Table Of ContentSTRESS
The hidden adversary
To my Mother
and in loving memory of my Father
STRESS
The hidden adversary
Clifford B. Dobson
MSc, PhD, LCP, ABPsS, FRSH
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MTPPRESS
LIMITED' LANCASTER' ENGLAND
International Medical Publishers
Published by
MTP Press Limited
Falcon House
Lancaster, England
Copyrigh t© 1982 Clifford B. Dobson
Softcover reprint of the hardcover 1st edition 1982
All rights reserved. No part oft his publica tion
may be reproduced, stored in a retrieval
system, or transmitted in any form or by any
means, electronic, mechanical, photocopying,
recording or otherwise, without prior
permission from the pu blishers.
Bri tish Library Cataloguing in Pu blica tion Data
Dobson, C. B.
Stress.
1. Stress (Physiology) 2. Stress (Psychology)
I. Title
616.8 BF575.S75
ISBN 978-94-010-9800-7 ISBN 978-94-010-9798-7 (eBook)
DOl 10.1 007/978-94-010-9798-7
Typesetting by Robert MacLehose & Co. Limited, Renfrew
CONTENTS
Preface Vll
1 The nature and sources of stress
2 Personality and stress 35
3 Stress and the self-concept 73
4 Physiological and psychological responses to stress 97
5 Mental illness in response to stress 139
6 The physical and behavioural effects of stress 169
7 Stress and medical disorders - I 201
8 Stress and medical disorders - II 225
9 Stress and social pathology 263
10 Occupational stress 287
11 Stress in education 323
12 Stress in young people 359
13 The control of stress 393
Appendix A 419
Appendix B 421
Author index 425
Subject index
PREFACE
This book is intended as an introductory text on stress and is aimed
principally at students in the medical, para-medical and nursing
professions, and for students of psychology and the social sciences.
Additionally, students preparing for other 'caring' professions whose
chief concern is with helping people in distress should find the book
informative and instructive.
Stress is a complex subject and the book will provide students with
the opportunity to become acquainted with a multiplicity of topics cur
rently in vogue which are subsumed under the general heading of
stress. The book should also enable readers to gain some insight into
the symptoms of stress in those whom they are seeking to help, and to
empathize with them. A secondary objective of the book is to help
readers to understand and come to terms with their own personal stress
experiences, especially those which arise in connection with their
professional work.
The book begins by examining the nature and sources of stress, and
highlights the difficulties inherent in attempting to formulate an
adequate definition of the concept. There follows a survey of some of the
conceptual models of stress which have been produced by researchers
in the field, and a related section is also devoted to anxiety. Not all stress
is harmful, and its motivational aspects are discussed. Nevertheless, a
comprehensive study of the research evidence suggests that stress is
detrimental to the organism's well-being, and various general causes of
stress are mentioned.
Why does one person react to stressful stimuli when another person
does not? Individual differences are important and the book goes on to
examine the concept of personality and the instruments which have
been devised to measure it. The works of Eysenck and Cattell feature
prominently, and their respective concepts of extraversion-introversion
and exvia-invia are related to stress. This leads on to the notion of the
self-concept and the stress which can arise when dissonance occurs
between the 'real' self and the 'ideal' self, and between the ways in
Vll
Vlll STRESS
which we see ourselves and the ways in which we are evaluated by
others.
The book then looks at the ways in which we respond to stress. The
physiological and psychological responses to stress are considered in
some detail and the section concludes with some examples of defence
mechanisms. This is followed by a discussion of mental illness in
response to stress, and various types of mental illnesses are described
with illustrative case-studies.
The effects of stress on the organism are considerable, and the next
part of the book deals with the physiological effects of stress (tension
headaches, respiration, blood pressure) and the psychological effects
(anger, resentment, fatigue). Two chapters are devoted to stress and
medical disorders, the first of which deals entirely with stress and heart
disease. The second chapter examines a selection of stress-related
ailments. There is also a chapter on stress and social pathology which
inspects some of the empirical evidence on such variables as alcoholism,
drug abuse, crime and suicide.
The emphasis of the book shifts to occupational stress and a few of
the more stressful occupations have been selected to emphasize some of
the problems. There is mounting evidence to proclaim that stress is
taking its toll in educational institutions where it is affecting
administrators, teachers and pupils. A chapter has been devoted to this
acute problem.
Stress is often treated in the literature as something to be found solely
within the adult world, and to dispel this notion a chapter has been
included which deals with young people and stress. Among the topics
presented are: adoption, family disruption, illness and hospitalization,
bereavement and certain constitutional disorders.
The book concludes with a section on the control of stress and
incorporates material on relaxation and meditation, psychotherapy,
behaviour modification, and self-instructional methods (biofeedback).
