Select Quotes
1 Why Don’T Zebras Get Ulcers?
For animals like zebras, the most upsetting things in life are acute physical crises. – Page 17
An organism can also be plagued by chronic physical challenges. – Page 17
For the vast majority of beasts on this planet, stress is about a short-term crisis, after which it’s either over with or you’re over with. When we sit around and worry about stressful things, we turn on the same physiological responses—but they are potentially a disaster when provoked chronically. – Page 19
also in expectation of them. – Page 21
(The field uses this Zen-ish sound bite about how allostasis is about “constancy through change.” I’m not completely sure I understand what that means, but it always elicits meaningful and reinforcing nods when I toss it out in a lecture.) – Page 24
Or suppose there’s a water shortage in your body. Homeostatic solution: kidneys are the ones that figure this out, tighten things up there, produce less urine for water conservation. Allostatic solutions: brain figures this out, tells the kidneys to do their thing, sends signals to withdraw water from parts of your body where it easily evaporates (skin, mouth, nose), makes you feel thirsty. Homeostasis is about tinkering with this valve or that gizmo. Allostasis is about the brain coordinating body-wide changes, often including changes in behavior. – Page 24
And regardless of the stressor—injured, starving, too hot, too cold, or psychologically stressed—you turn on the same stress-response. It is this generality that is puzzling. – Page 25
For us vertebrates, the core of the stress-response is built around the fact that your muscles are going to work like crazy. And thus the muscles need energy, right now, in the most readily utilizable form, rather than stored away somewhere in your fat cells for some building project next spring. One of the hallmarks of the stress-response is the rapid mobilization of energy from storage sites and the inhibition of further storage. Glucose and the simplest forms of proteins and fats come pouring out of your fat cells, liver, and muscles, all to stoke whichever muscles are struggling to save your neck. If your body has mobilized all that glucose, it also needs to deliver it to the critical muscles as rapidly as possible. Heart rate, blood pressure, and breathing rate increase, all to transport nutrients and oxygen at greater rates. Equally logical is another feature of the stress-response. During an emergency, it makes sense that your body halts long-term, expensive building projects. – Page 26
Along with these changes, immunity is also inhibited. – Page 27
If you are that zebra and your innards are dragging in the dust, you still have to escape. Now would not be a particularly clever time to go into shock from extreme pain. – Page 28
The army does not run out of bullets. Instead, the body spends so much on the defense budget that it neglects education and health care and social services (okay, so I may have a hidden agenda here). It is not so much that the stress-response runs out, but rather, with sufficient activation, that the stress-response can become more damaging than the stressor itself, especially when the stress is purely psychological. – Page 29
Thus, medical practitioners often say, in effect, “You feel sick because you have disease X, not because of some nonsense having to do with stress; however, this ignores the stressors’ role in bringing about or worsening the disease in the first place. – Page 34
2 Glands, Gooseflesh, And Hormones
You sit in your chair not moving a muscle, and simply think a thought, a thought having to do with feeling angry or sad or euphoric or lustful, and suddenly your pancreas secretes some hormone. Your pancreas? How did you manage to do that with your pancreas? You don’t even know where your pancreas is. Your liver is making an enzyme that wasn’t there before, your spleen is text-messaging something to your thymus gland, blood flow in little capillaries in your ankles has just changed. All from thinking a thought. – Page 38
The set of nerve projections to places like sweat glands carry messages that are relatively involuntary and automatic. It is thus termed the autonomic nervous system, and it has everything to do with your response to stress. One half of this system is activated in response to stress, one half is suppressed. – Page 40
If you’re paying a fortune for painful daily injections of extracts of some beast’s testicles, there’s a certain incentive to decide you feel like a young bull. One big placebo effect. – Page 45
It is now recognized that the base of the brain, the hypothalamus, contains a huge array of those releasing and inhibiting hormones, which instruct the pituitary, which in turn regulates the secretions of the peripheral glands. – Page 50
Taylor argues convincingly that the physiology of the stress-response can be quite different in females, built around the fact that in most species, females are typically less aggressive than males, and that having dependent young often precludes the option of flight. Showing that she can match the good old boys at coming up with a snappy sound bite, Taylor suggests that rather than the female stress-response being about fight-or-flight, it’s about “tend and befriend”—taking care of her young and seeking social affiliation. – Page 54
James Henry, who has done pioneering work on the ability of social stressors such as subordinance to cause heart disease in rodents, has found that the sympathetic nervous system is particularly activated in a socially subordinate rodent that is vigilant and trying to cope with a challenge. In contrast, it is the glucocorticoid system that is relatively more activated in a subordinate rodent that has given up on coping. Studies of humans have shown what may be a human analogue of that dichotomy. Sympathetic arousal is a relative marker of anxiety and vigilance, while heavy secretion of glucocorticoids is more a marker of depression. – Page 57
3 Stroke, Heart Attacks, And Voodoo Death
Therefore, stress can promote plaque formation by increasing the odds of blood vessels being damaged and inflamed, and by increasing the likelihood that circulating crud (platelets, fat, cholesterol, and so on) sticks to those inflamed injury sites. For years, clinicians have tried to get a sense of someone’s risk of cardiovascular disease by measuring how much of one particular type of crud there is in the bloodstream. This is, of course, cholesterol, leading to such a skittishness about cholesterol that the egg industry has to urge us to give their cholesterol-filled products a break. High levels of cholesterol, particularly of “bad” cholesterol, certainly increase the risk for cardiovascular disease. But they’re not a great predictor; a surprising number of folks can tolerate high levels of bad cholesterol without cardiovascular consequences, and only about half of heart attack victims have elevated cholesterol levels. In the last few years, it is becoming clear that the amount of damaged, inflamed blood vessels is a better predictor of cardiovascular trouble than is the amount of circulating crud. This makes sense, in that you can eat eleventy eggs a day and have no worries in the atherosclerosis realm if there are no damaged vessels for crud to stick to; conversely, plaques can be forming even amid “healthy” levels of cholesterol, if there is enough vascular damage. – Page 66
