Skip to 0 minutes and 8 seconds What is stress? How would you define it? I think we all know what stress is. If you asked a huge group of people what is stress, do you experience stress, everyone would be able to understand what it is, because everyone has experienced it. I teach loads of doctors and if you ask a big room of doctors, you say who’s experienced stress in the last week, everyone puts their hands up. Everyone intuitively knows what it is. But finding a sort of pithy definition is a bit harder. But essentially what stress is, is the body’s reaction to external circumstances or situations that we find difficult.
Skip to 0 minutes and 48 seconds And what’s very interesting is there are some of these external factors or stresses as they’re called which are universal. Excessive workload, excessive demands on our time, relationship difficulties, work difficulties, not having work, financial difficulties, these things are universal. But then there are other things which are individual to particular people. And as doctors, we see this all the time. For example, for some people, coming to see the doctor and just having something very simple like a blood pressure taken is incredibly stressful event whereas for others, it’s not. So there are general universal factors and individual factors, but stress is the way our body reacts to those external difficult situations.
Skip to 1 minute and 36 seconds I’m quite interested in this because I don’t remember the word ‘stress’ when I was growing up. It seems that we all… are we overusing it? Because it just seemed to be there was a sort of moment in time when we all started to say we had stress. And our parents’ generation, who had had much more stress than we did, didn’t. Do you think that’s true? I think that is true. I think they did have I think this sort of ‘keep calm and carry on generation’ did deal with it in a different way.
Skip to 2 minutes and 6 seconds And I think it is very true that we are more aware of stress now and of the effects that it sort of has on our bodies and on our health. And I think culture has also changed. And we’ve changed from a more stiff upper lip, emotionally contained culture to a more emotionally expressive culture as well. And I think talking about stress is a very important part of that. But undoubtedly, society has sort of changed and changed. And we have changed into a sort of 24/7 society with incredible demands on our time. And that comes also with great expectations.
Skip to 2 minutes and 48 seconds Expectations that we’ll have a wonderful job, that we’ll have a lovely house, that we’ll be able to travel, the 100 things we must do before we die, that we’ll have fantastic sex lives and be brilliant at this, that or the other. That also creates a type of pressure and expectation which I think our parents’ generation and previous generations, their expectations were much, much, much, much, more lower. Much lower and in many ways, much more realistic. And they didn’t have things like social media. So we’re all under this pressure to look like we’re living the perfect life and doing all these interesting things.
Skip to 3 minutes and 27 seconds But I want to just ask you a little bit about ‘fight and flight’ and the sort of physiological aspects of stress. Can you talk to me about what’s happening in our bodies when we feel stressed? What’s happening is we get a surge of hormones, of chemicals, which create very immediate, real, tangible effects in the body. And one of the things that’s really important to explain to sort of patients when you’re seeing them with stress related symptoms, is people often think if a doctor says to them, oh, this is due to stress, or things where you’re imagining it. You’re not imagining it. It’s very, very real. You get this surge of adrenaline, of cortisol, these ‘fight or flight’ chemicals.
Skip to 4 minutes and 14 seconds They make the heart go faster, they make the breathing go faster, they make the hairs on the back of your neck turn up, they stimulate the gut, they make your muscles tense. And that can then feed into a positive feedback loop whereby your heart is starting to go faster and you start to think, oh my goodness, I’m developing heart disease or a heart attack. And of course, that then creates even more anxiety and stress. So those are the short term physical effects of stress. But then there’s also short term emotional effects of stress in terms of it making us feel much more anxious, on edge, more difficult to sort of concentrate.
Skip to 4 minutes and 56 seconds And then longer term, this has very profound effects in terms of being associated with increasing our risk of chronic diseases, like high blood pressure, lowering our immunities so we’re more likely to get infections, and also causing long term mental illness, particularly depression. The real difficulty for the doctor is stress does sort of two predominant things to our bodies. Firstly, it creates physical symptoms. And secondly, if we have pre-existing physical symptoms, it makes them worse. So, for example, everybody has a weak spot. Everyone has an Achilles heel. For me, it’s migraines. For someone else, it’ll be irritable bowel syndrome. For someone else, it’ll be their back. And at times of stress, it makes those problems worse.
Skip to 5 minutes and 50 seconds One of the things that we’re very interested in the course is sort of mindful reading. Can be mindful reading of a poem or a piece of prose help with that? Taking you out of the chaos. So if you think of the sort of model of the stress on the underground, reading a poem on the underground, so all the chaos is out there. You’re on a busy commute. You’re going to work. You’re stressed. And instead of seeing an advertisement on the train, you read this beautiful haiku or poem and suddenly, you’re there. You’re transformed just for that moment. And that… is there any sort of scientific evidence that that can just lower your blood pressure, that can calm you down?
