MENTAL HEALTH MOMENT
MENTAL HEALTH MOMENT
23 March 2001
"Action is the antidote to despair." - Joan Baez
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SLEEP APNEA RISK LESS WITH HORMONE REPLACEMENT
New research from the College of Medicine shows that postmenopausal
women who take hormone replacement therapy greatly decrease their
chance of getting sleep apnea and the health complications it can
cause. "Women have many concerns when their doctor discusses hormone
replacement therapy. This research clearly shows one of the benefits
of such therapy," explains Dr. Edward O. Bixler, professor of
psychiatry. "Many scientists have anecdotally thought this might be
the case but it has not been scientifically proven." Bixler and his
colleagues' paper titled, "Prevalence of Sleep Disorder Breathing in
Women: Effects of Gender," is published in the March issue of the
American Journal of Respiratory and Critical Care Medicine. For more
on this story, to http://www.hmc.psu.edu/news/pr/Mar/Hormone.htm
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SMALL TALK: MOST WHO SEE CHILD ABUSE DO NOTHING
Fifty percent of Americans who witness child abuse do nothing about
it because they don't know how to effectively respond to the
incident. And those who do respond often give the offending adult a
disapproving look or a verbal reprimand - two responses that can
actually further endanger a child by angering the adult, according to
Prevent Child Abuse America. Child abuse and neglect doesn't just
occur behind closed doors. In a 1999 survey of 1,250 Americans: 32
percent said they had seen an adult abuse a child physically; 66
percent said they had seen an adult abuse a child emotionally; 47
percent said they had seen an adult neglect or fail to meet a child's
needs. According to Prevent Child Abuse America, people who witness
child abuse in a public place can address it by starting a
conversation with the adult to direct attention away from the child,
diverting a misbehaving child's attention by talking to the child,
looking for an opportunity to praise the child or parent or offering
assistance if the child is in danger.
Small Talk is a weekly column of safety and health information
for parents and other caregivers for children. It is a community
service of the Penn State Children's Hospital, located at The Milton
S. Hershey Medical Center in Hershey, Pa. Please direct any comments
or questions to Patricia Millner, director of nursing at the Penn
State Children's Hospital, at mailto:pmillner@psu.edu.
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DISASTER WORK AND STRESS
Stress is a natural phenomenon. It is not necessarily negative. The body needs
certain levels of stimulation and stress in order to be able to function. Stress
is the body's normal, adaptive response to the environment. A stressor is
the actual event which produces a demand or stress on an individual. The
resulting wear and tear on an individual is called strain (Mitchell & Resnik,
1981).
Stress and distress are two different things. When an individual is
distressed it is due to a disorder in their adaptation to stressors. Stressors
fall into a number of categories. Charlesworth and Nathan (1984) have identified
the following, some of which are positive stressors:
Cognitive
Social
Family
Work
Transitional
Environmental
Chemical
Physical
The following, generally considered to be positive events, are also considered
stressors:
Change
Progress
Creativity, Invention
Growth
Survival
Increased energy and endurance
The stress reaction prepares the body for change. It puts the body on alert
to respond and adapt. This reaction goes back to a much earlier time
in the evolution of the human species. The need to adapt to the environment still
exists, but the physical dangers no longer exist as they once did. However, the
stress reaction provokes the same biochemical reactions.
The part of the brain known as the hypothalamus alerts the nervous system to
release energy when faced with physical danger or threat. The nervous system
alerts the endocrine system to send large amounts of hormones into the blood
stream, mobilizing the body for action. Muscles tighten up, blood sugar rises,
adrenalin and noradrenalin provide emergency energy. This all prepares the body
for what is termed the "fight or flight response".
Hans Selye (1956, 1978) labeled three phases of this normal defense reaction of
the body "The General Adaptation Syndrome". General because the consequences
of the stressors have effects on several areas of the body. Adaptation refers
to its stimulation of defenses designed to help the body adjust or deal with the
stressors. Syndrome indicates that the individual pieces of the reaction occur
more or less together and are at least partially interdependent. These reactions
are similar for all forms of animal life. The physiological responses are the
same whether the stressor produces fear, anger, or anxiety (Mitchell & Resnik, 1981).
While the physiological effects occur whether the stress is positive or negative,
the psychological effects depend on the type of stress. Excitement, joy and high
self-esteem are associated with positive stress. This extra charge of energy, for
a short time, produces a controlled form of intense concentration called "eustress".
Some examples of eustress include athletes striving to win, surgeons operating
for long hours, and marathons. Such examples of eustress contribute to individual
excellence. The benefits of optimal stress, if handled properly, include: opportunity
for increased growth and maturity, independence, and control.
