Stress

 By Dr. Jim Ferguson

Life is often complicated, and doesn’t always go as envisioned or as we desire. I recently wrote about why I now practice concierge medicine, and described the stress that nearly 50% of doctors say is causing them to consider leaving medical practice.

I suspect there is some validity to a modern doctor’s frustrations, but I can assure you that life in any career or vocation can be challenging at times. Perhaps the expectations of doctors are different now than when I trained. I worked 100 hours a week as an intern (specimen couriers smoking pot in the inner city hospital stairwell made more per hour than I did). And during my traditional career I always worked sixty hours a week. (I also walked uphill in the snow to and from school everyday!).

The rigors and stress of my profession are real, but are not unique. Everyone has to deal with stress, though some more or less than others. Humans are designed to deal with stressful and even dangerous situations. You may recall the “fight or flight” mode described in high school health class. When our integrated nervous system recognizes a threat, a signal is sent to the adrenal glands which are located above the kidneys. These glands secrete hormones which modulate a variety of bodily functions, and when a threat is perceived adrenaline is released. This hormone increases heart rate and blood pressure, shunts blood to muscles and makes you more alert to either face the threat or run to safety.

There is an obvious survival benefit for the release of adrenaline in an emergency, but what if someone endures constant or repeated threats or perceives all situations as always stressful or threatening? An example might be growing up in the streets on the Southside of Chicago or being in an abusive relationship. Science has shown the adverse effects of stress on the immune and cardiovascular systems. Issues of cancer, hypertension and heart attacks come to mind. I once read that being overwhelmed or depressed can produce fatigue equivalent to digging a ditch all day long.

Everyone has experienced anxiety or fear at some time. Surely you remember awakening from a nightmare or having a near collision while driving. Now, imagine that same fear from an unknown source which can’t be easily or quickly corrected. Chronic stress is not healthy and can cause bodily manifestations (somatic) of the mind (psyche), the so-called psychosomatic symptoms. Examples are tension headaches, heart palpitations or insomnia from stress and adrenaline.

Sometimes, understanding the body’s reaction to fear, and the resulting adrenaline-induced anxiety, helps patients cope. I’ve told many patients that there are two reasons to do tests: one reason is to aide in clinical diagnosis; the other is to allay a patient’s fear of disease and assure them that the doctor is listening and not missing some important clue. Both forms of testing are appropriate and negative tests can be therapeutic!

Another avenue of dealing with stress is to organize vague or nebulous feelings on paper or to verbalize them to a therapist, a spouse or a friend. There is something in the human wiring that makes us feel better when we organize and then verbalize our feelings. I describe it as a catharsis for the psyche. Recognize that your stress and fears may be too much for your spouse or friend to handle and in that case a therapist is best.

The Psalmist sang, “We are fearfully and wonderfully made.” We take for granted that this wonderful vessel in which we reside, works . . . until it doesn’t. Proper functioning of our nervous system depends upon a balance of at least a half dozen chemical messengers such as dopamine, norepinephrine, GABA and serotonin. A deficiency of dopamine can produce Parkinson’s Disease and an imbalance of the others contributes to depression, anxiety or phobias. I don’t want to get lost in the weeds of arcane medical concepts, but doctors often treat neurochemical imbalances with antidepressants which reestablish proper ratios of signaling neurochemicals. An example are serotonin modulators (SSRI medications like Prozac) which help stabilize mood and treat depression. Another modality is to use medications like Xanax which allay anxiety by enhancing the effects of the neurochemical GABA (gamma aminobutyric acid).

A stress inducing problem in our modern information age is the constant state of crisis engineered by the media. You’ve heard the journalistic adage, “If it bleeds, it leads” in news reporting. As a responsible adult I feel it is my civic duty to stay informed of news and current events. This has become harder because of politically motivated disinformation of agencies like CNN and other media outlets. And it is stressful sifting through reports to try and find the truth. There is good and bad in most people, but you come to question so-called “news” which is 92% negative regarding President Trump.

The President is no saint, but hatred has become the basis of most Trump reporting. When I teach medical students I challenge them to look beyond what is happening with their patients. I want them to ask why their patient has developed, for instance, congestive heart failure. You will also come closer to the truth when you go beyond media reports and ask yourself why something is being reported in a certain way. As an example, Whoopi Goldberg recently asked the ladies of the View why the media keeps making mistakes such as in the recent Buzzfeed and the Catholic High School brouhahas. Joy Behar quickly answered the “why” question. She said, “It’s to get Trump out of office.”

Elie Wiesel was a Jew who survived the Nazi concentration camps and became an American citizen, a noted professor, an author of 57 books and a Nobel Laureate. He once observed, “The opposite of love is not hate, it’s indifference.” If that is true, there is hope for Joy Behar, who I discern as filled with the pitiable and delusional Trump-hatred syndrome. I can even hope that Twitter trolls who cravenly and anonymously savage others retain some aspects of redemptive humanity. C. S. Lewis posited that sinful humans can lose the last vestiges of their humanity, and all that is left is their sin.

Our Western Civilization was founded on the precepts of Judeo-Christian ethos. It is under attack everywhere. The Master said, “Those with eyes will see,” and he commanded us to to pray for the lost and confused, and those co-opted by the “rulers, the powers and the forces of darkness.” I do so every day.

 

 

 

 

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