In general, the monkeys under the most social stress were most at risk for plaque formation. Kaplan showed that this can even occur with a low-fat diet, which makes sense, since, as will be described in the next chapter, a lot of the fat that forms plaques is being mobilized from stores in the body, rather than coming from the cheeseburger the monkey ate just before the tense conference. – Page 69
Moreover, all sorts of psychological stressors could trigger them, like public speaking, pressured interviews, exams. According to the old dogma, if you had heart disease, you had better worry when you were undergoing physical stress and getting chest pains. Now it appears that, for someone at risk, trouble is occurring under all sorts of circumstances of psychological stress in everyday life, and you may not even know it. – Page 72
Back to the autonomic nervous system never letting you put your foot on the gas and brake at the same time—by definition, if you are turning on the sympathetic nervous system all the time, you’re chronically shutting off the parasympathetic. And this makes it harder to slow things down, even during those rare moments when you’re not feeling stressed about something. – Page 73
Whenever you inhale, you turn on the sympathetic nervous system slightly, minutely speeding up your heart. And when you exhale, the parasympathetic half turns on, activating your vagus nerve in order to slow things down (this is why many forms of meditation are built around extended exhalations). – Page 73
It also is thought to have a lot to do with why exposure to New York City is a risk factor for a fatal heart attack.* – Page 75
Once again, we deal with the central concept of stress physiology in explaining similar responses to being too hot or too cold, a prey or a predator: some parts of our body, including the heart, do not care in which direction we are knocked out of allostatic balance, but rather simply how much. Thus wailing and pounding the walls in grief or leaping about and shouting in ecstasy can place similarly large demands on a diseased heart. Put another way, your sympathetic nervous system probably has roughly the same effect on your coronary arteries whether you are in the middle of a murderous rage or a thrilling orgasm. Diametrically opposite emotions then can have surprisingly similar physiological underpinnings (reminding one of the oft-quoted statement by Elie Wiesel, the Nobel laureate writer and Holocaust survivor: “The opposite of love is not hate. The opposite of love is indifference.”). – Page 76
4 Stress, Metabolism, And Liquidating Your Assets
The basic process of digestion consists of breaking down chunks of animals and vegetables so that they can then be transformed into chunks of human. We can’t make use of the chunks exactly as they are; we can’t, for example, make our leg muscles stronger by grafting on the piece of chicken muscle we ate. Instead, complex food matter is broken down into its simplest parts (molecules): amino acids (the building blocks of protein), simple sugars like glucose (the building blocks of more complex sugars and of starches [carbohydrates]), and free fatty acids and glycerol (the constituents of fat). – Page 85
We even secrete insulin when we are about to fill our bloodstream with all those nutritive building blocks: if you eat dinner each day at six o’clock, by five forty-five you’re already secreting insulin in anticipation of the rising glucose levels in your bloodstream. – Page 87
Combine the insights into these measures mathematically and, collectively, this information was significantly predictive of who was going to have heart disease, a decline in cognitive or physical functioning, and mortality, far more predictive than subsets of those variables alone. – Page 100
5 Ulcers, The Runs, And Hot Fudge Sundaes
The official numbers are that stress makes about two-thirds of people hyperphagic (eating more) and the rest hypophagic.* – Page 103
What is really fascinating is that glucocorticoids don’t just stimulate appetite—they stimulate it preferentially for foods that are starchy, sugary, or full of fat—and we reach for the Oreos and not the celery sticks. – Page 104
What this first person is actually experiencing is frequent intermittent stressors. And what’s going on hormonally in that scenario? Frequent bursts of CRH release throughout the day. As a result of the slow speed at which glucocorticoids are cleared from the circulation, elevated glucocorticoid levels are close to nonstop. Guess who’s going to be scarfing up Krispy Kremes all day at work? So a big reason why most of us become hyperphagic during stress is our westernized human capacity to have intermittent psychological stressors throughout the day. The type of stressor is a big factor. – Page 106
That’s exactly the time when most people decide that, as a coping device, as a means of being nice to themselves during a tough time, they need to ease up on something about which they’re normally pretty regimented. So if you normally force yourself to watch Masterpiece Theater instead of reality TV as some sort of gesture of self-improvement, on goes Survivor XII. And if it’s food intake that you’re normally regimented about, out come the fudge brownies. – Page 108
Glucocorticoids not only increase appetite but, as an additional means to recover from the stress-response, also increase the storage of that ingested food. – Page 109
It turns out that when glucocorticoids stimulate fat deposition, they do it preferentially in the abdomen, promoting apple-shaped obesity. – Page 110
Take some extremely applish people and some very peary ones. Match them for weight, and it’s the apples who are at risk for metabolic and cardiovascular disease. Among other reasons, this is probably because fat released from abdominal fat cells more readily finds its way to the liver (in contrast to fat from gluteal fat stores, which gets dispersed more equally throughout the body), where it is converted into glucose, setting you up for elevated blood sugar and insulin resistance. – Page 111
Once everybody in the field got used to the idea of Marshall and Warren being carried around on sedan chairs for their discovery, they embraced Helicobacter with a vengeance. It makes perfect sense, given the contemporary desire of medicine to move toward hard-nosed, reductive models of disease, rather than that wimpy psychosomatic stuff. – Page 123
6 Dwarfism And The Importance Of Mothers
Just think, your femur is made up of tiny pieces of your mother’s chicken potpie that you ate throughout your youth. – Page 130
In other words, these FOADish tendencies can be transmitted across generations, without the benefit of genes. It’s not due to shared genes, but to shared environment, namely, the intimately shared blood supply during gestation. – Page 139
To take a concrete, nuts and bolts feature of growth, the rate at which this child was depositing calcium in his long bones could be successfully predicted by his proximity to a loved one. You can’t ask for a clearer demonstration that what is going on in our heads influences every cell in our bodies. – Page 150
