In 1925 a student at the Charles University medical school in Prague sat through his first lecture in the science of diagnosis, taking careful notes about how to examine a patient, and was struck by an observation that profoundly changed the history of modern medicine. The student, then 19, was Hans Selye, and the observation he made was this: although the patients brought forward for diagnosis by his professor were in the early stages of different illnesses – measles, scarlet fever, the flu, various allergic reactions, duodenal ulcers, shingles – their symptoms all appeared remarkably similar. To a man and woman, they complained of “a coated tongue, more or less diffuse aches and pains in the joints, intestinal disturbances and loss of appetite. Most had fever (sometimes with mental confusion), an enlarged spleen or liver, inflamed tonsils, a skin rash and so forth…”. Moreover, the patients “felt and looked ill”.
Selye was startled to discover, however, that his professor was not much interested in these symptoms that made all illnesses look the same. The professor was, perhaps not surprisingly, more concerned with the symptoms that made each illness look different, in order to make his diagnosis and propose treatment.
This concept troubled Selye. Looking back on that particular afternoon, 50 years later, he suggested: “I could not understand why, ever since the dawn of medical history, physicians should have attempted to concentrate all their efforts upon the recognition of individual diseases and the discovery of specific remedies for them, without giving any attention to the much more obvious ‘syndrome of being sick’.” When Selye mentioned that “syndrome of being sick” notion to his professor, he received a look of disdain, though it continued to obsess him. Still, he mostly kept quiet about it until 10 years later, when he was an assistant in the department of biochemistry at McGill university in Montreal, researching sex hormones by injecting ovarian tissue into laboratory rats.
In the course of this work, Selye was overwhelmed by a similar epiphany to that first one. The rats showed clear and measurable responses to foreign tissue – enlargement of the adrenal glands, shrinkage of the thymus, the spleen and the lymph nodes, a decrease of white blood cells – but, to Selye’s surprise, these impacts were the same, whatever kind of tissue he introduced, and later, whatever toxic substance. He developed from this another hypothesis: that the body produced “a single non-specific reaction to damage of any kind”, what he called, somewhat clumsily, “a syndrome of response to injury as such”.
He felt this universal response might be related to his previous “syndrome of being sick”, and again presented the idea to the director of his research. Again he was laughed out of the lab. Responding to Selye’s suggestion, made in “enraptured” tones, that he proposed to investigate why any toxicity introduced to the body produced a similar reaction, his professor told him: “Selye, try to realise what you are doing before it is too late! You have now decided to spend your entire life studying the pharmacology of dirt!”
This time, Selye was not put off. He continued his research by observing the physiological reaction of lab rats to as many physical agents as he could think of: subjecting rats to extremes of cold and heat, to x-rays, “psychological” trauma, haemorrhage, starvation, pain or forced exercise, as well as toxins of every kind. He found “no noxious agent that did not produce the syndrome” of responses in the adrenal glands, thymus, spleen and white blood cells. As well as that he determined that those responses underwent a three-stage cycle, a beginning middle and end, of alarm, resistance and exhaustion. He called this pattern “the general adaptation syndrome”, or GAS for short, and he wrote up the results of his experiments in the journal Nature. It was published in a single‑column, down-page note in July 1936. The title was “A syndrome produced by diverse noxious agents”.
Over the next decade, through the war years when there was no shortage of “diverse noxious agents”, Selye sought to disseminate and popularise his findings, with limited success. What he needed, he decided, was a name for all those diverse agents and the apparently nonspecific effects they produced, effects that he by now had hypothesised – he was not a cautious man – were a root cause of “high blood pressure, angina, disorders of the digestive system, kidney diseases, diabetes, rheumatism, certain cancers and most nervous and mental disorders”. By 1946 he had landed on the single word he needed to get his idea across. He called his syndrome, both cause and effect, “stress”. Selye never looked back.
Just before Christmas I sat thinking about Hans Selye and his GAS experiments in the audience in a seminar room at a conference centre in a leafy Birmingham suburb. “WorkStress” was the annual conference of the UK National Work-Stress Network. Ian Draper, a retired teacher and union organiser has been overseeing and promoting this event for 21 years, during which time, he suggested, it had only got bigger. The room, for the weekend event, was packed with representatives of just about every profession and occupation. They were, in general, health and safety officers, mostly union officials, and the reasons for this conference, the facts before them, were fairly stark.
The number of cases of work-related stress in the UK, in the year to April 2015, was 440,000, or 1,380 per 100,000 workers. The number of working days lost due to this condition was 9.9m (which equated to an average of 23 days lost per case). In 2014/15 a diagnosis of stress accounted for 35% of all work-related ill health and 43% of all working days lost due to illness. The condition was much more prevalent in public services, particularly education, health and social care. The main work factors cited by respondents as causing work-related stress were workload pressures, including tight deadlines, too much responsibility and a lack of managerial support. Evidence suggested that these problems are only getting worse.
