Wednesday, May 28, 2008

Stress (Part 2)

(My 15-year-old dog was up six times last night. I slept badly, and awakened late this morning with a terrible headache. So...I'm spending the day resting. I'll let the comments run without moderation, and I'll respond to everyone as soon as I feel better--probably late this afternoon or tonight.)
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What a great discussion we had yesterday, and I would like thank everyone who participated. As I mentioned in yesterday's post, I am finding The Relaxation & Stress Reduction Workbook by Martha Davis, Ph.D., Elizabeth Robbins Eshelman, MSW, and Matthew McKay, Ph.D., to be a wonderful resource.

While I have finally realized that the initial triggering event for my first depressive episode 40 years ago was stress, others agree that this is what happened to them as well. And Naturalgal wrote something that confirmed a central hypothesis of mine, which is that labeling people is far less helpful than providing support. What follows is taken from her comment.
"If someone had said, 'Hon, you are perfectly normal. It's just that your body and mind can only handle so much stress. Here we will show you how to get back to health.'

"I was told this but I was also told I had a chronic mental illness. No. I was a normal person with too much stress."
The authors of The Relaxation & Stress Reduction Workbook write that stress comes from four sources: your environment, social stressors, physiological problems, and thoughts. They write: "How you interpret and label your present experience and what you predict for the future can serve either to relax or to stress you...

"Stress researcher Richard Lazarus has argued that stress begins with your appraisal of a situation. You first ask how dangerous or difficult the situation is and what resources you have to help you with with it. Anxious, stressed people often decide that (1) an event is dangerous, difficult, or painful, and (2) they don't have the resources to cope with it."

What's ironic to me is that if many of us believe our symptoms are stress-related, then how much more stress do we feel when our doctors say, "You're bipolar--which is a form of mental illness--and the only thing I can do for you is give you medication."

Following Naturalgal's lead, think of how much better we'd feel if our doctors said, "You seem to have difficulty dealing with stress, but that's okay because it's a learned skilled, and we have great resources to help you."

Tomorrow, I'll describe some of the tools these authors recommend for dealing effectively with stress. I'd also recommend that you read the comments from yesterday's post because a lot of people provided great examples of the methods they're already using to to promote relaxation and reduce stress.

10 comments:

Jena said...

Wow, where to start!!!

"Stress researcher Richard Lazarus has argued that stress begins with your appraisal of a situation...and what resources you have... Anxious, stressed people often decide that (1) an event is dangerous, difficult, or painful, and (2) they don't have the resources to cope with it."

I personally think that is an unfair assumption, as anxiety is a common emotion that could be experienced in a wide variety of contexts. It is experienced by myself on a random, occasional basis as a minimal symptom of my unwellness. Fleeting, if you may. Then again, I suppose if we are evaluating the other side of the coin - my resources include resilience, positive attitude, perseverence and medication.

You said: "What's ironic to me is that if many of us believe our symptoms are stress-related, then how much more stress do we feel when our doctors say, "You're bipolar--which is a form of mental illness--and the only thing I can do for you is give you medication."

I'm not sure how much you know about the diagnostics of Bipolar illness, but though stress can induce mental illness and exacerbate symptoms, the diagnosis is given based on certain criteria. The criteria has to be followed for the diagnosis- not for being "labeled" as per stigma, but to place one in terms that are used are understood by care providers in the field of psychiatry for treatment protocols. Just as chronic medical illnesses have diagnostics and titless/labels, such as Grave's Disease, or COPD, Asthma, Chrone's. These medical diagnoses are not given to patients to stress them out, but rather identify their illness and move on with treatment protocol. Unfortunately stigma with mental illness still exists, and I think we tend to associate stress with the condition in general. Maybe the stress is related to the stigma? And taking medication for some, is also related to stigma, rather than wellness? The fact is, many people find relief with medication or other therapies (or combination) for their mental illnesses.

