Understanding Stress Factors and Related Matters

Stress

by Dr. Bob Kamath

Yes, stress is contagious. There is much truth in the following story: An irate woman verbally abuses her timid husband, a schoolteacher. Humiliated, the teacher takes his anger out on his student by paddling him. Outraged over the unjust punishment, the student kicks his hapless dog. The resentful dog bites the lazily snoozing cat. The incensed cat works out its frustration by mauling an unlucky rat. Running scared for its life, the wounded rat topples an oil lamp, shattering it into a thousand pieces on the floor. The burning oil from the broken lamp sets the house on fire. Carried by the blowing wind the raging fire jumps from house to house and spreads rapidly across the doomed town. The whole town goes up in smoke—all because of the wrath of one woman.

Not only does stress adversely affect the health of people Suffering from it, but it also negatively affects everyone around them. A stressed-out boss can upset all his underlings and create an intolerably tense atmosphere at work. These upset workers might take out their anger, helplessness and frustration on their family members. Sometimes I see many workers from the same company, all seeking psychiatric help immediately after a new boss has come on board. Sometimes I see several siblings at the same time for the treatment of depression or anxiety; their histories reveal that, several decades earlier, they were all traumatized by an alcoholic father who routinely brutalized the whole family.

Or a stressed father of a four-year-old boy suddenly wants to abandon his family; his history reveals that his parents split up when he was four years old. A grown man sexually abuses an innocent child; he reveals that he was sexually abused by an adult when he was a child. A woman gives up her child for adoption soon after giving birth, because her own mother gave her up for adoption soon after she was born. An African American man abandons his wife and his newborn baby, because that is what his father, grandfather and great-grandfather did to their families. Thus, the ripple effect of stressful events can be felt not only by the people in the immediate circle of those events, but also by several generations to come. Arguably, stress has a far greater direct or indirect negative impact on humanity than any other single factor.

2. Stress means getting upset about something.

Since stress means different things to different people, we need to get a firm handle on this slick term before we can make sense throughout the rest of this book. Effective communication of a concept requires that the particular terms used in the book mean the same to the reader as to the author.

Simply put, stress means getting upset about something. One’s peace and tranquility of mind are gone.

A stressed person is an upset person. He experiences one or more painful emotions, such as fear, hurt, sadness, anger, guilt, etc. in his conscious mind, in response to whatever has upset him. He is fully aware of these emotions. Because of their effect on his brain chemicals, he might experience some transient stress symptoms: irritability, sleeplessness, headache, poor concentration and the like. Once he has coped with the situation that has upset him, the painful emotions will disappear, he will calm down and his stress symptoms will go away. For example, one might become upset over losing his job. He might feel sad, hurt, fearful, guilty, ashamed and angry. He might experience many stress symptoms, such as sleeplessness, anxiety, tension, headaches and the like. After a while, he accepts the reality that people find jobs and lose them, lose jobs and find new ones. He calms down, gets another job and moves on with his life. The opposite of being stressed or upset is feeling calm.

We can compare the conscious mind to a balloon: when the mind is "inflated" with painful emotions, one experiences stress symptoms. When these painful emotions disappear from the conscious mind/balloon, it "deflates," or shrinks, and the stress symptoms disappear (see picture 1).

When painful emotions inflate the conscious mind Picture 1: When painful emotions "inflate" the conscious mind, stress symptoms appear.

Rule #1: When painful emotions appear in the conscious mind/balloon, we experience stress symptoms. Conversely, whenever stress symptoms are present, the conscious mind/balloon is filled with painful emotions.

We can illustrate this point with following example: If there is sufficient smoke in the room, the fire alarm will go off. Conversely, if the fire alarm goes off, there must be significant amount of smoke in the room.

The conscious mind inflates and deflates with painful emotions day in and day out in response to numerous upsetting events and life problems. Even our dreams can upset us, inflating the sleeping mind with painful emotions and causing stress symptoms to appear. For example, if I dreamed of being chased by a ferocious bear I would be scared, my mind/balloon would inflate with fear and terror, and I would have several stress symptoms: fast heartbeat, shortness of breath, sweating, etc. Upon waking up, I would realize that it was only a bad dream. My fear would disappear, my balloon would deflate and I would calm down. The more upset we are, the more painful emotions we experience in the conscious mind; the more painful emotions we experience, the bigger the balloon becomes and the more we are troubled by stress symptoms.

Learning to keep the balloon shrunk is fundamental to coping with stress. Those who are unable to rid the conscious mind/balloon of painful emotions will experience more and more stress symptoms until the balloon pops and they come down with a stress disorder, such as depression or anxiety disorder. Then they will need a shrink to do the shrinking for them. Now you know why psychiatrists are called shrinks!

