How To Cope With Stress

I have defined stress as "the nonspecific response of the body to any demand made upon it." Today, stress is so defined in virtually every textbook of medicine or psychology, but at first it was quite difficult to convince people that the body can respond in the same manner to things as different as a painful burn or the news that you won the jackpot of the Quebec lottery. It was not easy to accept that every type of normal action or the fight against any kind of disease could provoke an identical stereotyped response in our body. And yet, this is the case. Of course, we do reply to each stimulus in a specific manner also--to cold with shivering, to heat with sweating, to infection with immune reactions--but superimposed upon each of these responses that are adjusted to the particular needs created by a particular situation, there is always the "biologic stress-reaction." This is also known as the "general adaptation syndrome," since it represents a response that helps adaptation in general, that is, adaptation to anything.

In this chat we need not go into technicalities; a few of the highlights will suffice:

In situations of considerable stress, our adrenal glands produce adrenaline and a group of hormones that I have called "corticoids"; of these, cortisone is perhaps the best known. All the stress reactions are essentially defensive but, if they are insufficient, excessive or otherwise faulty, they themselves may cause diseases. We call these "diseases of adaptation," because they are caused much more by deranged adaptive reactions of our body than by the direct damaging effects of disease-producing agents. If a blow breaks a bone, if a knife penetrates the skin, the resulting damage is due to the injurious agent itself. However, many diseases have no identifiable single cause and can be produced by anything to which our stress mechanism responds inappropriately. Among the best-known diseases of adaptation are: gastrointestinal ulcers, high blood pressure, cardiac accidents, allergies, and many types of mental derangements.

An example will explain in principle how diseases can be produced indirectly, by our own inappropriate adaptive reactions. If you meet a drunk who showers you with insults, nothing will happen if you go past and ignore him. But, if you respond, you may start a fight and get hurt, not only by the drunk but also by your own emotional reactions which increase your blood pressure, accelerate your pulse and change the entire biochemistry of your body in a dangerous manner. As we have seen, any kind of activity sets our stress mechanism in motion; hence, not only anger but any kind of activity can cause disease in predisposed individuals. It will largely depend upon accidental factors--such as genetic predisposition or previous disease in one or the other organ--whether the heart, kidney, gastrointestinal tract, or brain will suffer most. In the body, as in a chain, the weakest link breaks down under the stress of tension, although all parts are equally exposed to it.

Does all this mean that we should avoid stress whenever possible? Certainly not. Stress is the spice of life. Being associated with all types of activity we could avoid it only by never doing anything. Who would enjoy a life of "no runs, no hits, no errors"? Besides, certain types of activities have a curative effect and actually help to keep the stress mechanism in good shape.

All of you know that occupational therapy is one of the most efficient ways of dealing with certain mental diseases, and that exercise of your muscles keeps you fit. It all depends on the type of work you do and the way you take it.

Work is a basic biologic need of man. The question is not whether we should or should not work, but what kind of work suits us best. In order to function normally, man needs work as he needs air, food, sleep, social contacts or sex. Few people would enthusiastically welcome the discovery of test-tube babies making sex superfluous; let us not look forward with eager anticipation to the days when automation will make everything redundant.

The Western world is being wrecked right now by the unsatiable demand for less work and more pay. But why should we work so hard to avoid work? The French philosopher, Henri Bergson, justly pointed out that it would be more appropriate to call our species "Homo faber" (the making man) than "Homo sapiens" (the knowing man), for the characteristic feature of man is not his wisdom but his constant urge to work on improving his environment and himself.

The most important aim of man is not to work as little as possible while earning enough to acquire the security that he will never have to work much harder. For the full enjoyment of leisure, you have to be tired first, as for the full enjoyment of food the best cook is hunger.

Only the physically or mentally handicapped really prefer not to work. Short hours are a boon only for the underprivileged who are not good at anything and do not like to do anything in particular. These--not those who earn little are the true paupers of mankind.

Those who could allow themselves the luxury of permanent idleness are rarely idle; they do not want to retire just because they "can afford it," but they do not consider their work as an obligation, a duty, but rather as a privilege, a fascinating play which gives them enormous satisfaction.

Speaking about the leisure hours of retirement, let me remind you that there exists a close relationship between stress and aging. Stress, as I have said, is the nonspecific response to any kind of activity at any one time; aging is the sum of all the stresses to which the body has been exposed during a lifetime.

