Smash Stress Blog

It's a comment doctors are not surprised to hear from heart attack patients. "But... I didn't know I was stressed."

You can be the last to know about the time bomb ticking inside your body from chronic stress. This is particularly true for Type A's and workaholics, who are prone to ignore the signals -- the gastric volcanoes, insomnia, tightness in the chest, frequent headaches -- and keep doing what they've been trained to and gotten props for their whole lives, keep on going until the paramedics arrive.

That happened to Tom Row, a former scientist in Tennessee, who had a heart attack in his office and had to be carted off on a stretcher. "I didn't know I was even stressed," Row told me for my book, Work to Live. He racked his brain in the ambulance on the way to the hospital. What got him here on the brink of death? He realized that 60-hour workweeks, 10-12-hour days, and the lack of downtime to recover had done a number on his health.

In my work as a trainer in stress management, I run across people from every walk of life who have had to find out the hard way that chronic stress is a very insidious thing. It can be wreaking havoc on your body, and you can be completely oblivious to it. The problem is that stress sets off a flood of adrenaline, a hormone that masks the damage done being done by keeping the body in emergency mode too long. It plants a time bomb we pay for later -- not just the individual with a trip to the ER, but in staggering costs to the nation.

The stress response was meant to be a momentary event until you were out of harm's way. The changes it triggers in your body to enable you to fight or run -- suppressing the immune system and tissue repair system, jacking up blood pressure, interfering with gut function, decreasing the good cholesterol and increasing the bad -- aren't sustainable over the long run. The surge of adrenaline creates a sense of power, as it's supposed to in a real life-and-death emergency, a belief you are handling everything, when you are not. Over time you can wind up adapting to the adrenaline buzz, while the damage goes on inside.

This is one of many reasons we need regular stress screening and monitoring to walk us back from our ledges. Some 525,000 people have heart attacks every year in the U.S., like Tom Row. How many lives and tens of millions of dollars could we save with effective stress prevention? The lack of a plan to deal with stress fuels the last-minute myopia of our healthcare-by-ER system.

Most of us know it's important to monitor our cholesterol or blood sugar numbers. Why not our stress levels? The evidence tells us that stress levels are the most crucial item to be keeping track of, since stress is a factor in five out of the six leading causes of death and costs the nation a staggering $1 trillion a year, according to Peter Schnall's Unhealthy Work.

We can stop surprise heart attacks and save lives by making sure everyone has access to stress screening and management. Very few have access to these critical preventive services now. You can change that by joining with the Smash Stress Campaign to sign this petition here that would get stress screening and management covered for all, by making it a preventive service of the Affordable Care Act. It's a simple executive action that would add stress screening to 16 other preventive services, such as cholesterol screening and colorectal screening. This could be one of the most important actions you ever take, since stress plays a role in the vast majority of all doctor visits.

The Obama Administration released a 125-page document, the National Prevention Strategy, outlining the preventive approach that is the basis for the new health care law. It's a plan designed to keep people out of doctor's offices and ERs, yet stress prevention is left out of the equation. Stress is always the forgotten health hazard, with no social or political constituency to champion it. Policy-makers have been giving it the ostrich treatment for decades.

But ignoring it is only making it worse. Stress has grown as much as 30 percent for some in recent decades. Some 90 percent of Americans will have hypertension, a condition multiple studies link with stress, by the time they are 75, cites the Center for Social Epidemiology. We can't afford the silent treatment any longer.

Humans are creatures of adaptation, and had to be through the eons, or we wouldn't still be around. We're so good at it our bodies have the ability to adapt to conditions that are extremely harmful, such as chronic stress.

But it's all a colossal mistake, a maladaptation. The ancient stress response was built for another time and place, tens of thousands of years ago on an African savanna. It doesn't 
know how to cope with the social stresses of the modern world, which might be challenging, but aren't life-or-death. Identifying and managing modern stressors can turn off the danger signals, so they're not sowing the seeds of heart disease, cardiovascular problems, irritable bowel, cancer, stroke, and a host of other diseases that drive unnecessary suffering and unsustainable medical bills.

When we learn how to turn off the false danger signal of stress, the stress response stops in four minutes. We can get that knowledge out there through the stress screening petition and prevention movement.

Let's make stress prevention a normal, covered service and insure that everyone has the tools to avoid adaptation to self-destruction. It's nonsensical to wait until after the rush to the ER before we treat the root cause of so many chronic diseases. It's time to treat stress as what it is: America's number one health risk.