It turns out to be touch, and it has to be active touching. – Page 151
You begin by reading her book assuming it is going to be an assortment box of prescriptions, that at the end, you’ll emerge with a perfect combo for your kids, a mixture of the Kwakiutl Baby Diet, the Trobriand Sleeping Program, and the Ituri Pygmy Infant Aerobics Plan. But, Small emphasizes, there is no perfect, “natural” program. Societies raise their children so that they grow into adults who behave in a way valued by that society. As Harry Chapin sang in “Cat’s in the Cradle,” that ode to baby boomer remorse, “My boy was just like me.” – Page 160
Something roughly akin to love is needed for proper biological development, and its absence is among the most aching, distorting stressors that we can suffer. – Page 163
They have taught us the science of why we primates love individuals who treat us badly, why the mistreatment can at times increase the love. They have taught us about why being abused as a child increases the risk of your being an abusive adult. – Page 167
7 Sex And Reproduction
Obviously, if you don’t exercise at all, it is not good for you. Exercise improves your health. And a lot of exercise improves your health a lot. But that doesn’t mean that insanely large amounts of exercise are insanely good for your body. At some point, too much begins to damage various physiological systems. – Page 171
Getting an erection to work properly is so incredibly complicated physiologically that if men ever actually had to understand it, none of us would be here. Fortunately, it runs automatically. – Page 172
This new understanding generates tricks that sexual therapists advise—if you are close to ejaculating and don’t want to yet, take a deep breath. Expanding the chest muscles briefly triggers a parasympathetic volley that defers the shift from parasympathetic to sympathetic. – Page 174
The Gods Must Be Crazy) – Page 184
Think about it: over the course of her life span, she has perhaps two dozen periods. Contrast that with modern Western women, who typically experience hundreds of periods over their lifetime. Huge difference. The hunter-gatherer pattern, the one that has occurred throughout most of human history, is what you see in nonhuman primates. Perhaps some of the gynecological diseases that plague modern westernized women have something to do with this activation of a major piece of physiological machinery hundreds of times when it may have evolved to be used only twenty times; an example of this is probably endometriosis (having uterine lining thickening and sloughing off in places in the pelvis and abdominal wall where it doesn’t belong), which is more common among women with fewer pregnancies and who start at a later age.* – Page 186
Theresienstadt concentration camp, 54 percent of the reproductive-age women were found to have stopped menstruating. This is hardly surprising; starvation, slave labor, and unspeakable psychological terror are going to disrupt reproduction. The point typically made is that, of the women who stopped menstruating, the majority stopped within their first month in the camps—before starvation and labor had pushed fat levels down to the decisive point. Many researchers cite this as a demonstration of how disruptive even psychological stress can be to reproduction. To me, the surprising fact is just the opposite. Despite starvation, exhausting labor, and the daily terror that each day would be their last, only 54 percent of those women ceased menstruating. Reproductive mechanisms were still working in nearly half the women (although a certain number may have been having anovulatory cycles). And I would wager that despite the horrors of their situation, there were still many men who were reproductively intact. That reproductive physiology still operated in any individual to any extent, under those circumstances, strikes me as extraordinary. – Page 196
The basic machinery of reproduction can be astoundingly resistant to stress in a subset of individuals, as evidence from the Holocaust shows. Reproduction is one of the strongest of biological reflexes—just ask a salmon leaping upstream to spawn, or males of various species risking life and limb for access to females, or any adolescent with that steroid-crazed look. But when it comes to the pirouettes and filigrees of sexuality, stress can wreak havoc with subtleties. That may not be of enormous consequence to a starving refugee or a wildebeest in the middle of a drought. But it matters to us, with our culture of multiple orgasms and minuscule refractory periods and oceans of libido. And while it is easy to make fun of those obsessions of ours, those nuances of sexuality, the Cosmos and GQs and other indices of our indulged lives, matter to us. They provide us with some of our greatest, if also our most fragile and evanescent, joys. – Page 196
8 Immunity, Stress, And Disease
The autonomic nervous system sends nerves into tissues that form or store the cells of the immune system and eventually enter the circulation. Furthermore, tissue of the immune system turns out to be sensitive to (that is, it has receptors for) all the interesting hormones released by the pituitary under the control of the brain. – Page 198
The evidence for the brain’s influence on the immune system goes back at least a century, dating to the first demonstration that if you waved an artificial rose in front of someone who is highly allergic to roses (and who didn’t know it was a fake), they’d get an allergic response. – Page 198
The loosening of the capillaries also allows fluid containing proteins that can fight the invasive microbes to flow in from the circulation. And what happens as a result of that? The proteins fight the microbe, but the fluid also makes the area swell up, causing edema. This is your innate immune system leaping into action, causing inflammation.* – Page 206
Why should evolution set us up to do something as apparently stupid as disassembling our immune system during stress? Maybe there isn’t a good reason. This actually isn’t as crazy of a response as you might think. Not everything in the body has to have an explanation in terms of evolutionary adaptiveness. Maybe stress-induced immunosuppression is simply a by-product of something else that is adaptive; it just came along for the ride. This is probably not the case. – Page 210
And as does the frequent theme of this book, namely, that if you have a stressor that goes on for too long, an adaptive decline back to baseline can overshoot and you get into trouble. – Page 212
Amid his skepticism, what he found was that the group therapy intervention extended life span an average of eighteen months, a whopping great effect. – Page 241
The advocates of a rather damaging overstatement of these psychology-health relationships are not always addled voices from the lunatic fringe. They include influential health practitioners whose medical degrees appear to lend credence to their extravagant claims. – Page 244
In his world, deceased patients come back as birds, there are unnamed countries in which individuals consistently live for a century, and best of all, people who have the right spirituality not only successfully fight cancer but can drive cars that consistently break down for other people. This is relatively benign gibberish, and history buffs may even feel comforted by those among us who live the belief system of medieval peasants. – Page 245
