety and Health (NIOSH) conduct an independent study to determine the potential radiation exposures to employees who operate X-ray-generating machines. Monitoring of the machines began in 2003. A complete report is expected during 2005. NIOSH has determined that it is safe for a pregnant employee to work around the machines if proper work practices are followed and if the machine is not leaking radiation above the FDA limits. Sometimes employees must reach inside the entrance and exit tunnels of the machines to load, unload, or clear bag jams. However, if an employee reaches into the entrance or exit tunnels while certain indicator lights are on, there may be some radiation exposure. The amount of exposure depends on how long the employee reaches into the tunnel,
alcoholism and alcohol dependence 23 the size of the baggage (which could serve as a shield), how far and how often the employee reaches into the tunnel, and the type of machine. Passengers’ Concerns Some passengers are concerned if their lunch or other food goes through a cabinet X-ray system. According to the Food and Drug Administration’s Center for Food Safety and Nutrition and the U.S. Department of Agriculture Food Safety Inspection Service, there are no known adverse effects from eating food that has been irradiated by a cabinet Xray system used for security screening. The radiation dose typically received by objects scanned by a cabinet X-ray system is one millirad or less. The average dose rate from background radiation is 360 millirads per year. The minimum dose used in food irradiation for food preservation or destruction of parasites or pathogens is 30,000 rad. Electronic equipment is also not harmed by the X-ray dose received when a piece of equipment is scanned by a cabinet X-ray system. While it is unlikely that photographic film will be damaged, it is possible. Most cabinet X-ray systems used in the United States for security screenings are built to be safe for film speeds below 1,000. Multiple exposures of film even in film-safe X-ray systems may eventually result in fogging or grainy images. However, some systems, usually those scanning checked baggage, and some X-ray systems used in other parts of the world are not designed to be film-safe. Manufacturers are not required by federal regulation to build their systems to be filmsafe. Film manufacturers can provide more specific recommendations about the storage and transport of exposed and unexposed film. Health Effects from Radiation Exposure According to the Environmental Protection Agency (EPA), radiation can damage genetic material (DNA) in the body’s cells, especially dividing cells. If a small amount of radiation is absorbed in the body, it does not always damage the cells. If it does, the cells can sometimes repair themselves. Damaged cells can die right away or, if they survive, may be transformed into cells that could cause a tumor. No one is sure how much radiation can cause cancer, but it is assumed that the risk of cancer is
proportional to the absorbed dose. Even low doses could cause cancers five to 30 years or longer after exposure, according to NIOSH. See also AIRPLANES; AIRPORTS; CANCER; RADIATION; TERRORISM. FOR FURTHER INFORMATION:
The Nuclear Regulatory Commission Office of Public Affairs (800) 368-5642 (toll-free) (301) 415-8200 (301) 415-5575 (TDD) http://www.nrc.gov/what-we-do-/radiation.html U.S. Environmental Protection Agency Office of Radiation and Indoor Air Radiation Protection Division 1200 Pennsylvania Avenue NW MC 6608J Washington, DC 20460-0001 (202) 343-9290 (202) 343-2304 (fax) U.S. Food and Drug Administration Center for Devices and Radiologic Health 1350 Piccard Drive Rockville, MD 20850-4307 (800) 638-2041 http://www.fda.gov/cdrh/comp/cabinetxrayfaq.html SOURCE: John Candarelli, et al. “NIOSH Airport X-Ray Study Update,” Available online. URL: http://www.cdc.gov/ niosh/topics/airportscreener. Downloaded on June 4, 2005.
Alcoholics Anonymous
See
ALCOHOLISM AND
ALCOHOL DEPENDENCE.
alcoholism and alcohol dependence
Alcoholism (alcohol dependence) is characterized by compulsive, habitual, long-term and heavy consumption of alcohol and with withdrawal symptoms when intake of alcohol suddenly ceases. Many factors interact to lead to alcohol dependence. People who abuse alcohol often begin to drink to relieve personal, social, or business stresses. When they find temporary relief, even at the cost of occasional hangovers, they may gradually begin to drink whenever they feel tense or anxious. The more they need alcohol to fight their
24 alcoholism and alcohol dependence ANXIETY, the less they can do without it. Some individuals may start out as moderate drinkers and then begin to depend on alcohol during times of extreme STRESS, such as bereavement, loneliness, job difficulties, DIVORCE, or their illness or an illness of a close family member. Some agoraphobics become alcoholic as a way of coping with their fears. Because some agoraphobic individuals do not go out, it is fairly easy for them to conceal their alcoholic habit. Some depressed individuals turn to alcohol to temporarily improve their mood; instead of mood elevation, it results in sedation. Genetic factors as well as personality and environmental factors play a role in causing dependence in some cases, but it is widely understood that anyone can become addicted to alcohol if she or he drinks heavily and regularly for a prolonged period of time.
Stress on Family Members When an individual drinks to excess, it can cause stress on family members as well as employers. For example, abusers may neglect home or child care responsibilities and may often be absent from their jobs. They may be difficult to live with because they are often irritable and sometimes violent. Abusers may be drunk under physically hazardous circumstances, such as operating machinery. There may be legal difficulties, such as an arrest for driving while under the influence of alcohol. Alcohol is an important factor in deaths and injuries from industrial and motor vehicle accidents, suicides, domestic violence, marriage breakdown, child abuse, and other types of crime. Physical tolerance for alcohol varies between individuals. The shift from social drinking to alcoholism can happen almost imperceptibly over a long period of time, or may occur rapidly. Drinking habits vary too. Some individuals are “binge” drinkers who go on drinking sprees, while others drink constantly and are never quite sober. Spouses, friends, and employers of binge drinkers must cope with the stresses of unpredictable variations in the mood behavior of the drinker, making everyday life a challenge. Alcoholism: Public Health Problem The number of American adults who abuse alcohol or are alcohol dependent rose from 13.8 million
(7.41 percent) in the period 1991–92 to 17.6 million (8.46 percent) in the period 2001–02, according to results from the 2002–03 “National Epidemiologic Survey on Alcohol and Related Conditions” (NESARC), a study directed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NESARC study, a representative survey of the U.S. civilian noninstitutionalized population aged 18 years and older, showed that the rate of alcohol abuse increased from 3.03 to 4.65 percent during the decade while the rate of alcohol dependence, commonly known as alcoholism, declined from 4.38 to 3.81 percent. The NIAAA defines alcohol abuse as a condition characterized by failure to fulfill major role obligations at work, school, or home; interpersonal, social, and legal problems; and/or drinking in hazardous situations. The NIAAA defines alcohol dependence, also known as alcoholism, as a condition characterized by impaired control over drinking, compulsive drinking, preoccupation with drinking, tolerance to alcohol, and/or withdrawal symptoms. NESARC survey questions are based on diagnostic criteria for alcohol abuse and alcohol dependence contained in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Fieldwork for the NESARC was performed by the U.S. Census Bureau, which interviewed 43,093 respondents. The combined household and individual response rate was 81 percent. According to Elias Zerhouni, M.D., director of the National Institutes of Health, “Change or stability in the prevalence of alcohol disorders has important public health implications for researchers, policy makers, and the public.” “The NESARC report reinforces the need for ongoing research to define genetic and environmental factors that contribute to alcohol abuse and dependence, as well as current NIAAA initiatives for the early identification of at-risk drinkers and the application of research-based interventions in vulnerable populations, especially underage drinkers,” according to Ting-Kai Li, M.D., director, National Institute on Alcohol Abuse and Alcoholism. “The fact that alcohol disorder rates are highest among young adults underscores the need for concerted research on drinking patterns that initiate in adolescence.”
alcoholism and alcohol dependence 25 Overall, the NESARC data show that rates of alcohol abuse and dependence in the period 2001–02 were substantially higher in men than in women and among younger study participants aged 18–29 and 30–44 years. Alcohol abuse is more prevalent among whites than among Hispanics, Blacks, and Asians. Alcohol dependence is more prevalent among Native Americans, Hispanics, and whites than among Asians. The prevalence of alcohol dependence declined during the 1990s for men but remained almost static for women, effectively narrowing the gender gap for that diagnosis. Alcohol dependence rates decreased significantly among whites and Hispanics overall but, at the subpopulation level, the changes were significant only for white men overall and for Hispanic men both overall and in the 18–29 and 45–64 age groups. Alcohol dependence prevalence remained relatively stable among blacks, Native Americans, and Asians overall. In contrast, black women and Asian men aged 18–29 years showed significant increases in alcohol dependence. Alcoholism as a Disease Most authorities, including the American Medical Association and the American Bar Association, recognize alcoholism as a disease; others say that it is a self-inflicted condition and cannot properly be designated a disease. However, as a physiological and psychological dependence on alcohol, alcoholism must be considered an ADDICTION. Contrary to popular belief, alcohol is a depressant, not a stimulant. The effects of alcohol are felt most noticeably in the central nervous system. As sensitivity is reduced in the nervous system, the higher functions of the brain are dulled, leading to impulsive actions, loud speech, and lack of physical control. The drinker’s face may turn red or pale. While drinking, the alcoholic loses any sense of guilt or embarrassment, gains more self-confidence, and sheds inhibitions as the alcohol deadens restraining influences of the brain. Large quantities of alcohol impair physical reflexes, coordination, and mental acuteness. Symptoms and Stages of Alcoholism There are four stages of alcoholism. In the first phase, the heavy social drinker may feel no effects from alcohol. In the second phase, the drinker
experiences lapses of memory relating to drinking episodes. In the third phase, there is lack of CONTROL over alcohol and the drinker cannot be certain of discontinuing drinking by choice. The final phase begins with long binges of intoxication and observable mental or physical complications. Behavior symptoms may include aggressive or grandiose actions, irritability, jealousy or uncontrolled anger, frequent changing of jobs, repeated promises to give up drinking, hiding of bottles, and neglect of proper eating habits and personal appearance. Physical symptoms may include unsteadiness, confusion, poor memory, nausea, vomiting, shaking, weakness in the legs and hands, irregular pulse, and redness and enlarged capillaries in the face. In general, alcohol-dependent persons are more susceptible than others to a variety of physical and mental disorders. Professional Treatment and Self-Help Groups Medical help for alcohol dependence includes detoxification, which is assistance in overcoming withdrawal symptoms, and psychological, social, and physical treatments. Psychotherapy is usually done in groups and uses a variety of techniques. Therapists for alcoholic dependent persons may be psychiatrists, psychologists, or social workers. Family members are involved in the treatment process. Many alcohol dependent persons benefit from involvement in SELF-HELP GROUPS. These groups are also available for other family members. Alcoholics Anonymous (AA) is an international organization, founded in 1935, devoted to maintaining the sobriety of its members and helping them control the compulsive urge to drink though self-help, mutual support, fellowship, and understanding. Medical treatment is not used. The program includes the individual’s admission that he (or she) cannot control his (her) drinking, the sharing of experiences, problems, and concerns at meetings, and helping others who are in need of support. At the core of the AA program is the desire to stop drinking. Members follow a 12-step program that stresses faith, disavowal of personal responsibility, passivity in the hands of God or a higher power, confession of wrongdoing, and response to spiritual awakening by sharing with others. The first step involves the idea of despair and a breakdown of denial concerning alcohol. Second is
26 Alexander technique the idea of hope, or seeing the light. Third is the shifting of responsibility from oneself to a higher authority figure. The next steps involve confessing, making amends, continuing confirmation of a new image of oneself, and redirecting energy to help others.
Children of Alcoholics Foundation 200 Park Avenue, 31st Floor New York, NY 10166 Phone: (212) 949-1404 http://www.coaf.org
Life Expectancy May Increase with Abstinence Alcoholics who go dry may increase their life expectancy, according to results of a study published in the Journal of the American Medical Association (January 4, 1992). Results supported the notion that achievement of stable abstinence reduces the risk of premature death among alcoholics. Kim D. Bullock, Psychiatry and Research Services, Veterans Affairs Medical Center, San Diego, and colleagues reported on 199 men who had histories of at least five years of drinking at alcoholic levels. All were current or former patients of the V.A. Alcoholism Treatment Program and/or members of Alcoholics Anonymous. Follow-up on relapse and mortality was obtained; 101 men had relapsed and 98 were abstinent. A control group of 92 nonalcoholics equated for age, education, and sex was also studied for mortality. There were 19 deaths among the relapsed alcoholics compared with the expected number of 3.83. Among abstinent alcoholics there were four deaths. Alcoholic men who achieved stable abstinence did not differ from nonalcoholic men in mortality experience. However, alcoholics who relapsed died at a rate 4.96 times that of an age-, sex-, and race-matched representative sample. See also AGORAPHOBIA; CODEPENDENCY; DEPRESSION; SUPPORT GROUPS.
Mothers Against Drunk Driving 511 E. John Carpenter Freeway, Suite 700 Irving, TX 75062 (214) 744-6233 http://www.madd.org
FOR FURTHER INFORMATION:
AL-ANON Family Group Headquarters 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617 (757) 563-1600 http://www.al-anon.alateen.org Alcoholics Anonymous World Services Grand Central Station P.O. Box 459 New York, NY 10163 (212) 686-1100 http://www.alcoholics-anonymous.org
National Institute of Alcohol Abuse and Alcoholism National Clearinghouse for Alcohol Information 5635 Fishers Lane, MSC 9304 Bethesda, MD 20892 http://www.niaaa.nih.gov SOURCES: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994. Clayman, Charles B., ed. Encyclopedia of Medicine. New York: Random House, 1989. O’Brien, Robert, and Morris Chafetz. The Encyclopedia of Alcoholism. New York: Facts On File, 1982. Tarini, Paul. American Medical Association news releases, Oct. 1, 1991, January 4, 1992, and February 4, 1992. National Institutes of Health. “Alcohol Abuse Increases, Dependence Declines.” Available online. URL: http://www.alcoholism.about.com/od/homework/a/ blnih040610.htm. Downloaded on June 4, 2005.
Alexander technique
Method of realigning body posture for relief of stress, chronic pain, or muscle tension, and to increase well-being and health. With verbal and gentle physical instruction from trained teachers, individuals learn how to eliminate common habits such as hunching, slouching, and tensing the spine that often accompany periods of stress. The technique was developed by F. Matthias Alexander (1869–1955), an Australian Shakespearean actor who moved to England and established his first school for the technique in England in 1924. It has drawn many actors, dancers, and musicians who experience the stresses of tightness, injuries, or physical ailments related to the practice of their arts. The technique also appeals to people
allergies 27 suffering from orthopedic or neurological problems, joint pain, headaches, and fatigue. With Alexander exercises, individuals become aware of their bodies and learn to make conscious changes. They are taught that when they are able to release muscles, the muscles will work efficiently and without strain for the task at hand. Additionally, some of them find it helpful to lie down for 15 to 20 minutes each day and visualize the Alexander instructions. See also ALTERNATIVE MEDICINE; BODY THERAPIES; MEDITATION.
allergic rhinitis
See
HAY FEVER.
allergies
A collection of disease symptoms caused by exposure of the skin to a chemical, or the respiratory system to particles of dust or pollen, or of the stomach or intestines to food. Allergies are sources of stress for many people because symptoms of allergies are unpredictable and may make people uncomfortable. Allergies are often exacerbated by emotional stress. Though apparently not a direct cause, stress can trigger allergic attacks. If individuals are prone to allergies, it is likely that they will have less trouble with them if they can reduce the stress and tension in their lives. While they cannot eliminate an allergy, they can usually learn how to live with it, sometimes with the aid of RELAXATION techniques and GUIDED IMAGERY, or with prescription medications. Allergic Reactions Some allergic reactions limit the sufferer’s participation in certain activities, such as hiking in forests or partaking of certain foods. Such seemingly harmless, everyday encounters as with a vase of flowers, a glass of milk, or the neighbor’s cat can bring on misery for the sufferer. Depending on the allergy, the reactions can vary greatly, from coughing, sneezing and a runny nose to skin irritations such as HIVES and rashes, to vomiting and diarrhea. Some people must curtail their social activities during periods when their allergy symptoms are severe. According to the American Academy of Allergy and Immunology, 41 million American people (one in six) have ASTHMA and allergies. Of these, 22.4 million have hay fever and 10 million are
affected with eczema, urticaria (hives) and angioedema (swelling); and by allergic reactions to food, medications, and insect stings. These last are dangerous as well as uncomfortable, accounting for at least 50 deaths a year. The most common type of allergy, known as allergic rhinitis, affects the upper respiratory tract. Sufferers of this type of allergy often complain of cold-like symptoms such as runny eyes, drippy noses, coughing, and congestion. Since allergic rhinitis is often caused by pollen, molds, and spores, it is primarily a seasonal affliction, striking in spring and fall. Asthma is an allergic reaction that affects the lungs and afflicts some 10 million Americans. Sufferers complain of “attacks,” in which the chest tightens and breathing becomes extremely difficult. Some people gasp and feel that they might die at any moment. Asthma is also stressful for those around the sufferer. An asthma attack may be brought on by a wide variety of allergens, including house dust, certain foods, and feathers. Exercise as well as stress can also induce attacks. Effective prescription medications are available for asthma. Other common allergies include those that affect the skin, which are caused by a number of allergens, and those that affect the digestive system, most often caused by foods such as dairy and wheat-based products. Pets, especially cats, can trigger severe reactions, usually within the allergic rhinitis and skin allergy range of symptoms. Foods can set off reactions. For example, eggs, even in tiny quantities, make many people ill. If you have an allergy and suspect that food is responsible, you can leave one item at a time out of your diet for periods of several weeks, then reintroduce it until you discover the allergen or allergens. Allergic contact dermatitis is a skin condition produced by substances that touch the skin directly, in contrast to eruptions that occur on the skin from an internal or systemic reactions. Fabrics and dyes may do this. POISON IVY is another example of allergic contact dermatitis. Knowing that one is allergic to poison ivy makes for a stressful situation while walking in a wooded or forested area. Diagnosis and Treatment Most allergies begin during childhood, some 80 percent before the age of 15 years. The first step is
28 alopecia to identify the allergen and then to remove it from the person’s environment if possible, or else to take the person away from the allergen. Sometimes a change of climate works but may result in other allergies. Some hay fever sufferers have moved to the opposite end of the country, only to find a new allergen there. Air conditioners and filters help persons allergic to pollen. In other cases, more radical measures may be called for; for example, work-related allergens may require a change in occupation or, at the least, a face mask on the job. Hypoallergenic cosmetics (preparations that are compounded without the most common allergens) help many people who are allergic to makeup and perfume. Many people mistake allergies for other problems and only after recurring episodes seek medical help. Being examined by an allergist, or a physician who specializes in allergies, is a wise move for people who think they have an allergy but do not know its cause. In many cases, the allergist conducts skin tests in which the skin is exposed to minute amounts of various materials to see which one causes a reaction. Efforts are then made, wherever possible, to eliminate or reduce contact with that allergen. Prescription medications are available to relieve allergies. See also ALTERNATIVE MEDICINE. FOR FURTHER INFORMATION:
American Academy of Allergy and Immunology 555 East Wells Street, Suite 1100 Milwaukee, WI 53202 (414) 272-6071 http://www.aaai.org American College of Allergy and Immunology 85 West Algonquin Road, Suite 550 Arlington Heights, IL 60005 (708) 359-2800 http://www.acaai.org National Institute of Allergy and Infectious Diseases Public Response 6610 Rockledge Drive, MSC 6612 Bethesda, MD 20892 (301) 496-5717 http://www.niaid.nih.gov
alopecia
See
HAIR LOSS.
alprazolam
Antianxiety drug (also referred to as an anxiolytic or sedative) marketed under the trade name Xanax. A member of drug group known as the benzodiazepines, it has been useful in treating some individuals who suffer from effects of extreme stress, anticipatory ANXIETY or PANIC ATTACKS AND PANIC DISORDER, and DEPRESSION, particularly in mixed states of depression and anxiety. The clinical reasons for its antidepressant effects are still unknown. Studies have shown that it has no effect on nerve cell receptors that are targets of some antidepressive drugs. Alprazolam is comparable to tricyclic antidepressant medications and is used as an antidepressant for individuals who have an extremely high degree of anxiety and agitation; alprazolam causes sedation and lethargy. Because it has no apparent cardiac side effects, it is applicable in treatment of anxious or depressed cardiac patients. As with other drugs of this class, dependency develops with prolonged use and withdrawal effects can occur when treatment ends. These can be prevented by gradually tapering off the dosage of the drug. See also BENZODIAZEPINE DRUGS; PHARMACOLOGICAL APPROACH. SOURCES: Fawcett, Jan A., and Howard M. Kravitz. “Alprazolam: Pharmacokinetics, Clinical Efficacy and Mechanism of Action.” Pharmacotherapy no. 5 (September–October 1982). Kahn, Ada P., and Jan A. Fawcett. Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
alternative medicine A set of practices that, depending on the viewpoint, either complement or compete with conventional medicine in the prevention and treatment of stress-related disorders as well as other diseases. According to the National Center for Complementary and Alternative Medicine (NCCAM), based on a 2002 study, 36 percent of adults in the United States used some form of complementary and alternative medicine (CAM). When megavitamin therapy and prayer specifically for health reasons were included in the definition of CAM, that number rose to 62 percent. More women than
alternative medicine 29 men were likely to use CAM; people with higher educational levels, people who were hospitalized in the past year, and former smokers were likeliest to use CAM. According to the study, people use CAM for many diseases and conditions. People were most likely to use CAM for back, neck, head, or joint aches, and other painful conditions; colds; anxiety or depression; gastrointestinal disorders, or sleeping problems. It appears that CAM is most often used to treat or prevent musculoskeletal conditions or other conditions involving chronic or recurring pain. Alternative therapies for dealing with stress and healing mind as well as body, include emotional release therapies with or without body manipulation, emotional control or self-regulating therapies, religious or inspirational therapies, cognitive-emotional therapies, and emotional expression through creative therapies. Some of these have been known by such names as encounter groups, gestalt therapy, primal therapy, EST, bioenergetic psychotherapy, ROLFING, TRANSCENDENTAL MEDITATION, and BIOFEEDBACK. It is important to note that alternative therapies are not subject to scientific scrutiny through controlled efficacy studies with placebo or comparisons of treatments. They are accepted and promoted as helping on the basis of “anecdotal evidence” stemming from individual reports of success. Some may be truly helpful while others may be useless or ineffectual. Many individuals find relief for stress-induced conditions from one or from a combination of alternative therapies either along with or after seeking traditional care. For example, MENTAL IMAGERY is rated one of the six most commonly used alternative treatments among cancer patients and is believed by physicians as well as patients to reduce both the pain and distress of symptoms. However, as with other medical conditions, individuals should not overlook traditional psychiatric or medical treatments in favor of alternative therapies because they may be robbing themselves of valuable time as their condition progresses. Alternative vs. Conventional Care Conventional medical practitioners adhere to scientific models and methodologies that many alternative medical practitioners believe focus too exclusively on reductionist and physiochemical
explanations of biological phenomena. Proponents of alternative medicine suggest that this approach shows limited understanding of health and disease and, in particular, of interactions among mindbody connections, psychological, social, and biological factors that influence coping with stress and disease processes. Advocates of alternative approaches, in recent decades known also as “holistic” (or “wholistic”) medicine or complementary medicine, regard the influence of psychological factors and cognitive processes as equal to, if not more powerful than, the insights and methods of conventional medicine in coping with stress and disease and improving clinical outcomes. For most of the 20th century, the generally accepted model for understanding biological phenomena and intervening therapeutically was the allopathic method. It achieved scientific, economic, and political primacy over the competing models such as osteopathic medicine, homeopathy, and chiropractic as well as other alternative approaches. However, the public’s interest in alternative therapies has grown tremendously during the last two decades of the 20th century. In a survey by Harvard Medical School, researchers reported that more than a quarter of the people they interviewed saw a physician regularly but were also employing another treatment, usually with their doctor’s knowledge. One in 10 respondents were relying on nontraditional treatments exclusively. The study emphasized the widespread acceptance of “alternative medicine,” a variety of unrelated practices from acupuncture to yoga that are promoted as having healing benefits. The common factor between them is that they have not yet been subjected to scientific review, the process most of the Western world uses to determine whether a treatment is safe and effective. Herbal and “Folk” Therapies In many cultures, herbs and other natural and botanical products are used to relieve stressinduced health conditions instead of modern diagnostic techniques and pharmacological treatments. Herbs are used both to cure specific illnesses, improve health, lengthen life, and increase sexual vigor and fertility.
30 alternative medicine Herbal medicine in the West may have begun with the Greeks and spread across Europe with the Roman conquests. However, the development of an organized approach to using herbs took place in central Europe and the British Isles. Practices and beliefs in folk medicine are preserved in isolated, traditional cultures such as in Appalachia and among Native American tribes. Folk medical treatments have developed by trial and error and serendipity without benefit of the scientific method. Since folk cultures generally mix religious or spiritual beliefs with concepts of health and illness, they attribute disease to causes other than the natural causes recognized by conventional medicine. In folk beliefs, mental or physical illness may be caused by divine retribution for transgression or by the will of spirits or other magical beings. Folk healers pass down techniques from one generation to the next and may jealously guard their secrets. Because of the cultural and other exchanges that took place at the end of the 20th century, many practitioners of Western medicine learned about folk medicine, leading to better communication with patients from other cultures. Increasing Interest by Government and Insurers In 1991 the National Institute of Health’s Office of Alternative Medicine (OAM) (now the Office of Complementary and Alternative Medicine) was created within the National Institutes of Health. The goal of the OAM is to research and evaluate the many alternative or unconventional medical treatments. Increasingly, some health insurers are paying for alternative therapies, removing some of the financial stress involved in seeking these treatments. A study reported in the Journal of Health Care Marketing (spring 1995) included insurers from government, third-party insurance companies, and HMOs; results indicated the mechanisms through which each of three alternative therapies (chiropractic, ACUPUNCTURE, and biofeedback) gained some credibility and acceptance by insurers. Results indicated that these therapies have each achieved at least moderate success in obtaining third-party reimbursement. Choosing Alternative Therapies Individuals who decide to take an unproven therapy should let their physician know what they are
doing. He or she will need to take the effects of that treatment into account when evaluating their care. Be wary when encountering claims that a treatment works miracles, such as rejuvenating skin or curing cancer with no pain or side effects. Watch out for contentions from proponents of a treatment that the medical community is trying to keep their “cure” a secret from the public. Also, be wary of any demands by the practitioner that an alternative treatment be substituted for a currently accepted practice. According to Harvard Women’s Health Watch (June 1994), while there may be little harm in adding an alternative practice such as MEDITATION or massage therapy to a therapeutic regimen, replacing a valid treatment with one that has no proven efficacy may have serious consequences. Watch out for claims that the treatment is better than approved remedies just because it is “natural.” Natural products are not necessarily more benign than agents synthesized in a laboratory. A drug is any substance that alters the structure or function of the body, regardless of its source. It is important to remember that many plants contain toxic substances that can be harmful when taken in uncontrolled doses. See also ACCULTURATION; AYURVEDA; CHIROPRACTIC MEDICINE; GUIDED IMAGERY; HOLISTIC MEDICINE; MIND-BODY CONNECTIONS; RELAXATION. FOR FURTHER INFORMATION:
Ayurvedic Institute 1311 Menaul Boulevard NE Albuquerque, NM 87112 (505) 291-9698 http://www.ayurveda.com National Center for Complementary and Alternative Medicine National Institutes of Health NCCAM Clearinghouse P.O. Box 7923 Gaithersburg, MD 20898 (888) 644-6226 http://nccam.nih.gov Sharp Institute for Human Potential and Mind/Body Medicine 8010 Frost Street, Suite 300 San Diego, CA 92123 (800) 82-SHARP (toll-free)
Alzheimer’s disease 31 SOURCES: Eisenberg, D., et al. “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use.” New England Journal of Medicine 328 (1993): 246–252. Facklam, Howard. Alternative Medicine: Cures or Myths? New York: Twenty-First Century Books, 1996. Gellert, George. “Global Explanations and the Credibility Problem of Alternative Medicine,” ADVANCES: The Journal of Mind-Body Health 10, no. 4 (fall 1994). Goldfinger, Stephen, ed. “Alternative Medicine: Insurers Cover New Ground.” Harvard Health Letter 22, no. 2 (December 1996). Gordon, James S. Manifesto for a New Medicine: Your Guide to Healing Partnerships and Wise Use of Alternative Therapies. Reading, Mass.: Addison-Wesley, 1996. Morton, Mary and Michael. 5 Steps to Selecting the Best Alternative Medicine. Novato, Calif.: New World Library, 1996. Weil, Andrew. Eight Weeks to Optimum Health: Proven Program for Taking Full Advantage of Your Body’s Healing Power. New York: Alfred A. Knopf, 1997.
Alzheimer’s disease At least 50 percent of all dementia cases are due to Alzheimer’s disease, a progressive, irreversible disorder that attacks the brain and has sometimes been called “death of the mind.” Families of Alzheimer’s disease sufferers cope with stresses of caregiving that are physical, emotional, social, and financial. These stresses become worse as the disease advances. The sufferers themselves experience stress, particularly during the onset of the illness when they are still able to recognize some of the symptoms of the disease. The disease was named in 1906 by Dr. Alois Alzheimer (1864–1915), after diagnosing a 51-yearold patient. Although it may occur as early as age 40, Alzheimer’s more commonly strikes people 65 years and older. It is the fourth leading cause of death for people between the ages of 75 and 84 (after heart disease, cancer, and stroke). Once diagnosed, many individuals live an average of three to 20 years. An estimated 4 million Americans have Alzheimer’s disease and a reported 100,000 deaths are due to the disease each year. As the population of older Americans increases, so will the number of people at risk for this disease. Symptoms Symptoms of Alzheimer’s should not be confused with age-associated memory impairment (AAMI),
a term health care professionals use to describe minor memory difficulties that come with age. Although Alzheimer’s symptoms vary in rate of change from person to person, there are three progressive stages of the disease. In Stage One, which can last two to four years, mild symptoms begin to be noticeable. There may be memory loss, but often this is associated with the AGING process. Recent memory is affected and the ability to learn and retain new information is impaired. Individuals may resort to writing themselves notes and labeling drawers and cabinets to remind themselves of items used in everyday living. There may be difficulty in concentrating or engaging in conversation without losing train of thought. Individuals exhibit tiredness and an unkempt appearance, and often blame others for what is happening to them. They feel out of CONTROL and many become depressed. Personality changes include being quick to anger, particularly at the inability to communicate thoughts clearly. In Stage Two, symptoms become more severe, memory losses increase, and there are more marked changes in behavior. There is less ability to comprehend what is being said. Words are used wrong and in senseless combinations (paraphasia), and there is an inability to recognize objects (visual agnosia). Supervision of daily activities may become necessary. There is increasing disorientation regarding time and place. Some sufferers do not recognize themselves in the mirror and others do not recognize their spouses or children. Confusion often increases in the late evening (sundown syndrome). Bladder or bowel incontinence may develop; the individual may forget where the bathroom is or how to undress and use the facilities. Impaired gait develops and the body weakens. In Stage Three, signs and symptoms continue to progress until deterioration causes the person to become bedridden. Diagnosis Before diagnosis of Alzheimer’s disease is made, the physician will want to rule out other conditions, such as potentially reversible DEPRESSION, adverse drug reactions, metabolic changes, nutritional deficiencies, head injuries, and stroke. Until the last decade, when more technologically sophisticated testing procedures became available, many sufferers were misdiagnosed and consequently
32 Alzheimer’s disease treated incorrectly. For example, screen star Rita Hayworth was misdiagnosed with alcoholic dementia in the 1970s and only later was diagnosed as suffering from Alzheimer’s disease, from which she died in 1987. Her film career ended when she could not remember her lines. Diagnosis usually begins with a search for treatable causes for memory loss and mental changes. Evaluation includes screening for depression, previous history of mental illness, and an assessment of the overall mental state. Many diagnostic procedures may be used, including blood studies, computerized axial tomography (CT scan), or electroencephalogram (EEG). In some cases a lumbar puncture is done to rule out neurosyphilis, which can cause inability to carry out purposeful movements (aproxia), inability to express thoughts (aphasia) and an inability to recognize items (agnosia). The CT scan for an individual who has Alzheimer’s disease typically shows brain shrinkage. The EEG is typically slow in a person with Alzheimer’s disease. Stresses Facing Caregivers of Alzheimer’s Patients The National Alzheimer’s Disease and Related Disorders Association has characterized Alzheimer’s as “the disease that robs the mind of the victim and breaks the heart of the family.” For caregivers of Alzheimer’s sufferers, it is a very frustrating and dehumanizing condition to witness. Alzheimer’s disease can be an extraordinarily demanding and frustrating experience, both for those afflicted with the disease and for their families. Caring for a parent, grandparent, or spouse whose mind is deteriorating requires stamina and patience. Confronted with a disease that afflicts the mind of a loved one, caregiving family members often feel alone and helpless. However, SUPPORT GROUPS and friends can be helpful, as can senior day-care centers. In addition to the emotional strain on the CAREGIVER, there may be financial expenses, such as reconstructing living arrangements for the safety and convenience of the patient, giving up a job to devote full time to care, hiring people to provide part-time care or do household chores, and possibly providing nursing home care, which may or may not be covered by health insurance. Information Line and Support Groups The Alzheimer’s Association has a national, tollfree information and referral service telephone
GUIDELINES FOR CAREGIVERS OF ALZHEIMER’S PATIENTS • Take one day at a time, tackling each problem as it arises. One cannot know how an Alzheimer’s patient will behave the next day. • Try to put yourself in the patient’s shoes. You will feel less annoyed the tenth time you are asked what day it is if you imagine how unsettling it must be not to be oriented in time and space. • Maintain a sense of humor. This is especially valuable in getting through potentially embarrassing situations. • Arrange for time for yourself. Get another family member or friend to relieve you for an hour or two each day. Hire a part-time caretaker. Arrange for the patient to spend time at a senior day-care facility. • Pay attention to your own needs. Be sure to maintain good nutrition and get regular exercise; develop hobbies and outside interests. Find people you can talk to, such as family members, friends or, if needed, professional counselors.
number. It offers callers the most current information available on Alzheimer’s disease and support services through the association. The number is: (800) 272-3900. The Alzheimer’s Disease and Related Disorders Association (ARDRA) is a privately funded national voluntary health organization, founded in 1980 and headquartered in Chicago. ARDRA has over 1,000 support groups and 160 chapters and affiliates nationwide. ARDRA’s board of directors comprises business leaders, health professionals, and family members. A medical and scientific advisory board consults on and monitors related issues. Alzheimer’s Disease International was formed in 1984 to share program and research developments on Alzheimer’s disease worldwide. The nationwide hotline number is: (800) 621-0379. FOR FURTHER INFORMATION:
Alzheimer’s Association 225 North Michigan Avenue, Floor 17 Chicago, IL 60601 (800) 272-3900 (toll-free) http://www.alz.org
anger 33 ADEAR Center Alzheimer’s Disease Education and Referral P.O. Box 8250 Silver Spring, MD 20907-8250 (800) 438-4380 http://www.alzheimers.org SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
ambivalence Refers to the simultaneous existence of two sometimes contradictory feelings, attitudes, values, or goals. Feelings of ambivalence are stressful for many people. For example, some individuals have feelings of ambivalence toward a mate whom they love but who abuses them. Other individuals may be ambivalent about work and other major life issues. The term “ambivalence” was introduced by Eugen Bleuler, a Swiss psychiatrist (1857–1939), to refer to the simultaneous feeling of antagonistic emotions, such as approach or avoidance of the same activity or goal. See also EMOTIONS; PHOBIAS. amenorrhea
See
MENSTRUATION.
Americans with Disabilities Act of 1990 A law protecting the rights of disabled persons; it applies to architectural designs of public buildings, removing stressful limitations from the daily activities of many disabled persons who previously had little or no access to public buildings or jobs. In 1991, the U.S. Equal Employment Opportunity Commission issued regulations to enforce the provisions of Title I of the Americans with Disabilities Act (ADA) and covered employers with 25 or more employees. The threshold dropped to include employers with 15 or more employees in 1994. According to Title I of the act, an individual with a disability is a person who has a physical or mental impairment that substantially limits one or more major life activities, one who has a record of such an impairment, or one who is regarded as having such an impairment. The law prohibits private employers, state and local governments, employment agencies, and labor unions from discriminating against qualified indi-
viduals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other terms, conditions, and privileges of employment. A qualified employee or applicant with a disability is an individual who, with or without reasonable accommodation, can perform the essential functions of the job in question. Reasonable accommodation may include, but is not limited to, making existing facilities used by employees readily accessible to and usable by persons with disabilities, job restructuring, modifying work schedules, and reassignment to a vacant position. Disclosure and Inquiry about Disability Applicants may be asked about their ability to perform specific job functions. A job offer may be contingent on results of a medical examination, but only if the examination is required for all entering employees in similar jobs. Medical examinations of employees must be job-related and consistent with the business needs of an employer. Current employees or job applicants using illegal drugs are not covered by the ADA when an employer acts on the basis of such use. Tests for illegal drugs are not subject to the ADA’s restrictions on medical examinations. Employers may hold illegal drug users and alcoholics to the same performance standards as other employees. FOR FURTHER INFORMATION:
Equal Employment Opportunities Commission 1801 L Street NW Washington, DC 20507 (202) 663-4001 (202) 663-4110 (fax) http://www.eeoc.gov SOURCE: Kahn, Ada P. The Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
amnesia anger
See
FORGETTING; MEMORY.
For most individuals, anger is an intense emotional state in which there is a high level of displeasure and FRUSTRATION. It can be caused by STRESS or can be a reaction to stress and is indicated by feelings ranging from slight irritation to explosive HOSTILITY that are directed to other people, objects, or oneself.
34 anger Physiological changes occur when one feels angry. For example, anger increases heart rate, blood pressure, and flow of ADRENALINE. Suppressed anger may result in HEADACHES, HIGH BLOOD PRESSURE, and skin rashes. More clearly visible signs include frowning, gritting the teeth, pacing, and clenching the hands. There may be changes in vocal tone; one may yell or shout, or, on the other extreme, speak in short, clipped sentences. Through such displays, an angry person attempts to gain CONTROL of a situation but at the same time clearly demonstrates that he or she has lost control. Negative Anger There are two attitudes—positive and negative— with regard to anger. On the negative side, anger can be destructive, leading to inappropriate or illegal behavior. Negative anger seems to be directly related to frustration and feelings of inferiority. Sigmund Freud observed in his book Mourning and Melancholia that DEPRESSION is actually anger turned inward, directed at the self. Bigotry, for instance, appears to be anger turned against specific groups or humanity as a whole. Adults may express anger directly with physical violence or verbal abuse behavior on others in their environment or because there seems to be a reward for violent behavior. Since in most situations it is unacceptable to express anger directly, many people react by becoming sulky or indifferent, or by adopting a superior, patronizing attitude toward the person or situation that angered them. The first cries of a baby may be an expression of anger or simply a less focused reaction to the birth experience. Small children react directly to situations that make them angry, sometimes by simply screaming, pulling, or striking the object or person who has angered them. As children mature, angry behavior becomes focused on retaliation. By the early teens, sulking and impertinence replace retaliation. Many people who have a chronic illness react with anger. For example, some rheumatoid arthritis sufferers also have a situation of longtime, repressed anger. These people, particularly women who have been brought up to think anger is unladylike, tend to say that everything is okay even when the opposite is true. Repressed anger and other personality and behavior patterns are the subjects of continued study, as researchers try to identify the role of psychological forces that exist in autoimmune diseases.
Positive Anger Anger may be helpful and constructive. There are psychological and medical opinions indicating that suppressing anger is physically and psychologically damaging. Further, limiting the expression of anger may bring regrets later. If an individual chooses to work off anger in an exercise program, it may do him good in other ways. For example, releasing an angry feeling sometimes brings with it a sense of pleasure. Some mental health professionals equate ambition and attempts to improve society with a healthy expression of anger. Among athletes, anger can have both a harmful and positive effect on athletic performance. Anger at the opposition can drain energy and divert attention from winning the game. However, professional athletes such as members of the Chicago Bulls and other championship teams are competitive and able to turn their anger into playing more forcefully. How to Overcome Anger An individual in psychotherapy who expresses extremely stressful and angry feelings might be given three goals: first, to identify the feelings of anger; second, to use constructive release of the energy of anger; and third, to identify thought processes that lead to anger. For example, to identify thought processes that lead to anger and the resulting feelings of anger, one might keep a diary of what led to the angry feelings and how they were handled. By doing this, the individual will learn to recognize anger before losing control, take responsibility for his or her own emotions and stop blaming others. Also, with validation from a therapist, the individual will learn to accept that some anger is justified in certain situations. In learning to use constructive release of the energy of anger, the individual may benefit from ASSERTIVENESS TRAINING, and learn to express anger verbally to the appropriate source. Assertive techniques may help the individual increase feelings of self-esteem, demonstrate internal control over behavior, and harness energy generated by the anger in a nondestructive manner. Also, individuals can learn to use energy through physical activity that involves the large muscles, such as running, walking, or playing tennis or racquetball. Other techniques that are helpful in controlling stress and anger are ALTERNATIVE MEDICINE therapies such as BIOFEEDBACK, GUIDED IMAGERY, and MEDITATION.
antidepressant medications 35 Relationship of Anger to Grief It is common to feel angry and stressed after the death of a loved one. The anger may be directed toward the deceased person for leaving the mourner alone, the medical care system for not being able to cure a disease or mend a body, God, or the fatal disease itself. In cases of accidents, there is often anger at the perpetrator of the loved one’s death, whether a drunk driver, a druginduced criminal, or the person who sold them drugs or alcohol. Anger is a normal part of the cycle of GRIEF reaction. However, prolonged anger that leads to depression may indicate a need to consult a mental health professional. See also AGGRESSION; ANXIETY; HOSTILITY.
angina pectoris A chest pain usually caused by a low supply of oxygen to the heart muscle resulting from hardening and narrowing of the coronary arteries. It is stressful and disturbing to the sufferer as well as family or friends who are there when it occurs. The term unstable angina refers to an accelerating pattern of chest pain where previously stable angina now occurs with less exertion, lasts longer, and is less responsive to medication. It can be a sign of an impending HEART ATTACK and immediate treatment by a physician should be sought. See also HIGH BLOOD PRESSURE; TYPE A PERSONALITY. anniversary reaction
The feeling of DEPRESSION that arises around the anniversary of a significant event such as a divorce or the death of a family member or close friend. The reaction brings stress because it may involve the recall and reliving of the events. Some individuals experience dreams or minor illness at the same time each year as part of this reaction. See also GRIEF.
anorexia
See
anorgasmia
EATING DISORDERS.
Old term meaning an inability to achieve an orgasm. This term has been replaced with psychosexual dysfunction, and refers to lack of orgasm in men or women, which may result from stress, sociocultural attitudes of the partners,
anatomical or neurophysiological problems, or fear of painful intercourse. SEX THERAPY is helpful in many such cases. See also FRIGIDITY; SEXUAL DIFFICULTIES.
anthrax An infectious disease of animals that can be secondarily transmitted to humans. Anthrax became a source of stress in the United States in the early 2000s when anthrax spores were detected in mailed objects and a few deaths resulted. Postal facilities were shut down and mailrooms across the United States instituted special precautions for detecting the substance. One cannot catch anthrax from someone else. At present, anthrax vaccine is only available to the military. It is caused by a bacillus (Bacillus anthracis) that primarily affects sheep, horses, hogs, cattle, and goats and is almost always fatal in animals. Transmission to humans normally occurs through contact with infected animals but can also occur through breathing air laden with the spores of the bacilli. The disease is almost entirely occupational, as it is usually restricted to individuals who handle hides of animals, such as farmers, butchers, and veterinarians, or workers who sort wool. However, in 2001, several humans contracted anthrax from an unknown source when several anthrax-laced letters were mailed to government and media offices. The perpetrator of the anthrax disseminations has not been identified. More than one post office and other office buildings were closed for inspection because of detected anthrax spores. Many people who handled mail at work chose to wear gloves and face masks as protection against possibly anthrax-tainted letters. There are different kinds of anthrax. The two kinds of anthrax reported as part of the tainted mailings are skin anthrax and inhaled anthrax. With skin anthrax, spores enter the body through a cut or other opening in the skin. Inhaled anthrax comes from breathing in the spores and is more serious and requires hospitalization. See also FARMING; TERRORISM. anticipatory anxiety
See
AGORAPHOBIA; ANXIETY;
STRESS.
antidepressant medications
See AFFECTIVE DISORDERS; DEPRESSION; PHARMACOLOGICAL APPROACH.
36 antidepressants and suicide rate antidepressants and suicide rate
See DEPRESSION;
SUICIDE.
anxiety Feeling of tension and/or apprehension that comes from anticipating a situation, which may be known or unknown. Anxiety is different from fear: Fear is a response to a consciously recognized and usually external threat or danger, whereas anxiety is typically caused by an “internal” threat not apparent to any but the anxious individual. Most people experience the stresses of anxiety in everyday life. For example, they may experience anxiety about getting to a job interview on time, going on a first date, or wearing the right clothes at an important social event. Other become anxious about being held up in traffic or when they hear reports of incoming bad weather. Possible Causes of Anxiety Individuals who face a threat or change in their health status often become anxious and feel stressed. These stresses may relate to the possibility of unpleasant treatment, pain, and possible disability. Many abused and psychologically traumatized individuals, such as victims of DOMESTIC VIOLENCE or RAPE, have lifelong anxiety symptoms. Anxieties also occur for socioeconomic reasons. For example, threats of job layoffs cause many people stress and anxieties, while others become anxious over changes in stock market prices and develop constant fears that their fortunes will diminish. Coping with the Stress of Anxiety Most people learn to relieve some stress by COPING with transient anxieties; this includes taking more time, doing additional preparations, and facing the fact that most situations are temporary and/or really nonthreatening. Unfortunately, some people turn to smoking and alcohol or drug use to cope with the stress caused by their anxieties. These habits are not considered healthy coping mechanisms, as they can lead to health hazards and addictions. Physicians may prescribe anti-anxiety drugs or anxiolytic drugs for some individuals who, at certain times, are experiencing severe anxieties. See also GENERAL ADAPTATION SYNDROME.
anxiety disorders
These are disorders that are characterized by anxiety and, at times, avoidance behaviors. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, they include generalized anxiety disorder, PHOBIAS, PANIC DISORDER, OBSESSIVE-COMPULSIVE DISORDER, and POST-TRAUMATIC STRESS DISORDER. Anxiety disorders may result from extreme STRESS. They also produce ongoing stress for sufferers and those around them. An individual can have one or more anxiety disorders at the same time. Generalized Anxiety Disorders (GAD). Excessive levels of anxiety and apprehension often are the main characteristics of GAD suffered by both men and women. Symptoms generally appear when individuals are 20 to 40 years old. GADs are caused by the fear of life circumstances such as the possible death of a loved one or losing one’s job, even though there is no evidence these stress-producing events will actually happen.
SYMPTOMS ASSOCIATED WITH GENERALIZED ANXIETY DISORDER Motor tension • Trembling, twitching, feeling shaky • Muscle tension, aches, soreness • Restlessness • Easily tired Autonomic hyperactivity • Shortness of breath or smothering sensations • Palpitations or accelerated heart rate • Sweating, cold, clammy hands • Dry mouth • Dizziness, light-headedness • Nausea, diarrhea, other abdominal distress • Flushes (hot flashes) or chills • Frequent urination • Trouble swallowing or “lump in the throat” Hypervigilance • Feeling keyed up or on edge • Exaggerated startle response • Difficulty concentrating or “mind going blank” • Trouble falling asleep or staying asleep • Irritability
anxiety disorders 37 Phobias. People who suffer from phobias feel terror, dread or panic when confronted with an object, situation, or activity that they fear. Some people have such an overwhelming desire to avoid the source of their fear that it causes stress on the jobs and in family and social relationships. SOCIAL PHOBIAS, such as fear of public speaking, meeting new people or eating in public, are very common. Simple phobias involve fear of one activity, such as flying, or of an object, such as snakes. AGORAPHOBIA is fear of going into public places, riding on public transportation, and entering shops and restaurants where one feels far from safety. Sufferers fabricate any number of excuses to remain at home. People seek help for agoraphobia more than for any other phobia and are usually successfully treated by psychotherapy and pharmaceutical medications. Panic Disorder. Sufferers from panic disorders experience intense but brief acute anxiety dominated by a fear of dying or being out of control. Because many of the symptoms of panic disorder are also symptomatic of a heart attack, many people rush to emergency rooms. Treatment of panic disorder is important; untreated panic sufferers can become suicidal. Obsessive-Compulsive Disorder. People with this disorder usually suffer from obsessions or from persistent ideas such as fear of infection by germs or dirt, which make them carry out compulsive, repetitive, ritualized acts such as hand washing, counting, and checking. These involuntary responses to their obsessions cause stress for sufferers and, particularly, the people with whom they live. Post-traumatic Stress Disorder (PTSD). This anxiety disorder comes after a stressful or frightening event that causes an unusual, severe physical or mental trauma. This may result from such events as military combat, natural disasters, violence, rape, or serious injury. Most people recover when given counseling and support; however, some post-traumatic stress disorders last a lifetime. Causes of Anxiety Disorders There are several theories about the causes of anxiety disorders. No single condition or situation causes them; a person may even inherit or develop a biological susceptibility to anxiety disorders.
Psychoanalytic theory suggests that anxiety stems from unconscious conflicts in infancy or childhood. For example, a person may carry the unconscious conflict of sexual feelings toward the parent of the opposite sex, or may have developed problems from experiencing illness or fright as a child. According to this theory, anxiety can be resolved by identifying and resolving the unconscious conflict. The learning theory suggests that anxiety is a learned behavior that can be unlearned. People who feel very stressed in a given situation or near a certain object will begin to avoid it. However, such avoidance can limit a person’s ability to live normally. In many cases, sufferers learn that their anxiety diminishes by persistently facing the feared object or situation. Another theory is that biochemical imbalances may lead to anxiety disorders. There may be complex eletrochemical interactions in the central nervous system. Some studies indicate that infusions of certain biochemicals can bring on a panic attack in some people. According to this theory, treatment of anxiety should correct these biochemical imbalances. Biochemical changes can occur as a result of emotional, psychological or behavioral changes. Diagnosing and Treating Anxiety Disorders A good diagnostic approach for anxiety disorders follows the same guidelines as for any other medical illness: a complete history, physical examination, and laboratory tests and mental status assessment. In most cases, anxiety disorders are treated with a combination of therapies that are individualized for each person. There is no cure-all for everyone. Treatment focuses on teaching the individual how to identify feelings, counteract negative thinking, and apply what they have learned to real-life situations. Also, treatment enables the sufferer to gain skills to control the behavior that brings about the anxiety through a gradual process of identifying and controlling the anxiety-provoking situations. Phobias and obsessive-compulsive disorders often are treated by BEHAVIOR THERAPY. This may involve exposing the sufferer to the feared object or situation under controlled circumstances until the fear is significantly reduced or cured. With this method, many phobic individuals have long-term recoveries.
38 anxiety disorders Prescription medications can help reduce extreme symptoms so that an individual can make the best use of behavior therapy and other psychotherapeutic techniques. In addition to behavior modification techniques and medications, talking with a therapist during psychotherapy can be important for relief and improvement. Medications Below is a chart listing the names of drugs commonly prescribed for anxiety disorders, the disorder for which they are indicated, and how they are thought to work. Medications approved by the Food and Drug Administration for the treatment of the various anxiety disorders are identified with a “†”.
Drug Class
Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
Other Antidepressants
Brand Name
Celexa Lexapro† Luvox† Paxil*† Prozac*† Zoloft† Adapin* Anafranil* Aventyl* Elavil* Ludiomil* Norpramin* Pamelor* Sinequan* Surmontil* Tofranil* Vivactil* Marplan* Nardil* Parnate* Cymbalta Desyrel* Effexor† Remeron Wellbutrin
Generic Name
Note: The information provided in this table applies to the treatment of anxiety disorders in adults 18 years of age and older, and does not apply to the treatment of these conditions in children and adolescents. Key: GAD = Generalized Anxiety Disorder * Generic commercially available OCD = Obsessive Compulsive Disorder † FDA approved for the treatment of one or more anxiety disorders PD = Panic Disorder PTSD = Post-traumatic Stress Disorder SAD = Social Anxiety Disorder Target Anxiety Disorder
How Is Thought to Work
Citalopram PD, OCD, SAD, Affects the concentration Escitalopram GAD, PTSD and activity of the neuroFluvoxamine transmitter serotonin, a Paroxetine chemical in the brain thought Fluoxetine to be linked to anxiety Sertraline disorders Doxepin PD, PTSD, GAD Affects the concentration and Clomiprimine OCD (Anafranil activity of the neurotransmitNortriptyline only) ters serotonin and norepiAmitriptyline nephrine, chemicals in the Maprotiline brain thought to be linked to Desipramine anxiety disorders Nortriptyline Doxepin Trimipramine Imipramine Protriptyline Isocarboxid PD, SAD, PTSD Blocks the effect of an important Phenelzine brain enzyme, preventing the Tranylcypromine breakdown of serotonin and norepinephrine Duloxetine PD, OCD, SAD, Affects the concentration of the Trazodone GAD, PTSD neurotransmitters serotonin Venlafaxine (data in PTSD and/or norepinephrine, chemMIrtazapine is sparse) icals in the brain thought to be linked to anxiety disorders Bupropion No current indica- Exact mechanism unknown. tion for any Effects may be mediated anxiety disorder. through the neurotransmitters Depression, norepinephrine and dopamine possibly ADHD
anxiety disorders 39 Drug Class
Anxiolytics Azapirones Benzodiazepines
Antihistamines
Brand Name
Generic Name
Target Anxiety Disorder
BuSpar*†
Buspirone
GAD
Ativan* Dalmane* Klonopin*† Halcion* Librium* Restoril* Serax* Tranxene* Valium* Xanax*† Atarax, Vistaril*
Lorazepam GAD, SAD, PD Flurazepam Clonazepam Triazolam Chlordiazepoxide Temazepam Oxazepam Clorazepate Diazepam Alprazolam Hydroxyzine GAD
How Is Thought to Work
Enhances the activity of serotonin Exact mechanism unknown. Some research shown to enhance the function of gamma aminobutyric acid (GABA)
Sedative effects through blockade of histamine receptors in the brain
Anticonvulsants
Augmentation therapy
Gabitril Neurontin Depakote* Lamictal Topimax
Tiagabine Gabapentin Valproate Lamotrigine Topiramate
Inderal* Tenormin* Minipress* Catapres Tenex
Propranolol Atenolol Prazosin Prazosin Clonidine Guanfacine
These medications may be added when symptoms only partially respond to another medication to increase the overall response to treatment Enhances the function of GABA Exact mechanisms unknown. Possible effects include: enhancing or inhibiting effects of neurotransmitters believed to be associated with anxiety; blockade of sodium channels in the brain
Noradrenergic Agents
Beta blockers
Alpha Blocker
Performance Blocks receptors associated anxiety, possibly with physiologic symptoms PD of anxiety PTSD (nightmares) Some evidence in PTSD, anticipatory anxiety
Atypical Antipsychotics
Augmentation therapy
These medications may be added when symptoms only partially respond to another medication to increase the overall response to treatment (Table continues)
40 anxiety disorders Drug Class
Brand Name
Generic Name
Abilify Geodon Risperdal Seroquel Zyprexa
Aripiprazole Ziprasidone Risperidone Quetiepine Olanzapine
Target Anxiety Disorder
How Is Thought to Work
Atypical Antipsychotics
Affects the concentration and activity of the neurotransmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders
Disclaimer: This information is for educational purposes only. Speak with your doctor if you have questions about a medication or are experiencing side effects from your medication. http://www.adaa.org/AnxietyDisorderInfor/chart.htm
Research reported by the American Psychiatric Association indicates that 90 percent of phobic and obsessive-compulsive individuals who cooperate with their therapists and comply with instructions recover with behavior therapy. Studies have shown that while they are on medications, 70 percent of individuals who suffer from panic attacks improve. Medication is effective for about half of those suffering from obsessive-compulsive disorder. RELAXATION training, self-hypnosis, BIOFEEDBACK and GUIDED IMAGERY are also effective therapies for many individuals. If one has a friend or a loved one who won’t go for treatment, it is important to find out why he or she will not go. Often people think that going for treatment means that they are mentally ill, and they find that stressful to accept. Such people should be assured that seeking treatment for an anxiety disorder is the same as seeking treatment for any medical concern. Role of Support Groups Support groups are very helpful in the treatment of anxiety disorders because many people develop a secondary feeling of reduced morale, which results in lower levels of functioning. Support groups are effective in raising that morale as well as the selfesteem of their participants. Also, in learning about other people’s problems, an individual’s own feelings of unique inadequacy and inferiority often can be dispelled. Social Costs of Anxiety Disorders The social costs of anxiety disorders far outweigh the expenses incurred for direct treatment, concluded a study reported in 1995 by Andrew C. Leon, Ph.D.,
Cornell University Medical College, and Myrna M. Weissman, M.D., of Columbia University. An estimated 10 million adult Americans have had an anxiety disorder at some point in their lives. In the six months prior to the study, those who suffered from an anxiety disorder were more likely to have higher rates of drug and alcohol abuse, as well as higher rates of financial dependence and unemployment, than those who had not experienced an anxiety disorder. In particular, the researchers found that those with panic disorder or obsessive-compulsive disorder were more likely to be chronically unemployed or to receive disability or welfare payments than those without. “One problem,” said Dr. Leon, “is the current lack of implementation of recently developed screening procedures. Sufferers of anxiety disorders often use the general medical system and emergency rooms for treatment; unless primary care and emergency care settings employ the screening procedures for these disorders, the burden on the health care system will remain substantial.” See also AFFECTIVE DISORDERS; COPING; PANIC ATTACKS AND PANIC DISORDER; PHARMACOLOGIC APPROACH. FOR FURTHER INFORMATION:
American Psychiatric Association Division of Public Affairs 1000 Wilson Boulevard, Suite 1825 Arlington, VA 22209 (800) 368-5777 (toll-free) http://www.apa.org Anxiety Disorders Association of America 8730 Georgia Avenue, Suite 600 Silver Spring, MD 20910
aromatherapy 41 (240) 485-1001 http://www.adaa.org National Alliance for the Mentally Ill Colonial Place Three 2107 Wilson Boulevard, Suite 300 Arlington, VA 22201 (703) 524-7600 http://www.nami.org National Institute of Mental Health Office of Communications 6001 Executive Boulevard Room 8184, MSC 9663 Bethesda, MD 20892 (301) 443-4536 SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Margolis, Simeon, ed. “Living Without Anxiety.” Health After 50, August 1997. Ross, Jerilyn. Triumph over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks, and Phobias. New York: Bantam Books, 1994. Warneke, Lorne. “Anxiety Disorders: Focus on Obsessive-compulsive Disorder.” Canadian Family Physician 39 (July 1993).
arithmetic
See
MATHEMATICS ANXIETY.
aromatherapy The art and science of using essential oils from plants and flowers to reduce stress and enhance health. Essential oils are essences extracted from flowers and plants, as well as herbs, roots, leaves, bark, and wood, by distillation; they deeply penetrate the skin and have powerful medicinal and psychological effects. Practitioners of aromatherapy assess the patient’s current physical, emotional, and bioenergetic condition. Then they blend essential oils from around the world and apply them with a specialized massage technique focusing on the nervous and lymphatic system. Aromatherapy massage has been used to treat conditions ranging from job stress to muscle soreness to varicose veins and allergies. How Essential Oils Are Used Essential oils almost always require dilution with water or carrier oils, such as almond oil, apricot oil, jojoba oil, or grapeseed oil.
As inhalation therapy, the oils can be used either by steam or ambient. For steam inhalation, three to seven drops of oil can be added to one-half cup of boiling water. Inhale the vapors with your head about a foot away from the solution. Alternate breathing in the vapors and fresh air. For ambient inhalation, add one to three drops of oil to a tissue or cotton ball and place the item about one to two feet from your nose. Alternately inhale the vapors and fresh air. As part of massage therapy, 10 to 20 drops of essential oil can be added to one ounce or more of carrier oil. Massage into yourself or have someone massage you. Avoid getting the oils into your eyes or genital areas. During bathing, five to seven drops of essential oil can be mixed with one ounce of carrier oil and added to the bathwater, making sure that it is mixed into the water well before climbing into the tub. Household uses include room freshening, general freshening, and as an insect repellent. For room freshener, add 10 drops of essential oil to one to two cups of boiling water and place around the room. Be careful to keep out of the reach of pets. For household freshening, add a few drops of oil to the trash containers, vacuum bags, drains, or on a cotton ball to place in drawers and closets. Lavender, citronella, and peppermint are natural insect repellents. Place a few drops on windowsills and doorways. Avoid letting pets near the drops. The art of aromatherapy is fairly new in the United States, but has been used for centuries elsewhere in the world, particularly in Egypt and Greece. During World War I, Dr. Jean Valnet, a Parisian physician, used essential oils to treat injured soldiers. He also influenced Marguerite Maury, a biochemist who developed a special way to apply the penetrating oils with massage. Finding a Practitioner of Aromatherapy Techniques vary from practitioner to practitioner. Many therapists are employed in spas in large cities or resort areas. If you are seeking this therapy, look for someone who is a licensed, certified massage practitioner and who can show proof of training in the use of essential oils. See also ALTERNATIVE MEDICINE; BODY THERAPIES; MASSAGE.
42 arrhythmia SOURCES: Cooksley, Valerie Gennari. Aromatherapy. A Lifetime Guide to Healing with Essential Oils. Englewood Cliffs, N.J.: Prentice Hall, 1996. Griffin, Katherine. “A Whiff of Things to Come.” Health, November/December 1992.
arrhythmia An abnormal heart rhythm, usually detected by an electrocardiogram. When some individuals hear this diagnosis, they became anxious and find the diagnosis stressful. An arrhythmia may or may not be of potential significance, and can be caused by several factors, such as coronary artery disease, heart valve problems, or hyperthyroidism. Individuals with this diagnosis should question their physician carefully about what it means, about possible lifestyle changes, ways to eliminate stress and the need for medication. See also BIOFEEDBACK ; BREATHING ; HEART ATTACK; HIGH BLOOD PRESSURE; RELAXATION; TYPE A PERSONALITY. arthritis
A painful, debilitating chronic condition that afflicts more than 40 million Americans, most of them women. When doctors diagnose arthritis, they are identifying painful inflammation in a joint, which in some forms brings with it swelling and redness. The most common of these forms are osteoarthritis and rheumatoid arthritis. Osteoarthritis typically affects older adults and is caused by wear and tear on the joints, particularly hands, knees, feet, hips, and back. Rheumatoid arthritis is the most severe form and is caused by the body’s IMMUNE SYSTEM attacking the joints and surrounding tissues, often leading to severe deformity of the shoulders, elbows, hands, wrists, feet, and ankles. Unlike osteoarthritis, rheumatoid arthritis strikes children as well as adults, and it is estimated that more than 250,000 children have juvenile rheumatoid arthritis. Since the early 1900s, doctors have recognized that rheumatoid arthritis can be provoked or exacerbated by stress, continuous worry, or anxiety. Results of studies since then have agreed that emotional stress can trigger rheumatoid arthritis in a susceptible child or adult and, once the disease has established itself, can make it worse. The stress involved is usually acute, often resulting from such
crises as the death of a family member, loss of a job, or a divorce. According to the Epidemiology Section, Centers for Disease Control and Prevention, Atlanta, Georgia, arthritis and other rheumatic conditions will increase in prevalence by 50 percent by the year 2020, with the number affected growing from 40 million to 60 million people. The number of people affected will grow because of the aging population. Most people probably think that arthritis is part of normal aging and there is nothing you can do about it. But there are things that can be done to reduce its impact, such as losing weight and limiting the risk of joint injuries from sports and occupation. Pharmacological Approaches and Alternative Therapies Many pharmacological approaches are available for treating individuals who have arthritis. New prescription medications are being developed and many over-the-counter remedies are available. Increasingly, researchers are trying ALTERNATIVE MEDICINE, either in conjunction with prescription medications or as sole therapies. As a result of early research in PSYCHONEUROIMMUNOLOGY, a few behavioral, stress-reducing programs to treat arthritis have been developed. One activity is exercise; the chief benefit is to move the blood flow to the affected joints and keep them flexible. Arthritic individuals may be advised to do stretching exercises to keep their joints moving smoothly and do strengthening exercises to maintain muscle tone. Walking and non-weightbearing exercises such as swimming are also helpful. At the Stanford University Arthritis Center, physicians suggest relaxation tapes that also reduce PAIN for patients with arthritis. The logic behind these tapes is that if the mind is distracted by mental exercise, it will not feel the arthritis pain. Additionally, some researchers believe that the relaxation response increases the body’s production of endorphins, which are natural painkillers. Other researchers have used BIOFEEDBACK as a technique to help people deal with stress and to train people with arthritis to relax. In one study, one group of arthritics had biofeedback training; the other had a standard physical therapy program.
asbestos 43 Those in the group using biofeedback and relaxation felt better; additionally, their erythrocyte sedimentation rate (ESR), a blood test measuring the activity of the disease, showed that their immune systems held stable against the disease or that the disease had somewhat abated. Many psychological forces seem to have a role in autoimmune diseases. Psychotherapy can help arthritis patients understand the possible emotional factors associated with their symptoms. In conjunction with psychotherapy, or by themselves, techniques including RELAXATION exercises, MEDITATION, and biofeedback can be helpful. See also ANGER; AUTOIMMUNE DISORDERS; CHRONIC ILLNESS. FOR FURTHER INFORMATION:
Arthritis Foundation P.O. Box 7669 Atlanta, GA 30357 (404) 872-7100 http://www.arthritis.org National Institute of Arthritis and Musculoskeletal and Skin Diseases 1 AMS Circle Bethesda, MD 20892-3675 (301) 495-4484 http://www.niams.nih.gov SOURCES: Kahn, Ada P. Arthritis. Chicago: Contemporary Books, 1983. Locke, Steven, and Douglas Colligan. The Healer Within. New York: New American Library, 1986.
artificial insemination asbestos
See
INFERTILITY.
Asbestos is a stressful topic because fibers released from minerals in the material cause irritation and inflammation of the lungs. More than 3,000 products in use today contain asbestos, including carpet underlays, roofing materials, brake pads and linings, pot holders and ironing board pads, hair dryers, floor tiles, cement, toasters and other appliances, furnaces, and furnace door gaskets. Asbestos has been used in heat and acoustic insulation, on boilers and steam pipes, fireproofing or structural steel and decking, and/or sprayed or troweled on plaster material for
acoustic, decorative, or other purposes on ceilings, walls and other surfaces. Certain workers in construction, ship and boat building, railroads, maintenance trades, and particularly those who have done plastering, fireproofing or pipe or duct insulation may have had heavy exposure to asbestos. The health risk from asbestos is also high for people who work in asbestos-contaminated buildings. Building renovation work can also release asbestos fibers into the air. The Environmental Protection Agency (EPA) reports that about 20 percent of all public and commercial buildings in the United States contain some asbestos material. In about two-thirds of those buildings, at least some of the asbestos material is damaged, and almost half have significantly damaged asbestos. It is not possible to tell whether a building material contains asbestos by looking at it because asbestos and asbestos-substitute materials look very similar. The only way to tell for certain whether material contains asbestos is to have a small sample examined under a microscope. Asbestos that is tightly bound or sealed into building material does not pose a health hazard. It is only when the asbestos material becomes friable, or capable of becoming crumbled and releasing asbestos fibers into the air, that the danger of asbestos disease exists. This can happen when asbestos-containing material becomes damaged or deteriorated due to age, heat, water leaks, vibration, maintenance work, or renovation. According to the Safety and Health Department, International Brotherhood of Teamsters (IBT), another potential hazard exists where asbestos fireproofing is exposed to airflow, when the air space between a ceiling and the floor above is used as part of the air conditioning system of a building. This air movement can pick up asbestos fibers and circulate them throughout the building. According to the American Lung Association, there is no known safe exposure to asbestos. The Occupational Safety and Health Administration (OSHA) has separate standards governing worker exposure to asbestos in general industry and for construction. The construction asbestos standard covers asbestos removal, demolition, and renovation work. These standards are designed primarily for people who work directly with asbestos,
44 Asperger’s syndrome not for people who work in asbestos-contaminated buildings. Asbestosis: A Crippling Disease Caused by inhaling asbestos fibers, asbestosis is a progressively crippling disease. It is not a cancer; it is caused by the scarring of the lung tissue by heavy exposures to asbestos fibers. The body attempts to neutralize the foreign fibers of asbestos in various ways, and some of these processes lead to further inflammation and cell damage. Eventually a fibrosis or scar tissue develops in the interstitial spaces around the small airways and alveoli. This thickening and scarring prevents oxygen and carbon dioxide from traveling between the alveoli and the blood cells, so breathing becomes more difficult. Asbestosis affects both lungs and, although it is mainly in the lower fields of the lungs, it is usually widespread. The condition is detected by X-ray. Symptoms typically include shortness of breath and coughing. It can be a progressive disease, worsening even after exposure to asbestos has stopped. In some cases it is fatal. The condition is usually caused by heavy exposure to asbestos, such as sustained exposure over a period of years (for example, a longtime job at an asbestos textile plant) and/or intense exposure during a shorter period (for example, workers in the engine rooms of ships under construction during World War II). Asbestos has been found to cause cancer. The most common asbestos-related cancer is lung cancer. Asbestos also causes cancer of the mouth and throat areas, larynx, esophagus, stomach, colon, rectum, and kidneys. Asbestos is the only known cause of mesothelioma, cancer of the lining of the lungs or the lining of the abdomen. Even a very small amount of asbestos exposure can lead to cancer. People who have worked with asbestos for only a few days and members of the families of asbestos-exposed workers have been known to contract asbestos-related cancer. According to the IBT, asbestos related cancers usually do not show up until 20, 30, or more years after the person is first exposed. There is currently no effective treatment or cure for asbestosis. Some uses of asbestos have been banned: spraying of asbestos-containing materials (1973); certain pipe coverings (1975); certain patching compounds
and artificial fireplace logs (1977); sprayed-on asbestos decorations (1978); and asbestos-containing hair dryers (1979). See also AIR POLLUTION; CANCER; SICK BUILDING SYNDROME. FOR FURTHER INFORMATION:
American Lung Association 61 Broadway, Sixth Floor New York, NY 10006 (800) LUNG USA (toll-free) (212) 315-8872 (fax) http://www.lungusa.org SOURCE: Kahn, Ada P. The Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
Asperger’s syndrome (AS)
A neurobiological disorder also known as Asperger’s disorder, which may include a wide range of characteristics on a spectrum ranging from mild to severe, such as marked deficiencies in social skills, difficulties with transitions or changes, and preference for sameness. These characteristics may be a source of stress for parents and teachers because they may not understand the reasons for a particular child’s behaviors. Individuals who have AS may follow obsessive routines and may be preoccupied with a particular subject of interest. They have difficulty reading nonverbal cues (BODY LANGUAGE) and may have difficulty determining proper body space. Overly sensitive to sounds, tastes, smells, and sights, the person with AS may prefer soft clothing, certain foods, and be bothered by sounds or lights no one else seems to hear or see. Asperger’s syndrome was named for Hans Asperger, a Viennese physician, who in 1944 published a paper describing a pattern of behavior in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. It is only since 1994, when the American Psychiatric Association added Asperger’s syndrome to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, that the disorder has been generally recognized. There is controversy as to exactly where AS fits categorically. It is currently described as an AUTISM
asthma 45 spectrum disorder, while others consider it a nonverbal learning disability. AS shares many of the characteristics of PDD-NOS (pervasive developmental disorder, not otherwise specified). Because of the differences of opinion on classifying the disorder, parents and teachers experience stress when diagnosing a child with symptoms of Asperger’s syndrome. See also DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; SENSORY INTEGRATIVE DYSFUNCTION.
manipulation or undue CONTROL. Nonassertive behavior, on the other hand, involves suppression, frustration, and thinking of a proper response too late. As a result, nonassertive individuals feel uneasy and guilty and become stressed because they are not able to express their real feelings. See also AGGRESSION. SOURCE: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
assertiveness training
A process through which individuals can change unwanted behaviors that cause them stress. It teaches individuals to see themselves as equal human beings, with rights regardless of their roles and titles. It raises SELFESTEEM and clarifies the choices that are available to individuals when responding to others. Many people who are too inhibited or anxious to express themselves honestly in social situations can benefit from assertiveness training. By teaching individuals to act upon their real feelings, assertiveness training helps them improve specific situations. Such situations might involve an over-demanding boss; a friend who takes advantage of one’s generosity; the wife who resents that her husband does not do his share of housework, but is too meek to confront him with her true feelings; or the employee who wants to ask for a raise but lacks the courage to do so. Training sessions, conducted either with a therapist or through self-help techniques, include rehearsing how to act and what to say in common situations. Assertiveness training can help people act more effectively in their own best interests, to make life decisions, take the initiative, trust their self-judgment, set goals and work to achieve them, and ask for help from others when necessary. It can empower them to stand up for themselves without undue anxiety, set limits on time and energy, respond to others’ put-downs or anger, and express or defend personal opinions. It allows them to be comfortable and honest when expressing agreement or disagreement; when showing anger, affection, or friendship; and when admitting fear or anxiety. Assertive behavior is self-expressive, honest, direct and firm, and respectful of the rights of others without unfair criticism or hurtful behavior,
assisted-living facilities
See
AGING; ELDERLY PAR-
ENTS; LONG-TERM CARE INSURANCE.
assisted reproduction techniques
See INFERTILITY.
asthma A chronic, allergic, inflammatory lung disease characterized by recurrent breathing problems. It is a source of STRESS to the sufferers, many of whom become depressed due to the chronically recurring condition and the ANXIETY experienced during asthma attacks. Families, too, become stressed and anxious as they learn to deal with the symptoms of the disease. People with asthma typically have recurrent attacks or flare-ups of breathlessness, accompanied by wheezing. Some people have mild to moderate symptoms that can be life threatening. Even in the same individual, asthma attacks vary in severity from day to day. In many individuals, attacks begin in childhood and tend to become less severe in adulthood; however, asthma attacks can begin at any age. Often attacks are brought on by stress or anxiety. Asthma is a major cause of lost time from school and work and of sleep disturbances. During a severe attack, as breathing becomes increasingly difficult, there is wheezing, sweating, rapid heartbeat, and an increasingly high anxiety level. The individual cannot lie down or sleep, breathes rapidly, wheezes loudly, and may be unable to speak. He/she may fear dying, and those watching and trying to help the sufferer may add to the overall stress level by showing their own anxieties. Asthma may get worse at night because at that time chemical changes in the body narrow airways, the airways become cooled, and there may be delayed allergic reactions.
46 asthma Contrary to a popular notion, asthma is not a psychosomatic illness. It is a disease and not a sign of emotional disturbance. Understanding the physiology involved in asthma can help one manage the disease, reduce the stress it brings about, and improve the quality of life. During an asthma attack, several things occur to inhibit the flow of air in and out of the airways. Inflammation causes a swelling in airways that blocks the passage of oxygen to the lungs, and this is turn is exacerbated by the contraction of pulmonary muscles and the production of thick mucus. Asthma may be extrinsic, in which an allergy (usually to something inhaled) triggers an attack, or intrinsic, in which there seems to be no apparent external cause. Intrinsic asthma tends to develop later in life than extrinsic asthma. About 10 million Americans have asthma; of these, about 3 million are children under the age of 18. Asthma affects women and men equally. In the United States, the reported number of cases of asthma is increasing but the death rate for asthma is still one of the lowest in the world. What Triggers an Asthma Attack Many people get warning signs hours or days before an attack. Signs may include tiredness, a change in breathing, coughing, change in mucus color, trouble sleeping, itching of the chin or throat, sneezing, headache, dark circles under the eyes, and moodiness. Triggers vary from person to person, and many people with asthma have more than one. Common triggers include: Excitement or stressful situations. Emotional factors themselves do not cause asthma. However, laughing, crying, or yelling may bring on symptoms. Airborne allergens. An allergen is a substance that causes an allergic response. Common airborne allergens include pollen, dust mites, mold, and animal dander. Common irritants. These include cigarette smoke (as well as secondhand smoke); smoke from other sources, such as candles, burning leaves, or woodburning stoves; aerosol sprays and other chemicals; and strong odors. Exercise. Exercise is a trigger for many people; however, most people with asthma can lead active lives, including playing sports. There are steps one can take to reduce the risk of problems.
Respiratory infections. Respiratory infections can be particularly troublesome for children who tend to get more colds than adults. Cold air. Cold air is a trigger for many people. Covering the nose and mouth when outdoors can help. Reduce Stress by Managing Asthma Triggers A physician can help the asthma sufferer identify triggers and learn to reduce them. For example, one can reduce exposure to mold by ventilating the kitchen, bathroom, and other damp areas, running a dehumidifier in the basement, and frequently cleaning areas where mold is likely to grow. Airborne allergens can be shut out by keeping doors and windows closed or they can be reduced by an air filtration system. To deal with dust mites, the asthma sufferer should clean up clutter, remove carpets, cover fabric upholstery with plastic or replace it with leather or vinyl, use synthetic bedding instead of cotton, and have someone else do the vacuuming. The asthmatic should live in a home that is smokefree, and avoid public places where smoking is permitted. Diagnosis, Treatment, and Self-Help Asthma is sometimes difficult to diagnose because many of its symptoms resemble EMPHYSEMA, bronchitis, and lower respiratory infections. For some individuals, the only symptom is a chronic cough, especially at night, or coughing or wheezing occurring only with exercise. Diagnosis is made by consideration of medical history, thorough physical examination and certain laboratory tests. Asthma cannot be cured, but it can be controlled with proper treatment. With current drug therapies, people who suffer repeated attacks can learn to manage episodes. Quality of life need not be impaired, as demonstrated by the successes of athletes who have had asthma. There are two main groups of medications. One is anti-inflammatory medications; these can help prevent asthma attacks by reducing swelling. Anti-inflammatory medications include corticosteroids (usually inhaled), cromolyn, and nedocromil. Inhaled steroids are absorbed primarily by the lungs. That means little gets into the bloodstream, lowering the risks of side effects. The second group is the bronchodilators. These medications can open airways during
attention-deficit/hyperactivity disorder 47 asthma attacks. They include beta2 agonists and theophylline. Asthma sufferers should have a bronchodilator handy. Asthma sufferers should follow their health care provider’s instructions for when to take the medication and how much to take. If they have an anti-inflammatory medication, it should be taken regularly, even when they feel fine. Exercise can improve lung power and wellness. However, before embarking on an exercise program, asthmatics should talk with their health care providers who may provide extra medication. A warm-up before exercising in cold air is necessary as well as a scarf or mask over the nose and mouth. Hospitals and local health departments offer breathing improvement programs and support groups for asthma sufferers and members of their families. Topics for discussion typically include coping with the stresses asthma produces on the sufferer as well as family members, avoiding asthma triggers, and new developments in medications. Groups can be helpful for parents of asthmatic children; family counseling is also useful for all concerned. Research Under Way Research on asthma is under way at the National Institutes of Health. Projects focus on identifying basic abnormalities that cause asthma, developing better drug treatments and emergency measures, educating people with asthma to help themselves more effectively, and training patients in asthma self-management techniques while under medical supervision. See also ALLERGIES; CHRONIC ILLNESS; DEPRESSION; GUIDED IMAGERY; MEDITATION. FOR FURTHER INFORMATION:
American Lung Association 61 Broadway, Sixth Floor New York, NY 10006 (212) 315-8700 http://www.lungusa.org Asthma and Allergy Foundation of America 1233 20th Street NW, Suite 402 Washington, DC 20036 (202) 466-7643 http://www.aafa.org
SOURCES: Adams, Francis V. The Asthma Sourcebook: Everything You Need to Know. Los Angeles: Lowell House, 1995. Garnett, Leah R., ed. “Chronic Conditions: Asthma Increases, but So Do Treatments.” Harvard Health Letter, June 1997. Litin, Scott C., ed. “Management of Adult Asthma.” Mayo Clinical Update 13, no. 2 (1997).
atherosclerosis
Common disease in which deposits of plaque containing fatty substances, such as CHOLESTEROL, are formed within the inner layers of the arteries. Commonly known as “hardening of the arteries,” it produces anxieties and stress because potential complications may include coronary artery disease and strokes. The disease progresses over decades, chiefly affecting the arteries of the heart, brain, and extremities. See also CHRONIC ILLNESS; HEART ATTACK; HIGH BLOOD PRESSURE.
attention-deficit/hyperactivity disorder (ADHD) A persistent pattern of inattention and/or hyperactivity-impulsivity, occurring mostly in school-age children and occasionally in young adults. It is a source of stress to the children, their parents, and teachers because it interferes with the child’s learning in school, causes disruptions in the classroom, and brings about anxieties for the parents. ADHD sufferers are often overactive, impulsive, and easily distracted. Estimates are that ADHD affects 3 percent to 5 percent of the school-age population, and is more common in boys. Data on prevalence in adolescence and adulthood are limited. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, attention deficit is the central feature of the disorder and the other symptoms are variable; the book also recognizes that ADHD exists as a separate entity from conduct disorder. The essential feature of conduct disorder is a persistent conduct pattern in which rights of others and age-appropriate societal norms or rules are violated. While the two conditions often occur in the same individual, it is not assumed that one is a necessary concomitant of the other. Making the distinction has important implications for outcome. Diagnosing ADHD To warrant the diagnosis of ADHD, according to the DSM, some of the hyperactive-impulsive or inatten-
48 attention-deficit/hyperactivity disorder tive symptoms must have been present in the child before age seven, although many children are diagnosed only after symptoms have been present for a number of years. Additionally, there must be clear evidence of interference with developmentally appropriate social, academic, or occupational functioning, and the disorder cannot be better accounted for by another mental disorder, such as ANXIETY DISORDER, dissociative disorder, or personality disorder. Diagnosis is usually made by a pediatrician, psychologist, or neurologist. Often other health and education professionals, such as special education teachers or social workers, become involved in the diagnosis and treatment plan. Diagnosis is usually based on description of the child’s behavior from parents and teachers, as well as observation of the child’s behavior in the health professional’s office. Often the children are restless while the physician talks with parents. Many parents look back and report that their child was hyperactive from a very early age, even from one to two years of age. However, many parents do not seek medical attention until the child is in first or second grade, and this presents difficulties. In children with a later onset, the disorder is more likely to be associated with social disruption or specific behavior at school. To determine whether the child has an associated disorder, such as a learning disorder or mild mental retardation, psychological tests are useful. Treating ADHD Individualized management, on a case by case method, is most effective. No one approach to treatment is universally accepted. Successful treatment depends on multimodal therapy involving parents, teachers, and mental health professionals. In an effort to reduce stress levels of both the child and the family, the physician usually explains the nature of ADHD, with the objective of reducing the family’s feelings of guilt and blame while at the same time improving the child’s self-esteem. When there are disorders of family dynamics or learning disorders underlying the symptoms, these must be addressed. Physicians counseling families with an ADHD child usually address behavior management and how to avoid confrontation with the active, restless child. Such a child should be encouraged to channel energy into productive activities, such as doing
errands, taking out the garbage or walking the dog. Support groups can be helpful to the child, parents, and siblings. Behavior modification and COGNITIVE THERAPY are used in some cases of ADHD. Other approaches include dietary restrictions of food additives or refined sugar (Feingold diet) or supplementation of diet with megavitamins, trace elements, or amino acids. However, best results have been noted with multimodal therapy, including behavior management, special educational intervention, and, in some cases, use of stimulant drugs. Symptomatic treatment with stimulant medication in selected patients is effective and safe, but not curative. A widely used but controversial stimulant medication is methylphenidate hydrochloride (trade name, Ritalin). The drug is effective for three to four hours and is often prescribed for use in the morning and at noon. Individualizing dosage is important because high doses may help hyperactivity but have also been found to impair learning. When the dose is too high, some children become excessively quiet, indecisive, and cry easily. When symptoms occur only in school, the medication may be given only on school days. A child on stimulant medication should be evaluated by the prescribing physician with some regularity. When young people are untreated in childhood, they may develop very negative attitudes toward school and patterns of failure. Even with treatment, some develop behavioral problems in later life, including substance abuse. FOR FURTHER INFORMATION:
Attention Deficit Information Network 58 Prince Street Needham, MA 02492 (781) 455-9895 http://www.addinfonetwork.com National Attention Deficit Disorders Association P.O. Box 543 Pottstown, PA 19464 (484) 985-2101 http://www.add.org SOURCES: American Medical Association. Archives of General Psychiatry 52, no. 66 (June 1, 1995). American Medical Association. The Journal of the American Medical Association 273, no. 23 (June 21, 1995).
autism 49 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994.
autism
A neurological disorder that affects development of social abilities, communication, and behavior in characteristic ways. It is stressful for the child or adult involved, and also for parents, family members, teachers, and others who interact with the autistic person. Autism has an effect on education and community services. Autism, also known as autistic spectrum disorder (ASD), can range from relatively mild to severe. People with the disorder face challenges in understanding and relating to others. Problems with language comprehension may make communication difficult. Language difficulties may also be a problem in social situations, for example, not being able to begin or keep a two-way conversation going. People with the disorder may have repetitive patterns of thinking and behaving and a limited variety of interests and activities. Research shows that ASD is a genetic disorder, but the specific causes are not yet known. In severe forms it is usually recognized by age two or three, because the child is not yet speaking and shows little interest in people. However, subtle signs of moderate autism may not be recognized until later, often when the child enters school. Estimates indicate that one of every 200 children may be affected. Diagnosing and Treating Autism Autism is usually diagnosed by a clinical child psychologist or a specialist physician. Diagnosis is made by gathering information about the child’s development from parents and others and by making systematic observations of the child’s behavior, including what he or she does as well as what he does not that would be expected of a typicallydeveloping child. Advances in psychological research have improved understanding of the challenges faced by people with autism. Methods of recognizing as well as psychological assessment of children’s ability profiles and areas of relative strengths and weaknesses can guide the development of appropriate intervention programs for children with ASD. Major areas for interventions include social skills, communication, daily living skills, academics,
self-management or coping skills, and family support. Teaching opportunities arise naturally every day in the home and community and structured teaching, which emphasizes organizing schedules, materials, and settings helps optimize the individual’s ability to learn and function. Peer intervention, in which other children are taught effective ways to interact with a child with ASD, can promote more positive social opportunities. For older and more able individuals with autism, modified cognitive behavioral strategies in which behavior is changed by changing the way the person thinks, as well as systematic relaxation therapies, can be used to help manage the anxiety that is often associated with social situations and daily living challenges. Autism: Study and Research The Center for the Study of Autism (CSA) provides information about autism to parents and professionals, and conducts research on the efficacy of various therapeutic interventions. Much of the research is in collaboration with the Autism Research Institute in San Diego. The nonprofit Autism Research Institute (ARI) was established in 1967 and conducts research and disseminates the results on causes of autism and methods of preventing, diagnosing, and treating autism and other severe behavioral disorders of childhood. FOR FURTHER INFORMATION:
Autism Research Institute 4182 Adams Avenue San Diego, CA 92116 (619) 563-6840 (fax) http://www.autism.com Autism Society of America 7910 Woodmont Avenue, Suite 300 Bethesda, MD 20814-3067 (800) 3AUTISM (toll-free) (301) 657-0881 http://www.autism-society.org Canadian Psychological Association 141 Laurier Avenue West, Suite 702 Ottawa, Ontario K1P 5J3 (888) 472-0657 (613) 237-2144
50 autogenic training Center for the Study of Autism P.O. Box 4538 Salem, OR 97302 http://www.autism.org National Institute of Mental Health 6001 Executive Boulevard, Room 8184 Bethesda, MD 20892-9663 (800) 421-4211 (toll-free) (301) 443-4513 (301) 443-4279 (fax) http://www.nimh.nih.gov/publicat/autism.cfm SOURCE: Canadian Psychological Association. “Psychology Works for Autism,” Available online. URL: http://www.cpa. ca/factsheets/autism.htm. Downloaded on June 4, 2005.
autogenic training RELAXATION and STRESS management technique developed in 1932 by Johannes Heinrich Schultz (1884–1970), a German neurologist. Dr. Schultz used it successfully for the treatment of high blood pressure, digestive disorders, and musculoskeletal problems. Since then, its therapeutic applications have expanded to include a wide variety of cardiovascular, respiratory, endocrine, gastrointestinal, metabolic, and sleep disorders. In autogenic training, the individual self induces a hypnotic-like state and achieves relaxation through breathing and muscular decontraction exercises. The technique is often accompanied by MEDITATION and affirmative statements regarding feelings of relaxation, warmth, inner quietness, and calm. A basic assumption behind autogenic training is that people are innately equipped with “self-regulatory brain mechanisms” that maintain a dynamic balance in all bodily functions. When this balance is disrupted, the body’s self-regulating mechanisms have the capability of restoring a healthy equilibrium, whether by calming an escalated heart rate, lowering elevated blood pressure, or healing an ulcer. See also ALTERNATIVE MEDICINE; BEHAVIOR THERAPY; BIOFEEDBACK; PROGRESSIVE MUSCLE RELAXATION. SOURCES: Kerman, D. Ariel (with Richard Trubo). The H.A.R.T. Program: Lower Your Blood Pressure without Drugs. New York: HarperCollins, 1992.
Lehrer, Paul M., and Robert L. Woolfolk, eds. Principles and Practice of Stress Management. New York: Guilford Press, 1993.
autoimmune disorders
Diseases caused by a reaction of the individuals’ immune system against tissues or organs of that person’s own body. Such disorders include rheumatoid ARTHRITIS, systemic lupus erythematosus, and insulin-dependent diabetes mellitus. Autoimmunity refers to the condition in which the body’s immune system fails to recognize its own tissues and attempts to reject its own cells as if they were foreign matter. Autoimmunity increases with age as the immune system deteriorates. Treatment of autoimmune disorders may include correcting major deficiencies; replacement of hormones such as thyroxin or insulin that are not being produced by a gland may be necessary. At times treatment may involve replacing components of blood by transfusion. Treatment may also include reducing the activity of the immune system, controlling the disorder while maintaining the body’s ability to fight disease. Corticosteroid drugs are commonly used; in more severe cases, immunosuppressant drugs are prescribed. Autoimmune disorders are sources of stress for the sufferer as well as family members because some of the disorders are difficult to diagnose and some drugs may cause serious side effects, such as damaging bone marrow.
automated teller machines (ATMs) Machines used by the banking industry to receive and dispense funds. The technology, developed during the 1960s, changed the way banking business is conducted, bringing about convenience but also the stresses of impatience and frustration. There are times when ATMs are closed because of technical problems or lack of funds, causing patrons to seek another machine. At times there are long waits for machines in popular locations, particularly before major holidays. Some people are wary of using machines and prefer completing their transaction with a bank teller. In 2004 there were 371,000 ATMs in the United States. According to Fortune magazine (July 16, 2004), there are ATMs on the South Rim of the Grand Canyon and above the Arctic Circle.
automobiles 51 The advent of ATMs did not reduce the number of tellers or reduce the need for bank branches, as developers of the machines had anticipated. There are now about 75,000 bank branches as compared to 58,000 in 1985, while the number of tellers is 539,000 compared to 484,000 back then. SOURCE: Florian, Ellen. “The Money Machines.” Fortune 150, no. 2 (July 16, 2004): 100.
automation in the workplace Automated production and service systems where machines do the repetitive elements of the work process that used to be handled by people. As a result of automation, workers may be displaced or left with mainly supervisory functions. The introduction of automation is generally considered a positive step, if the worker is assisted by the machine but maintains some CONTROL over its services. However, if operator skills and knowledge are taken over by the machine, the resulting monotony, lack of control, and social isolation may result in stress for the worker. Even when automation requires high skill from process operators, the monitoring of machines can become monotonous. Skills are used only during a small percentage of the work hours, and mechanical breakdowns can mean loss of work already completed. All of these elements constitute sources of stress at both the psychological and physiological level. Many industries, particularly manufacturing, have experienced displacement of workers since the advent of computerization and as a result of automation in their production lines; offices have been automated as well. It is estimated that office workers spend as much as 90 percent of their time at computers. Use of computers has also meant automation of delivery of services. A good example is the automatic bank teller, which not only cashes checks and deposits money, but can also provide these services 24 hours a day. See also AUTONOMY; BOREDOM; CHANGING NATURE OF WORK; JOB CHANGE; JOB SECURITY. automobiles
Americans spend an increasing amount of time in their automobiles—commuting to work, running errands, chauffeuring children,
shopping, banking, and seeking recreation. It has been estimated that the typical American driver covers 12,000 miles each year; stress begins when drivers realize that they are handling a machine that is potentially deadly to themselves and others. Even the purchase of the automobile may be a stress-filled situation. The buyer is faced with decisions whether to buy or lease; purchase new or used. Next comes a multitude of choices relating to dealer, brand, model, and optional features. Finally, before the purchase is consummated, the buyer worries whether he/she has used the best buying strategy and obtained lowest possible price. Car ownership carries with it the stresses of coping with repair scams, gas-pump ripoffs, and car thefts. Stresses of driving include unending traffic, stop lights, poor road conditions, road repairs, detours, competition for parking spaces, and ANGER at the driving mistakes of others. Driving also involves constant decisions. Steering, passing, turning, braking, and looking out for other drivers puts one in a highly reactive state. Thus many drivers, when given sufficient reason, are ready to release their pent-up frustrations, let their tempers soar, and exhibit aggressive behaviors. Some vent their stress by using the horn, shouting out their windows, or making gestures to other drivers. These techniques do little to reduce the stress inherent in the situation. Better alternatives include patience, self-control, and keeping a sense of humor. Continued exposure to traffic jams and long-distance commuting can have many adverse effects such as higher blood pressure and greater incidence of colds and flu. Driver tensions can lead to what researchers call “inter-domain transfer.” That means that drivers who are stressed going to and from work are likely to carry a negative mood into the office or back to their families when they get home. With today’s new car equipment and gadgets, drivers are encouraged to add to existing stressors by talking on car phones, dictating memos, eating “one-handed” food, and sipping hot and cold drinks. Others who have overslept and are already under stress because they are late to work may be seen in their cars combing hair, flossing teeth, applying makeup, or tying ties. Keeping attention focused on the task at hand is probably the best antidote to the stresses involved in driving an automobile.
52 autonomy TIPS FOR REDUCING DRIVING STRESS • • • • • • •
Allow more time than you think you need. Avoid the peak morning and evening commutes. Keep your mind on the task at hand. Practice patience and self-control. Listen to music or audiotapes. Keep your sense of humor. Relax before or after driving by using MEDITATION or another form of BREATHING exercise.
See also RAGE.
autonomy
GUIDED IMAGERY; RELAXATION; ROAD
A feeling of being in CONTROL along with feelings of independence and freedom. When people lose their sense of autonomy, they may lose SELF-ESTEEM, become frustrated, and feel very stressed. Many stressful situations throughout life can contribute to loss of autonomy. Individuals may experience automation on the job, job loss, codependent relationships, sickness and disabilities, and old age. In most cases, autonomy can be regained, at least to some degree, by taking assertive steps, such as learning a new skill or forming new relationships or finding a new job. In developing a sense of autonomy, peer groups play an important role. Children with peer group relationships in which all group members play an equal role in leadership generally acquire good feelings about themselves and develop confidence that others will like them. They will also develop the ability to realize what others expect of them and to make choices about meeting those expectations in a flexible way and without stress. For some individuals, particularly teenagers, peer groups may be destructive to autonomy. They are individuals whose experiences with their peers have not enabled them to develop self-confidence. Under these circumstances, their desire for approval or acceptance may lead to taking drugs, smoking cigarettes, or other unhealthy behaviors that seem to make them feel part of the group. See also AGING; ANGER; ASSERTIVENESS TRAINING; CODEPENDENCY; ELDERLY PARENTS; FRUSTRATION.
SOURCES: Johnson, D. S., and R. T. Johnson. “Peer Influences,” in Corsini, Raymond J., Encyclopedia of Psychology, vol. 2. New York: Wiley, 1984. Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997. May, Rollo. Freedom and Destiny. New York: W. W. Norton, 1981. Vinack, W. E. “Independent Personalities.” In Corsini, Raymond, ed. Encyclopedia of Psychology. Vol. 2. New York: Wiley, 1984.
aversion
Dislike for certain situations or things. When individuals face something they extremely dislike—whether food, loud music, or a certain person or animal—it can be stressful. Aversion therapy helps them overcome habits and unwanted behaviors that cause stress by associating those habits or behaviors with painful experiences or unpleasant feelings. Aversion therapy has been used to treat many stressful situations, including ALCOHOLISM, BEDWETTING, SMOKING, sex addiction, and NAIL BITING. The most widely used form is chemical therapy, in which the individual receives a drug to induce nausea and is then exposed to smoking, nail biting, or other stressful habits that he or she is trying to overcome. The chemical method has been used most widely in the treatment of alcoholism. A more modern form of aversion therapy is known as covert sensitization. Based on modification of behavior, this therapy requires the individual to imagine the unwanted stressful habit and then to imagine some extremely undesirable consequence, such as pain or nausea. The word aversion is commonly misused in place of PHOBIA, which is a more severe reaction. See also BEHAVIOR THERAPY; PSYCHOTHERAPIES. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
avian flu A type of influenza produced by avian influenza viruses; also known as “bird flu.” In February 2004, different strains of avian flu were detected among several flocks of birds in the United States, and state officials ordered the destruction of hundreds of thousands of birds. Pre-
avian flu 53 viously, outbreaks had been reported in several countries in Asia. Cases of avian influenza in birds were confirmed in Cambodia, China, Indonesia, Japan, Laos, Russia, South Korea, Thailand, Turkey, and Vietnam. Human cases of avian influenza have been reported in China. During these outbreaks, it was not determined that avian flu is spread from person to person; however, the situation is a source of stress for many people concerned about birds in their area and the spread of the disease. The strain of avian influenza A (H5N1) affecting Asia has not been found in the United States. The current outbreak of avian influenza prompted the killing of more than 25 million birds in Asia, according the U.S. Department of Labor. Wild birds are the natural hosts for the virus. Avian flu viruses circulate among birds worldwide and are highly contagious among birds. The United States annually imports an estimated 20,000 birds from countries with current avian influenza outbreaks, according to the U.S. Fish and Wildlife Service. How Avian Flu Spreads Most human influenza infections are spread by virus-laden respiratory droplets that are expelled during coughing and sneezing. They are carried in respiratory secretions as small-particle aerosols. In agricultural settings, animal manure containing influenza virus can contaminate dust and soil, causing infection when the contaminated dust is inhaled. Contaminated farm equipment, feed, cages, or shoes can carry the virus from farm to farm, and it can also be carried on the bodies and feet of animals such as rodents. In food handling/preparation settings, there is also some concern that avian influenza could be transmitted from uncooked birds or bird products. The World Health Organization has also reported a study that found avian influenza A (H5N1) in imported frozen duck meat. Eggs from infected poultry could also be contaminated with the virus. Ban on Importation of Potentially Infected Animals According to the U.S. Department of Labor, Occupational Safety and Health Administration, the U.S. government (as of July 2004) issued an order for a ban on importation of all birds from the following
Asian countries: Cambodia, Indonesia, Japan, Laos, People’s Republic of China, including Hong Kong, South Korea, Thailand, and Vietnam. The ban applies to all birds, whether dead or alive, and all bird products, such as eggs. This step was taken because birds from these affected countries potentially can infect humans with influenza A (H5N1). This order is enforced by the U.S. Department of Agriculture (USDA), the Centers for Disease Control and Prevention (CDC), and other federal agencies, such as the Animal Plant Health Inspection Service of the U.S. Department of Agriculture, Bureau of Customs and Border Protection of the Department of Homeland Security, and the U.S. Fish and Wildlife Service of the Department of Interior. Precautions for Travelers The CDC has issued precautions for travel to countries that are reporting outbreaks of avian influenza A in humans and animals. While the CDC does not recommend the general public avoid travel to any of the countries affected by avian influenza A, it makes the following recommendations: • Assemble a travel health kit containing basic first-aid and medical supplies, including a thermometer and alcohol-based hand sanitizer for hand hygiene. • Become educated about influenza. Information about influenza is available on CDC’s influenza Web site: http://www.cdc.gov/flu • Update your shots, and see your health care provider at least four to six weeks prior to travel to get any additional shots or information you may need. CDC’s health recommendations for international travel are available on CDC’s Travelers’ Health Web site: http://www.cdc.gov/travel • Check with your health insurance plan or get additional insurance to cover medical evacuation in the event of illness. Information about medical evacuation services is available on the U.S. Department of State Web site: http://www. travel.state.gove/medical.html • Prior to your trip, identify in-country health care resources. • In countries where outbreaks of this disease are ongoing, avoid areas with live poultry, such as live animal markets and poultry farms. Large
54 Ayurveda amounts of the virus are known to be excreted in the droppings from infected birds. • If you develop respiratory symptoms or any illness requiring prompt medical attention, a U.S. consular officer can assist in locating appropriate medical services and informing family or friends. • After your return, monitor your health for 10 days. If you become ill with fever or respiratory symptoms during this 10-day period, consult a health care provider and tell the provider that you have traveled to an area reporting avian influenza. Precautions for Airline Flight Crews Airline flight crews must be aware of symptoms of avian influenza. Experience with human infection is limited, but persons infected with avian influenza would likely have fever and respiratory symptoms (cough, sore throat, shortness of breath). Personnel should wear disposable gloves for direct contact with blood or body fluids of any passenger. According to the CDC, the captain of an airliner bound for the United States is required by law to report the illness to the nearest U.S. quarantine station prior to arrival or as soon as illness is noted. Quarantine officials will arrange for appropriate medical assistance to be available when the airplane lands and will notify state and local health departments and the appropriate CDC officials. FOR FURTHER INFORMATION:
U.S. Department of Labor Occupational Safety and Health Administration http://www.osha.gov SOURCE: Nicholson K. G., et al., “Influenza.” The Lancet 362, no. 9397 (November 23, 2003): 1,733.
Ayurveda
Ayurveda (“the science of life,” as it translates literally) originated at least 3,000 years ago in India and is considered to be the oldest system of natural medicine. Ayurveda employs the healing powers of breathing exercises, natural foods, massage, herbs and aromas to reduce stress and promote health and long life. While Western medicine works on illness, Ayurvedic medicine focuses on the person as a
complex being, and treatment is highly individualized. For a person who feels well, Ayurvedic activities make the most of mental, physical, and spiritual well-being, enabling better COPING skills against the stresses of daily life. When a person is fighting illness or coping with stress, Ayurvedic therapy works by enhancing the healing potential within himself or herself. Ayurvedic beliefs hold that life is a relationship between body and mind. In the United States, Ayurvedic health care is considered a form of ALTERNATIVE MEDICINE (or complementary medicine), meant to complement, not replace, modern medicine. Ayurveda is an art of insight that brings harmony to daily life and relationships and to such stressful EMOTIONS as pain, grief, and sadness. A characteristic element of Ayurveda is the determination of an individual’s mind/body type. It is a combination of three fundamental principles, known as doshas, which govern thousands of mental and physical processes. These three principles— Vata (movement), Pitta (metabolism) and Kapha (structure)—are the controlling agents of nature. Permutations of the doshas determine an individual’s subtype; through careful history taking and pulse diagnosis, a practitioner can determine imbalances of energy. Disease is diagnosed through questioning, observation, palpitation, percussion, and listening to the heart, lungs, and intestines. Another diagnostic technique associated with Ayurveda reveals the status of internal organs merely by observing the surface of the tongue. It is considered the mirror of the viscera and can reflect many pathological conditions. Ayurveda classifies seven major causative factors in disease: heredity, congenital factors, internal factors, external trauma, seasonal influences, natural tendencies or habits, and supernatural factors. Disease can also result from misuse, overuse, and underuse of the senses: hearing, touch, sight, taste, and smell. It also can result from imbalanced emotions, such as unresolved anger, fear, anxiety, grief, or sadness. Prana, the Ayurvedic term for energy, has counterparts in Oriental medicine (Qi) and homeopathy (Vital Force). Pranic energy is mental and physical and can be changed by diet, exercise, herbs, or spiritual practices such as MEDITATION. Pranic energy flows along specific paths, called nadis, which con-
Ayurveda 55 verge and cross in energy centers called chakras located along the length of the body. During an Ayurvedic examination, chakras are studied and doshas may be determined to be out of balance, leading to ill health. In the United States, physician training in Ayurveda is under the direction of the Maharishi Training Program in Fairfield, Iowa, and directed by Dr. Deepak CHOPRA, who is also a contemporary writer about Ayurvedic medicine. See also ALTERNATIVE MEDICINE; IMMUNE SYSTEM; MIND-BODY CONNECTIONS; PSYCHONEUROIMMUNOLOGY. FOR FURTHER INFORMATION:
Ayurvedic Institute 11311 Menaul Boulevard NE Albuquerque, NM 97192-1445
(505) 291-9698 http://www.ayurveda.com Sharp Institute for Human Potential and Mind/Body Medicine 8010 Frost Street, Suite 300 San Diego, CA 92123 (800) 82-SHARP (toll-free) SOURCES: Anselmo, Peter. Ayurvedic Secrets to Longevity and Total Health. New York: Prentice Hall, 1996. Chopra, Deepak. Perfect Health. New York: Harmony Books, 1990. Lad, Vasant. Ayurveda: The Science of Self-Healing. Santa Fe: Lotus Press, 1984. Morrison, Judith M. The Book of Ayurveda. New York: Fireside, 1995.
B A good job market and a rapidly expanding economy greeted baby boomers upon graduation from college, and they were soon described as having tendencies toward materialism that included acquiring possessions at an early stage and “HAVING IT ALL.” In reaction, baby boomers tended to become entrepreneurial and viewed a job as something that should be fulfilling and stimulating rather than simply a means to the end of supporting themselves and their families. However, the sheer numbers of the baby boom generation created a population bulge that increased competition for the remaining corporate and government positions. A changing economy, DOWNSIZING, the future of Social Security, rising health care costs, and the need for RETIREMENT savings, has led to frustrations and additional stress. See also COMMUNICATION; INTERGENERATIONAL CONFLICTS; SEXUAL REVOLUTION; WOMEN’S MOVEMENT; WORKING MOTHERS.
baby boomers The 76 million Americans born between 1946 and 1964. They are products of the population explosion that began during World War II, peaked following the war, and lasted until the mid-1960s. The baby boom has been attributed to several causes, including the wartime prosperity that followed the Great Depression, increased births as servicemen husbands returned after the war, a lower MARRIAGE age than for previous generations, and a tendency to have children in quick succession early in marriage rather than spacing childbearing over a period of years. This generation has experienced many stresses, both individual as well as societal. These stresses have not been static but have been influenced by the changing times in which baby boomers have lived. As young adults, their protest against the Vietnam War labeled them as hedonistic, rebellious, and undisciplined. When they reached college age, they were fighting for civil rights and were active in the women’s movement. Improved birth control, more permissive sexual standards, and an emphasis on education for both sexes plunged young women of the baby boomer generation into a world of choices. The resulting questions about pursuing careers, entering marriage, and having children are issues of stress that continue to haunt women into the 21st century. The concept of family has not been totally attractive to baby boomers, who frequently have substituted networks of FRIENDS and LIVE-IN or communal arrangements for the traditional marriage and family. When marriages occur, they are often at a later age than in previous generations. For many couples, this has meant stress that is brought about by INFERTILITY problems because of the later age or, for single women, stress brought about by the ticking of their BIOLOGICAL CLOCK.
SOURCES: Mills, D. Quinn. Not Like Our Parents: How the Baby Boom Generation Is Changing America. New York: William Morrow, 1987. Silver, Don. Baby Boomer Retirement: 65 Simple Ways to Protect Your Future. Los Angeles: Adams-Hall Publishers, 1994.
back pain Discomfort in the spinal column and supporting structures. Estimates are that 50 percent to 80 percent of the population have back problems significant enough to cause them to be out of work at some point during their lifetime. Of these, only a handful of backache sufferers, perhaps 10 percent to 20 percent, ever discover a reason for their pain. Diagnosis often remains an unsolved mystery because the causes of back injury vary widely and the pain usually goes away on its own. 56
barbiturate drugs 57 The STRESS that occurs because of back pain can affect the individual and his or her family and WORKPLACE. Often appearing at a particularly stressful time in a person’s life, back pains can be the result of a one-time injury, or they can occur after years of poor posture, OBESITY, emotional stress, or simple wear and tear. Back pain can lead to the loss of work days. People who do heavy lifting, carrying or sitting in one place, or are overweight, often develop backaches. Understanding how work habits can lead to back pain and making appropriate changes is a step toward alleviating chronic discomfort and the accompanying stress. Stress, Muscle Strain, Ligament Injuries, and Disk Damage The most common one-time injury is muscle strain caused by falling, twisting, or improper lifting of heavy objects. When muscles are pulled and do not have strength to support the trunk of the body, they can contract into painful spasms. Ligament injuries can also trigger back problems. Years of poor body mechanics can permanently stretch the ligaments, bands of fibrous tissue that connect bone and muscle to strengthen the joints of the back. When they are sprained, the muscles have to work harder to support the back. Disk damage affects only a small percentage of backache sufferers. Disks are located between each vertebra. They are composed of a strong, fibrous ring of tissue. When enough pressure is placed on a disk, the ring can be torn. If the ring has become weakened through long and strenuous use, the tear can occur with only a slight pressure or strain. A slipped, or ruptured, disk occurs when the spongy interior of the disk seeps out and puts pressure on the nerves coming from the spine, causing severe pain in the back and often down the leg. As people age, ruptured disks are more likely because the disks lose some of their fluid and become less elastic. In rare cases, back pain may indicate more serious health problems, such as disease or injury to the spine itself, pelvic or abdominal disorders, and kidney disease. When simple self-help techniques do not work, one should consult a physician about back pain. When back pain persists over time, many individuals experience sufficient stress to lead to mild DEPRESSION and withdrawal. Persistent pain with-
TIPS FOR PREVENTING STRESS DUE TO BACK PAIN • Stay in good physical condition and exercise regularly to keep muscles strong, particularly abdominal muscles, as they are important in back support. • Stand tall, with your chin and abdomen tucked in and the curve of your lower back as straight as possible. When standing in one place for any length of time, put one foot up on the rung of a stool, box, or some other object to adjust your weight. • When sitting, sit well back in your seat with your back straight. Do not slouch. Change your position from time to time. • Sleep on your side with your knees bent, or on your back with only a small pillow under your knees to release stress on your lower back. Avoid sleeping on your stomach. • When lifting objects, squat down with your knees and hips bent. Use your leg muscles to rise, keeping your back straight and elbows bent. Hold the object as close to your body as possible to avoid strain on other muscles.
out relief makes one feel out of CONTROL of one’s body. Taking a positive attitude and pursuing avenues of relief can give the individual more control over the situation. See also ALEXANDER TECHNIQUE; ALTERNATIVE MEDICINE; BODY THERAPIES; MASSAGE THERAPY; RELAXATION. SOURCES: Goodfriend, Judy, ed. “Getting a Grip on Back Pain.” Vital Signs 9 (March 1995). Jetter, Alexis. “Fighting Back Pain.” Health, September 1996. Sinel, Michael S. Win the Battle against Back Pain: An Integrated Mind-Body Approach. New York: Dell, 1996.
barbiturate drugs Medications that provide sedation and induce sleep. They have been prescribed by physicians for stress, tension, and anxiety; they act as depressants to the CENTRAL NERVOUS SYSTEM. These drugs slow down the activity of nerves that control many mental and physical functions, such as EMOTIONS, heart rate, and BREATHING.
58 battered child syndrome Some sleeping pills are “short-acting” barbiturates; their effects last only five or six hours and, if properly used, produce little or no aftereffects. When abused, barbiturates can cause addiction and exacerbate the sleeping difficulties. There are many serious disadvantages to barbiturates, which have led to a sharp decline in their use by physicians. They are very toxic. Death through overdose, accidental or intended, is a significant danger, particularly when they are combined with alcohol. Physical and psychological dependency and mood changes can result from too much use. In recent years, physicians are prescribing drugs in a newer class known as benzodiazepines for many stress and anxiety conditions. Benzodiazepines can produce dependency but not to the degree of dependency, toxicity, or cell death that occurs with the barbiturates. See also BENZODIAZEPINE DRUGS; PHARMACOLOGICAL APPROACH. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
battered child syndrome battered women bed-wetting
See
See DOMESTIC VIOLENCE.
DOMESTIC VIOLENCE.
Medically known as enuresis; means unconscious or unintentional urinating by a child over the age of three while asleep. This problem is a major source of stress for the child, who may be embarrassed or feel guilty, as well as for the parent, who may feel confused about how to handle the situation. About 10 percent of children still wet the bed at age five; many more continue to do so until the age of eight or nine. The situation seems more prevalent among boys than among girls. Bed-wetting in young children may also be a symptom of other stresses, ranging from the arrival of a new sibling to moving to a new house, from starting nursery school to the absence of a parent. Punishing or shaming a child for bed-wetting is not advisable. Parents should not focus undue attention on the situation, as doing so may make the child feel more stressed and anxious, worsening
the problem. Instead, parents should try to reassure the child and relieve his or her fears. Understanding the Causes of Bed-Wetting In coping with the attendant stresses on child and parent, an understanding of some possible causes for the problem may be helpful. For example, if the cause of bed-wetting seems to be emotional, the parent can begin to identify contributing factors and start taking positive steps to correct the situation. In some cases, a skilled counselor may be able to help locate and explain the habits and reactions of the child, parents, and/or other caretakers. All concerned should try to reinforce a child’s successes and reward good behavior by compliments and encouragement. Some little children fear bed-wetting, or may have reacted severely to embarrassment from a previous accident. As a result, they may have bad DREAMS about the accident and during such dreams may urinate in the bed. In other cases, children sleep very deeply and cannot awaken to normal urinary impulses. A new schedule can be another cause of bed-wetting, particularly when a child who is accustomed to napping has just begun nursery school or kindergarten. Making a Diagnosis and Beginning Treatment In cases of repeated bed-wetting, a physician will try to determine whether or not the cause is emotional or physical. Physical causes such as infection or illness can be detected by assessing bladder function. There may be a structural abnormality of the urinary tract present from birth, diabetes mellitus, or an infection in the urinary tract. In these cases, the child may also have difficulty controlling urine during the day. Because bed-wetting may lead to further shame and stressful situations, other symptomatic treatments have been used. For example, medications such as imipramine, a tricyclic antidepressant, have helped some children. The decision to medicate should be made by a pediatrician. A nighttime alarm system is available, which consists of a moisture-sensitive pad to be placed in the child’s bed between the mattress and the lower sheet. This triggers an alarm when urine is passed, and awakens the child, who can then use the toilet. After a while, the child awakens whenever the urge
behavior therapy 59 TIPS FOR HELPING A CHILD OVERCOME THE STRESS OF BED-WETTING • Estimate the approximate times when bedwetting occurs and consider contributing factors before bedtime. • Give the child less liquid in the few hours before bedtime. • Plan on awakening the child a few hours after he has gone to sleep and have him go to the bathroom. • Help him train reflexes during waking hours by having him visit the bathroom immediately on feeling the first impulse. • Reward the child with a gold star on a chart for each dry night. • For an older child, consider use of an alarm pad in the bed.
to pass urine is felt. This is more useful to children over seven years old than to younger children. Whether the causes are physical or emotional, a child can be retrained regarding toilet habits to help restore coordination of mental, neurological, and physical impulses. The National Enuresis Society is a self-help organization to help parents cope with the stresses of children’s bed-wetting. See also TOILET TRAINING; URINARY INCONTINENCE. FOR FURTHER INFORMATION:
National Enuresis Society 7777 Forest Lane, Suite C-737 Dallas, TX 75230-2518 (800) NEW-8080 (toll-free) SOURCES: Brownstone, David, and Irene M. Franck. The Parent’s Desk Reference. New York: Prentice Hall, 1991. Glenzer, Milton W. How to End Bedwetting: Facts Not Fancy. Des Plaines, Ill.: Habit Publications, 1980.
beepers
See
ELECTRONIC DEVICES.
behavior therapy
Behavior modification; includes several techniques intended to change the way an individual responds to stressful situations by influencing actions, thoughts, and feelings that result from such situations. Maladaptive (negative or self-
defeating) behaviors often can be reduced or eliminated through behavior modification techniques. This therapy form became a widely used alternative to psychodynamic theory during the 1950s. It developed because mental health professionals recognized a lack of specificity and verifiability in the treatment outcomes of other approaches to stress and anxiety problems. Behavior therapy focuses on behaviors and responses rather than on underlying causes. Therapists in this area believe that behaviors are not inherited but learned in response to environment. They help individuals learn to relax, to overcome stress, and to avert ANGER, panic, and undesirable behaviors such as avoidance and anxiety. Instead of trying to alter the personality by probing into unconscious reasons that may motivate a person’s behavior, behavior therapy is often used in conjunction with therapies such as PSYCHOTHERAPY and medication. It has proven effective in treating anxieties, DEPRESSION, PHOBIAS, obsessions, compulsions, ALCOHOLISM and sexual problems as well as other stress-related disorders. The goal of behavior therapy is to help the individual develop self-control and an increased number of revised, adaptive behaviors. The therapist and patient together define treatment goals, often in conjunction with the family of the patient. The therapist acts as a coach or instructor and encourages the patient to make choices about how and when to learn new behaviors. Behavior therapists tailor specific treatment techniques to the needs of their patients, focusing on measurable aspects of observable behaviors such as frequency or intensity (for example, of ritualistic hand washing), physiological responses (such as sweating) and self-rating scales and verbal reports by the patient. Therapists may utilize any one or more of many techniques, including classical CONDITIONING, exposure therapy or desensitization, flooding, HYPNOSIS, and BIOFEEDBACK. Exposure Therapy (Desensitization) Exposure therapy employs several techniques to reshape an individual’s responses to stress-producing situations. A therapist may choose systematic desensitization, exposure at full intensity (flooding and implosive therapy) or exposure with modification of thought processes (contextual therapy). Systematic desensitization gradually exposes the
60 behavior therapy individual to stress or anxiety-producing situations. Such exposure may take place in the individual’s imagination or in real life. To retrain the thought processes, this technique is often combined with relaxation training. In contextual therapy, developed by American psychiatrist Manuel Zane (1913– ), the therapist tries to keep the patient anchored in the present situation and works with individual internal cues, which present stresses and anxieties. Systematic Desensitization In 1958, John Wolpe (1915–97), an American psychiatrist with a background in learning theory, reported successful results in treating adults with a variety of stress and anxiety concerns, including phobic anxiety, reactive depression, and obsessivecompulsive disorder, with a process he called “systematic desensitization.” He adapted his process from a technique developed in the 1920s for helping children overcome animal phobias. This process trains the individual to relax muscles, imagine increasing degrees of anxiety-producing stimuli, and then face these stimuli in real life until the maximum stimulus no longer causes great anxiety. Thus, an individual who fears sexual intercourse might place coitus at the top of the list of anxietyproducing stimuli; thinking about sitting with a date in a bar might rank at the bottom of the list. After going through a series of relaxation training exercises, the patient is asked to imagine, with as much detail as possible, the least anxiety-producing item from the list. While relaxing and imagining the situation, the patient tries to weaken the association between it and his or her anxieties. After becoming comfortable with imagining the least threatening situation, the patient gradually moves up the hierarchy of stress-producing situations. While many therapists believe that facing a stress-producing situation in the imagination may be just as effective as facing it in reality, others believe that it is not. Once the patient has completed desensitization treatment and goes on to face the real stress-producing situation, he or she may regress slightly down the hierarchy of stressproducing events. For example, a socially phobic individual who has learned to remain calm while walking into a party and meeting new people, may be comfortable in small groups but not at large
cocktail parties. However, eventually that individual will be able to move from nonthreatening small group social events to a larger setting and progress to a desired level of social behavior. Flooding Like desensitization, the technique known as flooding involves the patient imagining or experiencing stress-producing situations in real life. The technique was developed in the 1960s by Thomas Stampfl, an American psychologist at the University of Wisconsin. The patient is exposed directly to a maximum level of stress-producing stimulus without a graduated approach. The therapist, rather than the patient, controls when and which stressful scenarios are to be imagined. The therapist describes vivid scenes in a purposeful effort to make them as disturbing as possible to the patient, with no instructions for the patient to relax. Such prolonged and repeated exposure to feared situations helps eliminate the individual’s stress-filled response and replace it with another that is more acceptable. Implosive therapy, or implosion, is a variation and extension of the flooding technique. The patient is repeatedly encouraged to imagine a stressproducing situation at maximum intensity in order to experience as intense a stress response as possible. Assuming that there is no actual danger in the situation, the stress response is not reinforced and thus becomes gradually reduced. While flooding and implosive techniques help reduce stress-filled responses in some individuals who have simple anxieties, for others, desensitization appears to be more effective and more permanent. Modeling and Covert Modeling Modeling therapy is also known as social learning or observational learning. The anxious individual watches another person, often of the same sex and age, successfully carry out a particular stress-producing action, such as speaking in front of a group of people or being introduced to members of the opposite sex. In some cases, the therapist models the action. The “cure” occurs when the patient experiences vicarious extinction of the previously stress-filled and anxiety-producing responses. With COVERT MODELING the patient simply imagines another person facing the stress-producing situation without experiencing undue stress.
Benson, Herbert, M.D. 61 Biofeedback Biofeedback is a technique that enables the individual undergoing therapy to monitor psychophysiological changes through an electrical feedback device. It offers an individual a way to self-regulate certain processes, such as reactions to stress-producing situations. The technique is useful with some individuals who get headaches in response to stress or become extremely nervous when thinking about potentially stressful situations such as public speaking. By noting physiological reactions to stressful events, biofeedback techniques help establish a diagnostic baseline that enables therapists to relate this information to an individual’s verbal reports, fill gaps in the individual’s history, and encourage relaxation of the body part to which the biofeedback equipment is applied. In many cases, relaxation training is used in conjunction with biofeedback to give the patient a better sense of control and to break the cycle that elicits unwanted responses to stress-filled situations. Aversion Therapy This form of therapy helps the individual focus on the negative consequences of self-defeating behavior. For example, when alcoholics are treated with mild electrical shocks or given a nausea-inducing medicinal substance every time they taste alcohol, they develop an aversive reaction to the smell and taste of the alcoholic beverage. Hypnosis Hypnosis is considered a behavioral technique because the role of the therapist is active. When successful, hypnosis produces a trance-like state in which the patient becomes very receptive to suggestions for behavior changes. With use of posthypnotic suggestion, an individual may learn to change a response to a stressful situation, such as meeting new people. Hypnosis is usually considered an adjunctive therapy, because it is used in conjunction with other therapies. It is also considered an alternative therapy because it makes use of processes outside of the mainstream of medicine and psychiatry. See also AGORAPHOBIA; ALTERNATIVE MEDICINE; AVERSION; COVERT REHEARSAL; COVERT REINFORCEMENT; MIND-BODY CONNECTIONS; PANIC ATTACKS AND PANIC DISORDER; PSYCHOTHERAPIES.
SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Kaplan, Sheldon J. The Private Practice of Behavior Therapy: A Guide for Behavioral Practitioners. New York: Plenum Press, 1986.
belching
See
INDIGESTION.
Benson, Herbert, M.D. (1935– ) Founding president of the Mind/Body Medical Institute; associate chief, Division of Behavioral Medicine, Harvard Medical School; and chief, Division of Behavioral Medicine, New England Deaconess Hospital. He is a cardiologist who discovered and described how the RELAXATION response is a protective mechanism against overreaction to stress. He is the author or coauthor of several books relating to relaxation and stress, including The Relaxation Response and The Mind/Body Effect; hundreds of his articles have appeared in medical journals and popular magazines. Dr. Benson discovered the relaxation response while studying people who practiced TRANSCENDENTAL MEDITATION. As a specialist in HIGH BLOOD PRESSURE, Dr. Benson’s particular interests have included how the relaxation response can help people with high blood pressure and other health concerns. He warns that people with high blood pressure should not just give up their medication. What MEDITATION and the relaxation response do, he maintains, is improve upon the benefit of the medication. See also ALTERNATIVE MEDICINE. FOR FURTHER INFORMATION:
Mind-Body Medical Institute New Deaconess Hospital Harvard Medical School 185 Pilgrim Road Cambridge, MA 02215 (617) 632-9530 SOURCES: Benson, Herbert. Beyond the Relaxation Response. New York: Berkeley Press, 1985. ———. The Mind/Body Effect: How Behavioral Medicine Can Show You the Way to Better Health. New York: Simon and Schuster, 1979. ———. The Relaxation Response. New York: Avon Books, 1975.
62 benzodiazepine drugs benzodiazepine drugs
A class of prescription medications widely used to help relieve symptoms of stress and anxiety. They act as sedatives, muscle relaxants, and anticonvulsants. Different drugs in this class are approved for different conditions. For example, ALPRAZOLAM (trade name, Xanax) is approved for use in panic disorder. Benzodiazepine drugs have less toxicity and fewer drug interaction problems than barbiturates and non-barbiturate sedative-hypnotic drugs. Also, benzodiazepines have a lower risk of cardiovascular and respiratory depression compared with barbiturates and are often used before general anesthesia. Persons taking benzodiazepine drugs should avoid alcohol because interaction may result in depression of the central nervous system. See also ANXIETY DISORDERS; PANIC ATTACKS AND PANIC DISORDER; PHARMACOLOGICAL APPROACH.
bereavement
See
GRIEF.
bibliotherapy A form of supportive or alternative therapy in which carefully chosen readings are recommended for helping the individual gain insight into personal sources of stress. Bibliotherapy also includes learning through reading about the MIND-BODY CONNECTIONS in stress management. It is used in conjunction with many other therapies, such as BIOFEEDBACK, GUIDED IMAGERY, and RELAXATION training. See also ALTERNATIVE MEDICINE; GUIDED IMAGERY. binge drinking
Excessive consumption of alcoholic beverages that is a major factor in nearly all the leading causes of death for youth. Hazardous drinking has been implicated in automobile crashes, homicide, suicide, and fatal injuries among your people. Dangerous drinking is a source of stress and anxiety for parents, school and college administrators, and for young people themselves. Approximately 10 million Americans under the age of 21 drink alcohol; nearly half of them drink to excess, consuming four or more drinks in a row one or more times in a two-week period. Alcohol is most frequently used by high school seniors, and its use is increasing. The stress of peer pressure is a factor. Studies show that one of three American colleges has a majority of students who engage in
high-risk drinking. More than two of every five college students are binge drinkers, with excessive drinking accounting for 1,400 student deaths, 500,000 injuries, and 70,000 sexual assaults or date rapes every year according to a study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol also has harmful effects on the brains of adolescents, according to Zeigler, et al., writing in Preventive Medicine. “Today’s college students face powerful social and commercial influences to drink. If we are to reduce the dangerous levels of campus drinking and its consequences, college and surrounding communities must cooperate to reduce the numerous environmental factors that contribute to alcohol abuse,” said AMA president J. Edward Hill, M.D., in 2004. Traditional efforts to reduce underage drinking have focused primarily on youth education and prevention techniques, often simply trying to convince youth not to drink. Research shows that this model has been only marginally successful. To combat alcohol abuse among underage youth and college students and the health risks and societal harms associated with it, the American Medical Association (AMA) and the Robert Wood Johnson Foundation (RWJF) have joined forces to help communities throughout the country find solutions that go beyond simply admonishing youth to say no to alcohol. The AMA and RWJF are working to create solutions through two national programs: “A Matter of Degree: The National Effort to Reduce High-Rish Drinking among College Students” and “Reducing Underage Drinking through Coalitions.” “We are finally taking decisive action against a major public health crisis that has taken the lives and futures of young Americans,” said Percy Wootton, M.D., a past president of the AMA. A Matter of Degree With funding from the RWJF and management by the AMA, the two entities have been working together since 1996 with 10 university-community coalitions in a national effort to reduce binge drinking among college students. A Matter of Degree (AMOD) is an $8.6 million, multiyear program designed to foster collaboration between participating universities and the communities in which they are located to address this issue and
binge drinking 63 TEN CAMPUS-COMMUNITY PARTNERSHIPS IN AMOD Florida State University and Tallahassee, Florida Georgia Institute of Technology and Atlanta, Georgia Lehigh University and Bethlehem, Pennsylvania Louisiana State University and Baton Rouge, Louisiana University of Colorado and Boulder, Colorado University of Delaware and Newark, Delaware University of Iowa and Iowa City, Iowa University of Nebraska at Lincoln and Lincoln, Nebraska University of Vermont and Burlington, Vermont University of Wisconsin and Madison, Wisconsin Source: http://www.alcoholpolicysolutions.net/overview_ amod.htm
improve the quality of life for all community residents. Participants in the program identify environmental factors such as alcohol advertising and marketing, institutional policies and practices, local ordinances, social and cultural beliefs, and behaviors that converge to encourage alcohol abuse, and work together to create positive changes. For example, coalitions may seek to curb the practice of alcohol discounting, such as two-for-one drink specials, ladies’ nights, and other promotions in their communities that encourage excessive drinking. They also work to limit alcohol industry sponsorship of social events, including sports and other celebrations. According to an evaluation conducted by the Harvard School of Public Health published in the American Journal of Preventive Medicine (October 2004), college students at universities participating in AMOD are less likely to miss class, be assaulted by a drunk student, or hurt themselves after drinking. The study also found a decline in the drinking rates themselves at college incorporating the most AMOD policies or interventions. Further findings indicated that the five colleges that had achieved a high level of implementation by 2001 saw significant reductions, not only in actual rates of drinking, binge drinking, and frequent drunkenness relative to 32 comparison schools, but also in the direct and secondary harms of alcohol use, including reports of missing a class, falling
SUGGESTIONS FOR CAMPUS, LAW ENFORCEMENT, AND COMMUNITIES • Alcohol advertising and promotion controls • Keg registration • Mandatory training for responsible beverage service • Stronger, more consistent campus-university enforcement and policy collaboration • Curbs on selling alcohol without a license • Alcohol-free activities and residence halls
behind in schoolwork, vandalizing property, injuries due to drinking, being assaulted by a fellow college student who is drinking, and experiencing an unwanted sexual advance by someone drinking. According to Richard A. Yoast, Ph.D., director of the AMA Office of Alcohol and other Drug Abuse, AMOD’s national office, “Levels of implementation were affected by numerous obstacles common on and around campuses such as alcohol industry resistance, little or no cooperation from the community, lack of student support, and high drinking rates common in the states themselves. However, findings in this study validate the environmental prevention model and offer hope to colleges, universities and their surrounding communities seeking ways to confront the academic and public health problems causes by high-risk drinking.” Reducing Underage Drinking through Coalitions This second initiative embraces an approach that focuses on how the social environment encourages and even enables alcohol abuse among young people. Through this $10.2 million initiative, 12 coalitions of youth, business civic organizations, the religious community, and other leaders identify factors in the environment that contribute most to underage drinking in their communities and work together to create positive influences. These factors may include illegal alcohol sales to minors, pricing of alcohol in bars, cultural norms, and marketing and advertising promotions. Young people see almost as much television alcohol advertising as adults. According to the Center on Alcohol Marketing and Youth, young people (ages 12–20) saw two beer and ale ads in 2001 for every three seen by an adult, and an estimated 30
64 binge eating REDUCING UNDERAGE DRINKING THROUGH COALITIONS 12 coalitions include: The Connecticut Coalition to Stop Underage Drinking The Georgia Alcohol Policy Partnership The Indiana Coalition to Reduce Underage Drinking The Louisiana Alliance to Prevent Underage Drinking The Minnesota Join Together Coalition to Reduce Underage Alcohol Use Missouri’s Youth/Adult Alliance Against Underage Drinking The National Capital Coalition to Reduce Underage Drinking (Washington, D.C.) The North Carolina Initiative to Reduce Underage Drinking The Oregon Coalition Initiative to Reduce Underage Drinking Pennsylvanians Against Underage Drinking The Puerto Rico Coalition to Reduce Underage Drinking Texans Standing Tall, a Statewide Coalition to Reduce Underage Drinking Source: American Medical Association http://www.ama-assn. org
percent of youth saw at least 780 alcohol commercials in 2001. Examples of environmental policy changes that coalitions may seek include enforcement to assure that merchants are not selling alcohol to minors, or social host liability laws, which addresses adults providing alcohol to minors (usually supplied at parties) and making the adults liable for any problems that occur. Robert Wood Johnson Foundation The Robert Wood Johnson Foundation, based in Princeton, New Jersey, is the largest philanthropy devoted exclusively to health and health care. It concentrates its grant making in four areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social, and economic harm caused by abuse of tobacco, alcohol, and illicit drugs. The foundation supports scientifically valid, peer-reviewed research on the prevention and treatment of illegal and underage substance
use, and the effects of substance abuse on the public’s health and well-being. See also ALCOHOLISM. FOR FURTHER INFORMATION:
American Medical Association Richard A. Yoast, Ph.D., Director Office of Alcohol and Other Drug Abuse American Medical Association 515 North State Street Chicago, IL 60610 (312) 464-4202 (312) 464-4024 (fax) http://www.ama-assn.org Janet Williams, Deputy Director Reducing Underage Drinking Through Coalitions American Medical Association 515 North State Street Chicago, IL 60610 (312) 464-5073 Robert Wood Johnson Foundation P.O. Box 2316 College Road East and Route 1 Princeton, NJ 08543 (888) 631-9989 http://www.rwif.org Donald W. Zeigler, Ph.D., Deputy Director A Matter of Degree Office of Alcohol and Other Drug Abuse American Medical Association 515 North State Street Chicago, IL 60610 (312) 464-5687 SOURCES: Weitzman, Elise R., et al. “Reducing Drinking and Related Harms in College: Evaluation of the ‘A Matter of Degree’ Program.” American Journal of Preventive Medicine, 27, no. 3 (October 2004): 196–197. Zeigler, Donald W., Claire C. Wang, and Richard A. Yoast, et al. “The Neurocognitive Effects of Alcohol on Adolescents and College Students.” Preventive Medicine 40, no. 1 (2005): 23–32.
binge eating
See
EATING DISORDERS.
binge-purge syndrome biofeedback
See
EATING DISORDERS.
Technique that enables a person to use information about a normally unconscious
birth control 65 physical function, such as blood pressure, to develop conscious control over that function. This technique is often used as a STRESS MANAGEMENT tool in conjunction with other stress reduction therapies, such as MEDITATION and GUIDED IMAGERY. Biofeedback operates by detecting physiological changes in the individual and, by means of auditory or visual signals, informing him/her of these changes. The individual, using the information, then endeavors to make the signals change in the desired direction. With the biofeedback tool as a guide, the individual learns fairly quickly how to control the biological response system generating the biofeedback signals. For example, he or she might learn to control heart rate or body temperature. Biofeedback can be effective in treating certain types of hypertension, anxiety and migraine. Training for biofeedback involves three basic stages. The first is acquiring awareness of the maladaptive response. The person learns that certain thoughts as well as certain physical events influence the response. In the second stage, guided by the biofeedback signal, the person learns to control the response. In the third stage, the person learns to transfer the control into everyday life and to manage stress without the biofeedback instrument. In addition to helping individuals improve their physiological activities into better ranges of function, biofeedback also helps them realize that it is possible to control events that affect their well-being and their capacity to cope with stressful circumstances. Early work with biofeedback helped people relax before a BEHAVIOR THERAPY procedure known as “systemic desensitization,” which involves counterconditioning of anxiety with relaxation. See also ALTERNATIVE MEDICINE; HEADACHES; HIGH BLOOD PRESSURE. FOR FURTHER INFORMATION:
Association of Applied Psychology and Biofeedback 10200 West 44th Avenue, #304 Wheat Ridge, CO 80303 (303) 422-8436 SOURCES: Basmajian, John V., ed. Biofeedback: Principles and Practice for Clinicians. Baltimore: Williams & Wilkins, 1983. Lehrer, Paul M., and Robert L. Woolfolk, eds. Principles and Practice of Stress Management. New York: Guilford Press, 1993.
biological clock For the many women in their mid- to late thirties who hope to bear a child, the words biological clock refer to the limited period of time in which they are biologically able to produce children. As their biological clock “runs out,” women in their late thirties or early forties who are having difficulty in becoming pregnant experience a great deal of stress and anxiety. Statistics show that a woman’s fertility is reduced and her ability to conceive becomes more difficult with age, and birth defects occur more frequently in infants born to older mothers. See also BABY BOOMERS; INFERTILITY; PARENTING. SOURCE: McKaughan, Molly. The Biological Clock. New York: Penguin Books, 1989.
biological hazards
See
HEALTH CARE WORKERS;
NEEDLESTICK INJURIES.
biorhythms
Physiological functions, such as menstrual cycles, that follow a regular temporal pattern. These biological rhythms regulate psychological as well as physiological functions in the individual: energy level, hunger, sleep, and elimination can all be affected. These rhythms vary considerably from person to person and within a single individual at different times. Such external factors as changing travel and time zones or changing routines in unpredictable and unfamiliar ways, can disrupt biorhythms and lead to stress. To deal with the stress caused by disruptions in biorhythms, individuals develop their own techniques. For example, some traveling through time zones may prepare by waking earlier for several days before the trip, or getting more rest upon return. Some develop particular dietary patterns that they find helpful, such as eating small meals more often and drinking lots of water. See also CIRCADIAN RHYTHMS; JET LAG; MENSTRUATION; SHIFT WORK.
birth control
The term birth control refers to controlling the number of children born by preventing or reducing the chance of conception by natural or artificial means. The issue is stressful for many people, including those making a choice of birth control methods or those whose religious convictions
66 birth order are counter to using birth control as a practical and economic plan for their families. Methods of Birth Control Each method of birth control has advantages, disadvantages, and sources of stress. They should be discussed by couples before they engage in sexual intercourse. Women and men must weigh the factors in a birth control method, including effectiveness in preventing unwanted PREGNANCY, protection from a sexually transmitted disease, freedom from side effects, costs, and spontaneity of use. According to the 1995 National Survey of Family Growth by the National Center for Health Statistics, the most popular method of birth control is female sterilization (29.5 percent), followed by the birth control pill (28.5 percent), male prophylactics (17.7 percent), vasectomy (12.5 percent), the diaphragm (2.8 percent), the IUD (1.4 percent) and all other methods (4.9 percent). The numbers total more than 100 percent because some women use more than one method. See also SEXUALLY TRANSMITTED DISEASES; UNWED MOTHERS. FOR FURTHER INFORMATION:
American College of Obstetricians and Gynecologists 409 12th Street SW Washington, DC 20024-2188 (202) 638-5577 SOURCES: Franklin, Deborah. “The Birth Control Bind.” Health, July/August 1992. Kahn, Ada P., and Linda Hughey Holt. The A–Z of Women’s Sexuality. New York: Facts On File, 1990.
birth order
Studies of birth order have led to some generalizations about how a child’s position in relation to his parents and siblings may affect his stress level, personality, and view of the world. The first child born to a FAMILY has the advantage of undivided attention and resources. Whether that child becomes the only child of the family or the oldest child with a sibling(s) to follow, he or she may tend to be more adult in behavior and more interested in goals and personal achievement. As a group, first children are strongly represented in the ranks of the successful and powerful.
They also tend to score highest on intelligence tests. Only children often have characteristics and resulting stresses of their own. Having been the center of their parents’ attention, they are in danger of becoming selfish and spoiled. Likewise, their parents’ expectations for them to succeed at anything they do may be unreasonably high. With more exposure to adults, they may not relate well to other children and may have problems with sharing. For older children, the arrival of a sibling, even though happily anticipated, has the ultimate effect of making them feel dethroned. They often assume a certain amount of responsibility for younger children in the family and may be responsible for setting a good example, showing younger children how to do things and baby-sitting. Older children are frequently more aware of family difficulties and problems and their own parents’ insecurities. As a result, they tend to be more anxious, conservative, and responsible than younger brothers and sisters. The middle child position in the family has more variables since the age and sex of siblings may have a profound effect on him or her. Middle children usually become good at sharing, but also guard their privacy. They may perceive that they are too young for the privileges of the oldest and too old for the coddling of the youngest. As a result, middle children may show off to get attention and may also seek rewarding relationships outside the family. The need to belong to a peer group is strong in middle children and they are team players, frequently quite popular. To compete with an older sibling, a middle child will develop his abilities in an area quite different from the talents of his older brother or sister. The youngest child of a family never has the experience of having his position usurped. Younger children tend to preserve and use childish characteristics such as crying, acting cute, or emphasizing their dependence and inadequacy to get what they want. Younger children frequently have very positive feelings about themselves because of their position in the family and tend to be charming and popular. They have the best sense of humor in the family. Their disadvantage is that they often obtain information and opinions from other children rather than from adults and therefore lack the wisdom and realism they might gain from adult contact.
body image 67 Another type of younger child is the “change of life” baby, who arrives several years after the other siblings. This younger child is really more in the position of being the only child, but with several parents, since usually one or more of his or her siblings acts as a parent. These children grow up with a great deal of attention and support, but may also have the additional stress of a confused sense of themselves, from a variety of images and ideas from siblings they perceive as adult but who are, in fact, children. Other positions in the family that can have longlasting effects on personality are the “only daughter” or “only son” syndromes. Only daughters have traditionally had the “feminine” chores of the family and, in many cultures, are expected to take care of the parents as they grow old, even if it means a personal sacrifice. “Only sons” were expected to enter the family business or succeed at some profession. See also COMMUNICATION; SIBLING RELATIONSHIPS. SOURCES: Brownstone, David, and Irene Franck. The Parent’s Desk Reference. New York: Prentice Hall, 1991. Franklin, Deborah. “Why Are Siblings So Different?” In Health, March/April 1991. Richardson, Ron, and Lois A. Richardson. Birth Order and You: How Your Sex and Your Position in the Family Affects Your Personality and Your Relationships. Bellingham, Wash.: Self-Counsel, 1990.
bisexuality
See
SEXUAL PREFERENCES.
bladder difficulties
See
BED-WETTING; URINARY
INCONTINENCE.
bloating
See
INDIGESTION.
blog (Web log)
A blog is a Web site on which someone writes their thoughts, usually daily, on any topic, ranging from personal life, family news and opinions to sports or politics. Blogging is the act of communicating through a blog. As of 2004, there were an estimated 5 million blogs, with some 15,000 new ones appearing each day, according to Technorati.com, a research company attuned to the blogosphere. The word blog is a short form of “Web log.” Since 2000, writing and reading blogs has gone from an obscure fad to a routine alternative to
mainstream news outlets, rivaling networks and newspapers in power and influence. Because blog writers can expound on any subject, blogging may be an outlet for stress in their lives. Those who find attention useful for their own self-image enjoy putting forth their ideas for the world to see. Web logs provide the opportunity for almost anybody to be a foreign correspondent, behind-the-scenes leader of information, or just someone seeking to share personal stories over the Internet. On the other hand, web logs can cause stress for politicians, writers, filmmakers, and others who are criticized on widely read blogs. There may be up to 3 million family-oriented blogs, and baby blogs are becoming common. According to an October 2002 study by the Pew Internet and American Life Project, parents are more likely to be online than nonparents, and 53 percent of parents say the Internet has improved the way they connect with family. Blogging may be a natural extension of today’s confessional culture. For many ordinary Americans who divulge their innermost secrets or hear those of others on television talk shows, blogging about one’s personal situations seems natural. According to Sherry Turkle, director of the Initiative on Technology and the Self at the Massachusetts Institute of Technology, even people who normally guard their privacy can experience a kind of disinhibition with blogs, in which boundaries seem to disintegrate. Bloggers may lose sight of the fact that they are publishing to a potential worldwide audience of millions. Parents who struggle with a particular issue, such as a child with a chronic illness, may find blogging helpful as an outlet and a way to connect with others who face the same problems. Blogging parents form a community society linking to one another’s sites and posting helpful words.
bloodborne pathogens
See
HEALTH CARE WORK-
ERS: HOSPITAL HAZARDS; NEEDLESTICK INJURIES.
blood pressure
See
HIGH BLOOD PRESSURE.
body image The mental picture an individual has of his or her body at any moment. Many people are
68 body language stressed by their own body image, thinking that one or more parts are too big, too small, or misshapen. Perception of their own body often determines their level of SELF-ESTEEM and self-confidence. Misperception of their body image can lead to avoidance of social or sexual activities and EATING DISORDERS, such as anorexia nervosa or bulimia. When a normal-appearing individual becomes preoccupied with some imagined defect in appearance, the individual is said to have dysmorphic disorder. Any slight anomaly evokes a grossly excessive concern. This is often associated with anorexia nervosa and other eating disorders in which the person perceives herself or himself as obese. See also ACNE. SOURCES: Hillman, Carolynn. Love Your Looks: How to Stop Criticizing and Start Appreciating Your Appearance. New York: Simon & Schuster, 1995. Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
body language
A form of COMMUNICATION through facial expression, posture, gestures or movements, accompanied with or without words. Both the communicator and the listener may employ body language. It can be a device used to express emotion or a reaction to the meaning of communication. Body language may be an indicator of the stress that the communicator and the listener are experiencing. According to Gay Turback in The Rotarian (April 1995), “Without uttering a syllable, it’s possible to communicate love, hate, fear, rage, deceit, and virtually every other emotion in the human repertoire.” The article goes on to describe how body signals have been around for more than a million years, with some researchers having catalogued 5,000 hand gestures and 1,000 postures, each with its own message. Says Turback, “Although some body language is nearly universal, much of it is an accoutrement of one culture or another. Certain actions may have one meaning in Mexico, a different meaning in the United States, and no relevance in Canada. Other examples given in the article that are especially common among North Americans are shown in the table.
EXAMPLES OF BODY LANGUAGE THAT ARE INDICATORS OF STRESS Action
Toes pointed outward Toes pointed inward A jutting chin Lip and nail biting Lip licking Foot tapping Leaning backward Leaning forward Open palms Rubbing hands together
Meaning
Confidence Submission Belligerence Disappointment Nervousness Impatience A relaxed attitude Interest Honesty Excitement
body therapies Body therapies encompass ancient Eastern traditions of spirituality and cosmology along with contemporary Western neuromuscular and myofascial systems of skeletostructural and neuroskeletal reorganization. They postulate that the traumas absorbed by the psyche from “false understanding” are simultaneously absorbed as traumas in specific areas of the body. The body remembers after the mind forgets. Thus body therapies facilitate clarification of these traumas through the use of physical manipulations, movement awareness training, energy-flow balancing, and emotional release techniques. Body therapies are used by many people to prevent effects of stress as well as relieve them. Ancient disciplines in the category of body therapies include YOGA, T’AI CHI, Zen, Taoism, Tantra, and samurai. In the 20th century, Wilhelm Reich observed that clinical patients with emotional disturbances all demonstrated several postural distortions. This observation helped to uncover more connections between the body-psyche and led to the development of the Reichian school of body therapy. Another modern pioneer in the field was Moshe Feldenkrais, who postulated that the human organism began its process of growth and learning with one built-in response, the “fear of falling.” All other physical and emotional responses were learned as the human organism grew and explored. To attain the full potential of the bodymind-emotions-spirit, there must be, according to
boredom 69 Feldenkrais, “reeducation of the kinesthetic sense and resetting of it to the normal course of selfadjusting improvement of all muscular activity.” This would “directly improve breathing, digestion, and the sympathetic and parasympathetic balance, as well as the sexual function, all linked together with the emotional experience.” Feldenkrais believed that reeducation of the body and its functions was the essence of creating unity of the being. His method has helped many people with problems of BACK PAIN, whiplash, and lack of coordination. The method is also used to help people who have TEMPOROMANDIBULAR JOINT SYNDROME (TMJ), which is a collection of symptoms including pain, that affect the jaw, face, and head, often brought about by stress and tension. Four Systems of Body Therapies Although many systems overlap and emcompass aspects of the others, body therapies can be divided into four general categories, based on their methods. Physical manipulation systems include the connective tissue work of the Ida Rolf school (Rolfing) and the deep tissue release systems such as myofascial release used by John Barnes, an American physical therapist. Energy balancing systems include Chinese ACUPUNCTURE and ACUPRESSURE, polarity, and Jin Shin Jystu. Emotional release systems include bioenergetics, primal therapy, and rebirthing. Movement awareness systems include those of Aston, Feldenkrais, Trager, and Aguado. See also ALTERNATIVE MEDICINE; AYURVEDA; MASSAGE THERAPY; MIND-BODY CONNECTIONS. FOR FURTHER INFORMATION:
The Feldenkrais Foundation P.O. Box 70157 Washington, DC 20088 (301) 656-1548 North American Society of Teachers of the Alexander Technique P.O. Box 517 Urbana, IL 61801 (217) 367-6956 Rolf Institute P.O. Box 1868
Boulder, CO 80306 (303) 449-5903 SOURCES: Feldenkrais, Moshe. Awareness Through Movement. San Francisco: Harper & Row, 1972. ———. Explorers of Humankind. San Francisco: Harper & Row, 1979. Feltman, John, ed. Hands-On Healing. Emmaus, Pa.: Rodale Press, 1989.
books as stress relief
Therapy with books, or bibliotherapy, is an interdisciplinary field that combines the skills of psychotherapists, librarians, and educators. In the course of a bibliotherapy stress-relief program, books are selected to change disturbed patterns of behavior. The books may be directly concerned with mental health or may be fiction or nonfiction works relating to and interpreting the readers’ problems and stress-producing concerns. It has been suggested that reading about a disturbing subject such as death, divorce, or aging may give readers a sense of control over their problems and a way of mentally working them out. Use of selected books with children may alleviate concerns about frightening topics by clearing up misconceptions and giving information about the unknown. Reading may also give children the comforting knowledge that others share their concerns and may promote communication with their parents. See also CONTROL.
boredom According to HANS SELYE (1907–82), Austrian-born Canadian endocrinologist and psychologist, as well as pioneer researcher in the field of stress, boredom is not a defense against stress. Instead, as he reported in a research project, “bored subjects experienced an intense desire for extrinsic sensory stimuli and bodily motion, increased suggestibility, impairment of organized thinking, DEPRESSION, and in extreme cases, HALLUCINATIONS, delusions and confusion.” Normal function of the brain, Selye said, depends on constant arousal generated by continuous sensory input. Hallucinations, which may cause accidents, have been noted in pilots and long-distance truck drivers, presumably because the monotony of their work acts as a form of sensory deprivation.
70 bowel movements What is Boredom? Boredom can be a self-imposed prison that keeps people from trying new things or having new, lifeenriching experiences. An essential characteristic of boredom is that it is almost always the creation of the person who is bored. As a result, there are those who are bored by everything while many others are never bored. Some people view things as boring because they really are afraid of failure. In his book, A New Guide to Rational Living, Dr. Albert Ellis said: “Viewing failure with fear and horror, some people avoid activities that they would really like to engage in.” The rationale of such people is: If life is boring, nothing is worth doing. Thus, if nothing is worth doing, a person can hardly fail. Overcoming Boredom Overcoming boredom depends on whether people are bored because they cannot live without excitement or because they have chosen to remain in a shell of inaction. Life is not supposed to be thrilling all the time. If people crave continuous thrills, they should reduce their expectations for excitement. If people are experiencing stress because of boredom, they should try to face reality. They should get out and do one new thing each day, such as talking to unfamiliar people, volunteering in a nonprofit organization, learning a new skill, or writing letters. Boredom carried to the extreme can be a threat to health and lead to depression. See also GENERAL ADAPTATION SYNDROME; HOBBIES; VOLUNTEERISM. FOR FURTHER INFORMATION:
The Boring Institute P.O. Box 40 Maplewood, NJ 07040 (201) 763-6392
bowel movements
See CONSTIPATION; DIARRHEA; INDIGESTION; IRRITABLE BOWEL SYNDROME.
brainstorming A specialized approach to problemsolving, by group or team effort. It is based on the concept that a person alone may not be able to arrive at a solution to a problem because of a block in the thinking process or external distraction, but several people working together will be more likely to reach a solution.
When properly conducted, brainstorming sessions can be an important management tool. Employees who take part in a brainstorming session feel a part of the company. Furthermore, by giving employees entree to problems and solutions, they develop a feeling of CONTROL and ownership in what they do. As such, employee participation in brainstorming sessions may help to alleviate stress in the WORKPLACE. In a typical brainstorming session, the coordinator who is in charge of collecting the ideas indicates that there should be a free flow of ideas, with no right or wrong answers or suggestions. All participants are encouraged to be a part of the process. However, if this brainstorming rule is not established, participants can be made to feel self-conscious and may experience a great deal of stress and anxiety. The basic proposition of brainstorming is that one idea can lead to another and thus increase the creative output. When successful, this approach generates enthusiasm and a large number of suggestions, as one person expands upon ideas of others. Often, brainstorming sessions backfire. Participants never see the results of a brainstorming session carried out. This leads to an increase of employee stress and the lowering of morale. See also CREATIVITY.
brainwashing Form of mind control related to propaganda or political indoctrination. It is an extremely stress-provoking situation in which all of a person’s COPING skills are called into use. Although situations and techniques of brainwashing vary, there are common elements that are used to change thought patterns and deeply held values. For example, subjects of brainwashing can be made to feel totally out of CONTROL and to know that their needs and actions are subject to an authority before which they are powerless. They may be subjected to mental or physical harassment and experience ridicule of deeply held beliefs. As much as possible, their persecutors make them feel that their future is uncertain. If they feel that one of the group who is controlling them is somewhat kinder than the others, they may begin to feel somewhat dependent on that person. Since subjects of brainwashing are usually
breast cancer 71 kept in isolation, kept as inactive as possible and deprived of food and sleep, their bodies weaken, their thought processes become disorganized, and they will agree to almost anything. As their suggestibility increases, their SELF-ESTEEM decreases. They begin to feel guilty about past behavior that is at odds with their captors’ standards. An example of brainwashing is the treatment given American prisoners held captive by the Vietnamese during the Vietnam War. Another example is the religious CULTS that flourished in the years following the 1960s. Members of religious cults showed evidence of brainwashing techniques, such as changed speech and behavior patterns, obedience to an authoritarian leader, and rejection of friends and family outside of the cult. See also ADVERTISING; AUTONOMY. SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001. Somit, Alters. “Brainwashing,” in Sills, David, ed., International Encyclopedia of the Social Sciences, vol. 1. New York: Macmillan, 1968.
breast cancer The anxiety, fear, and apprehension each woman faces when she discovers a lump in her breast is the beginning of a long, stressful period in her life, and one that deeply affects her family as well. According to an article in National Women’s Health Report, “It (finding a lump) may well be the reason that women resist establishing a routine for examining their breasts each month.” Once a lump has been discovered either through self-examination or mammography, the woman enters a world of baffling terminology in which she must depend on others for understanding. Next, she must deal with the stress of tests and procedures used to identify a breast symptom and the time lapse before a final diagnosis is made. If a malignancy is found, she must select from a variety of treatment options and find the right resources to assure that the best decision is made. The more information she has, the easier it may be to determine the advantages and disadvantages of various therapies. Inherent at this point is the tremendous physical and emotional adjustments a woman must make regarding removal of a breast(s). Finally, when treatment is completed, she is faced
with the fear that the CANCER is out of control and she must deal with the continuing anxiety over recurrence of the disease. More Aggressive Therapy Wanted According to a report in Y-ME Hotline (November–December 1995) final results of a survey of women with advanced breast cancer reveal that 77 percent are willing to do whatever it takes to get more aggressive drug therapy, despite the financial, emotional, and physical side effects of the treatment. In addition, 93 percent of the women surveyed believed that the Food and Drug Administration is too slow in approving treatment options. The findings were announced in 1995 by three national information and advocacy organizations participating in the Roper Search mail survey: the National Alliance of Breast Cancer Organizations (NABCO), the Susan G. Komen Foundation, and the Y-ME National Breast Cancer Organization. The survey was conducted by sending questionnaires to women with advanced breast cancer; results were tabulated from 256 responses. The majority of women (53 percent) in the Roper survey stated that they themselves are the most influential party in selecting their medical treatments. Seventy-seven percent felt that the chance for a favorable response (shrinking of the tumor) is the most important consideration in their treatment decision, 11 times the number for whom side effects are most important. The most encouraging aspect of chemotherapy, according to 41 percent of respondents, is feeling hope for their future. According to another Gallup poll, 80 percent of 1,500 women receiving chemotherapy want their chemotherapy treatment to be as aggressive as they can tolerate. Sixty-one percent said that chemotherapy is worth the discomfort and inconvenience. Role of Psychoneuroimmunology In the early 1980s, researchers in the Behavioral Medicine Branch of the National Cancer Institute tested an observation on breast cancer patients. They believed that women with better survival rates were also those who were fighters, or those who had an aggressive attitude toward conquering the disease and were active in choosing their physicians and their treatments. Even before that, in the 1970s, British researchers followed the health of breast cancer
72 breast reconstruction patients. They found that breast cancer patients often seemed to hold their emotions, especially ANGER, in check. Those women who survived longest with no recurrence of disease were also those who initially reacted to the news that they had cancer in one of two ways: denying there was anything serious wrong with them or showing “fighting spirit,” a determination to do everything possible to conquer cancer. In contrast, women who succumbed had reacted to the news of their cancer either by demonstrating a stoic attitude and living their lives as though nothing had changed or having a helpless, hopeless response. Studies conducted at Stanford University during the 1980s demonstrated that breast cancer patients who were in SUPPORT GROUPS while undergoing therapy lived longer than those who received medical treatment alone. Although there are no hard scientific data that other complementary treatments, such as RELAXATION, BIOFEEDBACK, massage, herbal remedies and many others similarly extend survival, there is little evidence that they are harmful. They can be helpful supplements to, but not substitutes for, conventional therapy. Choosing to use an “alternative” therapy in addition to the prescribed medical therapy also gives a woman more of a sense of control over her situation. See also ALTERNATIVE MEDICINE; CHRONIC ILLNESS; PSYCHONEUROIMMUNOLOGY. FOR FURTHER INFORMATION:
Susan G. Komen Breast Cancer Foundation 5005 LBJ, Suite 370 Dallas, TX 75244 (214) 450-1777 Y-Me National Breast Cancer Organization 212 West Van Buren Street Chicago, IL 60607 (312) 986-8338 SOURCES: Love, Susan M. Dr. Susan Love’s Breast Book, 2nd ed. Reading, Mass.: Addison-Wesley, 1995. Merz, Beverly, ed. “Breast Cancer.” Harvard Women’s Health Watch. October 1995. ———. “The Mammography Muddle.” Harvard Women’s Health Watch 4, no. 7 (March 1997). “Patients Want Aggressive Therapy,” Y-ME Hotline, 534 (November/December 1995).
breast reconstruction
Depending on their prognosis after removal of a breast (or breasts), women can choose an additional procedure during which the breast is reconstructed with artificial substances or with tissue from another body part, such as the abdomen. For those who are candidates for reconstruction, making the choice of methods can be a very stressful situation. “Preserving the breast after cancer can reduce stress and increase the quality of life,” said plastic surgeon John Bostwick, M.D., in a clinical study released by the American Society of Plastic and Reconstructive Surgeons (ASPRS) in October 1995. The study explored immediate partial breast reconstruction using endoscopic surgery. It recommended such construction after lumpectomy and radiation treatments for women with smaller breasts when primary tumors are 2.5 centimeters, as well as for women who had large portions of their breasts removed leading to considerable deformity and asymmetry of the breast. “The ability to examine the breast with a mammogram is extremely important,” said Dr. Bostwick. “Since women have elected to keep as much of the breast as possible, they need to know that reoccurrence of the cancer can be detected.” However, just as in women who have very dense breasts, detecting early cancerous changes behind an implant with mammography may, in some cases, be difficult. There is some controversy regarding the effectiveness of mammography following reconstruction with an implant. Because women do not always choose or have a choice of reconstruction after surgery, they return to a society that places a high value on the breast as a sex symbol and fashion statement. Marriages or relationships can be put under a terrific strain and often do not last. For these women, the stress of maintaining a sense of BODY IMAGE and selfworth follows them throughout their lives. On the other hand, many women who are able to make a choice of breast reconstruction find that their sense of SELF-ESTEEM is enhanced. They have fewer concerns about looking attractive in clothing, entering relationships, or preserving their marriages. See also BREAST CANCER; CHRONIC ILLNESS; SUPPORT GROUPS.
breathing 73 breath-holding spells Childhood breath-holding spells, a common and frightening phenomenon that occurs in healthy, otherwise normal children, are a source of stress for parents and child alike. Treatment of children with breath-holding spells has largely focused on providing reassurance to families after a diagnosis has been made. Some children use breath-holding as an act of rebellion or a demonstration of AUTONOMY. When children know that they can terrify their parents with this behavior, the behavior becomes somewhat reinforced. According to Francis DiMario, Jr., M.D., Department of Pediatrics, University of Connecticut Health Center, Farmington, “It is neither feasible nor helpful for parents to attempt to avoid circumstances that may provide emotional upset in their child. Even though pain and fear may serve as provocatives, simple frustration and the expression of autonomy are both normal and expected in young children.” If parental stress leads to continuous attempts at appeasement, the child may soon learn to manipulate the parent with the threat of crying. This does not imply a willful attempt at breath-holding, since in some cases these spells are reflexive and unpredictable. There is, nonetheless, the potential for parents to reinforce behavioral outbursts if appropriate, calm firmness is not displayed at times of customary disciplining. Breath-holding spells pose no physical danger to the child. If spells are causing anxiety to the parents, a physician should be consulted. See also BREATHING; PARENTING. SOURCES: Brownstone, David, and Irene Franck. The Parent’s Desk Reference. New York: Prentice Hall, 1991. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001.
breathing
The major features of breathing are respiration and ventilation. Respiration puts oxygen into body cells and ventilation removes the excess carbon dioxide. Poor breathing habits diminish the flow of gases to and from the body, making it harder for individuals to cope with stressful situations. With increased awareness of how people breathe and by incorporating certain controlled breathing techniques into relaxation
practice, they will be able to quiet thoughts, calm emotions, deepen relaxation, and control blood pressure and other physical functions. Although breathing seems very easy and very normal, relearning breathing techniques can help many individuals who suffer from STRESS, PHOBIAS, anxieties, and panic attacks. Some performers and athletes learn this technique in order to combat STAGE FRIGHT or PERFORMANCE ANXIETY. Breathing is controlled by the autonomic or involuntary nervous system. Breathing patterns change during different psychological states. For example, in a state of calm and relaxation, breathing becomes deeper and more rhythmic. Under stress, breathing is shallow and irregular. When frightened, an individual may even hold the breath. However, breathing patterns can be consciously controlled in order to influence the autonomic system toward relaxation, thereby interrupting the physiological arousal that can lead to stress-related disorders and high blood pressure. Breathing Styles Most people breathe in one of two patterns: One is chest or thoracic breathing; the other is abdominal or diaphragmatic breathing. Chest breathing, which is usually shallow and often rapid and irregular, is associated with anxiety or other emotional distress. When air is inhaled, the chest expands and the shoulders rise to take in air. Anxious people breathing in this manner may experience breath holding, HYPERVENTILATION or constricted breathing, shortness of breath, or fear of passing out. When an insufficient amount of air reaches the lungs, the blood is not properly oxygenated, the heart rate and muscle tension increases, and the stress response is triggered. Abdominal or diaphragmatic breathing is the natural breathing of sleeping adults. The diaphragm contracts and expands as inhaled air is drawn deep into the lungs and exhaled. When breathing is even and unconstricted, the respiratory system performs efficiently in producing energy from oxygen and removing waste products. Symptoms of Inefficient Breathing Many people who feel stressed also have breathingrelated complaints. Some can’t seem to catch their breath or get enough air. Others may frequently
74 bronchial asthma sigh, yawn, or swallow. Some breathe too deeply and hyperventilate. Symptoms associated with hyperventilation resemble those of PANIC DISORDER. Researchers have noted the overlap between hyperventilation, anxiety, and stress symptoms. It has been found that patients will hyperventilate just by asking them to think back on unpleasant or stressful events. Physical conditions associated with breathing difficulties, particularly hyperventilation, include hypertension, ALLERGIES, anemia, angina, ARTHRITIS, ARRHYTHMIAS, ASTHMA, colitis, diabetes, gastritis, HEADACHES, heart disease and IRRITABLE BOWEL SYNDROME. Deep, diaphragmatic breathing is a cornerstone for many relaxation therapies. Many therapeutic techniques (many known as ALTERNATIVE MEDICINE) and BEHAVIOR THERAPIES incorporate control of breathing as a basis because the cycle of stress can be altered with breath control. Individuals who have mastered these techniques find that as soon as they are aware of a stressor, they become aware of their breathing, and try to control their stress by deep, slow breaths. By contrast, holding the breath, as
TIPS FOR DIAPHRAGMATIC OR ABDOMINAL BREATHING FOR STRESS REDUCTION • Lie down comfortably on your back on a padded floor or on a firm bed, with eyes closed, arms at your sides and not touching your body, palms up, legs straight out and slightly apart, and toes pointed comfortably outward. • Focus attention on your breathing. Breathe through your nose. Place your hand on the part of your chest that seems to rise and fall the most as you inhale and exhale. • Place both of your hands lightly on your abdomen and slow your breathing. Become aware of how your abdomen rises with each inhalation and falls with each exhalation. • If you have difficulty breathing into your abdomen, press your hand down on your abdomen as you exhale and let your abdomen push your hand back up as you inhale. • Observe how your chest moves; it should be moving in synchronization with your abdomen.
well as shallow, irregular breathing, can initiate as well as augment many stressful feelings and physiological responses. Posture can also affect breathing. Keeping the body in alignment allows greater lung capacity. Breathing and Yoga YOGA is a more than 2,000-year-old method for developing and unifying mind, body, and spirit. Yoga practitioners have long recognized the relationship between breathing and health and maintain that the life force is carried in the breath. Exercises to control breathing are incorporated into yoga postures (asanas) and practices. Yoga practitioners believe that extending and deepening the breathing process draws breath all the way down to one’s heels and that deep and slow breathing can increase longevity. See also BIOFEEDBACK; GUIDED IMAGERY; MEDITATION; PANIC ATTACKS AND PANIC DISORDER. FOR FURTHER INFORMATION:
American Lung Association 61 Broadway, Sixth Floor New York, NY 10006 (212) 315-8700 SOURCES: Kerman, D. Ariel. The H.A.R.T. Program: Lower Your Blood Pressure without Drugs. New York: HarperCollins, 1993. “RX: Breathing for Health and Relaxation.” Mental Medicine Update 4, no. 2 (1995): 3–6.
bronchial asthma bruxism
See
See
ASTHMA.