The keynote speaker at the stress conference was Gail Kinman, professor of occupational health psychology at the University of Bedfordshire. Kinman opened with a caveat that went back in some ways to Selye’s struggle to find a name for his “adaptative illness” syndrome. “Put 100 experts in a room,” she said, “and you will come up with 100 different definitions of stress.” The one she used, in relation to the workplace, was that approved by the Health and Safety Executive: “The process that arises where work demands of various types and combinations exceed the person’s capacity and capability to cope.” Stress was an imbalance between environmental demands and personal resources; it was taken as read that this was a dangerous thing.
Kinman’s particular concern – and the concern of the thought-provoking conference in general – was whether stress, and its assumed and sometimes proven knock-on effects on health, could be linked to austerity measures and the state of the economy. So far, she admitted, there was not enough evidence to make a definitive case; although perceptions of stress had increased between 2006 and 2012, there was also a sense that much more went unreported. Anxieties about job insecurity led to denial. Two-thirds of British employees agreed that people in their organisation would be “unlikely” or “very unlikely” to reveal that they were experiencing stress-related illness. This appeared to go hand in hand with evidence that among people iwn managerial roles a growing number – more than three-quarters – considered creating a work-life balance as the employee’s responsibility, not theirs.
Many of those who reported being stressed cited technological changes – email following them home in the evenings and at weekends – as a prime factor.
Kinman had worked closely in longitudinal studies of two particular groups – university academics and prison officers. In both groups the perception and fact of stress had grown markedly in the years since 2008 across every perceived measure – demands had increased, personal control over work had reduced, relationships had worsened, roles were less understandable and the ability to adapt to change had decreased. 80% of academics “agreed or strongly agreed” that their work was “very stressful”. If anything the figures from among prison officers were more disturbing. Falling staff levels, changing shift patterns and rising levels of violence meant that their stress levels were measurable both in impaired problem solving and reduced creativity but also in very high incidence of relationship breakdown, alcohol abuse and the symptoms of post-traumatic stress disorder.
Kinman was not alone in citing Sanjay Basu and David Stuckler’s book The Body Economic, which examined health and economic data over decades, concluding that austerity was bad for both physical and mental health. “If austerity were tested like a medication in a clinical trial, it would have been stopped long ago, given its deadly side effects,” they observed.
That conclusion was also used in evidence by the pressure group Psychologists Against Austerity, represented by Laura McGrath of the University of East London and Vanessa Griffin of the University of Essex. They had formed their group to protest at what they saw as the advance of five stress-related “austerity ailments”: humiliation and shame, instability and insecurity, isolation and loneliness, being trapped or feeling powerless, and fear and distrust. The collective result of these ailments was that “Mental health problems are being created in the present, and further problems are being stored for the future.”
There followed from the floor a long series of questions and related experiences about the effects of short-term and zero-hours contracts, the impacts of job insecurity and constant change, and workplace bullying. Each profession had its charge sheet of stressors. “The average working life of a social worker is eight years.” “Among teachers, stress is the most common cause of early retirement.” “Prison officers [and I had to get someone to repeat and verify this statistic] lived only on average 18 months after retirement”.
Certain themes seemed universal. “It gets to the point where every time you read your emails your blood pressure increases,” a council official observed. Many people felt threatened by a “culture of constant appraisal and evaluation”. There was growing evidence of people using holidays when they were ill, to avoid taking sick leave and “showing weakness”; this was particularly prevalent among older members of staff. There was widespread agreement that GPs are routinely asked to keep the word stress out of a diagnosis because the question of whether any days have been lost to the condition routinely turns up on application forms. “People are just terrified of losing their jobs…”
Though much of this anecdotal evidence was shocking, it seemed to me, listening to those stories, that stress was sometimes being used as a catch-all shorthand for other issues – as had always been the case since Selye created the term. In many cases it sounded like a medicalisation of a cultural or a political trend. Many of the issues described were the result of insensitive management practices and cultures of long hours or unreasonable demands.
The more I listened the more it seemed that the mental health of individuals had become the battleground in what might once have involved broader standoffs. (It was tempting to think that the frontline of labour disputes had shifted from picket lines to worry lines and that collective grievances had become individual psychological battles; in the 1980s an average of 7,213,000 working days were lost each year to strikes; that number fell to 647,000 between 2010 and 2015. Meanwhile the days lost to stress-related illness went exponentially in the other direction, including a 30% increase in occupational stress between 1990 and 1995.) Stress appears to be standing in for older concepts like injustice, inequality and frustration, seen at the level of the individual rather than of the wider workforce.
