Today there is an epidemic of stress-related disease in the technologically advanced countries, and the developing countries are inheriting the same problems as they adopt the faster western lifestyle. Hypertension, coronary atherosclerosis and cancer are by far the biggest killers in western societies, and each is known to be causally related to stressful living. Add to these the myriad other stress disorders: asthma, allergic phenomena, peptic ulceration, ulcerative colitis, thyrotoxicosis and thyroid deficiency, obesity, diabetes, arthritis, mental illnesses and many more, and you begin to see the dimensions of the stress problem we are facing today.

In dealing with this epidemic, the doctors of the world are adopting a new systematic approach to the classification, diagnosis and treatment of stress-induced illnesses in their patients. Doctors now realize that the major diseases which they encounter every day are the end result of poor adaption to stress.

Stress disorders are now recognized as a continuum spanning a number of years. In a recent study, Dr. K.N. Udupa of the Institute of Medical Sciences, Banaras Hindu University, Varanasi, India has proposed the following classification of stress disorders. * 1

1. Psychic phase

Here the individual develops psychological changes resulting from excessive psychic trauma. As a result the central nervous system becomes overactive. He becomes irritable and hyperactive and may develop mild tremors. His sleep patterns are disturbed and he becomes increasingly anxious. He looks worried and may dwell on impending disasters. The state can be objectively measured by estimating levels of the neurotransmitter acetylcholine in the blood, which are usually remarkably elevated. This phase can extend from a few days to a few months, depending on the type and severity of stress phenomena, and on the type of body constitution and personality.

2. Psychosomatic phase

Here certain physical manifestations become evident such as palpitations, tremor, raised blood pressure and rapid pulse.

3. Somatic phase

Here there is an increased function of the target organs. The stress disease usually settles upon a particular organ, depending on a person’s hereditary background and environmental factors. One individual will develop a hyperthyroid state, another an elevated heart rate and high blood pressure, another hypercholrhydria or elevated acid level in the stomach, and so on. This phase can be objectively measured by recording elevated levels of catctcholamines (adrenalin and noradrenalin) in the blood.

4. Organic phase

Here disease fully settles down into a particular organ. The earlier psychosomatic and somatic excessive functions settle down and chronic inflammation and organ destruction begins. The individual develops the signs and symptoms of coronary insufficiency, thyrotoxicosis, bronchial asthma, peptic ulceration or some other clinical condition. There is plasma cell and lymphocyte infiltration in the target organ and tissue destruction. Fibrosis progressively impedes the function and destroys the organ. The end result is that disease states such as diabetes mellitus, myxoedema (chronic thyroid insufficiency), emphysema and cardiac insufficiency develop.

These diseases are well known clinical entities and medical and/or surgical treatment is indicated. However, the background of stress is often overlooked, whereas with awareness of the disease continuum from phase 1 through 4, earlier therapy can arrest the disease at a less serious stage. In this light, greater emphasis is now being placed on preventive and community health as a way of confronting the stress problem before it manifests in irreversible disease states. Doctors are taking the lead in this direction, for they have both the respect of the community and the best knowledge of the overall dimensions of the stress problem in our lives. Doctors are responsible for the health care of the community in the widest sense, and with them rests the responsibility of leading the community back towards a more healthy lifestyle and of providing more effective methods of coping with stress.

Dr. Udupa has found yoga therapy, programs of asanas and pranayamas combined with relaxation in shavasana or yoga nidra, to be most effective in treating psychic, psychosomatic and somatic phases of stress disorders. When these techniques are combined with competent psychotherapy (using tranquillizing drugs on a short term basis in extreme exacerbations of stress symptoms), most disease processes can be arrested in the earlier phases before the irreversible organic phase begins. This is an infinitely preferable course of action to the necessary medical or surgical intervention which alleviates symptoms once the organic phase is manifest. Even in these cases it is noted that psychotherapy and yoga therapy produce marked subjective improvement in the patient’s condition.

Many doctors are becoming familiar with yoga. But if the stress epidemic is to be arrested, more doctors must know how to utilize yoga in their medical practices. They have a duty to their patients who look to them for guidance and help with their difficulties and problems. The long term use of tranquillizing and psychoactive drugs does not get to the root of the problem, but yoga does. With instruction in the correct yoga practices during the early phase of illness, both doctor and patient can come to terms with the harmful effects of stress, paving the way for a happier, more fulfilled life while nipping a major stress illness in the bud.