TEETH GRINDING.
bulimarexia
See
bulimia
EATING DISORDERS.
bullies
See
EATING DISORDERS.
People who are habitually cruel or intimidating to those who are weaker and subordinate. Their aggressive behavior is a source of stress in homes, schools, the community, and the workplace. Men who are bigger, taller, and stronger may use their physical size to intimidate; female bullies are more likely to use verbal harassment.
burnout 75 REDUCE STRESS CAUSED BY BULLIES • Stand up to the bully or report the situation to a teacher or supervisor. • Consider changing your response to the bullying behavior. • Practice some negotiation techniques and communication skills. • Role play and know how you will respond before the bully next attacks. • Work on remaining calm but firm with any bully. Exert self-control. • Do not let the bully get away with it. Tell others what is happening. • Separate tactless putdowns from constructive criticism. • Pick your conflict: raise only issues that really matter to you. • Watch your body language; do not transmit cues of defensiveness or subservience.
Employees valued in bureaucracies play by the rules and are punctual and detail-oriented. They do not question authority. They follow orders and procedures regardless of the consequences, and they spend long hours in meetings in which the most trivial as well as the most important decisions are made. They do not know if they are doing a good job until someone blames them for something. As a result, employees often suffer from the stress of covering for themselves regarding how the job was done rather than what the final outcomes were. Doing business with a bureaucracy as a citizen, client, or customer can be equally frustrating and stressful. Finding the right person who knows the answer to questions or can give information and getting through to him/her, particularly when a recording is giving directions, has become a major feat. See also AUTONOMY; BOREDOM; CONTROL; WORKPLACE.
burnout Bullies are often overly self-confident people who feel superior to their victims. Some may be compensating for their own anxieties or failures by feeling and behaving this way. Many who show bullying behavior as adults were also bullies in school. Bullying incidents could not be ignored in schools or workplaces. In schools, uncontrolled bullying can lead to further aggression and violence. In the workplace, replacing people whom bullies drive away can be an economic cost to the employer. Intangible costs, such as a bad reputation, can make it harder to replace bully victims. See also BODY LANGUAGE; STRESS.
bureaucracy Bureaucracy involves organizations that are made up of tightly structured hierarchies bound up in structured procedures marked by delay or inaction. Examples of bureaucracies are government agencies, insurance companies, academia and higher education, banks, health care providers and hospitals, pharmaceutical and chemical companies, utilities, and most heavily regulated industries. They have been criticized by modern management theorists as rigid and easily co-opted by power structures to serve ends other than economic efficiency. In a bureaucracy, management’s expectations for employees can be stressful.
Contemporary term for a progressive loss of energy, purpose, and idealism resulting from overexposure to a job or other stimulus that leads to STRESS, stagnation, FRUSTRATION, and BOREDOM. It may result from ongoing, chronic stress, and it is also a cause of stress for the sufferer as well as his or her family and coworkers. It can strike anyone, from top executives, surgeons, defense attorneys, and airline pilots, to occupiers of such monotonous positions as assembly-line worker and postal employee. Burnout has no relationship to intelligence, money, or social position. Burnout victims are often high achievers, workaholics, and idealists and are competent, selfsufficient, and overly conscientious individuals. Their common denominator is the assumption that the real world will be in harmony with their ideals. They often hold unrealistic expectations of themselves, their employers, and society, and often have a vague definition of personal accomplishment. Burnout begins slowly and progresses gradually over weeks, months, and years to become cumulative and pervasive. Physical symptoms of burnout include excessive sleeping, eating, or drinking, physical exhaustion, loss of libido, frequent colds, headaches, backaches, neck aches, and bowel disorders. The burnout victim desires to be alone, is irritable, impatient, and withdrawn, and complains of boredom,
76 butterflies in the stomach TIPS FOR COPING WITH THE STRESS OF BURNOUT • Recognize that no one job (or personal relationship) is a total solution for life. Strive for variety in work, avoid routine. • Put priorities into perspective; stop trying to be “all things to all people.” • Take responsibility for change. • Set personal goals by answering these vital questions, “Where am I going?” “What do I want to achieve?” and “How am I going to do it?” • Learn a new skill to enhance your optimism. • Create an “outside life,” interest and activities unrelated to your work. • Develop a support system, people you can turn to for help in problem solving. • Consider switching careers. • Learn how to manage your personal time. • Take breaks during the workday; go out for lunch, take walks, etc. • Establish an exercise program at least three times a week. • Look into alternative therapies such as relaxation techniques. • Take mini vacations.
difficulty concentrating, and burdensome work. Fellow workers may notice indecisiveness, indifference, impaired performance, and high ABSENTEEISM. Intellectual curiosity declines and interpersonal relationships deteriorate. “Overloaded,” “tired of thinking,” and “I don’t know what I’m doing anymore” are some phrases that express the inner agony and stress of burnout sufferers. Key Areas Identified by Research Burnout involves six key areas: workload, control, reward, community, fairness, and values. The first two areas are reflected in the demand-control model of job stress. Increased workload has a consistent relationship with burnout, particularly with the dimension of exhaustion, and problems in control, such as restricted autonomy, decisionmaking, and role conflict. The area of reward refers to the power of reinforcements to shape behavior; insufficient reward (whether financial, institutional, or social) increases people’s vulnerability to burnout.
Community captures all of the work on social support and interpersonal conflict. Findings show that burnout is predicted by a lack of support and a lack of a sense of community in the work environment. The area of fairness relates to situations of perceived unfairness or inequitable social exchange. Finally, the area of values picks up the cognitiveemotional power of job goals and expectations, and initial research suggests that value conflicts may be a critical predictor of burnout, according to Christina Maslach, Ph.D., University of California, Berkeley. Various forms of negative responses to the job contribute to burnout. These include job dissatisfaction, low organizational commitment, absenteeism, intention to leave the job, and turnover. People who are experiencing burnout can have a negative impact on their colleagues, both by causing greater personal conflict and by disrupting job tasks. According to Maslach, the few studies that have looked at performance outcomes have found that burnout leads to poor job performance. However, the actual causal link between burnout and negative job outcomes is still a matter of speculation. For example, Maslach questions whether burnout causes people to be dissatisfied with their job or low satisfaction serves as the precursor to burnout. However, both burnout and job dissatisfaction may be caused by another factor, such as poor working conditions. SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Maslach, D., W. B. Schaufeli, and M. P. Leiter. “Job Burnout,” Annual Review of Psychology. 52, no. 1 (February 2001): 397–422.
butterflies in the stomach The uneasy sensation people refer to as “butterflies in the stomach” is caused by a contraction of the abdominal blood vessels and is a response to STRESS. It is a common sensation experienced by people who must perform in front of an audience, go for a job interview, or participate in any type of activity that causes ANXIETY. The feeling can be overcome, at least in part, by appropriate and adequate preparation for the performance, speech, or interview. Paying attention to BREATHING by taking regular and deep breaths before the event can also provide relief. See also ALTERNATIVE MEDICINE; RELAXATION; YOGA.
C tea contains about half and cola about one-third of that amount. Interruption of this physical dependence on caffeine can result in withdrawal symptoms such as severe HEADACHES. Many people who drink large amounts of coffee on weekdays have headaches on weekends because they may be consuming less caffeine. Caffeine has been known to produce panic attacks in susceptible individuals. About half of the people who suffer from panic disorder have attacks after consuming the caffeine equivalent of four to five cups of coffee. Research has yet to determine whether caffeine has a direct or causative effect on panic or whether it simply alters the body to a state that triggers a panic cycle. It may be that caffeine produces its effects by blocking the action of a brain chemical known as adenosine, a naturally occurring sedative. Caffeinism is a disorder caused by an individual’s recent consumption of over 250 milligrams of caffeine. Symptoms of caffeinism may include restlessness, increased anxiety, increased phobic reactions in people with that diagnosis, nervousness, excitement, insomnia, frequent and increased urination, gastrointestinal complaints, rambling thoughts and speech, and cardiac arrhythmia. See also PANIC ATTACKS AND PANIC DISORDER.
caffeine
One of several stimulants that affect the central nervous system by causing a rise in heart rate, blood pressure, and muscular tension. Drinking caffeine-containing drinks—such as coffee, tea, cola, and cocoa—or taking over-the-counter medications such as NoDoz or Vivarin and certain headache and diet pills may actually increase the individual’s stress level because of caffeine’s stimulating effect on all organs and tissues. Peak blood levels are reached in about 30 minutes after consumption. Caffeine directly affects individual cells by causing chemical reactions within them. It acts indirectly on the adrenal glands by increasing the release of epinephrine (adrenaline) and norepinephrine (noradrenaline), hormones that stimulate cell activity into the circulation system. When taken in small amounts, caffeine can stimulate brain cells, helping reduce drowsiness and fatigue. Concentration may be improved and reactions speeded up. However, taken in large amounts, caffeine is known to cause overstimulation, ANXIETY, irritability, and restlessness. Many people who consume caffeine before going to bed complain of having INSOMNIA, which is a delay in the onset of SLEEP, a shortened sleep time, or a reduction of the average “depth of sleep.” Caffeine also may increase the amount of dream sleep (REM) early in the night, while reducing it overall. People who feel stressed by insomnia should consider the amount of caffeine that they consume in the course of a day.
SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
call forwarding
Additional Effects of Caffeine While caffeine, in moderate doses, may increase alertness and decrease fatigue for some individuals, regular use of 350 milligrams or more per day may result in a form of physical dependence. Coffee contains 100 to 150 milligrams of caffeine per cup;
See
ELECTRONIC DEVICES; TELE-
PHONES.
call waiting
See
camera phones 77
TELEPHONES.
See
TELEPHONES.
78 cancer cancer It is not easy today to live without the fear of cancer. Changing reports of things in our diet, lifestyle, or environment that do or do not cause or cure cancer have placed a great deal of stress on many people. Yet in the last few decades, the outlook for those with cancer has improved considerably. Cancer is a condition in which abnormal body cells reproduce uncontrollably. The defective cells grow slowly and are open to attack by macrophages, large cells in the IMMUNE SYSTEM that characteristically consume foreign debris and foreign bodies. When they are successful in taking over the invading cells, cancer is averted. When they fail, a tumor grows. The defensive cells are inhibited by corticosteroids, biochemicals released under stress. Research on stress and coping shows that generally people who do not cope well in stressful situations have a decline in the activity of their natural killer cells. Many individuals with TYPE C PERSONALITY also may fall into this category. Physicians have recognized significant associations between stress and development of malignancies for as long as 2,000 years. In the 19th century, British physicians believed that emotional distress was the most powerful cause of cancer, and increased rates of the disease were subsequently correlated with the psychosocial stresses that have progressively developed along with lifestyle changes. As reported in Stress, the newsletter of the American Institute of Stress, studies since 1950 have demonstrated that stress accelerates development and growth of different malignancies without actually causing them. Similarly, stress reduction strategies have been shown to retard tumors in laboratory animals and to prolong life in cancer patients. In a publication of the EHS Hospital and Medical Center, Oak Lawn, Illinois, strategies were listed that can “make a difference.” An adaptation follows: There is increasing focus on another important strategy, affirmation. Research reports that state of mind may be more important than the seriousness of the disease in predicting longevity. Keeping a positive attitude through strong faith, participation in SUPPORT GROUPS, and using mind/body treatments such as HYPNOSIS, GUIDED IMAGERY, visualiza-
STRESS AND CANCER: HOW TO MAKE A DIFFERENCE • Change or modify your lifestyle. Since 75 percent of all cancers can be rooted in individual behavior, prevention is key. It is important to eat a healthy diet, not smoke, and use sunscreen when outdoors. • See your doctor for regular checkups and when symptoms arise. Cancer caught early generally require less treatment and have better odds for survival. That’s why early detection can be crucial. Screening for colon, prostate, ovarian, breast, and lung cancer is particularly important for those over 40. • Be sure you are receiving the most up-to-date care. The best way to do that is through intervention, learning about how diagnoses are made, what the latest treatments and followups are, and where the best research is being done. Information on cancer is readily available for online computer users.
tion, and other adjunctive treatments, may improve the quality and extend the length of a cancer patient’s life. Positive emotions elicited by these positive approaches seem, in some cases, to retard or even reverse malignant growths. Stress on Families of Cancer Patients Family members of cancer patients are open to considerable stress as they watch their loved ones undergo uncomfortable procedures and wonder about possible outcomes. At times, family members may wonder whether or not the procedures are worth the suffering they inflict on the patient. While it may be difficult to keep up a cheerful, optimistic outlook, doing so is usually helpful to all concerned. Family members and friends who observe the progression of the disease in a cancer patient may have feelings of confronting their own mortality. There may be subconscious (or even conscious) fears of contagion. Support groups for family members as well as the patient can be helpful. See also ALTERNATIVE MEDICINE; BREAST CANCER; CHRONIC ILLNESS; MIND-BODY CONNECTION; PROSTATE CANCER; PSYCHONEUROIMMUNOLOGY; SIEGEL, BERNIE.
caregivers 79 FOR FURTHER INFORMATION:
American Cancer Society 1599 Clifton Road NE Atlanta, GA 30329 (404) 320-3333; (800) 227-2345 Cancer Information Clearinghouse (NCI/OCC) Building 31, Room 10A18 9000 Rockville Pike Bethesda, MD 21205 (301) 496-5583 National Cancer Institute 9000 Rockville Pike Bethesda, MD 20982 (800) 4CANCER; (800) 422-6237 (toll-free) Sloan Kettering Institute for Cancer Research 1275 York Avenue New York, NY 10021 (212) 639-2000 SOURCES: Locke, Steven, and Douglas Colligan. The Healer Within: The New Medicine of Mind and Body. New York: New American Library, 1986. McAllister, Robert M., Sylvia Teich Horowitz, and Raymond U. Gilden. Cancer. New York: Basic Books, 1993. Terkel, Susan Neiburg, and Marlene Lupiloff-Brass. Understanding Cancer. New York: F. Watts, 1993.
carbonless copy paper A frequently used product in many businesses and offices that produces stress for many people due to mild to moderate symptoms of skin irritation and irritation of the mucosal membranes of the eyes and upper respiratory tract. In most cases, adequate ventilation, humidity, and temperature controls can reduce this situation. Also, periodic cleansing of hands and minimal hand to mouth and hand to eye contact can reduce the problem. See also ALLERGIES. FOR FURTHER INFORMATION:
National Institute for Occupational Safety and Health Centers for Disease Control and Prevention U.S. Department of Health and Human Services Robert A. Taft Laboratories 4676 Columbia Parkway Cincinnati, OH 45226
(800) 356-4674 (513) 533-8573 (fax) http://www.cdc.gov/niosh/topics/ccp
cardiac arrest
See
HEART ATTACK.
caregivers
In contemporary society, caregivers include family members or friends of a child, elderly adults, or an ill or disabled person who cannot completely care for himself. The term also applies to individuals who are health care professionals or social workers. Stresses of Caregiving The caregiver role can be extremely stressful because of its physical and emotional demands. For example, family members who are caregivers may feel powerless and depressed in the face of the suffering of a loved one. Professional caregivers may build a wall around themselves or go to the other extreme and allow the pain and suffering they see to overwhelm them. Caregivers have a considerable amount of power and work in a close, personal relationship with their charges, frequently with little or no supervision. Unfortunately, some situations of abuse have occurred with elderly adults as well as with children. Children are frequently victims of sexual abuse by their caregivers, while the elderly are often subjected to neglect or emotional and financial abuse. When an elderly person, disabled person, or child is entrusted to the care of another, credentials and references should be carefully checked and verified. Caregiving to the Elderly Even though institutional options are available, 75 percent of care for the elderly is still provided by a family member. Increased longevity means many spouses will be caring for each another. Social mobility and shrinking family size put some women in the sole caregiver role for both their own and their husbands’ aging parents. The Older Women’s League in Washington, D.C., reported that at least a third of all women over age 18 can expect to be continuously in the caregiver role from the birth of their first child to the death of their parents. At the same time, women are moving into highly respon-
80 carpal tunnel syndrome sible professional positions at the time in life that their parents need care. According to the American Association of Retired Persons, some women turn down promotions, avoid traveling, and even take early retirement to care for aging parents, adding stress to all concerned. Individuals who have ELDERLY PARENTS or are over the age of 65 may be able to relieve some stress by planning ahead. Planning and preparation can deter the emotional and financial stress that often accompanies caring for an elderly loved one. Identify Needs: Disabled Children, Adults, or Elderly Persons When an individual realizes that she or he will be in the caregiver role, stress can be relieved by identifying the kinds of assistance the disabled or elderly person wants and needs. Some needs that can be met by a family member or by outside sources include meals, shopping, cleaning, yard work, household repairs, finances, living arrangements, personal care, and home health care. An elderly person or disabled child or adult may need services to help him or her maintain social interaction or participation in the community. These services may include transportation to the doctor, shopping, or church; psychological support such as cutting through the red tape of health insurance carriers and Medicare, Medicaid, Social Security, and other governmental bureaucracies; and protective services such as safety devices. A disabled child may also need home tutoring or special education. If possible, the caregiver and disabled elderly person or child can explore how needs, once identified, may best be met. They can consider the resources of other family members, and their willingness and/or ability to help. Together they may look at possibilities for blending resources within the family with those from outside the family. When caregiving is a shared responsibility among family and/or friends, it leads to greater understanding of the difficulties, sharing of stress, development of positive relationships, and enhancement of communication. Community and social services, such as Meals on Wheels, respite programs, support groups, and elderly day care, can also supplement caregivers’ efforts.
FOR FURTHER INFORMATION:
Care Options (Elder Care Management) 2012 Business Center Drive, Suite 130 Irvine, CA 92715 (714) 254-4140 SOURCES: “Caregiving Solutions.” Care Options 2, no. 3 (summer 1993). Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
carpal tunnel syndrome
A chronic condition characterized by numbness, tingling, and pain in the thumb, index, and middle fingers, and sometimes by weakness in the thumb. It may affect one or both hands. This syndrome results from pressure on the median nerve where it passes into the hand via a gap (the carpal tunnel), under a ligament at the front of the wrist. The median nerve carries sensory messages from the thumb and some fingers and also motor stimuli to the muscles in the hand. Damage to the nerve results in sensory disturbances, particularly the numbness and tingling sensations. Carpal tunnel syndrome is one of several possible repetitive stress injuries (RSIs) common to certain occupations in which the wrist is subjected to repetitive stresses and strains, particularly those involving gripping or pinching with the wrist held flexed. For example, computer operators, typists, carpenters, factory workers, meat cutters (meat cleaver’s elbow), violinists, and even hobbyists such as golfers or canoers may develop carpal tunnel syndrome. This injury is stressful for some sufferers because they may experience confusion over whether to continue or quit a job or activity that contributes to their discomfort. The number of workers with disorders caused by repeated trauma on the job is increasing. Some severely injured carpal tunnel victims qualify for help under the Americans for Disabilities Act. However, proof of the source of injury may be difficult, as two people may perform the identical job with only one of them developing carpal tunnel syndrome. Carpal tunnel syndrome is especially common among middle-aged women and in women who are pregnant or have just started using birth-control pills, as well as among people who suffer from rheumatoid arthritis, myxedema, or acromegaly.
changing nature of work 81 Treatment With appropriate treatment, the pain can be relieved and there may be no permanent damage to the wrist or hand. Resting the affected hand at night in a splint may alleviate symptoms. Some health professionals may recommend ACUPUNCTURE. If symptoms persist, a physician may inject a small quantity of a corticosteroid drug under the ligament in the wrist. If this does not help, surgical cutting of the ligament may be performed to relieve pressure on the nerve. See also WORKPLACE. FOR FURTHER INFORMATION:
American Physical Therapy Association /PR-IH 1111 North Fairfax Street Alexandria, VA 22314 (703) 684-2782 Association for Repetitive Motion Syndromes P.O. Box 514 Santa Rosa, CA 95402 (707) 571-0397 SOURCE: Spooner, G. Richard, et al. “Using Pyridoxe to Treat Carpal Tunnel Syndrome.” Canadian Family Physician 39 (October 1993).
catastrophize The habit of imagining that the worst cases scenario will happen. People who frequently catastrophize have little self-confidence, low SELF-ESTEEM, and have difficulties making positive and desirable life changes. An example of catastrophizing is saying to oneself, “If I go to the party no one will know me and I won’t have a good time,” or “If I take this new job I’ll fail because I don’t have the right computer skills.” Catastrophizing causes stress because it keeps people in situations they might really prefer to change, such as improving their social life, changing jobs, or moving to a new city. With positive SELF-TALK and learned techniques to improve selfesteem, the habit of catastrophizing can be overcome. In severe cases, various PSYCHOTHERAPIES may be helpful. SOURCE: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
changing nature of work Job demands, intellectual and psychological demands, and the design, implementation, and monitoring of work processes have all increased over the last several decades. These changes contribute to stress in all categories of workers and employers. Results of these changes include fewer workers with job security and health and pension benefits. According to Edward Yelin, Ph.D., University of California, San Francisco, in his presentation at the forum on “The Way We Work and Its Impact on Our Health,” April 2004, in Los Angeles, major issues in the changing nature of work include quantity of employment, distribution of jobs by occupations and industries, and the shifting nature of the employment conditions. Quantity of Employment Overall, a larger proportion of the working-age population is employed, the average worker is putting in more hours per year, and fewer are working a standard full-time workweek. There have been changes in the age of the working population. In 1965, 58.9 percent of the working-age population was in the labor force, but by 2000, 67.2 percent were, an increase of 14.1 percent in relative terms. This overall increase is the result of a 7.4 percent decrease among men (mostly among men aged 55–64) and a 53.2 percent increase among women. The overall result is more women in the labor force. Average hours worked per week among U.S. workers have stayed relatively constant, (according to the International Labor Office, 2001), while weeks worked per year have increased, resulting in a net increase in the amount worked per year. At the same time, there has been an increase in the proportion working more than 40 hours per week and nonstandard shifts. Distribution of Jobs Has Changed There has been a shift from production of goods and blue-collar occupations to service industries and white-collar occupations. Within white-collar occupations, there has been a shift to professional and managerial positions and a slight decrease in the proportion in clerical occupations, probably due to computerization of offices. According to Yelin, between 1960 and 2000, the number of nonfarm workers increased from 54.2
82 chemical dependencies to 131.8 million. During that time, the number or workers in goods-producing sectors rose only slightly, while the number in the service sectors increased more than three times. Thus workers in goods production represented 38 percent of the workforce in 1960, but less than 20 percent by 2000. Shifting Nature of Work Responsibilities Many firms now maintain a small core of permanent workers and hire outside workers for specific projects. Many functions of permanent employees are farmed out to contractors that may be located overseas. In recent years, there has been a shift in the types of jobs performed by outside workers. Initially, day-to-day production activities were performed outside the firm, such as manufacturing of goods or the provision of services. Now, some higher-level design functions such as computer programming have shifted outside. A decreasing share of workers is hired long term and given health and pension benefits. In some industries there has been significant down trend in wages as a result of international competition, while for other workers with skills in high demand, wages have risen. For workers in occupations that are in demand, the increase in opportunities for contingent forms of labor may allow them to move among jobs rapidly and to intersperse periods of work with leisure. However, for a larger number of workers, the combination of higher demands on the job, lower levels of job security, and decline in real wages make the current labor market stressful. See also SHIFT WORK; WORKPLACE. SOURCE: Yelin, Edward. “The Changing Nature of Work,” Forum on “The Way We Work and Its Impact on Our Health,” Los Angeles, Calif., April 22–23, 2004.
chemical dependencies chemical hazards
See
ADDICTION.
Substances in workplaces, offices, and homes that contribute to allergic reactions or illness and stress. The Occupational Safety and Health Administration (OSHA) defines hazards as those chemicals that are capable of causing harm. In this definition, the term “chemicals”
includes dusts, mixtures, and common materials such a paints, fuels, and solvents. The harm may include allergies due to contact with or inhaling formaldehyde vapors and other synthetic or natural allergenic substances; exposure to metallic, solvent, and other fumes; exposure to various carcinogenic, mutagenic, and teratogenic agents; mercury poisoning; and skin irritations due to contact with chemicals, such as solvents, pesticides, herbicides, detergents, and disinfecting agents. Additionally, chemical hazards include exposure to anesthetic gases administered to patients, lead poisoning, and blood changes as a result of exposure to solvents such as benzene. See also HEALTH CARE WORKERS. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. New York: Facts On File, 2004.
chemical warfare Chernobyl
See
RICIN; SARIN; TERRORISM.
A city in Ukraine in which a large nuclear power plant accident occurred on April 26, 1986. It was the most dangerous accident of its kind in the world until then and contributed to public fears about nuclear power plants. Effects of the Chernobyl incident were acute, short-term, and long-term, both locally and in distant places. Although the death toll was officially 32, countless illnesses occurred years later. In 1990, thyroid pathology was noticed in children and adolescents. There was a positive correlation between the exposure to caesium-137 and thyroid pathology. Years later, thyroid cancer continued to appear in adults who had been exposed. At least 5 million people were exposed to low levels of ionizing radiation as a result of the accident. Because of the politics of the Soviet Union at that time, the term “radiophobia” was applied to explain fearful reactions in the population, despite evidence of objective reasons for a considerable degree of stress and fear. Years later, many people feared getting cancer and other diseases because of lack of information from their government. The explosion produced acute stress reactions and subsequent POST-TRAUMATIC STRESS DISORDER (PTSD) for countless individuals. Many people had to be evacuated from their homes and underwent
child labor 83 disruption in communities and social connections. They worried about housing and employment. Many moved to new settlements, feared isolation, and were concerned for the health of their children. Symptoms noted during the first few years after the accident included fatigue, loss of memory, depression, headaches, loss of appetite, increased illness awareness, lowered thresholds for illness roles, increased help-seeking behaviors, and psychosomatic symptoms. Several terms have been proposed to describe the health problems occurring after toxic exposure, according to Lars Weisaeth, University of Oslo, writing in the Encyclopedia of Stress. These terms include chronic environmental stress syndrome, radioactive contamination syndrome, and toxic stress syndrome. See also ENVIRONMENT; NUCLEAR WEAPONS. SOURCE: Lars Weisaeth. “Stress Effects of Chernobyl,” in Fink, George, ed., Encyclopedia of Stress. San Diego: Academic Press, 2000.
childbirth The birth of a child, usually by passage through the birth canal. Individuals about to participate in the childbirth experience may find it stressful. Many women experience stress in handling some of the most practical details surrounding the birthing experience, such as recognizing the start of labor and getting to the hospital on time. Some women approach childbirth with anxieties exacerbated by reports of difficulties from friends and relatives. First-time mothers, in particular, feel stressed by the unknown aspects of childbirth. Some first-time fathers, planning to attend the birth, may be stressed by a fear of blood, as well as the uncertainties of parenthood. Possible Relief for Some Stressors: Natural and Prepared Childbirth The term natural childbirth specifically refers to a movement toward unmedicated deliveries started by Fernand Lamaze (1891–1957), a French obstetrician. Interest in natural childbirth began developing during the 1940s and 1950s when use of drugs for pain relief and medical procedures such as routine episiotomies and enemas required removing women from their families, who had no sense of participation in the childbirth process.
While the specific methods for childbirth outlines by Lamaze and Grantly Dickread (1900–59), a British obstetrician and advocate of natural childbirth, vary, they both incorporate nonmedical relaxation techniques as a “natural” method of pain control during labor. In addition, they questioned the need for routine medical procedures and advocated a more active participation in labor by the woman and her lay labor coach, often meaning the father of the baby or a nurse-midwife. The natural childbirth movement has expanded to include the use of birthing rooms (in which labor and delivery take place in a homelike setting) and the presence of extended family and friends at the delivery. Some women choose to have their babies delivered at home to assure being surrounded by family members. Some opt for delivery by specially trained nurse-midwives rather than physicians. Nurse-midwives, however, require the back-up of physicians in case of medical emergencies. The term prepared childbirth became popular in the early 1990s, and includes prenatal exercise classes and a wide variety of breathing and relaxation techniques. See also PARENTING; POSTPARTUM DEPRESSION; PREGNANCY. FOR FURTHER INFORMATION:
Informed Homebirth/Informed Birth and Parenting P.O. Box 3675 Ann Arbor, MI 48106 (313) 662-6857 American College of Obstetricians and Gynecologists 409 12th Street SW Washington, DC 20024-2188 (202) 638-5577 SOURCES: Eisenberg, Arlene, and Heidi Murkoff. What to Expect When You’re Expecting. New York: Workman Publishing, 1984. Kahn, Ada P., and Linda Hughey Holt. The A to Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992.
child care
See
DAY CARE.
child labor Across the world, an estimated 246 million children between ages five and 14 are
84 child labor engaged in child labor, according to the United Nations Children’s Education Fund (UNICEF). Of those, almost three-quarters work in stressful and hazardous situations or conditions, such as in running rug looms, in agriculture, or working with dangerous machinery. Millions of girls work as domestic servants and unpaid household help and are especially vulnerable to exploitation and abuse. Many of these children cannot go to school because they work, and they suffer undue stress. Child labor issues and reports of child exploitation are also a secondary stressor for individuals concerned about human rights. In the United States, more than half of 16- and 17-year-olds and more than a quarter of 15-yearolds are part of the workforce. Estimates are that some 5.5 million youths are working. This number does not include those under 12 years old who work illegally. According to the Bureau of Labor Statistics, almost four out of five young workers aged 16 through 19 are concentrated in three types of employment: retail sales and service (particularly food service), as administrative support staff, and as laborers and handlers. Working youths are involved in many accidents and injuries. The National Institute of Occupational Safety and Health (NIOSH) estimates that each year more than 64,000 teenagers are treated in emergency rooms for occupational injuries, exclusive of agricultural injuries. Adolescents suffer an estimated occupational injury rate of up to 16 per 100 full-time employees, compared with the adult rate of less than nine per 100 full-time employees. The most common youth injuries at the workplace are cuts and lacerations, usually of the fingers and hands, followed by bruises and contusions, and strains and sprains. However, these injuries result from inexperience, not age. A large proportion of workplace injuries, some 30 percent, occur to workers in their first year of work, regardless of their age. Child Labor Laws Aim to Reduce Stress Regulations by federal and state governments concerning conditions under which minors may work, as well as hours and wages, help reduce the stress upon these young people. Child labor laws are important now because more teenagers are work-
ing at more types of jobs, during more weeks of the year for longer weekly hours than has even been true in the past. Child labor laws evolved out of the movement to prevent exploitation of children. Exploitative child labor is presently defined by the Child Labor Coalition as employment whether paid or unpaid that is coerced, forced, bonded, or otherwise known to be unfair in wages, injurious to the health and safety of children, and/or obstructs a child’s access to education. The Fair Labor Standards Act of 1938 (FLSA), as amended, administrated by the U.S. Department of Labor’s Wage and Hour Division, is applicable in most instances in every U.S. state. Additionally, each state has its own child labor laws, which vary widely. Some were enacted in the 19th century, and some address every type of labor and many working conditions. Other states have enacted minimal child labor provisions. Universally, the more common form of enforcement is the “complaint method,” in which state labor investigators respond to complaints received by letter or telephone. Investigating complaints helps assure that young people are safe, legal, and healthy on their jobs. Child Labor Coalition The Child Labor Coalition (CLC) begun in 1989, provides a forum and a unified voice on protecting working minors from stress and ending child labor exploitation. It is a national network for the exchange of information about child labor. CLC also develops informational outreach to the public and private sectors to combat stressful child labor abuses and promote progressive legislation and initiatives. Among the objectives of the CLC are influencing public policy on child labor issues through an increased understanding of the effect of work on children’s health, increasing recognition of how child labor exploitation reinforces and promotes stress, adult unemployment, and low literacy rates. The CLC works for stronger protection, guarding youth from excessive, inappropriate, and stressful labor. The CLC also aims to educate the public, business, and governments, and broaden awareness and understanding about the nature of child labor exploitation in the United States and other countries. The CLC also hosts conferences, creates educational and public awareness materials, testifies
cholesterol 85 before state and federal legislatures and agencies on child labor, presents comments in response to regulatory initiatives, and initiates research. See also TEENAGE WORKERS. FOR FURTHER INFORMATION:
The Child Labor Coalition http://www.stopchildlabor.org National Consumers League 1701 K Street NW, #1200 Washington, DC 20006 (202) 835-3323 (202) 835-0747 (fax) http://www.nclnet.org
chiropractic medicine
Chiropractic medicine deals with the relationship between the skeleton and the nervous system and the role of this relationship in restoring and maintaining health. Many people visit chiropractors to relieve stress as well as physical discomforts. According to chiropractic philosophy, the body is a self-healing organism and all bodily function is controlled by the nervous system. Abnormal bodily function may be caused by interference with nerve transmission and expression. This interference can be caused by pressure, strain or tension on the spinal cord, spinal nerves or peripheral nerves as a result of a displacement of the spinal segments or other skeletal structures. The art of the chiropractic practitioner involves detecting and correcting problems of the vertebral subluxation complex. Subluxation refers to a slight dislocation or biomechanical malfunctioning of the vertebrae (bones of the spine). According to the International Chiropractors Association, subluxation can irritate nerve roots and blood vessels, which branch off from the spinal cord between each vertebrae. The irritation causes pain and dysfunction in muscle, lymphatic and organ tissue as well as imbalance in normal body processes. Causes of subluxation include stress, falls, injuries, trauma, inherited spinal weaknesses, improper sleeping habits, poor posture, poor lifting habits, OBESITY, lack of rest, and exercise. Chiropractors restore misaligned vertebrae to their proper position in the spinal cord through
procedures known as “spinal adjustments” or manipulation. The adjustment itself does not directly heal the body. Rather, it is the resulting alignment of misaligned spinal vertebrae that restores balance so that the body can function more optimally. Although chiropractic is often chosen as therapy for headache, TEMPOROMANDIBULAR JOINT SYNDROME (TMJ), whiplash, and bursitis, it may not be the treatment of choice for all medical problems or conditions. Choosing a Chiropractor Before choosing a chiropractor, ask him or her to fully explain the benefits, risks, and costs of all diagnostic and treatment options. Interview more than one doctor of chiropractic medicine before making a decision on the practitioner. Chiropractors are licensed by each state’s Board of Chiropractic Examiners. The American Chiropractic Association has a membership directory listing ACA members. See also ALTERNATIVE MEDICINE. FOR FURTHER INFORMATION:
American Chiropractic Association 1701 Clarendon Blvd. Arlington, VA 22209 (703) 276-8800 SOURCES: McGill, Leonard. The Chiropractor’s Health Book: Simple, Natural Exercises for Relieving Headaches, Tension and Back Pain. New York: Crown, 1997. Rondberg, Terry A. Chiropractic First: The Fastest Growing Healthcare First . . . Before Drugs or Surgery. Chandler, Ariz.: Chiropractic Journal, 1996.
chlamydia choices
See
See
cholesterol
SEXUALLY TRANSMITTED DISEASES.
DECISION MAKING.
A complex fatlike substance in the body, most of which is produced naturally in the liver. Cholesterol is needed to survive, but too much of the wrong kind, LDL (low-density lipoprotein) cholesterol, can be a risk to health and a source of personal stress. When LDL cholesterol builds up in the walls of the arteries, it forms
86 Chopra, Deepak HIGH CHOLESTEROL: ONE OF SEVERAL RISK FACTORS FOR HEART DISEASE • • • • •
High LDL cholesterol Smoking Age (a man 45 or older; a woman 55 or older) High blood pressure (treated or untreated) Hereditary (father, brother or son had heart disease before 55; mother, sister, or daughter before 65) • Low HDL cholesterol
plaque. The technical name for this is atherosclerosis or “hardening of the arteries.” If plaque builds up, causing arteries to become thicker, harder, less flexible and less efficient at transporting blood, it can lead to a HEART ATTACK or STROKE. There are no obvious symptoms of high LDL cholesterol. The only way to find out if a person has a problem is to have cholesterol checked by a blood test and evaluated by a doctor or health care professional. The stress of learning that a person’s cholesterol level is too high can be relieved by understanding what contributes to the level and how it can be controlled. Many factors raise cholesterol, including certain inherited tendencies as well as lack of exercise. One of the most common and controllable factors is diet. Eating saturated fats can raise the LDL cholesterol. Saturated fats come from animal sources, such as meat, butter, milk, and cheese, as well as the oils in tropical plants, such as coconuts and palms. Reducing Cholesterol Level The first step in reducing cholesterol is to follow a low-fat, low-cholesterol diet. A low-fat diet generally requires that a person eat less high-saturated fat and high-cholesterol foods, such as meats, eggs, and dairy products, and more fruits, grains, and vegetables. This diet can contain small portions of turkey and chicken without the skin, and welltrimmed lean beef. Fish, broiled or baked without butter, is another low-fat source. The American Heart Association recommends limiting the total fat in your diet to less than 30 percent of your calories each day.
Some people worry needlessly that they may be eating too much cholesterol. These individuals may be interested to know two important facts: (1) On average, one’s body absorbs only half the cholesterol in the food eaten; and (2) when the amount of cholesterol from food increases, the body produces less of its own cholesterol and will increase the amount of cholesterol it excretes. Regular exercise raises the level of “good” cholesterol, HDL. HDL helps remove LDL, the “bad” cholesterol from the blood. Exercise also helps keep the heart muscle active and healthy. The most commonly stated goal for a heart-healthy exercise is 20 minutes of moderate exercise three times a week. Several types of cholesterol-lowering medications are available. Medications should always be used along with a low-fat, low-cholesterol diet. A physician will decide whether medication is necessary and which medication is best for each individual. See also ATHEROSCLEROSIS; CORONARY ARTERY DISEASE. SOURCES: Giles, Wayne H., et al. “Cholesterol.” The Journal of the American Medical Association 9 (March 3, 1993): 1,133–1,138. Grover, Steven A., et al. “HDL Cholesterol Level Is Important Indicator of Potential Heart Disease.” The Journal of the American Medical Association, September 12, 1995.
Chopra, Deepak (1947– ) Indian-born physician whose philosophy of healing, disseminated through books, tapes, lectures, and clinics, is based on the Indian holistic system called AYURVEDA. He was once a disciple of Maharishi Mahesh Yogi, but formed his own organization in 1993. Among his books are the best-selling Ageless Body, Timeless Mind: The Quantum Alternative to Growing Old (1993) and a work of fiction, The Return of Merlin (1995). Chopra claims the MIND-BODY CONNECTION can reduce stress, facilitate healing, lead to inner peace and even reverse the aging process. His mind/body programs incorporate massage, YOGA, MEDITATION, herbal supplements, nutritional guidelines, and exercise regimens. He recommends doing something that brings joy, concentrating fully on that
chronic fatigue syndrome 87 activity, reducing distractions at work and finding inner satisfaction in daily tasks. In one chapter on longevity in Ageless Body, Chopra outlines some suggestions that may be useful for those wishing to reduce stress in their lives. Techniques include listening to your body’s wisdom, living in the present, taking time to be silent, and meditating to quiet the internal dialogue. See also ALTERNATIVE MEDICINE; IMMUNE SYSTEM; RELAXATION. FOR FURTHER INFORMATION:
Chopra Center for Well Being 7590 Fay Avenue, #403 La Jolla, CA 92037 (619) 551-7788 Sharp Institute for Mind/Body 3131 Berger Avenue San Diego, CA 92123 (619) 541-6737 SOURCES: Chopra, Deepak. Ageless Body, Timeless Mind: The Quantum Alternative to Growing Old. New York: Crown, 1993. ———. Creating Health. Boston: Houghton Mifflin, 1991. ———. Quantum Healing. New York: Bantam, 1989. ———. Unconditional Life. New York: Bantam, 1992.
chronic fatigue syndrome (CFS) Illness characterized by fatigue that occurs suddenly, improves and relapses, bringing on debilitating tiredness or easy fatigability in an individual who has no apparent reason for feeling this way. It is stressful to the sufferer because the profound weakness caused by CFS does not go away with a few good nights of sleep, but instead steals a person’s vigor over months and years. Because many individuals who have CFS experience frustration both before being diagnosed and on learning that there is no cure, DEPRESSION often accompanies the disease. While the illness strikes children, teenagers, and people in their fifties, sixties, and seventies, it is most likely to strike adults from their mid-twenties to their late forties. Women are afflicted about twice to three times as often as men; the vast majority of those who suffer this illness are white. Because young urban professionals were most afflicted during the 1980s, the name “yuppie flu” was attached to CFS. However, individuals regarded this name as trivializing their illness.
CFS Symptoms CFS can affect virtually all of the body’s major systems: neurological, immunological, hormonal, gastrointestinal, and musculoskeletal. According to the National Institutes of Health, CFS leaves many people bedridden, or with headaches, muscular and joint pain, sore throat, balance disorders, sensitivity to light, an inability to concentrate, and inexplicable body aches. Secondary depression, which follows from the disease rather than causing it, is just as disabling. However, knowing that there is a chemical basis for mood swings and that they are directly related to illness, can be reassuring. Symptoms wax and wane in severity and linger for months and sometimes years. Some individuals respond to treatment, while others must function at a reduced level for a long time. However, for all sufferers, the cumulative effect is the same—transforming ordinary activities into tremendously stressful challenges. They cannot tolerate the least bit of exercise, their cognitive functions become impaired, and their memory, verbal fluency, response time, and ability to perform calculations and to reason show a marked decrease. Disruption of sleep patterns causes the CFS sufferer additional stress. Despite constant exhaustion and desire for sleep, they rarely sleep uninterruptedly and awake feeling refreshed. Some have severe INSOMNIA, while others have difficulty maintaining sleep. There is often not enough rapid-eye movement sleep (REM), which is considered necessary for a good night’s rest. Many CFS sufferers experience stressful disorders of balance, or of the vestibular system, which is modulated by the inner ear. They sometimes feel dizziness, light-headedness, or nausea. Even walking can be difficult, with sufferers tilting off balance or stumbling for no apparent reason. Some individuals who have balance disorders develop PHOBIAS, such as a fear of falling. Some who have this fear even become housebound. CFS causes stresses on sufferers, family, and friends. Those in a sufferer’s support circles can reduce their stress by being helpful, understanding, and available to listen. Sufferers are likely to feel estranged from some of their friends because they believe that no one really understands their feelings of emotional and physical exhaustion. This belief is exacerbated because many sufferers think
88 chronic illness that others do not take their illness seriously. In addition, some friends and family members may fear that CFS is contagious and try to maintain a distance from the sufferer. (Medical opinion seems to indicate that CFS is not contagious.) Spouses face the issue of reduced sexual activity, although both partners can satisfy their needs by engaging in sexual activity during peak periods of energy. Diagnosing CFS Diagnosing CFS is stressful for physicians as well as patients because many of the symptoms are like those of other disorders. Until the mid-1980s, many CFS patients were misdiagnosed as suffering from depression, accused of malingering, encouraged to undergo stressful, costly, and inappropriate laboratory tests, or simply pushed aside by the medical community because of lack of understanding of the disease. In recent years, however, studies on the immune system, viruses, and the physiological effects of stress have contributed to better understanding of CFS. Individuals with CFS no longer have to feel abandoned by their physicians or fear that they are going crazy because no one takes their illness seriously. Treatment for CFS Many therapies have been tried on CFS sufferers. Usually a plan is devised for each patient, depending on symptoms. Pharmcological therapies include use of antidepressant drugs, pain relieving drugs, and muscle relaxing drugs. Other therapies that have been tried include deep relaxation, YOGA, BIOFEEDBACK, and visualization therapy to relieve stress and chronic pain. Nutritional therapies have included emphasizing certain vitamins, such as Vitamins A, B6, B12, C and E, as well as zinc, folic acid, and selenium, all of which are said to have immune-boosting potential. Oil extract from the seeds of the evening primrose plant is another medicine that some CFS patients have found helpful. The theoretical basis for its use (although not yet scientifically proven) is that evening primrose oil contains gammalinolenic acid (GLA), which converts in the body to prostaglandin, a vital substance in the regulation of cellular function. Role of Support Groups and Self-Help Several nationwide organization encourage research and political advocacy and also provide lists of local
SUPPORT GROUPS.
CFS sufferers may find relief from some stressors and help with practical and emotional needs through these organizations. See also CHRONIC ILLNESS.
FOR FURTHER INFORMATION:
The CFIDS Association of America P.O. Box 220398 Charlotte, NC 28222 (704) 365-2343 National Chronic Fatigue Syndrome Association 919 Scott Avenue Kansas City, KS 66105 (913) 321-2278 SOURCES: Feiden, Karyn. Hope and Help for Chronic Fatigue Syndrome. New York: Prentice Hall, 1990. McSherry, James. “Chronic Fatigue Syndrome: A Fresh Look at an Old Problem.” Canadian Family Physician 39 (February 1993).
chronic illness
Disorder or set of symptoms that has persisted for a long time with progressive deterioration. In addition to the stresses of physical pain, chronic illness often brings with it emotional consequences that can be more far reaching than the illness itself. These affect not only the patient but also cause stress for the immediate CAREGIVERS. Some, particularly close family members, let illness-related anxieties take over their lives, and their DEPRESSION arises from COPING with illness and the threat of possible long-term disability or death of a loved one. Reactions to illness are similar to the stages of GRIEF after the death of a loved one. First there is the patient’s shock and a feeling of loss of CONTROL and of AUTONOMY and of the way things used to be. In addition, they experience physical losses ranging from having to give up their job or favorite sport to impaired speech or vision. Stress and symptoms of depression may follow, including hopelessness, self-blame, shattered self-esteem, or withdrawal. Some ill persons may develop many fears. They may fear exercise and being active again, while others may deny the realities of their condition and overdo activities too soon. The stresses of PAIN and fears about disability and death lead some ill people to substance abuse
circadian rhythms 89 as a form of escape. Anger, denial, or perceived helplessness lead others to abandon medical treatment or assume a “why me” attitude that gives them a pessimistic view of their world. The crucial issue is “whether you can get past the stage of rage, sadness, and overwhelming anxiety,” says Lloyd D. Rudley, M.D., an attending psychiatrist at the Institute of Pennsylvania Hospital, Philadelphia. “Will you resume the initiative for living or become psychologically paralyzed?” Many people become trapped by emotions that do not serve them well, according to Dr. Rudley. Unfortunately, there are chronically ill people who do not comply with instructions from their physicians. This may take the form of not showing up for physical therapy, refusing medication, or driving a car against the physician’s advice. Individuals with emphysema may continue to smoke. According to Dr. Rudley, “People want to think everything will be normal again if they follow the doctor’s orders. When things don’t work this way and there is no magic formula, a patient may give up on treatment.” Some individuals neglect medical advice as a means of getting more attention. Others who harbor shame or guilt about their condition may punish themselves, in effect, by not complying with prescribed treatment. Forces of denial may be at work, too, in those who try to “bargain with illness” by following some recommendations, but not others. How individuals coped with life stress before the illness will determine how well they respond when illness occurs. However, even when symptoms of illness go into remission or people have adjusted to their illness, a whole new set of external stressors may arise or family dynamics can change dramatically. “Patients need to accept that chronic illness changes them permanently, that a change in lifestyle is necessary,” advises Dr. Rudley. Healthy acceptance is achieved when people come to terms with the stresses of their illness as a part of who they are, “forming a sort of coexistence with it,” he says. Some individuals feel certain “benefits” from being chronically ill. Such motivations are referred to as secondary gains and increase the likelihood of their continuing to be ill or to have symptoms.
Common “benefits” of illness include receiving permission to get out of dealing with a troublesome problem, situation, or responsibility of life; getting attention, care, or nurturing; and not having to meet their own or others’ expectations. Every area of a person’s life is affected by ill health, including marriage, family, work, financial affairs, and future plans. Professional counseling can help individuals and their families adapt to stresses brought on by chronic illness. Counseling may also help individuals who feel a need to hide their illness, to increase their use of drugs or alcohol, or who fail to follow treatment recommendations or exhibit a fear of resuming their activities. It can help those who have insomnia and disrupted sleep, who experience prolonged depression, show negative personality changes, and have obsessive anxiety or preoccupation with death. See also ELDERLY PARENTS; GENERAL ADAPTATION SYNDROME. SOURCE: Rudley, Lloyd D. “Conquering the Psychological Hurdles of Chronic Illness.” The Quill, fall 1991.
chronic pain
See
circadian rhythms
CHRONIC ILLNESS; PAIN.
Cycles of sleep and wakefulness coordinated by an inherent timing mechanism known as the body’s internal clock. The circadian rhythm of a person’s body temperature is a marker for those clocks. Body temperature rises and falls in cycles parallel to alertness and performance efficiency. When body temperature is high, which it usually is during the day, alertness and performance peak—and sleep is difficult. A lower temperature (generally during the night) promotes sleep, but hinders alertness and performance. Stress may result when tasks are attempted that are not in synchronization with circadian rhythms. Alertness and mental capability seem to be best when people follow their internal clocks, which are synchronized to the Sun’s 24-hour cycle. For example, sunrise means waking and working, while sundown means dinner and sleep. However, individuals who work night shifts find that their “day” is reversed. Many shift workers go home to sleep during the day when their bodies want to be awake and they have to work at night when their
90 claustrophobia bodies want to sleep, according to Charmaine I. Eastman, Ph.D., in her report, Insights into Clinical and Scientific Progress in Medicine. Circadian rhythms affect many performances of mental feats. For example, different skills follow different cycles, so that at any time a person’s mind is naturally sharp for certain tasks and dull for others. Memory varies though the day, and short-term memory is at its peak at nine in the morning while memorizing for the long term works best around three in the afternoon. Problem-solving peaks in the morning and falls during the afternoon and evening. However, reaction time improves throughout the day and finally peaks in the evening. Readjusting from Jet Lag Jet lag—the discrepancy between an individual’s internal clock and the exaggerated passage of time brought on by air travel across time zones—is a well-known disruption of circadian rhythms. Physical as well as mental stress may result. Symptoms of jet lag may include insomnia, headache, loss of appetite, or nausea. A conventional rule says that each time zone passed takes one day of recovery. Generally, recovering from jet lag is easier when one flies west, rather than east. That is because it seems easier to delay the body’s schedule than force it to advance. Exposure to daylight can help the body resynchronize more quickly. For similar reasons, most people have an easier time changing from daylight savings time back to standard time in the fall than the reverse in the spring. Setting clocks back in the fall allows an hour more of sleep. However, in the spring, when clocks are set ahead and people have to get up an hour earlier than is customary, sleep deprivation may make them tired. Adjusting to Night Work People who work at night can adjust more easily and reduce stressful effects if they have darkness during the day and bright light at night. Night workers can also adjust more quickly if they can maintain a schedule of work-sleep-leisure, rather than the work-leisure-sleep pattern of day workers. See also AIRPLANES; SHIFT WORK. SOURCES: “Circadian Rhythms.” Mayo Clinic Health Letter, March 1995.
Dolnick, Edward. “Snap out of It.” Health, February/ March 1992. Eastman, Charmaine I. “Bright Light, Dark Goggles and Circadian Rhythms.” Insights into Clinical and Scientific Progress in Medicine 14, no. 3 (1991).
claustrophobia From the Latin word claustrum, meaning “lock” or “bolt”; an intense fear of being confined in spaces such as elevators, phone booths, airplanes, small rooms, and very crowded areas with no perceived possibility of escaping to a safe place. Most people feel mildly stressed in closed-in spaces. However, claustrophobics experience extreme stress, fearing that they will suffocate in an elevator or that an airplane carrying them may suddenly fall. These extremely high levels of stress may lead to PANIC ATTACKS AND PANIC DISORDER for some claustrophobics. Such individuals may experience palpitations and fear that they are having a HEART ATTACK. True phobics may tend to avoid places in which panic attacks might occur. The origins of claustrophobia vary. For some sufferers, it begins after a bad experience involving an enclosed space, such as being locked in a closet or room, while for others, the fear develops for no known reason. Using BEHAVIOR THERAPY techniques, many people overcome claustrophobia. See also AGORAPHOBIA; ALTERNATIVE MEDICINE; ANXIETY DISORDERS; BREATHING; PHOBIAS. FOR FURTHER INFORMATION:
Anxiety Disorders Association of America 8730 Georgia Avenue, Suite 600 Silver Spring, MD 20910 (240) 485-1001
Clean Air Act of 1990 A law passed by Congress to assure that Americans have safe air to breathe without the stress of inhaling harmful substances. The law also protects the environment from damage caused by AIR POLLUTION. Public health protection is the primary goal of the law. Although the basic provisions of the act were written in 1970 and amended in 1977, the 1990 act specifies new strategies for assuring cleaner air. The U.S. Environmental Protection Agency (EPA) specifies limits on how much of a specific pollutant can be in the air. Individual states may
club drugs 91 have stronger pollution controls, but are not allowed to have weaker controls than those set for the whole nation. States are assisted by the EPA in scientific research, engineering designs, and funds to support clean air programs.
more than 500 inner-city residents died in their homes, is a testimonial to the possibly dramatic effects of climate stress. See also RANDOM NUISANCES; SEASONAL AFFECTIVE DISORDER.
climacteric
SOURCE: Sherrets, S. D. “Climate and Personality,” in Corsini, Raymond, ed., Encyclopedia of Psychology, vol. 1. New York: Wiley, 1984.
climate
See
MENOPAUSE.
Climate influences health, work, housing, transportation, dress, sports, and leisure activities and the types of products and businesses that are necessary to satisfy basic human needs. Some people prefer to live in a warm climate; others thrive on seasonal changes. Unless there are physical reasons that make it necessary to live in a warm climate, people generally live where they can find work and where they have family and friends. Factors of climate and changes in climate induce stress for many people. Cooler climates require the body to burn and produce energy more quickly. On the other hand, cold weather raises blood pressure, is generally hard on the circulatory system, and tends to make people crave foods high in fat and starch. Warmer climates slow the body’s metabolism and, if humidity is added to the heat, produce a more languid lifestyle. In the last quarter of the 20th century air-conditioning was perfected and became widespread in most industrialized countries. Being able to control the environment through the use of air conditioning or heating reduced the stress level for many individuals and gave greater impetus to industriousness and change. Stormy and changeable weather, which is usually accompanied by sudden barometric changes, may produce in individuals the stresses of irritability and mood changes because the rising and falling pressure affects body fluids. A disturbing correlation between climate and human activity that is supported by statistics is the relationship between hot weather and violence. Figures show that crimes and riots are far more likely to occur in hot weather than in cool or rainy weather. Climate affects the elderly and those who have weakened immune systems more than other individuals. The near-record-breaking heat wave in the summer of 1995 in Chicago, during which
clinical depression clinical psychology
See
DEPRESSION.
See
PSYCHOLOGY; PSYCHO-
THERAPIES.
club drugs The term club drugs refers collectively to a group of various drugs synthetically concocted by underground chemists and commonly used by young adults at parties, “raves” (giant dance parties featuring loud, pulsating music), dance clubs, and bars. Two of the more popular club drugs are methamphetamine (methylenedioxymethamphetamine, MDMA) known as Ecstasy, and gamma hydroxybutyrate, GHB. Persons concerned about the health of young people view the club drug scene as a stressful one. There may be temptation by peers to try these drugs without knowledge of the possible harmful effects. Club drugs can cause serious health problems and possibly death, especially when combined with the use of alcohol. Both MDMA and GHB are swallowed and come in the form of tablets or capsules. GHB can also be found as a liquid or a power. MDMA is a stimulant and GHB is a depressant, but both drugs cause a similar high. The drugs induce feelings of warmth and openness, greatly enhance the sense of touch, and increase the desire for sex. In low doses, GHB can also relieve anxiety and produce relaxation. Ecstasy is a stimulant sometimes called Adam, XTC, hug, beans, and love drug. Warning Signs of Methamphetamine Use Warning signs may include insomnia, decreased appetite and weight loss, increased agitation and
92 cluster headaches physical activity, excited speech, compulsive actions such as cleaning and grooming or sorting and disassembling objects, intense paranoia, hallucinations and delusions, episodes of sudden violent behavior, presence of inhaling paraphernalia (razor blades, mirrors, and straws), and presence of injecting paraphernalia (syringes, spoons, or surgical tubing). See also ADDICTION; ADOLESCENCE. FOR FURTHER INFORMATION:
Partnership for a Drug-Free America 405 Lexington Avenue, 16th Floor New York, NY 10174 (212) 922-1560 http://www.drugfreeamerica.org SOURCE: National Institute on Drug Abuse. “NIDA Community Drug Alert Bulletin—Club Drugs,” Available online. URL: http://165.112.78.61/ClubAlert/Clubdrugalert. html. Downloaded on June 17, 2005.
cluster headaches
See
HEADACHES.
COBRA (Consolidated Omnibus Budget Reconciliation Act) This law, enacted in 1986, enables workers to keep their health coverage during times of voluntary or involuntary job loss, reduction in hours worked, or transition between jobs. In certain cases, it may alleviate much of the stress from these events. COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the preceding year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end. Events that can cause workers and their family members to lose group health coverage may result in the right to COBRA coverage. These include: • Voluntary or involuntary termination of the covered employee’s employment for reasons other than gross misconduct • Reduced hours or work for the covered employee • Covered employee becoming entitled to Medicare • Divorce or legal separation of a covered employee
• Death of a covered employee • Loss of status as a dependent child under plan rules Coverage under COBRA may be for 18 or 36 months, depending on circumstances. Qualified individuals may be required to pay the entire premium for coverage up to 100 percent of the cost to the plan. Premiums may be higher for persons exercising the disability provisions of COBRA. Premiums may be increased by the plan; however, premiums generally must be set in advance of each 12-month premium cycle. Individuals subject to COBRA coverage may be responsible for paying all costs related to deductibles and may be subject to catastrophic and other benefit limits. See also HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATIONS.
cocaine An addictive drug that stimulates the central nervous system and induces feelings of euphoria. Some people erroneously try to combat the stresses in their lives with this and other addictive drugs, and become further stressed if they cannot find the money for supplies of cocaine. Some, recognizing their ADDICTION, become stressed when trying to give up the drug. Cocaine is most often used in the form of white powder and is typically ingested by inhaling, or “snorting,” usually through a straw or other tube in the nose. It can also be injected into the veins. After conversion to its base form, cocaine can be smoked, which is known as “freebasing.” Different users react to the drug in different ways. However, many experience an instant feeling of enormous pleasure known as a “rush.” Some users also may initially feel energetic and self-confident. However, the pleasurable feelings produced by cocaine are followed by depression and fatigue, known as a “crash.” To avoid a “crash,” users take more cocaine, establishing a stressful and expensive cycle of use and dependency, which is extremely difficult to end and often requires lengthy treatment. Use of cocaine can lead to severe psychological and physical dependence. It can increase the pulse, blood pressure, body temperature, and respiratory rate. Paranoid psychosis, hallucinations, and other stressful problems can result from cocaine use,
cognitive therapy 93 which also causes bleeding and other damage to nasal passages. Cocaine is sometimes used with other drugs. The cocaine/heroin combination is called a “speedball,” and the cocaine/PCP mixture is known as “space base.” Cocaine-related heart and respiratory failure can lead to death. Crack is the street name given to tiny chunks or “rocks” of freebase cocaine in smokable form. Crack is even more rapidly addicting than powdered cocaine. Extremely high blood levels of cocaine delivered to the brain by smoking crack increase the likelihood of serious toxic reactions, including potentially fatal brain seizures, irregular heartbeat, and HIGH BLOOD PRESSURE. Congestion in the chest, wheezing, black phlegm, and hoarseness may also result from smoking crack. Use of crack by pregnant women can cause fetal loss or damage, and lead to babies with low birth weights who are extremely sensitive to noise, touch, and other stimuli, and cry frequently. The stresses involved in parenting such babies can be eliminated by avoiding use of addictive substances. FOR FURTHER INFORMATION:
Cocaine Anonymous 3740 Overland Avenue, Suite C Los Angeles, CA 90034-6337 (310) 559-5833 SOURCES: Carroll, Marilyn. Crack and Cocaine. Hillside, N.J.: Enslow Publishers, 1994. Nuckols, Cardwell C. Cocaine: From Dependency to Recovery. Blue Ridge Summit, Pa.: Tab Books, 1989.
codependency
A RELATIONSHIP in which the participants have a strong need to be needed, as well as to create mutual needs in a detrimental, weakening manner. Such an interplay of needs is required to preserve the dependent relationship. Codependent relationships are extremely stressful on at least one or both of the partners. In many cases, an individual would like to eliminate the stressors caused by the codependent relationship but is too addicted to the situation to change. An example of a codependent relationship is one in which the husband covers up for his wife’s ALCOHOLISM. He does the household chores, drives the children to their activities, and explains her problem as an “illness.” He is an “enabler,” because
he makes it possible for her to continue with her ADDICTION. The enabler promotes the codependent relationship by compensating for or covering up difficulties or flaws in the behavior of the other out of an addictive need to be needed and to keep the relationship going. There are many kinds of codependent relationships: a parent who continues to support an adult child who should be responsible for himself because the parent wants the child to feel dependent on him or her; a husband who does all the household chores, shopping, and driving children to activities, while explaining that his agoraphobic wife is “not feeling well.” Such a husband is an enabler to his wife. It is difficult for an individual to live with AGORAPHOBIA without an enabler. Many alcoholics and drug addicts also have enablers. When a parent continues to compensate for or cover up a child’s difficulties in school or with the law, thinking that they are protecting the child, that is also a co-dependent relationship. It is often interpreted that this behavior persists because preserving the child’s flaws and immature behavior will keep him or her forever dependent on the parent. Since codependency is viewed as a type of addiction, advocates of the codependent theory feel that these tendencies can be overcome with a process similar to the recovery process used by Alcoholics Anonymous. FOR FURTHER INFORMATION:
Co-Dependents Anonymous P.O. Box 33577 Phoenix, AZ 85067-3577 (602) 277-7991 SOURCES: Becnel, Barbara. The Co-Dependent Parent. San Francisco: HarperCollins, 1991. Rieff, David. “Victims All?” Harper’s (October 1991): 49–56.
coffee
See
ANXIETY; CAFFEINE; GUIDED IMAGERY;
HEADACHES; INSOMNIA; MEDITATION.
cognitive therapy Centers on the concept that in some people, unwanted behaviors or moods can result from distorted patterns of thinking and that these behaviors or moods can be altered by changing thinking patterns. It is an approach some-
94 cohabitation times used to treat individuals who experience the stresses of ANXIETY DISORDERS or DEPRESSION. The therapy focuses on the individual’s own cognitive appraisals. Stressful ideas, thoughts and perceptions are directly examined and tested to determine their validity. The therapeutic benefit is that the individual’s thinking may be restructured, so that situations or circumstances that were once perceived as extremely stressful are viewed in a less stressful and more realistic light. The cognitive therapy approach was introduced in the 1970s by Aaron Beck (1921– ), an American psychiatrist. See also BEHAVIOR THERAPY; PSYCHOTHERAPIES.
cohabitation
Situation of unmarried individuals living together. This arrangement can lead to stress when one of the partners desires MARRIAGE and the other does not, or when, after living together for a number of years, the couple decides to separate. As in a DIVORCE, there may be additional stress when division of property, including real estate, and consequent legal arrangements occur. There have been dramatic increases in cohabitation during the last decades of the 20th century. Greater approval and societal acceptance of living together without benefit of marriage has resulted from general attitudinal changes, including fears of permanent commitment, effectiveness of contraception during a long-term sexual relationship, and the havoc raised by divorce. Many couples sign a cohabitation contract that is intended to remove some of the stresses in the practicalities of the living together arrangement. The cohabitation contract is a legal document in which unmarried partners agree to specified arrangements, such as how much each partner pays toward specified expenses. It may also specify division of belongings, should the couple split up. See also LIVE-IN.
cold stress People who work or spend a great deal of time in cold temperatures face the stress of exposure. Prolonged exposure can result in health problems such as frostbite, trench foot, and hypothermia. Cold-related disorders are a constant source of stress for workers in such industries as construction, commercial fishing, and agriculture.
SOURCES OF COLD STRESS • Inadequate or wet clothing increases the effects of cold on the body. • Certain drugs or medications such as alcohol, nicotine, caffeine, and medication inhibit the body’s response to the cold. • Certain diseases such as diabetes and heart, vascular, and thyroid problems may make a person more susceptible to the winter elements. • Effects of the cold may be enhanced by becoming exhausted or immobilized, especially due to injury or entrapment. • The elderly are more vulnerable to effects of harsh, cold weather. Source: Occupational Health and Safety Administration
Frostbite, Hypothermia, and Trench Foot Frostbite occurs when the skin tissue actually freezes, causing ice crystals to form between cells and draw water from them which leads to cellular dehydration. Although this typically occurs at temperature below 30° F (–1° C), wind chill effects can cause frostbite at temperatures above freezing. General hypothermia occurs when body temperature falls to a level where normal muscular and cerebral functions are impaired. Hypothermia is generally associated with freezing temperatures, but it may occur in any climate if a person’s body temperature falls below normal. Trench foot is
COPING WITH COLD-RELATED SOURCES OF STRESS • Protect hands, feet, face, and head. • Footgear should be insulated. • Wear at least three layers; an outer layer will keep wind out and allow some ventilation. • The middle layer of wool or synthetic fabric will absorb sweat and retain insulation. • Down is a useful lightweight insulator; however, it is ineffective when it becomes wet. • An inner layer of cotton or synthetic weave allows ventilation. Source: Occupational Safety and Health Administration
color blindness 95 caused by long, continuous exposure to a wet, cold environment, or actual immersion in water. This is a source of stress for commercial fishermen, who experience these types of cold, wet environments on a regular basis.
colic
The causes for colic are unknown, although there are reasons to believe that it is due to a spasm in the newborn baby’s intestines. It appears around the third or fourth week of life and usually goes away on its own by the age of 12 weeks. Signs that the baby is experiencing colic are irritability, excessive screaming, and tightening of the body. There are few solutions to the problem, and parents are placed under the stress of trying to make the baby comfortable. Feeding, cuddling, or changing diapers does not seem to help. Because episodes of colic seem to be worse in the evening, both parents and baby suffer from deprivation of sleep. Handling the Colicky Baby Parental anxiety may make the infant even more irritable. Feeding the baby when he or she cries could worsen the situation by causing the stomach to bloat. Rhythmic, soothing activities, such as rocking the baby, carrying the baby in a front sling or pouch, or taking the baby for a ride in the car, usually work best. To avoid compounding the stress caused by the situation, new parents should try to avoid fatigue and exhaustion. They may find that sleeping in shifts, where one parent deals with the baby and the other gets rest, will be helpful. See also PARENTING.
color
Studies have determined that colors have certain psychological and physical effects on the human body. Under certain circumstances, color can produce stress or induce relaxation. For example, red is the strongest and most stimulating of colors. It has been shown to increase hormonal activity and to raise blood pressure. Red stimulates creative thought and is a good mood elevator, but is not conducive to work. Orange shares many of the qualities of red, but it is considered more mellow and easy to live with. Blue has the opposite effect of red. It lowers bodily functions and creates a restful atmosphere,
although, if used too extensively, may have a depressing effect. Participants in psychological tests, when surrounded by blue, tend to underestimate time periods and the weight of objects. Purple, a combination of red and blue, has a neutral effect. When used in large amounts, for instance as a typeface, the eye does not focus on purple easily. Having the characteristic of visibility, yellow is useful for road safety signs. Green and blue-green promote an atmosphere of relaxation, concentration, and MEDITATION. Monotonous use of the same color has been found to be more disturbing than a variety of colors. With age, attraction to colors and their stressful and soothing effects seems to change somewhat. Babies tend to be attracted to yellow, white, pink, and red. Older children are less attracted to yellow and tend to like colors in the order of red, blue, green, violet, orange, and yellow. As adults mature, blue tends to become a favorite color, possibly because of changes in the eye itself and the way it sees color. Colors carry with them stressful, psychological associations, which are expressed in language. For example, we are “green with envy,” “see red” and “have the blues.” Certain clear shades of red, orange, and yellow are associated with food and are very appetizing, while tinting foods with blue, violet, or a mixtures of colors, has the adverse effect, making the foods unappetizing. Throughout history, mystical and healing properties have been ascribed to color. For example, the ancients associated colors with the houses of the zodiac and with the elements. They were highly important in the practice of magic. Some superstitious people believe that blue and green divert the power of the evil eye. Part of a religious symbolism and ritual, red, blue, purple, and white have been considered divine colors in Judaism, while green, the color of life and rebirth, is important in Christianity. In many cultures, surrounding a patient with red clothing, red furniture and coverings and giving him red food and red medicine was thought to aid the healing process. See also COLOR BLINDNESS.
color blindness Inability to recognize any colors or certain colors; usually a genetic defect located in
96 combat fatigue the cones, small color-sensitive cells in the retina of the eye. Some individuals who are color blind may not be aware of their condition and experience stress when mistaking signs and symbols. They confuse color changes with dark and light shades, not understanding the nature of colors they have never seen. People who are color blind reduce the stress of the disability by training themselves to use other visual clues. For example, they learn shapes and sizes of safety signs and memorize vital information such as that the red light is usually above the green. Other disorders of the eye may result in temporary or permanent color blindness, including degeneration of the optic nerve due to neuritis or anemia, and also infectious diseases such as syphilis or malaria. Malnutrition and ingestion of poisonous chemicals or drugs can also cause color blindness or a limited perception of colors. While cataracts and other eye diseases that result in opacities (nontransparent areas) of the lens and cornea will reduce color vision, when underlying diseases are relieved, color vision may improve. SOURCE: Birren, Faber. Color Psychology and Color Therapy. Secaucus, N.J.: Citadel Press, 1961.
combat fatigue (battle fatigue, combat neurosis) Anxieties occurring after the extreme stresses of war or battles. The term has been replaced in contemporary usage with POST-TRAUMATIC STRESS DISORDER (PTSD). Veterans of World War I were said to have “combat fatigue,” or “shell shock,” while Vietnam veterans with the same symptoms have PTSD. See also ANXIETY DISORDERS.
comfort foods Under stress, people may reach for foods they enjoyed as a child. Comfort foods such as meat loaf, mashed potatoes, macaroni and cheese, and chocolate chip cookies are available prepackaged and ready to eat or may be readily available at fast-food restaurants. The inclination to seek comfort from food has a scientific basis, according to a study that appeared in the Proceedings of the National Academy of Sciences. The researchers suggested that high fat, high carbohydrate comfort foods actually fight stress by stemming the tide of stress-related hormones that are
released when people are exposed to stress. Researchers determined that 24 hours after activation of the chronic stress system, which stimulates a flood of hormonal signaling from the hypothalamus to the adrenal glands, glucocorticoids prompted rats to engage in pleasure-seeking behaviors, which included eating high-energy foods (including sucrose and lard). The negative aspects of the chronic stress response system, otherwise ushered in by the glucocorticoids, were blunted. The downside of this behavior is weight gain, obesity, and a tendency toward developing diabetes. In humans, over time, elevated stress levels can initiate many harmful effects on the body, such as a loss or gain of weight, depression, obesity, and a loss of brain tissue. The study suggests that comfort food slows a key element of chronic stress, according to Mary Dallman, a professor of psychology at the University of Southern California, San Francisco. It also may help explain why solace is often sought in such foods by people with stress, anxiety, or depression, and also bulimic and night-bingeing eating disorders. According to the researchers the drive to eat comfort foods makes sense from an evolutionary perspective. In the animal kingdom, it is an “eat or be eaten” world, and an animal under constant or chronic stress may prefer to eat high-energy foods to stay in the game. Under the model proposed by the researchers, glucocorticoids would both prompt vigilance to threats and send a signal to the brain of a chronically stressed animal to seek highenergy food. If it were successful in finding such food, stress and its attendant feelings would be cut back. See also ANXIETY; DEPRESSION; DIET; EATING DISORDERS; STRESS; WEIGHT GAIN. SOURCES: Dallman, Mary F., Norman Pecoraro, Susan F. Amana, et al. “Chronic Stress and Obesity: A New View of Comfort Food.” Proceedings of the National Academy of Sciences 100, no. 20 (September 2003): 11,696–11,701. Raloff, J. “Stress Prone? Altering the Diet May Help.” Science News 158 (July 8, 2000): 23.
commitment
See
COHABITATION; DATING; INTI-
MACY; MARRIAGE; RELATIONSHIPS; SELF-ESTEEM.
communication 97 communication Process through which meanings are exchanged between individuals. When individuals feel understood, they are communicating effectively. They are in control of events; other people trust and respect them; in work settings, they feel valued. Communicating effectively enhances health and SELF-ESTEEM, nurtures relationships and helps people cope with stress. Failure to Communicate When individuals do not communicate well, they feel misunderstood, frustrated, distressed, defensive, and often hostile, which increases their stress level. Faults and flaws in communication habits, or communication gaps, cause stress to many people, to those they love and those with whom they interact on all levels, from the most intimate to the most distant of acquaintances. People who don’t communicate effectively are more vulnerable to disease; they can be hostile and confrontational and are at increased risk for heart disease. People who feel misunderstood report more DEPRESSION and more mood disorders of the kind shown to weaken their immune function. When communication breaks down, heart rate speeds up, cholesterol and blood sugar levels rise, and they become more susceptible to HEADACHES and digestive problems and are more sensitive to pain. In work settings, communication gaps can reduce productivity, make workers irritable and even increase the risk of accidents. Differences in Male-Female Communication Styles According to Bee Reinthaler, a personnel communications specialist, in business, differences between the communications styles of male and female managers can cause problems in efficiency and in accomplishing goals. Males in the corporate world often use a complex combination of business, sports, and military jargon. Their behavior is action-oriented and competitive. On the other hand, women generally are more demonstrative and express their feelings. Many women frame their speech with qualifiers, questions, and questioning intonations. They express doubts and uncertainties more frequently than men. According to Reinthaler, when women wait for men to speak first, they create an image of incompetence. “Men may then fall into the stereotypical role of treating women as incompetent and the stereotypical interaction continues in a destructive
way. It would be more effective if both genders of managers would ‘speak the same’ language.” “Many women attempt to crack the male communication code in the workplace until something happens that shows they have underestimated its
OVERCOMING STRESS BY AVOIDING COMMUNICATION GAPS • Learn to cope with criticism. Receiving criticism causes stress. The impact on our mood and body depends more on how we describe the negative feedback to ourselves. Ask yourself: Does this seem reasonable? Is it fact or opinion? Are there others who might confirm or dispute this view? How would others have behaved? • Learn to listen. Listening is an active process requiring openness and receptivity. Keep your mind free of distracting reactions, responses, judgments, and questions and answers. • Observe your own body language. Research shows that more than half of what we communicate is conveyed by BODY LANGUAGE. Smiling, frowning, sighing, touching, or drumming fingers give out strong messages. Women tend to smile more than men, nod their heads, and maintain more continuous eye contact while listening and speaking than men. Under stress or in new situations, this tendency becomes even more pronounced. • Recognize and respect differences in conversational styles. Styles of conversing play a major role in triggering misunderstandings. For example, women tend to ask more personal questions than men. Men more often give opinions and make declarations of fact. • Become more assertive. Speak and act from choice and stand up for your rights without being aggressive. • Learn to say no when you want to. Avoid feeling resentful, frustrated, or guilty. Take time before you respond to a request. You need not give lengthy explanations for saying no. • Try to resolve conflicts when you recognize them. Use “I” statements whenever possible, rather than attacking the other person with a “you” statement. Make sure you understand each other’s concerns, positions, or feelings by summarizing what you heard.
98 commuter marriage complexities,” says Candiss Rinker, an expert in the science and practice of change management. She explains that women have been socialized from childhood to avoid direct communication about difficult issues, so they often use a sugarcoated approach that other women understand, but men do not. Deborah Tannen, a linguistics professor, says gender differences put women in a double bind at work that is not as evident in personal RELATIONSHIPS. “Workplace communication norms were developed by men, for men, at a time when there were very few women present. The situation is aggravated when women hold positions of authority. If they talk in ways expected of women, they may not be respected; if they talk in ways expected of men, they may not be liked,” says Tannen, author of Talking from 9 to 5: How Women’s and Men’s Conversational Styles Affect Who Gets Heard, Who Gets Credit and What Gets Done at Work.
commuter marriage
Removing the Stress from Your Communication Style Individuals should apply the old “golden rule” in communicating with others. They should speak in the way in which they would like to be spoken to and listen to others the way they hope others will listen to them. It is important that they learn to express their likes and dislikes in a tactful and diplomatic way. They will find that when they are more direct, other people will be more responsive. With slight adaptations, these suggestions may be useful in communicating with children, siblings, parents, coworkers, bosses, or acquaintances and should be helpful in most situations. See also ASSERTIVENESS TRAINING; IMMUNE SYSTEM.
SIVE DISORDER; SHOPAHOLISM.
SOURCES: Reardon, Kathleen Kelley. They Don’t Get It, Do They?: Communication in the Workplace—Closing the Gap Between Women and Men. Boston: Little, Brown, 1995. Reinthaler, Bee. “Verbal Communications.” The Professional Communicator, fall 1991. Sobel, David S. “Rx: Prescriptions for Improving Communication.” Mental Medicine Update 3, no. 2 (1994). Tannen, Deborah. Talking from 9 to 5: How Women’s and Men’s Conversational Styles Affect Who Gets Heard, Who Gets Credit and What Gets Done at Work. New York: William Morrow, 1994. Tingley, Judith C. Genderflex, Men and Women Speaking Each Other’s Language at Work. New York: Amacom, 1995.
See
MARRIAGE.
competition
One of the many dichotomies present in American life today that induces stress. It encourages individual achievement and the need to win. As such, it is the extreme opposite of another American concept—teamwork—which teaches us to respect others, appreciate their strengths and weaknesses, share our skills and knowledge, and help others meet their goals. Early in life, children on the playing field experience the contradiction of competition and teamwork. Thus begins a source of stress we carry through much of our adulthood. Competition encourages comparisons between ourselves and others, both on a social and economic level; this in turn affects our feelings of SELF-ESTEEM. See also AUTONOMY; CONTROL; TYPE A PERSONALITY.
compulsions
See
GAMBLING; OBSESSIVE-COMPUL-
computers When introduced into the workplace, computers were promoted as tools to simplify tasks and thus save time and effort and the stress related to getting jobs done the “old way.” Nominally, the computer is designed to serve as an extension of employees’ skills and capabilities. Implied is that the user is in control and the computer maintains the burden of adaptation. In fact, in many cases, the opposite has occurred. For lower-level employees, use of computers may diminish skill levels and autonomy and increase morale and health problems. While these workers report that the computer makes their work more enjoyable, they also report job changes associated with computers that involve stressors, including increased time pressures and reduced possibilities for control of the task. Added to that is the stress of having their work on the computer monitored by the computer itself, which collects all aspects of employees’ activities and centralizes the information for management review. For higher-level employees, computers seem to have increased the work done and set new standards of higher quality for doing it. With the advent of desktop and laptop computers, professionals in all fields are expected to do their own
conflict resolution 99 word processing, spread sheets, electronic mail, and presentation preparation. This has allowed management to cut back on staff. Although computers are a powerful technology, they are continuously changing the way we do business and, thus, have become a major stressor for employees at all levels. See also AUTOMATION; ELECTRONIC DEVICES; INFORMATION EXPLOSION; REPETITIVE STRESS INJURY.
conditioning
Frequently used in BEHAVIOR THERas a technique to reduce stress in unwanted conditions, such as phobias and anxieties. Conditioning occurs in two major ways: classic and operant. In classic or Pavlovian conditioning, two stimuli are combined: one adequate, such as offering food to a dog to produce salivation (an unconditioned response), and the other inadequate, such as ringing a bell, which by itself does not have an effect on salivation. After the two stimuli have been paired several times, the inadequate or conditioned stimulus comes to elicit salivation (now a conditioned response) by itself. In operant conditioning, consequences are introduced that strengthen or increase the rate or intensity of the desired activity (reinforcement) or weaken or decrease the rate or intensity of the undesired activity (punishment). Partially reinforcing or punishing the activity will increase its resistance to extinction. APY
condom
A cylindrical sheath of rubber, placed on the penis prior to sexual intercourse, which catches seminal fluid and prevents sperm from entering a woman’s vagina and impregnating her. For some individuals, the use of a condom becomes a stressful issue. Some couples say a condom interferes with their enjoyment of sexual intercourse; in some cases, the man refuses to wear one. In the 1980s and throughout the 1990s, during the escalation of the AIDS (ACQUIRED IMMUNODEFICIENCY SYNDROME) epidemic, condoms were promoted as a SAFE SEX measure and means of reducing the risk of the spread of AIDS and SEXUALLY TRANSMITTED DISEASES (STDs) between partners. Advantages of use of a condom as a contraceptive include relatively low cost, availability without a physical examination or prescription, and some
protection against STDs. Disadvantages may be the possibility of a dulling sensation in the penis and the care in which condoms must be used. Invention of the condom is often attributed to Dr. Condom (1650–85), a physician in the court of Charles II. However, the first published report of use of a condom to prevent venereal disease was in the work of the Italian anatomist Fallopius in 1564. SOURCE: DiClemente, Ralph J., and Gina M. Wingood. “Sexual Assertiveness Training Produces More Consistent Condom Use.” Journal of the American Medical Association, October 25, 1995.
confined spaces
Fear of being in a confined space is known as CLAUSTROPHOBIA. In addition to the stressful fear aspect of enclosed places, considerations include attention to any area where it might be possible for a person to become trapped, such as walk-in freezers or elevators, or where there is a possibility of anything collapsing or overturning and causing considerable stress to themselves, their employer, or a home owner. Areas of low head height such as cellars and mezzanine floors should be identified and appropriate precautions taken to prevent risk of injury to persons entering these areas. If there is no alternative to working in a confined space, it is essential that the persons carrying out such work be properly trained, competent, and physically capable of doing so. Working alone is not recommended in such situations; if it cannot be avoided, a means of communication must be available. Where there is a possibility of oxygen deficiency or a contaminated atmosphere, suitable breathing apparatus must be used, and at least one other person who is trained and equipped to carry out rescue procedures and sound an alarm for help in case of an accident must be present. See also PHOBIAS. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
conflict resolution
The ability of people to come out of a stressful encounter respecting and liking each other. This is a win-win situation in which the stress of ANGER and confrontation are minimized,
100 congestive heart failure HOW TO USE CONFLICT RESOLUTION • • • • • • •
Think before speaking. Say what you mean and mean what you say. Listen carefully to the other person. Do not put words in the other person’s mouth. Stick to the problem at hand. Refrain from fault-finding. Apply the same rules to handling business and personal conflicts.
and those involved are able to be heard, to express their position, and articulate their needs. See also COMMUNICATION. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Injuries. New York: Facts On File, 2004.
congestive heart failure The end result of many different types of heart disease where the heart cannot pump blood out normally. This results in congestion (water and salt retention) in the lungs, swelling in the extremities, and reduced blood flow to body tissues. Living with congestive heart failure is a very stressful situation for the sufferer as well as those around him or her. Medical treatment can improve the quality of life for many of these patients. See also CHOLESTEROL; CHRONIC ILLNESS; CORONARY ARTERY DISEASE; HEART ATTACK; HIGH BLOOD PRESSURE. FOR FURTHER INFORMATION:
American Heart Association 7272 Greenville Avenue Dallas, TX 75231-4596 (800) 242-USA1 (toll-free) (214) 373-6300 (214) 987-4334 (fax) www.americanheart.org
constipation
Abnormally delayed or infrequent passage of hard, dry feces. Many people feel very stressed because they do not have a bowel movement every day. Parents become anxious and cause their children to be stressed. Yet, many healthy people may not have a bowel movement for several days and suffer no ill effects. Today, advertising seems to have created an “illness” called “irregularity” for which laxatives are
the cure. A better approach to solving the constipation problem is through diet and regular exercise. At any age, a persistent change in the pattern of bowel movements should be investigated by a physician to rule out a serious disorder. Causes of Constipation Emotional factors, such as frustration and resentment may result in constipation. Tension may cause the muscles of the intestine to tighten, or contract, in what is called spastic constipation. This is often part of the syndrome known as IRRITABLE BOWEL SYNDROME. Constipation is also caused by lack of fiber in the diet. Fiber is found in foods such as whole-grain breads, fresh fruit, and vegetables. it provides the bulk that the muscles of the large intestine needs to stimulate propulsion of the fecal matter along its way. Some individuals who have continuously ignored the urge have trouble with bowel movements. Disabled and elderly people often suffer from constipation, in some cases because of the diminishing tone of intestinal and other muscles, slowing down of body signals from reduced efficiency of the nervous system, and immobility. Hemorrhoids or an anal fissure result in pain and may inhibit an individual’s efforts to begin a bowel movement. Atonic constipation may be the result of constant use of laxatives and enemas. These lead to weakening of the intestinal wall, making the individual even more dependent on laxatives or enemas than ever before. Many medications have a side effect that leads to constipation. These include medications containing morphine and codeine, verapamil (a calcium channel blocker used in the treatment of high blood pressure, angina, and cardiac rhythm disorders); any of the beta blockers (used for the same reason, but they can also cause DIARRHEA); various sedatives and tranquilizers; calcium supplements (especially the carbonate variety); and several antacid products. Being aware of the side effect may help reduce the stress of constipation. Coping with Constipation If constipation is accompanied by alternating attacks of diarrhea, a physician should be consulted. This sometimes occurs in people who have diabetes. An examination will reveal if there is an
coping 101 obstruction, such as a polyp or a tumor in the colon, or the constipation may be a symptom of irritable bowel syndrome. In hypothyroidism, chronic constipation may result. Try a change in diet, such as eating grainy products at breakfast, or eat them later in the day. For many people, being aware of their own stress levels helps. Try to reduce stress by techniques such as MEDITATION and BIOFEEDBACK. Learn RELAXATION training techniques. With these techniques, in conjunction with diet and regular exercise, constipation should improve.
consumer privacy
See
contraception
BIRTH CONTROL.
See
IDENTITY THEFT.
control A feeling of control over people’s lives means that they are directing the outcomes of everyday events. While life is going well, most people do not consciously think about their level of control. However, when that sense of control is threatened, they become aware and this loss of control leads to stress, ANGER, and FRUSTRATION. Issues of loss of control involve situations in which people who could help themselves, do not do so. They may lose motivation because of previous failures or may be experiencing what sociologists call “learned helplessness.” They feel that whatever they do will not make any difference. Their learned response is to not try to gain control over their lives. But they continue to feel the stress of the anger, frustration, and hostility, which may lead to physical problems. The stress in some people’s jobs is caused by no control over the pace of work, or the work environment, or DECISION MAKING. People living in institutions or other such situations are frustrated because they can’t change their environments and feel that things are being done to them or for them. An example is patients in hospitals who feel that their sense of control and AUTONOMY has been taken away from them because of the hospital routine. Other people do not recognize their own options for making decisions and feel trapped by invisible forces. People who always try to please others in an effort to gain validation and selfesteem are an example of this. Those who fear fly-
ing do so because, when they put themselves in the hands of the pilot, they feel totally out of control. Although individuals cannot always control all events happening around them, they can learn healthier responses to these stressful situations. RELAXATION, BREATHING, or BIOFEEDBACK techniques can help a person gain a feeling of control. See also HARDINESS.
coping
The psychological as well as practical solutions that people must find for extremely distressing as well as everyday situations. Examples of these situations are dealing with cancer, caring for an aging relative, readjusting after the death of a loved one, facing unemployment, and dealing with RANDOM NUISANCES. Different individuals develop different ways of coping and learn to adapt their responses and reduce their stress and anxieties. Stone and Porter, writing in Mind/Body Medicine (March 1995), defined coping as “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.” To some, “coping” means getting on with life and letting things happen as they may. To others, it is consciously using the skills they have learned in the past when facing problem situations. Coping can mean anticipating situations, or it can mean meeting problem situations head-on. For example, managers who are able to handle employees in everyday situations become nervous and jittery just anticipating giving a public speech. In a serious medical crisis, some people cannot cope with their own illness but manage to muster strength when they need to care for a loved one. Individuals can learn new coping skills from psychotherapists as well as those who practice alternative or complementary therapies such as MEDITATION and RELAXATION training. Relaxation and deep BREATHING techniques can help overcome the stress involved in a difficult situation. Better Coping for Better Health When Hans Selye (1907–82), an Austrian-born Canadian endocrinologist and psychologist, wrote his landmark book The Stress of Life, he described the GENERAL ADAPTATION SYNDROME. The secret of
102 coronary artery disease health, he said, was in successful adjustment to ever-changing conditions. Research studies have shown that people who cope well with life’s stresses are healthier than those who have maladaptive coping mechanisms. In his book, Adaptation to Life, George Valliant, a Harvard psychologist, summarized some insights about relationships between good coping skills and health. He found that individuals who typically handle the trials and pressures of life in an immature way also tend to become ill four times as often as those who cope well. Stone and Porter reported that coping efforts may have direct effects upon symptom perception and may have indirect effects on physiological changes and disease processes, as well as on mood changes, compliance with physician’s instructions, and physician-patient communication. See also BEHAVIOR THERAPY; COMMUNICATION; EXERCISE; HARDINESS. SOURCES: Locke, Steven, and Douglas Colligan. The Healer Within. New York: Mentor, 1986. Selye, Hans. The Stress of Life. New York: McGraw-Hill, 1956. ———. Stress without Distress. Philadelphia: Lippincott, 1974. Stone, Arthur A., and Laura S. Porter. “Psychological Coping: Its Importance for Treating Medical Problems.” Mind/Body Medicine 1, no. 1 (March 1995).
coronary artery disease
Caused by ATHEROSCLE(hardening) of the arteries that supply blood and oxygen to the heart. The disease is a source of stress to the sufferer as well as those who are caregivers. It is preventable to a great extent by lifestyle modifications and dietary changes. See also CHOLESTEROL; CONGESTIVE HEART FAILURE; HEART ATTACK; HIGH BLOOD PRESSURE; TYPE A PERSONALITY. ROSIS
corporate buyout The purchase of a controlling interest in a company by either the employees or another company. The word originated in the mid1970s when there was a marked increase in company takeovers and tender offers. When corporate buyouts occur, employees are under stress due to the possibility of downgrading of their jobs, dupli-
cation of their job functions, and loss of jobs that may come during and following reorganization. See also DOWNSIZING; LAYOFFS; WORKPLACE.
cortisol
See
DEPRESSION.
cosmetic surgery Procedures performed by plastic and reconstructive surgeons to improve appearance in a healthy person. Many people undergo cosmetic surgery to overcome negative and stressful feelings about parts of their face or bodies. In a society that worships beauty, being beautiful has long been a goal of women of all ages and, more recently, men as well. At the same time, older adults are waging their battles against wrinkles and other signs of aging. Nearly 400,000 cosmetic procedures were performed in 1994. The stress of maintaining looks and appearing younger has created a multibillion-dollar market for cosmetic, clothing, food, and health care products. For plastic and reconstructive surgeons, the increase in patient demand for cosmetic surgery has been both a blessing and a curse. According to the American Society of Plastic and Reconstructive Surgeons, “The 1990s have changed the way the media—and the public—view PLASTIC SURGERY and its practitioners. From the breast implant coverage to health care reform to chemical face peels, the profession has moved farther into the public eye, with all the opportunities—and drawbacks—that entails.” Choosing a Cosmetic Surgeon The consumer considering cosmetic surgery can remove some of the stress from the situation by following a few guidelines. First, find a physician who has a great deal of experience in performing the procedures; be sure the surgeon is certified by the American Board of Plastic Surgery. This certification means that the surgeon has had at least five years of surgical training after medical school, including a minimum two-year plastic surgery residency. To determine the doctor’s experience, talk with the doctor and with other patients and look at the diplomas. A reputable doctor will not only allow prospective patients to interview him/her, but will question them as well as to what their motives are and, if appropriate, offer alternative nonsurgical procedures.
Cousins, Norman 103 New techniques and surgical tools such as lasers now being used for facelifts, liposuction, breast reduction and augmentation, and nose jobs alleviate much of the stress connected to aesthetic surgery and herald a new century in which such procedures will become even more commonplace. See also BODY IMAGE; SELF-ESTEEM. FOR FURTHER INFORMATION:
American Academy of Facial Plastic & Reconstructive Surgery 310 South Henry Street Alexandria, VA 22314 (703) 299-9291 American Society of Plastic and Reconstructive Surgeons 444 E. Algonquin Arlington Heights, IL 60005 (708) 228-9900 Referral Service: (800) 635-0635 SOURCES: Elson, Melvin L., and John H. Harley. The Good Look Book: Today’s Options for Prolonging the Prime of Life. Atlanta: Longstreet Press, 1992. Willis, Jan. Beautiful Again: Restoring Your Image and Enhancing Body Changes. Santa Fe: Health Press, 1994.
co-therapy counseling
See
PSYCHOTHERAPIES.
Many varied professional services available to individuals seeking help in some area of their life, including stress. These services may range from those of a trained social worker to a psychiatrist. Individuals, couples and families can find appropriate counseling services. They may be provided in situations such as a school, the workplace, a hospital, clinic, or a community center. To seek counseling assistance, call a local hospital or look in the yellow pages of the telephone directory under psychologists or psychiatrists. Some listings have the heading “counselors.” There are also many community self-help and SUPPORT GROUPS in which members share their experiences. For participants in these groups, sharing means they are not alone with their problems, and they learn from one another to problem-solve. Before beginning therapy with any counselor, ask what his or her credentials are and whether
they are certified by any state agency or professional board. As with any other professional, some may meet an individual’s needs better than others. Individuals should not be afraid to change counselors if they are not meeting their needs. See also BEHAVIOR THERAPY; MARITAL THERAPY; PSYCHOTHERAPIES.
Cousins, Norman (1915–1990)
American author, professor of medical humanities, and leader in biobehavioral healing. Cousins managed to heal himself of a life-threatening disease and a massive coronary attack. Both of these times, he used his own regimen of nutritional and emotional support systems as opposed to traditional methods of treatment. The experiences are detailed in his books, including Anatomy of an Illness as Perceived by the Patient, a worldwide best-seller, and The Healing Heart: Antidotes to Panic and Helplessness. Cousins is sometimes described as the man who laughed his way to health, a simplified description of the controversial healing method he employed when he was diagnosed in the mid-1960s as having ankylosing spondylitis. This degenerative disease causes the breakdown of collagen, the fibrous tissue that binds together the cells of the body. Almost completely paralyzed and given only a few months to live, Cousins checked himself out of the hospital and moved into a hotel room. While maintaining a positive mental outlook, he took massive doses of vitamin C and exposed himself to high doses of HUMOR, including old movies and books by James Thurber, P. G. Wodehouse, and Robert Benchley. In Anatomy of an Illness, Cousins wrote: “I made the joyous discovery that ten minutes of genuine belly LAUGHTER had an anesthetic effect and would give me at least two hours of pain-free sleep.” In 1980, about 15 years after his major illness, Cousins suffered a near-fatal heart attack in California. According to an article in the Saturday Review, Cousins told his physicians at the UCLA Intensive Care Unit that they were “looking at what is probably the darndest healing machine that has even been wheeled into the hospital.” The article said that “Cousins makes his body a personal laboratory and befriends the society within his skin. He refused morphine; he asked for a
104 covert modeling change in the visiting routine to ensure rest. Gradually he improved.” When facing the treadmill stress test with fear, Cousins realized that his fear was a factor in slowing his progress, so he adopted a more relaxed lifestyle, changed his diet, and specifically avoided stress-producing situations. When he did the treadmill test again, he approached it in a relaxed manner, listened to classical music and comedy tapes, and had a better result. A Saturday Review article commenting on The Healing Heart said that “It was not a medical textbook, but a study of awareness, listening, trust, choice, and intention about the intelligent use of a benevolent, centering will. It is about communication and partnership between the healer and the healed. It addresses as complementary the art of medicine and the science of medicine, the person and the institution, and freedom of choice and professional responsibility. The book affirms hope and belief as biologically constructive forces, with belief guided by knowledge and tempered by reason.” At one point, Cousins interviewed 600 people with malignancies and found that in many cases their disease took a sharp turn for the worse when they received their diagnoses. He determined that a physician can activate the healing process by building up both his or her and the patient’s confidence and creating a partnership for healing. See also ALTERNATIVE MEDICINE; IMMUNE SYSTEM; RELAXATION. SOURCES: Cousins, Norman. Anatomy of an Illness as Perceived by the Patient. New York: Bantam, 1981. ———. The Healing Heart: Antidotes to Panic and Helplessness. New York: Norton, 1983.
covert modeling
Imagining or observing another person performing a behavior or action and then imagining the particular consequences. For example, a person who feels extremely stressed about speaking in public can imagine another person getting up on the stage, delivering a talk, answering questions, and feeling successful about the situation. The next step in the concept is when the individual imagines himself or herself doing the same thing at a reduced stress level. See also BEHAVIOR THERAPY; COVERT REHEARSAL; PSYCHOTHERAPIES.
covert rehearsal
An imagery technique in which an individual in therapy is asked to imagine himself or herself effectively doing a stressful task. The individual may repeat the visualization many times, and consider different alternatives. This procedure often follows COVERT MODELING. The goal of the technique is to motivate the individual to believe that he or she can face the situation or do the task at a reduced level of stress. See also BEHAVIOR THERAPY; COVERT REINFORCEMENT; PSYCHOTHERAPIES.
covert reinforcement A technique used in psychotherapy in which the individual imagines two responses to an action or situation, one stressful and another less stressful. For example, the person who first imagines seeing another give a public speech (COVERT MODELING) and then practices COVERT REHEARSAL (imagining giving the speech), now imagines that the speech has been given and that there was a favorable audience response without an undue level of stress. See also BEHAVIOR THERAPY; PSYCHOTHERAPIES. coworkers
The quality of a person’s work relationships, particularly with colleagues, relates to his/her level of job stress. Colleagues who don’t pull their weight and complain constantly can make work life miserable. Backstabbers, gossips, and tattletalers damage reputations and can bring innocent people’s careers to a halt. One of the stresses relating to the unemployed worker today is lack of companionship. The day-today interactions with coworkers are gone, and the unemployed worker often becomes withdrawn, spending less and less time with peers. On the other side of the coin are the coworkers who are left in the corporation after DOWNSIZING or LAYOFFS have occurred. Research has shown that their productivity is reduced, they develop poor work attitudes and they often seek new positions. Factors influencing these reactions include: when the layoff is seen as unnecessary, when workers receive information about termination in a degrading or unfair way, when criteria used to select workers in a layoff is perceived as politically motivated or biased in any way, and when termination benefits and compensation are not considered adequate. See also CORPORATE BUYOUT.
creativity 105 TIPS FOR AVOIDING STRESS WHEN WORKING WITH TROUBLESOME COWORKERS • Tell them, in a nonconfrontational manner, how their actions affect your work. • Avoid providing the complainer with an audience and the bully with a target. • Consider talking to your supervisor about the problem, but be prepared for possible negative results. • Remember that you cannot change someone else’s behavior, but you can change how you react to that behavior.
crack
See
COCAINE.
creativity
Creativity involves unusual association of ideas or words and ingenious methods of problem solving. It may involve using everyday objects or processes in original ways or may involve using an imaginative skill to bring about new thoughts and ideas. Some creative ideas are ahead of their times and may never be appreciated or are not appreciated until after their creator’s death. These creative people may be stressed by feelings of inadequacy and lack of self-esteem. On the other hand, there are those who overestimate their creativity and feel stress from thinking they are undervalued and underappreciated. Creativity and Work While creativity is strongly associated with the arts, it is equally important in fields such as science, business, or manufacturing. People who try to be creative and cannot, feel stressed. This is particularly true of people who were hired because of their creativity. Fortunately, in corporations today, a free and voluminous flow of ideas is thought to be an important part of the creative process, even though many of the ideas may not be truly creative. Techniques such as brainstorming and other group approaches encourage the flow of ideas. These techniques bring in new people who have never been a part of the creative process and encourage a fresh viewpoint. The Creative Process Biographers and researchers of creative individuals have identified certain stages in the creative
process. Often the scientist or artist identifies an area of work or a project but, after approaching it, feels dissatisfied and returns to less creative endeavors. Suddenly during this incubation period, a solution or artistic concept emerges. It then must be fleshed out, elaborated or tested. Creativity has been found to correlate with certain personality and intellectual characteristics. Although intelligence and creativity are thought to be separate mental gifts (and not all intelligent people are creative), intelligence does seem to be necessary for creativity. Creative people have been found to be leaders and independent thinkers. They are self-assured, unconventional and have a wide range of interests. Since they are frequently involved in their own thoughts and inner life, they tend to be introverted and uninterested in social life or group activities. Passion for their field of work and a sense that what they do will eventually be recognized and make a difference are also qualities that support creativity. The Creativity Theory Many behaviorists have adopted the position that there is no such thing as a creative act, that what appears to be new is, in fact, “old wine in new bottles” or arrived at by luck and random experimentation. For example, Shakespeare created dramatic masterpieces without using original plots. Others have come up with the theory that a necessary element of creativity is a relationship with reality. A work of art may be original, but not truly creative unless it relates somehow to experiences, feelings, or thoughts, even though previously undefined, of the observer. Mental health professionals have been interested in creativity for years. For example, J. P. Guilford (1897–1987), who explored this area in the 1960s, described two areas of thinking: convergent, or narrow, focused thinking, and divergent thinking, which allows the individual to let his or her mind roam and explore a broad spectrum of ideas. Guilford felt that the latter type of thinking was most creatively productive. Under his direction, the Torrance Tests of Creative Thinking were developed at the University of Southern California. Stimulation to increase creativity also is of interest to researchers. It has been found that people’s creativity may increase or decrease according to
106 credit record their environment and work habits. For example, certain people can be more or less productive at work depending on the atmosphere, the time of day and even the clothing they wear. See also BRAINSTORMING. SOURCES: Weisberg, Robert. Creativity, Genius and Other Myths. New York: W. H. Freeman, 1986. Wilmer, Harry A. Creativity: Paradoxes and Reflections. Wilmette, Ill.: Chiron Publications, 1991.
credit record
See
IDENTITY THEFT.
crime, witnessing
People witnessing a crime can be subjected to stress on many levels. First, they may be faced with a decision to come to the aid of the victim. Once the decision for involvement has been made, they may face the stress of being questioned by the police, exposed to threats of harassment from the associates or family of the criminal, and harried by postponement and rescheduling of the trial with no regard for their work schedule and other personal responsibilities. A decision not to become involved is often made. These people may feel that there are other witnesses to the crime, and they want to avoid a difficult and personally dangerous situation. Some of them may later feel the guilt of doing nothing and they will experience extreme stress. Watching a violent crime may also result in POST-TRAUMATIC STRESS DISORDER, with symptoms of anxiety, nightmares, insomnia, and other fears. Recovery can be aided with a variety of PSYCHOTHERAPIES administered by professionals. Victim/witness assistance programs, whose services include psychological counseling, have been initiated in some areas of the United States. During a trial, program administrators may make arrangements for witnesses to get in and out of court buildings with minimum public and media exposure and intervene with the court on behalf of the witness when he or she is a victim of stressful threats or intimidation. See also ANXIETY DISORDERS.
crisis
A turning point for better or worse in an acute disease, or an emotionally significant event or radical change in status in a person’s life. The
stress involved in a crisis situation may result from a combination of the individual’s perception of an event as well as his or her ability or inability to cope with it. Some people will cope with a crisis situation better than others. Crisis intervention is often necessary to provide immediate help, advice, or therapy to individuals with acute stress or psychological or medical problems. Many crisis intervention centers utilize telephone counseling. For example, in cities throughout the United States, there is a SUICIDE hotline for those contemplating ending their lives. In some cases, a RAPE victim’s first step toward seeking professional assistance is to call a rape crisis hotline. When a bombing or shooting occurs in a public place, crisis intervention services are provided for survivors who witnessed the event in an effort to prevent the onset of, or ameliorate, POST-TRAUMATIC STRESS DISORDER (PTSD). The goal of crisis intervention is to restore the individual’s equilibrium to the same level of functioning as before the crisis, or to improve it. Many different types of therapists and SELF-HELP GROUPS provide crisis intervention. Therapy may include talking to the stressed individual and appropriate family members or short-term use of appropriate prescription medications. However, crisis intervention is not a substitute for longer-term therapy. The individual may learn to immediately modify certain environmental factors as well as interpersonal aspects of the situation causing the crisis. Emphasis should be on reducing stress and anxiety, promoting self-reliance and learning to focus on the present. Longer-term therapy is helpful after the individual has regained some degree of composure and COPING skills. See also CRIME, WITNESSING; GENERAL ADAPTATION SYNDROME; SUPPORT GROUPS.
criticism
Comments directed to individuals regarding behavior, appearance, performance, quality of work, or other characteristics that reflect on their SELF-ESTEEM. Criticism may be favorable, but usually is regarded as the opposite of praise and, as such, can be very stressful. Fear of being criticized makes many individuals reluctant to do or try certain activities. For example, when children receive negative criticism
crying 107 regarding singing ability from a teacher, they may carry this message for the rest of their lives. Selfcriticism can be just as harsh. After judging themselves a failure at public speaking, some adults will not try it again. Often, criticism can be stressful for the critic as well. In employment settings, for example, there are supervisors who find it difficult and very stressful to criticize employees. An ability to accept criticism that is appropriate, and then alter behavior associated with that criticism, is considered self-improvement. Children thrive on encouragement, even when it is tinged with criticism, particularly when they receive it from a parent or teacher. On the other hand, some people take criticism very badly, and the stress of the experience results in defensiveness or feelings of helplessness and low self-worth. Constant criticism can lead to an INFERIORITY COMPLEX, which are feelings of inadequacy in most social situations. Constructive criticism should genuinely explain and define what is desirable as well as what is not. Focusing criticism on the task or skill rather than on the person is useful. Comparing children with their siblings should be avoided to prevent further stressful situations. See also ANXIETY DISORDERS; PHOBIAS; SOCIAL PHOBIA. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
crowding The gathering of large numbers of people or animals in a mass. In HANS SELYE’s landmark book, The Stress of Life (1976), he suggested that in humans, crowding may make men more competitive, somewhat more severe and to like each other less, whereas women tend to be more cooperative and lenient and like each other more. Selye speculated that residential crowding in itself does not produce psychological or physical symptoms of STRESS. In fact, under certain conditions, interpersonal contact is supportive, as long as the people know they have the space to get away from each other when they want to. His studies, however, did not reflect such later 20th-century stresses as heavy traffic, high-rise living, air pollution, and noise, associated with contemporary Western society urban life.
See also
AUTONOMY; CONTROL; GENERAL ADAPTA-
TION SYNDROME; PERSONAL SPACE.
cruise ship virus
Vacation cruises are intended to reduce stress and induce relaxation; however, many people either worry about or experience a vexing stomach illness on cruise ships. In June 2004, the cruise industry’s newsletter Cruise Week reported that 1,355 cases of a norovirus-like illness occurred on 12 ships during the first five months of the year. That report was newsworthy because the number was almost double the 700 cases recorded on seven ships during the same period the year before. In June, 2004, 66 passengers on an Alaskan cruise aboard the Island Princess were felled with the stomach illness, after a wider breakout on the ship the week before that affected 425, the industry’s largest recorded incident since 1994. Other ships reporting outbreaks in 2004 included the Norwegian Crown, Holland America’s Veendam and Ryndam, Celebrity’s Zenith and Horizon, Cunard’s Queen Mary 2, Carnival’s Celebration, and Royal Caribbean’s Brilliance of the Seas. Outbreaks made headlines in late 2002 when the disease ran though seven ships, causing 1,340 reported cases.
crying Vocal expression of emotion, accompanied by tears. It is both a cause of stress and a stress reliever, depending on the situation. For example, at funerals, it is a normal response to express GRIEF; at weddings, it is a response to happiness. As a natural reaction based in social custom and personal experience, people cry when they are very sad or very glad. Sometimes, people cry because they cannot cope any longer with stressful situations. There may be stress from pain or from real or anticipated loss of status, security, or friendship. According to William Frey, a biochemist, giving in to a good cry is cathartic. “Emotional tears contain a higher protein concentration than tears that are shed when the eye is irritated by onion vapor. We are quite literally crying it out, removing chemicals that have built up in the body due to stress.” Certain emotional disorders include crying as a symptom. In a depressive state, an individual may cry easily and without cause. In severe DEPRESSION,
108 cubicles an individual may lose the capacity to cry or weep, despite a feeling of profound sadness. In a newborn baby, crying serves to inflate the lungs and clear secretions from both the eyes and the lungs. For them, hunger and pain stimulate crying. See also COLIC.
cubicles
Workspaces defined by walls, usually not reaching to the ceiling. Often the walls are of soft material intended to deaden noises. Office workers in cubicles may experience stress because their space is small and crowded, they lack privacy, and they overhear conversations and noise from adjacent cubicles. Small plants may help to improve the cubicle worker’s mood. The addition of a small table lamp, desk lamp, or floor lamp will also help. If the area uses fluorescent lights, taking a walk outside each day will increase exposure to natural light and may help reduce effects of stress. People who work in a cubicle should try to organize their workspace using file cabinets, drawers, and bookshelves. Put items you work with frequently closer at hand and put others away for storage. Clutter may include too many personal items, such as photos or toys. These items pose a distraction. Many offices use grays, beiges, and other neutral colors for cubicle walls. A cubicle can be brightened by tacking a few yards of colorful fabric on the walls. Adding a throw rug can also add some color to a cubicle. See also FENG SHUI; PERSONAL SPACE; STRESS; WORKPLACE.
cults
Groups of people who frequently have a religious philosophy and are often started by religious leaders or self-appointed, pseudoreligious individuals. Cults also may have social and political reform or terrorism as their goals. Family and friends of cult recruits are usually very stressed by their affiliations. Some new cult members sever all close ties and disappear without warning. Cults share certain similarities. They seem to have arisen from a time period in the 1960s when
social values were questioned and considered inadequate. Depending on the cult, new recruits are people who may not be emotionally stable, may lack family and close friends, and are searching for relief from the confusion and emotional stress of modern life. Cult leaders welcome new members with an attitude of caring and acceptance, creating a strong emotional experience for them. The moral behavior and attitudes of the cult are dictated by strong peer pressure. Members are made to feel that there are continually higher levels of commitment or sanctity that they can attain. Leaving or questioning the values of the group are looked upon as evil or sinful. Members are reminded that to return to the outside would be to return to the confusion and stress they had formerly faced. Deprogrammers who specialize in trying to extricate cults members are often hired by their families. These deprogrammers may use force or coercion to remove members from the cult environment, and then implement BRAINWASHING techniques similar to those used by the cults in their training. FOR FURTHER INFORMATION:
Cult Hotline and Clinic 1651 Third Avenue New York, NY 10028 (212) 860-8533 Task Force on Cults 711 Third Avenue, 12th Floor New York, NY 10017 (212) 983-4977 SOURCES: Johnson, Joan. The Cult Movement. New York: Franklin Watts, 1984. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001.
culture shock cyberstress
See
ACCULTURATION; MIGRATION.
See CHANGING NATURE OF WORK; COM-
PUTERS; ELECTRONIC DEVICES.
D dance therapy
Dance therapy permits release of stress and expression of emotion through body movement. It can be used effectively with a wide variety of individuals, from those who have mild stress symptoms to those who have severe mental health disorders. Many individuals who will not speak about their stressful concerns will indicate something about them with movement. Therapists who use this technique are usually trained in dance and body movement as well as psychology. Dance therapy alone does not relieve symptoms of extreme stress, but may be used in conjunction with other therapies or medication. See also ALTERNATIVE MEDICINE; CREATIVITY.
TIPS TO REDUCE STRESS IN DATING • Know something about the person’s background before the date. • Accept “blind” dates arranged only by people you know and trust. • Seek out people who treat others with respect. • Date people who agree with your values. • Avoid people who are overly critical or abusive.
wait until their college years. There are often issues of SELF-ESTEEM, and many are often held back from dating because of negative feelings about themselves. Others may have the additional stressors of CRITICISM of their dates by their parents. Additionally, peer pressure can make young people drink, smoke, or enter sexual relationships before they are ready and they may suffer the stresses of pain and guilt because of their actions. Individuals who are divorced or widowed find themselves back in the dating scene. Many of the young people’s issues also hold true for older people, such as concern about self-esteem and appearance. For single parents, dating presents particular stresses as young children often “screen” their parents’ dates. Some children ask embarrassing questions, such as “Are you going to marry my Daddy?” Despite the stresses inherent in dating, the process allows people a socially acceptable way of getting acquainted with others.
FOR FURTHER INFORMATION:
National Dance Association 1900 Association Drive Reston, VA 22091 (703) 476-3436 Center For Dance Medicine 41 East 42nd Street, Room 200 New York, NY 10017 (212) 661-8401
date rape
See
RAPE.
date rape drugs
See
RAPE.
dating
A social process by which individuals become acquainted with each other and develop a RELATIONSHIP that may lead to friendship, romance, a sexual relationship, and/or marriage, is stressful for participants of all ages. For young people, dating is a rite of passage from childhood to adulthood. Some young people begin dating during their teen years while others
Internet Dating Many Web sites promote introductions of people via their computers. There are Web sites for certain interest groups, such as graduates of certain colleges, religious groups, and affinity groups, such as music or book lovers. While many people meet
109
110 day care compatible others this way, Internet dating involves particular stresses not inherent in traditional dating. For example, first introductions, read on computer screens, may include false information and exaggerated claims. The photo provided on the Web site may be very old or actually of someone else. There have been instances where young people are deliberately lured into unwholesome situations by someone on the Internet giving false identification about their gender or age. See also DIVORCE; INTIMACY; PUBERTY; REMARRIAGE. SOURCE: Vedral, Joyce L. Boyfriends; Getting Them, Keeping Them, Living without Them. New York: Ballantine, 1990.
day care System of caring for children or other dependents in other people’s homes, in churches, and in other community centers while parents work. Changes in the economy, employment, and family patterns during the last years of the 20th century have made day care an important yet stress-filled issue for many people. Today, when both parents need or want to work, they are faced with the dilemma of seeking day care. Some parents, traditionally the mother, feel some degree of guilt about seeking day care for their children. However, as a practical matter, it has become more difficult to support a family on one income. Additionally, wives and mothers who are not forced to work for financial reasons have been encouraged by contemporary media and the Women’s Movement to believe the position of housewife and mother is not rewarding. Still others, faced with the specter of a high divorce rate, may want to keep up their skills and have their own employment benefits “just in case.” For the single working parent with small children, some type of child care is a necessity. Many children whose parents work are still cared for by a relative or sitter in their own home; however, the day-care alternative does offer certain benefits. Children learn to socialize with their peers before entering school. Day care may offer educational programs, toys, and equipment. Daycare centers are licensed and run by professionals. However, there have been some cases of abuse and negligence in day-care centers. Parents should take extreme care in choosing a day-care facility by checking it out with local authorities, interviewing
families that have children at the facility, and closely monitoring the facility when their children are enrolled. Social mobility has also increased the need for some type of daytime child care. At one time, stayat-home mothers depended on grandmothers when they needed child care. Now, grandmothers may be hundreds of miles away and may be working themselves. To meet the needs of sick children, some daycare centers have separate areas. Also, some daycare centers specifically for sick children have been set up either independently or in pediatric wards of hospitals. Among some employers, day care has become a corporate responsibility. A day-care center in the mother or father’s place of employment solves transportation problems and allows the parent to visit with the child during the day. The Stride Rite Corporation in Cambridge, Massachusetts, is an example of a company that started a program that combines for care small children and elderly dependents of employees in the same facility. Studies of the effect of day care on children have not shown that children suffer any real difficulties from participation in day care and that, in some cases, children from deprived backgrounds benefit from day care; however, putting children in the hands of CAREGIVERS may lessen the extent to which mothers can influence their child with their own values and standards. Day Care for the Elderly At the end of the 20th century, a trend in day care has been the establishment of facilities for care of elderly persons, whose condition does not necessitate institutional care, but who need assistance that their family cannot provide during the day. Although many midlife children experience the stress of guilt about placing an elderly parent in day care, they understand that there are benefits. For example, senior day care offers socialization, learning opportunities, and encouragement of better nutritional patterns for the midday meal. See also AGING; DIVORCE; ELDERLY PARENTS; WORKING MOTHERS. SOURCES: Deutsch, F. “Day Care Centers.” In Corsini, Raymond, ed., Encyclopedia of Psychology. Vol. 1. New York: Wiley, 1984.
deafness 111 Edmundson, Brad. “Where’s the Day Care?” American Demographics 12 (July 1990): 17–19. Gallo, Nick. “Too Sick for School?” Better Homes and Gardens, September 1990, 62–65. Kantrowitz, Barbara. “Day Care Bridging the Generation Gap.” Newsweek, July 16, 1990, 52.
daydreaming
When people daydream, they are awake and experiencing a pleasant reverie, usually of wish fulfillment. Daydreaming occurs during idle moments or when people are unconcerned about the activity around them. In these ways, daydreaming, which may be a form of stress relief, differs from serious, logical, and controlled thinking which is done in a more deliberate manner. Some people may daydream about developing great ideas or inventions, or taking new directions in life; in daydreaming, their mind is free to roam without inhibition and self-censorship. Different views of work and family situations are often developed during moments of daydreaming, because daydreams are usually concerned with ends, not means. People of all ages daydream. Young and old may be caught staring out the window, putting down a book and gazing at nothing in a trance-like state. Unless they share their dream, it is difficult to tell if they are lost in their reveries or just bored. See also BOREDOM; CREATIVITY.
deadlines Most people have experienced stress in meeting or failing to meet a date or time at which something must be done. Once they have fallen behind, it is difficult to catch up. They find that rushing tends to add to the stress and decrease effectiveness. Ineffectiveness leads to frustration. Some people become moody and emotional and blame themselves or others for the deadline failure. The key to avoiding the stress produced by deadlines is setting realistic time schedules, enlisting the help needed when deadlines go awry, and negotiating new deadlines when it appears that, for one reason or another, deadlines are going to be missed. For individuals to keep a positive outlook, they should break deadlines down to a series of small steps. As each step is completed, they will feel some success, and that success, in turn, will keep them motivated toward their final goal. See also AUTONOMY; CONTROL; WORKPLACE.
deafness Loss of hearing, either complete or partial. Hearing loss becomes a stressor for many individuals who begin to lose their hearing and try to draw attention away from their loss or cover it up. While hearing aids help many individuals, some are embarrassed to wear them or find them uncomfortable. Some people associate loss of hearing with AGING, and hence postpone getting a hearing aid to preserve their image of youthfulness. Deafness and hearing loss is a major societal problem. Estimates are that about a quarter of a million persons in the United States are completely deaf, and about three million have major hearing problems. Causes of Hearing Difficulties Hearing difficulties are related to many things, including problems within the ears themselves, overall body health, emotions and external environment. People tend to shut off certain sounds at certain times and will hear only what is interesting or significant. For example, a man may hear all of a sports newscast but not hear a request to fix something around the house. In some nursing homes, it has been observed that individuals say they cannot hear, but when asked whether they want ice cream they are able to answer. The term psychogenic deafness pertains to such mental “shutting off” of hearing carried to an extreme. Some patients may have such a strong subconscious desire not to hear that they become completely deaf, yet have physically normal ears. The term psychosomatic deafness relates to situations in which actual physical deterioration occurs in the ear as a reaction to a mental or emotional problem. There also may be combinations of both physical and psychologically induced hearing difficulties. See also DISABILITIES. FOR FURTHER INFORMATION:
American Speech-Language-Hearing Association 10801 Rockville Pike Rockville, MD 20852 (800) 638-8255; (800) 638-TALK SHHH (Self-Help for Hard of Hearing People, Inc.) 7910 Woodmont Avenue, Suite 1200 Bethesda, MD 20814 (301) 657-2248
112 death death
One of the most stressful life experiences is the death of a spouse, parent, child, close relative, or beloved friend. Another serious source of stress is when we are told that our own death is imminent. On a scale of life-stressing events, death rates a top position. People of all ages fear death as well as the process of dying. Included in the specific sources of stress related to death are shock, GRIEF, necessity for making funeral arrangements, and perhaps the practicalities of handling the deceased person’s personal affairs. How people deal with the stressors brought on by another’s death vary. Many factors influence individual responses. For example, when a series of losses have occurred or if the death is sudden and unexpected, the reaction may be more extreme. If the deceased had been ill and the survivor regards the death as the loved one’s liberation from pain and suffering, the grief may be somewhat tempered with those thoughts, although the loss nevertheless creates an irreplaceable void in the survivor’s life. Making funeral arrangements is extremely stressful. In the midst of extreme emotional upheaval, the survivor is faced with choosing funeral arrangements, selection of a casket, heavy expenses, and contacting friends and relatives. Calling upon relatives or friends to assist in these tasks can lighten the burden. The stress of making funeral arrangements can be alleviated somewhat by developing a pre-need plan, which may include selection of type of funeral and burial, selection of casket, and written wishes for a service. In some cases, the individual herself/himself makes these arrangements, while these arrangements can also be made by another when a death seems imminent. Making these arrangements ahead of time relieves some of the stress during a heavily emotion-laden time. Mourning, the period of grief that follows the loss of a loved person, is a stressful period. The mourner may have a period of feeling numb. Gradually, one’s personality reestablishes itself, but during mourning the intensity of grief may lead to psychological disturbances, such as depression, and physiological disturbances, such as headaches or digestive disturbances. The mourner may withdraw from others and be almost completely preoc-
cupied with thoughts of the loss, spending a great deal of time recalling experiences, meanings, and the emotional significance of the lost relationship. To help a grieving person, friends should encourage the survivor to express emotions and talk about the deceased. It is important for the survivor to maintain adequate nutrition and do some physical exercise during the grief process. A strong body contributes to clearer thinking and an improved emotional state. Encourage the person to stay involved with family and friends and to reconnect with familiar routines and interests. Those who have lost a spouse need to begin to learn to do the things for themselves that their spouse may have done before. This may mean learning new skills, such as cooking, maintaining the car, balancing the checkbook, and paying the bills. As one does these things, a new and healthy sense of mastery over life can be gained. When facing the stressors brought on by the death of a loved one, many people find relief in their personal faith, PRAYER, or SUPPORT GROUPS. Facing One’s Own Death When one is faced with the fact of his own approaching death, reactions, and sometimes those of family members, may follow a pattern. Many people go through a serious of emotional stages at such times. The initial reaction is denial, which usually lasts a short time in a mentally healthy person. After the initial shock, the patient becomes angry and asks, “Why me?” If these feelings cannot be expressed, the anger may turn inward and the patient may become extremely depressed. The next stage is negotiation, and one may try to make a deal with the doctors or with his or her God hoping that if he or she cooperates or devotes time to noble causes, he or she will survive. As the patient becomes aware that demise is inevitable, he or she will admit what is happening and either give up to hopelessness or try to discover some sense of meaning and purpose. Next comes a stage of commitment, characterized by acceptance; at this point, many patients find new courage. As death nears, one has either a sense of fulfillment or a feeling of forlorness and depression. If one has adequately worked through the first stages and reacts with fulfillment, one’s last moments can be peaceful and tranquil.
death 113 Ethical, Moral, and Legal Aspects Death is an ethical and legal issue and how people die can be stressful for health care professionals as well as the individuals concerned and their families. Some patients who are near death may ask for a death-inducing potion or instrument. Physicians are stressed by the dilemma of providing assistance in such cases. There have been instances in which family become involved in a loved one’s death, sometimes incriminating themselves in subsequent unpleasant legal situations. The question of assisted suicide is both a moral and legal issue. Legal definitions of death vary, causing stress for family members, physicians, lawyers, and courts. At one time death was simply when the heartbeat and breathing stopped. Now it is recognized that the brain is the basis for life. People whose hearts and lungs have stopped working can be maintained for years on machines, but no one is really “alive” when they are brain dead. Brain death means an unconscious state, in which the person has no reflexes and cannot breathe or maintain a heartbeat. The electroencephalogram (EEG) of the person would be flat, without any regular oscillations indicating function of the brain. Brain death occurs naturally within a few minutes after the heart stops, because oxygen necessary for life is not carried through the blood to the brain. In most states a physician must certify death, and indicate the time, place, and cause. In some cases, circumstances of death play a major role in insurance payments; when there are suppositions of homicide or SUICIDE, the death takes on additional stressful dimensions for the family. In the latter part of the 20th century, many individuals choose the place for their death. Some who have terminal illnesses opt to go home, rather than stay in the hospital with its impersonal surroundings. Advance Directives and Dying with Dignity While medical science has created ways to prolong life even in terminal cases, an increasing number of people are beginning to take charge of their own deaths by advance directives so that they will not be kept alive on respirators or by other artificial means. On these legal documents, they can specify the types of life support systems they do and do not want. For example, one man may say he will not
tolerate being tube-fed when he can no longer keep food down in the normal way, while another will want nutrition provided but not assistance in breathing. This permits a physician to omit heroic treatment efforts without civil or criminal liability. “Dying with dignity” is a phrase that gained popularity during the 1980s and 1990s when high technology enabled health care practitioners to maintain terminally ill people on life support systems. Wanting to “die with dignity,” individuals can plan ahead by executing a document known as an advance directive, in which they make treatment wishes known while still healthy. In 1991, the federal Patient Self-Determination Act was enacted, under which health care providers must give patients information about advance directives, including living wills and durable power of attorney for health care. Living will. A living will allows people to specify when and under what conditions they want treatment to be withheld, should a terminal illness be suffered. They can spell out, for example, that if an irreversible coma occurs, they do not want heroic lifesaving measures to be taken. In some states, the living will must be signed by the person executing it, as well as two witnesses who are at least 18 years old. When the physician determines and notes in the medical record that the patient has met four specific conditions, a living will goes into effect. The four criteria are that the patient has a condition that is terminal, incurable, and irreversible, and death is imminent. Additionally, some state laws regarding living wills do not recognize the withdrawal of hydration and nutrition. Individuals who do not wish fluids and nutrition to be administered when they meet the four conditions required for a living will, either cross those items off from the living will document or execute a durable power of attorney for health care, spelling out this wish. Durable power of attorney for health care. This document allows people, as principals, to appoint another person, known as the agent, to make medical care decisions in case they become mentally or physically incompetent. The document permits one to determine at what point the power of attorney becomes effective and the scope of the agent’s decision-making powers. Durable powers of attor-
114 decision making ney enable people to give very specific directions about what treatment they want and do not want. Advance directives may be revoked at any time while one is still competent. If it is necessary to revoke a durable power of attorney after individuals become incapacitated, legal action may be necessary. Advance directives become part of the permanent medical record. However, health care providers are not bound to carry out an advance directive that conflicts with state legislation, and it is important for concerned individuals to check the laws of each state involved for optimal peace of mind. See also END-OF-LIFE CARE. SOURCES: Kübler-Ross, Elisabeth. On Death and Dying. New York: Macmillan Company, 1996. Logue, Barbara. Last Right: Death Control and the Elderly in America. New York: Lexington Books, 1993.
decision making
Some decisions are made easily, while others are arrived at after considerable struggle. Decision making is stressful because it involves addressing alternatives, options, and possibilities for reassessment at a later time. The most important decisions people can make usually focus on their health and well-being, affect other people, involve large amounts of money, and require risk taking. Because many people are uncomfortable taking risks, doing so many generate stress and, in turn, that stress can interfere with making the best decisions. Information used in making decisions is extremely important. How people perceive a situation, past experiences with like situations, as well as their own background and culture, play a large part in the decision-making process. Problems may occur when complete information is not gathered or not carefully analyzed in terms of where it is has come from. See also COPING; GENERAL ADAPTATION SYNDROME.
defense mechanisms
Part of an unconscious mental process that individuals use to reach compromise solutions with stressful problems. Individuals have a wide variety of defense mechanisms, ranging from projection, which is blaming someone else for one’s situation, and rationalization, which is justifying questionable behavior by defending its propriety, to
sublimation, which is rechanneling energy into creative projects. DENIAL is another defense mechanism. The presence of pathological denial (for example, of a drinking problem) is often seen in people with alcoholism or substance abuse problems. In cases of extreme child abuse, dissociation (splitting of one’s mind from the physical circumstance) becomes a defense mechanism. While defense mechanisms can be helpful in coping with daily life, excessive use of such devices and dependence on them can lead to higher levels of STRESS for the individual. In follow-up studies of the Harvard University class of 1934, Dr. George Vaillant found that, though virtually all of his subjects had significant life crises, those who overcame them tended to have “mature” defenses such as suppression (the capacity to focus on only the most important issue at the time, suppressing thought or worry about other problems until the one of high priority is solved) and a good sense of HUMOR. Those who were overwhelmed by the stresses of life crises tended to employ “less mature—more primitive” (blaming others) and denial (not admitting the presence of a problem to oneself). See also COPING; GENERAL ADAPTATION SYNDROME.
defibrillators (automated external defibrillator; AED) Portable devices used by emergency medical personnel on cardiac arrest victims. In recent years the portable devices have been available in many public places, including office buildings, airports, and restaurants. The availability of the devices relieves stress for some persons who may fear having a cardiac arrest while they are far from help. More than 80 percent of cardiac arrests occur in the home, with 60 percent of them witnessed by a family member or others. The potential for saving lives with home AEDs is huge. In November 2002, the U.S. Food and Drug Administration (FDA) approved an AED designed by Phillips Electronics for home use. Also, since 2004 Medicare has covered the cost of home AEDs for individuals with certain heart conditions. Each year about 250,000 Americans collapse and die of cardiac arrest; the survival rate is about 5 percent. During cardiac arrest, the rhythm of the heart suddenly becomes erratic and the heart can-
depression 115 not pump blood effectively. A defibrillator can restore the heart’s normal rhythm with a jolt of electricity, but must be used within the first few minutes of collapse. The AEDs have voice cues and visual prompts. They deliver a shock only if they detect a life-threatening heart rhythm. A study of use of AEDs is underway by the National Heart, Lung and Blood Institute. See also HEART ATTACK. FOR FURTHER INFORMATION:
National Heart, Lung and Blood Institute 9000 Rockville Pike Building 31 #5A52 Bethesda, MD 20891-2486 (301) 496-5166 (302) 402-0818 (fax) http://www.nhlbi.nih.gov
denial A DEFENSE MECHANISM in which individuals do not admit to themselves that a problem or event produces STRESS and ANXIETY. Additionally, a denial of a situation by some people can be a source of stress to others. See also CHRONIC ILLNESS; COPING; ELDERLY PARENTS; GENERAL ADAPTATION SYNDROME. dentists
Many people experience stress when going to a dentist or even thinking about it. In fact, many people are so fearful of dentists and dentistry that they wait until they have a severe toothache or other dental problem before seeking help. Stress relating to dentistry is fairly common. According to the American Dental Association, 35,000,000 Americans experience moderate to high anxiety about dentistry. Estimates are that possibly 12,000,000 people experience such severe anxiety that they avoid going to the dentist, some for many years. Some people may have had bad experiences in a dental chair as a child and developed a fear of dentistry. Others are afraid of pain and blood, of having a shot, or of the sound of the dentist’s drill. Others fear being out of CONTROL while seated in the dental chair. Some are truly dental phobics and experience queasy feelings in their stomach, trembling hands, sweaty palms and increased pulse rate; others may fear having a panic attack while in the chair.
Fears surrounding dentistry that are most frequently expressed by individuals include (in descending order) the injection needle, seeing the local anesthetic syringe, feeling vibrations from the drill in their mouths, the dentist using a probe to examine their teeth, seeing the dentist walk in, being taken into the dental chair, hearing the drill sounds while in the waiting room, entering the waiting room, driving to the dentist’s office, seeing the calendar showing one day left before an appointment, calling for an appointment, and being reminded that a dental appointment is needed. Managing Dental Stress Many people overcome their stressful feelings with complete explanations of procedures that will be done, how anesthetics will be administered, and of how long the procedure will take. Knowing that they can ask the dentist to stop a procedure for a moment helps many people feel more CONTROL about their situation. Some individuals choose to use deep BREATHING and RELAXATION techniques, including their own audio tapes, BIOFEEDBACK devices, or HYPNOSIS. BEHAVIOR THERAPY helps many who are phobic about dentistry. See also ANXIETY DISORDERS; PANIC ATTACKS AND PANIC DISORDER; PHOBIAS. FOR FURTHER INFORMATION:
American Dental Association 211 East Chicago Avenue Chicago, IL 60611 (312) 440-2500
depression
A mood or AFFECTIVE DISORDER characterized by a wide range of symptoms, including hopelessness, helplessness, personal devaluation, and extreme sadness. Some depressions are marked by extreme stress, anxiety, withdrawal from others, and changes in sleep patterns. The person suffering from depression may exhibit lethargy or agitation, loss of appetite or compulsive eating, loss of sexual desire, an inability to concentrate and make decisions, exaggerated guilt feelings, and thoughts about SUICIDE. Depression causes stress for family members as well as the sufferer. Symptoms may change or increase over days or weeks. Depressed persons may withdraw from human contact but not admit
116 depression to symptoms. Others are so disabled by their condition that they cannot call a friend, relative, or medical help. If another person calls a doctor for them, they may refuse to go because they do not believe that they can be helped. Many depressed persons will not follow a doctor’s advice, and may refuse help and comfort. Persistence on the part of family and friends is essential, although stressful, because in many cases depression is the illness that underlies suicide. Defining Depression The term depression applies to a condition on a continuum of severity; it can be a temporary mood fluctuation, a symptom associated with a number of mental and physical disorders, or a clinical syndrome encompassing many symptoms, such as major depression or dysthymic disorder. Clinical depression refers to a depression that lasts for more than a few weeks or includes symptoms that interfere with job performance and the ability to handle everyday decisions and routinely stressful situations. Clinical depression is a term that overlaps with the terms major depression, dysthymia, unipolar depression, and exogenous depression. SEASONAL AFFECTIVE DISORDER. Some individuals have mood symptoms related to changes of season, with depression occurring most frequently during winter months and an improvement in the spring. Many of these individuals experience periods of increased energy, productivity, and even euphoria in the spring and summer months. This type of depression often responds well to light therapy. Melancholia. Melancholia is a severe form of depression that may originate without any precipitating factors, such as stress. This is in contrast to a reactive depression, which occurs after some stressful life event such as loss of a job or divorce. Age of Onset and Incidence People of all ages can become depressed, although major depressive episodes peak at age 55 to 70 in men and at age 20 to 45 in women. About 20 percent of major depressions last two or more years, with an average of eight months. About half of those experiencing a major depression will have a recurrence within two years. Estimates are that 2 percent to 3 percent of men and from 4 percent to 9 percent of women in the
United States suffer a major depression. The lifetime risk may be as high as 10 percent for men and 25 percent for women. Unfortunately, about 66 percent of those who suffer from depression fail to recognize the illness and do not seek treatment. Some individuals may have only one episode of clinical depression during their lifetimes. Others have episodes that are separated by several years or suffer clusters of episodes over a short time span. Between episodes, such individuals function normally. However, 20 percent to 35 percent of sufferers have chronic depression that prevents them from functioning totally efficiently. For these people, it is a recurrent disorder that may require maintenance on medication to prevent additional episodes. Depression in Older Adults Of the nearly 35 million Americans age 65 and older, an estimated 2 million have a depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder) and another 5 million may have subsyndromal depression, or depressive symptoms that fall short of meeting full diagnostic criteria for a disorder. Subsyndromal depression is especially common among older persons and is associated with an increased risk of developing major depression. In any of these forms, however, depressive symptoms are not a normal part of aging and are a constant source of stress. In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, they tend to be persistent and to interfere significantly with an individual’s ability to function. Depression often occurs with other serious illnesses such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. Because many older adults face these illnesses as well as various social and economic difficulties, health care professionals may mistakenly conclude that depression is a normal consequence of these problems, an attitude often shared by patients themselves. These factors together contribute to the underdiagnosis and undertreatment of depressive disorders in older people. Depression can and should be treated when it occurs along with other illnesses, because untreated depression can delay recovery from or worsen the outcome of these other illnesses. Research has revealed varying patterns of clinical and biological features among older adults with depression. As compared to older persons
depression 117 SIGNS AND SYMPTOMS OF DEPRESSION Psychological • Loss of interest • Unexplained anxiety • Inappropriate feelings of guilt • Loss of SELF-ESTEEM • Worthlessness • Hopelessness • Thoughts of death and suicide • Tearfulness, irritability, brooding Physical • Headache, vague aches and pains • Changes in appetite and changes in weight • Sleep disturbances • Loss of energy • Psychomotor agitation or retardation • Loss of libido • Gastrointestinal disturbances Intellectual • Slowed thinking • Indecisiveness • Poor concentration • Impaired memory
whose depression began earlier in life, those whose depression first appears in late life are likely to have a chronic course of illness. Additionally, there is growing evidence that depression beginning in late life is associated with vascular changes in the brain. Both antidepressant medications and shortterm psychotherapies are effective treatments for late life depression. Existing antidepressants are known to influence the functioning of certain neurotransmitters in the brain. The newer medications, chiefly the selective serotonin reuptake inhibitors (SSRIs), are generally preferred over the older medications, including tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), because they have fewer and less severe potential side effects. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another. According to the National Institute of Mental Health, research has shown that certain types of short-term psychotherapy, particularly cognitive-
behavioral therapy and interpersonal therapy, are effective treatments for late life depression. Additionally, psychotherapy alone has been shown to prolong periods of good health free from depression. Combining psychotherapy with antidepressant medication, however, appears to provide maximum benefit. Causes of Depression Many factors can lead to depression, including a family history of depression, psychosocial stressors, diseases, alcohol, drugs, and anxiety disorders. Individuals who have personality disorders, especially obsessive-compulsive, dependent, avoidant, and borderline personality disorders, may tend to be more susceptible to depression than other individuals. Psychosocial factors. Depression can come from an individual’s lack of confidence in his or her interpersonal skills, overdependency on others, perfectionism, unrealistic expectations, and psychosocial events, such as the death of a spouse, loss of a job, or, for some, the stresses of urban living. Environmental influences. Researchers view depression as the result of an interaction of environmental and biological factors. Historically, depression has been viewed as either internally caused (endogenous depression) or externally related to environmental events (exogenous or reactional influences). Major changes in the individual’s environment, such as a move or job change, or any major loss, such as a divorce or death of a loved one, can bring on depression. Feeling depressed in response to these changes is normal, but when depression lasts over one month and interferes with effective functioning, treatment can be helpful. Some environmental factors relating to depression include being unemployed, elderly, alone, poor, and having financial problems. Illness. Psychological stressors caused by chronic illness can lead to depression. For example, a debilitating disease that severely restricts usual lifestyle or any illness that impinges on cerebral functioning and impairs blood flow to the brain can produce depression. Such illnesses may include adrenal cortex, thyroid, and parathyroid dysfunctions, and many neurologic, metabolic, and nutritional disorders, as well as infectious diseases.
118 depression Medications. Some medications can cause depression. For example, during the 1950s, doctors learned that some people taking reserpine, a medication for high blood pressure, suffered from depression. Since then, depression has been noted as a side effect of some tranquilizers and hormones and, of a number of medications. However, alcohol is more likely to cause depression than any medication. Social learning theory. Stress can disrupt involvement with others, resulting in less positive reinforcement, which in turn leads to more negative self-evaluation and a poor outlook for the future. Depressed people view themselves and their world negatively; this leads to a further sense of low selfworth, feelings of rejection, alienation, dependency, helplessness, and hopelessness. Cognitive theory. Unrecognized negative attitudes toward oneself, the future and the world can result in feelings of failure, helplessness, and depression. Especially under stress, such attitudes may activate a prolonged and deepening depressive state. Negative attitudes are usually distorted; learning what they are can help reverse both depression and a tendency for future depression. Interpersonal theory. This theory emphasizes the importance of social connections for effective functioning. An individual develops adaptive responses to the psychosocial environment at an early age. When early attachment bonds are disrupted or impaired, the individual may be vulnerable later on to depression. An example is a young child who loses a parent to death or through divorce. Psychoanalytic theory. A psychoanalytical position regarding depression is that a loss, or a real or perceived withdrawal of affection in childhood, may be a predeterminant for depression in later life. Other theories suggest that unrealistic expectations of self and others and loss of self-esteem are essential components leading to depression. Depression that arises following a loss may result from failure to fully come to terms with the reality of the loss. Genetic factors. Some individuals may be biologically predisposed to develop depression, based on genetic factors that researchers do not yet fully understand. There are genetic markers that indicate susceptibility to manic-depressive illness, and there has been considerable research in the last decades of the 20th century focused on under-
standing the biochemical reactions influenced by these genes. Evidence indicates that depression runs in families; among more severe depressives, family is a more significant factor. For example, if one identical twin suffers from depression or manic-depression, the other twin has a 70 percent chance of also having the illness. Research studies looking at the rate of depression among adopted children support this finding. Depressive illnesses among children’s adoptive family have little effect on their risk for the disorder; however, among adopted children whose biological relatives suffered depression, the disorder is three times more common than the norm. Neurotransmitter theory. Recent research indicates that people who have depression have imbalances of NEUROTRANSMITTERS, natural biochemicals that enable brain cells to communicate with each other. Biochemicals that often are out of balance in depressed people include SEROTONIN, NOREPINEPHRINE, and dopamine. An imbalance of serotonin may cause anxiety, sleep problems, and irritability. An inadequate supply of norepinephrine, which regulates alertness and arousal, may contribute to fatigue and lack of motivation. Dopamine imbalances may relate to a loss of sexual interest and inability to experience pleasure. Researchers continue to find other neurotransmitters that may be important in clinical depression. Cortisol. Another body chemical that may be out of balance is cortisol, a hormone produced by the body in response to extreme cold, fear, or anger. In most people, cortisol levels in the blood peak in the morning, then decrease later in the day. In people who have depression, however, cortisol peaks early in the morning and does not level off or decrease in the afternoon or evening. Psychotherapies for Depression Estimates are that between 80 percent and 90 percent of all depressed people can be effectively treated for depression by a variety of types of therapist. In general, therapists use “talk” treatment to try to understand the individual’s personal and social relationships that may have caused or contributed to the depression. Depression, in turn, may make these relationships more stressful. Psychoanalysis. Treatment of depression with psychoanalysis is based on the theory that depres-
depression 119 sion results from past conflicts pushed into the unconscious. Psychoanalysts work to help the patient identify and resolve past conflicts that led to depression. Short-term psychotherapy. In the mid-1980s, researchers reported effective results of short-term psychotherapy in treating depression. They noted that cognitive/behavior therapy and interpersonal therapy were as effective as medications for some depressed patients. Medications relieved patients’ symptoms more quickly, but patients who received psychotherapy instead of medication had as much relief from symptoms after 16 weeks, and their gains may last longer. Data from this and other studies may help researchers better identify which depressed patients will do best with psychotherapy alone and which may require medications. Behavior and cognitive therapy. These therapies are based on the understanding that people’s emotions are controlled by their views and opinions of themselves and their world. Depression results when individuals constantly berate themselves, expect to fail, make inaccurate assessments of what others think of them, CATASTROPHIZE, and have negative attitudes toward the world and their future. Therapists use techniques of talk therapy to help the individual replace negative beliefs and thought patterns with positive ones. Electroconvulsive therapy (ECT). Use of ECT to treat depression declined in the last two decades of the 20th century as more effective medications were developed. However, ECT is still used for some individuals who cannot take medications due to their physical condition, or who do not respond to antidepressant medication. ECT is considered as a treatment when all other therapies have failed or when a person is suicidal. If psychotherapy is not helpful or the depression is at such a severe level that there is a loss of work or of function, or persistent and increasing suicidal ideation over one to three months, medications may be needed to lift the depression in conjunction with therapy. Pharmaceutical Approach to Treating Depression Effectiveness of medication depends on overall health, metabolism, and other unique characteristics. Results are usually not evident right away; antidepressant medications usually become fully
effective in about 10 to 20 days after an individual begins taking them. Approximately 70 percent of patients will improve or recover while taking antidepressant medications, but some may need to continue medication over a six-month or year-long period to prevent relapse or recurrence. The major types of medications used to treat depression are tricyclic antidepressants, MAO inhibitors (MAOIs), lithium, and “novel antidepressants.” Tricyclic antidepressants are often prescribed for individuals whose depressions are marked by feelings of hopelessness, helplessness, fatigue, inability to experience pleasure, and loss of appetite and resulting weight loss. Monoamine oxidase inhibitors (MAOIs) are often prescribed for individuals whose depressions are characterized by anxiety, phobic and obsessivecompulsive symptoms, increased appetite and excessive sleepiness, or those who fail to improve on other antidepressant medications. Lithium is sometimes prescribed for people who have manic-depressive illness (a severe affective disorder characterized by a predominant mood of elation or depression, and in some cases an alternation between the two states). Sometimes it is prescribed for people who suffer from depression without mania. Those most likely to respond to treatment with lithium are depressed individuals whose family members have manic-depression or whose depression is recurrent rather than constant. “Novel antidepressants.” During the 1990s, more specifically active antidepressant drugs with less propensity for side effects were developed. Serotonin reuptake inhibitors (SRIs), for example, fluoxetine (Prozac) and sertraline (Zoloft), are one class; buproprion (Wellbutrin) is another class. Many other new medications are under development to treat depression. Anticonvulsants as antidepressants. For patients with manic-depressive illness (bipolar disorder) where lithium is not effective, drugs used to prevent temporal lobe seizures are sometimes used. Side effects of antidepressant medications. Some people experience side effects from antidepressant medications, which in themselves may be stressful. Common side effects include dry mouth, constipation, drowsiness, and weight gain; these effects
120 depression RECOGNIZING ADOLESCENT DEPRESSION • • • • • • • • • • • • •
Sadness; feelings of helplessness or hopelessness Poor SELF-ESTEEM and loss of confidence Overreaction to criticism Extreme fluctuations between boredom and talkativeness Sleep disturbances Anger, rage, and verbal sarcasm; guilt Intense ambivalence between dependence and independence Feelings of emptiness in life Restlessness and agitation Pessimism about the future Refusal to work in school or cooperate in general Increased or decreased appetite; severe weight gain or loss Death wishes, suicidal thoughts, suicide attempts
usually diminish somewhat or disappear as the body makes adjustments. The more recently developed “novel antidepressants” have a lower incidence of these side effects. Depression in Adolescents Depression in teenagers may be somewhat different from that in adults. Some adolescent symptoms may be overlooked as part of growing up. Teenagers may be depressed because of being in trouble, or in trouble because of being depressed. Their depression is sometimes linked to poor school performance, truancy, delinquency, alcohol and drug abuse, disobedience, self-destructive behavior, sexual promiscuity, rebelliousness, GRIEF, and running away. They may feel a lack of support from family and other significant people, and a decrease in their ability to cope effectively. Adolescence is a period of demanding and complicated conflicts that lead many young people to develop anxieties, negative self-esteem, and fears about their future. Some develop depression when overwhelmed by the stresses of peer pressure, feelings of loneliness, powerlessness, and isolation. Low performance in school can lead to a feeling of rejection, social expectations may be unrealistic, and conflicting messages from family may magnify struggles for independence and assertiveness.
Contributing factors to adolescent depression may include exaggerated concerns, misperceptions, and continual self-criticism. The lack of ability to embrace what life has to offer results in boredom, which may be an indicator of vulnerability to depression. Suicide and Adolescent Depression In 2004, the news media pointed to the apparent relationship between certain antidepressant medications and teen suicide. Some advocacy groups say that clinical studies indicate increased suicidal behavior in teens on antidepressants. British regulators banned most antidepressants for minors in December 2003. However, the U.S. Food and Drug Administration (FDA) says there is no proof that the pills cause suicidal behavior in children. Still, the FDA in 2004 asked drug makers to add warnings to widely used antidepressants that instruct parents and doctors to closely monitor patients for such behavioral and emotional changes as increased anxiety, impulsiveness, or aggression. A 2003 World Health Organization study found that the teen suicide rate dropped in 15 nations by 33 percent in the past 15 years, coinciding with the widespread use of antidepressant medications. In the United States, the suicide rate among adolescents dropped 25 percent during the 1990s, according to the Centers for Disease Control and Prevention (CDC). Five widely used antidepressants dispensed to those under age 17 in 2002 included sertaline (Zoloft), paroxetine (Paxil), bupropion (Wellbutrin), citalopram (Celexa), and fluoxetine (Prozac). Self-help for Individuals and Their Families Self-help and support groups allow individuals of all ages to share ideas for effective COPING and selfcare. Benefits of these groups include increasing contacts with other people, for example, by participation in special interest groups; learning to cope with exaggerated thoughts; and following regular exercise programs. The National Depressive and Manic-Depressive Association is a national self-help organization, with chapters throughout the country that meet locally to help members cope effectively with depression. The Depression and Related Affective Disorders Association (DRADA) is a nonprofit organization
diabetes 121 focusing on manic depressive illness and depression. DRADA distributes information, conducts educational meetings, and runs an outreach program for high school counselors and nurses. DRADA helps organize support groups and provides leadership training programs and consultation for those groups (see below). See also AGORAPHOBIA; DEFENSE MECHANISMS; PHARMACOLOGICAL APPROACH; PSYCHOTHERAPIES; PUBERTY. FOR FURTHER INFORMATION:
Depression and Related Affective Disorders Association 2330 West Joppa Road, Suite 100 Lutherville, MD 21093 (410) 583-2919 National Alliance for the Mentally Ill Colonial Place Three 2107 Wilson Boulevard, Suite 300 Arlington, VA 22201 (703) 524-7600 National Depressive and Manic Depressive Association 222 South Riverside Plaza, Suite 2812 Chicago, IL 60606 (312) 993-0066 National Institute of Mental Health Office of Scientific Information Public Inquiries Section 5600 Fishers Lane, Room 15C-17 Rockville, MD 20857 (301) 443-4513 National Mental Health Association 1020 Prince Street Alexandria, VA 22314 (703) 684-7722 SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Karp, David Allen. Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness. New York: Oxford University Press, 1996. Klerman, Gerald. Suicide and Depression among Adolescents and Young Adults. Washington, D.C.: American Psychiatric Press, 1986. Mitchell, Philip B. “Is Antidepressant Prescribing Associated with Suicide Rates?” Psychiatric Times xxi, no. 5 (May 2004): 53–59.
Robb-Nicholson, Celeste. “Depression.” Harvard Women’s Health Watch, March 1995, 2–3.
dermatitis
Inflammation of the skin, sometimes due to allergy, but sometimes occurring without any known reason. It can result in painful itching and the distress of extreme discomfort. For some individuals, if the itching persists without relief, dermatitis leads to a feeling of helplessness and DEPRESSION. Many types of dermatitis are better known as eczemas, such as atopic, common in babies; nummular, which occurs in adults, cause unknown; and dermatitis of the hand, the result of household detergents and cleansers. Other types of dermatitis include seborrheic, which appears on the face, scalp, and back, develops during stress, and is a reaction to something that comes in contact with the skin. See also ALLERGIES; CHRONIC ILLNESS; HIVES; POISON IVY. FOR FURTHER INFORMATION:
American Academy of Dermatology 930 North Meacham Road Schaumburg, IL 60168 (708) 330-0230
desensitization, systematic
See
BEHAVIOR THER-
APY; PHOBIAS.
diabetes (diabetes mellitus)
Disorder in which the pancreas produces too little or no insulin for the body’s needs. Insufficient insulin results in an abnormally high glucose level in the blood, leading to excessive urination, constant thirst, and hunger. When the body cannot store or use glucose, there is weight loss and fatigue, and accelerated degeneration of small blood vessels. Diabetes is not contagious, although it tends to run in families. While there is no cure for it, with appropriate medical care and patient compliance, the disease can be kept under control.
Coping with the Stresses and Treatment of Diabetes Diabetes brings with it the stresses and consequences of a CHRONIC ILLNESS for the individual as well as the family. When diabetes is diagnosed,
122 diabetes many highly charged feelings enter into its acceptance. There may be ANGER, GUILT, or anxieties, both expressed and unexpressed, and these feelings should be discussed with family members. If it is a child who is diabetic, encourage discussion so that the child understands that having such feelings is part of the COPING process. Stable mental health is important for proper control of diabetes because emotional stresses affect secretions of hormones that may counteract or interfere with the helpful effects of insulin. Diabetic health care teams will have suggestions to help individuals reduce their stress levels. They may suggest ALTERNATIVE MEDICINE, such as RELAXATION exercises and BIOFEEDBACK. They may encourage participation in group therapy sessions with other families to learn how others cope with diabetes. Such groups foster exchanges of helpful ideas concerning the practical aspects of diabetes. They may suggest use of the “buddy system,” working with another diabetic to reinforce support and provide a model for adjustment to life with diabetes. There are groups run by local affiliates of the American Diabetes Association, hospitals, and community health departments. Awareness of existing services is the first step toward obtaining assistance and maintaining a good mental attitude about the disease. The health care team of the diabetic will consider individual emotional needs along with menu and exercise plans, and therapy with insulin and other medications. Problems such as mishandling the food plan, refusing to take insulin injections, consciously overeating, and DEPRESSION occur in some diabetics, and compound their stress levels. These situations can be successfully handled with the support of health care professionals, parents, spouses, or significant others. The personal role in the treatment of diabetes is important. For example, diabetic individuals need to devote more time to personal care than may have been done before, particularly giving specific attention to skin, feet, and teeth, and promptly treating minor injuries such as burns, cuts, and bruises. Keeping diabetes under control can help diabetics avoid later stresses such as difficulties in the vascular system and eye and kidney disease. Individuals afflicted with diabetes face not only a shortened life span but also the probability of
incurring acute and chronic complications. People who have diabetes are two and a half times more likely to suffer from strokes than those without diabetes; people with diabetes are two to four times more likely to develop cardiovascular disease. Diabetes is the leading cause of new cases of blindness in adults from 20 to 74 years of age and is the leading cause of end-stage kidney disease. Prevalence, Causes, and Types of Diabetes In the United States, about two persons per 1,000 have insulin-dependent diabetes by the age of 20; the insulin-dependent form (type 1) affects about 150 to 200 persons per 100,000. Non-insulindependent (type 2) diabetes is more common; approximately 2,000 persons per 100,000 are affected. With age, the risk for developing diabetes increases. People of middle or older age are more likely to develop diabetes than younger people, and women are more likely to have diabetes than men. Heredity, obesity, and stresses such as emotional shocks, family disturbances, or surgery can lead to diabetes. Researchers have emphasized the power of disruptive and stressful life events as influencing the course of the disease. Pregnancy also places extra stresses on the body, and diabetes is often diagnosed in pregnant women or women who have repeated miscarriages. People who have diabetes, especially type 2, often have high blood pressure too. Type 1, insulin-dependent diabetes, can occur at any age, though it most commonly occurs during youth. Type 1 diabetes used to be called juvenileonset diabetes and is still called that by some health care professionals. About one of every 2,500 children has this disease. Because the pancreas produces little or no insulin, such patients become dependent on outside sources of insulin. The disease can be controlled with insulin, proper diet, exercise, and careful monitoring. Type 2 is non-insulin-dependent diabetes. Estimates are that between 60 percent and 90 percent of those with non-insulin-dependent diabetes in Western societies are obese. Thus it is important for obese individuals to lose weight. This type of diabetes used to be called maturity-onset diabetes and may still be called that by some health care professionals. Type 2 is much more common than type 1; more than 5 million Americans have the disease. This type is less severe than insulin-dependent dia-
diarrhea 123 betes and starts more slowly. Often it can be controlled by diet alone or by a combination of diet, exercise and oral medication. See also IMMUNE SYSTEM; OBESITY; SUPPORT GROUPS. FOR FURTHER INFORMATION:
American Diabetes Association National Service Center 1660 Duke Street Alexandria, VA 22314 (703) 549-1500 (800) 232-3472 (toll-free) National Diabetes Information Clearinghouse Box NDIC Bethesda, MD 20892 (301) 468-2162 SOURCES: Eastman, Richard. “Prevalence of Diabetes Increasing in U.S.” Journal of the American Medical Association, November 2, 1995. Kahn, Ada P. Diabetes. Chicago: Contemporary Books, 1983. Schade, David S. “The Stress Factor.” Diabetes Forecast, March–April 1982.
Diagnostic and Statistical Manual (DSM IV-R) A categorical guide for classification of mental disorders, first published by the American Psychiatric Association in 1994. DSM diagnoses can be used by courts or schools; and although the book is useful for many purposes, sometimes being “labeled” according to DSM can cause extreme stress for individuals and their families. Mental disorders are grouped into 16 major diagnostic classes, for example, anxiety disorders and mood disorders. The book is used for clinical, research, and educational purposes by psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, counselors, and other health professionals who wish to base a diagnosis of mental disorders, including anxieties and phobias, on standardized criteria. It was planned to be useful across settings including inpatient, outpatient, partial hospital, consultationliaison, clinic, private practice, and primary care, and with community populations. The first DSM was published in 1952 so that all mental health-related terms would have the same meaning across the United States. However, many
of the terms that appear as diagnostic criteria in the DSM are sometimes signs of a disorder and sometimes signs of normal behavior. Thus the DSM includes a cautionary statement saying it takes clinical training to tell the difference between disorderly and normal behavior. About 350 listings range from “mild mental retardation” to “personality disorders.” In 2005, the DSM-IV was being reviewed and revised by the American Psychiatric Association. A fifth edition, the DSM-V, is slated to be published around 2010. The APA will host conferences, review literature, and conduct studies to determine if proposed changes will be useful in intended settings. SOURCES: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994. Cloud, John. “How We Get Labeled.” Time, 161, no. 3 (January 20, 2003): 102–105. Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook of Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000.
diaphragmatic breathing diarrhea
See
BREATHING.
Refers to fluidity, frequency, or volume of bowel movements when compared with the usual pattern for a particular person. It is not a disorder, but a symptom of a problem. In some individuals, stress and ANXIETY bring on diarrhea. Individuals who have IRRITABLE BOWEL SYNDROME may suffer bouts of diarrhea. While diarrhea may be the result of anxiety, it also causes stress and anxious moments. The traveler who has a sudden attack must quickly find a public restroom. The speaker or performer about to go onstage must take time to deal with the personal emergency. Acute diarrhea affects almost everyone at some time, often as a result of eating contaminated food or drinking contaminated water. Usually attacks clear up within a day or two with or without treatment; many effective treatments are available as over-the-counter medications. Chronic diarrhea may be symptomatic of more serious conditions requiring medical attention.
124 dieting FOR FURTHER INFORMATION:
American Gastroenterological Association 4930 Del Ray Avenue Bethesda, MD 20814 (301) 654-2055
dieting
Generally refers to following a special or modified diet for the purpose of losing weight. Motivation to be as thin as models unrealistically motivates many people, particularly women, to begin dieting. Dieting is stressful because losing weight is not easy; it means setting realistic goals. It requires time—often a year for positive results— for some people; it means hard work, both losing the weight and keeping it off. It is also stressful because many people perceive themselves as overweight, whether this is the case or not. Some dieting approaches involve extensive behavior modification. These programs offer SUPPORT GROUPS and education about good NUTRITION and exercise. Most important, they offer help in altering the individual’s behavior in order to limit food intake, increase physical activity, and reduce the stress of the current social pressures to be thin. Individuals who believe they are overweight should have a physical examination from their family physician to determine whether they are actually overweight or are weight-, shape- or foodobsessed. If overweight, further assessment is necessary; if not overweight, they need supportive strategies to help them feel better about themselves and referral to community resources to help them with their concern. See also BODY IMAGE; EATING DISORDERS; OBESITY. FOR FURTHER INFORMATION:
American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 60606-6995 (800) 877-1600 (toll-free) Food and Nutrition Information Center National Agricultural Library Building, Room 304 Beltsville, MD 20705 (301) 504-5414 SOURCES: Ciliska, Donna. “Women and Obesity.” Canadian Family Physician, January 1993.
Hamilton, Michael, et al. The Duke University Medical Center Book of Diet and Fitness. New York: Fawcett Columbine, 1991. Thomas, Patricia, ed. “Dieting May Be a Losing Proposition.” Harvard Health Letter 19, no. 10 (August 1994).
disabilities
A disability refers to a temporary or permanent loss of faculty. It may refer to physical disabilities, such as loss of a leg or of hearing, or mental capabilities, such as retardation or autism. COPING with a disability causes stress for the one who has the disability and also for parents, siblings, and children who face caring for the disabled person. Persons who become disabled often struggle with the anxiety of trying to be like everyone else. Because of their disability they may feel a loss of SELF-ESTEEM compounded, in many cases, by the limitations of the living situations they encounter. According to Reverend John A. Carr of the Yale–New Haven Medical Center, who was born with the congenital absence of both hands and one foot, “Coping with a handicap will depend on how human interactions occur, to allow more or less progress toward meaningful life.” In the book, Coping with Crisis and Handicap, Reverend Carr recommends that open dialogue between those who are disabled and those who are not is essential because, “In denying our efforts to fight for a world more open to the handicapped, whether we refer to architectural or attitudinal barriers, we may be denying ourselves accessible avenues we will need later.” Coping with a Disability in the Family Mary S. Challela, director of nursing and training at the Eunice Kennedy Shriver Center defines parental coping as “managing the day-to-day activities of meeting the disabled child’s needs, the parents’ needs, and those of other children in the family, in a realistic manner. Before parents can be expected to assume any of these tasks effectively, they must be allowed and encouraged to respond emotionally to the crisis of disability.” How parents react, she explains, is influenced by how and when they are told of the abnormality, their degree of social isolation, the type and severity of the disability, social class and education, attitudes of families and friends, and information received from and attitudes of professionals. Parents need emotional
divorce 125 support and counseling in dealing with the initial and subsequent crises, education in learning how to care for the child’s special needs, guidance in dealing with other family members, and continued interest and encouragement. According to Allen C. Crocker, Children’s Hospital Medical Center, Boston, there are many emotions generated in the sister or brother of a disabled child, including “concern, curiosity, protectiveness, frustration, sorrow, grief, anxiety, longing, unhappiness, jealousy, and resentment. The elements of stress assuredly exist and are troubling to consider.” Many professionals urge special support for siblings, and value the role of self-help groups for parents, siblings, and other family members. Such groups can help resolve problems and feelings, serve as a socializing agency for all concerned, and provide a way to reach out to others in similar situations. Also, these SUPPORT GROUPS provide an important exchange of resources and often become an important force for obtaining services through legislation and social pressure. In some cases, it may be an ELDERLY PARENT who becomes disabled. Coping mechanisms for relieving the stresses of the situation include obtaining professional guidance and social support. See also GENERAL ADAPTATION SYNDROME; PARENTING. FOR FURTHER INFORMATION:
Architectural and Transportation Barriers Compliance Board 1331 F Street, NW, Suite 1000 Washington, DC 20004-1111 (202) 272-5434; (800) 872-2253; (800) USA-ABLE (toll-free) Mobility International, U.S.A. P.O. Box 10767 Eugene, OR 97440 (541) 343-1284 National Information Center for Children and Youth with Disabilities P.O. Box 1492 Washington, DC 20013 (800) 695-0285 SOURCE: Milunsky, Aubrey, ed. Coping with Crisis and Handicap. New York: Plenum Press, 1981.
dis-stress HANS SELYE (1907–82), an Austrianborn Canadian endocrinologist, differentiated between the unpleasant or harmful variety of STRESS called dis-stress (from the Latin dis = bad, as in dissonance, disagreement) and eustress (from the Greek eu = good, as in euphonia, euphoria). During both distress and EUSTRESS the body undergoes virtually the same nonspecific responses to various stimuli acting upon it. However, certain emotional factors, such as frustration and hostility are particularly likely to turn stress into dis-stress. See also COPING; GENERAL ADAPTATION SYNDROME. SOURCES: Selye, Hans. The Stress of Life, rev. ed. New York: McGrawHill, 1978. ———. Stress without Distress. Philadelphia: Lippincott, 1974.
diversity Relates to any group of people that is mixed in terms of race, religion, ethnicity, or gender. Because diversity may be perceived as an approach to quotas in schools or in the WORKPLACE, the concept can be a source of stress for those involved. Stress can also arise between individuals from diverse backgrounds because of cultural differences. Respect for, and understanding of, these differences can make diversity a successful concept in business, religious, or community activities. Conducting diversity awareness workshops is one way in which companies have introduced the idea of valuing personal differences. However, these workshops are only a first step in creating an environment in which previous prejudices, a major source of stress, will be erased and a true sensitivity to diverse employee needs will prevail. See also ACCULTURATION; COMMUNICATION. divorce The legal ending of a MARRIAGE and a situation in which all involved experience stress. Husband, wife, children, and even grandparents are affected by the dissolution of a marriage in the family. During the 1990s, about half of all marriages ended in divorce. Women and men who seek divorce do so because they have any one or more of many stressors in their marriage, such as a poor sexual relationship, difficulties in communicating with each other, differences in goals, or financial problems.
