Abstract
The paradox of health today is that the UK population is increasingly long-lived, and workplaces have never been safer. The average number of working days per employee lost through sickness has fallen from 7.2 in 1993 to 4.4 in 2013 and yet record numbers are claiming disability benefits for psychosomatic illnesses. This is because the time lost by UK workers as a result of stress, anxiety and depression has risen steadily over the last decade to reach a total of 15.2 million days in 2013. This in-depth collection of essays on stress is, therefore, a timely contribution.
Of course, stress did not originate in the 1950s when the term first rose to prominence. It was then, as Mark Jackson explains, that Hans Selye offered a neurobiological model designed to tie stress to chronic illnesses such as hypertension, peptic ulcer and asthma. Although the ‘general adaptation syndrome’ proposed by Selye has not survived the rigours of evidence-based medicine, his discussion of the relationship between emotion and disease proved pivotal and, as Elizabeth Siegel Watkins argues, it prepared the ground for a flood of new drugs introduced in the 1950s and 1960s. Tranquillizers and anxiolytics became top sellers as pharmacology appeared to offer an instant cure for stress at home and in the workplace.
The armed forces have an enduring occupational interest in stress, and in the aftermath of World War II psychiatrists in the US Army began to measure its impact using records of units exposed to prolonged combat. Theodore M. Brown argues that this conflict saw stress promoted to the role of primary agent in the cause of breakdown, supplanting the traditional emphasis on personality factors. While this process undoubtedly began then, it is far from clear that a paradigm shift had occurred by 1945. Rather, it was not until the recognition of post-traumatic stress disorder (PTSD) in 1980 that the about-turn in causality had achieved widespread support. During World War II the majority of battlefield breakdowns were considered the result of inherited or acquired psychological vulnerability triggered by combat, while servicemen without such vulnerabilities exposed to extreme trauma were expected to recover with no long-term effects. Indeed, the chapter by Tulley Long on military research into combat stress during the Cold War era shows that the emphasis was increasingly away from a generalized neuro-biological construct towards greater understanding of an individual soldier’s psychology and situational context.
Chapters explore the manifestation and interpretation of stress in particular environments. These include: in the workplace (Joseph Melling and Junko Kitanaka), the science of animal welfare (Robert G.W. Kirk), the cancer patient (David Cantor) and urban planning (Edmund Ramsden). Allan Young argues that the impact of 9/11 and formulation of PTSD led to a re-definition of resilience as mastery over stress, while Otniel Dror proposes that the phenomenon of sudden unexpected death was reframed as a consequence of constitutions weakened by the stress of modern civilization.
In a challenging chapter, Rhodri Hayward explores how researchers interpreted the impact of stress on the community and in particular its manifestation as mental illness. Based on semi-structured interviews of women in Camberwell, George Brown and Tirril Harris found that depression was more common among lower-income groups. They concluded that different rates based on class were associated with two variables: life events experienced in the previous year (commonly involving loss), and a set of four ‘vulnerability’ factors (the absence of a confiding relationship, having three or more children under 14 to look after, not having paid work outside the home, and the loss of one’s mother before the age of 11). Strictly speaking, Brown and Harris advanced a sociological and psychological explanation of mental illness in which stress was hypothesized as an element in a pathological process. Indeed, the relationship between stress and sadness is far from clear. In some cases, it could be argued that stress serves as an active defence against mood disorders, and depression arises when the stressed person runs out of energy.
The book arose from a workshop conducted at the National Institutes of Health in 2010, and the editors, David Cantor and Edmund Ramsden, are to be congratulated on assembling a diverse collection of essays executed to a high standard of scholarship. Stress, Shock, and Adaptation will be of great interest to medical historians as well as psychiatrists, psychologists, and others studying the topic of stress.