How to Cope With Stress (Part Three)

Stress is such an important topic that two lengthy discussions of the subject are a mere introduction. I have lectured on this topic frequently, and Dr. Krippner and my DOROT Institute co-presentation from 2004 can be heard on my website. Our recent follow-up discussion is the March 13th WOR broadcast of "The Park Avenue Diet Show".

What is the biochemistry of stress? Although incompletely understood, it can be simplified by focusing on three discrete body parts: the hypothalamus, the pituitary, and the adrenal gland. Let's start at the top, namely the cerebral cortex, the outermost part of the brain where we do most of our thinking. As we view challenging situations or think stressful thoughts, impulses are sent to the hypothalamus, a tiny organ at the base of the human brain.

In addition to dozens of other known and unknown functions, the hypothalamus will secrete a chemical called corticotropin releasing hormone. This will travel a very short distance to the pituitary gland nearby, which will in turn secrete ACTH, adrenocorticotropin hormone. And this chemical in turn will stimulate the adrenal glands adjoining the kidneys to release cortisol.

You may not have heard of any of these chemicals before, and you are probably not aware of this cascade of hormones that rapidly follows exposure to a stressful situation. But you certainly know the feelings that they engender: nervousness, palpitation, dizziness, forgetfulness, and unremitting worrying.

Human neurochemistry is an extremely complex topic, as is physiological psychology, although both are extraordinarily interesting. Why we think what we think is an amalgam of neurotransmitters, hormones, behavioral patterns, social relationships, and personal mythology. Yet no one needs to be told what stress feels like. Everyone experiences it from cradle to grave.

Sometimes we can get used to stress and become less worried under a given set of circumstances. This is called desensitization. New Yorkers for example are accustomed to hearing car horns, police sirens, and other noises that might be startling to someone from a quiet rural area. Emergency room physicians are unaffected by beeps, buzzers, flashing lights, and other noises that might startle or frighten an already tense patient.

The stress response that is "pre-installed" in our bodies was a protective mechanism in our pre-historic past. "Fight or flight" might have been a daily activity in the dangerous world of cavemen and cavewomen. The adrenal gland was thus a lifesaver: this organ which sits on top of both kidneys is the control center for dealing with pre-historic environmental crises. Not only would it allow humans to flee dangerous animals by increasing cardiac and respiratory rates, it would allow the glucose supply to be rapidly increased, fueling the leg muscles so they could work in overdrive.

But these days, although we may have severe stress throughout the day, we certainly do not need excessive blood sugar, a racing heart, or hyperventilation. A simplistic definition of anxiety might be excessive secretion of cortisol and adrenaline when none is necessary.

Anxiety is also a complex topic, one usually discussed by prominent psychologists like Dr. Stanley Krippner rather than physicians. Needless to say anxiety like many other mood disorders depends in part on altered or dysfunctional neurochemistry.

People who suffer from unremitting anxiety may also have certain generalized fears, sometimes worsened by stress. Acrophobia (a fear of heights) is actually quite normal: extremely few people feel comfortable standing on a cliff overlooking Grand Canyon. But agoraphobia (a fear of public places) can be extremely debilitating and frightening. Acute and/or chronic stress can make certain individuals extremely reclusive, prohibiting them from virtually all social interactions.

Stress can affect one's perception of one's own health. Unremitting anxiety can lead to a somatization disorder, when an individual seeks medical attention repeatedly for an illness that doesn't exist. Another possible scenario is called a conversion disorder where neurological symptoms such as paralysis, numbness, or apparent blindness are a direct result of extreme personal stress.

These are considered psychiatric conditions, but stress unfortunately can be a co-factor in dozens of medical ailments. Excessive cortisol can decrease the production of mucus that lines the stomach and protects it from highly caustic hydrochloric acid. In this way, stress causes ulcers, a subject which I unfortunately am an expert in (having suffered an attack in 1991).

Stress is translated into hair loss for many people. How do you know if this is affecting you? When you run your hands gently through your hair, if 5 out of 12 hairs become loosened and fall out, stress may be the reason. And how does stress cause hair loss? "Growing" hairs are converted into "resting" hairs (which are not implanted as well) and fall out.

One of the most fascinating medical expressions of stress can be seen in a hyperventilating patient. Due to carbon dioxide and calcium imbalances, an extremely stressed out person may develop main d'accouchment [delivery hand, namely the hand shape that an obstetrician uses].

But enough talk about the neurochemistry, physiology, and pathology of stress. I'm sure that you are familiar with a great deal of this already. Did you know that the human body also has embedded anti-stress hormones and "software"? We have focused primarily on the sympathetic nervous system, which is responsible for "fight or flight". It has a mirror-image in the parasympathetic nervous system, a parallel set of nerves, neurotransmitters, hormones, and physiologic responses.

By gently rubbing one side of the neck near the carotid artery, a cardiologist or emergency room physician is able to stimulate an "anti-adrenaline" mechanism when faced with a patient with an extremely rapid heart rhythm. Don't try this, but gentle pressure on the eyes elicits a similar response, namely stimulation of the vagus nerve, the superhighway of the parasympathetic nervous system.

Another outstanding example is the "diving reflex". When certain birds and animals plunge into ice water, their heart rate, breathing rate, and metabolic rate all rapidly decrease. One of the extremely rarely used emergency room treatments for palpitations due to life-threatening arrhythmias is to plunge the patient's face into a basin of ice water, eliciting a type of "diving reflex" in a human being. Do not try this at home.

These examples although quite dramatic will show you that there exists in the human body a neurochemical balance to the stress mechanisms we have already discussed. Of course these emergency room heroic techniques are inappropriate for solving personal problems or coping with daily stresses. I'm sure you probably have not been aware of this unusually complex interrelationship.

Depersonalization, however, is a common and rather unconscious technique of coping with stress. This can be broadly defined as a technique of forgetting about one's self and directing one's thoughts totally externally. And I'm sure you have done this rather frequently in the last few months. Going to an exciting sports event, watching a thrilling James Bond movie, even reading a gossip magazine--all of these are activities that allow us to escape from our problems and briefly enter a "parallel universe" nearby. The stressful problems we are temporarily escaping will still be there later on, but our bodies are refreshed by the relief from unremitting bombardment by stress.

Alpha waves in the brain appear on EEG's when people are in a relaxed state, and quite often people can be taught how to achieve this level of psychological comfort. One classic way is through meditation, which can be somewhat duplicated by repeating a particular word or phrase over and over. Recent research has focused on endorphins, neurochemicals that are associated with positive and pleasurable feelings. You have no doubt heard that aerobic exercise, particularly jogging, is associated with the release of endorphins. Moreover, aerobic exercise "tones down" the sympathetic nervous system. This partially explains why "cardio" is a useful ancillary therapy for high blood pressure and heart disease.

Many people feel that coping with stress is best achieved through the use of minor tranquilizers such as Valium or Xanax. But I think it's more important to understand the neurochemical, physiological, and psychopharmalogical aspects of the topic rather than simply resorting to the simplistic therapy of prescription medication. Let's leave our discussion of this extraordinarily important issue at this point. We will continue at another time. Now go have a totally stress-free day!