3. Stress symptoms are caused by painful emotions in the brain.

As we evolved into modern human beings over millions of years, we developed the ability to experience and express hundreds of painful emotions in response to upsetting situations. Thirty-six of them are responsible for bringing on many stress symptoms and disorders, and we will deal with those in some detail:

Fear, hurt, anger, sadness, guilt, shame, disappointment, frustration, helplessness, hopelessness, humiliation, hate, bitterness, resentment, envy, jealousy, terror, horror, disgust, embarrassment, rage, exasperation, insecurity, despair, dejection, remorse, regret, worthlessness, hostility, vengefulness, dread, sorrow, sinfulness, despondency, uselessness and powerlessness.

The presence of these potentially toxic, painful emotions in the conscious mind and brain causes the brain chemicals to change, resulting in the appearance of stress symptoms. In other words, pain in the brain is the basis of stress symptoms. The brain is connected to the body organs via circulating hormones and a vast network of nerves. Changes in brain chemicals are felt as changes in the functions of the body organs, such as the heart, lungs, stomach and skin. Stress symptoms are the brain’s way of warning us: "I am sensing many painful emotions in your mind. Get rid of them as soon as possible or do something to stop them from coming in." This is no different from a fire alarm going off when it detects more than the usual amount of smoke in the room.

The brain is hardwired to produce different groups of stress symptoms in response to different painful emotions. For example, fear and its cohorts in the brain produce a "fight or flight" response; sadness and related emotions produce stress symptoms related to "grief"; anger and allied emotions produce an "attack" type of stress response; and guilt and related emotions produce "guilty" behavioral responses. Readers interested in mastering the art of coping with stress must thoroughly learn about the nature of painful emotions, how they produce different stress symptoms and how to handle them. In other words, one must become emotionally savvy. In coping with stress, one’s Emotional Quotient (EQ) is more important than one’s Intelligence Quotient (IQ). We will study more about the nature of painful emotions in Chapter Four.

4. Stressors pump painful emotions into the conscious mind.

A. Sensory input. The conscious mind is constantly bombarded with information from the world around us. The five senses—seeing, hearing, touch, smell and taste—are conveyor belts that bring thousands of bits of information into the conscious mind/balloon on a daily basis. This continuous inflow of information is known as sensory input. The nature of most of the incoming information is neutral; that is, we feel neither good nor bad about it. For example, if you look at a chair, you feel neither good nor bad about the chair. Some of the incoming information is perceived by the mind as good, and we feel happy about it. For example, if you get a phone call from your boss telling you that he is pleased with your performance and is giving you a big raise, you will feel happy. Some other information is perceived by the mind as bad for us. For example, if you are told that your performance at work is not good and you could be fired from your job at any time, you will feel very upset. The upsetting situations are known as stressors.

B. There are two types of stressors:

Stessors Picture 2: Stressors pump painful emotions into the mind.

1. Bad events—such as the death of a loved one, the breakup of a relationship, betrayal or infidelity, an accident, robbery, assault, rape, the loss of a job, etc.—are extremely upsetting. They are one-shot painful events. When bad events occur, we experience many painful emotions in our conscious minds all at once, such as fear, terror, hurt, anger, sadness, guilt, shame and disappointment. The mind/balloon inflates suddenly with these painful emotions, and we experience severe stress symptoms.

2. Bad problems of life—such as problems with one’s job, money, health, relationships, etc.—are ongoing life problems. They upset us a little bit at a time, day after day, week after week and month after month. Often, we feel trapped in these bad problems. In this case, the mind/balloon inflates gradually, over a period of time, with painful emotions such as anger, fear, bitterness, resentment, insecurity, frustration or helplessness, and the stress symptoms are not as dramatic as when they are caused by a single bad event. If unsolved, most bad problems lead to the balloon popping because of the relentless buildup of painful emotions in the mind. When the balloon pops, one is brought down with a serious stress disorder, such as major depression or panic disorder.

C. The bicycle pump as a model for stressors. Since bad events and life problems pump painful emotions into the conscious mind/balloon, let us represent them as a simple bicycle pump. Bad events and bad life problems have something else in common with the pump: they both suck! We will read more about stressors in Chapter Five.

5. The hidden mind is like a soda bottle with fizzy soda inside it.

Copint means shrinking balloon Picture 3: The hidden mind holds millions of bits of information in its folders.