It would be great if stress were an exotic flu or an illness that needs a cure. It's our bad luck, though, that stress is far from exotic, and we know exactly how to fix it. This has allowed stress to have the perceived virulency of a hangnail. So under the radar it's off the radar, stress has exploded to an invisible, $1 trillion health epidemic, according to Peter Schnall's Unhealthy Work. That's more expensive than the cost of cancer, smoking, diabetes, and heart disease combined.

It's an astounding enough fact to be in Ripley's, yet one we've never heard of. And there is more hidden from view. Stress is a factor in five out of the six leading causes of death -- heart disease, cancer, stroke, lower respiratory disease, and accidents. An estimated 75 percent to 90 percent of all doctor visits are for stress-related issues.

There seems to be a trend here. Illness and stress. Spending wild amounts of money and stress. The culprit behind so many of our health problems is staring us in the face. Want to cut chronic diseases and health bills? Start with stress, the crisis at the heart of the health care crisis. Want to cut the deficit? Encourage policies that prevent and manage stress, and lop off a few hundred billion bucks.

Of course, stress is more than numbers. It's a daily crucible for millions of us. I meet a lot of people caught in its vice-grip as a work-life balance and stress management educator. Away from earshot of work colleagues, people pull me aside to confide the toll stress is taking. I met a 29-year-old government worker who had an assortment of illnesses you'd expect to see in someone in their 70s. A man in his 40s at an aerospace company told me about the heart attack he'd had two months earlier. He managed to get another position at the firm to get the stress down, but the new position was even more stressful. On the legal frontlines, an attorney told me, "Everyone I know is on Paxil!"

If there were an America's Most Wanted for health problems, stress would be at the top of the list. The U.N. calls stress the 21st century health epidemic. So why does it continue to remain out of sight and out of mind for policy makers and health insurance when it's ravaging so many lives and bankrupting the nation? One, stress is thought to be normal and no big deal. Two, stress is considered a personal, and what's worse, mental problem with no effect on anyone else. Three, there has been no social or political movement to challenge stress as there has been to fight smoking or cancer.

The good news is that we can do something about the latter and in the process fix the other two. I've launched a campaign to fill the grassroots void called Smash Stress. We have a very specific health care policy petition I hope you'll check out and sign here that calls for stress screening and management for all. It only requires an executive action, and it could transform health in America. I hope you will join the Center for Social Epidemiology, a group of the top stress researchers led by Peter Schnall, to get stress out of the back alleys of personal agony and into the forefront of public health policy. We have the opportunity to do something historic right now.

The problem is that we've been treating the symptoms of stress -- heart disease, high blood pressure, stroke, diabetes -- instead of the cause, stress itself, and shutting that down. Our petition calls for reversing that approach, adding stress screening to the preventive services of the Affordable Care Act. There are currently 16 preventive services covered by the law (22 preventive services for women), from colorectal screening to depression screening. We are asking President Obama and Health and Human Resources Secretary Kathleen Sebelius to add stress screening, the most important preventive measure of all, to the law, as well as accessible and affordable stress management. This is a doable executive action that fits perfectly with the Administration's National Prevention Strategy, which states that, "preventing disease and injuries is key to improving America's health."

Can signing a petition do anything? Ask Dena Patrick, of the social volunteering site wishadoo.com. She submitted a petition at change.org calling for health benefits for part-time FEMA workers, who didn't get any. They get health benefits now, because the administration changed the policy after her petition attracted 112,000 signatures. We can do it too and save millions of lives and billions of dollars.

Collective action helped change social behavior around smoking. Sarah Speck, a cardiologist at Swedish Hospital in Seattle, calls stress "the new tobacco." Like nicotine and tobacco, it constricts blood vessels. Also like smoking, stress is another default habit that requires social intervention to change the attitudes that create it, both for stress perpetrators and reactors. With knowledge and social sanctions, it becomes less acceptable, more costly, more stupid to engage in stress.

We know how to manage stress. We just need to get the information out to everyone. 
Smash Stress is lobbying the surgeon general and the CDC to sponsor vigorous, ongoing stress awareness and prevention programs.

We've been sold the idea that stress is some kind of personal flaw whose demons we alone must bear. Though it's not infectious, stress is highly contagious. It's easily spread between workmates, spouses and significant others through "pass-along strain." It drives the hair-trigger emotions and false crisis mentality that spill out into the accident and crime reports of our communities and make our world more angry, panicked, sleep-deprived, and dangerous than it needs to be.

Maybe we can say someday, beginning with action on stress screening and management today, that we made our world a less angry, healthier, safer place to live.