I subsequently put that point to Professor Sir Cary Cooper, the most visible advocate of workplace wellbeing in the UK, president of the CIPD (Chartered Institute of Personnel Development) and author of 120 books and pamphlets on stress and related concepts at work. In 2008 Cooper was commissioned by the Labour government to oversee the Foresight programme into “Mental Capital”; with the help of 350 scientists from across the world he examined factors from birth onwards that cause stress, and developed recommendations for evidence-based policy to enhance wellbeing. Then the recession happened.
Hadn’t stress, mental capital, in the years since, I asked him, become a proxy for other more traditional employee relations issues?
Cooper thought it had, up to a point. “The fact is there are fewer people doing more work, greater insecurity, fear of job loss. And the stresses we face in the workplace are generally no longer physical, they are other people.”
But isn’t that just the reality of most working lives now – lack of control, information overload, working more for less? Isn’t stress inevitable?
“Perhaps,” Cooper says. “But how do we change that?” In his view one useful step would be to pin a sign to every office door reading: “Your manager is potentially dangerous to your health”. “The line manager for all of us is absolutely fundamental to our wellbeing,” he says. “The problem is that we recruited people prior to the recession not on the basis of their social and interpersonal skills but on the long hours they worked, and their perceived effect on the bottom line, or whatever. The evidence is clear that [working] long hours will not only do nothing for productivity, it will eventually make you ill.”
Does that mean not mentally fatigued but physically unwell?
“Yes. Core morbidity, we call it. If you have a physical illness, there is a mental health aspect to it. Stress could be the trigger to some of these illnesses: if you are in a really bad marriage, or if you are in a job you value and you fear losing, it can lead to these illnesses…”
Cooper wrote a book examining the links between such emotional stress and cancer (links that are debatable). Countless other studies have sought to back up Selye’s argument of stress as the root cause of cardiovascular disease; while a strong link between depression, social isolation and heart disease has been shown, there is little persuasive evidence that such things as job stress or anxiety disorders have a measurable effect.
I wonder if Cooper thinks it useful to have “stress” as this one-stop term for workplace anxieties and related illnesses. If we have the unsupported sense that unexpected or unreasonable challenges and demands are literally killing us, isn’t that likely to heighten the anxiety?
“There may be some of that,” Cooper says. “I tend to prefer to think in terms of wellbeing rather than stress.”
After he first coined the term “stress”, Hans Selye’s big idea became one of the most virulent of all ideas in the second half of the 20th century. You could be forgiven for believing that human existence is currently something like the seven ages of stress. Babies can be stressed from birth by overstressed parents (stress is infectious), and even be stressed prenatally. We stress toddlers with too much TV and too little play; children with too much pressure and too many exams; teenagers with the insistent anxieties of social media; adults with the requirement to juggle all the responsibilities of their lives; and the ageing population with the stresses of ageing.
In spite of our relative affluence in comparison with previous generations, and the long years of peace since Selye first publicised his idea in 1946, it can seem that we have become a society that understands itself, both in the workplace and beyond it, through stress. Mark Jackson, in his book The Age of Stress, offers a brilliant account of how that happened.
In the first instance Selye himself proved an indefatigable proponent of his own theory. The popularity of stress, as an idea, quickly became international. The French suffered from le stress, Germans from der Stress, Italians from lo stress, and Spanish from el stress. By 2010 “stress” was the best-known foreign-language term in Japan.
Selye’s original project was helped by two factors. The decline in mortality rates from infectious diseases focused attention on how cells might age and die (Selye’s seductive proposition was that they were undone by hormonal imbalances caused by uncontrollable reactions to external pressures).
At the same time, increased consumption, and a shift from manual work to service economies, emphasised a disconnect between mental and physical health. The growth of technology exaggerated that disconnect. Selye’s greatest propagandist was the futurist Alvin Toffler, with whom he collaborated and whose bestselling book FutureShock predicted “the shattering stress and disorientation that we induce in individuals by subjecting them to too much change in too short a time”.
Selye, who worked with Toffler to create the International Institute of Stress in 1975, had a gift for popularising his idea. He proposed that the best method for the diagnosis of stress should come from the individual. To this end he proposed a 31-point stress test which detailed symptoms that every person should be aware of. Signs of stress included, in no particular order: high-pitched laughter, floating anxiety (we are afraid but we don’t know what of), dryness of the throat, the frequent need to urinate, increased smoking, the overpowering urge to run and hide (who won’t admit to that one?).
Many early proponents appeared to find in the concept of a universal adaptive illness a useful metaphor for their political worldview. In his introduction to the UK edition of Selye’s book The Stress of Life, Sir Heneage Ogilvie, an eminent British surgeon, observed that it was “perhaps the greatest contribution to scientific medicine in the present century” and argued that the rising incidence of “stress diseases was the result of a failure to balance work with rest, particularly among ‘the more intelligent, ambitious, and hardworking members of society”. Ill health became a consequence of the inability to adjust to a consumer society “that equated happiness with a 40-hour week, a smart car, a television set and a chromium-plated bathroom. In the less stoutly built, it is the mind that gives way,” Ogilvie argued.