How does the conscious mind decide what is bad for it? The mind has a hidden compartment, like the basement of a house or the hard drive of a computer, where it stores a large amount of information that is gathered over a lifetime. The information pertains to whether an object or situation is good or bad for the mind: if it is bad, how bad, as well as how to react to it. As the powerful hard drive of a computer saves millions of bits of information in its numerous folders and files, this hidden compartment of the mind holds its own millions of bits of information. Every time the conscious mind receives some input from one or more of the five senses, it checks with the hidden mind by asking, "What is this? Is it good or bad for me? If it is bad, how do I react to it?" For example, if a stranger offered you a cookie, your conscious mind would ask your hidden mind, "Is this safe to eat?" Your hidden mind might say something such as, "You don’t know this person. The cookie he’s offered could be dangerous. Don’t eat it." This type of interaction takes place between the conscious mind and the hidden mind thousands of times a day. If your hidden mind does not know whether something is good or bad for you, your conscious mind will feel baffled or confused. A person whose hidden mind does not have the information needed to make the right decision in response to a piece of sensory input is said to be naïve, or innocent. We warn our naïve children about the dangers of the world by saying such things as, "Don’t talk to strangers! Don’t accept cookies from strangers! Don’t get into the car with strangers!"

The soda bottle is an ideal model for the hidden mind. We can compare the hidden mind to a full bottle of soda. Just as the dissolved gas in the soda is invisible until the bottle is shaken, all the information in the hidden mind is out of our immediate awareness until some sensory input activates it and brings it to our awareness. For example, right now, you are not thinking of President Bush—until you read his name. Immediately after reading it, your conscious mind might see his image on the screen of your mind, and you might experience neutral, good or bad emotions related to him. After a while, his image will disappear from the screen and go back into the "Memory" folder of your hidden mind. We will read more about the hidden mind in Chapter Seven.

6. Coping means shrinking the balloon.

Coping means getting rid of the toxic, painful emotions in the mind. This allows the brain chemicals to go back to their original position. Then the stress symptoms disappear. In effect, coping with stress simply means being able to shrink the balloon by appropriate methods. Coping requires us to become aware of the painful emotions in the conscious mind; get rid of them by expressing them; cancel them out by means of various mental skills; and skillfully turn off the pump by solving the problems that are hounding us. Then we calm down, and peace and tranquility return to the mind. It’s as simple as that—except that stressed-out people are not able to do any of these things. That is why they need a shrink to do the shrinking for them. Unfortunately, most psychiatrists these days attempt to control the symptoms of depression and anxiety by coating the balloon with drugs, rather than by shrinking it or teaching people how to shrink it themselves. Therefore, this book will focus on guiding the reader to shrink his balloon. We will read more about how to shrink the balloon in Chapter Thirteen.

Let us represent coping by a tube coming out of the right side of the balloon (see picture 4). Now the model of the mind is complete.

The model of the mind Picture 4: The model of the mind.

7. The model of the mind.

Let us briefly review the completed model of the mind. The bicycle pump in the picture above represents stressors. As soon as the conscious mind/balloon receives sensory input from the pump, it asks the hidden mind (soda bottle) about the nature of this input. When told, "This is bad," the conscious mind becomes upset. The balloon inflates with painful emotions, the brain chemicals change and stress symptoms appear. The side tube represents those actions that shrink the balloon. For example, if someone we love has died, the balloon will immediately inflate with painful emotions related to grief: sadness, hurt and sorrow. Inflation of the balloon will cause the appearance of severe stress symptoms: fullness in the chest, swelling of the face, intensely sad feelings. By grieving, crying, sobbing and expressing our emotions (using the side tube), we shrink the balloon and get rid of stress symptoms. Those who are able to keep the balloon shrunk all the time stay well.

The main idea of coping is that the output of painful emotions should equal the input. The reader must thoroughly understand this model of the mind and the interaction between its four components, to make sense of the various stress-related phenomena we will discuss in the chapters ahead.

8. Managing stress means leading a wisdom-based lifestyle.

Managing stress means living a lifestyle that minimizes the occurrence of bad events and problems. This boils down to making wise choices in all aspects of life. To accomplish this, we have to wisely manage our relationships, money, time, health, job and other aspects of daily life. The bottom line in stress management is that one should live a simple life, guided by wisdom. Whereas coping has to do with ridding the conscious mind of painful emotions after one has become upset, managing stress has to do with preventing upsetting events and problems from happening.

A wise person always does the right thing. For example, to avoid money problems, he lives within his means, saves money regularly, refrains from incurring nonessential debts, does not get into businesses about which he knows nothing, etc. To avoid health problems, he resists bad habits, gets adequate exercise, and takes good care of his body. To avoid conflicts with others, he holds back from imposing his views on people or taking advantage of their friendships; he engages others in adult to adult interactions, and so on. In effect, stress management means gaining a good deal of control over all aspects of one’s life (the pump).

Stress management also requires that we avoid making wrong choices and doing wrong things. Both these mistakes are always based on deep-rooted personality weaknesses, such as greed, insecurity, possessiveness, arrogance, lust, hate and jealousy. Every serious life problem, whether it is connected to one’s job, money, health or relationships, is fueled by a personality weakness. We will study how one could put leash on these weaknesses and more about stress management in Chapter Fourteen.

