Sociology Essay 221

19

CHAPTER 2. SWEATING THE SMALL (AND BIG) STUFF: HOW AND WHY STRESS AFFECTS OUR MENTAL HEALTH

Everyone has had an occasional “bad day” when they wake up feeling blue, cranky, or fearful of what the day holds in store. Often, these feelings fade quickly and are chalked up to “waking up on the wrong side of the bed.” Yet for people undergoing high levels of stress in their daily lives, feeling sad, anxious, angry, or depressed is rarely something that is just “in our heads.” Intense and persistent symptoms of depression, anxiety, and even anger often can be traced back to stress, whether events are life-altering, such as the death of a loved one, or fleeting, such as a looming deadline on a major work assignment. For those experiencing overwhelming stress, such as military combat or sexual assault, the psychological consequences can be even more severe.

Why and how does stress affect our mental health? Which aspects of mental health are affected most profoundly? Are some stressors particularly damaging? How long do these effects last? Why might some people react to stress by feeling depressed, while others become angry or anxious? In this chapter I summarize classic and contemporary theories on stress and mental health, and describe both the psychosocial and biological explanations of how stress can harm us. I provide evidence from recent studies showing precisely how stress may rob us of our emotional well-being, as well as a handful of studies that document psychological growth in the face of personal challenges. Before delving into the questions of why and how stress affects mental health, I provide a brief review of precisely what mental health is, how stress researchers document linkages between stress and mental health, which symptoms may be particularly susceptible to the stressors in our lives, and the reasons why different people react with different symptoms.

What Is Mental Health and How Do We Study It?

Mental health refers to one’s emotional well-being and absence of mental health disorders. However, stress researchers are more likely to discuss mental health problems rather than emotional wellness. Part of the reason for this emphasis on mental health problems is that stress researchers are interested in identifying and ultimately eradicating the negative psychological consequences of stress. Stress researchers also tend to focus on mental health symptoms that could afflict almost any person at a particularly difficult time in their lives; these symptoms generally include depression, anxiety, anger, and grief. A growing number of scholars also explore more intense outcomes, such as suicidality or post-traumatic stress disorder, which may afflict persons exposed to extreme stress. (Stress researchers also examine harmful strategies individuals adopt to soothe their emotional distress, including drinking and overeating; I discuss these and other health behaviors in .)Chapter 3

Stress researchers typically do not focus on major mental illnesses that may have a strong genetic component. Such disorders, including bipolar disorder (i.e., manic depression) or schizophrenia may be triggered by a major stressor or by living in a stressful environment, but stress alone (in absence of family history of mental illness) is typically not sufficient to “cause” schizophrenia or manic depression. Additionally, many stress researchers conduct their studies by using large surveys of the U.S. population, measuring exposure to stress, and documenting statistical associations between one’s stressful experiences and responses to checklists that capture one’s symptoms of depression, anger, or anxiety (for an example, see figure 2.1). Because major mental health disorders such as bipolar disorder and schizophrenia affect relatively small populations (4 and <1 percent of the U.S. population, respectively), most researchers would not find a sufficient number of cases to examine in a survey study. Persons with major mental health conditions also are unlikely to complete the survey they’ve been given. (A full discussion of complex conditions such as schizophrenia is beyond the scope of this book, although the National Institute of Mental Health has helpful resources for understanding these conditions. See nimh.nih.gov.)

C o p y r i g h t 2 0 1 4 . R u t g e r s U n i v e r s i t y P r e s s .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE AN: 1239118 ; Deborah Carr.; Worried Sick : How Stress Hurts Us and How to Bounce Back Account: s4214197.main.ehost

20 EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

21

Mental health symptoms may be general responses to stress, meaning that they may be triggered by a broad range of possible events and experiences, or specific, meaning that they may be triggered by a much narrower set of stressors. Three of the most common general symptoms or conditions studied by stress researchers are depression, anxiety, and anger. Think about the times you’ve sighed and said, “I’m so depressed,” or clenched your fists and growled, “I’m so mad I could scream.” On other occasions, you might have lamented, “I’m on pins and needles,” or, even worse, “I’m a nervous wreck.” Think about the major events in your life at that time, or even trivial hassles on the days when you’ve uttered these words; you can probably recall dozens of different events or experiences that contributed to your feelings of depression, anger, or anxiety. Scientific research concurs that a broad range of acute and chronic stressors contribute to those general symptoms. By contrast, some symptoms are very specific to a particular stressful context; the most widely studied one is grief, which is a direct emotional response to the loss of a person or object to which we were deeply attached emotionally. Symptoms of grief tend to be triggered by very specific losses, such as the death of a family member.

General Symptoms

Depression.Phrases like “I’m so depressed” or “That movie was depressing” are a part of our dailyso vocabularies, yet many of us do not know precisely what depression entails. Many believe that “depressed” simply means “sad,” yet that would be an incomplete characterization. Depression has four components: emotional, cognitive, motivational, and somatic symptoms. The emotional aspects of depression include the sad mood and diminished pleasure that almost always accompany depression. Cognitive components include the ways that our thought processes change when we are depressed; we may develop a very bleak view of the world and may become hopeless about the future or may believe that we are worthless. The motivational component of depression is linked to our behaviors; it is often difficult to get motivated or to take action when one is depressed. Depressed people often struggle with getting out of bed in the morning. Finally, somatic aspects of depression are physical conditions, such as fatigue, headaches, or sleeping too much or too little.

