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STRESS AND ILLNESS
(see also stress: explanation)

Stress can be a powerful factor underlying certain pathological states and when a person can no longer cope with it effectively, there will be a risk of developing some form of psychological and/or physical disorder. Coping strategies are the more or less functional actions and reactions we all occasionally adopt to deal with stressful situations. A great number of research projects have been carried out with the aim of measuring tolerance to stress and the capacity to cope in different people and, in particular, in subjects suffering from various forms of physical pathology. The results tell us that that individuals capable of coping with difficult situations suffer fewer and less intense negative effects, moreover obtaining improvements in the disorder from which are affected, while those who tend to present avoidance behaviour (see ‘Anxiety’), negation and disengagement tend to suffer more, and further worsening their disease. The latter are susceptible to experiencing higher levels of stress and the consequences are obviously more severe.

Besides coping skills, there are other fundamental factors capable of reducing stress. One of these is social support, which can occur in a variety of forms. The term ‘structural social support’ refers to an individual’s network of social relations: for example, whether a person is married or not and the number of his/her friends. The term ‘functional social support’ refers to the quality of social relations: for example, whether a person believes that he/she has friends that can be turned to in times of need (Cohen and Wills, 1985). Ample proof has now been obtained in support of the idea that structural support is a good predictor of mortality. Older people with very few friends or relations tend to have a higher mortality rate than people who enjoy a higher degree of structural support. Similarly, persons with a lower level of structural support have a higher risk of mortality following myocardial infarction with respect to those who present higher levels of this kind of support (Ruberman et al., 1984).

In what way does social support play a beneficial role? A possible explanation is that higher levels of social support are conducive to a healthier lifestyle, characterised by a balanced diet, refraining from or simply not smoking and lower levels of alcohol consumption. An alternative explanation would suggest that social support – or the lack of it – might have a direct effect on certain biological processes. Moreover, for example, low levels of social support is associated with an increase in negative emotions, which in turn may have an effect at the endocrinological level, by altering the levels of certain hormones, and may also cause a modification of the immune system. However, numerous questions have still not been answered in a specific way. For example, why does stress engender pathological states in some individuals and not in others? Why does stress sometimes generate an organic rather than a psychological disorder? Researchers from the fields of both biology and psychology have tried to find an answer to these questions.

The biological theories. The biological approaches attribute particular psychophysiological disorders to weaknesses or a specific hyperactivity of certain organs in their response to stress. It is possible that the influence of genetic factors, past diseases, diet and other similar factors may lead to alterations in the functioning of a particular organ or system of organs, which may consequently become weakened and vulnerable to stress. According to the somatic weakness theory, the link between stress and a certain psychophysiological disorder lies in the weakness of a specific organ. For example, a constitutionally weak respiratory system might predispose an individual to developing asthma. According to the specific reaction theory however, every individual responds to stress in his/her own way and the organ most sensitive to stress is the one most likely to become the focal point of a later psychophysiological disorder.

For example, an individual whose response to stress tend to consist in an increase of arterial pressure is more susceptible to developing essential hypertension. In general terms, stress factors have multiple effects on various systems in the human organism, and in particular on the autonomous nervous system, hormone levels and cerebral activity. At present, one of the main areas of interest is the immune system, which may be of crucial importance in the development of infectious diseases, cancer, allergies and autoimmune disorders such as rheumatoid arthritis, which causes the immune system to attack the body itself. It has been shown that there is a wide range of stress factors capable of producing modifications in the immune system, which, by way of example, might include examinations, depression and the loss of loved ones, marital conflict and divorce or losing one’s job. One study has for example confirmed the relationship between stress and infection of the respiratory tracts. In this particular research project, volunteers were infected with a mild influenza virus by administration through the nose of a series of drops and were then submitted to a series of tests aimed at measuring the degree of recent stress. The results showed that the persons who had more recently been subjected to strong stress contracted the virus more easily, while those who had not been subjected to stress in the weeks preceding the study were found to be more resistant to the artificially induced form of influenza (Cohen, Tyrell and Smith, 1991).

Psychological theories. These theories attempt to explain the development of psychophysiological disorders by referring to such factors as subconscious emotional states (see ‘psychoanalysis’), personality traits, cognitive evaluation and personal strategies adopted in reaction to stress. According to the psychoanalytical point of view, psychophysiological disorders originate in specific psychic conflicts and their associated negative emotional states. Amongst psychoanalysts who have studied psychophysiological disorders, Franz Alexander (1950) is probably the researcher who has made the greatest impact in this field of study. In Alexander’s conception, the various disorders are the product of subconscious emotional states that are specific for each type of disturbance. In his opinion, for example, non-expressed hostile impulses engender a chronic emotional state which underlies essential hypertension. Moreover, on account of their being constantly repressed, the hostile feelings will increase in intensity. This will lead to the creation of even stronger defensive measures aimed at keeping the repressed hostile impulses under control. Alexander elaborated this theory of non-expressed anger (withheld anger) on the basis of his observations of patients who had undergone analysis.

Bibliographical references:

Cohen, S., Wills, T.A. (1985). Stress, social support, and the buffering process. Psychological Bulletin, 98, 310-357.

Cohen, S., Tyrell, D.A.J., Smith, A.P. (1991). Psychological stress and susceptibility to the common cold. New England Journal of Mrdicine, 326, 606-612.

Ruberman, W., Weinblatt, E., Goldberg, J.D., Chaudhary, B.S. (1984). Psychosocial influences on mortality after myocardial infarction. New England Journal of Medicine, 311, 552-559.