126 dizziness Feelings of failure are common when a marriage breaks up; lack of success in a marriage should not reflect on a sense of SELF-ESTEEM, but it does. While many divorced individuals learn from their experiences and bring new insights to new relationships, some of these will end in second or third divorces. Divorced people are commonly angry with each other, feel that perhaps they have been exploited or treated badly, and suspect infidelities. Depending on what triggered the anger, it may not be easy to forget. However, if appropriately contained, one’s anger will not interfere with adjusting to a new life. According to Ada P. Kahn, in “Divorce: For Better Not For Worse,” published by the Mental Health Association of Greater Chicago, studies show that when parents are unhappy, children do not feel that keeping the marriage together on their behalf is a gift. There is no advantage for children when parents stay in a marriage in which they are constantly stressed and cannot resolve basic issues. Kahn advises telling children why you are getting a divorce, that it was a rational decision by both parties, deliberately and carefully undertaken with reluctance and with full recognition of how stressful it would be. Children have the right to know why, with an explanation suited to their age and level of understanding. Parents should try to communicate what divorce will mean for the children, specifically, how it will affect their visiting and living arrangements. They should be assured that they have parental support, permission to love both parents, and that both parents will continue to love them. Assurance that the children are not responsible for the rupture and that they are not responsible to heal the rupture should come from both parents. More complex explanations are in order in case of desertion or abuse. As a consequence of divorce, many children feel a diminished sense of being parented, because their parents are less available, emotionally, physically, or both. Children may feel that they are losing both parents. This is an expected part of the divorce experience. In most instances, it is temporary, but in a significant number of families, unfortunately, it is a feeling that lasts a long time. The most serious long-range effect is that children feel less protected in their growing-up years and become concerned that they will repeat their parents’ mistakes of a failed man-woman relation-
ship. To address this issue, parents should talk about it or be ready to talk when children ask questions. They should not continue to fight the battles after their divorce, and should never criticize former mates in front of the children. Parents should realize that they are role models after the divorce just as they were in the marriage. Divorced individuals do marry again. However, according to the Center for the Family, Corte Madera, California, 60 percent of second marriages fail, particularly if one or more of the mates bring children into the marriage. DATING and meeting new people after divorce brings stress and anxieties about acquiring a sexually transmitted disease, because of the prevalence of AIDS (ACQUIRED IMMUNE DEFICIENCY SYNDROME) and STDs (SEXUALLY TRANSMITTED DISEASES). Rebuilding life after divorce may be stressful, complicated, and difficult. The best advice is to take one step at a time and start by choosing one step you really need or would like to take. Newly divorced people can seek out resources for their particular needs in their community where there are churches, synagogues, and community mental health agencies that may be able to help. Divorce differs from annulment, in which a court declares that a marriage has been invalid from its beginning; reasons for annulment vary among states and countries. See also COMMUNICATION; COPING; SEXUALLY TRANSMITTED DISEASES. FOR FURTHER INFORMATION:
Center for the Family 5725 Paradise Drive, #300B Corte Madera, CA 94976 (415) 924-5750 SOURCES: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House Publications, 1992. Wallerstein, Judith S. Second Chances: Men, Women, and Children a Decade after Divorce. New York: Ticknor & Fields, 1989.
dizziness
A feeling of being unsteady, lightheaded, or faint and a sensation of spinning, turning, falling in space, or of standing still while objects around are moving. Some individuals experience
domestic violence 127 dizziness in extremely stressful situations or as a phobic reaction. People who come into contact with an object that they fear may react with dizziness, weak knees, and sweaty palms; they also may fear fainting, falling, having a HEART ATTACK, or otherwise embarrassing themselves. Dizziness, as a result of a PHOBIA, usually disappears when the phobic object is removed or when the person gets to a place of safety. During a phobic reaction or a panic attack, an individual may hyperventilate (breathe more than they need to). This results in a drop in the carbon dioxide in the blood, causing constriction of blood vessels in the brain, leading to dizziness or fainting. HYPERVENTILATION is sometimes caused by a physical condition, but is often the result of stress, anxiety, worry, or panic attacks. Dizziness also may accompany seasickness. Some sailors advise keeping one’s eyes on the horizon to give one a steady spot to watch. In most cases, dizziness disappears when the individual sets foot on land. Dizziness as a result of intoxication with alcohol usually subsides after a period of sleep. There are prescription drugs as well as some over-the-counter remedies available to help control dizziness. When dizziness occurs often, a physician should be consulted, as it may be a symptom of a condition in need of medical treatment. See also AGORAPHOBIA; PANIC ATTACKS AND PANIC DISORDER.
doctors
See
PHYSICIANS.
domestic violence Abuse of spouses, children, or parents in the home. This may take the form of wife-battering, child abuse, INCEST, or abusing elders. All of these situations are extremely stressful to the victims as well as others in the family. The abuser may behave violently as a response to particular stressors in his or her life. Domestic violence happens in all strata of society, and there are many more cases than official records indicate because it is a subject often covered up out of fear and shame. Characteristics of persons who are victims of family violence include ANXIETY, powerlessness, GUILT, and lack of SELF-ESTEEM. Professionals who treat victims of family violence are concerned with getting the victims, usu-
ally women or children, away from the abuser and into therapy before the abuse becomes too severe and additional stressors arise. Some perpetrators as well as victims of family violence compound their difficulties with use of alcohol or drugs. Battered Women Battered women are victims of physical assault by husbands, boyfriends, or lovers. Battering may include physical abuse, sometimes for purposes of sexual gratification, such as breaking bones, burning, whipping, mutilation, and other sadistic acts. Generally, however, battering is considered part of a syndrome of abusive behavior that has very little to do with sexual issues. Drug and alcohol-related problems are more common among families with battering behaviors. Women who select and choose to remain in abusive relationships were also often abused as children. Many women stay in such relationships without reporting the abuse and without seeking counseling. Batterers often were abused themselves as children. Women who are abused by their husbands or boyfriends not only sustain injuries from physical beatings but also suffer from many mental and emotional scars, including POSTTRAUMATIC STRESS DISORDER, DEPRESSION, and anxiety. Help for battered women is available. First, physical protection, often provided by women’s shelters within the community, must be assured for the woman and her children. Second, social support services must provide economic protection, since women often stay in abusive relationships due to lack of practical economic alternatives. Finally, psychotherapeutic intervention should be aimed at both batterer and victim to trace antecedents of the violent behavior, correct substance abuse problems, and substitute positive COPING mechanisms for violent behavior patterns. Most abused women do not seek help until beatings become severe and have occurred over a period of time, often two to three years. Some women are too embarrassed or believe that if they report the beating to police they will not be taken seriously. The majority of women who seek help because of family violence are between ages 20 and 60. In 75 percent of households in which abuse takes place, the husband or boyfriend is an alcoholic or on drugs.
128 domestic violence A study at the University of California, San Francisco, during 1992 indicated many details about living conditions and circumstances surrounding battered women. According to the study, the battered women who were interviewed did not depend on their violent partner for most of their financial support; almost 30 percent had jobs and many had income from families, welfare, social security, and other sources. Among other findings, 40 percent of the women had to be hospitalized for injuries. One in three of the women had been attacked with a weapon, most often a knife or a club; four had been shot. One in 10 was pregnant when beaten; 30 percent of the group said they had been abused before they were pregnant. In about half the cases, the husbands or boyfriends drank heavily or abused drugs; 86 percent of the women had been beaten at least once before. According to Kevin J. Fullin, M.D., St. Catherine’s Hospital, Kenosha, Wisconsin, as many as one in two women has suffered from an episode of domestic violence sometime in her life. Due to such a high rate, physicians and health care workers are developing new approaches to domestic violence in order to increase its detection. The goal is to properly identify anyone who comes to a hospital with a domestic abuse situation. The woman, child, or adult who is suspected of being abused is questioned in a nonthreatening, nonjudgmental manner without any other family members present. The goal of this confidential questioning is to find the real cause of the problem and do something to stop the abuse. Battered Child Syndrome Battered child syndrome includes rough physical handling by caregivers resulting in injuries to the baby or child. This can result in failure to grow, a disability, and sometimes death of the baby or child. Studies have shown that parents who repeatedly injure or beat their babies and children have poor CONTROL of their own feelings of AGGRESSION, or may have been abused or psychologically rejected as children. The syndrome is found among people with stable social and financial backgrounds as well as in parents who are mentally unstable, alcoholic, or drug-dependent. In most states, laws require physi-
WHAT BATTERED WOMEN CAN DO • Leave the scene of the abuse; stay with a friend or family member who will be supportive emotionally and provide a safe haven. • To eliminate confrontation, leave the home when the abuser is absent. • Take bank records, children’s birth certificates, cash, and other important documents along with clothing and personal items. • If possible, photograph or videotape any consequences of abuse, such as injuries to yourself or damage to the home. These could be important for possible later court proceedings. • Call the police and file a police report. Obtain an order of protection as soon as possible. • Seek counseling for yourself and your children; join a SUPPORT GROUP along with others who have been victims of family violence.
cians to report instances of suspected, willfully inflicted injury among young patients. When it appears that the child will continue to be battered, steps are taken to remove the child from the home. Legal Rights of Domestic Violence Victims Until the late 20th century, police and the legal system often viewed domestic violence as a private matter and not a crime. Now, in many states, the police may arrest a batterer if there is evidence of abuse. Civil actions might include legal separation, child custody, child support, and divorce. One common civil action in cases of domestic violence is the temporary restraining order, which involves making a complaint and going to a hearing to obtain a legal document that limits how close a person may come to a woman and her children. A criminal complaint can be filed in addition to or instead of civil actions. A criminal complaint involves a police investigation, and if enough evidence is found, may lead to an arrest and involvement of the judicial system. See also ADDICTION; ALCOHOLISM; CODEPENDENCY. FOR FURTHER INFORMATION:
Batterers Anonymous 1269 North East Street San Bernardino, CA 92405 (714) 355-1100
Dossey, Larry 129 National Coalition Against Domestic Violence P.O. Box 34103 Washington, DC 20043-4103 (212) 638-6388 National Council on Child Abuse and Family Violence 1155 Connecticut Avenue NW Washington, DC 20036 (202) 429-6695 SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Shannon, Kari. “Domestic Violence Detection at St. Catherine’s.” Chicago HealthCare, December 1991.
Dossey, Larry (1940–
) Dallas, Texas, physician, lecturer, and author of Healing Words (The Power of Prayer and the Practice of Medicine), Meaning and Medicine (Lessons from a Doctor’s Tales of Breakthrough and Healing), and other books. Much of his writing is directed toward helping readers relieve stress in their lives. He believes that American society is in the grip of a “time sickness” epidemic. He defines this as a disorder in which we feel so overloaded and stressed by schedules that our bodies rebel and we respond to all ringing bells—alarm clocks, telephones—as signals to get ready for action. Our bodies pump stress hormones, which in turn suppress immune response. Cholesterol and stomach acidity is increased. “The end result,” he says, “is frequently some form of ‘hurry’ sickness, expressed as heart disease, high blood pressure, insomnia, irritable bowel syndrome.” About Dossey’s best selling books, a reviewer in Whole Earth Review (fall 1993) said: “Modern medicine is based on standardization, the assumption that the criteria for symptoms, prognoses and curative practices can be measured and objectified. Individuals with a set of symptoms are expected to be helped by the same course of treatment, and the percentage who will recover can be predicted. Dossey brings us quite a different perspective, one which taken to its extreme would create a totally different and ultimately individualized medicine.” Dossey emphasizes that meaning, or the significance that one attaches to an interpretation of an
event, has been overlooked in modern medical practice. Significant life events that are highly stressful and are known to contribute to susceptibility to disease, such as death of a spouse or loss of a job, can have a very different subjective meaning. Each interpretation of a similar event will bring about stress in different ways. In his writings, Dossey suggests many possible avenues toward stress reduction and relief, including PRAYER and MEDITATION. He believes that therapies should be judged according to their effects and under conditions in which they work. For example, experiments with people have shown that prayer and meditation positively affected HIGH BLOOD PRESSURE, wounds, heart attacks, HEADACHES, and anxiety. He believes in utilizing our powers of intuition and telepathy as well as meditation to deepen RELAXATION. Also, he encourages becoming aware of the unconscious part of ourselves in order to summon all the healing powers within ourselves and others, when we need them to overcome stressful situations. Dossey suggests that prayer and standard medical approaches can be used together; he does not suggest that prayer be relied on instead of other therapies. He insists that science and religion stand side by side, respecting the domain of each other and preserving the highest aims of each. His view of the mind is that it is not localized or confined to the body, but extends outside it. This suggests that mind is capable of affecting not only one’s own body but also other bodies that may be far away; this lends an explanation to Dossey’s concept of the effectiveness of distant prayer. He has co-chaired a panel on MIND-BODY CONNECTIONS at the National Institutes of Health’s OFFICE OF ALTERNATIVE MEDICINE. When referring to several eras of medical practice, he says Era I was and remains based on the materialist theory of disease and its treatment. Era II discovered the mind/body link; it conceives mind as implicated in healing, though it understands mind as local, existing within the body and limited by the body’s position in time and space. Era III medicine, he continues, expands this understanding by focusing on how the powers of the mind work between people. See also ALTERNATIVE MEDICINE; FAITH; PLACEBO EFFECT.
130 downsizing SOURCES: Dossey, Larry. Healing Words: The Power of Prayer and the Practice of Medicine. San Francisco: Harper, 1993. ———. Meaning and Medicine: Lessons from a Doctor’s Tales of Breakthrough and Healing. New York: Bantam/Doubleday, 1991. ———. Prayer Is Good Medicine. San Francisco: Harper, 1996.
downsizing
Refers to employee cutbacks (LAYand not rehiring for jobs that employees have vacated. Downsizing is stressful for the managers who make the decision as to who will go and who will stay and for the employees who are asked to leave. In many cases, the stress involved in downsizing leaves workers with ANGER and is a possible trigger for DEPRESSION. To help workers avoid and/or handle anger, such issues as job category, seniority, and performance must be addressed. Equally important issues include treatment of dismissed employees, positive employee recommendations, and dealing with surviving employees. Most companies now consider downsizing or employee cutbacks as a routine part of business. As they become more and more an everyday occurrence, the very idea of downsizing brings stress to many workers. In 1994, an American Management Association (AMA) survey of 713 companies showed that 30 percent of companies reporting a downsizing planned to repeat the exercise. Respondees gave business downturn, improved staff utilization, transfer of production or work, automation or other new technology, merger or acquisition, and plant or office obsolescence as reasons for downsizing. With downsizing, workers at all levels are affected, no matter how long they may have worked for the organization, no matter how well they perform their jobs or how effectively they have managed their budgets and staffs. Of the 430,000 identified jobs eliminated by AMA respondents since July 1988, half belonged to hourly workers and half belonged to salaried workers. Signs of impending downsizing include a hiring freeze, pessimistic budget projections, closed-door meetings, decreasing sales, and consolidation of operations. Middle managers should be particularly alert to requests for department justification and work plans based on budget reductions. OFFS)
See also CHANGING NATURE OF WORK; JOB CHANGE; WORKPLACE.
SOURCE: Meyer, G. J. Executive Blues: Down and Out in Corporate America. New York: Franklin Square Press, 1995.
dreams Mental activity that occurs when one is asleep. Some people enjoy their dreams while others find them stressful, particularly if they are scary or otherwise unpleasant. Dreaming usually involves many vivid sensory images, such as sight, sound, motion, touch, and even smell or taste. For many people, dreaming at night is a continuation of mental impressions, ideas, and thoughts from that day, and there are no deeply hidden meanings. They may be sorting out events from the day in a distorted way because the mind is not conscious and awake. For others, images in dreams may be symbols of unconscious thoughts that may mean nothing, or may refer to many things. For example, for some people, water may symbolize birth. There are individuals who believe that through interpretations of symbols in a dream, people can have a better understanding of how best to cope with life’s stresses. However, symbols are highly individual matters. Dreaming occurs during periods of rapid eye movement (REM) sleep, which last for about 20 minutes and occur four or five times a night. SLEEP deprivation, stress, DEPRESSION, and drug abuse often interfere with REM time. Necessary biochemical changes occur at REM and non-REM times that are essential for normal daytime functioning. People who are awakened during periods of REM sleep usually can report their dreams clearly. Those who awaken normally may not remember dreams at all, or only in a fragmentary way. People have tried to give meanings to dreams for thousands of years. Many interpretations of dreams have come forth, from Joseph in Egypt to Sigmund Freud in Vienna. Much folklore has developed around the subject of dreams, some of which may add to or relieve the dreamer’s stress. See also JOURNALING. FOR FURTHER INFORMATION:
Association for the Study of Dreams P.O. Box 1600 Vienna, VA 22183 (703) 242-8888
dyspareunia 131 Community Dream Sharing Network P.O. Box 8032 Hicksville, NY 11802 (516) 735-1969; (516) 796-9455 SOURCES: Delaney, Gayle. Living Your Dreams. San Francisco: Harper & Row, 1988. Faraday, Ann. The Dream Game. New York: HarperCollins, 1990.
driving
See also AUTOMOBILES; RANDOM NUISANCES.
drug therapy
See also
DEPRESSION; PHARMACO-
LOGICAL APPROACH.
durable power of attorney
See
DEATH.
dysfunctional family This term indicates that the developmental and emotional needs of one or more members of a FAMILY are not being met, leading to STRESS for all concerned. Research has shown that people raised in dysfunctional families—where alcohol or drug abuse, emotional or physical abuse, neglect, incest, marital conflict, or severe workaholism were present—carry varying vestiges of these problems well into adulthood. These issues generally surface in intimate RELATIONSHIPS and on the job. Since these are places where other kinds of stress can be found, unresolved family issues can compound the stressors. People from dysfunctional families usually are excellent employees. They are hard workers, dependable, resourceful, loyal, kind—attributes that have helped them survive their earlier experiences. However, because people from dysfunctional families have often not learned to feel good about themselves, they may have poor SELFESTEEM, compensate by working longer hours than others, try for PERFECTION, and take on more than they can handle. This leads to even more stress, which impacts their job performance and physical health. Causes of Dysfunctional Relationships Often, the basic problem is lack of COMMUNICATION or poor communications between family members, even though they live in the same household. An example of a dysfunctional family is one in which
there is marital conflict between the parents that results in their young son showing signs of aggressive behavior in school. The family may come to the attention of a school nurse because of the behavior problems of the child, which may be a symptom of the dysfunction of the family at home. The parents may be unaware that their behavior is causing a great deal of stress for the child. In a dysfunctional family, there is little emphasis on encouraging each child to develop AUTONOMY. An example is a family that expects its adolescent child to obey curfew rules appropriate for a younger child. Dysfunctional families usually do not communicate constructively when they are having difficult times. For example, when a child becomes seriously ill, there may be little communication about the illness between family members, and this leads to unexpressed feelings of guilt. ALCOHOLISM and substance abuse tends to be a characteristic of dysfunctional families, as the substance abuser cannot be depended on to fulfill expectations. Family therapy is helpful in improving life situations for members of dysfunctional families. In therapy, family members learn to improve their communication skills and learn new coping skills to deal with everyday problems as well as major life events. See also AGGRESSION; COPING; INTIMACY; PSYCHOTHERAPIES.
dysmenorrhea dyspareunia
See also
MENSTRUATION.
Sexual intercourse that is painful for the woman. It causes extreme stress for both partners and may lead to avoidance of sexual intercourse and ultimately to the breakup of a relationship. The first step in reducing the stress of pain during sexual intercourse for a woman is to discuss it with her partner. For some women, psychological factors play a part; once the pain has been experienced, the woman may fear recurrence of the pain. This happens to some women who have been abused as children or raped. Some of these women may fear pregnancy or acquiring a SEXUALLY TRANSMITTED DISEASE (STD) and are not able to relax during intercourse. Tension and anxiety, or a lack of adequate stimulation before actual
132 dysthymia penetration, may also contribute to pain during intercourse. SOURCE: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992.
dysthymia A chronic and persistent mood disturbance that has been present for at least two years and is characterized by relatively mild symptoms of DEPRESSION, such as low SELF-ESTEEM, difficulty in concentrating, feelings of hopelessness, loss of appetite, and difficulty in sleeping. This disturbance is a source of stress for the individuals and
their families, employers, and coworkers because it limits participation and productivity. Individuals who have dysthymia are usually chronically unhappy. Some develop major depression, improve, and then return to the milder state of dysthymia. The coexistence of these mild and severe forms of depression is referred to as double depression. This condition is treatable; help is available from trained social workers, psychologists, and psychiatrists. In some cases, medications may be prescribed. See also AFFECTIVE DISORDERS; MOODS; PHARMACOLOGICAL APPROACH.
E from anorexia nervosa are higher than from any other psychiatric illness. Causes of anorexia vary widely. Many anorexics are part of a close family and have special relationships with their parents. They are highly conforming, anxious to please, and may be obsessional in their habits. There is speculation that girls who refrain from eating wish to remain “thin as a boy” in an effort to escape the burdens of growing up and assuming a female sexual and marital role. Another contribution to the increase in anorexia is contemporary society’s emphasis on slimness as it relates to beauty. This is particularly prevalent in the fashion industry with its overly thin models. Most women diet at some time, particularly athletes and dancers, who seem more prone to the disorder than other women. In some cases, anorexia nervosa is a symptom of depression, personality disorder, or even schizophrenia. Symptoms include severe weight loss, wasting (cachexia), food preoccupation and rituals, amenorrhea (cessation of the menstrual period), and hyperactivity (constant exercising to lose weight). The anorexic may suffer from tiredness and fatigue, sensitivity to cold, and complain of hair loss. Eating disorders sometimes result in other mental health disorders as well as depression. Individuals may suffer from withdrawal, mood swings, and feelings of shame and guilt. Both anorexics and bulimics develop rituals regarding eating and exercise. They often are perfectionists in habits, such as clothes and personal appearance, and have an “all or nothing” attitude about life.
eating disorders
Eating disorders involve compulsive misuse of food to achieve some desired physical and/or mental state. They are characterized by an intense fear of being fat and severe weight loss and may result in ill health and psychological impairments. People with eating disorders may be experiencing stress in some aspect of their lives, which they think will be improved by dieting in excess. They have low SELF-ESTEEM and a fear of fatness. When sufferers acknowledge their compulsive behavior, their stress is often expressed in feelings of DEPRESSION and a wish to commit SUICIDE. Sufferers typically hide their illness; when family, friends, or coworkers discover their illness, they try to help. Typically, people with eating disorders feel they don’t deserve to be helped, and this creates a great deal of stress for all concerned. Eating disorders share common addictive features with alcohol and drug abuse, but unlike alcohol and drugs, food is essential to human life and proper use of food is a central element of recovery. Estimates indicate that there are 8 million reported victims of eating disorders in the United States—7 million of them women (although the number of males is increasing) between the ages of 15 and 30. Eating disorders can be cured when the sufferer accepts treatment; an estimated 6 percent of all reported patients die. Anorexia Nervosa Anorexia nervosa is a syndrome of self-starvation in which people willfully restrict intake of food out of fear of becoming fat, resulting in life-threatening weight loss. Anorexics (people who suffer from anorexia nervosa) “feel fat” even when they are at normal weight or when emaciated, deny their illness, and develop an active disgust for food. Deaths
Bulimia Bulimia is characterized by recurrent episodes of binge eating followed by self-induced vomiting, vigorous exercise, and/or laxative and diuretic
133
134 ejaculation abuse to prevent weight gain. Most people view vomiting as a disagreeable experience, but to a bulimic, it is a means toward a desired goal. Another eating disorder is bulimarexia, which is characterized by features of both anorexia nervosa and bulimia. Some individuals vacillate between anorexic and bulimic behaviors. After months and perhaps years of eating sparsely, the anorexic may crave food and begin to binge, but the fear of becoming overly fat leads her/him to vomit. Bulimics may be of normal weight, slightly underweight, or extremely thin. Binging and vomiting may occur as much as several times a day. In severe cases, it may lead to dehydration and potassium loss, causing weakness and cramps. A Cycle of Addiction Behaviors of anorexics and bulimics are driven by the cycle of addiction. There is an emotional emptiness that in turn leads to the psychological pain of low self-esteem. The individual looks for a way to dull the pain by using addictive agents (starvation or bingeing), which usually results in the need to purge or medical problems. Finally, suffering from guilt, shame, and self-hate, the individual goes back to a routine of starvation and/or bingeing and purging. Treatment Medical problems caused by the disorder should be diagnosed and managed first. When the medical complications are severe, an individual may be hospitalized to stabilize physical functions and monitor nutritional intake. Often, small feedings are carefully spaced because the patient cannot handle very much food at one time. In some cases, antidepressant medications are begun during the hospital stay. In 2005, treatment of eating disorders can cost an excess of $30,000 a month, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). Many patients need repeated hospitalizations and can require treatment extending two years or more. Some therapists believe that anorexia/bulimia is never cured but merely arrested. However, some behaviorists believe that weight gain indicates a cure. There are several therapies used in treating the eating disorders; these should be discussed with the individual’s therapist. A major part of therapy for eating
disorders involves helping the individual rethink her/his perception of BODY IMAGE, because often it is perceived flaws that led to the eating disorder in the first place. Many people with eating disorders are treated on an outpatient basis. There may be weekly counseling that includes individual and group sessions for outpatients and family, marital therapy, and specialized support for eating disorders. See also OBESITY. FOR FURTHER INFORMATION:
National Association of Anorexia Nervosa and Associated Disorders Box 7 Highland Park, IL 60035 (847) 831-3438 (847) 433-4632 (fax) http://www.anad.org National Eating Disorders Association 603 Stewart Street, Suite 803 Seattle, WA 98101 (800) 931-2237 (toll-free) (206) 382-3587 (206) 829-8501 (fax) http://www.nationaleatingdisorders.org
ejaculation The emission of semen from the penis at orgasm, usually during intercourse or masturbation. Ejaculation disorders are conditions in which ejaculation occurs before or very soon after penetration, does not occur at all, or in which the ejaculate is forced back into the bladder. Because ejaculation disorders interfere with the completion and enjoyment of sexual intercourse, they are very stressful for men as well as for their partners, who do not always know how to help and may feel some blame. Early ejaculation is ejaculation occurring within 10 to 60 seconds after penile penetration of the vagina and is also known as premature ejaculation. It is the most common sexual problem in men, often because of overstimulation or anxiety and stress about sexual performance. Inhibited ejaculation is a rare condition in which erection is normal but ejaculation does not occur. It may be psychological or it may be a result of a complication of other disorders or drug use.
elderly parents 135 Retrograde ejaculation occurs when the valve at the base of the bladder fails to close during an ejaculation. This forces the ejaculate backward into the bladder. Retrograde ejaculation may be the result of a neurological disease or can occur from pelvic surgery, surgery on the neck of the bladder, or after a prostatectomy. Treatment for ejaculation difficulties may begin with a visit to a physician, a urologist, or a sex therapist. See also SEX THERAPY; SEXUAL DIFFICULTIES.
elderly parents
By the year 2050, estimates indicate that the elderly population age 85 and over will be 18.9 million, equaling those at present age 65 to 69. While people are living longer, healthier lives, care for the very elderly has become a common and stressful issue for society at large and for families. The decision to take a more active role in their parents’ lives is one of stress for many middle-aged children. Role Reversal Adult children should be attentive to changes in their parents’ judgment and ability to take care of themselves and their affairs. To overcome the awkwardness of the role reversal, children should talk to their parents, find out how they perceive their circumstances, and discuss mutual concerns. They can agree to explore the situation further and work together toward a mutually agreeable approach. If the parents do not acknowledge problems, the adult children can keep the dialogue going by asking how they would advise a friend in similar circumstances. This technique may help everyone focus more clearly on immediate needs and solutions as well as longer-range solutions. The more elderly the parent becomes, the more dependent he or she becomes. Adult children may face a range of other more stressful emotions, and possibly the reappearance of long-forgotten feelings. In some families, they may have always felt grateful to their parents and welcome the opportunity to repay them. In other families, they may find their parents’ dependency too stressful to accept and feel overburdened, resentful, or guilty about their inability or unwillingness to help. Taking on more responsibility for one’s parents is an evolving process. Sometimes it may be one or
another sibling who does not want to accept the fact that the parent is becoming dependent or differs with the way problems are approached. In time, children and parents will become more comfortable with the role reversal and move toward new patterns of meeting everyday situations. Physical Care As people age, they are more susceptible to a variety of physical disorders. Some conditions such as anemia often result from a poor diet or an underactive thyroid gland; both conditions can be diagnosed and treated. Failing vision and hearing, also thought to be attributable to old age, may be rectified by removing a cataract or using a hearing aid. It is necessary, but stressful, that CAREGIVERS remain alert to signs of illness and find the time to take their elderly parent in for regular checkups and visits to the doctor when symptoms appear. Emotional Care In general, the elderly as a group are as mentally healthy as the general population. Still, there are some illnesses specific to this age group that can affect their behavior, judgment, and memory. For example, elderly parents may be overly fearful of losing CONTROL of what is going on around them. Symptoms may be mild, such as sadness, loneliness, irritability, or confusion, or they may be severe, such as DEPRESSION, agitation, or delusions. Common causes of depression in the elderly are isolation and feelings of not being wanted or needed. They are afraid of being a nuisance and at the same time fear being put away in a nursing home even more. Elderly parents, feeling the stress of losing their independence, may direct their HOSTILITY toward the adult child. Making them a part of family plans and activities, and encouraging them to attend a senior citizen or day-care centers, can provide the socialization they need and, at the same time, make them feel like useful members of society. Adult children should watch for mental health symptoms such as forgetfulness and paranoia in their elderly parent and get appropriate help. There are specialists in geriatric mental health who can be consulted. Living Arrangements As parents age, they may decide that it is in their own best interest to discuss and review their living
136 electricity options. Most older people, despite increased physical or mental frailty, want to live independently as long as possible. They may want to live near family members so that help with daily activities and personal care is at hand. While this type of arrangement may be ideal for the elderly person, it places a great deal of stress and strain on the family. Others may want to live with their families, ideally in a separate part of the house where they can maintain their independence. Two or three (maybe four) generations living under one roof can prove to be very stressful for most families. Today, there are many other living arrangements for the elderly, ranging from independent residential living in adult communities, assisted living in apartments where some meals and health and social programs are provided, shared housing in the elderly person’s own home or in a communal living arrangement, plus skilled nursing and rehabilitation centers. Social workers usually advise not rushing changes in living, unless needs are immediate and obvious. When difficult questions such as choosing living arrangements arise, all people, the elderly included, may not be ready to make decisions. They may want more time before talking about the problem again. Adult children should consider involving others, such as grandchildren, trusted friends, or their doctor in discussions. Advance Directives As parents age, they may begin to think about DEATH and whether doctors should use life-prolonging interventions when they are ill. Advance directives are arrangements that can help ease the ethical dilemma of decision making when facing a parent’s major illness or prolonged disability. Advance directives are legal documents signed by the parent that direct adult children to do what the parents desire in the matter of using life-prolonging medical technology. Reducing Stress as a Caregiver Many adult children find that they cannot cope with their elderly parents alone. They may have few or no other family members with whom to share the caregiving responsibilities. If there are siblings, they may live too far away or have heavy demands on their time.
PREVENT FUTURE STRESS: TIPS FOR TALKING WITH AN ELDERLY PARENT • Be patient in starting your discussion. • Set goals for each discussion. Be realistic. • Discuss his/her wishes; permit parents to maintain their dignity and keep a sense of control. • Use specific examples: “I’ve been concerned about your safety at home since your neighbor, Maggie, broke her hip.” • Suggest some options; explain advantages and disadvantages. • Make some specific short-term as well as longterm plans to give both of you peace of mind.
The idea of sharing responsibilities can be important for the major caregiver. It also increases the number of people to whom parents continue to relate. To get some ideas about available services in the community, such as day care, meals, recreation, living arrangements, and respite help, consult the local Office on Aging. Many such programs feature sliding-scale fees. Additionally, community mental health programs have specialists in the care of older adults who can provide counsel and references to SUPPORT GROUPS to help share concerns and practical approaches. For adult children whose parents live away from them, local social workers are affiliated with networks that can help them arrange for long-distance care. See also AGING; DEATH. SOURCE: Kahn, Ada P. “Becoming a Parent to Your Parents.” Chicago: Mental Health Association of Greater Chicago, 1988.
electricity Electric current as a source of power, while necessary in modern civilization, can be a source of stress for home owners and many workers. Safety concerns make the presence of electric power lines stressful for workers in construction, telecommunications, painting, pest exterminating, utilities, and many other areas of employment. Safety procedures must be followed while working on or around electrical systems. Circuits and conductors must be tested before touching
electroconvulsive therapy 137 them. Wearing personal protective equipment is essential. The right tools must be used for each job. Equipment must be isolated from energy sources and hazards identified. Regulations concerning electrical safety requirements are set forth by the Occupational Safety and Health Administration (OSHA). When these rules are followed properly, working with electricity becomes less stressful and less dangerous. Guidelines by OSHA as well as many industry groups (such as the National Fire Protection Association) cover electrical standards for many industries. Safe work practices include being sure that operating procedures are up to date and appropriate for the working conditions, evaluating circuit information drawings, and determining the degree and extent of hazards. Physical barriers around energy sources such as fences and insulators on conductors must be watched. Work areas should be clean and dry; cluttered work areas and benches invite accidents and injuries. Lightning Strikes Are a Source of Stress Lightning causes fear and stress for many people because it is dangerous. Approximately 93 people
WORKING WITH ELECTRICITY WITH LESS STRESS • Never operate an electric saw while wearing loose clothing such as long, floppy sleeves. • Read and follow all equipment operating instructions. All equipment repairs and adjustments should be done by authorized personnel. • Inspect work areas daily for hazards such as flickering lights, warm switches or receptacles, burning odors, loose connections, and frayed, cracked or broken wires. • Choose proper cords and connectors, making sure any portable cord used to power any type of light and/or heavy-duty industrial equipment is suitable for the equipment. • The extension cord thickness should be at least as big as the electrical cord for the tool. • Calibrate all testing equipment properly. • Repair sticking switches on electrical saws right away. • Turn off equipment when finished with each job; disconnect energy sources.
die each year in the United States as a result of being struck by lightning. Outdoor workers face a high risk of suffering a fatal lightning strike. A lightning strike can injure or kill one or more people. Of those struck by lightning, 30 percent die and 74 percent are left with permanent disabilities. Death from a lightning strike usually occurs within one hour of injury. Most lightning strikes occur outdoors between May and September. Several steps can be taken to reduce the fear and stress caused by lightning. Weather forecasts can be monitored during the thunderstorm season, because lightning is present in all thunderstorms. Know that lightning often precedes rain and can strike as far as 10 miles away from the rain of a thunderstorm. Seek shelter immediately when thunder is heard. Avoid trees or tall objects, high ground, water, open spaces, and metal objects such as fences, umbrellas, tools, and metal overhangs on buildings and recreational areas. Remain inside a vehicle; it is safe because rubber tires are nonconductive. When indoors, shut off appliances and electronic devices and avoid using the telephone. Use surge protection to prevent line surges from traveling to equipment such as computers. See also LADDERS. FOR FURTHER INFORMATION:
National Electrical Safety Foundation 1300 North 17th Street, Suite 1847 Rosslyn, VA 22209 (703) 841-3229 http://www.nesf.org Centers for Disease Control 1600 Clifton Road NE Atlanta, GA 33033 (800) 311-3435 (toll-free) (404) 639-3311 http://www.cdc.gov
electroconvulsive therapy (ECT)
Also known as electroshock therapy; a treatment that produces a convulsion by passing an electrical current through the brain. It may be stressful for family members as well as the patient. ECT is given only to carefully selected patients (such as those who have depression that is unresponsive to medications or are suicidal) under close medical monitoring. Individuals
138 electronic devices with severe depression may be referred for this treatment after a course of therapy with a mental health professional. Historically, ECT has been used for serious symptoms of mental illness. ECT affects many neurotransmitters in the brain, including norepinephrine, serotonin, and dopamine. It is also sometimes used to treat acute mania and acute schizophrenia when other treatments have failed. The number of ECT treatments needed for each person is determined according to the therapeutic response. After a course of ECT treatments, such patients usually are maintained on an antidepressant drug or lithium to reduce the risk of relapse. In people who are too medically ill to tolerate medication or who are not eating or drinking (catatonic) the treatment can be lifesaving. Side effects, including memory loss, are not uncommon. Patients must give informed consent to ECT. See also DEPRESSION; PSYCHIATRIST.
electronic devices
In the early 2000s, many new electronic devices were developed and in frequent use by consumers. While many devices are convenient time savers, they also can cause stress because of misunderstanding and malfunction. Commonly used electronic devices include remote control devices for television sets and radios, garage door openers, cell phones, handheld personal digital assistants, calendars and messaging systems that connect with computers, beepers, camera telephones, security cameras, fax machines, and many others. See also CHANGING NATURE OF WORK; COMPUTERS; IDENTITY THEFT.
elevators Elevators are sources of stress for many people. Fear of riding in an elevator may influence where an individual works or conducts business. Severe fear can be disabling because it limits one’s activities. Therapists treat elevator PHOBIA with many techniques, of which the exposure therapies are the most effective. EMPLOYEE ASSISTANCE PROGRAMS (EAPs) may refer an individual afraid to take elevators for appropriate mental health counseling. Elevators are a necessary mode of transportation in multifloor workplaces. Elevator safety procedures are a constant concern in all workplaces
and businesses; inspections by local authorities take place regularly. When electricity in a building is shut off for any reason, elevators are usually unavailable for workers, and another evacuation route must be designated. Usually during fires elevators are not used, and other routes of egress must be found. For maintenance workers as well as passengers, there is the hazard of working or riding in a confined space, often with electrical and other mechanical equipment. For workers outside the elevator cab, there is a risk of falling or being crushed between moving parts of the mechanism. There is a need for adequate lighting when working in the elevator shaft and also for wearing PERSONAL PROTECTION EQUIPMENT (PPE). See also BEHAVIOR THERAPY; CLAUSTROPHOBIA; CONFINED SPACES; ELECTRICITY; EMERGENCY RESPONSE.
ELISA test (enzyme-linked immunosorbent assay) Laboratory test commonly used in the diagnosis of infectious diseases; a highly sensitive screening test for evidence of the presence of HIV antibodies, considered a causative agent of AIDS (ACQUIRED IMMUNODEFICIENCY SYNDROME.) Tests found positive by this procedure are usually subsequently tested with another confirmatory assay (after the late 1980s, the Western blot confirmatory assay). Waiting for test results is a stressful time. Learning about a positive test result causes considerable stress and increasing dilemmas for many individuals. Therefore, appropriate counseling and expert interpretation should be done before and after test results are known. See also CHRONIC ILLNESS; HUMAN IMMUNODEFICIENCY VIRUS. FOR FURTHER INFORMATION:
CAIN (Computerized AIDS Information Network) San Francisco AIDS Foundation 54 Tenth Street San Francisco, CA 94103 (415) 864-4376 SIECUS (Sex Information and Education Council of the U.S.) 130 West 42nd Street, Suite 2500 New York, NY 10036 (212) 819-9770
emphysema 139 National AIDS Information Clearinghouse Centers for Disease Control and Prevention P.O. Box 6003 Rockville, MD 20850 (800) 458-5231
emergency response A coordinated effort to provide help in reaction to an emergency or disaster in homes, workplaces, or wherever hazard strikes. Those who respond to emergencies face the stress of floods, hurricanes, tornadoes, gas releases, chemical or biological attacks, chemical spills, explosions, or civil disturbances. Each year, more than 20,000 emergencies involving the release or threatened release of oil and hazardous substances are reported in the United States, affecting both large and small communities and the surrounding environment. Emergency response teams support local officials at work on the front lines. Response may be to send an ambulance or fire truck, or a team specially trained to confront large-scale disasters. Often people are forced to evacuate, causing stress and anxiety for a community or a worksite. Relocation is a stressful procedure for all involved because of uncertainty and disruption of routines. See also CHEMICAL HAZARDS; ELECTRICITY; HAZARDOUS AND TOXIC SUBSTANCES; TERRORISM; VIOLENCE. emotions
A range of feelings that humans experience. These may include joy, happiness, sadness, gladness, despair, loving, disgust, fear, surprise, or many others. These feelings are unique to each individual, and in periods of stress, many emotions may become evident. Researchers say that emotional feelings begin before the age of two months (when the baby first smiles) and continue to develop as the infant advances into childhood. Developing emotional feelings is an important factor in having good mental health in later life. Researchers have found that lack of loving attention and a trusting relationship during infancy may result in emotional deprivation. Children who are emotionally deprived often crave attention and experience a great deal of stress in COPING with their frustration. As individuals grow older, their emotional reactions are influenced by past experiences. For example, before a job interview, there may be feel-
ings of stress and nervousness; before a happy occasion there may be feelings of joy or gladness mixed with the stress of not knowing what lies ahead. Sweaty palms, red face, nervous tic, weak knees, or rapid heartbeat are some of the indications that individuals are under stress from their emotions. The term “emotional problem” or “emotional disorder” is applied to many mental health concerns; how people express their emotions is an important aspect of mental health. For example, many emotional responses such as nervousness, LAUGHTER, CRYING, and elation are considered within the range of normal. However, when responses are out of the range of normal, such as pervasive sadness in DEPRESSION, mental health is threatened. The term “emotional charge” refers to a stressful build-up of feelings stored in the body and mind. An emotionally charged discussion is one in which one or more of the participants have a built-up store of emotions and “let loose” those feelings; often the feelings have nothing to do with the discussion at hand. Self-Help for Emotional Problems Emotional Health Anonymous is a national selfhelp program that provides support to men and women who experience emotional problems and illnesses. The self-help groups of EHA use a modified version of the 12 steps to recovery of Alcoholics Anonymous to help participants during and after their crisis periods. Founded in 1970, there are SUPPORT GROUPS throughout the United States as well as in other countries. FOR FURTHER INFORMATION:
Emotional Health Anonymous General Service Office 2430 San Gabriel Boulevard San Gabriel, CA 91779 (818) 573-5482 SOURCE: Padus, Emrika, ed. The Complete Guide to Your Emotions and Your Health. Emmaus, Pa.: Rodale Press, 1992.
emphysema A chronic, obstructive lung disease that causes its victims to struggle for every breath they take. Because their lungs have lost much of their natural elasticity, people suffering from this
140 Employee Assistance Programs disease cannot completely exhale the carbon dioxide that is trapped in their lungs. They experience extreme stress as they fight to replace the stale air with fresh oxygen. Family members who wish to be helpful feel useless and frustrated. Emphysema develops over time. A chronic cough, often called a “smoker’s cough,” and a general shortness of breath are warning signs of emphysema. Sufferers do not realize they have it until the first signs of breathlessness appear, and by then delicate lung tissue may have been damaged excessively. Emphysema is a CHRONIC ILLNESS; there is no cure. Some people who have emphysema require use of a portable oxygen tank, making traveling complicated and stressful because of the need to make arrangements to replenish their supplies periodically. For these individuals, because of the constant use of oxygen, eating out in restaurants or going to movies or concerts is also a stressful experience for them as well as their companions. There is no known cause for emphysema, but most cases are related to cigarette SMOKING. Other contributing factors are air pollution and certain dusts and fumes. The disease is not caused by a germ or a virus and it is not an infectious or contagious disease. Easing the Stress of Emphysema Physicians can prescribe medications to relieve the feeling of breathlessness that accompanies this disease. There are also medicines that help clear mucus from the lungs and that can ward off chest infections. Also, emphysema patients can be taught by physical therapists to use their abdominal, chest, and diaphragmatic muscles to help them breathe more easily. See also BREATHING. FOR FURTHER INFORMATION:
Chicago Lung Association 1440 West Washington, Boulevard Chicago, IL 60607 (312) 243-2000
From the employer’s point of view, whatever EAPs can do to help reduce stress for the employee, helps with the stress of running a business. Employee Assistance Programs (EAPs) have been in existence for the past 50 years. Most authors trace their origin to the founding of Alcoholics Anonymous in 1935. In the 1960s and 1970s the scope of EAPs began to include help for employee problems such as DEPRESSION and other mental health concerns, drug abuse, DIVORCE, and other family difficulties. Since then, these programs expanded to include issues such as environmental stress, corporate culture, managing rapid technological change, and retraining. According to the Employee Assistance Professionals Association (EAPA), in mid-2005, 90 percent of Fortune 500 companies had an EAP. In the service industry, 68.4 percent of companies had them, and 100 percent of transportation and utility companies had EAPs. The demand for services from EAPs continues to increase, according to the EAPA. How EAPs Work While the programs are geared to identifying employees whose personal problems may adversely affect their job performance, they also take a proactive stance in helping employees avoid problems before they occur. For example, companies are offering their employees seminars on stress reduction, PARENTING, adolescents and drugs, exercise, health, and diet. EAPs provide referrals to appropriate professional services for employees and their immediate families. Confidentiality is assured; most employees would not use an EAP if they thought their problems would be revealed. Employers implement EAPs for a variety of reasons. One is the skyrocketing costs related to providing a medical benefits program; another is the huge cost attributed to downtime due to employee alcohol addiction and mental illness. See also ADDICTIONS; JOB CHANGE; JOB SECURITY; WORKPLACE. FOR FURTHER INFORMATION:
Employee Assistance Programs (EAPs)
EAPs are designed to provide employees with help for stressful problems they face on or off the job; having an EAP in one’s company is an important employee benefit.
Employee Assistance Professionals Association 4350 North Fairfax Drive Suite 410 Arlington, VA 22203
end-of-life care 141 (703) 387-1000 (703) 522-4585 (fax) http://www.eapaassn.org
empty nest syndrome
Situation in which children have grown up and left home; a source of stress experienced by many middle-aged parents. Typically, the syndrome seems to affect women more than men, and particularly women whose lives have focused on their children at the expense of engaging in activities for themselves. For these women, the empty nest syndrome can be a mild form of DEPRESSION that occurs after the children have left. Such women (and men, too, to some extent) no longer feel needed and feel a void in their life. On the other hand, there are many middle-aged couples who view their children leaving home with a sense of relief and fulfillment at having accomplished a major life task. Many empty nesters, particularly women, return to work, take on volunteer activities in their community, enroll in classes, or engage in new HOBBIES for which they previously had no time. See also MENOPAUSE.
enabler
See
CODEPENDENCY.
end-of-life care
There is need for discussion and physician education in the area of health care at the end of life, according to a report of a study by the Robert Wood Johnson Foundation released in 1995. Persons near DEATH and their family members often experience extreme stress because of use or nonuse of medical procedures and lack of communication with their health care practitioners. Also in 1995, the American Medical Association established the Task Force on Quality of Care at the End of Life, “to aid physicians in identifying when in the caregiving process, a transition in care needs may occur, and to identify actions that can be taken to improve the quality of life for those facing the end of life.” Ethical Considerations In a background paper, the American Medical Association’s Task Force reported that end-of-life issues have always been fraught with problems that society as a whole has not yet addressed.
Through their close relationships with their patients, physicians continue to hold a significant role in how people address these issues. Assuming patients do not misunderstand the prognosis and treatment options and they are not suffering from a treatable form of DEPRESSION, physicians in virtually all cases are morally obligated to abide by the competent patient’s directions in the provision or stoppage of life-sustaining treatment. Physicians have an obligation to relieve pain and suffering and to promote dignity and AUTONOMY of dying patients in their care. This includes providing effective palliative treatment, even though it may foreseeably hasten death. The AMA also is developing a working definition of “futile treatment” that physicians will be able to use in consultation with patients and their families when intensive care is requested and the physician does not believe such treatment has a reasonable chance of benefiting the patient. Euthanasia and Physician-Assisted Suicide While competent patients generally retain autonomy in end of life decisions, this does not extend to requests for euthanasia or physician-assisted SUICIDE. Dire social implications are inherent in these issues, and they pose a serious risk of abuse that is virtually uncontrollable, according to the AMA background paper. Such practices are ethically prohibited. They are fundamentally inconsistent with the physician’s role as healer, and they could contribute to erosion of the patient/physician relationship. Importance of End-of-Life Issues Patients deserve full information about their clinical status, honest assessment of prognosis, and education about potential treatment options, including palliative and hospice care. Physicians should encourage patients to consider their attitudes and beliefs about health care and quality of life prior to a crisis. They should advocate completion of advance directives, a signed paper that states the patient’s wishes as to prolonging life. At the same time, medicine recognizes its responsibility to take actions to enhance the decision-making ability of the medical/health care team that is ethically, morally, and professionally trained and can be entrusted to provide care for patients at the end of life.
142 endogenous depression To increase understanding and use of advance directives, in late 1995 the AMA took action to familiarize physicians with the patient guide jointly released in October 1995 by the AMA, the American Association of Retired Persons (AARP) and the American Bar Association (ABA): Shape Your Health Care Future and Health Care Advance Directives. See also DEATH; ELDERLY PARENTS. SOURCE: Background paper, American Medical Association, November 21, 1995.
endogenous depression
See
DEPRESSION; EXOGE-
NOUS DEPRESSION.
endorphins
Group of substances formed within the body that relieve PAIN and STRESS. Endorphins have a chemical structure similar to morphine. Since the early 1970s, researchers have understood that morphine acts at specific sites called opiate receptors in the brain, spinal cord, and at other nerve endings. From this knowledge, they identified small peptide molecules produced by cells in the body that also act at opiate receptors. These morphine-like substances were named endorphins, short for endogenous morphines. Effects of endorphins are noted, for example, in accident victims, who feel no initial pain after a traumatic injury, or in marathon runners, who do not feel muscle soreness until they complete their race. In addition to their effect on pain, endorphins are considered involved in controlling the body’s response to stress, regulating contractions of the intestinal wall, and in determining mood. Addiction and tolerance to narcotic analgesics, such as morphine, are thought to be due to or to cause suppression of the body’s production of endorphins. Withdrawal symptoms that occur when effects of morphine wear off may be caused by a lack of these natural analgesics. Conversely, ACUPUNCTURE is thought to produce pain relief partly by stimulating release of endorphins. LAUGHTER and EXERCISE are also said to promote endorphins. See also MEDITATION; RUNNER’S HIGH.
enuresis
See
BED-WETTING.
environment The stresses caused by the environment are a reality of life today. In cities throughout
the United States, there is a rising number of days when the Pollution Standard Index (PSI), which is a combined reading of five major pollutants—particulate matter, sulfur dioxide, carbon monoxide, ozone, and nitrogen dioxide—goes beyond acceptable standards. In fact, PSI can fluctuate from as few as three to a high well over 200 in any given year. Difficulties in breathing, runny eyes, and lightheadedness, all sources of STRESS for the sufferer, are just some of the symptoms caused by bad air. Inside the home or WORKPLACE, environmental hazards continue to prevail. It is estimated that up to 15 percent of the population is sensitive to indoor pollutants, which may be 10 times more concentrated than in nearby outdoor air. Some chemicals found in and around the household and workplace are pesticides, permanent press fabrics, gas stove fumes, car exhaust, and particleboard. Even water causes environmental illnesses; symptoms range from mild to disabling and are often nonspecific. Every part of the body can be affected by flu-like headaches, muscle aches, and fatigue, or more debilitating food intolerance and central nervous system problems such as memory loss, confusion, and DEPRESSION. See also CLIMATE: RANDOM NUISANCES; SICK BUILDING SYNDROME. FOR FURTHER INFORMATION:
National Safety Council 1121 Spring Lake Drive Itasca, IL 60143-3201 (800) 621-7619 (toll-free) (630) 285-1121 (630) 285-1315 (fax) http://www.nsc/org
Environmental Protection Agency (EPA) A U.S. government agency whose mission is to protect human health and the natural environment. Since the 1970s, EPA has provided leadership in environmental science, research, and education efforts. Through its many activities, the EPA reduces stress among the public caused by potential environmental toxins and AIR POLLUTION. The EPA works with other federal and state agencies, local governments, and Indian tribes to develop and enforce regulations and environmental laws. The EPA is responsible for setting national standards for many environmental programs. Where
ergonomics 143 national standards are not met, the EPA issues sanctions and takes steps to assist in improving environmental quality. The EPA also works with industries and all levels of energy conservation efforts and voluntary pollution prevention programs.
envy At one time or another, most people experience envy, a sense that something that others have is lacking in their lives. It is a stressful emotion and people usually are unwilling to admit to this feeling. Envy can spring from many types of RELATIONSHIPS. However, it is the situations close at hand, involving FRIENDS, relatives, neighbors, or colleagues, that are generally more intense and generate envy. An ability to imagine or identify with an admired person’s strengths is an intellectual asset, which may enable individuals to progress and better themselves. However, it becomes negative when the envious person remains fixated on another person’s life and does not try to better his own life in a constructive way. Low SELF-ESTEEM produces envy, which often does not improve by the attainment of material things, status symbols, or fame. Healthy self-esteem makes envy unlikely and allows for creative identification with admired traits in others. Modern American life is full of elements that create envy. For example, the mobile quality of society deemphasizes social class and creates the feeling that all things are possible for all people. This can create stressful feelings of FRUSTRATION, failure, and envy when expectations are thwarted. Mass media, especially TELEVISION, allows Americans to view “lifestyles of the rich and famous.” ADVERTISING plays on feelings of envy with situations of “keeping up with the Joneses.” The “Me Decade” of the 1980s, with its narcissism and “yuppie” lifestyle, created a climate in which envy flourished. Faced with a wide array of consumer products made available by high technology, it is always possible for individuals to feel that someone else has more than they do. Because feelings of envy imply that someone is in a superior position and because most religions regard envy as sinful, people develop various ways of masking or suppressing it. To avoid expressing envy, some people develop superior and snobbish attitudes and gossip, criticize, or imply that the person to be envied is really the envious one. See also HOSTILITY; JEALOUSY.
epinephrine Hormone secreted by the adrenal gland; also called ADRENALINE. It is a powerful stimulant and is sometimes referred to as the “emergency” hormone, as it effects the entire body. Epinephrine is responsible for reactions to FEAR and ANGER during stressful times, such as rapid heartbeat and the feeling of nervousness and agitation. Release of epinephrine throughout the body is part of the human body’s FIGHT OR FLIGHT readiness response to danger or threat of danger. As a last resort in cases of cardiac arrest, epinephrine is injected into the heart to start it beating again. See also NEUROTRANSMITTERS; STRESS. ergonomics
Ergonomics issues arise from particular jobs and include the repetitiveness of chores and the use of body force or posture to perform tasks, plus the environment in which the job is being done, such as poor lighting and ventilation, chair and desk heights, and level of noise. These issues can be viewed as stress carriers in the WORKPLACE and may be a cause of illness and injury resulting from job tasks. The science of designing the job, workplace, or task to fit the individual, rather than to force the individual to fit the job. Many jobs and tasks involve repetitive motion and the use of body force or posture to perform the tasks. These issues are carriers of stress and may cause illness and injury resulting from the effort, whether at home or at work. The field of ergonomics gained national attention during the 1990s when OSHA noted that the meatpacking industry had a very high rate of “repeated trauma disorders (RTD),” approximately 75 times that of all other national industries. In 2001, Labor Secretary Elaine Chao reported that work-related repetitive strain injuries and similar muscular disorders account for more than a third of all job injuries. Most occupational injuries and illnesses are often diagnosed as musculokskeletal disorders. Cumulative trauma disorders (CTD) are reported as the single fastest growing occupational issue among the U.S. working population, according to NIOSH. In the workplace, the objective of an ergonomics program is to focus on identifying individuals and their jobs, implementing medical and work
144 estrogen replacement therapy APPLYING ERGONOMICS CONCEPTS CAN MINIMIZE STRESS • Participatory ergonomics programs require strong direction, support, and significant expertise. • Training programs must develop both teamwork and ergonomic skills among participants. • In workplaces, team size should be kept minimal, but should include production workers engaged in the jobs studied, area supervisors, and maintenance and engineering staff who can effect proposed job improvements. • Effective team problem-solving requires access to injury and illness information. In addition, reports on the team’s objectives, progress, and accomplishments need to be circulated to keep all parties informed about the program. • Evaluation of results is an important component of a participatory ergonomic program. Such data will enable teams to appraise their progress, provide feedback to affected or interested parties, and make suitable corrections where necessary to improve the overall effort. SOURCE: DHHHS (NIOSH) Publication No. 95–102
interventions to prevent stress, and then evaluate the effectiveness of those interventions. See also CARPAL TUNNEL SYNDROME; REPETITIVE STRESS INJURIES. SOURCES: Brown, Stephanie. The HandBook: Preventing Computer Injury. New York: Ergonomne, 1993. Donkin, Scott W. Sitting on the Job: How to Survive the Stresses of Sitting Down to Work—A Practical Handbook. Boston: Houghton Mifflin, 1986. Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. New York: Facts On File, 2004.
estrogen replacement therapy eustress
See
MENOPAUSE.
HANS SELYE (1907–82), pioneer researcher in the field of STRESS, coined the term eustress to refer to “good stress.” During eustress and DISSTRESS (bad stress), the body undergoes virtually the same nonspecific responses to the various positive or negative stimuli acting upon it. However, he explained, the fact that eustress causes much
less damage than dis-stress demonstrates that “how you take it” determines whether one can adapt successfully to change. Examples of “good stress” include starting a new romance, getting married, having a baby, buying a house, getting a new job, or getting a raise at work. All these situations, as well as others, demand adaptations on the part of the individual. Both eustress and dis-stress are part of the GENERAL ADAPTATION SYNDROME (G.A.S.), which Selye described as being the controlling factor in how people cope with stresses in their lives. Later researchers (Holmes and Rahe) included several “good stress” situations in their Social Readjustment Rating Scale, which was designed to be a predictor of ill health. Sources of good stress included marriage, marital reconciliation, retirement, pregnancy, buying a house, and outstanding personal achievement. See also COPING; HOMEOSTASIS; LIFE CHANGE SELFRATING SCALE. SOURCES: Selye Hans. The Stress of Life, rev. ed. New York: McGrawHill, 1978. ———. Stress without Distress. Philadelphia: Lippincott, 1974.
euthanasia
See
END-OF-LIFE CARE.
exercise When individuals exercise to reduce their STRESS, they are usually participating in such cardiovascular activities as walking, jogging, weight lifting, using aerobic machines, and engaging in aerobic programs or sports such as skiing, swimming, cycling, or rowing. They participate in daily workouts and in weekends devoted to sports to combat the stress-related, physical tension in their lives at work or at home. In addition to relieving stress and muscle tension, exercise helps boost energy levels, improves posture, lowers blood pressure, and helps control BREATHING. All of these things have a calming effect on individuals because they raise their pulse rate, increase the supply of blood and oxygen to muscles and vital organs, raise ENDORPHIN and metabolism levels, and rev up the immune system. Exercise can have positive benefits that serve as a way to raise SELF-ESTEEM and increase CREATIVITY.
Eye Movement Desensitization and Reprocessing 145 According to Jeff Zwiefel, M.S., director of the National Exercise for Life Institute, physical strength and stamina and a confident attitude are the main by-products of exercise. A study at Baruch College, New York, found that people who are stronger and more muscularly fit have a significantly better self-image than their peers. Psychological tests have indicated that those who exercise are more confident and emotionally stable, and outlive those who are sedentary. The same positive effects of exercise on creativity were found by Joan C. Gondola at Baruch College, when she administered a test on female college students. One group had exercised 20 minutes before the test and the other group had not; the exercise group had more imaginative responses than those who had not. The boost in creativity may be attributed to the release of ADRENALINE and ENDORPHINS during exercise. The right side of the brain is stimulated by these chemicals, which control creative and intuitive processes. See also BODY IMAGE. FOR FURTHER INFORMATION:
Aerobics and Fitness Association of America 15250 Ventura Boulevard, Suite 310 Sherman Oaks, CA 91403 (800) 445-5950 (toll-free) National Fitness Foundation 2250 East Imperial Highway, Suite 412 El Segundo, CA 90245 (213) 640-0145
exogenous depression DEPRESSION
Exogenous (reactive) is a type of depression that originates
outside the body. It is often caused by emotional factors, such as BURNOUT, GRIEF, or STRESS. Exogenous depression is contrasted with endogenous depression, which researchers believe may be caused by a chemical imbalance in the body.
expatriate workers
See
CHANGING NATURE OF
WORK.
exposure therapy
See
extramarital affairs extroversion
See
BEHAVIOR THERAPY.
See
ADULTERY.
INTROVERSION.
Eye Movement Desensitization and Reprocessing (EMDR) A technique for treating a stress-producing traumatic experience that combines a representation of the trauma and self-evaluation of emotions and bodily sensations while experiencing bilateral stimulation (eye movement, tapping sounds, etc.). This procedure has empirical support as a trauma treatment. EMDR was developed in the early 1990s by Francine Shapiro, Ph.D., a northern California psychologist. FOR FURTHER INFORMATION:
Matthew J. Friedman, M.D. Ph.D., Director National Center for Post-Traumatic Stress Disorder VA Medical Center White River Junction, VT 05001 (802) 296-5132
[email protected] http://www.ncptsd.org
F faith
See
chosomatic aspects of many diseases. Also, many spontaneous remissions or recoveries from serious or hopeless conditions without benefit of the faith healing process have been recorded. A psychological study of individuals who had a physical stress condition relieved by faith healing showed that, while there was little indication of mental illness, they had strong DENIAL mechanisms. These denial mechanisms could have kept them from recognizing continuing symptoms of their stress. See also ALTERNATIVE MEDICINE; IMMUNE SYSTEM; MIND-BODY CONNECTIONS; PLACEBO EFFECT; PRAYER; RELIGION.
PRAYER; RELIGION.
faith healing
The essence of faith healing, for those who believe in it, is the strong conviction of “mind over matter.” For some people, belief in faith healing contributes to relief of stress. Historically, some faith healing takes place with the assistance of a “healer” who places hands on the individual who is then healed. For example, faith healing was and still is an accepted phenomenon of Roman Catholicism, where certain saints have been thought to have healing powers. The Catholic shrine at Lourdes has gained the reputation for causing miraculous recoveries. Native American religious practice includes rituals intended to promote healing of mental and physical ills. Faith healing is a central doctrine of Christian Scientists, who actively discourage reliance on doctors and conventional medicine. Today, there is a renewed interest in faith healing brought about by the resurgence of the fundamental and Pentecostal religious movements. Some of the movements’ ministers seem able to cure their congregants’ afflictions by arousing in them a religious fervor or hysterical response. Psychosomatic illnesses are thought to lend themselves best to the faith healing process. To counter the claim that faith healing has succeeded where conventional medical treatments have failed, some skeptics take the position that patients resort to faith healing only when desperate. Feeling that something must work, a person gets into a state of mind in which psychosomatic symptoms disappear, or if the problem is genuinely physical, patients at least feel better. Research methods are difficult to apply to faith healing, in part because of the questionable psy-
SOURCES: Oxman, T. E., et al. “Lack of Social Participation or Religious Strength and Comfort as Risk Factors for Death after Cardiac Surgery in the Elderly.” Psychosomatic Medicine 57 (1995): 681–689. Rose, Louis. “Faith Health,” in Cavendish, Richard, ed., Man, Myth and Magic, vol. 4. New York: Marshall Cavendish, 1983. Sobel, David, and Robert Ornstein, eds. “Faith Heals.” Mental Medicine Update 4, no. 2 (1995).
falling merchandise Workers as well as customers may be injured by items that fall from store shelves. As stores become larger, stress from falling merchandise increases. Such accidents are often referred to as “big box” injuries, as many occur in warehouse-style retail establishments that sell items in large containers or quantities. Since 1990, thousands of people have been injured and some killed by falling merchandise in retail warehouses. Items that fall range from toys to doors to housewares to television sets and other electronic equipment. Falling merchandise incidents often occur because of high stacking, which means storage of merchandise on the sales floor about eye level. To 146
family 147 handle merchandise, a salesclerk must climb on shelves, stretch, or use a ladder or step stool. Typically, stores do not use restraining safety devices such as security bars, fencing, safety ties, and shelf extenders on high shelves because of the expense involved and the employee time it might take to use them. Merchandise can be made to fall by moving merchandise that has been stacked in an unstable manner; moving merchandise on one shelf in such as way that merchandise on an adjacent shelf falls, referred to as “push through”; stacking different size boxes on top of one another, and stacking heavy merchandise on top of lighter merchandise. A problem can be caused by vibrations in and out of a store, merchandise too large for a shelf, or goods left hanging over the lip of a shelf. These incidents are particularly stressful because merchandise usually falls without any warning on an unsuspecting worker or customer. Even though merchants know about the risk of falling merchandise and the potential for serious injury to workers or customers, most do not give warnings of the risks with signs, banners, or placards. Many stressful incidents could be prevented if merchants would train employees in procedures for recognizing hazards and safely stacking items. See also LADDERS; SLIPS, TRIPS, AND FALLS. SOURCE: Kahn, Ada P. The Encyclopedia of Work-Related Injuries, Illnesses, and Injuries. New York: Facts On File, 2004.
family
Family and other RELATIONSHIPS sometimes buffer the stresses faced by individuals during their lifetime. However, for many people, families can also be a source of stress. As an example, men and women going through marital problems are especially vulnerable to the effects of relationship conflict. They may suffer from emotional consequences such as DEPRESSION and can have a compromised immune function leading to an increased rate of physical illness. CAREGIVERS who provide support for family members who are ill are another example of a highly stressed group. A decreased immune function has been observed in spouses caring for mates with ALZHEIMER’S DISEASE. George R. Parkerson, M.D., and colleagues at Duke University Medical Center reported in the
Archives of Family Medicine (March 1995) that individuals who see themselves as enduring high family stress are likely to have greater health problems than those reporting low family stress. Patients completed several different surveys that looked at SELF-ESTEEM, life events and changes, DEPRESSION, and family-induced stress. In addition, information on the number of physician visits, referrals to other physicians, hospitalizations, severity of illness, and cost of treatment incurred by these patients was tabulated. Results showed that family stress often had a stronger impact on health outcomes than other types of stress such as social or financial stress. Those with high family stress scores had more frequent follow-up visits to the clinic, more referrals to specialists, more hospitalizations, a higher severity of illness, and incurred higher charges for clinical health care than did those with low family stress. They also had fewer social support systems. The Duke University researchers recommended that family physicians identify patients with high family stress and give them the special care they may require to prevent unfavorable outcomes. They suggested that questionnaires such as those used in the study can help identify patients who are at high risk of adverse health-related outcomes and who may not be recognized as such through standard medical history reports, physical exams, and medical tests. Having patients bring family stress issues out in the open with their physicians can be useful. The researchers said that one randomized, controlled trial showed that when family physicians discussed details about stressful and supportive family members with their patients after reviewing questionnaire results, patients said they felt generally better and the process helped them to improve relationships with their families. See also COMMUNICATION; DYSFUNCTIONAL FAMILY; INTIMACY. SOURCES: Burg, M. M., and T. E. Seeman. “Families and Health: The Negative Side of Social Ties.” Annals of Behavioral Medicine 16 (1994): 109–115. Parkerson, George R., et al. “Perceived Family Stress as a Predictor of Health-Related Outcomes.” Archives of Family Medicine 4 (March 1995).
148 Family and Medical Leave Act of 1993 Family and Medical Leave Act of 1993 (FMLA)
A federal law, applying to businesses of 50 or more employees, that became effective in 1993 that helps to relieve stress from many family situations that require a worker to be off the job. It provides certain employees with up to 12 workweeks of unpaid, jobprotected leave a year and requires employers to maintain the group health benefit during the leave. The law mandates the unpaid leave for qualified employees for the birth or adoption of a child and when they or a family member have a serious health condition during a 12-month period. FMLA has a positive effect on retention of qualified employees. The U.S. Department of Labor’s Employment Standards Administration, Wage and Hour Division, administers and enforces the FMLA for all private, state and local government employees, and some federal employees. When employees and their families understand the provisions of the law, stressful situations can be improved. For example, “serious health condition” means an illness, injury, impairment, or physical or mental condition that involves either (1) any period of incapacity or treatment connected with inpatient care in a hospital, hospice, or residential medical care facilities or (2) continuing treatment by a health care provider, including any period of incapacity, such as inability to work, attend school, or perform regular daily activities due to: 1. A health condition (treatment or recovery) lasting more than three consecutive days, and any subsequent treatment or period of incapacity relating to the same condition that also includes treatment two or more times by or under the supervision of a health care provider, or one treatment by a health care provider with continuing regimen of treatment; or 2. Pregnancy or prenatal care. A visit to the health care provider is not necessary for each absence; or 3. A chronic serious health condition that continues over an extended period of time, requires periodic visits to a health care provider, and may involve occasional episodes of incapacity (e.g., asthma, diabetes). A visit to a health care provider is not necessary for each absence; or 4. A permanent long-term condition for which treatment may not be effective (e.g., Alzheimer’s,
a severe stroke, terminal cancer). Only supervision by a health care provider is required, rather than active treatment, or 5. Any absence to receive multiple treatments for restorative surgery or for a condition which would likely result in a period of incapacity of more than three days if not treated (e.g., chemotherapy or radiation treatments for cancer). An employer may require workers to provide a certification issued by their health care provider or that of a son, daughter, spouse, or parent to support the request. The employer must allow the employee at least 15 calendar days to obtain certification. Some states have their own family leave laws. If the state law provides family and medical leave rights better than the federal law, the state law applies. If the FMLA is better, it applies. FOR FURTHER INFORMATION:
U.S. Department of Labor Employment Standards Administration Wage and Hour Division Frances Perkins Building 200 Constitution Avenue NW Washington, DC 20210 (866) 4-USWAGE (877) 889-5627 (TTY) http://www.dol.gov/esa
family therapy family violence farming
See
PSYCHOTHERAPIES.
See
DOMESTIC VIOLENCE.
Stressful occupation because farmers have little CONTROL over their lives; weather affects their yield, international trade dictates their prices, and government subsidies affect their income. For many families, farming is a way of life and comes with a whole set of values, standards, mores, and characteristics. Currently, farming as a vocation is also threatened by a lack of respect from the public because many farmers have to rely on government subsidies to make their livelihood. This lack of respect, added to the farmer’s stress, pressure, and frustra-
fathering, older 149 tion, can result in physical violence, first focused on the spouse and then on the children. This is a major social problem, but one that cannot be easily addressed because of the private, independent nature of farmers, who live in relative isolation and have few options on how to change their lot. Musculoskeletal injuries, such as sprains, strains, and traumatic injuries are the greatest working hazard for farmers. These sources of stress are present in farming because of the repetitive nature of much labor-intensive farmwork. Farmers bend or stoop to reach crops. Sometimes they must balance on a ladder, or, when harvesting, may have to carry or lift heavy bags full of the harvested commodity. Motor vehicle accidents are one of the most serious causes of fatal injuries to farmworkers. These often occur when workers are driving or being driven to or from fields early or late in the day on unsafe rural roads; collisions may also occur with slow-moving farm equipment. Tractors of all sizes are used on many farms: Tractor attachments include tillers, snow blowers, and trimmers. These tractors all have engines, use fuel, have moving parts, carry an operator, and are often used with towed or mounted equipment. Some tractors can be overturned and cause serious injury. The fuel used on these tractors may also pose a fire hazard. Children riding with adults have fallen from tractors and been crushed under the wheels or chopped by mower blades. Mowers pose two types of hazards: potential contact with rotating blades and being struck by objects thrown from the blades. Both front-end loaders and blades are operated hydraulically; they are a hazard because they can fall on anyone standing under the attachment. Among farmworkers, skin diseases are a common source of stress, as are trauma from using hand equipment such as clippers, irritants and allergens in agrochemicals, allergenic plant and animal materials (including poison ivy and poison oak), nettles and other irritating plants, skin infections caused or worsened by heat or prolonged water contact, and sun exposure (which can cause skin cancer). Farmworkers experience the stress of respiratory symptoms and disease from exposure to dust and chemicals. In dry climate farming, inorganic-
dust exposure may result in dust-borne lung diseases and chronic bronchitis. See also CHILD LABOR; CONTROL; FRUSTRATION; LADDERS; POISON IVY; STRESS; WHEEZING. See also DOMESTIC VIOLENCE. SOURCE: Haverstock, Linda. “Stress in Farming.” Canadian Family Physician 38 (1992): 405–406.
fathering, older
Fathering later in life is less stressful than fathering at an earlier age, according to economist Martin Carnoy, a Stanford University professor of education. In his book, Fathers of a Certain Age, Carnoy and his coauthor, and son David argue that men in their late 40s, 50s, and even 60s, secure in their careers and ready to make time for families, are more nurturing and willing to share in child care responsibilities than their younger counterparts. As a result, they find fatherhood less stressful at their age. The Carnoys reviewed literature comparing fathering experiences at different ages and interviewed many older fathers, exploring how they feel about PARENTING small children late in middle age. “These older fathers are more stable financially and better able to provide for a child,” the elder Carnoy said. “But more important, they are usually willing to spend a great deal of time on the FAMILY. They have fought the workplace wars and are much less sanguine about the rewards of long work days. Almost everyone we interviewed who was raising second families was spending more time with their children than they did as 30-yearold fathers trying to climb career ladders. Family plays a much more important everyday role in older fathers’ lives.” Fathers of a Certain Age suggests that middle-age fathering is on the increase after many years of decline, and that this is no accident. As college-educated women seek to build their professional careers and postpone child-bearing to their early 30s and beyond, they are much more likely to end up marrying a man who is in his mid-40s or older. This has resulted in “fathers at a certain age,” and census data indicate that more than 350,000 men in the United States over age 45 fall into this category. Although the Carnoys found that older fathers are intensively involved with their children, the
150 fatigue book discusses some of the major pitfalls of later fatherhood. Not only do many middle-aged fathers have to deal with their disapproving older children from a previous marriage, they also face the sheer energy requirements of raising a young child, the possibility of paternal death early in a child’s life, and the financial difficulties of facing RETIREMENT and paying for a college education. SOURCE: Carnoy, Martin, and David Carnoy. Fathers of a Certain Age. Boston: Faber and Faber, 1995.
to an individual who is seeking comments about his feelings or actions. It is a sharing of feelings or thoughts and ideally should be given without evaluating consequences to the individual or demanding that he make a change. Negative feedback, even when given with complete objectivity, can be stressful and generally arouses defensiveness in the individual. Positive feedback, on the other hand, enhances SELF-ESTEEM and makes the individual feel good. See also COMMUNICATION; LISTENING.
fatigue
Feldenkrais method
See
fax machines
CHRONIC FATIGUE SYNDROME.
See
ELECTRONIC DEVICES.
fear
An emotion that results in an intense and unpleasant stress that comes about because of a real threat. In fear, there may be intense feelings of wanting to escape, together with physiological reactions including weakness, DIZZINESS, rapid breathing, rapid heartbeat, nausea, muscle tension, and weakness in the knees. Different individuals have different physiological responses to fear. The terms fear and phobia are often misused and are improperly interchanged. Fear is a real and knowable danger, and usually can be recognized by others. Phobia on the other hand, is an inappropriately fearful response to a situation and is out of proportion to the real danger, if there is danger at all. Real fear is normal. Chronic PHOBIAS that cause avoidance behavior are considered ANXIETY DISORDERS. At times, fear can be a helpful emotion. For example, the fear reaction enables people to get out of the way when they hear the whistle of a train. It signals the hypothalamus, which triggers a release of ADRENALINE into the body. Adrenaline acts immediately to prepare the body for FIGHT OR FLIGHT. Breathing deepens, perspiration increases to cool the body, pupils dilate to sharpen vision, the face may turn pale, and the heart beats noticeably faster. See also AGORAPHOBIA; ANXIETY; SOCIAL PHOBIA.
feedback
Involves objective information given by a therapist, teacher, or parent, or by others in a
SUPPORT GROUP,
See
BODY THERAPIES.
feng shui
One way to reduce chances for stress is to practice a philosophy that ensures harmony and good fortune. Such is the Chinese art of geomancy, or feng shui, which involves the proper alignment of objects with geographical features. In Hemispheres magazine (November 1993), John Goff translates feng shui as “wind and water” and defines it as “a product of a culture that honors the spirits of mountains and rivers and views the landscape as a living thing with cosmic currents.” Practiced first in Hong Kong, where it influenced the design of many corporate buildings, including Citicorp International and Motorola Semiconductors Hong Kong, Ltd., feng shui has spread to other parts of the world as well. In addition to corporate offices, there are factors that can remove stress from a household (see below).
USE FENG SHUI TO REMOVE STRESS WHEN BUILDING OR FURNISHING A HOUSE
• Entryways and windows should be wide enough to allow light, which symbolizes the Sun and allows good energy to come in. • Mirrors are particularly used in cramped spaces and over furniture that does not face windows or doors because they reflect positive energy and deflect negative forces. • Buildings near water are good because water is an element of wealth, insight, and motivation. Avoid building near tall buildings because they block positive energy and on cul de sacs because negative energy has no place to escape.
firefighters and rescue workers 151 fertility
See
INFERTILITY.
fibromyalgia
Form of soft tissue or muscular rheumatism that causes PAIN in the muscles and fibrous connective tissues (ligaments and tendons). It is an accepted clinical syndrome that causes stress for the sufferer, not only because of the pain and discomfort, but also because of the difficulty in having it diagnosed properly. According to Barry M. Schimmer, M.D., chief of the section on rheumatology at Pennsylvania Hospital, “For a long time we thought that their problems were psychosomatic and these patients were referred for psychiatric help. Today we know that this condition is very real and needs to be dealt with and treated like any other chronic illness.” The exact cause of fibromyalgia is unknown, and there is no known cure. Many different factors trigger the pain, including an illness, such as the flu, hormonal changes, or physical or emotional trauma. Symptoms The ailment, which affects 3 million to 6 million Americans, primarily Caucasian middle-class women between the ages of 45 and 55, results in muscles becoming tight and tense, and the person feeling emotionally drained. Other symptoms of the disease in addition to pain and constant fatigue are feeling “down” and anxious; numbness and tingling in the hands, feet, and legs; sleep disturbance, tension headaches, subjective swelling, bladder spasms, and irritable bowel. Cold weather, extremes of activity, fluctuation of barometric pressure, and stress often aggravate the symptoms of fibromyalgia. Diagnosis and Treatment Since diagnosis of fibromyalgia is so difficult, a rheumatologist does extensive detective work in sorting out the patient’s medical history and performing a thorough examination. Said Dr. Schimmer, “When we examine the patient we will find tender ‘trigger points’ in certain patterns over the neck, shoulders, chest, lower back, and hips and this helps to separate fibromyalgia from other conditions.” Nonsteroidal anti-inflammatory agents are used, as are corticosteroids, but they often do not help. Efforts are made to improve sleep. Nonphar-
macologic treatment emphasizes aerobic exercise, particularly water aerobics. Light sports, such as swimming, bicycling, and walking, are encouraged. Some people find BIOFEEDBACK, hypnotherapy, massage, and SUPPORT GROUPS helpful. Many patients, in an acute stage of their disease, worry about having bone cancer or other ominous disorders; some become very anxious. Psychotherapy can help certain individuals overcome the attendant stresses of this disorder. See also MASSAGE THERAPY; PSYCHOTHERAPIES. SOURCES: McIlwain, Harris H., and Debra Fulghum. The Fibromyalgia Handbook. New York: Henry Holt, 1996. Starlanyl, Devin. Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual. Oakland: New Harbinger Publications, 1996. Williamson, Miryam Ehrlich. Fibromyalgia: A Comprehensive Approach: What You Can Do about Chronic Pain and Fatigue. New York: Walker and Company, 1996.
fight or flight response
This is an innate reaction present in humans as well as animals to a stressful or threatening situation in which the SYMPATHETIC NERVOUS SYSTEM (SNS) mobilizes the body for maximum output and use of energy. When facing a stressful situation, the SNS causes many physiological reactions, including a rapid heartbeat, deep breathing, slowing down of digestion, and an increase in blood pressure. These physical functions enable the person (or animal) to quickly flee the dangerous situation or fight back against an aggressor. An example of the fight or flight response is when an individual realizes that he is on a railroad crossing and the train is coming closer than he thought. Fast flight ensues. Also, when a mother animal’s cubs are threatened by a predator animal, her instincts take over and the fight or flight response follows. See also ANXIETY DISORDERS; FEAR; PANIC ATTACKS AND PANIC DISORDER; STRESS.
financial stressors
See
MONEY.
firefighters and rescue workers
The stressful and dangerous work of these occupations involves buildings collapsing, deadly smoke, and heart
152 fires attacks. The workers are often the first emergency responders at the scene of a vehicle crash, fire, flood, earthquake, or act of terrorism. About 2 million fires are reported each year in the United States; every 18 seconds, fire departments respond to emergency situations. Firefighters perform many duties to protect lives and minimize property destruction. Duties may include rescuing victims, administering medical aid, salvaging contents of buildings, connecting hose lines to hydrants, operating pumps, or positioning ladders. Each year, on average, about 50 firefighters die from injuries on the job, accounting for about 1 percent of all fatal work injuries. In the period 1992–97, the total number of fatalities for firefighters was about 17 firefighters per 100,000 employed. This compares to five fatalities per 100,000 employed for all workers. Firefighters are about three times as likely to be fatally injured on the job as the average worker, causing stress for the workers’ families as well as the injured workers. Despite efforts to reduce firefighter mortality with better protective equipment, breathing machines, and a buddy system that sends two firefighters into a burning building together, deaths continue to rise. Fire and smoke are responsible for the largest proportion of deaths and for a high percentage of injuries, according to Kristin Kloberdanz, M.D., director of the Occupational Medicine Service at the University of Medicine and Dentistry of New Jersey. According to Kloberdanz, the attack on the World Trade Center in 2001 saw the single highest count of firefighter deaths in U.S. history. Other Stressful Hazards: Heart Disease and Cancer The work is stressful because sites are uncontrolled and sometimes extremely hot environments. Firefighters and rescue workers wear protective clothing, which is heavier than most winter clothes, and carry 75 to 90 pounds of equipment, including breathing apparatus. Additionally, rescue workers may find themselves in agonizing life-or-death situations, which can lead to depression or post-traumatic stress disorder (PTSD). Firefighters and rescue workers also suffer a higher than normal risk of certain types of cancer, including bladder cancer and lymphoma, which
experts attribute in part to the toxins that firefighters are exposed to inside burning buildings. Respirators and air tanks are mandatory, but these safeguards do not prevent all toxic substances, such as benzene, ASBESTOS, and polycyclic aromatic hydrocarbons from entering the system. In addition to fighting building fires, firefighters are called on to control and extinguish forest fires. Some pilot aircraft to locate forest fires or use chain saws and axes to create fire trails, among other duties. Forest fires are particularly stressful because they may increase rapidly and can surround the firefighters who are trying to put them out. Rescue workers also risk coming into contact with body fluids from victims, sprains and strains, cuts, and hearing loss, often caused by wailing sirens. See also ELECTRICITY; EMERGENCY RESPONSE; HEART ATTACK; HEALTH CARE WORKERS; LADDERS; NOISE; SLIPS, TRIPS AND FALLS. SOURCES: NIOSH. Preventing Injuries and Deaths of Fire Fighters Due to Structural Collapse. Publication No. 99-146, August 1999. NIOSH ALERT. Preventing Injuries and Deaths of Fire Fighters. DHHS (NIOSH) Publication No. 94-125, September 1994.
fires Fires are a major source of fear and stress for home owners, workers, and businesses. Fires
TIPS FOR AVOIDING THE STRESS OF FIRE HAZARDS Eliminate fire hazards Keep all spaces free of waste paper and other combustibles, replace damaged electrical cords, and avoid overloaded circuits. Prepare for emergencies Make sure all smoke detectors work, know who to call in an emergency, and participate in fire drills. Report fires and emergencies promptly Sound the fire alarm and call the fire department. Evacuate safely Leave the area quickly in an emergency. Use stairs instead of elevators, and help other members of your household or coworkers.
flexible work hours 153 put people out of their homes or places of work and severely affect their livelihoods. According to former U.S. labor secretary Robert Reich, “There is a long and tragic history of workplace fires in this country. One of the most notable was the 1911 fire at the Triangle Shirtwaist Factory in New York City, in which nearly 150 women and young girls died because of locked fire exits and inadequate fire extinguishing systems. That tragedy helped put basic workplace safety and health considerations on the national agenda.” FOR FURTHER INFORMATION:
National Fire Protection Association 1 Batterymarch Park P.O. Box 9101 Quincy, MA 02269-9101 (800) 344-3555 (toll-free) (617) 770-0700 (Fax) www.nfpa.org
fireworks Explosive devices used for celebrations are a source of stress for many bystanders because of the possibility of injury. All fireworks are dangerous, especially to children. In 2003, 9,300 people were treated in U.S. hospital emergency departments for fireworks-related injuries. Injuries from fireworks most often affect the hands and fingers, eyes, head, and face. Children 14 years and younger sustained about 45 percent of injuries related to fireworks, and boys represented 72 percent of all those injured. According to the U.S. Centers for Disease Control and Prevention (CDC), two-thirds of injuries from fireworks in the United States occur in the days surrounding the July 4th holiday. Under the Federal Hazardous Substances Act, the federal government banned the sale of the largest and most dangerous fireworks to consumers. Some states have banned the general public’s use of fireworks altogether. The U.S. National Fire Protection Association and CDC strongly recommend that fireworks be used only by professionals. FOR FURTHER INFORMATION:
National Center for Injury Prevention and Control Mailstop K65 4770 Buford Highway NE Atlanta, GA 30341-3724 (770) 388-1506
(770) 488-1667 (fax) http://www.cdc.gov/ncipc/duip/spotlite/ firework_spot.htm E-mail:
[email protected] SOURCE: National Center for Injury Prevention and Control
fitness
See
flashbacks
EXERCISE.
See
POST-TRAUMATIC STRESS DISORDER.
flatulence The expulsion of air, usually swallowed when eating, from the stomach or intestine but can also be induced by ANXIETY in times of stress. Fear of passing wind or gas is a common SOCIAL PHOBIA and can cause stress or embarrassment. Certain foods are well known as tending to cause flatulence, including beans, cabbage, onions, peppers, cucumbers, celery, and dairy products. See also INDIGESTION; IRRITABLE BOWEL SYNDROME. flexible work hours (flex time)
An alternative to the traditional nine to five, 40-hour workweek. The policy allows employees to arrange their arrival and or departure times to fit their family or personal schedules. For many people, flexible work hours reduce the stress involved in working, commuting, and managing a family. Flexible work hours vary and may be arranged to suit the convenience of employees, such as working parents. Under some policies, employees must work a prescribed number of hours and be present during a daily “core time.” Alternative work arrangements such as flexible work schedules are a matter of agreement between the employer and the employee. In a Chicago Tribune column, writer Carol Kleiman reported on two studies that found flexible work hours advantageous. One was conducted by Flexible Resources, Inc., a consulting and staffing firm in Cos Cob, Connecticut, that specialized in permanent jobs with flexible hours. The other was by Catalyst, a nonprofit agency in New York that works with businesses to advance women. According to the research, job assignments with flex time are satisfying even though promotions are slow. Salaries are surprisingly good. Both studies included only women because they are more
154 flooding likely to work flexible schedules. Both studies focused on high-ranking, well-educated, experienced professionals and did not include employees in support or administrative jobs. Lower-level employees are less likely to be allowed flexible hours and more often are required to be on the job site all the time. Kleiman quoted Linda Coletti, a marketing executive at a consumer product company in Stamford, Connecticut, as saying, “There’s been a tremendous change in employers’ attitudes since I started working flexible hours eight years ago. Some companies viewed you as a second-class citizen, but now your experience is valued.” A Bureau of Labor Statistics Monthly Labor Review article stated that from 1991 to 1997, the percentage of full-time wage and salary workers with flexible work schedules on their principal job increased from 14.1 percent to 27.6 percent. See also CHANGING NATURE OF WORK; HOURS OF WORK; WORKING MOTHERS. SOURCES: Beers, Thomas M. “Flexible Schedules and Shift Work: Replacing the ‘9 to 5’ Workday?” BLS Monthly Labor Review Online. Available online. URL: http://www.bls. gov/opub/mir/2000/06/art3exc.htm. Downloaded on June 15, 2005. Kleiman, Carol. “Price Is Right for Flexible Work Hours.” Chicago Tribune, June 12, 2001, sec. 3.
flooding flying
See
See
BEHAVIOR THERAPY.
AIRPLANES.
folk medicine
See
ALTERNATIVE THERAPIES; FAITH
HEALING; PRAYER.
forgetting
An inability to retrieve stored long- or short-term memories. It is a common occurrence and a source of stress to many people. Most people forget short-term as well as long-term memories, particularly the elderly who experience MEMORY loss as they grow older. But forgetting is a sign not just of old age. Many people consciously block out stressful memories and many are simply forgetful. They may forget recently made appointments, forget what their boss told them earlier in the day, or forget occurrences that happened in childhood.
See also ALZHEIMER’S
DISEASE; POST-TRAUMATIC
STRESS DISORDER.
Framingham Type A friends
See TYPE A
PERSONALITY.
Friends are unique among human RELAWhile individuals have little or no choice in family or neighbors, they can choose their friends. Some friendships evolve from shared interests or values, some simply from a shared history, and some from compatible personalities. Qualities most appreciated in friends include loyalty, trust, and an ability to keep a confidence. People want to feel that they can rely on their friends and can have an open and honest friendship during good as well as stressful times. When friends are supportive, they help relieve the stress during periods of turmoil or crisis. Individuals who experience DEPRESSION often report a lack of friends, although having a wide circle of friends is not a preventive factor for depression. Some reports have indicated that individuals who have many friends may be healthier and actually live longer than those who do not. Friends can also be a source of stress because they may challenge or be challenged by other relationships in the individual’s life. For example, a friendship may be broken or changed when one friend marries. A friend of the opposite sex frequently is unsettling to a spouse or lover. Friends who do not meet with parents’ approval can be a source of family conflict. Friends who decide to share housing or enter into a business partnership sometimes discover undesirable facets of the other person’s personality that could be ignored when the relationship was less formal. In the WORKPLACE, a friendship may dissolve when two people are vying for the same promotion. A 1990 Gallup poll reported that the typical American places much importance on friendship. It also indicated some frustrations about the time and flexibility needed to form friendships. The survey showed that women and men approach friendship quite differently. Women tended to form more intimate relationships with other women than men with men. One-on-one activities that promote conversation are more popular with women, whereas men are more likely to get together in groups for sports, cards, or other such TIONSHIPS.
fungi 155 activities. Men rely on their wives for emotional support, but many women, even those who are married, often rely on women friends. Women are more likely than men to have a best friend of the same sex, but a third of the men surveyed said a woman was their best friend. People make friends in many ways. In the Gallup report, 51 percent of the 18- to 29-year-olds made most of their friends at school. Of the 30- to 49-yearolds, 51 percent said they made most of their friends through work. From the age of 50 up, friends came from a greater variety of sources, including church, work, clubs, or other organizations. When participants were asked about arguments with friends, those under age 30 reported more disagreements. Friendship evidently becomes more tranquil with age, possibly because friends settle their differences and learn to recognize sore spots, or possibly because age enables people to recognize and discard difficult and stressful relationships. See also INTIMACY. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
frigidity
An old term that refers to the inability of a woman to obtain satisfaction (usually orgasm) during sexual intercourse. Sex researchers Masters and Johnson coined the term “female orgasmic dysfunction” to replace this term. Regardless of the label, the situation may be a cause of stress for the woman as well as her partner. Lack of satisfaction during sexual intercourse may result from a combination of many factors, including the desirability of one’s partner, poor COMMUNICATION between the partners concerning sexual behaviors and desires, and cultural rejection of certain sexual practices. Other factors necessary to the woman’s arousal—stimulation and satisfaction—vary widely between individuals. Also, the fear of desertion, acquiring a SEXUALLY TRANSMITTED DISEASE (STD), or pregnancy may interfere with satisfaction for some women. See also ANORGASMIA; DYSPAREUNIA; SEX THERAPY; SEXUAL DIFFICULTIES.
frustration Interference with an individual’s impulses or desired actions of internal or external
forces. Internal forces are inhibitions and mental conflict, and external forces can come from a parent, teachers, and friends, as well as the rules of the society. There are deep feelings of discontent and tension because of unresolved problems, unfulfilled needs, or roadblocks to personal goals. Regardless of the cause, frustration causes stress for most people. Modern life is filled with frustrations from birth to old age. Crying babies may be frustrated because of hunger, school-age children may be frustrated by high expectations of their parents, parents may be frustrated by their jobs, and the elderly may be frustrated by their increasing lack of independence. People who are repeatedly and constantly stressed by frustrations respond in many ways. A person who is mentally healthy usually deals with frustration in an acceptable way, sometimes with HUMOR. Others react with ANGER, HOSTILITY, AGGRESSION, or DEPRESSION, while still others become withdrawn and passive. Many children and adults who are constantly frustrated show regressive behavior—going back to childlike behavior, particularly aggression or depression—and may become unable to cope with problems on their own. See also CONTROL; COPING; GENERAL ADAPTATION SYNDROME; STRESS MANAGEMENT.
funeral arrangements fungi
See
DEATH.
Organisms in indoor air in homes and workplaces that can cause stressful problems such as ALLERGIES, ASTHMA, lung diseases, and other respiratory problems and contribute to SICK BUILDING SYNDROME. The kind of fungi found in indoor air normally reflect those in outdoor air when windows are kept open. To grow and proliferate indoors, however, fungi require a suitable substrate such as wood, paper, gypsum board, or other materials that have a high cellulose content and water. Homes or buildings where there is chronic water damage or where humidity levels are high are particularly at risk of contamination with fungi. Fungal growths have potentially stressful injurious effects on health. For example, certain species of fungi produce mycotoxins, natural organic compounds that initiate a toxic response in humans,
156 fungi including mucosal and skin irritation, immunosuppression, and systemic effects. Humans are exposed to these toxic chemicals primarily by inhalation of spores or of material that has been contaminated by MOLD. Some people develop allergies such as rhinitis and asthma when exposed to molds. Repeated and heavy exposure to small fungal particles can also cause hypersensitivity pneumonitis in certain people.
Symptoms caused by exposure to mold should disappear once exposure ceases. Systemic effects, such as headache, fever, excessive fatigue, cognitive and neuropsychological effects, gastrointestinal symptoms, and joint pain, have been observed in some people exposed to molds. Certain species of fungi can cause infectious diseases, but this is rare, unless the exposed person is severely immunosuppressed.
G gagging, hypersensitive
galvanic skin response (GSR) Use of an electronic device attached to an individual’s fingertips that measures minute amounts of perspiration in the skin in response to emotional or psychological stressors. The more tense the individual is, the more perspiration is on his skin; as the individual becomes calmer, there is less perspiration. The device converts its electrical information to an easily observable form, such as light or a buzzing sound, and can be used in conjunction with BIOFEEDBACK or as a test after an individual has learned the biofeedback technique to reduce effects of stress. See also RELAXATION.
The feeling that one will gag or choke is often associated with stress and anxiety. A fear of gagging is related to the feeling of a lump in the throat that one cannot seem to swallow. Those who are hypersensitive gaggers cannot tolerate foreign objects in their mouths, such as objects used during dental treatment. In some cases, individuals may gag, retch, or vomit if they hear or think about dentistry or smell an odor associated with dental procedures. It can relieve stress to understand that gagging is a normal protective reflex for the oropharynx. Also, the sensitivity and trigger area is greater in some individuals than others. In mild cases, gagging can be triggered just by touching near the back of the mouth with the tongue or being touched by a dental instrument. In more severe cases, the trigger can be touching the front of the mouth, the face, and the front of the neck; certain smells or signs associated with unpleasant oral experiences such as dentistry; or becoming ill due to certain foods. Some hypersensitive gaggers swallow with their teeth clenched and thus have difficulty during dental procedures. Such individuals have particular difficulty in swallowing with their teeth apart. Individuals who are hypersensitive gaggers can learn to relieve their stress and modify their swallowing pattern, for example, swallowing with the teeth slightly apart and the tongue further back in the mouth. If sharp teeth make the tongue overly sensitive, the teeth can be smoothed down somewhat by a dentist.
gambling Playing a game (such as cards or slot machines and roulette) for money or other stakes or betting on an uncertain outcome (such as a horse race or football game). The fascination with gambling and the prospect of winning can reduce stress for certain individuals by helping them forget their problems. This is particularly true when they are able to control their gambling by setting a dollar limit on their losses and stopping their gambling at that point. However, for many people, gambling becomes an ADDICTION and a compulsion, and they play on and on. People gamble for many reasons. Some simply enjoy the sociability of the event while others find the risk and unpredictability of the game exciting and stimulating. Some derive a sense of power and importance from winning; others may gamble out of rebellion. To gamble is still illegal in some situations or considered sinful or immoral by some religious groups.
SOURCE: Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000.
A Compulsion or an Addiction Gambling may be considered a compulsion or addiction when the gambling activity becomes the
157
158 gay marriage most important aspect of a person’s life. Such individuals will direct all of their efforts toward obtaining money to gamble. Seeking funds to enable gambling can become a stressor. For family and friends of the addicted gamblers who may not be able to pay household bills and provide a living, it becomes a source of stress as well. Although gambling does not involve ingesting substances, compulsive gambling has many characteristics in common with alcoholism. Both the National Council on Compulsive Gambling and Gamblers Anonymous have estimated that there are 6 million compulsive gamblers in the United States. Typically, the compulsive gambler is a married man in his early to mid-30s, employed in a field involving money and high risks, such as investment, business, or the law. Usually, compulsive gamblers are outgoing, generous, and gregarious, but are prone to sudden negative mood swings. Even in serious stages of compulsive gambling, gamblers will express concern about their health, but not about their addiction to gambling and the stress caused by it. National attention was focused on the problem of compulsive gambling in the late 1980s with the well-publicized problems of baseball star Pete Rose. Shortly afterward, a Gallup poll showed a somewhat ambivalent public attitude toward gambling. Survey results indicated that gambling as an activity, both legal and illegal, is on the upsurge and extremely popular. Public sentiment ran toward increasing legalized gambling, although 61 percent of those surveyed said they thought legal gambling encouraged excessive gambling. Historically, there have been underworld aspects surrounding gambling. Films frequently depict expensively dressed, glamorous men and women gambling in casinos in exotic locations all over the world, or seedy, down-on-their-luck characters playing cards or shooting craps and about to get raided by the police. Today, when more and more states are passing laws that allow gambling and lotteries have become an American way of life, gambling has become completely accessible to people in all walks of life. Gamblers Anonymous offers a recovery program similar to Alcoholics Anonymous. The Council on Compulsive Gambling offers a crisis intervention hotline for compulsive gamblers and their families. See also ADDICTIONS; SELF-HELP GROUPS.
FOR FURTHER INFORMATION:
Gamblers Anonymous 3255 Wilshire Boulevard, Suite 610 Los Angeles, CA 90010 (211) 386-8789 National Council on Compulsive Gambling John Jay College of Criminal Justice 445 West 59th Street New York, NY 10019 (212) 765-3833 SOURCES: Hugick, Larry. “Gambling on the Rise; Lotteries Lead the Way.” The Gallup Poll, June 1989. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
gay marriage
See
MARRIAGE; REMARRIAGE.
gender role A collection of attitudes and behaviors that are culturally and socially associated with maleness or femaleness. Along with many societal changes, gender roles have also changed significantly, particularly during the last half of the 20th century. The gender role for many women in Western cultures was historically passive and submissive, until the women’s liberation movement and sexual revolution. Child care is no longer exclusively the woman’s role, and earning the larger part of the family income is no longer exclusively the man’s role. These changes have not occurred without stress. Some women try to handle motherhood and a career at the same time or sacrifice one for the other, while some men fear that wives will advance more rapidly in their career than they will, and others have mixed emotions about their role as fathers. Stressors from gender roles also occur when individuals have persistent feelings of discomfort about their sexual identity. Transsexualism is the most common example of this situation. When people have internal conflicts regarding gender identity and do not accept their biological designation, stressful anxieties may develop, leading them into practices such as cross-dressing and adopting the role of the other sex. Many individuals who believe that they are men or women in the body of the other sex experience stressful anxieties to the
genetically modified foods or genetically modified organisms 159 extent that some of them seek surgical sex change operations. See also HAVING IT ALL; SEXUAL DIFFICULTIES.
withdraw from it throughout life, but cannot add to it. See also COPING; DIS-STRESS; EUSTRESS; HARDINESS; HOMEOSTASIS; PSYCHONEUROIMMUNOLOGY.
general adaptation syndrome (G.A.S.)
SOURCES: Selye, Hans. The Stress of Life. New York: McGraw-Hill, 1956. ———. Stress without Distress. Philadelphia: J. B. Lippincott, 1974.
Refers to a term we now know as STRESS; it was coined by HANS SELYE (1907–82), an Austrian-born Canadian endocrinologist and psychologist, in his landmark book, The Stress of Life (1956). The G.A.S. is the manifestation of stress in the whole body as it develops over time. It is through the G.A.S. that various internal organs, especially the endocrine glands and the nervous system, help individuals adjust to constant changes occurring in and around them and to “navigate a steady course toward whatever they consider a worthwhile goal.” Dr. Selye was a pioneer in an area that has continued to look at stress as a threat to wellness. The secret of health, he contended, was in successful adjustment to ever-changing conditions. Life, he said, is largely a process of adaptation to the circumstances in which we exist. He viewed many nervous and emotional disturbances, such as high blood pressure and some cardiovascular problems, gastric and duodenal ulcers, and certain types of allergic problems, as essentially diseases of adaptation. Selye called his concept the general adaptation syndrome because it is produced only by agents that have a general effect on large portions of the body. He called it adaptive because it stimulates DEFENSE MECHANISMS. He used the term syndrome because individual manifestations are coordinated and interdependent on each other. There are three stages in the G.A.S., Selye said. Individuals go through the stages many times each day as well as throughout life. Whatever demands are made on us, we progress through the sequence. The first is an alarm reaction, or the bodily expression of a generalized call for our defensive forces. We experience surprise and anxiety because of our inexperience in dealing with a new situation. The second stage is resistance, when we have learned to cope with the new situation efficiently. The third stage is exhaustion, or a depletion of our energy reserves, which leads to fatigue. Adaptability, Selye continued, was a finite amount of vitality (thought of as capital) with which we are born. We can
generalized anxiety disorders (GADs)
See
ANXIETY.
generation gap
See
BABY BOOMERS; COMMUNICA-
TION; INTERGENERATIONAL CONFLICTS; LISTENING.
genetically modified foods (GM foods) or genetically modified organisms (GMOs) Plants created for human or animal consumption using molecular biology techniques to improve nutritional content or increase resistance to herbicides. Many people experience STRESS and disagreement concerning the controversy regarding such foods. Traditionally, desired traits have been developed through breeding, but this can be very time consuming and may not yield accurate results. Genetic engineering, on the other hand, can create plants with the exact desired trait rapidly and accurately. An example is creating a drought-resistant corn crop or a crop that can resist unexpected frost. Proponents say that genetic engineering can help increase the nutritional value and shelf life of some foods. Crops modified to resist attack by pests or disease could result in greater yields, more economical production, and ultimately lower cost. This could be advantageous for feeding rapidly growing populations in developing countries. Opponents say that GMOs are an unknown quantity and that it is impossible to know the potential effects on human health and the environment. New allergens could be created inadvertently and known allergens transferred from traditional foods into genetically modified variants. Research needs to be conducted on the risks of consuming genetically modified foods. Environmental concerns include the possibility that GM crops could accidentally cross-pollinate non-GM crops, leading to contamination and
160 geriatric depression increasing the spread of GM crops. Growing GM crops on a large scale may have implications for biodiversity. Labeling of GM foods and food products is also a contentious issue. Generally, agribusiness industries believe that labeling should be voluntary and influenced by the demands of the free market. Others believe labeling should be government mandated. According to the U.S. Food and Drug Administration, more than 40 plant varieties have completed federal requirements for commercialization. Some examples of these plants include tomatoes, cantaloupes, soybeans, sugar beets, corn, and cottons. Not all of these products are yet available in supermarkets. However, the ubiquity of soybean derivatives as food additives in the contemporary American diet assures that most U.S. consumers have been exposed to GM food products. In 2000, 13 countries grew genetically engineered crops commercially; U.S. farmers grew 68 percent of all GM crops. Soybeans and corn, the top two most widely grown crops, made up 82 percent of all GM crops harvested in 2000. FOR FURTHER INFORMATION:
Economic Research Service U.S. Department of Agriculture 1800 M Street NW Washington, DC 20036 (202) 694-5050 http://www.ers.usda.gov/briefing.biotechnology E-mail:
[email protected] geriatric depression geropsychiatry gestalt therapy
See
See
DEPRESSION.
PSYCHOTHERAPIES.
A type of psychotherapy and one of many therapies useful in treating individuals who experience debilitating stress, anxieties, or phobias. It emphasizes treatment of the person as a whole, including biological aspects and organic functioning, perceptions, and interrelationships with the outside world, and focuses on the sensory awareness of the individual’s here-and-now experiences rather than on past recollections or future expectations. Gestalt therapy can be used in individual or group therapy settings because it uses role-playing,
acting out anger or fright, reliving traumatic experiences, and other techniques, such as the “empty chair,” to elicit spontaneous feelings and selfawareness, promote personality growth and help the individual develop his or her full potential. Gestalt therapy was developed by Frederick S. Perls, a German-born U.S. psychotherapist (1893–1970). See also PSYCHOTHERAPIES.
glass ceiling
An invisible barrier that keeps many working women from rising to the top of their field despite good qualifications, experience, and hard work. This frustration leads to stress and anxiety and, for many individuals, DEPRESSION. There are many variations of the effects of the glass ceiling. For example, men in high-level posts may be brought from outside the organization to provide a fresh outlook while qualified women already in the organization are passed over. Also, in discussions involving teamwork and negotiations, women are often kept on the periphery of the decision making process. Teasing and harassment may discourage women from seeking a promotion. Women in lower-level positions are sometimes given responsible, demanding work that is not reflected in title or salary. As women attempt to progress in an organization, they may find that performance standards are higher for them than for men. Women may also be inhibited by assumptions that a feminine management style is more passive and nurturing toward fellow workers and less goal oriented and driven than the masculine management style. Women who do make it past the glass ceiling frequently credit the influence of a mentor, spouse, or parent. Some women avoid the glass ceiling by striking out on their own. In the late 1980s, the number of self-employed women was growing faster than the number of men. See also SEXUAL HARASSMENT; WOMEN’S MOVEMENT.
glaucoma
A group of eye diseases in which a specific pattern of damage to the nerve located in the back of eye (optic nerve) results in loss of eyesight. People who are diagnosed with glaucoma experience stress as vision loss worsens, leading to total blindness over time if glaucoma is not treated.
global warming 161 After diagnosis of glaucoma, people need to be checked regularly by an eye specialist. The most common form of glaucoma in the United States is open-angle glaucoma. In openangle glaucoma, the optic nerve is slowly damaged, usually causing gradual loss of vision. Both eyes can be affected at the same time, although one may be affected more than the other. In some cases, much of the person’s eyesight can be affected before he or she notices a change. Closed-angle glaucoma is less common, accounting for about 10 percent of all glaucoma cases in the United States. It may cause sudden blurred vision with pain and redness, usually in one eye first. Causes of Glaucoma The damage to the optic nerve in glaucoma is thought to be caused partly by increased pressure in the eye (intraocular pressure or IOP) that results from the buildup of fluid inside the eye. However, damage often occurs without increased IOP. Many doctors believe that glaucoma should be considered as a neurodegenerative disease, caused by damage to and loss of nerve cells, rather than just a disease of high intraocular pressure. Symptoms of Glaucoma Many people who have open-angle glaucoma have no symptoms until they begin to notice loss of vision. Peripheral (side) vision is usually lost before central vision, which is necessary to see details sharply. A person usually does not notice side vision loss until it becomes severe because the less affected eye makes up for the loss. Also, the person does not notice loss of sharpness of vision until late in the disease. By that time, significant vision loss may have occurred. Some people with closed-angle glaucoma do not have any apparent symptoms or have only mild symptoms. Others may have several symptoms that require immediate medical attention. Symptoms of closed-angle glaucoma usually affect only one eye at a time and often include sudden severe blurring vision, severe pain in the eye itself or in areas immediately around the eye, colored halos around lights, redness of the eye, nausea, and vomiting. Testing for Glaucoma and Treatment During routine visits to eye health professionals, patients are usually tested for glaucoma. When a
person is diagnosed with glaucoma, a target type pressure for each eye is established. The target is based on the amount of damage to the optic nerve and the pressure at which the damage occurred. The target eye pressure is approximately 20 percent less than the prior eye pressure. During treatment, the target eye pressure is adjusted as needed to prevent damage to the optic nerve. Treatment is centered on preserving eyesight by slowing damage to the optic nerve. In adults, treatment cannot restore eyesight that has already been lost as a result of glaucoma. Most treatment focuses on lowering the pressure in the eyes. Optic nerve damage can occur at any level of eye pressure, even within the normal range. Lowering the pressure in the eyes often can help protect the optic nerve from further damage. Treatment usually begins with medications; when medications do not successfully lower pressure in the eyes, laser or surgical treatments may be considered. However, in moderate to severe cases, it may be appropriate to use laser or surgical treatments first. Treatment with medication or surgery are both effective; however the risks and benefits may differ depending on the type of glaucoma, age, race, and other factors.
global warming
The idea that human activities can rapidly change Earth’s climate is a cause for concern and stress for people all over the world. Global warming is not a new concept. Jean Fourier, a French physicist, was the first to understand the “greenhouse” effect. In 1824 he suggested that Earth stays warm at night because its atmosphere traps sun-warmed gases in the same way a greenhouse holds heated air. In 1892, Svante Arrhenius, a Swedish physical chemist, predicted that, if levels of carbon dioxide in the atmosphere doubled, the average temperature of Earth would rise between 1.5 and four degrees Celsius, close to the prediction most climatologists share today. Stresses arise for many people who become concerned about the increased incidence of more intense cold during winter and more intense heat during summer, as well as flooding, landslides, tornadoes, and hurricanes. Additionally, some people are concerned about the use of products such as
162 globus hystericus aerosol sprays and chemical pollutants, which may contribute to global warming.
globus hystericus goals
See
gonorrhea
See
LUMP IN THE THROAT.
HARDINESS.
See
SEXUALLY TRANSMITTED DISEASES.
gout A disease caused by the deposit of uric acid crystals in the joints of the body. It is a source of stress for many people because they experience pain, swelling, redness, and heat as well as stiffness in one or more joints. Gout can flare up without specific causes, or can be brought on by a variety of factors, including a high-protein diet (foods rich in purines, such as organ meats, anchovies, or sardines), moderate to heavy alcohol intake, obesity, or very-low-calorie diets. Gout is a form of ARTHRITIS (inflammation of the joints) and affects 2.1 million Americans; it is most common in men aged 40–50. Gout is caused by too much uric acid in the blood (hyperuricemia). Hyperuricemia usually is not harmful, and most people who have high levels of uric acid in their blood never develop gout. Why people develop gout is largely unknown, although inherited factors seem to play a large role. When uric acid levels in the blood are too high, uric acid may crystallize and accumulate in the connective tissue, joint spaces, or both. Symptoms of Gout A gout attack typically involves pain, swelling, tenderness, redness, and inflammation in a single joint, most often the big toe. Other joints of the feet and joints of the ankles, knees, wrists, fingers, and elbows may also be involved. Often symptoms disappear. Mild attacks may stop after several hours or last for one to two days. Severe attacks may last up to several weeks, with soreness lasting for up to a month. Some people only experience one attack with no recurrence. However, most people have a second attack of gout within six months to two years after their first attack, but there may also be intervals of many years between attacks. If gout is untreated, the frequency of attacks usually increases with time.
Diagnosing and Treating Gout Physicians use tests to measure the amount of uric acid in the blood or urine. The only certain way to diagnose gout is to have a joint fluid aspiration (arthrocentesis) test to see whether uric acid crystals are present. Usually, gout can be successfully treated by taking medication and monitoring dieting carefully. However, physicians usually wait two to four weeks after a gout attack is over to begin a medication to lower the high uric acid levels. For an acute gout attack, a patient may be advised to use heat on the affected joints, rest the joint, and then take one of several possible prescription medications, such as nonsteroidal antiflammatory drugs (NSAIDs), colcicine, or prednisone. Aspirin should be avoided because it elevates serum uric acid levels and may worsen symptoms. To prevent recurrent attacks, many patients are advised to take a medication that lowers serum uric acid levels, such as allopurinal. Allopurinal blocks uric acid production and is the drug most often used in long-term treatment for older patients and those with high levels of excreted uric acid. See also PAIN. FOR INFORMATION CONTACT:
American College of Rheumatology/Association of Rheumatology Health Professionals 1800 Century Place, Suite 250 Atlanta, GA 30345-4300 (404) 633-3777 (404) 633-1870 (fax) http://www.rheumatology.org Arthritis Foundation 1330 West Peachtree Street Atlanta, GA 30309 (800) 283-7800 (toll-free) (404) 872-7100 http://www.arthritis.org National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) National Institutes of Health 1 AMS Circle Bethesda, MD 20892-3675 (877) 226-4267 (301) 495-4484 TTY: (301) 565-2966 Fax: (301) 718-6366
grief 163 http://www.niams.nih.gov E-mail:
[email protected] greenhouse effect
See
AIR POLLUTION.
grief An intensely powerful, painful, and stressful emotional reaction caused by the loss of a loved one or of something with very important personal significance in an individual’s life. While the expression of grief is unique to each individual, there are recognized stages of grief (bereavement), which include some common characteristics as well as sources of STRESS for most people. Many individuals call into play their own DEFENSE MECHANISMS. These mechanisms may help an individual cope with the pain of the loss. Numbness is a pervasive feeling that enables the mourner to get through the first few days following the DEATH of the loved one; it may last from a few days to a few months. HALLUCINATIONS are also common among the recently bereaved; in some cases, they believe that the dead person walks into the room or they see him/her in a crowd. In the case of a deceased infant or child, a parent may hear his/her cry or voice. As the initial feeling of numbness begins to wear off, the individual may feel anger and despair and feel overwhelmed by the circumstances; these feelings can lead to DEPRESSION. In some cases, such as death or divorce, people may feel angry that the person deserted them. Physical symptoms are fairly common, including HEADACHES, INSOMNIA, or gastrointestinal complaints. Attempted SUICIDE is an abnormal expression of grief, but is not uncommon. There may be an increase in use of tranquilizer drugs and alcohol at this time. The individual may experience intense feelings of helplessness. Questions arise: “Could I have prevented this from happening? Why wasn’t I powerful enough to do something more?” Such thoughts are part of the human condition. People like to feel that they are in CONTROL at all times, and with grief they feel the loss of that control. Many people who have experienced loss say that it can take up to two years to adjust and get on with life. However, overwhelming feelings of loss do recur. In the long run, a positive attitude can
help overcome depressed feelings and the stresses of adjustment. A support system often influences how well an individual adjusts after a period of grief. The recovery process may be accelerated with friends and family nearby. Widowed persons with no relatives and few friends seem to have the most stressors and the most difficult time adjusting to the death of a loved one. Some parents who have lost an infant try to have another baby within a few years; however, the feeling of loss of the first one never really goes away. Many divorced people remarry but others do not. Overcoming the Stresses of Grief Individuals who continue to suffer from the stresses of grief for a long period of time may find mental health counseling helpful. Getting help when it is needed is a sign of strength and wisdom; appropriate referrals for mental health help can be obtained from a social worker or a physician. SUPPORT GROUPS for widows and widowers, parents and divorcees are effective for many people. Knowing that others had the same emotional reactions can help participants cope better with their grief stressors. Those grieving for the loss of a child may also find help in appropriate support groups. The Bereavement of Loss Center in New York is an organization that provides professional counseling services for individuals who have suffered loss or who anticipate a loss, such as loss of a spouse, child, relative, or friend. The center is nonsectarian and provides psychiatric social workers and psychiatrists with an advisory staff, including other medical specialists, financial advisers, and attorneys. Other sources of help can be found through many organizations that offer telephone information and referral services. Crisis telephone lines and centers and hospital social service departments are sometimes a fast way of getting help; these numbers should be listed in a special section of local telephone books. Another’s Grief as a Stressor One person’s grief is often a source of stress for another. Some individuals are at a loss for what to say or what to do. Despite these feelings, there are some supportive activities that might be helpful. For example, offering a quiet supportive presence;
164 group therapy encouraging the bereaved person to talk and share happy as well as sad memories; avoiding being judgmental of any comments the bereaved person might make; encouraging him or her to remain connected to former support systems, such as social or church groups; and being available in a proactive way to get the person back into the cycle of a mentally healthy lifestyle. See also DEATH; PREGNANCY; SUDDEN INFANT DEATH SYNDROME. FOR FURTHER INFORMATION:
Bereavement and Loss Center of New York 170 East 83rd Street New York, 10028 (212) 879-5655 Elisabeth Kübler-Ross Center South Route 616 Head Waters, VA 24442 (703) 396-3441 Mental Health Association of Greater Chicago 104 South Michigan Avenue Chicago, IL 60603-5901 (312) 781-7780 Parents of Murdered Children 100 East Eighth Street, Suite B41 Cincinnati, OH 45202 (513) 721-LOVE Pregnancy and Infant Loss Center 1415 Wayzata Boulevard, Suite 105 Wayzata, MN 55391 (612) 473-9372 Theos 1301 Clark Building 717 Liberty Avenue Pittsburgh, PA 15222 (412) 471-7779 SOURCES: Kahn, Ada P. “Living with the Death of a Loved One,” (brochure). Chicago: Mental Health Association of Greater Chicago, 1989. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Kübler-Ross, Elisabeth. On Death and Dying. New York: Macmillan, 1971. Ramsay, R. W., and R. Noorbergen. Living with Loss. New York: William Morrow, 1981.
group therapy grudges GSR
See
See
See
PSYCHOTHERAPIES.
HOSTILITY.
GALVANIC SKIN RESPONSE.
guided imagery
A technique to help the individual generate vivid mental images that help reduce STRESS. It creates positive mental pictures and promotes the relaxation necessary for a healing process. The individual pictures an image, such as a calm, serene lake with sailboats slowly moving along, breathes in a relaxed manner, and becomes more relaxed. The individual gradually learns to notice every detail of the imagined scene and how the sense of RELAXATION deepens with this self-talk. He learns, too, that this sense of calm can be created at any time by BREATHING and imagining the positive vision. Some case studies and clinical reports suggest that the guided imagery technique may be helpful in the treatment of chronic PAIN, ALLERGIES, hypertension, autoimmune diseases, and stress-related gastrointestinal, reproductive, and urinary symptoms. In addition to direct effects, imagery may augment the effectiveness of medical treatments and help people tolerate discomforts and side effects of some medications or invasive procedures. Imagery has qualities that make it valuable in mind/body medicine and healing; it can bring about physiological changes, provide psychological insights, and enhance emotional awareness. Use of imagery, in some cases, changes the need for medication. Depending on an individual’s medical condition, imagery is best used under the supervision of a physician in conjunction with holistic medicine. Guided imagery can be used alone or together with other relaxation techniques. It is often used in conjunction with HYPNOSIS, although the two techniques are distinct. While hypnosis serves to induce a special state of mind, imagery consists of a focused, intentional mental activity. See also ALTERNATIVE MEDICINE; IMMUNE SYSTEM; IRRITABLE BOWEL SYNDROME. FOR FURTHER INFORMATION:
The Academy for Guided Imagery P.O. Box 2070 Mill Valley, CA 94942 (800) 726-2070 (toll-free)
Gulf War Illness 165 SOURCES: Goleman, Daniel, and Joel Gurin, eds. Mind Body Medicine: How to Use Your Mind for Better Health. Yonkers, N.Y.: Consumer Reports Books, 1993. Kerns, Lawrence. Chicago Medicine 97, no. 22 (November 21, 1994).
guilt Emotional response to a perceived or actual failure to meet expectations of the self or others. Guilt is a stressor for many people because guilt feelings can be destructive if carried to an extreme. It can destroy people’s sense of SELF-ESTEEM and feeling of capability. However, these feelings can also be constructive when people begin to understand their sources of guilt and learn to cope with this very common aspect of the human condition. Some individuals, depending on differences in conscience, can steal or commit crimes against others and not feel any guilt, while others will suffer from stressful guilt feelings over incidents that occur all their lives. Many individuals may experience guilt feelings for not remembering the birthday of a parent or spouse. Middle-aged adults may experience guilt feelings when dealing with their aging parents. Some individuals who are bereaved over a death of a loved one may feel some guilt about not having done enough for the person when they were alive. Parents of infants who die of SUDDEN INFANT DEATH SYNDROME (SIDS) suffer stress because of feelings of guilt over not preventing the death of their child. Spouses and relatives of people who commit SUICIDE may have guilt feelings for years, wondering if they could have prevented the death. For some individuals, mental health counseling or participation in an appropriate support group can help relieve some of these uncomfortable feelings of guilt. See also COPING; DEPRESSION. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
Gulf War Illness Symptoms reported by many who served in the armed forces in the Persian Gulf War in 1991. The illness has been a major source of stress for more than 100,000 American veterans, who, within six to 12 months after exposure, reported a wide variety of symptoms including skin rashes, headaches, disabling fatigue, intermittent fevers, joint and muscle pains, and short-term memory impairment. The sufferers of Gulf War Illness may have been exposed to depleted uranium, used in artillery shells; fallout from destroyed nuclear reactors; biological contaminants, such as bacteria and viruses; or chemical mixtures, possibly anti-nerve and nerve agents. In the late 1990s, the United States launched a health care outreach effort to evaluate their health concerns of those with Gulf War Illness symptoms. The Department of Defense allocated up to $12 million for general research on possible causes of Gulf War Illness. In 2004, after studying more than 2.5 million veterans for nearly four years, the Department of Defense and Veterans Affairs announced that veterans of the conflict are nearly twice as likely as other soldiers to suffer from amyotrophic lateral sclerosis (Lou Gehrig’s disease). Officials said they will offer disability and survivor benefits to affected patients and families. Research on the health of these veterans is still under way. FOR FURTHER INFORMATION:
Environmental Agents Service Veterans Health Administration Department of Veterans Affairs 810 Vermont Avenue NW Washington, DC 20402 (202) 273-8580 (202) 273-9080 (fax) http://www1.va.gov/environagents VA Gulf War Information Helpline (800) 749-8387 http://www.va.gov/gulfwar
H With appropriate diagnosis, many people suffering from hair loss can be helped. Diagnosis is the first step. Hair loss can be due to many different causes, such as pregnancy, high fever, severe infection, or severe flu. It may also be due to thyroid disease, inadequate protein in the diet, certain prescription drugs and cancer treatment drugs, birth control pills, low serum iron, major surgery, chronic illness, or ringworm of the scalp. After some forms of hair loss, hair will regrow. Individuals undergoing chemotherapy experience hair loss; expectations are that hair will grow back some time after completion of chemotherapy. Other forms can be treated successfully by dermatologists. About 90 percent of a person’s scalp hair is continually growing. Shedding 50 to 100 hairs a day is considered normal. When a hair is shed, it is replaced by a new hair from the same follicle located just below the skin surface. Scalp hair grows about a half-inch a month. As people age, their rate of hair growth slows down, and thinning hair may be noticeable. See also AGING.
habits
Learned responses that one performs automatically and frequently. They may include useful procedures, such as knowing how to use a computer keyboard, taking a shower in the morning, or always leaving a key in a certain place. Habits can also be responses to stressful situations, such as scratching the head, NAIL BITING, HAIR PULLING, or reaching for a cigarette. These unwanted or undesirable habits, if continued, can contribute to people’s stress levels. Habits can include certain repetitive and ritual behaviors such as those practiced by sufferers of OBSESSIVE-COMPULSIVE DISORDER. These habits that usually cause the individual stress can be changed by BEHAVIOR THERAPY, psychotherapy, and the substitution of more constructive habits. RELAXATION therapy, GUIDED IMAGERY, HYPNOSIS, and BIOFEEDBACK may also be helpful techniques in overcoming these habits. See also ANXIETY DISORDERS.
hair loss
Hair falling out, extremely thinning hair, and baldness. Hair loss is stressful for people because they associate their “crowning glory” with SELF-ESTEEM and BODY IMAGE. For many, hair loss is also symbolic of aging. Sufferers of hair loss may resort to so-called magic potions, megavitamins, and scalp massage and treatments to encourage new hair to grow. More recently, several hair loss products have been developed and are selling as over-the-counter products. They have proved successful for some people but must be used on a continuous basis to be effective. Hair loss is common; nearly two out of three men develop some form of balding. An even higher percentage of men and women combined have some form of hair loss during their lives.
FOR FURTHER INFORMATION:
American Academy of Dermatology P.O. Box 4014 Schaumburg, IL 60168-4014 (708) 330-0230 American Hair Loss Council 125 Seventh Street, Suite 625 Pittsburgh, PA 15222 (214) 581-8717 National Alopecia Areata Foundation P.O. Box 150760 San Rafael, CA 94915-0760 (415) 472-3780
166
hallucinations 167 hair pulling A habit that involves pulling out scalp hair and sometimes hair on eyebrows, eyelashes, and body; men may pull out beard and mustache hairs. For many people, hair pulling is a mechanism for COPING with STRESS. They do it when they are feeling nervous or tense; or it is a compulsion, known as trichotillomania. Some individuals pull hair in front of others, but most often the activity is pursued in secret. The hairs are carefully hidden or disposed of. The hairless areas have distinctive features and help distinguish trichotillomania from other forms of hair loss and disease. The patches are irregular in outline, not sharply defined, and the hair loss is never complete. Many of the hairs will break off rather than be completely pulled out, so that variable amounts of stubble remain. There are usually no signs of inflammation, and the scalp elsewhere is normal. The habit can be treated with BEHAVIOR THERAPY or other forms of PSYCHOTHERAPIES. See also ANXIETY DISORDERS; HAIR LOSS; HYPNOSIS; OBSESSIVE-COMPULSIVE DISORDER. FOR FURTHER INFORMATION:
The Obsessive Compulsive Disorder Foundation P.O. Box 9573 New Haven, CT 06535 (203) 772-0565
Hakomi
Form of body-centered psychotherapy based on principles that show individuals ways to live in harmony with themselves and others. It teaches individuals to enter a state of awareness in which spontaneous and often nonverbal information becomes available and from which basic and unconscious beliefs stem and direct their lives. Many people use Hakomi as a way of preventing the harmful effects of stress. The body stores and expresses what the mind and heart believe. Trained to look at nuances of voice and body language, posture and gesture, Hakomi therapists help individuals study these avenues to unexpressed feelings and past trauma, and gain release from the past. Hakomi teaches how to observe oneself from a step away (witnessing) as well as from inside one’s present experience. Individuals learn to have a choice of responses. Through the use of witnessing,
unwanted defenses can be studied and willingly yielded. Hakomi is a blend of many philosophies and ideologies, including Eastern philosophy, Western psychology, Taoism, Feldenkrais, Reichian, Rolfing, and other structural bodywork therapies, Ericksonian hypnosis, focusing, and neurolinguistic programming. See also ALTERNATIVE MEDICINE; BODY THERAPIES.
hallucinations
Seeing, hearing, smelling, tasting, or feeling something that is really not there. They are sources of stress because these perceptions cannot be reinforced by anyone else. Hallucinations may be disturbing to sufferers as well as those who are trying to understand what they are feeling. Hallucinations sometimes occur as a reaction to certain medications, to high fevers, and serious illnesses. They also occur in some severe mental disorders, such as schizophrenia.
Reactions to Hallucinogens Hallucinogens are drugs and agents that produce profound distortions to one’s senses of sight, sound, smell, and touch, as well as the senses of direction, time, and distance. Although some individuals may resort to hallucinogens for relief from stress, there are no acceptable medical uses for hallucinogens. People may experience a “high” associated with use of hallucinogens that may last as long as eight hours. However, there are aftereffects, including acute ANXIETY, restlessness, and sleeplessness. Long after the hallucinogen is eliminated from the body, the user may experience “flashbacks,” which are fragmentary recurrences of hallucinogenic effects. Hallucinogens occur naturally but are primarily created synthetically. The most common hallucinogens are LSD (lysergic acid diethylamide), mescaline, peyote, psilocybin mushrooms, 3,4-methylenedioxymethamphetamine MDMA, and phencyclidine (PCP). See also ADDICTION. FOR FURTHER INFORMATION:
American Society on Addiction Medicine 5225 Wisconsin Avenue NW, Suite 409 Washington, DC 20015 (212) 244-8948
168 handedness handedness handicap
See See
LEFT-HANDEDNESS.
DISABILITIES.
hangover A disagreeable physical effect that occurs after consuming too much alcohol, or disagreeable aftereffects from the use of drugs. Sometimes sleeping medications cause hangover-like symptoms. A hangover is a source of stress as it produces physical as well as emotional symptoms that differ between individuals. Some may experience nausea, vomiting, or DIZZINESS, while others may have HEADACHES, sleepiness, unsteadiness, blurred vision, depression, or self-pity. For many individuals, symptoms do not occur until several hours after drinking the alcohol, when they awaken from sleep. They may blame the mixing of drinks, but drinking any one alcoholic beverage alone can cause a hangover. The distinctive headache experienced as part of a hangover may be due to toxic substances that are released into the bloodstream and cause irritation of the brain membranes. Headaches may also come from the pressure of swollen blood vessels, which is an effect of alcohol. When alcohol promotes excessive urination, the resulting loss of fluid may reduce spinal fluid pressure, which has been known to bring on a headache. Usually individuals recover from hangovers without medical assistance. Recommendations from physicians generally include aspirin (unless one is aspirin intolerant), bed rest, and solid food as soon as possible. A cup of coffee and a meal helps most people feel better. See also ALCOHOLISM AND ALCOHOL DEPENDENCE. harassment hardiness
See
SEXUAL HARASSMENT.
Term adopted by Salvatore Maddi, Ph.D. (a University of Chicago psychologist), to describe stress-buffering characteristics of people who stay healthy. People with hardiness are able to withstand significant levels of STRESS without becoming ill; those who are more helpless than hardy develop more illnesses, both mental and physical. In working with executives at a major American employer, Dr. Maddi and colleagues determined
three techniques that can augment hardiness as well as happiness and health. Focusing is a technique developed by Eugene Gendlin, an American psychologist. It is a way of recognizing signals from one’s body that something is wrong, such as tension in the neck or a mild headache. With stress, these conditions worsen. Maddi suggests mentally reviewing where things are not feeling just right and reviewing situations that might be stressful. Focusing increases one’s sense of CONTROL over stress and enables one to make changes. Reconstructing stressful situations. This is a technique in which you think about a recent stressful episode and write down three ways in which it might have gone better and three ways in which it might have gone worse. If you can’t think of what you could have done differently, focus on a person you know who deals with stress well and what he or she would have done. Realize that things did not go as badly as they could have. Also, realize that you can think of ways to cope better with the same situation. Self-improvement. In this technique, you know there are some situations you cannot control; you cannot avoid some situations, such as a serious illness or illness of a member of your family. To regain your sense of control and achieve more effective COPING, choose a new task to master, such as learning how to swim, dance, or develop a new hobby. Suzanne Kobasa, a City University of New York psychologist, also used the term hardiness to identify and measure a style of psychological coping. Some of the characteristics people with hardiness exhibited included viewing life’s demands as challenges rather than threats, responding with excitement and energy to change, and having a commitment to something they felt was meaningful, such as their work, community, and family. A third trait was a sense of being in control. Having the right information and being able to make decisions can make an important difference in coping with stress. Issue of Control in Hardiness A study reported in the Journal of Personal and Social Psychology (April 1995) detailed how 276 Israeli recruits completed questionnaires on hardiness, mental health, and ways of coping at the beginning and end of a demanding, four-month combat training period. Two components of hardiness,
hazard communication 169 commitment and control, measured at the beginning of the training, predicted mental health at the end of the training. Commitment improved mental health by reducing the appraisal of threat. Control improved mental health by reducing appraisal of threat and by increasing the use of problem-solving and support-seeking strategies. See also GENERAL ADAPTATION SYNDROME; LEARNED HELPLESSNESS. SOURCES: Floria, V., et al. “Does Hardiness Contribute to Mental Health during a Stressful Real-life Situation? The Roles of Appraisal and Coping.” Journal of Personal and Social Psychology 68 (April 1995): 687–695. Goleman, Daniel, and Joel Gurin, eds. Mind Body Medicine. How to Use Your Mind for Better Health. Yonkers, N.Y.: Consumer Reports Books, 1993. Padus, Emrika, ed. The Complete Guide to Your Emotions and Your Health. Emmaus, Pa.: Rodale Press, 1992.
“having it all”
Expression that became popular during the 1980s; refers to career WOMEN who follow their chosen business or profession, get married, and raise a family. For many, this has become a satisfying way of life, but others have experienced many stressors, such as frustrations and anxieties. Some women feel that they are not giving adequate attention to their MARRIAGE and children, are constantly tired, and feel some guilt over having their children in DAY CARE centers. Nevertheless, an increasing number of women do opt to enter business and professions. Those who are most successful say it is due to the helpfulness and understanding of their spouses as well as an adequate day-care situation. See also WOMEN’S MOVEMENT; WORKING MOTHERS.
hay fever
Allergic rhinitis, which is commonly called hay fever, is an inflammation of the nasal passages caused by an allergic reaction. It is a type of respiratory allergy that may affect the nose (allergic rhinitis), sinuses (allergic sinusitis), or bronchial tubes (asthma). Allergic rhinitis causes symptoms primarily but not exclusively in the nose. The most stressful symptoms of allergic rhinitis include sneezing repeatedly, particularly when waking in the morning; a runny nose and postnasal drip; watery and itchy eyes; and itchy ears,
nose, and throat. For some people, symptoms occur almost immediately, or as in as little as five minutes after they have been exposed to an allergen such as air pollution, diesel fumes, cigarette or wood smoke, insecticides, strong odors, perfume, and other irritating substances in the air. In addition to the nose, the eyes, ears, throat, and mouth may be affected. People who develop allergic rhinitis may have the allergy for many years but may lose some of their sensitivity as they grow older. What Causes Hay Fever? Allergic rhinitis is caused by an allergic reaction that occurs when the immune system overreacts to a substance called an allergen. It is not known why people develop allergic rhinitis or other types of allergies. Most people who have allergies have family members who also have some kind of allergies. Some studies suggest that viral or bacterial infections of the nose, throat, and bronchial tubes (also called upper respiratory infections [URIs]), may play a role in whether a person develops allergies. Coping with Hay Fever Avoidance of the factors (allergens) that may cause symptoms is a good first step. Knowing the allergens to which one is sensitive is important. If allergic avoidance does not relieve symptoms, or if the symptoms are severe, a physician will consider other treatment methods. Some medications only relieve symptoms, but other medications may improve the underlying condition as well. Sometimes allergy shots are recommended. See also ALLERGIES; ASTHMA.
hazard communication (HazCom) Identifying and alerting workers or others about dangers or hazards at their location. The goals of a hazard communication program are to reduce stress, assure that workers and others are aware of dangers and how to protect themselves, and reduce the incidence of illness and injuries. Generally, hazard communications programs cover chemical injuries. Chemicals pose a wide range of health hazards such as irritation, sensitization, carcinogenicity, and physical hazards such as flammability, corrosion, and reactivity. The Health Communication Standard of the Occupational
170 hazardous and toxic substances Safety and Health Administration is designed to ensure that information about these hazards and associated protective measures is disseminated to workers and employers. This is accomplished by requiring chemical manufacturers and importers to evaluate the hazards of the chemicals they produce or import, and to provide information about them through labels on shipping containers and more detailed information sheets known as material safety data sheets (MSDSs). All employers with hazardous chemicals in their workplaces must prepare and implement a written hazard communication program, and must ensure that all containers are labeled, tagged, or marked with an appropriate hazard warning. Employees must be provided access to MSDSs and receive an effective training program for all potential exposures to reduce the stress associated with disasters. The Hazardous Chemicals Standard provided workers with the right to know the hazards and identities of the chemicals to which they are exposed in their workplace. A list of the chemicals can serve as an inventory of all items for which an MSDS must be maintained. When workers have this information, they can effectively participate in their employers’ protective programs and take steps to protect themselves. In addition, the standard gives employers the information they need to design and implement an effective protective program for employees potentially exposure to hazardous chemicals. These actions can result in a reduction of chemical sources of illnesses and injuries. See also HAZARDOUS AND TOXIC SUBSTANCES; NEEDLESTICK INJURIES. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
hazardous and toxic substances According to the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, hazardous and toxic substances are chemicals that are capable of causing harm. In this definition, the term chemicals includes dusts, mixtures, and common materials such as paints, fuels, and solvents. People who work or live in environments where these substances may be present may experience stress if they are aware of dangers associated with them.
OSHA currently regulates exposure to approximately 400 substances. The OSHA Chemical Sampling Information file contains listings for approximately 1,500 substances; the Chemical Substances Inventory of the Environmental Protection Agency lists information on more than 62,000 chemicals or chemical substances. Some libraries maintain files of material safety data sheets for more than 100,000 substances. OSHA provides guidelines related to chemicals for employers as well as for physicians, industrial hygienists, and other occupational safety and health professionals who may need such information to conduct effective occupational safety and health programs with as little stress as possible. See also CHEMICAL HAZARDS. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
headaches
Headaches include pains in the head, from the outer linings of the brain and from the scalp and its blood vessels and muscles; headaches occur due to tension in or stretching of these structures. They are a source of stress because of their discomfort and unpredictability. They may be caused by a reaction to stressful situations as well as to overindulgence in alcohol, extreme fatigue, and certain infections. Headaches are fairly common in DEPRESSION, sleep disorders, and in individuals who have many anxieties, as well as those suffering from BOREDOM. The National Headache Foundation estimates that more than 80 million Americans develop headaches each year that are serious enough to warrant treatment by a physician. They are the most frequent complaint that physicians treat and may indicate a more serious condition. Types of Headaches Tension or muscle contraction headaches, caused by tightening in the muscles of the face, neck, and scalp, may result from stress or poor posture; they may last for days or weeks and can cause variable degrees of discomfort. About 90 percent of all headaches are classified as tension headaches. Cluster headaches. The term refers to a characteristic grouping in a series of attacks. The pain is gen-
headaches 171 erally very intense and severe and is almost always one-sided; during a series, the pain remains on the same side. In a new series, it can occur on the opposite side. Cluster headaches are not associated with the gastrointestinal disturbances or sensitivity to light that typically accompany other vascular headaches, such as migraine. Temporomandibular joint (TMJ) headaches cause a dull ache in and around the ear that gets worse when one chews, talks, or yawns. Sufferers may hear a clicking sound on opening the mouth and feel soreness in the jaw muscles. Stress, a poor bite, or grinding of the teeth may bring on the headache. Caffeine headaches occur in some individuals who drink too much CAFFEINE in coffee, tea, and soft drinks. Some people can relieve their symptoms by eliminating drinks containing caffeine from their diet. Others, however, who drink large quantities of such liquids and stop abruptly, may suffer caffeine withdrawal symptoms, including headaches, irritability, depression, and sometimes nausea; relief may occur with ingestion of a caffeinated beverage. Migraine Headaches Migraine or vascular headaches are characterized by the throbbing sensation that occurs when blood vessels in the head dilate or swell. Migraine is an often debilitating disease that occurs in periodic attacks, with each attack lasting from four to 72 hours. Symptoms may include intense pain, often associated with nausea, vomiting, appetite loss, and an unusual sensitivity to light and/or sound. Migraines generally start on either side of the head and usually remain one-sided. Of the 23 million American migraine sufferers, 60 percent are women. Men and women between the ages of 35 and 45 years suffer most from migraine headaches, according to a study reported in the Journal of the American Medical Association (December 31, 1991). More than three-fourths of migraine sufferers come from families in which other members have the same disorder. The JAMA researchers reported that 8.7 million females and 2.6 million males suffer from migraine headache with moderate to severe disability. Of these, 3.4 million females and 1.1 million males experience one or more attacks per month. Common migraine headaches start unexpectedly, while classic migraine is usually preceded by a warning symptom known as an aura, which occurs
five to 30 minutes prior to the headache. Typically, the aura includes HALLUCINATIONS of jagged light or color, speech impairment, perception of strange odors, confusion, and tingling or numbness in the face or limbs. Why Migraine Headaches Are So Stressful Because migraine headaches usually recur, sufferers become concerned that an attack will happen at an unfortuitous time, such as on the day of a graduation, a wedding, or important appointment. Migraine headaches often begin during a period of time filled with anxieties, such as during adolescence or MENOPAUSE, or around the time of a DIVORCE or death of a mate. When a physician diagnoses headaches, the individual’s anxieties and COPING styles will be considered. Migraine headaches, which often occur in members of the same family, may result from a predisposing genetic biochemical abnormality. Also, personality traits may play a role in determining who gets migraines. Although there is no typical personality associated with these headaches, some migraine sufferers have characteristics of compulsivity and PERFECTION. Emotional tension and stress may lead to migraine attacks, because under extreme stress, the arteries of the head and those reaching the brain draw tightly together and restrict the flow of blood. This in turn may result in a shortage of oxygen to the brain. When blood vessels dilate or stretch, a greater amount of blood passes through, COMMON MIGRAINE TRIGGERS • Dietary habits (see detailed listing following) • Environmental factors, such as weather, bright lights, glare, or noise • Emotional factors such as depression, anxiety, resentment, or fatigue • Activity, such as motion from riding in a car or airplane, lack of sleep, too much sleep, eyestrain, and a fall or head injury • Hormonal, such as menstrual cycle or use of oral contraceptives or estrogen supplements • Medications, such as overuse of over-thecounter pain relievers and some prescription medications
172 headaches putting more pressure on the pain-sensitive nerves in and close to the walls of the arteries. Common Migraine Triggers In a susceptible person, the migraine trigger might be something seen, smelled, heard, eaten, or experienced; it may be one particular trigger or a combination of factors. Approximately 20 percent of all migraine sufferers have a sensitivity to a specific food or foods. Knowing that certain foods may trigger migraines is an additional source of stress. Many individuals find that certain foods (such as cheese, chocolate, and red wine) containing a substance known as tyra-
DIETARY FACTORS: POSSIBLE MIGRAINE ATTACK TRIGGERS • Caffeinated foods and drinks; coffee, tea, chocolate, cocoa, colas/soft drinks • Alcohol: especially red wine, vermouth, champagne, beer • Dairy products: aged cheeses, sour cream, whole milk, buttermilk, yogurt, ice cream • Breads: sourdough, fresh yeast, and some types of cereals • Vegetables: some types of beans (broad, Italian, lima, lentil, fava, soy), sauerkraut, onions, peas • Snacks: nuts, peanuts, peanut butter, pickles, seeds, sesame • Meats: organ meats, salted meats, dried meats, cured meats, smoked fish, meats with nitrites (such as hot dogs, sausages, lunch meat) • Fruits: most citrus fruits, bananas, avocados, figs, raisins, papaya, passion fruit, red plums, raspberries, plantains, pineapples • Monosodium glutamate (MSG): a flavor enhancer often used in restaurants and also in seasoned salt, instant foods, canned soup, frozen dinners, pizza, potato chips • Soups: particularly those containing MSG; soups made from bouillon cubes • Desserts: chocolate, licorice, molasses, cakes/cookies made with yeast • Seasonings and flavorings such as soy sauce, some spices, garlic powder, onion powder, salt, meat tenderizers, marinades • Hunger: missing meals, fasting, dieting
mine trigger migraine attacks. Sodium nitrite, a preservative used in ham, hot dogs, and many other sausages, is a trigger for some people. Although some migraine researchers have recommended that all migraine sufferers avoid these foods, only about 30 percent of people who have migraine headaches experience this reaction to some foods. Not eating or missing meals can cause low blood sugar levels, which are also a migraine trigger. Identifying and avoiding the triggers that cause headaches is one of the most significant management techniques for controlling headache frequency and stress. Migraine Headaches, Hormones, and Pregnancy Although migraine headaches are more common on young boys than in young girls, the number of girls affected increases sharply after the onset of MENSTRUATION. Certain hormonal changes that occur during PUBERTY in girls and remain throughout adulthood may be implicated in the triggering and frequency of migraine attacks in women. The link between female endocrine changes and migraine headaches is reinforced by the finding that 60 percent of women sufferers involved in a clinical study related attacks to their menstrual cycle. Individual differences exist: attacks may occur several days before, during, or immediately after the woman’s menses. In females with migraine, about 77 percent find that their attacks disappear completely, occur less often, or are milder during pregnancy. In others, attacks either worsened or remained unchanged. Oral contraceptives also affect the incidence of migraine attacks. Some migraine sufferers find their attacks are worsened while they are on the Pill. Others find that they are not affected, and a small percent report improvement. Yet some women, even without any predisposition to migraine, develop it while on the Pill, and nearly three-quarters find their headaches disappearing after they stop taking the Pill. Diagnosis and Therapies When a headache does not respond to RELAXATION, rest, sleeping, simple self-medication such as aspirin or nonsteroidal anti-inflammatory drugs available over the counter, cold compresses on the head, or relaxation in a dark room, medical assis-
health care workers 173 tance should be sought. During a complete physical and neurological examination, the physician will ask about the history of the headaches, the period in time in which they have been occurring, when they occur, the circumstances at the time, and how long they last. Diagnostic techniques may include use of computerized tomography scanning (CT scanning) or magnetic resonance imaging (MRI). Diagnosis is necessary before an individual takes any medication for headaches. Medications that help tension headaches will not help severe migraine headaches, and drugs targeted to relieve migraine headaches may not help any other type. Also, it is important that one does not overmedicate for headaches and bring on other side effects from medications. Treatments for headaches include nonpharmacological treatments, such as BIOFEEDBACK, MEDITATION, and relaxation techniques, as well as prescription medications. In the mid-1990s, a medication became available in tablet form (sumatriptan succinate) that is a highly selective serotonin receptor-agonist for the treatment of migraine with or without aura. It is not indicated for cluster headache. Alternative Therapies A wide variety of ALTERNATIVE MEDICINE may be helpful for headache sufferers. Some individuals experience relief with their use and without medication while others use them in conjunction with medication. When individuals consider alternative therapies, they should be discussed with the attending physician. Although some people can relieve their headache pain with alternative therapies, for others these therapies act as an adjunct or complement to the PHARMACOLOGICAL APPROACH, making the sufferer more receptive to medical treatment. Biofeedback involves teaching a person to control certain body functions through thought and willpower, with feedback from an electronic device. Meditation is a technique of inward contemplation that helps some people relieve anxieties and in turn relieve some headaches, by relaxation. During meditation, the mind, as well as other organs in the body, slows down; heart rate decreases, breathing becomes slower, and muscle tensions diminish. ACUPUNCTURE has been successfully used to treat some headache sufferers. Acupuncture probably
works because the needle insertions somehow stimulate the body to secrete ENDORPHINS, naturally occurring hormonelike substances that kill pain. ACUPRESSURE involves pressing acupuncture points with the hands, and can be done by a professional as well as by a trained layperson. See also ANXIETY; GUIDED IMAGERY; HANGOVER; HYPNOSIS; TEMPOROMANDIBULAR JOINT SYNDROME. FOR FURTHER INFORMATION:
American Association for the Study of the Headache P.O. Box 5136 San Clemente, CA 92672 (714) 498-1846 (800) 255-ACHE National Headache Foundation 5252 North Western Avenue Chicago, IL 60625 (773) 878-7715 SOURCES: Diamond, Seymour. The Hormone Headache: New Ways to Prevent, Manage, and Treat Migraines and Other Headaches. New York: Macmillan, 1995. Inlander, Charles B., and Porter Shimer. Headaches: 47 Ways to Stop the Pain. New York: Walker, 1995. Maas, Paula, and Deborah Mitchell. The Natural Health Guide to Headache Relief: The Definitive Handbook of Natural Remedies for Treating Every Kind of Headache Pain. New York: Pocket Books, 1997.
healing touch
See
THERAPEUTIC TOUCH.
health care workers Approximately 6 million persons work in more than 6,000 U.S. hospitals and health care settings, such as nursing homes and laboratories. Nearly 1 million workers provide care in a variety of community health settings, including patient homes, where available control measures are more limited than in the hospital setting. Individuals working in health care face many stresses. Assaults in the workplace and work organization issues such as inadequate staff, poor indoor air quality, and exposure to infectious agents and drug-resistant infections like tuberculosis (TB) pose challenges to many health care workers and their employers. Female nurse’s aides and licensed practical nurses are approximately two and a half
174 health insurance times more likely to experience a work-related lower back disorder than all other female workers. Health care workers are at a higher risk of occupational exposure to a number of airborne and bloodborne infectious disease relative to the general population. For example, urban health care workers have a rate of seropositivity on tuberculin skin tests approximately eight times that of the U.S. population. There are hospital-based outbreaks of multi-drug-resistant TB; 17 cases have been documented among workers. In prevaccine surveys, the annual incidence of HBV (hepatitis B virus) among physicians and dentists was five to 10 times higher than among blood donors. The Centers for Disease Control and Prevention (CDC) estimated that in 1994 there were approximately 1,100 occupationally acquired HBV infections in health care workers in the United States, causing 250 to 1,000 cases of clinical acute hepatitis and 50 hospitalizations. “Occupational exposure” accounts for approximately 2 percent of all cases of hepatitis C. Although the incidence of occupational hepatitis C virus infection among health care workers is unknown, dentists, in particular oral surgeons, have been found to have a significantly higher seropositivity rate than blood donors. At the end of 1996, the CDC reported 163 U.S. health care workers with documented or possible occupational transmission of human immunodeficiency virus (HIV) as a consequence of the approximately 800,000 needlestick injuries that occur each year. The first case of occupational transmission of HIV infection to a health care worker was documented in 1984, and it raised fear among health care workers and their families. As a consequence, advances in occupational health and infection control practices occurred. Health care workers in nursing and occupational medicine have always faced many sources of stress. National professional societies in occupational medicine and nursing were established in 1916 and 1942, respectively. As recently as the 1950s, there was no consensus regarding the occupational risk of TB exposure. A number of factors may have caused this lack of consensus, including fear that young people would avoid nursing careers if they knew the risks involved. When TB
declined significantly in the general public but remained elevated in the medical profession, TB was recognized as an occupational hazard. Stress Reduction for Health Care Workers Stressful factors can be reduced for health care workers. For example, nonhazardous substances can be substituted for hazardous ones, workers can be isolated from hazardous exposure, engineering controls such as better ventilation can be established, and there can be more administrative controls covering work practices, and personal protective equipment. Psychosocial and organizational factors may correlate with hazards, such as risk-taking personality profiles or perceived conflict of interest between providing optimal patient care and protecting oneself from exposure. Adequate and appropriate staff mix to meet the increasing acuity of hospitalized patients may have a relationship with work-related injuries among nurses, according to a study by the Institute of Safety and Health Research. Priorities to reduce sources of stress include infectious diseases, allergic and irritant dermatitis, asthma and chronic obstructive pulmonary disease, lower back disorders, indoor exposures, and organization of work. See also CONFINED SPACES; FUNGI; HUMAN IMMUNODEFICIENCY VIRUS; NOISE; NURSING HOMES; SHIFT WORK; SLIPS, TRIPS, AND FALLS; REPETITIVE STRESS INJURIES; STRESS; VIOLENCE.
health insurance Coverage for costs of specified illnesses, injuries, or treatments. Health insurance is a particular source of stress for those who do not have it. Many people who are self-employed, work part time, or are unemployed do not have health insurance. Rising health care costs, a soft labor market in which employers are passing more health care costs to workers, and reductions in state safety net programs have resulted in substantial increases in the numbers of uninsured. Specific benefits may include short- and longterm disability, dental, medical, and vision care, and in some cases, accidental death coverage as well as other benefits. There are now several forms of health insurance. Although health insurance began as indemnity insurance, with programs in which the
hearing loss 175 insured person was reimbursed or the provider was paid for covered expenses after services were rendered, today health insurance may mean coverage by one of many forms of managed care, including HEALTH MAINTENANCE ORGANIZATIONS, preferred provider organizations, or other types of prepaid plans. See also LONG-TERM CARE INSURANCE.
basic and supplemental health maintenance and treatment services, and it must serve a group of people who have voluntarily enrolled. The four most prevalent models of HMOs are the group model, individual practice association, network model, and staff model. Many HMOs are hybrids of two or more of these types. See also HEALTH INSURANCE; MANAGED CARE.
health maintenance organizations (HMOs)
health promotion
Prepaid comprehensive health coverage to an enrolled population for both outpatient physician services and hospital charges. HMOs are offered to many employed people as an alternative to more traditional indemnity insurance. Controversies have existed over whether HMOs use “gatekeepers” to reduce the number of health care services used by its enrolled members. Unlike traditional health insurance, in which patients seek out and choose their own health care providers, the HMO arranges for as well as provides designated health services needed by plan members for a fixed, prepaid premium. The HMO is paid monthly premiums or capitated rates by the payers, who may be employers, insurance companies, government agencies, and other groups. HMOs contract with health care providers, such as physicians, hospitals, and other health professionals. HMO members must use participating or approved providers for all health services, and generally all services must be approved by the HMO through a program of utilization review. In most HMOs, a primary care physician assists in finding specialists and coordinating needed care. Members enroll for a specified period of time, usually one year and, in most instances, have an option to move in or out of an HMO annually if their employer offers more than one option of health insurance. In some states, HMOs also cover persons covered by Medicare. The federal HMO Act of 1973 specifies that each HMO meet certain regulations; there are also state regulations that each HMO must follow. Under the federal HMO Act, an entity must have three characteristics to be designated as an HMO: It must be an organized system for providing health care or otherwise assuring health care delivery in a geographic area, it must have an agreed-upon set of
Stress reduction and stress management are part of many promotion programs in workplaces and communities. According to the American Journal of Health Promotion, health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health. A combination of efforts can help people enhance awareness, change behavior, and create environments that support good health practices. Nearly half of all premature deaths in the United States and other developed countries are due to lifestyle-related conditions. Many of these deaths are preventable, and quality of life can be enhanced if people exercise regularly, eat more nutritious foods, avoid smoking and excessive use of alcohol, build social networks, and have a sense of gratification from intellectual pursuits. Because of this understanding, an increasing number of communities and employers are taking steps to implement health promotion activities. The American Journal of Health Promotion was the first peer-reviewed journal devoted to health promotion and it remains the largest, with subscribers in all 50 United States and about 40 other countries. The publication provides a forum for the many disciplines that contribute to health promotion. See also EMPLOYEE ASSISTANCE PROGRAMS; STRESS MANAGEMENT; WORKSITE WELLNESS PROGRAMS. FOR FURTHER INFORMATION:
American Journal of Health Promotion 4301 Orchard Lake Road, #160-201 W. Bloomfield, MI 48323 (248) 682-0707 http://www.healthpromotionjournal.com
hearing loss
See
DEAFNESS.
176 heart attack heart attack
Known medically as myocardial infarction; the sudden death of a part of the heart muscle, characterized, in most cases, by severe, unremitting chest pain. Contributory factors to a heart attack include STRESS, HIGH BLOOD PRESSURE, and TYPE A PERSONALITY. The onset of a heart attack is extremely stressful for the sufferer as well as onlookers. The individual may be short of breath, restless, feel nauseated or vomit, or lose consciousness. It is crucial to respond immediately to a suspected heart attack. In mild cases, pain and other symptoms are very slight or do not develop at all, in which case the attack is known as a “silent heart attack.” Such an episode may be discovered only by subsequent tests. Fear of having a heart attack is a common sources of stress, because many symptoms of anxieties and PHOBIAS (including HYPERVENTILATION, PALPITATIONS, and faintness) mimic some of the symptoms of a heart attack. Such fears are not unfounded; heart attack is the leading cause of death for both men and women in the United States. Every year, 1.5 million Americans have a heart attack; one-third of them die as a result. However, from 1981 to 1991, death rates from heart attack decreased more than 30 percent, due partly to better diagnosis and advancements in prevention, treatment, surgery, and medication. Treatment of heart attacks with clot-dissolving drugs, for example, has helped reduce the death rate dramatically. Once the coronary artery gets blocked by a clot, a heart attack can occur quite suddenly. Within minutes of a heart attack, the heart muscle begins to change. Deprived of oxygen, the affected portion of the heart muscle deteriorates and dies; surrounding tissue may also be damaged. The longer the artery remains blocked, the greater the damage and possibility of death. According to the American Heart Association, about 60 percent of all heart attack deaths occur within the first hour. Fear, unfamiliarity with the symptoms, and DENIAL are some of the reasons why individuals and their families delay getting help. Many deaths from heart attack can be prevented with proper and prompt treatment. Symptoms of a Heart Attack If the warning signs listed in the box occur, individuals should get help immediately.
WHAT TO DO IF A HEART ATTACK IS SUSPECTED Seventy percent of heart attacks occur in the home; family members can assist immensely if they know what to do in response to the emergency, including cardiopulmonary resuscitation (CPR) procedures. Also: • Do not spend time trying to reach your physician. Have someone call your local emergency number (911 in many urban areas) or an ambulance service. Tell the dispatcher that heart attack is suspected. Chew one regular tablet of aspirin if you are not allergic. • If getting to a hospital is faster by car, have someone drive you there instead of waiting for an ambulance. • Ask to be taken to an area hospital equipped with 24-hour emergency cardiac care. • Try to stay calm. Lie down, propped up with pillows. Agitation can increase the likelihood of abnormal, life-threatening heart rhythms. • Have someone call your personal physician.
Symptoms may be mild, or severe, or even completely absent. Often, older individuals have the fewest or mildest symptoms of heart attack. Few people have all the classic signs. The sooner a person receives appropriate medical treatment, the greater the chances of surviving a heart attack and avoiding permanent damage to the heart. Some potent new drugs that can prevent the death of the
HEART ATTACK WARNING SYMPTOMS • A crushing chest pressure or pain in the center of the chest that lasts more than a few minutes or goes away and comes back. The discomfort may be felt as a burning sensation that can be mistaken for severe heartburn. • Chest pain that spreads to the shoulders and arms or the left or both sides, as well as to the neck or back • Accompanying nausea, vomiting, sweating, cold sweats, shortness of breath, palpitations, lightheadedness, or faintness • A sensation of impending doom
heartburn 177 heart muscle, for example, work only if they are given within the first few hours after the heart attack. Diagnosis and treatment for heart attack in an emergency room may be stressful for the sufferer. One may be fearful and anxious about the surroundings, expectations for life, and hopes for recovery. Stresses after a Heart Attack Individuals who have suffered a heart attack have an increased risk of suffering another one in the following few years. They live with the stress of ANXIETY about this probability. Many such individuals benefit from psychological counseling. The chances of surviving for many years can be improved by attention to lifestyle changes, including more RELAXATION, increased exercise, better diet, reduction of OBESITY, and cessation of SMOKING. An individual who has had a heart attack should have regular check-ups by a physician. Support and exercise groups can be helpful. See also ATHEROSCLEROSIS; BIOFEEDBACK; CHOLESTEROL; HEARTBURN; MEDITATION. FOR FURTHER INFORMATION:
American Heart Association 7320 Greenville Avenue Dallas, TX 75231 (800) 242-USA1 (214) 373-6300 (214) 987-4334 (fax) www.americanheart.com National Heart, Lung and Blood Institute 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5166 (301) 402-0818 (fax) http://www.nhbli.nih.gov
heartburn
Burning sensation in the upper part of the abdomen or under the breast bone. It is a cause of STRESS for many people who may fear that it is related to heart disease. Heartburn is also a symptom of stress, because it can be brought on by nervousness or overeating. The burning sensation is actually associated with the esophagus, a muscular tube that connects the throat with the stomach.
The tube passes behind the breastbone alongside the heart, which is why irritation or inflammation here is known as heartburn. Heartburn and distress in the digestive tract is frequently a response to emotional stress. Tense, nervous people who worry about their jobs and family problems often complain of acid INDIGESTION and heartburn. The list of foods that disagree with heartburn sufferers includes just about anything a person would want to eat. When things go smoothly for these people, everything agrees with them. When they are upset or frustrated, nothing does. Heartburn usually starts slowly, about an hour or so after they have eaten a heavy or spicy meal. The pain can sometimes be quite intense and may last a few hours. Coping with Heartburn In some cases, the pain is due to irritation (esophagitis) from hydrochloric acid in the stomach juice that has backed up into the esophagus; relaxation of the valve between the stomach and the esophagus is one cause of esophagitis. Hiatus hernia, in which part of the stomach slips up into the chest, is another. This type of heartburn is often brought on by lying down, especially after overeating. It may be helped by raising the head of the bed, by avoiding certain foods, especially sweets, and by a low-fat, low-calorie diet.
TIPS FOR RELIEVING THE STRESS OF HEARTBURN • Avoid certain foods that are spicy, acidic, tomato-based or fatty, such as sausages, chocolate, tomatoes, and citrus fruits. • Avoid alcohol, tea, colas, and coffee, even decaffeinated. • Eat modern amounts of food to avoid overfilling your stomach. • Stop or at least cut back on smoking. • Don’t try to exercise immediately after eating or before lying down. • Elevate the head of your bed or use extra pillows to raise the level of your head above your feet. • Avoid tight belts and other restrictive clothing. • Learn relaxation techniques. • If none of these help, see your doctor.
178 heights See also
ALTERNATIVE MEDICINE; MEDITATION; PEP-
TIC ULCER.
heights (acrophobia, altophobia, hyposophobia, hypsiphobia) Fear of heights is a very common source of stress, particularly for people in large cities or in mountainous areas. For those who fear heights, visual space is important. They will not be able to go down a flight of stairs if they can see the open stairwell. They may be frightened looking out of a high window that stretches from floor to ceiling but not if the window’s bottom is at waist level or higher. They may have difficulty crossing bridges on foot because they are near the edge but may be able to do so in a car. Sometimes fear of heights is related to an acute fear of falling (which is innate). Babies usually begin to be wary of heights some time after starting to crawl. The person who experiences extreme stress from heights may experience symptoms associated with panic attacks and phobias, such as palpitations, sweating, dizziness, and difficulty breathing. A person who fears heights may also fear the idea of heights. Fear of heights is sometimes associated with a fear of airplanes and flying, although height is only one element in the complex reaction that leads to fear of flying. Fear of heights is sometimes involved in other related fears, such as bicycles, skiing, amusement park rides, tall buildings, stairs, bridges, and freeways. See also PHOBIA.
helplessness A stressful feeling that one cannot do anything for oneself or influence the outside world in any way. In some instances, helplessness can be a symptom of DEPRESSION. Sigmund Freud (1856–1939) used the term psychic helplessness to describe the experience during the birth process when respiratory and other physiological changes occur; he believed that this psychic helplessness state led to later anxieties. Freud also believed that the baby’s helplessness and dependence on the mother created frustration, which in turn led to an inability to cope with later sources of stress. During the 1970s, psychologist Martin Seligman (b. 1942) developed a concept he called learned
helplessness to describe an individual’s dependence on others. Many people who feel very stressed have characteristics of learned helplessness, particularly agoraphobics, who cannot go away from home without someone accompanying them. See also LEARNED OPTIMISM.
help lines
See
HOT LINES; SELF-HELP GROUPS; SUP-
PORT GROUPS.
hemophilia
The oldest-known bleeding disorder. Low levels or complete absence of a blood protein essential for clotting causes hemophilia. The severity of hemophilia is related to the amount of the clotting factor in the blood. There are 20,000 hemophilia patients in the United States. Each year 400 babies are born with this disorder. The most significant stresses facing the hemophilia patient, health care provider, and research community today are safety of products used for treatment, management of the disease (including inhibitor formation), irreversible joint damage, life-threatening hemorrhage, and progress toward a cure. Sufferers of hemophilia have their own fears that may produce stress in those who are aware of their condition and who may witness bleeding episodes. Hemophiliacs are rarely female. Because the disease is hereditary and recessive in females, a mother may fear and/or feel guilty about passing the disease to her child. Parents of hemophiliacs may be excessively protective toward their hemophiliac child. The child may react by being fearful of all physical activity or by rebelling against reasonable limitations and putting himself or herself in danger. Siblings of hemophiliacs may be overprotective or jealous of the extra attention given to their brother or sister. Teachers or other adults responsible for the hemophiliac child may fear small cuts, which in actual fact are not particularly dangerous. Internal bleeding, particularly around the joints, is the greatest danger to hemophiliacs. In recent years, the AIDS (acquired immunodeficiency syndrome) epidemic has produced a new fear for hemophiliacs because some early cases of AIDS resulted from infected blood transfusions. After the late 1980s, however, new testing procedures were developed to assure a safe blood supply. See also ACQUIRED IMMUNODEFICIENCY SYNDROME.
herbal medicine 179 SOURCE: Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000. FOR INFORMATION:
National Hemophilia Foundation 116 West 32nd Street, 11th Floor New York, NY 10001 (800) 42-HANDI (toll-free) (212) 328-3700 (212) 328-3777 E-mail:
[email protected] http://www.hemophila.org
hemorrhoids
Enlarged veins at the lowest part of the intestine. Hemorrhoids may be painful or bleed, causing stress for the sufferer. The word literally means a blood (hemo) flow (rhoid), describing one of the characteristics of the disease, bleeding from the anus. “Piles” is a layman’s term for hemorrhoids. Hemorrhoids are also stressful because in many cases their cause cannot be determined. CONSTIPATION, straining while defecating, sitting for long periods, and infections can aggravate the condition once it starts. The disorder usually is mild, but if neglected, may result in annoying or painful complications such as itching, protrusion outside the anus, or fissures in the anus, and possibly secondary infection. Treatment consists of warm sitz baths, soothing ointments, antibiotics for infection, measures such as laxatives or stool softeners to relieve constipation, and a diet of digestible foods. Any bleeding from the anus should be investigated by a physician. See also IRRITABLE BOWEL SYNDROME.
hepatitis B
See
herbal medicine
SEXUALLY TRANSMITTED DISEASES.