A newborn baby, while crying and struggling, is under considerable stress but shows no sign of aging, whereas a man of 90, quietly sleeping in his bed, is under no stress but shows all the signs of aging.

Each period of stress, especially if it results from frustrating, unsuccessful struggles, leaves some irreversible chemical scars which accumulate to constitute the signs of tissue aging. But successful activity, no matter how intense, leaves virtually no such scars. On the contrary, it provides you with the exhilarating feeling of youthful strength, even at a very advanced age. The most eminent among the hard workers in almost any field became very old. Think of Leonardo da Vinci, Pablo Casals, Winston Churchill, Henry Ford, Charles de Gaulle, Bertrand Russell, Konrad Adenauer, Picasso, Matisse, Toscanini and--in my own profession of medical research--the Nobel Prize winners Szent-Gyorgyi, Otto Loewi, Waksman, Rous, Warburg. All these men continued to be successful--and, what is more important, on the whole happy--well into their seventies, eighties or even nineties. Of course, none of these people ever "worked" in the sense of the dictionary definition ("work is what you don't like but have to do"); despite their many years of intense activity, they lived a life of leisure by doing what they liked to do.

It is true that few people belong to his category of the intellectual elite; admittedly, their success in meeting the challenge of stress cannot serve as a basis for a national code of behaviour. But I believe that this way of life is applicable to almost any productive occupation. A carpenter can have the satisfaction of success and fulfillment by looking at a wellmade table; a tailor, a shoemaker, can get fun and the feeling of fulfillment from making a suit or a pair of shoes that his customers admire. Even a hunting dog is proud to bring in his quarry unscathed; just look at his face and you will see that his work has made him happy. Only the stress of frustration, of lack of purpose, can spoil the satisfaction of performance. The art is to find the job that you like best and that people honour. Man must have recognition, he cannot tolerate constant censure, for that is what makes work frustrating and stressful. With the progress of science and automation, most of the tedious, unpleasant activities will no longer be necessary, and more people will have to worry about what to do with their leisure time. Soon we will be able to cut down on obligatory working hours to a point where work deprivation will become our major problem. If man has no more incentive to work out his role as "Homo faber", he is likely to find destructive, revolutionary outlets to relieve his basic need for self-asserting activity.

On the endless voyages of the old sailing ships, when there was often nothing to do for weeks, the sailors had to be kept busy washing the deck or painting the boat just to avoid mutiny for the relief of boredom. Let us start preparing right now not only to fight pollution or the population explosion, but also to combat boredom. The lack of work threatens to become extremely dangerous. Let us begin a fullscale effort to teach "play-professions"--the arts, philosophy, craftsmanships, science--to the masses at large; there is no limit to how much man can work on the perfection of his own self.

Perhaps this outline could serve as a basis for the planning of a better, healthier philosophy than that which guides our society now. I think we should adapt our moral code and value-judgements, to fit the exigencies of the times to come. But I do not feel competent to preach what I have learned. Besides, it would be contrary to my basic predilection for professionalism, for sticking to what we can do best. I have been trained to do medical research. Laboratory work on stress can furnish a solid scientific basis for social improvements. But what is needed now are sociologists and psychologists who could prepare the territory by re-orienting the motivation of the masses. Then we shall need the media for driving the lesson home; and after that, we shall require practical politicians who can translate the fruits of medical research and psychological reorientation into the terms of a national or even international policy and code of behaviour. It would be a long job far beyond my ken. Meanwhile it is a dream, but you must first be able to dream before you could even try to make your dream come true. The conquest of smallpox, the discovery of penicillin, a trip to the moon were all but dreams before they became realities. Let's be optimists; there are talented people.

No Society can be entirely just; ours is certainly not. I won't try to offer any solution, but I think it may be worthwhile to call your attention to the kind of grotesque social injustice that can arise right here in our Country, simply as a consequence of the innate disinclination of creative medical scientists to participate in political pressure movements. I use this particular example merely because I happen to know something about it, but the same could be said about many other creative activities.