In summary, the book attempts to answer the following questions:
What is stress?
How do we respond to stress?
What are the effects of stress?
Do young people experience stress?
Where do we encounter stress situations?
How can we control stress?
The book is illustrated, contains a wealth of references to empirical
research and has a useful index. Since no chauvinistic overtones are
PREFACE IX
intended, the reader is asked to accept that the use of masculine
pronouns throughout the book is purely to facilitate the mechanics of
writing, and that they should be sensibly applied to 'embrace' the
female sex.
I wish to acknowledge my indebtedness to the many scholars in this
country and abroad, especially those in the USA, who have so
generously made their research findings available to me. My thanks
must also go to students and colleagues for their helpful comments and
assistance. lowe to my typists, Mrs Elma Parkin and Mrs Shirley
Hinchcliffe, a special debt of gratitude for producing uncomplainingly
(to me at least!) a fine manuscript from illegible drafts. My special
thanks must go to family and friends who encouraged me and suppressed
their own needs for my time during the writing of this book.
Clifford B. Dobson Bradford, 1982
Chapter 1
THE NATURE AND SOURCES
OF STRESS
WHAT IS STRESS?
Stress is a familiar concept to us since it is an inescapable part of life.
We feel we know what stress is because we experience it in its various
forms in everyday life. We recognize it when we are faced with the
prospect of having to pay an overdue bill, have an argument with
another motorist, become frustrated with the boss, anticipate surgery
at the dentist's, or await a driving test. We speak of stress in general
terms because it incorporates so many areas of our lives. Moreover, the
concept is understood by professionals and laymen alike. Company
directors experience it, and so do teachers, actors, airline pilott', govern
ment officials, sportsmen, soldiers in combat, housewives, students,
and so on. The list is inexhaustible.
A glance on the shelves of university libraries will reveal a wealth ~
printed material on stress in different fields such as medicine, biology,
biochemistry, sociology, psychology, psychiatry, physiology,
anthropology, ergonomics, etc. Several types of studies have been
undertaken into the subject of stress and have made distinctive con
tributions to the literature. Three research areas in particular which
have proved invaluable in helping us understand stress are studies con
cerned with anxi~ty subJects, investigations into life-stress events, and
laboratory experiments involving induced stress. We shall look at some
ofthese studies and their findings in this and later chapters.
In spite of the abundance of available written material, it would be
difficult to present an adequate definition of stress - one which would
be acceptable to all. The concept remains vague and ambiguous and
any definition must of necessity reflect the interests, methodologies and
2 STRESS
subject-matter of the disciplines which attempt to study it. A search of
the literature reveals that there are over 300 definitions of stress and
words which are semantically akin to it. It may be helpful to regard it as
a situation-specific word, i.e. a word which assumes various meanings
according to the particular situation or context in which it is used.
Richardson has a~so referred to the generality of the concept of stress
and has suggested that for the concept to have any specific usefulness
'. . . it should be further differentiated into a set of elements or compo
nents germane to the phenomenon under study. . .'
The term probably derives from the Latin stringere (strictus) which
means to draw tightly or bind. It was certainly used in Old French
(estrece) and in Middle English where it appeared as 'stres', 'straisse',
or with other similar spellings. The original connotation of the word
'stress' referred to hardships or adversity, but by the eighteenth century
it came to denote a force. Any attempt to resist this force by change or
distortion became known as 'strain'. Indeed, a definition of stress which
dates from 1843 introduces the related term strain - 'strain upon a
bodily organ, or a mental power'. This same idea is to be found in the
Shorter Oxford English Dictionary - 'to subject (a material thing, a bodily
organ, a mental faculty) to stress or strain'.
The term 'stress' was introduced into the physical sciences where it
referred to the external force or pressure applied to an object, and' strain'
was the change or distortion which took place within the object when
stress was applied. More precisely, engineering sciences refer to the
external force as the load, the internal force is the stress, while the
change, distortion or breaking of the object is the' strain'.
When we apply this information to the human situation, the Concise
Oxford English Dictionary shows a close affinity between the words
'stress', 'distress', and the 'fatigue' which follows exertion or strain.
Underlying these definitions there would seem to be an implicit model
of stress which proposes that it is an excessive force which acts upon the
individual, causing him to respond to it and cope with it in such ways
that strain ensues. Osler (1910) associated stress with working too
hard, and strain with worry. His concern was that these conditions, if
allowed to continue unchecked, could result in physical or mental
illness for the individual. More recently, Levi (1972) has suggested that
'stress is one of the mechanisms suspected of leading under certain
circumstances to disease. '
Lazarus, writing in the International Encyclopedia of the Social Sciences
(1968), notes that 'Stress suggests excessive demands made on man and
animals, demands that produce disturbances of physiological, social