In 1983 Time magazine put stress on its cover, and the phrase “stressed out” entered the language, and never left it. The developed version of Selye’s theory proposed that the pace and complication of modern life caused the continuous activation of the hormonal responses to danger that cavemen used for flight or fight, and these led to psychological trauma and, because unnaturally sustained and unchecked, to disease. “Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injury, cirrhosis of the liver and suicide – six of the leading causes of death in the US,” the Time article asserted, based on patchy evidence (and with the emphasis very much on “directly or indirectly”).
Selye himself not only promoted the idea that the stress of life was responsible for such illnesses, he also suggested – funded in part by the Sugar Research Foundation – that a diet rich in carbohydrates but low in salt was capable of moderating them. For more than 20 years after the publication of The Stress of Life, the tobacco industry also funded some of the pipe-smoking Selye’s institute (with $300,000 in 1969 alone). In return he endorsed smoking as a defence against stress, appeared in films questioning any link between smoking and cancer, and emphasised stress itself as far a more significant factor.
Stress and its management quickly became a multi-billion-dollar business. Academic departments and behavioural medicine institutions were created to counter its advance, not to mention a new category of pharmacology and whole sections of bookshops devoted to stress management and calm theory, relaxation, yoga and meditation.
Living became like a thermostat for stress control; the challenge was to eliminate stress wherever possible. A few dissenters were not convinced that this was necessary. Daniel Thomson, a professor of endocrinology, undertook a famous study of English civil servants in 1968, at the request of Harold Wilson. The study was a forerunner of the current investigations into occupational psychology. Thomson concluded, somewhat against the grain of Selye’s theory, that “Many civil servants complain about the stress, strain and frustrations of modern living. Many of these problems are, however, largely of their own making, because of their failure to reach emotional maturity and to become tolerant, patient and relaxed individuals, aware of their own limitations, having come to terms with their own surroundings, no matter how uncongenial.”
Criticised by those who argued that stress was in many instances a powerful motivating and creative force, that necessity was the mother of invention, Selye modified his initial theory that any challenge to the norm was a stressor by suggesting that there was good stress and bad stress, or “eustress” and “distress”. “Stress is not even necessarily bad for you,” he wrote, by way of revision, “it is also the spice of life, for any emotion, any activity causes stress.” Selye himself worked 14 hours a day, seven days a week, selling stress to the world, and claimed to relish every second of it.
His distinction between eustress and distress never really caught on. Stress remained a largely pejorative term, and one that seems to plague each successive generation as lives threaten to become more complex and jobs less secure. A survey from the insurer Friends Life last year found that one in four of the UK population had called in sick due to stress in the previous 12 months. And more than one in three of 18-24-year-olds had done so.
Another study published last month, however, does at least give some credence to the idea that effects of stress can be mitigated by a certain cast of mind. The large-scale project at the University of California, San Diego, with findings published in the journal Biological Science, looked at the ways certain individuals – extreme sportsmen, special operations soldiers – seemed able to develop resilience to the intense physical and emotional stresses of their jobs. The researchers invited some of these individuals to lie in brain-scanning machines while wearing face masks to which the oxygen supply could be controlled. When the oxygen seemed about to be shut off, the first part of Selye’s GAS process kicked in – the subjects displayed the beginnings of bodily signs of panic – rising heart rate, a burst of adrenaline – but, after sudden activity in the part of the brain that monitors bodily response, the flight or fight reaction was quickly dampened. The subjects experienced stress but they did not overreact to it; they “switched off” the second and third parts of Selye’s three-stage process – there was no resistance or exhaustion, and their bodies remained in a steady state. When people who were not experienced in those fields underwent the same tests, a great range of responses to the imminent stress of suffocation was observed; those best able to “listen’ to their body’s response, who showed most activity in that part of the brain, were most resilient; those who simply panicked went into a full-blown stress pattern, and found it hard to return to any kind of normal or steady state. It was not clear from the study whether the responses could be learned or were innate.
Such studies open up the question of the value of monitoring your own stress levels through analysis of brain activity and perhaps attempting to “switch off” a response accordingly. Not surprisingly, given our obsession with stress, the latest generation of “wearable tech” attempts to answer that need; various headsets are already available that purport to monitor stress levels by working to measure electrical activity in the brain – much in the way that a Fitbit monitors physical activity. It is early days for such technology, but in the near future some of the gadgets will apparently not only be able to work out when you are in a state of anxiety but also “support you in becoming calm” – by assisting in meditation techniques, turning off your mobile phone, placing your email on hold, or introducing favourite soothing music. The headsets are advertised as an aid to wellbeing, balance and calm. You can’t help feeling, however, that they will just as likely prove one more thing to stress about.