As you have read in the newspapers in connection with the debates about Medicare, a general practitioner in Canada can easily make $50,000 per year and, to practise, it suffices to have an M.D. and a licence. The vast majority of medical students succeed in obtaining these documents. On the other hand, the Quebec Ministry of Education offers $3,000, the Quebec Medical Research Council $5,600 and the Medical Research of Canada $4,800 per annum to the elite of young physicians who wish to practise the much more complex art of medical research. Even these incomes are difficult to come by. Among the carefully selected M.D.S of my Institute, five submitted applications for such posts to the Medical Research Council of Quebec last year, because they were so highly motivated that they wanted to do research even under these conditions. All five have been refused for lack of funds. Even an assistant professor at our Institute (who usually must have both M.D. and PH.D. degrees) is offered an initial salary of $14,000 and a lecturer (charge d'enseignement) $8,900 per annum. Why?

Competent crane operators earn $16,640 for a 40-hour week (The Montreal Star, Aug. 20, 1970). They deserve every cent of it, but my boys must pay for a much longer education before they become competent at their job, and then they have to put in much longer hours to stay competent.

It is perfectly justified that the general practitioners should be properly paid for the immensely useful service they render. Nor do I blame any of the above-mentioned Institutions for the pitiful support they offer. They are dependent upon the Government which, in turn, is likewise not to blame because, under our conditions of value judgements, that is all it can do. I am raising the point only to ask you: who is to blame? To me, it seems neither just nor in the national interest to discourage medical research by such restrictive financial measures.

I think the public should know about these things, because in the final analysis, it is footing the bill for all salaries and I cannot believe that, if people knew about it, they would approve these guide lines for the distribution of funds.

Before the moon shot, I had spent a few most inspiring days with Wernher von Braun on the Grand Bahama island. Among other things we spoke about the relative distribution of national funds for space travel and for medical research respectively. When I complained about the comparatively meagre support for medical research, he looked at me with dreamy eyes which I shall never forget, and said: "You do not have the Moon to offer."

But, don't we? What could be of greater concern to man than the agony of excruciating pain and the humiliation of impending, certain death which wipes out all other motives? There may be something worth having on the Moon. Undoubtedly, the first nation to reach another planet has earned much admiration and prestige, and yet, there is no reason to doubt that, with an equal investment of money and (more important) talent, a systematic attack on cancer, heart disease, or premature aging would be less likely to succeed than our dreams of future interplanetary travel. Even the grandeur of conquering the Universe, or the fear that war may break out, or that our world may become overpopulated, seem to pale at the bedside of a patient who will die because we were remiss in our efforts to learn more about disease.

Even if we are badly paid, we do have our own "moons" to conquer. I think society could and should support medical research more generously than it does. It is hardly in the interest of national health that those entrusted with the direction of medical research must, under our system, spend such a large part of their time begging for the salaries of their colleagues and the expenses of their materials.

Let us not finish this lecture on a tone of complaint and dissatisfaction. As I have said before: more than anything, man needs approval and self-esteem; more than anything, he fears censure and contempt with the resulting sense of frustration which is the worst kind of stress. Scientists enjoy, no less than other people, an approving pat on the back and, according to current opinion polls, they are, on the whole, the most highly honoured class of the population.

Their work requires a great deal of dedication. Like other people in creative positions who strive for excellence, scientists have little time to spend with their families. Their wives--like those of most people dedicated to any cause are tempted to complain about husbands who care "only" for their beloved lab, plant, or office. "Not only." Besides, those dedicated to creative accomplishments can always answer with Richard Lovelace, the Seventeenth Century poet: "I could not love Thee Dear, so much, loved I not honour more." For even love, to be valuable, must be offered by someone who is someone.

I have told you about the dangers and the benefits of stress, about the importance of finding the proper proportions between work and leisure and, most important, about trying to make them one by selecting such work that, to you, is play. We must find the right balance between the excessive or abnormal use of our body which "overheats" its motor, and the lack of use that makes it rust. To function well, you must first warm up, but not to the point of exhaustion. I do no preach a life of leisure; we should provide an outlet to our talents, but at all cost we must avoid frustration by not attempting that which is beyond us.

In my book "The Stress of Life" I tried to sum it all up in a jingle which I should like to read you, first in French, since it sounds better in the language in which it was composed:

"Lutte farouchement pour ce que to crois un noble
mais abandonne tout effort quand to to sais battu."
In English, it reads:
"Fight for the highest attainable aim,
But do not put up resistance in vain."

The gratitude of the Club was expressed by Senator Joseph A. Sullivan, M.B., F.R.C.S. (C.).