Stress & Multiple Sclerosis

Stress has been implicated in several studies and by the experience of people with MS in the onset of the disease or exacerbations of the disease.

Yet stress is often misunderstood. In this short article the concept of stress will be reviewed and several ways it is misunderstood will be discussed.

Understanding stress and its unique effects on each person with MS can only be beneficial in keeping symptoms to the minimum one's particular version of MS allows and, in general, reducing one's overall vulnerability to ill health.

Stress was first observed by researcher Dr. Hans Selye early in this century and named the General Adaptation Syndrome. Selye observed that people were less healthy and showed distress when forced to make changes in lifestyle or environment.

His work was suggestive in how we view stress, but it languished on the back shelves until Holmes and Rahe came out with a series of articles in 1967 that clearly demonstrated the effect of stress on human health.

Holmes and Rahe developed a life events scale that included 43 events that were rated by volunteers according to the amount of adjustment required by each event.

The highest rated event on the scale was the death of a spouse and it included such things as marriage, loss of job, starting school, bankruptcy, and many other items.

These researchers then placed these items into a questionnaire and scored each according to the rating they got from the first set of volunteers. Then they gave the questionnaire to people arriving in an emergency room. They gave it both to the patients who were sick and to the people who accompanied them.

Then they compared the scores. The result rocked the world of psychology and medicine: sick people had experienced far more of these life events in the year prior to their illness then the healthy people that brought them to the hospital emergency room.

Since these seminal studies the concept of stress has become increasingly important and recognized. Stress is now understood as the thing that happens to people when they are forced to adapt to new life circumstances. The greater the amount of change required, the greater the stress.

Since the original studies there have been a deluge of studies on stress. It has been implicated in heart disease, Cancer, accidents, as well as MS and almost every other disease that is being studied - including the common cold.

A whole area of study, Health Psychology, has arisen from these roots. Almost every family physician has told patients that some benign symptom is "probably caused by stress."

Yet stress is still misunderstood. Unlike in common usage, stress is not the equivalent of anxiety.

While anxiety prone individuals are likely to find their anxiety increasing with their stress, they also have anxiety in circumstances that are not new and to which they are not adapting.

Similarly, people who suffer little or no anxiety are still likely to show the negative health effects of stressful life changes and adaptations regardless of their calm demeanor.

Another surprise to people looking at this area for the first time is that stress is not always a negative event. It is not always perceived by people who are stressed as bad.

While lists of stressful events are dominated by negative stresses, they also include events that are very positive. Getting married, going to school, getting a new job, buying a house - all these things demand adaptation and are therefore stressful.

Yet they are seldom viewed as negative or as unwanted experiences. Stress is what happens when we are forced to adjust to new life circumstances.

Think about a plant that is moved from a cool spot with moderate light to a warmer, brighter spot. Even in what would be considered a better environment it often fails to thrive for a period of time until after it has adjusted.

During this time of adjustment it is more vulnerable to diseases and more sensitive to shocks from the environment. Plant growers suggest that such a plant be left without water for a few days and that it be left undisturbed for longer than that until it has reached a new equilibrium.

Like plants, humans have events in their lives that force them to adjust and adapt. Yet just as we are more complicated than plants, there are far more events that happen to us.

Holmes and Rahe's' original life events scale has been expanded by other researchers to include far more events. The death of a spouse has been replaced at the top of the list by the death of child.

Lists have been divided into positive and negative stress, and they have been expanded to include more than 120 items at times.

The stressful value of buying a car, of promotions at work, of increases in income, of launching children, and many other things have been recognized.

Yet to understand stress, one must personalize ones experiences and understand ones own vulnerabilities. For example, the loss of a job would provide very different kinds of stress for different people.

For a person in mid life who has highly identified with his or her job the experience would be very stressful. But for a young person who was just starting out and had a list of jobs he or she would like to try, such a loss would require less adjustment.

It could be even less stressful for a person who lost a part time job and was identified most directly with the role he or she played in the immediate family, in raising children or in keeping a home.

For people with MS, stress is even more individualized, because the disease may well add stresses and be reactive to stress in ways that complicate their lives substantially.

Many MS bulletin boards on the Internet have examples of the kinds of stresses people face and how these stresses interact with the disease and with the rest of the life of the person with MS and his or her family.

For this reason it is important to understand stress and to monitor the life events to which one must adapt. Avoiding too much stress at one time will reduce one's overall burden of adaptation.

One can make choices to not seek a new job, or to keep one's responsibilities at a lower level, or to avoid making certain changes. Doing so will reduce stress.

Yet some stresses are unavoidable because they are required by life's circumstances. Children grow up and leave, companies close, spouses get sick, parents die.

Ideally one will organize one's overall stress load to make the best use of one's adaptive resources. When successful, such management can only reduce ones vulnerability to the negative effects of stress.

But even when high stress is unavoidable, many researchers and clinicians believe one can reduce the impact of stress.

One can buffer oneself from stress by staying in the best possible health with a reasonable amount of exercise and good diet, by keeping one's baseline commitments at a reasonable level so there is room for unexpected change, by balancing responsibilities with rewards, and by maintaining a supportive group of family and friends who can be called upon for support.

Avoiding and managing stress will not cure MS. It cannot make one invulnerable to new diseases and it will not completely stop the progression of the particular form of MS one individual may have.

Indeed researchers have also looked at the other extreme on this scale and noticed the negative effects of not having enough stress in one's life.

Nevertheless high stress is the norm in this society and for most people with MS. And high stress is clearly associated with a corresponding vulnerability to ill health.

For these reasons it is important for each person to understand stress and how it works for him or her.

The benefit, while not necessarily specific to a particular symptom or disease, is that it will be helpful in reducing one's overall vulnerability to the whole range of potentially distressing and uncomfortable syndromes.

Thinking of it in a different way, by reducing stress we increase our resistance to diseases of all sorts. Regardless of how we think of it, paying attention to stress is a good idea.

by: J. Lamar Freed, Psy.D., Feb. 21, 1996. This article may be printed or posted without permission, but not without attribution.

Dr. Freed is a psychologist in private practice in the northern suburbs of Philadelphia, Pa. He has been diagnosed with MS since 1993.

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