THE USE AND ABUSE OF STRESS

The local newspaper applauded, as well it might. For the problem Negroni cited — stress — is now viewed as a society-wide scourge, and efforts to battle it are expensive and intense. According to the journal of the Society for the Advancement of Management, stress is the cause of as many as 90 percent of all jobrelated doctors’ visits, is responsible for over half the sick days American workers take, and is the culprit in up to 80 percent of on- the-job accidents. The total cost to American companies: up to $ 300 billion a year.

Companies now call for outside “stress audits,” courts throughout the world are increasingly indulgent of stress-based awards, and “stress management” has become a multi-billion-dollar industry. A survey by stress expert Kenneth R. Pelletier found that stress-management plans are by far the leading priority for corporate health programs, cited four times as often as the next closest concern (cardiac care). What should alarm us, and lead us to distrust all of the statistics cited above, is that no one — not the doctors who study it, not the plaintiffs who claim it, not even the “stress-management consultants’ who have become the ethicists of the stress trade — can come to any agreement on what stress is.

It’s not that the medical study of stress is bogus and newfangled; quite the contrary. Hippocrates spoke of something like stress (ponos). Our current understanding of the problem has its beginnings with doctors Walter Bradford Cannon and Hans Selye, who, working separately between the wars, uncovered the syndrome Selye would name “stress.” Cannon investigated the ” fight-or-flight” response — the way in which the human body produces adrenaline and other hormones in response to outside stimuli. When activated, these hormones sharpen the attention, speed up the heart, and prepare the body for action. But the response also depletes the immune system and temporarily halts the normal function of certain of the body’s regulatory networks. Cannon and Selye speculated that, in the 20th century, the fight-or- flight response was not being evoked at rare moments of extreme need, as it presumably was when prehistoric man had to outrun a lion, but that it had become a chronic condition. The irony was that 20th-century man, awash in conveniences and more divorced from nature than ever before, lived in a state of constant, or at least over-frequent, bodily vigilance that was causing his body to squander its whole bank account of self-protective resources.

Cannon and Selye were medical researchers, but their followers turned their research into an amalgam of social theory and psychiatric dogma. Now, it seems, practically everything causes stress. According to the Society for the Advancement of Management,

causes of workplace stress include: schedules and deadlines, fear of failure, inadequate support, problems with the boss, job ambiguity, role conflict, change, new technology, work overload or underload, repetitive work, excess rules and regulations, lack of participation in decisions, poor interpersonal relationships, career development factors (obsolescence, under/over promotion, organizational structure, organizational leadership, culture), and poor working conditions that include the climate, overcrowding, politics, and communication problems.

(Sorry — did someone say “the climate”?) As if that weren’t enough to worry about, success on the job — or the “success syndrome,” as stress- management consultants put it — affects one in five managers, and can cause ” apathy, irritability, uninvolvement in projects, decline in productivity, marital problems, and excessive drinking or smoking.” Stress-management candidates include people dying of AIDS, hot-tempered adolescents, people scared of surgery, binge drinkers, undergraduates with exam anxiety, athletes who choke, vaguely defined “Type A personalities,” and on and on.

The comprehensive nature of the stress theory is the first indication that we’re in the presence of a racket. Stress-related lawsuits and claims are booming in courts across the country. Under the 1970 Occupational Safety and Health Act, companies are responsible for “all diseases arising out of and in the course of employment,” and that is now taken to include stress. The National Institute for Occupational Safety and Health considers stress one of the 10 leading occupational diseases. Recent rulings on the Americans with Disabilities Act make it likely that that act, too, will be used to buttress stress-related claims. The U.S. Court of Appeals for the 6th Circuit recently ruled that a factory employee in Michigan could collect for a heart attack suffered on the factory floor and caused, he said, by the stress-inducing incompetence of one of his fellow workers and the unpleasant noise at work.