*1. K.N. Udupa, “Pathogenesis and Management of Stress Disorders”, Quarterly Journal of Surgical Sciences, Banaras Hindu University, Vol. 13, no. 2, June 1977.

(Courtesy Yoga Magazine, January, 1979)

Dr. S.V.Rao, M.D., Gandhi Medical College, Bophal

“This is dedicated to those who suffer from stress. To those who- in their efforts for good or evil, for peace or war- have sustained wounds, loss of blood or exposure to extremes of temperature, hunger, fatigue, want of air, infections, poisons or deadly rays. To those who are under the exhausting nervous strain of pursuing their ideal- whatever it may be. To the martyrs who sacrifice themselves for others, as well as to those hounded by selfish ambition, fear, jealousy and worst of all hate. For my stress stems from the urge to help and not to judge I understand that I cannot and should not be cured of my stress, but merely taught to enjoy it.”
Dr. Hans Selye

The neo-industrial age, also called the age of anxiety, is introducing newer forms of stress into the everyday life of common man. His life is full of subtle psychological plagues- worries, value conflicts. Loneliness, disillusionment and doubts as to whether he can weave a successful course through the complex maze of freeways and blind alleys that make up modern existence.

Tremendous growth of knowledge, coupled with scientific and technological discoveries, has provided the opportunities for a higher life, health, happiness and leisure. But our distressed generation is obscurely aware that the present crisis is a spiritual one. What we need is a healing of the discord between the outward resources of power, which are assuming frightful proportions, and the inward resources of spirit, which seem to be steadily declining. To redeem and recreate our civilisation, we need a recovery of spiritual awareness, a new transforming contact with the inner springs of life, a sense of values. Despite the extraordinary achievements of affluent countries in art and science, intellectual and political life, hundreds of thousands of young people flee from reality by opting for drug-induced lassitude. Millions of parents retreat into video stupors or alcoholic haze. Legions of elderly folk vegetate and die in loneliness. The flight from family and occupational responsibility has become an exodus. Masses tame their raging anxieties with a score of tranquillisers and psychic pacifiers. Affluent nations, whether they know it or not, are passing through a stage of acute stress. All developing countries wedded to industrial progress are passing through similar phases differing only in degree. Man today is not standing on an enviable pedestal as a builder of a civilisation; he is lying low as a victim of a civilisation which is growing at an unbelievably rapid pace beyond his comprehension.

In the modern materialistic culture of the neo-industrial age, the all-pervasive values of the acquisitive, materialistic, competitive, technological society have been spreading all over the world. This materialistic drive is towards the exploitation of natural resources and ‘getting rich quick’. It stresses hedonism and improving one’s own standard of living regardless of the consequences for others, the only rule of conduct being each man’s own pleasure. The average product of the industrial civilisation is an individual who is selfish, coarse, proud, lazy, envious, intemperate, ill natured and lubricious. Everyone is enclosed in his own egoism, like the crab in its shell, seeking to devour his neighbour.

Today there is a spreading alarm over air pollution, and environmental pollutions like dissipation of energy in the form of heat, noise vibrations, radiations and urban crowding. More and more health authorities are coming around to the ecological notion that the individual needs to be seen as a part of a total system and that his health is dependent on many subtle external factors. Change itself- not this or that specific change, but the general rate of change in a person’s life- can be one of the most important environmental factors of all.