9. How stress leads to stress disorders.

To most depressed or anxious patients, why they suffer from these maladies is a great mystery. They go to their doctors with symptoms such as sleeplessness, anxiety, tension, crying spells, tiredness and poor concentration. After thoroughly examining and testing them, the doctors tell them that no medical reason can be found for their seemingly serious symptoms. To make sense of the symptoms, the doctors then say that the disorder is a result of a chemical imbalance. However, the truth is that the chemical imbalance is the end result of an extraordinary amount of stress combined with poor coping.

Reading this, almost all people in such a situation might wonder, "How could this be when I handled my stress so well by being strong?" Therein lies the problem. People who readily fall apart when upset never become sick with stress disorders. And curiously, by the time a person is down with a stress disorder, he has blocked off from his awareness almost all his painful emotions, as well as the memory of stressful events and the problems that caused them.

A. History of serious traumas. The symptoms of the stressed-out person are just the tip of the iceberg (see picture 5). Every person suffering from stress disorder has been through many bad events and problems in his life, and he has experienced numerous painful, toxic emotions related to these problems. His balloon has inflated many times because of death of loved ones, abandonment, betrayal of trust, conflict, disappointment, assault, accident, physical, emotion and sexual abuse, breakups, serious illness and other tragedies. Bad memories of these events and problems, stored in his hidden mind, have become the submerged part of the iceberg.

Stress symptoms of just the tip of the iceberg Picture 5: Stress symptoms are just the tip of the iceberg.

B. A stressed-out person has had an overdose of painful emotions. In response to these serious bad events and problems of life, the stressed-out person has repeatedly experienced large doses of toxic, painful emotions in his mind. We noted thirty-six of them above. The majority of stressed-out people admit to skilled therapists having experienced most, if not all, of these painful emotions in large doses, over several years prior to becoming sick.

C. Coping by burying. As painful emotions flood the conscious mind, the stressed person gets rid of them, shrinks his balloon and calms himself down by making one simple mistake: instead of shrinking his balloon by means of appropriate coping methods, he says to himself, "This is too upsetting for me. I will be strong. I will not think about it, I will not talk about it. I will just forget it." He simply puts the painful emotions out of his awareness by burying them in his hidden mind/soda bottle. In other words, he bottles up his emotions. The balloon shrinks, the brain chemicals go back to their normal state and the stress symptoms disappear. The prompt relief from stress symptoms gives the person reason to believe that he has handled his stress well, producing a false sense of security. Since this method of burying (hiding or bottling up) painful emotions in the hidden mind seems to work well, it becomes a habit. However, all the person is doing is transferring his painful emotions from the conscious mind/balloon to the hidden mind/soda bottle (see picture 6).

Burying causes the balloon to shrink Picture 6: Burying causes the balloon to shrink, making a person feel calm.

D. The saturation point of the hidden mind. The problem is that the hidden mind does not have a limitless capacity to store painful emotions. As the person’s hidden mind keeps filling up with painful emotions, he finds it harder and harder to calm himself down by burying them. When the hidden mind finally reaches its saturation point, he can no longer bury his painful emotions. Now, when painful emotions related to new bad events and problems appear in the conscious mind/balloon, they stay there. The re-inflated balloon responds by obeying Rule #1: When the balloon inflates, stress symptoms appear. We will read more about saturation point in Chapter Seven.

As the balloon gets bigger and bigger, stress symptoms begin to reappear one by one, become persistent and get worse over time. As more painful emotions enter the balloon, it inflates even more and stress symptoms steadily worsen, such as poor concentration, anxiety, tension, depression, aches and pains, sleeplessness, irritability and impatience. If one asks this person, "How long have you had these symptoms?" he will say something like, "Oh, well, probably about three years." What this means is that his hidden mind reached its saturation point about three years earlier, and his balloon started re-inflating from then onwards. Unfortunately, most people do not seek psychiatric help until the balloon is about to pop, or until it has already popped.

E. Low stress tolerance syndrome. As stress symptoms reappear one by one, the person is at a loss as to why he has them. He also notices that when he is upset about something, he stays upset. No matter what he does, he cannot calm himself down. Why? Because he can no longer bury emotions in his hidden mind and shrink his balloon. This person is known as stressed-out. His symptoms have been warning signals sent by his brain chemicals to his conscious mind, saying, "Your soda bottle became saturated some time ago. Now your balloon is filling up with toxic, painful emotions. Get rid of them properly as soon as possible, damn it!" However, his focus now is on his increasingly uncomfortable stress symptoms, not his accumulating painful emotions. He’s like a person who has not noticed the gradual build-up of smoke in the house, and whose main focus is on how to switch off the screaming fire alarm.