Use of a plant or portion of a plant valued for its medicinal, savory, or aromatic qualities. Herbalism gained popularity in the United States toward the end of the 20th century. Estimates are that Americans spend more than $1 billion per year on herbal remedies in a year; many people seek these alternative remedies to relieve stress. Herbal medications are deeply rooted in most folk medicine traditions and have played an important role in the evolution of modern medicine and
HERBAL REMEDIES FOR STRESS RELIEF • See a physician first for serious conditions. Do not attempt to self-medicate. • Consider the sources of your products; select reputable brands. • Choose reliable forms such as tinctures or freeze-dried, as powdered forms may lose potency upon exposure to air. • Overdosing can have harmful effects. Take recommended dosages at suggested intervals. • Watch for reactions; if unwanted reactions occur, stop the medication.
pharmacology. For example, when the Pilgrims landed in Plymouth in 1630, they set up herb gardens that contained the medicinal varieties brought from the Old World. The settlers soon discovered that the Native Americans had their own healing plants, including cascara sagrada and golden seal. According to the World Health Organization, 80 percent of Earth’s population uses some form of herbal therapy. Many contemporary medications are based on specific herbs but are manufactured from synthetic substances believed to be more effective than the natural herbs. Still, herbal therapies remain a major component of Ayurvedic, homeopathic, and other alternative approaches. Herbal products are marketed in the United States as foods, and are permitted by the Food and Drug Administration provided that the products do not make any therapeutic claims. Herbal products are sold over the counter and are not subject to the same safety and efficacy standards that apply to over-the-counter medications. Herbal packaging labels rarely contain guidelines regarding indications for proper use. As with any medication, herbal remedies are best used under the guidance of a knowledgeable individual, in this case, an herbalist. See also ALTERNATIVE MEDICINE; AYURVEDA; HOMEOPATHY. FOR FURTHER INFORMATION:
The Herb Research Foundation 1007 Pearl Street, Suite 200 Boulder, CO 80302 (303) 449-2265
180 herpes simplex virus SOURCES: Chevallier, Andrew. The Encyclopedia of Medicinal Plants. Boston: Houghton Mifflin, 1996. National Women’s Health Report. “Alternative Therapies and Women’s Health,” Washington, D.C.: National Women’s Health Resource Center, May/June 1995.
herpes simplex virus HSV can cause blisterlike sores almost anywhere on a person’s skin. It usually occurs around the mouth and nose or the buttocks and genitals. Herpes is a name used for some 50 related viruses. Herpes simplex is related to the risk for infectious mononucleosis, chicken pox, and shingles (varicella zoster virus). HSV infections can be very stressful because they can reappear without any predictability; also, the sores may be painful and embarrassing. Two Types of HSV Type 1. Studies show that most people get Type 1, which affects the lips, mouth, nose, chin, or cheeks during infancy or childhood. It is transmitted by close contact with family members or friends who carry the virus. It can be transmitted by kissing, or by using the same eating utensils and towels. A rash or cold sores on the mouth and gums appear shortly after exposure. Symptoms may be barely noticeable or may need medical attention for relief of pain. Type 2. Type 2, which includes genital herpes, one of the many diseases caused by the herpes virus, most often appears following sexual contact with an infected person. It has reached epidemic numbers, affecting from 5 million to 20 million persons in the United States, or up to 20 percent of all sexually active adults. Genital herpes, although relatively uncommon in the United States until the late 1960s, may have been the most common sexually transmitted disease in the late 1990s. The chronicity of the disease and the fact that no cure exists is a source of significant stress in the lives of its sufferers. Stress and anxiety associated with having this SEXUALLY TRANSMITTED DISEASE can be reduced with education, counseling, and supportive physical care. Herpes is particularly stressful because once the virus invades the body, it remains for life, although it may be dormant most of the time. In different individuals, episodes recur with more or less frequency.
Although genital herpes is not usually a medically serious disease, it can lead to DEPRESSION and other emotional conditions. Many victims tend to resent the sex partner from whom they contracted the disease, often leading to divorce or the breaking up of a relationship. Others consider themselves damaged for life, fearing that they are unfit for marriage or a lasting relationship. The disease is most commonly spread by direct contact, meaning that to get herpes, uninfected skin must come in contact with an active herpes sore. However, the virus may be shed without noticeable symptoms and may thus be transmitted. As herpes sores may be hidden in the internal parts of the female genitalia or may not be painful, one victim may unwittingly infect another. Once the herpes virus has entered the skin, it multiplies rapidly. First symptoms are usually itching or a tingling sensation, followed by the eruption of unusually painful sores or blisters. Typically, in the first attack the sores appear two days to two weeks after exposure and last two to three weeks. Subsequent attacks, which may occur in a few weeks or not for years, generally last about five days. When an attack subsides, the virus lies dormant and travels along the nerve fibers until it reaches a resting place. Complications In rare cases, the herpes virus may travel to the brain and cause a serious, often fatal, form of encephalitis. More commonly, herpes may infect the cornea of the eye; if untreated, the infection can lead to visual damage and even blindness. None of these complications, however, is as common as periodic recurrences at the original site of infection. A serious complication of genital herpes affects infants born to women who have active infections at the time of birth. Some infants who contract disseminated herpes infections die, and half of those who survive may suffer brain damage or blindness. Many doctors recommend that the baby be delivered by Cesarean section if the mother has an active infection near the time of delivery. Prevention The most effective way of preventing genital herpes is avoiding all sexual contact with an infected
high blood pressure 181 person. Use of a condom and spermicidal agent will reduce the risk, but this is not absolutely foolproof, particularly when the lesions are on the skin of the perineum and not on the penis or in the vagina. Treatment and Self-help There is no way to rid the body of the herpes virus. However, antiviral agents developed during the 1990s shorten the duration of an active infection, relieve discomfort, and speed healing. By halting the virus from reproducing itself and spreading to other cells, these agents stop the formation of new herpes blisters and help existing sores heal faster. Many herpes sufferers learn to recognize patterns of recurrence and factors that trigger subsequent episodes. RELAXATION techniques to reduce stress are indicated if stress is a factor in recurrent disease. There are a number of herpes counseling centers and groups throughout the country to lend support and help to victims of the disease. The American Social Health Association maintains a National Herpes Information Hotline number: (919) 361-8488. The toll-free number to request free literature is (800) 230-6039. FOR FURTHER INFORMATION:
The Herpes Resource Center 260 Sheridan Avenue, Suite 307 Palo Alto, CA 94306 (800) 227-8922 (toll-free) (415) 328-7710 American Academy of Dermatology 930 North Meacham Road P.O. Box 4014 Schaumburg, IL 60168-4014 (847) 330-0230 SOURCES: Nourse, Alan Edward. Herpes. New York: Franklin Watts, 1985. Sacks, Stephen L. The Truth about Herpes, 3rd ed. Seattle: G. Soules Book Publishers, 1988.
hierarchy of needs
Some theorists believe that human behavior is motivated by a series of needs than can be arranged in hierarchical order, beginning with basic physiological needs such as food and water and progressing to safety needs such as protection against danger, social or love needs, esteem or ego needs, and self-actualization. Stress
can result from incomplete attainment of these levels. The theory was originated by Abraham Harold Maslow (1908–70), a U.S. psychologist who was known as a leader of the human potential movement because of his emphasis on self-fulfillment.
high blood pressure
The term blood pressure, as used in medicine, refers to the force of blood against the walls of the arteries, created by the heart as it pumps blood through the body. As the heart pumps or beats, the pressure increases; as the heart relaxes between beats, the pressure decreases. High blood pressure (hypertension) is the condition in which blood pressure rises too high and stays there. High blood pressure is an important individual as well as public health issue because it affects as much as 25 percent of the adult population in the United States. High blood pressure has been associated with the stresses resulting from certain negative emotions or aggressive and hostile behaviors. Although the degree of stress is difficult to assess objectively, acute and probably chronically stressful situations can result in an elevation of the blood pressure. Certain individuals are overreactive to stress and may suffer more than others when confronting certain situations. Individuals with high blood pressure have higher irritability levels, more GUILT feelings, and more psychic distress. There are many studies of the effects of psychological factors such as stress, psychological or PERSONALITY characteristics, and life events on blood pressure. A problem with these studies has been the difficulty of assessing psychosocial factors and determining whether they are causes or consequences of high blood pressure. It is possible that the process of labeling or treating a person with blood pressure elevation can induce a stressful psychological change. Diagnosing High Blood Pressure According to the National Heart, Lung and Blood Institute, high blood pressure is more likely to develop in people with a family history of high blood pressure, those who are overweight, eat a high-salt diet, drink excessively, and/or are physically inactive.
182 high blood pressure In its early stages, high blood pressure does not usually produce any symptoms; thus it is sometimes called “the silent killer.” Many people who have high blood pressure feel just fine. Regular check-ups are the only way to detect high blood pressure. High blood pressure is usually diagnosed during an office visit to a physician. The physician uses a stethoscope and a sphygmomanometer, an inflatable cuff attached to a device that measures blood pressure. With each heartbeat, blood is pumped through the arteries and veins. The force with which blood pushes against the artery walls creates blood pressure, which is represented by two numbers. The top number, systolic pressure, indicates the maximum pressure with which blood pushes against the arteries during a heartbeat. The lower number, diastolic pressure, indicates pressure against the arteries when the heart is at rest. Normal or healthy blood pressure is in the 120/90 range. If the reading regularly hits 140/90, one is said to have high blood pressure. High blood pressure usually starts when arteries become too narrowed or constricted, impeding the flow of blood. High pressure in these damaged arteries makes them susceptible to a buildup of fatty, cholesterol-containing deposits, a condition known as ATHEROSCLEROSIS. If blood vessels feeding the heart become blocked and/or hardened, a person may suffer chest pain (known as angina) or may have a HEART ATTACK. When the blood supply to the brain is disrupted, STROKE may occur. Other effects may be kidney failure and eye damage. “White Coat Hypertension” Some individuals actually show elevations in their blood pressure when visiting a physician’s office. Their blood pressure is generally normal but increases in the presence of physicians and other health care professionals. This is because these individuals feel stressed and fearful of doctors or the surroundings, such as laboratories, where they might encounter needles or blood testing devices. They may be diagnosed with high blood pressure. Physicians who understand this phenomenon usually take the patient’s blood pressure at the end of the visit as well as the beginning, and take a careful history to determine the effects of the patient’s phobias on the blood pressure.
Treating High Blood Pressure Nondrug measures can help many people control their high blood pressure. In many cases, however, these measures may be recommended along with medication because they are beneficial for overall good health. Helpful techniques include BIOFEEDBACK; BREATHING; GUIDED IMAGERY; HYPNOSIS; RELAXATION; T’AI CHI. Role of Exercise in Reducing High Blood Pressure Many activities that reduce stress, including aerobic exercise, running, biking, walking, and swimming, also reduce both systolic and diastolic blood pressure. The American College of Sports Medicine (ACSM) recommends aerobic activities three to five days a week for 20 to 60 minutes per workout at intensities 40 percent to 80 percent of maximum effort. However, the ACSM advises people with high blood pressure to avoid high-intensity strength training, or weight training, because it temporarily elevates blood pressure whether one has high blood pressure or not.
SELF-HELP FOR TREATING HIGH BLOOD PRESSURE • Stress control. Training in relaxation techniques and use of biofeedback help some patients handle stressful life situations in more constructive ways. • Weight reduction. Some overweight people can reduce their blood pressure by losing excess weight. • Salt restriction. In combination with medication, salt restriction is often helpful. • Restriction of dietary cholesterol. High blood levels of cholesterol, coupled with high blood pressure, can damage arteries. • Restriction of alcohol consumption. Drinking should not exceed two ounces of 100-proof, which equals eight ounces of wine or 24 ounces of beer a day. • No smoking. Nicotine directly affects the heart and blood vessels producing acute increases in blood pressure. Independent of high blood pressure, smoking can damage arteries.
high blood pressure 183 Role of Nutrition Maintaining a proper diet can be beneficial in treating high blood pressure. Weight reduction, sodium chloride restriction, and avoidance of excessive alcohol consumption appear to be the best nutritional approaches to the treatment of high blood pressure. The role of dietary alterations of fiber, calcium, magnesium, potassium, dietary fats, carbohydrates, and protein is less convincing. Unfortunately, much of the available data are insufficient to make a final recommendation regarding a potential role for these alterations in the prevention and treatment of high blood pressure. Weight control is important because the prevalence of high blood pressure is 50 percent higher among overweight adults than among adults of normal weight; 33 percent of people who have high blood pressure are overweight. Overweight individuals have a twofold to sixfold increased risk for developing high blood pressure. Modest weight loss can favorably affect high blood pressure. Recommendations for a prudent diet for high blood pressure prevention and treatment, based on the current review of the literature, include modest weight loss (10 percent of present weight), limiting sodium intake to 100 millimoles (six grams of sodium chloride) and limiting alcohol consumption to no more than two drinks per day (30 milliliters of ethanol).
• Vasodilators relax the small arteries, reducing their resistance to blood flow, causing blood pressure to go down.
Drug Treatment for High Blood Pressure Taking medication for high blood pressure is stressful for some individuals because many medications cause side effects or other problems that complicate treatment. These effects may include fatigue, sexual IMPOTENCE, and DIZZINESS. In some cases, one drug will maintain pressure control over time. More often, one drug controls it for a time; then a second or third may be needed. High blood pressure can be controlled, as long as appropriate medicines are taken:
TION; PETS;
• Diuretics act on the kidneys, causing them to flush out salt and water. As fluid in the blood vessels goes down, pressure goes down. • Beta blockers act on the heart, reducing the rate at which it beats and the amount of blood it pumps; with less output, pressure drops.
• Sympathetic inhibitors act on the sympathetic nervous system and also relax the arteries, keeping pressure down. • Calcium channel blockers lower the levels of calcium in the blood vessel muscle cells. This relaxes the vessels, and pressure drops. • ACE inhibitors work in a unique way in the body, and have been shown to be effective in controlling high blood pressure, usually without causing some of the troublesome side effects caused by older drugs. ACE inhibitors interrupt a chemical chain reaction in the body that causes blood pressure to rise. The kidney triggers the process by releasing an enzyme called renin into the bloodstream. As part of the chain reaction, the lungs produce an enzyme called ACE (angiotensinconverting enzyme). The presence of ACE leads to production of another chemical that raises pressure. ACE inhibitors bind up ACE, interrupting the chemical chain and maintaining more normal pressure. • Alpha blockers and central alpha agonists keep blood vessels open by blocking the action of certain nerves. See also
ALTERNATIVE MEDICINE; EXERCISE; NUTRI-
TYPE A
PERSONALITY.
FOR FURTHER INFORMATION:
American Heart Association 7320 Greenville Avenue Dallas, TX 75231 (800) 242 USA (toll-free) (214) 373-6300 (214) 987-4334 (fax) http://www.americanheart.org SOURCES: Kerman, D. Ariel. H.A.R.T. Program: Lower Your Blood Pressure without Drugs. New York: HarperCollins, 1992. Lardinois, Claude K. “Role of Nutrition in Treating Hypertension.” Archives of Family Medicine, August 14, 1995. Pickering, Thomas G., et al. “How Common Is White Coat Hypertension?” The Journal of the American Medical Association, January 8, 1988, 225–228.
184 hives hives
Pink swellings sometimes called wheals that occur in groups on any part of the skin. They are stressful to the sufferer because, as they are forming, they usually are very itchy and may also burn or sting. Until they are diagnosed, the sufferer may be bewildered about the cause and possibilities for relief. Hives usually go away within a few days to a few weeks. Occasionally, a person will continue to have hives for many years. About 10 percent to 20 percent of the population will have at least one episode in their lifetime. When hives form around the eyes, lips, or genitals, the tissue may swell excessively. Although frightening in appearance, the swelling usually goes away in less than 24 hours. Dermatologists may use the term angioedema to describe this type of swelling, which is also used to describe very deep large hives on other areas of the body. In the commonest kind of hives, each individual wheal lasts a few hours before fading away, leaving no trace. New hives may continue to develop as old areas fade. They can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. Causes of Hives Hives are produced by blood plasma leaking through tiny gaps between the cells lining small blood vessels in the skin. Histamine, a natural chemical, is released from cells called “mast cells,” which lie along the blood vessels in the skin. Many different things, including allergic reactions, chemicals in food, or medications, can cause a histamine release. Sometimes it is impossible to find out why histamine is being released and hives are forming. The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk. Fresh foods cause hives more often than cooked foods; food additives and preservatives may also be responsible. Hives may appear within minutes or up to two hours after eating, depending on where the food is absorbed in the digestive tract. Almost any prescription or over-the-counter medication can cause hives. Some of these drugs include antibiotics (especially penicillin), pain medications, sedatives, tranquilizers, and diuretics. Antacids, vitamins, eye and ear drops, laxatives, vaginal douches, or any other nonprescription item can be a potential cause of hives.
Many infections can cause hives. Viral upper respiratory tract infections are a common cause in children. Other viruses (including hepatitis B) may also be a cause, as well as a number of bacterial and fungal infections. Some people develop hives from sunlight, cold, pressure, vibration, or EXERCISE. Hives due to sunlight are called solar urticaria. This is a rare disorder in which hives come up within minutes of sun exposure on exposed areas and fade within one to two hours. Reaction to the cold is more common. Hives appear when the skin is warmed after exposure to cold. If the exposure to cold is over large areas of the body, large amounts of histamine may be released, which can produce sneezing, flushing, generalized hives, and fainting. A simple test for this type of hives can be done by applying an ice cube to the skin. Diagnosis and Treatment of Hives Diagnosis depends on each individual’s medical history and a thorough examination by a dermatologist. The best treatment for hives is to find the cause and then eliminate it, which is not always an easy task. While investigating the cause of hives, or when a cause cannot be found, dermatologists often prescribe antihistamines to provide some relief to the sufferer. Antihistamines work best if taken on a regular schedule to prevent hives from forming. In cases of severe hives, an injection of epinephrine (adrenaline) or a cortisone preparation, may bring relief. See also ALLERGIES. FOR FURTHER INFORMATION:
American Academy of Dermatology 930 North Meacham Road Schaumburg, IL 60172-4965 (847) 330-0230
HIV positive
See
ACQUIRED IMMUNODEFICIENCY
SYNDROME; HUMAN IMMUNODEFICIENCY VIRUS.
hobbies Activities people engage in because they want to, not because they must for economic reasons. They are sources of satisfaction, RELAXATION, and relief from the stresses of everyday life for many people. People who look forward to RETIRE-
Holmes, Thomas H., M.D. 185 MENT do so because they will have more time for hobbies. Choosing hobbies is up to each individual, although in many cases they bring people with common interests together. For many people, collecting antiques or other collectibles is a hobby. According to Allen Elkin, Ph.D., director, Stress Management and Counseling Center, New York City, “people who derive most of their identity from their profession are going to need other sources of SELF-ESTEEM when they leave that profession behind.” People who have hobbies usually have a consuming interest in their chosen activity. Many former workaholics find satisfaction in a hobby that forces them to concentrate and be patient, such as building a model train, bird watching, or producing clay sculptures. See also VOLUNTEERISM.
SOURCES: Godbey, Geoffrey, and John Robinson. Time for Life: The Surprising Ways Americans Use Their Time. University Park: Pennsylvania State University Press, 1997.
holiday depression
Many individuals experience as a low mood swing during periods of the year in which holidays occur or on holidays themselves. They can be stressful times, particularly for some single and widowed individuals who may feel alone and lonely, and see the rest of their world in a celebratory mood surrounded by families. The anticipation of holidays induces some people to drink, eat, or smoke more. The stresses of holiday depression often occur when individuals have been uprooted from their families and moved elsewhere for employment or other reasons. The stresses of moving and relocation are compounded by their being alone. Some individuals in family settings experience mood shifts out of nostalgia for lost loved ones or for circumstances that existed earlier in their lives. DEPRESSION
Avoiding Holiday Depression People who know that they will be alone on holidays and will feel stressed should avoid their holiday depressive episodes by planning ahead. They can take a trip to an interesting place, engage in some enjoyable activity with a group, or invite other people without families to share holiday activities together. Other individuals who know
COPING WITH HOLIDAY STRESS • Have a realistic expectations so that you will not place too many demands on yourself. Be assertive and learn to say no. • Consider your support system. If you don’t have one, devote some time and energy to developing a support system by reaching out to others. • Identify your major annoyances at this time of year. Be aware of when they happen and plan to have alternative responses if you usually become depressed.
they will be alone on holidays may volunteer their services to hospitals or shelters for the homeless. Feeling that they will be helpful to others is a way of combating the stressful feelings associated with these times. Usually the depressed mood brought about by holidays under such circumstances goes away after the holiday season. However, when the depressive mood does not improve as the calendar rolls on, individuals should seek professional help. See also AFFECTIVE DISORDERS; SEASONAL AFFECTIVE DISORDER.
holistic medicine
Holistic medicine involves a shift in belief systems from the dualistic mind/body split toward a view of mind, body, and spirit as being closely connected. It has come to mean a specific way of thinking and practicing the art and science of medicine and for dealing with illness as well as relieving stress. Practitioners of holistic medicine view the individual as a totality, rather than as a headache to be relieved or a backache to be cured. See also ALTERNATIVE MEDICINE; AYURVEDA; HERBAL MEDICINE; HOMEOPATHY; MIND-BODY CONNECTIONS; PSYCHONEUROIMMUNOLOGY.
Holmes, Thomas H., M.D. (1918–
) Neuropsychiatrist who researched effects of stressful life change events on health status. He is known for devising a social adjustment rating scale along with Richard H. Rahe, M.D., another researcher in the area of life changes, as a predictor of illness. See also LIFE CHANGE SELF-RATING SCALE.
186 home care home care
As the population ages, many people make use of home care, which brings on stresses for themselves as well as the professionals who work with them. Physicians, nurses, case managers, health care aides, therapy specialists, social workers, laboratory technicians, nutritionists, and transportation providers are among workers in the home care industry. Demand for health care services continues to increase as there are more early discharges from hospitals, more outpatient surgeries, and technical advances and pharmaceutical developments that lengthen the survival of chronically ill patients. Some home care patients have AIDS, are on dialysis or ventilators, receive chemotherapy, or have mental illnesses or physical disabilities. Health care workers manage intravenous therapy, tracheostomy care, and wound irrigations, in addition to managing the risks inherent in home environments. Potential stressful hazards to home care workers include potential violence from clients or others, exposure to communicable diseases, ergonomic issues such as lifting the patient, physical conditions (poor lighting, broken stairs), hazardous chemicals, environmental tobacco smoke, and oxygen equipment. Some hazards can be controlled, reduced, or eliminated through use of lifting devices, having specific training in certain work practices, good hygiene practices such as hand washing and proper body mechanics, and personal protective equipment such as gloves and eye protection. See also ERGONOMICS; HEALTH CARE WORKERS; SLIPS, TRIPS, AND FALLS. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
homelessness Stresses of homeless people range from solving everyday practical problems such as finding shelter and enough food, to serious disorders such as substance abuse, DEPRESSION, and schizophrenia. The stresses of physical as well as mental health problems are intensified by homelessness and, conversely, homelessness precipitates health problems. Because of the nature of the population, it is difficult to assess the numbers of homeless people and their characteristic stressors.
The difficulties in providing medical and mental health care for the homeless are related in part to the reluctance of some of the people to present themselves for care, as well as insufficiencies of community health centers. Many of the psychiatrically impaired homeless avoid contract with the health care system. Community mobile outreach services are an important way to help these individuals obtain food, clothing, and medical and mental health care. For many of the poor and homeless populations, emergency department physicians are their source of primary care. These physicians often provide care for families that are in dire financial shape, the elderly, victims of rape and domestic violence, and drug abusers. A survey of homeless adults living in beach areas near Los Angeles revealed a high rate of prior psychiatric hospitalization. The survey covered 529 people who had spent the previous night outdoors, in a shelter, in a hotel, or in the home of a relative with whom they did not expect to stay very long. Sixty-four percent of the people interviewed were white; 73 percent were men. They had been homeless for an average of two years. Altogether, 44 percent had been in hospitals for psychiatric reasons, including ALCOHOLISM and drug dependence. Twenty-one percent had made an outpatient visit for a mental or emotional problem within the past year. Forty-one percent had never used mental health services. The worst symptoms were noted in the hospitalized group. There were more SUICIDE attempts, more daily drinking and delirium tremens. Seventy-six percent of the hospitalized group and 48 percent of the others had been arrested. People who had been hospitalized were more likely to be living in shelters. The 41 percent who had never used mental health services had been homeless about half as long as the rest and were least likely to be sleeping outdoors. Surprisingly, they scored at the same level as the general population on a questionnaire estimating well-being. According to mental health professionals, to address the complex needs of those categorized as homeless persons requires a multidisciplinary approach. Social services are needed for short-term and long-term food, housing, and entitlement services. Networks should be developed to enable
homeopathy 187 access for those people to specialty medical services, emergency food pantries, transportation, overnight shelter, and respite care for children while the parent negotiates the systems. Churches often provide for emergency needs and long-term support. Legal services are needed to advocate for their rights and entitlements. Children who are homeless require interaction with school systems, health care providers, day care centers, and, often, child protective services to promote health and prevent further illness or trauma. SOURCE: Kahn, Ada P., and Jan Fawcett. Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001.
homeopathy
A system to promote healing based on a philosophy of not bombarding the body with medications, but stimulating and assisting the body to heal itself, using the smallest amount of medication possible. Many people use homeopathic remedies to prevent, reduce, and alleviate stress. Homeopathy is considered an alternative therapy. Homeopathy uses medicines made from plants, minerals, animals, animal substances, and chemicals. Whereas some conventional medications suppress symptoms and the body’s immune response, and occasionally unfortunate reactions to drugs or drug interactions occur, homeopathic practitioners prescribe only one medication at a time and claim that there are rarely, if ever, unwanted side effects. Homeopathic medicines are produced in accordance with processes described in the Homeopathic Pharmacopoeia of the United States. In this person-oriented instead of disease-oriented system, homeopathic practitioners treat patients based on their symptoms rather than relying solely on diagnostic techniques. Homeopathic practitioners seek to find causes as well as treat symptoms; this is often done in a holistic way by talking extensively with the patient to obtain a complete health and psychosocial history. In this regard, homeopathy has a characteristic in common with the Chinese belief that the best doctors do not use medicine; they heal by giving guidance for healthful living. Homeopathy is used for a wide variety of chronic and acute problems. These include (but are not limited to) anxieties, ALLERGIES, digestive prob-
lems, gynecological conditions, and skin diseases. Many homeopathic remedies can be self-prescribed and purchased over the counter. However, as with any medication, it is prudent to consult a practitioner who is knowledgeable about the subject. Such individuals can be located through reputable local homeopathic pharmacies or the National Center of Homeopathy, Alexandria, Virginia, or the International Foundation for Homeopathy, Seattle. Historical Background of Homeopathy The history of homeopathy goes back about 250 years. Samuel Hahnemann, M.D., a German physician, noted that Peruvian bark cured malaria. To test his theory that the bark might cause as well as cure malaria, he ingested small amounts of the bark and developed symptoms of malaria. He termed this effect a “proving” of symptoms. Another example of a “proving” of symptoms is that poisons in large doses are fatal; moderate doses can cause symptoms, but small doses can stimulate the body toward reduction of symptoms. Homeopathy is based on the law of similars, or “let like cure like.” What has the power to cause also has the power to cure. There is a parallel in western medicine, where vaccines and allergy shots are used that contain tiny amounts of killed virus, or allergens, to stimulate the body’s immune system and prepare it for actual challenge. The practice of homeopathy came to the United States in the early 1800s. By the mid-1800s, several medical colleges taught homeopathy. Around 1900, there were 22 homeopathic medical colleges and one out of five doctors used homeopathy. However, by 1920, only 15 colleges remained. The decline in the use of homeopathy in the United States coincided with medical science’s increasing view of the body as a mechanistic device, the advent of medical specialization, development of other prescription drugs and medicinal technology, and opposition by the American Medical Association. The American Foundation for Homeopathy began teaching homeopathy as a postgraduate course for doctors in 1922. Today, courses are offered by the National Center for Homeopathy. In recent years, interest in homeopathy has increased along with a widening interest in HOLISTIC MEDICINE and ALTERNATIVE MEDICINE. Homeopa-
188 homeostasis thy may appeal to many people because only natural substances are used as medications. Remedies include substances that can be dissolved in a liquid medium; metals and salts are not dissolvable. According to Hahnemann’s original description, remedies are ground together 10 times for 10 minutes. Subatomic energy is released. For an inexplicable reason, once diluted beyond the 12th dilution, nothing is found under a microscope. Also, because medications are so diluted, possibilities of side effects are reduced. Some homeopathic practitioners in the United States also use other adjunctive therapies, such as spinal manipulation and nutritional counseling. The largest use of homeopathic medications is in India. It is also popular in France and England and becoming popular in Australia and Germany. In Switzerland and Germany, homeopathic practitioners work under direction of doctors of medicine. According to Dr. Sujatha Pillai, a practitioner at Ehrhart & Karl, Chicago, 32 percent of family physicians in France prescribe homeopathic medicines. A survey in the British Medical Journal (June 7, 1986, 1498–1500) indicated that 42 percent of British physicians refer patients to homeopathic physicians. According to Everybody’s Guide to Homeopathic Medicines (1991), members of the English royal family are homeopathic medicine users and the queen of England is the patron of the Royal London Homeopathic Hospital and the British Homeopathic Association. Another Homeopathic Technique: Bach Flower Remedies Bach flower remedies are named after Edward Bach (1886–1936), a British bacteriologist and homeopath. Flower remedies are a branch of homeopathic medicine, and said to be useful in acute situations. He developed a system of 38 flower remedies for 38 different emotional states, based only on a person’s psychological symptoms. Distinct from homeopathy, more than one Bach remedy is prescribed at a time. Homeopathic practitioners believe in their efficacy. SOURCES: Cummings, Stephen, and Dana Ullman. Everybody’s Guide to Homeopathic Medicines. New York: Jeremy Tarcher/ Perigree Books, 1991.
Merz, Beverly, ed. “Complementary Therapies: Homeopathy.” Harvard Women’s Health Watch 4, no. 5 (January 1997).
homeostasis
The body’s tendency to maintain a steady state, despite stressful external changes. The physical properties and chemical composition of body fluids and tissues tend to remain remarkably constant. However, when our self-regulating powers fail, often because of repeated STRESS, the individual’s health is threatened. In the late 19th century, Claude Bernard, a French physiologist at the Collège de France in Paris, taught that one of the most characteristic features of all living beings is their ability to maintain the constancy of their internal milieu, despite changes in the surroundings. Subsequently, Walter B. Cannon, a Harvard physiologist, named this power to maintain constancy homeostasis, which can be translated as physiological “staying power or self-preservation.” Coping with stress and disease involves a fight to maintain the homeostatic balance of our tissues, despite damage. HANS SELYE, the Austrian-born Canadian pioneer in stress research, discussed the concept of homeostasis in his landmark works, The Stress of Life (1956) and Stress without Distress (1978). He said that the nervous system and the endocrine system play particularly important parts in maintaining resistance during stress. They help to keep the structure and function of the body steady, despite exposure to stress-producing or stressor agents, such as nervous tension, wounds, infections, or poisons. He explained this steady state as homeostasis. See also COPING; GENERAL ADAPTATION SYNDROME; MIND-BODY CONNECTIONS; STRESS MANAGEMENT. SOURCES: Selye, Hans. The Stress of Life, rev. ed. New York: McGrawHill, 1978. ———. Stress without Distress. Philadelphia: Lippincott, 1974.
homesickness Not really a sickness; it happens when people are away from familiar surroundings and family to whom they feel close. Many people have experienced the stresses of homesickness as children while away at camp or visiting friends or
hopelessness 189 relatives; soldiers may experience it while stationed in distant lands. Homesickness may involve feelings of loneliness and confusion with the unfamiliar. How individuals adapt to such situations depends on their personal COPING skills and ability to adapt. If homesickness persists, it may lead to symptoms of mild DEPRESSION. However, in most cases of homesickness, relief occurs when individuals return to the familiar or when they adapt to the new situation. See also ACCULTURATION; GENERAL ADAPTATION SYNDROME ; INTIMACY; MIGRATION ; NOSTALGIA ; RELATIONSHIPS.
homosexuality
Sexual activity between members of the same sex, ranging from sexual fantasies and feelings through kissing and mutual masturbation, to genital, oral, or anal contact. The individual who practices homosexuality, if a man, is termed a homosexual; a female homosexual is referred to as a lesbian. Both men and women homosexuals are sometimes referred to as “gay.” Fear of or prejudice against homosexuals is known as homophobia and is a source of stress to many in the general community. The term “homosexuality” was popularized during the 1960s. During the 19th century, other terms were proposed, including “homoerotic” (aroused by the same sex) and “homophile” (lover of the same sex). Cunnilingus between two women was called sapphism after the ancient Greek poet Sappho, and lesbianism was named for the Greek island of Lesbos where she lived.
Homosexual Panic Homosexual panic (Kempf’s disease) is a panic attack that develops from a fear or delusion that one will be sexually assaulted by an individual of the same sex. The term, coined by Edward Kempf, an American psychiatrist (1885–1971), in 1920, also applies to the fear that one is thought to be homosexual. This feeling occurs more often in males than in females. There may be DEPRESSION, conscious GUILT over homosexual activity, agitation, HALLUCINATIONS, and ideas of SUICIDE. This type of panic attack may develop after many varied life circumstances, such as a loss or separation from an individual of the same sex to whom one is emotionally attached, or
after failures in sexual performance, illness, or extreme fatigue. See also GENDER ROLE; LESBIANISM; PANIC ATTACKS AND PANIC DISORDER; SEXUAL DIFFICULTIES; SEXUAL PREFERENCES. SOURCES: Marcus, Eric. Is There a Choice? Answers to 300 of the Most Frequently Asked Questions about Gays and Lesbians. San Francisco: Harper, 1993. National Museum and Archive of Lesbian and Gay History. The Gay Almanac. New York: Berkley Books, 1996.
hopelessness
State of mind in which individuals feel that it is impossible to deal with the stresses of life and that situations they face have no possible solutions. They may see limited or no available desirable alternatives and may experience the stresses of emptiness, pessimism, and being overwhelmed. Nothing matters, and they give up. Hopelessness is a characteristic of DEPRESSION. A hopeless person is passive and lacks initiative. Such an individual may not be able to reach a desired goal, accepts the futility of planning to meet goals, has negative expectations of the future, perceives a personal loss of CONTROL, and sees no way out. Successful treatment of depression with medication and certain types of psychotherapy can reverse this profound state of hopelessness. The stress of extreme feelings of hopelessness may lead to ADDICTION or SUICIDE. Hopelessness sometimes results from false or unrealistic expectations. For example, hopeless people may feel that they should be able to accomplish anything and everything, and then descend into despair upon failure. Some individuals with depression feel that nothing they do will work out and that they are powerless. Some people who are stressed may tend to magnify events to the extent that everything appears as an insurmountable obstacle in relation to themselves. Still another type of magnification results in despair, when they idealize other people and events. For example, a new friend may be thought to be perfect, or an upcoming vacation is planned to run a smooth course. When the friend proves to have perceived personality flaws and bad weather spoils the vacation, the individual who is the most unrealistic and idealistic may begin to lose hope about any friends or any vacation.
190 hormone replacement therapy The stress of hopelessness may also result from a sense of being trapped in a negative set of circumstances from which there is no escape. When presented with a task that must be performed, but seems to be impossible, a sense of FRUSTRATION and futility leads to hopelessness. The stress of confusion also leads to a sense of hopelessness, as confusion contributes to people’s feelings of loss of control. It is important to understand that hopelessness is a subjective state, related to the way in which people perceive their prospects as potentially reversible. See also COPING; PERFECTION. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001.
hormone replacement therapy
See
MENOPAUSE.
hospitalization The stress of illness is often intensified by the threat of being in a hospital, which most people find fraught with ANXIETY from beginning to end. Stress starts with the need for a second medical opinion, which, unless there is an emergency, is often a requirement of medical insurers before commitment to a hospital can be made. Stress then follows patients to the hospital registration desk where the approach of many admissions personnel to gathering patient information does little to make them feel comfortable. Loss of privacy, another key stressor, begins at the very moment patients exchange their clothes for hospital gowns and settle down in rooms shared with at least one or more strangers who may be a great deal more or less sick than they. It is further compounded by the number of visitors they or their roommates may have—people who talk loudly as they spill into all corners and all sides of what can be a too small hospital room. In teaching hospitals, the stress continues to prevail when doctors and interns gather around patients’ beds to discuss clinical aspects of their illnesses, sometimes as if the patients did not exist or at least were not right there in the bed. Stress escalates when loss of privacy combines with the loss of CONTROL patients experience as they are thrown into the uneven rhythm of the
hospital routine—being aroused at early hours for medication before a change in shifts occurs, moving on stretchers or in wheelchairs from one end of the hospital to another, waiting in drafty corridors for countless tests and X-rays, buzzing for nursing assistance that never comes, having unappealing meals served at hours when they are often least hungry, and facing constantly changing caretakers and variations in the delivery of care. The most serious sources of hospitalization stress are being in PAIN and having to rely on others for help in controlling that pain. A device that allows patients to control the intake of pain medication when they need it has alleviated this problem for some. Today, patients waiting to receive various transplants—heart, lungs, kidney, and liver—experience an additional aspect of stress regarding when or whether the transplant will come. The lists of those needing transplants far exceed availability, and for some there is little likelihood of a match. Questions also arise concerning the criteria for the lists and for those who are given priority. An example of that arose in 1995, when baseball star Mickey Mantle
HOSPITAL UTILIZATION* Hospital Inpatient Care
Number of discharges: 34.7 million Discharges per 10,000 population: 1,199.7 Average length of stay in days: 4.8 Number of procedures performed: 43.8 million Hospital Outpatient Department Care
Number of outpatient department visits: 83.3 million Outpatient visits per 100 persons: 29 Hospital Emergency Department Care
Number of emergency department visits: 113.9 million Emergency department visits per 100 persons: 38.9 Number of emergency department visits resulting in hospital admission: 15.8 million Number of emergency department visits resulting in admission to an intensive care unit or coronary care unit: 1.5 *In nonfederal short-stay hospitals, 2003 U.S. data Source: National Center for Health Statistics Available at: http://www.cdc.gov/nchs/fastats/hospital.htm. Last downloaded: October 3, 2005.
hostages 191 received a transplant a short time after a diagnosis was made. The shortened hospital stays of the later 1990s have increased the anxiety of most patients. Much of the time needed for rehabilitation and recovery now is spent outside of the hospital, which puts a good deal of the burden of care on patients’ families. For those without families, other means of home care must be found and questions arise about the costs of this care. Lastly, there is the stress on family and friends related to hospitalization of the dying—ethical questions relating to withdrawal of nourishment and treatment, particularly when there are no directions from the patient. See also ACCESS TO CARE; AUTONOMY; DEATH; ENDOF-LIFE CARE; PERSONAL SPACE. Stresses Facing Hospital Workers Workers in hospitals face stresses of diverse potential hazards that include biological, chemical, psychological, physical, environmental, mechanical, and biomechanical challenges. Biological stresses include infectious/biological agents, such as bacteria, viruses, fungi, or parasites, that may be transmitted by contact with infected patients or contaminated body secretions/fluids. Examples of these include: human immunodeficiency virus (HIV), vancomycin-resistant enterococcus (VRE), methicillin-resistant staphylococcus aureus (MRSA), hepatitis B virus, hepatitis C virus, and tuberculosis. Chemical stresses include various forms of chemicals that are potentially irritating to the body or toxic, including medications, solutions, and gases. Psychological factors and situations encountered or associated with one’s job or environment can create emotional strain and/or other interpersonal problems. Inadequate staffing, heavy workload, and high rates of severe or acute illness among patients can create stress. Physical stress can occur within the hospital work environment, such as trauma to one’s body or exposure to radiation, lasers, noise, electricity, extreme temperatures, and violence. Environmental, mechanical, and biomedical factors in daily activities of hospital workers can cause accidents, injuries, strains, or discomfort. There may be trip-
ping hazards, unsafe/unguarded equipment, poor air quality, slippery floors, confined spaces, cluttered or obstructed work areas/passageways, forceful exertions, awkward postures, vibration, and repetitive and/or prolonged motions or activities. See also HEALTH CARE WORKERS; FUNGI; HUMAN IMMUNODEFICIENCY VIRUS; NOISE; NURSING HOMES; SHIFT WORK; SLIPS, TRIPS, AND FALLS; STRESS; VIOLENCE.
hostages Victims who are subjected to the extreme stresses of isolation, confinement, and sometimes mental and physical torture. Captors frequently keep hostages in a state of uncertainty about their fate. Hostages may be individuals in a foreign country or held locally by criminals for any one of many purposes. Hostages may be blindfolded, kept in darkness, and have their ears covered. The sensory deprivation experience may produce HALLUCINATIONS. Some hostages have become paranoid, depressed, and think that their country and families have forgotten them. Readjustment to normal life after release, though welcome, is sometimes stressful for exhostages. Many experience nightmares, insomnia, bouts with abnormal fears, DEPRESSION, and feelings of rage and helplessness for some time. Mental health professionals are gaining an understanding of the state of mind of former hostages through experience. Current thinking is that a regulated “decompression period” helps former hostages adjust to normal life and to being back with their families. Following the Persian Gulf war during 1991, several hostages were released after long years of captivity. Richard Rahe, M.D., director of the Nevada Stress Center at the University of Nevada School of Medicine, and a former Navy psychiatrist with extensive experience working with hostages and disaster victims, in an interview with Psychiatric News, said that how the individuals behaved before, during, and after the hostage experience can aid in predicting who might have difficulties upon reentry. “People who do well have done well in the past with stress. They have had adequate-to-good childhoods. They did well in captivity. They passed through depression, and found themselves
192 hostility through helping others. They turned the experience into a positive one, by reviewing their lives, making positive changes.” Rahe also said that survivor GUILT is common, as are recriminations about the way they might have behaved in captivity, and many are angry toward their families or the government for not doing enough to help them. At greatest risk of developing full-blown POST-TRAUMATIC STRESS DISORDER (PTSD) are those people who already had symptoms before being taken hostage and those without a good support system. Elmore Rigamer, M.D., chief psychiatrist, U.S. State Department, quoted in Psychiatric News (January 4, 1991) regarding the “keys to staving off deterioration” in a hostage situation, commented that “mastery” and “connectedness” are the keys to overcoming psychological hurdles associated with having been a hostage. Mastery (a sense of CONTROL) and connectedness (feeling accurately informed) are both important for hostages and their families. “The ones who were able to take control of themselves will do wonderfully. The more feeling of loss of control, the worse.” Dr. Rigamer emphasized the psychological value of relaying information to hostages and families during and after the crisis. During the crisis he spent as much time as he could on the telephone with State Department hostages in Baghdad and Kuwait and their families back home, clearing up rumors and giving out information. In Psychiatric News (January 4, 1991), Thomas M. Haizlip, M.D., University of North Carolina, outlined seven stages of mastery applicable to both the hostages and their families: 1. Discriminating between good and bad forces 2. Coping by knowing what to do if it ever happens again 3. Putting your life back in order 4. Dealing with survivor guilt (having left some people and worldly goods behind) 5. Realizing that healthy people are willing to take advantage of a two-to-three-week “window” after the experience, when willingness to talk is greatest 6. Hooking up any symptoms with the event, rather than further repressing them
7. Recognizing that many people do not want help because they feel they themselves are important dispensers of help Many of these stages are also applicable after other life traumas, such as domestic violence, witnessing, or being a victim of a crime. See also AUTONOMY; BRAINWASHING. SOURCES: Haizlip, Thomas M. “Hostages.” Psychiatric News, January 4, 1991, p. 18. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
hostility A persistent attitude of deep resentment and intense ANGER. It may be the result of stressful situations or may also cause stress for the individual. The hostile person may have an urge to retaliate against a person or situation. During some situations of intense FRUSTRATION, deprivation, or discrimination, feelings of hostility may be a normal reaction. However, hostile attitudes also may occur during ANXIETY attacks, in OBSESSIVE-COMPULSIVE DISORDER, or DEPRESSION. Some people who have antisocial personalities frequently have hostile attitudes. At best, hostile people are simply grouchy. At worst, they are consumed by hatred. A hostile person may have a tense-looking face and body. They are easily excitable. They seem to have chips on their shoulders and a bitterness toward the world. They may be sarcastic and moody and respond aggressively when challenged. For many individuals, the stresses of hostilities can be worked out through EXERCISE, better COMMUNICATION skills, BEHAVIOR THERAPY, use of MEDITATION and RELAXATION, and psychotherapy. See also AGGRESSION; ALTERNATIVE MEDICINE; PERSONALITY; PSYCHOTHERAPIES; TYPE A PERSONALITY. hot flashes
A sudden feeling of warmth occurring on the face, chest, or entire body. They are a major symptom of MENOPAUSE experienced by many midlife WOMEN. Hot flashes are sources of stress because they come on unexpectedly, and can be embarrassing as well as uncomfortable. The woman’s body may become flushed, and patches of redness may appear on her chest, back, shoul-
hot flashes 193 ders, and upper arms. She may perspire profusely; episodes may last from seconds to minutes. As sweat evaporates, the body temperature decreases, causing chills and a cold, clammy sensation. Women experience the symptoms of hot flashes in a variety of ways. Some have only a few, others continue to have them for years; some women have hot flashes several times a day, once a week, or less frequently. For most women, however, hot flashes are self-limiting symptoms and disappear without any treatment. Effects of Hot Flashes Because hot flashes may occur during the night and disrupt sleep, women experiencing hot flashes may become irritable, tired, and depressed. In a 1986 survey (Holt and Kahn), typical complaints about hot flashes included waking up at night drenched in sweat, ruining clothes from perspiration, feeling embarrassed at flushing and shivering with no control, and being intolerant of heat or cold. Many women find their bodies unable to deal comfortably with even slight temperature variations. Some women say that the most stressful aspect of a hot flash is that it makes them feel out of CONTROL and interferes with their sense of well-being. While hot flashes are not a threat to health, they can make a woman uncomfortable and even anxious about having one in social or professional situations. Previous generations of women were sometimes told that hot flashes were “all in their head,” and that menopause was expected to be a time filled with bizarre behavior and delusions. Such comments from medical professionals no doubt added to the stress level of those women. Fortunately, this is no longer the case as medical practitioners understand the triggers for hot flashes, and supplements and medications are available to treat them. Why Hot Flashes Happen Hot flashes occur because of hormonal changes. A hormone known as luteinizing hormone (LH) rises after menopause. Before menopause, it is the substance that helps trigger ovulation. LH “surges” seem to set off hot flashes by dilating surface blood vessels. Hormonal changes associated with the hot flash may also be due to nerve activity in the hypothalamic area that controls temperature and anterior pituitary function.
Medical and Self-Help When hot flashes occur so often that a woman feels stressed by them, or if she cannot get a good night’s sleep, if they interfere with sexual activity or work, or if they make her chronically exhausted and depressed, medical assistance should be sought. Hot flashes are often treated with hormone replacement therapy and alternative medications including sedatives and anticholinergic agents (substances that block or interfere with transmission of certain impulses in the parasympathetic nervous system). A woman’s diet may play a role in whether she suffers from hot flashes. Refined sugars, caffeine, alcohol, and spicy foods may trigger hot flashes in some women. Recognizing the potential role of diet in reducing or eliminating hot flashes, many alternative therapists recommend that women ingest foods or herbs containing phytoestrogens. Phytoestrogens are natural-occurring sources of estrogen. Sources of phytoestrogens include soybeans, alfalfa, and rice. In addition to certain foods, nutritional supplements are frequently recommended by alter-
TIPS FOR RELIEVING THE STRESS OF HOT FLASHES • Air stuffy rooms; keep a window open if one is too warm. • Layer clothing. A suit with a lightweight blouse gives the wearer more flexibility than a wool dress. • Wear a cotton (or other absorbent material) blouse under a sweater. Avoid wearing a sweater next to the skin. • For desk-workers, use a small, desk-top fan. • During a hot flash, do not overreact. Keep calm; others will not pay attention. • Learn RELAXATION techniques to feel in control of the situation. • Regular exercise will tone the vascular system and may help a woman feel better. • Keep weight down. Slender women seem to have less erratic estrogen production, and hence fewer erratic experiences with hot flashes. • Seek homeopathic or alternative remedies; add soy products to your diet.
194 hotlines native health providers as a means of reducing the incidence of hot flashes. Vitamin E and bioflavinoids have shown some promise in this area. Herbal remedies for hot flashes include ginseng, vitex, garden sage, sarsaparilla, and dong quai. See also ALTERNATIVE MEDICINE; BIOFEEDBACK; HERBAL MEDICINE; HOMEOPATHY. SOURCES: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992. ———. 50 Ways to Cope with Menopause. Lincolnwood, Ill.: Publications International, 1994. National Women’s Health Report. “Alternative Therapies and Women’s Health.” Washington, D.C.: National Women’s Health Resource Center, May/June 1995.
hotlines
Telephone lines maintained by trained personnel to provide crisis intervention service or information on a given topic. Throughout the United States, hotlines cover many concerns related to stress and mental health. In many cases, the numbers for information and help are toll free and usually operate on a 24-hour basis. Most city telephone directories list some of the available hotlines. See also SELF-HELP GROUPS; SUPPORT GROUPS.
human immunodeficiency virus (HIV) The HIV virus is considered responsible for causing the infection that leads to Acquired Immunodeficiency Syndrome (AIDS), which continues in epidemic proportions in the United States and elsewhere in the world in the early 2000s. According to Avert.org, an international AIDS charity, during 2004 about 4.9 million people became infected with the human immunodeficiency virus. In 2004, there were 3.1 million deaths worldwide from AIDS. Many people experience stress because of concern about this virus; those who have it are anxious about their health and those who do not have it are fearful of contracting it. Many people have a misunderstanding about how it is transmitted, which adds to their stress level. How the Virus Is Transmitted The virus is usually transmitted by direct exchange of body fluids, such as blood or semen, or by using contaminated needles for illicit drug use. Many
individuals experience stress about contracting the virus by eating in restaurants in which infected individuals may work or by sending their children to a school that an infected child is known to attend. In most cases, these anxieties are unfounded, as the virus does not survive outside the body, according to research reports. Individuals who suspect their partners of highrisk sexual contacts, such as homosexual men or prostitutes, should seek medical advice about screening for and preventing transmission of the HIV virus. Use of condoms during sexual intercourse is promoted as a way to prevent the transmission. HIV and AIDS in Pregnancy According to the March of Dimes, an estimated 120,000 to 160,000 women in the United States are living with the virus; many do not know they are infected. Approximately 15,000 children in the United States have contracted HIV; about 3,000 have died. About 90 percent contracted the virus from their mothers during pregnancy or birth. Since 1994, when a government study showed that drug treatment during pregnancy greatly reduced the risk that an HIV-infected mother will pass the virus to her baby, the number of babies who contract the virus from their mothers has dropped. Between 1992 and 1999, the number of children reported by the Centers for Disease Control and Prevention (CDC) with HIV infection contracted from their mothers declined 83 percent. However, according to the CDC, between 280 and 370 infants per year in the United States still contract HIV from their mothers. In 2002, the CDC recommended that all pregnant women be offered voluntary testing for HIV as a routine part of prenatal care. Women who know they carry the virus can get treatment to help protect their babies. About 600,000 babies worldwide contract HIV each year. About 90 percent of cases occur in developing countries where new treatments are not generally available. According to the March of Dimes, HIV-infected babies do not show signs of HIV infection at birth, but about 15 percent develop symptoms or die in the first year of life. Nearly half die by age 10. However, new drugs are improving the prognosis for infected children and many are free of serious symptoms much of the time.
humanistic psychology 195 Concerns about Getting HIV from a Health Care Professional Some people experience stress when having blood drawn or dental and medical procedures done because they fear contracting the HIV virus. According to an article in Health (September 1992) the person who draws the blood presents virtually no risk. To infect a person, a health professional who is HIV positive would have to get stuck with the needle, and in turn stick that person with the contaminated needle. There is little likelihood of this happening. In the case of dental hygienists who manipulate sharp instruments inside a person’s mouth, they would have to injure themselves and bleed into exposed tissue in that person’s mouth. According to an article in Health (September 1992), one can reduce one’s stress level about this situation by being sure that one’s health care professional is taking universal precautions. Look over the doctor or dentist’s office. Equipment and instruments should look clean. Personnel should wash their hands before and after procedures, and should wear gloves, masks, and eye guards (during procedures where body fluids might splatter). Protective gear should be changed or discarded between patients. Needles and other sharp objects should be disposed of in secure containers. Anything that goes in your mouth or inside your body should arrive in sterile packaging, be disinfected, or be sterilized by autoclave or dry heat. See also HIV/AIDS TREATMENT INFORMATION SERVICE; SEXUALLY TRANSMITTED DISEASES. FOR FURTHER INFORMATION:
CAIN (Computerized AIDS Information Network) San Francisco AIDS Foundation 54 Tenth Street San Francisco, CA 94103 (415) 864-4368 AIDS-Hotlines National AZT Hotline (800) 843-9388 (toll-free) National AIDS Information Clearinghouse Centers for Disease Control and Prevention Box 6003 Rockville, MD 20850 (800) 458-5231 (toll-free) March of Dimes 1275 Mamaroneck Avenue
White Plains, NY 10605 http://www.marchofdimes.com Avert.org 4 Brighton Road West Horsham Sussex RH13 58A England http://www.avert.org
humanistic psychology
This approach to psychology and treating stress centers on the person and his or her own experiences. Humanistic psychology opposes Freudian psychology, which holds that sexual drive is the sole motivating force, and behavioral psychology, which explains human behavior as the produce of a multiplicity of organismic and environmental relationships, each of which in turn dominates the others at certain times. In humanistic psychology, emphasis is on human qualities such as choice, creativity, valuation, and self-realization; meaningfulness is the key to selection of problems for study. The ultimate concern of humanistic psychology is the development of each person’s inherent potential. According to humanistic psychologists, a person has a hierarchy of many needs, beginning with physiological needs, safety, love and “belongingness,” needs for esteem, esthetic needs, the need to know and understand, and ending in the essential needs for self-actualization. In contemporary society, many of these needs are not met, causing stress for the individual. Humanistic psychology is a value orientation that holds a hopeful, constructive view of human beings and of their substantial capacity to be selfdetermining. The Association for Humanistic Psychology The Association for Humanistic Psychology (AHP) was founded in 1962 by Abraham Maslow, Kurt Goldstein, Rollo May, Carl Rogers, and others. It is a worldwide community of diverse people promoting personal integrity, creative learning, and active responsibility in embracing the challenges of being human. AHP attracts therapists, teachers, consultants, body workers, lawyers, social workers, corporate managers, futurists, and politicians because
196 humming personal encounter and social responsibility is at the heart of the organization’s tenets. See also HIERARCHY OF NEEDS. FOR INFORMATION:
Association for Humanistic Psychology 1516 Oak Street, #320A Alameda, CA 94501-2947 (510) 769-6495 http://
[email protected] humming
Humming is a voiced sound that sounds like “hmmm.” Humming gently can help relieve stress. Sound moves though the body as vibration. Sound moves by compressing and expanding the material it is moving through, whether air, water, or the wood of a door. That wave of compression and expansion is what happens when you make a sound that moves through your body. Through your body, this pulse of opening and closing presses and releases many levels of tissue, from fluid to bone. Muscle, fluid, nerves, vital organs, bone—all are touched and massaged by the pulsation of sound. • Let the sound move up into your brain, out into your arms and hands, down through your torso and legs and feet. The more relaxed you are as you make the sound, the further it will travel. • People around you may not hear the sound, but you will feel it as it moves throughout your body. • Hum a while, rest and feel the sound move through you.
SOURCE: Henderson, Julie. Embodying Well-Being: How to Feel as Good as You Can. Napa, Calif.: Zapchen Resources, 2003.
humor
A positive emotion that usually provides a helpful release of stress and anxieties for many people. Humor may actually ease PAIN and may help the respiratory system by exercising the lungs. LAUGHTER, the expression of humor, may influence the immune system, by stimulating production of certain hormones that help to ease pain and lift one’s mood.
USE OF HUMOR TO RELIEVE STRESSFUL SITUATIONS • Reduce tension by joking about universal human frustrations and faults. • Encourage people to relax and laugh. • Delight in poking fun at oneself. • Unite people by building rapport. • Create a supportive atmosphere of fun and caring. • Note the positive aspects of human relationships.
Humor is a universal language and has universal appeal. The basis for much humor is that we are prepared for one thing and something else happens. Although we are startled, we know there is no danger, and we release our surprise in laughter. Thus a story with an unexpected ending, or a game of peek-a-boo for an infant, can seem humorous and bring about a laughter response. Shared humor relieves anxiety in stressful group situations, such as when airplanes or trains are delayed. It also relieves stresses that result from BOREDOM. At times when it seems that nothing is left to talk about, familiar topics can be renewed by employing humor. In work situations, a humorous approach can help one face sources of stress an daily disappointments. Blumenfeld and Alpern, in their book Humor at Work, outline some characteristics of stress-reducing humor, which can be used in the workplace as well as in other settings. How-
PREVENT STRESS: AVOID THESE USES OF HUMOR • Poking fun at other people’s individual shortcomings • Reflecting anger • Offending with inappropriate use of sexual references or profanity • Dividing a group by put-downs • Using a stereotype to denigrate a person or group • Creating a cruel, abusive, and offensive atmosphere
hyperventilation 197 ever, the authors warned against using humor that can be misused and actually lead to stress. Some therapists employ humor to momentarily relieve DEPRESSION during therapy sessions. One technique is known as paradoxical therapy, in which the therapist gives the individual new perspectives on his or her problems by exaggerating them to the point of making them seem funny. The therapist might assign the individual to be depressed or anxious at a certain time of day. Sometimes the silliness of such situations helps alleviate the individual’s depressed or anxious feelings. Historical Overview of Humor Ancient scholars understood the role of humor in good health. The Book of Proverbs says: “A merry heart doeth good like a medicine.” Conversely, many individuals who suffer from depression lose their sense of humor and few things make them smile or laugh. Studies in the late 20th century suggested that an ability to enjoy humor and to laugh have effects on mental as well as physical health. NORMAN COUSINS’s book Anatomy of an Illness (1977) stimulated interest in the use of humor in recovery from both mental and physical illness. While fighting ankylosing spondylitis, he checked out of the hospital and spent weeks watching Marx brothers movies and other comedies. He believed that the positive feelings aroused by humor and laughter helped him recover. Increasingly, hospitals and health care practitioners are bringing humor programs into their compendia of therapies. SOURCES: Blumenfeld, Esther, and Lynne Alpern. Humor at Work. Atlanta: Peachtree Publishers, 1994. Ziv, Avner. Personality and Sense of Humor. New York: Springer Publishing Co., 1984.
hypersensitivity pneumonitis (HP) Repeated inhalation of a foreign substance, such as an organic dust, a fungus, or a mold, causes an inflammation of the lungs and stress for the sufferer. The immune system of the body reacts to these substances, called antigens, by forming antibodies, molecules that attack the invading antigen and try to destroy it. The acute inflammation, or pneumonitis (a hypersensitivity reaction), is produced by the combination of antigen and antibody, which later can develop into chronic lung disease. The ability of the lungs to take
in oxygen from the air and to eliminate carbon dioxide is impaired. The condition is also known as allergic alveolitis. Allergic refers to the antigen-antibody reaction, and alveolitis means an inflammation of the alveoli, tiny air sacs in the lungs where the exchange of oxygen and carbon dioxide takes place. Certain changes occur in the lungs of persons who have HP. In the acute stage, there are large numbers of inflammatory cells throughout the lungs and the air sacs may be filled by a thick fluid mixed with these cells. In the subacute stage, disease extends into the small breathing tubes, or bronchioles, and the inflammatory cells collect into tiny granules called granulomas. Finally, in the chronic stage of HP, the previously inflamed parts of the lungs become scarred and unable to function. Stressful occupational factors cause several types of hypersensitivity pneumonitis. For example, farmer’s lung is a type of HP caused by antigens from tiny microorganisms on moldy hay. After a time, very little of the allergenic material is needed to set off a reaction in the lungs. Bird fancier’s lung is a form of external allergic alveolitis caused by the inhalation of avian proteins present in droppings and feathers of certain birds, particularly pigeons and caged birds. As in farmer’s lung, there is an acute and a chronic form. Malt workers’ lung is caused by inhalation of malt dust. SOURCE: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004.
hypertension
See
hyperventilation
HIGH BLOOD PRESSURE.
Deep and fast BREATHING; it is sometimes referred to as overbreathing. Some individuals who feel very stressed and those who have panic attacks and PHOBIAS may react with hyperventilation, which in turn makes them fear that they are dying or having a HEART ATTACK. Hyperventilation can result in rapid heartbeat, sweating, and numbness or tingling in the hands and feet, light-headedness, DIZZINESS, fainting. These symptoms in turn exacerbate the individual’s stress and anxiety level. Individuals who are hyperventilating typically feel short of breath, and when they breathe deeply
198 hypnosis and faster to get more air into their lungs, they are really taking in too much air. This breathing pattern makes them feel even more stressed, as it removes too much carbon dioxide from the blood, where it is needed for the body to perform efficiently. When an individual has a dizzy spell or feels the effects of hyperventilation, breathing into a paper bag for a few minutes can help restore the balance of oxygen and carbon dioxide in the blood. When some of the exhaled carbon dioxide from the bag returns to the lungs, the individual will begin to breathe more normally again. RELAXATION therapy, including breathing instruction, helps some individuals relieve the stressful symptoms of hyperventilation. See also COPING; MEDITATION.
hypnosis (hypnotherapy)
A type of attentive, receptive and focused concentration accompanied by an altered state of consciousness and a diminished awareness of environmental stimuli. It is considered an alternative therapy and is sometimes used to help relieve symptoms of stress, such as ANXIETY, PHOBIAS, and PAIN, and insomnia and to control habits such as SMOKING, overeating, or NAIL BITING, often in conjunction with other therapies. Hypnosis is sometimes used for memory enhancement. While hypnosis does not help a person remember better, it relieves some of the stress and tension that may be inhibiting memory. The greater the stress the individual feels, the less likely he is to remember clearly and accurately. Hypnotherapy utilizes the hypnotic “trance,” a state of deep RELAXATION, to produce a state of high suggestibility. While in this state, suggestions are offered either by a therapist or the individual himself; such suggestions are aimed at improving some aspect of physical or mental health, or stress reduction. Often the suggestion takes the form of imagining a desired result in detail. In that state some people gain the ability to change their perceptions of stress, anxiety, pain, memories, and feelings. “This opens up a tremendous use of hypnosis in pain control,” says Peter B. Bloom, M.D., past president of the International Society for Hypnosis. Hypnotherapy has been used as a complement to medical therapy in a number of conditions and as a primary treatment modality in others. In the man-
agement of pain, for example, hypnosis has been used not only to reduce the stress and anxiety that accompany painful medical procedures, but also to reduce the discomfort and need for analgesics associated with labor and delivery, hysterectomy, coronary bypass surgery, and abdominal surgery. Benefits of hypnotherapy include decreased nausea and pain, shorter hospital stays, and more rapid healing. Hypnotherapy has been used to decrease bleeding in hemophiliacs, to help stabilize blood sugar in diabetics, and to reduce the severity of asthmatic attacks. Self-Hypnosis Treatment with hypnosis involves teaching self-hypnosis techniques so participants can induce a trancelike state in themselves and use suggestions to help them restructure their thinking regarding the condition for which they are seeking help. Some individuals undergo hypnotic induction by listening to a voice giving them instructions to become increasingly relaxed and focused. Many people are then taught to enter the hypnotic state on their own and to give themselves suggestions aimed at achieving their goals. For example, in management of pain, hypnosis helps to block the perception of pain by drawing the individual’s attention away from it. Self-hypnosis has been shown to be effective for the control of chronic headaches. Self-hypnosis is sometimes used to promote relaxation on cue in stressful situations. In general, autohypnosis by itself will not significantly relieve stress responses. It can, however, be used as a supplement to BEHAVIOR THERAPY to make images more vivid and to heighten one’s ability to concentrate. Contrary to popular belief, the power of hypnosis lies within the individual and not the hypnotist. In a therapy situation utilizing hypnosis, the individual cooperates with the therapist to utilize this form of intense concentration to facilitate and accelerate reaching particular therapeutic goals. Individuals cannot be hypnotized against their will, but some individuals are more or less capable of achieving a hypnotic trance. See also HEADACHES. FOR FURTHER INFORMATION:
American Society of Clinical Hypnosis 140 N. Bloomingdale Road Bloomingdale, IL 60108-1017
hypothalamus 199 (630) 980-4740 http://www.asch.net SOURCES: Callahan, Jean. “Hypnosis: Trick or Treatment?” Health, May–June 1997. Kerns, Lawrence L. “A Clinician’s Guide to Mind-body Treatments.” Chicago Medicine, November 21, 1994. Lehrer, Paul M., and Robert L. Woolfolk, eds. Principles and Practice of Stress Management, 2nd ed. New York: Guilford Press, 1993.
hypochondriasis
Preoccupation with the belief that one has a serious disease is based on the individual’s own interpretation of physical symptoms or sensations. This situation is a source of stress for the individual as well as health care professionals. A thorough physical examination does not support the diagnosis of the supposed physical disorder or the individual’s unwarranted interpretation of them, although a coexisting physical disorder may be present. The unwarranted belief of having a disease persists despite medical reassurance. However, the belief is not delusional, as the hypochondriac can acknowledge the possibility that he or she may be exaggerating the extent of the feared disease or that there may be no disease at all. The preoccupation may be with bodily functions, such as heartbeat, sweating, or digestion, or with minor physical abnormalities, such as a small sore or an occasional cough. The individual interprets these sensations as evidence of a serious dis-
ease. The feared disease or diseases may involve several body systems at different times or simultaneously. Alternatively, there may be preoccupation with a specific organ or a single disease, for example, in which the individual fears or believes that he or she has heart disease. Hypochondriasis often causes people to show signs of ANXIETY, depressed mood, and obsessivecompulsive personality traits. The most common age of onset is between 20 and 30 years. It is equally common in males and females. See also DEPRESSION; OBSESSIVE-COMPULSIVE DISORDER.
hypothalamus
The coordinating center of the brain; plays an important part in reacting to stressful situations. It is a small area located above the pituitary gland, with nerve connections to most other areas of the nervous system; it controls the SYMPATHETIC NERVOUS SYSTEM (controls the inner body organs). During STRESS, FEAR, or excitement, the brain sends signals to the hypothalamus, which initiates a chain of activity, including faster heartbeat, faster BREATHING rate, and increased blood flow to the muscles (the FIGHT OR FLIGHT RESPONSE). The hypothalamus also controls reactions that cause sweating or shivering, stimulates appetite and thirst, regulates sleep, motivates sexual behavior, and determines EMOTIONS and MOODS; it indirectly controls many of the endocrine organs that secrete hormones.
I In December 2004 Congress passed the Fair and Accurate Credit Transaction Act to slow the rising tide of identity theft. The law gives people access to their credit reports and requires that financial institutions be alert to the patterns of identity theft. The Federal Trade Commission estimates that identity thieves in 2003 cost consumers $5 billion in out-of pocket expenses and cost businesses $48 billion. If you suspect identity theft, close the account you think has been fraudulently used, file a police report, contact the credit reporting agencies, place a fraud alert on your accounts, and contact the Federal Trade Commission.
identity theft
Identity theft has reached epidemic proportions in the United States, causing many people concern and stress. Most people do not know that they have been victimized until it is too late. According to Betsy Broder, an identity theft expert with the Federal Trade Commission, “Identity thieves are able to get the equity out of your house, buy luxury cars in your name, and they have evaded law enforcement by using some else’s name when they are arrested. They are resourceful and creative.” According to the Federal Trade Commission’s first national survey of the problem in 2004, 3.3 million Americans found within the past year that their names had been used to open fraudulent bank or credit card accounts or to commit other crimes. An additional 6.6 million people reported unauthorized purchases on their existing accounts. According to Carole Fleck, in her article “Stealing Your Life,” experts say the number has been doubling every year since 2000. A factor that increases the stress involved in identity theft is that the crime can take many forms; however, it always involves misappropriation of names, Social Security numbers, credit card numbers, or other pieces of personal information for fraudulent purposes.
FOR FURTHER INFORMATION:
Equifax (888) 766-0008 (toll-free) http://www.equifax.com Experian (888) 397-3732 (toll-free) http://www.experian.com Federal Bureau of Investigation Internet Fraud Complaint Center http://www.idtheftcenter.org Federal Trade Commission http://www.consumer.gov/idtheft TransUnion (800) 680-7289 (toll-free) http://www.transunion.com
PROTECT YOURSELF AGAINST IDENTITY THEFT • Shred your mail. Shred preapproved credit card solicitations. If bills for credit cards you already hold are late, call your issuer. • Guard your Social Security number as it is the key to an identity thief’s attack. • Watch your credit. Place an alert on your credit reports if you suspect any fraudulent activity.
SOURCE: Fleck, Carol. “Stealing Your Life.” AARP Bulletin 45, no. 2 (February, 2004): 3–4.
illiteracy The inability to read or write. It is a personal stressor for many people, contributing to their 200
immune system 201 poor self-image and affecting their ability to obtain employment with which to support their families. People who are unable to read or write or who do one or both poorly may develop techniques to hide or compensate for their lack. Embarrassment may keep them from seeking help. For children, the illiteracy of a parent can also be a source of embarrassment and cause them a great deal of stress. Illiteracy is a fairly common problem in the United States estimates are that 75 percent of unemployed Americans are illiterate. In the early 1990s, the New York Telephone Company had to give 60,000 people an entry-level exam in order to hire 3,000 employees. Some major corporations have had to use graphics on assembly lines to compensate for workers’ inability to read simple phrases. As jobs have become increasingly technical and the economy has shifted from an industrial to a service base, more jobs will require skills that include reading and writing ability. LEARNING DISABILITIES account for some illiteracy; however, there is not always agreement among educators as to what extent. There is a growing movement in American education to reduce illiteracy by treating reading and writing problems as learning disabilities at an early stage in schooling. At the end of the 20th century, many community organizations have taken on illiteracy as a project. Volunteers work with people who need help reading and writing. See also SELF-ESTEEM; VOLUNTEERISM.
imagery
See
immigration
GUIDED IMAGERY.
See
ACCULTURATION; MIGRATION.
immune system A collection of cells and proteins that protect the individual against possibly harmful microorganisms such as viruses, bacteria, and fungi. It is involved in problems of ALLERGIES and hypersensitivity, rejection of tissues after grafts and transplants, and probably CANCER. Suppression of the immune system can occur as an inherited disorder or after infection with certain viruses, including HIV (the virus that causes AIDS), resulting in lowered resistance to infections and to the development of malignancies. There is evidence that severe STRESS and DEPRESSION may inhibit normal immune function, although this has not been proven.
Relationship of Stress and the Immune System There are possible physiological and behavioral explanations for changes in the immune system due to stress and negative emotional states. Stress is associated with activation of several systems, including the hypothalamicpituitary-adrenal axis and the SYMPATHETIC NERVOUS SYSTEM. Certain lifestyle factors influence the immune response. For example, lack of SLEEP or EXERCISE and use of alcohol and drugs affect the immune system in adverse ways. The best ways for a person to maintain immune system health are to have a balance of exercise, rest, RELAXATION, recreation, fun, and LAUGHTER, a nutritionally healthy diet, and positive connections with family and/or friends. Writing in World Health (March–April 1994), Dr. Tracy B. Herbert, Carnegie-Mellon University, reported on studies relating stress and the immune system. Factors such as bereavement, DIVORCE, UNEMPLOYMENT, and caring for a relative with ALZHEIMER’S DISEASE were investigated. Generally, studies found that there is a large decrease in both lymphocyte proliferation and natural killer cell activities in individuals who have experienced stress. The duration of stress also affects the amount of immune change; the longer the stress, the greater the decrease in the number of specific types of white blood cells. Dr. Herbert also reported that interpersonal stress seems to produce different immune outcomes when compared with the stress due to unemployment or exams. Researchers have also looked at relationships between ANXIETY and depression and the immune system. Results suggest that depression and anxiety are associated with decreases in lymphocyte proliferation and natural killer cell activity, changes in the numbers of white blood cells, and the quantity of antibodies circulating in the blood. It seems that the ability of the body to produce antibodies to a specific substance is related to the level of anxiety. More anxiety results in less antibody production after exposure to a potentially harmful substance. See also AUTOIMMUNE DISORDERS; ALTERNATIVE MEDICINE; GUIDED IMAGERY; HUMAN IMMUNODEFICIENCY VIRUS; MEDITATION; MIND-BODY CONNECTIONS; PSYCHONEUROIMMUNOLOGY.
202 implosive therapy SOURCES: Herbert, Tracy B. “Stress and the Immune System.” World Health, March–April 1994. Locke, Steven, and Douglas Colligan. The Healer Within. New York: New American Library, 1986. Sapolsky, Robert M. Why Zebras Don’t Get Ulcers: A Guide to Stress, Stress-Related Diseases, and Coping. New York: W. H. Freeman, 1994.
implosive therapy
See
BEHAVIOR THERAPY.
impotence The inability of a male to complete sexual intercourse due to partial or incomplete achievement of, or maintaining, an erection. Estimates indicate that 10 million American men have erectile impotence and consequently the stress of FRUSTRATION, embarrassment, and irritability. Impotence may take the form of low interest in sexual activity, premature ejaculation, coitus without ejaculation, or erectile capacity only with prostitutes. It is a stressor for men as well as their partners. Diagnosing Impotence Diagnosing the causes of impotence involves many physical and psychological tests conducted with the impotent man, and, in some cases, his partner. The physical examination includes blood, hormone and circulation tests, neurological studies, and tests on penile blood pressure and temperature, among others. An important test to distinguish organic from psychological impotence is the Nocturnal Penile Tumescence Test (NPT), in which erections that occur during sleep are measured. Most men have between two and five erections while asleep, each lasting from five minutes to half an hour. In the test, which can be conducted in sleep laboratories or in the home, an electronic device is used to record changes in penile size. An insufficent number of nocturnal erections may indicate a physical problem for which further medical attention is necessary. Treatment Emotional factors, such as marital stress or depression, also affect impotence. It was once thought that psychological factors caused most impotence, but with increasing medical knowledge, the pro-
portion that can be explained on physiological grounds is increasing. It is important for men suffering from impotence to have a thorough checkup for physical as well as emotional causes by a knowledgeable physician and/or sex therapist. Treatment may be as simple as treating the disease or eliminating the drug causing it, or as complicated as surgical implantation of a prosthesis. SEX THERAPY is helpful to many men. In 1998 the FDA approved Viagra (sildenafil citrate), the first oral pill to treat impotence. Other medications have become available since then. See also PROSTATE CANCER; SEXUAL DIFFICULTIES; SEXUAL RESPONSE CYCLE. FOR FURTHER INFORMATION:
American Urological Association 1000 Corporate Blvd. Lithicum, MD 21090 (866) RING-AVA (toll-free) http://www.auanet.org Impotence Institute of America, Impotents Anonymous 10400 Little Patuxent Parkway, Suite 485 Columbia, MD 21044-3501 (800) 669-1603 (toll-free) National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892-3580 (800) 891-5390 (toll-free) (703) 738-4929 (fax) http://kidney.niddk.nihigov SOURCES: Church, Paul, and Peta Gillyatt. “Impotence: No Need to Suffer in Secret.” Harvard Health Letter 21, no. 7 (May 1996). Frye, Christopher C., ed. “Impotence.” Mayo Clinic Health Letter, August 1997.
incest Generally defined as sexual intercourse between persons so closely related that they are forbidden by law to marry. When these sexual relations occur, many family members, including the victims, do not report them out of fear of reprisal or fear of being abandoned by the perpetrator. Stress and family tensions are ongoing in such situations.
industrial hygiene 203 In Western society, sexual intercourse between father and daughter or mother and son, between cousins, or between uncles and nieces, aunts and nephews, is prohibited. See also DOMESTIC VIOLENCE. SOURCES: Spies, Karen Bornemann. Everything You Need to Know about Incest. New York: Rosen Publishing Group, 1992. Tritchell, James B. Forbidden Partners: The Incest Taboo in Modern Culture. New York: Columbia University Press, 1987.
incontinence, urinary indecision
See
See URINARY INCONTINENCE.
DECISION MAKING.
indigestion
Refers to a variety of symptoms brought on by eating, including FLATULENCE, HEARTBURN, abdominal pain, and NAUSEA. It causes a burning discomfort in the stomach because the individual has eaten too much, too fast, or toorich, spicy, or fatty foods. Nervous indigestion is a common cause of stress. This stress generally results from anything that causes ANGER, ANXIETY, PAIN, and FEAR. STAGE FRIGHT, going for a job interview, or going on a first date are sometimes stressful situations that can cause indigestion. To keep stress levels in line, eat a balanced diet; do not overdo. Allow plenty of time for eating. Limit foods that cause indigestion; eat small meals four times a day instead of three larger ones. Get adequate sleep and practice deep breathing, visualization, and other stress-reducing techniques. Belching Belching, or common burping, comes from the swallowing of air or from gas in the stomach caused by the chemical reactions of food and digestive juices. Many individuals feel stressed by the embarrassment that results from belching in a social situation or public place. To overcome the embarrassment, as well as the source of the problem, careful attention to diet may make a difference. Also, taking more time to select foods carefully and eat slowly may reduce the incidence of this annoying reaction. Belching may occur more frequently when an individual feels stressed because he or she either eats too fast or selects foods that contribute to
TIPS TO RELIEVE STRESS DUE TO BLOATING • Relax before eating; eat and drink slowly. • Limit foods/beverages that contain air, such as carbonated drinks, baked goods, whipped cream, and souffles. Do not smoke, chew gum, suck on hard candy, or drink through straws or narrow-mouthed bottles. • Correct loose dentures. • Eat fewer rich foods, such as fatty meats, fried foods, cream sauces, gravies, and pastries. • Do not lie down immediately after eating. • Do not try to force yourself to belch.
heartburn, bloating, and belching. In addition to diet, RELAXATION techniques may be useful. Bloating The term bloating applies to the full, distended feeling in the abdomen, which occurs after overeating. Many people react to stressful situations by overeating, eating too fast, or eating spicy, greasy foods, all of which contribute to bloating. The discomfort causes further stress, as bloating leads to belching or burping, which can be socially embarrassing. See also IRRITABLE BOWEL SYNDROME; NUTRITION.
industrial hygiene
A profession concerned with many stressful factors regarding safety and health in workplaces, the community, and the environment. Professionals in this field include scientists and engineers who work to protect the health and safety of workers and the community. Their jobs involve assuring that local, state, and federal laws and regulations are followed. Industrial hygienists face the challenges of planning emergency response and coordinating teams, assessing risks, and making recommendations for improving the safety of workers and those in the community. They also advise government officials and participate in developing regulations regarding health and safety of workers and their families. In doing so, they encounter stresses of trying to satisfy authorities as well as employers and community residents. According to the American Industrial Hygiene Association, workers also advise on ergonomics, noise hazards, and respiratory protection.
204 inferiority complex See also
AIR POLLUTION;
CLEAN AIR ACT
OF
1990;
EMERGENCY RESPONSE; ERGONOMICS; NOISE.
inferiority complex
An individual’s feeling of very low SELF-ESTEEM. He or she feels that other people are better-looking, better achievers, or more successful. Some children develop an inferiority complex because they are the victims of bullies while they are growing up. Other children do so because their parents have not encouraged them or belittle or overly criticize all their efforts. In some families one child may be compared unfavorably with another; this can lead to an inferiority complex. Inferiority complexes can haunt individuals throughout their lives and cause them stress in business and social situations. It can lead to mental and physical disorders such as sleeplessness, DEPRESSION, loss of appetite, and HEADACHES. Some people have inferiority complexes because of their BODY IMAGE. Contemporary advertising may contribute to the negative image many people, particularly women, have of their bodies. Female models are often anorexic and compulsive about remaining thin, some to the point of interfering with their good health. They set examples that are impossible, and unhealthy, for the average person to attain. The term inferiority complex was first used by Carl Jung (1875–1961), a Swiss psychiatrist and philosopher. A complex includes ideas linked together and related to feelings that affect an individual’s behavior and PERSONALITY. People with serious inferiority complexes can learn to raise their self-image during psychotherapy. See also EATING DISORDERS; PSYCHOTHERAPIES. SOURCE: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: A Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
infertility An inability of a couple to conceive. Usually the diagnosis of infertility is made after at least one year of sexual intercourse without contraception. Infertility is often a cause of STRESS and ANXIETY for many couples, particularly those who have delayed marriage and childbearing until their late 30s or early 40s. This frustrating and often anguishing problem affects about 15 percent of all
couples of childbearing age, and only about onehalf the couples professionally treated for infertility achieve pregnancy. Female Infertility Failure to ovulate is a common cause of female infertility. It may be caused by a hormonal imbalance, stress, or a disorder of the ovary, such as a tumor or a cyst. Disorders of the uterus and blocked Fallopian tubes are other reasons for infertility. It is rarely caused by a chromosomal abnormality or allergy to her partner’s sperm. Reasons why subfertility increases with time are largely based on changes that take place in a woman’s body as she ages. For example, older ovaries in middle-aged women produce less fertility-enhancing hormones. Additionally, these ova are not as receptive to sperm penetration and they tend to be spontaneously aborted once fertilized. Male Infertility According to Dana Ohl, M.D., assistant professor of surgery, University of Michigan Medical Center, anabolic steroids, which can lower sperm count drastically and sometimes irreversibly, will also leave an indelible mark on infertility statistics in the years to come; young men in high school who use steroids will find difficulty in impregnating their wives five to 10 years from now. Some men perceive their condition as a stressful threat to their masculine identity, which they may associate with their sexual prowess. One of the best ways to get men to accept infertility is to encourage them to talk about their condition, both with their partners and in support groups. Assisted Reproduction Techniques Assisted reproduction techniques, which were developed during the 1980s and 1990s, offer hope to conceive a child, even for couples stressed by complex forms of infertility. These techniques originated in England with the birth of the first IVF (in vitro fertilization) baby, Louise Brown, in 1978. Since then, assisted reproduction procedures have been successfully performed worldwide, enabling thousands of couples with otherwise untreatable infertility to produce their own healthy babies. Couples most suited for IVF are those in which the wife has a normal uterus and ovaries, but her
inhibition 205 Fallopian tubes are damaged, blocked, or absent. Many patients in IVF programs have previously been treated for tubal disease that required surgery, which proved unsuccessful, or which required complete removal of the Fallopian tubes. Women suffering from endometriosis, or adhesions affecting reproductive organs, may be candidates for IVF or GIFT (gamete intra-fallopian transfer). Couples in whom the husband has an infertility problem may also be suitable for IVF, TET (tubal embryo transfer), or ICSI (direct sperm injection into an egg cell). Options with Technology Understanding the options with assisted reproduction techniques helps relieve the stress of infertility for many couples. IVF is essentially a tubal bypass procedure. Mature eggs are retrieved from the ovary with ultrasound guidance. The eggs are fertilized by the husband’s sperm in the laboratory. In special circumstances, IVF procedures may be performed using donated egg cells, sperm, or embryos. The resulting embryos are transferred into the woman’s uterus or into her tubes via laparoscopy. Tubal embryo transfer (TET) is performed through laparoscopy in an operating room. GIFT (gamete intra-fallopian transfer) is similar to IVF, but the eggs and sperm, instead of being incubated in vitro, are placed together in the Fallopian tubes of the wife. GIFT can be performed if at least one of the tubes is healthy but an egg is unable to reach it. Couples interested in exploring how medical technology can help them conceive should contact local medical centers and thoroughly check the credentials of the physicians who specialize in infertility or reproductive endocrinology, as well as the laboratories and facilities they are considering. Knowing that they are in the hands of experts will help relieve some of the stresses of undergoing the assisted reproduction procedures, which may be emotionally and financially costly. A support group started by infertile couples is RESOLVE. See also BIOLOGICAL CLOCK; IMPOTENCE. FOR FURTHER INFORMATION:
American Fertility Society 2140 11th Avenue South, Suite 200 Birmingham, AL 35205-2800 (205) 933-8494
Fertility Research Foundation 1430 Second Avenue, Suite 103 New York, NY 10021 (212) 744-5500 RESOLVE, Inc. P.O. Box 474 Belmont, MA 02178 (617) 484-2424 SOURCES: Berger, Gary S., Mark Goldstein, and Mark Fuerst. The Couple’s Guide to Fertility, rev. ed. New York: Doubleday, 1994. “Costly Choices, No Guarantees: The Maze of Fertility Services.” Women’s Health Center Management 5, no. 7 (July 1997).
information explosion Today, all types of professionals are caught in the volume of information they need to do their jobs. This is occurring at the same time that career and family commitments are taking up more and more of their time. The fact that there is more to read and less time available to read it is in itself stressful. It is not only the growing stacks of magazines and newspapers in homes and memos and reports in offices that causes the concern described by Richard Wurman in his book, Information Anxiety. It is also the information forced on us through COMPUTERS with their on-line programming, fax machines, electronic mail, cellular phones, voice mail, answering machines, VCRs, audio and videotapes, and through the increasing number of regular and cable TV channels. The problem is, Wurman says, that while print and computer information envelops us, what we really need is knowledge. However, the solution for something that sifts through and synthesizes all of the data to make it usable is still a long way off. In the meantime, it is necessary to be creative in the approach to information gathering. See also RANDOM NUISANCES. inhibition The inner restraints within individuals that prevent them from carrying out mental or physical activities. As a psychoanalytic term, inhibition means unconsciously restraining instinctual impulses. Inhibitions cause stress for many people because they feel blocked from doing many things
206 insomnia they might like to do. Some people who have many inhibitions are shy and withdrawn. Some, who are extremely inhibited about certain areas of their lives and activities, may develop SOCIAL PHOBIAS. They may feel inhibitions about speaking in front of a crowd, about walking into a room filled with strangers, or calling a new acquaintance to arrange a social engagement. Others have inhibitions related to sexual activity; SEX THERAPY may be helpful with these concerns. The stresses associated with many inhibitions can be overcome with a variety of therapies, including BEHAVIOR THERAPY. See also PHOBIAS; PSYCHOTHERAPIES.
insomnia The inability to SLEEP or stay asleep; often a stressful situation and may be a symptom of other disorders. Among the most prevalent causes of insomnia are a history of STRESS, recent GRIEF, ANXIETY, or DEPRESSION. According to a study reported in Canadian Family Physician (February 1992), insomnia occurs in up to 35 percent of patients who have depression, anxiety, or mania. Certain prescription drugs (antihypertensives, antiasthmatics) along with CAFFEINE, nicotine, and alcohol are believed to account for another 12 percent of cases of insomnia. While alcohol helps some people fall asleep more easily, they often awaken in about four hours with rebound insomnia. Other causes of insomnia include tolerance to, or withdrawal from, sedative-hypnotics, restless leg syndrome (aching, burning, pricking sensations in leg muscles during the night in bed), and sleep apnea. See also ALCOHOLISM AND ALCOHOL DEPENDENCE. FOR FURTHER INFORMATION:
American Academy of Sleep Medicine One Westbrook Corporate Center, Suite 920 Westchester, IL 60154 (708) 492-0930 (708) 492-0943 (fax) http://www.aasmnet.org
insurance NANCE
See HEALTH INSURANCE; HEALTH MAINTEORGANIZATIONS; LONG-TERM CARE INSURANCE.
intense illness concern
See
HYPOCHONDRIASIS.
intergenerational conflicts Intergenerational conflicts resulting in stress have particular meaning
within the family. Because people live longer, it is not unusual to have family members representing as many as three or four generations. Having more than two of those generations living under one roof is less likely to occur today than in earlier times, but it is generally agreed that generational conflicts are often due to living together in one residence. However, no matter how close or far apart the generations live, as long as they continue to meet and share holiday and other family celebrations, some areas of generational conflict, often labeled as a generation gap, will persist. Generation gap refers to the inability to communicate, viewing the same phenomenon with opposite conclusions, insensitivity to the feelings of others, and criticism of one’s feelings and beliefs. While generation gaps have always existed, the gap, which usually extended between parents and children, has broadened to include grandparents as well. In these three-generational families, issues that most often involve all three generations in areas of disagreement include behavior. Some young people often carry a stereotype of older adults as “living in the past,” overly conservative and unable to understand the young and how much things have changed since they were young. While many young people admire and love older people, and in specific instances (parents, relatives, friends, teachers) even use them as role models, the stress-filled intergenerational conflicts persist. A good deal of stress emanating from middleaged and older adults toward the young, in fact, due to the overpowering youth culture of this generation. In addition, older people’s view of the younger generation may be colored by their own feelings of self-achievement and life satisfaction. When they feel good about themselves, they are more likely to have higher expectations of the younger generation. See also AGE DISCRIMINATION; BABY BOOMERS; COMMUNICATION; ELDERLY PARENTS; LISTENING; PARENTING; PUBERTY.
Internet dating
See
DATING.
intimacy Intimacy is marked by very close association and friendship between individuals. Emo-
Iraq 207 tional intimacy can exist between lovers, friends, siblings, or children and parents. There is evidence that intimacy can be linked to good health, but when a relationship turns sour, it can be a source of stress for many people. Close Relationships and Good Health There is evidence that suggests that when individuals have happy relationships, the likelihood of disease and complications from disease is far less, according to Len Sperry, M.D., Duke University. A five-year study found that unmarried heart patients who did not have a confidante were three times more likely to die from cardiac disease than those who were married or had a close friend. Similar findings were presented in a Canadian study of 224 women with breast cancer. Seven years after they had been diagnosed, 76 percent of the women with at least one intimate relationship survived. The explanation for this, Sperry says, is that feeling cared about and important helps maintain a person’s optimism in times of stress. These emotional boosts translate into a strong immunity that helps fight disease. The Stress and Fear of Intimacy Author of the book, Too Close for Comfort: Exploring the Risks of Intimacy, Geraldine Piorkowski, Ph.D., explored the theory that the fears and stress of intimacy can be healthy when they are realistic and protective of the self. To do this, Piorkowski suggests that individuals reflect and learn from past experiences, schedule enough time to develop
TAKING THE STRESS OUT OF INTIMATE RELATIONSHIPS • Do not plunge in. Relationships should develop slowly. • Autonomy is important, do not lose control of your own needs. • Do not expect perfection in yourself or the other person. • Set boundaries and recharge, using periods of distance to strengthen your sense of self. • Accept criticism, rejection, and disappointment as a fact of life. • Maintain a life away from the relationship.
these relationships, be willing to share feelings with others, work at relationships but allow for failures, and be on intimate terms with more than one person. Dr. Piorkowski comments, “There is a level of imperfect intimacy that is good enough to live and grow on. In good-enough intimacy, painful encounters occasionally occur, but they are balanced by the strengths and pleasures of the relationship. There are enough positives to balance the negatives. People who do well in intimate relationships don’t have the perfect relationship, but it is good enough.” Developing Intimacy in Cyberspace More and more people are developing relationships online. They meet in chat rooms, and, for more intimacy, carry on their affair using e-mail and exchange photos via the Internet. There’s also an addictive quality to conversing online, and some people, particularly those who have not been honest, may have been wasting the other’s person’s time. But the real danger is that online relationships are not limited to consenting adults. Sexual predators use the information highway as a route to meet children and lure them to meeting places and abuse them. Because not all Internet users are benign, parents should warn their children about the dangers of online predators. See also DATING. SOURCE: Piorkowski, Geraldine K. Too Close for Comfort: Exploring the Risks of Intimacy. New York: Plenum Press, 1994.
introversion A PERSONALITY characteristic marked by self-reliance and more of an interest in working alone or doing recreational activities alone than with others. The opposite personality type is characterized by extroversion, which involves more outgoing tendencies. Introverts may be stressed because they are preoccupied with their own inner thoughts and feelings rather than with other people. Introverts tend to be rather contemplative and sensitive people, and may seem aloof to others. See also PERSONALITY; SELF-ESTEEM. Iraq
See
NUCLEAR WEAPONS; VIOLENCE.
208 irradiated mail irradiated mail To make mail safe from biohazards following ANTHRAX attacks in fall 2001, U.S. Postal Service and government officials began irradiating mail destined for government offices in specified zip codes in the Washington, D.C., area. Postal workers as well as mail recipients experienced anxiety and stress when several federal workers began reporting health symptoms they believed were related to handling irradiated mail. Irradiation destroys bacteria and viruses that could be present in the mail. The National Institute for Occupational Safety and Health (NIOSH) conducted health hazard evaluations on the handling of irradiated mail by postal employees, federal workers, and congressional employees. NIOSH sent teams of investigators, including industrial hygienists and occupational medical physicians, to survey employees about their symptoms and to monitor the air for chemical by-products that could be released from the mail. NIOSH did not detect airborne contaminants above occupational exposure limits. Employees reported skin irritation, eye, nose, and throat irritation, headaches, and nausea. These symptoms may have resulted from a combination of various factors, including suboptimal environmental humidity, drying effects on the skin of handling irradiated paper, odors, and stress. See also ANTHRAX; STRESS; TERRORISM. irritable bowel syndrome (IBS)
Applies to a pattern of symptoms in the digestive tract that affect about twice as many women as men. Only rarely does IBS begin in people over the age of 50; it is a disease of young adulthood and sometimes adolescence. For many, the attacks are brought on by certain stressful life situations. IBS is one of the most common gastrointestinal conditions seen by physicians today. The symptoms most commonly experienced include abdominal pain, CONSTIPATION or diarrhea, and gaseousness. Symptoms may vary in severity and may last for a day or even months, if not treated. Irritable bowel syndrome in the past was referred to as mucous colitis, spastic colitis, nervous diarrhea, and irritable colon; these terms have generally been discarded. IBS often has been considered to be caused by emotional conflict or STRESS because doctors have
been unable to pinpoint its organic cause. However, many individuals who suffer from ANXIETY DISORDERS, panic attacks, or panic disorder also suffer from IBS. While stress is a link, there are also other contributing factors. For example, eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the exaggerated reflex can lead to cramps. Sometimes the spasm delays the passage of stool, leading to constipation. At other times, the spasm leads to more rapid passage of feces or diarrhea. While some symptoms, such as abdominal pain, may be triggered by emotional stress, the symptoms are real and not imaginary. Symptoms occur because the intestinal tract does not function properly, although no organic disease is present. IBS can cause a great deal of discomfort, but is not serious. However, for some people it can be a source of stress and disabling. Some people may be afraid to go to dinner parties, seek employment, or travel on public transportation. However, with attention to stress management, proper diet, and sometimes medication prescribed by a physician, most people with IBS can control their symptoms effectively. Self-Help for IBS Individuals who have been diagnosed with IBS may be advised to engage in more tension-relieving activities, such as sports or HOBBIES, and physical EXERCISE. They may be advised to concentrate on RELAXATION techniques and possibly counseling by a psychologist who can provide guidance in relaxation techniques. Also, they may be advised to eat meals at regular times and with good eating practices, such as chewing slowly, and with measures designed to keep them from swallowing air. Large meals may also cause cramping and diarrhea in some people, so that eating smaller meals more frequently, or eating smaller portions of foods may be recommended. Foods that are low in fat and rich in carbohydrates and protein may also help alleviate symptoms. Dietary fiber, present in whole grain breads and cereals and in fruits and vegetables, has also been shown to be helpful in lessening IBS symptoms. High-fiber diets keep the colon mildly distended, which helps to prevent spasms from developing. Some forms of fiber also keep
itching 209 water in the stools, thereby preventing hard, difficult-to-pass stools from forming. Although highfiber diets may cause gas and bloating, over time, these symptoms may dissipate as the digestive tract becomes used to the increased fiber intake. Chewing gum, drinking carbonated beverages, caffeine, and alcohol, and smoking should be avoided. Getting Medical Help Periodic flare-ups of IBS symptoms are fairly common. When IBS becomes the body’s habitual way of reacting against undue stress—and since most people experience some physical symptoms of stress at least occasionally—the goal should be to control these symptoms. Individuals who have IBS may be advised to take a combination of antispasmodic drugs and tranquilizers, which may relieve symptoms. Antispasmodic medications are sometimes called anticholinergics; as painful spasms may be the primary symptom of IBS, treatment with these medica-
tions is often useful. However, in an effort to regulate colonic activity or minimize stress, some individuals become dependent on laxatives or tranquilizers. When this occurs, the physician may try to withdraw the drug slowly and work with the individual to control specific symptoms of stress, as well as the irritable bowel symptoms, with life-style changes. See also ANXIETY; GUIDED IMAGERY; INDIGESTION; MEDITATION; PANIC ATTACKS AND PANIC DISORDER. SOURCES: Cunningham, Chet. The Irritable Bowel Syndrome (I.B.S.) & Gastrointestinal Solutions Handbook. Leucadia, Calif.: United Research Publishers, 1995. Tannenhaus, Norra. Learning to Live with Chronic IBS. New York: Dell, 1990.
isolation itching
See See
LONELINESS.
ALLERGIES; LICE.
J Japan, stress in
See
SOURCE: Wingler, Sharon. Travel Alone & Love It: A Flight Attendant’s Guide to Solo Travel. Willowbrook: Chicago Spectrum Press, 1996.
KAROSHI.
jealousy
An attitude or EMOTION that encompasses a continuum of ENVY, distrust, hostility, and rivalry with another person. It sometimes leads to suspicion of unfaithfulness or apprehension of a loved one’s exclusive devotion. When an individual experiences jealousy, he or she has feelings of low SELF-ESTEEM and self-imposed stress. Examples of jealousy include the feeling that some children experience when a new sibling arrives, or when one’s spouse has an intimate RELATIONSHIP with another. An individual may be jealous about another’s ability to afford the luxuries of life, such as elegant housing, country club memberships, expensive clothes, and fur coats. Jealousies also occur when one individual perceives another as smarter, or at work when one individual is passed over for another who gets a promotion. Stress caused by jealousy can be relieved by a realistic look at oneself and one’s capabilities, whether academic, financial, or professional. An assessment of one’s own good points can override feelings of envy of others. If not dealt with, jealousy can lead to inappropriate behavior such as stalking, sexual abuse, and criminal action. See also RELAXATION.
job change
Making the transition into a new position, whether continuing to work for the same company or for a new one, can be stressful. Both situations have pros and cons. Coming from the outside means the individual does not have to worry about managing coworkers or friends. However, when the individual does not have a mentor or friend in a new company, he has no one to rely on, to show him the ropes and to introduce him to corporate policies and politics. Starting out fresh also means not knowing what employees are good at, who are the hard workers, and who sloughs off. Promotion, whether from within or without, can also significantly raise stress levels because it raises fear of incompetence and fear of failure. Usually these fears and stresses will go away once the new position is mastered and evidence of SUCCESS becomes visible. See also CHANGING NATURE OF WORK; DOWNSIZING; JOB SECURITY; LAYOFFS; NETWORKING; OCCUPATIONAL STRESS; WORKPLACE. SOURCE: Snyder, Don J. The Cliff Walk: A Memoir of a Job Lost and a Life Found. Boston: Little, Brown, 1997.
jet lag
Term given to the disruption of one’s body rhythms (CIRCADIAN RHYTHMS) resulting from traveling through several time zones within a short span of time. It takes many individuals several days or longer to recover from the stress of this type of travel. The sleep schedule, appetite, and ability to concentrate well while recovering from jet lag vary from individual to individual. See also AIRPLANES.
job loss
See
OCCUPATIONAL STRESS.
job security Lack of job security is a major cause of instability and stress for workers throughout the world. This was not so 30 to 40 years ago. Then, many employers had implicit or explicit long-term employment contracts with their workers, contracts that emphasized management’s commitment and 210
judicial proceedings 211 pledge to minimize the need for LAYOFFS. Wages and job benefits increased over the years, and it was not unusual for the company to pay the total cost of employees’ health care and charge minimally for family coverage. This job security led workers to expect to remain in their jobs for many years, and it was not unusual for workers to devote their entire working lives to one company, retiring with the traditional gold watch and company pension. During the later 1990s and early 2000s, DOWNSIZING, layoffs, MERGERS, and other organizational changes have greatly altered the job security picture. Employers are no longer sharing their wealth; raises and employee benefits have been scaled back. Full-time jobs are harder to find. Suggestions for improving one’s job security include learning to operate one’s own business, becoming a free agent or “gun for hire,” setting new professional goals, looking for new jobs while still employed, considering new fields, building portable skills; setting up a network of trusted colleagues, clients, former bosses, and other professionals who know the worker’s track record and opportunities available in his/her field; creating an escape hatch (options, lateral moves, further education); and being ready to accept change. See also JOB CHANGE; NETWORKING; OCCUPATIONAL STRESS; WORKPLACE. SOURCE: Alderman, Lesley, and Karen Cheney. “Here’s the Good News about Jobs.” Money, May 1996, pp. 111–121.
job stress
See
OCCUPATIONAL STRESS.
journaling Writing down thoughts and experiences in a daily or weekly journal is a way for the individual to relieve stress, sort out confusion, and deal with problems. Writing, and reading what has been written, sometimes exposes suppressed, subconscious feelings that can be dealt with more constructively when they are recognized. In this sense, a diarist may get closer to his/her feelings and better understand self-motivations. The cathartic effect of writing involves a distancing from negative feelings and experiences. Once the feelings or experiences are described on paper, the writer frequently has a sense of being rid of them, of being able to go on to something else.
Writing may also help to bring repressed thoughts and attitudes out into the open and eliminate some of the restrictions that sap energy and limit productivity. Simply the act of writing may grant a sense of CONTROL, a way of giving some order and manageability to problems. Symptoms such as ANXIETY, DEPRESSION, and apathy may be masks for envy, JEALOUSY, and rage turned inward at the self. Some diarists have found it useful to write a portrait of a person whom they envy or who has angered them. The portrait sometimes reveals qualities of their own that they wish to either develop or change. Making lists in a diary can be a good way of setting goals and giving order to what may seem to be an enormous or chaotic task. Journaling also can be useful for the person who is attempting to control addictive or obsessive behavior. Journaling is used by many SUPPORT GROUPS for overeaters, as well as those who wish to stop SMOKING or drinking. The diary not only improves self-understanding and serves as a way to record progress, but also gives the individual something to do over which he/she has complete control when he wants a drink, cigarette, or is about to give in to a desire to overeat. See also EATING DISORDERS; SELF-ESTEEM. SOURCE: Adams, Kathleen. Journal to the Self. New York: Warner Books, 1990.
judicial proceedings
Stresses endured by individuals serving on juries range from being away from their families in the event of a sequestered jury, to the agonizing DECISION-MAKING processes in which they will have to engage. First there is the stress of the selection process, during which an individual faces the feeling of being out of CONTROL of his destiny for the next day or, perhaps, for weeks. Then here is the concern about being sequestered or a period of time with a group of strangers. Some stress surrounds how well the individual will get along with fellow jury members. There is also the stress of making the right decision, particularly in a life or death matter, and having one’s own judgment swayed by others in making a decision.
212 junk food Stresses for Lawyers LAWYERS are the first to attest to the extreme stress that arises during a jury trial. This stress often is exhibited by a loss of temper on both sides of the issue. That is why stress management is a popular topic of seminars offered to lawyers nationwide. These seminars encourage lawyers to recognize the stressors such as physical separation from their families and disruption of normal routines that may occur, particularly when a trial goes on for a long period of time, and to strategize ways to handle the stress. The seminars emphasize the need for lawyers to maintain themselves physically and emotionally and to try to talk out feelings, something that can be alien to those involved in legal work.
When asked about effective ways to handle stress, many lawyers highly rate building a wall of separation between their professional and private lives. Others value a healthy regimen that includes no SMOKING or drinking, staying in shape by exercising, and establishing healthy lifestyle habits. SOURCE: Kahn, Ada P. “Win the Case against Stress.” Record (Chicago Bar Association), May 1994.
junk food
See
COMFORT FOODS; WEIGHT GAIN AND
See
SPAM.
LOSS.
junk mail
K SOURCES: Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York: Delacorte, 1991. ———. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1993.
Kabat-Zinn, Jon, Ph.D.
Founder and director of the Stress Reduction Clinic, University of Massachusetts Medical Center, Worcester, where he is also an associate professor of medicine. He is the author of popular books about coping with STRESS including Mindfulness Meditation in Everyday Life, Meditation for Daily Living, and Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. Dr. Kabat-Zinn is a proponent of mindfulness MEDITATION, a more than 2,000-year-old Buddhist method of meditation, and living fully in the present. This approach offers a unique way to cope with stress and illness. Mindfulness meditation can help induce deep states of RELAXATION and, at times, directly improve physical symptoms. Other forms of meditation involve focusing on a sound or the sensation of breath leaving and entering the body. Anything else that interferes in the mind during these types of meditation is seen as a distraction to be disregarded. Mindfulness, on the other hand, is insight meditation and encourages the meditator to note any thoughts as they occur and observe them intentionally but non-judgmentally, moment by moment. This practice of observing thoughts, feelings, and sensations can help the meditator to become calmer and have a broader perspective regarding life. Kabat-Zinn teaches readers to reflect on the beauty of the present and emotional and spiritual applications of meditation. See also ALTERNATIVE MEDICINE; GUIDED IMAGERY; MIND-BODY CONNECTIONS.
karoshi
“Death from overwork”—synonymous with stress in Japan. An article by C. Frank Lawlis in Alternative Therapies (July 1995) reports that “People (in Japan) are literally dying at their workstations. It appears that their entire physiological system collapses or shuts down.” Lawlis draws from a 1989 study by Chiyoda Fire and Marine Insurance, Ltd., one of the top insurance carriers in Japan. Chiyoda, which covers over 100,000 Japanese corporations, conducted a major study on health problems Japanese people are likely to encounter. One important conclusion of the study was that in 40 percent of the health problems, stress played a major role. As a result, Chiyoda established N.C. Wellness, a company that developed programs integrating Oriental medicine into health promotion for employees. Buildings housing the programs were constructed to focus on tranquil space and function in a similar fashion to that of a “cocoon.” At the same time, they were designed as places for nonordinary pleasure where “interference from everyday affairs is barred” and where the environment to practice the mind-body and awareness elements of balance is enjoyable and protective. The first prototype center was opened in Kichjoji, Musashino-shi, Tokyo, in June 1994. The core program offered at this site incorporated six “directions”: self-management, self-promotion, self-discovery/purpose of life, fun and pleasure, interpersonal skills, and community.
FOR FURTHER INFORMATION:
Stress Reduction Clinic University of Massachusetts Medical Center Worcester, MA 01655 (508) 856-1616
213
214 kinesics See also
ACCULTURATION; ALTERNATIVE MEDICINE;
MIND-BODY CONNECTIONS.
kinesics
The study of COMMUNICATION as expressed through facial expression and other body movements. Theories and techniques of studying this type of nonverbal communication were developed by Ray L. Birdwhistell (1918– ), who found that certain gestures and expressions were specifically male or female and also related to regional and national groups. BODY LANGUAGE changes with age, health, mood, and the degree of STRESS or RELAXATION experienced by the individual. Birdwhistell
developed his theories with the use of photography and a notation system of symbols called kinegraphs to describe gestures and expressions. SOURCE: Birdwhistell, Ray L. Kinesics and Context. Philadelphia: University of Pennsylvania Press, 1970.
kleptomania
See
SHOPAHOLISM.
Kohut, Heinz
See
kundalini
YOGA.
See
SELF-PSYCHOLOGY.
L wood, or brick. They may be inside or outdoors, temporary or permanent.
labyrinth
Originally an ancient spiritual tool, the labyrinth is now experiencing a worldwide comeback as a form of stress relief and self-healing. A labyrinth is a geometric design made on the ground or on the floor. It consists of a single path leading from the entrance to the center and back out again. The defined space, usually in spiral form, has a number of circuits. The labyrinth is not attached to any particular religion and has a wider and more spiritual quality than do symbols of specific religions. It is used as a walking meditation and for ceremony and rituals. “We in the West especially need to learn how to quiet our minds. The labyrinth is a safe place to order chaos and to calm the frightened heart,” according to Rev. Lauren Artress, author of Walking a Sacred Path, Rediscovering the Labyrinth as a Sacred Tool. People walking labyrinths frequently relate feelings of peace that come over them as they follow the path. Others report suddenly seeing solutions to problems they have been facing. A labyrinth is not a maze. Mazes have dead ends and serve to challenge the mind. The labyrinth, however, is a single path which invites quiet introspection without the dead ends of a maze. Labyrinths date back thousands of years and have been found in Arizona, Peru, Iceland, Egypt, India, and Sumatra, according to the Labyrinth Resource Center based in England. In the United States, about 1,100 labyrinths are listed on an international labyrinth locator Web site. They are in shopping centers, hospitals, colleges, parks, prisons, churches, and backyards. More than 100 hospitals nationwide have built labyrinths that are used by patients, their families, hospital staff, and community groups. Labyrinths typically range in size from 24 to 166 feet or even longer in diameter and are made of stones, grass, flowerbeds, portable canvas, concrete,
SOURCES: Artress, Lauren. Walking a Sacred Path: Rediscovering the Labyrinth as a Sacred Tool. New York: Riverhead Books, 1995. DuBois, Elise. “Labyrinths Can Be Paths to Inner Peace.” Life-Times 20, no. 1 (January 2005): 4.
ladders Use of ladders is a source of stress for many people at home and at work. Falls from ladders are a common cause of injuries. According to REMOVE STRESS FROM LADDER USE: CHOOSE THE RIGHT LADDER • Ladder style: Step or extension. Both may be needed. A stepladder can be used indoors and outdoors but has height limitations. Use an extension ladder primarily outdoors where extra height is needed. An extension ladder can be used indoors where high ceilings are hard to reach. • Size of ladder: For stepladders, the height of the ladder plus four feet equals the total reach. For example, a four-foot ladder can be used to reach an eight-foot ceiling. Use a six-foot ladder to reach a 10-foot ceiling, etc. • For an extension ladder, the base and upper sections must overlap. Thus a 20-foot extension ladder is only good for about 17 feet. The ladder must travel above the roofline two to three feet so that it can be used for balance as one climbs onto the roof. • Duty rating: Ladders are sold by duty rating, which means how much weight a ladder is rated to carry. The more weight it will hold, the stronger it must be. (continues)
215
216 lasers • Construction material: Choices are wood, aluminum, and fiberglass. • Wood ladders are solid and sturdy. However, they are heavy and thus cumbersome and somewhat difficult to transport. Wood must be maintained to prevent cracking, splitting, and rotting. Wood is economical and does not conduct electricity when clean and dry. When doing electrical work, choose a fiberglass ladder. • Ladders made from high-strength aluminum are lightweight, but salt air or chemicals can corrode and weaken an aluminum ladder. • Fiberglass ladders are lighter than wood but heavier than aluminum. They are not subject to rot, and do not bend easily.
the American Academy of Orthopedics, more than 500,000 people a year in the United States are treated for ladder-related injuries. About 300 people die from ladder-related injuries annually. Occupations involving use of ladders include construction, plumbing, heating and air conditioning, electrical work, and roofing. See also CONFINED SPACES; ELECTRICITY; SLIPS, TRIPS, AND FALLS.
lasers
Laser remote pointing devices used at presentations by computer projection can be a source of stress if used improperly. Care must be taken with laser pointers that produce an intense, highly directional beam of light of a single wavelength. The penlike laser pointer produces a fine beam that can be hazardous to unprotected eyes if one looks at the laser from within the direct beam. Repeated exposure to relatively low-powered lasers, or from a single exposure to medium-powered lasers, may cause long-term damage to sight or minor damage to the skin. Exposure to high-level lasers may cause severe burns and depigmentation. There is a wide range of applications of lasers in scientific use and for cutting and welding. Medical lasers are used on eyes and for microsurgery, neurosurgery, and dermatology. Protective eyewear specifically designed for protection against nonionizing radiation lasers and laser systems may be used to reduce stressful effects of laser use. Such equipment includes goggles, face shields, specta-
cles, or prescription eyewear using special filter materials or reflective coatings. At all times, users should avoid looking into a laser beam or a laser reflection. Lasers should be used in a controlled area with emphasis on controlling the path of the laser beam.
laughter An individual’s response, a smile, chuckle, or explosive sound, to something that inspires joy or scorn. The ability to laugh, and its companion, a sense of HUMOR, can provide psychological relief from stress, tension, ANXIETY, HOSTILITY, and emotional pain. Laughter helps individuals deal with stressful situations, whether at work, in social situations or in health care settings. Laughter may be a defense against personal feelings of self-consciousness or embarrassment. An ability to laugh at oneself can be an important COPING mechanism against these stresses. However, many people find it difficult to poke fun at themselves and to acknowledge that they have made a mistake. Individuals suffering from DEPRESSION often lose their ability to laugh and see no humor in their lives or in the world around them. The Curative Powers of Laughter Maintaining a sense of humor can help most people stay healthy. It causes the body to have a physiological response, and the IMMUNE SYSTEM gets the benefit. For example, when one laughs, various muscles tense, then relax, which can result in toning. BREATHING gets faster, allowing the body to take in more oxygen and to get rid of more carbon dioxide. Heart and pulse rate and blood pressure also increase to promote more vigorous circulation, and an increase in the brain’s chemical transmitters aids mental alertness. Research shows that laughter, like exercise, can stimulate the brain to produce secretions known as ENDORPHINS. Endorphins increase one’s sense of physical and mental well-being and, to some extent, relieve pain. The curative power of laughter is not a 20thcentury discovery. In the Book of Proverbs, it says: “A merry heart doeth good like a medicine.” Norman Cousins (1915–90), former editor of the Saturday Review and later a member of the faculty of the medical school at the University of California at Los Angeles, used the curative power of laughter to
lawyers 217 help himself recover from a degenerative disease of the body’s connective tissue. Following are a few excerpts from Cousins’ Anatomy of an Illness, in which he described the benefits of laughter: I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep . . . Exactly what happens inside the human mind and body as the result of humor is difficult to say. But the evidence that it works has stimulated the speculations not just of physicians but of philosophers and scholars over the centuries.
Cousins checked out of the hospital and spent weeks watching Marx brothers’ movies and other comedies. He attributed his recovery to the positive feelings that laughter aroused in him. Research in Laughter In an article titled “Laughter” in American Scientist (January–February 1996), University of Maryland psychologist Robert R. Provine attempted to shed some light on laughter as a stereotyped, species-specific form of COMMUNICATION. Among other things, Provine’s research provides a novel approach to the mechanisms and evolution of vocal production, speech perception, and social behavior. The laugh tracks of television situation comedies—attempts to stimulate contagious laughter in viewers—and the difficulty of extinguishing “laugh jags” or fits of nearly uncontrollable laughter are familiar phenomena. “Rather than dismissing contagious laughter as a behavioral curiosity,” Provine suggests, “we should recognize it and other laughrelated phenomena as clues to broader and deeper issues. Clearly, laughter is a powerful and pervasive part of our lives.” Provine and his assistants observed human laughter in various natural habitats, such as shopping malls, classrooms, sidewalks, offices, and cocktail parties. Among other things, they found that, contrary to their expectations, most conversational laughter is not a response to structured attempts at humor, such as jokes or stories. Spontaneity, mutual playfulness, in-group feelings, positive emotional tone, and not comedy, mark the social settings of most naturally occurring laughter. They also found that the average speaker laughs
about 46 percent more often than the audience, and that females, whether they are speakers or audiences, laugh more often than males. “In some respects laughter may be a signal of dominance/ submission or acceptance/rejection,” Provine concluded. “In some situations, laughter may modify the behavior of others by shaping the emotional tone of a conversation.” See also PSYCHONEUROIMMUNOLOGY. SOURCES: Peter, Laurence J. The Laughter Prescription. The Tools of Humor and How to Use Them. New York: Ballantine Books, 1982. Provine, Robert R. “Laughter.” American Scientist 84, no. 1 (January–February 1996). Roach, Mary. “Can You Laugh Your Stress Away?” Health, September 1996.
lavatories, public Many people are fearful of using public lavatories and experience stress when they want to urinate or have a bowel movement in a place where another person might be aware of what they are doing. Others experience stress because they fear contracting a disease from a toilet seat or from a towel or sink in a public lavatory. Some people fear producing odors and others fear encountering odors in public lavatories. Some individuals are unable to pass urine or move their bowels in a place other than their own bathroom at home. Because of the incidence of AIDS (acquired immunodeficiency syndrome), stress regarding public lavatories has increased, despite educational campaigns. Young children who are being toilet-trained may use the toilet appropriately at home but not use public lavatories until they are more accustomed to using facilities outside of their home. This is a source of stress for both child and parent. See also ACQUIRED IMMUNODEFICIENCY SYNDROME; PHOBIA; TOILET TRAINING. lawyers Individuals whose profession is to conduct lawsuits and provide advice regarding legal obligations for clients. Under constant pressure to win, there are extremely high levels of STRESS associated with practicing law. Lawyers are frequently in adversarial situations and face deadlines and
218 layoffs pressures from many people, including clients, partners, and opposing lawyers. Litigators, lawyers who represent clients in JUDICIAL PROCEEDINGS, must have a tough exterior to dominate the situations that they encounter and to win. In private life, some find it difficult to switch to a more equal role with personal partners or family, resulting in still another level of stress and tension. Lawyers as individuals tend to be high achievers. Usually they have high expectations of themselves and others; often these expectations are unreasonable, causing a disparity. “Most lawyers are by nature compulsive people,” said Nancy Weisman, general counsel, Rush North Shore Medical Center, Skokie, Illinois, in an article in the Chicago Bar Association’s journal, Record (May 1994). “Lawyers are often the bringers of news, both good and bad. We bear the burden of delivering answers from other lawyers or the courts. It’s easy to explain a win. Explaining a lost motion or case is a stressor lawyers face at times,” said Weisman. Additionally, lawyers must be good listeners and watch for BODY LANGUAGE and unspoken signals to try to anticipate the opposing lawyer’s responses. Body language plays an equally important role in anticipating feelings of the judge or jury. At the same time, lawyers usually make efforts to hide signs of their vulnerability, which in itself is a stressful posture to take. Different Stressors at Different Career Stages Lawyers face different stresses that may threaten their mental and physical health at various career stages. Just out of law school, in midcareer, and when nearing RETIREMENT they face particular tension-producing factors. Personal stressors compound the tension levels they face throughout their lives. Most young lawyers begin careers as associates and are single. Hoping to meet a mate, they try to maintain an active social life, but find it difficult while working 80 hours a week or more. The added pressure of a new social relationship when they do enter into one, while meeting the demands of their bosses and clients, can be overwhelmingly stressful. Married lawyers, particularly those who have children, are often torn between wanting to do their jobs well and enjoying family life. They may
have experienced feelings of resentment about being absent from family events because of clients’ needs. They want to have time and energy for their children’s needs and for their partners. They have to factor these stressors into already stressful days. As careers advance, there is the COMPETITION to become a partner as well as comparison with the careers of former classmates. Some law firms’ new family leave policies have great appeal for young lawyers; still they worry that they will be on a slower track than their peers. Lawyers who are solo practitioners or in very small firms face the constant challenge of bringing in enough business to stay afloat. Lawyers whose firms have reorganized or merged with another firm may find the prospect of being downsized out of the firm a serious stressor. Those who do stay find that they have a new boss to report to, a new internal structure to adjust to, and new or additional responsibilities beyond their full workload. As they near retirement, some lawyers feel threatened by younger partners in their firms. Others may regret not reaching the top echelon of their firm. They become concerned about what they will do after they retire from their positions, which have centered on their practice and their clients. Some face the stressful situation of having had too little time to develop outside interests or HOBBIES, which are usually the key to making a smooth transition from career to retirement. See also CHANGING NATURE OF WORK; DOWNSIZING; JOB SECURITY; LAYOFFS; MERGERS. SOURCE: Kahn, Ada P. “Win the Case against Stress.” Record (Chicago Bar Association), May 1994.
layoffs Layoffs or reductions in force (RIFs) have become everyday occurrences for companies. The potential for this occurrence affects everyone and is a cause for stress. Today, more than ever, there is no JOB SECURITY, and the big organization that took care of its workers is a thing of the past. During the recession years of the 1980s, job reduction was blamed on national or international business conditions. Today more and more companies are reducing their workforces in order to save money (after merger or acquisition) or realize productivity gains.
learning disabilities 219 Layoffs also are due to plant closings, work slowdowns, corporate DOWNSIZINGS or MERGERS, and acquisitions. Being laid off is different from being fired, though the individual will probably feel the same stress. When workers are fired, it is because their performance is lacking; when layoffs occur, performance is rarely cited. Typically, there are five emotional stages that follow a termination, and they are not unlike those felt at the time of any major loss:
with other animals for food or avoiding social AGGRESSION. Such animals have a motivational problem; they are helpless because they do not even attempt to cope with a new situation. The condition that the animals experienced was a condition very similar to depression in humans. Later, Seligman coined the term LEARNED OPTIMISM to refer to the opposite behavior, in which an individual does not give up but persists toward a goal. See GENERAL ADAPTATION SYNDROME.
Stage One: Denial. It must be some mistake, this can’t be happening to me. Stage Two: Self-Blame. I must have done something wrong. How did I screw up? Stage Three: Anger. Why did management do this to me? Stage Four: Depression. It’s not worth getting out of bed in the morning. Stage Five: Acceptance. What happened may be all for the best.
SOURCE: Seligman, Martin E. P. Learned Optimism. New York: Alfred A. Knopf, 1991.
On virtually every indicator of mental and physical health, job loss due to layoffs has a negative impact. People who lose their jobs are often anxious, depressed, unhappy and, in general, dissatisfied with their lives. They have lowered SELF-ESTEEM, are short-tempered, and are fatalistic and pessimistic about the future. Thus, job loss is clearly hard on one’s health, and it is important to get CONTROL over one’s life and one’s stress after a job loss. See also WORKPLACE.
learned helplessness According to Martin E. P. Seligman, an American psychologist (1942– ), learned helplessness refers to a feeling of helplessness and stifling of motivation brought about by exposure to aversive events over which people have no CONTROL. Such stressful situations lead to feelings of powerlessness, BOREDOM, and DEPRESSION, and the individual becomes passive and nonassertive. In experiments, Seligman and Steven Maier, another psychologist, exposed animals to pathologic amounts of psychological stressors. Those stressors included loss of control and predictability within certain contexts, a loss of outlets for FRUSTRATION, a loss of sources of support, and a perception of life worsening. The animals had trouble COPING with many varied tasks, such as competing
learned optimism A term coined by Martin E. P. Seligman in his book Learned Optimism (1991), describing attitudes and behaviors people exhibit when they face the stress of failures and disappointments that inevitably are a part of life’s experience. According to Seligman, in childhood, individuals learn to explain setbacks to themselves. Some are able to say and believe: “It was just circumstances; it’s going away quickly, and there is much more in life.” Scientific evidence has shown that this optimism is vitally important in overcoming defeat, promoting achievement, and maintaining or improving health. He documents the effects of optimism on the quality of life. In his book, Seligman shows how to stop automatically assuming GUILT, how to get out of the habit of seeing the direct possible implications in every setback, and how to be optimistic. The opposite is LEARNED HELPLESSNESS, a term he coined earlier, which relates to an attitude of hopelessness about the future and future activities. See also COPING; GENERAL ADAPTATION SYNDROME. SOURCE: Seligman, Martin E. P. Learned Optimism. New York: Alfred A. Knopf, 1991.
learning disabilities A group of physical and psychological disorders that interfere with learning. Because they may be taunted by their peers, young people who have such disabilities may also suffer stress from a loss of SELF-ESTEEM and motivation. Learning disabilities are also a source of stress to parents who have high expectations for their children. Even when the disabilities are diagnosed,
220 left-handedness they may wonder why their children are not doing well in school and urge them to do better. Learning disabilities include problems in learning caused by defects in speech, hearing, and memory; they do not include disabilities due to emotional or environmental deprivation or to poor teaching. Children with minimal or borderline MENTAL RETARDATION generally have difficulty learning. Other children suffer from hyperactivity, which lowers the attention span; dyslexia, which is difficulty in reading; dyscalculia, an inability to perform mathematical problems; and dysgraphia, referring to writing disorders. Specific learning difficulties in children of normal intelligence may be caused by forms of minimal brain dysfunction, which may be inherited and untreatable. Generally difficult to diagnose, children with learning disabilities should be observed and taught by teachers who have a degree in special education. Stresses of learning difficulties faced by children, parents, or adults can best be handled by obtaining help from social workers or psychologists specializing in learning disabilities. In addition to diagnostic testing, these professionals can provide necessary psychological support. See also ATTENTION-DEFICIT HYPERACTIVITY DISORDER; PARENTING. SOURCES: Grey House Publishing. The Complete Learning Disabilities Directory. Lakeville, Conn.: Grey House Publishing, 1994. Hall, David. Living with Learning Disabilities: A Guide for Students. Minneapolis: Lerner Publications, 1993.
left-handedness
In religious symbolism and folklore, the left side is associated with the devil, and this attitude has permeated outlooks held by many people for centuries. Left-handers often deal with subtle attitudes reflected in such phrases as a “lefthanded compliment” that imply that something is wrong with being left-handed. Left-handed people are a minority in the United States, comprising about 13 percent of the population. In earlier generations, children were encouraged to use their right hands instead of their left, creating stressful situations for both parents and children. Studies of left-handedness in the population by age group show proportionally more young
left-handers, probably an indication that parents and teachers are no longer trying to switch these children into using their right hands. Probably the biggest stress factor facing individuals who are left-handed is that handwriting techniques, scissors, and other kitchen and household tools are not designed with them in mind. However, catalogs with special products made for lefthanders abound. SOURCES: Coren, Stanley. The Left-Hander Syndrome: The Causes and Consequences of Left-Handedness. New York: Free Press, 1992. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
leisure
See
HOBBIES; RECREATION; VACATIONS.
lesbianism Female HOMOSEXUALITY. Lesbianism is a term derived from the Greek poet Sappho, who lived on the island of Lesbos. Women who practice lesbianism (lesbians) prefer women as sexual partners, although some lesbians have or have had heterosexual partners. Lesbians are part of the gay community along with homosexual men. Today, lesbians still face some stresses of nonacceptance by their families, childhood friends, coworkers and bosses, and members of their community at large. More and more lesbian couples have become parents (co-mothers) through artificial insemination and ADOPTION. While facing all the concerns and stresses of parenthood, they may encounter particular stressors because of their choice of living situation. The gay liberation movement during the 1970s and 1980s encouraged homosexuals to meet and discuss their important issues and provided a political organization to work toward legal change and fight job discrimination. The National Gay and Lesbian Task Force is a clearinghouse for these groups and provides information on local organizations. FOR FURTHER INFORMATION:
The National Gay and Lesbian Task Force 90 William Street, Suite 1201 New York, NY 10038 (212) 604-9830 (212) 604-9831 http://www.thetaskforce.org
life change self-rating scale 221 SOURCES: Jay, Karla, ed. Dyke Life. From Growing up to Growing Old, a Celebration of the Lesbian Experience. New York: Basic Books, 1995. McDaniel, Judith. The Lesbian Couples Guide: Finding the Right Woman and Creating a Life Together. New York: HarperPerennial, 1995. Slater, Suzanne. The Lesbian Family Life Cycle. New York: Free Press, 1995.
lice
Small insects that live on humans and survive by feeding on blood. They are a source of stress, particularly to children in day care or elementary school and their parents/caregivers. Lice spread from one person to another through close bodily contact or through shared clothing or personal items such as hats, hairbrushes, helmets, earphones, or bedding. Lice cannot fly or jump. Head lice are particularly common in school-age children; however, adults can be affected too, particularly if they live in a household with children. Body lice are most often spread by contact with personal items, especially clothing and hats. They live and lay eggs in the seams of clothing and are present on the body only when they feed. Under certain conditions, such as during natural disasters or wartime, lice may transmit life-threatening diseases such as typhus, relapsing fever, and trench fever. Symptoms and Treatment Symptoms may vary depending on which type of lice is present. Itching is the most common symptom of all types of infestation. Itching usually begins a week or more after lice infest the person. The eggs (called nits) of head lice may be seen on shafts of hair; one may need a magnifying glass to see them. Nits are brown before they hatch and white to light brown after hatching. They are tightly attached to the hair shaft and do not slide up and down on the hair. Lice will not go away without appropriate treatment. The most common treatment for lice is applying a cream, lotion, or shampoo that contains an ingredient that kills lice. Treatment should usually begin when symptoms of lice are present or when live lice and nits have been found on the person’s body or in clothing. Usually, children may return to school or day care after their first treat-
ment. However, some schools have a “no nits” policy, which means that the child can only return to school or day care after nits have been removed. Pubic Lice (Crab Lice) Pubic lice live in pubic hair or, more rarely, in armpits, body hair, or beards. They are usually passed from one person to another during sexual contact; sexual partners of an infected person should also be treated. They are called crab lice because of their crablike claws, which they use to grasp hair. Their bites can cause itching. In children, crab lice may attach to the eyelids. Persons who believe they or their children are infested with lice of any type should seek advice regarding treatment from their physician or pharmacist.
life change events
See
GENERAL ADAPTATION SYN-
DROME; LIFE CHANGE SELF-RATING SCALE; SELYE, HANS.
life change self-rating scale The original life change rating scale was developed as a predictor of illness based on stressful life events by authors Holmes and Rahe and presented at the Royal Society of Medicine in 1968. In many variations, this type of rating scale has been used to help individuals determine their composite stress level within the last year. To take this test, mark any of the changes listed below that have occurred in your life in the past 12 months. Your total score indicates the amount of stress you have been subjected to in the one-year period. Your score may be useful in predicting your changes of suffering illness in the next two years due to physiological effects of serious stressors. What Your Score Means A total score less than 150 may mean you have only a 27 percent chance of becoming ill in the next year. If your score is between 150 and 300, you have a 51 percent chance of encountering poor health. If your score is more than 300, you are facing odds of 80 percent that you will become ill; and as the score increases, so do the odds that the problem will be serious. To avoid these consequences, attention to RELAXATION and STRESS relief can help.
222 lightning LIFE CHANGE SELF-RATING SCALE Event
Value
Death of spouse Divorce Marital separation Death of close family member Personal injury or illness Marriage Fired from work Marital reconciliation Retirement Change in family member’s health Pregnancy Sex difficulties Addition to family Business readjustment Change in financial status Death of close friend Change to different line of work Foreclosure of mortgage or loan Change in work responsibilities Son or daughter leaving home Trouble with in-laws Outstanding personal achievement Spouse begins or stops work Starting or finishing school Change in living conditions Trouble with boss Change in residence or school Change in recreational habits Change in church or social activities Change in sleeping habits Change in eating habits Vacation Christmas season Minor violation of the law Your total score:
100 73 65 63 53 50 47 45 45 44 40 39 39 39 38 37 36 30 29 29 29 28 26 26 25 23 20 19 19 16 15 13 12 11
Adapted from Holmes, Thomas, and Richard Rahe. “The Social Readjustment Rating Scale.” Journal of Psychosomatic Research 11 (1967): 213–218.
SOURCE: Adapted from Holmes, Thomas, and Richard Rahe. “The Social Readjustment Rating Scale.” Journal of Psychosomatic Research 11 (1967): 213–218.
lightning
Many people find lightning such a source of stress that they will not go outdoors on
days when lightning is predicted. When rain is forecast, they might call the weather bureau to check for the possibility of lightning. During a storm that includes lightning, frightened people might take refuge in a closet or in bed, feeling safer in an enclosed place. Some people acquire the fear of lightning from observing their parents or others, while many people have experienced traumatic incidents in connection with lightning or thunderstorms. Some people overcome fears of natural phenomena such as lightning with exposure therapy. See also ELECTRICITY; PHOBIA.
light therapy
See
PSORIASIS; SEASONAL AFFECTIVE
DISORDERS.
listening Hearing with thoughtful attention; a skill necessary for good COMMUNICATION between individuals. It is an active process in which one gives complete attention to what others are saying and how they are saying it. According to Deborah Tannen, author of Talking from 9 to 5: How Women’s and Men’s Conversational Styles Affect Who Gets Heard, Who Get Credit and What Gets Done at Work, “Listening taps two important areas, gathering information and developing relationships.” Active listening can reduce the stress of communication not only in business but in personal life as well. By using nonverbal gestures such as a nod of the head or a smile, active listeners can convey concern and reinforce or encourage the other’s verbalizations. Listeners contribute by asking good questions, providing FEEDBACK on what they hear,
REDUCE STRESS WITH BETTER LISTENING SKILLS • Focus on the speaker; use eye contact. Keep interruptions, such as phone calls and other conversations, down to a minimum. • It helps to question the speaker. You can gently guide a conversation, show that you are interested in what he/she is saying, and what you might want to learn. • Do not judge the person speaking; concentrate on the information he/she is presenting.
loneliness 223 and seeking consensus or pointing out differences of opinion within a group. On the other hand, people feel listened to when more than just their ideas get heard; they feel valued, and they will contribute a lot more to the conversation. See also BODY LANGUAGE. SOURCES: Nichols, Michael P. The Lost Art of Listening. New York: Doubleday, 1995. Tannen, Deborah. Talking from 9 to 5: How Women’s and Men’s Conversational Styles Affect Who Gets Heard, Who Gets Credit and What Gets Done at Work. New York: William Morrow, 1994.
lithium
See MANIC-DEPRESSIVE DISORDER; PHARMACOLOGICAL APPROACH.
live-in
Common term for members of the opposite sex who share a domicile without the benefit of marriage. In many cases, stresses arise when one individual decides he or she wants to get married and the other does not. Additionally, stresses arise if the couple decides to break up. Besides the hurt feelings and blows to the ego, there may be mutually owned property or equipment, and live-ins may face the same dilemmas as a couple going through a DIVORCE. Live-in is a term that evolved during the last two decades of the 20th century when this practice became fairly common in the United States among men and women of all ages. The demographic term for this situation, used by the United States Census Department, is POSSLQ (person of the opposite sex sharing living quarters). See also FRIENDS; INTIMACY; RELATIONSHIPS.
living will
See
END-OF-LIFE CARE.
loneliness State of mind relating to lack of companionship or separation from others. It is different from being alone, which is a question of choice. It is this lack of choice that make loneliness so stressful. When people feel lonely, they are most likely to react in one of two ways. The first is a sadness response indicated by too much time spent eating, sleeping, and crying. The other response is “creative solitude” where a person finds a way to deal with loneliness such as reading a good book or
watching a movie, listening to or playing music, using artistic talents to paint, crochet, quilt, weave, or do ceramics, spending time in the garden, or pursuing other interests and HOBBIES. When people deal with loneliness creatively, they are in fact fighting BOREDOM and, in that process, they become happier, calmer, and less stressed. Some lonely people fit the shy, retiring stereotype; others compensate for their feelings by trying to become the center of attraction whether it be in the classroom or at a party. Individuals who have spouses and families can be lonely even though they are surrounded by people. Adolescents and teenagers may become lonely when they long to be part of their peer group and are not. Many widowed or divorced people in their later years become lonely as their friends die and they find it increasingly difficult to make new friends. Conditions such as mental and physical DISABILITIES or language or ethnic barriers, sometimes produces isolation that results in loneliness. Research on Loneliness In some cases, loneliness results from a sense of loss, a feeling that the past was better than the present. A 1990 Gallup poll showed that loneliness is most common among the widowed, separated, and divorced. Over half of this group felt lonely “frequently” or “sometimes” compared with 29 percent of the married participants. Adults who had never married fell in between. According to the survey, women are more likely to be lonely than men, possibly, not because they genuinely have less companionship but because they place more importance on friendship and are more willing to confess to being lonely. Loneliness is often a factor in DEPRESSION, drug ADDICTION, and alcoholism. In recent years, many studies have shown that the more connected to life individuals are, the healthier—mentally and physically—they will be. According to The Complete Guide to Your Emotions and to Your Health, results of a survey conducted by social researchers Rubenstein and Shaver indicate that loneliness has little to do with the number of people in a given living situation, but is more apt to be defined by people’s expectations of life and reactions to their environment. Rubenstein and Shaver’s questionnaire drew 22,000 respondents
224 long-term care insurance over the age of 18. The survey confirms that “feeling lonely”—regardless of living arrangement—is associated with greater health risks, including some psychological symptoms such as ANXIETY, depression, CRYING spells, and feeling worthless. Nearly one-quarter of the people who lived alone fell into the “least lonely” category. They had more FRIENDS on the average than people who lived with other people and were less troubled by symptoms of stress such as HEADACHES, ANGER, and irritability. By comparison, young people who continued to live with parents after college appeared to be the loneliest of all respondents. Rubenstein explains, “A young person in this situation has different expectations. If there’s no girlfriend or boyfriend in the picture, they face a social-psychological conflict. For young adults, in particular being alone— especially on Saturday night—can be a stigma. This makes them feel rejected and lonely.” Key to combating loneliness is maintaining a feeling of self-worth and the ability to care not only for yourself but also for other people and other things. Altruistic people lose themselves in others. The process can block out depression, make us less aware of our own inadequacies, and help us surmount our personal problems. When you maintain a pattern of caring, whether for a house, a garden, pets, or other people, you are protecting yourself against despair. And in the process, you’ll live a more happy and healthy existence—whether alone or in the company of others. See also ALCOHOLISM AND ALCOHOL DEPENDENCE; COPING; GENERAL ADAPTATION SYNDROME; VOLUNTEERISM. SOURCES: Padus, Emrika. The Complete Guide to Your Emotions and Your Health: Hundreds of Proven Techniques to Harmonize Mind and Body for Happy, Healthy Living. Emmaus, Pa.: Rodale Press, 1992. Wilson, Marlene. You Can Make a Difference! Boulder: Volunteer Management Associates, 1990.
long-term care insurance
Insurance to care for oneself or another on an ongoing basis due to disability or age. The decision to purchase long-term care insurance can be a stressful one. Many spouses vow to care for each other, and middleaged children assure parents that their needs will
be cared for. However, the reality is that when the elder needs care, younger family members may be working, and spouses may need care themselves. Some people decide to save the yearly premium for this kind of insurance and use it for the care when needed. However, escalating costs may make this situation unworkable, because as of 2004, the annual cost of care averages $58,000 a year, according to the American Council of Life Insurers. Unlike health insurance policies, which are generally standardized, long-term care policies offer many options affecting the cost. One can select the daily or monthly dollar amount for care, the number of years of payments, the type of care, such as facility-based, home- and community-based, or both, and other details. People age 18 to more than 84 may purchase long-term care insurance when they are fully independent mentally and physically. A medical screening may be required before obtaining a policy, and certain conditions may be uninsurable. It is advantageous from a price standpoint to purchase this type of insurance at a younger age. Premiums are based on age when the policy is taken out as well as the specific health risks of the individual. See also AGING; ELDERLY PARENTS; HEALTH INSURANCE.
loss
See
GRIEF.
lost work days
According to the Bureau of Labor Statistics, U.S. Department of Labor, in 2003, 1.3 million injuries and illnesses in private industry required recuperation away from work beyond the day of the incident. Days away from work are stressful for the employer, who must find a replacement to do necessary work, and stressful for the employee, who may lose income. There may also be stress for a caregiver who is responsible for the injured or ill worker. The National Safety Council defines lost work days as days away from work on which the employee would have worked but could not. Days of restricted activity are days on which the worker was assigned to a temporary job, or worked at a permanent job less than full time, or worked at a permanent job but could not perform all duties normally involved with that job.
Lyme disease 225 low back pain
See
BACK PAIN.
lump in the throat Many individuals experience a “lump in the throat,” which is the feeling of a need to swallow but, upon swallowing, the sensation does not go away. The medical term for this unpleasant situation is globus hystericus. Some individuals have this feeling before a stressful event, such as a court appearance, a public speaking engagement, a role in a play, or a singing solo, and they are concerned that they will not be able to speak or sing. Dryness and muscular contraction play a causative role. RELAXATION and BREATHING techniques can help overcome this feeling. For some, MEDITATION and GUIDED IMAGERY is also helpful. See also ANXIETY; STRESS. lying
Many individuals experience stress when lying because they fear being caught and punished. Lying, making false statements with conscious intent to deceive, may be considered nonpathological or pathological. When adults or children seek to avoid punishment or to save others from distress, these nonpathological lies are sometimes referred to as “white lies.” Pathological lying is a major characteristic of an antisocial personality and may be a symptom of many psychophysiological disorders due to guilt and fear reactions. The lie detector (polygraph) is based on physiological reactions. See also GUILT.
Lyme disease A disease caused by a bacterial infection spread by ticks; it is a source of stress to those who hike, camp, or spend a lot of time outdoors, particularly in wooded areas. Lyme disease is the most common disease transmitted by insects in the United States. There are about 17,000 cases of Lyme disease each year. Lyme disease occurs in North America, Europe, and Asia. Deer ticks spread Lyme disease in the northeastern and upper midwestern United States. Western blacklegged ticks spread the disease on the Pacific coast (mostly in northern California and Oregon). Lyme disease is named after Lyme, Connecticut, where it was first recognized. Anyone can develop Lyme disease, and the risk of Lyme disease is highest during the spring, summer, and early fall months when young ticks are
most active and people spend more time outdoors. Infected ticks can travel from one state to another on birds, deer, and other animals. These animals and the ticks they carry find their way into local forest preserves, parks, golf courses, and backyards. Symptoms, Treatment, and Prevention of Lyme Disease Early signs and symptoms can include an expanding skin rash and flulike symptoms such as body aches and mild fever. Tick bites can go undetected because not all people infected with Lyme disease develop a rash. Lyme disease may be diagnosed based on the symptoms, medical history, and whether or not one has been exposed to infected ticks. A blood test may be used to confirm diagnosis. It is reassuring to know that most people who get bitten by ticks do not develop Lyme disease, especially if exposure to the ticks occurred outside the high-risk areas. If Lyme disease is diagnosed early, antibiotic treatment usually gets rid of the infection so that no further complications develop. If Lyme disease goes undetected or untreated, problems involving the skin, joints, nervous system, and heart may develop weeks, months, or even years later. Antibiotic treatment can be used at that time, and in rare cases the disease may cause permanent damage. Prevention is the only way to avoid Lyme disease. Use insect repellents specific for ticks, wear light-colored clothing, and check yourself and family members for attached ticks after being in grassy or wooded areas. The Lyme Disease Foundation The Lyme Disease Foundation (LDF) is dedicated to finding solutions for tick-borne disorders. LDF includes businesses, patients, government, and the medical community working together to find solutions to tick-borne disorders. The LDF has strong ties to the international scientific community. FOR FURTHER INFORMATION:
The Lyme Disease Foundation Box 332 Tolland, CT 06084-0332 (860) 870-0070 (860) 870-0080 (fax) http://www.lyme.org E-mail:
[email protected] M In some pharmaceuticals regulated by the FDA, including human vaccines and animal drugs used on farms, cow products are used routinely during manufacture. Cow remnants left over from slaughter have long been used to manufacture vaccines. Serum is drawn from cow’s blood and sugars from cow’s milk. Amino acids from cow bones are added to growth media to encourage viral vaccines grown in living cells. In summer 2004 the FDA strengthened safety measures to reduce the chance of mad-cow-tainted cow parts being used in consumer goods such as lipstick and hair spray. In 2000 the FDA told manufacturers to replace products in their vaccines derived from cows born, raised, and slaughtered in countries with confirmed mad cow cases. Manufacturers hurried to find replacement materials from countries whose cows were free of the fatal brain malady. The FDA banned brains and other cattle parts that could carry the disease’s infectious agent from use in dietary supplements and cosmetics. The ban affects products made from animals at least 30 months old, the age at which the brain-wasting disease can be found, according to the FDA. The restrictions prohibit the use of the brain and spinal cord, where the misshapen proteins blamed for mad cow disease are considered most likely to be found. Other banned parts from older animals include skulls, eyes, and nervous system tissue close to the spinal cord. In December 2003 the Organic Consumers Association recommended universal mad cow testing to assure safe meat supply.
“mad cow” disease (bovine spongiform encephalopathy) A progressive neurological disorder of cattle. Because there is evidence that mad cow disease, formally known as bovine spongiform encephalopathy (BSE), has been transmitted to humans, primarily in the United Kingdom, many people in the United States became concerned about eating meat and using products that contain meat by-products. The disease was first diagnosed in cattle in England in 1996. The first confirmed case among U.S. cattle occurred in December 2003. Canada’s first case emerged in May 2003, prompting the U.S. to stop Canadian beef imports. In January 2005 the third case of mad cow disease was confirmed in Canada. In the United Kingdom, the disease that occurred in humans was a variant form of Creutzfeldt-Jakob disease (vCJD). More than 1 million cattle may have been infected with BSE. Although a substantial species barrier appears to protect humans from widespread illness, as of November 2004 more than 150 cases of vCJD had been reported worldwide, primarily in Britain. The one case of vCJD in the United States was in a young woman who likely contracted the disease while living in Britain. Determining Causes, Eliminating Risks According to the National Center for Infectious Diseases, the nature of the transmissible agent is unknown. Currently, the most accepted theory is that the agent is a modified or misshapen form of a normal cell surface component known as prion protein. The pathogenic form of the protein is both less soluble and more resistant to enzyme degradation than the normal form. People who eat meat containing the prions face a possible risk of contracting the rare but fatal human condition, variant Creutzfeldt-Jakob (vCJD) disease, according to the Food and Drug Administration (FDA).
FOR INFORMATION:
Centers for Disease Control and Prevention 200 Independence Avenue SW Washington, DC 20201 (202) 401-6997 (202) 260-4462 (fax) http://www.cdc.gov
226
mammography 227 Organic Consumers Association 6101 Cliff Estate Road Little Marais, MN 55614 (218) 226-4164 (218) 353-7652 (fax) http://www.organicconsumers.org
mammography A specific type of imaging using a low-dose X-ray system for examination of the breasts. The images of the breasts can be viewed on film at a view box or on a digital mammography workstation. The subject of mammography causes stress for many women. Concerned about possible findings and fear of cancer, many women postpone having this screening examination. Some fear discomfort from the procedure. However, medical experts agree that successful treatment of breast cancer often is linked to early diagnosis. Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them. Current guidelines from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA), and the American College of Radiology (ACR) recommend mammography screenings every year for women beginning at age 40. The National Cancer Institute adds that women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening. Fear of Possible Risks Causes Stress Some women postpone having mammograms because they fear possible risks of radiation from the procedure. However, the reality is that the effective radiation dose from a mammogram is about 0.7 mSv, which is about the same as the average person receives from background radiation in three months. The federal mammography guidelines require that each unit be checked by a medical physicist each year to insure that the unit operates correctly. Five to 10 percent of screening mammogram results are abnormal and require more testing (more mammograms, fine needle aspiration, ultra-
sound, or biopsy) and most of the follow-up tests confirm that no cancer was present. According to the Radiological Society of North America, estimates are that a woman who has a yearly mammogram between ages 40 and 49 would have about a 30 percent chance of having a false-positive mammogram at some point in that decade, and about a 7 to 8 percent chance of having a breast biopsy within the 10-year period. The estimate for false-positive mammograms is about 25 percent for women age 50 and older. Limitations of Mammography Interpretations of mammograms can be difficult because a normal breast can appear different in each woman. Also, the appearance of an image can be compromised if there is powder or salve on the breasts, or if the woman has undergone breast surgery. Because some breast cancers are hard to visualize, a radiologist may want to compare the image to views from previous examinations. Not all cancers of the breast can be seen on mammography. Breast implants can also impede accurate mammogram readings because both silicone and saline implants are not transparent on X-rays and can block a clear view of the tissues behind them, particularly if the implant has been placed in front of, rather than beneath, the chest muscles. However, the National Cancer Institute says that experienced technologists and radiologists know how to carefully compress the breasts to improve the view without rupturing the implant. When making an appointment for a mammogram, women with implants should ask if the facility uses special techniques designed to accommodate them. Before the mammogram is taken, they should make sure the technologist is experienced in performing the exam on patients with breast implants. A study at Massachusetts General Hospital reported in 2004 indicated that only 6 percent of women who received a mammogram in 1992 received mammograms yearly for the next 10 years, according to the study of more than 72,000 women of all ages. Most of the women received only five exams during the 10-year time period. “I think it’s very likely this is a widespread phenomenon in America, the failure of women to return promptly to get mammograms,” said James Michaelson, study author and
228 managed care assistant professor of pathology at the hospital and Harvard Medical School. “Prompt annual return is really important to get the maximum life-sparing benefit of screening mammography.” Women who are screened annually and are diagnosed with breast cancer die from the disease at a rate half that of those who do not get annual exams, Michaelson said. Poor women, those without insurance, and those from nonwhite racial groups had particularly low rates of receiving mammograms, he said. See also CANCER. SOURCE:
Radiological Society of North America, Inc. 820 Jorie Boulevard Oak Brook, IL 60523-2251 (630) 571-2670 (620) 571-7837 (fax)
managed care
A variety of types of health insurance, including health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs permit specified services for a prepaid fee to an enrolled population that uses services in specified places or from specified providers. Some people find this limitation in their choice of physicians a stressful factor. Sometimes employers and employees share costs of coverage for employees and their families. Those who object to HMOs believe that care may be withheld to save the plan money. HMOs have been touted for bringing affordable health coverage to a wide range of consumers, as well as criticized for cutting costs by limiting treatment options and patient choice. In the early 2000s, doctors and patients continue to seek new ways to regulate the managed care industry by giving patients new rights, including the ability to sue their health plans. Controversy continues over how to protect patients without further driving up already expensive health care costs. Enrollment in managed care plans rose significantly after 1973 when a federal law paved the way for insurance companies to finance and deliver health care. The increase was due in large part to employers shifting their workers away from the traditional, and considerably more expensive, “fee-for-service” health insurance plans.
Although critics of HMOs claim limitation of choices regarding doctors, proponents claim higher quality of care and closer monitoring of care. Some managed care plans have physicians as their employees, while other plans compensate physicians on a “capitation” basis (number of patients they served). As health care costs spiraled upward, health plans became the subject of popular criticism and a source of stress by enacting limits on what managed care would cover. For example, in most cases, managed care plans limit the number of mental health visits for which a patient may be covered. HMOs and other forms of managed care are also available to retirees as a supplement to Medicare. However, in the early 2000s, some HMOs across the United States stopped covering the local Medicare population, and those individuals were forced to find other health insurance providers.
manic-depressive disorder Disorder characterized by mood disturbances and changes. It is a mental health disorder that puts stress on the individual as well as those around him or her because there may be moods of mania as well as DEPRESSION or a swing between the two states (bipolar disorder). In the manic state, the individual is excessively elated, agitated, hyperactive, and has accelerated thinking and speaking patterns; in the depressed state, the individual feels extremely sad, helpless, and hopeless. An individual in a manic state will show an abnormal increase in activity and believe that he or she is capable of achieving any goal. There may be a grandiose sense of knowing more than others, extravagant spending of money, little need for sleep, increased appetite for food, alcohol, and sex, or inappropriate bursts of LAUGHTER or ANGER. Severe mania may result in violence and hospital admission is often required. Relatively mild symptoms of the manic state are known as hypomania. First appearance of manic attacks is usually before age 30, and they may last for a few days or several months. When attacks begin after age 40, they may be more prolonged. Mania often runs in families and may be genetically transmitted. Depression is more common than mania. Depression affects about one in 10 men and one in
marijuana 229 five women at some time in their lives. Mania (unipolar or bipolar) affects only about eight per 1,000 people, men and women equally. The recovery rate from manic-depressive disorder is about 80 percent. Severe manic-depressive illness often requires hospitalization. Antidepressant medications and, in some cases, electroconvulsive therapy are used in treating depression. Antipsychotic drugs are prescribed to control the symptoms of mania. To prevent relapse, lithium is often used. Many people who have manic-depressive illness lead healthy, well-balanced lives when taking lithium under the guidance of their physician.
See also AFFECTIVE DISORDERS; PHARMACOLOGICAL APPROACH.
manic episode marijuana
See
MANIC-DEPRESSIVE DISORDER.
A drug derived from the plant Cannabis sativa, is used as a stress reliever by some people because it is said to intensify sensory experiences, including seeing, hearing, tasting, and touching. It may make the user feel relaxed, but in some cases it creates feelings of ANXIETY and distrustfulness. There is no accepted medical use for smoking marijuana, although THC (delta-9 tetrahydro-
230 marital therapy cannabinol) in capsule form is prescribed in certain carefully selected medical cases. The only marijuana currently approved for medical use is the synthetic form of its most active component, tetrahydrocannabinol, available as Marinol. It was developed as an antiemetic for chemotherapy patients. Advocates of medicinal marijuana continue their efforts for easier access to the illicit drug. Proponents cite anecdotal evidence that smoked marijuana restores appetite in patients with AIDS wasting syndrome, controls chemotherapy-induced nausea and vomiting, reduces interocular pressure in glaucoma patients, and alleviates painful spasticity in multiple sclerosis. Most of mainstream medicine disagrees, however, and insists that the health risks far outweigh the potential benefits. Marijuana, in the later 1990s, was federally designated as a Schedule I drug, like LSD and heroin, with high potential for abuse and no medical application. Advocates want marijuana downgraded to Schedule II, where it would be classified like cocaine and morphine as having a proven therapeutic value. There were an estimated 2.6 million new marijuana users in 2002. This means that each day an average of 7,000 Americans tried marijuana for the first time. About two-third (69 percent) of these new marijuana users were under age 18, and about half (53 percent) were female. A report by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Office of Applied Statistics, indicated that the annual number of marijuana initiates generally increased from 1965 until about l973. From l973 to l978, the annual number of marijuana initiates remained level at more than 3 million per year. After that, the number of initiates declined, reaching a low point in 1990, then rose again until 1995. From 1995 to 2002, there was no consistent trend, with estimates varying between 2.4 million and 2.9 million per year. The proportion of marijuana initiates under age 18 (69 percent in 2002) has generally increased since the 1960s, when less than half of initiates were under age 18. The average age of marijuana initiates was around 19 in the late 1960s and 17.2 in 2002, the most recent year for which statistics are available. (See chart on page 229.) See also ADDICTIONS.
marital therapy Many individuals who are stressed by a difficult or troubled MARRIAGE choose to engage in marital therapy. This may involve couples in therapy, or therapy for each individual alone. The therapy may be directed toward overcoming specific problems, such as COPING with the other’s DEPRESSION, helping one partner manage MONEY better, helping one partner overcome an unwanted compulsion, such as GAMBLING, or toward saving a marriage that might end in DIVORCE. Psychological counseling or sexual therapy, or a combination of both, may be involved in marital therapy. In some cases, just the suggestion of marital therapy is a source of stress to one or the other partners. For the therapy to have a chance at succeeding, it is essential that both partners participate. See also BEHAVIOR THERAPY; INTIMACY; MARRIAGE; PSYCHOTHERAPIES; RELATIONSHIPS; REMARRIAGE; SEX THERAPY. marriage The marriage of one man to one woman, or monogamy, is the most common form of marriage in the Western world. As a personal arrangement, marriage means a lifelong emotional and legal commitment to another individual. For people unwilling to make a commitment, the thought of marriage is extremely stressful. In the 1990s, many young people avoided marriage until their late thirties. Marriage later in life may bring with it the stress of the BIOLOGICAL CLOCK for women and increased anxieties about becoming parents before both the woman and the man are too old. Stresses Involved in the Marriage Ceremony Planning for the marriage ceremony may be stressful for one or both partners or for parents of the couple. Some weddings in the United States involve hundreds of guests, while other ceremonies take place in a judge’s chambers or the study of a clergyperson. Plans for large weddings may result in stress for members of the wedding party. Ceremonies for marriage may be lengthy and complex or very simple, and ceremonies frequently contain elements of religious observance. In interfaith marriages, particularly, decisions must be made about who will perform the ceremony and in which tradition the wedding will be conducted. Good COMMUNICATION and mutual agreement between bride and groom are essential to
marriage 231 avoid ongoing stress. Most marriage ceremonies are followed by the consumption of food, and planning this event can also be stressful for those involved who seek PERFECTION in the special day. Commuter Marriages A study by Barbara Bunker, State University of New York, noted that nearly 1 million American couples who work in different cities and see each other only on weekends feel no more stress than dual-career couples who live in the same place. From previous research, Bunker knew that longdistance “commuter couples” experience specific strains different from those felt by dual-career couples living together full time. Not surprisingly, the commuters were less pleased with their relationships, but more satisfied with their work lives and the time they had for themselves. The researchers were surprised that the stay-athome couples reported feeling just as much stress in their lives as did the commuters, and, in fact, felt more overloaded. Bunker and her colleagues speculated that people who see their spouses only on weekends are better able to focus fully on their work during the week and on their domestic lives when they are at home. This separation of work and family might make it easier to handle multiple roles, while stay-at-home couples must learn to manage all aspects of their lives simultaneously. Alternative Forms of Marriage Because so many traditional monogamous marriages have resulted in stress and divorce, many individuals have experimented with alternative marital or sexual relationships. While some of the stresses in traditional marriages are overcome by these alternative unions, many stressful situations also arise in them. At the latter part of the 20th century, the possibility of marriages between homosexual couples has become an issue for many individuals. Gay marriage. During the early 2000s, there was increasing interest in as well as controversy over the issue of marriage between two persons of the same sex. Advocates of “same-sex marriage” believe that lawful marriage and the benefits thereof should be available to same-sex couples and that denial of lawful marriage denies one or more of their rights as American citizens. Advo-
cates of traditional marriage oppose this position and hold that lawful marriage should be defined as between one man and one woman. This controversy induces stress on both sides of the issue, particularly for some individuals who wish to marry. Legal recognition of same-sex partners has four forms; marriages, civil unions, reciprocal benefits, and domestic partnerships. Forty states have laws or constitutional amendments forbidding marriages between those of the same sex. Many national organizations have advocated for the legal rights of persons in same-sex unions. These rights include health insurance, hospital visitation, and Social Security survivor benefits. Since the early 2000s, many national organizations have spoken out in favor of legal rights for same-sex partners; these include the American Civil Liberties Union, American Psychiatric Association, Human Rights Campaign, National Association for the Advancement of Colored People, National Organization for Women, and United Farm Workers Union. As of October 2005 in the United States, only the state of Massachusetts recognized same-sex marriage, while an increasing number of other states offered persons in same-sex relationships legal status similar to those in civil marriages, by way of domestic partnerships, civil unions, or reciprocal beneficiary laws. Proponents of equal marriage rights in the United States say there are more than 1,050 federal laws, as well as state and private benefits, such as discounts and family memberships, in which marital status is a factor, thereby excluding same-sex couples. In 2004, a poll by the Columbia Broadcasting System found that only 22 percent of the American public favored legal recognition of same-sex marriages, while 73 percent opposed legal recognition of these marriages. Many people distinguish between same-sex marriage and civil unions, which provide same-sex couples some legal rights. Although fewer than one-fourth of Americans thought gay and lesbian people should be allowed to marry, there was larger support for civil unions. More than half of Americans supported some type of legal status for same-sex couples wishing to make a long-term commitment. Forty percent thought that relationships of same-sex couples should have no legal
232 masked depression recognition. Opposition correlated with level of religious service attendance, age, political affiliation, and residence in southern states. Support was highest among residents of western and New England states as well as among young, nonchurchgoers. Open marriage. The concept of open marriage was espoused by Nena and George O’Neil in their book, Open Marriage (1972). Disadvantages of this system include possibilities for JEALOUSY and fear of losing one’s spouse. Open marriage emphasizes equality and flexibility for both the male and female roles in the marriage and includes an agreement not to be emotionally, socially, or sexually exclusive. While this system attracted attention, it was largely discarded as generally unworkable for most couples. Swinging. Sharing sexual activities between couples has been termed swinging. A couple may switch partners with another married couple, or a married couple may engage in sexual activities with a single female, single male, or an unmarried couple. Recreational swingers are primarily interested in sexual activities without close friendships or involvement with their sexual partners. Swinging first gained public attention during the 1950s (then known as “wife swapping”). Clubs and magazines devoted to swinging exist. Major reasons for dropping out of the swinging scene include the stress of jealousy, the threat to marriage, and the threat of sexually transmitted diseases and the HIV virus. See also COHABITATION; FATHERING, OLDER; LIVEIN; MARITAL THERAPY; MOTHERS; REMARRIAGE; STEPFAMILIES. FOR FURTHER INFORMATION:
American Association of Marriage and Family Therapy 112 South Alfred Street Alexandria, VA 22314-3061 (703) 838-9808 (703) 838-9805 (fax) http://www.aamft.org SOURCES: Bunker, Barbara, et al. “Quality of Life in Dual-Career Families: Commuting Versus Single-Residence Couples.” Journal of Marriage and the Family, May 1992. Gottman, John Mordechai. Why Marriages Succeed or Fail: What You Can Learn from the Breakthrough Research to
Make Your Marriage Last. New York: Simon & Schuster, 1994. Roloff, Tamara L., and Mary E. Williams, eds. Marriage and Divorce. San Diego: Greenhaven Press, 1997. Simpson, Eileen B. Late Love. A Celebration of Marriage after Fifty. Boston: Houghton Mifflin, 1994. Steinem, Gloria. Outrageous Acts and Everyday Rebellions. New York: New American Library, 1983.
masked depression Some people appear to be well but work hard at hiding DEPRESSION. For them, the hiding is a heavy source of stress. They outwardly do what they think is expected of them while inwardly they feel hopeless and even suicidal. They may have little facial animation, appear to have a fixed expression, and show little emotion. The terms depressive equivalents, affective equivalents, hidden depression, and missed depression are also used for this situation. Some mental health professionals use the term borderline depression for such individuals. See also AFFECTIVE DISORDERS; MANIC-DEPRESSIVE DISORDER; PHARMACOLOGICAL APPROACH. massage therapy
A form of body therapy in which the practitioner applies manual techniques such as kneading, stroking, and manipulation of the soft tissues of the body, the skin, muscles, tendons, and ligaments with the intention of positively affecting the health and well-being of the client. Massage therapy helps many people relieve STRESS and body aches caused by tension and anxieties. A professional massage increases blood flow and relaxes muscles. Massage therapy can provide anything from soothing RELAXATION to deeper therapy for specific physical problems. It can aid in recovery from pulled muscles or sprained ligaments. Massage therapy can also ease many of the uncomfortable stresses of child bearing, the discomforts of BACK PAIN and exhaustion, as well as the pains of certain REPETITIVE STRESS INJURIES related to on-thejob activities. According to the American Massage Therapy Association, once the massage is under way, many beneficial reactions are set in motion. Massage therapy can hasten the elimination of waste and toxic debris that are stored in muscles, increase the interchange of substances between the blood and tissue cells, and stimulate the relaxation response
massage therapy 233 within the nervous system. Responses to massage therapy can help to strengthen the immune system, improve posture, increase joint flexibility and range of motion, and reduce blood pressure. Types of Massage The most universally understood Western form of massage is Swedish, also called Esalen. It consists of many types of strokes: gliding the hand across the skin, kneading, lifting, squeezing and grasping the muscles, gentle pushing, friction, vibration, jostling and rocking, and percussion (hacking, chopping, and rapid pounding). Oriental massage, sometimes referred to as SHIATSU or ACUPRESSURE, involves pressing at certain points along invisible energy meridians that run through the body; the practitioner looks for tight spots, knots, or anything that interferes with the flow of energy. Deep tissue massage uses slow strokes and deep finger pressure to combat aching muscles, such as a stiff neck or bad back. Sports massage is a combination of stretching and Swedish or deeptissue massage performed before or after strenuous exercise. REFLEXOLOGY, the massage of the hands, feet, and ears, is based on the belief that specific areas govern all parts of the body. For example, the tips of the toes correspond to the head, while the inside arch of the foot reflects the spine. The theory is that by stimulating the nerve endings of the different organs in the body, changes can be effected. Choosing a Massage Therapist According to the American Massage Therapy Association (AMTA), a qualified massage therapist should have a solid foundation in physiology and be knowledgeable about the inner workings of the body. Therapists from an accredited school have usually completed 500 hours of training, including classes in anatomy, first aid, and cardiopulmonary resuscitation. The American Massage Therapy Association, founded in 1943, is the largest and oldest national organization representing the profession. Membership in the AMTA is limited to those who have demonstrated a level of skill and expertise through testing and/or education. All AMTA therapists must agree to abide by the AMTA Code of Ethics.
