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Excerpt 1: They Can’t Find Anything Wrong!

How Stress Causes Illness

By now, you may be curious about how stress can literally make you sick. For the answer, a brief explanation of the stress response system is in order. Begin by imagining that millions of years ago, one of your ancestors was picking berries when she observed a hungry saber-tooth cat emerging from the bushes. In her brain, a series of interconnected areas called the stress response system kicked into high gear to help her cope. Another name for this is the "fight or flight" system because it mobilizes the body to face danger head on or to run away. This system operates in many species to co-ordinate the response to predators and other threats. The human stress response apparatus sent nerve signals into your ancestor's body and caused her heart to beat faster, muscles to tense, breathing to become more rapid, sweat to appear and digestive and bowel function to slow. These changes helped her survive the confrontation, which is why we need a stress response system in our bodies.

Human beings are no longer confronting saber-tooth cats, but the stresses we face today can still trigger the stress response system. Running a race, speaking in public, taking a chemistry exam (my personal saber-tooth cat), walking into an important job interview, fighting with your mother, going on a first date, or having a dispute with a neighbor can all cause stress. Happy occasions such as the birth of a child, the purchase of a new home, getting married, or winning an award, can cause stress too. The resulting "butterflies in the stomach," fast and shallow breathing, muscle tension, rapid heartbeat or sweating palms are experiences common to us all. These physical responses are part of our preparation for maximum effort.

It is important to recognize that some stresses last for just a short time, others for much longer. For example, imagine you are driving down a residential street. A small child darts in front of your vehicle. You see the child and your brain calculates the danger. Your stress response system surges into action. Nerve signals race into your body, enabling you to apply the brakes quickly and forcefully. The child is unharmed. In this case, the stress is over in a short time. The nerve signals from the stress response system stop and the body returns to its usual state, so there are no long-lasting consequences.

Prolonged stress, on the other hand, can cause problems for the body. When the nerve signals from the stress response center persist, the body is unable to return to an unstressed state. For example, imagine you are living with someone who loses his or her temper often or hits you. You are never sure when you may be threatened so there is stress whenever that person is present. Most of the time the level of stress is not as high as in the previous example, but it is present for a much longer period. For our purposes, it is convenient to assume that the physical symptoms of stress illness occur when nerve signals from the stress response system persist for too long at too high a level.

Symptoms that result from this process may be indistinguishable from those caused by other diseases. They may be mild or severe and can occur almost anywhere in the body. In one of my patients, the strongest nerve signals from the stress response system went to the stomach. Her illness began with abdominal "butterflies." Over time, her stress became worse and the nerve signals strengthened. Her condition progressed to nausea, then vomiting and finally complete paralysis of the stomach. Finding a solution to her stress stopped the nerve signals and her stomach returned to normal.

The nerve signals rarely cause damage to the body's organs. This is why diagnostic tests are nearly always normal. One of my patients was ill for over eighty years and her diagnostic tests still showed no physical abnormalities. Of course, this causes a major dilemma for doctors who usually are unable to "find anything wrong" and the patient becomes a medical mystery.

Fortunately, as we have seen with Ellen and Catherine, the diagnosis of stress illness does not depend on tests, but rather on understanding the patient as a person. The diagnostic process can then begin with a search for stresses capable of causing illness.

It is worth repeating that many doctors are reluctant to mention the possibility that a patient's symptoms could be due to stress. This is because patients often resent any implication that symptoms are "in their head" or in any way imaginary. This is why I emphasize that stress causes symptoms just as real as those of any other disease. As physicians, we can remind our patients that the symptoms of stress illness are due to nerve signals from the brain similar to those that help us react to sudden threats -- a real process that has operated in all human beings since we became a species.

Another tool for understanding how this may apply to you, is the diagram below. The arrows from the word "Stress" to the brain illustrate difficult life events arriving at the stress response system for processing. For our purposes, it is reasonable to assume that if the level of incoming stress is excessive, this system may unload stress into the body in the form of nerve impulses. When these signals are strong enough, they can cause symptoms. The location of the symptoms depends on where the signals go in the body. In this diagram, you can see the nerve impulses emerging from the spinal cord, headed for various parts of the body.

Now that you understand the stress response process, your next step is to determine what stresses in your life might be strong enough to trigger this reaction in your body.