After saturation point the balloon starts to reinflate Picture 7: After the saturation point the balloon starts to re-inflate.

Some of these symptoms, such as chest pain, are very frightening. The person thinks they are caused by a real physical disorder, perhaps heart disease. Stress is the last thing on his mind, since he has thought all along that he was coping well with whatever was upsetting him. To get quick relief from his dreadful symptoms, he abuses alcohol or drugs or goes to see his doctor. His doctor diagnoses him as having a minor anxiety disorder or depressive disorder, and puts him on a tranquilizer or antidepressant medication. This takes care of his symptoms and gives him some temporary relief.

Over time, as more emotions accumulate in the conscious mind/balloon because of the inevitable stresses of daily life, the stress symptoms become worse. In addition, the painful emotions such as frustration and helplessness experienced in response to the unremitting symptoms themselves further inflate the balloon. The severity of persistent symptoms depends upon the size of the balloon. The bigger the balloon, the more stress symptoms there are. A person in this unfortunate predicament is said to be having low stress tolerance syndrome (see picture 8). Depending upon the size of one’s balloon and the type of painful emotions in his balloon, he suffers from many stress symptoms: irritability, angry outbursts, sleeplessness, excessive sleeping, anxiety, tension, poor concentration, inability to shut the brain down, a hundred different thoughts and emotions swirling in the mind, near-panic attacks, depression and many more. Depending upon the predominance of symptoms, people at this stage of stress are often diagnosed with minor stress disorders such as generalized anxiety disorder (GAD), Dysthymic disorder or chronic depression, Cyclothymic disorder (minor mood swings), attention deficit disorder (ADD), Fibromyalgia and the like. Their balloon could pop at any time. To prevent this from happening, they avoid all sensory stimulation, including people, commotion, traveling to distant places, watching television or anything that might upset them. They become increasingly withdrawn from social activities. We will read more about low stress tolerance syndrome in Chapter Eight.

Low stress tolertance syndrome Picture 8: Low stress tolerance syndrome: the balloon is inflating again.

F. The breaking point of the balloon: the slow progression of symptoms finally results in stress disorder. While all this has been going on, the brain chemicals have kept changing in order to deal with the accumulating toxic, painful emotions in the brain or the conscious mind/balloon. Finally, goaded by a precipitating or triggering bad event—the straw that breaks the camel’s back—the emotional pressure in the conscious mind/balloon reaches its breaking point, and the balloon pops. The changes in the brain chemicals have finally resulted in a chemical imbalance. At this critical moment, the mind continually feels, "I just can’t take it any more!" The stress symptoms have finally crystallized into a relatively well-defined stress disorder, such as major depression, panic disorder, etc. (see picture 9). Unable to tolerate emotional pain, many people in this predicament experience suicidal ideas. We will read more about various stress disorders in Chapter Twelve.

The breaking point Picture 9: The breaking point: a stress disorder is born.

G. The double whammy—a blast from the past. Some people’s balloons pop suddenly and quite unexpectedly, and they are struck down with a major stress disorder like a bolt from the blue. In these people, a current painful event—say, the breakup of a relationship—brings into the conscious mind/balloon some painful emotions related to an old trauma buried deep in the hidden mind, such as being abandoned by one’s mother or father in childhood. The fury of the painful emotions spewing from the hidden mind is so great that it pops the balloon (see picture 10). It is as if the soda bottle has been so vigorously shaken that fizz bursts into the balloon attached to the bottle’s mouth. These people’s soda bottles may not have been saturated at all, but they did hold, under pressure, painful memories of a very traumatic event in their past. Double whammy is a blast from the past. Sometimes, however, double whammy is milder in severity and causes only a few symptoms. We will read more about double whammy phenomenon in Chapter Nine.

H. Rule #2: The more severe the persistent stress symptoms, the less one is aware of the painful emotions in his mind and the stressors that caused them.

As the balloon begins to re-inflate, stress symptoms become worse, and a curious thing begins to happen: the stressed-out person becomes more and more focused on his symptoms—sleeplessness, anxiety, poor concentration, panic attacks, depression, mind racing—and less and less aware of his inner, painful emotions and the stressors that caused them. People in this condition often make statements such as, "I don’t know why I feel so miserable," "I don’t know why I cry all the time," "I can’t sleep a wink, and I don’t know why," or "I have panic attacks, and nothing has happened to bring them on." If you ask the stressed-out person directly, "Is something bothering you?" he will answer, "Nothing at all, except my panic attacks!" If you ask, "What painful emotions are you having in your mind?" he will reply, "I have no painful emotions in my mind at all. The only pain I have is in my chest." If you ask, "Did something happen recently to upset you?" he will say, "I don’t know what it could be. The only thing that happened to upset me was my headache attack!"