According to the AMTA, their number of members increased from under 5,000 in 1986 to over 20,000 in 1994. Experiencing a Massage Most massage therapists work in small, semi-darkened rooms, where soft music of the client’s choice will be playing. Some therapists offer a choice of scented candles. The massage therapist leaves the client alone to undress and lie down on a padded massage table. During the massage, the entire body is draped in a sheet; only the portion that is currently being worked on is exposed. Quiet is an essential feature of the massage experience. While conversation with the therapist may be limited, a person should speak up if experiencing discomfort, feeling hot or cold, or desiring more or less pressure, or wanting more attention paid to a certain area of the body, such as an aching back. Massage is “productive down time.” During the massage, the body feels very heavy and sinks into the table. As the therapist’s hands locate areas of tension, the individual consciously tries to let go and relax these areas. He or she lets go of a desire to control movement and allows the therapist to move limbs into whatever position is required. Patricia Deer, a certified massage therapist and owner of Energy Breaks, Chicago, says that a good neck and shoulder massage may contribute toward better mental performance as well as relief of stress. One study reported that people who received 15-minute seated massages during their workday showed brain-wave patterns consistent with greater alertness. Those people were also able to complete arithmetic problems twice as fast and with half the errors, as they did before the massage. “Employers are increasingly recognizing the benefits of “mini-tune-ups” for people who sit at desks or computers much of the day,” says Deer. See also ALTERNATIVE MEDICINE; BODY THERAPIES; MIND-BODY CONNECTIONS; ROLFING. FOR FURTHER INFORMATION:
American Massage Therapy Association 800 Davis Street, Suite 100 Evanston, IL 6001 (888) 843-2682 (toll-free) (847) 864-0123 (847) 864-1178 (fax) http://www.amamassage.org
234 masturbation masturbation
Usually refers to sexual self-stimulation for gratification and pleasure and usually to an experience of orgasm. The method is to massage the penis or clitoris with the hand. The subject of masturbation is stressful for many people because in previous generations, parents warned young people against masturbation, suggesting that doing so would lead to dire consequences such as acne, impotence, insanity, or worse. Thus many people who believed that they were going against cultural mores developed anxieties and GUILT about the practice. Now masturbation is considered normal behavior, particularly among teenagers and adults without sexual partners. Sex therapists during the latter part of the 20th century use masturbation as a technique to instruct clients in learning to know what pleases them so that they can later instruct a partner. Compulsive masturbation is an obsessive urge to masturbate without sexual feeling or satisfaction. Such an individual may substitute masturbation for a lack of social satisfaction that arises from shyness, or an inability to establish relationships with the opposite sex, or to relieve anxieties. See also SAFE SEX; SEX THERAPY.
SOURCE: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992.
mathematics anxiety Experiencing stress related to practical applications of mathematics in everyday life, such as counting small change or reading timetables. Additionally, math ANXIETY results because mathematics is an abstract science and many people have difficulties understanding abstractions. As simple a chore as balancing a checkbook causes many individuals to perspire and experience a more rapid heartbeat. Many students who are good in all subjects experience feelings of discomfort in math classes. Why this happens isn’t a clearcut issue. There are many factors involved in why this happens; the individual may be unsure of his or her abilities regarding adding and subtracting or there may be a fear of making a mistake. In a school setting, making a mistake when called upon would be embarrassing.
meditation
A learned technique to relieve STRESS and involves deep RELAXATION brought on by focusing attention on a particular sound or image and breathing deeply. One directs thoughts away from work, family, relationships, and the environment. During meditation, the heart rate, blood pressure, and oxygen-consumption rate decrease, temperature of the extremities rises and muscles relax. Meditation also has been shown to reduce a number of medical symptoms and improve healthrelated attitudes and behaviors. For example, people with chronic obstructive pulmonary disease (COPD) who practiced meditation reduced the frequency and severity of episodes of shortness of breath and the number of visits to emergency rooms. People with heart disease, hypertension, CANCER, DIABETES, and chronic PAIN have reported feeling more self-confident, more in CONTROL of their lives and better able to manage stress after mastering the meditation technique. Meditation has been used successfully by individuals who have PANIC ATTACKS AND PANIC DISORDER. Meditation may bring out increased efficiency by eliminating unnecessary expenditures of energy. Individuals who practice meditation sometimes report a beneficial surge of energy marked by increased physical stamina, increased productivity on the job, the end of writer or artist’s “block,” or the release of previously unsuspected creative potential. Learning to Meditate Meditation is a very self-disciplined routine and a way to learn more about one’s own thoughts and feelings. Simple procedures can be learned easily. The basics include sitting in a quiet room with eyes closed, breathing deeply and rhythmically with attention focused on the breath. Also, there may be a focus on either a special word, or mantra, such as “peace,” which one repeats over and over again, or on steadily watching an object, such as a candle flame, for a 20-minute period once or more daily. Meditation relies on the close links between mind and body. When one meditates, the alpha brainwaves indicate that the body is relaxed and free from physical tension and mental strain. BIOFEEDBACK monitoring has indicated that meditation encourages the brain to produce an evenly
memory 235 SITUATIONS IN WHICH MEDITATION MAY REDUCE STRESS • • • • • • • • • •
Tension or anxiety Chronic fatigue Insomnia and hypersomnia Abuse of alcohol or tobacco Excessive self-blame Chronic subacute depression Irritability, low tolerance for frustration Strong tendencies to submissiveness Difficulties with self-assertion Prolonged bereavement reactions
balanced pattern of alpha and theta brain wave rhythms. This means that the body is relaxed and the mind calm, yet alert. The “relaxation response” sets in, which is the opposite of the physical tension that results from stress. Types of Meditation Vary Modern meditation techniques are derived from spiritual practices in Eastern cultures dating back more than 2,000 years. Traditionally, the benefits of the techniques have been defined as spiritual in nature, and meditation has constituted a part of many religious practices. In the latter part of the 20th century, however, simple forms of meditation have been used for stress management with excellent results. Contributing to the rising interest is the fact that these meditation techniques are related to biofeedback (which also emphasizes a delicately attuned awareness of inner processes) and to muscle relaxation and visualization techniques used in BEHAVIOR THERAPY. There are two basic types of meditation. One is concentration and the other, insight. Concentration types, such as TRANSCENDENTAL MEDITATION, often use a special sound or silently repeated phrase to focus attention and screen out extraneous thoughts or stimuli. Insight-oriented meditations, such as mindfulness meditation, accept thoughts and feelings that arise from moment to moment as objects of attention and acceptance. The goal of mindfulness is an increased awareness of what is happening in one’s mind and body right now. Recognition and acceptance of present reality provide the basis for changes of attitudes and conditions.
See also
ALTERNATIVE MEDICINE;
BERT; GUIDED IMAGERY;
BENSON, HERKABAT-ZINN, JON.
SOURCES: Benson, Herbert. The Relaxation Response. New York: Morrow, 1975. Chopra, Deepak. Creating Affluence: Wealth Consciousness in the Field of All Possibilities. San Rafael, Calif.: New World Library, 1993. ———. Creating Health: How to Wake up the Body’s Intelligence. Boston: Houghton Mifflin, 1991. Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York: Delacorte, 1991. ———. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1993. Kerman, D. Ariel. The H.A.R.T. Program: Lower Your Blood Pressure without Drugs. New York: HarperCollins, 1992. Mahesh Yogi, Maharishi. Science of Being and Art of Living: Transcendental Meditation. New York: Meridian, 1995.
memory
An ability to learn by observation and to retain, remember, and call up information presented through the senses. Many people feel stressed and anxious because of their poor memories and inability to recall things at will. Some people fear they are developing ALZHEIMER’S DISEASE when their memory fails them. During periods of extreme stress, many people experience memory difficulties. The exact amount of retention depends on factors such as the thoroughness of the learning, on repetition, and on the nature of the content. The more thoroughly the person learns, the greater the duration and amount of retention. Many people retain visual images of what they have learned, such as people, objects, pictures, or the printed page. Children have superior visual imagery, but this ability usually declines after about the age of 15. Individuals have recall in various steps. Immediate recall involves remembering from a few seconds to a few minutes; an example is remembering a phone number long enough to write it down. Short-term recall involves memory from a few minutes to a few days. Long-term memory refers to memory from a few days to a few years. Verbalizing the memory involves finding the right words, which then calls into play the entire left side of the brain where words are stored. All
236 menopause parts of the brain are required for comprehension and storage of memory. A poor memory may be due to poor learning, but sometimes there are psychological reasons for FORGETTING a fact, an event, or a person. This may be called motivated forgetting, as the person subconsciously tries to forget. Many people have a tendency to forget unpleasant things, but when forgetting becomes extreme it is called repression. When thoughts associated with GUILT, shame, or FEAR are pushed into the unconscious mind, tension and ANXIETY may result. How Memory Works There is ongoing research to determine just how the memory works. However, researchers agree that certain events occur in the central nervous system. It has been suggested that there are chemical and/or physical changes in brain cells and nerve pathways. Another theory is that memory is established in the cerebral cortex through a scanning process comparable to that of a computer. Memory is a cell-to-cell transmission of information across a synapse that has both electrical and chemical properties. This interaction and transmitting across cell walls takes place in a split second. Memories of smell, touch, and taste are placed in several places in the brain, awaiting a similar stimulus, such as the smell of a familiar food, to reactive the memory. Age-Related Memory Impairment Many individuals are less able to remember certain types of information as they get older. The term “age-associated memory impairment” (AAMI) is used to describe minor memory difficulties that come with age. AAMI is often most noticeable when the individual is under severe stress. When the person is relaxed, he or she will be able to remember the forgotten material with no difficulty. There is no treatment for AAMI, but written reminders, lists, the use of association to remember names, and allowing more time to remember may be helpful. Amnesia and Other Forms of Memory Loss Amnesia may be produced by physical or chemical changes in the brain. If the cause is psychological, the loss of memory is a defense against experiences that have been extremely painful and intolerable. Amnesia may be total or only for certain events or
periods of time. Paramnesia is a false or distorted memory and serves as a protection against unbearable anxiety. The individual fills in the gaps in his memory by statements that are not true, although he believes they are. This condition occasionally occurs in senility and in alcoholic psychoses. Hypermnesia is an extreme degree of retentiveness and recall. There is unusual clarity of memory images. It occasionally occurs in individuals faced with death and also in mental prodigies, but is more common in individuals during hypnosis and in a drug intoxication induced by amphetamines and hallucinogens. Impressions arising from emotionally colored events are registered with more than usual intensity and the result is that one has a vivid recollection of details. Getting Help Individuals should seek professional help for memory difficulties if they feel extremely stressed, anxious, or fearful because of the loss; if they feel out of touch with reality because they cannot remember what day of the week it is or where they are; or if they feel that forgetting things is upsetting their work or home life. Local hospitals that have geriatric centers may be a helpful resource; additionally, local departments of health may be able to make referrals to centers that have facilities for memory evaluation. SOURCES: Kra, Siegfried J. Aging Myths; Reversible Causes of Mind and Memory Loss. New York: McGraw-Hill, 1985. Mark, Vernon H. Reversing Memory Loss: Proven Methods for Regaining, Strengthening, and Preserving Your Memory. Boston: Hougthon Mifflin, 1992.
menopause
Cessation of menses (menstrual periods). Menopause occurs at midlife (average age 50–51), when a woman’s ovaries stop producing eggs (ovulating) and monthly bleeding from the uterus ceases. During the climacteric (a period of time when gradual hormonal changes occur before and after menopause itself), the ovaries gradually produce less estrogen and progesterone. Stress during Menopause Menopause occurs at a time in women’s lives when they have many psychosocial concerns as well as concerns about their changing bodies.
menstruation 237 Many women experience particular stresses, conflicts, and challenges at this time. In generations past, the “change of life” was considered to be a time when women would be naturally irritable and even irrational. Many of women’s complaints around the time of menopause were written off by doctors as being “all in your head.” Now, however, it is recognized that other issues in a woman’s life at midlife contribute to her stress level in addition to changes in hormonal levels. However, differences of opinion regarding hormone replacement therapy by experts leave many women feeling stressed, confused, and in search of additional opinions. Many women are affected by a variety of stressors around the time of menopause. One is a feeling that they are no longer attractive to men; another is a feeling of loss because they are no longer able to bear children. They may be divorced or widowed and facing a husband’s retirement or their own. They may be dealing with grown children who have returned home, or may be anticipating financial difficulties due to an inflationary economy. Hormone Replacement Therapy Controversy For more than 40 years, women who experienced hot flashes before, during, and after menopause were advised by physicians to take hormone replacement therapy, which consisted of a combination of estrogen and progestin drugs. Women with an intact uterus were advised to take the combination because of the possibility that estrogen alone might contribute to development of uterine or other cancers. Those without a uterus were advised to take estrogen alone. Estimates are that as of 2002 about 6 million women in the United States were taking estrogen and progestin for various reasons, including relief of menopausal symptoms and for the prevention of heart disease and brittle bones (long-term use). In summer 2002, the U.S. government stopped a major study of hormone replacement therapy on the risks and benefits of combined estrogen and progestin in healthy menopausal women, citing an increased risk of invasive breast cancer. Researchers from the National Heart, Lung, and Blood Institute of the National Institutes of Health also found increases in coronary heart disease, stroke, and pulmonary embolism.
The study, known as the Women’s Health Initiative (WHI), was stopped after participants were tracked for an average of 5.2 years and found that the risks of the therapy exceeded the benefits. Many women stopped taking estrogen and progestin. Some women were advised to take the lowest effective dose for a short term to combat serious hot flashes and vaginal dryness. Physicians also counseled all women to consider their own situations, intensity of symptoms, and risk factors for disease. Physicians advised women to improve health habits and have yearly mammograms and physical examinations with checks of blood pressure and cholesterol levels. Women who stopped taking the hormones were advised to have a bone density test, with a follow-up about year later, to determine if they needed another bone preserving drug. Many women turned to ALTERNATIVE MEDICINE for relief of symptoms. Other aids to relieve some discomforts are layering clothing, avoiding wool fabrics close to the skin, and using a portable fan. When vaginal dryness occurs along with diminishing estrogen levels, these factors may contribute to DYSPAREUNIA and sexual difficulties. What a husband or lover may interpret as lack of interest may actually be fear of painful intercourse or serious discomfort during intercourse. A thorough physical examination by a gynecologist should be sought, with sex therapy useful in some cases. See also HOT FLASHES. SOURCES: Holt, Linda Hughey, and Ada P. Kahn. 50 Ways to Cope with Menopause. Lincolnwood, Ill.: Publications International, 1994. Kahn, Ada P., and Linda Hughey Holt. Midlife Health: A Woman’s Practical Guide to Feeling Good. New York: Avon Books, 1989. Wright, Karen. “Menopause Naturally.” Health, January–February 1996.
menstruation
Term for the uterine bleeding that commonly occurs in WOMEN approximately once a month between PUBERTY and MENOPAUSE. Some young women in the United States begin menstruating as early as age nine and as late as age 16. Many have an irregular pattern of menstruation varying from one- to three-month intervals. Periodic flow varies from extremely light to moderate
238 menstruation or very heavy. Blood loss during each period averages about one ounce but can vary from a third of an ounce to almost two ounces. Although the menstrual period usually lasts about four to five days, it can last fewer or more days and still be considered within the range of normal. The fact that there are so many individual differences between women’s menstrual patterns is often a source of stress for women. Historically, for many women, the onset of menstruation (menarche) has been filled with wonder, awe, and sometimes fear. Menstruation marks the beginning of physical adulthood for women, as bearing children becomes possible after menarche. Young women can become pregnant shortly after the onset of menstruation, and this can lead to unwanted children and the stresses of childraising. Understanding Menstruation Menstruation is the removal of the lining of the uterus that is prepared each month to provide for a potential PREGNANCY. At the same time, the ovary ripens an egg (ovum) each month and releases it (ovulation) so that it can be fertilized and implanted in the uterus. When fertilization does not occur, the uterus empties and these cyclical preparations begin again. Menstruation usually begins two weeks after ovulation if the egg is not fertilized. Menstruation is caused by cyclic fluctuation of the hormones estrogen and progesterone. During a “typical” menstrual cycle, ovarian estrogen is produced in response to stimulation from the pituitary hormones known as follicle stimulating hormone (FSH) and luteinizing hormone (LH). At midcycle, ovulation occurs in response to an “LH surge” and the ovary forms a small cyst (a corpus luteum) in the follicle that has surrounded the egg or ovum. Progesterone is produced, which causes structural changes in the uterine lining. If the ovum is fertilized and implants in the uterine lining, menstruation does NOT occur; hence a late menstrual period may be a signal of pregnancy or of some menstrual irregularity. Stressful Aspects Surrounding Menstruation Premenstrual syndrome (PMS). Many women experience higher levels of stress or are more irritable or depressed just before and during their menstrual
periods. Some notice annoying bloating, fluid retention, breast tenderness, and HEADACHES. Some women who have migraine headaches find that the onset is associated with their menstrual periods. Most women cope successfully with their symptoms by getting a little extra rest, limiting or decreasing salt intake, and recognizing the temporary nature of the annoyances. Women who have excessive premenstrual symptoms should bring them to the attention of a physician. Sexual intercourse during menstruation. In some cultures, menstruating women have been excluded from society during their periods. Over centuries, concerns regarding menstruation have included the notion that sexual intercourse during menstruation is harmful to both men and women’s health and that deformed children may result from intercourse during this time. Historically, some men have avoided contact with menstruating women out of fear of castration, or that menstrual blood was meant to form the body of a child and therefore is filled with potent and dangerous energy. Menstrual cessation. When periods stop for an unexplained reason, great feelings of stress ensue as a woman may fear pregnancy or disease. Absence of menstruation is called amenorrhea. Amenorrhea is normal prior to puberty or after menopause; it occurs frequently as a response to extreme stress, weight loss, or to a wide range of hormonal, physical, or emotional causes. Anorexia nervosa, an EATING DISORDER, usually results in amenorrhea. Runner’s or athlete’s amenorrhea is a commonly observed syndrome in which women undergoing rigorous physical training temporarily cease having periods. Pain. Painful menstruation is known as dysmenorrhea, and is a source of stress for the sufferer because the discomfort often leads to lost days from work, school, or social activities. Cramplike pain (cramps) may be associated with the passage of uterine clots and may start just before or during menstruation and may last only while the mass is passing out of the uterus, or may continue for hours or days. Many women feel cramps in their lower abdomen, lower back, and thighs. Medications may relieve discomfort. Personal protection. Protecting clothing and hiding the fact that a woman is having her menstrual
mergers 239 period has been a concern for generations. The most common ways of disposing of menstrual fluid are use of externally worn sanitary napkins (in Britain, known as sanitary towels) or internally worn tampons. Internally worn tampons can be used by young women from the start of menstruation. Physicians say that virginity is intact until one’s first act of sexual intercourse. The hymeneal ring, a tissue between the internal and external genital organs, is usually large enough to admit a tampon, which has been slightly lubricated for easier insertion. Many women of all ages find tampons a neater way to deal with menstruation, and a way to avoid external irritation of the genital area with a sanitary napkin. During the 1980s, concern about a condition called toxic shock syndrome, a serious infectious disease linked to tampon usage, caused many women to stop using tampons. However, with proper attention to hygiene and frequent replacement of tampons, women need not fear toxic shock syndrome. Also, some of the materials used in tampons have been changed by the manufacturers, making them safer to use. SOURCES: Holt, Linda Hughey, and Melva Weber. Guide to WomanCare. New York: Random House, 1984. Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1989.
mental retardation
Impaired intellectual function that results in an inability to cope with the normal responsibilities of life. To be classified as mentally retarded, a person must have an IQ below 70 and impairment must be present before the age of 18. For families, stress results from COPING with the responsibilities of raising a retarded child. Early diagnosis is extremely important so that special education and training programs can be started and the child given every opportunity to learn. It is crucial that families then seek professional help to define the retardation problem honestly and clearly. Next, they must gather information on community resources in order to make informed decisions about their child’s future. While every state and most urban areas now have special governmental departments concerned with retarda-
tion where advice and consultation are available, accessing these agencies is not always easy and they are often bureaucratic. Faced with the sadness and difficult problems of raising a retarded child, one of the first decisions families must make concerns institutionalization. Unless the child has debilitating physical problems as well as severe retardation, most families will opt to keep the child at home. While the mentally retarded child remains a child all his or her life, they can experience feelings, concerns, emotions, fears, wonder, discovery, love, and laughter, as do all children. A retarded child does learn when given good training and support. If they are well cared for in a responsible and loving home, they will thrive and some may become reasonably independent and self-supporting. FOR FURTHER INFORMATION:
American Association on Mental Retardation 444 North Capitol Street NW, Suite 846 Washington, DC 20001-1512 (800) 424-3688 (toll-free) (202) 387-1968 (202) 387-2193 (fax) www.aamr.org National Down’s Syndrome Society 141 5th Avenue New York, NY 10010 (800) 221-4602 (toll-free) (212) 460-9330 SOURCES: Dolce, Laura. Mental Retardation. New York: Chelsea House, 1994. Dunbar, Robert E. Mental Retardation. New York: Franklin Watts, 1991. Grossman, Herbert J., et al., eds. AMA Handbook on Mental Retardation. Chicago: American Medical Association, 1987. McNey, Martha. Leslie’s Story: A Book about a Girl with Mental Retardation. Minneapolis: Lerner Publications, 1996.
mergers
The transformation of two or more corporations into one organizational structure for reasons of growth, economy of scale, diversification or vertical integration. They are becoming increasingly common in the late 1990s. In their book The Human Side of Mergers and Acquisitions, Buono and Bowditch state, “mergers and
240 midlife crisis acquisitions can sufficiently transform the organizational structures, systems, processes; in one or both of the firms involved people often feel stressed, disoriented, frustrated, confused, and even frightened.” Emotions felt by employees during mergers may arise in stages and can be conflicting. These emotions range from shock, disbelief, ANGER, and hopelessness to excitement and high expectations for the future. When the merger is completed, employees move slowly toward acceptance, often experiencing a period of mourning and GRIEF. When a proposed merger does not go through, it usually means that one of the companies is seeking change and sometime down the road the change will occur. This outlook compounds the stress for employees, particularly at the management level where there is bound to be job redundancy. An analysis of LAYOFF announcements in the summer months of 1995 by the outplacement firm of Challenger, Gray & Christmas showed that one out of three jobs cut was a result of mergers. Such job cuts could be attributed to corporate restructuring and plant and office closings. Staff reductions that occur due to mergers create less dissatisfaction and bitterness when they are handled with sensitivity and concern. Where possible, staff redundancies can be managed through attrition, early RETIREMENT, and attractive severance packages. When involuntary termination is necessary, decisions should be made objectively and supported by outplacement assistance and related job search services. Most of those who lose their jobs through mergers may have little financial loss, as they are usually white-collar employees who are given generous severance packages. However, they often experience the stress of having to rethink their careers and relocate to obtain new employment. See also CHANGING NATURE OF WORK; DOWNSIZING; WORKPLACE. SOURCE: Buono, Anthony F., and James L. Bowditch. The Human Side of Mergers and Acquisitions: Managing Collisions between People Cultures and Organizations. San Francisco: Jossey-Bass, 1989.
midlife crisis
Certain stressful situations that occur at or around middle age are often referred to
as “midlife crisis.” Men and women both experience these stressors. For some, stresses occur as individuals realize that they have reached the prime of their lives and so begin to question whether or not they have achieved their goals. Others reset goals and, in some cases, turn their lives in new directions. Specific stressors that occur at midlife include children growing up and leaving home, job loss, forced RETIREMENT, DIVORCE, widowhood, loss of a sex life because of lack of a partner, seeking a new partner, REMARRIAGE, stepchildren, and care of ELDERLY PARENTS. Men and women at midlife realize that they no longer have the physical strength and stamina that they had when they were younger. For women, MENOPAUSE marks the end of their fear of having unwanted children. Many men and women begin to fear that they are losing their attractiveness and sex appeal and so turn to COSMETIC SURGERY for such procedures as relieving age lines or removing excess body fat. They may embark on strenuous courses of exercise at health clubs and gyms in an effort to retard effects of aging. Some resort to purchasing of sports cars to make themselves feel younger. Divorces occur as one of the spouses becomes involved with another younger partner. See also EMPTY NEST SYNDROME; MENOPAUSE; SELF-ESTEEM; STRESS. SOURCE: Kahn, Ada P., and Linda Hughey Holt. Midlife Health. A Woman’s Practical Guide to Feeling Good. New York: Avon Books, 1989.
migraine
See
BIOFEEDBACK; GENERAL ADAPTATION
SYNDROME; HEADACHES; MENSTRUATION; PAIN.
migration
Leaving one’s country to settle in another. Doing so can set in motion a stressful mourning process similar to that which occurs after losing a loved one. The country one is leaving appears as an object, a nonhuman object, with which one develops a relationship. At first, loss of country might appear more stressful for the involuntary emigrant; however, it is no less difficult for the voluntary one. Some relatives and friends might feel abandoned and resent the person leaving. Although the emigrant adjusts
mind-body connections 241 to a new life in the new country, at the same time he or she may long for the old country. Some may prolong their stress by holding on to a fantasy of transience in the new country for as long as 30 years. For example, by not learning the language of the new country or, more subtly, by not becoming a citizen. Culture Shock Another stressful aspect of migration is culture shock, which is the result of a sudden change from a known environment to a strange, unknown one. The impact can be violent and, combined with the mourning process set in motion by the loss of that which is familiar, can cause a threat to the newcomer’s identity. The sense of the continuity of the self and the sense of self-sameness, is threatened. At the same time, the consistency of one’s own interpersonal interactions is disrupted. No longer is there the same confirmation of one’s identity in interaction with the environment. As an example, an American living in a hostile country would be acutely aware of his nationality. Whether in a hostile country or not, environmental clues that normally confirm the emigrant’s identity are absent and are replaced by unfamiliar phenomena, including language, architecture, housing, manner of dress, food, music, and smells. One means of COPING with the stress of a new environment is to try to translate the unfamiliar into the familiar. For example, an individual from a forested country may look at tall buildings in a city and say that tall buildings look like the forest. There may have been a similar mechanism at work when the early American settlers chose an area that was physically like the one they left, thus reducing the psychologically “unsettling” effect of beginning a new life in a strange environment. See also ACCULTURATION; HOMESICKNESS; MOVING. SOURCE: De Vryer, Miepje A. “Leaving, Longing, and Loving: A Developmental Perspective of Migration.” Journal of American College Health 38 (September 1989).
mind-body connections
Health philosophers in the 21st century emphasize the mind-body connections or links between the mind, brain, and other organ systems. Research studies have demon-
strated that psychological as well as physical stress has effects on health. Increasingly, physicians are recognizing that BEHAVIOR THERAPY and ALTERNATIVE MEDICINE such as GUIDED IMAGERY, RELAXATION, BIOFEEDBACK, and HYPNOSIS are useful adjuncts in the comprehensive care of many patients, many of whom have stress-related disorders. The term mind-body medicine relates to many treatments and approaches, ranging from MEDITATION and relaxation training to social SUPPORT GROUPS planned to engage the mind in improving physical as well as emotional well-being. According to Herbert Benson, M.D., author of The Relaxation Response, “Too often in practice of modern medicine, the mind and body are considered to be separate and distinct, which is not in our best interests. Because of specialization, patients are no longer treated as whole persons. Instead, we are separated into groups of organs and specific symptoms are not considered in context.” In The Mind/Body Effect, Dr. Benson emphasized the need for practicing behavioral medicine, which incorporates the principles of medicine, physiology, psychiatry, and psychology. Patients are viewed in their entirety, with the realization that what happens in their mind has direct bearing on the state of their physical health. In The Mind/Body Effect, Dr. Benson makes it clear that psychological factors often induce physical ailments. He indicates that, in extreme cases,
ADVANTAGES OF MIND-BODY CONNECTIONS FOR STRESS RELIEF • Can be used along with standard medical practices • Financial cost of procedures is low • Physical and emotional risk is minimal; potential benefit is great • Many can be taught by paraprofessionals. • No high-tech interventions • May improve quality of life by reducing pain and symptoms for people with chronic diseases • May help control or reverse certain underlying disease processes • May help prevent disease from developing
242 mindfulness meditation fear and a sense of hopelessness can even induce death. Many conditions have been found to respond to such techniques when they are used alone or in combination with standard medical and surgical treatments. These include HIGH BLOOD PRESSURE, coronary artery disease, CANCER, chronic PAIN, TMJ syndrome, HEADACHES, eczema, PSORIASIS, IRRITABLE BOWEL SYNDROME, ARTHRITIS, rheumatic diseases, ASTHMA, and DIABETES. The Mind/Body Group at Boston’s Beth Israel Hospital The Mind/Body Group is part of a program of the Division of Behavioral Medicine at Beth Israel Hospital and is headed by Herbert Benson, M.D., a cardiologist. It is one of many programs across the country to help individuals suffering from a variety of medical disorders, including cancer, arthritis, and diabetes. The program uses a variation of the relaxation response, the meditation method pioneered by Dr. Benson. Since the early 1980s, the group has taught people to use the power of their minds to help themselves bring about the relaxation response, learn how to change their own physiology, and finally have some sense of CONTROL over themselves and their lives. An Example of Mind-Body Connection: Diabetes Control Dr. Joan Borysenko, one of the group and an instructor at Harvard Medical School who is trained in cell biology and psychology and is an innovative researcher in PSYCHONEUROIMMUNOLOGY (PNI), has developed a program for diabetics. These sessions are attended only by diabetics, creating a therapeutic dynamic group identity. Members of the group give each other social support in their relaxation procedures and encourage each other to follow the regimen. Results indicate that in those who practiced the relaxation response and exercised, blood sugar was lowered. Thus, diabetics had a drug-free technique in controlling levels of blood sugar that could help minimize damage from the disease and help them live longer and with better quality of life. See also KABAT-ZINN, JON; PRAYER; RELIGION; SIEGEL, BERNIE; SOCIAL SUPPORT SYSTEM; WEIL, ANDREW.
SOURCES: Benson, Herbert. Beyond the Relaxation Response. New York: Berkeley Press, 1985. ———. The Mind/Body Effect: How Behavioral Medicine Can Show You the Way to Better Health. New York: Simon & Schuster, 1979. ———. The Relaxation Response. New York: Avon Books, 1975. Borysenko, Joan. Minding the Body, Mending the Mind. New York: Bantam, 1988. Goleman, Daniel, and Joel Gurin, eds. Mind Body Medicine: How to Use Your Mind for Better Health. Yonkers, N.Y.: Consumer Reports Books, 1993. Kerns, Lawrence L. “A clinician’s guide to mind-body treatments.” Chicago Medicine 97, no. 22 (November 21, 1994). Locke, Steven, and Douglas Colligan. The Healer Within. New York: New American Library, 1984.
mindfulness meditation
See also ALTERNATIVE KABAT-ZINN, JON; MEDITATION; MIND-BODY CONNECTIONS.
MEDICINE;
mining workers According to the National Institute for Occupational Safety and Health (NIOSH) these workers have one of the most stressful as well as dangerous jobs in the United States: mining the earth, underground and on the surface, for coal, ore, and stone. In mining settings, confined workspaces, poor visibility, and the use of large, powerful equipment are sources of stress as well as hazards. Coal and metal miners who suffer injuries tend to lose twice as many days of work as workers in other industries. Mining techniques and stressful conditions are diverse and differ substantially between the coal sector and metal and nonmetal mining. The latter includes production of metals such as gold and copper, nonmetals such as salt and phosphate, and production of stone, sand, and gravel. In the United States approximately 400,000 miners are employed in more than 11,000 surface and underground mines. An estimated 2,000 miners die from lung diseases caused by exposure to coal mine dust every year. According to NIOSH, mining has the highest rate of fatal injuries of all U.S. industries. More than 80 miners die from fatal work injuries each year. However, the Mine Safety and Health
mining workers 243 Administration reports that total mining fatalities reached the lowest level in history in 2001. For every fatality, there is often a family facing the stress of grief and handling family affairs. Preventing Stress and Illness among Miners Inhaling fine particles of silica causes silocosis, an often fatal lung disease. This is a stressful disease for miners because each year thousands of coal workers are afflicted with it. To reduce silicosis among miners, NIOSH disseminates information to inspectors, miners, and employers throughout the surface-mining industry describing steps to prevent silicosis. NIOSH promotes methods of monitoring workers’ exposures, procedures for medical screening and surveillance of miners, and the use of personal protective equipment to reduce the health risks of underground and surface coal miners and to prevent pneumoconiosis. Further, to protect miners from respiratory diseases, NIOSH recommends an exposure limit for respirable coal mine dust. As long as people have worked in mines, the occupation has been a stressful one. In 1891 Congress passed the first federal statute governing mine safety, a modest law that applied only to mines in U.S. territories. Among other things, it established minimum ventilation requirements at underground coal mines and prohibited operators from employing children under 12 years of age. In 1910, following a decade during which the number of coal mine fatalities exceeded 2,000, Congress established the Bureau of Mines as a new agency in the Department of the Interior. The bureau was responsible for conducting research about reducing accidents in the coal mining industry, but was given no inspection authority until 1941, when Congress empowered federal inspectors to enter mines. In 1947, Congress authorized the formation of the first code of federal mine safety regulations. The Federal Coal Mine Safety Act of 1952 provided for annual inspections in certain underground coal mines and gave the bureau limited enforcement authority, including power to issue violation notices and imminent danger withdrawal orders. The first federal statute directly regulating noncoal mines did not appear until the passage of the Federal Metal and Nonmetallic Mine Safety Act of 1966, which provided for the promulgation of
standards, many of which were advisory, and for inspections and investigations; however, its enforcement authority was minimal. The Federal Coal Mine Health and Safety Act of 1969, generally referred to as the Coal Act, was more comprehensive and more stringent than any previous federal legislation governing the mining industry. The Coal Act included surface as well as underground coal mines within its scope, required two annual inspections of every surface coal mine and four at every underground coal mine, and dramatically increased federal enforcement powers in coal mines. The Coal Act also required monetary penalties for all violations and established criminal penalties for knowing and willful violations. The safety standards for all coal mines were strengthened, and health standards were adopted. The Coal Act included specific procedures for the development of improved mandatory health and safety standards and provided compensation for miners who were totally and permanently disabled by pneumoconiosis, or black lung disease, the progressive respiratory disease caused by the inhalation of fine coal dust. In 1973, the Mining Enforcement and Safety Administration (MESA) was created as a new departmental agency separate from the Bureau of Mines. In 1977, Congress passed the Federal Mine Safety and Health Act (Mine Act), the legislation that currently governs MSHA’s activities. The Mine Act amended the 1969 Coal Act in many ways and consolidated all federal health and safety regulations of the mining industry, coal as well as noncoal mining, under a single statutory system. The Mine Act strengthened and expanded the rights of miners and removed one source of stress by enhancing protection of miners from retaliation for exercising such rights. The Mine Act transferred responsibility for carrying out its mandates from the Department of the Interior to the Department of Labor and named the new agency the Mine Safety and Health Administration (MSHA). Mining fatalities dropped sharply under the Mine Act from 272 in 1977 to 86 in 2000. Stresses that mining workers face have been reduced significantly because of provisions of the Federal Mine Safety and Health Act of 1977 (Mine Act). Compliance and enforcement of mandatory
244 Minnesota Multiphasic Personality Inventory safety and health standards has eliminated some fatal accidents and reduced the frequency and severity of nonfatal accidents. Uranium Miners Uranium mining is an occupation in which there is a higher incidence of lung cancer and other lung diseases than in most other areas of work. There is also an increased incidence of skin cancer, stomach cancer, and kidney disease among uranium miners. Because of the risks and the diseases, uranium mining may be one of the most stressful occupations in a dangerous industry. Increased rates of lung cancer have been noted in studies of hard rock miners exposed to radon in the United States, Canada, and Europe. Higher exposure correlates with higher numbers of cancer deaths. Increases in lung cancer due to radiation have been noted in both smokers and nonsmokers. See also CANCER; CONFINED SPACES; NUCLEAR WEAPONS; RADON.
Minnesota Multiphasic Personality Inventory (MMPI) A self-rating questionnaire to determine personality types. The MMPI may be of some use to therapists in helping people with stress concerns or phobias. It is also a source of stress for individuals who must take the test before employment or for purposes of promotion. The MMPI was developed by Starke Rosecrans Hathaway (1903–84), a U.S. psychologist and John Charnley McKinley (1891–1950), a U.S. psychiatrist, in 1942. Results of the questionnaire point toward nine personality scales: hypochondria, depression, hysteria, psychopathic deviate, masculine-feminine interest, paranoia, psychasthenia, schizophrenia, and hypomania. The taker of the test indicates agreement or disagreement with 550 statements. Results are scored by an examiner or by computer to determine the individual’s personality profile as well as any tendency to fake responses. The MMPI is widely used in clinical research.
miscarriage
The spontaneous loss of a PREGbefore the fetus is capable of surviving outside the uterus. Many women who experience miscarriage also experience symptoms of extreme STRESS, GRIEF, and DEPRESSION for a period of time NANCY
after the event. They feel the loss, even though the child was never born and they never saw the child. Family and friends sometimes may seem less sympathetic toward women who have suffered miscarriages than toward those whose babies are stillborn or die in early infancy. Many are encouraged to try to achieve another pregnancy very soon. Those who do try often overcome their depressed feelings, but for those who have difficulty in achieving another pregnancy, mourning over the lost pregnancy may continue. Miscarriage: What Is It? Understanding the physiology involved in the process may help women who experience miscarriage to mentally adjust to the situation. Early miscarriages are usually the result of defects in the fetus. Later miscarriages, which occur in the middle trimester, are more likely to be caused by an incompetent cervix, uterine abnormalities, toxemias, or preexisting chronic disease. Women who miscarry after some strenuous activity may feel GUILTY and some even believe that they induced the miscarriage. Usually this is not the case. Normal exercise does not usually induce miscarriage. Most women who have been tennis players, hikers, or swimmers usually are advised by their obstetricians to continue exercising throughout their pregnancy (or until the last two months). The first sign of the possibility of miscarriage is vaginal bleeding, with or without cramping; however, not all vaginal bleeding indicates miscarriage. Some bleeding may be associated with implantation, or it may come from the vagina, vulva, or cervix. If bleeding occurs from the uterus without any dilation of the cervix, and usually without pain, the situation is termed threatened abortion. With appropriate medical care, cases of threatened abortion can be salvaged, and many women have healthy babies who were in the “threatened” stage during pregnancy. Treatment includes rest. Late miscarriage may be the most stressful and difficult for a woman (and the infant’s father) to accept. If she has had good medical care and followed her obstetrician’s advice, she should not feel that anything she did or did not do induced the miscarriage. In a later miscarriage, when the placenta and embryo are totally evacuated, the term used is complete abortion. When placental tissue
mold 245 remains in the uterus, the term is incomplete abortion, and the tissue must be removed by curettage. Miscarriage is also known as spontaneous abortion; the term miscarriage is more commonly used because it is more socially acceptable. Both terms refer to the loss of an embryo or fetus before maturity. See also POSTPARTUM DEPRESSION.
mitral valve prolapse
See
PANIC ATTACKS AND
PANIC DISORDER.
modeling
A BEHAVIOR THERAPY technique in which a person learns by observation without reinforcement from a therapist. The troubled individual watches someone else perform a particular action such as giving a speech in public (in the case of one who is fearful about speaking in front of others) and then gradually becomes able to perform the action without fear. In a traditional learning sense, modeling is a form of social learning; children learn appropriate culturally acceptable behaviors in this way from parents and elders. See also PUBLIC SPEAKING.
mold
Organisms in indoor air and elsewhere that are sources of stress because they can cause ALLERGIES, ASTHMA, lung diseases, and other respiratory problems and contribute to SICK BUILDING SYNDROME. The molds or FUNGI that affect indoor air quality are multicellular organisms formed of microscopic branched filaments called hyphae. A visible colony of interwoven hyphae forms a mycelium, and the myceloid fungi most commonly found indoors are called molds; the terms mold and fungus are used interchangeably in this entry. When windows can be kept open, the kind of fungi in indoor air normally reflect those in outdoor air. To grow and proliferate indoors, however, fungi require a suitable substrate such as wood, paper, gypsum board, or other materials that have a high cellulose content and water. Buildings or homes where there is chronic water damage or where humidity levels are high are particularly at risk of fungal contamination. Various aspects of fungal growth and structure have potential stressful and injurious effects on health. Certain species of fungi produce mycotoxins, natural organic compounds that initiate a toxic
response in humans, including mucosal and skin irritation, immunosuppression, and systemic effects. The primary mode of human exposure to these toxic chemicals is by inhalation of spores or of material that has been contaminated by mold. Some people develop stressful allergies, such as rhinitis and asthma, when exposed to molds. Heavy and repeated exposure to small fungal particles can also cause hypersensitivity pneumonitis in certain people. Molds also produce various volatile organic compounds such as alcohols and ketones. These compounds, which are responsible for the musty odor associated with the presence of molds, are irritants. Other Stressful Health Concerns Systemic effects, such as headache, fever, excessive fatigue, cognitive and neuropsychological effects, gastrointestinal symptoms, and joint pain, have also been observed in some people exposed to molds. Symptoms caused by exposure to mold should disappear once exposure ceases. Whether there is a threshold for exposure below which no health effects occur is unknown. A 281-page study by the National Academy of Sciences released in May 2004 is the most definitive look to date at the national controversy over mold, which has prompted hundreds of lawsuits, millions of dollars in cleanup costs, and claims that the fungi breed many illnesses. The scientific review found no proof that mold causes memory loss, fatigue, seizures, inhalation fevers, skin outbreaks, or other conditions that many people said they have experienced. “The consequences of being exposed to toxic mold have largely been overstated,” said Dr. Karin Pacheco, assistant professor of occupational and allergic disease at National Jewish Medical Research Center in Denver. The National Academies’ report did, however, confirm well-documented and generally accepted claims that symptoms in people with asthma can be exacerbated by mold. See also CHEMICAL HAZARD. SOURCES: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Injuries. New York: Facts On File, 2004. King, Norman, and Pierre Auger. “Indoor Air Quality, Fungi, and Health.” Canadian Family Physician 48 (February 2002): 298–302.
246 money money
A cause of stress in one way or another for most people. Lack of money is stressful, and having money to invest or spend, wisely or unwisely, is also a source of stress. Money is involved in every aspect of life, from housing to education to social life. For some, money arouses stressful feelings of ENVY—possibly one reason that those who have it may be reluctant to discuss it and those who lack it may pretend that they are well off. Parents may be reluctant to reveal their financial matters to their children, which may lead them to fantasize that they are quite well off, in serious financial straits, or simply lead them to think that money is a TABOO subject. For practical purposes, many households have no disposable assets to respond to emergencies and absorb shocks. There are more stresses on those in this situation. There are effects on one’s sense of CONTROL, optimism, happiness, security, and SELF-ESTEEM. Western tradition offers two conflicting messages regarding money: that of self-denial, generosity, and spirituality, and that of capitalism and materialism. The most practical attitude seems to be that it is good to have money, but not to flaunt it or even discuss it. As a group, the very rich are a minority and may experience the same stressful feelings of isolation and alienation that other minorities experience. Middle- and upper-middle-class children sense that both rich and poor children are different and may reject them for that reason. Marriage among the wealthy is often riddled with divorce and extramarital affairs, possibly because the marriages are frequently entered into for financial or social rather than emotional reasons. If both spouses are well-todo, each may go his or her own way and never have to form the cooperative couple of the middle class. When wealthy men or women “marry down” they may acquire a more attractive and personable spouse than they deserve. However, day-to-day living may make some of the stresses of this type of relationship difficult. Children of the wealthy may experience a stressful type of upbringing in which one or both parents may be traveling or preoccupied with social or business events much of the time. The child may have
to live up to the larger-than-life achievements and reputation of his family. At the same time, he may be indulged in ways that reduce the possibilities of his ever developing the characteristics and talents to meet his family’s expectations. See also PERFECTION; SHOPAHOLISM. SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Krueger, David, ed. The Last Taboo. New York: Brunner/Mazel, 1986.
monoamine oxidase inhibitors (MAOIs)
See
PHARMACOLOGICAL APPROACH.
moods
A mood is an emotion that determines how a person feels and often relates to his or her stress level. Examples of moods include sad or glad and angry or happy. According to the American Psychiatric Association (in Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), for diagnostic purposes, moods are characterized as follows: Dysphoric: An unhappy or sad mood, such as depressed, anxious or irritable. Elevated: A more cheerful than usual mood. Euphoric. A feeling of extreme well-being; also occurs in MANIC-DEPRESSIVE DISORDER. This type of mood is beyond what most people rate as simply “feeling good.” Euthymic: Feeling good; absence of depressed or elated mood, and feeling able to cope with life. Irritable: A feeling of internal tension and being easily annoyed and provoked to anger. See also
AFFECTIVE DISORDERS; DEPRESSION.
SOURCES: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994. Justice, Blair. Who Gets Sick: How Beliefs, Moods and Thoughts Affect Your Health. Los Angeles: J. P. Tarcher, 1988. Kals, W. S. Your Health, Your Moods and the Weather. Garden City, N.Y.: Doubleday, 1982.
Moon
Many people attribute their stress to the Moon. The effect of the Moon on human behavior, particularly as causing insanity, has been a topic of
mothers-in-law 247 speculation for centuries. The word lunatic, coined by the physician Paracelsus in the Middle Ages, derives from the Latin word for “moon.” In some cultures there is a fear that the “man in the Moon” is the biblical Cain, accounting for the observation that as the Moon becomes fuller and stronger, human behavior becomes more violent and erratic. People who are mentally unstable are thought to be particularly affected by the cycles of the Moon. Although scientific proof is lacking, professionals such as nurses, police, and firefighters who deal with large numbers of people in emergency situations report an upsurge in activity and more extreme behavior at the time of the full Moon. Many stress-inducing superstitions are connected with the Moon. For example, a full Moon on Christmas prophesies a poor harvest; on Sunday, bad luck. A red Moon foretells murder or war. Sleeping in the moonlight is thought to produce a twisted face. Ancient Greeks and other cultures believed that the rays of the Moon contained damaging power that could be collected by witches and magicians and used for evil purposes. SOURCE: Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000.
mothers
Traditionally, they protect and nurture offspring. They give their infants and children emotional warmth as well as sensory stimulation, both of which are necessary for them to develop a sense of self-worth and an ability to deal effectively with stresses of the environment. For many women, motherhood may serve purposes other than the simple desire for a child. For example, children may seem to be the solution for a stressful or troubled MARRIAGE. Women may expect their children to succeed where they have failed and may live vicariously through their offspring. Faced with her older children maturing and the threat of no longer being needed, some women will have another child rather than explore the next phase of life. Changing Images of Mothers The media at the end of the 20th century reflect the fact that mothers have changed, or possibly the audience has grown more realistic and tolerant,
even admiring, of different types of mothers. For example, in the 1950s and early 1960s television mothers were always homemakers, dispensing wisdom and charm, while dressed appropriately. Title roles in the later 1990s include unmarried mothers and WORKING MOTHERS. Today, many mothers undertake the double role of having a career and family, sometimes out of economic necessity. However, even though women work they still tend to be saddled with home, family, and social responsibilities. While men may be willing to stay home with a sick child or leave work punctually because of a family obligation, they may not be met with the understanding they need from their employers. Working mothers’ responsibilities include getting themselves to work and quite often getting their child to a DAY CARE facility. Some mothers of school-age children may have to deal with the worries of having “latch key” children. Careers may have to be adapted to eliminate travel or situations where the mothers are inaccessible to a telephone. HOBBIES, interests, or just having time for oneself are almost nonexistent on such a mother’s schedule. Faced with these pressures, more women are expressing an interest in limiting their family to one child or staying home with their children and/or trying to work from their home. Many women who completed their education in the late 1970s, began careers, married, and had children, tried HAVING IT ALL—meaning marriage, family, and career—and feel constantly stressed by all factors. Since the 1990s, some women who work outside the house are opting for less aggressive career tracks so that they can spend more time with their families and have less stress in their lives. See also ADOPTION; MOTHERS-IN-LAW; REMARRIAGE; STEPFAMILIES; UNWED MOTHERS. SOURCES: Jetter, Alexis, Annelise Orleck, and Diana Taylor, eds. The Politics of Motherhood: Activist Voices from Left to Right. Hanover, N.Y.: University Press of New England, 1997.
mothers-in-law The butt of many jokes, which comedians find good for a laugh. While jokes may reflect some underlying social truths, in practice,
248 motion sickness many spouses have excellent RELATIONSHIPS with their in-laws; many don’t. Sometimes stresses and conflicts arise between a daughter-in-law and her husband’s mother or the husband and the wife’s mother. The source of these conflicts may be the children’s repressed resentments of their own parents being projected toward in-laws; ethnic, social, and religious differences; or the mother-in-law’s own stress in adjusting to the departure of her children and the aging process. Open lines of COMMUNICATION may improve the situation. See also LISTENING; MOTHERS; PARENTING. SOURCE: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992.
motion sickness
Uncomfortable feeling of queasiness, NAUSEA, and DIZZINESS. It occurs because of constant motion, along with conflicting signals from the eyes, inner ears, and sensors in muscles and joints. Anticipating motion sickness is a source of stress for many people, and some even avoid certain situations because of their fears. Motion sickness occurs when in a moving vehicle, such as a car, boat, or airplane. Many people develop motion sickness during a car trip on a bumpy road. Other people require more unstable conditions, such as a ride aboard a pitching boat to become upset. Still others do not experience motion sickness, and their doubts about a sufferer’s discomfort lead to further stress for the unfortunate ones. Understanding Motion Sickness and Using Self-Help Techniques Understanding how motion sickness occurs may help relieve its attendant stress. On a ship, for example, the eyes record movement, the inner ears detect rolling motion, yet the body is stationary. One technique that helps many people is focusing on the horizon or on a fixed, distant object instead of looking at swirling waves or roadside trees that seem to be moving. Preventive measures and natural remedies also may prevent, or at least relieve, the dizziness, nausea, vomiting, and clamminess symptomatic of motion sickness. Over-the-counter medications work by depressing signals from the inner ear and by quieting the gas-
trointestinal tract and decreasing nausea. Most of these preparations should be taken an hour or so before departure. In an airplane, motion is less pronounced in an aisle seat over a wing, preferably on the right side where there is less swaying, because most flight patterns call for left turns. In a car, ride in the front seat and, unless driving, lean back against a stable headrest to minimize inner-ear reaction to movement. Looking down or reading while riding can produce motion sickness because of the apparent movement outside the windows. Being the driver also helps as drivers seldom suffer from motion sickness. At sea, reserve a midship cabin near the waterline where motion is minimal and, as much as possible, stay topside in the middle of the deck. Eat lightly before a trip and eat small amounts at frequent intervals while traveling. It is easier to become queasy on an empty stomach. Sucking on a lemon or eating olives at the first sign of nausea are folk remedies that work for some people. They may work because motion sickness creates superfluous saliva, which trickles down to the stomach and contributes to nausea. Lemons and olives contain mouth-drying agents that diminish the queasiness. Fortunately, most sufferers from motion sickness find relief as soon as they get off the airplane, out of the car, or off the ship. Symptoms and their stress usually disappear quickly.
mourning
See
DEATH; GRIEF.
moving Moving involves relocating to another place of residence, or possibly to another place of work or business. Moving is a source of stress for many people because it removes them and their families from familiar surroundings, families, friends, neighbors, schools, and sports and other activities. Moving may be the third most stressful event, after the death of a loved one and divorce. The length of the distance moved may increase the level of stress, as visiting the old familiar territory becomes more difficult. The U.S. Census Bureau reports that according to Census 2000, more than 22 million people were domestic migrants who changed their state of residence between 1995 and 2000. Of these, approximately half relocated to a state in a different region.
muscle relaxants 249 Younger people seem to move more often than older people. The U.S. Census Bureau reported that Americans age 20–29 were the likeliest to move during 1998–99. In that age group, 32.4 percent moved, more than double the national average of 15.9 percent. Of 30–34-year-olds, 22.8 percent moved. Of 35–44-year-olds, 14 percent moved; 25–54-year-olds, 9.5 percent, 55–64-year-olds, 6.7 percent, and those 65 and older, 4.5 percent. One of the stressors people find in moving is “sticker shock.” Home prices in the new location could be a pleasant surprise, and they find they can buy more house than they had before for less money. Unfortunately, that is not always the case, and some couples are faced with “downsizing” their living accommodations in the new more costly setting. Many companies turn to specialized providers of relocation services who range from small, often geographically specialized concerns, to real estate conglomerates that handle thousands of relocations each year and are responsible for orchestrating all details of a move. When a company decides to transfer an employee to another city, sometimes on short notice, it should do so with as little stress as possible for the employee and the employee’s family. From the employee’s viewpoint, the key question concerns what level of support the employer will provide in the move. According to Stephen C. Roney, president of Coldwell Banker Relocation Services in Mission Viejo, California, “from the employer’s viewpoint, the key issue is ultimately one of productivity.” Migration from one country to another carries with it all the stresses of moving as well as adapting to new culture. See also ACCULTURATION; MIGRATION.
mugging
A realistic contemporary source of stress that many people experience because victims are confronted unexpectedly and may suffer physical harm as well as losing possessions. The concern about the possibility of being mugged leads many people to avoid wearing expensive, attention-getting clothes or jewelry on the streets. The concern about mugging is related to the overall fear of violence in our society. See also VIOLENCE.
Multiple Chemical Sensitivity syndrome A variety of stressful symptoms that some people experience as a result of exposure to agents in the environment. These agents may include many natural and artificial substances, some of which have several chemical constituents. For many sufferers, symptoms interfere with daily activities. Some people report that they were symptom-free before a single large exposure. Later they find that they suffer more in response to previously tolerated low-level exposures. There are controversies regarding this syndrome among regulatory agencies, legislators, clinicians, researchers, patients, lawyers, and others. Symptoms may occur in the central nervous system, with respiratory and mucosal irritation, or gastrointestinal problems. There may be difficulty concentrating, depressed mood, memory loss, weakness, dizziness, headaches, heat intolerance, and arthralgias. Substances that may induce symptoms include insecticide sprays, paint thinner, fumes from varnish, shellac, or lacquer, aerosol air fresheners, cigarette smoke, gasoline and diesel exhaust, dry cleaning fluid, floor cleaner, furniture polish, and fumes from certain indelible marking pens. To reduce stress induced by these symptoms, health professionals aim to control (not cure) symptoms and treat concomitant psychological symptoms. Sufferers are encouraged to engage in activities they can tolerate, learn relaxation exercises, and avoid isolation and social withdrawal as well as unproved therapies. See also AIR POLLUTION; RELAXATION; SICK BUILDING SYNDROME; STRESS. muscle relaxants Pharmacological agents that act on the central nervous system or its associated structures to reduce muscle tone and spontaneous activity. Many people experience tense, tight, or strained muscles as a result of stress or injury and some resort to these prescription medications instead of or in addition to using mind-body techniques for RELAXATION. Many skeletal muscle relaxants also function as minor tranquilizers. See also MIND-BODY CONNECTIONS; PHARMACOLOGICAL APPROACH.
250 music music A basic social and cultural activity of mankind, involving sounds produced by the voice or by instruments. Music is often used a therapy to reduce stress and help people relax. It is a way to connect with people and a way of getting through to people who are otherwise unreachable. Some songs embody life experiences and may bring back memories of courtship, a wedding or even wartime. For example, in many nursing homes, individuals who have been very untalkative and unresponsive may start to tap their feet to music, particularly live music that they watch as it is performed, or will begin to hum or even sing. According to Oliver Sacks, American neurologist, author of The Man Who Mistook His Wife for a Hat and a pioneer in developing therapies, music organizes motor functions, thus smoothing out, for example, the uncontrolled movements that afflict patients with Parkinson’s disease and enabling people with speech losses to sing the words to familiar melodies. Historical Background: Music and Healing Using music as a relief of stress and as a healer is not a new concept. In Greek mythology, Apollo was god of both music and medicine. His son Aesculapius became god of medicine and cured mental diseases with song and music. Plato, a Greek philosopher, believed that music influenced a person’s EMOTIONS and character. According to the Bible, David’s harp-playing relieved King Saul’s melancholy (DEPRESSION). In his plays, Shakespeare referred to the healing powers of music. The first English-language book on music as therapy, Medicina Musica, was written in the early 1700s by Richard Browne, an apothecary. Browne said music could “soothe turbulent affections” and calm “maniacal patients who did not respond to other remedies.” Music therapy was used in the early part of the 19th century in the form of brass bands for patients with the then-identified mental disorders, including ANXIETY. In the 20th century, particularly during World War II, many American psychiatric hospitals began active music therapy programs. In 1950, the National Association for Music Therapy (NAMT) was organized; in 1954, NAMT recommended a curriculum for preparation of music
STRESS-RELIEVING RESPONSES TO MUSIC • Heart rate acceleration is correlated with loudness, tempo, and musical complexity; heart rate deceleration is correlated with resolution of musical conflict, decreasing loudness, and slowing tempo. • Stimulative music increases heart rate; sedative music decreases heart rate. • Rock music leads to heart deceleration. • Tachycardia (fast heartbeat) is associated with driving rhythms and increasing dynamics; bradycardia (slow heartbeat) is associated with changes in rhythm, texture, and dynamics. • Sedative music significantly increases finger temperature. • Blood pressure is affected by music listening, but the type of music that affects these changes is unknown; music is effective in reducing blood pressure in essential hypertensives. • Music that is enjoyed increases respiration. • Music decreases stomach acid production. • Popular music produces more electroencephalograph (EEG) changes than classical music, particularly in middle-aged subjects. Popular music causes a decrease in blood flow to the brain in young adults; classical music promotes brain blood flow enhancement in middle-aged subjects.
therapists. Subsequent organizations of music therapists were formed in England, Europe, South America, and Australia. Since the 1980s there has been a growing focus on medical/physiological applications of music therapy. Music and Stress Management Music therapy may be effective in reducing stress because it addresses the whole person concurrently and simultaneously on physical, affective, cognitive, and social levels. Music is a noninvasive technique with few if any side effects, with relative ease of administration and with increasing therapeutic promise as indicated by studies in many fields. Researchers have looked at the influences of music in managing stress in many anxiety-provoking situations. One example is test taking: Anxiety levels appear to rise in the absence of music, while
myocardial infarction 251 they are held constant with music. Music may have more effect on highly anxious subjects. Stimulative music may increase worry and emotionality; more sedative music decreases these feelings. The effects of music in reducing stress and anxiety associated with various medical procedures has been studied. For example, music appears to improve mood and to comfort adult patients in general hospitals and to reduce anxiety significantly in chronically ill patients. Several studies have reported successful applications of music to reduce anxiety during PREGNANCY. Additionally, music is reported to decrease PAIN responses during labor and to elicit positive psychological responses. A number of studies have examined the effects of music in dental procedures. Listening to music causes significant reductions in heart rate, blood pressure, and stress hormones, and significantly decreases the need for pain relieving medications. There is also an improvement in the patient’s feeling of CONTROL, as he/she has a choice of music. The pain threshold and tolerance during dental procedures increase with music. In a study of chronic pain, patients playing selfselected tape-recorded music reported not only a reduction in the emotional experience of suffering but also a reduction in the actual sensation of pain. In addition to reducing pain, particularly in pain clinics, music has been offered during chemotherapy as a form of relaxation and distraction to bring overall relief and to reduce nausea and vomiting. Music and Worker Productivity According to a report by Greg Oldham, professor of organizational behavior at the University of Illinois
at Urbana-Champaign, allowing employees to listen to personal stereo headsets can improve productivity. Among 75 employees who wore headsets an average of 20 hours during the workweek, productivity increased by 10 percent over a four-week period. Among 181 employees who did not wear headsets during the same period, there was no change in productivity. According to Oldham, the headset wearers were less nervous, less fatigued, more enthusiastic and more relaxed at work than were the employees in the control group. The most popular types of music were oldies and country music. See also ALTERNATIVE MEDICINE; ARTHRITIS; STRESS MANAGEMENT. SOURCES: Aldridge, David. “The Music of the Body: Music Therapy in Medical Settings.” ADVANCES, The Journal of MindBody Health 9, no. 1 (winter 1993). Allen, K., and J. Blascovich. “Effects of Music on Cardiovascular Reactivity among Surgeons.” Journal of the American Medical Association 272 (1994): 882–884. Crowley, Susan L. “The Amazing Power of Music,” Bulletin (American Association of Retired Persons), February 1992. Lehrer, Paul M., and Robert L. Woolfolk. Principles and Practice of Stress Management. New York: Guilford Press, 1993.
music therapy
See
MUSIC.
myocardial infarction
See
HEART ATTACK.
N medical establishment not only to take notice but also to establish the Office of Alternative Medicine (OAM) within the National Institutes of Health in 1992. In 1999, the name of the OAM was changed to the National Center for Complementary and Alternative Medicine (NCCAM). As such, it was the 25th independent component of the National Institutes of Health. One of NCCAM’s primary mandates from Congress is to award research grants to scientists studying the effects of alternative therapies on stress as well as various illnesses. The NCCAM strives to fund research projects and to establish an information clearinghouse on alternative medicine so that the public, policy makers, and public health experts can make informed decisions about health care options. Many of the grants awarded by the NCCAM focus on strategies to reduce stress and related disorders. For example, research grants awarded by the NCCAM have included studies on ACUPUNCTURE for unipolar depression, MASSAGE THERAPY for HIV, HYPNOSIS for chronic lower back pain, massage therapy for post-surgical outcomes, MUSIC therapy for psychosocial adjustment after brain injury, classical HOMEOPATHY for health status, T’AI CHI for mild balance disorders, GUIDED IMAGERY for ASTHMA, imagery and RELAXATION for breast cancer, Ayurvedic herbals for Parkinson’s disease, BIOFEEDBACK and relaxation for DIABETES, and YOGA for OBSESSIVE-COMPULSIVE DISORDER. Since its inception, hundreds of awards have been granted. The grants provide a proving ground to determine if it is the alternative therapy that works or if it is the patients’ belief in the therapy that helps them get better. Alternative practitioners are encouraged about the potential for scientific evidence confirming the value of therapies that do
nail biting
A difficult habit to break. In spite of the stereotype of the nervous nail biter, nail biting does not correlate with specific personality qualities. However, many children as well as adults bite their nails when affected by stress. Situations that cause ANXIETY, FEAR, BOREDOM, PAIN, or tension relate to nail biting. With some people, nail biting continues because it is a routine and unconscious HABIT without an obvious underlying cause. Many people are embarrassed and bite their nails only when no one is around to see them. A somewhat universal habit, nail biting has no relationship to sex, race, or intelligence. It is estimated that over 50 percent of the population has had the nail biting habit at some point in life. Nail biting usually starts in childhood after the age of three and frequently ends in adolescence when peer pressure and personal grooming become important. About 20 to 25 percent of adults remain nail biters. More women than men seek help to break the habit. There seems to be a slight hereditary tendency to nail biting, but, because family members are prone to mimic each others’ habits, this is hard to establish. It seems, however, that a nail-biting parent is likely to have trouble correcting a nail-biting child. See also NERVOUS HABITS; OBSESSIVE-COMPULSIVE DISORDER. SOURCE: Smith, Frederick Henry. Nail Biting: The Beatable Habit. Provo, Utah: Brigham Young University Press, 1980.
National Center for Complementary and Alternative Medicine An increasing number of people in the United States are turning to ALTERNATIVE MEDICINE for stress reduction and improvement of wellness. This trend encouraged the United States
252
needlestick injuries 253 not involve drugs, surgery, or other invasive procedures. Such evidence may prove to physicians that alternative therapy has credibility. The NCCAM provides a directory of alternative health care associations relating to holistic health care, diet/nutrition/lifestyle changes, MIND-BODY CONNECTIONS, art, music, dance and humor therapy, traditional and ethnomedicine, structural and energetic therapies, pharmacological and biological treatments, bioelectro-magnetic applications, and more. See also AYURVEDA; CHIROPRACTIC MEDICINE; MEDITATION; NATUROPATHY. FOR FURTHER INFORMATION:
National Center for Complementary and Alternative Medicine National Institutes of Health Bethesda, MD 20892 (888) 644-6226 (toll-free) (886) 464-3615 (TTY) (866) 464-3616 http://www.nccam.nih.gov E-mail:
[email protected] naturopathy
A form of alternative medicine. It is based on two principles: the accumulation of waste products and toxins in the body causes disease; symptoms of disease are the body’s way of trying to get rid of these substances. Proponents believe that nature heals itself by strengthening the healing powers within, and that individuals can do the same by dealing with factors that potentially hinder wellness. In addition to the accumulation of waste products and toxins, these hindrances include bodily structural imbalances, emotional stressors, and detrimental lifestyles. The goal of naturopathy therapy is to free the body to heal itself by enhancing its self-healing power. Practitioners agree that it is the ultimate goal of any type of wellness practitioner to encourage the body’s own life force to operate more efficiently within the individual. He/she may encourage the individual to use many techniques for controlling STRESS and promoting wellness, including nutritional and herbal supplements, BREATHING and EXERCISE programs, and MEDITATION. See also ALTERNATIVE MEDICINE; HERBAL MEDICINE; NUTRITION.
FOR FURTHER INFORMATION:
American Association of Naturopathic Physicians 3201 New Mexico Avenue NW, Suite 350 Washington, DC 20016 (866) 538-2267 (toll-free) (202) 895-1392 (202) 274-1992 (fax) http://www.naturopathic.org
nausea
A feeling of sickness in the stomach that causes a loathing for food and an urge to vomit. Some people experience nausea when under stress or recalling an anxiety-producing experience from the past. Others experience stress from DIZZINESS, light-headedness, or sweating that accompanies nausea. When individuals become nauseated before certain events, such as a public speaking appearance or a dramatic performance, playing in a sports event or taking an examination, BEHAVIOR THERAPY techniques can help. However, in all cases of repeated nausea, physical causes should be ruled out before undergoing psychotherapy for the condition. Some medications may produce nausea as a side effect in susceptible individuals. See also PERFORMANCE ANXIETY; SOCIAL PHOBIA.
needlestick injuries Approximately 5.6 million workers in the health care industry and related occupations face the stress of possible needlestick injuries (NSIs). These workers risk being exposed to blood-borne pathogens, including human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and others. An estimated 600,000 to 800,000 needlestick injuries and other percutaneous (though the skin) injuries occur annually among health care workers, according to a report by the Occupational Safety and Health Administration (OSHA) in March 1999. Nurses sustain the majority of these injuries. As many as one-third of all NSIs may be related to the disposal process. The Centers for Disease Control estimates that 62 to 88 percent of sharps injuries can potentially be prevented by using safer medical devices and better disposal techniques. In November 2000, Congress passed the Needlestick Safety and Prevention Act, directing OSHA to
254 nerve agents revise its blood-borne pathogen standards and to describe in more detail requirements for employers to identify and make use of effective and safer medical devices. Since then, OSHA has educated employers, health care workers, and the general public on its revised standards. New provisions require employers to maintain NSI logs and involve nonmanagerial employees in selecting safer medical devices. Enforcement of these new provisions began in July 2001. Safer handling of medical sharp devices will help reduce the stress of possible NSIs. See also HEALTH CARE WORKERS; HUMAN IMMUNODEFICIENCY VIRUS.
nerve agents
See
SARIN.
nervous habits
Habits that include involuntary twitches and facial tics and voluntary behaviors such as nose picking, thumb sucking, and nail biting. These habits may be a reaction to STRESS or a means of relieving stress and anxieties for some people. If the individual has a strong desire to overcome these nervous HABITS, in some cases BEHAVIORAL THERAPY techniques will help. See also ANXIETY; IRRITABLE BOWEL SYNDROME; NAIL BITING; OBSESSIVE-COMPULSIVE DISORDER.
concentric circles starting with coworkers, past employers, friends, relatives, and other people with whom you have contact within your community and personal life. Not to be overlooked is an immediate former boss. A survey by Lee Hecht Harrison, an outplacement firm based in New York, indicated that as many as one in three job seekers get help in their networking efforts from their former boss. Kennedy calls the people in the first concentric circle the individual’s inner sanctum. Having asked each inner sanctum person for contacts, these contacts become a second concentric circle. The third concentric circle consists of people referred by the the second circle. Keeping a log of the networking calls you make each day is an important part of the process. Through contacts, certain employers or job descriptions are identified for follow up. Other information coming from referrals should be collected and filed for future use. See also JOB CHANGE; JOB SECURITY. SOURCE: Burg, Bob. Endless Referrals. Networking Your Everyday Contacts into Sales. New York: McGraw-Hill, 1994.
neurotransmitters
networking
Using one’s contacts in business and in personal life to acquire information, to achieve some professional advantage, or to expand one’s circle of friends. It is a useful technique in finding out about marketing and industry trends and is unsurpassed for generating job leads and interviews. The stress involved in networking is that the individual may be bothering his friends, casual acquaintances, or complete strangers; the individual may fear rejection in these efforts. Despite the stress, networking has become an important part of finding work. One of the important rules of networking is that people should never call anyone with whom they don’t have a connection or referral. According to Marilyn Moats Kennedy, managing partner of Career Strategies, Chicago, the goal in networking is to amass a list of 400 people with similar interests and skills in your target industry who will remember your name and answer your calls. To gain that network, Kennedy recommends forming
Chemicals that carry messages from one nerve cell to another or to muscle cells; these messages are transmitted within a fraction of a second. Norepinephrine (a neurotransmitter) is released by the adrenal gland in response to signals triggered by STRESS, exercise, or by an emotion such as fear. Norepinephrine helps maintain a constant blood pressure by stimulating certain blood vessels to constrict when the blood pressure falls below normal. Serotonin (a neurotransmitter) is thought to be involved in controlling states of consciousness and MOOD. See also ANXIETY; DEPRESSION; PHARMACOLOGICAL APPROACH.
nightmare
A frightening DREAM characterized by a sense of oppression or suffocation that usually wakes people up during sleep. It occurs, most frequently, during REM (rapid eye movement) sleep and during the later part of the nighttime sleep period. Immediately after a nightmare, people feel
noise 255 very stressed. They have a clear recollection of the dream accompanied by intense uneasiness. Children often have nightmares after a day filled with great excitement, such as a first day of school or seeing a frightening movie or TV show. When they grow older and can distinguish a dream from reality, they are less frightened when nightmares occur. Some individuals suffer nightmares as part of POST-TRAUMATIC STRESS DISORDER (PTSD), particularly those who have witnessed a crime, been a victim of a crime, or served in a battle. They may relive their experience in the nightmare and wake up just as frightened as they felt when the event first happened. See also BEHAVIOR THERAPY. SOURCE: Krakow, Barry. Conquering Bad Dreams & Nightmares: A Guide to Understanding, Interpretation and Cure. New York: Berkeley, 1992.
night shift
See
SHIFT WORK.
nitrous oxide (N2O)
Commonly called laughing gas, nitrous oxide is an anesthetic agent used in operating rooms and during dental procedures. Workers are exposed to N2O while administering the anesthetic gas to patients. The threat of exposure is a source of stress for them because devices to reduce exposure have created a false sense of security in many health care workers. “Employers must ensure that these systems provide the expected level of protection,” according to National Institute of Occupational Safety and Health (NIOSH) past director D. Linda Rosentock. “Health care workers should not have to risk their health to improve the health of others,” she emphasized. Several studies have shown that occupational exposure to N2O may cause reduced fertility, spontaneous abortions, and neurological, renal, and liver disease as well as documented decrease in mental performance, audiovisual ability, and manual dexterity. Animal studies have shown that exposure to N2O during gestation can produce adverse health effects in offspring. Operating rooms are often equipped with scavenging systems that vent unused and exhaled gas away from the work area. Research shows that
appropriate systems can significantly reduce the risk of impaired fertility among female dental assistants exposed to N2O. However, a report by NIOSH indicated that even with scavenging systems in place, measurements have been reported as 12 times higher than recommended limits in hospital operating rooms and more than 40 times the NIOSH recommended limit in dental operating rooms. These systems must be continuously monitored and maintained to effectively reduce exposure to N2O. Many people who fear dental work receive N2O to help them relax and undergo dental procedures. See also DENTISTS. FOR FURTHER INFORMATION:
National Institute for Occupational Safety and Health 200 Independence Avenue SW Washington, DC 20201 (202) 401-6997 (202) 260-4464 (fax) http:/www.cdc.gov/niosh
noise A stress issue because of its psychological as well as physiological characteristics. Noise can be wanted or unwanted or distracting. The volume or frequency of the noise can be physically debilitating. Certain forms of noise, such as loud music, may simply annoy some people while others feel more productive with certain types of music. As chronic noise levels approach 85 decibels, significant potential for permanent hearing loss increases. Usually, hearing loss occurs only on specific frequency levels, depending on the amount of the exposure. It may be difficult for an individual to become aware of a hearing loss until it evolves significantly. The federal government mandates that workers exposed to high levels of noise wear protective ear equipment. Certain workers are more prone to injuries from noise than others. These include rock musicians, machine shop workers, and lumber mill employees. SOURCE: Girdano, Daniel A., George S. Everly, Jr., and Dorothy E. Dusek. Controlling Stress and Tension: A Holistic Approach. Englewood Cliffs, N.J.: Prentice Hall, 1990.
256 norepinephrine norepinephrine A hormone secreted by nerve endings in the sympathetic nervous system and by the adrenal glands. Its primary function is to help maintain a constant blood pressure by stimulating certain blood vessels to constrict when the blood pressure falls below normal. In some cases, an injection of the hormone may be given in the emergency treatment of shock or severe bleeding. Excessive levels of norepinephrine in the brain have been associated with manic states. Norepinephrine is also sometimes called noradrenaline. nostalgia A longing to return to a place where one may have emotional ties or a yearning to return to some past period or irrecoverable condition. When nostalgia is characterized by excessive or abnormal sentimentality, it becomes stressful because it is related to feelings of isolation. According to Miepje DeVryer, in the Journal of American College Health, nostalgia should be distinguished from the stress of experiencing HOMESICKNESS, which tends to be resolved by returning “home.” In contrast, when the individual longs or yearns for a lost past, and does so without desire to actually return, he is merely experiencing a normal response to nostalgia. His memories are usually of experiences with places and things rather than people. He is encompassed by a bittersweet feeling, painful and stressful on the one hand, pleasurable and soothing on the other. See also ACCULTURATION; LONELINESS; MIGRATION; MOVING. SOURCE: DeVryer, Miepje A. “Leaving, Longing and Loving: A Developmental Perspective of Migration.” Journal of American College Health 38 (September 1989).
nuclear weapons
A source of stress that began during the later 20th century and continues. The concern is related to the development of atomic and nuclear power. The fear is based on a feeling by individuals that they have no control over the fate of the world and that nuclear weapons can kill off all of human life and civilization. This fear is also related to a fear of death and a fear of the apocalypse, or the end of the world.
Although nations have worked out treaties governing manufacture and storing of nuclear weapons, many people around the world still fear that such weapons may be used for mass destruction. In 2002, U.S. troops went to Iraq to disarm Saddam Hussein following reports that weapons of mass destruction existed there. An international surveillance team spent two years looking for them. In early 2005 the group charged with hunting banned weapons said the ongoing violence in Iraq, coupled with lack of new information, led them to abandon the effort. The report concluded that Iraq had no stockpiles of biological and chemical weapons and its nuclear program had decayed before the U.S.-led invasion, in findings contrary to prewar assertions by the Bush administration. However, in 2005, many issues surrounding nuclear weapons continue to be ongoing sources of stress. There are concerns about nuclear weapons in North Korea and Iran, missing nuclear materials that can become bombs, and threats of so-called dirty bombs that can cause mass destruction. The lack of security concerning nuclear materials is also a source of stress. See also TERRORISM; VIOLENCE; WAR.
nursing homes
Homes that provide care at various levels for individuals who cannot care for themselves. Older persons today are faced with stressful choices in determining how they will spend their final years. Adult children, as well, feel the tremendous stress of helping their parents make the right choice. In some cases, they must make the choice for the parents when the parents are unable to do it themselves. For some older adults, the preference will be to remain in their own home; others may choose to move in with their children. However, the latter option may not be as viable as it was in years past. Space could be at a premium in their children’s homes, and both husband and wife may be tied down to a job. Even more likely, these adult children may be at the beginning of their RETIREMENT years, having only recently shed the responsibility of their own sons and daughters. Some older adults will find comfort and safety in housing complexes built specifically to meet the needs of senior citizens. In these complexes, they
nursing mothers 257 will have all the conveniences of independent living combined with meal service and planned social, cultural, and recreational activities. Any of these options work as long as the older persons involved remain independent and healthy. However, when illness and physical limitations related to living longer occur, the need for full-time care becomes a priority. It is that priority that often is best met in a nursing home environment. Stress for Nursing Home Workers Coping with the idiosyncracies of residents can be stressful for workers. Many nursing home workers face similar sources of stress as those in hospitals and in the home care industry. Major sources of stress for nursing home workers include injuries while handling patients, such as slips, trips, and falls, contact with objects and equipment, assaults and violent acts by patients, and exposure to harmful substances in the air such as air “fresheners” and insecticides. According to the U.S. Department of Labor, Bureau of Labor Statistics, nursing aides, orderlies, and attendants suffer 70 percent of nursing home injuries that result in days away from work. More lost workdays are reported for female workers than male workers. Workers in nursing homes include nurses, licensed practical nurses, health aides, maids, cooks, janitors, and laundry staff. See also HEALTH CARE WORKERS; NEEDLESTICK INJURIES; SLIPS, TRIPS, AND FALLS; TUBERCULOSIS; VIOLENCE. SOURCE: Yeh, Elizabeth, How to Achieve Quality of Life and Care in a Nursing Home. Houston: Rosenwasser Publishing, 1996.
nursing mothers
Many nursing mothers feel insecure about starting to breast-feed. Their concerns may include the ability to produce milk and possible nipple discomfort. Nursing an infant brings both physical and emotional sources of stress. Working women have particular stresses, as they may become concerned about being able to continue to feed their infant when they return to work. However, some of the stress associated with breast-feeding and working have been reduced because as of 2000, at least 20 states had legislation
protecting mothers who breast-feed. The number of states with legislation addressing nursing mothers in the workplace nearly doubled that year. An example is the state of Illinois, which in 2001 regulated that employers must accommodate nursing mothers. Under the Illinois Nursing Mothers in the Workplace Act, an employer must provide unpaid break time for nursing mothers. The law applies to employers who have more than five workers other than immediate family. The break time must, if possible, run concurrently with break time already provided to the employee. An employer is not required to do so, however, if it would unduly disrupt an employer’s operations. Additionally, employers must make reasonable efforts to provide a room or location near the work area (other than a toilet stall) to allow the mother privacy either to feed her infant or to pump milk. Representing another advance, in 2002, the Hawaii legislature passed an amendment to its fair employment practices law providing that no employer can prohibit a worker from expressing breast milk during any meal period or other break period required to be provided by the employer by law or by a collective bargaining agreement. In 1998, other states, among them California, Florida, and Texas, enacted similar laws. A California law simply urges all employers to support and encourage working mothers who want to continue breast-feeding. Both the Texas Breast Feeding Rights and Policies Law and the Florida Public Health Law encourage breast-feeding in the workplace by allowing businesses that develop a policy supporting worksite breast-feeding to use the designation “mother-friendly” or “baby-friendly” in their promotional materials. President Clinton signed a law making breastfeeding legal on all federal property where a woman and her child have a right to be. Under the law, it is illegal to ask a woman who is nursing her infant child to move from federal property. Many major corporations have already included mother-friendly programs in their employee benefits packages. These companies have been prompted by studies citing decreased rate of absenteeism of mothers who continue to breast-feed after returning to the job and the lower medical bills of nursing mothers and their children. Some
258 nutrition companies report that accommodating mothers has been excellent for their bottom line. Women can find support, education, and some relief from some of the stresses they face from the La Leche League, an international organization devoted to assisting women with breast-feeding. See also WORKING MOTHERS. FOR FURTHER INFORMATION:
La Leche League P.O. Box 4079 Schaumburg, IL 60168-4079 (847) 519-7730 or (800) LA-LECHE (toll-free) (847) 519-0035 (fax) http://www.lalecheleague.org
nutrition
The study and science of the food people eat and drink and the way food and drink are digested and assimilated in the body. STRESS plays an important role in nutritional aspects of life. At times of certain mental or physical illnesses, an individual’s nutrition may be less than optimal. For example, a severely depressed person may have little interest in eating, and lose weight, or a patient with a chronic illness, such as cancer, may have little appetite because of chemotherapy. ALCOHOLISM and substance abuse can suppress the appetite, leading to a decrease in food intake. In Western societies today, many people feel stressed over the relationship between diet and health. The focus is on the danger of too much fat in the diet, and on the effects of food additives, coloring, and preservatives. Inadequate intake of protein and calories may occur in people who restrict their diet and try to lose weight. This can lead to EATING DISORDERS such as anorexia nervosa. It can also occur because of mistaken beliefs about diet
TAKE THE STRESS OUT OF CHOOSING A NURSING HOME • Tour the facility for cleanliness, safety and security. • Check the activity calendar. • Ask to see its annual report/financial statement. • Observe and talk with residents or drop in unannounced. • Look for conveniences such as handrails, call buttons, and other devices designed specifically to assist older people. • Observe how personal privacy is respected. • Determine what help is available in making the transition.
and health. Emphasis on thinness in our society has led many to poor nutritional habits in an effort to lose weight. Hence one’s perception of BODY IMAGE may interfere with proper nutritional intake. Psychotropic medications can contribute to inadequate nutrition for some individuals. For example, dry mouth, a side effect of some medications, may make eating less pleasurable than usual. Other side effects that interfere with one’s ability to maintain good nutrition include glossitis, nausea, abdominal pain, vomiting, and diarrhea. See also OBESITY; WEIGHT GAIN AND LOSS. SOURCES: Bland, Jeffrey S. “Psychoneuro-Nutritional Medicine: An Advancing Paradigm.” Alternative Therapies 1, no. 2 (May 1995). Napier, Kristine. “Nutrition: Fat Is Everyone’s Issue.” Harvard Health Letter 21, no. 3 (June 1996). Thomas, Patricia, ed. “Nutrition: High-Protein Diets: Where’s the Beef?” Harvard Health Letter 22, no. 3 (January 1997).
O lead to social withdrawal and have debilitating effects on the body. Commercial diet programs have attracted millions of overweight individuals. Estimates indicate that Americans spend about $40 billion each year on weight loss products and services. Many resort to radical surgery or drugs to reduce obesity.
obesity
Obesity is body weight in excess of biological need. In the early 2000s, obesity was declared an epidemic in the United States by the Centers for Disease Control and Prevention. In early 2005, between 44 and 64 percent of U.S. adults were considered overweight or obese. Estimates are that 34 percent of adult women are obese, compared with 28 percent of men. In children and adolescents, the rate of obesity has climbed sharply in recent years. Now it is understood that halting and reversing the upward trend of the obesity epidemic will require a commitment to action by individuals as well as effective collaboration among government, voluntary, and private sectors. Obesity is now a private as well as public source of stress. Obesity is defined as having a body mass index (BMI) of 25 or more. Current obesity numbers reflect an increase of up to 74 percent since 1991. During the same time frame, diabetes increased by 61 percent, reflecting the strong correlation between obesity and development of diabetes. An estimated 17 million people have diabetes in the United States. Obesity can affect a person’s SELF-ESTEEM, feeling of attractiveness, and mental well-being. It can
Overweight and Lean Muscle Mass Overweight may or not be due to increase in body fat. It may also be due to an increase in lean muscle. For example, professional athletes may be very lean and muscular, with very little body fat, yet they may weigh more than others of the same height. While they may qualify as “overweight” due to their large muscle mass, they are not necessarily overly fat, regardless of BMI. Waist Circumference Waist circumference is a common measure used to assess abdominal fat content. The presence of excess body fat in the abdomen, when out of proportion to total body fat, is considered an independent predictor of risk factors and ailments associated with obesity. According to the U.S. Centers for Disease Control and Prevention, in general, men are considered at risk who have a waist measurement greater than 40 inches, and women are at risk who have a waist measurement greater than 35 inches.
The BMI is a single number that evaluates an individual’s weight status in relation to height. BMI is a mathematical formula in which a person’s body weight in kilograms is divided by the square of his or her height in meters (wt/[ht]2). BMI is highly correlated with body fat. The criteria for obesity are the same for men and women. Someone who is five feet, seven inches tall is obese at 192 pounds and a person who is five feet, 11 inches is obese at 215 pounds.
New Dietary Guidelines for Better Food Choices The sixth edition of Dietary Guidelines for Americans, released in early 2005 by the U.S. Departments of Health and Human Services and Agriculture, gives action steps to reach achievable goals in weight control, stronger muscles and bones, and balanced nutrition to help prevent chronic diseases such as heart disease, diabetes, and some cancers. Promoting good dietary habits is key to reducing the problems of
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260 obsessive-compulsive disorder obesity and physical inactivity. The guidelines focus on helping individuals to maintain body weight in a healthy range and balance calories from foods and beverages with calories expended. They also aim to prevent gradual weight gain over time, make small decreases in food and beverage calories, and increase physical activity. Surgery to Reduce Obesity For some people for whom diets have failed, surgery is their last resort in the battle to lose weight. An increasing number of persons take this route. In 2004, the number of weight-loss surgical procedures rose 36 percent to 141,000, five times the 1999 level, according to the American Society for Bariatric Surgery. In the conventional gastric bypass and a minigastric bypass, the stomach is radically reduced in size using surgical stapling and the intestines are shortened. People lose weight afterward because their stomachs hold less food and the shorter intestinal tract gives the food less chance of being absorbed into the body. Before this type of surgery, patients usually receive psychological counseling; after surgery, there is close followup by nutritionists. In sum, nothing is more effective than psychological motivation to help obese people to lose weight by dieting and exercise and to keep it off. See also BODY IMAGE; DIETING; EATING DISORDERS; WEIGHT GAIN AND LOSS. FOR FURTHER INFORMATION:
American Society of Bariatric Physicians 5600 South Quebec, Suite 1600 Englewood, CO 80111 Phone: (303) 7794833 National Association to Aid Fat Americans P.O. Box 188620 Sacramento, CA 95818 Phone: (916) 443-0303 U.S. Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201 http://www.hhs.gov/news SOURCES: Krueger, Anne. “How Did I Get So Fat?” American Association of Retired Persons Magazine. Available online. URL: http://www.aarpmagazine.org/health/articles/
a2004-11-18-mag-sofat.html. Downloaded on June 22, 2005. National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, Md.: Department of Health and Human Services, National Institutes of Health, National Heart, Lung and Blood Institute, 1998. Stunkard A. J., and T. A. Wadden (eds.) Obesity: Theory and Therapy. 2nd ed. New York: Raven Press, 1993.
obsessive-compulsive disorder (OCD)
An ANXIcharacterized by a person’s obsessions, which are repeated intrusive, unwanted thoughts that may lead to carrying out ritualized, compulsive acts. This disorder affects 2.4 million Americans and is a cause for stress for the sufferer as well as family members, coworkers, and friends. OCD may come on suddenly, often beginning in early childhood, around age eight to 10. The disorder is twice as prevalent in the general population as panic disorder or schizophrenia. OCD is partly inherited and partly the result of environmental factors. Personality traits of orderliness and cleanliness are said to be related to OCD and certain brain disorders can result in compulsive behavior.
ETY DISORDER
Obsessions Obsessions come into the mind involuntarily and recur. Sufferers are not able to ignore them; they consider these thoughts, such as fear of being infected by germs or dirt and constant doubt about such things as turning the coffeepot off or locking the front door, senseless and somewhat unpleasant, but unrelenting. Compulsions A normal lifestyle routine is impossible for many OCD sufferers because they constantly repeat rituals that take up considerable time. People who have OCD are aware that their compulsions and rituals are irrational, but they cannot help themselves. Some are ashamed of their actions and hide them from family and friends, often delaying treatment for years. Hand washing, checking, and counting are the most common compulsions among people with this disorder. Other types of rituals relate to fastidiousness and PERFECTION, such as cleaning the house, showering, repeating names or phrases,
obsessive-compulsive disorder 261 hoarding, avoiding objects, and performing tasks extremely slowly and repeatedly. OCD and Links with Depression Researchers speculate that OCD may be closely associated with DEPRESSION. Some individuals experience only OCD while others suffer from both OCD and depression. The link between OCD and depression is borne out by laboratory tests on patients who have the two illnesses. For example, obsessive-compulsives, like some people who have depression, do not stop producing dexamethasone, a steroid naturally produced in the body, during a dexamethasone suppression test. When the steroid is injected into the body, the body should stop producing dexamethasone on its own. OCD patients continue to make the steroid. Also, obsessive-compulsives, like depressed people, show an abnormal lapse in the time it takes between first falling asleep and the first dream, normally from one to two hours. When researchers looked at the immediate family members of people suffering from OCD, they found a high percentage had depression or manic-depressive disorder. Many OCD sufferers have symptoms associated with depression, such as GUILT, indecisiveness, low self-esteem, ANXIETY, and exhaustion. Pharmacological and Behavior Therapies include use of prescription medications for some individuals. Researchers have learned that medications that affect the serotonergic system (such as clomipramine PHARMACOLOGICAL APPROACHES
and fluoxetine) can be useful in relieving symptoms in some patients. BEHAVIOR THERAPY is one of the most effective treatments for OCD. During therapy sessions, the person is exposed to situations that cause extreme stress and anxiety and provoke compulsive behaviors. The individual is not allowed to go through the usually performed rituals, such as excessive hand washing after handling money. This technique works well for people whose compulsions focus on situations that can be easily recreated. For those who follow compulsive rituals because they fear catastrophic events that cannot be recreated, individuals must rely more on imagination. FOR FURTHER INFORMATION:
Anxiety Disorders Association of America 11900 Parklawn Drive, Suite 100 Rockville, MD 20852 Phone: (301) 231-9350 Obsessive-Compulsive Disorder Foundation P.O. Box 70 Milford, CT 06460-0070 (800) 639-7462 (toll-free) SOURCES: American Psychiatric Association. Obsessive-Compulsive Disorder. Washington, D.C.: American Psychiatric Association, 1988. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Reyes, Karen. “Obsessive-Compulsive Disorder: There Is Help.” Modern Maturity, November–December 1995, 78.
BEHAVIOR THERAPY FOR OCD Technique
Prevention of response Thought stopping Imagery
Modeling Exposure
Action experienced
Individual gradually delays performing ritual for longer intervals. Individual tries to voluntarily interrupt obsessive thoughts. Individual is encouraged to imagine being exposed to feared situation and prevent an unwanted response. Therapist actively models response. Individual is gradually exposed to the feared thought or object.
Anticipated effect
Helps reduce compulsion. Helps decrease obsessions. Help decrease obsessions and anxiety.
Alters patient’s unwanted behaviors to more acceptable ones. Reduces anxiety; decreases obsessions and compulsions.
262 occupational health psychology occupational health psychology (OHP)
A new field of psychology that takes an active role in research and practice to prevent OCCUPATIONAL STRESS, illness, and injury. Although research and practice in OHP covers a wide range of topics, the National Institute for Occupational Safety and Health (NIOSH) has urged that the field give special attention to primary prevention of organizational risk factors for stress, illness, and injury at work. This viewpoint is expressed in the NIOSHproposed definition of OHP: “OHP concerns the application of psychology to improving the quality of work life, and to protecting and promoting the safety, health and well-being of workers.” The notion of health “protection” in the NIOSH definition refers to intervention in the work environment to reduce worker exposures to workplace hazards, while health “promotion” refers to individual level interventions to equip workers with knowledge and resources to improve their health and thereby resist hazards in the work environment. OHP is particularly concerned with the dramatic transformation of work and employment that has been under way in industrial economies since the 1980s and how changing organizational structures and processes influence the health and well-being of workers and their families. Graduate Training Programs in OHP During the 1990s, NIOSH and the American Psychological Association launched a series of initiatives to promote the field of OHP. A program has been implemented to support both postdoctoral and graduate level training in OHP at major universities. These programs have strong interdepartmental linkages that expose psychology students to topics and methods in occupational safety and health and provide opportunities for workplace internships. Core curricula in these training programs usually include course work addressing job stress theory, organizational risk factors for occupational stress, injury, and illness, health implications of stressful work, organizational interventions (e.g., work design), and programs (e.g., employee assistance programs) for reduction of occupational stress, illness, and injury. Journal of Occupational Health Psychology Journal of Occupational Health Psychology was launched in 1996 and publishes research, theory,
and public policy articles in occupational health psychology, representing a broad range of health psychology concerns. It focuses on the work environment, the individual and the work-family interface. The journal publishes articles by researchers and practitioners, concerning psychological factors in relationship to all aspects of occupational health, including stress. See also NOISE; OCCUPATIONAL STRESS; STRESS MANAGEMENT. FOR FURTHER INFORMATION:
American Psychological Association 750 First Street NE Washington, DC 20002-4242 (800) 374-3120 (toll-free) (202) 386-5700 (202) 336- 5568 (fax) http://www.apa.org
[email protected] Editor Journal of Occupational Health Psychology School of Business Queen’s University Kingston, ON K7L 3N6 Canada
occupational stress
The Bureau of Labor Statistics (BLS) Survey of Occupational Injuries and Illnesses classifies occupational stress as “neurotic reaction to stress.” Many employees undergo stress as a normal part of their job, but some experience it more severely than others, to the point that they need time away from work. According to the BLS, there were 3,418 such illness cases in 1997. The median absence from work for these cases was 23 days, more than four times the level of all nonfatal occupational injuries and illnesses. More than two-fifths of the cases resulted in 31 or more lost workdays, compared to one-fifth for all injury and illness cases. The 1997 estimate of 3,418 cases of occupational stress is the lowest since 1992, when BLS began collecting these data. The decline is consistent with the trend for all nonfatal occupational injuries and illnesses involving days away from work. Occupational stress cases declined by 15 percent over the 1992–97 period, whereas all injuries and illnesses declined by 21 percent.
occupational stress 263 White-Collar Occupational Stress White-collar occupations had a higher proportion of stress cases than both blue-collar and service occupations combined. Managerial and professional occupations, with 16 percent of the cases, and technical, sales, and administrative support occupations, with 48 percent, had higher proportions of occupational stress cases than they did of all occupational injury and illness cases involving days away from work, 5 percent and 15 percent, respectively. Three occupations accounted for almost 80 percent of all cases of occupational stress; the two white-collar occupations just mentioned and operators, fabricators, and laborers. Occupations most often leading to occupational stress disorders include bookkeepers, accounting, and auditing clerks—5 percent; supervisors and proprietors, sales occupations—4 percent; investigators and adjusters, excluding insurance—4 percent; cooks—4 percent; and production occupational supervisors—4 percent.
Industries with High Occupational Stress According to the BLS, finance, insurance, and real estate, with 12 percent of the cases, and services, with 35 percent, had higher proportions of occupational stress cases than they did of all occupational injury and illness cases involving days away from work, 2 percent and 23 percent, respectively. The proportion of occupational stress disorders was lower in all other industries than comparable proportion of all injuries and illnesses. Four industries accounted for the bulk of occupational stress cases: services (35 percent), manufacturing (21 percent), retail trade (14 percent), and finance, insurance, and real estate (12 percent). Incidence Rates of Stress by Industry and Occupation The nonfatal occupational injury and illness incidence rate for occupational stress cases was less than one case per 10,000 full-time workers in each
264 Ohashiatsu of the major industry divisions in 1997, the lowest since BLS began collecting such data in 1992. The incidence rate for occupational stress in finance, insurance, and real estate (FIRE) in 1997 was the lowest in six years, and for the first time since 1992, did not significantly exceed the rates for all other industry divisions. In contrast, for all injuries and illnesses, the rate of 67.4 in FIRE was the lowest among the major industry divisions, and less than one-third of the total private industry rate. Relative Risk of Stress by Occupation The risk of injury or illness faced by employees’ individual occupational groups compared to the risk faced by all occupations combined is called relative risk. When constructing an index for such a risk faced by all occupations combined, the index is equal to one. In 1997, the index for occupational stress ranged from 0.6 for managerial and professional occupations to 1.6 for technical, sales, and administrative support occupations. The relative risk for occupational stress exceeded the relative risk for all injuries and illnesses for white-collar jobs. Among blue-collar and service jobs the reverse was true: Relative risk for occupational stress was lower than the risk for all injuries and illnesses. FOR FURTHER INFORMATION:
U.S. Department of Labor Bureau of Labor Statistics Postal Square Building, Room 2850 2 Massachusetts Avenue NE Washington, DC 20212-0001 (202)606-6179 http://www.bls.gov
Ohashiatsu
Based on the same system of Oriental medicine as ACUPUNCTURE; a form of therapy useful for relief of stress in some people. Ohashiatsu addresses the body’s energy meridians and points along those meridians called tsubos. Instead of using needles, however, the practitioner of Ohashiatsu use hands, elbows, and sometimes even knees as tools. The goal is to achieve a feeling of deep RELAXATION, harmony, and peace. Ohashiatsu adds psychological and spiritual dimensions to traditional SHIATSU by incorporating Zen philosophy, movement, and MEDITATION to balance the energy of body, mind, and spirit.
See also
ALTERNATIVE MEDICINE; BODY THERAPIES;
MIND-BODY CONNECTIONS; ZEN.
operant conditioning orgasm
See
outsourcing overeating
See
CONDITIONING.
SEXUAL RESPONSE.
See See
CHANGING NATURE OF WORK.
OBESITY; NUTRITION; WEIGHT GAIN
AND LOSS.
overtime Hours worked beyond the usual workday or workweek. According to Paul Landsbergis, Ph.D., of Mount Sinai School of Medicine, long work hours are related to work-related injuries, fatigue, less SLEEP, blood pressure elevation, and cardiovascular disease. Recent research on overtime and health effects suggest that overtime may act directly as a stressor, may act to increase exposure to other workplace hazards, or may promote unhealthy behaviors. The average number of hours worked annually by workers in the United States increased steadily from 1970 through the 1990s and currently surpasses that of Japan and most of western Europe. The influence of overtime and extended work shifts on worker health and safety, as well as on worker errors, is gaining increased attention from the scientific community, labor representatives, and industry. Extended work hours have been associated with work accidents and injuries, and with musculoskeletal disorders and pain. Some studies have found links between long work hours and perceived STRESS, other psychological symptoms, excessive alcohol use, and smoking (usually above 50 hours per week). In a study of overtime and performance, researchers investigated United Auto Workers working day and evening shifts. They reported poorer performance on tests of cognitive function and executive function, such as the ability to prioritize and plan tasks, for individuals who worked overtime as compared with those who did not. In another study, as work hours increased among health care workers, automobile crashes and onthe-job accidents increased.
overtime 265 Overtime has been associated with fatigue and shorter sleep hours. Insufficient sleep can increase the activity of the sympathetic nervous system, heart rate, and blood pressure, and may be an important pathway connecting long work hours and illnesses, according to Landsbergis. “Dual-job families in the United States work far longer hours than in most other industrialized countries. Parents face an economy that offers fast-track jobs with many extra hours a week, or dead-end jobs, at 20 to 25 hours, with little in between,” according to Natalie Gahrmann, author of Succeeding as a Super Busy Parent. Parents have choices. They can remain in a “good” job that keeps them away from home 10 to 12 hours a day, they can take a part-time job with lower wages, fewer benefits, and no advancement, or they can quit. Extra hours at the office may mean more opportunities for advancement, or opportunities for BURNOUT. It can also mean missing out on important family milestones. Gender, Age, and Overtime Studies have given more attention to male workers than to female workers and less is known about
how overtime and extended work shifts influence health and safety in women. However, one Canadian report indicated that women tend to spend more of their time away from work on child care and domestic responsibilities, which may reduce the time available for sleep and recovery from stress at work. Another study provided some support for increased risk for musculoskeletal disorders when long hours worked combined with additional domestic workload. One study examined the influence of age on extended work shifts and reported that younger participants maintained better performance with longer work shifts when compared with older participants. SOURCE: Caruso, Claire C., et al. “Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries, and Health Behaviors,” Available online. URL: http:// www.cdc/gov/niosh/docs/2004-143/pdfs/2004-143. pdf. Accessed on June 22, 2005.
P pain A feeling that can range from mild distress to unbearable, acute suffering. It occurs following injury or as a result of disease when the body’s sensory nerve endings are stimulated. Pain is not restricted to a specific type of stimulus; it can be aroused by extreme stimulation of any sense. Loud noise and bright lights can be painful, as can be HEADACHES, toothaches, cancer, inflammation of tissue and muscles, and bone breakage. In his book Painstoppers, author Norman D. Ford identifies stress as the genesis of pain. Ford says, “Stress occurs only when we perceive life through a filter of fear-based, negative beliefs. Stress is the underlying cause of some 70 percent of all chronic pain. Virtually all pain in the neck, upper and lower back, and shoulders is stress-related and so are most headaches. Such pain-provoking diseases as ulcers, irritable bowels, rheumatoid ARTHRITIS, cancer, and heart disease are also stress related. Overeating because of emotional stress also leads to OBESITY, which worsens the pain of osteoarthritis.”
REDUCE STRESS: PARTICIPATE IN PAIN CONTROL • Identify small steps toward independence from pain, such as accepting the pain and not blaming others for your problems. • Track pain levels and activities with awareness of the difference between physical pain sensations and emotional pain distress. • Check the “costs/benefits” in relation to participation in family activities, work and play, and relationships with people. • Express feelings and anxieties; learn ways to decrease anger responses. • Block negative thoughts; use relaxation techniques to fight the chronic stress of sleep disturbance, fatigue, poor concentration, increased muscle tension, anxiety, depression, and loss of self-control—all of which amplify pain. • Distract yourself by focusing on the environment, singing or using imagery to concentrate on pleasant, dramatic, and healing thoughts. • Indulge in healthy pleasures and fun. • Focus on the pain and the thoughts and feelings that accompany the pain. • Reclaim an active life by setting short- and longterm goals. • Exercise on a regular basis; increase the amount gradually. Modify how you use your body, such as during lifting, bending, and sitting, and what you use for physical support—chairs, desks and counters, wrist bands, and other methods. • Prepare for flareups by knowing the specific pain relievers that work best for you.
Treatment Course of treatment at the Texas pain clinic is based on how patients are categorized: somatic, those whose pain is primarily of physical origin, with some psychological issues possible; psychogenic, those who experience pain but have nothing physically wrong; malingering, those who are either faking or greatly exaggerating their pain. Treatments include RELAXATION training, HYPNOSIS, BIOFEEDBACK, behavior modification, and family, marital, and sexual counseling. In Mental Medicine Update, Robert Ornstein, Ph.D., and David S. Sobel, M.D. stated that 10 percent to 30 percent of Americans suffer from chronic or recurrent pain, which extracts a heavy toll on health, ability to work, and sense of well-
being. While feelings of anxiety, frustration, and loss of control and confidence can amplify the experience of pain, it does not mean that the pain is not “real.” It just means that emotions make it
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palpitations 267 worse. In addition to physical treatment of pain, the authors suggest behavioral self-management that includes mind-body strategies such as relaxation techniques, SUPPORT GROUP therapy, and biofeedback training. To those suffering chronic pain, Ornstein and Sobel suggest that when they become partners in pain treatment, they become part of the solution. See also ALTERNATIVE MEDICINE; CHRONIC ILLNESS; GUIDED IMAGERY. FOR FURTHER INFORMATION:
American Academy of Pain Medicine 4700 W. Lake Glenview, IL 60025 (847) 375-4731 (877) 734-8750 (fax) http://www.painmed.org SOURCES: Ford, Norman D. Painstoppers: The Magic of All-Natural Pain Relief. West Nyack, N.Y.: Parker Publishing, 1994. Ornstein, Robert, and David Sobel. “RX: Managing Chronic Pain.” Mental Medicine Update 4, no. 1 (1995).
paintball A fast-paced action sport usually played on an open field, although there are some indoor arenas. Parents and spouses may worry when they know their loved ones are playing, because the sport involves paintball guns and may cause injuries. Usually, the game is a variation of the childhood game capture the flag. Some people find the activity exhilarating while others find it terrifying. There are two teams and each player gets an air gun. Team members wear colorful armbands for identification. The object of the game is to capture the other team’s flag, bring it back to base, and touch it to one’s own flag without being eliminated. Getting eliminated means being hit with a paintball. Referees remove players once they are eliminated. The paintballs are marble-sized and have a hard shell to enable it to sail long distances. Typically, paintball guns have a barrel to launch the paintball, a trigger to activate the launch procedure, a reservoir to hold extra paintballs, and some type of pressurized gas to provide propulsion. Players usually receive several hits in the course of a game; the hits may leave a little redness at the
point of contact but most players say they usually do not hurt. Protection, Safety, and Following Rules The Paintball Times recommends a face protection/goggle system to protect the eyes. Players are advised to never take off the mask, except in designated areas. Dark clothing, in layers, is recommended. The magazine advises; • Be sure you understand your gun and its limitations • Wear comfortable hiking/running shoes or football or soccer cleats to provide traction in grass and mud • Obey the orders from the captain of your team Traveling to paintball tournaments by air with paintball equipment can be a stressful experience. Players must be prepared to carry goggles in checked luggage or as carry on, but paintguns may only be transported in checked luggage and compressed gas (CO2 or HPA) tanks may be carried in checked luggage only if the valve or regulator assembly is completely removed from the tank, allowing inspectors to see inside the open tank neck. However, as of the end of 2005, most tanks are not yet designed this way. Players traveling with equipment should check with their airline’s policies for prohibited items. Some airlines may not accept compressed air and CO2 tanks for transport under any conditions. SOURCE: Khan, Sami. “What Is Paintball?” The Paintball Times. Available online. URL: http://www.PaintballTimes. com. Downloaded on November 26, 2004.
palpitations
A conscious sensation of the heart’s beating harder and faster than normal or skipping beats. Whereas normally people are not aware of how their hearts beat, many of them experience palpitations when they participate in strenuous exercise or have stress-producing experiences. Thumping or fluttering feelings in the chest do not normally indicate heart disease and may be a result of heavy use of caffeine, alcohol, or smoking. An arrhythmia (irregular beat) may cause a palpitation. Individuals may feel faint and breathless
268 panic attacks and panic disorder and their pulse may be as high as 200 beats per minute but remain regular. Hyperthyroidism, overactive thyroid glands, may also cause palpitation by speeding up the heartbeat. Many individuals experience palpitations during panic attacks or as a phobic reaction to a stimulus they fear. For example, a person who is phobic about dogs may experience palpitations just at the sight of a dog walking on the sidewalk. Although the dog is on a leash and does not pose any threat, the phobic individual may experience palpitations along with sweaty palms, weak knees, and DIZZINESS. Those who experience palpitations may fear that they are having a heart attack or that they are going to die. For many people, just thinking these thoughts and becoming afraid of imagined consequences can cause palpitations to increase. Symptoms of ANXIETY, such as palpitations, are treated with BEHAVIOUR THERAPY and, in some cases, drug therapy. If an individual experiences palpitations for several hours or the feeling recurs over several days, or if they cause chest pain, breathlessness, or dizziness, a family physician, general internist, or specialist in cardiology should be consulted as soon as possible. If palpitation episodes are brief, they are probably within the range of normal. Some medications may produce palpitations in individuals. See also ANXIETY DISORDERS; PANIC ATTACKS AND PANIC DISORDER ; PHARMACOLOGICAL APPROACH ; PHOBIAS.
panic attacks and panic disorder
A panic attack is a short period (five to 10 minutes) of suddenly occurring, intense fear or discomfort, usually for no apparent reason. The feeling may be caused by stress but it also causes extreme stress in the affected individual because it is usually accompanied by a fear of dying, a sense of imminent danger or impending doom, and an urge to escape. Panic attacks are considered one of several ANXIETY DISORDERS. They can occur in a variety of anxiety disorders, such as panic disorder, AGORAPHOBIA , SOCIAL PHOBIAS , and POST- TRAUMATIC STRESS DISORDER. The word panic is derived from the name Pan, whom Greeks worshiped as their god of flocks, herds, pastures, and fields. Pan loved to scare peo-
ple and make eerie noises to frighten passersby. The fright he aroused was known as “panic.” Criteria for Diagnosis To be diagnosed as a panic attack, organic factors have to be ruled out as the cause of the disturbance. The panic incident must include at least four or more of the characteristic symptoms, which are a sense of breathing difficulty, PALPITATIONS or rapid heartbeat, sweating, trembling, shaking, feelings of smothering or choking, chest pains, nausea or abdominal distress, DIZZINESS or light-headedness, paresthesia, and chills or hot flushes. HYPERVENTILATION (fast, shallow breathing) worsens the symptoms and leads to a pins and needles sensation and to a feeling of derealization or depersonalization. These symptoms are usually the result of underlying emotional conflicts such as fear of being trapped or loss of emotional support. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (DSM-IV), typically the first attack occurs in individuals in the late teens. Initially, attacks are unexpected and do not occur immediately before or on exposure to a stressful situation, such as a simple phobia or social PHOBIAS. Subsequently, certain situations may be identified with having a panic attack, such as crossing a bridge or being on an escalator. Once a panic attack has occurred in a particular setting, the individual may become fearful that it will happen again and tend to avoid that situation. The Context of Panic Attacks When a health professional assesses the significance of the problem, it is important to determine the context in which it occurs. According to DSMIV, three characteristic types of panic attack relate in different ways to the onset of the attack and the presence or absence of situational triggers: Unexpected panic attack: The onset of the attack is not associated with any situational trigger. Situationally bound attack: The attack almost invariably occurs immediately on exposure to, or in anticipation of, the stressful situational trigger. Situationally predisposed panic attack: More likely to occur on exposure to the situational cue or trigger, but is not invariably associated with the cue and does not necessarily occur immediately after exposure to the stressful factor.
panic attacks and panic disorder 269 Panic Disorder When panic attacks recur frequently and disrupt an individual’s life, the condition is known as panic disorder. Sufferers (1 percent to 2 percent of the population) may have attacks ranging from two or three a day to two to four times a week. This type of disorder tends to run a fluctuating course and becomes worse when the individual comes under stress. Panic disorder usually begins during periods of choices, transitions, separation, and added responsibilities. There is often a family history of panic disorder. For example, first-degree relatives of patients with panic disorder are at a markedly higher risk of developing the disorder (15 percent to 20 percent compared to 1 percent in the general population). In diagnosing panic disorder, the essential feature is the presence of recurrent, unexpected panic attacks followed by at least one month of persistent concern about having another panic attack, worry about the possible implications or consequence of the attacks, or a significant behavioral changed related to the attacks. Personality Characteristics Personality characteristics of those who have panic disorder vary considerably. However, H. Michael Zal, a clinical professor of psychiatry at the Philadelphia College of Osteopathic Medicine, has observed some common factors. Additionally, cross-sectional studies of persons with panic disorder or agoraphobia have demonstrated personality traits of dependency, avoidance, low SELF-ESTEEM, and interpersonal sensitivity. One common attribute shared by panic-prone people may include placing a great value on CONTROL. Any loss or threatened loss of control, particularly changes in their lifestyles, causes them to feel anxious and stressed. According to Dr. Zal, panic-prone people overvalue their independence and feel great discomfort in acknowledging their dependency needs. They are often reluctant to accept help and prefer helping others. Known to repress feelings, they feel anxious when their EMOTIONS surface. As perfectionists and compulsive individuals, they have high expectations of themselves and others. It is difficult to estimate how many men suffer from panic disorder because men may attempt to mask their symptoms by drinking alcohol or by other means. This type of self-medication can
develop into a secondary problem. Many men go to family physicians, see multiple specialists, or end up in emergency rooms, thinking they have physical disorders. They complain of lower gastrointestinal problems, which are sometimes a symptom of panic disorder. When the panic disorder is treated, these gastrointestinal symptoms disappear. Treatment for Panic Disorder Treatment for the stresses that come with panic disorder may involve COGNITIVE THERAPY, BEHAVIOR THERAPY, or medical therapy. Often a combination of treatments is specifically chosen for each patient. Treatment begins with education about the illness and encouragement to reenter situations the person has come to avoid. Help for some individuals is in cognitive therapy (changing how they think and dealing with their feeling of anxiety). For others, behavior therapy (changing how they act in response to certain situations and using desensitization techniques to gradually expose sufferers to the situations they have avoided) is useful. In the late 1990s, ALPRAZOLAM (trade name, Xanax) was the first and only medication approved in the United States for panic disorder. Previously, various studies indicated that tricyclic antidepressant drugs (such as imipramine) provided an effective, safe treatment for panic disorder. However, these medications typically take three to six weeks for noticeable improvement, and side effects including anxiety symptoms occur in up to onethird of the patients. Help for Panic Disorder Sufferers Family members can help in recognizing panic disorders by being alert to the individual’s level of anxiety. Because symptoms can be hidden, repeated avoidance of situations is often the best clue. Family members can give the sufferer support, be good listeners, and talk openly and constructively among each other. Instead of enabling the person to avoid a situation, family members can help him or her make a small step forward by finding something positive in that effort. See also PHARMACOLOGICAL APPROACH; TACHYCARDIA. FOR FURTHER INFORMATION:
Anxiety Disorders Association of America 8700 Georgia Avenue Silver Spring, MD 20910
270 parental afterschool stress (240) 487-0120 http://www.adaa.org National Mental Health Association 1021 Prince Street Alexandria, VA 22314-2971 (800) 969-6642 (toll-free) (703) 684-7722 (703) 684-5968 (fax) http://www.nmha.org SOURCES: American Psychiatric Association. Diagnostic and Statistical Manual, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994. Kahn, Ada P. “Panic Attacks” and “Family Members Can Help Sufferers Cope with Attacks.” Chicago Tribune, June 23, 1991. Zal, H. Michael. Panic Disorder: The Great Pretender. New York: Insight Books, Plenum Press, 1990.
parental afterschool stress (PASS)
Working parents worry about their children during the late afternoon hours. More than 37 percent of the labor force consists of parents of minor children; most of those children are school age. However, most of these parents have work schedules that prevent them from being home when their children get out of school. The gap between the end of the school day and the time most parents get home from work is estimated at about 20–25 hours each week. There are significant health, academic, and social risks associated with leaving school-age children unsupervised. Children’s well-being as well as parental work performance is affected. A study by the Community, Families and Work Program at Brandeis University and funded by the Alfred P. Sloan Foundation of 243 parents, mostly mothers, employed at JPMorgan Chase, revealed the impact of reliable after-school options on parents’ productivity at work and their psychological well-being. In 2004 researchers Rosaline Barnett and Karen Gareis reported that parents with high parental after-school stress are much more frequently interrupted, distracted, and drained of energy at work by nonwork issues; they much more frequently make errors, turn down requests to work extra hours, and miss meetings and deadlines at work. The quality of their work is significantly lower than that of their low-PASS counterparts.
Parental concerns about children’s afterschool arrangements have a bottom line cost in lost productivity. This cost may be reflected in up to five extra days of missed work per year per employee. On average, not including vacation days, employed parents with high PASS miss about eight days of work per year, while their counterparts with lowPASS miss about three days of work per year. Employed parents who were at the highest risk for parental afterschool stress were those whose jobs were less flexible and whose children spent more time unsupervised after school. Other factors contributing to parental stress included a long commute time. See also FLEXIBLE WORK HOURS; SHIFT WORK; WORKING MOTHERS.
parenting
Caring for and nurturing children. The term may also apply to the situation when grandparents take over the care of their grandchildren because their sons or daughters are no longer able to fulfill their responsibilities. Of all the roles in life, parenting is one of the most important; it is one for which there is the least preparation and which therefore brings with it a great deal of STRESS. For those with little instruction and no experience, the stress of parenting begins with the basics of feeding, bathing, and caring for the baby. As role models, parents provide moral and ethical values; as disciplinarians, they reward good conduct and withhold reward when conduct is bad. They deal with family disputes including sibling rivalry and, at the same time, try to avoid playing favorites, recognizing the needs of all their children. Keeping children safe throughout their lifetime is a constant concern. Parenting involves responding to problems and concerns of children, both physical and mental. As children grow, parents watchfully wait to step in when there is trouble while recognizing their own capacities and respecting their children’s need to do things for themselves. Parenting Adult Children When children become adults, the parenting role often becomes one of friend and companion. Many adult children and their parents enjoy the same sports activities, traveling together, and sharing hobbies. Characteristics of a good relationship while
peer group 271 the children were growing up, such as open and honest communications, carry over into later life. Eventually the young people leave home and some parents are faced with the EMPTY NEST SYNDROME and no longer feel needed. While this may be a time of stress and loneliness, it is a time when parents can explore their own interests and enjoy the intimacy they shared as newlyweds. DIVORCE carries with it special stresses for the parents as well as children. Another stressful dimension of parenting is when grandparents take over the role of parents. A growing number nationwide have assumed the financial, physical, and emotional responsibility for their grandchildren. Grandparents Raising Grandchildren was founded in 1988 to provide the information and resources needed for those facing this stressful challenge. Current census figures indicate 4.7 million children living with grandparents and 1.1. million being raised by grandparents alone; however, this may be an understatement because the figures do not cover informal living arrangements. See also BIRTH ORDER; ELDERLY PARENTS; SIBLING RELATIONSHIPS; STEPFAMILIES; WORKING MOTHERS; UNWED MOTHERS. SOURCES: Leach, Penelope. The Child Care Encyclopedia. New York: Alfred A. Knopf, 1984. Rogers, Fred. “Parenting: A Lifelong Commitment.” The Rotarian (September 1995): 12–14.
passive aggression passwords
See
See
AGGRESSION.
COMPUTERS; IDENTITY THEFT.
PDA (personal digital assistant)
See
ELECTRONIC
DEVICES.
Peck, M(organ) Scott (1936–
) American psychiatrist, author and lecturer and author of several best-selling books, including The Road Less Traveled: A New Psychology of Love, Traditional Values and Spiritual Growth and The Road Less Traveled and Beyond. Peck postulates that when an individual accepts the inherent stresses in life, he can transfer weakness into strength through self-discipline and love. This “real love” is “an act of the will to extend one-
self for the purpose of nurturing one’s own or another’s spiritual growth.” For many years, Peck has had an interest in the growing interface between RELIGION and science. He received his M.D. from Case Western Reserve University and his A.B. from Harvard University. See also GENERAL ADAPTATION SYNDROME; HARDINESS; PRAYER. SOURCE: Peck, M. Scott. The Road Less Traveled and Beyond. New York: Simon and Schuster, 1997.
peer group
A group whose members are of equal standing with each other. This refers to people who are of the same age, educational level, or have the same job or profession. A peer group can cause stress for the individual because it can influence feelings of self-concept, SELF-ESTEEM, attitudes, and behaviors. Peer group relationships are important to children as well as adults. While children look to each other for acceptance and approval, so do adults who are seeking new friends and acceptance in a group. Peers are crucial to psychological development of the individual throughout life. Children learn to cooperate, work together, handle aggressive impulses in non-destructive ways, and explore differences between themselves and their friends. Throughout the school years, children rely on their peers as important sources of information and may use peers as standards by which to measure themselves. Many look to their peers as models of behavior and for social reinforcement as often as they look to their own families. Some children who do not learn to combat LONELINESS by fitting into a peer group may develop emotional problems later in life. These children who feel different from their peers may endure particular stresses as they work toward fitting in. Such children may be those who are in recently divorced families, recently merged families with two sets of parents, or adopted children of single parents. However, there are children, when there are no extenuating circumstances, who are born loners and shun the values of their peers. For adults, the increasing mobility that often cuts them off from family and longtime friends has
272 peptic ulcer made the development of peer relationships at work and in other social and community activities extremely important. Peer Pressure Peer pressure is the influence of the peer group on the individual. It begins in adolescence, because teenagers want to belong to a group. Teenagers react to the physical changes they are going through, as well as their changing responsibilities and experiences by close bonding with those in their own age group. Music, language, and clothing are held extremely important by the peer group. The rallying cry of teenagers often is “everybody’s doing it.” Parents frequently become stressed by this peer pressure on their youngsters. They may also fear that the influence of friends may lead their children to genuinely damaging activities such as experimenting with drugs, irresponsible sexual activity, criminal behavior, or dropping out of school. Peer pressure doesn’t end with the teens but becomes more subtle in the ways it affects adults. It may be caused by ADVERTISING that brings the “keeping up with the Jones” philosophy that everyone else on the block has one; it may arise from the COMPETITION generated by the BABY BOOMERS who influenced their generation by placing a high value on possessions, or it may be human nature that among peers there will always be leaders who have the power to influence. See also PARENTING; PUBERTY.
peptic ulcer Ulcers in the part of the digestive tract where gastric (stomach) secretions are present are known as peptic ulcers. They may occur in the esophagus, stomach, or duodenum. STRESS may create an opportunity for peptic ulcers to develop because it can cause people’s stomachs to churn out excess gastric acid. However, doctors now believe that infection by the bacterium Helicobacter pylori is the primary cause of many ulcers. The symptoms of peptic ulcers sometime disappear for periods of days, weeks, or months, only to reappear, often after a person has become emotionally tense or nervous, or has picked up an infection that disturbs the chemical balance of the system. Other symptoms are loss of appetite, belching, feeling bloated, weight loss, nausea, and vomiting.
Every day, an estimated 4,000 Americans develop a peptic ulcer. Heredity can be a factor. If a person’s blood relatives have had ulcers, his or her chance of getting one is increased two or three times. Two additional risk factors are involved in getting ulcers: smoking and overuse of aspirin. Smoking cessation improves the odds against getting an ulcer. Aspirin can adversely affect the protective lining of the stomach and duodenum. Types of Ulcers There are two common types, duodenal and gastric. A duodenal ulcer is a sore that occurs in the duodenum, the first part of the intestine into which the stomach empties. More than 80 percent of all peptic ulcers are found in this area in young or middle-aged people. A sharp, gnawing pain may occur one to three hours after meals and will usually go away when a little food is eaten. Pain may also occur in the middle of the night when food has left the stomach and the ulcer is being bathed in acid. Individuals may often feel extremely hungry, but eating sweets and foods that stimulate the secretion of the acid will probably start or intensify the pain. Gastric ulcers are sores in the lining of stomach. Increasingly, they have become a disease of older people, most often occurring between the ages of 55 and 65; men and women are equally affected. The pain may begin with a meal or soon after and feels relatively constant. It is not likely to be relieved by eating food and may even be made worse with eating. Antacids may not provide any relief. Advice About Diet and Medication Bland diets were once recommended for ulcer patients, but that is rarely the case anymore. A physician may suggest that the sufferer avoid any foods that irritate the stomach, but will probably write a prescription for an ulcer medication. Several pharmaceutical products now are available that are quite successful at eliminating ulcer pain and healing the ulcer itself. Doctors often prescribe antibiotics to kill the H. pylori bacteria. Even when symptoms vanish, taking medication as prescribed is necessary. This is extremely important since the ulcer may not quite be healed, even if the pain has been relieved. Most ulcers generally
performance anxiety 273 TIPS TO AVOID THE STRESS OF LIVING WITH AN ULCER • Avoid foods that cause you to experience ulcer pain. • Avoid alcohol, juice, and caffeinated drinks such as coffee, tea, and cola beverages. • Eat three nutritionally balanced meals each day. • Milk may relieve some pain at first but actually causes the stomach to produce even more acid. Ask your doctor if you should avoid milk. • Take medication exactly as your doctor prescribes it.
heal within four to six weeks of treatment, but they can rapidly recur if the medication is stopped too soon. Duodenal ulcer can be a chronic condition and there is a good chance that the ulcer will recur. Some physicians recommend that certain people take, on an ongoing basis, a reduced dosage of ulcer medication to prevent recurrence. See also RELAXATION. FOR FURTHER INFORMATION:
Digestive Disease National Coalition 507 Capitol Court NE, Suite 200 Washington, DC 20002 (202) 544-7497 (202) 546-7105 (fax) http://www.ddnc.org
perfection The state of being expert, proficient, flawless, without fault or defect. It is an unrealistic goal, a drive toward the impossible and unattainable and is a source of stress for many people. Perfectionists are very achievement-oriented. They are unable to select what is important and have the faulty idea that perfectionism equals quality. The perfectionist faces stress and frustration with failure of any kind, imagined, real, large, or small. The obsession with perfection ultimately results in fragmentation of self, loss of efficiency, sleep deprivation, less time for exercise, rest and quiet meals, increased use of alcohol and drugs and, ultimately, exhaustion. The perfectionist ideal leaves out the important fact that people are only human, and have limitations of body, mind, and spirit.
CONQUER PERFECTIONISM: AVOID STRESS • Look for sources of satisfaction in simple pleasures. • Pursue special interests such as painting, music, gardening, reading, or handicrafts. • Take better care of the personal self with improved diet, rest, and exercise. • Concentrate on the process of achieving a goal instead of the goal itself. • Establish friendship outside work and family. • Set personal priorities and stay with them. • Find time to be alone and become better acquainted with yourself.
Overcoming Perfectionism People who are plagued by the need to be perfect and the stresses that are incurred should realize their own limitations and reevaluate personal priorities. They must decide what is important and what is not and set realistic deadlines and shortand long-term goals, and choose values that matter. See also OBSESSIVE-COMPULSIVE DISORDER; SELFESTEEM.
performance anxiety Many people experience extreme stress over any kind of performance because they fear failure, CRITICISM, or not measuring up to real or imaginary standards. Issues of SELF-ESTEEM are involved. Time and energy spent in thinking about their fears may interfere with concentration on preparation and on the performance. For some individuals, performance anxiety may cause loss of sleep, indigestion, DIZZINESS, or even faintness. However, if properly directed, the nervous energy generated by stress before a performance can become an advantage. When focused on the best possible outcome, for example, that there will be a standing ovation, the individual will be challenged to do a good job. Performance anxiety is a common stressor to people who speak publicly before large or small audiences, as well as musicians, actors, and other on- and off-stage performers. Anyone who is the central focus of other people’s attention can experience performance anxiety.
274 performance review Coping with Performance Anxiety Many individuals use MEDITATION and deep BREATHING exercises to reduce stress before performances. Others carry a good luck charm, which provides their anxieties with a placebo-like effect. Some follow certain rituals before every performance: establishing a routine way of getting dressed, avoiding certain foods or beverages (caffeine and alcohol particularly) or taking a walk. For severe cases of performance anxiety, physicians may prescribe medication; however, medications may have side effects. See also PUBLIC SPEAKING; SOCIAL PHOBIA; STAGE FRIGHT.
performance review
Reviews that are held separately from salary reviews and are annual (sometimes biannual) management evaluations of how well employees are doing their jobs. The evaluations, held face-to-face, are a source of stress for both the managers and the employees. According to Dr. Susan E. Brodt, assistant professor of business administration, Duke University, “The process of job evaluations often is so stressful because most companies do not do them correctly.” Brodt researched how some 100 firms do employee reviews and concluded that they may be a waste of time because the important topics were often not discussed. Brodt added that appraisals “generally are conducted too late to change performance, often long after problems occur. They’re anxietyfilled and people tend to avoid sensitive subjects.” Finally and tragically, Brodt continues, they can lead to misunderstandings in which talented employees are fired or forced to leave the company. Chris B. Bardwell, a Chicago-based human resource consultant, argues in favor of performance reviews “because employees need to know areas in which they should improve and also areas where they are having success.” However, it has been reported that when layoffs occur, employees often feel that performance evaluations are either not used at all or are purposely downgraded to justify terminations. One study on termination showed that 75 percent of the survey respondents had received “excellent” or “outstanding” in their last reviews and were still let go. As a management tool, performance reviews are often seen as political devices—inflated to assure maxi-
mum merit raises and deflated to speed up the termination procedure—according to which way the wind is blowing. See also JOB SECURITY; LAYOFFS; MERGERS; WORKPLACE.
Perls, Frederick
See
GESTALT THERAPY.
personality
The sum of all of an individual’s behavioral and emotional tendencies. Personality develops from the interaction of many complex factors, including heredity and environment. Many theorists hold that genetics is more important than environment, while others take the opposite view. Personality characteristics may be predictors of how well an individual copes with the stresses of life. According to studies by psychologist Suzanne O. Kobasa and associates at the University of Chicago, survivors, or people with “HARDINESS,” share three specific personality traits that appear to afford them a high degree of stress resistance: they are committed to what they do, they feel in CONTROL of their lives, and they see change as a challenge rather than a threat. Personality Disorders For some individuals, personality traits and patterns are severe enough to cause them extreme stress and interfere with normal functioning. Such individuals are said to have a personality disorder. Personality disorders usually are recognizable by adolescence or earlier, continue through adulthood, and become less obvious in middle or old age. They involve behaviors or traits that affect recent and long-term functioning. Individuals may have more than one personality disorder at a time. Their patterns of perceiving and thinking are usually not limited to isolated episodes, but are deeply ingrained, inflexible, maladaptive, and severe enough to cause mental stress or anxieties, or interfere with interpersonal relationships and normal functioning. Personality Tests Personality tests are questionnaires designed to determine various traits, assist in psychological research and, at time, determine the suitability of
personal space 275 an individual for a particular field of work or job assignment. Personality tests measure many aspects of an individual’s being, such as how easily she is disturbed by stressors, how she relates to people and her degree of extroversion or INTROVERSION. See also HOSTILITY; TYPE A PERSONALITY; TYPE B PERSONALITY; TYPE C PERSONALITY.
personal protective equipment (PPE) Accessories and clothing designed to provide a barrier against hazards while people work certain jobs. PPE can reduce stress for workers because they feel safer with the devices. Examples of PPE include hard hats, work boots, safety goggles, eye and face protectors, hearing protectors, gloves, and respirators. Many PPE regulations are set by the U.S. Occupational Safety and Health Administration (OSHA), including some to reduce hazards for those who work with chemicals. For example, important OSHA PPE regulations for chemical workers include requirements that employers perform a written hazard assessment, select appropriate PPE to protect workers, and maintain a written record indicating that employees have been properly trained before performing any job task. The training must include understanding when PPE is essential, what PPE is necessary, how to properly put on, remove, adjust and wear PPE, limitations of the PPE, and the proper care, maintenance, and disposal of the PPE. While people may feel safer following these regulations, many employers as well as employees find complying with these regulations an additional source of stress because of necessary paperwork and reports. Despite the protection from PPE, there are ongoing sources of stress involved in their use. Appropriate PPE does not provide a 100 percent guarantee of safety, leaving workers in hazardous areas with varying degrees of stress on their jobs. In addition to using PPE appropriately, workers know that every piece of PPE has limitations. For example, gloves may develop small holes and respirator cartridges may not indicate when they need replacement. personal space
The invisible zone of privacy that individuals unconsciously put between themselves
and other people. Although personal space is something rarely noticed, when it is invaded by someone approaching too closely, people may feel stressed and become anxious, irritated, and even hostile. According to Lisa Davis, in In Health, “We invite others in to our personal space by how closely we approach them, the angle at which we face them, and the speed with which we break a gaze. It’s a subtle code but one we use and interpret easily and automatically, having absorbed the vocabulary since infancy.” Anthropologists have reported that people follow fairly established rules regarding how far apart they stand, depending largely on their relationship to each other. For example, friends, spouses, lovers, parents, and children tend to stand inside a “zone of intimacy,” or within arm’s reach, while a personal zone (about four feet) is comfortable for conversation with strangers and acquaintances. The size needed for personal space depends on many variables, including the individual’s cultural background, gender, and the nature of the occasion. Individuals from North European or British ancestry usually want about a square yard of space for conversation in uncrowded situations. However, people from more tropical climates choose a smaller personal area and are more likely to reach out and touch the occupant of another space. In Mediterranean and South American societies, social conversations include much eye contact, touching, and smiling, typically while standing at a distance of about a foot. In the United States, however, people usually stand about 18 inches apart for a social conversation; while they will shake hands, they tend to talk at arm’s length. Understanding cultural and gender differences in interpretations of personal space is becoming more important as intercultural trade and business transactions escalate. The interpretation of personal space leaves much room for misinterpretation. Consultants have developed businesses interpreting for people of all nationalities the meaning and use of personal space to relieve the possibilities for occurrences of stressful situations. See also ACCULTURATION; CROWDING; MIGRATION. SOURCES: Davis, Lisa. “Where Do We Stand?” In Health, September/ October 1990.
276 pets Padus, Emrika, ed. The Complete Guide to Your Emotions & Your Health. Emmaus, Pa.: Rodale Press, 1994.
pets
Pets reduce the stress of LONELINESS, provide companionship, and give owners a sense of order in their lives. No matter what, the routine of caring for pets provides a distraction from life’s stressful problems and draws the owners out of themselves. According to Health (November–December 1994), 60 percent of American households have a pet. Researchers have found that pets can be important factors in reducing stress and providing positive effects on human health. James Serpell, a zoologist at the University of Pennsylvania says: “People who acquire pets report fewer minor health problems such as colds, flus, and backaches. They tend to think less about their problems and are happier with their lives.” According to a University of Pennsylvania study, blood pressure drops sharply when people simply stroke a cat or dog. A study of 5,741 Australians reported that those who owned pets had cholesterol and triglyceride levels markedly lower than those who did not. Some nursing homes and other institutions may have pets in residence or programs through which pets visit residents or patients. A UCLA study reported that older adults who had pets made fewer visits to doctors than those without. Caring for an animal seemed to make them feel less anxious about their own health. Many dentists keep aquariums in their offices because it seems that dental patients suffer less anxiety if they watch fish in an aquarium before oral surgery. In an effort to learn more about the symbiotic relationship between humans and pets, the American Animal Hospital Association asked pet owners questions about day-to-day interactions with their pet in a pet owner survey. Results from the survey show that: 75 percent of dog owners and 69 percent of cat owners spend 45 to 60-plus minutes each day engaged in activities with their pets; 69 percent of dog owners and 60 percent of cat owners said they give their pets as much attention as they would to their children; 59 percent of the dog owners and 57 percent of the cat owners admitted to having their pet sleep with them or next to or under the bed; and 54 percent of survey respon-
dents claimed that they feel an emotional dependence on their pets. The survey was conducted by AAHA drawn from its membership. Respondents were pet owners from 39 states, the provinces of Canada, and the District of Columbia, who take their pets to AAHA veterinarians. Choosing the Right Pet It is said that the world is divided into “dog people” and “cat people.” Cat owners admire their pets’ independence, graceful shape and movements, and wild instincts. Since cats tend to require less human companionship than dogs, they are ideal for busy people who must be away from home for long periods of time. Dogs, on the other hand, have been called the “yes men of the animal world.” They have an affectionate, emotional nature and an appetite for food, regardless of whether they are really hungry or if it is good for them. Most important, dogs offer unconditional love and act out human behavior, which their more inhibited masters can enjoy vicariously. Stress of Pet Loss The death of a pet can be a devastating and stressful experience. The child who has lost a pet is inconsolable for a time; however, this brush with genuine loss may lead to maturity. Adults who lose pets often are reluctant to express themselves freely about their sorrow because they fear that others will think their behavior is childlike and self-indulgent. The fact that veterinary hospitals now send a sympathy card or letter of condolence on the death of a pet shows the awareness of the stressful effect of a pet owner’s loss. See also GRIEF. SOURCES: American Veterinary Medical Association. Animal Health News and Feature Tips. Summer 1995. Dossey, Larry. “The Healing Power of Pets: A Look at Animal-Assisted Therapy.” Alternative Therapies 3, no. 4 (July 1977). Laskas, Jeanne Marie. “When the Nine Lives Are Over.” Health, March 1997.
pharmacological approach
Therapy for disorders caused or worsened by stress are often treated with a pharmacological approach. In many cases, prescription medications are used in combination with
pharmacological approach 277 psychotherapy, BEHAVIOR THERAPY, or some of many ALTERNATIVE MEDICINE approaches. Prescription medication is often helpful for individuals who have ANXIETY DISORDERS, DEPRESSION, AGORAPHOBIA, PANIC ATTACK AND PANIC DISORDER, OBSESSIVE-COMPULSIVE DISORDER, POST-TRAUMATIC STRESS DISORDER, as well as other disorders. In many cases, use of MEDITATION, BIOFEEDBACK, GUIDED IMAGERY, and RELAXATION therapy continue to be helpful after prescription medication is stopped. While there are many effective techniques for managing stress without medications, the pharmacological approach may be helpful, sometimes just for the short term. Anxiety disorders, like some medical conditions, can be controlled but not cured; chronic conditions require long-term management, often with a combination of alternative therapies as well as pharmacological therapies. The best principle with pharmacological therapy is to use the lowest effective dose for the shortest possible period of time. However, before any medication is taken, an individual should have a thorough medical and psychiatric examination. Categories of Medications There are three major classes of medications used for the disorders discussed in this book: benzodiazepines (BZDs), cyclic antidepressants, and noncyclic antidepressants. Additionally, a number of pharmacological agents are categorized as “other antianxiety medications.” Alcohol is the oldest antistress drug and remains the most frequently used (and misused) nonspecific tranquilizer. BARBITURATE DRUGS have been available since 1903; they are respiratory depressants and are contraindicated in people with respiratory insufficiency. In the 1930s, a series of nonbarbiturate, non-BZD hypnotic drugs were developed. Many of them carried the same problems as the barbiturates and most are no longer available. In 1957 the first BZD, chlordiazepoxide (Librium) was introduced for the safe management of anxiety. Benzodiazepine Drugs BZDs are popular choices in the early 2000s for the pharmacological management of anxiety. Other indications for BZDs include insomnia, seizures, muscles spasms, and the induction of anesthesia.
All BZDs have similar anxiolytic, sedative, and anticonvulsant properties. The length of BZD treatment varies between individuals. Some individuals continue medications for several years. Generally, long-term anxiolytic treatment should continue for at least two weeks after complete remission of symptoms. The dose should then be tapered off, and, if possible, the medication should be discontinued. Should the symptoms return, the medication can be used again but, upon remission, tapered off. Antidepressant Medications Antidepressants usually are not recommended for treating episodic anxiety or even excessive anxiety. However, in cases of depression for which they are prescribed, doses will vary between individuals. Most drugs used to treat depression either mimic certain NEUROTRANSMITTERS (biochemicals that allow brain cells to communicate with each other) or alter their activity. Antidepressants are thought to decrease the activity or concentration of these neurotransmitters, which occurs during expression. The major neurotransmitters involved appear to be NOREPINEPHINE, SEROTONIN, and dopamine. The precise pharmacologic mechanisms of antidepressant drugs, as well as the balances of neurotransmitters in individuals who have depression, still are not entirely understood. As newer, more SOME COMMONLY USED BENZODIAZEPINE DRUGS Trade name
Generic name
Long Acting
Librium Klonopin Tranxene Valium Dalmane Paxipam Centrax Doral
chlordiazepoxide clonazepam clorazepate diazepam flurazepam halazepam prazepam quazepam
Short Acting
Xanax Ativan Serax Restoril Halcion
alprazolam lorazepam oxazepam temazepam triazolam
278 pharmacological approach specific antidepressants are developed, understanding of antidepressants and depression evolves and improves.
ANTIDEPRESSANT MEDICATIONS Trade name
Generic name
Cyclic antidepressants
Historical Development of Antidepressants Antidepressant medications were developed during the 1950s after physicians noted that tuberculosis patients treated with iproniazid sometimes became extremely cheerful. The notion that this elevated mood might be a side effect of the drug led to the development of a class of antidepressants known as monoamine oxidase inhibitors (MAOIs). They were followed by the tricyclic antidepressants and lithium. The three major categories of antidepressants are tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and lithium. There are also “novel” antidepressants. Commonly, antidepressant medications take up to two to three weeks before having a full effect (although side effects may begin immediately). The time elapsing before the drug becomes therapeutic varies with the drug. Antidepressants may have to be taken regularly for months, even years, if their gains are to continue. For some individuals, relapse often occurs upon stopping the drug.
Anafranil Asendin Aventyl, Pamelor Elavil, Endep Ludiomil Norpramine, Pertofrane Sinequan, Adapin Surmontil Tofranil, Janimine Vivactil
Tricyclic Antidepressants Tricyclic antidepressants are so called because the chemical diagrams for these drugs resemble three rings connected together. An example of a tricyclic antidepressant is imipramine, which has been used since the late 1950s. Tricyclics elevate mood, alertness, and mental and physical activity, and improve appetite and sleep patterns in depressed individuals. When given to a non-depressed person, tricyclics do not elevate mood or stimulate the person; instead, the effects are likely to increase anxiety and arouse feelings of unhappiness. Tricyclic antidepressants are generally well tolerated, relatively safe, and cause minimal side effects. Their antidepressant effects, however, often take several weeks to appear; because of this lag, tricyclics are not prescribed on an “as-needed” basis. Some depressed individuals may respond well to one tricyclic, but not at all to another. Due to the time lag of several weeks before any beneficial effects show up, a physician will try first one drug for the time needed, and then, if results are not
noticeable, prescribe another tricyclic, and give it several weeks. Such trials, with their waiting and uncertainty, may lead to some anxiety and stress for both the individual and physician. Some of the more well-known tricyclic antidepressants (and their trade names) are shown in the accompanying chart. Side effects of tricyclic antidepressants. Side effects of tricyclic antidepressants include excessive dry mouth, sweating, blurred vision, HEADACHE, urinary hesitation, and constipation. Drowsiness and DIZZINESS, as well as vertigo, weakness, rapid heart rate, and reduced blood pressure upon standing upright are likely to occur early on, but usually disappear within the first several weeks. Tricyclics should be used cautiously in persons with heart problems. Drug interactions and cautions. Tricyclic antidepressants and MAO inhibitors are not recommended to be combined except under unusual circumstances. A common drug interaction involves the combination of tricyclics and alcohol, and possibly other
clomipramine amoxapine nortriptyline amitriptyline maprotiline desipramine doxepin trimipramine imipramine protriptyline
Monoamine oxidase inhibitors (MAOIs)
Eldepryl Eutonyl Marplan Nardil Parnate
selegiline/deprenyl pargyline isocarboxazid phenelzine tranylcypromine
Examples of “Novel” antidepressants
Desyrel Prozac Wellbutrin
trazodone fluoxetine bupropion
pharmacological approach 279 COMMONLY USED TRICYCLIC ANTIDEPRESSANTS Trade name*
Generic name
Anafranil Asendin Aventyl Elavil Emitrip Endep Enovil Janimine Norfranil Norpramin Pamelor Sinequan Surmontil Tipramine Tofranil Tofranil-PM Vivactil
climipramine amoxapine nortriptyline amitriptyline
imipramine desipramine doxepin trimipramine
protriptyline
*Trade names as used in the United States.
sedatives, as tricyclics enhance effects of these substances. In large doses, use of other anticholinergic drugs (those that block effects of acetylcholine, a chemical released from nerve endings in the parasympathetic division of the autonomic nervous system) may interfere with actions of histamine, serotonin, and norepinephrine. Side effects may include slurred speech, confusion, hallucinations, and memory deficits, particularly short-term memory impairment. Monoamine Oxidase Inhibitors (MAOIs) MAO inhibitors (MAOIs) are primarily used for individuals who have not responded adequately to tricyclic antidepressants. These drugs are generally considered somewhat less effective than the tricyclics, and, due to a wider range of potential and often unpredictable complications, use is limited. However, MAOIs may be prescribed for certain types of depressions and generalized anxiety disorders and are used to help individuals who have panic attacks. When a tricyclic antidepressant is tried and discontinued because of ineffectiveness, a gap of several days is recommended before the monoamine oxidase inhibitor is tried. In the reverse case, where
the MAOI is ineffective and is to be replaced by a tricyclic, a much longer period of two weeks between medications is recommended. Interactive effects. A drawback of the MAOIs, as a group, is that they may lead to unpredictable and occasionally serious interactions with some foods and drugs. For example, combining MAOIs with a class of drugs called sympathomimetic drugs may lead to serious complications; common nasal decongestant sprays often include phenylpropanolamine or phenylephrine, both sympathomimetics. Also, cough and cold preparations or any preparation not specifically recommended by a physician should be avoided. The pain drug Demerol should not be given with MAOIs, but other pain relieving drugs, for example, morphine, can safely be used. Individuals taking MAOIs must avoid the amino acid tyramine or they may experience a dangerous rise in blood pressure. Tyramine is present in many foods, including alcoholic beverages, cheese, liver, lima beans, and beverages containing caffeine and chocolate. A side effect of MAOIs is that they lower blood pressure, an effect not well understood by researchers; one MAOI, pargyline, is used to treat hypertension. Lithium Lithium is effective in individuals who have both depression and mania and in preventing future episodes. It acts without causing sedation, but, like the tricyclics and MAO inhibitors, requires a period of use before its actions take effect. Side effects of lithium may rule it out for use as an antidepressant; there may be nausea and vomiting, muscular weakness, and confusion. Other Treatments for Depression (Xanax) may lift depression, although it is primarily a drug used to treat anxiety and panic disorder. In some individuals, alprazolam has shortened or interfered with panic attacks and also induced sleep. In depressed individuals with a high level of anxiety, alprazolam may be added to tricyclic antidepressants. ALPRAZOLAM
Development of “Novel” Antidepressant Medications In the past several decades, while conventional antidepressants have been helpful for many indi-
280 phobia viduals, limitations of these antidepressants have been noted, namely their lack of specificity of action, delayed onset of action, side-effect profile, and potential for lethality in overdose. Approximately 20 percent to 30 percent of depressed persons do not respond to traditional antidepressants. During the late 1980s and 1990s, the emergence of newer antidepressants, such as fluoxetine and bupropion, offered the advantages of antidepressants with fewer side effects and less potential for lethality in overdose. However, research has shown that both of these agents have unique side effects. Their overall efficacy appears to be no greater than conventional antidepressant treatments, and they also have a delayed onset of action. The goal of recently developed antidepressants is to act faster and more powerfully than previously used antidepressants, with less frequent and less severe side effects and with more ability to target an individual’s specific type of depression. Newer antidepressants are unicyclic, bicyclic, or of other molecular configurations. Where tricyclics and MAOIs are understood to influence chemicals known as neurotransmitters, the newer antidepressants are technically classified by their preferential influence over individual neurotransmitters—norepinephrine, serotonin, or dopamine. Fluoxetine. Fluoxetine (Prozac), one of the “novel” antidepressants, was introduced in the United States in 1988. Fluoxetine is part of a class of selective serotonin reuptake inhibitors (SSRIs) with low toxicity and free of many side effects attributed to tricyclic antidepressants. Fluoxetine is not sedative, has no anticholinergic side effects, and does not promote weight gain. Another SSRI, Sertaline, has similar advantages. Like other antidepressant drugs, fluoxetine does not help everyone with depression. It has its own unique side effects, including possible nausea and weight loss, both usually time limited, insomnia, and anxious agitation that occurs rarely and is doserelated. Most people adjust to these side effects. Other Antianxiety Medications Beta-blockers. Beta-blockers (beta-adrenergic receptor antagonists) are frequently used in treating hypertension, angina, and migraine headaches. They are occasionally used to help individuals with symptoms of anxiety such as rapid heartbeat,
tremor, tingling, perspiration, blushing, and chest constriction. A number of beta blockers are effective in treating both generalized anxiety and situationally produced anxiety, such as SOCIAL PHOBIA and PERFORMANCE ANXIETY. Buspirone. Buspirone (trade name: BuSpar), is considered a “novelty” antianxiety agent and is pharmacologically unrelated to BZDs or other anxiolytics. It is popular because it causes less sedation and has less potential for dependence than other anxiolytics. However, there is a four-week lag in efficacy; with BZDs individuals notice a rapid onset of improvement. See also AFFECTIVE DISORDERS; BENZODIAZEPINE DRUGS; EXOGENOUS DEPRESSION; HERBAL MEDICINE; IMMUNE SYSTEM; MANIC-DEPRESSIVE DISORDER; MINDBODY CONNECTIONS; PSYCHOTHERAPIES; VALIUM. SOURCES: Appleton, William S. Prozac and the New Antidepressants: What You Need to Know about Prozac, Zoloft, Paxil, Luvox, Wellbutrin, Effexor, Serzone, and More. New York: Plume, 1997. Carlin, Peter. “Treat the Body, Heal the Mind.” Health. January/February 1997. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001. Sachs, Judith. Nature’s Prozac: Natural Therapies and Techniques to Rid Yourself of Anxiety, Depression, Panic Attacks and Stress. Englewood Cliffs, N.J.: Prentice Hall, 1997. Turkington, Carol. Making the Prozac Decisions: A Guide to Antidepressants. Los Angeles: Lowell House, 1994. Wilkinson, Beth. Drugs and Depression. New York: Rosen Publishing Group, 1994.
phobia
An irrational, intense fear of an object or situation and a strong desire to avoid the feared object or situation. Most people have minor fears, for example, experiencing some ANXIETY when unable to avoid contact with bugs, bees, and other undesirable encounters. However, when a fear interferes with normal social function, causes significant distress, and is out of proportion to any real or apparent danger, it is considered a phobia. Phobia sufferers are subject to a great deal of stress because they cannot explain or understand their fear. Nor can they voluntarily control their anxiety response and their need to avoid the dreaded stimulus or situation. Phobic reactions that occur when the phobic stimulus appears include: persistent and irrational
phobia 281 panic, dread, horror or terror; rapid heartbeat, shortness of breath, trembling and overwhelming desire to flee the situation; and avoidance of the situation. Phobias are classified by the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) as the most common form of ANXIETY DISORDER. People of all ages, at all income levels, and in all geographic locations suffer from phobias. Between 5.1 percent and 12.5 percent of Americans suffer from phobias. Broken down by age and gender, phobias are the most common mental health concern among women in all age groups and the second most common illness among men over age 25. Categorizing Phobias Phobias cannot be neatly classified because fear of almost any situation can occur and may be associated with any other psychological symptoms. However, in a general way, phobias can be classified as: Specific phobias, also known as simple phobias. Specific phobias are characterized by a persistent, irrational fear of, and compelling desire to avoid, specific situations or objects. The category of specific phobias contains an endless list of fears, as almost any object or situation can be phobic for any given individual. Commonly recognized specific phobias relate to particular animals (dogs, rats, mice, birds, spiders, and snakes); enclosed spaces (claustrophobia), such as being in an elevator or sitting in the middle of a theater row; darkness; heights; or thunderstorms. Some specific phobias have to do with transportation, such as driving across bridges, riding in trains, or flying in airplanes. Phobias related to the sight of blood or injury are unique types of specific phobias. Unlike other specific phobias, which cause increased pulse and other physiological signs of arousal, blood and injury phobias produce lower pulse and blood pressure, and bring on fainting spells. A person who has a specific phobia experiences stressful physiological symptoms and behavior typical of many phobic disorders. However, because these fears are so specific, the individual can usually manage to avoid contact with the object of their phobia. On the other hand, individuals who fear common situations, such as riding in elevators
or going over bridges, may not easily avoid these stressful stimuli. How simple phobias start is not well understood. Researchers differ in their explanations; some report that direct conditioning—for example, a traumatic event—is an important factor, while others say that indirect learning experiences or exposure to negative instructions and vicarious experiences are also influential. Opinions vary regarding effects of family influences on specific fears. While some experts say that the majority of simple phobics come from families in which no other member of the family shares the same fear, some studies have found relatively strong associations between the fears of mothers and children. Many simple phobics are dependent or anxious individuals, and their family backgrounds may have contributed to these characteristics. Individuals who have simple phobias may not recall the origin of their fear. Treatment of the phobic symptom, however, does not have to wait until the origin is uncovered. Specific phobias can begin at any age. However, certain phobias are more common among certain age groups. For example, infants often fear loud noises and strangers. Fear of animals, which is prevalent in children between the ages of nine to 11, stays with many girls after age 11 but disappears in most boys. Fear of aging occurs most commonly in people over age 50. Social phobia involves fear of being scrutinized by others. People with SOCIAL PHOBIAs may fear making mistakes, being criticized, and making fools of themselves. They also may fear eating or making a speech in public, using public toilets, writing in public, and making complaints. Because of the fear of interacting with the opposite sex, strangers, or aggressive individuals, social phobics are stressed when they are in social or business situations such as parties, meetings, and interviews. Some individuals will participate in a particular activity only when they cannot be seen—for example, swimming in the dark. Social phobias develop over many months or years, but sometimes a precipitating event can be determined. Social phobics have ongoing problems with excessive stress, generalized anxiety, dependence, and DEPRESSION. Sweating, fainting, blushing, and vomiting may all be symptoms of social phobia.
282 phobia Usually social phobias begin in a range from 15 to 30 years of age. They tend to persist throughout adulthood, unlike specific or simple phobias, which tend to diminish as the individual enters young adulthood. Many such individuals have traits that interfere with social and marital adjustment. Some social phobics attribute their fears to direct conditioning, some to vicarious factors, and some to instructional and informational factors; direct negative learning experience may play an important role. Development of social phobias may be influenced somewhat by parental behavior. For example, parents who have few friends and are socially anxious in the presence of others may influence their children to react in similar ways. Also, the presence of anxiety in children is often associated with criticism and verbal punishment. Agoraphobia. Possibly the most stressful and serious of the phobias. Agoraphobics are afraid to leave a safe place such as their home or be apart from a safe person such as a spouse or close relative. Such separations cause intense anxiety and panic. A small percentage of agoraphobics remain housebound, sometimes for many years. Symptoms of AGORAPHOBIA include a wide range of avoidance behaviors, including a fear of entering public places or open spaces, traveling, social interaction, and even being alone. Agoraphobics often have physiological symptoms such as palpitations, lightness in the head, weakness, atypical chest pain, and difficulty in breathing. Some agoraphobics have panic attacks. Agoraphobics express fears of losing CONTROL, going insane, embarrassing themselves, and dying. Phobias of internal stimuli. These are fears that develop within the individual without reason. As an example, fear of dying from an illness, such as cancer, heart disease, or venereal disease, for which there are no physical symptoms. Some of these fears, which occur in both sexes, may be regarded as an extreme form of hypochondria. Often characteristic of depressive illnesses, these phobias improve when the depression improves. Obsessive phobias. Examples of obsessive phobias are fear of harming people or babies, fear of swearing, or a fear of contamination that leads to obsessive hand washing and cleaning. Such phobias usually occur along with other obsessive-compulsive symptoms.
Treatment of Phobias Many forms of therapy, ranging from BEHAVIOR THERAPY to psychoanalysis, are used by qualified psychiatrists, psychologists, social workers, and other mental health professional to treat phobias. In behavior therapy, the therapist focuses on the symptoms and attempts to change the physiological reactions. There are phobic people who have good results with exposure therapy. They are able to face their feared object or situation and, as a result, are desensitized. Many others are helped with BIOFEEDBACK, RELAXATION, GUIDED IMAGERY, and MEDITATION therapies. Sometimes antianxiety drugs and a variety of other medications can help people face their phobic situations and overcome them. Pharmacological treatment for phobias varies with individuals and should be used only with supervision by a physician or mental health professional. See also ALTERNATIVE MEDICINE; OBSESSIVE-COMPULSIVE DISORDER; PANIC ATTACKS AND PANIC DISORDER; PERFORMANCE ANXIETY; PHARMACOLOGICAL APPROACH; PSYCHOTHERAPIES; PUBLIC SPEAKING. FOR FURTHER INFORMATION:
American Psychiatric Association 1400 K Street NW Washington, DC 20005 (202) 692-6850 http://www.psych.org Anxiety Disorders Association of America National Mental Health Association 1021 Prince Street Alexandria, VA 22314-2971 (800) 969-6642 (toll-free) (703) 684-7722 (703) 684-5968 (fax) http://www.nmha.org SOURCES: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association, 1994. Bourne, Edmund J. The Anxiety & Phobia Workbook. Oakland: New Harbinger Publications, 1995. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Monroe, Judy. Phobias: Everything You Wanted to Know, But Were Afraid to Ask. Springfield, N.J.: Enslow Publishers, 1996.
placebo effect 283 Nardo, Don. Anxieties and Phobias. New York: Chelsea House, 1992.
physician-assisted suicide
See
END-OF-LIFE CARE.
physicians Stress affects physicians, just as it does members of any other occupational group. An increasing number of American physicians are becoming employees in managed care systems, and this possibly means that they will have less AUTONOMY and less CONTROL over their time management. Some physicians will change their profession entirely or will find other work in the health care field, such as medical administrators, government analysts, or health journal editors. According to Peter Orton, in Canadian Family Physician, among family physicians, stressors predicting job dissatisfaction and lack of mental wellbeing have included the demands of the job and patient expectations, interference with family life, constant interruptions at work and home, practice administration, and greater external management of the profession. Stress has effects on physicians, staff, family, and patients. Among physicians, stress is a leading cause for SUICIDE, accidental poisoning, alcoholism, liver disease, substance abuse, and ANXIETY and DEPRESSION; marital problems and accidents increase because of these factors. The effect on physicians’ families often goes unnoticed until it is too late. While spouses believe their partners are emotionally drained, physicians deny it. Spouses often comment on physicians’ inability to discuss emotional problems and complain that they are essentially left to bring up their children as single parents. This has an effect on marital relationships, particularly when it is a relationship between two doctors. Staff and patients also suffer from physicians’ stress. Staff may be blamed for the physicians’ mistakes and be the butt of their short tempers. Patients complain of being kept waiting for doctors’ appointments and hurried through their examinations. Still, there are many benefits in being a physician, particularly a family physician. Historically, they have had autonomy, job security, and career opportunities. Their work allows for a regular sharing of experiences with colleagues.
Preventing Stress Once a stress-related problem is recognized by physicians, they can try to reduce demands on their time. Stressors should be identified at an early stage and practical steps taken to reduce them. In some cases, physicians need to improve their organizational skills, become proactive, and take control. This involves using tools of human resource management, time management, delegation, COMMUNICATION, and teamwork. COPING mechanisms can be improved by seeking support in the WORKPLACE and at home. Time should be allocated for family, exercise, and relaxation. SOURCES: Chambers, R. “Health and Lifestyle of General Practitioners and Teachers.” Occupational Medicine 42, no. 2 (1992): 69–78. Orton, Peter. “Stress and Family Physicians.” Canadian Family Physician 41 (February 1995).
placebo effect The therapeutic benefit of a chemically inactive substance that has no medicinal effect but that superficially resembles an active pharmacological effect or therapy. The word placebo is Latin and means “I shall please.” Patients believe that taking a placebo will have positive effects on their health, and this can be an important factor in relieving the stresses involved in many illnesses and conditions. Usually the word placebo refers to a pill or capsule that has no pharmacologically active substance; however, the term placebo effect is not restricted to therapy with an inert pill. It applies also to therapeutic results, both psychological and physiological, that occur by any method that has no demonstrable specific action on the disorder being treated. Sometimes placebos induce reactions because of the power of suggestion. For example, individuals enrolled in a “double-blind” study do not know if they are taking a placebo or the real drug, and many improve because they think they are taking an active substance. The placebo effect was described in The Healing Mind, by Irving Oyle. “Whatever you put your trust in can be the precipitating agent for your cure.” See also ALTERNATIVE MEDICINE; MIND-BODY CONNECTIONS; PRAYER.
284 plant closings plant closings
See
CORPORATE BUYOUT; COST-CUT-
TING; DOWNSIZING; LAYOFFS; MERGERS.
plastic surgery Any operation carried out to repair or reconstruct skin and underlying tissues that have been damaged or lost by injury or disease, malformed since birth, or changed with aging. Plastic surgery techniques enable an injured or diseased person to regain some sense of SELFESTEEM and remove the stress of coping with the deformity. Operations performed mainly to improve appearance in a healthy person are known as COSMETIC SURGERY. The scope of plastic surgery improved dramatically during the 1990s by the use of microsurgical techniques to join blood vessels, allowing transfer of blocks of skin and muscle from one part of the body to another. See also BODY IMAGE. play therapy
Used in psychotherapy as a treatment for stress-related problems in children. It is based on the theory that all play in children has some symbolic significance. Children choose from toys, such as dolls and puppets, and drawing and art materials, such as clay and finger paint, and games. These activities mirror children’s emotional life and fantasies, enabling them to act out feelings and thoughts that cause anxiety and stress. Observing them at play helps the therapist diagnose the source of the child’s stresses. Play therapy is also referred to as analytical play therapy and ludotherapy. See also PSYCHOTHERAPIES.
plumbing
A stressful occupation because it involves mending burst pipes, cutting openings in walls and floors, and often using hand and power tools. Working hazards including falling from ladders, scaffolds and roofs, and slipping and falling on wet and slippery surfaces. Plumbers experience stress because of cuts, stabs, bruises, and finger crushing from hand tools and machinery, and being hit on the head with pipes, particularly in CONFINED SPACES or in low-ceiling basements and passageways. Plumbers are also exposed to the stresses of biological hazards, such as many microorganisms and parasites in sewage, stagnant water, and unsani-
tary installations. Additionally, they work in excessively damp, cold, or hot places and may experience wrist problems due to overexertion during threading and cutting work, and calluses on the knees (plumber’s knee) because of prolonged work while kneeling. They may have burns from hot or corrosive liquids from burst pipes, and burns from portable blowtorches used for soldering. Additional hazards come from electric shock and electrocution from portable lamps and electric tools, and fires and explosions as a result of using mobile electric lamps or tools in confined spaces. Plumbers may experience stress from chemical hazards such as contact dermatitis from exposure to various components of draining and sewage liquids, from exposure to solvents and other components of cleaning fluids, and irritation of the respiratory system and eyes from exposure to acids, alkalis, and various corrosive liquids used to unclog pipes. They might also face oxygen deficiency or exposure to gases when working in confined spaces, irritation to the respiratory tract, and possible damage to lungs from exposure to ASBESTOS, mineral fibers and other fibers when applying or dismantling piping insulation or pipes. See also CHEMICAL HAZARDS; ELECTRICITY; SLIPS, TRIPS, AND FALLS.
poison ivy
Poison ivy (including sumac and oak) can cause severe skin rashes and is the most common cause of allergic reactions in the United States. It affects 10 million to 50 million American every year and can be a very stressful experience. Itching, burning, and blistering cause stress for poison ivy sufferers; they also experience stress from knowing that they can get poison ivy without coming in contact with the plant. The colorless or slightly yellow oil (urushiol) that oozes from any cut or crushed part of the plant, including the stem and the leaves, is easily spread. Sticky, and virtually invisible, it can be carried on the fur of animals, on garden tools and sports equipment, or on any objects that have come into contact with a crushed or broken plant. The effect on the skin can be neutralized to an inactive state by water. Once the urushiol touches the skin, it penetrates in a few minutes. In those who are sensitive, a reaction appears in the form of a line or streak of
postpartum depression 285 rash, sometimes resembling insect bites, within 12 to 48 hours. Redness and swelling will be followed by blisters and severe itching. It is additionally stressful because the rash can affect almost any part of the body, especially areas where the skin is thin; the soles of the feet and palms of the hands are thicker and less susceptible. First-aid treatment includes thorough cleansing of the infected area, sponging with alcohol, and applying calamine lotion. Severe reactions should be reported to a physician, who may prescribe corticosteroids drugs to be taken by mouth or injection. Prevention is the best cure. One should be watchful for the plants whenever out of doors. If going to areas where poison oak or ivy is likely to grow, wear protective clothing. See also ALLERGIES. FOR FURTHER INFORMATION:
American Academy of Dermatology 930 Meacham Schaumburg, IL 60172-4965 (708) 330-0230
police Police and other law enforcement personnel have jobs that are inherently stressful and dangerous; they face unique hazards and are more likely than workers in other fields to die violently, for example, suffering a fatal incident while pursing criminals or in highway chases. Law enforcement officers perform a range of duties from apprehending criminals to issuing traffic citations. Detectives may work as plainclothes investigators, collect evidence for criminal cases, and participate in raids and arrests. Special agents employed by federal government agencies conduct complex criminal investigations, do surveillance of criminals, and sometimes infiltrate illicit drug organizations using undercover techniques. Law enforcement personnel can reduce their sources of stress by some degree through good training, teamwork, and special equipment such as bullet-resistant helmets and vests. See also VIOLENCE. politically correct
Term coined in the early 1990s that refers to a sensitivity about many causes, including the needs and problems of minorities and disabled people, avoidance of sexist and racist terms
and attitudes, and respect for animals and the environment. In an effort to be “politically correct,” politicians, government officials, and organizational leaders are adding an additional stressor to their own activities as well as those of their constituents who must use an additional caution in their actions. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001.
postpartum depression
DEPRESSION immediately following the delivery of a baby. It is probably caused by hormonal changes after the birth as well as stressful psychological factors. Postpartum depression ranges from extremely common and short-lived “maternity blues” or “baby blues” to a state of serious depression in which the mother may have to be hospitalized. Some women become depressed after CHILDBIRTH because they fear being a parent or being a failure as a parent. They feel less loving toward the baby than they think they should and feel sexually unattractive to their mates because their bodies have not regained normal shape. Women may be overwhelmed with chores of a new baby, and sleep deprivation, caused by the baby’s frequent waking during the night, can lead to additional stresses of irritability and chronic fatigue. If women go from careers outside the home into full-time motherhood, they may also suffer a loss of SELF-ESTEEM. With reassurance and support from family and friends, this type of “blues” lasts only two or three days. However, in about 10 percent to 15 percent of women the depression is more marked and lasts for weeks. There is a constant feeling of tiredness, difficulty sleeping, restlessness and loss of appetite. These symptoms are more likely to happen when there is a strained relationship with the father, financial or other concerns, no family support or a personality disorder. First-time mothers, single mothers, or women who suffered from depression during PREGNANCY are likely sufferers. The condition may clear up on its own or may be treated with antidepressant drugs. Persistent, severe depressions may become major depressions or bipolar (manic-depressive disorders) and require psychiatric treatment.