ONGOING OR LONG-TERM STRESS EFFECTS
Following long continued exposure to the same stressor(s), to which the body has
become adjusted, adaptation energy is finally exhausted. This results in what
Selye called "diseases of adaptation". These include asthma, chest and back
pains, migraines, neuroses, psychoses, skin rash, and others (Selye, 1956; Cox, 1978).
Selye pointed out that if stressors did not diminish over a certain period of
time, the organism would move from a state of alarm into a state of exhaustion.
With continued exhaustion, severe illness may occur. Finally, if signs of the
alarm reaction reappear, resistance is gone. The situation becomes irreversible,
and the individual dies.
The following are some of the health effects that continued strain, wear and
tear can have on individuals (Mitchell & Resnik, 1981; Davis et al, 1982; Charlesworth
& Nathan, 1984):
Decrease in the effectiveness of the body's immune system,
with an increase in colds, flu, and other communicable diseases.
high blood pressure
headaches
Gastrointestinal upsets, diarrhea, ulcers, colitis
Muscle tension, strains, backaches, and back injuries
Increased problems with allergies, skin conditions, asthma
Arthritis
Possibly increased vulnerability to heart disease, diabetes, cancer
Weight loss or gain
Sleep problems
Increase in use of alcohol, tobacco and other drugs
Psychological difficulties: depression, withdrawal, apathy; or anger,
irritability, huperexcitability
Relationship problems
Sexual problems
Work problems
Most of the time the stress reactions elicited are so mild that they go unnoticed.
Everyone has experienced events which were intensely stressful for a brief period
of time. However, once the threat has passed, systems return to normal. Such an
isolated stress event, in spite of the internal havoc it raised, probably resulted
in absolutely no long-lasting physical damage to the body. On the other hand,
a constant state of agitation can result in serious health dysfunctions (Ivancevich
& Matteson, 1980). While mild stress and short-term infrequent intense stress
produce no lasting harm, constant stress, or acute stress, results in a step-by-
step exhaustion of the body's fuel reserves, with the end result - burnout.
BURNOUT
Burnout is an effect of long-term stress. It shows up most commonly in the
level of an individual's work performance. Farberow & Gordon (NIMH, 1978) have
defined burnout as a state of exhaustion, irritability, and fatigue which
markedly decreases an individual's effectiveness and capability.
Burnout is an advanced stage of stress. It occurs when there is chronic stress
over a long period of time. Burnout can be defined as "collapse of the human spirit".
Emotional exhaustion is another way to define it. Some of the early signs of
burnout are the same as those for advanced stages of stress: fatigue, sleep
disturbances, negative attitude, disillusionment, lowered resistance to infection,
hypertension, headache, and stomach disturbances.
IMPACT OF STRESS
The impact of stress depends on a number of factors. Three of these are one's
general health, genetics, and prior exposure to stressors. These factors may
strengthen and support a disaster worker, resulting in mitigation or softening
of the emotional consequences of a disaster. On the other hand, they may place
the worker at risk for stress reactions.
GENERAL HEALTH
The relationship of stress to physical and psychological health has been documented
extensively in literature and research. Selye's (1956) research has demonstrated
that stressors can cause changes in the immune system, thus wearing down resistance.
A super-abundance of hormones secreted can considerably reduce immunity to infection.
GENETICS
Evidence suggests that individuals with certain physical or psychological characteristics
are more at risk as potential victims of stress disorders. For example, Type A
individuals constantly strive to attain achievements. They are competitive and
hard driving. They strive to accomplish more and more in less time. They are chronically
impatient with people and situations which they perceive as thwarting their attempts.
Type B individuals, on the other hand, are characterized by the absence of these
behaviors. They are relatively relaxed and easygoing, even though they too may be
goal-oriented. They appear to have a protective shield which allows them to experience
less stress.
EXPOSURE TO PREVIOUS STRESSORS
It is a recognized fact that illness is due to external viruses and pathogenic
agents entering the body. However, there is increasing evidence that illness is also
due to the eventual broken-down state of the body. After long and continuous exposure
to stress (or intermittent periods of intensive stress) hypertension, coronary heart
disease, diabetes and ulcers occur (Cox, 1978; Beehr & Newman, 1978).
Research has demonstrated that stressful experiences can make animals more or less
vulnerable to a number of cancer tumors, and researchers can speed up the time at
which the tumors appear by controlling the number of times the animals are exposed
to stress. The stressors applied in these studies resemble many human experiences
of stress, such as forced restraint, crowding, handling, shock and noise (as opposed
to a non-demanding more protected environment). Over time, the body parts break down.
On the other hand, research has demonstrated that less severe physiological damage
to the body occurs when the following circumstances are present: fewer major life
changes, socially supportive relationships, experience in handling stress, immunity
as a result of many experiences with stress, and high self-esteem (House, 1980).
ADDITIONAL FACTORS AFFECTING STRESS
AMONG DISASTER WORKERS
Four groups of factors can affect the stress levels experienced by disaster workers.