Life implies a constant interaction between organism and environment. Life is a constant stream of tiny events flowing into and out of our range of experience. A change in the stimuli of environment triggers what experimental psychologists call an orientation response which is a complex, even massive, bodily operation. Apparently we have a special novelty detection apparatus built into our brains. When new stimuli arrive, these are matched against the neural models in the cortex. The neural cells in the cortex store information about intensity, duration, quality and sequence of incoming stimuli. If stimuli are novel, they do not match any existing neural model and the orientation response takes place. The orientation response is not an accident. It is nature’s gift to man, one of his key adaptive mechanisms. It appears as a preparation for his fight or flight. Yet each orientation response takes its toll in wear and tear of the body, for it requires energy to sustain it. The orientation response is particularly stressing when a novel event or fact challenges one’s whole preconceived worldview. Orientation response is primarily based on the nervous system; the adaptive reaction is heavily dependent on the glands and hormones they shoot into the blood stream. The first line of defence is neural; the second is hormonal. Repeated stimulation of the adaptive reaction can be seriously damaging. Excessive stimulation of the endocrine system leads to irreversible ‘wear and tear’. Psychophysiologists studying the impact of change on various organisms have shown that the successful adaptation can occur only when the level of stimulation is neither too low nor too high, judged from the amount of change and novelty in the environment. It is true that some people can tolerate more novelty than others; the optimum mix is different for each one of us. Today there is hidden conflict in our lives between the pressures of acceleration and those of novelty. One forces us to make the hardest, most time consuming decisions, the other compels us to make faster decisions. These two clashing forces within us, along with the uncontrolled acceleration of scientific, technological and social change, subvert the power of the individual to make sensible, competent decisions about his own destiny. The combined effects of sensory and cognitive overload with decisional stress produce several common forms of individual maladaptations viz. functional illnesses, neuroses, neuropsychiatric disturbances and psychosomatic disorders. Caught in the turbulent flow of change, called upon to make rapid fire, significant life decisions, he feels not simply intellectual bewilderment but disorientation at the level of personal values. As the pace of change quickens, this confusion is tinged with self-doubt, anxiety and fear. One grows tense, tires easily and my fall ill. As the pressures relentlessly mount, tension shades into irritability, anger and sometimes senseless violence. Life becomes painfully disorganised, exhausting and anxiety filled. Pushed to its extreme, the end point is psychosis.

The above are a few of the general considerations ordinarily responsible for the causation of mental stress among crowded, industrial city dwellers through frustration, conflict and pressures. Compare this with an agrarian society where social and economic security is available through the joint family and less challenging life situations. When these people are suddenly exposed to sensory and cognitive overload- with the decisional stress of the highly competitive, individualistic, industrial city life- they succumb unless they are made of very tough fibres.

The specific industrial hazards like air pollution with poisonous gas, vapours, noxious fumes, dust; water pollution with toxic chemicals; environmental pollution with heat, noise, vibrations, harmful radiations, accidental risks, etc. act as chronic stressors. Added to these is time-limited, target-oriented, monotonous work carried on in the midst of job and economic insecurity, adverse labour policies, poor work environments, poor communications, and various expressions of poor leadership and supervision such as favouritism, laxity, and undercutting. These condition not only act as aggravating stressors but in some cases they are the last straw on the camel’s back.

Remedy

Life needs to be reprogrammed by accepting right values, finding a purpose in life higher than that of a mere biological existence for sensual pleasures alone, and hooking all the activities to that purpose. Developing spiritual tendencies through the first stages of ashtanga yoga, which are yama and niyama (self-control and restraint), helps in the reprogramming.

Life has to be made wider, deeper, bolder and more joyful. Strength is the only thing which allows man to rise higher. Strength is comprised of stamina, harmony and suppleness of muscles, organs and mind, along with the capacity to bear fatigue, hunger, sorrow and anxiety. It is the will to hope and to act, the solidarity of the body and soul which does not admit the possibility of defeat, the joy which permeates our whole being. The desired strength of body and equanimity of mind is attainable through regular practice of asanas (postures), bandhas (psychic locks) and kriyas (internal cleansing techniques).

The mind has to be purified and the spirit within us given full scope to rise and soar higher. The ascent of the spirit is made possible through the ideal of love, born from the sacrifice of selfish desires; and beauty, born from annihilation of the ego. These ends are attainable through pratyahara (sense withdrawal), dharana (one-pointed concentration) and dhyana (meditation), assisted by kirtan (singing God’s name) at all stages.

Practice of ashtanga yoga, the eight limbs of raja yoga, results in the evolution of mind, the ascent of spirit and the dawn of true self-knowledge.

“The knot of the heart is released for him who realises the self, the higher and lower Brahman. For him all doubts have disappeared, all karmas vanished.”

In the midst of the apparent stresses of the world such a one lives unaffected, just as a lotus leaf remains in water without getting wet. He alone is ultimately the jivan mukta, the liberated one.

It is not possible to remove all the stress from a man’s life. There can be no life without stress, just as there can be no music produced by a veena, the strings of which are free of tension. The beauty of life is learning the art of converting the tension of the veena strings into melody.

Courtesy: Yoga Magazine, June 1977