The double whammy Picture 10: The double whammy: buried emotions fizz up and pop the balloon.

People whose balloons have popped and who are suffering from serious stress disorders, such as panic disorder or major depression, have almost no awareness at all about their blocked off emotional pain or the stressors that caused it. Their total focus is now on the symptoms of the stress disorder. This is no different from one’s focusing on the screaming fire alarm, rather than on the smoke in the room.

How do we know that the stressed person’s mind/balloon is full of painful emotions, and that he has been through many seriously bad events and problems? Well, as soon as he starts talking with a professional who is sensitive, empathic, non-critical and non-judgmental, he will break down and express his emotions—much to his own surprise. He will also reveal numerous horrendous events and problems that have traumatized him over the years. He will say, "I didn’t know I had all these emotions in me and that I have been affected by all these bad events and problems." Raising one’s awareness of the blocked off painful emotions in his conscious mind/balloon is the first and the most important step in learning to cope with stress.

Since these people do not know why they have their seemingly serious stress symptoms, they begin to run to doctors in a futile attempt to find an answer. They are now on a medical wild goose chase, in a perpetual state of bewilderment. We will study this unfortunate phenomenon in greater detail in Chapter Eleven.

10. A case study in shrinking the balloon.

An eighteen-year-old woman, a university student, was brought to the emergency room of the local hospital by her friends because she had suddenly gone blind in both eyes. The woman made it clear that she was there only because her friends had forced her to come. She admitted to suffering from numerous other symptoms over the past several months: sadness, crying spells, headaches, sleeplessness, irritability and inability to concentrate. Obviously, her balloon had been inflating for a while. (Rule #1 above.)

When I saw her on the psychiatric ward, her face showed no emotion at all. When asked directly, she denied that she was upset about anything. (See Rule #2 above: No awareness of inner pain.) During the course of an empathic interview, she broke down and revealed that she had been extremely upset about her father, a retired policeman who lived about two hundred miles away and who had recently gone blind from diabetes. He was also seriously ill with heart disease, and he coughed all night long, almost choking on his own secretions. The woman worried a great deal over the fact that he was getting progressively sicker and his doctors were not doing anything to help him. When she had gone home during the Christmas holidays, six weeks earlier, she had found him in really bad shape. She was crushed when he told her that he could not see her, even when she stood six inches from his face. She had just made up with him after many years of estrangement, and was determined to make him proud of her. But alas, this was not to be.

Upon returning to school, the woman continued to experience painful emotions such as sadness, helplessness, hopelessness and frustration, because of this heartbreaking episode and the ongoing bad news about her father’s health. Week after week, her balloon kept getting bigger and bigger. But, because she believed that grieving was a sign of weakness, she tried to put these emotions out of her awareness and pretended to be strong. She could not bury her emotions because her hidden mind/soda bottle was already saturated due to past issues. She worried constantly that her father might die at any time. To cope with her agony, she drank alcohol to excess.

In the course of our interview, the woman became aware of her sadness, helplessness, hopelessness and other painful emotions. She expressed them through crying, sobbing, sighing, moaning and groaning. Her emotions began to show on her face. As she continued to grieve and express her pain, her eyesight began to return. Her pupils, which had been as tiny as pinpoints, dilated suddenly, as if her brain chemicals had abruptly switched back to their original state. At this point, her eyesight improved dramatically.

As the woman continued to express her painful emotions, her balloon shrank and she felt a whole lot better. She developed the insight that her blindness was her way of countering, as well as expressing, her extreme feelings of helplessness. Since she could not do anything to help her father, she was "doing something" by going blind. She revealed that all her life she had been taught to believe that expressing painful emotions was a sign of weakness, so she held her emotions in. In the interview, I told her to keep expressing her emotions and not to deny them, and she was discharged immediately afterwards. When I saw her briefly three days later, she said that she felt even better, having convinced her mother to appoint new doctors to treat her father. This made her feel less helpless and more hopeful.

In this particular case, the patient was an open-minded person; her stress symptoms had been present for a relatively short time; she responded well to empathy; she was eager to learn new ways of coping; and she was willing to change. At this stage, I decided not to deal with the issues buried in her hidden mind (the reasons for her estrangement with her father and other buried issues), and focused only on the current issues that had caused her balloon to inflate. She could deal with the past issues later.

The majority of the patients I see do not fall in this category. By the time they show up in my office, they have been too sick for too long and are too closed-minded, negative and distrustful to reverse the chemical changes as dramatically as this woman could do. However, all is not lost for them. Human beings are endowed with a wonderful ability to change and adapt. No one is really beyond hope if he is willing to learn new ways to cope.