Everything bad in human health now is not caused by stress, nor is it in our power to cure ourselves of all our worst medical nightmares merely by reducing stress and thinking healthy thoughts full of courage and spirit and love. Would that it were so. And shame on those who would profit from selling this view. – Page 249
This period, moreover, gave rise to the verb burking, named after one William Burke, the aging resurrectionist who pioneered the practice of luring beggars in for a charitable meal and then strangling them for a quick sale to the anatomists. (Ironic-ending department: Burke and his sidekick, after their execution, were handed over to the anatomists. Their dissection included particular attention to their skulls, with an attempt to find phrenological causes of their heinous crimes.) – Page 251
9 Stress And Pain
The strength of a pain signal, for example, can depend on what other sensory information is funneled to the spine at the same time. This, it turns out, is why it feels great to have a massage when you have sore muscles. Chronic, throbbing pain can be inhibited by certain types of sharp, brief sensory stimulation. – Page 259
Experiencing a good vigorous mauling massage inhibitsa the dull throbbing pain of sore muscles for a while. An insect bite throbs and itches unbearably, and we often scratch hard right around it to dull the pain. Or we’ll pinch ourselves. In all these cases, the slow chronic pain pathway is shut down for up to a few minutes. – Page 262
Their pain’s not going to seem all that painful—the war’s over for me; the drug’s working; what carpet? The brain’s interpretation of pain can be extremely subjective. – Page 264
It turned out that patients who had views of trees from their windows requested significantly less pain medication than those who looked out on blank walls. – Page 265
10 Stress And Memory
To begin, memory is not monolithic, but instead comes in different flavors. One particularly important dichotomy distinguishes short-term versus long-term memories. With the former, you look up a phone number, sprint across the room convinced you’re about to forget it, punch in the number. And then it’s gone forever. – Page 281
Another important distinction in memory is that between explicit (also known as declarative) memory and implicit (which includes an important subtype called procedural memory) memory. – Page 281
In contrast, implicit procedural memories are about skills and habits, about knowing how to do things, even without having to think consciously about them: shifting the gears on a car, riding a bicycle, doing the fox-trot. – Page 281
Memory can be dramatically disrupted if you force something that’s implicit into explicit channels. – Page 282
The synapse becomes persistently more excitable, so that next time it takes less of an excitatory signal to get the aha. – Page 288
11 Stress And A Good Night’S Sleep
Not getting enough sleep is a stressor; being stressed makes it harder to sleep. Yup, we’ve got a dread vicious cycle on our hands. – Page 311
During REM sleep, metabolism in the frontal cortex goes way down, disinhibiting the limbic system to come up with the most outlandish ideas. That’s why dreams are dreamlike—illogical, nonsequential, hyperemotional. You breathe underwater, fly in the air, communicate telepathically; you announce your love to strangers, invent languages, rule kingdoms, star in Busby Berkeley musicals. – Page 314
Moreover, the amount of certain subtypes of sleep at night predicts how well new information is recalled the next day. For example, lots of REM sleep during the night predicts better consolidation of emotional information from the day before, while lots of stage 2 sleep predicts better consolidation of a motor task, and a combination of lots of REM and slow wave sleep predicts better retention of perceptual information. – Page 317
During slow wave sleep, metabolism remains surprisingly high in areas like the hippocampus. It’s as if sleep is the time when the brain practices those new memory patterns over and over, cementing them into place. – Page 318
These folks had enough sleep, happily restored and reenergized, and by about eight in the morning, their brains knew it. Start secreting those stress hormones to prepare to end the sleep. But the second group of volunteers went to sleep at the same time but were told that they would be woken up at six in the morning. And what happened with them? At five in the morning, their stress hormone levels began to rise. – Page 325
But worst of all is too little sleep that is unpredictably fragmented. You finally get back to sleep, but with the corrosive knowledge that five hours or five minutes from now, another patient will come into the emergency room, or the alarms will go off and it’s back to the fire truck, or someone’s diaper will slowly but surely fill up. – Page 326
12 Aging And Death
Aging and Death  Predictably, it comes at the most unpredictable times. – Page 327
It’s all there—the universe is expanding; look how big infinity is and how finite we are—and he has been initiated into the great secret of our species: we will die and we know it. With that rite of passage, he has found the mother lode of psychic energy that fuels our most irrational and violent moments, our most selfish and our most altruistic ones, our neurotic dialectic of simultaneously mourning and denying, our diets and exercising, our myths of paradise and resurrection. It’s as if we were trapped in a mine, shouting out for rescuers, Save us, we’re alive but we’re getting old and we’re going to die. – Page 328
“I’ll take your malaria and parasites, I’ll take your appalling infant mortality rates, I’ll take the chances of being attacked by buffalo and lions. Just let me be as unafraid of dying as you are.” – Page 329
Connected to this, brain-imaging studies show that negative images have less of an impact, and positive images have more of an impact on brain metabolism in older people, as compared to young. – Page 331
It depends on how you test it. If you test young and old people and give them lots of time to complete the test, there is little difference. As you stress the system—in this case, by making the subjects race against a time limit—scores fall for all ages, but much further among older people. – Page 334
All the male mice of these species die shortly after seasonal mating; cut out their adrenal glands, however, and they too keep living. Pacific salmon and marsupial mice are not close relatives. At least twice in evolutionary history, completely independently, two very different sets of species have come up with the identical trick: if you want to degenerate very fast, secrete a ton of glucocorticoids. – Page 337
If we are crippled by an accident, if we lose our sight or hearing, if we are so weakened by heart disease as to be bed-bound, we cease having so many of the things that make our lives worth living. But when it is our brains that are damaged, when it is our ability to recall old memories or to form new ones that is destroyed, we fear we’ll cease to exist as sentient, unique individuals—the version of aging that haunts us most. – Page 343