These include:
A. Individual Factors
Health
Pre-existing stresses
Previous traumatic experiences
Coping skills
Prior disaster experience
Identity and self-expectations
Perception and interpretation of the event
B. Interpersonal Factors
Strength of social support system
Pre-existing stresses in relationships
Expectations and needs of others
States of family members in disaster
C. Community Factors
Size of community
Previous degree of social solidarity
Prior disaster experiences
Amount of social disruption due to disaster
D. General Aspects of the Disaster or Type of Event
Warning
Contrast of scene
Type of disaster
Nature of the destructive agent
Degree of uncertainty
Time of occurrence
Duration of disaster or continued threat
Scope of disaster
Location of disaster
There are three major sources of stress which disaster workers face in their
work. These are: Personal loss or injury; Traumatic stimuli; and Mission failure
or human error. Each of these can contribute significantly to the stress reactions
workers experience during or after a disaster event.
Occupational stressors also affect workers in disasters. Disaster work involves
some pretty heavy professional responsibilities. The stakes are high and often
involve life or death. Public as well as self-expectations for workers are high.
Emergency responses are immediate, continuous and often without letup. There are
significant physical, mental and emotional demands placed upon workers under
extremely adverse chaotic and traumatic conditions. The physical properties of
the work environment can cause additional stress. These include: work area,
amount of contact with victims (injured, dead and dying), weather, hazards, work
conditions, living conditions, human resources, frustrations and bystanders.
There are also organizational stressors that can occur due to the nature of the
emergency organization. Among these are stresses due to: differences among
professional vs volunteer organizations; day-to-day vs disaster responsibilities
(Warheit, 1970), role clarity and role conflict (Garaventa, 1984); the size of
the organization (Garaventa, 1984); rank of the individual in the organization
(Kahn et al., 1964; Schein, 1965); chain of command; organizational conflict;
and rewards.
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REFERENCES
Beehr,T.A. & Newman, J.E. Job stress, employee health, and organizational
effectiveness: A facet analysis, model and literature review. Personnel Psychology,
1978, 31, 665-699.
Beehr, T.A., Walsh, J.T., & Taber, T.D. Relationship of stress to individually
and organizationally valued states: Higher order needs as a moderator. Journal
of Applied Psychology, 1976, 61, 41-47.
Charlesworth, E.A. & Nathan, R.G. Stress management: A comprehensive guide to wellness.
New York: Atheneum, 1984.
Cox, T. Stress. Baltimore: University Park Press, 1978.
Davis, M.; Eshelman, E.R.; & McKay, M. The relaxation and stress reduction workbook.
Oakland, CA: New Harbinger Publications, 1982.
Farberow, N.L. & Gordon, N.S. Training manual for human service workers in major
disasters. National Institute of Mental Health, Rockville, MD, 1978.
Garaventa, D. "Role conflict and stress for emergency service workers". Paper
presented at the American Psychological Association, National Institute of Mental
Health, and Federal Emergency Management Agency Conference on Role Conflict and
Support for Emergency Workers, Washington, DC, 1984.
House, J. S. Occupational stress and coronary heart disease: A review and theoretical
integration. Journal of Health and Social Behavior, 1974, 15, 12-27.
Ivancevich, J.M. & Matteson, M.T. Stress and work: A managerial perspective.
Glenview, Ill.: Scott, Foresman, 1980.
Kahn, R.L.; Wolfe, D.M.; Quinn, R.P.; Snoek, J.D.; & Rosenthal,R.A. Organizational
stress: Studies in role conflict and ambiguity. New York: Wiley, 1964.
Kahn, R. Stress research and its implications: The United States. Proceedings
of the Industrial Relations Research Association, 1981.
Mitchell, J.T. & Resnik, H.L.P. Emergency response to crisis. Bowie, MD: Robert
J. Brady Co., 1981.
Schein, E.H. Organization psychology. Englewood Cliffs, NJ: Prentice-Hall, 1965.
Selye, H. Stress without distress. New York: New American Libraries, 1975.
Selye, H. Stress in health and disease. West Yarmouth, Mass.: Butterworths, 1976.
Selye, H. The stress of life (2nd ed.). New York: McGraw-Hill, 1978.
Selye, H. Guide to stress research: Volume I. New York: Van Nostrand Reinhold, 1980.
Warheit, G.J. Fire departments: Operations during major community emergencies.
American Behavioral Scientist 13(3): 363-367, 1970.
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For further information on this topic and to order and purchase books online, go
to the following and begin by trying the following descriptors in the search engine:
Organizational stressors, disasters and stress, stress and disaster workers, stress and
health, stress and genetics, burnout, lon-term stress, etc.
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENTS Online: https://www.angelfire.com/biz3/news