For all its American roots, stress is a global issue, at least in any country where people have grown impatient with modern life. Sweden’s incredibly generous 1991 Work Environment Act makes it the responsibility of employers to make sure “that the employee is not exposed to physical or mental loads which may lead to ill health or accidents.” One British citizen got a settlement for the stress of being stuck in an elevator. British papers have been in a panic about stress since 1994, when the social worker John Walker received 175,000 for being “severely mentally wounded” by the stress at work. More recently, the Scottish social worker Janet Ballantyne received a settlement of 66,000 for the stress caused by her ” outspoken and abrasive” boss. (It’s interesting that both these British stress collectors hail from UNISON, the same leftwing union of underpaid social workers. As one London businessman told the London Times, “I’ve yet to see a damages claim brought by a City stockbroker.”)

Clearly, if we’re looking for a synonym for stress it would be something like “modern life,” and the current anti-stress activism is an ethical and political critique of it. University of Chicago anthropologist Richard Shweder thinks that stress is merely a synonym for unhappiness, much as people a century ago talked of angst and ennui. Others see it as similar to the 19th-century fad ailment of hysteria. But it is more than that, for unlike its forebears, stress is linked to treatments and to states and corporations that mandate them. As University of Montreal psychologist Ethel Roskies puts it, “The most distinctive characteristic of stress management as a treatment is its universality; there is no one for whom treatment is apparently unneeded or inappropriate.” According to Roskies, “Essentially, the diagnosis of a clinical stress problem has less to do with the etiology or severity of the problem itself than with the prediction of its responsiveness to the teaching of coping skills.”

That means that stress can degenerate into a hunt for problems to fit preexisting (and lucrative) solutions. Some commonsense techniques for stress reduction appear to work. Meditation, biofeedback, hypnosis, “visualization therapy,” and relaxation coaching show results. But other techniques appear so common-sensical as to be laughable: Stress consultant Ray Shelton has said his Awareness-AttitudeAction model relies in part on “avoiding excess coffee and junk food.” And treatments can veer into charlatanism: “acupressure,” ” meridian energy flow,” and something called “trampoline therapy.” The Washington Post’s Liza Mundy attended a Fred Pryor mouvational seminar designed to fight stress and learned little more than that she ought to keep a “smile file” of happy thoughts and “take time out to just be.” European American Bank, meanwhile, reportedly invited Jesse “Two Owls” Teasley of the Oglala Sioux tribe to talk about tai chi — not, to the best of anyone’s knowledge, an American Indian cultural product.

The very idea of stress management, its opponents suggest, instills ” learned helplessness” — the assumption that people don’t have enough internal resources to quiet the storm within their own minds. Stress thus becomes the close relative of the “Twinkle Defense.” If self-help methods don’t work, then obviously society has the obligation to protect us from our own adrenaline.

The great pop-psych expression of this attitude is the Social Readjustment Rating Scale, devised by two psychologists in 1967. It ranks stressful events using a point system. Death of a spouse is 100, pregnancy is 40, problems with the law is 29, etc. If your tally rises above 150 points, you have a 50 percent possibility of suffering stress.

The effect of such a scale is to muddy all moral claims — the notion that maybe you ought to feel bad if you do something wrong. By assuming that a tragedy, like the death of a spouse, can be ranked on the same scale as a pregnancy makes the very idea of stress itself arbitrary. Is it worse than initiating a divorce or changing your diet? Where does “having an incompetent co-worker” (the problem that allegedly caused a heart attack) fit in?

The current conception of “stress” is a way of micromanaging fairness. It’s just unfair that someone’s stress rating should rise above 150 points, and there’s no reason it should! If a guy gets up to 300 points and flies off the handle, who can blame him? The goal of the Social Readjustment Rating System is to quantify moral, physical, and spiritual well-being so that they can be redistributed, as money and goods are in a socialist society.

Stress is now the preserve of those unacknowledged legislators of the world: social workers and other members of the caring professions. It is they, not the wider public, who decide the stress agenda. While 74 percent of corporate managers in one survey felt that the responsibility for stress management ” should lie with the individual rather than the organization,” institutional stress professionals continue to extend their reach and their agenda. That agenda is, not to put too fine a point on it, pro-feminist, anticompetitive, and inclined to see a racist under every bed.

The classic idea of stress has been easily adapted to a feminized America. Much of the initial research on stress had to do with men; the fact that they were undeniably more susceptible to stress-related heart attacks made it likely they suffered more stress. But recent research, all of it sociological and psychological rather than medical, has sought to put women at center- stage. The prevailing theory is that “juggling work and home” must make women’s lives more stressful than men’s, whether or not there’s any evidence to back it up. Too little attention has been paid, say the stress enthusiasts, to women’s stress, brought about by the fact that women have been ” socialized to care for others.”