13 Why Is Psychological Stress Stressful?
Two identical stressors with the same extent of allostatic disruption can be perceived, can be appraised differently, and the whole show changes from there. – Page 346
But this time, whenever the rat gets a shock, it can run over to a bar of wood and gnaw on it. The rat in this situation is far less likely to get an ulcer. You have given it an outlet for frustration. Other types of outlets work as well—let the stressed rat eat something, drink water, or sprint on a running wheel, and it is less likely to develop an ulcer. – Page 348
The stress-response is about preparing your body for an explosive burst of energy consumption right now; psychological stress is about doing all the same things to your body for no physical reason whatsoever. Exercise finally provides your body for the outlet that it was preparing for. – Page 349
There is not a single physically stressful thing going on in the rat’s world. It’s not hungry, pained, running for its life—nothing is out of allostatic balance. In the absence of any stressor, loss of predictability triggers a stress-response. – Page 353
Thus, the exercise of control is not critical; rather, it is the belief that you have it. – Page 356
The control element is more powerful than the demand one—low demand and low control is more damaging to one’s health than high demand and high control. – Page 357
Instead, it is stress about lack of control over the process—what work rate is expected and how much flexibility there is about it, what amenities there are and how much control you have over them, how authoritarian the authorities are. – Page 357
As an extraordinary example, both pigeons and rats prefer to press a lever in order to obtain food (so long as the task is not too difficult) over having the food delivered freely—a theme found in the activities and statements of many scions of great fortunes, who regret the contingency-free nature of their lives, without purpose or striving. – Page 358
Twenty-five shocks an hour, a certain degree of social instability, a one-in-four chance of your child dying—each can imply either good news or bad, and only the latter seems to stimulate a stress-response. It’s not just the external reality; it’s the meaning you attach to it. – Page 359
Nonetheless, some nonhuman primate studies in which rank was manipulated by the experimenters show that it can go in the other way, that if the change is sufficiently unexpected, it can be stressful, even if it is good change (and psychotherapy often must delve into the reasons why people sometimes find change for the good to be less desirable than persisting with a known misery). – Page 360
Collectively, these scenarios tell us that predictability does not always work to protect us from stress. The much more systematic studies with animals suggest that it works only in a midrange of frequencies and intensities of stressors, and with certain lag times and levels of accurate information. – Page 364
But when the stressor is truly awful, an artificial sense of control is damaging—it is difficult to conceive a yet-worse scenario that you managed to avoid, but easy to be appalled by the disaster you didn’t prevent. – Page 366
14 Stress And Depression
exotica – Page 369
The defining feature of a major depression is loss of pleasure. If I had to define a major depression in a single sentence, I would describe it as a “genetic/ neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.” Depression can be as tragic as cancer or a spinal cord injury. Think about what our lives are about. None of us will live forever, and on occasion we actually believe it; our days are filled with disappointments, failures, unrequited loves. Despite this, almost inconceivably, we not only cope but even feel vast pleasures. – Page 370
If you take subjects and, at random times throughout the day, have them record how they are feeling at that moment, the frequencies of feeling good and feeling bad are not inversely correlated. There’s normally not much of a connection between how much your life is filled with strongly positive emotions and how much with strongly negative ones. – Page 371
Cognitive therapists, like Aaron Beck of the University of Pennsylvania, even consider depression to be primarily a disorder of thought, rather than emotion, in that sufferers tend to see the world in a distorted, negative way. – Page 374
They are not only depressed about something, but see the goings-on around them in a distorted way that always reinforces that feeling. Their glasses are always half empty. – Page 374
I have to begin with Freud. I know it is obligatory to dump on Freud, and some of it is deserved, but there is much that he still has to offer. I can think of few other scientists who, nearly a century after their major contributions, are still considered important and correct enough for anyone to want to bother pointing out their errors instead of just consigning them to the library archives. – Page 406
In Freud’s formulation, in every loving relationship there is ambivalence, mixed feelings—elements of hatred as well as love. In the case of a small, reactive depression—mourning—you are able to deal with those mixed feelings in a healthy manner: you lose, you grieve, and then you recover. In the case of a major melancholic depression, you have become obsessed with the ambivalence—the simultaneity, the irreconcilable nature of the intense love alongside the intense hatred. Melancholia—a major depression—Freud theorized, is the internal conflict generated by this ambivalence. This can begin to explain the intensity of grief experienced in a major depression. If you are obsessed with the intensely mixed feelings, you grieve doubly after a loss—for your loss of the loved individual and for the loss of any chance now to ever resolve the difficulties. “If only I had said the things I needed to, if only we could have worked things out”—for all of time, you have lost the chance to purge yourself of the ambivalence. For the rest of your life, you will be reaching for the door to let you into a place of pure, unsullied love, and you can never reach that door. – Page 406