286 post-traumatic stress disorder post-traumatic stress disorder (PTSD)
ANXIETY
produced by an unusual and extremely stressful event, such as assault, an act of violence, rape, natural disaster, or physical injury. PTSD has been referred to as battle fatigue or shell shock when it occurred from military combat. Often PTSD surfaces several months or even years later, although its symptoms can occur soon after the event. Sufferers characteristically reexperience the trauma in painful recollections or recurrent DREAMS or nightmares. Some have diminished emotional responsiveness (“numbing”), feelings of estrangement from others, insomnia, disturbed sleep, difficulty in concentrating or remembering, GUILT about surviving when others did not, avoidance of activities that cause recollection of the traumatic event, and intensive thoughts related to the event. Avoidance behavior also affects sufferers’ relationships with others because they often avoid close emotional ties with family, colleagues, and friends. Sometimes the re-experience comes as a sudden, painful rush of EMOTIONS that seem to have no cause. These emotions may be anger or intense fear. Some PTSD sufferers endure anxiety and panic attacks as a result. During panic attacks, their throats tighten, BREATHING and heart rate increase, and they may feel dizzy and nauseated. DISORDER
Overcoming PTSD Individuals who have PTSD can learn to work through the trauma and pain and resolve their anxieties. Individual psychotherapy is one of many useful therapies. PTSD results, in part, from the difference between the individual’s personal values and the reality of what he/she witnessed or experienced during the traumatic event. Psychotherapy helps the individual examine his/her values and behavior with the goal of resolving the conscious and unconscious conflicts that were created. Additionally, the individual works to build SELF-ESTEEM and self-control, develops a reasonable sense of personal accountability, and renews a sense of integrity and personal pride. In many cases, family therapy is recommended because members of the family may affect and be affected by the PTSD sufferer. Some spouses and children report that their loved one does not com-
municate, show affection, or share in family life. The therapist can help members of the family recognize and cope with the range of emotions they feel and, when needed, help them improve their communication skills and learn techniques for parenting and stress management. A newer technique for PTSD involves “rap” groups, in which survivors of similar traumatic events are encouraged to share their experiences and reactions. Group members help each other realize that many people have gone through the same thing and experienced the same emotions. Over time, the members will experience an improved self-image and self esteem. Antidepressant medications have also been reported to reverse symptoms of PTSD. National Center for Post-Traumatic Stress Disorder The National Center for Post-Traumatic Stress Disorder was established in 1989 within the U.S. Department of Veterans Affairs to carry out multidisciplinary activities in research, education, and training. The center focuses on PTSD and other psychological and medical consequences of traumatic stress. The Executive Division in White River Junction, Vermont, directs the overall operations of the center. This division also houses the PTSD Resource Center, the largest collection of PTSD materials in the world, and manages the Web site. In West Haven, Connecticut, the Clinical Neurosciences Division specializes in pharmacotherapy, neurobiology, brain imaging, and genetic epidemiology. In Menlo Park, California, the Education and Clinical Laboratory specializes in education and dual diagnosis treatment, and houses a sleep laboratory. The Women’s Health Sciences Division in Boston, Massachusetts, emphasizes women veterans’ issues, including physical health, sexual assault, and Gulf War syndrome. In Honolulu, Hawaii, the Pacific Island Division has special expertise in ethnocultural issues. Although the center was created in response to a congressional mandate to address the needs of veterans with military-related post-traumatic stress disorder, the needs of others are also considered. PTSD is no longer considered a problem limited to
prayer 287 Vietnam War veterans; it is recognized as a major public behavioral health problem for military veterans and active duty personnel subject to the traumatic stress of war, dangerous peacekeeping operations, and interpersonal violence. Also, because of the prevalence of assault, rape, child abuse, disasters, and severe accidental and violent trauma among civilians, PTSD is also a public health problem in the general population. Estimates are that PTSD affects more than 10 million American children and adults at some point in their lives. While the center does not provide direct clinical care, the center’s research, educational, and consultation initiatives have positively affected the clinical treatment of veterans with PTSD. Also, the center’s efforts have contributed to the world’s most comprehensive body of literature on the subject. Since its inception, the center has made significant progress in furthering the understanding and treatment of PTSD both within the Veterans Administration and in the general population. As a leading authority on PTSD, the center serves and collaborates with many agencies and constituencies, including veterans and their families, government policy makers, scientists, researchers, doctors, journalists, and the lay public. See also COMMUNICATION; CONTROL; COPING; LISTENING; PSYCHOTHERAPIES. FOR FURTHER INFORMATION:
Anxiety Disorders Association of America National Center for Post Traumatic Stress Disorder VA Medical Center White River Junction, VT 05001 (802) 296-5132 E-mail:
[email protected] http://www.ncptsd.org National Institutes of Mental Health 5600 Fishers Lane Rockville, MD 20857 (301) 443-2403 U.S. Veterans Administration Mental Health and Behavioral Sciences Services 810 Vermont Avenue NW, Room 915 Washington, DC 20410 (202) 389-3416
SOURCES: Catherall, Donald Roy. Back from the Brink: A Family Guide to Overcoming Traumatic Stress. New York: Bantam Books, 1992. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health, 2nd ed. New York: Facts On File, 2001. Porterfield, Kay Marie. Straight Talk about Post-Traumatic Stress Disorder: Coping with the Aftermath of Trauma. New York: Facts On File, 1996.
powerlessness
Lacking the authority or capacity to act. It is a stressful situation for most people because they feel that they lack CONTROL and know that they cannot significantly affect the outcome of a situation. For some people, feelings of powerlessness underlie DEPRESSION, suspiciousness, and aggressive behavior. Powerlessness is also associated with withdrawal, passivity, submissiveness, apathy, increased frustration, agitation, ANXIETY, AGGRESSION, acting-out behavior, and even violence. A person who feels powerless may be unable to set goals or follow through on activities relating to school, work, or family life. This feeling can be induced by illness and hospitalization, because such events compromise a sense of self. Strategies to help people who feel powerless include teaching them to gain control of a situation and helping them to develop better means of COPING with the stressors in life. See also AUTONOMY; SELF-ESTEEM. SOURCE: McFarland, Gertrude K., and Mary Durand Thomas. Psychiatric Mental Health Nursing. Philadelphia: J. B. Lippincott, 1991.
prayer Act of the individual speaking to God in adoration, confession, supplication, or thanksgiving. According to researchers, repeating a prayer can help reduce stress and improve physical ailments by lowering the heart rate, breathing rate, and brain wave activity. At a national conference on faith in Boston in 1995, experts said that the idea of prayer is gaining support among cost-conscious health organizations. “The supposed gulf between science and spirituality in healing does not always exist,” said HERBERT BENSON, M.D., a Harvard Medical School professor. Benson explained that scientific studies have
288 pregnancy demonstrated that, by repeating prayers, words, or sounds and passively disregarding other thoughts, many people are able to trigger a specific set of beneficial physiological changes. Studies show that this RELAXATION response decreased visits to health maintenance organizations by 36 percent. Another internationally known authority in the field of mind-body medicine, LARRY DOSSEY, M.D., said that the power of prayer to heal should no longer be regarded as just a matter of faith. Dossey is a physician who has practiced medicine for more than 20 years. He has become a believer, not in RELIGION, but in a growing body of research suggesting that prayer is an important scientifically verifiable factor in healing. “I have come to regard it as one of the best-kept secrets in medical science,” he says in his book, Healing Words: The Power and the Practice of Medicine. See also ALTERNATIVE MEDICINE. SOURCES: Dossey, Larry. Healing Words (The Power of Prayer and the Practice of Medicine), San Francisco: Harper, 1993. ———. Meaning and Medicine (Lessons from a Doctor’s Tales of Breakthrough and Healing). New York: Bantam/Doubleday, 1991.
pregnancy
The period while a woman is carrying an embryo/fetus from conception to birth; it is marked by a cessation of menses. Many women may find that their MOODS are more changeable and that they are subject to mental, emotional, and physiological stresses at this time. They may experience bouts of DEPRESSION, become easily annoyed or angered, feel more lethargic than usual, and be subject to periods of CRYING. Emotional changes are due to hormonal as well as emotional adjustments involved in pregnancy. An important influence in reducing the natural stressors of pregnancy is a supportive emotional environment during and after the pregnancy. While most couples have a positive attitude, others have children to please the grandparents or because “everybody’s doing it.” In some cases, conception occurs in an attempt to save a marriage that is dysfunctional or to deal with anxiety about sterility. There are also anxieties relating to such questions as: Was the child wanted, was an abortion attempted or considered, or are there hereditary
disorders in the family. However, these anxieties usually are replaced by positive feelings as signs of life are experienced and the pregnancy progresses. For many women, an early symptom of pregnancy is morning sickness, which is sometimes considered “imaginary” but is a very real problem for sufferers. Nausea during the first months of pregnancy may be due to a low level of vitamin B6, or may occur because of the natural slowing down of a pregnant woman’s digestive process. When food remains undigested in the stomach for longer periods than normal, nausea and the urge to vomit occurs. Morning sickness usually diminishes or disappears by the time the pregnancy is in the fourth month. Other symptoms of pregnancy that can be troublesome are CONSTIPATION, HEMORRHOIDS, HEARTBURN, urinary tract infections, swollen ankles, BACK PAINS, varicose veins, leg cramps, and breathlessness. Women may cope with the psychological stresses of pregnancy better when they begin participating in “prepared CHILDBIRTH” classes, offered by many hospitals, which teach prospective parents about the physiological changes that occur during pregnancy and labor. These classes provide exercises to help the prospective mothers learn to relax and reduce tension. An example is the popular Lamaze method, named for a French obstetrician, which involves breathing and relaxing methods and massage routines for the expectant mother and her coaching partner right through the birth itself. Men and Pregnancy Couvade (the French word for “hatching”) is the term applied to the range of sympathetic physical changes men go through during their wives’ pregnancy. Some men actually experience such symptoms as nausea, fatigue, back pain, and weight gain as a result of the stresses of anticipated fatherhood. In Western cultures, however, men have a role in pregnancy and often participate in prenatal education classes and the birth event itself. Baby Blues Endocrine changes after childbirth as well as fatigue from being awakened during the night to feed the newborn often lead to POST-PARTUM DEPRESSION, or “baby blues.” Some women become weepy a few days after giving birth. Some who
pregnancy 289 experience clinical depressive symptoms may partially reject the infant and feel withdrawn. This response becomes evident in difficulties in feeding and patterns of mother-child interaction. In most cases, postpartum depression does not last more than two weeks. However, if it persists longer or if a woman develops irrational fears, despair, hopelessness, and violent anger toward the new baby, professional help should be sought. Fears Lead to Stress in Pregnancy Fears of pregnancy stem from both psychological and physical sources. For example, unmarried women fear conceiving and bearing a child out of wedlock, while some married women do not want a child; some fear the pain of childbirth, while others are frightened of dying during childbirth; some fear that their pregnancy makes them unattractive to their husbands, while others are concerned about returning to their original physical appearance. Many women become anxious and embarrassed by the physical symptoms associated with pregnancy. Morning sickness, food cravings, frequent urination, water retention, bloating, and swollen breasts are some of their complaints. First-time mothers may not understand the movements of the fetus and fear that their baby is abnormal or dead. Recent findings about effects on the fetus of the mother’s smoking and alcohol consumption have caused many pregnant women to abstain out of fear that they will have an unhealthy baby. Pregnancy and Sexual Intercourse Marital stress arises for many couples during pregnancy when they become concerned about the advisability of continuing sexual intercourse during pregnancy. In many relationships, partners may fear hurting the fetus or the man may fear hurting the woman. Depending on the course of the pregnancy, gynecologists usually allow women who have no unusual vaginal discharges, pain, or other symptoms, to continue sexual relations until the seventh month. In later months, modifications of coital position are suggested to assure that intercourse will not harm the baby or cause a miscarriage. The United States has the highest rates of teen pregnancy and births in the western industrialized world. According to the National Campaign to Prevent Teen Pregnancy (NCPTP), teen pregnancy
costs the United States at least $7 billion annually. Thirty-four percent of young women become pregnant at least once before they reach the age of 20, about 820,000 a year. Eight in 10 of these pregnancies are unintended and 79 percent are to unmarried teens. Teenage pregnancy may be a source of stress for the young woman, her family, and the community. Teen mothers are less likely to complete high school and only 1.5 percent have a college degree by age 30. Teen mothers are more likely to end up on welfare (nearly 80 percent of unmarried teen mothers end up on welfare), according to the NCPTP. Contraceptive use among sexually active teens has increased but remains inconsistent. Threequarters of teens use some method of contraception (usually a condom) the first time they have sex. A sexually active teen who does not use contraception has a 90 percent chance of pregnancy within one year. Pregnancy Loss Experts say that 20 percent to 30 percent of expectant couples will face the emotional pain and stress of prenatal loss. When a miscarriage occurs very early in a pregnancy, some people think it’s “nature’s way,” and that the couple should put the miscarriage behind them and go on with their lives. Jane Summers, M.D., director, Women’s Mental Health Program, Pennsylvania Hospital, disagrees. “You cannot predict the level of attachment based on the length of pregnancy.” According to Dr. Summers, parents-to-be develop a fantasy of their baby. When pregnancy loss occurs, they lose their fantasy baby: Even though they never got to see their baby smile or hear the baby coo, the child is real to them in many ways. Dr. Summers added: “Pregnancy loss has much in common with other losses and, in some ways, can be more painful. When an adult dies, mourners have memories of the deceased that can be shared. The parents of an unborn infant have only their private hopes and dreams. There are no tangible memories to laugh and cry about with others.” While women may have a harder time dealing with the loss, some men have a particularly hard time, too. Says Martin Rosenzweig, M.D., director, Mood Disorder Programs, Pennsylvania Hospital, “People extend sympathy to a woman in a way
290 pregnancy that may not be extended to a man.” Although not as obvious, men also may have dreams for their unborn child. Often his spousal role may prevent a man from sharing his feelings, because he must be strong for his wife. At the same time, the wife may interpret his silence as not caring. That’s why it is so important for couples to talk to each other about how they feel about the loss. Typically, reaction of couples to the initial loss follows a continuum. First, couples feel numb, empty, and shocked and are often in a state of disbelief. Denial, which may turn to anger or rage, can follow. Next comes a series of “what ifs.” What if the wife hadn’t gone dancing; what if the husband hadn’t taken the wife camping? Would the baby be alive? Though these reactions are unrealistic, they are typical feelings of self-blame. Emotions can be accompanied by physical reactions as well. Couples may notice changes in sleeping and eating habits, or feel anxious or tired. With time most people come to terms with their loss. However, if symptoms continue for too long, professional support can help. A therapist can help
HELPING OVERCOME THE STRESS OF PREGNANCY LOSS • For parents who have experienced a loss: After several weeks have passed, don’t hesitate to seek medical facts to help clarify misconceptions and facilitate your grieving process. • Join a support group and share your experience with others. • Plan how you will spend anniversary dates. • Accept the help and support of family and friends. • Give yourself time to heal. • For friends and relatives of the grieving parents: don’t trivialize the parents’ GRIEF with clichés such as “Don’t worry, you’ll have another.” • Don’t turn away from the grieving couple; try to provide a sympathetic ear and support, except when the couple doesn’t want to talk. • Help with tasks such as minding the grieving couple’s other children, shopping, or preparing meals. • If the baby was named, refer to the name and recognize anniversary dates.
people to come to terms with guilt and anger, and separate reality from perception. Assisted Reproduction Techniques Pregnancy and motherhood without marriage has become more culturally acceptable in some Western countries. Today, couples who cannot conceive can become parents with use of “assisted reproduction” techniques including in vitro fertilization and artificial insemination. Surrogate motherhood is also gaining some degree of acceptance, despite legal complications. Women who delay motherhood into their late thirties or early forties, because of their own or their husbands’ careers or because of the attraction of the single life, face diminished fertility and greater anxiety about possibility of birth defects, which increase with maternal age. However, amniocentesis (testing the amniotic fluid to detect abnormalities in the fetus) can allay some fears of women who postpone motherhood. See also INFERTILITY; UNWED MOTHERS. FOR FURTHER INFORMATION:
American College of Nurse-Midwives 8403 Colesville Road, Suite 1550 Silver Spring, MD 20910 (240) 485-1800 (240) 485-1818 (fax) http://www.midwife.org American College of Obstetricians and Gynecologists 409 12th Street SW P.O. Box 96920 Washington, D.C. 20090-6920 (202) 638-5577 http://www.acog.org National Campaign to Prevent Teen Pregnancy 1776 Massachusetts Avenue NW, Suite 200 Washington, DC 20036 (202) 478-8500 (202) 478-8588 (fax) http://www.teenpregnancy.org Planned Parenthood Federation of America 434 West 33rd Street New York, NY 10001 (800) 798-7092 (toll-free) (210) 541-7800 http://www.plannedparenthood.org
presenteeism 291 SOURCES: Eisenberg, Arlene, Heidi Eisenberg Murkoff, and Sandee Hathaway. What to Expect When You’re Expecting. New York: Workman Publishing, 1984. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Rockwell, Beverly. “Expectant Fathers: Changes and Concerns.” Canadian Family Physician 35 (May 1989): 663–665.
premenstrual syndrome (PMS)
See MENSTRUATION.
presenteeism Showing up for work even if one is too stressed, distracted, or ill to work productively. It is the opposite of ABSENTEEISM. Many workers have concerns such as children, elderly parents, or the health of a loved one, or their own discomforts due to poor health. Reasons for working when ill vary. Some feel they have a commitment to the job including coworkers and company. Others cannot afford to take sick days or go on disability, and others are afraid to lose their job. Sometimes it is a combination of reasons. Their minds are occupied with many random issues and their time may be taken up with phone calls relevant to these situations and not their jobs. There is a faulty assumption that when people are at work they are being productive. The problem of presenteeism is that such workers are a drain on productivity. Peter Schnall, M.D., and Maritza Jauregui, Ph.D., of the University of California, Irvine, characterized presenteeism, or “Lost Work Productive Time” by 1) time not on task, 2) decreased quality of work, 3) decreased quantity of work, and 4) unsatisfactory employee interpersonal factors. The researchers suggested that presenteeism is a larger productivity drain than either absenteeism or shortterm disability. In 1999, the Employee Health Coalition of Tampa, Florida, found that lost productivity form presenteeism was actually 7.5 times greater than productivity loss from absenteeism. A study by the Institute for Health and Productivity Studies at Cornell University, reported in April 2004, found that up to 60 percent of the total cost of employee illnesses comes from presenteeism. The study, supported by the National Pharmaceutical Council, the Cornell Institute, and a private firm, Medstat, used an insurance database on medical conditions and absences of about
375,000 employees over three years. They combined these with published studies on productivity among workers with certain illnesses. The researchers estimated that from 49 percent to 89 percent of the total costs caused by HEADACHES were due to reduced on-the-job productivity, rather than absent employees or health care costs. Workers showing up with ALLERGIES were responsible for an estimated 55 to 82 percent of allergy costs to businesses. Estimates of on-the-job arthritis costs ranged from 35 to 77 percent. In addition to not being mentally present on the job, some employees are afraid of losing their jobs through DOWNSIZING, so they work excessive hours or remain at work in the evenings in order to be seen when there is no work to do. The result is more stress, unhappiness, and poorer performance. To avoid this situation, many employers insist that workers stick to their assigned hours and take vacations at appropriate intervals, and they provide flexible working hours and other destressing techniques. Some employers realize that employees need not only lunch breaks but also a life outside the office. Solving the problem of presenteeism helps workers to achieve a work-life balance. British Telecom checks employee time sheets to identify where long hours are being worked and reminds staff that overtime is not acceptable. The British government is encouraging employers to help reduce stress by requiring employees to take lunch breaks and annual holidays and discouraging them from working long hours and taking work home. In 1998, France conducted an experiment concerning work-life balance by enforcing a new 35hour work-week. The aim was to reduce unemployment by redistributing labor between the overworked and the unemployed. However, employers said the 35-hour week failed to create jobs and was uncompetitive. Unemployment in France remained at 10 percent in 2005. Cary Cooper, professor of organizational psychology and health at Manchester University in the United Kingdom, is credited with coining the term presenteeism to describe the overwork and feelings of job insecurity resulting from downsizing and restructuring in the 1990s. According to Cooper, “The phenomenon of presenteeism, an overwhelming need to put in more hours, or at the
292 presurgical stress very least, appear to be working very long hours, is another dangerous symptom of the explosive degree of pressure in the workplace.” See also FLEXIBLE WORK HOURS; OVERTIME. SOURCES: Andrea, H., et al. “Associations between Fatigue Attributions and Fatigue, Health and Psychosocial Work Characteristics: A Study among Employees Visiting a Physician with Fatigue.” Occupational Environmental Medicine 60 (2003): 99–104. Schnall, Peter and Maritza Jauregui. “Work Stressors and Their Cost to Employers.” In The Changing Nature of Work and Workforces. Yelin, Ed, ed., Los Angeles, 2004.
Presurgical preparation is a health care service in which necessary information is provided to the patient some time before admission. Presurgical preparation has been shown to assist patients in dealing more effectively with surgery. Presurgical preparation has been associated with reduced stress, fewer complications, greater satisfaction, shorter time in hospital, and more positive psychological well-being. Such programs have also been effective in reducing pain and discomfort, as well as assuring that the patient follows self-care plans after the procedure. SOURCE:
presurgical stress
Fears about pain, body damage, health, limited function, complications, or even death. When patients understand beforehand what will happen and the possible consequences of any surgery, stress can be reduced to some extent. According to the Canadian Psychological Association, preparing patients for the challenges of surgery is an essential component of overall surgery care. Preparation is now more important than ever because recent health care reforms emphasize efficiency and cost-effectiveness, resulting in shorter hospital stays for all surgical procedures; the number of same-day surgeries has increased.
REDUCE PRESURGICAL STRESS Find out: • When to arrive at the hospital and where to check in • What to bring, particularly if staying overnight • The specific procedure scheduled • Presurgical and postsurgical medications, such as the anesthetic and pain medication • Expectations of how to feel after surgery • Self-care duties and related postsurgical exercise programs • How long to stay in hospital before returning home • How to prepare the home for recovery period after hospital care • A discharge plan, support when leaving the hospital and arriving at home
Canadian Psychological Association http://www.cpa.ca/factsheets/presurgical.htm
privacy protection
See
IDENTITY THEFT.
pro-choice and pro-life
Pro-life is the term usedfor those in favor of upholding the right to life for the developing fetus and who are therefore against abortion; pro-choice is the term used for those in favor of a woman’s right to choose whether or not to have an ABORTION. These terms arose in the United States in the 1970s and by the early 1980s had become central to political debate and an important election issue. Pro-life advocates, along with pro-family advocates who want a return to values based on the family unit, oppose legalizing abortion. Pro-choice advocates believe their position supports the civil rights of all women. The controversy between these groups continued throughout the 1990s, erupting in shootings and bombings by pro-lifers and causing emotional stress for individuals on both sides of the issue.
progressive muscle relaxation Also known as progressive RELAXATION; a stress management procedure in which individuals learn to make heightened observations of what goes on under their skin. They learn to control all of the skeletal muscles so that any portion can by systematically relaxed or tensed by choice. First, there is recognition of subtle states of tension. When a muscle contracts (tenses), waves of neural impulses are generated and carried to the
psoriasis 293 brain along neural pathways. This muscle-neural phenomenon is an observable sign of tension. Next, having learned to identify the tension sensation, the individual learns to relax it. Relaxation is the elongation (lengthening) of skeletal muscle fibers, which then eliminates the tension sensation. This general procedure of identifying a local state of tension, relaxing it away, and making the contrast between the tension and ensuing relaxation is then applied to all of the major muscle groups. As a stress management technique, progressive relaxation is effective only when individuals have the ability to selectively elongate their muscle fibers on command. They can then exercise the self-control required for progressive relaxation and more rationally deal with the stressful situation. See also ALTERNATIVE MEDICINE; BIOFEEDBACK. SOURCES: Jacobsen, E. “The Origins and Development of Progressive Relaxation.” Journal of Behavior Therapy and Experimental Psychiatry 8 (1977): 119–123. ———. Progressive Relaxation, 2nd ed. Chicago: University of Chicago Press, 1983. Lehrer, Paul M., and Robert L. Woolfolk, eds. Principles and Practice of Stress Management, 2nd ed. New York: Guilford Press, 1993.
prostate cancer The prostate is a walnut-sized gland located at the base of the bladder in males. It surrounds a part of the urethra, the tube that carries urine from the bladder through the penis. Prostate cancer is a malignant growth in the outer zone of the prostate gland. It is the second most common CANCER in men; particularly during the latter part of the 20th century, the threat of prostate cancer, which seems to be on the rise, has become a stressful issue. However, the increase in incidence may be partially attributed to early examinations for the disease. When prostate cancer is discovered at an early stage, the outlook for recovery is very good. This disease is especially common in AfricanAmerican men and may run in families. The fathers and brothers of men who have prostate cancer appear to have three times the risk of dying from the disease. Symptoms are caused by enlargement of the prostate and include difficulty in starting urination,
poor flow of urine, and increased frequency of urination. Eventually the flow of urine may cease because the urethra is blocked or because cancer has spread to the bladder and ureters. In advanced cases, pain may be in the nerves of the pelvis or be spread by cancer to anywhere in the body. Cancer of the prostate is diagnosed when the physician feels the prostate through the rectum and it is hard and knobby. This is verified by ultrasound scanning, pyelography, and prostatic biopsy. Also, a simple, painless blood test is available to detect prostate cancer. Treatment may be surgical removal of the prostate, radiation, or hormonal therapy. SOURCES: Goldfinger, Stephen E. “The Big Chill: Prostate Cancer.” Harvard Health Letter 20, no. 11 (September 1995). Jacobsen, S. J., et al. “Incidence of Prostatic Cancer Diagnosis in the Era before and after Serum Prostate-Specific Antigen Testing.” Journal of the American Medical Association 274, no. 18 (November 8, 1995): 1,445–1,449.
Prozac
See
PHARMACOLOGICAL APPROACH.
psoriasis A common and persistent skin disease characterized by thickened patches of inflamed, red skin covered by silvery scales. It causes physical discomfort as well as social embarrassment. The diagnosis of psoriasis is a source of stress to affected individuals because there is no treatment that permanently cures the disease. In the United States, two out of every hundred people between the age of 10 and 30, have psoriasis (4 million to 5 million people). Approximately 150,000 new cases occur each year. Psoriasis cannot be passed from one person to another, although it is more likely to occur in individuals whose family members have it. The name of the disease comes from the Greek word meaning “itch.” Causes of Psoriasis Dermatologists say that specific causes are unknown; however, there may be an abnormality in the functioning of certain white cells in the bloodstream, which triggers inflammation in the skin, causing the skin to shed itself too rapidly, every three to four days. New spots may be noticed
294 psychiatrist 10 to 14 days after the skin is cut, scratched, or severely sunburned. Psoriasis also can be activated by infections, such as strep throat, and by certain medications. Dry skin and lack of sunlight sometimes bring about flareups of the disease. Forms of Psoriasis Forms of psoriasis differ in the shape and pattern of the scales, how long they last, and where they are. The most common form begin with little red bumps, which gradually grow larger and form scales. Although the top scales flake off easily and often, scales below the surface stick together. When they are removed, the tender, exposed skin bleeds; these small red areas grow, sometimes becoming quite large. The most common sites affected by psoriasis are the elbows, knees, groin and genitals, arms, legs, scalp, and nails. It often appears in the same sites on both sides of the body. Psoriasis affects nails by pitting them, and causing them to loosen, thicken, or crumble. Inverse psoriasis occurs in the armpit, under the breast, and in skin folds around the groin, buttocks, and genitals. Guttate psoriasis usually affects children and young adults. It often shows up after a sore throat, with many small, red, drop-like, scaly spots appearing on the skin. It often clears up without treatment in a few months or less. Diagnosis and Treatment of Psoriasis Dermatologists make a diagnosis of psoriasis by examining the skin, nails, and scalp, and may take a skin biopsy for microscopic examination. The goal of treatment is to reduce inflammation and slow down rapid skin cell division. Psoriasis outbreaks may improve with moderate exposure to sunlight or an ultraviolet lamp and use of a smoothing, emollient cream. Moderate attacks are treated with an ointment containing coal tar or anthralin. Other methods of treating psoriasis include corticosteroid drugs, PUVA (a type of phototherapy) and some types of anticancer drugs, such as methotrexate. Some patients with severe psoriasis are treated with the Goeckerman treatment, named for a Mayo Clinic dermatologist who first reported the treatment in 1925. The treatment combines coal tar dressings and ultraviolet light and is performed in specialized centers.
Dermatologists and researchers are continually testing new drugs and treatments. See also PAIN. SOURCE: Goldfinger, Stephen E. “Scales of Injustice: Psoriasis.” Harvard Health Letter 20, no. 2 (December 1994).
psychiatrist A physician (medical doctor with an M.D. degree) who specializes in the diagnosis and treatment of mental, emotional, or behavioral problems; some psychiatrists do research in the field of mental health. Many people who cannot cope with the stresses in their lives seek help from psychiatrists. Psychiatrists trace the patient’s personal and family history to seek possible causes of a problem. A psychiatrist can prescribe counseling, individually or in groups, and medications and, if necessary, can admit patients to hospitals. Psychiatrists are trained in a variety of diagnostic techniques and therapies. There is a strong medical emphasis because of the rapid development of techniques of psychopharmacology which require a knowledge of pharmacology, physiology, cardiology, and endocrinology, all subjects taught in medical training. Recent advances in neuroscience, as it relates to behavior, have provided a strong medical and psychosocial focus for psychiatry. In addition to providing direct patient care, many general, child, and adolescent psychiatrists devote time to other professional activities, such as administration, medical teaching, and research, and many work in more than one setting. Psychiatrists today are likely to devote at least part of their practice hours to salaried and managed care settings, including health maintenance organizations, preferred provider organizations, and large hospital systems. Cooperation and consultation between psychiatrists, primary care physicians, and other health care practitioners continues to be important for the provision of comprehensive care to patients. Especially in rural areas, primary care providers are critical gatekeepers for the diagnosis and treatment of mental health problems. The detection of mental disorders and the treatment of the less severe disorders, including the prescription of medications, often take place in a primary medical setting. Pri-
psychologist 295 mary care physicians, however, are less likely than psychiatrists to treat patients with serious or complex mental disorders, such as patients with dual diagnoses or comorbidity of psychiatric and medical illnesses. Primary care physicians are more likely to prescribe medications for anxiety, while psychiatrists are more likely to prescribe drugs for DEPRESSION. See also PHARMACOLOGICAL APPROACH; PSYCHOTHERAPIES. SOURCES: “The Future of Psychiatry.” Journal of the American Medical Association 264, no. 19 (November 21, 1990). Manderscheid, R. W., and M. A. Sonnenschein, eds. Mental Health, United States, 1990. DHHS Pub. No. (ADM) 90-1708. Washington, D.C.: Government Printing Office, 1990.
psychoanalysis
The mode of treatment for mental health disorders developed by Sigmund Freud and his followers at the beginning of the 20th century. He believed that mental disorders were a result of the failure of normal emotional development during childhood. Some individuals who suffer from extreme stresses in their lives, with which they cannot cope, seek psychoanalysis. The therapy aims to help the patient understand his or her emotional development and to make appropriate adjustments in particular situations. Psychoanalysis is practiced by clinicians who have undergone specialized training after residency training. Individuals who practice psychoanalysis are usually medical doctors, but not necessarily so. Those who are not must pass certain examinations given by an accredited institute of psychoanalysis. Psychoanalysts must undergo psychoanalysis themselves to resolve their own emotional problems before they start their practice. The American Psychoanalytic Association has more than 3,000 members, and the International Psychoanalytical Association numbers over 7,500. Analysts use features of free association, dream analysis, and the development and working through of transference or distortions in the individual’s relationship with the analyst. Sessions are usually held four or five times a week and a completed analysis may take three to five years, but
length of treatment varies considerably with the nature of the problems being treated. Changes in the Field The nature of psychoanalysis is changing to include multiple theoretical viewpoints that work synergistically. There is a proliferation of psychoanalytic publications dealing with clinical and theoretical issues, as well as the application of psychoanalytic study to other fields such as history, literature, anthropology, and art. See also PSYCHOTHERAPIES; SELF-PSYCHOLOGY.
psychodrama
An adjunct to psychotherapy in which the patient acts out certain roles or incidents; this is sometimes useful for individuals trying to overcome the serious effects of stresses in their lives. The roles or incidents may or may not be related to people closely involved with the individual or may concern situations that they find particularly stressful. The purpose of psychodrama is to bring out hidden concerns and to allow expression of a person’s disturbed feelings. Therapeutic value comes from the release of pent-up emotions and from insights into the way other people feel and behave. Psychodrama is often carried out with a partner or in a group. In many cases, use of music, dance, and pantomime may be included. The technique was developed by J. L. Moreno, a Viennese psychiatrist, in 1921. Psychodrama is considered an early form of group therapy or group psychotherapy. See also ALTERNATIVE MEDICINE; DANCE THERAPY; PSYCHOTHERAPIES.
psycho-imagination therapy (PIT) A technique that uses waking imagery and imagination to effect personality changes and alter the ways in which an individual copes with stress. The basic proposition of psycho-imagination therapy is recognizing people’s needs to become aware of how they define themselves in relation to others and how they think others define them. See also ALTERNATIVE MEDICINE; PSYCHOTHERAPIES. psychologist
A nonmedical specialist in diagnosing and treating mental health concerns such as
296 psychology difficulties in coping with stress. In most states, a psychologist has a Ph.D. degree from a graduate program in PSYCHOLOGY. Licensed psychologists receive insurance reimbursement, have hospital privileges, and act as expert witnesses in court cases. Prior to World War II, psychologists were primarily involved in academic institutions, with only a few individuals employed outside universities and actively engaged in mental health services. After 1977, with the passage of the Missouri psychology licensure act, all 50 states and the District of Columbia granted statutory recognition to the profession. Along with dramatic growth in the number of practitioners, there has been a significant expansion in the psychologist’s role as provider of mental health care. For example, today psychologists are involved in almost every type of mental health setting, including institutional or community based, research or treatment oriented, or general health or mental health focused. Within these environments, psychologists’ roles have also expanded beyond traditional activities of diagnostic assessment and psychotherapy to include primary prevention, community-level intervention strategies, assessment of service delivery systems, and client advocacy. Psychology has many subspecialties, which include child, developmental, school, clinical, social, and industrial; some psychologists have private practices, are employed by health care facilities, or teach in universities. Psychologists cannot prescribe medications; they refer patients requiring medication to a physician. See also BEHAVIOR THERAPY; PSYCHIATRIST; PSYCHOTHERAPIES.
psychology The study of the processes of the mind, such as memory, feelings, thought, and perception, as well as intelligence, behavior, and learning. Within this field, there are many different approaches. For example, behavioral psychology studies the way people react to events and adapt to stress; neuropsychology relates human behavior to brain and body functions; and psychoanalytic psychology emphasizes the role of the unconscious and the experiences of childhood.
Clinical Psychology Clinical psychology is a branch of psychology specializing in the study, diagnosis, and treatment of behavior disorders. This branch of psychology became popular in the United States during the late 1940s and 1950s. Much of the research in clinical methods, diagnosis, and therapy has taken place within departments of clinical psychology. In most states, clinical psychologists must be licensed to treat clients and, in some states, they must have a Ph.D. degree. Training for the Ph.D. in clinical psychology includes course work, development of research skills, and clinical practice. See also BEHAVIOR THERAPY; PSYCHOTHERAPIES. SOURCE: Manderscheid, R. W., and M. A. Sonnenschein, eds. Mental Health, United States, 1990. DHHS Pub. No. (ADM) 90-1708. Washington, D.C.: Government Printing Office, 1990.
psychoneuroimmunology (PNI) Relatively new branch of science that studies the interrelationships among the mind (psycho), the nervous system (neuro), and the IMMUNE SYSTEM (immunology). The aim of this field is to investigate and document interrelationships between psychological factors and the immune and neuroendocrine systems. Research efforts include looking at effects of emotional STRESS on the immune system and health. In a general way, PNI seeks to understand the scientific basis of the MIND-BODY CONNECTION. Authors Locke and Colligan, in The Healer Within, explain that a premise of PNI is that the immune system does not operate in a biological vacuum but is sensitive to outside influences. PNI researchers speculate that there is a line of communication between the mind and the cells that are the immune system. Tendrils of the brain’s nerve tissues run through important sectors of the immune system, including the thymus gland, bone marrow, lymph nodes, and spleen. Hormones and NEUROTRANSMITTERS secreted by the brain have an affinity for immune cells. Also, certain states of mind and feelings can have strong biochemical results. The field began in 1981 with the publication of a book edited by Robert Ader (Psychoneuroimmunology). While most of the research presented was pri-
psychotherapies 297 marily based on animal models of stress and illness, the collection paved the way for clinical research with humans. During the later 1980s and 1990s, researchers from various backgrounds were drawn to this new discipline. Social psychologists, experimental psychologists, psychiatrists, immunologists, neuroendocrinologists, neuroanatomists, biologists, oncologists, and epidemiologists, among other specialists, have all made contributions to PNI research. Together, they seek to explain the way in which the brain and mind contribute to illness or keep people healthy. PNI and Cancer Considerable research has been done with PNI and cancer patients. Work has progressed beyond looking at cell activity and now evaluates the role of ALTERNATIVE MEDICINE, such as group therapy, in inducing immune response in cancer patients, allowing identification of potentially helpful support modalities, and evaluation of possible mechanisms of action. In 1995, a pilot study was conducted to differentiate the effect of support from that of imagery / RELAXATION on immune function and to explore the relationship of emotional well-being and quality-of-life measures to the immune function. Arthritis and the PNI Link A research study evaluating personality traits of people who have rheumatoid arthritis was undertaken by Robert Fathman, Ph.D., a Dublin, Ohio, clinical psychologist, and Norman Rothermich, M.D., professor emeritus, Ohio State University, Columbus. “We found that rheumatoid arthritis sufferers have a personality that leads them to try overly hard to be nice to other people, not to lean on others for emotional support, and to stow things inside, especially anger,” they concluded. Many rheumatoid arthritis sufferers also had a situation of long-term tension or anger in their lives. “These traits seemed to precede the disease, not result from it. The end result is that repressed anger ‘eats them up’.” Rheumatoid arthritis is considered an autoimmune disease, in which the immune system mutinies against the body. In a well-known study in the field of psychoneuroimmunology, psychiatrist George Solomon, M.D., and Rudolf H. Moos, Ph.D., both then at the Stan-
ford University School of Medicine, discovered that the difference between people who develop rheumatoid arthritis and those who do not lies in their psychological profile. People who have the rheumatoid factor in their blood but stay in good psychological condition will not get arthritis. On the other hand, those who are genetically predisposed and endure long periods of stressful anxiety and/or DEPRESSION or suffer some major emotional upset are at a higher risk for arthritis. See also HUMOR; LAUGHTER; PLACEBO EFFECT; STRESS MANAGEMENT. SOURCES: Locke, Steven, and Douglas Colligan. The Healer Within. New York: New American Library, 1984. Moye, Lemuel A. “Research Methodology in Psychoneuroimmunology: Rationale and Design of the Images-P Clinical Trial.” Alternatives Therapies 1, no. 2 (May 1995). Padus, Emrika, ed. The Complete Guide to Your Emotions and Your Health. Emmaus, Pa.: Rodale Press, 1994.
Psychonomic Society The Psychonomic Society is an organization of researchers in psychology and allied sciences. Members must hold a Ph.D. degree or equivalent and must have published significant research other than their doctoral dissertations. At the end of 2004, the society had a membership of about 2,500. Many issues relating to stress are discussed in the six journals published by the society: Learning & Behavior (formerly Animal Learning & Behavior); Behavior Research Methods, Instruments, & Computers; Cognitive, Affective & Behavioral Neuroscience; Memory & Cognition; Perception & Psychophysics; Psychonomic Bulletin & Review. More than 700 papers and posters are presented at the society’s annual conference. FOR FURTHER INFORMATION:
The Psychonomic Society 1710 Fortview Road Austin, TX 78704 (512) 462-2442 (512) 462-1101 (fax) http://www.psychonomic.org
psychotherapies
The treatment of mental and emotional concerns by psychological methods. In a psychotherapy, a therapeutic relationship between
298 psychotherapies the patient and a therapist (psychotherapist) is established. The relationship is focused on the patient’s symptoms. Patterns of behavior—mood swings, low SELF-ESTEEM, and not being able to deal with stress—can benefit from this interaction between patient and therapist. There are many types of psychotherapists who can be recommended by friends, family physicians, or local community mental health centers. There are several rules to follow when choosing a therapist. Check out credentials. Know whether the therapist is a PSYCHIATRIST, PSYCHOLOGIST, or psychiatric social worker. Determine where the person received training, and check with that institution. Also, because there are professional societies for many specialties, check with the appropriate organization to see that the therapist has appropriate accreditation. Choosing a Psychotherapist People seeking help may be faced with the question of who to choose. If they recognize what their problems are and there are just occasional periods of feeling moody, a psychiatrist may not be needed. Guidelines for selecting psychotherapist rather than a psychiatrist include: The end of the stressful problem is in sight, but the individual just can’t get there by him/herself. The individual realizes that symptoms are of short duration and that the stress that brought them on can be identified. However, a person who has tried going to a therapist and has not found relief, may need a psychiatrist because of the following reasons: M.D.s are the only mental health therapists who can prescribe medications. For certain emotional illnesses, medications may be helpful. The individual has incapacitating or debilitating symptoms. The individual has other concurrent medical problems for which care and medications are being received. There is a history of mental illness in the family; other family members have ever been hospitalized for mental illness; or the individual requires hospitalization for a mental problem.
Group Therapy Group therapy is treatment of emotional or psychological problems in groups of patients or in selfhelp support groups led by a mental health professional. These groups attract individuals with similar concerns. For example, such groups may be for recently widowed persons (GRIEF), divorced people (self-esteem), parents who have lost a child to SUDDEN INFANT DEATH SYNDROME, people suffering from DEPRESSION, or those concerned with OBESITY. Therapy groups include from three to 40 people but work best with 10 to 12 participants who meet for an hour or more, once or twice a week. There is therapeutic interaction among the individuals in the group; members find that others share their feelings and experiences and this helps them feel less alone and less helpless. Group therapy is useful for people who have personality problems, ALCOHOLISM, drug dependency, EATING DISORDERS, and ANXIETY DISORDERS. Co-therapy This is a form of psychotherapy in which more than one therapist works with an individual or group. Co-therapy is also known as combined therapy, cooperative therapy, dual leadership, multiple therapy, and three-cornered therapy. Co-therapists work in various areas. For example, in SEX THERAPY one therapist is a male and the other is female to encourage both viewpoints in sexuality problems concerning a married couple. Geropsychiatry This is a specialized form of mental health care that addresses the complexities involved between mental and physical illness in the elderly. For example, an elderly patient who might appear to have psychotic symptoms may be experiencing symptoms of toxicity resulting from taking two or more incompatible drugs. Many psychosomatic disorders and chronic conditions manifest themselves with symptoms of depression. Physicians specializing in geropsychiatry are located in community hospitals where they can provide a safe and secure environment and offer psychological evaluation in conjunction with medical testing and liaison services for elderly patients being treated for medical or surgical conditions.
puberty 299 An increasing number of hospitals are adding this component to their mental health programs. Some hospitals contract with various managed care organizations which provide these services.
ent reason. Parents, teachers, and others need to be understanding, patient, tolerant, and sympathetic to help the adolescents weather this transition successfully.
Family Therapy Family therapy is a form of psychotherapy that focuses on the family unit, or at least the parent and child (in single-parent families), rather than separate treatment of one or more family members. It is based on the theory that an individual who is troubled or is mentally ill should not be seen in isolation from the family unit. Family members become aware of how they deal with each other and are encouraged to communicate more openly with each other. The discussions and confrontations lead to understanding. Family therapy usually focuses on here-andnow stresses and their practical solutions. It can be helpful when at least one member has a relatively serious problem, such as recurrent depression, or needs ongoing assistance in coping with outbursts of anger and emotional withdrawal. Family therapy has become increasingly popular for dealing with problems of children and adolescents. Typically, the therapy group will consist of both parents, or a parent and stepparent, two separated parents, or other parental pairings depending on the environment in which the child lives. In many cases, the child is brought to a mental health professional because of difficulties in school, such as exhibiting aggressive behavior or cutting classes. See also COMMUNICATION; LISTENING; MARITAL THERAPY; SUPPORT GROUPS.
Sexual and Physical Changes Puberty, also defined as the period at which maturation of the sexual organs occurs, begins at about age 11 or 12 for girls and 13 or 14 for boys. However, there are wide variations; some girls begin to menstruate as early as age eight or nine and others as late as age 16. In Western cultures, the average age at which adolescents reach sexual maturity has been steadily decreasing over the last century, possibly as a result of better nutrition and medical care. Many physical changes occur during puberty. In boys, this includes an increase in the secretion of male hormones and in testicular functions, and enlargement of the external sex organs. Nocturnal emissions or WET DREAMS are a normal, automatic release at night for secretions that accumulate in the boy’s sexual organs. Hair increases on the boy’s legs, pubic area, chest, underarms, and face. Later his voice deepens. A spurt of growth in height and general filling-out usually occurs shortly before the start of this period. Adolescents, particularly boys, often feel stressed by comparisons with their peers concerning physical development. Early-maturing boys seem to have advantages on later-maturing boys; they do better in athletics, are generally more popular, and have a positive sense of SELF-ESTEEM. In girls, female hormone production and ovarian activity increase, the uterus matures and nearly doubles in size, the breasts develop, and mammary glands mature. The pelvis also widens and rounds, and hair begins to show on the legs, pubic area, and underarms. MENSTRUATION and ovulation begin, often irregularly at first. Body weight may double during puberty, due to muscle growth in boys and increased fat in girls.
puberty The developmental stage between childhood and adulthood. It is the term used for the physical and emotional changes of adolescence: It usually occurs between the ages of 10 to 15 in boys and girls. This is a stressful period for many young people, as when they enter puberty they are no longer children but are not accepted by society as adults. Tensions exist between children’s dependence on their parents and their increasing desire for independence from their parents. Many young people feel stressed by the emotional ups and downs they experience. They may laugh, cry, or explode in anger without any appar-
Communications between Generations Adolescents need guidance and reinforcement along the way; it is important that they and their parents keep the lines of COMMUNICATION open. They may have questions about the physical, sexual, and personality changes that they are experiencing as well as concerns about making appropriate
300 public speaking choices and decisions. Today’s teenagers face many external sources of stress, such as peer pressure, drugs and alcohol, and the possibility of teenage pregnancy. For some, internal sources of stress may lead to EATING DISORDERS and SCHOOL problems. See also INTERGENERATIONAL CONFLICTS; LISTENING; PARENTING; PREGNANCY.
public speaking The art of making speeches to an audience. Individuals can experience stress related to public speaking ranging from mild apprehension to true phobic reactions. The anticipation of giving a speech in public may arouse feelings ranging from only a mild form of ANXIETY, which might be considered normal, to feelings of rapid heartbeat, faintness, DIZZINESS, nausea, or other symptoms of a phobia. An individual may suffer a mild degree of stress as a common reaction to being asked to give the speech, preparing it, and, finally, getting up in front of people to give it. There may be apprehension about how one looks or sounds and what people will think about the speech. All these apprehensions, however, could spur the individual to making the best possible presentation. A truly social phobic person who is phobic about public speaking probably would not accept such an invitation, nor would an individual who has an extreme fear of failure. People who manage to give a speech in public but are extremely uneasy often exhibit behaviors such as shuffling the feet, pacing, no eye contact, facial tics or grimaces, moistening the lips and clearing the throat frequently, and noticeably perspiring. Issues of self-confidence and SELF-ESTEEM are involved in the stress of public speaking. People who have given many speeches and feel confident about the subject matter, as well as their appearance, will probably experience only a mild degree of stress. See also BREATHING; PERFORMANCE ANXIETY; SOCIAL PHOBIA; STAGE FRIGHT. SOURCE: Moore, Amy Slugg. AMWA Journal 18, no. 1 (2003): 9–12.
public transportation
See
RANDOM NUISANCES.
TIPS FOR RELIEVING STRESS IN PUBLIC SPEAKING • Visualize yourself as the presenter you want to be. Visualize yourself doing well. • Practice your speech using a tape recorder or a videotape. Ask family members or friends for critiques. • Critique yourself: Consider if you mumble or talk too fast, if your voice is flat or monotonous. Do you overuse certain words? Do you vary pitch, range, tone, and volume? • Memorize your opening and closing remarks. Memorizing the opening will get you through the first nervousness that most presenters feel. Knowing the closing will allow you to end on a strong and positive note. • Avoid reading your visuals word for word. • Practice responses you may need if you are interrupted by those who digress. For example, “Let’s talk about that after the speech.” • Consider doing vocal exercises before the talk. Vary your pitch and tone using a syllable such as “ahh.” Yawn to relax your voice and to open your throat. • Arrive at least 30–60 minutes before your talk. Try out your projection equipment. Become familiar with the space: light switches, restrooms, and temperature controls. • Move chairs around if necessary, to make sure you can be seen by as many participants as possible, particularly if you are using any projection equipment. • Let your audience know your involvement with your topic. Spend a few minutes explaining your background to establish yourself as the expert. Remind yourself that you know more than your audience; that is why you were chosen to do this speech. • Encourage participation and interaction. React to raised hands. To start questions, pose your own: “This is a question I’m frequently asked.” • Maintain eye contact with the audience and with people while they are asking questions. • Use hand gestures to supplement your speech. Avoid distracting hand gestures. • Use props when you can. • If your mind goes blank, take time to think. Have a sip of water. Ask the audience to stand and stretch. Relax yourself. Take deep breaths.
Q To find a qi gong teacher, contact local martial arts centers, acupuncture clinics, yoga centers, or the teacher registry provided by the National Qigong Association.
qi gong
A self-healing art combining meditation, visualization, and movement to enchance the mindbody connection. Practitioners say that regular practice can reduce stress; establish balance; integrate mind, body, and spirit; bring peace; and prevent and treat illness. Qi gong comes from two Chinese words. The word qi (chi) means energy. Gong (kung) means skill, or practice of cultivating energy. Thus, qi gong means the skill of attracting vital energy. Internal qi gong is similar to meditation, with visualizations to guide energy. External qi gong includes movements to accompany meditations.
FOR INFORMATION:
National Qigong (Chi Kung) Association P.O. Box 252 Lakeland, MN 55043 (888) 815-1893
301
R since the mid-1980s. Programs that test for illicit drugs are more than twice as prevalent as those that test for alcohol use. Programs are most prevalent in large worksites, industries affected by drug testing legislation, and those employing high-risk or unionized workers. At many locations, drug testing is part of EMPLOYEE ASSISTANCE PROGRAMS. Indiscriminate urine testing can be stressful for employees or athletes. The American Civil Liberties Union (ACLU) opposes indiscriminate urine testing. The ACLU claims that urine tests do not determine when a drug was used—they detect only metabolites, or inactive, leftover traces of previously ingested substances. Also, the ACLU asserts that drug screens often used are not reliable and many tests yield false positive results 10 percent to 30 percent of the time. See also ADDICTION; ALCOHOLISM AND ALCOHOL DEPENDENCE; COCAINE; COPDEPENDENCY; WORKSITE WELLNESS PROGRAMS.
radon
Radioactive decay of radium produces a colorless, odorless, tasteless gaseous element called radon. It is a source of stress for many people because it has been found in communities and homes. Some researchers suggest that radon may lead to some cases of cancer, particularly lung cancer. Some people install devices in their homes to detect the presence of radon. Radon occurs naturally in many materials, such as rock, soil, and building materials. The gas is released continuously into the atmosphere. Uranium miners and workers with uranium are sometimes exposed to radon. See also CANCER; ENVIRONMENT; MINING WORKERS.
random drug testing A method of identifying people who use illicit drugs. Testing may be done before employment, after accidents, or when an employer believes there are reasonable grounds for testing. In many cases, drug testing is carried out as part of the preemployment physical examination. This situation is stressful for both the employers as well as the candidates, as positive tests may result in dismissal and false positive results can result in nonemployment. Drug tests may include tests for alcohol, cocaine, heroin, inhalants, LSD (acid), marijuana, MDMA (Ecstasy), methamphetamine, nicotine, and anabolic steroids. Testing is usually carried out by independent testing organizations. A variety of tests may be used. For example, Breathalyzers can be used to detect alcohol and urinalysis can detect many drugs present in the body. Hair, blood, saliva, and brain waves are also used for testing. According to authors Tyler D. Hartwell, et al., the incidence of testing is partially based on the type of worksite, characteristics of employees, and policies of the company. Drug testing has increased
FOR MORE INFORMATION:
American Civil Liberties Union 125 Broad Street 18th Floor New York, NY 10004 (212) 549-2500 (202) 549-2640 (fax) http://www.aclu-org SOURCE: Hartwell, Tyler D., et al. “Prevalence of Drug Testing in the Workplace.” Monthly Labor Review 119, no. 11 (November 1996): 35–46.
random nuisances
Annoying or unpleasant situations with which individuals cope. They may include difficult things such as commuting in traffic, finding a parking spot, depending on public
302
rape 303 transportation when the weather is bad; or annoying things like construction noise outside your office window, phone calls from telemarketers at dinnertime, last-minute dinner guests, or zippers that get stuck at a critical moment. Such nuisances differ for each person, but it they are perceived as stressful, they take their toll. Successful people regard random nuisances as “small stuff.” There is a saying, “Don’t sweat the small stuff; it’s all small stuff.” As stressors, random nuisances may seem small. However, the response to some of life’s “small stressors” may escalate into physical responses, such as ANGER and rage, that are similar to responses to major stressors. HANS SELYE explained the concept of STRESS with two basic ideas: The body has a similar set of responses to many of life’s stressors; this he called the GENERAL ADAPTATION SYNDROME (G.A.S.). Also, stressors can make an individual ill. To prevent illness induced by stressors, keeping a positive perspective on life and everyday occurrences is essential. The individual should endeavor to cope with the small stressors and keep them from escalating into more serious consequences. Many individuals find that MEDITATION at the end of a day helps them meet challenges of home, children, and paying bills. Others find that participating in regular EXERCISE helps them forget about the random nuisances of each day. See also HARDINESS; RELAXATION.
rape
Forcible sexual intercourse against the will of the partner. There is some variation among states as to the actual definition. In many states, sexual assault need not involve either force, actual penetration, or ejaculation; in others, genital contact under the threat of force or even implied threat of force meets the legal definition. Rape is an extremely stressful situation for the victim and her/his family members. The psychological effects of rape are severe. Many victims suffer significant ANXIETY, DEPRESSION, and post-traumatic stress reactions that last for years and can adversely affect their professional, personal, and sexual lives. While rape has traditionally been an offense between a man and woman, there has been an attempt to remove gender identification and to include homosexual rape and other offenses, such
as sexual contact between an adult and an underage child or adolescent and INCEST. Traditionally, women have feared violent sexual assault by a stranger. However, society now recognizes that forced intercourse can occur with perpetrators known to the victim, even the husband. The incidence of “date rape” (rape by a person with whom one has had a social engagement) is increasingly reported. Rape is now recognized as more a crime of violence than one of sexuality; rapists often have a history of other types of violent crime. As courts and law enforcement agencies have been more sympathetic toward victims, the number of reported rapes in the United States has increased dramatically. Rape victims may be physically injured at the time of the assault. They may be shot, knifed, or beaten, and immediate medical attention is usually given to injuries. The rape itself can cause perineal bruising or lacerations, particularly if the victim is very young, anal penetration occurs, and/or dangerous objects are used in the assault. Cultures are taken for gonorrhea and other SEXUALLY TRANSMITTED DISEASES and appropriate antibiotics may be recommended. If a victim is exposed to HERPES or AIDS, there is, at present, no effective way of preventing these diseases. After reporting a rape and being examined at a medical facility, the rape victim’s body and clothing will be examined for traces of blood, semen, hair, or clothing of the rapist. Recent development of DNA “fingerprints” from semen and blood permit accurate identification of the person responsible. Women at risk for pregnancy may be offered “morning after” contraception. Unfortunately, many victims fail to press charges either out of fear of having to relive the incident in court or out of fear of shame or reprisal. Date Rape and Date Rape Drugs Date rape is forced or coerced sex between partners, dates, friends, friends of friends, or general acquaintances. Some experts prefer to use the term “drug facilitated sexual assault” in place of “date rape.” Date rape can be coerced both physically and emotionally. If a person has had too much alcohol to drink or is on drugs he or she cannot consent to sex, thus having sex with them is legally
304 raves PROTECT YOURSELF AGAINST DATE RAPE The best defense against date rape is to try to prevent it whenever possible. • Avoid visiting secluded places (such as bedrooms) with someone until you know the person well and can trust them. • Never spend time alone with someone who makes you feel uneasy or uncomfortable. • Stay sober. Many date rapes involve drugs or alcohol, and a date might slip drugs such as Rohypnol (flunitrazepam), GHB (gamma-hydroxybutyrate), or Ketamine (ketamine hydrochloride) into a drink to make you more vulnerable. • What do these drugs look like? Rohypnol is a pill and dissolves in liquids. Ketamine is a white powder. GHB has a few forms: a liquid with no odor or color, white powder, or pill. • Learn to say no in a definite way. • Take self-defense courses. These can build confidence and teach valuable physical techniques that a person can use to get away from an attacker. Source: http:www.kidshealth.org
rape. There are certain “date rape” drugs that render the victim unconscious and limit memory; using these drugs on someone constitutes date rape and is a federal crime with a possible 20-year sentence. Date rape drugs may be difficult to trace but evidence of intercourse is not, and in cases where use of these drugs is suspected, evidence of rape standards are lower. Harrison, Maureen, and Steve Gilbert, eds. The Rape Reference: A Resource for People at Risk. San Diego: Excellent Books, 1996. Miller, Maryann. Drugs and Date Rape. New York: Rosen Publishing Group, 1995.
raves
See
CLUB DRUGS.
recreation The activities people do as a means of diversion or refreshment. For many people, these activities restore health and offset the effects of stress in everyday life. Recreation comes in many forms. Sports activities such as tennis, golf, bowling, ice skating,
rollerblading, and bike riding are activities many people enjoy. Others play cards, sing in choirs, act in plays, keep a journal, or go to movies, plays, and concerts. Most forms of recreation help individuals cope with stressors in their lives because they divert attention from them. At times, recreation itself can be stressful. Examples are games in which individuals are highly competitive or participation in community theater, when individuals may experience STAGE FRIGHT or fear of forgetting their lines. It is important to choose a balance of recreational activities that meet the need for personal satisfaction and achievement, as well as to bring healing to the spirit, mind, and body. See also EXERCISE; HOBBIES; MIND-BODY CONNECTIONS; PAINTBALL; RELAXATION; VOLUNTEERISM.
recreational therapists
Individuals also known as therapeutic recreation specialists who provide recreation activities and treatment services to people who have disabilities or illnesses or are elderly. Recreational therapists help their clients reduce STRESS, DEPRESSION, and ANXIETY and recover basic motor functioning and reasoning abilities, build confidence, and socialize effectively so that they can enjoy greater independence as well as reduce or eliminate effects of their illness or disability. They use a variety of techniques including arts and crafts, animals, sports, games, dance and movement, drama, music, and community outings. According to the U.S. Department of Labor, recreational therapists held about 27,000 jobs in 2002. About a third of salaried jobs for therapists were in nursing care facilities and another third in hospitals. Others worked in state or local government agencies and in community care facilities for the elderly, including assisted living facilities. Only a small number of therapists were self-employed, usually contracting with long-term care facilities or community agencies. Some teach, conduct research, or consult for health or social services agencies. Most employers prefer to hire candidates who are certified therapeutic recreation specialists. The National Council for Therapeutic Recreation Certification is the certificatory agency. See also DANCE THERAPY; DEPRESSION; STRESS.
relationships 305 FOR INFORMATION:
National Council for Therapeutic Recreation Certification 7 Elmwood Drive New City, NY 10956 (845) 639-1439 (845) 639-1471 (fax) E-mail:
[email protected] http://www.nctrc.org
reflexology A form of body therapy based on the theory that every part of the body has a direct line of communication to a reference point on the foot, hand, and ear. By massaging these reference points, professional reflexologists say they can help the corresponding body parts to heal. Through improved circulation, elimination of toxic by-products, and overall reduction of stress, the body responds and functions better because it is more relaxed. See also ALTERNATIVE MEDICINE; BODY THERAPIES. SOURCE: Feltman, John, ed. Reflexology: Hands on Healing. Emmaus, Pa.: Rodale Press, 1989.
USING REFLEXOLOGY TO REDUCE STRESS • Choose a quiet place. • Apply a few drops of a light, absorbent, greaseless lotion to your feet and massage them, continuing until the lotion is totally absorbed. • Grasp the ankle, heel, or toes of one foot firmly in one hand, place the thumb of your other hand on the sole of your foot at the heel and apply steady, even pressure with the edge of your whole thumb. • Keep your thumb slightly bent at the joint and use a forward, caterpillar-like motion. This is called thumbwalking; press one spot, move forward a little, press again, and so on. • When you reach the toes, start again at a new spot on the heel. Continue until the entire bottom of the foot has been worked. Then fingerwalk the top of the foot. Work your entire foot twice this way.
relationships Relationships are formed between individuals connected by affinity. These relationships include the individual’s FAMILY, spouse, lovers, friends, and business or professional associates. Good relationships are healthy and nurturing and act as a buffer against outside stressors. However, even the most meaningful relationships can at times be nonsupportive and sources of stress. Relationships and Health Best friends fit this category: He or she is on the same wave length with you and understands your personal situations, such as dealing with a difficult boss or overbearing parent; appreciates and admires who you are, even if there isn’t always agreement on what is being done or said; gives you compliments and makes you feel important in his or her life. According to S. Leonard Syme, Ph.D., University of California at Berkeley, people who have a close-knit network of intimate personal ties with other people seem to be able to avoid disease, maintain higher levels of health and, in general, deal more successfully with life’s difficulties. Dr. Syme and his research team found that people with many social contacts had the lowest death rate, and people with the fewest contacts had the highest rates. Single, divorced, and widowed people have higher rates of many diseases. Widows, particularly in the first year after their husbands’ deaths, have many more symptoms of physical and mental disease as well as death rates that are four times higher than average. “One can guard against the ill effect of being single through a solid network of friends and associates,” says Dr. Syme. Socially isolated people may be more likely to adopt self-destructive health habits and may get depressed and become suicidal or accident-prone. “All diseases are ‘social diseases,’” says Dennis Jaffe, author of Healing from Within. “It’s as though a breakdown in the social support structure precipitates a breakdown in the body’s immune system.” This breakdown in the body’s immune system resembles the body’s stress response. People who lack outlets for stress release are susceptible to a list of stress-related illnesses. Having one or two close friends with whom they feel free to say anything is invaluable. When they are overwhelmed, they
306 relaxation COMPONENTS OF A HEALTHY RELATIONSHIP • Realism: openness and honesty with each other • Trust: allowing the individuals to share their feelings • True friendship: having no hidden motives • Forgiveness: accepting the individual as he or she is • Security: knowing that individuals can count on one another • Vulnerability: exposing weaknesses that allow the relationship to grow
don’t trust their own judgment, and an objective view from a friend can help. Romantic Relationships Romantic relationships are far riskier and potentially more stressful to the individual’s emotional and physical well-being than people realize. Not only are feelings likely to be hurt, SELF-ESTEEM damaged, and trust betrayed, but there can be physical and mental battery by an outraged spouse. America’s high DIVORCE rate suggests that INTIMACY has painful consequences. According to Geraldine K. Piorkowski, author of Too Close for Comfort: Exploring the Risks of Intimacy, romantic relationships can be stressful because they are related to the process of getting close to another person. As we become more intimate (both emotionally and sexually), we reveal our deepest secrets, hopes, inadequacies, and even fantasies. We become more vulnerable, and thus easily cut to the core by a hostile comment, act of betrayal, or moment of rejection. Further, Piorkowski says, stress arises in relationships when our emotional needs and expectations are unrealistic. Also, we may lose our AUTONOMY and wind up feeling suffocated by the other’s demands; their neediness may drain energy needed to pursue our own desires and interests. We may be blamed for all the problems in the relationship and suffer GUILT and loss of self-confidence as a result. Relationships and Support Groups A lack of connections with other people can be detrimental to health, says Dr. Andrew Weil, author
of Spontaneous Healing. “Surrounding yourself with supportive people is an important step for any healing you need to do. Whenever I take a family history from a patient, I always ask about people who are helping or hindering someone’s illness. For example, sometimes a friend or family member who means well only make matters worse, maybe by not wanting the patient to express sadness about being sick or show discomfort from pain.” In terms of building relationships through support groups, Dr. Weil urges patients to find and develop relationships with people who have the same conditions and who have improved rather than simply to join a SUPPORT GROUP. “I find that some support groups can be counterproductive and cause more stress for the individual,” he says. “For example, some patients with cancer are horrified and extremely stressed when they see another person with a more advanced form of the disease. There is a similar phenomenon with chronic fatigue syndrome.” Some people are more fatalistic about their illness while others tend to be positive thinkers. This should be factored into any relationships developed through a support group, and especially with the regular people in your life, suggests Dr. Weil. See also COMMUNICATION; DATING; INTERGENERATIONAL CONFLICTS; LISTENING; LIVE-IN; MARRIAGE; PARENTING. SOURCES: Gilbert, Roberta M. Extraordinary Relationships. A New Way of Thinking about Human Interactions. Minneapolis: Chronimed Publishing, 1992. Jaffe, Dennis T. Healing from Within. New York: Knopf, 1980. Piorkowski, Geraldine K. Too Close for Comfort: Exploring the Risks of Intimacy. New York: Insight Books, 1994. Weil, Andrew. Spontaneous Healing: How to Discover and Enhance Your Body’s Natural Ability to Maintain and Heal Itself. New York: Knopf, 1995.
relaxation A feeling of freedom from anxiety and tension. Internal conflicts and disturbing feelings of STRESS are absent. Relaxation also refers to the return of a muscle to its normal state after a period of contraction. People who are very tense and anxious can learn to relax using relaxation training, a form of BEHAVIOR THERAPY or ALTERNATIVE MEDICINE. Relax-
religion 307 ation techniques are methods used to consciously release muscular tension and achieve a sense of mental calm. Historically, relaxation techniques have included MEDITATION, T’AI CHI, MASSAGE THERAPY, YOGA, MUSIC, and AROMATHERAPY. More modern developments include AUTOGENIC TRAINING, PROGRESSIVE MUSCLE RELAXATION, HYPNOSIS, BIOFEEDBACK, and aerobic EXERCISE. Many of these techniques were developed to help people cope with stresses brought on by the challenges of life. They are different approaches to relieving stress by bringing about generalized physical as well as mental relaxation. Relaxation techniques have in common the production of the relaxation response as one of their stress-relieving actions. Additionally, relaxation may counter some of the immunosuppressing effects of stress and may actually enhance the activity of the IMMUNE SYSTEM. Relaxation training programs are commonly used in conjunction with more standard forms of therapy for many chronic diseases. The MIND-BODY CONNECTION between relaxation and ill health has been demonstrated in many conditions. Some of the physiological changes that occur during relaxation include decreased oxygen consumption, decreased heart and respiratory rates, diminished muscle tension, and a shift toward slower brain wave patterns. The “Relaxation Response” In the 1970s, HERBERT BENSON, M.D., a cardiologist at Harvard Medical School, studied the relationship between stress and hypertension. In stressful situations, the body undergoes several changes, including rise in blood pressure and pulse and faster breathing. Dr. Benson reasoned that if stress could bring about this reaction, another factor might be able to turn it off. He studied practitioners of TRANSCENDENTAL MEDITATION (TM) and found that once into their meditative states, some individuals could willfully reduce their pulse, blood pressure, and breathing rate. Dr. Benson named this “the relaxation response.” He explained this procedure in his book (written with Miriam Z. Klipper), The Relaxation Response (1976). Relaxation Applications Relaxation training can be particularly useful for individuals who have “white coat hypertension,”
which means that their blood pressure is high only when facing certain specifically stressful situations, such as having a medical examination or visiting a dentist. It can also help reduce hostility and anger, which in turn affect the body and the individual’s physical responses to stress. Anxieties can lead to panic attacks, nausea, or gastrointestinal problems. There are many applications of relaxation training to help individuals learn CONTROL over their mental state and body and in treating conditions as diverse as high blood pressure, cardiac arrhythmia, chronic pain, insomnia, premenstrual syndrome, and side effects of cancer treatments. Relaxation training is an important part of childbirth classes to help women cope with the pain of labor. In a training program, individuals are instructed to move through the muscle groups of the body, making them tense and then completely relaxed. Through repetitions of this procedure, individuals learn how to be in voluntary control of their feelings of tension and relaxation. Some therapists provide individuals with instructional audio tapes for use during practice, while other therapists go through the procedure repeatedly with their clients. To determine the effectiveness of relaxation training, some therapists use biofeedback as an indicator of an individual’s degree of relaxation and absence of ANXIETY. See also GUIDED IMAGERY; HOBBIES; KABAT-ZINN, JON; MEDITATION; RECREATION. SOURCES: Benson, Herbert. Beyond the Relaxation Response. New York: Berkeley Press, 1985. ———. The Relaxation Response. New York: Avon Books, 1975. Goleman, Daniel, and Joel Gurin, eds. Mind Body Medicine. How to Use Your Mind for Better Health. Yonkers, N.Y.: Consumer Reports Books, 1993. Lehrer, Paul M., and Robert L. Woolfolk, eds. Principles and Practice of Stress Management, New York: Guilford Press, 1993.
religion
The service and worship of God. It is a commitment to a personal set or institutionalized system of attitudes, beliefs, and practices. Religion helps many people cope with stresses of life because it gives them a sense of security, meaning, order, and an ethical pattern for living.
308 relocation Faith in God Belief and trust in and loyalty to God or belief in the doctrines of religion historically have been an avenue for relieving stress and increasing an individual’s physical and mental health. Studies regarding benefits of religion indicate that religious beliefs offer some protection from hypertension, death from heart disease, and cancer. While a physician cannot recommend a patient participate in religion, asking about such behavior and positively reinforcing it may improve the patient’s quality of life. In some cases, it may prove to be a useful piece of evidence that patients will use to alter their survival behaviors. Involvement with religion very often increases in older adults, an observation that led researchers headed by psychiatrist Thomas Oxman at Dartmouth Medical School to investigate the role religion might play in the health of the elderly. They found that those who derive at least some strength and comfort from religion are more likely to survive longer after cardiac surgery than those who do not. Researchers looked at the effect on survival of a number of biomedical, psychological, and social factors as well as religious feeling and activity. Those who said they found at least some strength and comfort from their religious feelings were three times more likely to survive than those who had no comfort from religious faith. Those who participated in social and community activities, such as church suppers, senior centers, or historical societies, had three times the survival rate of those who did not participate in any organized activity. Those who had both protective factors—religious and social support—showed a tenfold increase in survival. However, while religion contains elements that are supportive, it also contains elements that may be damaging to a person’s management of stress. For example, the promise of reward in the afterlife has inspired and comforted many, but has also been held responsible for making believers passive or accepting of hardships and inequalities, which they could overcome through their own efforts, because they hope for a better life in the beyond. Religion in Wartime A survey of World War II veterans offered interesting insights into the religious state of mind of men who experienced the stresses of warfare. About 26
percent said that the war made them more religious; 19 percent that war made them less religious. Fifty-eight percent of those surveyed said that even though their religious conviction may have increased, decreased, or remained the same, their war experiences made them more interested in the subject of religion. The veterans exhibited an even stronger tendency when describing their religious attitude during battle. Most were of the opinion that everyone prays in combat. An interesting variation was the comment, “There were atheists in fox holes, but most of them were in love,” implying that the thought of a loved one might carry a man through danger almost as well as an appeal to a higher power. The influence of Religion on Mental Health Between 1930 and 1960, theologian Paul Tillich (1886–1965), philosopher Martin Buber (1878– 1965) and psychoanalyst Rollo May (1909–94) published important works attempting to synthesize religion, psychology, and modern philosophical movements. An interest in combining the mental health disciplines with the influence of religion has encouraged the development of training in pastoral counseling in recent years. In the early 1970s, priest-sociologist Andrew Greeley (1928– ), in his book Unsecular Man: the Persistence of Religion, described a conservative, religious social trend that recently has become more obvious in movements such as the creationist opposition to secular humanism in education and the political influence of religious leaders and celebrities publicizing their “born again” experiences. See also ALTERNATIVE MEDICINE; MEDITATION; MIND-BODY CONNECTIONS. SOURCE: Koenig, Harold George. Is Religion Good for Your Health: The Effects of Religion on Physical and Mental Health. New York: Haworth Pastoral Press, 1997.
relocation The need to transfer to a new company location as part of a promotion or lateral career move. Transfers may also become necessary due to reorganizations and MERGERS. A fact of life and a stressor for most workers and their families today, relocation means losing a SUPPORT GROUP (FRIENDS and/or relatives), finding a new residence and new
remarriage 309 community resources (places to worship, schools, doctors, dentists, etc.), handling the move (packing and unpacking), and, in the case of dual careers, the need for one spouse to find new employment and the possible financial impact of that. Children probably suffer the most stress during relocations. New schools can mean new methods of teaching and new textbooks, and, most important, new friends. Research had shown that adults who as children moved frequently due to parent job transfers may find it difficult to form lasting friendships and have not learned the necessary skills to form intimate relationships. Frequent transfers can be hard on all members of the family. They have been known to trigger a group of stress reactions called the mobility syndrome, which can include DEPRESSION, deterioration of health, dependency on one’s own family for emotional satisfaction, reclusiveness, a high rate of alcoholism and drug dependency, and marital discord that often leads to divorce. There is an increase of acting out behavior on the part of children and teenagers. Many of these stress reactions require professional help. For the first time, many people are assessing the viability of a transfer not only in terms of careers and the financial and housing implications of the move, but also in terms of the quality of life for themselves and their families. Since relocation often becomes a primary part of a promotion, it is important to see if it matches family values and priorities as well as the individual’s career plan. Whatever the decision, applying COPING techniques and strategies is necessary to handle the resulting stress. See also ACCULTURATION; CHANGING NATURE OF WORK; GENERAL ADAPTATION SYNDROME; MIGRATION; MOVING; NOSTALGIA.
remarriage
Entering into a MARRIAGE contract between a couple when one or both of them has been left a widow or widower or when there has been a DIVORCE. Bride and groom bring with them remembrances, some good and some bad, of previous marriages. If there are children, establishing new family RELATIONSHIPS as well maintaining old family ties are major concerns. Widows or widowers who experienced “good marriages” are less
likely to have fears and apprehensions than those who are divorced. Many people do find their second marriage, particularly after a divorce, a source of stress. For example, some divorced men and women marry a person very similar to their first spouse and encounter similar difficulties. Others try very hard to find a quality that was lacking in their first spouse. As a consequence, they may marry a person who has that particular quality but may be blinded to other ways in which they are actually incompatible. Divorced or widowed persons may remarry out of emotional and financial need without understanding themselves first or resolving their feelings about their previous marriage. Ex-mates may interfere when one or the other remarries and family members may make it obvious that they preferred the previous spouse. In some cases, men and women are stressed by feelings of GUILT about how the second marriage has affected their children or previous spouse. Being accepted into the family, a stressor for many, may relate to the circumstances of the courtship. For example, if a woman was the “other woman” while the new husband was still married, his relatives may regard the wife as a “home wrecker.” If a recently widowed woman marries too soon, her relatives may think the marriage was disrespectful to the deceased. Statistics on Remarriage In 1990, 31.3 percent of women who remarried were 35 to 44 years old, compared to about 20 percent aged 25 to 29 years old and about 22 percent aged 30 to 34 years old. Only 16 percent of women remarrying in 1990 were 45 to 64 years old, compared to 8 percent who were 20 to 24 years old. Only 2.7 percent of remarriages in 1990 were by women 65 years old and older. About one-third of remarrying men in 1990 were 35 to 44 years old, compared to about 20 percent being 30 to 34 years old. Another 24 percent of remarrying men in 1990 were 45 to 64 years old, compared to about 14 percent being 25 to 29 years old. Men 65 years old and older were more likely in 1990 to remarry than men 20 to 24 years old (5.1 percent vs. 2.6 percent).
310 repetitive stress injuries The rate of divorced women remarrying decreased from 123.3 per 1,000 women in 1970 to 76.2 per 1,000 women in 1990. The rate of divorced men remarrying decreased from 204.5 per 1,000 men in 1970 to 76.2 percent per 1,000 men in 1990. Seventy-five percent of divorced women remarry within 10 years. Many older individuals who are past childbearing and child-rearing years opt for a LIVE-IN arrangement instead of remarriage. See also INTIMACY; STEPFAMILIES. SOURCES: Gender Center. “Marriage, Divorce, and Remarriage in the United States,” Available online. URL: http:// www.gendercenter.org/mdr.htm. Downloaded on April 21, 2005. Kahn, Ada P., and Jan Fawcett. Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Statistical Abstract of the United States, 1991. Washington, D.C.: U.S. Department of Commerce, 1991. Wilson, Barbara Foley. “The Marry-Go-Round.” American Demographics, October 1991, 52–54.
repetitive stress injuries (RSI)
Injuries that result from repetitive motions, such as using a computer or certain types of factory work. As people spend more time at computers, sitting at a desk, looking at a screen, and typing information, they become more and more open to repetitive stress injuries. Human beings are not meant to do repetitive motions all day in work spaces not set up to accommodate either the equipment or their bodies. The result is damage to muscles in the fingers, wrists, hands, arms, neck, head, and back. The rate of RSIs is increasing as more Americans turn to computers at work and at home. RSIs are affected by the individual’s work pacing, work stress, environment conditions and personality traits. The kinds of problems computer users report include shooting pains in the arms, acute pain or stiffness in the arms, neck, shoulders, and/or back, acute wrist or finger pain, numbness or tingling in the fingers, hands, arms, or shoulders, and chronic pain in the neck, shoulders, or back. A specific type of repetitive stress injury relating to wrist and hand disorders is CARPAL TUNNEL SYNDROME, and it has been identified as one of the fastest growing occupational illnesses. Carpal tun-
AVOIDING REPETITIVE STRESS OF COMPUTER USE • Select chairs and desks that can be adjusted for maximum work comfort. The desk should be high enough and feet should be on the floor. • Support your back with a pillow to keep posture correct and relieve strain. • Be sure your keyboard and mouse are at a comfortable level; raise or lower if necessary. • Avoid flexing wrists; use a contoured wristsupport device. • Take work breaks—stretch, roll the neck, and use hand squeezing exercises; stand up and walk about. • Keep monitor at arm’s length (24 inches) from face. • If pain persists, see a doctor. Work space or work habit changes, physical therapy, special exercises, medication, braces, or surgery may be recommended.
nel syndrome is the result of inflamed tendons in the wrist. FOR FURTHER INFORMATION:
Association for Repetitive Motion Syndrome P.O. Box 471973 Aurora, CO 80047 (303) 369-0803 http://www.certifiedpst.com/arms
repression resolutions
See
MEMORY.
Statements of will or intent. Many people make resolutions at the beginning of the new year, and later in the year are stressed by the fact that they cannot live up to their own hopes and expectations. Commonly, people determine to change their negative behaviors and HABITS into positive ones, such as losing weight, stopping SMOKING, exercising more, and working hard to improve themselves. Often people are earnestly trying to change their habits, but find that doing so becomes increasingly hard. Other responsibilities get in the way and often the time is used for other tasks. They feel frustrated and finally abandon the reso-
retirement 311 lution with the thought that it might become a resolution the next year. To avoid the stress and FRUSTRATION of unkept resolutions, Mark Groder, author of Business Games: How to Recognize the Players and Deal with Them, suggests: Know your own limits; don’t make resolutions that are too ambitious. Consider the obstacles in keeping your resolution; set your priorities. Use breaking a resolution as an opportunity for self-understanding; perhaps you were overly optimistic in making it. See also PERFECTION; SELF-ESTEEM; WEIGHT GAIN AND LOSS. SOURCE: Groder, Martin. Business Games: How to Recognize the Players and Deal with Them. Des Moines: Boardroom Classics, 1995.
retirement
Retirement usually means that the individual is withdrawing from the work force of his or her own free will. It generally occurs when people are around age 65 or older, but in times of economic problems due to DOWNSIZING, LAYOFFS, and MERGERS, it can occur earlier. Retirement, highly desired by some, produces stresses including ANXIETIES, BOREDOM, and feelings of lack of productivity and loss of SELF-ESTEEM for others. Some retired people feel that they are not contributing members of society and become depressed and withdrawn. Some miss the identity and the prestige they formerly received from their position at work. Those who adjust the best to retirement and experience the least stress seem to be the people who participate in new activities and make new acquaintances. Most retired people enjoy having more time for family and FRIENDS, for travel, for continuing their education, and for pursuing HOBBIES. People who have planned ahead for their retirement generally start an interest or hobby before stopping work. For example, some individuals start to learn a musical instrument while others pursue a woodworking or sewing hobby. Many do volunteer work to help others who are in need of assistance. In most of the big cities in the United States, there is a “job corps” of senior citizens willing to
donate their time and use their knowledge in business and industry. Continuing education classes at local colleges and universities are targeted to retired people who enjoy learning. A great many of these people participate in Elderhostel activities, where they travel to college campuses all over the world to study and tour. Retirement and Second Careers Retirement is no longer a once-in-a-lifetime happening. Some individuals who retire go back to paid positions in an area in which they already have an expertise; some go to an entirely different area. Researchers at the University of Southern California tracked 2,816 American men who turned 55 between 1966 and 1976. Approximately one-third went back to work for an average of two more years after they retired. Other significant findings indicated that the average American male retires between ages 61 and 62, that white-collar workers stay on the job about two years longer than blue-collar workers, and that blue-collar workers spend an average of 10 years in retirement; white-collar workers, 12. Wives of retired men are sometimes affected by their mates’ retirement. A study reported in Modern Maturity (December 1991–January 1992) indicated that most women polled reported satisfaction with their husbands’ retirement. Effects of retirement on 413 upper-middle-class women married to men retired an average of 16 years were examined. More than one-third of the women had no problems with their husbands’ retirement, and twothirds said they were fully prepared for it. Only 12 percent said they felt stressed by some loss of personal freedom, and 5 percent to 6 percent reported an increase in household chores. Among those who said they would have done things differently, the majority mentioned the need to be better prepared financially for their later years. Planning Ahead Relieves Stress Relieving some of the stresses of retirement depends largely on pre-retirement planning and the retirement process itself. A variable in life satisfaction during retirement is socioeconomic status. According to the College of Family Physicians of Canada, those with middle and upper incomes
312 ricin report a higher degree of adaptation. Household income drops drastically (one-half to one-third). Many retirees experience poverty for the first time. Financial problems are the major reasons for stress and dissatisfaction with retirement. Actual financial hardship may differ from perceived financial hardship. Strategies to cope with the stress of reduced income include expenditure reduction, rearrangement of assets, or continued activity in the labor force. Education is the most influential factor related to successful coping with reduced income. See also AGING; ELDERLY PARENTS; HARDINESS; RECREATION; VOLUNTEERISM. SOURCES: Dennis, Helen, and John Migliaccio. “Redefining Retirement: The Baby Boomer Challenge.” Generations: Journal of the American Society on Aging 21, no. 2 (summer 1997): 45. Godin, Seth. If You’re Clueless about Retirement and Want to Know More. Chicago: Dearborn Financial, 1997. Manchester, Joyce. “Aging Boomers and Retirement: Who is at Risk?” Generations: Journal of the American Society on Aging 21, no. 2 (Summer 1997): 19.
ricin A poison that can be made from the waste left over from processing castor beans; it can be a powder, a mist, or a pellet, or dissolved in water or weak acid. Ricin is one of many substances that cause stress to those who fear terrorist attacks. A sign of ricin exposure would be that a large number of people who have been close to each other (such as in a subway or train car) suddenly develop fever, cough, or excess fluid in their lungs. There is no widely available reliable test to confirm that a person has inhaled ricin. Understanding more about ricin can alleviate fears that cause stress. To be exposed to ricin, it would take a deliberate act to make ricin and then use it to poison people. Accidental exposure to ricin is highly unlikely. People can breathe in ricin mist or powder and be poisoned. Ricin can also get into water or food and then be swallowed. Depending on the route of exposure (injection or inhalation), as little as 500-micrograms of ricin could be enough to kill an adult. A 500-microgram dose of ricin would be about the size of the head of a pin. A greater amount would likely be needed to kill people if the ricin were swallowed.
According to the Centers for Disease Control, some reports indicated that ricin may have been used in the Iran-Iraq War during the 1980s, and quantities of ricin were found in al-Qaeda caves in Afghanistan after 2000. Signs and Symptoms of Ricin Exposure The major symptoms of ricin poisoning depend on the route of exposure and the dose received, though many organs may be affected in severe cases. Initial symptoms of ricin poisoning by inhalation may occur within eight hours of exposure. Likely symptoms include difficulty breathing, fever, cough, nausea, and tightness in the chest. Heavy sweating may follow, as well as fluid building up in the lungs. Finally, low blood pressure and respiratory failure may occur, leading to death. Following ingestion, initial symptoms typically occur in less than six hours. The victim would develop vomiting and diarrhea that may become bloody. Severe dehydration may result, followed by low blood pressure. Other signs and symptoms may include hallucinations, seizures, and blood in the urine. Within several days, the person’s liver, spleen, and kidneys might stop working, and the person could die. With skin and eye exposure, ricin in its powder or mist form can cause skin or eye redness and pain. Treating Ricin Poisoning If ricin exposure cannot be avoided, the most important step in treatment is getting the ricin off or out of the body as quickly as possible. Get fresh air by leaving the area where the ricin was released. Treatment involves supportive medical care depending on the route by which victims were poisoned. Care might include helping victims breathe, giving them intravenous fluids and medications to treat conditions such as seizures and low blood pressure, or washing out their eyes with water if their eyes are irritated. If you are near a release of ricin, emergency coordinators may tell you to either evacuate the area or to shelter in place inside a building to avoid being exposed to the chemical. See also SARIN; TERRORISM. FOR INFORMATION:
Agency for Toxic Substances and Disease Registry Division of Toxicology
rotator cuff injuries 313 1600 Clifton Road, NE, Mailstop E-29 Atlanta, GA 30333 (888) 422-8737 http://www.atsdr.cdc.gov
right sizing
See
DOWNSIZING; LAYOFFS; MERGERS;
WORKPLACE.
risk
See
DECISION-MAKING.
road rage Stress-producing expression of anger and hostility while driving a car. People are in a hurry and become frustrated because of traffic delays, being cut off by other drivers, or being given obscene signals by other drivers. Road rage is dangerous because drivers become excited and may accelerate their speed or make sudden and risky moves. The term road rage implies that impatience and competition have increased in our culture, perhaps due, in part, to increased population density. Rohypnol
See
RAPE.
Rolfing One of the many contemporary BODY THERAPIES used to relieve stress and improve emotional and physical health. It is a form of deep tissue massage and is a combination of the disciplines of Eastern philosophical systems and practices and Western knowledge of muscular and skeletal structure. The technique, which is often combined with other body therapy techniques, was developed by Ida Rolf (1896–1979), an American biochemist. As a young woman, she had an accident and was successfully treated by both an osteopathic physician and a yoga instructor. She combined these two techniques with the medical system of homeopathy, a practice that calls upon the patient’s own healing powers rather than merely treating symptoms. The therapy gained recognition through Rolf’s work at the Esalen Institute in California during the 1960s. From what had been considered the fringe or one of many alternative therapies, Rolfing and other body therapies entered the mainstream of mental and physical treatments in the mid-1900s. Rolfing focuses on the network of connective tissue—fascia, tendons, and ligaments—that con-
tains the muscles and links them to the bones. Whenever connective tissue fails to work effectively, pain can result. For many, Rolfing helps to heal the body by bringing it into proper alignment and proper relationship to the forces of gravity. A Rolfing practitioner puts pressure on certain areas of the patient’s connective tissue to improve the structure of the body. Certified Rolfers have had training in human anatomy, physiology, kinesiology, and various massage techniques. See also ALTERNATIVE MEDICINE; BODY THERAPIES; MASSAGE THERAPY. FOR FURTHER INFORMATION:
The Rolf Institute 5055 Chaparral Court, Suite 103 Boulder, Colorado 80301 (303) 449-5903 (303) 449-5978 (fax) http://www.rolf.org SOURCE: Rolf, Ida P. Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well Being. Rochester, Vt.: Healing Arts Press, 1989.
rotator cuff injuries Injuries to the rotator cuff are stressful because they are painful and debilitating. Such injuries may be caused by overuse or a fall. They may result in loss of income from lost workdays or decreased involvement in personal and family activities. The rotator cuff is a reinforcing structure around the shoulder joint composed of four muscle tendons that merge with the fibrous capsule enclosing the joint. Falling or breaking a fall with the arm can bruise or tear a rotator cuff’s tendons or muscles. These injuries are common among professional and amateur athletes, especially baseball pitchers, tennis players, and swimmers. They also are common in workers whose jobs involve lifting, carrying heavy loads, and reaching, which can strain or tear tendons and muscles. Repeated overhead movement of the arms can stress the rotator cuff muscles and tendons, causing inflammation and eventually tearing. Diagnosis is usually confirmed with imaging techniques or Xrays. Treatments range from physical therapy to anti-inflammatory medications to surgery.
314 runner’s high runner’s high
A certain feeling of physical and mental well-being and a relief of stress is often reported by individuals who run or jog. This may occur during or after a period of EXERCISE, when the cardiovascular system works harder and longer than it usually does. For example, about 30 to 40 minutes of jogging may produce the feeling of “runner’s high” in many individuals. There is a common misconception that runner’s high is caused exclusively by the release of ENDORPHINS, brain chemicals that can reduce pain and
elevate mood in a manner similar to opiate drugs. In addition to the release of endorphins, exercise causes the body to discharge many neurochemicals that trigger physiological reactions. For example, stimulation of the sympathetic nervous system along with activation of the endocrine system’s adrenal medulla causes an increased heart rate and delivery of more oxygen to the brain, contributing to the relief of stress. See also RECREATION.
S “safe sex”
According to the Centers for Disease Control, sarin (also known as GB) and other nerve agents may have been used in chemical warfare during the Iran-Iraq War in the 1980s. Sarin was used in two terrorist attacks in Japan in 1994 and 1995. People can be exposed to sarin through skin or eye contact if it is released into the air, or via inhalation of air containing sarin. If sarin is released into water, people can be exposed by touching or drinking water that contains sarin. Following contamination of food with sarin, people can be exposed by eating the contaminated food. A person’s clothing can release sarin for about 30 minutes after it has come in contact with sarin vapor, which can result in exposure of other people.
Avoiding behaviors that may lead to
SEXUALLY TRANSMITTED DISEASES, AIDS, or PREGNANCY. Safe sex involves being in a monogamous
relationship, knowing one’s partner, avoiding sexual relationships with known drug users, and using CONDOMS and spermicidal agents properly. The need for practicing safe sex causes stress for many individuals who fear contracting a disease or find preparations and precautions annoying. For some couples, use of a condom becomes a stressful issue. See also BIRTH CONTROL; SEXUAL REVOLUTION.
“sandwich” generation
A term that describes people in midlife who have responsibilities for taking care of ELDERLY PARENTS as well as their own almost adult or adult children. Stresses abound because of the multiple and sometimes conflicting roles. Stressors include living arrangements, financial constraints, and time constraints, as in many cases both individuals in a midlife couple are still working. To improve such stressful situations, open COMMUNICATION between all parties involved is essential. Young people need to realize that their concerns must be balanced with the concerns of the elderly, to reduce some of the stress on the middle generation. Those caught in the middle need to take time for themselves and their own interests. RELAXATION techniques can also be helpful. See also INTERGENERATIONAL CONFLICTS; LISTENING; PARENTING.
How Sarin Works Sarin presents an immediate but short-lived threat because it evaporates quickly. Depending on the amount of sarin to which a person was exposed, how the person was exposed, and the duration of the exposure, the extent of poisoning may vary. Symptoms will appear within a few seconds after exposure to the vapor form of sarin and within a few minutes to up to 18 hours after exposure to the liquid form. Breathing function may be severely impaired. Sarin is the most volatile of the nerve agents, which means that it can easily and quickly evaporate from a liquid into a vapor and spread into the environment. People can be exposed to the vapor even if they do not come in contact with the liquid form of sarin.
sarin
An artificial chemical warfare agent classified as a nerve agent and originally developed as a pesticide. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. The mere mention of sarin is a source of stress for many people concerned about acts of terrorism throughout the world.
Signs, Symptoms, and Treatment for Sarin Exposure People may not know that they were exposed because sarin has no odor. Mildly or moderately exposed people usually recover completely. Severely
315
316 SARS exposed people are not likely to survive. People exposed to a low or moderate dose of sarin by breathing contaminated air, eating contaminated food, drinking contaminated water, or touching contaminated surfaces may experience some or all of the following symptoms within seconds to hours after exposure: runny nose, watery eyes, eye pain, blurred vision, drooling and excessive sweating, cough, chest tightness, rapid breathing, diarrhea, increased urination, confusion, drowsiness, weakness, headache, nausea, vomiting and/or abdominal pain, slow or fast heart rate, low or high blood pressure. Exposure to large doses may result in loss of consciousness, convulsions, paralysis, and respiratory failure. However, showing these signs and symptoms does not necessarily mean that a person has been exposed to sarin. Medical attention should be sought immediately after exposure. Treatment consists of removing sarin from the body as soon as possible and providing supportive medical care in a hospital setting. Antidotes are available. They are most useful if given as soon as possible after exposure. See also TERRORISM. FOR FURTHER INFORMATION:
Agency for Toxic Substances and Disease Registry Division of Toxiciology 1600 Clifton Road NE, Mailstop E-29 Atlanta, GA 30333 (888) 422-8737 (toll-free) (404) 498-0057 (fax) http://www.atsdr.cdc.gov Bioterrorism Preparedness and Response Planning Centers for Disease Control and Prevention Mailstop C-18 1600 Clifton Road Atlanta, GA 30333 (404) 639-3311 http://www.bt.cdc.gov
SARS (Severe Acute Respiratory Syndrome)
A viral respiratory illness caused by SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than 24 countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained. Many people experienced stress
out of fear of sitting next to an ill person on an airplane or having the virus spread in other ways. Unnecessary travel to many parts of the world was curtailed because of the epidemic. Changing vacation and business travel plans was a source of stress to many individuals and businesses. According to the World Health Organization (WHO), 8,098 people worldwide became ill with SARS during the 2003 outbreak; of these, 774 died. In the United States, only eight people had laboratory evidence of the infection. These people had traveled to other parts of the world with SARS. How SARS Spreads Close person-to-person contact is the main way that SARS seems to spread. The virus is thought to be transmitted most readily by respiratory droplets produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to three feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of nearby persons. The virus also can spread when person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye. “Close contact” in the context of SARS means having cared for or lived with someone with SARS or having direct contact with respiratory secretions or body fluids of a patient with SARS. Examples of close contact include kissing or hugging, sharing eating or drinking utensils, talking to someone within three feet, and touching someone directly. Close contact does not include activities such as walking by a person or briefly sitting across a waiting room or office. Symptoms of SARS SARS usually begins with a high fever (greater than 100.4°F), headache, overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10–20 percent of patients have diarrhea. After two to seven days, SARS patients may develop a dry cough. Most develop pneumonia. Centers for Disease Control and Prevention Response In 2003, the Centers for Disease Control and Prevention (CDC) of the U.S. Public Health Service
school 317 worked closely with the World Health Organization and other partners in a global effort to address the SARS outbreak of 2003. The CDC activated its Emergency Operations Center to provide coordination and response, committed more than 800 medical experts and support staff to work on the SARS response, and deployed medical officers, epidemiologists, and other specialists to assist with onsite investigations around the world. Additionally, CDC provided assistance to state and local health departments in investigating possible cases of SARS in the United States, conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease, and initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS. CDC continues to work with other federal agencies, state and local health departments, and health care organizations to plan for rapid recognition and response if person to person transmission of the virus recurs. CDC provides the latest information on SARS on the SARS Web site: http://www.cdc. gov/ncidod/sars. FOR FURTHER INFORMATION:
Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 (800) 311-3435 (toll-free) (404) 639-3534 http://www.cdc.gov SOURCES: Guan Y, Zheng B. J., He Y. Q., et al. “Isolation and Characterization of Viruses Related to the SARS Coronavirus from Animals in Southern China.” Science 302, no. 5643 (October 10, 2003): 276–278. Normille, D., and M. Enserink. “Tracking the Roots of a Killer.” Science 301, no. 5631 (August 15, 2003): 297–299.
school
This term refers to learning institutions, including nursery schools and preschools. The stress caused by fear of going to school may cause a child to be absent, tardy, or simply refuse to attend school. Fear of going to school may begin as early as kindergarten, but usually develops during elementary or junior high school. In many cases, the child begins to devise reasons for staying home. Some
develop symptoms, such as nausea, stomachaches, or HEADACHES; others leave home for school, then return without their parents knowing that they are absent from school, or spend their day elsewhere. Cases of extreme refusal to attend school may be considered school PHOBIA. (Fear of school, or school phobia, is known as didaskaleinophobia.) School avoidance (also known as school refusal or school absenteeism) is one of the most common ANXIETY DISORDERS in children. Avoidance may result from many aspects, such as anxiety over separation from the parents or getting along with teachers, a discipline issue, a complication of a mood disorder, or a fear of failure. Overcoming the Stresses of School Helping a child who feels stressed by school attendance should begin with discussions with the child and the teacher or teachers involved, and investigating possible causes of the child’s problem within the school or school transportation situation. Reasons may include low SELF-ESTEEM; being bullied, teased, or criticized; or feeling inferior to others. Situations surrounding actual school issues should be considered, such as riding on the school bus, eating in the school lunchroom, using the public washrooms, and undressing in the gym locker rooms. Issues of BODY IMAGE may be involved. With appropriate counseling and conferences with teachers or other school officials, all concerned can develop a new understanding of the children’s stresses regarding school. Treatment of a child who avoids school should be regarded as crisis intervention. The goal should be to get the child back in school as soon as possible and attending regularly with less fear and more confidence to meet the daily challenges. Stresses on Schoolteachers In today’s urban societies, teachers face more stresses than just in the classroom. Some neighborhoods in inner cities are populated by gang members, gun carriers, and drug dealers. From the time teachers leave their car in the parking lot, enter through a metal detecting machine, and arrive in their classrooms, there can be considerable uneasiness. Dealing with young people who are concerned only with getting through school and who nearly dare teachers to teach them something, is stressful
318 seasonal affective disorder syndrome for even the most dedicated of teachers. Counseling services within the school can be helpful. See also COPING; CRITICISM; PARENTING; PERFECTION; UNDERACHIEVEMENT.
seasonal affective disorder syndrome (SADS)
A form of mild DEPRESSION resulting from the stress of not seeing much sunshine or daylight for months at a time. It is characterized by severe mood swings corresponding to the change of seasons. Depression usually becomes more prevalent during the winter months, while the mood improves with the coming of spring. The incidence of SADS, which an estimated 35 million Americans suffer from, rises with geographic latitude, affecting 1.4 percent of Floridians but almost 10 percent of the population of New Hampshire. Role of Genetics People who eat more, sleep more, and are more depressed during the winter months may have family members experiencing similar changes, according to an article in the Archives of General Psychiatry. Researchers from Washington University School of Medicine surveyed 4,639 adult twins from Australia to determine if there is a biological predisposition to seasonal rhythms in mood and behavior (seasonality). Two types of seasonality were described: one characterized by a winter pattern and a second by a summer pattern of depressive mood disturbance. The researchers found that winter was much more likely than summer to lead to changes in mood, energy, social activity, sleep, appetite, and weight. They also found a “significant genetic influence” on those changes; 17 percent reported that they felt worse during the winter and 8 percent reported that they experienced a summer pattern of worsening in mood. The researchers concluded, “There is a tendency for seasonality to run in families, and this is largely due to a biological predisposition. These findings support continuing efforts to understand the role of the stress of seasonality in the development of mood disorders.” Role of Light Therapy Therapy for SADS includes use of specially made bright lights that extend the hours of illumination
during short winter days and help reset the body’s CIRCADIAN RHYTHMS. In some cases, a PHARMACOLOGICAL APPROACH and PSYCHOTHERAPY are useful. See also CLIMATE; MOODS. SOURCES: Anderson, Janis L., and Gabrielle I. Weiner. “Seasonal Depression.” Harvard Health Letter 21, no. 4 (February 1996). Madden, Pamela A. F. “Seasonal Changes in Mood and Behavior.” Archives of General Psychiatry, January 1996. Rae, Stephen. “Bright Light, Big Therapy.” Modern Maturity, February–March 1994.
secondary depression A DEPRESSION occurring in an individual who has another illness, either mental or physical, preceding the depression. For example, depression may accompany psychiatric disorders such as OBSESSIVE-COMPULSIVE DISORDER, ALCOHOLISM AND ALCOHOL DEPENDENCE (most common); depression may occur after or together with a medical illness. Careful evaluation of secondary depression by a physician is essential to determine the cause and course of treatment to reduce the stress the individual is experiencing. See also PHARMACOLOGICAL APPROACH. secondary gain A secondary gain is an obvious advantage that an individual gains from his or her anxiety or severe effects of stress. Family and friends may be more protective and more attentive and may release the individual from responsibility. For example, an agoraphobic person experiences secondary gains by having someone willing to accompany him or her outdoors or do errands and chores. See also AGORAPHOBIA; ANXIETY; PHOBIAS. secrets
Bits of information people hide or are afraid to tell. Some feel stressed about keeping their secrets or learning the secrets of others. The word secret is derived from the Latin secretus, meaning “separate” or “out of the way.” The current definition, according to the American Heritage Dictionary of the English Language, includes: “Something kept hidden from others or known only to oneself or to a few. Concealed from general knowledge or view. Dependably close-mouthed; discreet. Not visibly expressed; private; inward.”
self-efficacy 319 Most people know something that fits the above definition of secrets. However, the definition does not include many people who are uncomfortable and stressed. They think that there is something wrong in having a secret, don’t know what to do about it, and feel scared and threatened. Many people struggle lifelong with the keeping of secrets. A person’s own secrets become all-consuming, such as having committed a crime, attempted suicide, having mental illness in the family, or his or her own sexual orientation. There are women and men who are secret alcoholics, agoraphobics afraid to venture out of their homes, women who have had abortions or, after giving birth, gave babies away, and people who know they are adopted and never told their spouses. Some people keep prior marriages secret; others are or were victims of abuse by their husbands or wives. Hiding these secrets, as well as invisible disabilities, such as vision or hearing impairment, diabetes, or cancer, produces stresses that can lead to ANXIETY DISORDERS. Many people who hide secrets CATASTROPHIZE (constantly asking “what if”). Catastrophizing is predicting in the imagination the actuality of a negative event. They project the “worst case” scenario into the future and act on it as if it were true. As individuals continue worrying about hiding a secret, or worrying about what might happen if they tell, the stress produced leads to body tension, causing psychophysiological illnesses such as HEADACHES and stomachaches, and behavior symptoms such as irritability, short temper, difficulty concentrating, anxieties, DEPRESSION, and frustration. Sharing Secrets Divulging secrets at the wrong time to the wrong people can be embarrassing, shameful, and may interfere with one’s life and lifestyle. On the other hand, telling a secret at an appropriate time to an appropriate person, may help one feel freer, unburdened, and able to let go of real or imagined fears. According to Kahn and Kimmel, authors of Empower Yourself, secrets can be divided into those to keep, those to let go of and those to share. Many couples share secrets—the intimacies of their RELATIONSHIP. Family members and business associates share secrets. For many the sharing of secrets helps bond their loving and supportive relationships. See also COMMUNICATION; INTIMACY.
SOURCES: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997. Pennebaker, James W. Opening Up: The Healing Power of Confiding in Others. New York: William Morrow, 1990.
security object
A special object, such as a favorite toy or blanket, that gives a child comfort and reassurance. If the object is taken away or lost, even temporarily, the child will experience great stress and probably cry inconsolably. Loss of a child’s security object also causes stress for parents, as they must find ways to help the child deal with the loss. See also GRIEF; PARENTING.
self-confidence self-efficacy
See
SELF-ESTEEM.
The concept that one can perform adequately; it is also called self-confidence. The concept as it relates to anxiety disorders was researched during the 1970s by Albert Bandura (b. 1925), a U.S. psychologist at Stanford University. Self-efficacy (SE) measures how likely one believes one would succeed if one attempted a task. The SE rating correlates highly with performance in a behavioral test just after the rating. In people who had phobias asked to rate SE concerning their phobic task, SE is low before treatment and rises after individuals improve with exposure treatment. Improved SE or self-confidence at the end of treatment may be a major mediator in the reduction of stress regarding a phobia. However, a better way to increase SE is by exposure, the same procedure that can reduce fear. In experiments, SE correlated highly with low performance of a frightening task, but also with the stress and fear expected during it. In one experiment with 50 snake-phobic students, most refused to try to hold the snake because they were frightened, not because they felt inept. They were certain that they could hold the snake if they really “had to.” If a task is frightening, SE reflects an individual’s willingness rather than ability to do it. When willingness rises, there is less anticipated fear and stress. SE can predict psychological changes achieved by different modes of treatment. Expectations of
320 self-employment personal efficacy determine whether coping behavior will begin, how much effort will be expended, and how long it will be sustained in the face of aversive experiences. Persistence in activities that are subjectively threatening but, in fact, are relatively safe produces, through experiences of mastery, further enhancement of self-confidence, and corresponding reduction in defensive behavior and reduction of stressful factors. Individuals derive expectations of self-efficacy or self-confidence from four main sources: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more dependable the experiential sources, the greater the changes in perceived self-efficacy and reduction of stress. See also ANXIETY DISORDERS; PHOBIA; SELF-ESTEEM; STRESS. SOURCE: Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000.
self-employment
See CHANGING NATURE OF WORK.
self-esteem Accepting oneself, liking oneself and appreciating one’s self-worth. A high degree of self-esteem is a major characteristic of successful COPING with stress. Low self-esteem can lead to mental and physical disorders, such as DEPRESSION, poor appetite, HEADACHES, insomnia, and, in extreme cases, SUICIDE. Many people become stressed when they compare themselves with others or use unrealistic standards set for them by others. Those who think they do not measure up, have low levels of selfesteem and may feel inferior, either intellectually or physically. In contrast, individuals with high self-esteem feel confident and capable. People with low self-esteem often become workaholics and depend on approval from others. Lack of self-esteem has been indicated as one possible causative role for social ills, including juvenile delinquency, crime, and substance abuse. Lack of self-esteem can be life threatening, particularly in young people, where it is a major factor in depression and suicide.
Causes of Low Self-Esteem While causes of low self-esteem vary between individuals, there are many common themes. Some have low self-esteem because of physical appearance, for example, individuals who are overweight. This can be overcome by seeking counseling regarding a diet and exercise program. Some have prominent facial features, such as a misshapen nose or ear; with counseling and possibly cosmetic surgery, improvements can be made in both appearance and outlook. Abuse is another common cause. Having been abused as a child, either sexually or psychologically, or having been an abused spouse or in a codependent relationship can have a lasting effect on a person’s self-esteem. Some children lose their self-esteem on the athletic field because they do not complete well or do not have the physical ability to keep up or are bullied by team members. Other children lose selfesteem in the classroom when they are stressed by doing subjects they find hard. Simple comments and CRITICISM by teachers can be stressful to a child and can lower self-esteem. For example, a child told that he or she cannot sing well and should just mouth the words, may lose his confidence in ever trying to sing again. A high school student criticized because of a tendency to stutter may become afraid to stand up and speak in front of a crowd. In many cases, low self-esteem can lead to the stresses of social fears and phobias. See also BODY IMAGE; CODEPENDENCY; DATING; DOMESTIC VIOLENCE; INFERIORITY COMPLEX; INTIMACY; OBESITY; RELATIONSHIPS; SCHOOL; SOCIAL PHOBIAS; UNDERACHIEVEMENT. SOURCE: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
self-help groups The concept behind self-help groups is sharing feelings, perceptions, and concerns with others who have had or still have the same experience. According to the American Medical Association, self-help groups typically exhibit the following characteristics and benefits: Common problem: Members immediately identify with one another.
self-talk 321 Mutual aid/helper therapy: Members benefit as much from giving help as from receiving it. Network for support: Members provide a network of emotional and social support through regular and special gatherings, telephone calls, newsletters, visits, and computers. Unconditional acceptance: Members are usually encouraged to share their personal situations in a nonjudgmental, caring environment. Shared information: Through the group process and written material, members capture and share their successful techniques for COPING. Low cost: Expenses are shared through collections at meetings, minimal membership dues, or fund-raising projects. The self-help movement, with growing strength and visibility, has led to increased openness and understanding of many disorders, such as ANXIETY DISORDERS and CHRONIC ILLNESS. Such groups help many people develop better coping skills to meet the challenges they face. Self-Help Techniques Self-help groups utilize group discussions as well as audio and videotapes. Self-help can work if the individual is motivated to make it work. In fact, even with psychotherapy under the guidance of a professional, much of the improvement in a person’s ability to cope with STRESS actually comes from self-help. Many individuals join SUPPORT GROUPS to learn self-help techniques for particular situations. These include MEDITATION and PROGRESSIVE MUSCLE RELAXATION. Both are skills that can be learned and applied to relieve stress, ANXIETY, and PHOBIAS. See ALTERNATIVE MEDICINE. FOR FURTHER INFORMATION:
National Self-Help Clearinghouse 22 West 42nd Street New York, NY 10036 (212) 642-2944 SOURCE: American Medical Association. Healthcare Resource and Reference Guide. Chicago: American Medical Association, 1993.
self-hypnosis
See
HYPNOSIS.
self-psychology
Term for the psychological system propounded by Heinz Kohut (1913–81), an Austrian-born American psychoanalyst. His theory holds that all behavior as well as stresses can be interpreted in reference to the self. He proposed that even a young child has tendencies toward assertiveness and ambition, idealization of parents, and the beginnings of values. All these tendencies contribute to strong ties between the infant and parent. Kohut believed that the real mover of psychic development is the self, rather than sexual and aggressive drives, as Sigmund Freud suggested. Kohut used the term self-object to describe an object in an infant’s surrounding that the infant regards as part of himself or herself. People with narcissistic personality disorder cannot separate adequately from the self-object and thus cannot perceive or respond to the individuality of others. Kohut believed that the lack of emphatic response between parent and infant is the cause of later stresses and psychological disorders in the growing child. Kohut explained his major theories in several publications, including The Analysis of the Self (1971), The Restoration of the Self (1977) and The Search for the Self (1978). See also PSYCHOTHERAPIES.
FOR FURTHER INFORMATION:
Kohut Archives Institute for Psychoanalysis 180 North Michigan Avenue Chicago, IL 60601 (312) 726-6300 SOURCES: Kohut, Heinz. The Analysis of the Self. New York: International Universities Press, 1971. ———. The Psychology of the Self. New York: International Universities Press, 1978. ———. The Restoration of the Self. New York: International Universities Press, 1977.
self-talk
Messages one gives to oneself, often stemming from comments heard during childhood or earlier negative experiences. Negative self-talk may include such statements as “I can’t do this; this will never work out; I’m no good at this.” On the other hand, positive self-talk may include such
322 Selye, Hans messages as “I’ve done this before; everything will work out; I’ll find a way.” Negative self-talk is a source of stress for many people because it discourages them from taking any risks or making desired changes in their lives. Positive self-talk can help relieve stress because it reinforces confidence in one’s own abilities. SOURCE: Kahn, Ada P., and Sheila Kimmel. Empower Yourself: Every Woman’s Guide to Self-Esteem. New York: Avon Books, 1997.
Selye, Hans (1907–82)
An Austrian-born Canadian endocrinologist and psychologist, well known for his work in STRESS research. He introduced the concept of stress during the early 1940s. He is the author of The Stress of Life (1956) and Stress without Distress (1974). He defined stress as “the nonspecific response of the body to any demand made upon it. It is more than merely nervous tension.” He categorized over 1,000 physiological occurrences related to stress and adaptation. His theory is a description of what one may expect with chronic exposure to stressors, and with the body’s attempts to adapt and return to “normality.” In 1950, Selye coined the term GENERAL ADAPTATION SYNDROME (G.A.S.). Selye borrowed the term stress from physics, and applied it to the mutual actions of forces that take place across any section of the body to threaten HOMEOSTASIS. Although not all states of stress were harmful, according to Selye, he held that the more severe, protracted, and uncontrollable situations of psychological and physical distress led to disease states. His concept of G.A.S. focused on the reaction of the body to illness or foreign substances as opposed to concentrating on specific illnesses and their treatment. Although his work was controversial during his time, mental health disciplines profited from his ground-breaking work in stress research. His concept of stress opened new avenues of treatment through the discovery that hormones participate in the development of many degenerative diseases, including coronary thrombosis, hardening of the arteries, high blood pressure, arthritis, peptic ulcers, and even cancer. Selye received his medical training in Europe; he did most of his innovative research on the
effects of stress in Montreal at McGill University and the Institut de Medicine et de Chirurgie Experimentales de l’Universite de Montreal, of which he was director for many years. He received his medical degree and his Ph.D. from the German University in Prague. Selye earned doctorates in medicine, philosophy, and science, as well as at least 19 honorary degrees from universities around the world. He authored more than 32 books and more than 1,500 technical articles. See also DIS-STRESS; EUSTRESS; STRESS MANAGEMENT. SOURCES: Selye, Hans. The Stress of Life. New York: McGraw-Hill, 1956. ———. Stress without Distress. Philadelphia: J. B. Lippincott, 1974.
sense of humor
See
LAUGHTER.
sensory integrative dysfunction An inability to take in information through the senses (touch, movement, smell, taste, vision, and hearing) to combine it with prior information, memories, and knowledge stored in the brain to make a meaningful response. Many parents experience stress when their young children appear lazy or stubborn, shy, or headstrong. Young children may seem easily distracted, hyperactive, or uninhibited because they do not screen out nonessential sensory or visual information. They may constantly ask about or orient to sensory input that others ignore, such as fans or distant airplanes. Other children may fail to respond to certain stimuli, such as when their name is called. Children with regulatory disorders may have difficulty establishing appropriate sleeping and eating patterns. Understanding why this behavior occurs and taking steps to change the child’s behavior can help relieve stress between parent and child. Sensory integration occurs in the central nervous system and is generally thought to take place through complex interactions of the portions of the brain responsible for coordination, attention, arousal levels, autonomic functioning, emotions, memory, and higher level cognitive functions. Because there are many variables between children, personalities, and environment, there is no
separation anxiety 323 single list of symptoms identified with sensory integrative dysfunction. The syndrome was first researched and described in Sensory Integration and the Child, by A. Jean Ayres, Ph.D. She says: “Good sensory processing enables all the impulses to flow easily and reach their destination quickly. Sensory integrative dysfunction is a sort of ‘traffic jam’ in the brain. Some bits of sensory information get tied up in traffic, and certain parts of the brain do not get the sensory information they need to do their jobs.” According to Linda C. Stephens, writing in the AAHBEI News Exchange, parents and professionals should look at patterns of behaviors and the overall situation of how problems interfere with the child’s function in his or her play, physical and emotional development, and ability to develop independence. A child suspected of having a sensory integrative disorder should be evaluated by a health care professional who has had additional training in sensory integration evaluation and treatment. Identifying Dysfunctions in Young Children The child may lack purpose in his or her activity and be easily distracted. While young children’s attention span is generally short, a child who has sensory integration dysfunction shows even more distractibility, and does not play, climb, or swing in an organized way. Other children with this dysfunction may be very repetitive in playing with toys. They may learn one way to play with a toy or playground equipment without adding variations or playing creatively. Other children may have poor balance and trip easily and bump their heads because they lack protective responses when they begin to fall. Some children have difficulty calming themselves after exciting physical activity or after becoming upset. Tantrums may occur and the child may seen inconsolable. Other children seek excessive amounts of vigorous sensory input, such as swinging or spinning without experiencing dizziness. Children may become discouraged or develop poor SELF-ESTEEM, particularly if they are aware of differences in their function and those of their peers. A child’s difficulty with motor skills and play activities may make it hard for him to be part of a
group, cause aggressive behaviors, or cause the child to be a loner. The child may have difficulty with transitions, such as leaving one place to go to another. Parents should look at behavior patterns and how the problems interfere with the child’s function in his or her play, physical and emotional development, interaction with other children and adults, and ability to develop independence. Help is available from certified professionals (usually occupational or physical therapists). Therapists may administer and interpret results of the Sensory Integration and Praxis Tests and make recommendations to concerned parents. FOR FURTHER INFORMATION:
Klinefelter Syndrome and Associates 11 Keats Court Coto de Caza, CA 92679 (888) 999-9428 (949) 858-3443 (fax) http://www.genetic.org American Association for Home-Based Early Interventionists 6500 Old Main Hill Logan, UT 84322-6500 (800) 396-6144 (toll-free) (435) 797-5580 (fax) http://www.aahbei.org E-mail:
[email protected] SOURCES: Ayres, A. Jean. Sensory Integration and the Child. Los Angeles: Western Psychological Services, 1994. Stephens, Linda C. “Sensory Integrative Dysfunction.” AAHBEI News Exchange, 2, no. 1 (winter 1997): 1–7. Trott, Maryann Colby, et al. SenseAbilities: Understanding Sensory Integration. Tucson, Ariz.: Therapy Skill Builders, 1993.
separation anxiety A stressful feeling one experiences when separated from parents or individuals with whom one has an attachment. Infants and toddlers normally experience stress and anxiety when separated from parents or caregivers, but the intensity usually diminishes by the time the child is four to five years old. Children who fear separation cry, cling to the parent, and demand to be held and cuddled.
324 September 11, 2001 Symptoms of separation anxiety in childhood may be HEADACHES, stomachaches, and other vague complaints in an effort to keep the parent from leaving or to keep the child home from SCHOOL. School phobia, or school avoidance, is sometimes a case of separation anxiety. What some children fear is that something dreadful will happen to their parent(s) if they are away, or that the parent will not be there when the child returns. Sometimes the parent (usually the mother) has a fear of danger when her child is away from her, which is transmitted to the child and augments the child’s own fears. The mother of a child with separation anxiety may need supportive psychotherapy to help relieve her own stresses as well as those of the child. See also AGORAPHOBIA; GRIEF; SECURITY OBJECT.
September 11, 2001 (9/11) In a series of deliberate and deadly acts, the worst event of terrorism in the history of the United States occurred on this date. Two hijacked airliners crashed into the World Trade Center towers in New York City. Thousands were feared dead when the towers collapsed more than an hour after the impacts. A third hijacked airliner crashed into the Pentagon. A fourth, possibly bound for another target in Washington, D.C., crashed in Somerset County, Pennsylvania, apparently after passengers attempted to overpower the hijackers. The Federal Aviation Administration suspended all air traffic in the United States and diverted international flights to Canada. Federal offices and public buildings in Washington, New York, and other major cities were closed. More than 3,000 people died as a result of the tragic acts or remained missing following the attacks. • Victims came from 80 different nations, from many different races and religions. • 343 firefighters and paramedics perished at the World Trade Center. • 23 police officers and 37 Port Authority police officers died at the World Trade Center.
• Approximately 2,000 children were left without a parent and many families were permanently disrupted by the events. • One business alone lost more than 700 employees, leaving at least 50 pregnant widows. Many survivors and witnesses suffered symptoms of POST-TRAUMATIC STRESS DISORDER. President George W. Bush called the attacks “acts of war” and along with many world leaders, began steps to prevent future terrorist attacks. The event has come to be known as 9/11, and the event was and continues to be an inestimable source of stress for all Americans. As a result of the attacks, the USA PATRIOT Act of 2001 was signed into law in a stated attempt to pursue and punish terrorists and also to prevent further attacks. The USA PATRIOT Act in itself has been a source of stress for some who fear that the freedoms and liberties formerly enjoyed by Americans are being limited in the name of preventing terrorist attacks. September 11 was designated by President George W. Bush as Patriot Day (Public Law 10789) in December 2001. See also ANTHRAX; TERRORISM.
serious mental illness (SMI)
A diagnosable, mental, behavioral, or emotional disorder experienced by an individual in the past year that meets the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and that results in functional impairment substantially interfering with or limiting one or more major life activities. A scale of six questions is used to measure SMI. These questions ask how frequently a respondent experienced symptoms of psychological distress during the one month in the past year when he or she was at his or her worst emotionally. In 2003, according to the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, there were an estimated 19.6 million adults aged 18 or older with SMI. This represents 9.2 percent of all adults and is higher than the rate of 8.3 percent in 2002. (See chart.)
sex appeal 325 TABLE 6.1A SERIOUS MENTAL ILLNESS IN THE PAST YEAR AMONG PERSONS AGED 18 OR OLDER, BY GENDER AND DETAILED AGE CATEGORIES: NUMBERS IN THOUSANDS, 2002 AND 2003 GENDER Total Age Category
TOTAL 18 OR OLDER 18 19 20 21 22 23 24 25 26–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 66 or Older
2002
17,483 543 514a 511 571 533 518 426b 469 1,458 2,132 1,995 2,236 1,713a 1,397 904 416 1,148 b
Male 2003
2002
19,588 644 619 574 544 508 518 545 468 1,725 1,967 2,253 2,248 2,224 1,718 991 521 1,521
6,041 216 192 214 218 209 193 159 160 543 732 846 643 559 384 305 158 313
a
Female 2003
2002
2003
6,887 275 223 243 199 196 190 218 146 635 589 775 662 776 667 387 199 505
11,442 326 322 297 353 324 324 268 309 915 1,400 1,150a 1,593 1,154 1,013 599 259 835
b
12,702 369 395 332 345 311 328 327 322 1,090 1,378 1,478 1,586 1,448 1,050 604 322 1,016
*Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section B.4 of Appendix B of the Results from the 2003 National Survey on Drug Use and Health: National Findings. a Difference between estimate and 2003 estimate is statistically significant at the 0.05 level. b Difference between estimate and 2003 estimate is statistically significant at the 0.01 level. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.
serotonin
A NEUROTRANSMITTER found in the central nervous system, in many tissues, in the lining of digestive tract, and in the brain, serotonin influences SLEEP and emotional arousal and is indirectly involved in the psychobiology of DEPRESSION. Low levels of serotonin may contribute to development of depression. Some antidepressant medications increase the levels of serotonin and norepinephrine, another neurotransmitter. See also PHARMACOLOGICAL APPROACH.
serotonin reuptake inhibitors (SRIs) SION; PHARMACOLOGICAL APPROACH.
See DEPRES-
sex appeal
Usually refers to personal appeal or physical attractiveness for members of the opposite sex. A healthy, good-looking face, attractive hair, and an attractive body shape are generally the embodiment of sex appeal in the United States today. Individuals with these characteristics are featured in advertisements and in films. People may find these advertisements a source of stress as they seem to feel that these models are a threat to their SELF-ESTEEM. A person who has sex appeal may be said to be “sexy” based on cultural patterns and personal tastes. For example, men who are muscular and athletic are considered sexy, as are women who are
326 sex drive relatively slim but have large breasts. At other periods in history, women who were plump were considered attractive, as shown in paintings of Peter Paul Rubens, a Flemish painter (1577–1640) whose nudes gave our vocabulary the term Rubenesque, to refer to the well-developed and heavier body shapes. See also ADVERTISING; BODY IMAGE; EATING DISORDERS.
sex drive
A level of desire to have sexual activity. This level varies in strength and is different for women and men and at different ages and stages of their lives. Differences may be due to stress or to inhibitions influenced by parental, religious, and peer group attitudes about sex. People’s expression of sexual desire may differ also, according to whether or not they have a partner. For example, sex researchers have found that some widowed postmenopausal women who have no partner believe that their sex drive is not very strong, while women in the same peer group who date and have male companions feel a strong sex drive. While some researchers believe that sex drive decreases with age, many older adults will attest to the fact that sex drive can persist throughout all stages of life. Good health, freedom from chronic disease, and companionship with others of the opposite sex stimulates the sex drive to continue until older age. See also SEX THERAPY; SEXUAL DIFFICULTIES.
difficulties because of stress, while at the same time sexual difficulties are a cause of stress for them. The purpose of sex therapy is to address the anxieties that a couple has about sexual activity by learning what normal sexual behavior is and by increasing their enjoyment of sex by gradually engaging in intimate activities. Couples learn to communicate better with each other regarding sexual matters and preferences, retrain their approaches and response patterns, and thus reduce their feeling of stress. Sex Therapy Techniques Sex therapists use several techniques. One is sensate focus therapy, in which the couple explores pleasurable activities in a relaxed manner without sexual sensations. The couple might start with massage of non-erogenous areas of the body. Gradually, as anxieties diminish, the couple progresses to stimulation of sexual areas and finally to sexual intercourse. Other techniques sex therapists use are directed toward reducing premature EJACULATION, relieving vaginismus (muscle spasm of the vagina), and helping both partners reach orgasm. For sexual difficulties related to physical causes or illness, individuals should consult a physician, particularly specialists in gynecology or urology. See also ANORGASMIA; COMMUNICATION; DYSPAREUNIA; INTIMACY; LISTENING; SEXUAL PREFERENCES. SOURCE: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992.
sexism
An attitude or belief that one sex is superior to the other in certain situations. The attitude seems to cause stress for all concerned. The term often refers to male attitudes about women, such as “women in public office might cry if they are upset,” or “a woman shouldn’t be trained for a high-paying job because she will leave to have children.” To a large extent the WOMEN’S MOVEMENT during the latter half of the 20th century fought to overcome sexism. See also SEXUAL HARASSMENT.
sex therapy
Includes counseling and treatment for SEXUAL DIFFICULTIES that are not due to medical or physical causes. People may encounter sexual
sexual difficulties Any conditions that interfere with the process leading to and including enjoyment of sexual intercourse (coitus). Sexual difficulties are extremely stressful for the individuals involved. Indeed, many marriages and relationships break up because of sexual stress. The opposite of sexual difficulties are feelings of contentment after a pleasurable and satisfying sexual encounter. An individual has a feeling of intense fulfillment in the orgasmic and resolution phases of the SEXUAL RESPONSE CYCLE. This is accompanied by a feeling of extreme RELAXATION, sometimes a “high” feeling and emotional closeness with the partner.
sexual harassment 327 There are temporary sexual difficulties and there are dysfunctions or situations that persist lifelong. Use of some prescription drugs may cause sexual dysfunction for some individuals; it may be possible that other similar drugs can be substituted by a physician that do not have these unpleasant side effects. Examples of female sexual difficulties include ANORGASMIA, DYSPAREUNIA (painful sexual intercourse), and VAGINISMUS. Examples of male sexual dysfunctions include IMPOTENCE, difficulty in maintaining erection, premature EJACULATION, and retarded ejaculation. Sexual Fears Many people are under stress and that stress tends to impair or weaken their sexual responses to partners. For example, some women fear experiencing pain during intercourse or fear that they will not experience ORGASM. Some men fear that they will not be able to achieve or maintain an erection long enough for a satisfying experience for their partners. The stress of CHRONIC ILLNESS can cause people to fear that they will not be able to enjoy sexually fulfilling experiences. For example, some husbands after heart surgery fear the sexual act itself; their wives fear that sexual activity will harm their husbands. The threat of acquiring a SEXUALLY TRANSMITTED DISEASE (STD) or the HIV virus (known as the cause of AIDS) is a contemporary fear of many people who are not in monogamous relationships. These fears can largely be overcome by the use of SAFE SEX practices. See also BEHAVIOR THERAPY; COMMUNICATION; HUMAN IMMUNODEFICIENCY VIRUS; SEX THERAPY.
sexual harassment Unwelcome and unwanted sexual attention, usually on the job; it is particularly stressful for the person experiencing it. The harassment may involve men toward women, women toward men, or the same-sex individuals; it may include jokes, remarks, and questions about the other’s sexual behavior, “accidental” touching, and repeated and unwanted invitations for a date or for a sexual relationship. It can be verbal, visual, physical, or written.
EXAMPLES OF SEXUAL HARASSMENT • Dirty jokes or sexually oriented language • Nude or semi-nude photos, posters, calendars, or cartoons • Obscene gestures, lewd actions, or leering • Introduction of sexual topics into business conversations • Requests for dates or sexual favors that are not mutually acceptable • Unwelcome hugging, patting, or touching
Sexual harassment is defined in terms of its effect on the recipient. This means that behavior meant to be humorous or well-intentioned is sexual harassment if it is offensive to the individual at the receiving end. It is not the intent of the sender of the behavior that counts because what one person may view as harmless can be objectionable to others. Of all incidents of sexual harassment reported to the Equal Employment Opportunities Commission in fiscal year 1990, 92 percent were reported by women. Women in lower positions are far less likely to tell a harasser who holds a higher organizational position that his/her conduct is unwelcome. However, in a research study of female medical students, 61 percent reported having been
SEXUAL HARASSMENT: WHAT TO DO • Tell the offender promptly and clearly that the conduct is unwelcome and unacceptable. Do this verbally or in writing, or both. • Document in writing every incident, with specific details of the offensive behavior and your response. • Do not feel guilty. Sexual harassment is not your fault. By clearly voicing your expectations, you force the offender to choose whether to change the unwelcome behavior or to purposely continue it. • If the problem continues, tell your supervisor. If your supervisor is the harasser, talk to another executive or report it to the department of human resources.
328 sexuality sexually harassed by residents or interns and 48 percent claimed to be harassed by patients. A United States Supreme Court decision (Meritor v. Vinson) in 1980 declared that sexual harassment is a form of sex discrimination and, therefore, a violation of Title VII of the 1964 Civil Rights Act. During the 1980s, American society became increasingly aware of sexual harassment. For example, in the study by the U.S. Merit Systems Protection Board reported in 1988, federal workers were more inclined to define certain types of behavior as sexual harassment than in 1980. In the late 1990s, cases of sexual harassment in the military services were uncovered. Stresses arose when enlisted men and women felt obligated to follow requests of their superiors. Disciplinary charges occurred in many cases and led to discharge, which will probably serve as a deterrent to ongoing sexual harassment in the military.
sexuality The ability to think and behave as a sexual being; also, any aspect of human thought or behavior that has sexual meaning. It implies a selfconcept of oneself as a sexual being as well as having the capacity to respond to erotic stimuli and sexual activity. Sexuality encompasses being comfortable with sexual fantasies and erotic zones of the body as well as with one’s own gender identity. However, no specific set of behavior or SEXUAL PREFERENCE is necessary to have a good sense of one’s own sexuality. Social, psychological, and biological dimensions to human sexuality lead to stress for many people. See also SEXUAL DIFFICULTIES. sexually transmitted diseases (STDs)
Diseases that affect both men and women and are generally transmitted during sexual intercourse. STDs cause individuals considerable stress because of physical discomforts, psychological pain, possible INFERTILITY, and the potential that they may be life-threatening, as in the case of AIDS. STDs cause psychological distress for many reasons, including a need to communicate the problem to one’s partner and a need to disclose information about past sexual activities and partners. The term SAFE SEX relates to sexual practices that aid in the prevention of STDs as well as AIDS.
The stresses and long-term effects caused by two STDs, syphilis and gonorrhea, have been with human beings for centuries. Those two diseases were commonly referred to as venereal diseases long before the term STD was coined. Syphilis and gonorrhea are still prevalent, and on the increase due to the upswing in other concurrent STDs. These other STDs became notably widespread during the latter decades of the 20th century. They include chlamydia, herpes, hepatitis B, as well as genital warts, and other vaginal infections. Individuals who are widowed or divorced and who begin dating and seeking new partners after their loss, as well as never-married individuals, are concerned about STDs. Fear of acquiring STDs has led many formerly sexually active people to seek fewer sexual partners. Such concerns have also increased the use of condoms, which, when appropriately used, are thought to reduce the likelihood of spreading most STDs (as well as AIDS). Unlike infections with herpes, chlamydia, and gonorrhea, which can be transmitted at birth, congenital syphilis is a prenatal infection. Fetal infection may occur at any time during pregnancy. It is
HOW TO REDUCE RISKS OF ACQUIRING AN STD • Have sexual contact with only one partner who limits contact to you only. Have a monogamous relationship. • Ask your partner about any suspicious looking discharges, sores, or rashes. Look your partner over. • Use condoms. Condoms provide some (though not complete) protection against STDs. However, the condom must be put on before sexual activity begins and not removed until the end of the activity. • Use foam, a diaphragm with spermicides, or sponge spermicides, which kill many infectious agents; these should be used in addition to the condom. • If another partner has a STD, the other partner must be informed and treated at the same time to avoid reinfection. Avoid the “ping-pong” effect of infection.
shiatsu 329 more likely to occur if the mother has primary, secondary, or early latent syphilis, as many organisms are present in the circulation during these stages. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) has become a widely known disease during the latter part of the 20th century. The AIDS virus is known to be transmitted by direct exchange of body fluid, such as semen or blood, and thus is considered a sexually transmitted disease. FOR FURTHER INFORMATION:
National VD Hotline American Social Health Association (800) 227-8922; CA: (800) 982-5883 American Social Health Association P.O. Box 13827 Research Triangle Park, NC 27709 (919) 361-2742 (919) 361-8425 (fax) http://www.ashastd.org SIECUS (Sex Information and Educational Council of the U.S.) 130 W. 42nd Street, Suite 350 New York, NY 10036-7802 (212) 819-9770 (212) 819-9776 (fax) http://www.siecus.org SOURCES: Kahn, Ada P., and Linda Hughey Holt. The A-Z of Women’s Sexuality. Alameda, Calif.: Hunter House, 1992. Sack, Fleur. Romance to Die For: The Startling Truth about Women, Sex and AIDS. Deerfield Beach, Fla.: Health Communications, 1992.
sexual preferences The choices women and men make when experiencing attraction to and participating in sexual activities with other men, women, or both genders. These may be influenced by environment, early childhood experiences, possibly genetic makeup, and early hormonal exposure effects on central nervous system development. HOMOSEXUALITY refers to sexual attraction to members of the same sex. Bisexuality refers to sexual attraction to members of the opposite sex and members of the same sex. Stresses involve perceiving oneself as different from most people and at times not understanding one’s attractions. See also LESBIANISM.
sexual response A physiological reaction to sexual stimulation and arousal. In women, vaginal lubrication is an early sign in the sexual response cycle. In men, erection of the penis occurs. Responsiveness is a highly individual matter, largely determined by mutual feelings of love and affection between the partners and a wide variety of emotional and physical circumstances. Levels of responsiveness vary between individuals, and vary within the same individual at different times. Many people experience stress about their responses, not realizing that a wide range of differences are considered normal. See also SEX THERAPY. sexual revolution The changes in sexual attitudes and behaviors in the United States during the 1960s, 1970s, and early 1980s. With the changes came increased stresses for many people as more choices of lifestyle became socially acceptable. Generally, there were more liberal attitudes toward premarital sexual activity, changes in the double standard in which sexual activity had previously been seen as more acceptable for men than for women, and more open discussion of women’s sexual needs. Increases in premarital activity evolved in part as a result of development of better and easier means of BIRTH CONTROL, including oral contraceptives during the late 1950s. For many young people, DATING habits during the sexual revolution included sexual intercourse early in the relationship. However, with the increase of SEXUALLY TRANSMITTED DISEASES and ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) in the heterosexual population since the 1980s, people have become more cautious and selective about their sexual partners and monogamy has regained favor. The sexual revolution was closely tied with the WOMEN’S MOVEMENT. Many college dormitories became coeducational, and there was wider acceptance of unmarried adults “living together.” While this arrangement was acceptable to many, for others it was a source of stress. shell shock shiatsu
See POST-TRAUMATIC STRESS DISORDER.
Considered an alternative therapy that may be useful for some individuals to prevent or relieve the effects of stress. Shiatsu is a specific
330 shift work method for manipulating tsubos (points along the meridians where the flow of energy may become blocked). The manipulation may occur through pressing with the fingers and hands, or through the use of elbows, knees, and feet. The points that are manipulated are known as ACUPRESSURE or ACUPUNCTURE points. Manipulation of the body’s approximately 360 tsubos is thought to release the flow of energy (chi). There are many forms of shiatsu. See also ALTERNATIVE MEDICINE; BODY THERAPIES. SOURCE: McCarty, Patrick. A Beginner’s Guide to Shiatsu: Using Finger Pressure for the Relief of Headaches, Back Pain, and Hypertension. Garden City, N.Y.: Avery Publishing Group, 1995.
shift work
Usually refers to working a series of hours earlier or later in the day than the more usual 9 to 5 routine. Some work an afternoon shift, from 4 to 11 P.M.; others work the night shift, from 11 P.M. to 7 A.M. People who do shift work experience many unique stresses. How well one adapts to shift work depends on how well one handles the interruption of the body’s CIRCADIAN RHYTHMS. The break in circadian rhythm can affect mental ability, alertness, and temperament. Thus some night shift workers experience anxiety and lapses in memory as a result of SLEEP deprivation. Individuals who do shift work also suffer social stresses. For example, many people function on a 9 to 5 schedule, with most socialization occurring after work and on weekends. For night-shift people to have a family or social life, they must schedule creatively. Spouses and children of shift workers also experience stress because of this schedule. How Night Shift Workers Can Avoid Stress “The best strategy is to stay on one shift as long as possible. You’ll have the best chance of getting restful sleep that way; you’ll be more alert and potentially safer,” says Rebecca Smith-Coggins, M.D., a Stanford University emergency medicine physician who studies what happens when people’s sleep habits change. “People who work random shifts in a 24-hour work environment suffer in their ability to perform specific physical tasks and to make decisions. Other studies have shown that when workers are shifted forward rather than randomly, they perform better
and have fewer sick days. However, it still takes two weeks to get used to a night shift after a day shift,” according to Smith-Coggins. Workers new to the night shift can help themselves adjust by knowing that they won’t get a full six to eight hours’ sleep in one stretch immediately. To help make the change, Smith-Coggins advises that new night workers take a three-hour nap before starting work, then sleep again after their shift. “Studies as well as our own experience among emergency department workers point to this double sleep pattern as the easiest way to switch over,” she says. Eventually most shift workers will find themselves sleeping longer after they get home and napping less before they start work. Ultimately, a full “night’s” sleep is possible in the morning, after working the night shift. Changing Work Shifts For people who must change shifts, the healthiest approach seems to be to start the new shift later in the day. For example, it’s easier on sleep and rest patterns to change from an eight-hour shift starting at 7 A.M. to one starting at 3 P.M. rather than the reverse. Moving forward is better because most humans operate on a 25-hour sleep-wake cycle. “Our body temperature and other natural functions rotate as if the day were 25 hours long. You can see how that works by studies that place people in a darkened setting with no clues about time. They develop a natural tendency to get up one hour later everyday, a clear indication that we are on a forward rather than back or static cycle,” Smith-Coggins explained. Other ways for night workers to get more efficient rest include darkening the bedroom as much as possible or using a sleep mask. Ear plugs or socalled white noise, such as a humming sound from a fan or air conditioner, can help. It is also helpful to maintain the same bedtime rituals, such as relaxing with a book or television show, particularly if the material is not unsettling. SOURCES: Hurley, Margaret, and Elizabeth A. Neidlinger. “To Shift or Not to Shift.” Schumpert Medical Quarterly 9, no. 2 (October 1991). Smith-Coggins, Rebecca. “Night Shifts Can Be Easier.” Circulation, December 1, 1995.
sibling relationships 331 shopaholism
A compulsion to shop. While some people view shopping as recreation and a way to reduce stress, for others, shopping can lead to a compulsive syndrome. Excessive shopping shares some characteristics with OBSESSIVE-COMPULSIVE DISORDER, in which people perform certain rituals to relieve tension. In this way, compulsive shopping is similar to the problems of alcoholics or gamblers who exhibit obsessive behavior. Compulsive shoppers buy things in order to forget the stresses of their lives and make themselves feel good. However, over time it takes more and more spending and buying to improve their moods. Many people who are normally good about balancing their budgets overbuy around holidays, so for individuals who are compulsive shoppers, the problem will be magnified. Excessive shopping can be attributed in part to an attempt to promote a better self-image through buying multiple or expensive gifts, to change people’s perceptions about the giver, to make an economic statement, or to serve as a substitute for weaker aspects of the giver’s relationship with others. Support Group for Shopaholics Debtors Anonymous is a support group for overspenders based on the 12-step recovery program of Alcoholics Anonymous. DA members work toward financial solvency the way AA members work toward abstinence. Experienced DA members
COPING WITH THE STRESS OF SHOPAHOLISM • Shop with a list and buy only what is on the list. • Shop with a partner who will help you resist. • Avoid browsing and avoid sales. The excitement can trigger a shopping spree. • Develop new social outlets. Cultivate groups of friends with whom you can share activities as a healthful alternative to shopping. • Learn alternatives for COPING with stress. People with addictive illnesses usually do not cope well with stress. • Physical exercise is a good stress reliever and will clear your mind for better concentration later on. • Avoid using credit cards. Use them only for business, if you need to.
review new members’ finances and help them formulate an action plan for resolving debts and a spending plan for the future. DA members look to one another for support, hope, and strength in dealing with the stresses of indebtedness. FOR FURTHER INFORMATION:
Debtors Anonymous P.O. Box 920888 Needham, MA 02492-0009 (781) 453-2743 (781) 453-2745 (fax) http://www.debtorsanonymous.org SOURCES: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001 O’Connor, Karen. When Spending Takes the Place of Feeling. Nashville: Thomas Nelson, 1992.
shredding machines
See
IDENTITY THEFT.
shyness Generally refers to excessive discomfort, embarrassment, and INHIBITION in the presence of others, which can lead to avoidance. Shyness is a source of stress for many individuals who recognize their shyness. Shy people generally would like to be more dynamic, outgoing, and outspoken. They may be eager to meet new people and learn new activities, but are often reluctant to do so because of discomfort and anxiety about what to say or do. Excessive shyness sometimes becomes a SOCIAL PHOBIA. Shyness is fairly common in children and adolescents. However, as the young person develops an increasing sense of SELF-ESTEEM, shyness often disappears. See also PHOBIAS; PUBERTY. sibling relationships Relationships between brothers and sisters; stresses include COMPETITION between siblings who often vie for parental attention. The situation first occurs after the birth of a new baby, when an older sibling feels “displaced.” The feelings of rivalry may persist among siblings throughout life. One child may be continuously compared with another, and the parents may further the feeling of rivalry by appointing one child as the better example. Throughout school, brothers and sisters may strive to outdo one another.
332 sick building syndrome PERSONALITY differences may account for sibling rivalry. For example, while one sibling may be extroverted, have an outgoing personality, and make friends easily, another sibling may be more introspective, find it difficult to mingle but excels in school. The introspective sibling may be jealous of the extroverted sibling’s sociability, while the extrovert may be jealous of the other sibling’s academic achievements. Sibling rivalry may persist even after the death of parents, when brothers and sisters become jealous over uneven distribution of their parents’ possessions. See also BIRTH ORDER; JEALOUSY; RELATIONSHIPS.
sick building syndrome
Refers to illnesses caused by working or living in modern buildings. Symptoms may be caused by air-conditioning systems, fluorescent lighting systems, and not enough ventilation. Modern buildings are tighter in construction and depend on air circulators, as opposed to outside air from windows, for ventilation. A contemporary personal and societal source of stress, sick building syndrome was once known as “building-related illness.” Symptoms may include HEADACHES, itchy eyes, nose and throat, dry cough, diminished mental acuity, sensitivity to odor, and tiredness. Additionally, stressful symptoms may be caused by the FRUSTRATION of feeling closed in and not being able to control the amount of heat or light in the immediate ENVIRONMENT. Thus the stress of the syndrome is also related to feelings of lack of personal CONTROL. A ripple effect sometimes occurs when one employee in such a building begins complaining of illness. Soon others believe that they too have headaches as a result of the WORKPLACE. An outbreak of Legionnaires’ disease, a form of pneumonia, from bacteria in an air-conditioning system was first identified among American Legion conventioneers in a Philadelphia hotel during the 1970s; outbreaks of Legionnaires’ disease occurred as recently as 1995. Organisms responsible for the disease as a contaminant of water systems were responsible for earlier epidemics of pneumonia, although the cause had not been known. The influence of sick building syndrome as a source of employee stress was recognized on a
large scale when complaints of sick building syndrome to the U.S. Department of Occupational Safety and Health (OSHA) doubled between 1980 and 1981. Recognized by the insurance industry under the name “tight building syndrome,” Fireman’s Fund Insurance Company established its own “tight building syndrome” laboratory in late 1983, after investigating 48 buildings in the United States and discovering that about one-third presented health hazards from indoor air pollution. Relief of Stress Caused by Sick Building Syndrome Individuals who believe they are being made ill by their building should consult their company psychologist, if there is one, or department of human resources. Reports should be filed in a timely way so that investigations can be made. Removal of the pollutant, if possible, is essential. There may be possibilities to improve air balance and adjustment, including percentage of outside air being circulated. All humidifiers, filters, and drip pans must be checked. Overall maintenance of the building should be evaluated, and cleaning materials, air fresheners, and moth repellents should be selected carefully. New carpeting should be installed on a Friday, allowing ventilation of the building over the weekend. Additionally, individuals should determine if there are any possible steps they can take to relieve their personal stress. These may include requesting being moved to another part of the building, or bringing a small electric fan or heater to work. If necessary, a short vacation away from the pollutants may be helpful. FOR FURTHER INFORMATION:
National Safety Council 1121 Spring Lake Drive Itasca, IL 60143-3201 (800) 621-7619 (toll-free) (630) 285-1121 (630) 285-1315 (fax) http://www.nsc.org SOURCE: Griffin, Katherine. “When Your Office Calls in Sick.” Health, January–February 1993.
sick role
The protected position that an individual who is anxious, phobic, or considered not well
sleep 333 assumes or is put in by family and friends. The situation can be a source of stress for the individual or the caregivers. The sick role may give the labeled individual the advantages of attention and support, emotional and financial, that he or she might not otherwise have. However, the individual in the sick role may not be motivated to improve because he or she fears removal of attention, which is a powerful reinforcer. Some individuals who have AGORAPHOBIA are encouraged in the sick role because the families do errands and chores for them, enabling the phobic individuals to perpetuate their agoraphobic tendencies. The sick role may have positive effects on a family in that it may cause family members to become more cohesive. See also ANXIETY DISORDERS; SELF-ESTEEM. SOURCE: Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears and Anxieties. New York: Checkmark Books, 2000.
SIDS
See
SUDDEN INFANT DEATH SYNDROME.
Siegel, Bernie S(hepard), M.D. (1921– ) Surgeon, lecturer, and author of the best-selling book, Love, Medicine and Miracles. Through his leadership of Exceptional CANCER Patients (ECaP), a California SUPPORT GROUP that he founded, Dr. Siegel encourages members try to help heal themselves. By sharing their FEAR and ANGER with each other, ECaP members undergo a form of stress reduction and alternative therapy that, according to Siegel, aids in the healing process. They utilize the concept of “carefrontation,” a loving, safe, therapeutic confrontation, which facilitates personal change and healing and helps relieve the stress of chronic illness. Siegel believes that getting well is not the only goal; learning to live without fear and to be at peace with life and ultimately death is also important. He utilizes group therapy involving patients’ dreams, drawings, and images. Dr. Siegel travels extensively to speak, facilitate workshops, and share his techniques and experiences. Dr. Siegel completed his surgical training at Yale New Haven Hospital and the Children’s’ Hospital of Pittsburgh. He received his M.D. from Cornell University and his B.A. from Colgate University. He
has been a practitioner of pediatric and general surgery. See also SELF-HELP GROUPS; PSYCHOTHERAPIES. SOURCE: Siegel, Bernie S. Love, Medicine & Miracles. New York: Harper & Row, 1986.
sighing
Taking a deep breath, letting it all out at once with a light push from the central diaphragm, at the same time emitting a sound like “ahhh.” This is a good stress reliever, because when we breathe more, we feel more vital, more responsive, and more energized. Sighing pumps the central diaphragm, which helps all the other diaphragms to move. The more toned and resilient our diaphragms are, the more easily and appropriately we are able to move the fluids of our body (blood, lymph, cerebrospinal fluid), which means we feel more mobile and generally better. Appropriate fluid movement means appropriate energy movement and distribution and balanced internal fluid pressure. Appropriate inner pressure of fluid helps keep us easily upright and increases feelings of capability.
FOR FURTHER INFORMATION:
Zapchen Resources P.O. Box 6392 Napa, CA 94581 SOURCE: Henderson, Julie. Embodying Well-Being: How to Feel as Good As You Can in Spite of Everything. Napa, Calif.: Zapchen Somatics, 2003.
simple phobia (single or specific phobia) A simple PHOBIA is an intense, irrational fear that persists and compels a person to avoid one specific situation or object. Almost any situation or object such as heights, bridges, dogs, or cats can become a specific phobia for an individual. This kind of fear is an intense source of stress for the suffering individual. Help can be obtained with BEHAVIOR THERAPY. See also ANXIETY DISORDERS. skin cancer sleep
See
SUNLIGHT.
The natural state of lowered consciousness and reduced metabolism. Lack of sleep and inability
334 sleep to sleep are sources of stress for many people, while for others, sleep difficulties are symptoms of stress. Difficulties related to sleep are among the commonest problems patients complain about when they visit physicians. Age, state of health, medication, and psychological state affects sleep. DEPRESSION is a major factor that interferes with sleep, causing some individuals to sleep too much and preventing others from getting to sleep or sleeping through the night. Individuals who have a CHRONIC ILLNESS or PAIN often experience interrupted sleep. Sleeping habits affect most people’s MOODS and their ability to cope with stress. Many feel somewhat irritable and short tempered without adequate sleep. Men and women show some differences in sleep patterns. For example, as they age, men lose their ability for deep sleep (delta sleep) sooner than women, even though more women complain about insomnia and light sleeping. Men begin to lose their deep sleep in their late 40s and 50s, while women continue to have deep sleep later in life. The old adage “early to bed and early to rise” is too generalized a plan for most people, says Rosalind Cartwright, M.D., of Rush-Presbyterian-St. Luke’s Medical Center, Chicago. “There are many individual patterns of sleep that work well. Some elderly people don’t go to bed until 4 A.M. They stay awake until then, reading, knitting, or doing some creative work. They wake up at 8 A.M. when everyone else does and they feel good. Such individuals once went to bed at midnight and worried about staying awake for hours; now they turn those hours into doing something constructive.” Sleep Disorders There are two basic categories of sleep disorders. One is known as DIMS, or disorders of initiating or maintaining sleep. These include getting to sleep, staying asleep, or waking too early. The other is known as DOES, or disorders of excessive sleep. Characteristics may include falling sleep inappropriately and a difficulty in awakening. Such individuals are known as hypersomniacs. Sleep apnea is another common and more serious disorder of sleep. It involves brief periods of ceasing to breathe. There may be at least 250,000 people in the United States who cease breathing so often or for such long periods of time at night that
they are tired all day and are likely to drift off into sleep at any moment. They must walk around often to fight off sleep and cannot drive safely. Sleep apnea is marked by loud SNORING, prolonged periods between breaths (apnea), weight gain, and elevated blood pressure. Diagnosis of sleep apnea can be made from a tape recording at the bedside of the snorer. If there are repeated pauses of more than 10 seconds between snores, it may mean that the oxygen level in the brain is going down. The person must wake himself/herself to restart the brain. There is treatment for sleep apnea, and it is important that such people be treated because this disorder causes a strain on the heart. Repetitive nocturnal myoclonus involves involuntary jerky motions of the legs or episodes of twitching that disturb sleep. This is an uncomfortable sensation that occurs just before falling asleep. The individual feels an urge to get up and walk around. This sensation may increase with age and frequently runs in families; it is more common in individuals age 50 to 60 than in younger people. Sleep difficulties of menopausal women. Many midlife women experience stress because of changes in their sleep patterns around MENOPAUSE. Some changes may be due to HOT FLASHES or to other factors involving individual psychosocial stresses. According to Dudley Dinner, M.D., director, Sleep Disorders Center, Cleveland Clinic Foundation, while women may sleep seven to eight hours at age 20, they may decrease to six or sixand-a-half hours between ages 55 and 60. Also, sleep tends to become more “fragmented.” Women in this age group may awaken oftener and spend more time awake during the night, although their total time in bed may increase. Sleep disturbance related to medication. A side effect of medications can be sleepiness; all medications should be taken only under a physician’s supervision. Some medications may make sleep apnea worse. Medications used for inducing sleep. Individuals who are stressed by an inability to fall asleep or stay asleep sometimes have sleeping medications prescribed for them. Often at a time of great bereavement, such as after the death of a spouse or parent, an individual will have difficulty sleeping and can be helped with the assistance of an appropriately prescribed medication for short-term use.
sleep 335 Dreaming. Most dreaming takes place during the REM stage. Nightmares of being unable to move have a real basis during this phase of sleep because of the limpness of the muscles. People will probably forget DREAMS unless they awaken during a REM period or within 10 minutes afterward (see below). Sleepwalking (somnambulism) may occur while asleep during NREM (nonrapid eye movement) sleep; this affects about 5 percent of adults and many more children. For unknown reasons, boys are more likely to sleepwalk than girls. A child may sleepwalk after awakening from a nightmare or night terror, and may scream, talk, or even urinate in an inappropriate place. It is difficult to awaken a sleepwalker; the best approach is to calmly lead him or her back to bed. However, in a household where an individual is known to sleepwalk, it is best to close off stairwells and remove objects in possible pathways to prevent injury. Sleep Research Evaluation of sleep disturbances is carried out in many sleep laboratories across the United States. Sessions for a troubled sleeper in a sleep laboratory depend on the diagnosis and how complex the problem is. For example, some tests for narcolepsy, a disorder of excessive daytime sleepiness, are done during the day, with a series of five short naps. However, most sleep lab evaluations are done during the night. Patients are monitored for many things, including naso-oral air flow and heart rate. Insomniacs are tested to determine how much they really sleep. Typically, many physiological parameters are measured. There is an intercom from the control room, and researchers can talk to the patient’s room or tape record what is going on in any room. Stages of Sleep With use of an electroencephalogram (EEG), a graphic depiction of the brain’s electrical potentials recorded by scalp electrodes, sleep is divisible into two categories: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Dreaming sleep is another term for REM sleep. There are four stages of NREM sleep. Stage I occurs immediately after sleep begins, with a pattern of low amplitude and fast frequency. Stage II has
HOW TO GET A GOOD NIGHT’S SLEEP • Avoid stressful situations before bedtime. Postpone discussions of problems until morning, whenever possible. Avoid lengthy telephone conversations that may upset you before bedtime. • If you have an argument or tension-filled discussion late at night, don’t go to bed mad. • If you are alone and feel hostile, call a friend and talk. Venting may help you unload and you will sleep better. • Drink a cup of warm milk before bedtime. Eat a light snack. Avoid stimulating beverages containing CAFFEINE, such as coffee, cola beverages, and chocolate. • Take a warm, relaxing bath before going to bed. • Relax in bed and read something you enjoy. As your mind becomes engrossed, your muscles will relax. When your body is relaxed, you are likelier to become sleepy and ready for sleep. Watching television may have the same effect. • Read something you find very dull. When your mind cannot handle what you present, your internal coping mechanism of falling asleep may take over. Watching television may have the same effect. • Experiment by changing your environment. Make the room warmer or colder. Use different combinations of covers. Some people like the feeling of the “weight” of blankets, while others do not. If you like warmth without weight, use an electric blanket. Some have dual controls so that each bed partner can have individual arrangements. • Avoid using sleeping pills. People build up a tolerance to them and some have daytime hypnotic effects. Some pills induce sleep apnea. • If you must take a sleeping pill during times of extreme stress, such as after the death of a loved one, after surgery, or during extreme jet lag, take short-acting sleeping medications (see above). • Nightly use of a sleeping medication may not be effective after a while. If you have to use them at all, use them only every other night or every third night. • Avoid taking naps during the day; go to bed a little later each night.
336 sleep apnea characteristic waves of 12–16 cycles per second known as sleep spindles. Stages III and IV have progressive further slowing of frequency and an increase in amplitude of the wave forms. After the beginning of sleep, over a period of 90 minutes, a person goes through the four stages of NREM sleep and goes from them into the first period of REM sleep. Dreaming usually occurs during REM sleep and short cycles (20–30 minutes) of REM sleep recur about every 90 minutes throughout the night. This type of sleep is so named because of the coordinated rapid eye movements that occur. FOR FURTHER INFORMATION:
American Sleep Disorders Association 1610 14th Street NW, Suite 300 Rochester, MN 55901 (507) 287-6006 SOURCES: Carey, Benedict. “The Slumber Solution.” Health, July–August 1996. Hales, Dianne. The Complete Book of Sleep. Reading, Mass.: Addison-Wesley Company, 1981. Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
sleep apnea
See
SLEEP.
slips of the tongue
Saying one thing but meaning another. Such slips may be stressful for the person who speaks them as well as a source of embarrassment, or even CRITICISM and ridicule by listeners. Sigmund Freud theorized that these acts have a subconscious basis with some motivation that is not recognized by the person who commits them. This type of behavior is temporary and correctable. Although undesirable, it tends to fall within normal limits and is not considered a disorder. Slips of the tongue are also known as “lapsus lingae.” SOURCE: Campbell, Robert Jean. Psychiatric Dictionary. New York: Oxford University Press, 1981.
slips, trips, and falls Falls are a common cause of stressful injuries in homes and workplaces. They are often caused by slipping or tripping. For older people, falling is often associated with disabling injuries. For working people, falls are associated
with injuries and lost time from work. Workers who suffer falls also cause stress for employers in terms of lost production and the need to rehire workers to do the jobs. To avoid falling, looking for slip and trip hazards around the home or workplace such as uneven floors, trailing cables, and areas that are sometimes slippery due to spills. In the food service industry, in food processing plants, and in the meat industry, slippery floors are a common hazard that can lead to falling. In industry, maintenance includes inspection, testing, adjustment, and cleaning. Lighting should enable people to see obstructions and potentially slippery areas so they can work safely. Lights should be replaced or repaired before they become too dim for safe work. Floors should be checked for loose surfaces, holes and cracks, worn rugs and mats. Be sure mats are securely fixed and do not have curling edges. Footwear can play an important part in preventing slips and trips, both at home and work. In homes, shoes or slippers should not catch on carpets and at work should be heavy enough to prevent injuries to feet. In homes as well as work, all passageways, staircases, and means of access should be unobstructed and free from tripping hazards. Cleaning methods and equipment should be suitable for the type of surface being treated. Care should be taken not to create additional hazards while cleaning and maintenance work is being done. Openings in floors, edges of balconies, and platforms must be adequately fenced to prevent persons from falling. LADDERS and scaffolding must be suited to their intended use and must be properly erected, made secure, and checked before they are used.
smoking
The inhaling and exhaling of tobacco by using cigarettes. A major public health problem in the United States, smoking is a source of stress for nonsmokers as well as smokers. It was only in the late 1990s that cigarette companies had reluctantly admitted that the nicotine contained in cigarettes is habit-forming and addictive. Many smokers say they want to quit but cannot; expressing and following through with the desire to quit smoking becomes a source of stress for them.
smoking 337 Effects of Smoking Nicotine affects the central nervous system through routes that differ from other drugs, but it produces very similar results, such as pleasurable euphoria, dependency, and withdrawal symptoms when stopped suddenly. Smokers who quit may experience genuine physical discomfort and cravings. Withdrawal symptoms from nicotine include HEADACHES, irritability, upset stomach, BREATHING and circulation problems, trouble sleeping, DIZZINESS, and numbness. The actual physiological effects of smoking are somewhat at odds with the sensations that smokers report. When nicotine enters the bloodstream, it raises the heart rate and blood pressure and dilates the arteries. It also raises the level of glucose in the blood. However, smokers report a sense of relief from stress despite the stimulating effects of nicotine. Smokers claim it improves short-term memory, intellectual performance, and concentration.
Stresses between Smokers and Nonsmokers While scientists have documented the harmful effects of smoking, many smokers still believe that it is their “right” to smoke when and where they want to. Since antismoking laws were enacted in the United States during the 1980s and early 1990s, there have been frequent incidents of anger and hostility between smokers and nonsmokers. Nonsmokers maintain the “right” to clean air. Increasingly, workplaces are changing over to nonsmoking and setting up outdoor smoking areas for smokers. In the large cities of America, most restaurants have nonsmoking areas. Those that don’t will not attract nonsmokers. For asthmatics and those with other respiratory disorders, smoke in the air is more than an annoyance; being forced to breathe in secondhand smoke can make them feel physically ill. Eventually the United States may become a smokeless society. However, in developing countries, the numbers of smokers is unfortunately increasing and cigarette consumption is rising.