Skip to 6 minutes and 30 seconds Is there a place for that sort of reading? Absolutely there’s a place for it. And I think there are sort of several essential steps to mental wellbeing and improving mental wellbeing. and being more mindful, being made more aware of not just our own thoughts and emotions, but also what’s going on in the world and in the environment around us is fundamental. And poetry, music, art, literature, prose, whatever can be a very, very powerful tool for helping to sort of anchor you in a moment. To sort of cut out the sort of white noise that’s going on in the background and to really focus you in the moment.
Skip to 7 minutes and 15 seconds And that’s one of the key essential steps to wellbeing and improving mental health. So absolutely, yes. And I notice in your waiting room, you have some poems on your walls. Is there any evidence… I mean A, why? And B, has it been helpful for your patients? I think waiting rooms can be so stressful because sometimes you’re waiting for bad news or sometimes, well, you’re just anxious. And they’re anxious places. Normally you’re waiting for ages, anyway, aren’t you? And we wait a long time in yours. But they’re very anxious places. Or if you’ve got an ill child. There’s a lot of anxiety in the waiting room.
Skip to 7 minutes and 51 seconds I think for a lot of people, just don’t notice them, they gloss over them or they just see them. They’re just sort of poems and they don’t read them or they just think, well that’s a bit odd. But for some people, and it’s only a minority of people, really hone in on them and they really, really connect with them. And that really has quite a powerful effect. And, so it might only be one in 20 people that those poems have a really powerful effect. But what people fail to often to understand or realise is, that’s exactly the same with the drugs that we prescribe and the treatments that we prescribe. For most people, they don’t work.
Skip to 8 minutes and 36 seconds Painkillers for most people don’t work. And different ones work for different individual people. And for many sort of drugs, like drugs to prevent heart attacks, for example, if they prevent a heart attack in one person out of 20 that took them, that would be considered a really, really good result. So one of the things that I’m looking… concerned… I think it is a concern, is can reading certain poems or prose or books be harmful to somebody who’s feeling stressed? Yeah, absolutely. And I think when people in a very, very sort of vulnerable state, it potentially can be.
Skip to 9 minutes and 14 seconds And I think particularly, poetry and literature from the past, particularly from the Romantic past with a capital R, can romanticise suicide, self harm. And this is, of course, is replicated in sort of modern popular culture. We’d see pop stars, rap artists, sort of glamorising, almost, self harm. We’ve got a huge epidemic amongst our young people of deliberate self harm and cutting. And it’s terrible, it’s brutal, it’s savage. And there is nothing sort of romantic about it. But there is the potential to do harm if you’re in a very vulnerable place and you’re sort of reading some work that is either romanticises or glorifies suicide or self harm. There is a potential for danger. This has always been the case.
Skip to 10 minutes and 18 seconds In the 18th century, there was a very important novel called The Sorrows of Young Werther. It started a craze for suicide. People would read the novel in which the hero, who doesn’t get the girl he loves, kills himself. And there were copycat suicides. I mean, there’s a long history of this. But couldn’t you argue that you could give the wrong pills to somebody and that would be… Absolutely. So, is literature harmful? Absolutely, no, I’m not saying literature is harmful. Literature is again, to be incredibly positive thing and positive, helpful experience. But you asked the question, can it or could it ever be harmful? And potentially, as in the case of Werther, then potentially it sometimes, it could potentially be harmful.
Skip to 11 minutes and 11 seconds But you’re absolutely right, Paula. It’s exactly the same with all of the drugs that we prescribe. One of the commonest causes of admission to hospital in older people is adverse effects from drugs. And how ridiculous is that? We as doctors have tended to treat everybody the same. You’ve got condition A, we’re going to give you all drug B. You’ve got this particular problem, we’ll give you all of that treatment. And the beauty of your project or what you’re doing, here looking at literature and poetry, is everything will then be much more individually honed and tailored to the individual and their own individual experiences, hopes, fears.
Skip to 12 minutes and 3 seconds In other words, it will connect much more with the heart and soul of the patient, which is going to have such a much more profound effect on their physical symptoms.
Physiology of stress: discussion with Simon Curtis GP
In each week of the course, we’ll be speaking to medical practitioners to find out about the physiology of the different conditions that we discuss.
In the video above, we hear from Dr Simon Curtis, a general practitioner, about the physiology of stress. Although people don’t always realise it, stress is a real, medical condition, with physical as well as mental symptoms. Simon talks about the links between the mind and the body, explaining the chemistry behind the symptoms of stress, as well as discussing some of the different ways of coping with the stresses of modern life.
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