This theory also explains the tendency of major depressives in such circumstances to, oddly, begin to take on some of the traits of the lost loved/ hated one—and not just any traits, but invariably the ones that the survivor found most irritating. Psychodynamically, this is wonderfully logical. By taking on a trait, you are being loyal to your lost, beloved opponent. By picking an irritating trait, you are still trying to convince the world you were right to be irritated—you see how you hate it when I do it; can you imagine what it was like to have to put up with that for years? And by picking a trait that, most of all, you find irritating, you are not only still trying to score points in your argument with the departed, but you are punishing yourself for arguing as well. Out of the Freudian school of thought has come one of the more apt descriptions of depression—“ aggression turned inward.” Suddenly the loss of pleasure, the psychomotor retardation, the impulse to suicide all make sense. As do the elevated glucocorticoid levels. This does not describe someone too lethargic to function; it is more like the actual state of a patient in depression, exhausted from the most draining emotional conflict of his or her life—one going on entirely within. If that doesn’t count as psychologically stressful, I don’t know what does. – Page 407
Instead, it has learned, “There is nothing I can do. Ever.” Even when control and mastery are potentially made available to it, the rat cannot perceive them. This is very similar to the depressed human who always sees glasses half empty. As Beck and other cognitive therapists have emphasized, much of what constitutes a depression is centered around responding to one awful thing and overgeneralizing from it—cognitively distorting how the world works. – Page 410
Transferring that to the real world, with the same external stressors, the more that someone has an internal locus of control, the less the likelihood of a depression. – Page 412
15 Personality, Temperament, And Their Stress-Related Consequences
Thus, after factoring out rank, lower basal glucocorticoid levels are found in males who are best at telling the difference between threatening and neutral interactions; who take the initiative if the situation clearly is threatening; who are best at telling whether they won or lost; and, in the latter case, who are most likely to make someone else pay for the defeat. – Page 427
Just like the baboons who find a rival napping to be an arousing threat, these individual monkeys see challenges everywhere. But in their case, the response to the perceived threat is a shrinking timidity. Put them into a novel environment that other rhesus monkeys would find to be a stimulating place to explore, and they react with fear, pouring out glucocorticoids. Place them with new peers, and they freeze with anxiety—shy and withdrawn, and again releasing vast amounts of glucocorticoids. Separate them from a loved one, and they are atypically likely to collapse into a depression, complete with excessive glucocorticoids, overactivation of the sympathetic nervous system, and immunosuppression. These appear to be lifelong styles of dealing with the world, beginning early in infancy. – Page 428
The first reason harks back to a caveat I aired early in the book: a diagnosis of “psychogenic” anything (impotency, amenorrhea, abortion, and so on) is usually a diagnosis by exclusion. In other words, the physician can’t find any disease or organic cause, and until one is discovered, the disorder gets tossed into the psychogenic bucket. This may mean that, legitimately, it is heavily explained by psychological variables, or it may simply mean that the relevant hormone, neurotransmitter, or genetic abnormality has not yet been discovered. Once it is discovered, the psychogenic disease is magically transformed into an organic problem—“ Oh, it wasn’t your personality after all.” – Page 431
Another difficulty is that these studies are all retrospective in design: the researchers examine the personalities of women after they have had repeated abortions. – Page 431
As a final problem, none of the studies provides any reasonable speculation as to how a particular personality type may lead to a tendency not to carry fetuses to term. What are the mediating physiological mechanisms? What hormones and organ functions are disrupted? The absence of any science in that area makes me pretty suspicious of the claims. – Page 432
Unlike depressives, the anxiety-prone person is still attempting to mobilize coping responses. But the discrepancy is the distorted belief that stressors are everywhere and perpetual, and that the only hope for safety is constant mobilization of coping responses. Life consists of the concrete, agitated present of solving a problem that someone else might not even consider to exist.* – Page 433
Chapter 2 emphasized how the former defend you against stressors by handing out guns from the gun locker within seconds, in contrast to glucocorticoids, which defend you by constructing new weapons over the course of minutes to hours. Or there can be an elaboration of this time course, in which catecholamines mediate the response to a current stressor while glucocorticoids mediate preparation for the next stressor. When it comes to psychiatric disorders, it seems that increases in the catecholamines have something to do with still trying to cope and the effort that involves, where overabundance of glucocorticoids seems more of a signal of having given up on attempting to cope. – Page 434
Run them through the blood and guts, and, with them gripping the arms of their chairs and trying to remain stoic, and still, the sympathetic activation becomes even greater. Repressing the expression of strong emotions appears to exaggerate the intensity of the physiology that goes along with them. – Page 443
Stoic, regimented, hardworking, productive, solid folks who never stand out in a crowd (unless you begin to wonder at the unconventional nature of their extreme conventionality). – Page 450
A lesson of repressive personality types and their invisible burdens is that, sometimes, it can be enormously stressful to construct a world without stressors. – Page 452
16 Junkies, Adrenaline Junkies, And Pleasure
we stand in long lines to see movies that surprise and terrify us, we bungee jump and go on roller coasters that most definitely deprive us of a sense of control and predictability. We pay good money to be stressed sometimes. – Page 455
What Schultz’s findings show is that if you know your appetite is going to be sated, pleasure is more about the appetite than about the sating.* – Page 457
This is how gratification postponement works—the core of goal-directed behavior is expectation. – Page 458
Right after the task is completed, dopamine release starts to rise far higher than usual, peaking right around the time that the reward, if it’s going to happen, should be arriving. Introduce, “This is going to be great… maybe… probably…” and your neurons spritz dopamine all over the place in anticipation. This is the essence of why, as we learned in Intro Psych, intermittent reinforcement is so reinforcing. What these findings show is that if you think there’s a reasonably good chance that your appetite is going to be sated, but you’re not positive, pleasure becomes even more about the appetite than about the sating. – Page 458