338 smoking Consequences of Smoking The main harmful components of cigarette smoke are tar, nicotine, and carbon monoxide. The lungs retain 70 percent to 90 percent of these chemicals when one inhales. Tarry substances clog the lungs and affect breathing. Carbon monoxide decreases the ability of red blood cells to carry oxygen throughout the body. Smoking lowers one’s resistance to infection and ulcerative diseases. It also increases one’s risk for bad breath, severe gum diseases, tooth loss, and premature aging of the skin, which many people find sources of stress. Pregnant women who smoke have higher rates of miscarriage, stillbirth, premature birth, low birth weight, and complications of PREGNANCY. Infants of mothers who smoke during pregnancy also have more of a chance of SUDDEN INFANT DEATH SYNDROME (SIDS) than do infants whose mothers did not smoke. Smoking is credited as a factor in nearly 500,000 deaths per year, representing more Americans than die from accidents, infectious diseases, murders, suicides, diabetes, and cirrhosis combined. The disease most often associated with cigarette smoking is lung CANCER. This disease, which only 50 years ago was almost unheard of, is now the leading cause of cancer deaths in men and women. Lung cancer, once believed to be predominantly a disease of males, in the mid-1980s overtook breast cancer to become the number one cause of cancer deaths for women. Over 85 percent of the people who die of lung cancer could have avoided the disease completely if they did not smoke. For this reason, coping with their deaths is doubly stressful for their family members. Stop Smoking Programs Almost all health risks decrease when one gives up smoking. As withdrawal symptoms subside, one is likely to notice good symptoms such as improved senses of taste and smell, increased energy, and enhanced SELF-ESTEEM and self-control. Regular exercise will enable one to avoid or minimize weight gain and keep the body in good physical shape. Quitting smoking is not easy. Many stop-smoking programs exist to help cigarette addicts. However, for programs to be helpful, the individual must attend
STRESS RELIEVERS FOR THOSE WHO ARE QUITTING SMOKING • List your reasons for wanting to stop and wanting to continue smoking. • Note when and where you smoke the most. • Set a date for quitting; tell your family and friends. • Remove cigarettes, ashtrays, and matches from your home, car, and office. • Minimize stressful situations and other occasions when you previously craved a cigarette. • Spend time where smoking is prohibited. • Reach for high-fiber, low-calorie snacks, such as vegetables or fruits when you have the urge to smoke. • Talk to someone who is supportive until the urge to smoke passes. • Increase aerobic exercise (walking, biking). • User relaxation techniques (such as meditation, guided imagery). • Reward yourself for quitting smoking.
regularly and follow the rules set forth. For many, unfortunately, this is easier said than done. When one stops smoking, nicotine dependency may cause some stressful and unpleasant sensations. For example, one may temporarily experience withdrawal symptoms such as DEPRESSION, irritability, anxiety restlessness, trouble concentrating, headache, drowsiness, gastrointestinal disturbances, increased coughing, or difficulty sleeping. Many national organizations can help one affiliate with a stop-smoking program; check for a local chapter. See also ADDICTION; EMPHYSEMA; HABITS. FOR FURTHER INFORMATION:
American Cancer Society 1599 Clifton Road NE Atlanta, GA 30329 (800) 227-2345 (toll-free) (404) 315-9348 (fax) http://www.cancer.org American Heart Association 7320 Greenville Avenue Dallas, TX 75231 (800) 242-USA1 (toll-free) (214) 373-6300
snoring 339 (214) 987-4334 (fax) http://www.americanheart.org American Lung Association 61 Broadway, Sixth Floor New York, NY 10006 (800) LUNG USA (toll-free) (212) 315-8700 (212) 315-8872 (fax) http://www.lungusa.org Centers for Disease Control Office of Smoking and Health 1600 Clifton Road, NEW (Mail Stop K-50) Atlanta, GA 30333 (404) 639-3311 http://www.cdc.gov/tobacco National Cancer Institute 9000 Rockville Pike Building 31, 4A-21 Bethesda, MD 20892 (800) 4-CANCER (toll-free) (800) 422-6237 (toll-free) (301) 435-3848 http://www.nci.nih.gov SOURCES: Hammond, S. Katharine. “Environmental Tobacco Smoke Presents Substantial Risk in Workplaces.” The Journal of the American Medical Association, September 26, 1995. Spitzer, Joel. “Medical Implications of Smoking.” Skokie, Ill.: Good Health Program, Rush North Shore Medical Center, 1995.
snoring Noisy BREATHING through the open mouth during SLEEP; produced by vibrations of the soft palate. Snoring is stressful because it may deprive both the snorer as well as the bed partner of necessary sleep, resulting in irritability and tension for both the next day. Frequently, snoring occurs as people sleep on their backs; their tongues slide back into a position that partially blocks the nasal passage, forcing mouth breathing, particularly in a deep sleep. It is more common in overweight people, partly because they are more likely to sleep on their backs and also because fatty tissue in their throats may cause blockage. Snoring also may be caused by enlarged tonsils, nasal problems, heavy drinking, smoking, or eating just before sleep.
Measurements of snoring volume have recorded decibel levels as high as the sound of a jack hammer or pneumatic drill. Robert W. Hart, M.D., writing in Chicago Medicine (Dec. 21, 1991), characterized snoring as “mild, moderate, severe, or heroic.” According to Hart, the incidence of habitual snoring in an unselected population is estimated near 20 percent. However, in overweight males between the ages of 30 and 59, that incidence reaches 60 percent. Snoring, Sleep Apnea, and Stress Many stressed individuals who report chronic fatigue and irritability are victims of sleep apnea, known as obstructive sleep apnea syndrome (OSAS). If untreated, OSAS can have lethal consequences when daytime sleepiness leads to automobile and industrial accidents, as well as consequences for interpersonal relationships because of short tempers due to tiredness. OSAS is characterized by repetitive episodes of complete apnea or incomplete obstruction of the upper airways during sleep. OSAS is more common in males and post-menopausal females, with its frequency increasing with age and weight. The OSAS sufferer may complain of feelings of choking or suffocating during the night or feel panicky because of an inability to take in enough air. All these feelings are extremely stressful for the sufferer as well as his or her sleep partner. Treatment options for OSAS include general measures, such as weight loss, abstinence from alcohol, pharmacological approaches for limited periods of time, oral and orthodontic devices, and surgical procedures, such as nasal surgery or uvulopalatopharyngoplasty (repair of the uvula, the small, fleshy protuberance that hangs from the middle of the lower edge of the soft palate, which is part of the mouth). See also CHRONIC FATIGUE SYNDROME. FOR FURTHER INFORMATION:
American Sleep Disorders Association 1610 14th Street NW, Suite 300 Rochester, MN 55901 (507) 287-6006 SOURCES: Lipman, Derek S. Snoring From A to ZZZZ: Proven Cures for the Night’s Worst Nuisance. Portland, Ore.: Spencer Press, 1996.
340 social phobia Pascualy, Ralph A. Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment. New York: Demos Vermande, 1996.
social phobia The irrational fear and avoidance of being in a situation in which one’s activities can be observed by others. It involves a fear of being embarrassed, humiliated, criticized, censured, or in some way evaluated in social settings by the reactions of others. The most common social phobia is fear of speaking in public, whether in front of a large audience or in front of a small group such as during a party. Other common social PHOBIAS include blushing, eating, drinking, writing, urinating, or vomiting in the presence of others. Some social phobics fear that their hands will tremble or shake as they eat or write and tend to avoid restaurants, banks, and other public places. They often avert their eyes when talking to another person. Some social phobics have been known to cross the street to avoid greeting people they know, and social phobics are fearful of attending parties, particularly with people they do not know. Usually social phobias begin after puberty and peak after the age of 30, but social phobics have had lifelong SHYNESS and introverted habits. Both men and women suffer from social phobias and may have more than one at a time. Also, many agoraphobics have social phobias, and many social phobics have some agoraphobic symptoms. See also AGORAPHOBIA; ANXIETY DISORDERS. FOR FURTHER INFORMATION:
Anxiety Disorders Association of America 8700 Georgia Avenue Silver Spring, MD 20910 (240) 487-0120 http://www.adaa.org SOURCE: Kahn, Ada P., and Ronald M. Doctor. Encyclopedia of Phobias, Fears, and Anxieties, 2nd ed. New York: Facts On File, 2000.
social support system
A social support system involves an individual’s relationships with others, including significant others, friends, people on the job, in the community and religious groups, as well as material resources. An individual with a stress concern may have an inadequate social support
system because family members do not understand his/her circumstances and thus may not offer the assistance or encouragement that could be helpful. Individuals with good social support systems seem to have better recoveries from illnesses and surgeries than those without such support. See also SELF-HELP GROUPS; SUPPORT GROUPS.
social workers Workers trained to have expertise in counseling people regarding available community resources for various types of support and therapy; many of them provide counseling for individuals with concerns about stress. Social workers work in the public and private sector; they may work in publicly funded health and mental health clinics and in schools, family agencies, clinics, hospitals, and private practice. Some work in EMPLOYEE ASSISTANCE PROGRAMS (EAPs), alcohol and chemical dependency programs, and in religious settings. In the 1960s and 1970s, with the establishment of comprehensive community mental health centers, clinical social workers provided a major proportion of outpatient mental health treatment services. In the 1980s, an increasing number of clinical social workers moved into full- or parttime private practice and these practices continue to grow. In 2005, there were 153,000 members of the National Association of Social Workers (NASW), an organization limited to those persons who have a bachelor’s, master’s, or doctoral degree from a university program accredited by the Council on Social Work Education. See also PSYCHOTHERAPIES. FOR FURTHER INFORMATION:
National Association of Social Workers 750 First Street NE, Suite 700 Washington, DC 20002-4241 (800) 638-8799 (toll-free) (202) 408-8600 (202) 336-8310 (fax) http://www.socialworkers.org SOURCE: Manderscheid, R. W., and M. A. Sonnenschein, eds. Mental Health, United States, 1990. Washington, D.C.: Govt. Printing Office; DHHS Pub. No. (ADM) 90–1708, 1990.
spas 341 somatization An individual experiencing physical symptoms as a response to psychological stress, in the absence of disease or out of proportion to a given ailment. For example, people experience physical symptoms such as fatigue, shortness of breath, or even pain as a response to stress. Somatization can be hazardous to health because people who have ongoing complaints may undergo uncomfortable and invasive procedures that are not needed and can cause complications. Individuals who repeatedly report chest pains might eventually undergo coronary angiography to rule out serious arterial narrowing. Also, these individuals may be taking medications needlessly, some with serious side effects. Individuals who “somatize” are said to have somatoform disorders. Treatment of somatization may include use of various PSYCHOTHERAPIES, RELAXATION exercises, MEDITATION, MASSAGE THERAPY, taking VACATIONS or dealing more effectively with stresses at home or in the WORKPLACE. See also COPING; GENERAL ADAPTATION SYNDROME. SOURCE: Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
spam
Irritating and often deceptive junk e-mail; unsolicited commercial e-mail that frustrates consumers and costs businesses time and money. It is stressful because it seems to be an invasion of
COPING WITH STRESSFUL SPAM • Give your primary e-mail address only to persons you trust. • Maintain alternate e-mail addresses if you buy products online, register for free offers, or sign up for e-mail newsletters. • Create an e-mail address with numbers as well as letters. A more complicated address is harder for spammers to find. • When you go to a Web site, check their privacy policy before giving your e-mail address. Opt out of receiving e-mail from their partners. • Don’t open spam. Just delete it. Opening it confirms to the sender that yours is a working address.
time and space for most computer users. In 2004, according to the American Association of Retired Persons (AARP), 60 percent of all e-mail was spam. The first national anti-spam bill was signed into law in December 2003. The new law requires spammers to identify adult material and carries substantial penalties for those who write spam that uses phony greetings, fake sender addresses, and fraudulent sales approaches. Internet legal expert David Sorkin of the John Marshall Law School in Chicago says the new law may curb the growth of really obnoxious spam such as raunchy offers for sex devices, and “lowest” mortgage rates. See also COMPUTERS; ELECTRONIC DEVICES; RANDOM NUISANCES. SOURCE: Basler, Barbara. “Frazzled by Junk E-Mail?” AARP Bulletin Available online. URL: http://www.aarp.org/bulletin/ yourlife/articles/a2004-02-10-spam.html. Downloaded on April 25, 2005.
spas
Businesses that offer many services to counteract stress and help patrons relax. Spas may range from fairly basic establishments offering minimal services such as manicure, pedicure, and massage, to more elaborate places that also include hair styling, facials, steam baths, nutritious meals, exercise classes, personal training, and other services. Some spas are live-in facilities, while others are walk-in for the day. Some spas are “destination” spas that attract vacationers in search of respite from their daily routine. A study by Cornell University’s School of Hospitality Administration indicated that destination spas may help people have more energy, less fatigue, and more endurance. According to researcher Mary Tabacchi, a visit to a destination spa where the focus is on healthy living is one of the few travel options that leave vacationers feeling rested, refreshed, and energized. The 2004 study suggested that increased levels of energy and stamina during the day may contribute to a greater sense of self-confidence and body image, which translates positively into many aspects of life such as increased job performance, feelings of accomplishment, positive well-being, and less fatigue.
342 specific phobia SOURCE: Heart to Heart, newsletter of The Heartland Spa, December, 2004. FOR FURTHER INFORMATION:
The Heartland Spa 1237 East 1600 North Road Gilman, IL 60938 (800) 545-1853 (toll-free) (800) 683-2144 (fax) http://www.heartlandspa.com
specific phobia
See
SIMPLE PHOBIA; PHOBIAS.
spirituality Spirituality has been described as experiencing the presence of a power, a force, an energy, or of God. This definition is from the writings of HERBERT BENSON, M.D., president, The Mind/Body Medical Institute, and chief, Division of Behavioral Medicine, Deaconess Hospital, Boston. Spirituality, for many, is directly connected to PRAYER, faith, and RELIGION; belief systems help many individuals cope with symptoms of STRESS. Dr. Benson’s work at the Harvard Medical School considered the healing effects of spirituality; research later confirmed that some people experienced increased spirituality as a result of RELAXATION therapy whether or not they used a religious repetitive focus. This notion came about after Harvard researchers had systematically studied the benefits of mind/body interactions for more than 25 years. The research confirmed that when a person engages in a repetitive prayer, word, sound, or phrase and when intrusive thoughts are passively disregarded, a specific set of physiological changes ensues. There is decreased metabolism, heart rate and rate of breathing, and distinctly slower brain waves. These changes are the opposite of those induced by stress and are an effective therapy in a number of diseases including HIGH BLOOD PRESSURE, cardiac rhythm irregularities, many forms of chronic PAIN, INSOMNIA, symptoms of CANCER and AIDS, premenstrual syndrome, ANXIETY, and mild and moderate DEPRESSION. To the extent that any disease is caused or made worse by stress, increased spirituality brought about by relaxation is an effective therapy. See also ALTERNATIVE MEDICINE.
spouse abuse stage fright
See
DOMESTIC VIOLENCE.
An intense feeling of nervous anticipation that many people experience before giving a public speech or making an appearance on a stage. For some, the feeling occurs before they go on stage, while others experience it just as they enter the stage. Those who have been in theatrical productions, play a musical instrument or sing publicly, or have been videotaped, probably have experienced this feeling at some time. People who experience a high level of STRESS because of stage fright may view the audience as an adversary ready to judge them personally without regard to the content or message of their presentation. Because of the stress caused by intense stage fright, some people go out of their way to avoid PUBLIC SPEAKING and public appearances; and some may actually develop a phobia. Symptoms of this phobia have many common characteristics; people may become dizzy and nauseated, have sweaty palms and weak knees, feel a rapid heartbeat, and experience difficulty breathing. While most people feel these symptoms in a very mild manner, phobics momentarily fear that they will die due to their rapid heartbeat and difficulty in getting enough air to breathe, even though they may be over-breathing. These symptoms may occur for only a few moments before going onstage, but as soon as they are onstage their nervousness disappears and they focus all of their attention and energy on their performance. Many successful public figures have overcome stage fright. Some lose their fear by systematically becoming accustomed to appearing in front of people. BEHAVIOR THERAPY and RELAXATION techniques can help people overcome stage fright. Physical relaxation involves exercises to eliminate nervousness and ANXIETY and leads to physical ease and calmness. Mental and psychological relaxation involves exercises to develop objectivity, awareness, mental clarity, and a positive mental attitude. Overcoming the stress of stage fright depends on the individual’s developing confidence in his or her ability to speak or perform. Knowing the material well, whether it is a musical performance or a public speech, helps relieve stress. Confident individuals learn to convert their stress into positive energy.
stillbirth 343 See also
ALTERNATIVE MEDICINE; ANXIETY DISOR-
DERS; PERFORMANCE ANXIETY; SOCIAL PHOBIA.
stammering STDs
See
See
STUTTERING.
SEXUALLY TRANSMITTED DISEASES.
stepfamilies
Families formed when a divorced or widowed parent remarries. Stresses in stepfamilies are more complex than in traditional nuclear families, possibly because society has not defined the role of the stepparent as it has of the natural parent. As a result, everyone may have different ideas regarding how stepparent and stepchild should get along. Frequently, stepparents feel that they should assume the role of an actual parent. This may be very uncomfortable and objectionable to their stepchildren, specially when the children continue to have a strong relationship with their own natural parent. Children who live with a single parent may have had some sense of being the center of attention in the household and may have difficulty giving up that role with the arrival of a stepparent. The living arrangements that are set up when two families merge may cause stresses and challenges to all involved. For example, some children may be in residence, some may visit. A child who had been living with one parent may suddenly decide he wishes to leave that parent, possibly because of a new stepparent in that household. If conflicts erupt between stepsiblings, parents may side with their own child, rather than making peace as they would in a traditional family. Stresses may also arise in the stepparented household because there may be a highly charged sexual atmosphere in the home; the couple actually are newlyweds with children present. This may arouse real or potential relationships between stepsiblings, which are technically, although not biologically, incestuous. There is also a potential for technical incest between stepparent and stepchild, particularly if the stepparent is young, even close to the age of the child. In an attempt to be warm and friendly, some stepparents may unwittingly encourage these feelings in children. In situations involving older couples and adult children, children may feel that their inheritance
rights are threatened by the arrival of a stepfather or mother. Many people help relieve the stresses brought about by the formation of a stepfamily with family counseling services and SUPPORT GROUPS for stepparents and children. See also DIVORCE; REMARRIAGE; SELF-HELP GROUPS. FOR FURTHER INFORMATION:
Stepfamily Association of America, Inc. 650 J Street, Suite 205 Lincoln, NE 68508 (800) 735-0329 (toll-free) (402) 477-8317 (fax) http://www.saafamilies.org SOURCES: Belovitch, Jeanne. Making Re-marriage Work. Lexington, Mass.: Lexington Books, 1987. Wald, Esther. The Remarried Family. New York: Family Service Association of America, 1981.
stillbirth
The death of a fetus between the 20th week of gestation and delivery. A stillbirth causes a special kind of GRIEF and stress for the parents. Although they have never seen their child, they have imagined how he or she would look, what they would use for a name, and how the child would interact with others in the family. After the stillbirth, there are no “real” memories, such as photographs or items the child actually used or touched. Friends and others in the family do not share the loss with the parents in the way that they might in the case of an older infant who died, making grief even more stressful for the parents. Even though another child may arrive a year or more later, many parents of a stillborn never fully recover from their loss. Some remember the “due date” for years, and observe it with sadness, reviving the feeling of loss and sadness. Major causes of stillbirth appear to be loss of oxygen to the baby, either because of a problem with the placenta or an umbilical cord accident before or during labor. However, for more than half of stillbirths, there is no known cause, and the lack of an explanation is also a source of stress for the grieving parents. See also MISCARRIAGE; PREGNANCY.
344 stress stress The response of the body and mind to strains or burdens that demand adaptation; it is any hindrance that disturbs an individual’s mental and physical well-being. These interferences may range from RANDOM NUISANCES to life-threatening situations. From a scientific perspective, stress causes an imbalance in an individual’s equilibrium (HOMEOSTASIS). Controlling stress is essential for wellness because continued exposure can lead to symptoms, such as HEADACHES or more serious conditions such as HIGH BLOOD PRESSURE and DEPRESSION. Research has shown that stress also affects the IMMUNE SYSTEM and causes it to be less efficient in fighting off diseases. Coping well with stress also can improve an individual’s chances of living with CHRONIC ILLNESS. Understanding Stress Stress is an internal response to circumstances known as stressors. Stressors may be internal situations, such as feelings of insecurity or frustration, or external events, such as a bad review at work, or cancellation of an airplane flight. Stressors can also be reactions to happy events as well as to bad news and unhappy events; there are good stressors derived from satisfying personal and professional events as well as unpleasant ones. For example, happy personal stressors may include getting married, having a baby, or moving to a new house; happy work stressors may include landing a new job or getting a promotion at work. Unpleasant stressors may include marital difficulties, illness, or being fired. HANS SELYE, pioneer in stress research and author of Stress without Distress and The Stress of Life, termed the good events that cause stress as EUSTRESS and those that caused unpleasant effects as DIS-STRESS. Both types of stress cause physiological responses, including activation of the nervous system and of the FIGHT OR FLIGHT RESPONSE. That is why during stressful times, people may notice that they have a faster heartbeat and a sick feeling in their stomach; it is difficult to work or function efficiently at such times. How individuals accommodate to change influences the extent of stress they experience. Selye used the term GENERAL ADAPTATION SYNDROME to explain how individuals cope with stressors. He suggested that individuals cope with stressors. He suggested that individuals experience events in dif-
ferent ways; what results in emotional strain and for one person may not bring about those reactions in others. Also, in the same individual, adaptations that are tolerated well at one time may not be handled so well at another. Chronic stress results in ongoing wear and tear on the body’s organs and systems, making them more susceptible to illness. When symptoms show up, many individuals begin to seek medical or psychological help. According to Herbert BENSON, M.D., Harvard cardiologist and author of The Relaxation Response, more than 80 percent of visits to physicians’ offices may result from stress in patients’ lives. “Physicians are aware of stress as a factor in diagnosing and treating many common health concerns.” For example, many people seek help for gastrointestinal symptoms, an inability to SLEEP, headaches, depression, and chronic fatigue. They may have high blood pressure. “The best treatment is to get at the cause of the stress,” recommends Catherine R. Landers, M.D., a member of the Department of Medicine at Rush North Shore Medical Center, Skokie Illinois. “We know that physical problems, even if induced by stress, can interfere with the quality of one’s work and ability to meet the needs of family members. Medications won’t provide any long-lasting results. There are strong MIND-BODY CONNECTIONS. Helping the individual change his or her COPING styles usually works better than anything we can prescribe as medication.” ANXIETY
Research Reveals Effects of Stress on Health A study reported in Proceedings of the National Academy of Sciences focused on 119 men and women who were taking care of spouses with dementia. The health of the caregivers was compared with that of 106 people of similar ages who were not living with the stress of constant caregiving. Blood tests showed that a chemical called interleukin-6 (IL-6) sharply increased in the blood of the stressed caregivers compared with blood of the others in the test. Previous studies associated IL-6 with several diseases, including heart disease, arthritis, osteoporosis, type 2 diabetes, and certain cancers. The study also found that the increase in IL-6 can linger in caregivers for as long as three years after a caregiver had ceased that role because of the spouse’s death. Of the test group, 78 spouses died
stress 345 during the survey. According to Janice KiecoltGlaser, professor of psychology and psychiatry at Ohio State University, people under stress tend to respond by doing things that can increase their levels of IL-6. For example, they may smoke or overeat; smoking raises IL-6 levels, and IL-6 is secreted by fat cells. Stressed people also may not get enough exercise or sleep. Exercise reduces IL-6 and normal sleep helps regulate levels of the chemical. In 2004, other research findings attempted to explain how stress can lead to premature aging. Chronic psychological stress is associated with accelerated shortening of telomeres, caps on the ends of chromosomes in white blood cells, and hastens their demise, according to a report in Proceedings of the National Academy of Sciences. Dr. Elissa S. Epel at the University of California, San Francisco, and her colleagues investigated the theory that psychological stress affects telomere shortening and thereby contributes to accelerated aging. Their study included 39 healthy premenopausal women who were primary caregivers for a child with a chronic illness, and 19 agematched mothers of healthy children who served as a comparison (control) group. Stress was measured with a standardized questionnaire, and telomere length was measured in participants’ blood samples. Within the caregiving group, the longer that a woman had been a caregiver, the shorter was the length of her telomeres. These findings may have implications for health, as telomere shortening is associated with premature death from cardiovascular disease and infections. Sources of Stress Stress can come from an individual’s family, WORKPLACE or community connections. Stress within a family causes tension and difficulties in communicating effectively. There may be INTERGENERATIONAL CONFLICTS or situations arising from assisting ELDERLY PARENTS. In some cases, interpersonal stresses develop when an adolescent has two simultaneous feelings, such as wanting to be independent during PUBERTY and yet feeling dependent on parents. In a family, several people may be trying to cope with their own stress as well as the stress of others about whom they care. For example, when a father dies, the son tries to console his mother, even when struggling with his own sadness.
Stress that starts within the family can affect one’s work and the reverse is also true. Family problems can make a person irritable on the job, distrustful of coworkers, and prone to mistakes and accidents. Likewise, a difficult day at the office can make a person short-tempered and hostile at home. Workplace factors that contribute to stress include lack of autonomy, lack of satisfaction, and feeling bored, underpaid, or overworked. Many people feel stressed by demands made upon them from their community or religious activities. While these activities add to a person’s SOCIAL SUPPORT SYSTEM, they may have taken on too many responsibilities, and are asked to take on more, and feel that there is not enough time to complete all of them adequately. Already feeling overwhelmed, but wishing to maintain their reputation as a “doer,” they agree. Learning when to say no is an important skill to practice. While stress can be physiologically devastating to many people, others find that stress actually raises their energy level and helps them focus their mind better on their work, family, or social activities. Some thrive on many kinds of stressors, such as COMPETITION and comparison with others. People who do so are often attracted to high-stress occupations and professions, or do well at competitive games and sports. Learning to Manage Stress “Stressors cannot be eliminated, so our goal should be to control and manage stress,” says Elaine Shepp, LCSW, a psychotherapist on the staff at Rush North Shore Medical Center, Skokie, Illinois. She goes on to say, “It is possible to ‘neutralize’ the toxic effects of unrelenting stress. People who cope well with stress put their personal and professional lives into perspective. They may experience a constantly high level of pressure and unrealistic demands at work but develop their own ideals of conduct and test themselves by their own standards. They are able to prioritize their work and enjoy family life as well as their chosen recreational activities.” Relieving Stress: An Individual Matter Avenues toward relieving stress are personal matters. Many people find that regular physical workouts involving running, walking, or exercising in a
346 stress gym or health club, or using equipment at home, helps them overcome their reactions to today’s events and get ready to effectively face tomorrow’s challenges. Using muscles is a way to use up some of the “fight or flight” readiness in the body. A healthy diet with three meals a day is a basic for wellness and can also help prevent and relieve stress. Well-balanced meals provide a slow release of necessary nutrients throughout the day. For some people, too much CAFFEINE causes additional stress by bringing on symptoms of anxiety. “Crash diets” or “fad diets” can lead to anxiety, depression, and an inability to maintain an appropriate weight. Acceptance of one’s BODY IMAGE and a good sense of SELF-ESTEEM will encourage people to maintain good NUTRITION as well as good health. People use many alternative therapies to relieve stress. These include ACUPUNCTURE, GUIDED IMAGERY, MEDITATION, PROGRESSIVE MUSCLE RELAXATION, and YOGA. Some use MASSAGE THERAPY or listen to MUSIC as stress relievers. However, what allows one person to relax may actually cause stress for another. An example is noise level in the workplace or at home. Each individual should try to create an environment in which to work and live that is the least stressful in order to focus on reaching his or her peak performance and a feeling of well-being. HOBBIES help many people combat stress. Participating in an activity simply for the enjoyment of it, makes their stress level go down. Such hobbies may include dancing, art and painting, sewing, building model trains or planes, bird watching, or playing a musical instrument. Choices of hobbies are as diverse as human nature. A social support system is important, too. Many people find relief from stress in talking with their support groups. When they are able to talk about their issues, problems, and concerns and get FEEDBACK from trusted, objective family and friends, people get an enlightened perspective that often helps them to lighten their stress load. When Professional Help May Be Necessary There are times when reactions to stress detract from a person’s energy necessary for productive work and effective personal functioning. At these times, when talking to a friend just isn’t enough, professional assistance is available. Those who seek
RECOGNIZE YOUR PERSONAL SIGNALS OF STRESS Each person has unique sources of stress as well as personal signals of stress. Sources of stress come from within oneself (personal), from family life, from the workplace, and from community activities. Some common sources of stress and personal signals are listed below. SOURCES OF STRESS Individual stressors • Aging • Feeling unattractive or insecure • Achievement or success problems • Change in habits • Relationship concerns • Inability to pay bills; mortgage worries Family stressors • Death, illness, or injury of a family member • Divorce; remarriage • Marital difficulties; sexual difficulties • Holidays, vacations • Problems with children • Young adult leaving home or returning home • Lack of privacy • Not enough time Workplace/community stressors • Difficulties with boss or coworkers • Threatened layoffs • Boredom; not enough work • Overwork; underpayment • Lack of autonomy • Automation in the workplace Personal Signals of Stress • Irritability or bad temper • Headaches; stomachaches; digestive problems • Inability to sleep • Grinding teeth • High blood pressure • Lethargy; inability to work; finger-tapping • Depression; panic, or anxiety • Fatigue; restlessness; accident proneness • Sexual difficulties
professional help to overcome effects of extreme stress should not consider themselves “weak,” says Shepp. “Seeking help is an intelligent way of using available tools to increase one’s level of function-
stress 347 CHECKLIST: COPING WITH STRESS • Identify external stress-producing factors over which you have little or no control, such as on your job. • Identify internal factors such as perfectionism and unrealistic self-expectations. • Recognize your personal signs of stress, such as: Increased irritability with family members or coworkers Headaches; stomachaches; digestive disorders Overeating; increased alcohol consumption Sleeplessness; chronic fatigue Depression; feelings of hopelessness • Separate your problems at home from your work concerns, and vice versa. • Be realistic in your daily outlook; don’t expect too much of yourself or others. • Prioritize your responsibilities; learn to occasionally say no to requests you consider unreasonable or undoable. • Pay attention to a healthy lifestyle, such as eating a well-balanced diet and exercising. • Reduce your consumption of caffeinated beverages, cut down on coffee, tea, and cola, which can increase your heart rate and your irritability level. • Develop a regular habit of exercising; a 20minute walk each day can be effective in fighting muscle tension. • Develop a sense of humor; increase your ability to see humor in sometimes intolerable situations. • Learn some RELAXATION techniques that work for you, such as deep breathing or listening to your favorite music. • Seek professional help if you feel overwhelmed.
ing. Counseling can help prevent BURNOUT and assist in dealing with life situations requiring the input of a non-involved, knowledgeable person.” Death of a close relative or friend, divorce or remarriage, marital difficulties, sexual problems, or illness of one’s own or a family member are common stressful occurrences. Financial problems, such as facing a large mortgage or accumulated bills, can happen to anyone. Individuals faced with these and other serious life stressors may feel out of CONTROL and that their worlds are caving in around them. If you find yourself feeling totally overwhelmed and decide to seek professional help, how should
you select a psychotherapist and choose from a myriad of PSYCHOTHERAPIES? You may want to talk with a close relative, colleague, or friend who has experienced psychotherapy. However, if the issue of confidentiality is important to you, find a mental health professional or social worker in a hospital or community agency who can help direct you. The psychotherapist should be one with whom you have a sense of comfort, who also understands your particular stressors, and who can suggest practical ways for you to handle your stress. Find a therapist who is multifaceted in his or her approach to problems and knowledgeable about many options available to treat particular problems. Look for one who is open to consulting with other professionals who have additional expertise. See also ANGER; ANXIETY DISORDERS; BEHAVIOR THERAPY; CATASTROPHIZE; CORONARY ARTERY DISEASE; EXERCISE; KABAT-ZINN, JON; POST-TRAUMATIC STRESS SYNDROME; PSYCHONEUROIMMUNOLOGY; RELATIONSHIPS; SUPPORT GROUPS; VOLUNTEERISM; WEIL, ANDREW. SOURCES: Benson, Herbert. Beyond the Relaxation Response. New York: Berkeley Press, 1985. ———. The Relaxation Response. New York: Avon Books, 1975. Benson, Herbert, and Eileen M. Stuart. The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. New York: Carol, 1992. Carey, Benedict. “Don’t Face Stress Alone.” Health, April 1997. Field, Tiffany, Olga Quintino, et al. “Job Stress Reduction Therapies.” Alternative Therapies 3, no. 4 (July 1997). Hornig-Rohan, Mady. “Stress, Immune Mediators and Immune-Mediated Disease.” Advances: The Journal of Mind-Body Health 11, no. 2 (spring 1995). Kahn, Ada P. “Stress” (pamphlet), Chicago: Mental Health Association of Greater Chicago, 1989. ———. “Win the Case against Stress.” Chicago Bar Association Record, May 1994. ———. “Women and Stress.” Sacramento Medicine, September 1995. Pelletier, Kenneth R. Sound Mind, Sound Body: A Model for Lifelong Health. New York: Simon and Schuster, 1994. Sapolsky, Robert M. Why Zebras Don’t Get Ulcers. New York: W. H. Freeman, 1994. Selye, Hans. The Stress of Life, rev. New York: McGrawHill, 1978. ———. Stress without Distress. Philadelphia: J. B. Lippincott, 1974.
348 Stress and Anxiety Research Society Stress and Anxiety Research Society (STAR)
A multidisciplinary international organization of researchers who share interest in STRESS, COPING, and ANXIETY. Members from more than 35 countries meet annually to exchange research findings and clinical applications of a wide range of stress and anxiety-related issues. STAR conferences provide a unique opportunity to learn how psychology is studied and practiced through the world. Since 1980, yearly meetings have been held in many countries and provide a platform for major addresses by internationally known scholars, paper poster sessions, and workshops. The conferences are relatively small, with approximately 150–200 participants, meaning that close collegial relationships are easily established. Topics covered in recent years have included clinical issues, education, work-related stress, computers and technology, stress and coping of the elderly, test anxiety, disasters and post-traumatic stress disorder, stress and anxiety in sports, cross-cultural issues, stress and anxiety in music, and migration. STAR publishes an international journal, Anxiety Stress, and Coping. FOR FURTHER INFORMATION:
Anxiety Stress, and Coping Krys Kaniasty, Editor Department of Psychology Indiana University of Pennsylvania Indiana, PA 15705 (724) 357-5579 (724) 357-2214 Conference Office Stress and Anxiety Research Society Universiteit van Amsterdam P.O. Box 19268 1000 GG Amsterdam + 31 (0)20 525 4791 (phone) + 31 (0)20 525 4799 (fax)
[email protected] stress management
Refers to an individual’s personal COPING skills for dealing with STRESS. It also refers to a multibillion-dollar industry that includes programs, products, services, and techniques to help people reduce stress on an individual or group basis. For example, stress management programs offer
help to people interested in overcoming stressrelated disorders ranging from EATING DISORDERS to issues of SELF-ESTEEM. Programs may include use of many ALTERNATIVE THERAPIES. Many stress management programs are offered in the WORKPLACE and address such problems as ALCOHOLISM and other ADDICTIONS, finances, nutrition, and other employee concerns. See also EMPLOYEE ASSISTANCE PROGRAMS; PSYCHOTHERAPIES. SOURCE: Murphy, Lawrence R. “Stress Management in Work Settings: A Critical Review of the Health Effects.” American Journal of Health Promotion 11, no. 2 (November/ December): 112–35.
stressors
See
STRESS.
stress urinary incontinence (SUI)
The tendency to leak urine when the bladder is stressed by sneezing, coughing, running, jumping, or other activities. According to the American Urological Association, about one in five U.S. women over age 50 suffers from stress urinary incontinence (SUI). It is a concern that causes emotional stress and embarrassment and is a psychosocial issue because the condition may affect or disrupt social activities, work, and relationships. Urge incontinence, the sudden unbearable need to urinate, is less common. Stress incontinence is caused by an incompetent urinary sphincter and results in involuntary loss of urine with increased intra-abdominal pressure. Approximately one of three women who have had a vaginal birth, even an uncomplicated one, will develop SUI at some point in their life. Giving birth to twins or bearing more than one child does not necessarily raise the risk because the damage has usually been done with the first child, according to Dr. Linda Brubaker of Loyola University in Chicago. Young women may experience SUI after childbirth, but the problem becomes more noticeable later in life, particularly around the time of MENOPAUSE, when loss of estrogen contributes to weakening of muscle walls. Help for SUI Remedies for SUI have improved in recent years. Today 90 percent of women who seek help find
stuttering 349 relief, and new treatments are on the way. Many patients are advised to make lifestyle changes, lose weight, reduce intake of liquids, and cut back on irritants such as caffeine, alcohol, and cigarettes. If the patient’s pelvic floor is weak, she will need to learn how to train her muscles with Kegel exercises (pelvic contractions commonly taught to prevent SUI after childbirth). Medications used to treat stress incontinence are aimed at increasing the contraction of the urethral sphincter muscle. Treatment with medications tends to be more successful in patients with mild to moderate stress incontinence. Biofeedback techniques can help women isolate and work the pelvic muscles. Another approach gaining popularity is collagen or fat injections, administered under local anesthesia by a urologist, to plump up tissues around the urethra. The body tends to absorb collagen, and the injections must be repeated every year or so. Several surgical techniques are in use to help women who have SUI. Approximately 135,000 SUI surgeries are performed a year in the United States with a success rate of 75 to 95 percent. FOR FURTHER INFORMATION:
American Urological Association 1000 Corporate Boulevard Linthicum, MD 21090 (866) RING AUA (410) 223-4375 (fax) http://www.auanet.og
stroke An interruption to the blood supply of the brain, or leakage of blood outside vessel walls, that causes damage to a part of the brain. Sensation, movement, or function controlled by the damaged area may be impaired. Paralysis or some speech impairment may occur. Strokes are fatal in about one-third of cases and are a leading cause of death in developed countries. A stroke is a very stressful event in the life of the sufferer as well as the caregiver. According to the National Stroke Association (NSA), of the 750,000 strokes per year, more than 100,000 are recurrent strokes. NSA further estimates there is up to a 14 percent increased risk of recurrent stroke within one year and up to a 40 percent increased risk within five years of the initial stroke.
See also ATHEROSCLEROSIS; CORONARY ARTERY DISEASE: HEART ATTACK; HIGH BLOOD PRESSURE.
FOR FURTHER INFORMATION:
American Heart Association National Center 7272 Greenville Avenue Dallas, TX 75231-4596 (800) 242-8721 (toll-free) (214) 373-6300 (214) 987-4334 (fax) http://www.americanheart.org National Stroke Association 300 East Hampden Avenue Englewood, CO 80110 (800) 787-6537 (toll-free) http://www.stroke.org
stuttering A speech disorder involving repeated hesitation and delay in saying words or in which certain sounds are unusually prolonged. Stuttering is also known as stammering. Stuttering is stressful because it causes the sufferer embarrassment and ANXIETY. Some stutterers become socially withdrawn because they fear ridicule from others. Stuttering usually starts in early childhood and may be a temporary situation. However, about half of the children whose stuttering persists after age five continue to do so throughout adulthood. Causes of stuttering are not understood; theories say that it may be due to a subtle form of brain damage or may be related to a psychological problem. When people who have a stammer become anxious or fearful, their stuttering becomes worse. For example, some children who are fearful of getting up and speaking in the classroom have difficulty getting words out. Interestingly, these same children feel no particular stress and have no difficulty in reading aloud or singing in unison. Speech therapy helps some individuals improve their speech pattern; training may include learning to give equal weight to each syllable. See also SOCIAL PHOBIA. FOR FURTHER INFORMATION:
National Center for Stuttering 200 East 33rd Street New York, NY 10016 (212) 532-1460 (800) 221-2483 (toll-free)
350 substance abuse Stuttering Resource Foundation 123 Oxford New Rochelle, NY 10804 Phone (800) 232-4773
substance abuse
See
ADDICTION.
success
A favorable outcome or attainment of wealth or stature, success can be a source of stress when it happens as well as when it does not happen. Some who view success as a source of stress, fear that they will not be able to reach a higher plateau or that they will not be able to fulfill other people’s expectations. Others may fear that by achieving success they will have to move to a better neighborhood, bigger house, or send children to a better school. All these expectations may lead to anxieties and stressful feelings about change. While success can be a source of satisfaction, it also can be stressful because some individuals may fear that achievement will place them in another social, academic, or social class and they will lose friendships. Some individuals actually avoid success because they want to continue conforming to their group. Expectations for success are stressful because they correlate with people’s fear of failure. An inability to reach what people regard as success may reflect unfavorably on their self-image and SELF-ESTEEM. Certain PERSONALITY types are driven toward success. The TYPE A PERSONALITY, for example, is associated with intense drives for success. Such individuals have competitive feelings, are extremely goal oriented, take on multiple commitments, and become preoccupied with meeting deadlines. Often, after serious illness, such individuals learn to relax more and redirect their drives, placing more value on family and friendships. SOURCE: Van Fleet, James K. Lifetime Guide to Success with People. Englewood Cliffs, N.J.: Prentice Hall, 1995.
sudden infant death syndrome (SIDS) SIDS, or “crib death,” is the sudden and unexplained death of an infant. Infants who are victims of SIDS are usually between the ages of two to four months, when they stop breathing during a normal sleeping
period. Ninety percent of all victims die within the first four months, but SIDS may strike children as old as one year. In 2001, 2,236 children died of SIDS in the United States, according to the Centers for Disease Control and Prevention. The death rate has dropped by half since 1992, when the government and private organizations started a campaign telling parents to put their babies to sleep on their backs. Although causes of SIDS are unknown, it is not caused by childhood vaccines, suffocation, vomiting, or choking. Research projects are under way to determine predictive factors that may prevent future deaths. Parents who have lost a child to SIDS may find SUPPORT GROUPS helpful. See also GRIEF. FOR FURTHER INFORMATION:
American Sudden Infant Death Syndrome Institute 509 Augusta Drive Marietta, GA 30067 (800) 232-SIDS; (800) 232-7437 (toll-free) (770) 426-8746 (770) 426-1369 (fax) http://www.sid.org
suicide
Killing oneself voluntarily and intentionally. In some cases, suicide is the consequence of DEPRESSION and stress. It is a subject that is a stressful one for many people to talk about, and a verdict of suicide certainly is not one that the family wants to hear. Suicide is the eighth leading cause of DEATH in the United States and the second most frequent cause of death for young people in the 15–25 age group. About 12 percent of those who threaten or attempt suicide actually kill themselves. Current statistics may understate the actual occurrence of suicide. For example, there may be suicidal intentions behind many auto and other accidents. Additionally, because of insurance coverage issues and legal criteria for classifying cause of death, suicide may not be recorded as the cause in many cases. Preventing Suicide Suicide is a manifestation of depression that can be successfully treated. People who show signs of
suicide 351 depression and express hopelessness or suicidal impulses should be encouraged to get immediate professional help in order to avoid a crisis. If a suicidal crisis does occur, the family should remove all weapons and lethal means from the home, including prescription drugs, and the individual threatening suicide should not be left alone at any time. One of the most difficult challenges clinicians face is preventing the suicide of their patients. Such psychiatric clinicians routinely deal with patients whose diagnoses indicate a high risk for suicide. The physician, psychotherapist, or mental health worker is sometimes the only person who recognizes suicidal intent. Studies have shown that from 40 percent to 75 percent of suicidal individuals see a physician within six months to a year preceding their self-destructive acts. A number of studies have pointed out that even while receiving psychiatric treatment, psychiatric hospitalization, or treatment with psychotherapic drugs, patients do commit suicide. Evidence seems to support the contention that most suicides occur in the context of psychiatric illness. However, the absence of psychiatric treatment at the time of suicide does not necessarily preclude the existence of a serious mental disturbance; severely depressed patients may appear symptom-free just prior to suicide. This may lead to an erroneous assumption that the individual is “normal” at the time of suicide. Additionally, the presence of real or perceived physical illness may be significant in the assessment of suicidal risk. In malignant or incurable illness, two critical suicidal periods seem to be those of: a) uncertainty while diagnosis and prognosis are still at issue, and b) shock following the first realization of the upheavals and suffering, actual or fantasized, that are to follow. Depression and Suicide Individuals who have serious depression are high suicide risks. Symptoms may include feelings of hopelessness, helplessness, and emptiness, especially with severe anxiety or panic attacks, sleep disturbance, weight loss, complete loss of interest, loss of sexual interest, impairment of function, delusional guilt, neglect of personal appearance and cleanliness, and inability to make decisions. Generally, the risk of suicide appears to be greatest
in the early course of depressive illness (first three episodes). Common instances of increased suicidal risk in depressed individuals are associated with separation or loss. The loss does not necessarily have to be a death of a loved one, but may be simply a temporary loss such as home or job or temporary separation such as from therapist, money, or love. The “failure situation” ranks high as a precursor of suicide. This situation may occur when one is trying to regain or attain a higher level of function, such as starting a job or returning to college. Also, the failure factor ranks high when individuals try to meet higher expectations of themselves or others. Recognizing Suicide Intentions A characteristic of a chronically suicidal person is repeated communication of a wish to die or suicidal thoughts. However, this in itself is not sufficient to distinguish the high- from the low-risk individual, since the majority of the much larger group of people who attempt but do not complete suicide also convey intent in advance. Personalities of many suicidal individuals have shown tendencies toward rigid thinking, which does not allow for alternatives in a crisis; PERFECTION in all undertakings is a personality trait that is carried to a pathological extreme. A suicidal individual often shows intense dependency as an underlying lifestyle dynamic. This dependency may be notable throughout all spheres of the suicidal individual’s lifestyle where inordinately excessive demands are made on others for constant attention, affection, and approval, and where the individual feels unable to cope for himself, thereby needing continual supervision and guidance. Recognizing Youth at Risk There are some specific clues to predict suicide among youngsters or adolescents. For example, they are more likely to communicate with those in their peer group than with their parents. They may give away a prized possession with the comment that they will not be needing it anymore. They may be more morose and isolated than usual. Although there may be signs of insomnia, worry, and anorexia, the youngster may not have all the classical signs of depression.
352 suicide One study listed symptoms occurring in 25 college-age suicides in order of their frequency: despondency, futility, lack of interest in school work, tenseness around people, insomnia, suicidal communications, fatigue and malaise without apparent organic cause, feelings of inadequacy or unworthiness, and brooding over the death of a loved one. Having a gun in the home may increase the risk that a psychologically troubled teen will commit suicide, according to David A. Brent, M.D., in the Journal of the American Medical Association (December 1991). Dr. Brent and colleagues noted that the odds that potentially suicidal adolescents will kill themselves are raised 75-fold when a gun is kept in the house. They commented on differences between teen suicides and that of adults. For teens, they said, a suicide attempt may be an attempt to communicate that they are in great pain, although they may be ambivalent about wanting to die. For such adolescents, ready access to a firearm may guarantee that their plea for help will not be heard. Suicide and the Aging Population A federal study published during 1991 showed that from 1980 to 1986, suicides by Americans aged 65 and older jumped 23 percent for men and 42 percent for African-American men. The rate for white women rose 17 percent, while there were too few suicides among African-American women to show a meaningful trend. A study in Illinois under a
RECOGNIZING CHARACTERISTICS OF SUICIDAL INDIVIDUALS • Depressed mood; hopeless-helpless • Disturbed sleep patterns and appetite disturbances • Anger, hostility • Ambivalence; impaired concentration • Withdrawn, isolative behavior • Constricted thought processes; tunnel vision • Psychomotor agitation or psychomotor retardation • Anxious; attentive to internal stimuli • Verbalizes suicidal thoughts or plans and references to death • Gives away possessions; impulsive behaviors
grant from the American Association of Retired People Andrus Foundation showed that the great majority of the elderly who committed suicide were physically healthy. However, 79 percent had shown symptom of a major treatable psychiatric illness, usually depression or ALCOHOLISM. Assisted Suicide In 1991, Final Exit, a “how-to” book by Derek Humphry, executive director of the Hemlock Society (a group aimed at promoting death-with-dignity), was published. He emphasized that his controversial book for the terminally ill was not meant for unhappy or depressed people. Many mental health professionals were concerned that this book and others may legitimize suicide for troubled people with undiagnosed depression who could be treated if their illnesses were diagnosed correctly. Many expressed fear that such books could increase suicide rates, particularly among the elderly who are not terminally ill. However, according to David Clark, past president, American Society of Suicidology (an organization dedicated to preventing suicide), many people, when they recover from an attempted suicide, are extraordinarily glad that someone did not help them die. In March 1990, physicians writing in the New England Journal of Medicine about “The Physician’s Responsibility toward Hopelessly Ill Patients” held that “it is not immoral for a physician to assist in the rational suicide of a terminally ill person.” Two of the 12 authors of the paper dissented from this statement. Dr. Jack Kevorkian (1928– ), an American physician with a specialty in pathology, is famous and controversial for his advocacy of the right to die and his suicide assistance of terminally ill people. During the 1990s, he helped more than 100 people die in this manner. As of late 2005, he is in a Michigan prison, serving a 10–25-year sentence. He will be eligible for parole in 2007. The first time he assisted a terminally ill person with suicide was in 1990, and until 1998, he hooked patients up to a machine of his own invention to facilitate death. The patient would push a button, releasing chemicals or drugs to induce death. He was charged with murder in Michigan several times but was acquitted or had a mistrial. In
sunlight 353 1997, the U.S. Supreme Court ruled that states have the right to outlaw physician-assisted suicide. In March 1999, a jury in Michigan found Dr. Kevorkian guilty of second-degree murder and of delivering a controlled substance. He had administered a lethal injection to an ALS sufferer. In April 1999, he was sentenced to prison. On September 29, 2005, in a television interview, Dr. Kevorkian indicated that if he is granted parole, he will restrict himself to campaigning to have the law changed and would not resume helping people die. See also AFFECTIVE DISORDERS. FOR FURTHER INFORMATION:
American Academy of Child and Adolescent Psychiatry 3615 Wisconsin Avenue NW Washington, DC 20016 (202) 996-7300 American Association of Suicidology 5221 Wisconsin Ave NW Washington, DC 20015 (303) 692-0985 American Psychiatric Association 1000 Wilson Boulevard, Suite 1825 Arlington, VA 22209-3901 (703) 907-7300 National Alliance for the Mentally Ill Colonial Place Three 2107 Wilson Boulevard, Suite 300 Arlington, VA 22201-3042 (703) 524-7600 National Committee on Youth Suicide Prevention 666 Fifth Avenue, 13th Floor New York, NY 10103 (212) 677-6666 National Institute of Mental Health 5600 Fishers Lane Rockville, Maryland 20857 (301) 443-4513 National Mental Health Association 1021 Prince Street Alexandria, VA 22314-2932 (800) 969-NMHA (703) 684-7722
SOURCES: Brent, David A., et al. “Teens More Likely to Commit Suicide When Gun Is in Home.” Journal of the American Medical Association, December 3, 1991. Fawcett, Jan, William A. Scheftner, Louis Fogg, et al. “Time-Related Predictors of Suicide in Major Affective Disorder.” American Journal of Psychiatry 147, no. 9 (September 1990). Garrison, Jayne. “Rushing Heaven’s Door.” Health, May–June 1997. Humphry, Derek. Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. Secaucus, N.J.: Carol Publishing, 1991. Kahn, Ada P., and Jan Fawcett. Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001. Katz, Marvin. “Critics Fear Misuse of Suicide Books.” Bulletin, American Association of Retired Persons 32, no. 11 (December 1991). “Should the Doctor Ever Help?” Harvard Health Letter 16, no. 10 (August 1991).
sunlight
Light from the Sun, which helps plants grow and helps elevate people’s moods. Soaking up the Sun’s rays has been a favorite American pastime for many years. Lying in the sun was believed to be a great way to relax and escape from the stress of everyday life. The sun not only made people feel good, it also contributed to a tanned, outdoor look. That was before the dangers of ultraviolet rays were understood, said the American Academy of Dermatology (AAD) in its pamphlet The Sun and Your Skin, published in 1994. Now it is known that too much sun can cause wrinkles freckles, skin texture changes, dilated blood vessels, and skin CANCER.
Recommendations to Prevent Skin Damage It is important to avoid overexposure to the Sun because the Sun produces both visible and invisible rays, known as ultraviolet-A (UVA) and ultraviolet-B (UVB). Both cause suntan, sunburn, and sun damage. There is no “safe” UV light. People should use protection against the sun whenever outdoors. While the harmful UV rays are more intense in the summer, at higher altitudes, and near the equator, effects of the sun are also increased by wind and reflections from water, sand, and snow. Even on cloudy days, UV radiation reaches Earth. The AAD recommends avoiding deliberate sunbathing and wearing a wide-brimmed hat, sunglasses, and protective clothing if it is necessary to
354 superiority complex be in the sun, and to use a sunscreen, at all times. A sunscreen works by absorbing, reflecting, or scattering the Sun’s rays on the skin. Choosing the right sunscreen can be a source of stress because so many choices are available. All sunscreens, whether they are ointments, gels, creams, lotions, or wax sticks, are labeled with SPF (sun protection factor) numbers. The higher the SPF, the greater the protection from sunburn caused by most UVB rays. Some sunscreens, called “broad spectrum,” block out both UVA and UVB rays. Protecting against effects of the sun should start by avoiding the peak hours of the sun—usually between 10 A.M. and 4 P.M. Sunscreens should be applied about 20 minutes before going outdoors and should be reapplied about every two hours after swimming or strenuous activities. Skin Cancer While too much sun can cause painful sunburn, age the skin with wrinkles, freckles, and sunspots, set off allergic reactions such as rashes, hives, and blisters, and cause cataracts, the worst possible effect is skin cancer. There are three common types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Estimates indicate that approximately 700,000 Americans develop skin cancer every year. Fortunately, most skin cancers can be detected and cured if found early. Dermatologists recommend periodic self-examinations; watching the patterns of moles, freckles, and “beauty marks”; and being alert to changes in the number, size, color, and shape of pigmented areas. Contact a dermatologist if changes occur. Effects of Too Little Sunlight Too little sunlight in the environment, such as in northern locations during winter months, can result in a form of depression known as SEASONAL AFFECTIVE DISORDER. Treatment involves going to a place with a brighter atmosphere, or using specially designed light treatments. See also AFFECTIVE DISORDERS; BODY IMAGE; CHRONIC ILLNESS; CLIMATE; DEPRESSION. FOR FURTHER INFORMATION:
American Academy of Dermatology P.O. Box 4014 Schaumburg, IL 60168-4014
(847) 330-0230 http://www.aad.org
superiority complex
An unrealistic and exaggerated belief of a person that he or she is better than others. Such a complex is a source of stress for the individual as well as others. In some people, this is a compensation mechanism for unconscious feelings of low SELF-ESTEEM or inadequacy. For example, bullies who push other children around may act like that because, in reality, they have low self-esteem. Some adults with a superiority complex seem to be snobbish, but they may be covering up for an inadequacy, such as lack of a college education. See also INFERIORITY COMPLEX.
superstition
Beliefs that have survived since ancient times regarding the mysteries of nature. Superstitions abound among cultures around the world; many people who still hold superstitious beliefs become stressed when they allow their superstitions to take over their life. Many odd and amusing notions and customs persist; some are harmless and some are harmful. Scientific thinking supersedes the superstitious because modern science believes that everything in nature has a natural cause and that laws of nature can explain cause and effect. Superstitious beliefs are more common among people with little education, but even well-educated people have a tendency to cling to superstitious beliefs. For example, hotels and other commercial buildings sometimes avoid numbering the 13th floor because many persons believe it is unlucky. Fridays that fall on the 13th day of the month are considered unlucky. If your ears burn, it means someone is talking about you. Bad luck follows walking under a ladder, breaking a mirror, or having a black cat cross your path. It is supposed to be good luck if one finds a penny or a four-leaf clover. Stressful interactions may arise between family members or friends when one clings to these old superstitions and another counters them with more practical explanations. See also ACCULTURATION; TABOOS.
support groups
Individuals with the same experience about a specific health or social concern
support groups 355 who join together to help each other by sharing experiences and advice and by providing emotional support for each other. Support groups exist for patients as well as spouses and family members in almost every medical or social category. For example, individuals with MANIC-DEPRESSIVE DISORDER began an organization that now has become nationwide, with chapters in many cities. Individuals with CHRONIC FATIGUE SYNDROME (CFS) have done the same, with the result that sufferers no longer need feel alone with their problems. There are support groups for parents of children with specific diseases, as well as groups for spouses of ALZHEIMER’S DISEASE patients and for middle-aged people who care for ELDERLY PARENTS. Many physicians recommend that patients join support groups because the sharing with others can be effective and augment any therapies provided by medical means. An additional benefit of belonging to a support group for a particular concern is that one can stay up to date on progress as researchers work toward better treatments or legislators work on the issues. Many groups circulate articles from popular and scientific publications and bring in experts to discuss their latest findings. According to Karyn Feiden, author of Hope and Help for Chronic Fatigue Syndrome, benefits of support groups generally fall into three major areas: informing and educating the general public, and particularly patients, their families, and the medical community; counseling and consoling those who have been diagnosed with a particular disorder; and organizing and advocating for the cause at local and national levels. Support Groups for Breast Cancer Patients David Spiegel, M.D., Stanford University School physician and faculty member, pioneered work with support groups for BREAST CANCER patients. In 1991, at the national meeting of Y-ME (a breast CANCER advocacy organization), he reported conclusions of a 15-year study of 86 metastatic breast cancer patients. While we know that psychosocial support affects outcome in terms of length of survival, the mechanism by which it does so is not clear. However, results of this study strongly suggest that psy-
chosocial support can improve the quality of life for cancer patients, is inexpensive and easy to organize, and should be a standard part of care. Social support is an important stress buffer and is strongly related to survival. The risk of cancer and cancer mortality is higher if one is not socially integrated. The ratio may be as high as 2:1. For men, marital status is a protective factor, with married men at the lowest risk. For women, the best protective factor is relationships with women friends and relatives . . . When patients manage STRESS better, it may allow their bodies to devote more resources to fighting illness. This comes not by denying the illness and wishing it away, but by managing life, relationships with family and physicians, one’s own feelings about having a terminal illness as fully as possible, and making their lives fuller and richer. Such techniques are not a cure for cancer, but there is some evidence that they may prolong survival. From our support groups as well as other studies, we know that mutual support should be encouraged. There was a tremendous power among the women with the same problem. Most people don’t understand DEATH, feel isolated and that they are already dead. Enhancing mutual support made these women feel more a part of humanity.
A bonding develops quickly because women in the group know what others’ fears are like; this helps to normalize their reactions and relationships with each other. People feel awkward talking about cancer because they find it hard to deal with anxiety about death. “We found that it was not death itself, but the process of dying, including losing physical CONTROL, an inability to do what they did before, and PAIN, that were most difficult for the women to face. Thus there was a series of problems, not just one problem. However, there are some constructive things one can do, for example, work out a living will, improve means of pain control, and talk with one’s physician about ongoing care. “We were concerned that putting women with metastatic cancer together might demoralize some of them. Instead, direct confrontation with death led the women to discussions of positive coping strategies and no decline in mood.” The criteria for inclusion in the randomized prospective study was that women agreed to attend weekly support groups for a year. Fifty women were randomly assigned to the support
356 sympathetic nervous system group situation; 36 were assigned to their routine cancer care. The women had comparable kinds of initial surgery, similar initial staging, comparable degrees of metastatic spread, similar courses of chemotherapy and disease-free intervals (three years for both groups). Therapy groups included eight to 10 women and two therapists who met weekly for an hour and a half. Intervention focused on direct confrontation of fears of dying and death, realistic assessment of prognosis, and development of new coping strategies for interaction with physicians, family, and friends. Overall, patients in the treatment group showed a reduction in total mood disturbance while those in the control group worsened in terms of tension, fears, anxiety, confusion, and fatigue. The treatment group coped substantially better, and experienced less denial, significant reductions in mood disturbance, fewer phobic symptoms, and less pain. Both the treatment and control groups had routine oncologic care. At 10-year follow-up, only three of the original 86 patients were still alive, and death records were obtained for the other 83. Survival from the time of randomization and onset of intervention was 36.6 months for the treatment group, compared with 18.9 months for the control group. Four years after randomization, all of the control patients had died and one-third of the intervention sample were still alive. There was a difference in survival from the first metastases, 43 months vs. 58 months. In explaining the survival differences between the two groups, Dr. Spiegel said that women who are less depressed may eat better, exercise more, take better care of themselves, and may encourage physicians to be more assiduous in treatment. “We now call this supportive-expressive group therapy. The theme is how the women face their futures, not their pasts,” said Dr. Spiegel. See also BEHAVIOR THERAPY; CHRONIC ILLNESS; DEPRESSION. SOURCES: Feiden, Karyn. Hope and Help for Chronic Fatigue Syndrome. New York: Prentice Hall, 1990. Kahn, Ada P. “Psychosocial Support Influences Survival of Cancer Patients.” Psychiatric News, October 1991. Kreiner, Anna. Everything You Need to Know about Creating Your Own Support System. New York: Rosen Publishing Group, 1996.
Locke, Steve, and Douglas Colligan. The Healer Within. New York: New American Library, 1986.
sympathetic nervous system (SNS) One of two divisions of the autonomic nervous system. The system controls many involuntary activities of the glands, organs, and other parts of the body and readies it for coping with suddenly occurring situations. The SNS is very involved in stress responses, as it is responsible for preparing people for fighting, fleeing, action, or sexual climax. The SNS includes connections from the eyes to the urogenital organs. Typical sympathetic changes take place during heavy exertion or when facing extremely stressful situations. The pupils widen to facilitate vision, the arteries constrict to supply more blood to the muscles and the brain, heartbeat increases, ADRENALINE is secreted to increase metabolism, the skin perspires to eliminate waste products, and stomach and intestinal activities cease so that energy can be directed elsewhere. See also FIGHT OR FLIGHT RESPONSE. symptom
An indication of an illness or mental distress noticed by the sufferer. For example, symptoms of stress may be sleeplessness, fatigue, difficulty concentrating, or irritability. A symptom is different from a sign, which is an indication of a disorder noticed on an objective basis by another person, such as a physician. A group of symptoms as well as signs is sometimes referred to as a SYNDROME. An example is post-traumatic stress syndrome, which includes a wide range of symptoms, such as nightmares, feelings of claustrophobia, and an inability to concentrate; the physician may notice increased heartbeat, rapid breathing, and other signs during examination.
syndrome A group of SYMPTOMS or signs that occur together and make up a particular disorder. For example, the syndrome that leads a physician to diagnose extreme stress in an individual, may include elevated blood pressure, difficulty sleeping, loss of weight, inability to concentrate, lack of interest in sexual activity, as well as others. syphilis
See
SEXUALLY TRANSMITTED DISEASES.
systematic desensitization
See BEHAVIOR THERAPY.
T of power or mana that his shadow, parts of his body, and even objects that he touched were considered dangerous. See also SUPERSTITION.
taboos
Ideas, concepts, or practices that are not discussed or carried out openly by a given culture are referred to as taboos. Some taboos are so specific to a culture that they are difficult for outsiders to understand. The source or reason for a taboo may be unknown or forgotten; taboos may have given groups of people moral and ethical codes by which they lived. Certain taboos that are common to many cultures are a source of stress. For example, references to the dead and DEATH are frequently avoided, made in hushed tones, or accompanied by a ritual gesture or phrase; SUICIDE is not discussed in many cultures, nor is INCEST, so much so, that reference to the behavior and to the act itself may have been suppressed. During the 1990s in the United States there were revelations that incest had a higher incidence than previously thought. As a consequence, the taboo to speak out and protest about it was, to a large extent, lifted. Some taboos evolve from social hierarchies, such as the Hindu caste system, which rigidly regulates contact among the castes. Other taboos are related to rulers or persons in authority. For example, on a visit to the United States, Queen Elizabeth II accepted a friendly, but highly irregular, hug from a woman who was not familiar with royal protocol. Other taboos involve sex roles and contact between the sexes such as the exclusion of women from male clubs. Cleanliness, especially of food, and bodily functions, such as excretion or MENSTRUATION, give rise to taboos in many cultures; Native American tribes confined their women to a specific lodge during their menstrual periods. The word taboo is derived from the language of the Polynesian people, meaning “forbidden” or “dangerous.” It is the term used for behavior related to their king. He was thought to be so full
SOURCES: Douglas, Mary. “Taboo,” in Cavendish, Richard, ed., Man, Myth and Magic, vol. 10. New York: Marshall Cavendish, 1983; 2,767–2,771. Gregory, W. E. “Taboos,” in Corsini, Raymond J., The Encyclopedia of Psychology, vol. 3. New York: Wiley, 1984; 398.
tachycardia
Rapid beating of the heart, over 100 beats per minute in an adult. Most people experience 60 to 100 beats a minute, with an average of 72 to 78 beats. It is normal for tachycardia to occur under some conditions, such as vigorous EXERCISE or sexual activity. However, tachycardia is sometimes associated with AGORAPHOBIA, ANXIETY, PANIC ATTACKS AND PANIC DISORDER. People who already feel stressed, anxious, or fearful may become even more so when they become aware that their heart is beating rapidly. Under such circumstances they may fear that they are having a HEART ATTACK and, along with the rapid heartbeat, experience symptoms such as difficulty in BREATHING, PALPITATIONS, and DIZZINESS. Other reasons for tachycardia at rest are hyperthyroidism, coronary heart disease, a high intake of CAFFEINE, and treatment with an anticholinergic and some decongestant drugs.
t’ai chi
A physical, mental, and spiritual practice that uses movement to balance energy, and helps achieve and maintain harmony within oneself. Those who practice t’ai chi say that it aids them to develop more mental and spiritual energy, feel more overall vitality, and obtain relief from stress.
357
358 tantrums T’ai chi is an outgrowth of Chinese martial arts, spirituality, and Chinese medicine, and has been practiced for more than 2,000 years. As a martial art and a popular meditative practice, it is often called MEDITATION in motion. According to Chinese philosophy, to do t’ai chi is to connect the individual with nature through movement. It is considered “great shadow boxing,” which draws on Taoist beliefs in the interdependence of the body and the mind. In the open spaces and parks of China today, millions of young and old people practice t’ai chi, gently swaying, gliding, and stepping. Benefits of T’ai Chi Practitioners of t’ai chi usually experience deep and restful sleep. Their nervous system is soothed and calmed. The gentleness of t’ai chi ensures that they do not suffer strains and other muscular injuries, but instead develop greater strength, flexibility, and suppleness. Some athletes use t’ai chi as a way of warming up. People who perform t’ai chi move all their joints and exert more energy than it appears. Through the use of slow BREATHING, individuals can pace some of the systems of their body. They can stabilize their heartbeat, the exchange of oxygen and carbon dioxide, and the secretion and absorption of endocrine fluids. The movements also improve health by assisting the flow of blood, creating tranquility for the entire nervous system, and through deep concentration, fostering deep peace of mind. United States researchers have been studying the physical and mental benefits of t’ai chi, particularly for older people, many of whom suffer from a lack of balance and experience falls. In an article in the Journal of the American Geriatric Society (May 1996), an evaluation of a 15-week course taken by 72 men and women over age 70 showed that t’ai chi not only improved their balance but also helped these people abort falls by teaching them to cope with missteps and precarious positions. Another study, reported in the Harvard Health Letter (July 1997), said that older adults who practiced t’ai chi had significantly lower blood pressure readings after the exercise and a decreased fear of falling. T’ai Chi Classes Books and videos on t’ai chi are available, but the best way to learn t’ai chi is in classes held in t’ai chi
studios, adult education courses at high schools and colleges, YMCAs and YWCAs, and senior adult centers. Many people combine t’ai chi with other forms of exercise. See also ALTERNATIVE MEDICINE.
tantrums Fits of ANGER usually experienced by children, although some adults, particularly those who have mental disorders, also experience these physical outbursts. Tantrums can happen anywhere. Anyone who has ever witnessed children throwing a tantrum in public sympathizes with the stress and FRUSTRATION felt by their parents. Although physical outbursts are a normal part of childhood development, they are no less embarrassing for parents who must manage a child’s loss of CONTROL, and their own loss as well. Childhood tantrums come in many forms—usually a combination of screaming, stomping around, writhing on the floor, and breaking or wielding handy objects. Children may be angered by being unable to deal with new experiences or frustrated by a perceived obstacle. For example, objects they might want to handle can be too dangerous, too complex, or too delicate for their small fingers. When children learn that the world does not center on them nor does it necessarily revolve around what they want, a tantrum is the way in which they may revolt. They are protesting against limitations on their behavior set by their parents and society. Fortunately for parents, most children outgrow their tantrums and eventually learn how to interact with their environment in a more mature way. See also HOSTILITY; PARENTING. TASERs
Handheld weapons (also known as stun guns) that deliver a jolt of electricity to immobilize the target. The jolt may be up to 50,000 volts fired from as far away as 21 feet. A TASER shot can penetrate thick clothing and stun the target by inducing an uncontrollable contraction of muscle tissue. TASERs are a source of stress for many. There is controversy concerning use of stun guns because more than 50 people in North America have died since 2001 after TASER shocks (total population of this region is estimated at 490 million). Critics say more research is needed regarding their safe use.
TASERs 359 Amnesty International Canada has called for suspension of the use of TASERs until studies can determine how they can be safely used. However, 100,000 police officers have participated in a study, with no deaths. Also, no autopsy report from a death after a shot from a TASER by a police person has concluded that the TASER caused the death. However, persons who have a heart condition or are otherwise weak could be at risk. Officers from more than 7,000 of the 18,000 law enforcement agencies in the U.S. are armed with TASERs and many credit the stun guns with curbing shootings. Phoenix, Arizona, was the first major metropolitan police force to provide TASERs for its officers, and some 1,200 other Arizona agencies now use the stun guns. (Manufacturer TASER International is based in Arizona). Officials say the stun guns have reduced injuries to both officers and suspects. After TASERs were issued to all Phoenix patrol officers, police shootings fell to their lowest point in 13 years. TASERs, also known as stun guns, are intended to allow police officers to subdue violent individuals without killing them or injuring bystanders. Canadian police say TASERs have saved 4,000 lives since the police forces began using them in Canada in 1999. “TASERs are a less lethal alternative,” according to Staff Sergeant Peter Sherstein, of the Royal Canadian Mounted Polices (RCMP) Emergency Response Team in Edmonton, Alberta, Canada. “There are still risks. There could be a situation where a person hit with a TASER shot could fall and hit his head. But we have to balance that out. We have several cases where if TASERs were not present, guns would have been the alternative.” Use on Airlines In 2004, Korean Airlines received approval by the U.S. Homeland Security Department’s Transportation Security Administration (TSA) to carry electronic TASER stun guns on some of its flights in the United States to protect against hijacking and other attacks. Korean Air flights landing or departing the United States or crossing U.S. airspace are allowed to carry the weapons, but flights completely contained within the United States are not, as of the end of 2004. At least 50 flights a week will carry the weapons. “They will be used by specially
trained personnel,” said Tom Smith, president of Arizona-based TASER International, manufacturer of the TASERs. Other airlines are expected to follow the example in the next few years. TASER International lobbied the U.S. Homeland Security Department for three years to allow their TASER to be used as a security measure on board U.S. airlines. According to an article in the Washington Times, Yolanda Clark, a TSA spokeswoman, said an agency working group studied several “notso-lethal weapons” in 2003, including devices that shoot beanbags, nets, and chemicals. They concluded that only the electric-shock devices could be used to enhance commercial security. According to the article, thousands of flights are protected by armed federal air marshals, and nearly 6,000 pilots have been trained and carry guns to protect the cockpit against a terrorist attack. 2005 TASER Use Government Report According to the U.S. Government Acceptability Office, in a report issued in May 2005, lawenforcement agencies have studied policies and training requirements to assure safe use of TASERs. Operational protocols require that TASERs be visually inspected daily and, in some cases, tested weekly or at the beginning of an officer’s shift. Safety procedures specify that TASERs not be used on children, pregnant suspects, or bystanders. Some federal, state, and local jurisdictions have laws that address TASER use, but requirements differ. For example, the army prohibits TASERs from being brought into selected military installations in Georgia. The TSA (Transportation Safety Administration) may approve use of TASERs on aircraft but must prescribe training and guidance on appropriate circumstances for their use. At state and local levels, the state of Indiana and the city of Chicago, Illinois, regulate the sale or possession of TASERs by non–law-enforcement persons. TASERs are subjected to the same restrictions that apply to firearms. Other states, such as California, prohibit TASERs from being carried into public facilities such as airports. SOURCE: Kehaulani Goo, Sara. “Korean Air Stun Guns Approved.” Washington Post. Available online. URL: http://www.washingtonpost.com/wp-dyn/articles/
360 technostress A35529-2004Nov8html. Downloaded on June 22, 2005. U.S. Government Accountability Office. Report to the Chairman, Subcommittee on National Security, Emerging Threats and International relations, Committee on Government Reform, House of Representatives. “Taser Weapons: Use of Tasers by Selected Law Enforcement Agencies.” May 2005. Available online. URL: http://www.gao.gov//cgi-bin/getrpt?GAO-05464; www.gao.gov/new.items/d05464.pdf. Last downloaded October 7, 2005. FOR INFORMATION:
TASER International 7860 East McClain Drive, Suite 2 Scottsdale, AZ 85260 (800) 978-2737 (toll-free) (480) 991-0797 (480) 991-0791 http://www.taser.com
technostress
See
CHANGING NATURE OF WORK;
ELECTRONIC DEVICES.
teenage pregnancy
See
PREGNANCY;
UNWED
MOTHERS.
teenage workers
Finding a job is stressful for teenage workers. Teens face many stresses in finding jobs as well as while they work. According to the National Institute of Occupational Safety and Health (NIOSH), teens are often injured on the job due to unsafe equipment and working too fast. Also, teens may not receive adequate supervision or safety training because they are regarded as temporary workers. Teenage employees have the right to report safety problems to OSHA, and they may refuse to work if the job is immediately dangerous to life or health. By law, an employer must provide a safe and healthful workplace and safety and health training for workers of all ages. Particular stresses that face teenage workers include slippery floors and hot cooking equipment in the food service industry, heavy lifting and violent crimes in retail sales, toxic chemicals in cleaning jobs, and office politics in clerical jobs. In some cases teenage workers are asked to work long hours, particularly when other staff
members have time off. However, federal child labor laws protect younger teens from working too long, too late, or too early. Some states have laws on the hours that older teens may work.
teeth grinding
Known medically as bruxism, a many people practice when they feel stressed or anxious. Some people grind their teeth during the day and some do it only at night. For about 5 percent of the population, teeth grinding causes serious consequences. For example, it is possible to grind the enamel off the teeth, making them more susceptible to cavities and very sensitive to heat and cold. Years of grinding can cause facial and jaw pain from fatigued muscles. Grinding also may damage the joint between the jaw and the cranium (temporomandibular joint). When a person eats, the muscles responsible for chewing exert just enough pressure to hold in place the disk of cartilage that cushions the joint. When the person grinds his or her teeth, this disk gradually becomes displaced, causing soreness, inflammation and even ARTHRITIS. Dentists can prepare plastic retainer-like appliances called mouth guards or night guards that prevent grinding. Many people find that RELAXATION therapy, GUIDED IMAGERY, HYPNOSIS, and BIOFEEDBACK also help to relieve this unwanted habit. See also TEMPOROMANDIBULAR JOINT SYNDROME. HABIT
telecommuting
Working at a distant location; commuting by state-of-the art technological communication aids instead of physically traveling to one’s job. Telecommuting permits workers to work in a distant city or distant place in the same area. Working in this way reduces the stress of traveling to work by car or public transportation. Many employees enjoy the time saved by not having to travel to work. Globalization is making telecommuting increasingly common, as more managers supervise workers in different cultures and in different time zones. According to Kris Maher, writing in the Wall Street Journal, the trend is occurring because of faster broadband Internet connections between home and office, concerns about terrorism that make employers think about placing executives geo-
telephones 361 graphically apart to help reduce disruptions, and the comfort of employees who may prefer working in their own homes. OUTSOURCING of jobs to other countries also plays a role in the increased number of workers who telecommute on a regular basis. The number of Americans who work from home at least one day per month rose to 24.1 million in 2004 from 23.5 million in 2003. The number of people telecommuting full time rose 41 percent, to 12.4 million from 8.8 million, according to Dieringer Research Group, a Milwaukee, Wisconsin, market research and consulting company. Not all work can be handled effectively from remote locations. In many businesses, managers and other workers are called together to a central location to meet to discuss agendas that cannot be covered by telephone, fax, or e-mail. The downside to telecommuting is that it makes it difficult to develop relationships with coworkers. Also, it may be difficult for managers to motivate staff members. E-mails and phone messages can be misinterpreted, causing gaps in communication. See also CHANGING NATURE WORK; ELECTRONIC DEVICES. SOURCE: Maher, Kris. “Corner Office Shift: Telecommuting Rises in Executive Ranks.” Wall Street Journal, September 21, 2004, p. B1.
telemarketers telephones
See
RANDOM NUISANCES.
As modern technology has made dramatic advances in design and function of telephones as communication devices, sources of stress have also escalated. Now there are cordless telephones used in homes which can be misplaced under piles of newspapers and other clutter. Finding the phone when it rings causes stress among the family to find the phone. Mobile phones are a great convenience for making calls away from a “land line,” but stresses arise when each child in a family wants their own personal phone. Telephone service itself has become stressful because of the competition between providers and the difficulty of comparing services and prices. Call waiting is an option with many phone services. When one person calls another and then is put on hold because another call is waiting, the
first caller is often annoyed that the other call is considered more important than theirs. Call forwarding can also be a convenience and an annoyance because the call can arrive at an inopportune time for the recipient. Camera Phones: A New Source of Stress Cellular mobile telephones with the capability of taking pictures were made widely available in the early 2000s. They are a convenience and a source of fun but they are also a source of stress for many because, anyone, anywhere can take pictures with them and easily transmit them to others. Modern technology has created this new stressor in our society. Concerned about privacy violations, some companies have barred camera phones at the workplace. Dennis Nishi, writing in the Chicago Tribune, reported that camera phones have been banned in health clubs, courtrooms, and in 2004, in Saudi Arabia and North Korea. Legislators are considering making it illegal to take private photos of anybody without consent. According to Nishi, visitors to General Motors (GM) are asked to surrender cell phones in highsecurity research areas. Employees abide by an honor system and agree not to bring the phones to work. “It is a challenge considering all the camera phones and PDAs [personal digital assistants] out there, said Jim Burke, a GM spokesman. “We have employees dealing with confidential and proprietary information.” Signs are posted at GM facilities to reinforce the policy, and random checks are conducted. The U.S. Air Force has declared camera phones “an unacceptable risk to homeland security” and has banned them from all areas dealing with classified information. Federal officials said in a news release: “It is not just a good idea to limit their use in secure rooms where classified information is being processed. You should watch how you use and carry those anywhere you’re dealing with sensitive or proprietary information.” One solution posed in Nishi’s article is legislation requiring camera phones to emit an audible noise or flash when taking pictures. South Korea already requires manufacturers to include this feature in new phones; however, existing phones are exempt from this rule. See also RANDOM NUISANCES.
362 television SOURCE: Nishi, Dennis. “Camera Phones Give View of Need to Boost Security.” Chicago Tribune, July 17, 2004, pp. 3–4.
television
A popular form of entertainment and education that has been available for about 40 to 50 years. Now, sitting in front of the television set occupies so many Americans for so long that they have been labeled “couch potatoes.” The average American adult watches over 30 hours of television a week. While a common reason for watching TV is RELAXATION, a major study indicated that the longer viewers spent in front of the screen, the more stress they felt, because of guilt over frittering away their time or avoiding responsibilities. An additional source of stress felt by many Americans involves both the purchase of TV sets and selection of TV programming. When buying a TV, people do not have time to deal with the brand clutter on the retail shelves and to determine the best price offered by competitive dealers. A similar competition for TV viewers exists among the various TV networks and the growing number of cable channels. An example of this is the tremendous increase in television talk shows that occurred during the 1990s, many of which seek the same TV audience market and often run concurrently during the daytime and evening hours. Estimates indicate that early in the 21st century, there will be as many as 250 cable and network channels from which viewers will be able to choose. This dilemma, plus the production of digital TVs, which will make current sets obsolete, will have viewers stressed for years to come.
temporomandibular joint syndrome (TMJ)
TMJ occurs when the ligaments and muscles that control and support the jaw, face, and head do not work together properly. The disorder can be brought on by a spasm of the chewing muscles, teeth grinding (bruxism), or clenching the teeth as a response to STRESS and tension. Symptoms of TMJ may include tenderness of the jaw, HEADACHES, and dull, aching facial pain, jaws that lock, pain brought on by chewing or yawning, and a clicking or popping noise when opening the jaw. Psychological counseling sometimes helps individuals overcome the underlying causes of tension
and cope better with the stresses in their lives. Some people try GUIDED IMAGERY and RELAXATION exercises. Treatment may include relieving pain by applying moist heat to the face, taking muscle-relaxant drugs, and using a bite splint at night to prevent teeth clenching and grinding. Some individuals undergo orthodontia to correct their bite while others undergo surgery on the jaw. See also MEDITATION; TEETH GRINDING.
tendinitis An inflammation of a tendon, usually caused by injury. Because people who are under stress often do not play attention to their bodies’ signals, they increase the possibility that they are sitting, standing, and moving in ways that can lead to tendinitis. Precautions are necessary, particularly when people bend or lift. Additionally, people under stress are less likely to take the time to exercise regularly, leaving the muscles more vulnerable to strain when used for strenuous effort. Those most at risk for tendinitis perform repetitive motions for long periods of time. The repeated motions may be at work or during sports activities. Under most conditions, their bodies may be able to handle the repetitiveness; however, if they are under the demand of deadlines and other stressors, or fail to rest, stretch, or relax at regular intervals, tendinitis may occur. Exercising—which includes conditioning, stretching, and relaxation—can help to reduce the muscular symptoms of stress, and should be continued even after aches and pain disappear. When muscles are strong and healthy, they are far better able to tolerate the tensions that occur in everyday living. See also REPETITIVE STRESS INJURY. tension headache terrorism
See
HEADACHES.
The systematic use of terror as a means of coercion is a worldwide problem. Terrorism makes many people fearful and apprehensive about traveling and trusting strangers. It increases their levels of stress in airports and other public places; long waits often ensue because of security checks that are not fail-safe. On September 11, 2001 (9/11), the worst event of terrorism in the history of the United States
THG 363 occurred. More than 3,000 people died as a result of two hijacked airliners crashing into the World Trade Center Towers in New York City. A third hijacked airliner crashed into the Pentagon. A fourth plane crashed in Somerset County, Pennsylvania. The bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995 was another example of terrorism that killed many people and terrorized countless others, particularly those working in government buildings around the world. Hostage taking, which has made the headlines many times in the latter 1990s, is an act of terrorism. Terrorists are individuals who are fanatical about their cause and often have no concern for their victims or for their own lives. Most terrorist groups are supported by governments who find terrorism an effective and inexpensive way to wage wars in comparison to the high cost of a conventional military force. While little can be done to protect against most types of terrorism, certain precautions, such as awareness of surroundings in public places and of “unusual” people, should be taken. Knowing that there will be long waits for baggage searches, passport checks, and other forms of questioning at airports, buildings, and other security checks to ensure safety should help to reduce an individual’s levels of stress. See also AIRPORT SECURITY; HOSTAGES; POST-TRAUMATIC STRESS DISORDER; SEPTEMBER 11, 2005.
therapeutic touch A nontraditional therapy (alternative or complementary) developed by Dr. Dolores Krieger, professor of nursing at New York University, in which she relieves the pain and distress of illness by passing her hands over the patient. It is also known as healing touch and is derived from the laying-on of hands. Her method is described in her book The Therapeutic Touch, How to Use Your Hands to Help or to Heal. How the Technique Works The healer eases into an altered state of consciousness while focusing energy on the patient, then slowly passes his or her hands about four to six inches above the patient’s body in an effort to sense a transfer of energy. The healer scans the body for an area of temperature change as an indi-
cation that part of the body is troubled, then lays hands on the affected area, while the patient senses a change in temperature, perhaps a feeling of deep heat, in the area being touched. According to Dr. Krieger, at the very least, the method produces a relaxation response in the patient and works well for inflammation, musculoskeletal problems, and psychosomatic disorders. Explanation by healers whose patients have been helped say that energy passes between themselves and their patients. Skeptics believe that this healing has a PLACEBO EFFECT, but it seems to work for some individuals. Historically, physicians touched their patients far more than they do today with the advent of so many highly technical diagnostic machines. Until the invention of the stethoscope in the mid-1800s, physicians pressed their naked ears to the bodies of patients to listen for heartbeats and other internal sounds. This intimate gesture probably had a soothing effect on the patient, much as therapeutic touch has today. As author Lewis Thomas wrote in The Youngest Science, “It is hard to imagine a friendlier human gesture, a more intimate signal of personal concern and affection, than the close-bowed head affixed to the skin.” Now, many nurses and other health care practitioners, including body therapists, realize the need for human touch and practice healing touch either knowledgeably or unconsciously, along with massage and other techniques. See also ALTERNATIVE MEDICINE; BODY THERAPIES; MASSAGE THERAPY; RELAXATION RESPONSE. SOURCES: Locke, Steven, and Douglas Colligan. The Healer Within. New York: New American Library, 1986. Macrae, J. Therapeutic Touch: A Practical Guide. New York: Alfred A. Knopf, 1988. Thomas, Lewis. The Youngest Science. New York: Viking Press, 1983.
therapy
See
PHARMACOLOGICAL APPROACH; PSY-
CHOTHERAPIES.
THG
A substance called tetrahydrogestrinone (THG) that is reportedly used by athletes to improve their performance. Based on an analysis of this product, the U.S. Food and Drug Adminis-
364 Thich Nhat Hanh tration (FDA) has determined that THG is an unapproved new drug. As such, it cannot be legally marketed under the FDA’s rigorous approval standards, meant to ensure that the drugs sold to American consumers are safe and effective. Athletes and coaches who recommended this substance viewed the news as a source of stress. The use of THG by athletes, as an alternative to other banned anabolic steroids, was disclosed in 2003 by the U.S. Anti-Doping Agency. This substance is closely and structurally related to two other synthetic anabolic steroids, gestrinone and trenbolone. Anabolic steroids, which build muscle mass, can have serious long-term health consequences in men, women, and children. SOURCE: U.S. Food and Drug Administration. “FDA Statement on THG,” Available online. URL: http://www.fda.gov/bbs/ topics/NEWS/2003/NEW00967.html. Downloaded on June 8, 2005.
tic An involuntary, repetitive movement of a muscle or muscle groups, mostly affecting the face, shoulders, or arms. Typical tics are blinking, twitching of the mouth, and shoulder shrugging. They are also a characteristic of Gilles de la Tourette Syndrome, a disorder of the nervous system that is characterized by tics and involuntary noises. Tics are often the result of a minor psychological disturbance and may begin during childhood, affecting three times as many boys as girls. They are worsened by stress or by drawing attention to them. Tics appear to release emotional tension, so voluntary control is of questionable value. Tics usually stop within a year of onset, but some cases last to adulthood. In some individuals, stress-induced tics can be overcome with BEHAVIOR THERAPY, GUIDED IMAGERY, HYPNOSIS, or RELAXATION training. FOR FURTHER INFORMATION:
Thich Nhat Hanh (1926–
)
A Vietnamese Buddhist monk, poet, peace activist, and author of Being Peace, The Miracle of Mindfulness, and many other books. Many who are stressed by modern society find relaxation and peace in his poetry and writings, which appeal to people from various religious, spiritual, and political backgrounds. His practice of mindfulness helps people of all faiths by helping them resist and transform the speed and violence of modern society. His meditation community in the south of France is an abode of harmony, peace, and ethnic diversity. An example of his 14 precepts follows: Do not think that the knowledge you presently possess is changeless, absolute truth. Avoid being narrow-minded and bound to present view. Learn and practice non-attachment from views in order to be open to receive others’ viewpoints. Truth is found in life and not merely in conceptual knowledge. Be ready to learn throughout your entire life and to observe reality in yourself and in the world at all times. SOURCE:
Spiritwalk Foundation P.O. Box 1022 Thousand Oaks, CA 91358 (818) 999-2922 http://www.spiritwalk.org
Tourette Syndrome Association 42-40 Bell Boulevard Bayside, NY 11361 (800) 237-0717 (toll-free) http://www.tsa-usa.org
time management
Realistically prioritizing projects and avoiding procrastination. Time management was a catchword during the 1980s and 1990s as organizations strived to educate employees, particularly middle managers, to avoid the STRESS caused by a growing need to define business priorities and deal with the paper pile-up in their inboxes. Seminars on time management were often sponsored by date book and planning calendar manufacturers who offered products as solutions to the time management problem. However, it persists and is compounded today by staff reductions that add responsibilities to existing jobs and by computerization that has raised the standards for quality and promises to reduce time and effort, when in fact the opposite is often true. Another aspect of time management is the growing stress of balancing career and family. While this is applicable to both men and women, it is a particular problem for the working mother (both married and single) who continues to have major responsibility for running the home and car-
Transcendental Meditation 365 TIME MANAGEMENT TIPS TO REDUCE STRESS • Set realistic goals; don’t overestimate what you can do. • Don’t procrastinate. • Establish priorities; make lists. • Pace yourself; set “time-outs.”
ing for the children, as she shares in meeting the family’s income needs. See also PERFECTION; PRESENTEEISM; WORKPLACE.
tipping Gratuities given to service people. The word tip may have originated as an abbreviation of the phrase “to insure promptness.” Tipping usually is a sign of a job well done. Waiters and waitresses, taxi drivers, parking attendants, hotel concierges, cruise ship staff, and many others, particularly in the United States, expect tips and depend on tips as part of their income. Many people are stressed over the question of who to tip and how much. As a general guideline, table service waitstaff get 15 to 20 percent of the check, before tax, taxi drivers get 10 to 15 percent, and up to 20 percent if they help with luggage or make extra stops, and a parking valet gets $2. Guides on bus tours get 10 to 20 percent of the cost of the tour. Individuals who do not expect tips, and often refuse them if offered, include camp counselors, lifeguards, tennis and golf instructors, and nursing home aides. tiredness TM TMJ
See
CHRONIC FATIGUE SYNDROME.
See MEDITATION; TRANSCENDENTAL MEDITATION. See
tobacco
TEMPOROMANDIBULAR JOINT SYNDROME.
See
toilet training
SMOKING.
A process of teaching a child to use the toilet for urination and bowel movements. It can be an exercise in stress and anxiety for both the child and the parent because children generally will become toilet trained when they are ready. There is little to gain in speeding up the toilet-
training process at a very early age or holding the child to a rigid, demanding schedule. Some professionals connect toilet training, if it occurs when a child is too young or is too harsh in its administration, with later behavior that is obedient but resentful. On the other hand, a child whose toilet training was delayed may develop a self-centered personality. Even when trained, accidents happen and children can revert to soiling or wetting, particularly when they are anxious or under stress. The best advice for parents is to begin toilet training at a reasonable age; view the training as an educational experience; exhibit a great deal of patience; support performance with praises and rewards; and accept occasional accidents even after training is completed. See also BEDWETTING; PARENTING.
toxic shock syndrome traffic
See
See
MENSTRUATION.
RANDOM NUISANCES.
transactional analysis (TA)
Group or individual therapy in which the goal is to develop an individual’s identity and independence and help him or her develop better COPING skills to interact with others. TA was developed by Eric Berne, a Canadian-born American psychoanalyst (1910–70), and described by Thomas A. Harris in the book I’m OK, You’re OK: A Practical Guide to Transactional Analysis (1969). In TA, all behavior, thinking, feeling, and experience is categorized into three ego states: parent (critical and/or loving), adult (practical and evaluative) and child (feelings, such as dependency, funloving, and caring). All three states are considered to serve a valuable purpose. Individuals can learn to identify which ego state is in control by identifying both nonverbal changes and verbal changes such as voice tone and use of expressions and words. See also ALTERNATIVE MEDICINE; PSYCHOTHERAPIES. SOURCE: Harris, Thomas A. I’m OK, You’re OK: A Practical Guide to Transactional Analysis. New York: Harper & Row, 1969.
Transcendental Meditation (TM)
One of the Western world’s oldest and most scientifically documented techniques known to elicit the RELAX-
366 travel response. TM is a revised and simplified form and is the method on which most other MEDITATION techniques are based. Developed by Maharishi Mahesh Yogi, TM is based on ancient Hindu writings. It was introduced into the United States in the early 1960s by HERBERT BENSON, M.D., who studied people who practiced TM and developed his own methods for eliciting relaxation. His method is described in his book, The Relaxation Response. Typically, a TM meditator spends two 20-minute periods a day sitting quietly with eyes closed and attention focused totally on the verbal repetition of a special sound or mantra. Repetition of the mantra blocks distracting thoughts. The effect achieved is better relaxation and relief from stress. TM has also been referred to as mystic union. See also ALTERNATIVE MEDICINE. ATION
of
YOGA
SOURCE: Yogi, Mahesh. Science of Being and Art of Living: Transcendental Meditation. New York: Meridian, 1995.
travel
See AIRPLANES; RANDOM NUISANCES; VACA-
TIONS.
trends in work hours Annual hours worked per person have increased in the United States, while they have been declining in a number of European countries and Japan. Longer work hours may contribute to increased stress for U.S. workers. Annual work hours in the United States have surpassed Japan’s and are now the longest among wealthy industrialized countries. Americans work about 200–400 more hours (five to 10 more weeks) per year than workers in France, Germany, Norway, Sweden, or Denmark, according to Paul Landsbergis, M.P.H., Ph.D., Mount Sinai School of Medicine, who spoke at a forum called “The Way We Work and Its Impact on Our Health,” in Los Angeles, California, in April 2004. More workers are working more. Between 1976 and 1993, the proportion of men aged 25–54 working 49 hours or more hours increased from 22.2 percent to 29.2 percent, and the proportion of women aged 25–54 working such long hours increased from 5.7 percent to 12 percent. The increase for women is due to the greater proportion of women who now work for pay and who are employed in year-around jobs.
Extended Work Hours and Health According to Landisbergis, extended work hours have been associated with work accidents and injuries and with musculoskeletal disorders and pain. Working more than 60 hours per week was associated with a 2.75 times greater risk of disability retirement among Finnish men. Some studies, according to Landisbergis, have found links between long work hours and psychological symptoms, perceived stress, excessive alcohol use, and smoking; however, other studies have not found such associations. Overtime has been associated with fatigue and shorter sleep hours. Insufficient sleep can increase the activity of the sympathetic nervous system, heart rate, and blood pressure, and there may be a connection between long work hours and illness. Sleeping less than six hours per day is associated with an increased risk of heart disease compared with normal sleep hours of seven to eight hours per day. Several studies, beginning in 1958, suggested that long working hours may increase the risk of heart disease. Two Japanese studies found an association between long work hours and first heart attack in men, with a twofold increase in risk for weekly hours over 60 in one study. Another study found an increased risk for either short days (fewer than seven hours) or long days (more than 11 hours) in the previous month. The impact of overtime on health may be greater for workers in stressful jobs, such as professional driving, or those with poor social relations, or more physically demanding jobs. Shift workers working more than 48 hours per week experience greater mental and physical health problems. The impact may also be greater for older workers and women, especially if housework is also considered. More research is needed to see if overtime increases the risk of gastrointestinal, musculoskeletal, reproductive system, or immmune systems disorders. See also CHANGING NATURE OF WORK; SHIFT WORK; WOMEN. SOURCE: Landisbergis, Paul. “Extended Work Hours and Health,” Forum, “The Way We Work and Its Impact on Our Health.” Los Angeles, April 2004.
tsunami 367 trichotillomania
See
HABITS; HAIR LOSS; HAIR-
PULLING.
tricyclic antidepressants
See
DEPRESSION; PHAR-
MACOLOGICAL APPROACH.
truck drivers
Those who drive trucks for specific purposes, such as installing and repairing utility company lines, fighting fires, or towing cars, face particular sources of stress. General sources of stress for truck drivers may include responsibilities for paperwork, preparing receipts for loads, collecting payments, maintaining telephone or radio contact with supervisors or to receive delivery instructions, loading and unloading the truck, performing emergency roadside repairs, and carrying out inspections. Loss of control while driving heavily loaded trucks on slippery roads is a hazard. Mechanical failure can lead to accidents and overturning of a heavily loaded truck. Accidents may occur because of lengthy driving periods, night driving, driving under unfavorable weather conditions and on bad road conditions. Also, the lure of bonus payments may induce some truck drivers to speed. Drivers may suffer physical and mental fatigue, drowsiness, and irregular eating because of long driving hours. They are exposed to NOISE and may suffer delayed hearing loss, and are exposed to extremes of heat and cold, which may result in heat stress or frostbite. Low back pain and pains in their arms and legs may be cause by prolonged driving, sitting in uncomfortable seats, visual discomforts and eye problems caused by inadequate illumination and eyestrain, and effects of continued vibration. Accidents happen to truck drivers while they are lifting heavy items, changing tires, unfastening tight ropes, or using various maintenance and repair tools. They may encounter acute poisoning by exhaust gases, including carbon monoxide. They face fire hazards resulting from or as a result a road collision or overturning spills and leaks of inflammable materials. According to the fourth edition of the Encyclopaedia of Occupational Health and Safety, truck drivers also experience the stress of exposure to chemical toxicity because of hauling toxic and radioactive substances; skin diseases and condi-
tions caused by exposure to chemicals such as cleaning compounds, brake fluids, gasoline, and diesel oil; and chronic effects caused by inhaling gasoline or diesel fuel fumes and exhaust gases containing carbon monoxide, nitrogen oxides, and hydrocarbons. Smoking inside the cabin of the truck may affect the health of drivers. Also, truck drivers may be victims of violent crime because of valuable cargo in their trucks. See also BACK PAIN; NOISE; SLEEP; SMOKING; VIOLENCE. SOURCE: Mager-Stellman, Jeanne. Vol. IV, Encyclopaedia of Occupational Health and Safety, 4th ed. Geneva: International Labour Office, 1998.
tsunami
A Japanese word for “harbor wave.” On December 26, 2004, a giant tsunami hit the coasts of 13 countries in southern Asia, killing more than 238,000 people and leaving more than 14,000 missing, according to the USGS Earthquake Hazards Program. Thailand, Sri Lanka, Indonesia, and India were the countries most damaged by the wave. By far the highest death toll was on the remote northern end of the Indonesian island of Sumatra, which suffered the double shock of the quake and the earliest strike of the tsunami; 100,000 people died in Indonesia. The stress on surviving populations in all areas hit by the wave was inestimable. Hundreds of thousands lost loved ones, were made homeless, had their source of livelihood wiped out, had no source of medical care, and became dependent on charities for survival. In the aftermath of the tragedy, survivors feared another killer wave. While aftershock earthquakes did occur far out in the ocean, no wave hit the shores. Tsunamis are a result of a disturbance on the ocean floor. The 2004 tsunami happened after an earthquake hit off the coast of Sumatra, an island in Indonesia. According to Seth Stein, a geological sciences professor at Northwestern University, Evanston, Illinois, “The sea floor moves up as a result of the earthquake. That is what pushes up an enormous amount of water. The giant waves can travel for 2,000 miles and grow as large as 30 feet or more when they hit the coast.”
368 tuberculosis Warning systems exist elsewhere in the world, but there was no system in place in South Asia. Shortly after the 2004 tsunami, plans were underway to install a warning system. SOURCES: Aravind, Adiga, et al. “Magnitude 9.0-Sumatra-Andaman Islands Earthquake,” Available online. URL: http:// earthquake.usgs.gov/eqinthenews. Downloaded on June 22, 2005. LeBeau, Emilie. “Killer Waves Devastating but Fairly Rare.” Chicago Tribune, January 11, 2005.
tuberculosis
A treatable, communicable disease that is caused by bacteria called Mycobacterium tuberculosis. The threat of tuberculosis is a souce of stress because if TB is not treated, it can be debilitating or fatal. For many years, it was the leading cause of death in the United States. After World War II, there was a striking reduction in disease because of more effective treatments. Complacency led to disinterest in tuberculosis elimination and to dismantling of tuberculosis control programs. Basic public health measures were neglected, including surveillance activities, contact tracing, outbreak investigations, and case management services to ensure completed treatment of latent infection and active disease. This led to the resurgence of tuberculosis in the 1980s when new circumstances emerged, particularly the HIV and AIDS epidemic, the increase in the rate of multidrug-resistant disease (largely due to incomplete treatment), and expanded immigration to the United States from areas with high rates of tuberculosis. In 2003, there were 14,874 cases in the United States. TB is spread through the air from one person to another. The bacteria get into the air when a person with active TB of the lungs coughs or sneezes. People may breathe in these bacteria and become infected. However, not everyone who breathes in the bacteria becomes ill. Those without symptoms have latent TB infection and cannot spread disease to others. However, some people who have latent TB infection go on to get TB. Those with active TB can be treated and cured if they seek medical help soon enough. With few exceptions, only those who have active tuberculosis in the lungs or larynx can infect others, usually by coughing, sneezing, or otherwise expelling tiny infectious particles that
someone else inhales. People with active TB are most likely to spread it to people they spend time with every day, such as family members, coworkers, and friends. Conclusions of a study undertaken by the National Academy of Sciences and authorized by the U.S. Congress reflected the changing epidemiology of TB, continuing geographic variation in TB case rates, evolving institutional and public responses to TB in the workplace and the community, and ongoing risk from people with undiagnosed infectious TB. TB bacteria usually grow in the lungs and may cause symptoms such as a bad cough that lasts longer than two weeks, pain in the chest, and coughing up blood or phlegm from deep inside the lungs. Other symptoms of active TB may include weakness or fatigue, fever, chills, weight loss, and loss of appetite. A skin test, chest X-ray, or positive sputum smear or culture can be administered to determine whether or not a person has a TB infection. Persons who believe they may have been infected may find relief from stress by getting a negative diagnosis. See also ACQUIRED IMMUNODEFICIENCY SYNDROME; HUMAN IMMUNODEFICIENCY VIRUS (HIV); HEALTHCARE WORKERS. FOR FURTHER INFORMATION:
Centers for HIV, STD and TB Prevention Division of Tuberculosis Elimination 1600 Clifton Road NE, Mailstop E-10 Atlanta, GA 30333 (404) 639-8135 http://www.cdc,giv/nchstp/tb/faqs SOURCE: Field, Marilyn J., Tuberculosis in the Workplace. Washington, D.C.: National Academy Press, 2001.
Type A personality
Refers to hard-driving, fastpaced, and fast-talking individuals characterized by impatience, aggression, and ambition. They are workaholics, extremely competitive, and filled with feelings of ANXIETY, WORRY, ANGER, and HOSTILITY. Type A people constantly worry about problems they cannot solve, a self-destructive type of behavior that can lead to FRUSTRATION and BURNOUT.
Type C personality 369 Many of these individuals neglect family responsibilities in favor of working and tending to business interests. They tend to feel guilty if not working and take little pleasure in other activities. They may take on multiple commitments and become preoccupied with meeting deadlines. These attitudes lead to stress upon the family and interpersonal relationships. The Type A personality pattern was found to double the risk of developing heart disease, particularly in men under the age of 60. The power of the Type A behavior pattern to predict heart disease has been shown in many countries, with the data from Belgium, China, India, Japan, and Lithuania. Even when account is taken of other heart disease risk factors, such as cigarette smoking, HIGH BLOOD PRESSURE, and elevated serum cholesterol, the Type A pattern appears to contribute a further risk in many, but not all, people. Many individuals make efforts to change their personality traits after a serious illness, and, as a result, relax more and take advantage of their leisure in enjoyable ways. Studies involving Type A individuals show that they can change their behavior by learning RELAXATION techniques, developing a sense of HUMOR, and making other life-style changes, thus becoming a combination of Type A and Type B personalities. A study reported by psychologist D. Ariel Kerman, Ph.D., in her book, The H.A.R.T. Program: Lower Your Blood Pressure without Drugs, indicated that researchers at Duke University found that when Type A personalities participated in a walking/ jogging program (three miles per day, three days a week), their Type A characteristics became less dominant in their lives.
Type B personality A Type B individual usually has personality traits that enable him or her to enjoy activities that are not necessarily competitive. Type Bs are not particularly goal-oriented, do not constantly worry about work, and, when they are working, do so without agitation or sense of urgency. Relationship of Type A and B Personalities to Stress and Employment Successful executives are often people who can move back and forth between the Type A and Type B characteristics, depending on the situation.
These combined personality types are scattered fairly evenly among top and middle management. For optimal coping with stress, it seems that a combination of the A and B traits may be best. These individuals can enjoy a balanced life with aspects of work, family, love, FRIENDS, recreation, and fun. See also HOBBIES. SOURCES: Armand, M., Jr., ed. The New Harvard Guide to Psychiatry. Cambridge, Mass.: Belknap Press of Harvard University, 1988. Kerman, D. Ariel. The H.A.R.T. Program: Lower Your Blood Pressure without Drugs, New York: HarperCollins, 1992. Pelletier, Kenneth. Healthy People in Unhealthy Places. New York: Delacorte Press, 1984.
Type C personality
Individuals who have Type C personalities refuse to let any negative feeling show. They usually seem happily in CONTROL and do not express emotion, especially regarding ANGER, fear, sadness, or even joy. Type Cs tend to be patient and cooperative and are highly focused on meeting other people’s needs while showing little or no concern for their own. Usually, Type Cs tend to stay in stressful situations, such as bad marriages or frustrating jobs, longer than other people. They don’t recognize their emotions and may not even realize when they are under STRESS. However, their bodies produce stress hormones, including cortisol, which has been known to suppress the immune system. Because they don’t express their emotions, Type C people do not produce natural opiates, the brain chemicals that have a painkilling effect similar to artificial drugs such as morphine. This, too, reduces the overall effectiveness of their immune system.
TAKING THE STRESS OUT OF TYPE C PERSONALITIES • Be aware of your emotions; get psychotherapeutic help if necessary. • Be able to express your anger in a constructive way. • Become more assertive; learn how to say “no” when you want to. • Develop RELAXATION techniques that work best for you.
370 Type C personality According to psychologist Lydia Temoshok, Ph.D., author of The Type C Connection: The Behavioral Link to Cancer and Your Health, Type C personalities often are in the relapse group when compared with recoveries by individuals in other personality categories.
See also ASSERTIVENESS TRAINING; CODEPENDENCY; DEPRESSION; SELF-ESTEEM.
SOURCE: Temoshok, Lydia. The Type C Connection: The Behavioral Links to Cancer and Your Health. New York: Random House, 1992.
U Underachievement can also result from a child’s relationship with his/her parents. Parents who are high achievers themselves may have unrealistic expectations for their children. This creates a vicious cycle in which the child’s low SELF-ESTEEM as a reflection of parental attitudes causes his even poorer performance. Parents with average abilities who produce a child with exceptional intelligence may not understand and even discourage their child’s superior performance. Family problems such as DIVORCE, conflict, death, or serious illness of a parent may cause poor performance. Children may also become underachievers because they are perceived as different and are not socially well-adjusted to their PEER GROUP. Such factors as exceptionally high intelligence, ethnic or religious difference, a financial status that is far above or below classmates, or very mature or immature behavior patterns may set a child apart, limit friendships, and lower school performance. Achievement is also reduced when a child desires to become a member of the gang so badly that he/she associates with troublemakers or other students who perform poorly in school. See also PERFECTION.
UFOs (unidentified flying objects)
Many individuals and groups of people experience stress when they think they see UFOs. Stresses about sighting of UFOS are related to the times. For example, in the 20th century when space travel became a reality, there was increased speculation about life on other planets, and some came to fear invasion by alien beings. Movies and fictional books have probably increased these fears for many people. Stress arising from fear of UFOS is an example of fear of the unknown because no one is sure where the UFOs are from or exactly what they are, if they exist at all.
ulcers
See
PEPTIC ULCER.
underachievement An individual who is of average or superior ability but performs poorly in school or at work is an underachiever. Underachievement may be applied to specific areas such as arithmetic or reading ability or failure to advance in a chosen field; it is a source of stress for the person involved as well as parents, teachers and employers. Underachievement may be a result of faults in the academic environment. For example, large class sizes or school systems lacking personnel and techniques to address cases of poor performance may cause or exacerbate a child’s learning problems. Teachers who have personality conflicts with certain students can contribute to their poor performance by ignoring them. Underachievement, particularly in very bright students, may result from BOREDOM when the teacher does not stimulate them or challenge their abilities. Average or bright students with short attention spans can also appear to be below normal.
SOURCES: Dejnozka, Edward. “Underachievement,” in American Educator’s Encyclopedia. Westport, Conn.: Greenwood Press, 1982. Thiel, Ann, Richard Thiel, and Penelope B. Grenoble. When Your Child Isn’t Doing Well in School. Chicago: Contemporary Books, 1988.
unemployment Unemployment relates to all people who want to work but have been unable to find jobs—those who have worked but are laid off, recent high school and college graduates, people with disabilities, the poor and uneducated, women 371
372 unemployment returning to the workplace after child-rearing, and retirees who need additional income and/or stimulation. Because unemployment often means financial hardship, it can cause STRESS not only for the people directly involved, but also for their spouses, children, parents, and friends. Unemployment is also a source of stress for those who have jobs but are constantly threatened with losing them. However, a 1995 poll conducted by Towers Perrin, a management consulting firm, found that most workers are “amazingly stress hardy, pragmatic and coping with the uncertainties of corporate America.” The poll also showed that one measure of a worker’s adjustment to today’s climate of job instability is that less than half of the workers surveyed expect to spend their entire careers with one company. Among those under age 34, only one-third counted on retiring from their present employer. According to the U.S. Department of Labor, in September 2005, the unemployment rate rose to 5.1 percent; in August, it was 4.9 percent. In 2004, the average unemployment rate was 5.5 percent. The Bureau of Labor Statistics reports the unemployment rate on a monthly basis. Unemployment statistics data are released on the first Friday of the month for the previous month. In September 2005, the report indicated unemployment rates for most major worker groups— adult men (4.5 percent), adult women (4.6 percent), whites (4.5 percent), and Hispanics or Latinos (6.5 percent)—rose in September. The jobless rates for teenagers (15.8 percent) and blacks (9.4 percent) showed little change during 2005. The unemployment rate for Asians was 4.1 percent, not seasonally adjusted. Measures of employment and unemployment reported in September 2005 reflected both the impact of Hurricane Katrina, which struck the Gulf Coast in late August 2005, and ongoing labor market trends. Hurricane Rita made landfall during the September data collection period. As a result, response rates to surveys were lower than normal in some areas, but the impact of the storm on measures of employment and unemployment was negligible, according to the Department of Labor. For college graduates, the job outlook was strong during 2005. Employers hired more 2004–05 grad-
uates than they hired in 2003–04 and were offering new hires larger salaries than were offered to last year’s graduating class. In a survey done annually by the National Association of Colleges and Employers, more than 75 percent of employers polled nationwide described the job market as good (56 percent) or very good (22 percent). Many jobs would be available in the manufacturing or the service sectors, according to the survey. The manufacturing sector predicted an increase in hiring of 12.9 percent, compared to the previous year when they said they would hire 3.4 percent. Service sector employers planned to hire 12.1 percent more new college graduates in 2004–05. Government/nonprofit employers said they planned to hire 19.8 percent more new graduates. According to Leana and Feldman in their book, Coping with Job Loss, “Unemployment as a fact of life will continue, if not worsen. Current statistics on unemployment and layoffs underestimate the dimensions of the problem. Even with unemployment at six percent, there would still be seven million people out of work. Because government statistics do not include the discouraged job seekers (individuals who have stopped applying for new positions) and those who have joined the expanding ranks of the permanently unemployed, these figures vastly underrepresented the number of people actually out of work.” Leana and Feldman also reported that among the many situational factors influencing how a person reacts to a stressful life event, such as losing a job, perception of unemployment levels has a “substantial influence.” They write, “The higher workers perceive the unemployment rates in their communities and/or professions to be, the more pessimistic they will be about the prospects for finding new jobs, especially ones at equal pay.” Fran Lowry, in Canadian Medical Association Journal, says “Now when unemployment is still an important problem in many parts of the country [Canada], idle hands are making more work for physicians. People who are out of work make more visits to their physicians for a variety of complaints. Areas of high unemployment also report a higher incidence of alcohol use, and more marital and family abuse and violence. Because unemployment causes stress, it can have bad health conse-
urinary incontinence 373 quences not only for the unemployed but for the people who are closest to them.” See also GENERAL ADAPTATION SYNDROME; LAYOFFS; LIFE CHANGE SELF-RATING SCALE. SOURCES: Leana, Carrie R., and Daniel C. Feldman. Coping with Job Loss: How Individuals, Organizations and Communities Respond to Layoffs. New York: Lexington Books, 1992. Lowry, Fran. “Larger Private Sector Role in Health Care Needed Now, Think Tank Warns.” Canadian Medical Association Journal 154, no. 4 (February 15, 1995): 549–551.
unwed mothers
A woman who becomes pregnant and delivers a baby out of wedlock is referred to as an unwed mother. She faces many stresses in making a myriad of decisions. In most cases, she has several options to consider. She may choose to either terminate the pregnancy with a legal ABORTION or have the child, then choose between single parenthood or giving the child up for ADOPTION. Depending on her relationship with the baby’s father, the unwed mother may also choose marriage. In 1994, approximately one-half of pregnancies in the United States were unintended, according to the Centers for Disease Control and Prevention (CDC). The United States has set a national goal of decreasing unintended pregnancies to 30 percent by 2010. Better forms of contraception, increasing contraceptive use and adherence, and reducing risky behavior may decrease unintended pregnancy. According to Stanley K. Henshaw in Family Planning Perspectives, 54 percent of the unintended pregnancies concluding in 1994 ended in abortion. Forty-eight percent of women aged 15–44 in 1994 had had at least one unplanned pregnancy sometime in their lives. Twenty-eight percent of women aged 15–44 have had an unplanned birth. Between 1987 and 1994, the rate of unintended pregnancy fell from 54 pregnancies per 1,000 women of reproductive age to 45 per 1,000, a decrease of 16 percent. Changing social standards and even the examples of celebrities have encouraged unwed mothers to keep and raise their babies, but they still must face problems of providing financial support, coping with illness and other childhood problems while working, and being responsible for childrearing alone.
Often grandparents participate very actively in decision-making about an out-of-wedlock PREGNANCY and also in rearing the child. The results of their decision-making depend on the flexibility of their attitudes. However, if a child is reared by one’s grandparents it adds several stressors to the picture. The unwed woman and her parents may have different ideas of appropriate behavior, with resultant mixed messages for the child. Also, the grandparents may be at an age and stage of life at which having a young child around interferes with their long-planned activities. Pregnancy by Choice: Single Women In addition to women who unintentionally become pregnant, an increasing number of single women choose unwed motherhood. Some single women feel the “biological clock” ticking. That means they are in their late thirties and want to have a child. These single women may choose adoption or choose to become impregnated by a man whom they know but will not marry, sometimes even retaining a friendly relationship with the man. Still others may choose artificial insemination, but must recognize the reluctance of some doctors to inseminate single women and the psychological difficulties of knowing very little or nothing about the father of their child. In all of these cases, even though social standards are changing, unwed mothers still must eventually cope with the possibility that their children may feel different because they lack fathers. They may face many questions growing up in a peer group of children who have two known parents, even though many of these children will be in stepfamilies or merged families. See also BIOLOGICAL CLOCK; PARENTING.
urinary incontinence Inability to control the evacuation of liquids from the body. It affects people of all age groups; an overwhelming number of them are women. Incontinence is a cause of extreme stress for the individual who must cope with a problem that can mean personal FRUSTRATION, emotional devastation, social isolation, and physical discomfort. Incontinence in Women According to a study by the National Institutes of Health in 1996, 26 percent of women aged 30 to 59
374 urinary incontinence have experienced episodes of urinary incontinence. The most common form, stress incontinence, occurs when the pelvic floor muscles become weak and no longer support the bladder. Without support, such everyday events as laughing, coughing, or lifting a heavy object apply stress or pressure to the bladder. In younger women, childbirth often causes the weakening of the pelvic floor muscles; estrogen deficiency brought on by MENOPAUSE is often a cause of this weakness in older women. Urge incontinence usually occurs during involuntary bladder contractions, which may be caused by a variety of problems, including urinary infections. Help is available from urogynecologists (gynecologists who are specially trained in problems of the urinary tract). Surgical techniques for correcting the problem have advanced dramatically in the latter part of the 20th century. Exercises are also sometimes prescribed (Kegel exercises) by gynecologists to help restore muscle strength, particularly in milder cases. These exercises involve tightening the urinary muscles (as if to stop urination) repeatedly for 5–10 minutes at a time, with repetitions several times a day. Urinary incontinence is sometimes a symptom of nervousness and tension. In many cases, anxiety can affect one’s control over urinating, causing one to either feel the urge very frequently, or to be unable to void even though the urge seems present. Understanding the mechanisms for the problem can help one cope with its attendant stressful factors. A thorough examination by a physician is essential to determine possible physical causes. Male Incontinence In males, the cause of incontinence is frequently an enlarged prostate gland, which presses on and blocks the duct through which urine leaves the body. As more urine accumulates in the bladder and dilates it, the bladder cannot hold any more and it dribbles out. After surgical removal of the prostate, nerves controlling the urinary sphincter may be damaged, leaving a man incontinent. Radiation treatment for cancer also sometimes contributes to male incontinence. Symptoms of a prostate problem in a man include having trouble emptying the bladder, getting up several times a night to urinate, taking longer than usual to start and, after starting, notic-
HOW TO TAKE THE STRESS OUT OF INCONTINENCE • Keep a diary for a week or so noting how often you urinate, how often you leak, and what you are doing at the time of the incontinent episode. You may notice a pattern, either in the length of time you are able to wait between episodes or in the circumstances surrounding these episodes. • If you find that you are wet every hour or two, empty your bladder as completely as you can every 30 to 60 minutes. • Try to stop the urge to void a unscheduled times by relaxing or distracting yourself. For example, if you are at home, do a small household task until the urge to urinate passes; then void according to your planned schedule. • If you become too uncomfortable to wait until the scheduled time, go and use the toilet, but void again at the next scheduled time. • Reward yourself for staying on schedule. It takes effort, practice, and patience. • Keep a daily log to track your progress. If you are aware of fewer incontinent episodes and have been able to void on schedule for about a week, extend the times between voiding periods by 30 minutes or so each week. • Extend the intervals until you reach a comfortable schedule, such as two and a half to three hours between voidings. • If bladder training doesn’t help, ask your physician about other forms of treatment, such as medications or surgery. A combination of several therapies may be the most helpful.
ing a very slow stream, dribbling after finishing, and having the urge to void again just after voiding, or rectal pain. Any man experiencing these symptoms should consult a physician. Elderly people sometimes develop urinary incontinence because of neurological reasons, such as after a stroke or a spinal-cord injury. In some cases, a diuretic prescribed for high blood pressure or heart failure may increase the output of urine and lead to incontinence. Bladder Training The National Institute on Aging recommends steps for bladder training to help some individuals con-
urinary incontinence 375 trol the voiding reflex by teaching them to urinate at scheduled times. When starting the program, the scheduled times are every 30 minutes to one hour. Over a period of six weeks to several months, the time between trips increases. In the late 1990s, advertisements for adult diapers and products to hide the problem of incontinence attest to the fact that urinary incontinence is a common problem, and as the elderly population increases, the prevalence of the problem will also increase. According to the Harvard Health Letter, many people resign themselves to wearing adult diapers or pads because they mistakenly believe that urinary incontinence is a normal part of aging. Others are too embarrassed to bring it up at their doctor’s attention or they fear that invasive tests and surgery might result. Those who
have the condition can benefit from discussing the problem with a caring and knowledgeable physician. See also BEDWETTING; STRESS INCONTINENCE. FOR FURTHER INFORMATION:
The SIMON Foundation for Continence P.O. Box 815 Wilmette, IL 60091 (800) 23SIMON (toll-free) (847) 864-3913 http://www.simonfoundation.org Help for Incontinent People (HIP) P.O. Box 544 Union, SC 29379 (800) BLADDER (toll-free) http://www.shands.org
V stressful. Bad weather can do more than dampen one’s spirits, as it affects the enjoyment of many sights. Additionally, interpersonal relationships are really put to the test on vacations, when friends in couples or other groupings are together every day. These and many other vacation stressors can make you wish you’d stayed at home. See also CLIMATE; HOBBIES; RANDOM NUISANCES; RECREATION.
vacations
Breaks from the usual routine, sometimes involving travel, sightseeing, visiting friends or relatives, or remaining at home and just doing nothing. Many people who feel very stressed by work or family responsibilities look forward to vacations and anticipate relaxation and escape from stress. According to The Complete Guide to Your Emotions and Your Health, “getting away from it all, breaking free from routine, can bring a new perspective to old dilemmas, put a positive charge in your mental outlook, and help to fan those waning embers of enthusiasm. You’ll get to know yourself a little better. When you come home, you’ll be happier, healthier, and much more effective in coping with stress.”
SOURCES: Curtis, Richard. Taking Off. New York: Harmony Books, 1981. Padus, Emrika. The Complete Guide to Your Emotions and Your Health: Hundreds of Proven Techniques to Harmonize Mind and Body for Happy, Healthy Living. Emmaus, Pa.: Rodale Press, 1992.
Vacations as a Source of Stress However, vacations do not always result in stress reduction; they can add to an individual’s stress load. First there is stress that comes from the choice of how to travel: by car, train, ship, or plane, and making those reservations can be stressful, too. Packing presents difficulties and ensuring those left behind are taken care of can give parents many anxious moments that continue all through the vacation. When grandparents take on the responsibilities of caring for the children, INTERGENERATIONAL CONFLICTS may result. Delays of trains and planes, missed connections, and accommodations not up to expectations can be
vaccinations
One of the main types of immunization, a protective measure to stimulate or bolster the body’s immune system. Usually vaccinations involve an injection administered by a health professional. Some persons who are phobic about needles and encounters with health professionals experience stress when faced with or thinking about any type of vaccination. Vaccination, or active immunization, is a procedure in which killed or weakened microorganisms are introduced into the body. These microorganisms sensitize the immune system; if disease-causing organisms of the same type enter the body later, they are quickly destroyed by the action of antibodies produced by the immune system or by other immune mechanisms.
HOW VACATIONS CAN HELP RELIEVE STRESS • Afford a release from the daily routine. • Provide opportunities for relaxation. • See new sights, enjoy beauty, and have different experiences. • Learn new skills; participate in an adventure. • Anticipate pleasure and remember the joy.
Vaccines Are Available for Many Diseases Some vaccines require several doses, spaced some weeks apart; others require only one dose. The effectiveness of vaccines varies from near total protection
376
vasectomy 377 in most cases, to only partial or weak protection (for typhoid or cholera). The duration of effectiveness also varies from a few months to lifelong. Vaccines by injection are now available to protect against a wide variety of infectious diseases, including measles, mumps, and rubella, yellow fever, diphtheria and tetanus, cholera, pertussis, rabies, and influenza. The polio vaccine is given orally. In 2004, a shortage of vaccine for influenza caused stress for many people, particularly older adults and those with weakened immune systems. See also NEEDLESTICK INJURIES; PHOBIAS.
Valium
Trade name for an antianxiety drug chemically known as diazepam and in a class of drugs called the benzodiazepines. Valium is effective in the management of extreme stress that accompanies generalized anxiety disorder and panic disorder in appropriately selected patients. It is also sometimes used for skeletal muscle relaxation, seizure disorders, preanesthetic medication or intravenous anesthetic induction, and for alleviating symptoms during alcohol withdrawal. Valium has been used more extensively in treating more conditions than any of the other benzodiazepines. The drug is subject to abuse and may produce physical dependence after prolonged use. See also BENZODIAZEPINE DRUGS; DEPRESSION; PHARMACOLOGICAL APPROACH.
vasectomy A surgical operation that makes a man sterile, or unable to father a child. The decision to undergo this procedure is a difficult and stressful one for many men as well as their partners. It is chosen by men who have completed their families or by men who do not want children. According to Planned Parenthood Federation of America, reasons to consider vasectomy include: • You want to enjoy having sex without causing pregnancy • You do not want to have a child in the future • Your partner agrees that your family is complete, and no more children are desired • You and your partner have concerns about side effects of other methods • Other methods are unacceptable
• Your partner’s health would be threatened by a future pregnancy • You don’t want to pass on a hereditary illness or disability • You want to spare your partner the surgery and expense of tubal sterilization—sterilization for women is more complicated and costly Reasons not to consider vasectomy, according to the Planned Parenthood Federation include: • You want to have a child in the future • You are being pressured by your partner, friends, or family; you must want the operation • You have marriage or sexual problems, shortterm mental or physical illnesses, financial worries, or you are out of work; vasectomy is not a good solution for temporary concerns • You have not considered possible changes in your life, such as divorce, remarriage, or death of children • You have not discussed it fully with your partner • You plan to bank sperm in case you change your mind. Sperm banks collect, freeze, and thaw sperm for alternative insemination. However, some men’s sperm does not survive freezing. After six months, frozen sperm may begin to lose the ability to fertilize an egg Vasectomy is used as a means of contraception in many parts of the world. A total of about 50 million men have had a vasectomy, a number that corresponds to roughly 5 percent of all married couples of reproductive age. In comparison, about 15 percent of couples rely on female sterilization for birth control. According to the National Institutes of Health, approximately 500,000 vasectomies are performed in the United States each year. About one out of six men over age 35 has been vasectomized, the prevalence increasing along with education and income. Vasectomy involves blocking the tubes through which sperm pass into the semen. Sperm are produced in a man’s testes and stored in an adjacent structure known as the epididymis. During sexual climax, the sperm move from the epididymis through a tube called the vas deferens and mix
378 venereal diseases with other components of semen to form the ejaculate. All vasectomy techniques involve cutting or otherwise blocking both the left and right vas deferens, so the man’s ejaculate will no longer contain sperm, and he will not be able to make a woman pregnant. After vasectomy, sperm dissolve and are absorbed into the body. Vasectomy offers many advantages as a method of birth control. Like female sterilization, it is a highly effective one-time procedure that provides permanent contraception. Vasectomy is medically much simpler than female sterilization; it has a lower incidence of complications and is much less expensive. However, the chief disadvantage of vasectomy is its permanence. Reversing it is difficult, expensive, and often unsuccessful. Research is under way for surgical methods that would allow more successful reversal. Vasectomy should be undertaken only by men who are prepared to accept the fact that they will no longer be able to father a child. The decision should be considered along with other contraceptive options and discussed with a professional counselor. Men who are married or in a serious relationship should also discuss the issue with their partners. Concerns after Vasectomy After vasectomy, the man will probably feel sore for a few days, should rest for at least one day, and expect to recover completely in less than a week. A man can resume sexual activity within a few days after vasectomy, but precautions should be taken against pregnancy until a test shows that his semen is free of sperm. Usually this test is performed after the man has had 10–20 post-vasectomy ejaculations. Vasectomy does not affect production or release of testosterone, the male hormone responsible for a man’s sex drive, beard, deep voice, and other masculine traits. The operation also has no effect on sexuality. Erections, climaxes, and the amount of ejaculate usually remain the same. While vasectomy is effective for preventing pregnancy, vasectomy does not offer protection against AIDS or other SEXUALLY TRANSMITTED DISEASES. It is important that vasectomized men continue to use condoms, which offer considerable protection against the spread of disease in any sex-
ual encounter that carries the risk of contracting or transmitting infection. See also CONDOMS; CONTRACEPTION. FOR FURTHER INFORMATION:
American Foundation for Urologic Disease 1000 Corporate Boulevard, Suite 410 Linthicum, MD 21090 (800) 828-7866 (toll-free) (410) 689-3990 (410) 689-3998 (fax) http://www.afud.org National Institutes of Health National Institute of Child Health and Human Development Public Information and Communications Branch 31 Center Drive Building 31, Room 2A32 Bethesda, MD 20892-2425 (301) 496-5133 (310) 496-7101 (fax) http://ww.nichd.nih.gov Planned Parenthood Federation of America 434 West 33rd Street New York, NY 10001 (212) 541-7800 (212) 245-1845 http://www.plannedparenthood.org
venereal diseases
See HERPES SIMPLEX VIRUS; SEX-
UALLY TRANSMITTED DISEASES.
verbal slips vertigo
See
SLIPS OF THE TONGUE.
An illusion that one’s surroundings or self are spinning horizontally or vertically. It is stressful because attacks may come on suddenly and last for a few moments or even hours. Healthy people may experience vertigo when sailing, on amusement park rides, or even while watching a movie. Severe vertigo should be investigated by a health professional, as it may be a symptom of an underlying disease. Vertigo may be caused by normal stimulation of the hair cells and other nerve endings in the vestibular (ear) apparatus. Wind or even loud noises can stimulate these tiny hair cells. According
violence 379 to the American Medical Association Home Medical Encyclopedia, vertigo is sometimes erroneously referred to as dizziness, which can also result from seeing a phobic stimulus or being in a phobic situation, such as looking down from the top of a high building. Individuals who experience vertigo because of phobias should sit, lie down, or brace themselves. Sitting with the head between the legs is a good precaution against losing consciousness, but it might not stop the dizziness. Behavior therapies sometimes help people who experience dizziness because of phobic reactions. Some people who have atherosclerosis suffer from vertigo upon sudden movement of the head. Vertigo that comes on suddenly is often treated with rest and antihistamine drugs or anticholinergic drugs. See also BEHAVIOR THERAPY; DIZZINESS; PHOBIA.
violence
In the early 2000s, violence is a cause of stress all over the world. People are touched directly or indirectly by violence, such as TERRORISM, wars, murders, shootings, knifings, beatings, and other aggressive assaults. Violence can occur everywhere, including in the home, schools, and workplaces. In the United States, according to the National Institute of Occupational Safety and Health (NIOSH), homicide is the second leading cause of death on the job (second only to motor vehicle crashes). Homicide is the leading cause of death for workers under 18 years of age and of workplace death among female workers. However, men are at a three times higher risk of becoming victims of workplace homicides than women. The majority of workplace homicides are related to robberies (71 percent) with only 9 percent committed by coworkers or former coworkers. Seventy-six percent of all workplace homicides are committed with a firearm. There may be a difference between the circumstances of workplace violence and those of other types of homicides. While most workplace homicides are robbery-related, less than 10 percent of homicides in the general population occur during robberies. Also, about 50 percent of all murder victims in the general population were related to their assailants, whereas the majority of workplace homicides are believed to occur among people who
are unknown to each other. The Bureau of Justice Statistics (BJS) analyzed relationship of victims to offenders for violent acts. They found that female workers were most likely to be attacked by someone they knew, although only 5 percent of victimizations were attributed to a husband, ex-husband, boyfriend, or ex-boyfriend. Prediction and Prevention of Violence at Work According to Julian Barling, workplace violence can be predicted with the development of a profile of a potentially violent or disgruntled employee. Possible characteristics include being male, white, age 20–33, a loner, probably an alcohol abuser, and having a fascination with guns. Factors such as low selfesteem or a history of aggression in the family, may also contribute to violence at work. Stressful feelings of job insecurity, perceptions that management and supervision policies are harsh and unjust, electronic monitoring, perceived crowding, and extreme heat and noise may contribute to acts of violence. Risks of violence are higher in certain occupations than others, although anyone can become the victim of a workplace assault. Occupations with the highest homicide rates are taxicab drivers/chauffeurs, sheriffs/bailiffs, police and detectives, gas station/garage workers, and security guards. Taxicab drivers are at the highest risk, at 41.4 per 100,000, nearly 60 times the national
FACTORS CONTRIBUTING TO VIOLENCE AT WORK • • • • • • • • • •
Working in high-crime areas Guarding valuable goods or property Dealing with unstable people Working with volatile persons in health care, social service, or criminal justice Interacting with the public Exchanging money Having a mobile workplace, such as a taxicab or police cruiser Delivering services or goods Working late at night or during early morning hours Working alone or in small numbers
Source: NIOSH
380 volunteerism average of .70 per 100,000. The taxicab industry is followed by liquor stores (7.5), detective/protective services (7.0), gas service stations (4.8), and jewelry stores (4.7). The majority of nonfatal acts of violence occurred in the service and retail trade industries. Specifically, 27 percent occurred in nursing homes, 13 percent in social services, 11 percent in hospitals, 6 percent in grocery stores, and 5 percent in eating and drinking places. NIOSH suggests that while no single strategy is appropriate for preventing violence in all workplaces, all workers and employers should assess the risk of violence in their workplaces and take appropriate action to reduce those risks. Many environmental, administrative, and behavioral strategies may reduce these risks. These include employee training, good visibility and lighting within and outside the workplace, cash-handling policies, staffing patterns, physical separation of workers from customers or clients, and security devices. NIOSH also suggests that prevention programs in workplaces include a system for documenting incidents, procedures to be taken when incidents occur, and communication between employers and workers. Appropriate referrals to EMPLOYEE ASSISTANCE PROGRAMS or local mental health services may be appropriate for debriefing sessions after critical incidents. Adolescent violence in workplaces, schools, and the community is a public health issue with global relevance and far-reaching health consequences. According to Susanne Jordan, it impairs the wellbeing of those involved and makes demands on health services. The author contends that violence prevention in cities in particular relating to young people has relevance for current public health research and action. Center for the Study and Prevention of Violence The Center for the Study and Prevention of Violence (CSPV) was founded in 1992 with a grant from the Carnegie Corporation of New York to provide informed assistance to groups committed to understanding and preventing violence, particularly adolescent violence. Since that time, the CSPV’s mission has expanded to encompass violence across the life cycle. The mission of the CSPV includes collecting research and resources regarding causes and pre-
vention of violence, providing information services to the public with topical searches on customized databases, and offering technical assistance for evaluating and developing programs for preventing violence. See also AGGRESSION; DOMESTIC VIOLENCE; HEALTH CARE WORKERS; STRESS. FOR FURTHER INFORMATION:
Center for the Study and Prevention of Violence Institute of Behavioral Science, Building 9 University of Colorado, 442 UCB Boulder, CO 80309-0442 (303) 492-3968 (303) 449-8479 (fax) http://www.colorado.edu/ibs SOURCES: Barling, Julian. “Workplace Violence.” Encyclopaedia of Occupational Health and Safety, 4th ed. Geneva: International Labor Organization, 1998. Jordan, Susanne. Vol. 5, International Public Health Series. Lage, Germany: Jans Jacobs Editing Company, 2000. Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004. National Institute of Occupational Safety and Health. Current Intelligence Bulletin 57: Violence in the Workplace: Risk Factors and Prevention Strategies. DHHS (NIOSH) Publication No. 96–100.
volunteerism Involves making the personal choice to give of time or effort to some cause. These causes include a vast range of concerns, beliefs, attitudes, and needs of the diverse American population. There is a wide variety of options open to individuals, making it possible for them to find something to volunteer for that meets a real need. At the same time, it fits what they like to do or gives them an opportunity to learn. This “right match” is what most often brings fulfillment and may bring relief from personal stress to the volunteer. Often during life’s major transitions, such as loss of a loved one, moving to a new community, loss of a job, or divorce, individuals experience great loneliness. According to Marlene Wilson, in her book, You Can Make a Difference, during these times, volunteering can be a very helpful and healing experience, because it is in the reaching out to others that people “get out” of themselves and remove themselves from their own personal sources of stress.
volunteerism 381 According to the U.S. Department of Labor, about 64.5 million people age 16 and over did volunteer work at least once from September 2003 to September 2004. The proportion of the population who volunteered during the year held steady at 28.8 percent. In this survey, volunteers were defined as persons who did unpaid work (except for expenses) through or for an organization. Volunteers spent a median of 52 hours on volunteer activities during the period from September 2003 to September 2004. Most volunteers were involved with one or two organizations. Individuals with higher educational attainment were more likely to volunteer for multiple organizations than were individuals with less education. Older volunteers were more likely to work mainly for religious organizations than were their younger counterparts. For example, 45.2 percent of volunteers age 65 and over performed volunteer activities mainly through or for a religious organization, compared with 28.5 percent of volunteers age 16 to 24 years. Younger individuals
were more likely to volunteer through or for educational or youth service organizations. In fall 2005, countless people of all ages volunteered across the United States, particularly in southern states, to aid victims of Hurricanes Katrina and Rita. Many volunteered through the Red Cross. See also HOBBIES; RETIREMENT. FOR FURTHER INFORMATION:
Volunteer Management Associates 320 South Cedar Brook Road Boulder, CO 80304-0468 (720) 304-3637 (720) 304-3638 (fax) http://www.volunteermanagement.com SOURCE: U.S. Bureau of Labor Statistics. “Volunteering in the United States, 2004.” Available online. URL: http:// www.bls.gov/news.release/volun.nr0.htm. Downloaded on October 4, 2005. Wilson, Marlene. You Can Make a Difference! Boulder: Volunteer Management Associates, 1990.
W of oneself and one’s body shape contributes to reduction of stress. Concern about one’s weight is often related to one’s mental perception of BODY IMAGE and SELFESTEEM. Some individuals who fear gaining weight practice bulimia, the “bingeing and purging” syndrome, in which they gorge themselves and then induce vomiting. See also DIETING.
war neurosis Symptoms of anxiety caused by the extreme emotional and physical stresses of wartime experiences, including bombings, exposure to combat conditions, and internal conflicts over killing. Symptoms include ANXIETY, nightmares, irritability, DEPRESSION, and fears. The term has been generally replaced with POST-TRAUMATIC STRESS DISORDER. The terms war neurosis or shell shock were commonly used after World War I and into the mid-20th century.
Weil, Andrew (1942–
weapons of mass destruction
See
) American physician and author; known for his work in promoting alternative therapies and his books dealing with MIND-BODY CONNECTIONS. Among his best-selling books that include tips for beating stress are 8 Weeks to Optimum Health and Spontaneous Healing. He advocates selfadministered, commonsense cures such as eating less fat, getting more exercise, and reducing stress. He also suggests herbalism, acupuncture, naturopathy, osteopathy, chiropractic, and hypnotism. See also ALTERNATIVE MEDICINE.
NUCLEAR
WEAPONS.
weather
See
CLIMATE; SEASONAL AFFECTIVE DISOR-
DERS; TSUNAMI.
weekend depression
A type of DEPRESSION that some individuals experience when away from their work. Particularly for some individuals who live alone, facing solitude creates a stressful situation. To overcome the stresses of being alone, as well as the change in mood from the work week when one is surrounded by people, individuals can schedule pleasurable activities with FRIENDS or likeminded others so that they will not spend the entire weekend alone. Weekend depression should be distinguished from chronic depression, or SEASONAL AFFECTIVE DISORDER, which affects some individuals during dark months of the year. See also AFFECTIVE DISORDERS; PHARMACOLOGICAL APPROACH.
West Nile virus (WNV) An infection carried by mosquitoes. People get WNV from the bite of a mosquito that is infected with the virus. The threat of WNV is a source of stress for many people, particularly in certain areas of the United States. Mosquitoes become infected with WNV when they feed on infected birds that carry the virus in their blood. Once infected, the mosquito can spread the virus to humans and other animals. Anyone can become infected with WNV, but people over age 50 and those with diseases such as heart disease or cancer, or immunocompromised persons, may be more at risk for serious illness. Most human cases occur in north America in the late summer and early fall. In tropical climates, WNV can be transmitted year-round.
weight gain and loss
Weight gain and loss are sometimes related to EATING DISORDERS such as anorexia nervosa or bulimia. Many individuals become worried and impose stress on themselves because of concern about their weight. Acceptance
382
wet dreams 383 WNV has been found in Africa, the Middle East, and in parts of Europe, Russia, India, and Indonesia. WNV may have entered the United States through an infected traveler, bird, or mosquito and first appeared on the East Coast of the United States in 1999. The virus has since spread and can now be found in nearly every state. Symptoms and Treatment Most people infected with WNV have no symptoms and never become ill. However, estimates indicate that 20 percent of all people who become infected will develop West Nile fever. Some people may become ill three to 15 days after being bitten by an infected mosquito. Symptoms may include fever, headache, and body aches. More severe symptoms may be a high fever, stiff neck, confusion, and muscle weakness. Symptoms of severe infection (West Nile encephalitis or meningitis) include stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. Estimates are that one in 150 persons infected with WNV will develop a more severe form of the disease. There is no specific treatment or vaccine for WNV. Those who believe they have been infected should contact their physician. Avoiding WNV According to the National Center for Infectious Diseases, there are steps to take to avoid being bitten by an infected mosquito. • Check areas around the outside of houses for places that mosquitoes may breed. • Remove old tires, tin cans, buckets, drums, and other containers that can hold water from outdoor areas. • Empty plastic wading pools weekly or store upside down when not in use. • Change water every few days in bird baths. • Limit time outdoors when mosquito activity is heaviest (dusk to dawn). • If outside, wear socks, shoes, long pants, and a long-sleeved shirt. Light colored, loose-fitting clothing is best. • Use repellents containing 25–35 percent DEET (N,n-diethyl-meta-toluamide).
• Use mosquito netting over infant carriers and strollers. • Store boats covered or upside down. • Keep weeds and grass cut short. • Install or repair window screens to keep mosquitoes out. • Keep gutters around the house clean and in good repair. • Know that some mosquito control methods such as bug zappers are not effective in controlling biting mosquitoes. Dead Bird Locations The presence of dead crows and blue jays in a community is a sign of possible WNV in the area. If you find a dead bird, particularly a blue jay or crow, report your sighting to the local health department. Their staff will tell you if you need to pick up the bird for laboratory testing. Information regarding proper methods of handling and disposing of a dead bird is also available from local health authorities. (If you pick it up, use gloves or a shovel, double-bag the bird, and wait for instructions.) Blood Transfusions The Centers for Disease Control and Prevention believes that the virus can be spread through organ transplantation or blood transfusion. To prevent the spread of the virus through blood, all blood donated in the United States for transfusion is screened for the presence of West Nile virus. There is also evidence that the virus can be spread through breast milk, and from the mother to the fetus while still in the uterus. FOR FURTHER INFORMATION:
Centers for Disease Control Division of Vector-Borne Infectious Diseases P.O. Box 2087 Fort Collins, CO 80522 http://www.cdc.gov/ncidod/dvbid/westnile
wet dreams
Nocturnal emissions from the penis during sleep. Nocturnal emissions or ejaculations are part of normal adolescent development and are caused by accumulated normal tensions that find release while the young man is asleep. For a young
384 wheezing man who does not understand the normal processes of PUBERTY, these events can be stressful. A solid foundation of sex education is essential.
wheezing Coughing and shortness of breath, usually related to ASTHMA. The breathless feeling causes stress for the sufferer as well as the onlooker. Often individuals can identify a specific chemical compound, dust, or fume that causes coughing, shortness of breath, or wheezing. If something unique to a particular workplace or other site causes coughing or wheezing, the diagnosis may be asthma or occupational bronchitis. In classic allergic occupational asthma, a specifically inhaled substance from the workplace “sensitizes” the worker’s airways. Later exposure to the same vapor, dust, or fume can cause coughing, wheezing, or difficulty in breathing, all symptoms of an asthma attack. Many workers who inhale organic dusts are exposed to many types of microbes and other substances associated with plants, trees, animals, and crops. Some workers experience asthma symptoms, while other symptoms mimic pneumonia, with fever and shortness of breath. Most of the organic-dust reactions are allergic in nature and only affect some of the exposed population. Large amounts of inhaled dust are more likely to cause actual irritation of the lung passages. Genetic and additional environmental risk factors also play a part. Some 250 substances can cause occupational respiratory disorders, including chemicals, enzymes, animal proteins, and plant allergens. According to Brobson Lutz, in New Orleans Magazine, treatment for wheezing or asthma is the same whether work-related or not. It is best for people to avoid fumes and dusty areas as much as possible. For continuous exposures, workplace modifications and engineering controls are more practical than masks and respirator equipment. For those affected with occupational lung allergies, the stressful consequences from persistent exposure range from chronic cough to permanent lung damage. If it is not possible to avoid or safely reduce exposure to an asthma-causing dust or fumes, a job change or move may be the only alternative. See also ALLERGIES; STRESS.
SOURCES: Kahn, Ada P. Encyclopedia of Work-Related Injuries, Illnesses, and Health Issues. New York: Facts On File, 2004. Lutz, Brobson. “Wheezing While You Work: Occupational Allergies Are Nothing to Sneeze At,” New Orleans Magazine, 36, no. 3 (December 2001): 30(2).
“white coat” hypertension
See
HIGH BLOOD
PRESSURE.
women
Today, both women and men face daily stresses about family, relationships, hassles at work and in traffic, loan repayments, and uncertainties about the future. However, recent roles of women in society were homemaking and child-rearing. In the latter part of the 20th century these roles were expanded to include increasing participation in business, the military, government, and other fields previously considered “men’s fields.” The change in women’s roles has led in many cases to stress for women and for the men in their lives, as competition between the sexes increases, jealousies over being the provider in the family occur, and males feel an increasing loss of power and CONTROL over women in their personal and professional lives. For different women and at different times, stressors may vary; they may be emotional, physical, or environmental. An emotional stressor may be a RELATIONSHIP concern, a physical stressor may be an illness or pain, and an environmental stressor may be noise or air pollution. The same stresses that a woman meets with equanimity at one time may be overwhelming and a threat to her wellness at another. In reacting to stressful situations, women have choices: be overwhelmed, adjust, or adapt. Without adjustment or adaptation, cumulative demands may lead to lower resistance to illness. Statistically, women live longer than men. Paradoxically, women report more sick days and minor physical illnesses, and are more prone to ANXIETY and DEPRESSION than men; women make more visits to physicians’ offices. For many women, some complaints such as stomach and digestive problems, HEADACHES and sleeping difficulties may be traded to the cumulative effect of personal stressors. Gender-Related Stressors Different stressors occur at different stages of a woman’s life; responses vary between women.
women 385 Some young women are concerned about physical and breast development, MENSTRUATION, and then PREGNANCY and PARENTING. Young women face DATING in this age of an epidemic of SEXUALLY TRANSMITTED DISEASES and ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) and contemplation of MARRIAGE at a time when 50 percent of marriages end in DIVORCE. During their twenties, thirties, and forties, some women’s stressors may include the BIOLOGICAL CLOCK, INFERTILITY, child care, balancing home and work, and the GLASS CEILING in the corporate world. Many midlife women find MENOPAUSE stressful. Conflicting research reports on use of hormone replacement therapy make arriving at an informed decision a real dilemma. Midlife women also may face caring for their own ELDERLY PARENTS and in many cases the parents of their partners. At all ages, many women cope with being alone if they do not marry, as well as after divorce or widowhood. Additional contemporary societal stressors also include delayed marriages, two-career relationships, later childbearing, single parenting, remarriages and reconstituted families, adult children returning home, coping with a husband or partner’s loss of job, husband’s early retirement, one’s own unplanned retirement, chemical dependencies of self or partner, DOMESTIC VIOLENCE, crime victimization, rising costs of living, and proposed cuts in Medicare. In the year 2000 more than 19 million women were over the age of 65 and many of them had not planned for the financial implications of old age. More Stress: Men or Women? Until women went to work in great numbers, there was a popular notion that working men experienced more stress than women. At the same time, men were viewed as deriving satisfaction and SELF-ESTEEM from their work. Now nearly half of America’s workforce is female; while many may be deriving satisfaction from work, others experience gender-related work stressors. Women may be in low-pay jobs or in situations in which they have little AUTONOMY or receive SEXUAL HARASSMENT from the bosses and colleagues. Wives or single mothers who now have the dual role of balancing commitments to family and work are often tired, and may feel inadequate because they can’t live up to their own expectations on all fronts.
At home, women may be shouldering the greater proportion of household chores and child care responsibility, despite an increasing number of “househusbands” and cooperative partners. For many women, home is not always the place to relax. A team from Cornell Medical Center in New York City found that men’s blood pressure tended to fall as soon as they went home, while women’s blood pressure, particularly that of working mothers, experienced no decline and in some cases rose. Researchers at the Karolinska Institute in Stockholm, Sweden, found that men and women’s blood pressures varied with their emotions. The men’s tended to rise most sharply when they were angry, while the women’s rose when they were anxious. The term “Type A personality,” relating to a hard-driving behavior pattern, was originally applied to men. It was thought that the effects of such behavior in men led to high blood pressure and heart disease. Some women exhibit Type A personalities, but it is more prevalent in employed women than among women who work at home. According to the American Heart Association, the incidence of heart disease in women is increasingly recognized, and heart problems are the numberone killer of postmenopausal women. Traditionally, many women have been socialized to be the family nurturers and caregivers. They may be conciliatory rather than assertive (Type C personality). Some hide their anger rather than provoke an argument. They are haunted with guilt feelings, such as “I should.” From advertising and media messages, many are dissatisfied with their BODY IMAGE, accounting for money spent on fad diets and weight-loss programs that do not work. Coping Successfully with Stress There are a variety of effective means of COPING for women on an everyday basis as well as during particularly stressful situations. Techniques include MEDITATION, use of audiotapes for progressive relaxation, GUIDED IMAGERY, BIOFEEDBACK, JOURNALING, YOGA, and MASSAGE THERAPY. Jogging, walking, swimming, tennis, bicycle riding, dancing, and aerobic exercise groups also are effective. They are activities that use up the extra adrenaline stimulated by stress, help distract from stressors, leave muscles relaxed, and increase a sense of control.
386 women Women who cope well with stress have learned to be more assertive, to say no when they want to, to prioritize demands on them, make choices, and leave guilt feelings behind. They develop a more positive self-image regarding their bodies, and more realistic expectations of their roles at work and within the family. Increasingly, women are realizing that PERFECTION on all fronts can’t be achieved, but adequate planning and preparation will move them in that direction. They solve problems instead of worrying about them; some problems may be best handled by acceptance while others may require action. They learn to anticipate certain predictable stressors, such as upcoming holidays or starting a new job. They fight fatigue and keep their energy high with good nutrition and regular exercise. They learn to find HUMOR in the mundane. They avoid burnout by taking time to take care of themselves. According to the U.S. Census Bureau 2000 data, of the U.S. population of nearly 3 million, there were 14,409,25 males over age 65 and 20,582,128 females over age 65. Males of this age make up 5.1 percent of the total population, and females comprise 7.3 percent. Approximately 62 percent of people age 70 or older are married and living with their spouse and about 28 percent are widowed. Only 3.1 percent were never married, and 5.5 percent are divorced or separated. By age 90, the number of persons who are married and living with a spouse declines to 12.7 percent, and the number of widowed people increases to 76.5 percent. Because of longer life expectancies of women, there is a higher incidence of widowhood among women. Women are the largest subgroup of the elderly poor. The International Longevity Center reported that as of 2000, one-fifth of all women over 65 who lived alone, whether widowed, divorced, or never married, were below the poverty line and represented 70 percent of all older people living in poverty. Many women were either lifelong homemakers or changed jobs frequently as they cared for children, parents, or both and missed out on promotions and pay raises. At a time when some older adults receive pensions from their former jobs, many women do not. High costs of health care,
prescription drugs, housing, and transportation take a large part of their savings. Women, Stress, and Job-Related Injuries According to a 1998 U.S. Department of Labor, Bureau of Labor Statistics, survey (U.S. Department of Labor, Bureau of Labor Statistics, Summary 98-8, July, 1998), women experience fewer job-related injuries and deaths than men. Women incurred less than one-tenth of the job-related fatal injuries and about one-third of the nonfatal injuries and illnesses that required time off to recuperate in the period 1991–96. During this period, women accounted for slightly less than 50 percent of the nation’s workforce. One explanation for this discrepancy is that women are employed in relatively less dangerous jobs. Few women work in high-risk jobs where work is generally performed outdoors. However, as more women enter high-risk occupations, their risk of injury or death may increase. Fatal Injuries Of the 32,000 job-related fatalities that occurred during the period 1991–96, slightly more than 2,500 (8 percent) occurred to women. Two-thirds of these work injury deaths were attributed to homicides and highway incidents. Homicides. Women accounted for 20 percent of all job-related homicides in the period 1991–96. Most homicide victims were shot; women were strangled or beaten to death relatively more often than men. Two-thirds of the homicides occurred in the retail and service industries. About one-third of the women who were murdered on the job worked in sales occupations either as cashier, supervisor, proprietor, or clerk. Robbery was the primary motive for these fatal assaults. More than 25 percent of the female victims of job-related homicides were assaulted by people they knew (coworkers, clients, spouses, or friends). About 16 percent of female homicides resulted from domestic disputes that spilled over into the workplace. Highway vehicle crashes. Job-related highway incidents claimed the lives of 650 women during the period 1992–96, a little more than 2 percent of all fatalities during the period. Health care and social service workers accounted for almost 20 percent of these deaths, about the same number as
women’s movement 387 motor vehicle operators, such as truck and bus drivers and driver-sales workers. Other causes of fatalities. About 15 percent of the fatal injuries to women resulted from other transportation-related incidents, such as aircraft crashes or being struck by a vehicle. Falls accounted for 5 percent of the job-related fatalities among women, compared with 11 percent for men. Another 5 percent of female workers’ fatalities resulted from contact with objects and equipment, such as being crushed in running machinery or struck by a falling object. Death by exposure to harmful substances or environments, such as electrocutions, drownings, and the inhalation of chemicals, accounted for 4 percent of the fatalities among women workers. Two percent of the women killed at work were victims of fire and explosions. Nonfatal Injuries and Illnesses Women incurred slightly more than a third of the 2 million cases of work-related injuries and illnesses resulting in days away from work that occurred among private-sector wage and salary workers in 1995. Sprains and strains among women accounted for 45 percent of their job-related injury and illness cases, compared to 42 percent among men. Women accounted for more cases than men of carpal tunnel syndrome, tendinitis, respiratory system diseases, infectious and parasitic diseases, and disorders resulting from anxiety or STRESS. Almost half of the female workers’ injuries and illnesses resulted from bodily reaction or exertion, such as overexertion in lifting or pushing and repetitive grasping of hand tools. Falls, primarily on the same level, and contact with objects (such as being struck by falling objects, striking against objects, or getting caught in running equipment) each accounted for about 20 percent of the jobrelated injuries among women. Women were more likely to be assaulted than men and accounted for about 65 percent of the nearly 123,000 reported assault-related injuries. The manner in which women were assaulted varied. About 70 percent resulted in days away from work and occurred in the service industries, such as nursing homes, social services, and hospitals. Another 20 percent occurred in retail industries, the most vulnerable workers being female stock
handlers who incurred about 25 percent of those assaults. See also AGING; DOMESTIC VIOLENCE; HAVING IT ALL; INTIMACY; WOMEN’S MOVEMENT; VIOLENCE; WORKING MOTHERS. FOR FURTHER INFORMATION:
U.S. Department of Labor Bureau of Labor Statistics Postal Square Building, Room 2850 2 Massachusetts Avenue, NE Washington,DC 20212-0001 http://stats.bls.gov/oshhome.htm
[email protected] SOURCES: U.S. Department of Labor, Bureau of Labor Statistics, Issues in Labor Statistics, “Women Experience Fewer Job-Related Injuries and Deaths than Men.” Available online. URL: http://www.bls.gov/opub/ils/pdf/opbils 23.pdf. Downloaded on June 17, 2005. Genasci, Lisa. “For Many Women, the Ending Is Not So Happy.” Chicago Tribune, August 30, 1995. Kahn, Ada P. “Woman and Stress.” Sacramento Medicine, September 1995.
women’s movement Activities undertaken during the 1960s, 1970s, and early 1980s to elevate WOMEN from inferior positions in business, the professions, and social clubs, and to gain equal pay with men in the same work. Additionally, activities during the women’s movement were geared to help women gain freedom from the sexual double standard, and from total responsibility for child rearing and homemaking. The women’s movement confronted stresses on women entering previously male-dominated domains and on men who for the first time experienced working with, studying with, or socializing with women. The movement worked toward less overall dominance by men and against the traditional stereotype of women as dependent, passive, and fragile. It has enabled a generation of women to follow career paths not open to their mothers or grandmothers, to enjoy motherhood at the same time, and to participate in previously male-dominated professional and social organizations. At the same time, WORKING MOTHERS and women professionals have experienced unique stresses in their lives.
388 workers’ compensation The SEXUAL REVOLUTION, during which women began to express sexuality with an increase in premarital and extramarital relationships,was an outgrowth of the women’s liberation movement. Significant steps in the women’s liberation movement include publication of The Feminine Mystique (1963) by Betty Friedan, which exploded the myth of the happy housewife, passage of the Equal Pay Act by the U.S. Congress in 1963, the founding of the National Organization for Women (1966), the first accredited women’s studies course at Cornell University (1969), publication of Sexual Politics (1970) by Kate Millett, the founding of the National Women’s Political Caucus (1971), the historic Roe v. Wade decision by the U.S. Supreme Court legalizing abortion (1973), the election of the first woman governor (Ella Grasso, Connecticut, 1974), the declaration of 1975 as the International Year of the Woman by the United Nations, the First National Women’s Conference in Houston (1977), the march in 1978 of nearly 100,000 women in Washington to support the Equal Rights Amendment, the appointment of Sandra Day O’Connor as the first woman associate justice of the U.S. Supreme Court, and the candidacy of Democrat Geraldine Ferraro for vice president in 1984. The International Women’s Conference held in Beijing in 1995, which brought together many women from developing as well as developed nations, was another phase in the women’s movement. SOURCE: Cott, Nancy F. The Grounding of Modern Feminism. New Haven: Yale University Press, 1989.
workers’ compensation Laws that provide benefits for workers injured or killed in work-related situations; benefits are also provided for dependents of workers. Some laws also protect employers and fellow workers by limiting the amount an injured employee can recover from an employer and by eliminating the liability of coworkers in accidents. Understanding these benefits and making claims may be a source of stress for those who believe they should be covered and reimbursed. To relieve the stress involved in understanding what benefits are available and making claims, workers should talk with their benefits supervisors
to learn about applicable laws. For example, the Federal Employment Compensation Act provides workers compensation for nonmilitary federal employees. Many of its provisions are typical of most worker compensation laws. Compensation is awarded for disability or death sustained while performing the employee’s duties but not caused willfully by the employee or by intoxication. The act provides compensation for survivors of employees who are killed. The act is administered by the Office of Workers’ Compensation Programs. The Federal Employment Liability Act (FELA), while not a workers’ compensation statute, provides that railroads engaged in interstate commerce are liable for injuries to their employees if they have been negligent. The Merchant Marine Act (the Jones Act) provides seamen with the same protection from employer negligence as FELA provides railroad workers. Congress enacted the Longshore and Harbor Workers’ Compensation Act to provide workers’ compensation to specified employees of private maritime employers. The Office or Workers’ Compensation Programs administers the act. The Black Lung Benefits Act provides compensation for miners suffering from black lung (pneumoconiosis). This act requires liable mine operators to pay disability payments and establishes a fund administered by the secretary of labor providing disability payments to miners in cases where the mine operator is unknown or unable to pay. The Office of Workers’ Compensation programs administers the act. The Workers’ Compensation Act in California is an example of a comprehensive state compensation program applicable to most employers. The statute limits the liability of the employer and fellow employees. California also requires employers to obtain insurance to cover potential workers’ compensation claims and sets up a fund for claims against which employers have illegally failed to insure. See also STRESS; STRESS MANAGEMENT. FOR FURTHER INFORMATION:
Legal Information Institute Cornell Law School Myron Taylor Hall Ithaca, NY 14853
working mothers 389 SOURCE: Treaster, Joseph B. “Cost of Work Injuries Soars across U.S.” New York Times, 23 June 2003. Adapted from: Legal Information Institute, “Worker’s Compensation: An Overview,” Available online. URL: http://www.law.cornell.edu/topics/workers. compensation.htm. Downloaded on June 17, 2005.
work flow
See
CHANGING NATURE OF WORK;
WORKPLACE.
work hours Annual work hours in the United States have surpassed those in Japan and are now the longest among wealthy industrialized countries, while annual hours worked per person have been declining in a number of European countries and Japan. According to Paul Landsbergis, M.P.H., Ph.D., of the Mount Sinai School of Medicine, Americans work about 200–400 more hours (five to 10 more weeks) per year than workers in France, Germany, Norway, Sweden, or Denmark. Longer work hours contribute to family stress because of the absence of the worker and fatigue when the worker is present. For married couples with children in which the head of household is aged 25–54, between 1979 and 2000, annual hours increased by 388, or 11.6 percent. The large increase in work hours “provides compelling evidence of some of the stresses facing families trying to manage their work and family lives,” said Landsbergis. See also CHANGING NATURE OF WORK. working mothers
Many working MOTHERS are stressed by role conflicts between home and employment responsibilities. Despite these conflicts, they have feelings of self-fulfillment and realize economic advantages. Many find cooperation from their husbands or other family members helpful. Working mothers are a major issue for employers. About 60 percent of all women are working, compared with nearly 75 percent of all men. According to the U.S. Bureau of Labor Statistics, the long-term increase in the female labor force reflects the greater frequency of paid work among mothers. Women now account for 47 percent of the labor force, up from 40 percent in 1975. In
2003, 71.1 percent of mothers with children under 18 were working. Of those, more than 53 percent were mothers of infants. According to the Bureau of Labor Statistics, working mothers tend to earn less lifelong pay than men, due to some combination of loss of job experience, less productivity at work, and a tendency to seek lower-paying mother-friendly jobs. Since 1985, Working Mother magazine has assembled a list of family friendly companies. Those named in October 2005 to the “100 best” list regarding working women exhibited flexible scheduling, child care options, time off for new parents, and many other perks. An example was McGraw-Hill, which in 2004 introduced backup dependent care for its 13,500plus employees in North America. Employees can use 100 hours of backup care per year at a fraction of the actual cost: $2 per hour per child for drop in care and $4 per hour for in-home care, with McGraw-Hill paying the balance. The program also covers elder care. At McGraw-Hill, flexibility includes options of flextime, compressed workweeks, and job sharing. Allstate Insurance Company was recognized for its family friendly work/life policies and advancement opportunities for women. Allstate’s policies encouraged effective use of flexible work arrangements to help meet objectives of the business as well as needs of employees. Many Allstate working mothers choose flexible work options, such as changes in workday schedule, job sharing, telecommuting, compressed workweeks, and parttime status. The inclusion of Pfizer Inc. on the list was based on the company’s commitment to advancing women, its total compensation for working mothers, and its time-off policies for new parents and caregivers. According to Sylvia Montero, senior vice president of human resources, “Helping our colleagues live balanced, integrated lives is something we take very seriously, and we are committed to providing opportunities to manage the life-work balance, including care and referral programs, onsite facilities to manage health and options to care for children and other family members.” DuPont’s appearance on the 100 best list in 2005 was partly due to the fact that the firm makes flex-
390 workplace TIPS FOR WORKING MOTHERS TO REDUCE STRESS • Prioritize your home and work projects. • Develop realistic expectations for yourself and others. • Delegate projects to others in the family. • Know that you have choices. • Identify your key stressors and ways to reduce them. • Learn to say NO to excessive demands at home or work. • Ask for help when you need it. • Realize that perfection is not a realistic goal. • Make time for your own physical, emotional, and spiritual needs. • Find humor in everyday situations; learn to laugh more.
time widely available. More than half of DuPont’s 28,000 full-time employees took advantage of it. The company’s on-site child care center looks after about 150 infants, toddlers, and preschoolers at a time. Parent support services at headquarters include health fairs and family nights, in which employees and their children participate in company-sponsored activities. In addition to 26 weeks of maternity leave, with eight weeks fully paid, employees can take a six-month unpaid family leave for paternity, adoption, placement of a foster child, or to care for a sick family member. Because there are so many working mothers, DAY CARE facilities have become widespread. For many women, placing children in day-care facilities is a stressful and GUILT-ridden experience, which they must work through to come to terms with the reality of trying to remain in the work force as well as raise a family. See also COPING; HAVING IT ALL; PARENTING; WOMEN’S MOVEMENT. SOURCE: Evans, Carol. “100 Best Companies.” Working Mother 28, no. 10 (October 2005): 71–180.
workplace
Stress at the workplace occurs for most people in varying degrees and for many varied reasons. Some people are stressed because they have too much work, while others are stressed because
they are bored due to not enough work. cOWORKERS and interactions with coworkers and the boss can lead to stress. Additional sources of stress include environmental situations, such as noise, poor lighting or lack of fresh air, as well as the FRUSTRATION of being underpaid and overworked. Contemporary technological stressors at the workplace range from back strain due to sitting at a computer terminal, to REPETITIVE STRESS INJURIES (CARPAL TUNNEL SYNDROME) from use of computers, to standing on a manufacturing assembly line. Each occupation carries with it particular stresses, many of which are hidden by the employees. For example, many secretaries may resent doing the same chores over and over. Data processors may be bored with their work. Physicians find regulations imposed on them by managed care companies and insurance companies stressful. Accountants find the tax preparation season particularly stressful, while air traffic controllers are under constant pressure every minute while at work. LAWYERS must meet the demands of their clients as well as their superiors in their law firms. The issue of CONTROL is an important one in determining level of workplace stress. Those who feel they have more control over their situations, such as flexibility with work schedule, or decisionmaking about setting their own deadlines, may experience less stress than those who have no sense of control. PERSONAL SPACE is another issue. Workers who feel they have no privacy may feel more stressed than those who have offices or spaces with doors. Jobs with fairly controllable situations include computer programmer, writer, artist, appliance repairperson, and truck driver. While these jobs can be very demanding, the minute-to-minute pace may be unhurried. Certain positions may be slow-paced but with uncontrollable factors. These include janitor, security guard, and bus driver. Fast-paced and controllable professions include some physicians in private practice, business executives, and city administrators. Fast-paced and uncontrollable professions include waiter, cashier, firefighter, and nurse. Job mismatches can lead to stress. For some individuals, leaving the job is the solution. However, for many, that solution is not practical. Most people cannot walk away from their professions or
worksite wellness programs 391 businesses. The more realistic solution is learning to cope with the current pressures. Coping with Workplace Stress Some of the stresses of workplace relationships can be eased by taking certain actions. Listen carefully when someone is speaking to you instead of planning your response as they are speaking. Careful LISTENING can help prevent misunderstandings, which might make you angry. Additionally, ask for FEEDBACK, which is another person’s perception of what you are doing or saying. Feedback is not evaluative or judgmental. Speak with your coworkers or superiors at an appropriate place and time. Do not initiate a difficult conversation without appropriate privacy. Finally, always ask for a clear statement of performance expectations. Confront a superior with questions about job role and expected outcomes. Today workers are faced with additional stresses of possible and actual DOWNSIZING of corporations during which many employees are laid off, necessitating early retirement by many and finding new jobs by others. The term right-sizing has arisen to mean scaling down the number of employees to an efficient and profitable level. See also AUTONOMY; BOREDOM; CHANGING NATURE OF WORK; COPING; CUBICLES; JOB CHANGE; JOB SECURITY; LAYOFFS; WOMEN; WORKING MOTHERS. SOURCES: Adams, Scott. The Dilbert Principle: A Cubicle’s-Eye View of Bosses, Meetings, Management Fads and Other Workplace Afflictions. New York: Harper-Business, 1997. Field, Tiffany, Olga Quintino, et al. “Job Stress Reduction Therapies.” Alternative Therapies 3, no. 4 (July 1997). Murphy, Lawrence R. “Stress Management in Work Settings: A Critical Review of the Health Effects.” American Journal of Health Promotion 11, no. 2 (November– December 1996): 112–35. Peterson, Michael. “Work, Corporate Culture, and Stress: Implications for Worksite Health Promotion. American Journal of Health Behavior 21, no. 4 (1997): 243–252. Rosch, Paul J. “Measuring Job Stress: Some Comments on Potential Pitfalls.” American Journal of Health Promotion 11, no. 6 (July–August 1997): 400–401.
workplace shootings
The number of workplace shootings in the United States nearly doubled in 2003 from the previous year, increasing stress in
many workplaces. According to a report by Handgun-Free America, there were 25 workplace shooting incidents and 33 victims killed in 2002. In 2003, that number rose dramatically to 45 incidents, with 69 people killed and another 46 wounded. The report identified a five-year trend showing an increase in the number of American workplace shootings since 1998, when there were only nine. The report also indicated that about half of those who commit workplace shootings had experienced a “negative change in employment,” such as firing, demotion, suspension, or involvement in disputes. Nearly one-third of the workplace shootings occurred in white-collar job settings, and more than 90 percent of the shooters in these incidents are male. Further, at least 13.4 percent of the cases reviewed indicated the shooter had a publicly known history of mental health problems, and 9.1 percent of the shooters displayed warning signs prior to the shootings but these warning signs were ignored by those who noticed them. At least 13.4 percent of the incidents reviewed involved some type of domestic violence as the motive. The report concluded that California and Florida are the most dangerous states when it comes to workplace shootings. According to Chris McGrath, executive director of Handgun-Free America, “The unifying factor amongst all these tragedies is the availability of firearms, especially semi-automatic handguns, which are the weapons of choice for rampage and workplace shooters.” See also DOMESTIC VIOLENCE; SUICIDE; VIOLENCE. FOR FURTHER INFORMATION:
Handgun-Free America 1600 Wilson Boulevard, Suite 800 Arlington, VA 22209 (703) 465-0474 (703) 465-5603 (fax) http://www.handgunfree.org
worksite wellness programs Wellness promotion, through organized programming at the workplace, that encourages voluntary behavior changes including STRESS MANAGEMENT in employees. Worksite wellness activities are designed to reduce health risks and enhance individual productivity. Wellness programs provide employees with the
392 worksite wellness programs advantage of making the intentional choice toward a more stress-free physical, emotional, psychological, and occupational existence. In the late 1980s, the Wellness Councils of America was formed to help member companies build and sustain wellness programs. Since the inception of the Wellness Councils of America, much has been learned about the art and science of worksite health promotion. From improving health and well-being and reducing STRESS to demonstrating cost benefit, the discipline of worksite health promotion has rapidly gained acceptance among a variety of constituents, including business and industry, health care, education, and government. About half of companies with more than 750 employees offer a comprehensive employee health promotion program, according to a National Worksite Health Promotion Survey from 1999, the most recent year such a survey was done. According to the Wellness Councils of America and Canada, more than 81 percent of U.S. businesses with 50 or more employees have some form of health promotion program. The most popular ones are stress management, exercise, weight loss programs, stopsmoking classes, and back care programs. Health Promotion/Stress Reduction: Controlling Health Care Costs Health promotion is important to employers because health care costs continue to be an issue of major concern. More than $1 trillion is spent in the United States on health care, more than any other nation in the world. The average annual health care cost per person in the United States far exceeds $3,000. Lifetime costs per person are in the area of $225,000. Because much of these costs are linked to stressful habits, it is possible for employers to take action toward reducing health care utilization and containing costs by providing health promotion activities. A factor in rising health costs is Americans’ growing tendency toward obesity. David Hunnicutt, president of the Wellness Councils of America, has asserted that most Americans spend the majority of their time at sedentary jobs. Health experts say it is incumbent on employers to find ways to get workers to exercise and become more concerned about their health. A federal government survey in 2000 found that 56.4 percent of
Americans are overweight. Obesity can result in higher health insurance claims and employee absenteeism. A National Center for Health Statistics report released in April 2002 said seven in 10 adults do not exercise regularly and nearly four in 10 are not physically active at all. Companies say wellness programs have proven effective, with reductions in stress, blood pressure, smoking, and cholesterol levels. About 1,000 people participated in CIGNA’s weight management program in 2001, and the average weight loss was 10 to 15 pounds, according to Catherine Hawkes, assistant vice president of the insurer’s employee health and work-life programs. To reduce stress, autoworkers at General Motors Corp. relax and stretch with yoga and t’ai chi classes offered just floors above the assembly lines in Flint, Michigan. Union Pacific Railroad employees can use a fitness center at many remote spots; the company used to have traveling fitness railcars before workers started staying in hotels. Chrysler Group offers incentives for its employees to use its programs, giving out “well bucks” that can be redeemed for gym bags, golf balls, and other gear. Employees earn the well bucks if they get a health screening, check out a book or video from the company health library, or get a workplace massage, which can provide some stress relief. Increased Technology: A Source of Stress The typical American now works 47 hours a week. Because of modern technological conveniences such as laptop computers, modems, personal pagers, fax machines, e-mail and cellular phones, traditional boundaries of work have been erased. These devices are convenient but they become a threat to good health if they use up time people might have devoted to exercise or relaxing recreational activities. Progressive health promotion programs and stress management activities at the worksite can help alleviate some of these concerns. Additionally, increased reliance on technology has ushered in much new health concerns including repetitive stress injuries, low back problems, and compromised vision. Because almost one-third of the workforce now spends most of the day seated at desks or workstations, sedentary lifestyles have become a concern.
worry 393 Stress Level High in Many Jobs The pace of technological change and the challenge of information management has increased the level of stress for both employers and employees. According to the Wellness Councils of America, a recent nationwide poll indicated that 78 percent of Americans describe their jobs as stressful. High levels of organizational stress exact a toll on business. Increased accidents, reduced productivity, unnecessary absenteeism, and increased medical care costs show that the impact of stress is devastating. Increasingly, more business leaders and health promotion practitioners look to health promotion programs as a means of reducing, managing and, in some instances, even eliminating harmful sources of stress. By implementing a comprehensive stress management intervention, it is possible to successfully combat prevalent stressors in the workplace. Examples of stress reduction techniques include teaching employees stress management skills, implementing flexible work schedules, increasing the quality and quantity of social interaction, and increasing participation in the company decisionmaking process can all have significant effects. Increased Workforce Diversity May Cause Stress Because of increasing diversity in the workforce, there is a need to address many health and wellness issues to keep employees healthy and productive. For example, jobs generated by small firms are more likely to be filled by younger workers, older workers, and women. According to recent statistics obtained from the Small Business Administration, the number of women-owned firms and the firms owned by people of color have increased significantly. Between 1987 and 1992, the number of women-owned businesses rose approximately 43 percent. In 1996, nearly 8 million womenowned firms provided jobs for 18.5 million persons, more people than are employed in the Fortune 500 industrial firms. Data on black-owned businesses revealed an increase of 46 percent. Hispanic-owned businesses proved to be one of the fastest growing segments, increasing 82.7 percent between 1987 and 1992. Businesses owned by Asian Americans, American Indians, Alaska Natives, and Pacific Islanders increased 87.2 percent between 1987 and 1992. With increasing diversity comes the challenge of
being responsive to many additional health concerns. Because health promotion programs help pinpoint specific health issues of most concern, such initiatives can be used to identify and address a variety of diverse health issues. Stress Management Helps Prevent Illnesses Many causes of illnesses are preventable. Estimates are that preventable illnesses make up approximately 70 percent of the entire burden of illness and associated costs in the United States. Preventable factors include stress, tobacco use, highrisk alcohol consumption, sedentary lifestyle, and poor nutritional habits. By offering a health promotion initiative, employers can take important steps toward preventing unnecessary sickness and death. See also ABSENTEEISM; BACK PAIN; REPETITIVE STRESS INJURIES; STRESS; WORKERS’ COMPENSATION. FOR FURTHER INFORMATION:
Wellness Councils of America 9802 Nicholas Street, Suite 315 Omaha, NE 68114 (402) 827-3590 (402) 827-3594 (fax) http://www.welcoa.org SOURCE: Moses, Alexandra R. “Wellness Programs a Fit for Bottom Lines.” Chicago Tribune, 28 April 2002, Sec. 5, p. 9.
workstation
See COMPUTERS; CUBICLES; ERGONOM-
ICS; PERSONAL SPACE.