11. Five reasons why people become stressed-out.

The misery of stress and stress disorders, which millions of people in America suffer from, is preventable. It is based on the following five factors.

A. The lack of knowledge that the mind, brain and body are, in fact, one single unit, and that painful emotions affect our body organs, bringing on frightening physical symptoms and serious disorders. Ignorance of this single bit of information causes stressed-out people to ask such questions as, "How could my mind cause chest pain?" "How could stress cause my headache attacks?" "How could stress cause my heart to beat fast?" and to insist, "I am not imagining it! I am certain this is physical, not mental." They pursue repeated medical consultations with specialists to prove the point, and in the end, all they have to show for this medical wild goose chase is huge medical bills and three big Ds: disgust, disillusionment and demoralization.

The mind-brain body is one indivisible unit Picture 11: The mind-brain-body is one indivisible unit.

What we think and how we feel affects every single organ in the body. Painful emotions in the brain can cause frightening physical symptoms without anything being physically wrong. Because of the intimate and intricate connections between the mind, brain and body, prolonged stress can bring on physical disorders, such as irritable bowel syndrome, arthritis, Fibromyalgia, high blood pressure, heart disease, chronic fatigue syndrome, psoriasis and many more. People who are unwilling to accept this reality are doomed to be on a medical merry-go-round for the rest of their lives.

B. The erroneous focus on physical activity as a solution for stress. Every single stressed-out person, regardless of his level of education, intelligence, profession or social status, labors under the erroneous opinion that coping with and managing stress consist of doing something physical, such as jogging, exercising, taking hot tub baths or lifting weights. This focus on physical activities as a solution for stress symptoms is due to the fact that some of the most distressing stress symptoms are, indeed, physical, such as muscle tension and spasms, feelings of being "wound up," pain somewhere in the body, inability to relax, etc. However, this emphasis on mindless physical activity completely disregards the fact that stress is an emotional phenomenon. Physical stress symptoms are caused by blocked off painful emotions in the mind. Anyone interested in coping with stress must shift his focus from physical activity to learning to identify and deal with his blocked off painful emotions.

C. The use of inappropriate coping methods to calm down. Almost all stressed-out people harbor the erroneous belief that it is a sign of weakness to express their emotions, so they try to "be strong" when faced with stressful events and problems. When they are upset about something, they hide, bury or bottle up their painful emotions to calm themselves down. ("I don’t want to think or talk about it. I just want to forget it!") When they can no longer hide their painful emotions, they indulge in denial ("I’m not upset. I have no problems."). They become experts in blocking their emotions off from their awareness. The unexpressed painful emotions get buried in the hidden mind and they disappear from their awareness.

Both these inappropriate ways of coping go utterly against nature. Their roots go back five thousand years, to when primitive man was being transformed into civilized man, and civilized society curbed the free expression of emotions as a way of taming primitive behavior. People who want to cope with stress must give up their hang-ups about expressing emotions, and reject burying and denial as coping methods.

D. The habit of indulging in distractions to cope with pain promotes burying.

1. The most common distractions are pleasurable activities that millions of people indulge in: drinking alcohol to excess, abusing dangerous street drugs, smoking cigarettes, overeating, having promiscuous sex, gambling and overspending. These activities become bad habits that can lead to serious health, financial, family and legal problems. They block off painful emotions and promote the burying of those painful emotions in the hidden mind. The hidden mind of just about every alcoholic and drug addict is saturated and his balloon is full.

2. When recreational activities, such as vacationing, hiking, trekking, skiing, cruising and the like, are used to escape from having to deal with emotional pain, they also facilitate the burying process. These avoidance activities are, basically, an inappropriate response to stress.

E. The preference for the short-term benefit of drug treatment to the long-term benefit of learning better coping methods. More and more people are resorting to exclusive drug treatment of their stress disorders due to the erroneous belief that their disorders are just the result of a chemical imbalance. They do not realize that unless they learn better coping methods, their stress disorders will keep getting worse over the years. Drugs merely coat the surface of the mind/balloon and temporarily reduce the tension inside it; they don’t shrink the balloon. In fact, psychiatric drugs facilitate the burying process no different than alcohol and street drugs do. As more emotions build up in the balloon, it pops again, and now one has a "breakthrough" episode of his stress disorder. He will then need two, three or even four drugs to coat the balloon and to control his stress symptoms. Most doctors prescribing antidepressant medication base their decision on a list of symptoms provided them by drug companies rather than on adequate understanding of the stage of stress the patient is at. Nowadays, doctors prescribe medications even to people who are merely grieving over the death of loved ones. In fact, the inappropriate and reckless use of antidepressant drugs by uninformed doctors is now so widespread that many patients are immune to drugs by the time they see a competent psychiatrist. Instead of learning to cope with stress, these patients are perpetually in search of new drugs to control their stress disorders. We will study more about this unfortunate and increasingly common problem in the next chapter.