The tegmentum/ accumbens dopamine system seems to be about edgy, make-you-crazy-with-anticipation passion. Two years later, it’s the cingulate weighing in, mediating something akin, perhaps, to comfort and warmth… or maybe even a nonhyperventilating version of love. – Page 459
Part of what makes the Las Vegas world of gambling so addictive is the brilliant ways in which people are manipulated into thinking that the environment is a benign, rather than malevolent, one—the belief that the outcome is likely to be a good one, especially for someone as lucky and special as you… so long as you keep putting in those coins and pressing that lever. – Page 460
Pleasurable lack of control is all about transience—it’s not for nothing that roller-coaster rides are three minutes rather than three weeks long. Another thing that biases toward uncertainty being pleasurable is if it comes bound within a larger package of control and predictability. – Page 460
Maybe they release atypically low amounts of dopamine. Or, as another version of the same problem, maybe they have versions of dopamine receptors that are atypically unresponsive to a dopamine signal. In that scenario, it’s hard to “just say no” to some thrilling possibility when there’s not a whole lot of pleasurable yes’s in one’s life – Page 462
End of experience, dopamine levels go back down to baseline. What if someone’s brain happens not to be great at keeping up with dopamine reserves in the pleasure pathway? As a result, at the end of a stimulating increase in dopamine release, dopamine levels not only drop back to baseline, but to a smidgen below baseline. In other words, a little lower than where you started. What’s the only solution then to counteract this mild dysphoria, this mild inability to anticipate pleasure? Find something else that’s thrilling and, of necessity, a bit riskier, in order to achieve the same dopamine peak of the prior time. Afterward, your baseline drops a bit lower. Necessitating another, and another stimulant, each one having to be bigger, in the search for the giddy heights of dopamine that you reached that first time. This is the essence of the downward ratcheting of addiction. – Page 462
Toland Grinnell, Rodent Addiction System (White), detail, mixed media, 2003. – Page 465
Early on, addiction is about “wanting” the drug, anticipating its effects, and about how high those dopamine levels are when they’re pouring out in a drug-induced state (in addition, the release of endogenous opiates around this time fuels that sense of “wanting”). It’s about the motivation to get the reward of a drug. With time there’s the transition to “needing” the drug, which is about how low the dopamine lows are without the drug. The stranglehold of addiction is when it is no longer the issue of how good the drug feels, but how bad its absence feels. – Page 466
The dynamics of many of these drugs in the body is such that the amount of time that blood levels are rising, with their stress-reducing effects, is shorter than the amount of time that they are dropping. So what’s the solution? Drink, ingest, inhale, shoot up, snort all over again. – Page 469
Once, during a concert of cathedral organ music, as I sat there amid that tsunami of sound getting gooseflesh, I was struck with a thought—way back when, for a medieval peasant, this must have been the loudest human-made sound they would ever experience, something that would be awe-inspiring in ways we can no longer imagine. No wonder they signed up for the religion being proffered. – Page 474
His thinking centers around the fact that our anticipatory pleasure pathway is stimulated by many different things. For this to work, the pathway must rapidly habituate, must desensitize to any given source that has stimulated it, so that it is prepared to respond to the next stimulant. – Page 475
17 The View From The Bottom
Resources, no matter how plentiful, are rarely divvied up evenly. Instead of every contested item being fought for with bloodied tooth and claw, dominance hierarchies emerge. As formalized systems of inequities, these are great substitutes for continual aggression between animals smart enough to know their place. – Page 479
Primatologists these days talk about primate “culture,” and this is not an anthropomorphic term. – Page 486
being poor means that you often can’t cope with stressors very efficiently. Because you have no resources in reserve, you can never plan for the future, and can only respond to the present crisis. And when you do, your solutions in the present come with a whopping great price later on—metaphorically, or maybe not so metaphorically, you’re always paying the rent with money from a loan shark. Everything has to be reactive, in the moment. Which increases the odds that you’ll be in even worse shape to deal with the next stressor—growing strong from adversity is mostly a luxury for those who are better off. – Page 492
the diseases that people were dying of most frequently a century ago are dramatically different from the most common ones now. Different causes of death, but same SES gradient, same relationship between SES and health. Which tells you that the gradient arises less from disease than from social class. Thus, writes Evans, the “roots [of the SES health gradient] lie beyond the reach of medical therapy.” – Page 495
a 1967 study showed that the poorer you are judged to be (based on the neighborhood you live in, your home, your appearance), the less likely paramedics are to try to revive you on the way to the hospital. – Page 496
But in at least one study of people enrolled in a prepaid health plan, where medical facilities were available to all participants, poorer people had more cardiovascular disease, despite making more use of the medical resources. A second vote against the importance of differential health care access is because the relationship forms the term I’ve been using, namely, a gradient. It’s not the case that only poor people are less healthy than everyone else. Instead, for every step lower in the SES ladder, there is worse health (and the lower you get in the SES hierarchy, the bigger is each step of worsening health). – Page 497
A final vote against the health care access argument: the gradient exists for diseases that have nothing to do with access. – Page 498
Poorer people in westernized societies are more likely to drink and smoke excessively (sufficiently so that it’s been remarked that smoking is soon going to be almost exclusively a low-SES activity). – Page 499