World Trade Center
See SEPTEMBER 11, 2001.
worry A state of mental uneasiness, distress, or agitation due to concern for a past, impending, or anticipated stressful event, threat, or danger. Some degree of worrying is a common, everyday occurrence for most people. For some people, however, excessive worry adds to their stress levels. Individuals who have ANXIETY DISORDERS tend to worry more than others. For example, people who have AGORAPHOBIA may worry about what will happen if they go out of their homes, or people with a PHOBIA may worry about what will happen if they encounter a phobic object or situation. Worrying may be called negative imagery, because the worrier focuses on negative images or
394 writer’s block REDUCE STRESS: WORRY LESS • When you try not to worry about something, it is likely that you will worry about it more. It may be advantageous to stay with the worry and really concentrate on it, because you may stop worrying and begin solving your problem. • Make a distinction between matters you can do something about and those you cannot. • Instead of asking yourself repeatedly “what if . . .,” write down a number of possible solutions to a specific problem and then list the advantages and disadvantages of each idea. • Use a diversionary technique, such as going for a walk, doing some other form of exercise, playing a musical instrument, or listening to music. Doing so will help you organize your thoughts and come up with possible solutions. The best solutions may occur when you are not thinking about the immediate problem. • Various forms of psychotherapy and self-help can relieve the stresses of excessive worrying for many people.
worst-case scenarios (CATASTROPHIZEs). Worrying to excess can be an unhealthy stressor because it causes the body to react; the heart pounds, breathing quickens, and sweating may occur. For some individuals, GUIDED IMAGERY techniques, through which they imagine themselves in a given situation with a pleasant outcome, may be useful. Additionally, RELAXATION techniques, such as MEDITATION and BIOFEEDBACK, may be helpful. In a relaxed state, individuals can think more constructively and in a more organized manner. See also ANXIETY; COPING; GENERAL ADAPTATION SYNDROME; STRESS MANAGEMENT. SOURCES: Diamond, David. “Bound to Worry.” Health, July–August 1992. Padus, Emrika, ed. The Complete Guide to Your Emotions and Your Health, rev. ed. Emmaus, Pa.: Rodale Press, 1992.
writer’s block An obstacle to the free expression of ideas on paper; between the thought and the recording of it, there is an interruption in the flow. When a block occurs, the writer may feel stressed, frustrated, and stuck. Unable to go on while waiting
for an inspiration, the writer may have self-doubts about his or her capabilities, hopes, and even future. Many writers suffer from writer’s block at one time or another. The block may involve an inability to get started with a writing project, or to set words down on paper; it may occur in the middle of a project and the writer will feel unable to go on. Writers may be concerned about the validity of their topic, ability to communicate on paper, and acceptance by teachers, readers, or publishers. Too much STRESS can paralyze the writer, and too little stress can lead to apathy. The ideal state of mind, the one that unblocks, was called “eustress,” or good stress, by HANS SELYE, the Canadian author of The Stress of Life (1956) and Stress without Distress (1974). That middle point in the stress spectrum is the state of relaxed concentration accompanied by energy. Because writing can be hard work, one must be in the right mental framework to take risks and to have confidence and SELF-ESTEEM regarding one’s own abilities. Overcoming the Stress of Writer’s Block Writing usually involves several steps: incubation, planning, research, organization, first draft, incubation, revision, and final draft. Before starting, the writer unconsciously develops ideas and insights for the written material; this is the important incubation process. To bring these ideas out of the mind and onto paper, and break writer’s block, he or she must reach a state of relaxed, energized concentration in which self-criticism is set aside and there is room for creative thoughts. There are a number of exercises one can perform to help reach the state of energized relaxation. Physical EXERCISE energizes and is conducive to a relaxed state of mind. MEDITATION and imagery exercises are also very useful in reducing stress and minimizing the self-doubt that obstructs expression. Proper nutrition and enough SLEEP are similarly important to the writer. Another way to avoid writer’s block is to avoid people who are critical of the writer’s work or ideas in the early stage of the project. While their criticisms may be helpful later, early in the project criticism may be stifling. See also CREATIVITY; FRUSTRATION. SOURCE: Sloane, Beverly LeBov. “Creativity.” Town Hall of California Reporter, March–April 1987, 6–7.
X Studies suggest that alprazolam also has antidepressant activity in moderate depression. See also BENZODIAZEPINE DRUGS; AGORAPHOBIA; DEPRESSION; PANIC ATTACKS AND PANIC DISORDER; PHARMACOLOGICAL APPROACH.
Xanax
The trade name for alprazolam, a triazolobenzodiazepine compound with antianxiety and sedative-hypnotic actions. It is approved by the U.S. Food and Drug Administration for use in panic disorder and generalized ANXIETY DISORDER.
395
Y yawning
yoga A system of Indian philosophy and practice that is used as a stress management technique by many people. The word youga means “union.” Yoga teaches the means by which one can learn to commune with universal energy. Humans consist of both material and nonmaterial entities; the material entity is the physical body and the nonmaterial entities are the mind and the soul. Yoga attempts to bring together the body, mind, and soul, or the physical side, the social side (life in action), and the spiritual side. There are several types of yoga with varying emphasis on physical, mental, and social activity. Different paths for developing the mind are based on the fact that the mind has three different aspects: knowing, feeling, and willing. A popular type of yoga practiced in the United States is hatha yoga, which involves regulation of the mind and body through different breathing exercises. There are over 200 balanced physical postures (asanas) to EXERCISE every muscle in the body. They are planned to maintain flexibility of the body, teach physical and mental control, and are useful for RELAXATION. There are exercises for tapping into kundalini (a large reservoir of energy thought to be situated at the base of the spinal cord). Research studies have indicated that yoga is useful in the area of hypertension, coronary heart disease, anxiety disorders, asthma, and diabetes. See also ALTERNATIVE MEDICINE; MEDITATION.
Yawning is an easy way to reduce stress because doing so relaxes the throat, palate, upper neck, and the base of the brain. It helps balance the flow of cerebrospinal fluid, which helps keep the brain and spine clean and flexible. It also increases production of saliva and so improves digestion. Yawning also increases fluid flow to the eyes, which washes and soothes them. It also increases the brain’s production of serotonin, the neurotransmitter that tends to balance mood. Because of increased serotonin, yawning helps to induce sleep when one is tired but has trouble relaxing enough to sleep. How to Induce a Yawn • Take in a deep breath. • At the top of the breath, open your mouth wide, lift your soft palate (the upper back of your throat), and make yawning sounds. This should trigger a yawn. Try it again off and on, relaxing as much as you can, until you find yourself yawning. • Be with people who yawn and let their yawning trigger yours.
FOR FURTHER INFORMATION:
Zapchen Resources P.O. Box 6392 Napa, CA 94581 (707) 233-7120 SOURCE: Henderson, Julie. Embodying Well-Being: How to Feel as Good as You Can in Spite of Everything. Napa, Calif.: Zapchen Resources, 2003.
youngest children RELATIONSHIPS.
396
See
BIRTH ORDER; SIBLING
Z sued through contemplation of the nature of humankind. With this process, individuals release tensions and experience oneness with the universe. See also ALTERNATIVE MEDICINE; MEDITATION; TRANSCENDENTAL MEDITATION.
Zen
A form of Buddhism used as a basis for RELAXATION and STRESS MANAGEMENT; it is concerned with the individual meaning of a person’s life rather than just removal of symptoms or improvement of his or her adjustment to life. The goal of Zen is pur-
397
APPENDIX I ASSOCIATIONS AND ORGANIZATIONS (212) 870-3400 http://www.aa.org
Acoustical Society of America (ASA) 2 Huntington Quadrangle, Suite 1NO1 Melville, NY 11747-4502 (516) 576-2360 (516) 576-2377 (fax) http://asa.aip.org
American Academy of Ophthalmology (AOA) P.O. Box 7424 San Francisco, CA 94120-7424 (415) 561-8500 (415) 561-8533 (fax) http://www.aao.org
Agency for Toxic Substances and Diseases Registry (ATSDR) 1600 Clifton Road NE Atlanta, GA 30333 (888) 422-8737 (toll-free) (404) 498-0057 (fax) www.atsdr.cdc.gov
American Association for CFS (AAFCFS) c/o Harborview Medical Center 325 9th Avenue Box 359780 Seattle, WA 98104 (206) 521-1932 (206) 521-1930 (fax) E-mail:
[email protected] AIDS Clinical Trials Information Service P.O. Box 6421 Rockville, MD 20849-6421 (800) TRIALS-A (toll-free) http://www.actis.org
American Association of Naturopathic Physicians (AANP) 8201 Greensboro Drive, Suite 300 McLean, VA 22102-3814 (877) 969-2267 (703) 610-9037 (703) 610-9005 (fax) http://www.naturopathic.org
AIDS Health Project 1930 Market Street San Francisco, CA 94102 (415) 476-6430 http://www. ucsf-ahp.org Al-Anon/Alateen Family Group Headquarters, World Service Office (AFG) 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617 (800) 344-2666 (toll-free) (800) 4AL-ANON (757) 563-1600 (757) 563-1655 (fax) http://www.al-anon.alateen.org
American Association of Occupational Health Nurses (AAOHN) 2920 BrandyWine Road, Suite 100 Atlanta, GA 30341 (770) 455-7757 (770) 455-7271 (fax) http://www.aaohn.org/ American Association of Oriental Medicine (AAOM) 433 Front St. Catasauqua, PA 18032-2506
Alcoholics Anonymous (AA) A.A. World Services, Inc. P.O. Box 459 Grand Central Station New York, NY 10163
399
400 The Encyclopedia of Stress and Stress-Related Diseases (888) 500-7999 (toll-free) (610) 266-1433 (610) 264-2768 (fax) http://www.aaom.org American Cancer Society (ACS) 1599 Clifton Road NE Atlanta, GA 30329 (800) 227-2345 (toll-free) (404) 315-9348 (fax) http://www.cancer.org American Chemical Council (ACC) 1300 Wilson Boulevard Arlington, VA 22209 (703) 741-5000 (703) 741-6000 (fax) http://americanchemistry.com American Chemical Society (ACS) 1155 16th Street NW Washington, DC 20036 (800) 227-5558 (toll-free) (202) 872-4600 (202) 872-4615 (fax) http://www.acs.org American Chiropractic Association (ACA) 1701 Clarendon Boulevard Arlington, VA 22209 (800) 986-4636 (toll-free) (703) 276-8800 (703) 243-2593 (fax) http://www.amerchiro.org American Civil Liberties Union AIDS Project 132 West 43rd Street New York NY 10036 (212) 944-9800 American College of Medical Toxicology (ACMT) 777 E. Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820 (888) 633-5784 (717) 558-7846 (717) 558-7841 (fax) http://www.acmt.net American College of Occupational and Environmental Medicine 1114 North Arlington Heights Road Arlington Heights, IL 60004-4770
(847) 818-1800, ext. 368 (847) 818-9266 (fax) http://www.acoem.org American College of Toxicology (ACT) 9650 Rockwell Pike Bethesda, MD 20814 (301) 571-1840 (301) 571-1852 (fax) http://actox.org American Conference of Governmental Industrial Hygienists (ACGIH) 1330 Kemper Meadows Drive, Suite 600 Cincinnati, OH 45240 (513) 742-2020 (513) 742-6163 (513) 742-3355 (fax) http://www.acgih.org American Council of the Blind (ACB) 1115 15th Street NW, Suite 1004 Washington, DC 20005 (800) 424-8666 (toll-free) (202) 467-5081 (202) 467-5085 (fax) http://www.acb.org American Council on Science and Health (ACSH) 1995 Broadway, 2nd Floor New York, NY 10023-5860 (212) 362-7044 (212) 362-4919 (fax) http://acsh.acsh.org E-mail:
[email protected] American Diabetes Association (ADA) 1701 North Beauregard Street Alexandria, VA 22311 (800) DIABETES (toll-free) (703) 549-1500 (703) 836-7439 (fax) http://www.diabetes.org American Environmental Health Foundation (AEHF) 8345 Walnut Hill Lane, Suite 225 Dallas, TX 75231 (800) 428-2343 (toll-free) (214) 361-2534 (fax) http://www.aehf.com
Appendix I 401 American Federation of Labor-Congress of Industrial Organizations (AFL-CIO) 815 16th Street NW Washington, DC 20006 (202) 637-5000 (202) 637-5058 (fax) E-mail:
[email protected] American Lung Association (ALA) 1740 Broadway New York, NY 100019-4374 (800) LUNG USA (toll-free) (212) 315-8700 (212) 315-8872 (fax) http://www.lungusa.org
American Group Psychotherapy Association (AGPA) 25 East 21st Street, Sixth Floor New York, NY 10010 (212) 477-2677 (212) 979-6627 (fax) http://www.agpa.org E-mail:
[email protected] American Massage Therapy Association (AMTA) 820 Davis Street, Suite 100 Evanston, IL 60201-4444 (888) 843-2682 (toll-free) (847) 864-0123 (847) 864-1178 (fax) http://www.amtamassage.org
American Headache Society (AHS) 19 Mantua Road Mt. Royal, NJ 08061 (856) 423-0043 (856) 423-0082 (fax) http://www.aashnet.org American Healthcare Association (AHA) 1201 L Street, NW Washington, DC 20005-4014 (202) 841-4444 (202) 842-3860 (fax) http://www.ahca.org American Heart Association (AHA) 7272 Greenville Avenue Dallas, TX 75231-4596 (800) 242-USA1 (toll-free) (214) 373-6300 (214) 987-4334 (fax) http://www.americanheart.org American Industrial Hygiene Association (AIHA) 2700 Prosperity Avenue, Suite 250 Fairfax, VA 22031 (703) 849-8888 (703) 207-3561 (fax) http://www.aiha.org American Institute of Stress (AIS) 124 Park Avenue Yonkers, NY 10703 (914) 963-1200 (914) 965-6267 (fax) http://www.stress.org
American Mental Health Counselors Association (AMHCA) 801 North Fairfax Street, Suite 304 Alexandria, VA 22314 (800) 326-2642 (toll-free) (703) 548-6002 (703) 548-4775 (fax) http://www.amhca.org E-mail:
[email protected] American Nurses Association 600 Maryland Avenue SW, Suite 100W Washington, DC 20024-2571 (800) 274-4ANA (toll-free) (202) 651-7000 http://www.nursingworld.org American Psychiatric Association (APA) 1400 K Street NW Washington, DC 20005 (202) 692-6850 http://www.psych.org E-mail:
[email protected] American Psychological Association (APA) 750 First Street NE Washington, DC 20002-4242 (800) 374-3120 (toll-free) (202) 336-5700 (202) 336-5568 (fax) http://www.apa.org E-mail:
[email protected] American Public Health Association (APHA) 800 I Street NW Washington, DC 20001-3710
402 The Encyclopedia of Stress and Stress-Related Diseases (202) 777-2742 (202) 777-2534 (fax) http://www.apha.org
(303) 422-8436 (303) 422-8894 (fax) http://www.aapb.org
American Red Cross National Headquarters (ARC) 431 18th Street NW Washington, DC 2006 (800) 797-8022 (toll-free) (202) 639-3520 (202) 942-2024 (fax) http://www.redcross.org
Association of Occupational and Environmental Clinics (AOEC) 1010 Vermont Avenue NW, Suite 513 Washington, DC 20005-1503 (202) 347-4976 (202) 347-4950 (fax) http://www.aoec.org
American Sleep Apnea Association (ASAA) 1424 K Street NW Suite 302 Washington, DC 20005 (202) 293-3650 (202) 293-3656 (fax) http://www.sleepapnea.org American Society of Addiction Medicine (ASAM) 4601 North Park Avenue Arcade, Suite 101 Chevy Chase, MD 20815 (301) 656-3920 (301) 656-3815 (fax) http://www.asam.org Anorexia Nervosa and Related Eating Disorders (ANRED) P.O. Box 5102 Eugene, OR 97405 (541) 344-1144 http://www.anred.com Anxiety Disorders Association of America (ADAA) 8700 Georgia Avenue Silver Spring, MD 20910 (240) 487-0120 http://www.adaa.org Association for Advancement of Behavior Therapy 305 Seventh Avenue, 16th Floor New York, NY 10001-6008 (212) 647-1890 (212) 647-1865 (fax) http://www.aabt.org E-mail:
[email protected] Association of Applied Psychophysiology and Biofeedback (AAPB) 12267 West 44th Avenue, #304 Wheat Ridge, CO 80303
Better Hearing Institute (BHI) P.O. Box 1840 Washington, DC 20013 (800) EAR-WELL (toll-free) (703) 684-6048 (fax) http://www.betterhearing.org CDC National AIDS Hotline: (800) 342-2437 TTY/TDD: (800) 243-7889 English Hotline: (800) 342-AIDS Spanish Hotline: (800) 344-SIDA CDC National Prevention Information Network (NPIN) Box 6003 Rockville, MD 20849-6003 (800) 458-5231 (toll-free) (800) 243-7012 (301) 562-1050 (fax) http://www.cdcnpin.org Center for Substance Abuse Prevention (CSN) 5600 Fishers Lane, Rockwall II Rockville, MD 20857 (301) 443-0365 http://www.samhsa.gov E-mail:
[email protected] CFIDS Association of America, Inc. P.O. Box 2203398 Charlotte, NC 29222-0398 (800) 442-3437 (toll-free) (704) 365-9755 (fax) http://www.cfids.org Chronic Fatigue Immune Dysfunction Syndrome Activation Network (CAN) P.O. Box 345 Larchmont, NY 10538 (212) 280-4266 (914) 636-6515 (fax) E-mail:
[email protected] Appendix I 403 Cocaine Anonymous World Services (CAWS) 3740 Overland Avenue, Suite C Los Angeles, CA 90034-6337 (800) 347-8998 (toll-free) (310) 559-5833 (310) 559-2554 (fax) http://www.ca.org
Employee Assistance Professionals Association (EAPA) 2101 Wilson Boulevard, Suite 500 Arlington, VA 22201-3062 (703) 387-1000 (703) 522-4585 (fax) http://www.eap-assn.com
Commission on Mental and Physical Disability Law American Bar Association 740 15th Street NW Washington, DC 20005 (202) 662-1570 (202) 662-1032 (fax) http://www.abanet.org/disability E-mail:
[email protected] Employment Law Center 1663 Mission Street, Suite 400 San Francisco, CA 94103 (415) 864-8848
Depression and Bipolar Support Alliance 730 North Franklin Street, Suite 501 Chicago, IL 60610-3526 (800) 826-3632 (toll-free) (312) 642-0049 (312) 642-7243 (fax) http://www.dbsalliance.org Depression and Related Affective Disorders Association Johns Hopkins Hospital, Meyer 3-181 600 North Wolfe Street Baltimore, MD 21287-7381 (410) 955-4647 (410) 614-3241 (fax) http://www.med.jhu.edu/drada E-mail:
[email protected] Easter Seals National Headquarters 230 West Monroe Street, Suite 1800 Chicago, IL 60606 (800) 221-6827 (toll-free) (312) 726-6200 (312) 726-1494 (fax) http://www.easter-seals.org Eating Disorders Awareness and Prevention, Inc. (EDAP) 603 Stewart Street, Suite 803 Seattle, WA 98101 (800) 931-2237 (toll-free) (206) 382-3587 (206) 292-9890 (fax) http://www.edap.org E-mail:
[email protected] Environmental Health Clearinghouse Meridian Parkway, Suite 115 Durham, NC 27713 (800) 643-4794 (toll-free) (919) 361-9408 (fax) http://www.infoventures.com Environmental Protection Agency (EPA) 1200 Pennsylvania Avenue NW Washington, DC 20460 (202) 564-6953 (202) 501-1450 (fax) http://www.epa.gov Equal Employment Opportunity Commission (EEOC) 1801 L Street NW Washington, DC 20507 (202) 663-4001 (202) 663-4110 (fax) http://www.eeoc.gov Feldenkrais Guild of North America C/O Ruth A. Hurst 3611 South West Hood Avenue, Suite 100 Portland, OR 97201 (800) 775-2118 (toll-free) (503) 221-6612 (503) 221-6616 (fax) http://www.feldenkrais.com Gamblers Anonymous (GA) P.O. Box 17173 Los Angeles, CA 90017 (213) 386-8789 (213) 386-0030 (fax) http://gamblersanonymous.org Health Research Group (HRG) 1600 20th Street NW Washington, DC 20009
404 The Encyclopedia of Stress and Stress-Related Diseases (202) 588-1000 (202) 588-7796 (fax) http://www.citizen.org/hrg
(202) 223-0409 (fax) http://www.bazelon.org E-mail:
[email protected] International Association of Eating Disorders Professionals (IAEDP) P.O. Box 1295 Pekin, IL 61555-1295 (309) 346-3341 (309) 346-2874 (fax) http://www.iaedp.com
Narcolepsy Network P.O. Box 294 Pleasantville, NY 10570 (401) 667-2523 (401) 633-6567 http://www.narcolepsynetwork.org
International Foundation for Homeopathy (IFH) P.O. Box 7 Edmonds, WA 98020 (425) 776-1499 (fax) E-mail:
[email protected] International Occupational Hygiene Association (IOHA) I0HA Secretariat Suite 2, Georgian House Great Northern Road Derby DE ILT United Kingdom +44 1332 298101 +44 1332 298099 (fax) http://www.ioha.com International Safety Equipment Association (ISEA) 1901 North Moore Street Arlington, VA 22209-1762 (703) 525-1695 (703) 528-2148 (fax) http://www.safetyequipment.org International Society for Traumatic Stress Studies (ISTSS) 60 Revere Drive, Suite 500 Northbrook, IL 60062 (847) 480-9028 (847) 480-9282 (fax) http://www.istss.org E-mail:
[email protected] Judge David L. Bazelon Center for Mental Health Law 1101 15th Street NW, Suite 1212 Washington, DC 20005-5002 (202) 467-5730
Narcotics Anonymous (NA) P.O. Box 9999 Van Nuys, CA 91409 (818) 773-9999 (818) 700-0700 (fax) http://www.na.org National Alliance for Hispanic Health 1501 Sixteenth Street NW Washington, DC 20036 (202) 387-5000 (202) 797-4353 (fax) http://www.hispanichealth.org/ National Alliance for the Mentally Ill (NAMI) Colonial Place Three 2107 Wilson Boulevard, Suite 300 Arlington, VA 22203-3754 (800) 950-6264 (toll-free) (703) 524-7600 (703) 524-9094 (fax) http://www.nami.org National Alliance for Research on Schizophrenia and Depression (NARSAD) 60 Cutter Mill Road, Suite 404 Great Neck, NY 11021 (800) 829-8289 (toll-free) (516) 829-0091 (516) 487-6930 (toll-free) http://www.narsad.org National Association of Anorexia Nervosa and Associated Disorders (ANAD) P.O. Box 7 Highland Park, IL 60035 (847) 831-3438 (847) 433-4632 (fax) http://www.anad.org E-mail:
[email protected] Appendix I 405 National Association of Cognitive-Behavioral Therapists (NACBT) P.O. Box 2195 Weirton, WV 26062 (800) 853-1135 (toll-free) (304) 723-3982 (fax) http://www.nacbt.org E-mail:
[email protected] National Association of People with AIDS (NAPWA) 8401 Colesville Road, Suite 750 Silver Spring, MD 20910 (240) 247-0880 (240) 247-0574 (fax) http://www.napwa.org E-mail:
[email protected] National Association of Protection and Advocacy Systems (NAPAS) 900 Second Street NE, Suite 211 Washington, DC 20002 (202) 408-9514 (202) 408-9520 (fax) http://www.protectionandadvocacy.com E-mail:
[email protected] National Association of Social Workers (NASW) 750 First Street NE, Suite 700 Washington, DC 20002-4241 (800) 638-8799 (toll-free) (202) 408-8600 (202) 336-8310 (fax) http://www.socialworkers.org National Cancer Institute/NIH NCI Public Inquiries Office Suite 3036A 6116 Executive Boulevard, MSC 8322 Bethesda, MD 20892-8322 (800) 4-CANCER (800) 422-6237 (301) 435-3848 http://www.nci.nih.gov National Center for Complementary and Alternative Medicine (NCCAM) National Institutes of Health (NIH) P.O. Box 7923 Gaithersburg, MD 20898 (888) 644-6226 (301) 435-6549 (fax) http://www.nccam.nih.gov
National Center for Farmworker Health (NCFH) 1770 FM 967 Buda, TX 78610-2884 (512) 312-2700 (512) 312-2600 (fax) http://www.ncfh.org National Center for Homeopathy (NCH) 801 North Fairfax Street, Suite 306 Alexandria, VA 22314 (703) 548-7790 (703) 548-7792 (fax) http://www.homeopathic.org National Center for Post-Traumatic Stress Disorder (NCPTSD) VA Medical Center White River Junction, VT 05001 (802) 296-5132 E-mail:
[email protected] http://www.ncptsd.org National Chronic Fatigue Syndrome and Fibromyalgia Association (NCFSFA) P.O. Box 18426 Kansas City, KS 64133 (816) 313-2000 (816) 524-6782 (fax) http://www.ncfsfa.org National Clearinghouse for Alcohol and Drug Information (NCADI) 11426 Rockville Pike Rockville, MD 20852 (800) 729-6686 (toll-free) http://www.health.org E-mail:
[email protected] National Council on Alcoholism and Drug Dependence (NCADD) 20 Exchange Place, Suite 3902 New York, NY 10005-3201 (800) 622-2255 (toll-free) (212) 269-7797 (212) 269-7510 (fax) www.ncadd.org National Council on Problem Gambling (NCPG) 216 G Street NE, Suite 200 Washington, DC 20002 (202) 547-9204 (202) 547-9206 (fax) http://www.ncpgambling.org E-mail:
[email protected] 406 The Encyclopedia of Stress and Stress-Related Diseases National Eating Disorders Association (NEDA) 603 Stewart Street, Suite 803 Seattle, WA 98101 (206) 382-3587 (206) 829-8501 (fax) http://www.nationaleatingdisorders.org E-mail:
[email protected] National Fire Protection Association (NFPA) 1 Batterymarch Park P.O. Box 9101 Quncy, MA 02269-9101 (800) 344-3555 (toll-free) (617) 770-0700 (fax) http://www.nfpa.org National Foundation for Depressive Illness (NFDI) P.O. Box 2257 New York, NY 10116 (800) 239-1265 (toll-free) http://www.depression.org National Headache Foundation (NHF) 820 North Orleans, Suite 217 Chicago, IL 60610 (888) NHF-5552 (toll-free) (773) 388-6399 (773) 525-7357 (fax) http://www.headaches.org
(202) 260-4464 (fax) http://www.cdc.gov/niosh National Institute of Allergy and Infectious Diseases/NIH (NIAID) 6610 Rockledge Drive, MSC 6612 Bethesda, MD 20892-6612 (301) 496-2263 (301) 496-5717 (301) 496-5509 (fax) http://www.niaid.nih.gov National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH (NIAMS) I AMS Circle Bethesda, MD 20892-3675 (301) 495-4484 (301) 718-6366 (fax) http://www.niams.nih.gov National Institute of Environmental Health Sciences/NIH (NIEHS) Building 31 #B1CO2 31 Center Drive, MSC 2256 Bethesda, MD 20892-2256 (301) 496-3511 (301) 496-0563 (fax) http://www.niehs.nih.gov
National Heart, Lung and Blood Institute/NIH (NHLBI) P.O. Box 30105 Bethesda, MD 20824-0105 (301) 592-8573 (301) 402-0818 (fax) http://www.nhlbi.nih.gov
National Institute of Mental Health (NIMH) 6001 Executive Boulevard, Room 8184 Bethesda, MD 20892-9663 (800) 421-4211 (toll-free) (301) 443-4513 (301) 443-4279 (fax) http://www.nimh.nih.gov E-mail:
[email protected] National Highway Traffic Safety Administration (NHTSA) Transporation Department 400 Seventh Street SW Washington, DC 20590 (202) 366-1836 (202) 366-2106 (fax) http://www.nhtsa.dot.gov
National Institute on Aging (NIA) Building 31, Room 5C27 31 Center Drive, MSC 2292 Bethesda, MD 20892 (301) 496-9265 (301) 496-2525 (fax) http://www.nih.gov/nia
National Institute for Occupational Safety and Health (NIOSH) Centers for Disease Control and Prevention 200 Independence Avenue SW Washington, DC 20201 (202) 401-6997
National Institute on Alcohol Abuse and Alcoholism (NIAAA) 5635 Fishers Lane, MSC 9304 Bethesda, MD 20892-9304 (301) 496-4452 http://www.niaaa.nih.gov
Appendix I 407 National Institute on Disability and Rehabilitation Research (NIDRR) U.S. Department of Education 400 Maryland Avenue SW Washington, DC 20202-2572 (202) 245-7640 (202) 245-7316 (TDD) Web site: none National Institute on Drug Abuse (NIDA) National Institutes of Health 6001 Executive Boulevard, Room 5213 Bethesda, MD 20892-9561 (800) 644-6432 (toll-free) http://www.nida.nih.gov National Institutes of Health (NIH) 31 Center Drive, MSC-0148 Building 1, #126 Bethesda, MD 20892-0148 (301) 496-2433 (301) 402-2700 (fax) http://www.nih.gov National Mental Health Association (NMHA) 2001 North Beauregard Street, 12th Floor Alexandria, VA 22311 (800) 969-6642 (toll-free) (703) 684-7722 (703) 684-5968 (fax) http://www.nmha.org E-mail:
[email protected] National Oceanic and Atmospheric Administration (NOAA) U.S. Department of Commerce 14th Street and Constitution Avenue NW, Room 6217 Washington, DC 20230 (202) 482-6090 (202) 482-3154 (fax) http://www.noaa.gov National Safety Council (NSC) 1121 Spring Lake Drive Itasca, IL 60143-3201 (800) 621-7619 (toll-free) (630) 285-1121 (630) 285-1315 (fax) http://www.nsc.org National Self-Help Clearinghouse (NSHC) 365 Fifth Avenue, Suite 3300 New York, NY 10016 (212) 817-1822
(212) 817-2990 (fax) http://www.selfhelpweb.org National Sleep Foundation 1522 K Street NW, Suite 500 Washington, DC 20005 (202) 347-3471 (202) 347-3472 (fax) http://www.sleepfoundation.org Obsessive Compulsive Foundation (OCF) 676 State Street New Haven, CT 06511 (203) 401-2070 (203) 401-2076 (fax) http://ocfoundation.org Occupational Safety and Health Administration (OSHA) 200 Constitution Avenue NW Washington, DC 20210 (202) 693-1900 (202) 693-2106 (fax) http://www.osha.gov Office of Minority Health (OMH) Public Health Service U.S. Department of Health and Human Services P.O. Box 37337 Washington, D.C. 20013-7337 (800) 444-6472 (toll-free) (301) 443-5084 (301) 251-2160 (fax) http://www.omhrc.gov/omhrc/ Office of Smoking and Health (OSH) Centers for Disease Control and Prevention Mailstop K-50 4770 Buford Highway NE Atlanta, GA 30341-3724 (800) CDC-1311 (toll-free) (770) 488-5705 (770) 488-5939 (fax) http://cdc.gov/tobacco Office of the Americans with Disabilities Act (OADA) U.S. Department of Justice 950 Pennsylvania Avenue NW Civil Rights Division Disability Rights Section - NYAV Washington, DC 20025-6118
408 The Encyclopedia of Stress and Stress-Related Diseases (202) 514-0301 (202) 514-0383 (TDD) http://www.usdoj.gov/crt/ada/adahoml.htm President’s Committee on Employment of People with Disabilities 1331 F Street NW, 3rd Floor Washington, DC 20004 (202) 376-6200 (202) 376-6205 (TDD) Project Inform (PI) National HIV Treatment Line 205 13th Street 2001 San Francisco, CA 94103 (800) 822-7422 (415) 558-0684 (fax) http://www.projinf.org The Psychonomic Society 1710 Fortview Road Austin, TX 78704 (512) 462-2442 (512) 462-1101 (fax) http://www.psychonomic.org Recovery, Inc. 802 North Dearborn Street Chicago, IL 60610 (312) 337-5661 (312) 337-5756 (fax) http://www.recovery-inc.com Registry of Toxic Effects of Chemical Substances (RETECS) National Institute of Occupational Safety & Health 4676 Columbia Parkway Cincinnati, OH 45226 (800) 356-4674 http://www.cdc.gov/niosh/rtecs/default.html Rehabilitation Services Administration (RSA) U.S. Department of Education Mary E. Switzer Building, Room 3028 330 C Street SW Washington, DC 20202-2531 (202) 732-1282 Self-Help for Hard of Hearing People (SHHH) 7910 Woodmont Avenue, Suite 1200 Bethesda, MD 20814 (301) 657-2248 (301) 657-2249 (301) 913-9413 (fax) http://www.shhh.org
Skin Cancer Foundation (SCF) 245 5th Avenue, Suite 1403 New York, NY 10016 (800) SKI-N490 (toll-free) (212) 725-5751 (fax) http://www.skincancer.org Social Security Administration (SSA) Office of Disability, Room 545 Altimeyer Building 6401 Security Boulevard Baltimore, MD 21235 (301) 965-3424 http://www.ssa.gov/disability Society for Chemical Hazard Communication (SCHC) P.O. Box 1392 Annandale, VA 22003-9392 (703) 658-9246 (703) 658-9247 (fax) http://www.schc.org Society of Environmental Toxicology and Chemistry (SETAC) 1010 North 12th Avenue Pensacola, FL 32501-3367 (888) 899-2088 (toll-free) (850) 469-1500 (850) 469-9778 (fax) http://www.setac.org Society of Fire Protection Engineers (SFPE) 7315 Wisconsin Avenue, Suite 1225W Bethesda, MD 20814 (301) 718-2910 (301) 718-2242 (fax) http://www.sfpe.org Special Interest Group on Phobias and Related Anxiety Disorders (SIGPRAD) c/o Carol Lindemann, Ph.D. 245 East 87th Street New York, NY 10128 (212) 860-5560 http://www.cyberpsych.org/anxsig.htm Stress and Anxiety Research Society (STAR) Anxiety, Stress, and Coping Krys Kaniasty, Editor Department of Psychology Indiana University of Pennsylvania Indiana, PA 15705 (724) 357-5579 (724) 357-2214
Appendix I 409 Stress and Anxiety Research Society Conference Office Universiteit van Amsterdam P.O. Box 19268 1000 GG Amsterdam + 31 (0)20 525 4791 (phone) + 31 (0)20 525 4799 (fax) E-mail:
[email protected] Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services P.O. Box 42557 Washington, DC 20015 (800) 789-2647 (toll-free) (301) 443-2792 http://mentalhealth.samhsa.gov U.S. Nuclear Regulatory Commission (NRC) 11555 Rockville Pike, MSO16C1 Rockville, MD 20852 (301) 415-1759 (301) 415-1757 (fax) http://www.nrc.gov
U.S. Veterans Administration (USVA) Mental Health and Behavioral Sciences Services 810 Vermont Avenue NW, Room 915 Washington, DC 20410 (202) 389-3416 Volunteer Management Associates (VMA) 320 South Cedar Brook Road Boulder, CO 80304-0468 (800) 944-1470 (toll-free) (720) 304-3637 (720) 304-3638 (fax) http://www.volunteermanagement.com Wellness Councils of America (WELCOA) 9802 Nicholas Street, Suite 315 Omaha, NE 68114 (402) 827-3590 (402) 827-3594 (fax) http://www.welcoa.org E-mail:
[email protected] BIBLIOGRAPHY Roleff, Tamara L., ed. AIDS: Opposing Viewpoints. Farmington Hills, Mich.: Greenhaven Press, 2003. Siplon, Patricia D. AIDS and the Policy Struggle in the United States. Washington, D.C.: Georgetown University Press, 2002. White, Katherine G. Everything You Need to Know about AIDS and HIV. New York: Rosen Pub. Group, 2001.
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Alexandrova, Anna (ed.) AIDS, Drugs, and Society. New York: International Debate Education Association, 2002. Banish, Roslyn. Focus on Living: Portraits of Americans with HIV and AIDS. Amherst: University of Massachusetts Press, 2003. Clambrone, Desiree. Women’s Experiences with HIV/AIDS: Mending Fractured Selves. New York: Haworth Press, 2003. Gedatus, Gustav Mark. HIV and AIDS. Mankato, Minn.: Lifematters, 2000. Gifford, Allen. Living Well with HIV and AIDS. Palo Alto, Calif.: Bull Publishers, 2000. Goosby, Eric. Living with HIV/AIDS: The Black Person’s Guide to Survival. Roscoe, Ill.: Hilton Pub. Co., 2004. Guest, Emma. Children of AIDS: Africa’s Orphan Crisis. London: Sterling, Va.: Pluto Press, 2003. Holmes, Wendy. Protecting the Future: HIV Prevention, Care and Support among Displaced and War-Affected Populations. Bloomfield, Conn.: Kumarian Press, 2003. Jasper, Margaret C. AIDS Law. Dobbs Ferry, N.Y.: Oceana Publications, 2000. Jenkins, Mark. HIV/AIDS: Practical Medical, and Spiritual Guidelines for Daily Living When You’re HIV-Positive. Center City, Minn.: Hazelden Information & Educational Services, 2000. Null, Gary. AIDS: A Second Opinion. New York: Seven Stories Press, 2002. Peterson, Paula W. Penitent, with Roses: An HIV+ Mother Reflects. Hanover, N.H.: Middlebury College Press, published by University Press of New England, 2001.
ADDICTIONS (See also ALCOHOLISM; EATING DISORDERS; SMOKING) Chopra, Deepak. Overcoming Addictions: The Spiritual Solution. New York: Harmony Books, 1997. Dodes, Lance M. The Heart of Addiction. New York: HarperCollins, 2002. Gerdes, Louise I., ed. Addiction: Opposing Viewpoints. San Diego: Greenhaven Press, 2005. Hodgson, Barbara. In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines. Buffalo, N.Y.: Firefly Books, 2001. Knauer, Sandy. Recovering from Sexual Abuse, Addictions, and Compulsive Behaviors: “Numb” Survivors. New York: Haworth Social Work Practice Press, 2002. Pawlowski, Cheryl. Glued to the Tube: The Threat of Television Addiction to Today’s Family. Naperville, Ill.: Sourcebooks, 2000. White, Robert K., and Deborah George Wright, eds. Addiction Intervention: Strategies to Motivate. New York: Haworth Press, 1998. Young, Kimberly S. Caught in the Net: How to Recognize the Signs of Internet Addiction and a Winning Strategy for Recovery. New York: J. Wiley, 1998.
410
Bibliography 411 AFFECTIVE DISORDERS (See DEPRESSION)
BIPOLAR DISORDER,
AIR TRAVEL Beyer, Mark. Sky Marshals. New York: Children’s Press, 2003. Bogosian, Mark H., et al. Never Again: A Self-Defense Guide for the Flying Public. Dallas: Brown Books, 2004. Steward, Frank A. The Plane Truth: Shift Happens at 35,000 Feet. Manassas Park, Va.: Impact Publications, 2004.
ALCOHOLISM Carson-DeWitt, Rosalyn, ed. Encyclopedia of Drugs, Alcohol & Addictive Behavior. New York: Macmillan Reference USA, 2001. Cotter, Bruce. When They Won’t Quit: A Call to Action for Families, Friends and Employers of Alcohol and Drug-addicted People. Hunt Valley, Md.: Holly Hill, 2002. Ketchum, Katherine, and William F. Asbury. Beyond the Influence: Understanding and Defeating Alcoholism. New York: Bantam Books, 2000. Marshall, Shelly. Young, Sober & Free: Experience, Strength, and Hope for Young Adults. Center City, Minn.: Hazelden, 2003. O’Brien, Robert. Encyclopedia of Understanding Alcohol and Other Drugs. New York: Facts On File, 1999. Rotskoff, Lori. Love on the Rocks: Men, Women, and Alcohol in Post-World War II America. Chapel Hill: University of North Carolina Press, 2002. Torr, James D., ed. Alcoholism. San Diego: Greenhaven Press, 2000. Walton, Stuart. Out of It: A Cultural History of Intoxication. New York: Harmony Books, 2002.
ALTERNATIVE MEDICINE Facklam, Howard. Alternative Medicine: Cures or Myths? New York: Twenty-First-Century Books, 1996. Gordon, James S. Manifesto for a New Medicine: Your Guide to Healing Partnerships and Wise Use of Alternative Therapies. Reading, Ma.: Addison-Wesley Publishing Company, 1996.
Gordon, Rena J., Barbara Cable Nienstedt, and Wilbert M. Gesler. Alternative Therapies: Expanding Options in Health Care. New York: Springer Pub. Co., 1998. Mackenzie, Linda. Inner Insights, the Book of Charts: Alternative Medicine & Awareness Quick Reference Charts. Manhattan Beach, Calif.: Creative Health & Spirit, 1996. Mayo Clinic Health Information. Alternative Medicine and Your Health. Philadelphia, Pa.: Mason Crest Publishers, 2002. Sachs, Judith. Nature’s Prozac: Natural Therapies and Techniques to Rid Yourself of Anxiety, Depression, Panic Attacks & Stress. Englewood Cliffs, N.J.: Prentice Hall, 1997. Scully, Nicki. Alchemical Healing: A Guide to Spiritual, Physical, and Transformational Medicine. Rochester, Vt.: Bear & Company, 2004. Trivieri, Larry and John W. Anderson, eds. Alternative Medicine: The Definitive Guide. Berkeley: Celestial Arts, 2002.
ANGER AND ANGER MANAGEMENT McKay, Gary D., and Steven A. Maybell. Calming the Family Storm: Anger Management for Moms, Dads, and All the Kids. Atascadero, Calif.: Impact Publishers, 2004. Salmansohn, Karen. Burn Your Anger Book: Fill in Your Ire and Set It on Fire. New York: Sourcebooks, Inc., 2001. Schiraldi, Glenn R. Anger Management Sourcebook. New York: McGraw-Hill, 2002. Semmelroth, Carl. Anger Habit Workbook: Proven Principles to Calm the Stormy Mind. Naperville, Ill.: Sourcebooks Inc., 2004.
ANXIETY AND ANXIETY DISORDERS Beckfield, Denise F. Master Your Panic and Take Back Your Life! 3rd ed. Atascadero, Calif.: Impact Publishers, 2004. Bourne, Edmund J. Beyond Anxiety and Phobia: A Step-By-Step Guide to Lifetime Recovery. Oakland, Calif.: New Harbinger Publications, 2001. Dattilio, Frank M., and Jesus A. Salas-Auvert. Panic Disorder: Assessment and Treatment Through a WideAngle Lens. Phoenix, Ariz.: Zeig, Tucker & Co., 2000.
412 The Encyclopedia of Stress and Stress-Related Diseases Doctor, Ronald M., and Ada P. Kahn. The Encyclopedia of Phobias, Fears, and Anxieties, 2nd ed. New York: Facts On File, 2000. Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000. Lark, Susan M. Anxiety & Stress Self-Help Book: Effective Solutions for Nervous Tension, Emotional Distress, Anxiety, and Panic. Berkeley, Calif.: Celestial Arts, 1996. Root, Benjamin A. Understanding Panic and Other Anxiety Disorders. Jackson: University Press of Mississippi, 2000. Strong, Kenneth V. Anxiety Disorders: The Caregivers: Information for Support People, Family, and Friends. New York: SelectBooks, 2003. Trego, Elizabeth, and Judith Trego. The Undercurrents of Anxiety: The Revolutionary Approach to Dealing with and Recovering from: Anxiety, Panic, Agoraphobia and Stress. Kearney, Neb.: Morris Publishing, 1998.
BOREDOM
BACKACHE
CHRONIC FATIGUE SYNDROME
Amir, Mark, and Perry Bonomo. Why Does My Back Hurt So Much?: A Comprehensive Guide to Help You Prevent and Treat Lower Back Pain. New York: ErgAerobics, 2001. Borenstein, David G. Back in Control: Conventional and Complementary Prescription for Eliminating Back Pain. New York: M. Evans, 2001. Fox, Romy. 25 Natural Ways to Relieve Back Pain. Chicago: Keats Pub., 2001. Kostuik, John J., Suzanne M. Jan de Beur, and Simeon Margolis. Back Pain and Osteoporosis. Baltimore: Johns Hopkins Medical Institutions; New York: Medletter Associates, 2003. Reed, Stephen Charles. The Complete Doctor’s Healthy Back Bible: A Practical Manual for Understanding, Preventing, and Treating Back Pain. Toronto: R. Rose, 2004. Sauers, Joan, with Peter Edwards. Quick Fixes for Everyday Back Pain: Tips, Tricks, and Treatments to Stop the Pain. New York: Marlowe & Company, 2004. Swezey, Robert L., and Annette M. Seezey. Good News for Bad Backs. Santa Monica, Calif.: Cequal Pub. Co., 2002.
Berne, Katrina H. Chronic Fatigue Syndrome, Fibromyalgia and Other Invisible Illnesses: The Comprehensive Guide. Alameda, Calif.: Hunter House; Berkeley, Calif.: Publishers Group West, 2002. Forester, Jonathan. Conquering Chronic Fatigue. Ventura, Calif.: Gospel Light, 2003. Patarca-Montero, Roberto. Chronic Fatigue Syndrome and the Body’s Immune Defense System. New York: Haworth Medical Press, 2002. Teitelbaum, Jacob. From Fatigued to Fantastic: A Proven Program to Regain Vibrant Health, Based on a New Scientific Study Showing Effective Treatment for Chronic Fatigue and Fibromyalgia. New York: Avery, 2001.
Leckart, B., and L. G. Weinberger. Up from Boredom, Down from Fear. New York: Richard Matek Publishers, 1980. Rediger, G. L. Lord, Don’t Let Me Be Bored. Philadelphia: Westminster Press, 1986.
BURNOUT Berglas, Steven. Reclaiming the Fire: How Successful People Overcome Burnout. New York: Random House, 2001. Glouberman, Dina. The Joy of Burnout: How the End of the World Can Be a New Beginning. Maui, Hi.: Inner Ocean Pub., 2003. Potter, Beverly. Beating Job Burnout: How to Transform Work Pressure Into Productivity. Berkeley, Calif.: Ronin Publishing, 1994. Stevens, Paul. Beating Job Burnout: How to Turn Your Work Into Your Passion. Lincolnwood, Ill.: NTC Publishing Group, 1995.
COMPLEMENTARY THERAPIES (See MEDICINE)
ALTERNATIVE
CRISIS INTERVENTION Wright, H. Norman. The New Guide to Crisis and Trauma Counseling. Ventura, Calif.: Regal Books, 2003.
Bibliography 413 DEPRESSION/BIPOLAR DISORDER/MANIC DEPRESSION Fawcett, Jan, Nancy Rosenfeld, and Bernard Golden. New Hope for People with Bipolar Disorder. Roseville, Calif.: Prima Publishing, 2000. Kim, Henny H. ed. Depression. San Diego: Greenhaven Press, 1999. Martin, Philip. The Zen Path through Depression. San Francisco: HarperSanFrancisco, 1999. Preston, John. You Can Beat Depression. Atascadero, Calif.: Impact Publishers, 2004. Reichenberg-Ullman, Judyth. Prozac-free: Homeopathic Medications for Depression, Anxiety and Other Mental and Emotional Problems. Rocklin, Calif.: Prima Health, 1999.
DOMESTIC VIOLENCE (See DRUG ABUSE (See also
VIOLENCE)
ADDICTIONS)
Carson-DeWitt, ed. Encyclopedia of Drugs, Alcohol, & Addictive Behavior. New York: Macmillan Reference USA, 2001. Moe, Barbara. Drug Abuse Relapse: Helping Teens to Get Clean Again. New York: Rosen Pub. Group, 2000. Sullen, Jacob. Saying Yes: In Defense of Drug Use. New York: J. P. Tarcher/Putnam, 2003. Torgoff, Martin. Can’t Find My Way Home: America in the Great Stoned Age, 1945–2000. New York: Simon & Schuster, 2004. Walsh, J. Michael, and Steven W. Gust, eds. Workplace Drug Abuse Policy: Considerations and Experience in the Business Community. Rockville, Md.: Office of Workplace Initiatives, National Institute on Drug Abuse, 1989.
EATING DISORDERS Andersen, Arnold E., Leigh Cohn, and Thomas Holbrook. Making Weight: Men’s Conflicts with Food, Weight, Shapes & Appearance. Carlsbad, Calif.: Gurze Books, 2000. Berg, Frances M. Women Afraid to Eat: Breaking Free in Today’s Weight-Obsessed World. Hettinger, N. Dak.: Healthy Weight Network, 2000. Cassell, Dana K., and David H. Gleaves. The Encyclopedia of Obesity and Eating Disorders. New York: Facts On File, 2000.
Kirkpatrick, Jim, and Paul Caldwell. Eating Disorders: Anorexia Nervosa, Bulimia, Binge Eating and Others. Buffalo, N.Y.: Firefly Books, 2001. Rocha, Toni L. Understanding Recovery from Eating Disorders. New York: Rosen Publishing Group, 1999. Schaefer, Jenni, with Thom Rutledge. Life without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too. New York: McGraw-Hill, 2004.
ERGONOMICS (HUMAN ENGINEERING) Chaffen, D. B., and G. B. J. Andersson. Occupational Biomechanics. New York: John Wiley & Sons, 1994. Donkin, Scott W. Sitting on the Job: A Practical Survival Guide to People Who Earn Their Living While Sitting. North Bergen, N.J.: Basic Health Pub., 2002. Grandjean, E. Fitting the Task to the Man: A Textbook of Occupational Ergonomics. New York: Taylor & Francis, 1988.
HEADACHES Finnigan, Jeffrey. Life Beyond Headaches. Olympia, Wa.: Finnigan Clinic, 1999. Hartnell, Agnes. Migraine Headaches and the Foods You Eat: 200 Recipes for Relief. Minneapolis: Chronimed, 1997. Kahn, Ada P. Headaches. Chicago: Contemporary Books, 1983.
HEALTH AND WELL-BEING Groopman, Jerome E. The Anatomy of Hope. New York: Random House, 2004. Myss, Caroline. Anatomy of the Spirit: The Seven Stages of Power and Healing. New York: Harmony Books, 1996. ———. Sacred Contracts: Awakening Your Divine Potential. New York: Harmony Books, 2001.
MENOPAUSE Kagan, Leslee, Bruce Kessel, and Herbert Benson. Mind over Menopause: The Complete Mind/Body Approach to Coping with Menopause. New York: Free Press, 2004.
414 The Encyclopedia of Stress and Stress-Related Diseases OBSESSIVE-COMPULSIVE DISORDER
PHOBIAS
DeSilva, Padmal. Obsessive-Compulsive Disorder: The Facts. Oxford; New York: Oxford University Press, 1998. Gravitz, Herbert L. Obsessive Compulsive Disorder: New Help for the Family. Santa Barbara, Calif.: Healing Visions Press, 1998.
Doctor, Ronald M., and Ada P. Kahn. Encyclopedia of Phobias, Fears, and Anxieties, 2nd ed. New York: Facts On File, 2000. Kahn, Ada P., and Ronald M. Doctor. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Checkmark Books, 2000. Monroe, Judy. Phobias: Everything You Wanted to Know, but Were Afraid to Ask. Springfield, N.J.: Enslow Publishers, 1996.
OCCUPATIONAL STRESS Adams, John D. “Creating and Maintaining Comprehensive Stress-Management Training” in Stress Management in Workplace Settings. New York: Praeger Publishers, 1980, 89–91. Clay, Rebecca A. “Job Stress Claims Spin out of Control.” American Psychological Association Monitor 29, no. 7, (July 1998): 52–55. DeMarco, Tom. Slack: Getting Past Burnout, Busywork, and the Myth of Total Efficiency. New York: Broadway Books, 2001. Donatelle, R. J., and M. J. Hawkins. “Employee Stress Claims: Increasing Implications for Health Promotion Programs.” American Journal of Health Promotion (1989): 19–25. Fraser, Jill Andresky. White-Collar Sweatshop: The Deterioration of Work and Its Rewards in Corporate America. New York: Norton, 2001. Grappel, Jack L. The Corporate Athlete: How to Achieve Maximal Performance in Business and Life. New York: Wiley, 2000. Lazear, Jonathon. The Man Who Mistook His Job for His Life. New York: Crown Publishers, 2001. Lewis, Gerald W., and Nancy C. Zare. Workplace Hostility: Myth & Reality. Philadelphia: Accelerated Development, 1999.
PANIC ATTACKS, PANIC DISORDER (See also ANXIETY DISORDERS; PHOBIAS) Beckfield, Denise F. Master Your Panic and Take Back Your Life!, 3rd ed. Atascadero, Calif.: Impact Publishers, 2004.
PERFORMANCE ANXIETY Dunkel, Stuart Edward. The Audition Process: Anxiety Management and Coping Strategies. Stuyvesant, N.Y.: Pendragon Press, 1989. Robert Moss. “Stage Fright Is Actors’ Eternal Nemesis,” New York Times, January 6, 1992, E2.
POST-TRAUMATIC STRESS DISORDER (PTSD) Porterfield, Kay Marie. Straight Talk about Post-Traumatic Stress Disorder: Coping with the Aftermath of Trauma. New York: Facts On File, 1996. Rosen, Marvin. Understanding Post-Traumatic Stress Disorder. Philadelphia: Chelsea House, 2003. Shay, Jonathan. Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner, 2002. Semmelroth, Carl, and Donald E. P. Smith. The Anger Habit: Proven Principles to Calm the Stormy Mind. Naperville, Ill.: Sourcebooks, Inc., 2004.
PSYCHOLOGY, CONTEMPORARY Thich Nhat Hanh. Peace Is Every Step: The Path of Mindfulness in Everyday Life. New York: Bantam Books, 1992.
RELAXATION Benson, Herbert. The Relaxation Response. New York: Avon Books, 1975. ———. Beyond the Relaxation Response. New York: Berkeley Press, 1985. ———. Your Maximum Mind. New York: Times Books, 1987. Benson, Herbert, Eileen M. Stuart, and staff of the Mind/Body Medical Institute. The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. New York: Carol, 1992.
SMOKING (See also
TOBACCO)
Hirschfelder, Arlene B. Encyclopedia of Smoking and Tobacco. Phoenix, Ariz.: Oryx Press, 1999.
Bibliography 415 SOCIAL ANXIETIES AND PHOBIAS (See also PHOBIAS) Antony, Martin M. The Shyness & Social Anxiety Workbook: Proven Techniques for Overcoming Your Fears. Oakland: New Harbinger, 2000. Markway, Barbara G. Dying of Embarrassment: Help for Society Anxiety and Phobia. Oakland: New Harbinger Publications, 1992. Dayhoff, Signe A. Diagnonally Parked in a Parallel Universe: Working through Social Anxiety. Placitas, N. Mex.: Effectiveness-Plus Publications, 2000.
STRESS AND STRESS MANAGEMENT Adams, John D. “Creating and Maintaining Comprehensive Stress-Management Training” in Stress Management in Workplace Settings. Praeger Publishers, New York: 1989, 89–91. Boenisch, Ed, and C. Michele Haney. The Stress Owner’s Manual: Meaning, Balance and Health in Your Life, 2nd ed. Atascadero, Calif.: Impact Publishers, 2004. Evans, Karin. “Is Stress Wrecking Your Mood?” Health 14, no. 3 (April 2000): 119–124. Gonthier, Giovinella, and Kevin Morrissey. Rude Awakenings: Overcoming the Civility Crisis in the Workplace. Chicago: Dearborn Trade, 2002. Kahn, Ada P. The A-Z of Stress: A Sourcebook for Facing Everyday Challenges. New York: Facts On File, 2000. Lehrer, Paul M., and Robert L. Woolfolk, (eds.) Principles and Practice of Stress Management, 2nd ed. New York: Guilford Press, 1993. Sapolsky, Robert M. Why Zebras Don’t Get Ulcers. New York: W. H. Freeman & Company, 1994. Van Duyne, Sara. Stress and Anxiety-Related Disorders. Berkeley Heights, N.J.: Enslow, 2003.
VIOLENCE Allcorn, Seth. Anger in the Workplace. Westport, Conn. Quorum Books, 1994. Blythe, Bruce T. Blindsided: A Manager’s Guide to Catastrophic Incidents in the Workplace. New York: Portfolio, 2000. Carll, Elizabeth K. Violence in Our Lives: Impact on Workplace, Home, and Community. Boston, Mass.: Allyn and Bacon, 1999. Kelleher, Michael D. Profiling the Lethal Employee: Case Studies of Violence in the Workplace. Westport, Conn.: Praeger, 1997. Paulk, Daniel. Alert and Alive: Defusing Anger and Violence in the Workplace. West Des Moines, Iowa: American Media, 1999. Remsberg, Charles. Tactics for Criminal Patrol: Vehicle Stops, Drug Discovery and Officer Survival. Northbrook, Ill.: Calibre Press, 2000. Smith, Shawn T. Surviving Aggressive People: Practical Violence Prevention Skills for the Workplace and the Street. Boulder: Sentient Publications, 2003.
WOMEN AND STRESS
TOBACCO
Freudenberger, Herbert, and Gail North. Women’s Burnout: How to Spot It, How to Reverse It, and How to Prevent It. Garden City, N.Y.: Doubleday & Company, Inc., 1985. Kahn, Ada P. “Women and Stress,” Sacramento Medicine 46, no. 9 (September 1995): 16–17. Powell, J. Robin. The Working Woman’s Guide to Managing Stress. Englewood Cliffs, N.J.: Prentice Hall, 1994. Siress, Ruth Hermann. Working Women’s Communications Survival Guide: How to Present Your Ideas with Impact, Clarity, and Power and Get the Recognition You Deserve. Englewood Cliffs, N.J.: Prentice Hall, 1994.
Lovell, Georgina. You Are the Target: Big Tobacco: Lies, Scams—Now the Truth. Vancouver: Chryan Communications, 2002.
WORKPLACE STRESS (See
OCCUPATIONAL STRESS)
INDEX Note: Page numbers in boldface indicate main entries. A AA. See Alcoholics Anonymous AAD. See American Academy of Dermatology AAMA. See American Academy of Medical Acupuncture AAMI. See age-associated memory impairment AARP. See American Association of Retired Persons ABA. See American Bar Association abdominal (diaphragmatic) breathing 73, 74 abortion 1, 292, 373, 388. See also miscarriage absenteeism 2, 76, 291, 392 abuse 79, 110, 114. See also domestic violence ACA. See American Chiropractic Association accidents 2. See also injuries Chernobyl 82–83 of child workers 84, 360 falling merchandise as 146–147 farming and 149 personal protective equipment for prevention of 152, 216, 267, 275 slips, trips, and falls 16, 85, 152, 284, 313, 336, 358, 387 accountants 2–3, 390 acculturation 3–4, 240–241. See also homesickness Accutane 5 ACE inhibitors 183 acid rain 21, 22 acne 4–5 acquired immunodeficiency syndrome (AIDS) 5–7. See also human immunodeficiency virus medicinal marijuana use in 230 reference service on 20 statistics on 5–6, 194 transmission of 6, 99, 174, 178, 194, 195, 217, 329
ACR. See American College of Radiology acrophobia 7, 178 ACS. See American Cancer Society ACSM. See American College of Sports Medicine ACTIS. See AIDS Clinical Trials Information Service acupressure 7, 69, 173, 233 acupuncture 8–9, 69, 81, 142, 173, 264 ADA. See Americans with Disabilities Act adaptability 159 Adaptation to Life (Valliant) 102 addiction 9–10. See also alcoholism and alcohol dependence; smoking; substance abuse acupuncture for 8 to barbiturates 58 and codependence 93 eating disorders as 133, 134 endorphins and 142 gambling as 157–158 to hallucinogens 167 hopelessness and 189 journaling for 211 to marijuana 229–230 to methamphetamines 91–92 recognizing 9 severity index of 10 adenosine 77 ADHD. See attention-deficit/hyperactivity disorder adolescents 299–300. See also peer group acne in 4–5 angry 34 binge drinking 62–64 chronic fatigue syndrome in 87 dating 109 depression in 120 developing autonomy 52 HIV/AIDS in 6, 7 irritable bowel syndrome in 208 lonely 223, 224 masturbation in 234 menstruation in 238 methamphetamine use in 91–92 migraine in 171, 172
417
obese 259 occupational injuries of 84 parenting 299–300, 345 personality disorders in 274 pregnant 289 shy 331 suicide in 120, 351–352 thyroid cancer in 82 wet dreams of 383–384 in workplace 84, 360, 380 Adopting Your Child (Reynolds) 10 adoption 10, 118, 373 adrenaline (epinephrine) 10–11, 34, 143, 145, 150, 184, 356 advance directives 113–114, 136 advertising 11, 63–64, 143, 272 AED (automated external defibrillator). See defibrillators affective disorders 11–13. See also specific disorders affective equivalents. See masked depression affirmation 78 African Americans 6, 25, 293, 352, 393 after-school programs 270 age-associated memory impairment (AAMI) 31, 236 age discrimination 14 Ageless Body, Timeless Mind (Chopra) 86, 87 Agent Orange 14 aggression 14–15, 25, 75, 128, 131. See also anger; hostility aging 15–16. See also elderly; retirement and Alzheimer’s disease 31 and deafness 111 and employment 14, 81 and forgetting 154 and hair loss 166 and infertility 204 and memory 31, 236 and midlife crisis 240 and osteoarthritis 42 overtime and 265 premature 345 and sex drive 326 and sleep 334
418 The Encyclopedia of Stress and Stress-Related Diseases agoraphobia 17–20, 24, 37, 268, 269, 282, 318, 333, 340, 357, 393 AHP. See Association of Humanistic Psychology AIDS. See acquired immunodeficiency syndrome AIDS Clinical Trials Information Service (ACTIS) 20 AIDSinfo 20 air conditioning 91, 332 airplanes 20–21 avian flu precautions 54 jet lag 65, 90, 210 and motion sickness 248 phobia about 20, 21, 101, 178, 281 and security 21, 22–23 stun guns on 359 and terrorism 21 air pollution 21–22, 90–91, 142, 155, 245, 332 airport screening machines 21, 22–23. See also terrorism alcohol as antistress drug 277 and barbiturates 58 and benzodiazepines 62 as coping mechanism 36 and depression 118 and dizziness 127 effects of 25 for fear of flying 21 and hangover 168 and high blood pressure 183 and insomnia 206 and methamphetamines 91 and panic disorder 269 physical tolerance for 24 Alcoholics Anonymous (AA) 25–26, 140 alcoholism and alcohol dependence 23–26 acupuncture for 8 in agoraphobia 17, 19, 24 in anxiety disorders 40 and appetite 258 aversion therapy for 52, 61 behavior therapy for 59 binge drinking 24, 62–64 causes of 23–24 in chronic illness 89 and codependence 93 definition of 24 denial of 114 as disease 25 and domestic violence 127, 128 in dysfunctional families 131 in gamblers 158 in grief 163 in homeless 186
in immigrants 3 journaling for 211 loneliness and 223 as public health problem 24–25 self-help groups for 25–26 statistics on 24, 25 symptoms and stages of 25 Alexander, F. Matthias 26 Alexander technique 26–27 allergic alveolitis. See hypersensitivity pneumonitis allergic contact dermatitis 27 allergic rhinitis 27, 156, 169, 245 allergic sinusitis 169 allergies 27–28, 79, 82, 121, 159, 164, 184, 201, 284, 291. See also asthma Alpern, Lynne 196–197 alpha blockers 39, 183 alprazolam (Xanax) 21, 28, 62, 269, 279, 395 alternative medicine 28–31, 187, 346. See also specific therapies for addiction 9 for arthritis 42–43 for breast cancer 72 v. conventional medicine 29 for headaches 173 health insurers and 30 for menopause 237 selecting 30 statistics on 28–29 altophobia 178 Alzheimer, Alois 31 Alzheimer’s Association 32 Alzheimer’s disease 16, 31–33 and caregivers 31, 32, 147 diagnosis of 31–32 fear of developing 235 and immune system 201 statistics on 31 support groups for 32, 355 symptoms of 31 Alzheimer’s Disease and Related Disorders Association 32 Alzheimer’s Disease International 32 AMA. See American Management Association; American Medical Association A Matter of Degree (AMOD) 62–63 ambient inhalation (aromatherapy) 41 ambivalence 33 amenorrhea 238 American Academy of Allergy and Immunology 27 American Academy of Dermatology (AAD) 353 American Academy of Medical Acupuncture (AAMA) 9 American Academy of Orthopedics 216
American Animal Hospital Association 276 American Association of Retired Persons (AARP) 15, 80, 142, 341, 352 American Bar Association (ABA) 25, 142 American Board of Plastic Surgery 102 American Cancer Society (ACS) 227 American Chiropractic Association (ACA) 85 American College of Radiology (ACR) 227 American College of Sports Medicine (ACSM) 182 American Council of Life Insurers 224 American Dental Association 115 American Diabetes Association 122 American Foundation for Homeopathy 187 American Heart Association 86, 176, 385 American Industrial Hygiene Association 203 American Institute of Stress 78 American Lung Association 43 American Management Association (AMA) 130 American Massage Therapy Association (AMTA) 232, 233 American Medical Association (AMA) 25, 62, 63, 141, 142, 187, 227, 320–321, 379 American Psychiatric Association 40, 246, 262, 295. See also Diagnostic and Statistical Manual American Social Health Association 181 American Society for Bariatric Surgery 260 American Society of Plastic and Reconstructive Surgeons 72, 102 American Society of Suicidology 352 Americans with Disabilities Act of 1990 (ADA) 33, 80 American Urinary Association 348 amnesia 236 Amnesty International Canada 359 AMOD. See A Matter of Degree ANAD. See National Association of Anorexia Nervosa and Associated Disorders analytical play therapy. See play therapy Anatomy of an Illness as Perceived by the Patient (Cousins) 103, 197, 217 anger 33–35. See also aggression; hostility alcohol and 25 approaching death and 112 breast cancer and 72 in chronic illness 89 control and 34, 101 divorce and 126 downsizing and 130
Index 419 in grief 35 negative 34 and physiological changes 34 positive 34 repressed 34 angina pectoris 35 angioedema 27, 184 angiotensin-converting enzyme (ACE) inhibitors 183 ankylosing spondylitis 103, 197 anniversary reaction 35 anorexia nervosa 68, 133, 204, 238, 258, 382 anorgasmia 35, 155, 327 anthrax 35, 208 antianxiety drugs 13, 36, 38–40, 277, 280, 282. See also specific drugs antibodies 197, 201 anticipatory anxiety 20–21, 39 anticonvulsants 39, 62, 119 antidepressants 13, 117, 119–120, 277–280. See also specific drugs for anxiety disorders 38 for bed-wetting 58 for chronic fatigue syndrome 88 in elderly 16 historical development of 278 for manic-depressive disorder 229 mechanisms of 277–278, 325 for panic disorder 269 for post-traumatic stress disorder 286 side effects of 117, 119–120 and teen suicide 120 antigens 197 antihistamines 39 anti-inflammatory drugs 46–47 antipsychotic drugs 39–40, 229 anxiety 36 airplanes and 20–21 in anorexia nervosa 133 anticipatory 20–21, 39 biofeedback for 65 causes of 36 coping with 36 domestic violence and 127 in elderly 15, 311 v. fear 36 hypnosis for 198 and immune system 201 and irritable bowel syndrome 208 mathematics 234 music for 250–251 performance 39, 73, 76, 273–274. See also public speaking; stage fright rape and 303 research on 348
separation 323–324 witnessing crime and 106 anxiety disorders 36–41. See also specific disorders causes of 37 cognitive therapy for 94 diagnosis of 37 hostility in 192 secrets and 319 social costs of 40 support groups for 40, 321 treatment of 37–40, 59. See also antianxiety drugs anxiolytics 39 ARI. See Autism Research Institute aromatherapy 41–42 Arrhenius, Svante 161 arrhythmia 42, 267–268 arthritis 42–43, 162, 291, 297, 360 Artress, Lauren 215 asbestos 22, 43–44, 152, 284 asbestosis 22, 44 Asian Americans 25, 372 Asperger, Hans 44 Asperger’s syndrome (AS) 44–45 aspirin 162, 172, 176, 272 assertive behavior 45, 97, 386 assertiveness training 34, 45 assisted reproduction techniques 204–205, 290 assisted suicide 113, 141, 352–353 Association of Humanistic Psychology (AHP) 195–196 asthma 21, 27, 45–47, 155, 156, 169, 245, 384 atherosclerosis 47, 86, 102, 182, 379 ATIS. See HIV/AIDS Treatment Information Service atonic constipation 100 atopic dermatitis 121 attention-deficit/hyperactivity disorder (ADHD) 47–49, 220 autism 49–50. See also Asperger’s syndrome Autism Research Institute (ARI) 49 autogenic training 50 autohypnosis 198 autoimmune disorders 50, 164. See also specific disorders automated external defibrillator. See defibrillators automated teller machines (ATMs) 50–51 automation in the workplace 51, 81, 98–99, 138, 205, 392 automobiles 51–52, 248, 313, 367, 386–387 autonomy 52, 73, 88, 98, 131, 283. See also control aversion 52
aversion therapy 52, 61 avian flu 52–54 Aviation and Transportation Security Act of 2001 (ATSA) 22 Ayres, A. Jean 323 Ayurveda 54–55, 86 azapirones 39 B baby boomers 56 Bach flower remedies 188 back pain 56–57, 69, 232, 288, 367 Bandura, Albert 319 barbiturate drugs 57–58, 62, 277 Bardwell, Chris B. 274 Barling, Julian 379 Barnes, John 69 Barnett, Rosaline 270 battered women 127–128 battle fatigue. See combat fatigue; war neurosis Beck, Aaron 94 bed-wetting 52, 58–59 behavior therapy 59–61, 296. See also specific therapies for affective disorders 13 for agoraphobia 18 for anxiety disorders 59 for claustrophobia 90 for depression 59, 60, 119 for fear of dentistry 115 goal of 59 for habits 166, 254 for hair pulling 167 for hostility 192 with hypnosis 198 for inhibition 206 meditation in 235 for nausea 253 for obsessive-compulsive disorder 37, 40, 59, 60, 261 for pain 266 for palpitations 268 for panic disorder 269 for phobias 37, 40, 59, 60, 282, 333 for sexual difficulties 59 for stage fright 342 belching 203 Benson, Herbert 61, 241–242, 287–288, 307, 342, 344, 366 benzodiazepine drugs (BZDs) 39, 58, 62, 277. See also Valium; Xanax bereavement. See grief Bereavement of Loss Center 163 Bernard, Claude 188 Berne, Eric 365 beta blockers 39, 100, 183, 280 Beth Israel Hospital 242 bibliotherapy 62, 69, 335
420 The Encyclopedia of Stress and Stress-Related Diseases bicyclic antidepressants 280 binge drinking 24, 62–64. See also alcoholism and alcohol dependence binge eating 133–134, 382 biobehavioral healing 103–104 biofeedback 61, 64–65 for arthritis 42–43 for chronic fatigue syndrome 88 for constipation 101 for diabetes 122 for fear of dentistry 115 for fibromyalgia 151 with galvanic skin response 157 for habits 166 for headaches 65, 173 for high blood pressure 65, 182 with meditation 65, 234–235 for pain 266 for phobias 282 for urinary incontinence 349 biogenic amines 13 biological clock 56, 65, 230, 373 biorhythms 65. See also circadian rhythms bipolar disorder. See manic-depressive disorder bird fancier’s lung 197 “bird flu.” See avian flu Birdwhistell, Ray L. 214 birth control 65–66, 99, 172, 289, 303, 315, 329, 373, 377–378 birth order 66–67, 331 bisexuality 329 black lung 388 bladder training 374–375 Bleuler, Eugen 33 blindness 160–161, 180 bloating 203 blog (Web log) 67 blood pressure 181, 182, 254, 256, 278. See also high blood pressure blood transfusion 178, 383 Bloom, Peter B. 198 BLS. See Bureau of Labor Statistics blue (color) 95 Blumenfeld, Esther 196–197 body image 67–68, 320, 385, 386 breast reconstruction and 72 and cosmetic surgery 102, 284 and dieting 124 and eating disorders 133, 134, 382 exercise and 145 hair loss and 166 and inferiority complex 204 nutrition and 258, 346 body language 44, 68, 97, 214, 218, 222–223 body mass index (BMI) 259 body temperature 89–90
body therapies 68–69. See also mind-body connections; specific therapies books as stress relief 62, 69, 335 borderline depression. See masked depression boredom 15, 69–70, 196, 219, 223, 311, 371 Borysenko, Joan 242 Bostwick, John 72 bovine spongiform encephalopathy. See “mad cow” disease Bowditch, James L. 239–240 brain death 113 brainstorming 70, 105 brainwashing 70–71, 108 breast cancer 71–72, 207, 227–228, 355–356 breast-feeding. See nursing mothers breast reconstruction 72 breath-holding spells 73 breathing 73–74 exercise and 144 in guided imagery 164 inefficient 73–74. See also asthma; emphysema; hyperventilation in meditation 234 sighing 333 during sleep 73, 334, 339 styles of 73 t’ai chi and 358 wheezing 384 in yoga 74 breathing exercises 73, 74 for agoraphobia 18 in autogenic training 50 and coping skills 101 for fear of dentistry 115 for high blood pressure 182 for performance anxiety 274 Brent, David A. 352 Broder, Betsy 200 Brodt, Susan E. 274 bronchodilators 46–47 brothers. See sibling relationships Browne, Richard 250 Brubaker, Linda 348 bruxism 360, 362 Buber, Martin 308 “building-related illness.” See sick building syndrome bulimarexia 134 bulimia 68, 133–134, 382 bullies 74–75, 204, 317, 320, 354 Bullock, Kim D. 26 Bunker, Barbara 231 Buono, Anthony F. 239–240 buproprion 119, 120, 280 bureaucracy 75
Bureau of Labor Statistics (BLS) 84, 154, 224, 257, 262–264, 372, 386, 389 Burke, Jim 361 burnout 3, 75–76, 347, 386 burping 203 buspirone 280 butterflies in the stomach 76 BZDs. See benzodiazepine drugs C caffeine 77, 171, 206, 335, 346, 347, 357 calcium channel blockers 183 camera phones 361 Canadian Family Physician 4, 206, 283 Canadian Psychological Association 292 cancer 78–79. See also specific types of cancer in firefighters and rescue workers 152 guided imagery for 29, 78 hypnosis for 78 meditation for 234 in mining workers 244 psychoneuroimmunology and 297 religion for 308 support groups for 78, 333 Cannon, Walter B. 188 carbon dioxide 22, 161 carbonless copy paper 79 carbon monoxide 21, 142, 338, 367 “carefrontation” 333 caregivers 79–80, 110, 147 to Alzheimer’s patients 31, 32, 147 chronic illness and 88, 345 to elderly 79–80, 135, 136, 186, 224, 256–257, 355, 385 long-term care insurance and 224 research on 344–345 and sick role 333 support groups for 136, 355 Carnoy, David 149–150 Carnoy, Martin 149–150 carpal tunnel syndrome 80–81, 310, 390 Carr, John A. 124 cars. See automobiles Cartwright, Rosalind 334 castor beans 312 catastrophize 81, 119, 319, 394 cats 27, 276 cell phones 361 Census Bureau, U.S. 248–249, 386 Center for the Family 126 Center for the Study and Prevention of Violence (CSPV) 380 Center for the Study of Autism (CSA) 49 Center on Alcohol Marketing and Youth 63–64
Index 421 Centers for Disease Control and Prevention (CDC) on accidents 2 on arthritis 42 on avian flu 53, 54 on fireworks 153 on HIV/AIDS 6, 7, 194 on needlestick injuries 253 on obesity 259 on ricin 312 on sarin 315 on SARS 316–317 on SIDS 350 on teen suicide 120 on unwed mothers 373 on West Nile virus 383 CFS. See chronic fatigue syndrome Challela, Mary S. 124 changing nature of work 81–82. See also mergers Chao, Elaine 143 chemical hazards 82, 169–170, 191, 249, 275, 284, 367 chemotherapy 71, 230, 251, 258 Chernobyl 82–83 chest (thoracic) breathing 73 child abuse 128 by caregivers 79 in day care 110 in dysfunctional families 131 and self-esteem 320 childbirth 83, 180, 288, 348, 374. See also postpartum depression child labor 83–85, 360, 380 Child Labor Coalition (CLC) 84–85 children. See also fathers; mothers; parenting/parents; peer group; school; sibling relationships ADHD in 47–48, 220 adopted 10, 118, 373 advertising aimed at 11, 272 allergies in 27 angry 34, 358 anxiety disorders in 37 Asperger’s syndrome in 44–45 asthma in 45, 46 autistic 49 autonomy developed by 52 bed-wetting in 58–59 birth order of 66–67, 331 breath-holding spells by 73 bullies 74, 75, 204, 317, 320, 354 chronic fatigue syndrome in 87 codependence and 93 colicky 95 colors attracting 95 competition and 98 criticism received by 106–107, 204, 317, 320
in day care 110, 221, 247, 389, 390 death of 163, 165, 338, 350 at dentist 115 depression in 118 diabetic 122 disabled 80, 124–125 divorce and 126 in dysfunctional families 131 emotions of 139 of farmers 149 fireworks-related injuries in 153 frustrated 155, 358 helpless 178 hemophiliac 178 herpes virus in 180 HIV/AIDS in 6–7, 194 homeless 187 homesick 188–189 inferiority complex in 204 jealous 210 “latch key” 247, 270 of lawyers 218 learned optimism in 219 learning disabilities in 219–220 left-handed 220 lice on hair of 221 living with grandparents 271, 373 memory in 235 mental retardation in 220, 239 modeling in 245 and money 246 nail biting in 252 nightmares of 255 obese 259 obsessive-compulsive disorder in 260 pet loss and 276 phobias in 281 play therapy for 284 post-traumatic stress disorder in 287 psoriasis in 294 reading books 69 relocation and 309 remarriage and 309 rheumatoid arthritis in 42 security object of 319 self-object of 321 sensory integrative dysfunction in 322–323 separation anxiety in 323–324 of shift workers 330 shy 331 sleepwalking 335 in stepfamilies 343 stuttering 349 tantrums of 323, 358 thyroid cancer in 82 tics in 364
toilet training of 217, 365 underachievers 371 chiropractic medicine 85 chlamydia 328 cholesterol 47, 85–86, 182, 276 Chopra, Deepak 55, 86–87 chronic fatigue syndrome (CFS) 87–88, 355 chronic illness 88–89. See also specific illnesses and anger 34 and caregivers 88, 345 and depression 88, 117 and immune system 201 music for 250, 251 self-help groups for 321 and sexual fears 327 and sleep 334 and unpaid leave 148 chronic obstructive pulmonary disease (COPD) 234 cigarettes. See smoking circadian rhythms 89–90, 210, 318, 330 civil unions 231 Clark, David 352 Clark, Yolanda 359 classic (Pavlovian) conditioning 99 classic migraine 171 claustrophobia 18, 20, 90, 99, 138, 281 CLC. See Child Labor Coalition Clean Air Act of 1990 90–91 climate 91, 161–162, 318 clinical depression. See exogenous depression clinical psychology 296 closed-angle glaucoma 161 club drugs 91–92 cluster headaches 170–171 COBRA (Consolidated Omnibus Budget Reconciliation Act) 92 cocaine 8, 92–93 codependency 93 cognitive theory of depression 118 cognitive therapy 13, 48, 93–94, 119, 269 cohabitation 94, 329. See also live-in; marriage cold air 46, 184. See also climate cold stress 94–95 Coletti, Linda 154 colic 95 collagen injections 349 colleagues. See coworkers College of Family Physicians of Canada 311–312 Colligan, Douglas 296 color 95 color blindness 95–96 combat fatigue 96, 286. See also posttraumatic stress disorder; war neurosis
422 The Encyclopedia of Stress and Stress-Related Diseases comfort foods 96 commercials. See advertising common migraine 171 communication 97–98. See also body language; listening with blog 67 in conflict resolution 99–100 about divorce 126 in dysfunctional families 131 failure of 97 gender differences in 97–98 “golden rule” of 98 hazard 169–170 laughter as 217 lawyers and 218 in parenting 69 about sexual problems 155 sharing secrets 319 commuter marriage 231 commuting 51 competition 98, 107, 218, 331, 350, 368 complementary medicine. See alternative medicine complete abortion 244 Complete Guide to Your Emotions and to Your Health, The (Padus) 223–224, 376 compulsive behavior 260–261. See also obsessive-compulsive disorder in agoraphobia 18 gambling as 157–158 in lawyers 218 masturbation as 234 and migraine 171 and panic disorder 269 shopping as 331 computerized axial tomography (CT scan) 32, 173 computers 51, 81, 98–99, 138, 205, 310, 341, 390, 392 concentration-type meditation 235 conditioning 99, 281, 282 condoms 6, 99, 194, 315, 328, 378 confined spaces 90, 99, 138, 242, 281, 284, 332 conflict resolution 99–100 congenital syphilis 328–329 congestive heart failure 100 conscience. See guilt Consolidated Omnibus Budget Reconciliation Act. See COBRA constipation 100–101, 179, 208, 288 constructive criticism 107 consumers 11, 143 contact dermatitis 27, 284 contraception. See birth control control 101. See also autonomy airplanes and 20, 21 alcohol and 25 Alzheimer’s disease and 31
anger and 34, 101 behavior therapy and 59 brainstorming and 70 chronic illness and 88 computers and 98 at dentist 115 farming and 148 grief and 163 and hardiness 168–169, 274 and helplessness 219 and hopelessness 189, 190 in hospital 190 hostages and 192 journaling and 211 judicial proceedings and 211 layoffs and 219 menopause and 193 money and 246 music and 251 and panic disorder 269 powerlessness and 287 sick building syndrome and 332 convergent thinking 105 COPD. See chronic obstructive pulmonary disease coping 101–102, 144, 345, 347, 348 in agoraphobia 19 with anxiety 36 Ayurveda and 54 and cancer 78 defense mechanisms in 114 definition of 101 in diabetes 122 with disability 124–125 with domestic violence 127 hair pulling as 167 and health 101–102 and homeostasis 188 laughter for 216 with migration 241 for physicians 283 self-efficacy and 320 self-esteem and 320 support groups for 120 transactional analysis for 365 women 385–386 in workplace 101, 391 Coping with Crisis and Handicap (Carr) 124 Coping with Job Loss (Leana and Feldman) 372 copy paper, carbonless 79 coronary artery disease 35, 47, 86, 102, 176, 182 corporate buyout 102. See also mergers corticosteroids 46, 50, 78, 81, 151, 294 cortisol 118 cortisone 8, 184 cosmetic surgery 102–103, 240. See also plastic surgery
co-therapy 298 counseling 103. See also psychotherapies Cousins, Norman 103–104, 197, 216–217 covert modeling 60, 104 covert rehearsal 104 covert reinforcement 104 covert sensitization 52 coworkers 75, 76, 104–105, 291, 379, 388, 390, 391 crab lice 221 crack cocaine 93 creativity 70, 95, 105–106, 144, 145, 394 “crib death.” See sudden infant death syndrome crime, witnessing 106 criminal complaint 128 crisis 106 criticism 97, 106–107, 109, 204, 281, 317, 336, 394 Crocker, Allen C. 125 crowding 107, 275 cruise ship virus 107 crying 107–108, 223, 224, 288. See also colic CSA. See Center for the Study of Autism CSPV. See Center for the Study and Prevention of Violence CT scan 32, 173 cubicles 108 cults 71, 108 culture shock 241 cumulative trauma disorders (CTD) 143 cyclothymia 12 D Dallman, Mary 96 dance therapy 109 date rape 62, 303–304 dating 109–110, 126, 328, 329 Davis, Lisa 275 day care 110–111, 135, 136, 221, 247, 389, 390 daydreaming 111 day shift. See shift work deadlines 111 deafness 111, 255, 367 death 112–114. See also chronic illness; end-of-life care; grief; suicide advance directives 113–114, 136 from affective disorders 11–12 from AIDS 6 from Alzheimer’s disease 31 anniversary of 35 from binge drinking 62 of child 163, 165, 338, 350 ethical and moral aspects 113, 141 facing one’s own 112 of firefighters and rescue workers 152, 324
Index 423 from heart attack 176 in hospital 113–114, 191 karoshi 213–214 legal aspects 113–114 of loved one 112 of mining workers 242–243 of spouse 112, 163, 305, 344–345. See also widows as taboo topic 357 death certificate 113 Debtors Anonymous 331 decision making 101, 114, 160, 211 “decompression period” 191–192 deep tissue massage 233, 313 Deer, Patricia 233 deer ticks 225 defense mechanisms 114, 159, 163 defibrillators (automated external defibrillator: AED) 114–115 dementia 16, 31 denial 72, 115 of approaching death 112 in chronic illness 89 as defense mechanism 114 and faith healing 146 dentists 115, 157, 251, 255, 276, 360 depersonalization 17 depression 115–121, 228–229. See also antidepressants; dysthymia; manicdepressive disorder; seasonal affective disorder syndrome in adolescents 120 age of onset and incidence of 116 in Alzheimer’s disease 31 anger as 34 anniversary reaction 35 approaching death and 112 back pain and 57 behavior therapy for 59, 60, 119 causes of 13, 117–118 in children 118 chronic fatigue syndrome and 87 chronic illness and 88, 117 cognitive therapy for 94, 119 communication failure and 97 crying in 107–108 death rate in 11 definition of 116 in diabetics 122 domestic violence and 127 double 132 downsizing and 130 in eating disorders 133 in elderly 15, 16, 116–117, 135, 298–299 electroconvulsive therapy for 119, 138 in empty nest syndrome 141 endogenous 117, 145
exogenous 116, 117, 145 genital herpes and 180 glass ceiling and 160 in grief 112, 163 helplessness in 178, 219 holiday 185 in homeless 186 homesickness and 189 homosexuality and 189 hopelessness in 189 in hostages 191 hostility in 192 humor for 197 and immune system 201 and impotence 202 inferiority complex and 204 lack of friends and 154 loneliness and 223, 224 masked 232 menopause and 193 miscarriage and 244 and obsessive-compulsive disorder 261 personality and 13 postpartum 285, 288–289 powerlessness in 287 during pregnancy 285, 288 psychotherapies for 117, 118–119 rape and 303 relocation and 309 secondary 318 secrets and 319 self-help and support groups for 120–121 signs and symptoms of 115, 117 and sleep 130, 206, 334 social phobia and 281 subsyndromal 116 suicide in 11, 115, 120, 350–351 treatment of 13 weekend 382 in women 116, 229 Depression and Related Affective Disorders Association (DRADA) 120–121 depressive episodes 12, 18, 19, 116, 228 depressive equivalents. See masked depression depressive syndrome 12 deprogramming 108 dermatitis 27, 121, 284 desensitization 282. See also exposure therapy; Eye Movement Desensitization and Reprocessing; systematic desensitization DeVryer, Miepje 256 dexamethasone 261 diabetes (diabetes mellitus) 121–123 causes of 122
comfort foods and 96 constipation in 100 diagnosis of 121–122 insulin-dependent 50, 122 meditation for 234 mind-body connection for 242 non-insulin-dependent 122–123 obesity and 122, 259 prevalence of 122 treatment of 122 Diagnostic and Statistical Manual (DSM IV-R) 123 on ADHD 47 on agoraphobia 17 on alcoholism 24 on anxiety disorders 36 on Asperger’s syndrome 44 on panic attacks 268 on phobia 281 on serious mental illness 324 diaphragmatic (abdominal) breathing 73, 74 diarrhea 100, 123–124, 208 diary 211 diastolic pressure 182 diazepam. See Valium Dickread, Grantly 83 diet. See nutrition Dietary Guidelines for Americans 259–260 dieting 124, 133, 259, 346, 382. See also eating disorders DiMario, Francis, Jr. 73 DIMS. See disorders of initiating or maintaining sleep Dinner, Dudley 334 direct conditioning 281, 282 direct exposure 18 disabilities 124–125 and caregiving 80 children with 80, 124–125 and constipation 100 coping with 124–125 deafness 111 depression as 116 in elderly 125 law on rights of people with 33, 80 learning 201, 219–220 and loneliness 223 migraine headaches in 171 self-help and support groups for 125 workers’ compensation for 388 disk damage 57 disorders of excessive sleep (DOES) 334, 335 disorders of initiating or maintaining sleep (DIMS) 334. See also insomnia dissociation 114
424 The Encyclopedia of Stress and Stress-Related Diseases dis-stress 125, 144, 344 diuretics 183 divergent thinking 105 diversity 3–4, 125, 393 divorce 125–126, 231, 306, 328. See also remarriage anniversary of 35 dating after 109, 126 and immune system 201 and loneliness 223 midlife crisis and 240 and parenting 126, 271 relocation and 309 “Divorce: For Better Not For Worse” (Kahn) 126 dizziness 126–127, 168, 178, 197, 248, 253, 268, 273, 286, 300. See also vertigo DOES. See disorders of excessive sleep dogs 276 domestic violence 127–129. See also battered women; child abuse; incest and anxiety 36 dissociation in 114 in dysfunctional families 131 farming and 149 legal rights of victims 128 and self-esteem 127, 320 dopamine 118, 138, 277, 280 Dossey, Larry 129–130, 288 double depression 132 downsizing 14, 102, 104, 130, 211, 218, 219, 240, 291–292, 311, 391. See also layoffs DRADA. See Depression and Related Affective Disorders Association dreams 58, 77, 130–131, 286, 335. See also nightmare; sleep; wet dreams driving 51, 248, 313, 367, 386–387 drug abuse. See also specific drugs acupuncture for 8 in agoraphobia 17 in anxiety disorders 40 in chronic illness 89 as coping mechanism 36 and domestic violence 127, 128 in dysfunctional families 131 in grief 163 and HIV/AIDS 6 in homeless 186 loneliness and 223 and REM sleep 130 drug testing, random 302 DSM IV-R. See Diagnostic and Statistical Manual duodenal ulcer 272, 273 durable power of attorney for health care 113–114 dust mites 46
“dying with dignity” 113–114, 141, 352 dyscalculia 220 dysfunctional family 131 dysgraphia 220 dyslexia 220 dysmenorrhea 238 dysmorphic disorder 68 dyspareunia 131–132, 237, 327 dysphoric mood 246 dysthymia 12, 116, 132 E EAPA. See Employee Assistance Professionals Association EAPs. See Employee Assistance Programs early ejaculation 134 Eastman, Charmaine I. 90 eating disorders 68, 133–134, 204, 238, 258, 382. See also dieting ECaP. See Exceptional Cancer Patients Ecstasy (MDMA) 91 ECT. See electroconvulsive therapy eczema 27, 121 EEG. See electroencephalogram ejaculation 134–135. See also wet dreams ejaculation disorders 134–135, 202, 326, 327 elderly. See also aging; retirement age discrimination against 14 anxiety in 15, 311 caregivers of 79–80, 135, 136, 186, 224, 256–257, 355, 385 climate and 91 constipation in 100 cosmetic surgery in 102, 240 day care for 110, 135, 136, 389 depression in 15, 16, 116–117, 135, 298–299 disabled 125 as fathers 149–150 frustration in 155 geropsychiatry for 298–299 HIV/AIDS in 7 medication-related concerns in 16 mental health of 15–16 in nursing homes 250, 256–257, 276, 304, 380 parents 79–80, 135–136, 141, 206, 315, 345 peptic ulcer in 272 religious 308 sex drive of 326 slips, trips, and falls of 336, 358 stereotypes of 14, 16, 206 suicide in 16, 352 urinary incontinence in 374–375 volunteering 311, 381 West Nile virus in 382 electricity 136–137, 284
electroconvulsive therapy (ECT) 119, 137–138, 229 electroencephalogram (EEG) 32, 113, 335 electronic devices 138 elevated mood 246 elevators 138 ELISA test (enzyme-linked immunosorbent assay) 138–139 Elkin, Allen 185 Ellis, Albert 70 EMDR. See Eye Movement Desensitization and Reprocessing emergency response 138, 139, 203, 324. See also firefighters and rescue workers; police Emotional Health Anonymous 139 emotional release systems 69 emotions 139. See also moods in adolescents 299 ambivalent 33 and bed-wetting 58–59 breast cancer and 72 chronic illness and 88–89 hypothalamus and 199 and migraine 171 music and 250 during pregnancy 288 serotonin and 325 emphysema 139–140. See also lung cancer Employee Assistance Professionals Association (EAPA) 140 Employee Assistance Programs (EAPs) 2, 138, 140–141, 302, 380 Empower Yourself (Kahn and Kimmel) 319 empty nest syndrome 141, 271 “enabler” 93, 269, 333 encephalitis 180, 383 end-of-life care 141–142. See also death endogenous depression 117, 145 endorphins 8, 142, 144, 145, 173, 216, 314 energy balancing systems 69 enuresis. See bed-wetting environment 142. See also allergies air pollution 21–22, 90–91, 142, 155, 245, 332 Chernobyl 82–83 global warming 161–162 GM foods and 159–160 Environmental Protection Agency (EPA) 23, 43, 90–91, 142–143, 170 environmental tobacco smoke (ETS) 22 envy 143, 210, 246 enzyme-linked immunosorbent assay test. See ELISA test Epel, Elissa S. 345
Index 425 epinephrine (adrenaline) 10–11, 34, 143, 145, 150, 184, 356 Equal Employment Opportunity Commission 33, 327 ergonomics 143–144 erythrocyte sedimentation rate (ESR) 43 Esalen 233 essential oils 41–42 estrogen 237, 238 euphoric mood 246 eustress 125, 144, 344, 394 euthanasia 141 euthymic mood 246 evening primrose 88 Everybody’s Guide to Homeopathic Medicines (Cummings and Ullman) 188 Exceptional Cancer Patients (ECaP) 333 exercise 144–145 after heart attack 177 for anger 34 for arthritis 42 and asthma 46 and cholesterol 86 for constipation 100 for elderly 15 and endorphins 142, 144, 145, 314 for fibromyalgia 151 during grief 112 for high blood pressure 182 for hostility 192 and immune system 201 for irritable bowel syndrome 208 for lung power 47 midlife crisis and 240 and miscarriage 244 for stress 345–346, 347 and tachycardia 357 and tendinitis 362 and weight loss 124 exogenous depression 116, 117, 145 exposure therapy 18, 21, 59–60, 282, 319 extrinsic asthma 46 extroversion 207, 332 Eye Movement Desensitization and Reprocessing (EMDR) 145 F Fair and Accurate Credit Transaction Act of 2004 200 faith healing 146, 342. See also mindbody connections; religion falling merchandise 146–147 family 147. See also children; marriage; parenting/parents; sibling relationships of ADHD sufferers 47, 48 aggression in 15. See also domestic violence of agoraphobics 17, 19
of AIDS patients 6 of alcoholics 24 of Alzheimer’s patients 31, 32 of anorexics 133 of asthma sufferers 45 baby boomers and 56 of cancer patients 78 as caregivers 79–80, 147, 224, 256–257 of chronically ill persons 88, 89 of chronic fatigue syndrome sufferers 87–88 of cult recruits 108 death in 112, 113 of depressed persons 115, 116 of diabetics 122 of disabled persons 124–125 dysfunctional 131 envy in 143 farming 148 of gamblers 158 intimacy in 207 of mentally retarded child 239 online communication of 67 of panic disorder sufferers 269 of physicians 283 secrets in 319 of shift workers 330 sick role in 332–333 stepfamilies 309, 310, 343 Family and Medical Leave Act of 1993 (FMLA) 148 family conflicts 345, 346 acculturation and 3 friends and 154 incest and 202 intergenerational 206, 315, 345 relocation and 309 unemployment and 372 family therapy 131, 299 farmer’s lung 197 farming 35, 53, 148–149 fathers 83, 149–150. See also mothers; parenting/parents Fathers of a Certain Age (Carnoy and Carnoy) 149–150 Fathman, Robert 297 fats, saturated 86 FDA. See Food and Drug Administration fear 150. See also phobias of Alzheimer’s disease 235 v. anxiety 36 of dentistry 115 of diseases 199 hypothalamus and 199 of intimacy 207 v. phobia 150 of pregnancy 289 of public lavatories 217, 281
of school 317, 324 sexual 327 of surgery 292 Federal Trade Commission 200 feedback 150, 222–223, 346, 391 feelings. See emotions Feiden, Karyn 355 Feldenkrais, Moshe 68–69 Feldman, Daniel C. 372 Feminine Mystique, The (Friedan) 388 feng shui 150 fiber 100, 208–209 fibromyalgia 151 fight or flight response 143, 150, 151, 199, 344, 346 Final Exit (Humphry) 352 firefighters and rescue workers 151–152, 324 fires 152–153, 367 fireworks 153 fitness. See exercise flatulence 153, 203, 208 Fleck, Carole 200 flexible work hours (flex time) 153–154, 291, 389–390 flooding 19, 59, 60 flower remedies 188 fluoxetine 119, 120, 280 flying. See airplanes FMLA. See Family and Medical Leave Act folk medical beliefs 3, 4, 29–30 follicle stimulating hormone (FSH) 238 food. See nutrition Food and Drug Administration (FDA) on acupuncture 8 on antianxiety drugs 38 on antidepressants 120 on anti-HIV medication 20 on breast cancer 71 on defibrillators 114 on GM foods 160 on herbal medicine 179 on “mad cow” disease 226 on radiation exposure 23 on THG 363–364 on Viagra 202 on Xanax 395 Ford, Norman D. 266 forest fires 152 forgetting 154, 236 Fourier, Jean 161 Freud, Sigmund 34, 178, 195, 295, 321, 336 Frey, William 107 Friedan, Betty 388 friends 143, 154–155, 206–207, 305, 311. See also peer group frigidity 155 frostbite 94
426 The Encyclopedia of Stress and Stress-Related Diseases frustration 143, 155 and anger 33, 34 in children 155, 358 farming and 148–149 glass ceiling and 160 and hostility 192 impotence and 202 perfection and 273 resolutions and 310–311 FSH. See follicle stimulating hormone Fullin, Kevin J. 128 funeral arrangements 112 fungi 155–156, 245 G GAD. See generalized anxiety disorder gagging, hypersensitive 157 Gahrmann, Natalie 265 Gallup poll 71, 154–155, 158, 223 galvanic skin response (GSR) 157 Gamblers Anonymous 158 gambling 157–158 gamete intra-fallopian transfer (GIFT) 205 gamma hydroxybutyrate (GHB) 91 gamma-linolenic acid (GLA) 88 Gareis, Karen 270 G.A.S. See general adaptation syndrome gastric bypass 260 gastric ulcer 272 gastrointestinal problems 16, 112, 163, 164. See also specific problems gender. See also women and ADHD 47 and agoraphobia 17, 18 and alcoholism 25 and alternative medicine use 28–29 and anger 34 and bed-wetting 58 and blood pressure 385 and bullying 75 and communication 97–98 and depression 116 and diabetes 122 and friendships 154–155 and heart attack 176 and HIV/AIDS 6 and homelessness 186 and homicide 379 and infertility 204, 205 and irritable bowel syndrome 208 and laughter 217 and midlife crisis 240 and migraine 171, 172 and overtime 265 and panic disorder 269 and personal space 275 and puberty 299 and remarriage 309
and response to crowding 107 and sleep 334 and smoking 337 gender identity 158 gender role 158–159 Gendlin, Eugene 168 general adaptation syndrome (G.A.S.) 101–102, 144, 159, 303, 322, 344 generalized anxiety disorder (GAD) 36, 38, 39 generation gap 206 genetically modified foods (GM foods) 159–160 genetic factors of agoraphobia 18 of alcoholism 24 of autism 49 of color blindness 95–96 of depression 118 of hemophilia 178 of manic-depressive disorder 228 of migraine 171 of nail biting 252 of obsessive-compulsive disorder 260 of panic disorder 269 of peptic ulcer 272 of personality 274 of rheumatoid arthritis 297 of seasonal affective disorder syndrome 318 genital herpes 180, 328 geropsychiatry 298–299 gestalt therapy 160 GHB. See gamma hydroxybutyrate GIFT. See gamete intra-fallopian transfer GLA. See gamma-linolenic acid glass ceiling 160 glaucoma 160–161 global warming 161–162 GM foods. See genetically modified foods Goeckerman treatment 294 Goff, John 150 “golden rule” of communication 98 Goldstein, Kurt 195 Gondola, Joan C. 145 gonorrhea 328 gout 162–163 grandparents 271, 373 Greeley, Andrew 308 green (color) 95 “greenhouse” effect 161 grief 112, 163–164 anger in 35 another person’s 163–164 crying in 107 guilt in 165 headaches in 112, 163, 171 and immune system 201
insomnia in 163, 206 and loneliness 223 miscarriage and 244, 289–290 overcoming 163 pet loss and 276 SIDS and 350 stages of 163 stillbirth and 343 group therapy 160, 286, 298. See also self-help groups; support groups GSR. See galvanic skin response guided imagery 164–165 for addiction 9 for allergies 27, 164 with biofeedback 65 for cancer 29, 78 for habits 166 for high blood pressure 164, 182 for phobias 282 for worrying 394 Guilford, J. P. 105 guilt 165 about chronic illness 89 about day care 110, 390 homosexuality and 189 learning to stop assuming 219 about masturbation 234 about miscarriage 244, 290 about remarriage 309 survivor 192, 286 witnessing crime and 106 Gulf War Illness 165 guttate psoriasis 294 H habits 166, 198, 254, 260, 310. See also specific habits Hahnemann, Samuel 187, 188 hair loss 166 hair pulling 166, 167 Haizlip, Thomas M. 192 Hakomi 167 hallucinations 69, 163, 167, 171, 189, 191 hallucinogens 167 Handgun-Free America 391 handicap. See disabilities hangover 168 hardiness 168–169, 274 Harris, Thomas A. 365 Harrison, Lee Hecht 254 H.A.R.T. Program, The (Kerman) 369 Hart, Robert W. 339 Hartwell, Tyler D. 302 Harvard Health Letter 358, 375 Harvard Medical School 29, 61, 228, 242, 307, 342 Hathaway, Starke Rosecrans 244 “having it all” 56, 169, 247
Index 427 Hawkes, Catherine 392 hay fever 27, 28, 169 hazard communication (HazCom) 169–170 hazardous and toxic substances 82, 139, 170 headaches 170–173 alternative medicine for 173 biofeedback for 65, 173 caffeine and 77, 171 chiropractic medicine for 85 cluster 170–171 diagnosis of 173 in grief 112, 163, 171 in Gulf War Illness 165 in hangover 168 in inferiority complex 204 meditation for 129, 173 migraine 171–172, 173, 238 prayer for 129 in premenstrual syndrome 238 relaxation for 172, 173 in school phobia 317 secrets and 319 in separation anxiety 324 in sick building syndrome 332 temporomandibular joint 171, 362 tension (muscle contraction) 170 head lice 221 Healer Within, The (Locke and Colligan) 296 Healing from Within (Jaffe) 305 Healing Heart, The: Antidotes to Panic and Helplessness (Cousins) 103, 104 Healing Mind, The (Oyle) 283 healing touch 363 Healing Words (Dossey) 129, 288 Health and Human Services, Department of (HHS) 20, 227, 230, 259–260, 324 health care workers 173–174. See also dentists; physicians and AIDS patients 6, 174 exposure to infectious diseases 174, 191, 253–254 exposure to nitrous oxide 255 getting HIV from 195 home care provided by 186 in hospital 191 hypochondriacs and 199 needlestick injuries in 253–254 sexual harassment of 327–328 Health Communication Standard 169–170 health insurance 30, 92, 113, 174–175, 190, 224, 228, 392 health maintenance organizations (HMOs) 175, 228 health promotion 175, 213, 262, 392 hearing loss 111, 255, 367
heart attack 86, 176–177, 182 death from 176 defibrillators used during 114–115 epinephrine injection during 143 factors of 176 sign of 35 “silent” 176 stresses after 177 symptoms of 176–177 heartburn 177–178, 203, 288 heart failure 93, 100 heart rhythm. See arrhythmia; tachycardia heights 7, 99, 178, 281 Helicobacter pylori 272 helplessness 163, 178, 351 learned 13, 101, 178, 219 psychic 178 Hemlock Society 352 hemophilia 178–179 hemorrhoids 100, 179, 288 Henshaw, Stanley K. 373 hepatitis B virus 174, 328 hepatitis C virus 174 herbal medicine 29–30, 179–180, 187, 253 Herbert, Tracy B. 201 herbicide 14 heroin 8, 93 herpes simplex virus (HSV) 180–181, 328 HHS. See Health and Human Services, Department of hidden depression. See masked depression hierarchy of needs 181, 195 high blood pressure 176, 181–183 biofeedback for 65, 182 cocaine and 93 diagnosis of 181–182 drug treatment for 183 guided imagery for 164, 182 laughter for 216 meditation for 129, 234 music for 251 prayer for 129 relaxation for 61, 182, 307 religion for 308 smoking and 337 t’ai chi for 182, 358 “white coat hypertension” 182, 307 high-density lipoprotein (HDL) cholesterol 86 Hill, J. Edward 62 Hispanic Americans 25, 372, 393 HIV. See human immunodeficiency virus HIV/AIDS Treatment Information Service (ATIS) 20 hives 27, 184 HMO Act of 1973 175 HMOs. See health maintenance organizations
hobbies 184–185, 223, 311, 346 holiday depression 185 holistic medicine 29, 185, 187. See also alternative medicine Holmes, Thomas H. 185, 221 home care 186. See also caregivers homelessness 186–187 homeopathy 187–188 homeostasis 188, 322, 344 homesickness 188–189, 241, 256 homicide 379, 386 homophobia 189 homosexuality 6, 189, 220, 231–232, 329 homosexual panic 189 Hope and Help for Chronic Fatigue Syndrome (Feiden) 355 hopelessness 189–190, 351 hormone replacement therapy 237, 385 hormones 171, 172, 193, 285, 296, 299 hospitalization 190–191. See also health care workers; surgery death during 113–114, 191 domestic violence and 128 of homeless 186 in manic-depressive disorder 229 music during 250, 251 nitrous oxide exposure during 255 hostages 191–192, 363 hostility 135, 192. See also aggression; anger hot flashes 192–194, 237, 334 hotlines 71, 106, 163, 181, 194 HP. See hypersensitivity pneumonitis HSV. See herpes simplex virus human immunodeficiency virus (HIV) 194–195. See also acquired immunodeficiency syndrome ELISA test for diagnosing 138 medications for 20 reference service on 20 statistics on 5–6, 194 transmission of 6, 99, 174, 178, 194, 195, 217, 329 humanistic psychology 195–196 Human Side of Mergers and Acquisitions, The (Buono and Bowditch) 239–240 humming 196 humor 103, 114, 196–197, 201, 216, 347, 386. See also laughter Humor at Work (Blumenfeld and Alpern) 196–197 Humphry, Derek 352 Hunnicutt, David 392 Hurricane Katrina (2005) 372, 381 hyperactivity 47–49, 220 hypermnesia 236 hypersensitive gagging 157 hypersensitivity pneumonitis (HP) 156, 197, 245
428 The Encyclopedia of Stress and Stress-Related Diseases hypersomnia 334 hypertension. See high blood pressure hyperuricemia 162 hyperventilation 18, 74, 127, 197–198, 268 hypnosis (hypnotherapy) 61, 198–199 for cancer 78 for fear of dentistry 115 for fibromyalgia 151 with guided imagery 164 for habits 166, 198 for high blood pressure 182 for memory 198, 236 for pain 198, 266 for phobia about flying 21 hypoallergenic cosmetics 28 hypochondriasis 199, 282 hypomanic episodes 12, 228 hyposophobia 178 hypothalamus 199 hypothermia 94 hypothyroidism 101 hypsiphobia 178 I IBS. See irritable bowel syndrome identity theft 200 illiteracy 200–201 imagery. See also guided imagery for agoraphobia 18–19 for chronic fatigue syndrome 88 in covert modeling 104 in covert rehearsal 104 in covert reinforcement 104 in flooding 60 in modeling 60 in psycho-imagination therapy 295 in systematic desensitization 60 imipramine 58–59, 269, 278 immune system 201–202 adrenaline and 10 climate and 91 communication and 97 deficiency of. See acquired immunodeficiency syndrome; autoimmune disorders; human immunodeficiency virus humor and 196, 201, 216 massage therapy and 233 relationships and 305–306 relaxation and 307 stress and 201 immunization 376–377 I’m OK, You’re OK (Harris) 365 implosive therapy 60 impotence 202, 327 incest 131, 202–203, 343, 357 incomplete abortion 245 indigestion 153, 177, 203, 273
indirect exposure 18 indoor air pollution 22, 142, 155, 245, 332 industrial hygiene 2, 136–137, 153, 203–204, 275 inferiority complex 107, 204, 354 infertility 56, 204–205, 290. See also adoption; pregnancy Information Anxiety (Wurman) 205 information explosion 205 inhalation therapy (aromatherapy) 41 inhaled anthrax 35 inhibited ejaculation 134 inhibition 205–206, 331 injuries 2. See also accidents and back pain 57 chemical 82, 169–170, 191, 249, 275, 284, 367 chiropractic medicine for 85 falling merchandise and 146–147 farming and 149 in firefighters and rescue workers 151–152 fireworks-related 153 in health care workers 173–174, 191, 253–254 ladders and 147, 149, 215–216, 284, 336 and lost work days 224 in mining workers 242–244, 388 muscle relaxants for 249 needlestick 253–254 in nursing home workers 257 overtime and 264 paintball and 267 in plumbers 284 and post-traumatic stress disorder 286 repetitive stress 80–81, 143, 232, 310, 362, 390 rotator cuff 313 survey on 262–264 tendinitis 362 in truck drivers 367 in women 386–387 workers’ compensation for 388 in-laws 247–248 insight-oriented meditation 235 insomnia 206, 335. See also sleep caffeine and 77, 206, 335 in chronic fatigue syndrome 87 in grief 163, 206 in hostages 191 hypnosis for 198 jet lag and 90 witnessing crime and 106 insulin 121 insulin-dependent diabetes 50, 122 intelligence 105
intergenerational conflicts 206, 315, 345 interleukin-6 344–345 International Chiropractors Association 85 International Foundation for Homeopathy 187 International Longevity Center 386 International Psychoanalytical Association 295 Internet 67, 109–110, 207, 341, 360 interpersonal theory of depression 118 intimacy 206–207, 275, 306, 319. See also relationships intraocular pressure (IOP) 161 intrinsic asthma 46 introversion 207, 332, 340 inverse psoriasis 294 in vitro fertilization (IVF) 204–205, 290 irradiated mail 208 “irregularity.” See constipation irritable bowel syndrome (IBS) 100, 123, 208–209 irritable mood 246 isotretinoin 5 “I” statements 97 J Jaffe, Dennis 305 Jauregui, Maritza 291 jealousy 210, 232, 332. See also envy jet lag 65, 90, 210 job change 98, 102, 210, 390–391 job security 14, 210–211, 218, 291–292, 372 Jordan, Susanne 380 journaling 211 Journal of Personal and Social Psychology 168–169 Journal of the American Medical Association, The 3–4, 26, 171, 352 judicial proceedings 211–212, 218 Jung, Carl 204 juvenile-onset diabetes. See insulindependent diabetes juvenile rheumatoid arthritis 42 K Kabat-Zinn, Jon 213 Kahn, Ada P. 126, 319 karoshi 213–214 Kempf’s disease 189 Kennedy, Marilyn Moats 254 Kerman, D. Ariel 369 Kevorkian, Jack 352–353 Kiecolt-Glaser, Janice 345 Kimmel, Sheila 319 kinesics 214 Kleiman, Carol 153, 154 Kloberdanz, Kristin 152
Index 429 Kobasa, Suzanne 168, 274 Kohut, Heinz 321 Krieger, Dolores 363 L labor. See childbirth Labor, Department of 53, 148, 170, 257, 304, 372, 381, 386. See also Bureau of Labor Statistics labyrinth 215 ladders 147, 149, 215–216, 284, 336 La Leche League 258 Lamaze, Fernand 83, 288 Landers, Catherine R. 344 Landsbergis, Paul 264, 265, 366, 389 lasers 216 “latch key” children 247, 270 laughing gas. See nitrous oxide laughter 103, 142, 196, 201, 216–217. See also humor lavatories, public 217, 281 Lawlis, C. Frank 213 lawyers 212, 217–218, 390 layoffs 36, 102, 104, 211, 218–219, 240, 274, 311, 372, 391. See also downsizing LDF. See Lyme Disease Foundation Leana, Carrie R. 372 lean muscle mass 259 learned helplessness 13, 101, 178, 219 learned optimism 219 Learned Optimism (Seligman) 219 learning disabilities 48, 201, 219–220 left-handedness 220 Legionnaires’ disease 332 lesbianism 189, 220–221. See also homosexuality LH. See luteinizing hormone Li, Ting-Kai 24 lice 221 lie detector 225 life change self-rating scale 144, 185, 221–222 life support systems 113 ligament injuries 57, 232 lightning 137, 222 light therapy 318, 354 Link, Nathan 7 listening 97, 218, 222–223, 391 lithium 13, 119, 229, 279 live-in 223, 329. See also cohabitation; marriage living will 113 Locke, Steven 296 loneliness 223–224, 271, 276 long-term care insurance 224 long-term memory 154, 235 loss. See death; grief lost work days 224 Love, Medicine and Miracles (Siegel) 333
low-density lipoprotein (LDL) cholesterol 85–86 Lowry, Fran 372 ludotherapy. See play therapy lump in the throat 225 lung cancer 21, 22, 44, 244, 302, 338. See also emphysema luteinizing hormone (LH) 193, 238 Lutz, Brobson 384 lying 225 Lyme disease 225 Lyme Disease Foundation (LDF) 225 M “mad cow” disease (bovine spongiform encephalopathy) 226–227 Maddi, Salvatore 168 magnetic resonance imaging (MRI) 173 Maher, Kris 360 Maier, Steven 219 major depression. See exogenous depression major depressive episodes 12 major depressive syndrome 12 malingering pain 266 malt worker’s lung 197 mammography 71, 227–228 managed care 228, 390 manic-depressive disorder 228–229 death risk in 11–12 and obsessive-compulsive disorder 261 personality and 13 self-help and support groups for 120–121, 355 treatment of 13, 119, 229, 279 manic episodes 12, 228 Man Who Mistook His Wife for a Hat, The (Sacks) 250 MAOIs. See monoamine oxidase inhibitors March of Dimes 194 marijuana 229–230 marital therapy 230, 326. See also sex therapy marketing 11, 63–64, 143 marriage 230–232. See also cohabitation; dating; divorce; live-in; marital therapy; pregnancy agoraphobic spouse in 17, 19 alternative forms of 231–232 baby boomers and 56 breast reconstruction and 72 codependence in 93 commuter 231 death of spouse 112, 163, 305, 344–345 domestic violence in 127–128 infertility in 204, 205
and in-laws 247–248 jealousy in 210, 232 of lawyers 218 money and 246 open 232 of physicians 283 remarriage 126, 309–310 retirement of spouse 311 “same-sex” 231–232 spouse as caregiver in 79, 147 spouse with chronic fatigue syndrome 88 masked depression 232 Maslach, Christina 76 Maslow, Abraham Harold 181, 195 massage therapy 41, 151, 232–233, 341. See also acupressure; reflexology masturbation 234 material safety data sheets (MSDSs) 170 mathematics anxiety 234 maturity-onset diabetes. See non-insulindependent diabetes Maury, Marguerite 41 May, Rollo 195, 308 McGrath, Chris 391 McKinley, John Charnley 244 MDMA. See Ecstasy Meaning and Medicine (Dossey) 129 Medicare 114, 175 Medicina Musica (Browne) 250 meditation 234–235. See also Transcendental Meditation for addiction 9 in autogenic training 50 with biofeedback 65, 234–235 colors for 95 for constipation 101 and coping skills 101 for headaches 129, 173 for high blood pressure 129, 234 for hostility 192 Kabat-Zinn (Jon) on 213 learning 234–235 and mind-body connections 234–235, 241 for performance anxiety 274 for phobias 282 qi gong 301 t’ai chi as 358 Thich Nhat Hanh on 364 types of 235 melancholia 116 memory 154, 235–236 aging and 31, 236 in Alzheimer’s disease 31 circadian rhythms and 90 in Gulf War Illness 165 hypnosis for 198, 236 poor 154, 235, 236
430 The Encyclopedia of Stress and Stress-Related Diseases menarche 238 menopause 236–237, 238, 385 hot flashes in 192–194, 237, 334 and midlife crisis 240 migraine in 171 sleep difficulties in 334 urinary incontinence in 348, 374 menstruation 237–239 and agoraphobia 18 as biorhythm 65 cessation of. See menopause and migraine 172 as taboo topic 357 mental retardation 220, 239 mergers 14, 102, 130, 211, 218, 219, 239–240, 308, 311 MESA. See Mining Enforcement and Safety Administration mesothelioma 22, 44 methamphetamines 91–92 methylphenidate hydrochloride 48 Michaelson, James 227–228 midlife crisis 240 migraine headaches 171–172, 173, 238 migration 240–241. See also homesickness; moving Millett, Kate 388 mind-body connections 241–242, 344. See also body therapies Ayurveda and 54–55, 86 Dossey (Larry) on 129 guided imagery and 164 holistic medicine and 185 Kabat-Zinn (Jon) on 213 meditation and 234–235, 241 psychoneuroimmunology and 296 qi gong and 301 reading about 62 relaxation and 307 Mind/Body Effect, The (Benson) 61, 241–242 Mind/Body Group 242 Mind/Body Medical Institute 61, 342 mind control. See brainwashing mindfulness 213, 235 Mine Safety and Health Administration (MSHA) 242–243 minimal brain dysfunction 220 Mining Enforcement and Safety Administration (MESA) 243 mining workers 242–244, 388 Minnesota Multiphasic Personality Inventory (MMPI) 244 miscarriage 244–245, 289–290. See also abortion; stillbirth missed depression. See masked depression mobile phones 361 modeling 60, 245 mold 27, 46, 156, 245
money 246, 249, 311–312, 372, 386 monoamine oxidase inhibitors (MAOIs) 38, 117, 119, 278, 279, 280 monogamy 230, 315. See also marriage mood disorders. See affective disorders mood episodes 12 moods 199, 246, 251, 288. See also emotions mood syndrome 12 Moon 246–247 Moos, Rudolf H. 297 Moreno, J. L. 295 mosquitoes 382, 383 mothers 247. See also children; fathers; parenting/parents; pregnancy changing image of 247 in childbirth 83, 180, 288, 348, 374 of child with separation anxiety 324 HIV/AIDS transmitted from 6, 7 lesbian 220 nursing 6, 257–258 phobias in 281 postpartum depression in 285, 288–289 smoking 338 unwed 285, 289, 373 working 110, 169, 247, 257–258, 270, 364–365, 385, 387, 389–390 mothers-in-law 247–248 motion sickness 248. See also vertigo motivated forgetting 236 mourning. See grief Mourning and Melancholia (Freud) 34 movement awareness systems 69 moving 248–249, 308–309 MRI. See magnetic resonance imaging MSDSs. See material safety data sheets MSHA. See Mine Safety and Health Administration mucous colitis. See irritable bowel syndrome mugging 249 Multiple Chemical Sensitivity syndrome 249 muscle contraction (tension) headache 170 muscle relaxants 62, 249, 362, 377 muscle strain 57, 149, 232, 249, 387 music 250–251, 255 Mycobacterium tuberculosis 368 mycotoxins 155–156, 245 myocardial infraction. See heart attack mystic union 366 N NABCO. See National Alliance of Breast Cancer Organizations nail biting 52, 166, 198, 252 NAMT. See National Association for Music Therapy
narcissistic personality 321 narcolepsy 335 NASW. See National Association of Social Workers National Academy of Sciences 245, 368 National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine 8 National Alliance of Breast Cancer Organizations (NABCO) 71 National Association for Music Therapy (NAMT) 250 National Association of Anorexia Nervosa and Associated Disorders (ANAD) 134 National Association of Colleges and Employers 372 National Association of Social Workers (NASW) 340 National Campaign to Prevent Teen Pregnancy (NCPTP) 289 National Cancer Institute 71, 227 National Center for Complementary and Alternative Medicine (NCCAM) 28, 252–253. See also Office of Alternative Medicine National Center for Health Statistics 66, 392 National Center for Infectious Diseases 226, 383 National Center for Post-Traumatic Stress Disorder 286–287 National Center of Homeopathy 187 National Council on Compulsive Gambling 158 National Depressive and ManicDepressive Association 120 National Enuresis Society 59 National Exercise for Life Institute 145 National Fire Protection Association 153 National Gay and Lesbian Task Force 220 National Heart, Lung and Blood Institute 181, 237 National Herpes Information Hotline 181 National Institute of Mental Health 117 National Institute of Occupational Safety and Health (NIOSH) 22, 23, 84, 208, 242–243, 255, 262, 360, 379, 380 National Institute on Aging 374–375 National Institute on Alcohol Abuse and Alcoholism (NIAAA) 24, 62 National Institutes for Health (NIH) 24, 47, 87, 237, 373–374, 377. See also National Center for Complementary and Alternative Medicine; Office of Alternative Medicine National Organization for Women 388 National Safety Council 224 National Stroke Association (NSA) 349 National Survey of Family Growth 66 Native Americans 25, 146, 179
Index 431 natural childbirth 83 naturopathy 253 nausea 168, 171, 176, 198, 203, 230, 248, 253, 286, 288, 317 NCCAM. See National Center for Complementary and Alternative Medicine NCPTP. See National Campaign to Prevent Teen Pregnancy needlestick injuries (NSIs) 253–254 Needlestick Safety and Prevention Act of 2000 253–254 needs, hierarchy of 181, 195 negative anger 34 negative criticism 106–107 negative feedback 150 negative self-talk 321, 322 nervous diarrhea. See irritable bowel syndrome nervous habits 166, 198, 254, 310. See also specific habits networking 254 neurotransmitters 138, 254, 277, 280, 296. See also specific neurotransmitters neurotransmitter theory of depression 118 New Guide to Rational Living, A (Ellis) 70 NIAAA. See National Institute on Alcohol Abuse and Alcoholism nicotine. See smoking nightmare 254–255, 286, 335 night shift. See shift work nighttime alarm system 58–59 NIH. See National Institutes for Health 9/11. See September 11, 2001 NIOSH. See National Institute of Occupational Safety and Health Nishi, Dennis 361 nitrogen dioxide 22, 142 nitrous oxide 255 Nocturnal Penile Tumescence Test (NPT) 202 noise 255, 367 nonassertive behavior 45 non-insulin-dependent diabetes 122–123 non-rapid eye movement sleep. See NREM sleep nonsteroidal anti-inflammatory agents (NSAIDs) 151, 162, 172 nonverbal communication. See body language noradrenaline. See norepinephrine noradrenergic agents 39 norepinephrine 13, 118, 138, 254, 256, 277, 280 nostalgia 256 NREM sleep 335–336 NSA. See National Stroke Association NSIs. See needlestick injuries
nuclear power plant accident 82–83 nuclear weapons 256 nummular dermatitis 121 nurses. See health care workers nursing homes 250, 256–257, 276, 304, 380 nursing mothers 6, 257–258 nutrition 253, 258. See also dieting; eating disorders; obesity; weight gain and loss and acne 5 after heart attack 177 and allergies 27 and cholesterol 86 comfort foods 96 for constipation 100 in diabetes 123 GM foods 159–160 in gout 162 during grief 112 and heartburn 177 for high blood pressure 183 and hives 184 and indigestion 203 for irritable bowel syndrome 208–209 in menopause 193–194 and migraine 172 and motion sickness 248 for peptic ulcer 272 and stress relief 346 O OAM. See Office of Alternative Medicine obesity 96, 122, 183, 259–260, 392. See also weight gain and loss observational learning. See modeling obsessive behavior 260. See also obsessive-compulsive disorder in agoraphobia 18 in anorexia nervosa 133 in Asperger’s syndrome 44 journaling for 211 masturbation as 234 perfection and 273 shopping as 331 obsessive-compulsive disorder (OCD) 37, 260–261 behavior therapy for 37, 40, 59, 60, 261 habits in 166, 260 hostility in 192 medications for 38, 261 phobias in 282 and unemployment 40 obstructive sleep apnea syndrome (OSAS) 339 occupational health psychology (OHP) 262
Occupational Safety and Health Administration (OSHA) 43, 53, 82, 137, 143, 169–170, 253–254, 275, 332, 360 occupational stress 211, 262–264 Office of Alternative Medicine (OAM) 30, 129, 252. See also National Center for Complementary and Alternative Medicine Ohashiatsu 264 Ohl, Dana 204 Oklahoma City bombing (1995) 363 Older Women’s League 79 Oldham, Greg 251 open-angle glaucoma 161 open marriage 232 operant conditioning 99 optic nerve damage 160–161 optimism, learned 219 orange (color) 95 organ transplants 190–191, 383 orgasm 35, 326 Oriental massage 233 Ornstein, Robert 266 Orton, Peter 283 OSAS. See obstructive sleep apnea syndrome OSHA. See Occupational Safety and Health Administration osteoarthritis 42 overbreathing. See hyperventilation overtime 213, 264–265, 291, 366, 389 Oxman, Thomas 308 Oyle, Irving 283 P Pacheco, Karin 245 Pachter, Lee M. 3–4 pain 266–267. See also headaches acupuncture for 8 in arthritis 42 back 56–57, 69, 232, 288, 367 in childbirth 83 in chronic fatigue syndrome 87, 88 in chronic illness 88–89 endorphins and 142 in fibromyalgia 151 in gout 162 guided imagery for 164 in Gulf War Illness 165 in heart attack 176 in heartburn 177 in hospital 190 humor for 196, 216 hypnosis for 198, 266 during intercourse 131–132, 237, 327 in irritable bowel syndrome 208 massage therapy for 232
432 The Encyclopedia of Stress and Stress-Related Diseases pain (continued) meditation for 234 during menstruation 238 music for 251 in peptic ulcer 272 relaxation for 266, 307 in repetitive stress injuries 310 in rotator cuff injuries 313 and sleep 334 therapeutic touch for 363 Painstoppers (Ford) 266 paintball 267 palpitations 90, 267–268, 282 panic attacks and panic disorder 37, 268–270. See also phobias in agoraphobia 17, 18, 19, 268, 269, 282 caffeine and 77 in claustrophobia 90 at dentist 115 diagnosis of 268, 269 dizziness in 127, 178, 268 homosexual 189 hyperventilation in 74, 127, 268 and irritable bowel syndrome 208 medications for 38, 39, 62, 269 meditation for 234 and palpitations 268 personality and 269 post-traumatic stress disorder and 268, 286 tachycardia in 357 and unemployment 40 paradoxical therapy 197 paramnesia 236 parental afterschool stress (PASS) 270 parenting/parents 270–271. See also adoption; children; family; fathers; mothers abusive 128 ADHD sufferers 47, 48 adolescents 299–300, 345 anorexics 133 bed-wetting children 58, 59 binge drinkers 62 birth order and 66–67 breath-holding spells 73 child with sensory integrative dysfunction 322, 323 child with separation anxiety 323–324 and codependence 93 colicky baby 95 communication 69 criticism by 107, 109, 204 death of child 163, 165, 338, 350 disabled child 124–125 divorce and 126, 271 in dysfunctional families 131
elderly 79–80, 135–136, 141, 206, 315, 345 empty nest syndrome in 141, 271 frustration in 155 hemophiliacs 178 online 67 overtime of 265 peer pressure 272 and phobias 281, 282 and sibling relationships 331, 332 single 109, 110, 285, 289, 373 in stepfamilies 343 taboo subjects 246 and underachievement 371 Parkerson, George R. 147 PASS. See parental afterschool stress passive aggression 15 pathological lying 225 Patient Self-Determination Act of 1991 113 Pavlovian conditioning 99 Peck, M(organ) Scott 271 pediatric AIDS 6–7 peer group 271–272, 299 and binge drinking 62 in cult 108 and dating 109 in day care 110 and developing autonomy 52 and suicide 351 and underachievement 371 peer pressure 272 peptic ulcer 272–273 perfection 131, 133, 171, 260, 273, 351, 386 performance anxiety 39, 73, 76, 273–274. See also public speaking; stage fright performance review 274 peripheral vision 161 Perls, Frederick S. 160 Persian Gulf War (1991) 165, 191–192, 286 personality 274–275 and cancer 78 and creativity 105 and depression 13 extroverts 207, 332 and high blood pressure 181 introverts 207, 332, 340 and manic-depressive disorder 13 and migraine 171 narcissistic 321 and obsessive-compulsive disorder 260 and panic disorder 269 and sibling relationships 332 and suicide 351, 352 personality disorders 274 personality tests 244, 274–275
personality types 368–370 personal protective equipment (PPE) 152, 216, 267, 275 personal space 190, 275–276, 390. See also cubicles pets 27, 276 pharmacological approach 276–280. See also placebo effect; specific medications phobias 37, 280–283. See also panic attacks and panic disorder; specific phobias v. aversion 52 behavior therapy for 37, 40, 59, 60, 282, 333 in chronic fatigue syndrome 87 dizziness in 127 v. fear 150 hypnosis for 198 and palpitations 90, 268, 282 self-efficacy in 319 statistics on 281 and vertigo 379 physical manipulation systems 69 physician-assisted suicide 113, 141, 352–353 physicians 283, 363. See also dentists; health care workers phytoestrogens 193 Pillai, Sujatha 188 Piorkowski, Geraldine 207, 306 PIT. See psycho-imagination therapy placebo effect 274, 283, 363 Planned Parenthood 1, 377 plastic surgery 5, 72, 284. See also cosmetic surgery play therapy 284 plumbing 284 PMS. See premenstrual syndrome pneumonitis, hypersensitivity 156, 197, 245 PNI. See psychoneuroimmunology poison ivy 27, 284–285 police 285, 324, 359, 379, 380 politically correct 285 pollen 27, 28, 46 Pollution Standard Index (PSI) 142 polygraph 225 Pomeranz, Bruce 8 Porter, Laura S. 101 positive anger 34 positive feedback 150 positive self-talk 321–322 postal workers 208 postpartum depression 285, 288–289 post-traumatic stress disorder (PTSD) 37, 286–287. See also combat fatigue; war neurosis Chernobyl and 82–83 domestic violence and 127
Index 433 in firefighters and rescue workers 152, 324 in hostages 192 medications for 38, 39 and nightmares 255, 286 and panic attacks 268, 286 prevention of 106 rape and 303 September 11, 2001 and 324 witnessing crime and 106 powerlessness 287 PPE. See personal protective equipment prayer 129, 287–288, 308, 342 preferred provider organizations (PPOs) 228 pregnancy 288–291. See also abortion; birth control; childbirth; infertility; menstruation; miscarriage; mothers; postpartum depression; stillbirth biological clock and 56, 65, 230, 373 crack use during 93 depression in 285, 288 diabetes in 122 domestic violence during 128 HIV/AIDS and 6, 7, 194 migraine in 172 music during 251 smoking during 338 symptoms of 288, 289 syphilis in 328–329 premature ejaculation 134, 326, 327 premenstrual syndrome (PMS) 238 prepared childbirth 83 presenteeism 291–292. See also absenteeism presurgical stress 292 Proceedings of the National Academy of Sciences 96, 344–345 pro-choice and pro-life 1, 292 progesterone 238 progestin 237 progressive muscle relaxation 292–293 projection 114 propranolol 21 prostate cancer 293 Provine, Robert R. 217 Prozac. See fluoxetine PSI. See Pollution Standard Index psoriasis 293–294 Psychiatric News 191–192 psychiatrist 294–295, 298 psychic helplessness 178 psychoanalysis 118–119, 295 psychoanalytic theory of depression 118 psychodrama 295 psychogenic deafness 111 psychogenic pain 266 psycho-imagination therapy (PIT) 295 psychologist 295–296, 298
psychology 296 humanistic 195–196 occupational health 262 self-psychology 321 psychoneuroimmunology (PNI) 42, 71–72, 242, 296–297 Psychonomic Society 297 psychosomatic deafness 111 psychosomatic illness 146 psychotherapies 103, 297–299, 347. See also specific psychotherapies for alcoholism 25 for anger 34 for arthritis 43 with behavior therapy 59 for catastrophizing 81 coping skills from 101 for depression 117, 118–119 for domestic violence victims 127 for fibromyalgia 151 for habits 166 for hair pulling 167 for hostility 192 humor in 197 for inferiority complex 204 for irritable bowel syndrome 208 for nausea 253 for phobias 282 for post-traumatic stress disorder 286 for witness to crime 106 PTSD. See post-traumatic stress disorder puberty 299–300. See also adolescents pubic lice 221 public lavatories 217, 281 public speaking 225, 245, 273, 281, 300, 340, 342–343 purple (color) 95 Q qi gong 301 R radiation exposure 22–23, 82–83, 208, 227, 244 Radiological Society of North America 227 “radiophobia” 82 radon 302 Rahe, Richard H. 185, 191–192, 221 random drug testing 302 random nuisances 302–303, 344 rape 36, 62, 303–304 rape crisis hotline 106 rapid eye movement sleep. See REM sleep rationalization 114 “raves” 91–92 reactive depression. See exogenous depression
reading 62, 69, 335 reconstructive surgery. See cosmetic surgery; plastic surgery recreation 304. See also exercise; hobbies recreational therapists 304–305 red (color) 95 reductions in force. See layoffs reflexology 233, 305 Reich, Robert 153 Reich, Wilhelm 68 Reinthaler, Bee 97 relationships 305–306. See also dating; family; friends; intimacy; live-in; marriage abusive 127–128 codependent 93 coping skills in 102 dysfunctional 131 envy in 143 secrets in 319 relaxation 306–307, 347. See also breathing exercises after heart attack 177 for allergies 27 for arthritis 42 in autogenic training 50 Benson (Herbert) on 61, 241, 307, 342, 344, 366 in biofeedback 61 for childbirth 83 for chronic fatigue syndrome 88 colors inducing 95 for constipation 101 and coping skills 101 in diabetes 122 Dossey (Larry) on 129 for fear of dentistry 115 for flying 21 guided imagery and 164 for habits 166 for headaches 172, 173 for herpes sufferers 181 for high blood pressure 61, 182, 307 hobbies for 184–185 for hostility 192 humming and 196 for hyperventilation 198 in hypnosis 198 and immune system 201 for indigestion 203 for irritable bowel syndrome 208 Kabat-Zinn (Jon) on 213 labyrinth and 215 massage for 232 meditation for 234 Ohashiatsu for 264 for pain 266, 307 for phobias 282 prayer and 288
434 The Encyclopedia of Stress and Stress-Related Diseases relaxation (continued) progressive 292–293 for stage fright 342 in systematic desensitization 60 yoga and 396 Relaxation Response, The (Benson) 61, 241, 307, 344, 366 religion 95, 215, 232, 235, 307–308, 342. See also cults; faith healing; mind-body connections; prayer relocation 248–249, 308–309 remarriage 126, 309–310. See also stepfamilies REM sleep 77, 130, 254, 335, 336, 878 repetitive nocturnal myoclonus 334 repetitive stress injuries (RSI) 80–81, 143, 232, 310, 362, 390 repressed anger 34 rescue workers. See firefighters and rescue workers resolutions 310–311 restraining order 128 retirement 15, 184–185, 218, 240, 311–312 retrograde ejaculation 135 Return of Merlin, The (Chopra) 86 rheumatoid arthritis 42, 50, 297 rhinitis, allergic 27, 156, 169, 245 ricin 312–313 Rigamer, Elmore 192 Rinker, Candiss 98 Ritalin. See methylphenidate hydrochloride Road Less Traveled, The (Peck) 271 road rage 313 Robert Wood Johnson Foundation (RWJF) 62, 64, 141 Rogers, Carl 195 Rolf, Ida 69, 313 Rolfing 69, 313 Roney, Stephen C. 249 Rosentock, D. Linda 255 Rosenzweig, Martin 289 rotator cuff injuries 313 Rothermich, Norman 297 RSI. See repetitive stress injuries Rudley, Lloyd D. 89 runner’s amenorrhea 238 runner’s high 142, 314 S Sacks, Oliver 250 SADS. See seasonal affective disorder syndrome “safe sex” 6, 99, 194, 315, 327, 328, 378 “same-sex marriage” 231–232 “sandwich” generation 315 sarin 315–316
SARS (Severe Acute Respiratory Syndrome) 316–317 saturated fats 86 Saturday Review 103, 104 Schimmer, Barry M. 151 schizophrenia 12, 16, 138, 186 Schnall, Peter 291 school 317–318 ADHD sufferers in 47, 48, 220 binge drinking in 62–64 bullies in 74, 75, 317, 320 children with AIDS in 6–7 criticism in 107, 317, 320 diversity in 125 learning disabilities in 220 lice in 221 new 309 underachievement in 371 school avoidance 317, 324 school phobia 317, 324 Schultz, Johannes Heinrich 50 seasonal affective disorder syndrome (SADS) 116, 185, 318, 354 seborrheic dermatitis 121 secondary depression 318 secondary gain 318 “secondhand smoke” 22, 337 secrets 318–319 security object 319 selective serotonin reuptake inhibitors (SSRIs) 38, 117, 119, 280 self-criticism 107, 394 self-efficacy 319–320 self-esteem 320, 346 acne and 4, 5 ADHD and 48 of adolescents 299 and aggression 14 assertiveness training and 45 autonomy and 52 body image and 68 brainwashing and 71 breast reconstruction and 72 catastrophizing and 81 chronic illness and 88 criticism and 106, 107 dating and 109 divorce and 126 domestic violence and 127, 320 dysfunctional family and 131 in dysthymia 132 in eating disorders 133 of elderly 311 and envy 143 exercise and 144, 145 feedback and 150 guilt and 165 hair loss and 166 hobbies and 185
illiteracy and 201 in inferiority complex 204 and jealousy 210 layoffs and 219 learning disabilities and 219 loneliness and 224 midlife crisis and 240 money and 246 obesity and 259 and panic disorder 269 plastic surgery and 284 postpartum depression and 285 public speaking and 300 shyness and 331 success and 350 in superiority complex 354 and underachievement 371 self-help groups 103, 320–321. See also support groups for addiction 9 for agoraphobia 19 for alcoholism 25–26 for bed-wetting 59 for chronic fatigue syndrome 88, 355 in crisis intervention 106 for depression 120–121 for disabilities 125 for manic-depressive disorder 120–121, 355 self-hypnosis 198 self-object 321 self-psychology 321 self-talk 81, 321–322 Seligman, Martin 178, 219 Selye, Hans 69, 101–102, 107, 125, 144, 159, 188, 303, 322, 344, 394 sensate focus therapy 326 Sensory Integration and the Child (Ayres) 323 sensory integrative dysfunction 44, 322–323 separation anxiety 323–324 September 11, 2001 (9/11) 21, 152, 324, 362–363 serious mental illness (SMI) 324–325 serotonin 13, 118, 138, 254, 277, 280, 325, 396 Serpell, James 276 sertraline 119, 120 severance package 240 Severe Acute Respiratory Syndrome. See SARS sex appeal 325–326 sex drive 326 sexism 326 sex therapy 35, 202, 230, 237, 298, 326 sexual difficulties 326–327 anorgasmia 35, 327 dyspareunia 131–132, 237, 327
Index 435 ejaculation disorders 134–135, 202, 326, 327 frigidity 155 impotence 202, 327 inhibition and 206 transsexualism 158 vaginismus 326, 327 sexual harassment 160, 327–328, 385 sexual intercourse. See also rape between family members 131, 202–203, 343, 357 lack of satisfaction during 35, 155 during menstruation 238 painful 131–132, 237, 327 during pregnancy 289 sexuality 328 sexually transmitted diseases (STDs) 126, 303, 327, 328–329. See also “safe sex”; specific diseases Sexual Politics (Millett) 388 sexual preferences 189, 220, 231–232, 328, 329 sexual response 326, 329 sexual revolution 329, 388 Shapiro, Francine 145 “shell shock.” See combat fatigue; war neurosis Shepp, Elaine 345, 346–347 Sherstein, Peter 359 shiatsu 233, 264, 329–330. See also acupressure; acupuncture shift work 81, 89–90, 264, 330, 366 shopaholism 331. See also advertising short-term memory 154, 235 shyness 331, 340 sibling relationships 66–67, 331–332 disabled sibling 125 elderly parents 135 hemophiliac sibling 178 jealousy 210 in stepfamilies 343 sick building syndrome 22, 142, 155, 245, 332 sick role 332–333 SIDS. See sudden infant death syndrome Siegel, Bernie S(hepard) 333 sighing 333 sildenafil citrate. See Viagra “silent heart attack” 176 silocosis 243 simple phobia (single or specific phobia) 37, 268, 281, 282, 333 single parents 109, 110, 285, 289, 373 sinusitis, allergic 169 sisters. See sibling relationships situationally bound panic attack 268 situationally predisposed panic attack 268 skin anthrax 35
skin cancer 353, 354 sleep 333–336. See also dreams; insomnia; nightmare breathing during 73, 334, 339 circadian rhythms and 89–90 depression and 130, 206, 334 excessive 334, 335 initiating and maintaining 334 NREM 335–336 overtime and 265 in post-traumatic stress disorder 286 REM 77, 87, 130, 254, 335, 336 research on 335 serotonin and 325 shift work and 330 snoring during 334, 339–340 t’ai chi and 358 sleep apnea 334, 339 sleeping pills 57–58, 334, 335 sleepwalking 335 slips, trips, and falls 16, 85, 152, 284, 313, 336, 358, 387 slips of the tongue 336 SMI. See serious mental illness Smith, Tom 359 Smith-Coggins, Rebecca 330 smog 21, 22 smoking 336–339. See also marijuana and asthma 46 aversion therapy for 52 as coping mechanism 36 and emphysema 140 hypnosis for 198 in immigrants 3 and insomnia 206 journaling for 211 and peptic ulcer 272 quitting 336, 337, 338 “secondhand” 22, 337 truck drivers 367 snoring 334, 339–340 SNS. See sympathetic nervous system Sobel, David S. 266 social learning. See modeling social learning theory of depression 118 social phobia 19, 37, 206, 268, 281–282, 300, 331, 340 Social Readjustment Rating Scale 144 social support system 186–187, 340, 345, 346. See also friends; support groups social workers 340, 347 sodium 183 sodium nitrite 172 solar urticaria 184 Solomon, George 297 somatic pain 266 somatization 341 somatoform disorders 341
somnambulism. See sleepwalking Sorkin, David 341 South Asian tsunami (2004) 367 “space base” 93 spam 341 spas 341–342 spastic colitis. See irritable bowel syndrome speech disorders 349 “speedball” 93 Sperry, Len 207 Spiegel, David 355–356 “spinal adjustments” 85 spirituality 342 spontaneous abortion. See miscarriage Spontaneous Healing (Weil) 306 sports massage 233 SSRIs. See selective serotonin reuptake inhibitors stage fright 73, 225, 245, 273–274, 342–343. See also performance anxiety; public speaking stammering 349 Stampfl, Thomas 60 Stanford University Arthritis Center 42 STAR. See Stress and Anxiety Research Society STDs. See sexually transmitted diseases “Stealing Your Life” (Fleck) 200 steam inhalation (aromatherapy) 41 Stein, Seth 367 stepfamilies 309, 310, 343 Stephens, Linda C. 323 stillbirth 244, 343. See also miscarriage Stone, Arthur A. 101 stress 344–347 cold 94–95 dis-stress 125, 144, 344 endorphins and 142 eustress 125, 144, 344, 394 hypothalamus and 199 and immune system 201 occupational 211, 262–264 parental afterschool 270 post-traumatic. See post-traumatic stress disorder presurgical 292 research on 344–345, 348 sources of 345, 346 understanding 344 Stress and Anxiety Research Society (STAR) 348 stress management 345–347, 348. See also specific programs Stress Management and Counseling Center 185 Stress of Life, The (Selye) 101–102, 107, 159, 188, 322, 344, 394 Stress Reduction Clinic 213
436 The Encyclopedia of Stress and Stress-Related Diseases stress urinary incontinence (SUI) 348–349, 374 Stress without Distress (Selye) 188, 322, 344, 394 stroke 86, 182, 349 stun guns 358–359 stuttering 349–350 sublimation 114 subluxation 85 substance abuse. See also addiction; alcoholism and alcohol dependence; drug abuse and appetite 258 in chronic illness 88–89 denial of 114 in homeless 186 self-esteem and 320 subsyndromal depression 116 Succeeding as a Super Busy Parent (Gahrmann) 265 success 350 sudden infant death syndrome (SIDS) 165, 338, 350 suicide 350–353 in adolescents 120, 351–352 attempted 163, 186, 189 on death certificate 113 in depression 11, 115, 120, 350–351 in elderly 16, 352 and guilt 165 hopelessness and 189 physician-assisted 113, 141, 352 prevention of 350–351 recognizing intentions of 351, 352 statistics on 350 as taboo topic 357 suicide hotlines 106 sulfur dioxide 21, 142 Summers, Jane 289 sunlight 353–354 superiority complex 354 superstition 354 support groups 103, 298, 346, 354–356 for acne 5 for addiction 9 for agoraphobia 19 for AIDS patients 6 for Alzheimer’s disease 32, 355 for anxiety disorders 40, 321 for breast cancer 72, 355–356 for cancer 78, 297, 333 for caregivers 136, 355 for chronic fatigue syndrome 88, 355 for depression 120–121 for diabetes 122 for dieting 124 for disabilities 125 for emotional problems 139
for fibromyalgia 151 for grief 163 for guilt 165 for herpes sufferers 181 for infertility 205 for manic-depressive disorder 120–121, 355 and mind-body connections 241 for pain 267 for shopaholism 331 for stepfamilies 343 suppression 114 surgery. See also cosmetic surgery; plastic surgery fear about 292 lasers in 216 for reducing obesity 260 survivor guilt 192, 286 Susan G. Komen Foundation 71 swallowing 225 Swedish massage 233 swinging 232 Syme, S. Leonard 305 sympathetic inhibitors 183 sympathetic nervous system (SNS) 10, 151, 199, 201, 256, 356 symptom 356 syndrome 356 syphilis 328–329 systematic desensitization 18, 21, 59, 60, 65 systemic lupus erythematosus 50 systolic pressure 182 T TA. See transactional analysis Tabacchi, Mary 341 taboos 246, 357 tachycardia 357 t’ai chi 68, 182, 357–358 Talking from 9 to 5 (Tannen) 98, 222 tampons 239 Tannen, Deborah 98, 222 tantrums 323, 358 TASERs 358–360 taxicab drivers 379–380 TB. See tuberculosis TCAs. See tricyclic antidepressants teachers 317–318, 371. See also school teamwork 98 teenagers. See adolescents; puberty teenage workers 84, 360 teeth grinding 360, 362 telecommuting 360–361 telephones 361–362 television 11, 63–64, 143, 335, 362 telomere shortening 345 Temoshok, Lydia 370 temporary restraining order 128
temporomandibular joint (TMJ) headaches 171, 362 temporomandibular joint (TMJ) syndrome 69, 85, 360, 362 tendinitis 362 tension (muscle contraction) headache 170 terrorism 21, 35, 208, 312, 315, 324, 362–363. See also airport screening machines TET. See tubal embryo transfer tetrahydrocannabinol (THC) 229–230 therapeutic touch 363 Therapeutic Touch, How to Use Your Hands to Help or to Heal, The (Krieger) 363 THG (tetrahydrogestrinone) 363–364 Thich Nhat Hanh 364 Thomas, Lewis 363 thoracic (chest) breathing 73 threatened abortion 244 thunderstorms 137, 222, 281 thyroid cancer 82 tic 364 ticks 225 “tight building syndrome.” See sick building syndrome Tillich, Paul 308 time management 364–365 time zones 90 tipping 365 TM. See Transcendental Meditation tobacco. See smoking toilets. See lavatories, public toilet training 217, 365. See also bed-wetting Too Close for Comfort: Exploring the Risks of Intimacy (Piorkowski) 207, 306 Tourette’s syndrome 364 toxic shock syndrome 239 toxic substances. See hazardous and toxic substances tractors 149 traffic 51, 313 tranquilizers 13 transactional analysis (TA) 365 Transcendental Meditation (TM) 61, 235, 307, 365–366 Transportation Security Administration (TSA) 22, 359 transsexualism 158 trench foot 94–95 trends in work hours 81, 366 trichotillomania 167 tricyclic antidepressants (TCAs) 119, 278–279, 280 for anxiety disorders 38 for bed-wetting 58 drug interactions 278–279 for panic disorder 269 side effects of 117, 278
Index 437 truck drivers 367 TSA. See Transportation Security Administration tsunami 367–368 tubal embryo transfer (TET) 205 tubal sterilization 377, 378 tuberculosis (TB) 174, 368 Turback, Gay 68 Turkle, Sherry 67 Type A personality 176, 350, 368–369, 385 Type B personality 369 Type C Connection, The (Temoshok) 370 Type C personality 78, 369–370, 385 tyramine 172, 279 U UFOs (unidentified flying objects) 371 ultraviolet light 294, 353–354 underachievement 371 underage drinking 62–64 unemployment 14, 40, 104, 201, 291, 371–373. See also downsizing; layoffs unexpected panic attack 268 unicyclic antidepressants 280 unipolar depression 229. See also exogenous depression United Nations Children’s Education Fund (UNICEF) 84 Unsecular Man (Greeley) 308 unstable angina 35 unwed mothers 285, 289, 373 uranium 165, 244, 302 urge urinary incontinence 348, 374 uric acid 162 urinary incontinence 373–375. See also bed-wetting in Alzheimer’s disease 31 stress 348–349, 374 urge 348, 374 urticaria. See hives V vacations 107, 341, 376 vaccinations 376–377 vaginismus 326, 327 Vaillant, George 114 Valium 377 Valliant, George 102 Valnet, Jean 41 vascular headaches. See migraine headaches vasectomy 377–378 vasodilators 183 venereal diseases. See sexually transmitted diseases vertebral subluxation complex 85 vertigo 378–379. See also motion sickness veterans 14, 26, 71, 96, 165, 191–192, 286–287, 308, 382
Veterans Affairs, Department of 14, 286 Veterans Health Administration 14 Viagra 202 Vietnam War 14, 71, 96, 287 violence 379–380. See also aggression; anger; hostility; rape and bullying 75 domestic. See domestic violence mugging 249 police and 285, 359, 379, 380 and post-traumatic stress disorder 286 prevention of 379–380 at work 379–380, 386, 387, 391 visualization. See guided imagery; imagery volunteerism 185, 201, 311, 380–381 W waist circumference 259 Walking a Sacred Path, Rediscovering the Labyrinth as a Sacred Tool (Artress) 215 war neurosis 382 Web log. See blog weddings 230–231 weekend depression 382 weight gain and loss 96, 183, 382, 392. See also dieting; obesity Weil, Andrew 306, 382 Weisaeth, Lars 83 Weisman, Nancy 218 Weissman, Myrna M. 40 Wellbutrin. See buproprion Wellness Councils of America 392, 393 Western blacklegged ticks 225 West Nile encephalitis 383 West Nile fever 383 West Nile virus (WNV) 382–383 wet dreams 299, 383–384 wheals. See hives wheezing 384 WHI. See Women’s Health Initiative “white coat hypertension” 182, 307 “white lies” 225 widows 109, 112, 163, 223, 305, 309, 328, 386 “wife swapping” 232 Wilson, Marlene 380 win-win situation 99–100 withdrawal symptoms 8, 9, 25–26, 28, 77, 142, 337, 338 witnessing crime 106 WNV. See West Nile virus Wolpe, John 60 women 384–387. See also gender; mothers advertising aimed at 11 arthritis in 42
battered 127–128 biological clock of 56, 65, 230, 373 breast cancer in 71–72, 207, 227–228, 355–356 breast reconstruction in 72 as business owners 393 as caregivers 79–80, 385 carpal tunnel syndrome in 80 chronic fatigue syndrome in 87 coping 385–386 cosmetic surgery in 102, 240 crowding and 107 depression in 116, 229 dyspareunia in 131–132 eating disorders in 133 empty nest syndrome in 141 fibromyalgia in 151 flexible work hours of 153–154 glass ceiling and 160 as health care workers 173–174 HIV/AIDS in 6, 194 injuries in 386–387 lesbian 189, 220 lonely 223 as marijuana users 230 in menopause. See menopause menstruation in. See menstruation migraine in 171, 172, 238 obese 259 pregnant. See pregnancy sex appeal of 325–326 sexual harassment of 160, 327–328, 385 sexual response in 329 smoking 337, 338 traditional role of 158, 384, 387–388 unemployed 14, 372 urinary incontinence in 348, 373–374 veterans 286 Women’s Health Initiative (WHI) 237 women’s movement 158, 326, 329, 387–388 Wootton, Percy 62 workaholics 3, 131, 320, 368–369 workers’ compensation 388–389 work hours 389 and absenteeism 2 flexible 153–154, 291, 389–390 overtime 213, 264–265, 291, 366, 389 shift work 81, 89–90, 264, 330, 366 of teenage workers 360 trends in 81, 366 working mothers 110, 169, 247, 257–258, 270, 364–365, 385, 387, 389–390
438 The Encyclopedia of Stress and Stress-Related Diseases workplace 390–391. See also health insurance; work hours; specific occupations absenteeism in 2, 76, 291, 392 accidents in 2. See also accidents; injuries age discrimination in 14 alcoholics in 24 asbestos exposure in 43–44 automation in 51, 81, 98–99, 138, 205, 392 baby boomers in 56 and back pain 56, 57 brainstorming in 70, 105 bullies in 74, 75 bureaucracy in 75 burnout in 3, 75–76, 347, 386 carpal tunnel syndrome in 80–81, 310, 390 changing nature of 81–82 child labor in 83–85, 360, 380 communication in 97–98 coping in 101, 391 corporate buyout 102 coworkers 75, 76, 104–105, 291, 379, 388, 390, 391 creativity in 105, 106 criticism in 107 cubicles in 108 day care offered by 110, 389 deadlines in 111 death from overwork 213 diversity in 125 downsizing 14, 102, 104, 130, 211, 218, 219, 240, 291–292, 311, 391 Employee Assistance Programs in 2, 138, 140–141, 302, 380 employees from dysfunctional families in 131 employees with disabilities 33, 80
ergonomics in 143–144 feng shui in 150 glass ceiling 160 health promotion in 175, 213, 262, 392 humor in 196–197 indoor air pollution in 22, 142, 155, 245, 332 industrial hygiene 2, 136–137, 153, 203–204, 275 job change 98, 102, 210, 390–391 job security 14, 210–211, 218, 291–292, 372 layoffs 36, 102, 104, 211, 218–219, 240, 274, 311, 372, 391 lost work days 224 managed care plans by 228, 390 mergers 14, 102, 130, 211, 218, 219, 239–240, 308, 311 music in 251 networking in 254 occupational health psychology in 262 occupational stress in 211, 262–264 performance review in 274 presenteeism in 291–292 random drug testing in 302 and relocation 249, 308–309 repetitive stress injuries in 80–81, 143, 232, 310, 390 rotator cuff injuries in 313 sexual harassment in 160, 327–328, 385 smoking in 337 stressors in 345, 346 telecommuting 360–361 time management in 364–365 unemployment 14, 40, 104, 201, 291, 371–373
unpaid leave from 148 violence in 379–380, 386, 387, 391 workplace shootings 379, 391 worksite wellness programs 391–393. See also Employee Assistance Programs World Health Organization 53, 120, 179, 316 worry 393–394 writer’s block 394 Wurman, Richard 205 X Xanax (alprazolam) 21, 28, 62, 269, 279, 395 Y yawning 396 yellow (color) 95 Y-ME Hotline 71 Y-ME National Breast Cancer Organization 71, 355–356 Yoast, Richard A. 63 yoga 68, 74, 88, 366, 396 You Can Make a Difference (Wilson) 380 Youngest Science, The (Thomas) 363 “you” statements 97 “yuppie flu.” See chronic fatigue syndrome Z Zal, H. Michael 269 Zane, Manuel 60 Zeigler, Donald 62 Zen 397 Zerhouni, Elias 24 Zoloft. See sertraline Zwiefel, Jeff 145