Some doctors are not going to be very sensitive about the way they handle their patients, or give the news of diagnosis, and suggestions of medication.If I could wave a magic wand and make all the physicians caring and sensitive I would. Sine I can't, we have to think about how WE will react to them not being able to change their snarkly attitude, God forbid we have a run-in.. because they are still equipped to help us. I would recommend a paradigm shift. Do we want them to beat around the bush? I'd rather just get it out on the table and hash it out for awhile personally. Psychiatrists see these kinds of illnesses all the time so it's not new to them and they don't feel weird talking about it, as we may feel at times.

What a perfect segway into the next quotation- the much desired doctor's reaction:

"Following Naturalgal's lead, think of how much better we'd feel if our doctors said, "You seem to have difficulty dealing with stress, but that's okay because it's a learned skilled, and we have great resources to help you."

Our docs may not always come across as this polite and helpful, but they are resourceful and they are able to help us like this. Sometimes we have to be our own advocate.

Jena, Reg. Psych Nurse

P.J. said...

Yup, if the doctors were more positive, I think it would be better on us.

Jazz said...

Susan--
Another interesting post!
While I wouldn't go so far as to say that bipolar is caused by stress, in my own case, every episode I have had can be traced back to stress, so I do have to wonder if I'd had better coping mechanisms in place, would those stressors have precipitated mania/depression? Maybe not. Because what I've found since going off medication and learning to better manage stress, is that I'm not having these episodes anymore.

From an acorn said...

I'm going to throw a great ole spanner in the works by saying that some people will experience bipolar symptoms in the absence of stress. Today I am feeling symptoms and I am under none of the 4 causes of stress. My post today is about how bipolar can simply impose its symptoms on me without my participation, consent or generation.

I think it adds pressure to me to think that I must always be responsible somehow for my symptoms, because that's not always accurate. Sure I realy on a toolbox of strategies to help me, but these don't necessarily reverse or prevent symptoms.

As much as I encourage myself and others to think positive, I steer clear from being a Louise Hay devotee by claiming that I have created my own reality and as such I have created my symptoms. Phooey. Bipolar created my symptoms - how I deal with it is up to me. I choose positive ways to deal with it to reduce my stress and to prevent the need for later damage control.

Hope you feel better after your rest.

Coco said...

SO interesting. Stress is a huge trigger for so many bipolars it seems. Although I don't believe that most true biplars are 'normal people with too much stress'. I do however think it plays a large role in triggering episodes. There's just more to it, is what I feel on an intuitive level. Yet I do think that probably a HUGE amount of people have been TOLD they're bipolar (erroneously), and this is what it boils down to....stress management, nothing much more. I'm glad you're bringing awareness to this, as right now it's huge.

Coco said...

p.s. I hope you were able to rejuvenate, and that your dog is feeling better. Is your dog ill?

Gianna said...

Jena,
without getting into a full fledged argument about diagnosis and the legitimacy of people being labeled, I'd just like to say that as a clinical social worker who worked in mental health with psychiatrists and as someone who was also inappropriately diagnosed as bipolar, I believe that the strict DMS IV criteria is often ignored.

My personal opinion is that most bipolar as diagnosed today has little to do with criteria as set forth in the DSM and even if it was it's still a totally arbitrary book--that leaves much open to personal interpretation and misinterpretation.

Jena said...

gianna- you're right, let's not get into a full fledged argument. I'm sorry you've had a bad experience.

samanthagms said...

I think that stress management is beneficial, and a good skill to learn, regardless of whether it will improve your life slightly, or, move mountains for you. I often hope while reading your blog that doctors are part of your readership and will take into consideration what is written here.

David said...

I disagree that our doctors should just attribute all of our symptoms to stress and not tell us the real impact of our mental illness. Wouldn't a solely stress-focused approach undermine the importance of medication? While stress management is really important in reducing the symptoms of depression, it is not the only factor.