ANGINA AND LONG-TERM RESPONSES TO STRESS
We have covered the main physiological, emotional, cognitive and behavioural responses to stress. You will be able to identify one or more responses that you have experienced at some time.
These are all normal responses to stress on a continuum from mild to extreme. Someone who responded minimally to stress at one time may respond in an extreme way at a different time. The short-term mild responses may not be harmful at all but the long-term chronic stress responses can be catastrophic for some people.
We are all genetically programmed to develop certain illnesses under certain conditions favourable for that illness. What we don’t know is what illnesses, under which conditions, and for whom. Stress may act as a trigger for one or other of those illnesses, causing the body to identify its weak system and respond accordingly by showing signs of an illness. But because the symptoms of these illnesses may cause stress responses in themselves it is very difficult to know which came first, the stress or the illness.
There is sound research evidence to suggest that the way we behave (and therefore think and feel) can trigger coronary disease including hypertension, chronic pain, digestive ulcers and bowel disorders. There is some, albeit weak, evidence to suggest that stress may also be related to asthma, rheumatoid arthritis and diabetes. This does not always imply that stress causes these diseases but we know that for some people stressful events can trigger an exacerbation or ‘flare-up’ of the illness. This is especially true in angina. Chronic stress can manifest itself as chronic back pain, headaches, unexplained fatigue in one’s limbs, undue disability from a physical illness, sexual problems and many other disorders.
Being labelled’ ill’ or ‘disabled’ can have detrimental effects on the way some people behave. Being told you have a chronic illness can have an effect on the way you think and feel about yourself also. For example, if someone has a mental picture of a person with a long-term illness as a passive, pathetic figure who cannot perform essential tasks, then this will cause them to lose respect for themselves and to see themselves as dependent and even a burden on others. This can lead to severely strained relationships within the family. They may also believe that having a chronic illness (such as angina) means they have to stop doing any physical work and retire to the armchair. By behaving in this excessively passive way (known as sick role behaviour) they let their fitness lapse, bringing on more angina and other aches and pains as the joints and muscles deteriorate from underuse. This may begin the downward spiral of sadness, debilitation and depression.
There is good research evidence to suggest that people may be more disabled by their thoughts and feelings about their illness and what it means to them than the actual extent of the illness warrants.
People who behave, think and feel in this way have very poor expectations from life. They often feel they are not worthy of help and successfully merge into becoming the disabled person they had the image of in their mind. Sometimes they become irritable through frustration and may be aggressive to others. Because they behave in this way they may isolate themselves from their family and friends and eventually find themselves receiving little support from others and become more dependent on strangers for assistance.
This behaviour can have an effect on the way others see the person too. The medical and social services often treat disabled people as passive, pathetic recipients who will accept any standards of care. This is not too surprising if this is how the person behaves and thinks of him/herself. So, once again a vicious circle is set up with people being more disabled than their physical condition necessitates because their thoughts, behaviour and feelings play a role in their ‘disability’.
Tom used to be the life and soul of the party. He was a keen fisherman and everyone who knew him enjoyed his company. When he was told he had angina Tom remembered how a good friend of his had died from a heart attack and he connected the two. He began to ‘take it easy’. He retired from work, gave up fishing, and things went from bad to worse. He became irritable and frustrated because he could not do what he used to do and because he missed the social contact with friends.
Arguments with his wife increased because, as she said, ‘He’s around the house, getting in the way, all day long’. He began to see himself as a burden and lost respect for himself. He became snappy to the grandchildren and eventually they stopped visiting.
After a year Tom had an angiogram which showed he had very mild coronary disease and he enrolled in the physical training classes. Slowly but surely he regained some physical fitness and the angina became less troublesome. He began to renew his friendships and took up fishing again.
Tom still cannot do all the things he would like to do but now he accepts it. He still believes he is a person to be respected and his friends and family enjoy the new, more relaxed Tom as much as the one before he had angina.
Now that we have covered most of the stress responses, fill in your answers to the stress questionnaire which follows and try to build up a picture of your predominant responses to stress. Knowing yourself is half the battle of changing. The next chapter will look in more detail at ways of controlling your stress responses.
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