12. Summary: The five stages of stress.

Now that the reader has a fair idea of what stress is here is a glimpse of the stages of stress or emotional health that people experience. We will study these stages in greater detail as we go along. At any given time, everyone in the world is in one of the following five stages of stress (see picture 12).

Stage One: Stage of robust health. The person in this stage is in good emotional and physical health. He has no maladies. He enjoys life to the fullest. He is a wise person who always does the right thing. He is a highly aware person. He is good at getting rid of painful emotions from his mind and solving his life-problems. He has found balance in everything he does in life. His balloon is always shrunk. His soda bottle does not have many buried emotions. He does not abuse alcohol, drugs or indulge in other pleasurable things to cope with his everyday stress. Let me tell you, anymore it is harder and harder to find such people!

Stage Two: Stage of distress. In this stage, an emotionally well-adjusted person is temporarily upset due to a particular event or problem. He is now called a stressed person. He has many stress symptoms. However, he is fully aware of why he is upset. If you ask him, he will readily tell you something like "I am upset because I lost my job," or "My mother died," or some such thing. He does not have any hang-ups about expressing emotions. His balloon is full of emotions, but his soda bottle does not have any painful emotions related to the current upsetting event. He can calm himself down relatively quickly by ridding his mind of painful emotions and solving the problem. If his current life situation is a little too overwhelming, he might benefit from one or two visits with a trained counselor. For example, a middle-aged man is unable to grieve over his mother’s death because he has harbored some anger towards her. Once he talks out his anger, he grieves over the loss and can go back to being his normal self. It is best to avoid medication treatment at this stage.

Stage Three: Stage of low stress tolerance. In this stage, the person is said to be stressed-out. His soda bottle is saturated, and he can no longer cope by burying his emotions. His balloon is inflated to varying degrees. He is unable to calm himself down. He is irritable, impatient, snappy and crabby. He is not aware of why he has these symptoms. His total focus is on his symptoms. If he sees a doctor, he will be diagnosed as having one or more minor stress disorders. At this stage, he may be helped by therapy alone in the hands of a very competent therapist if his stress symptoms are not too severe. However, most people seeking medical help at this stage end up taking one or more psychotropic medications. Most people at this stage respond well to medications. However, sooner or later they reach the breaking point and come down with a major stress disorder, unless they learn to shrink their balloon.

Stage Four: Stage of stress disorder. The balloon has finally reached its breaking point either due to gradual inflating of the balloon or double whammy. Because of a precipitating event, it has popped. Chemical changes in the brain have resulted in a chemical imbalance, and the diverse stress symptoms have crystallized into a relatively well-defined stress disorder, such as major depression or panic disorder. At this critical moment, the patient continually feels, "I just can’t take it any more!" Counseling at this stage is generally useless, as the patient’s suffering is so great that he has no awareness of his blocked off painful emotions. All he is looking for is quick relief from his numerous symptoms. Such patients need one or more drugs to control their symptoms. Even after they are treated with drugs, many of them just go back to the low stress tolerance stage (stage three). This explains why 30-50% of patients do not become completely symptom-free even with aggressive medication treatment.

The five stages of stress Picture 12: Five stages of stress: from robust health to despair.

Stage Five: Stage of despair. At this stage, the person has been through many successive breaking points resulting in multiple stress disorders: depression, panic disorder, psychotic disorder, high blood pressure, Fibromyalgia, irritable bowel syndrome, etc. He has probably been traumatized by the treatment process as well, and so he does not trust either therapists or doctors. He is fearful of drugs, or he is on multiple drugs for his multiple stress disorders. He has no clue, no trust, no hope and no desire even to try to get help. He has frequent suicidal thoughts. He considers himself totally and permanently disabled. He is constantly trying to get on some type of disability program. None of his healers seems to have a clue as to how he reached this stage of devastation.

Reproducted from the book "Is Your Balloon About To Pop?: Owner's Manual for the Stressed Mind," with the permission of author Dr.Bob Kamath.

Suggestions for Further Reading

Author:Reproduced with the permission of  Dr. Bob Kamath, M.D. ©2007. All rights reserved. Graphics, Illustrations and Cover Art by Nikki Brown. Dr. Kamath, a Board Certified psychiatrist, has been in private practice in Cape Girardeau, Missouri since 1982. Dr. Kamath specializes in Stress and the psychopharmacological treatment of stress-related disorders such as depressive and anxiety disorders. He has been licensed to practice medicine in Missouri since 1977. To know more about him visit his website.

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