From heart attacks to the woes of caring for others — yet again we see, even inside the world of stress management, a great leveling taking place. These days, women are increasingly considered the true victims of stress. Take NBC’s “Stressed Out in America,” a series of spots that ran on the network’s weekend Today show throughout the month of April. “It’s estimated that — get this — 75 percent of all doctor visits are due to stress-related disorders,” said host Jodi Applegate. “Now there’s evidence to suggest that women may be more prone to stress than men.” Participants consistently favored stereotypical female coping mechanisms to stereotypical male ones. Take Xavier Amador of Columbia University: “Really what we mean is it’s important to talk about how you feel, and — and the worst thing you can do if you’re stressed out is to keep it inside and carry it with you.” Then Amador talked about the importance of using “I” statements: “It’s very important that you talk about how you feel, not what the other person is doing. So, if you’re stressed out, you come home, the dishes aren’t done, don’t say, ‘You don’t do the dishes, why didn’t you do the dishes?” Say, ‘I would really appreciate it.'”

The who-does-the-dishes example hardly came out of thin air. Indeed, one commonplace assertion in the world of stress management is that stress in men is caused by their being too aggressive, while stress in women is caused by women’s being too passive. Says Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke, “You should just cool out. Let it go.” But what if the situation is amenable to change? “That means you should really swing into action . . . and for women that often means being assertive.”

The agenda of the stress industry also includes race. The most notorious recent example was a study by Harvard epidemiologists Nancy Krieger and Stephen Sidney on “Racial Discrimination and Blood Pressure,” which appeared in last October’s American Journal of Public Health. Blacks die on average seven years earlier than whites, from cancer, heart attacks, and a variety of diseases to which they have a higher propensity. The two researchers asked for responses about exposure to racial discrimination and plotted the results against high-blood-pressure statistics. There was no statistically significant relationship; in fact, those blacks who had faced zero episodes of discrimination had higher blood pressure than those who had faced one or more. But Krieger and Sidney assumed a relationship anyway, on the grounds that those with the highest blood pressure were probably underreporting the number of racist incidents they’d been exposed to, and that they were thus merely victims of “internalized oppression.”

High stress, in the categories of race and gender, is seen as merely a stand-in for virtue. That’s not the case with stress in the category of achievement — and the contrast is instructive. We all know about how dangerous it is to be a “Type A,” shorthand for “Type A behavior syndrome,” which researchers define as “characterized by competitive drive, impatience, hostility, and rapid speech and motor movements.” For years, doctors and stress researchers have found a correlation between those behavioral qualities and a high incidence of coronary heart disease.

If, for physicians, the Type A is merely a cardiacward candidate who deserves attention, for stress professionals he’s the vice president in the penthouse with the five secretaries and the attitude. An unmistakable note of righteous discipline, even divine wrath, can be heard in their discussions of Type A personalities. In their view, for Type As, excessive work is an ” obsessive-compulsive disorder.” NBC’s “Stressed Out in America” suggested that Type As who are always nervously looking for the shortest line in a supermarket should instead seek out the longest one.

Here as elsewhere, “stress” is frequently an explicit indictment of competitiveness, and this means an implicit indictment of the economic status quo. Karen Nussbaum, the director of the working women’s department at the AFL-CIO, told a Newsday reporter that “companies that really want to relieve stress should be more concerned with redistributing work, paying a decent wage, and creating a family-friendly environment.” Stress thus serves as the ultimate pretext for gripes about the need for economic reorganization.

As a medical matter, the study of stress is an effort to examine the problem that the human animal lives under conditions of modernity to which his system has not adapted. It is a serious issue that deserves serious study. But that is not why America has become so addicted to talk about stress. ” Stress” is a smoke screen — a cover for what is, at root, a political and moral movement aimed at fixing “inappropriate” ways of responding to modernity. Its agenda is large enough and its rationale vague enough that it ought to be drawing more skeptical interest, and meeting more resistance.

Christopher Caldwell is senior writer at THE WEEKLY STANDARD.