Much of this book has been about how a certain style of “mainstream” medicine, overly focused on how disease is exclusively about viruses, bacteria, and mutations, has grudgingly had to make room for the relevance of psychological factors, including stress. In a similar way, among the “social epidemiologists” who think about the SES/ health gradients, the mainstream view has long focused on health care access and risk factors. And thus, they too have had to make room for psychological factors. Including stress. Big-time. – Page 502
Once you’ve done that, look at what health measures have to do with one’s subjective SES. Amazingly, it is at least as good a predictor of these health measures as is one’s actual SES, and, in some cases, it is even better. – Page 504
Adler shows that subjective SES is built around education, income, and occupational position (in other words, the building blocks of subjective SES), plus satisfaction with standard of living and feeling of financial security about the future. – Page 504
So SES reality plus your satisfaction with that SES plus your confidence about how predictable your SES is are collectively better predictors of health than SES alone. – Page 505
What Wilkinson and others have shown is that poverty is not only a predictor of poor health but, independent of absolute income, so is poverty amid plenty—the more income inequality there is in a society, the worse the health and mortality rates. – Page 506
What Kawachi shows is that the more income inequality in a society, the lower the social capital, and the lower the social capital, the worse the health. – Page 510
Agriculture allowed for the stockpiling of surplus resources and thus, inevitably, the unequal stockpiling of them—stratification of society and the invention of classes. Thus, it allowed for the invention of poverty. I think that the punch line of the primate-human difference is that when humans invented poverty, they came up with a way of subjugating the low-ranking like nothing ever before seen in the primate world. – Page 516
18 Managing Stress
Who are those six? What are they doing right? And with all scientific detachment abandoned, how can I do that, too? – Page 519
Do nothing more dramatic than pick a rat up and handle it fifteen minutes a day for the first few weeks of its life, put it back in its cage with the unhandled controls, come back two years later… and the handled rat is spared the entire feed forward cascade of hippocampal damage, memory loss, and elevated glucocorticoid levels. – Page 523
When the experience with an uncontrollable stressor occurs, the dog, in effect, is more likely to conclude that “this is awful, but it isn’t the entire world.” It resists globalizing the stressor into learned helplessness. – Page 528
It suggests that if you were to go away for a couple of zillion millennia, allow that differential selection to play out, and then return to finish your doctoral dissertation, your average baboon would be a descendent of these low-glucocorticoid guys, and the baboon social world would involve a lot of impulse control and gratification postponement. Maybe even toilet training. – Page 529
Why not give the painkillers to the patients and let them decide when they need medication? You can just imagine the apoplexy that mainstream medicine had over that one—patients will overdose, become addicts, you can’t let patients do that. It was tried with cancer patients and postsurgical patients, and it turned out that the patients did just fine when they self-medicated. In fact, the total amount of painkillers consumed decreased. – Page 534
When the staff present encouraged them, performance improved; when the staff present helped them, performance declined. – Page 536
It is true that hope, no matter how irrational, can sustain us in the darkest of times. But nothing can break us more effectively than hope given and then taken away capriciously. Manipulating these psychological variables is a powerful but double-edged sword. – Page 540
First, the studies are clear in showing physiological benefits while someone is meditating. It’s less clear that those good effects (for example, lowering blood pressure) persist for long afterward. – Page 542
This dichotomy can be roughly translated into the following rule for when something stressful occurs: the more disastrous a stressor is, the worse it is to believe you had some control over the outcome, because you are inevitably led to think about how much better things would have turned out if only you had done something more. – Page 545
However, in a world of people born into poverty, of limited educational or occupational opportunities, of prejudice and racism, it can be a disaster to be a John Henry, to decide that those insurmountable odds could have been surmounted, if only, if only, you worked even harder—John Henryism is associated with a marked risk of hypertension and cardiovascular disease. – Page 546
If any hell really could be converted into a heaven, then you could make the world a better place merely by rousing yourself from your lounge chair to inform a victim of some horror whose fault it is if they are unhappy. – Page 547
Another thing that folks like Sloan and Thoresen agree upon is that when you do see a legitimate link between religiosity and good health, you don’t know which came first. – Page 551
They also agree that when you do see a link, even one in which religiosity gives rise to good health, you still don’t know if it has anything to do with the religiosity. This is because being religious typically gets you a religious community, and thus social support, meaningful social roles, good role models, social capital, all that good stuff. – Page 551
And if on top of all that, the deity is viewed as benign, the stress-reducing advantages must be extraordinary. – Page 553
Seligman’s work has demonstrated how useful and healthy it is to be able to switch loci of control. When something good happens, you want to believe that this outcome arose from your efforts, and has broad, long-lasting implications for you. When the outcome is bad, you want to believe that it was due to something out of your control, and is just a transient event with very local, limited implications. – Page 555
Framed in the context of this book, when someone has gotten a zillion jumps’ worth of experience, they turn on the stress-response only during the actual stressor. As discussed earlier, what have been winnowed away by that experience are parts A and C—the psychological stress-response. – Page 556
Copyright
“A relationship is the price you pay for the anticipation of it.” (It was Shaw who once wrote, “Love is the gross exaggeration of the differences between one person and everybody else.”) – Page 923
You Just Don’t Understand – Page 947