Different people may experience different symptoms; for instance, women are more likely to report emotional symptoms like feeling sad or crying, whereas men may not report such feelings and instead say that they view the future as hopeless. Researchers have argued that the types of symptoms that people report on depression symptom checklists are consistent with socialization processes; men who were raised to hide their feelings may not admit that they feel sad or that they have cried, yet may be more likely to report other aspects of depression. This distinction is important for both clinicians and laypersons to recognize; depression in men often goes undetected (and untreated) because they do not easily admit to others that they are feeling sad and blue.

Depression is the most widely studied mental health outcome in stress research. There are at least three reasons why so many of the studies that you will read about in this book focus on depression. First, depression is one of the most common mental health diagnoses in psychiatry, and one of the most common mental health problems documented in the U.S. population. Recent studies estimate that about 16 percent of Americans have ever suffered from a major depressive disorder (MDD), and about 7 percent have experienced MDD in the past year. Major depressive disorder (MDD) occurs when a person has experienced severe depressive symptoms for a period of two weeks or more. These severe symptoms interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities. However, a much larger proportion of Americans may experience at least a few symptoms for a period of two weeks or more, a condition referred to as subclinical depression or minor depression. Although the latter is less serious than MDD, it is still a source of concern. Depressive symptoms may affect people’s ability to go to work, to maintain high-quality relationships, and to be effective parents. Policy makers have noted that depression accounts for more workplace absenteeism and more costly losses in worker productivity than any other illness. Persons who suffer from even minor depressive symptoms may be at risk for MDD if they encounter additional stressors in their lives.

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

22

Second, depression is a common outcome in stress research because it is a response to many stressful experiences that social scientists find most pressing. Scholars dating back to Sigmund Freud have observed that depression is a reaction to loss or “exit events.” It may arise in response to the loss of an important social role (e.g., retirement), a significant other (e.g., widowhood), one’s home and community (e.g., displacement following a fire), or even the loss of feelings of competence (e.g., having a business venture fail). Depression and hopelessness also may result when one feels overwhelmed, trapped, or fearful about the accumulation of stress in one’s life. In other words, depressive symptoms may emerge in the face of the broad range of stressful events, chronic stressors, network events, and daily strains.

Finally, depressive symptoms are relatively easy to measure in the general population, so scientists can relate individuals’ reports of stress with their reports of depressive symptoms. One of the most commonly used instruments for measuring depressive symptoms in population-based studies is the Center for Epidemiologic Studies Depression Scale (CES-D) designed in the 1970s by Lenore Radloff. This twenty-item checklist is shown in figure 2.1; the symptoms included in this measure reflect the four subcomponents discussed earlier: emotional, somatic, motivational, and cognitive. Researchers calculate a score for each individual, based on how many symptoms they report, and how frequently they experience each symptom. Persons scoring in the highest range are considered at risk for major depression. Other instruments are widely used to assess MDD in the population, including the Composite International Diagnostic Interview (CIDI) and the Diagnostic Interview Schedule (DIS). While the CESD shows one’s level of symptoms on a scale from none to many, tools such as the CIDI and MDD classify persons based on whether or not they have clinically significant depression.

This research approach helps scholars to document the depressive consequences of stress in the overall U.S. population. For example, a 2013 Gallup-Healthways survey of more than 100,000 Americans found that 10 percent have a current diagnosis of depression, yet this rate is as high as 17 percent among those who are unemployed. Many scholars believe that this population-based approach provides the most accurate portrait of the consequences of stress. Research approaches that examine stress and mental health in clinical populations, or in those populations already seeking psychiatric care, may overstate the harmful emotional effects of stress precisely because their studies are focused on those who by definition are suffering from a mental health problem.

A vivid example of this is Judith Wallerstein’s classic study .The Unexpected Legacy of Divorce Wallerstein, a clinical psychologist, concluded that children whose parents divorced when they were young were more depressed and anxious, and that these mental health woes followed them into adulthood, compromising their own romantic relationships. However, Wallerstein’s findings partly reflect the fact that she studied children who were already receiving psychological care to help them with the stress of their parents’ divorce. By contrast, studies based on population-based samples find that most children of divorce do just fine after the early months of the stressful transition have passed.

Anxiety.Anxiety includes unsettling feelings and emotions, as well as physical responses and behaviors associated with nervousness. Feelings might include worry, tension, and dread, whereas physical symptoms might include muscle tension, heart palpitations, difficulty breathing, heightened blood pressure, and sweating. Behavioral symptoms might include being easily excitable and “jumpy.” Extreme forms of anxiety might include panic attacks or even phobias (i.e., extreme and illogical fears). Anxiety disorders are very common in the United States today, with more than 18 percent of the U.S. population having such a condition in the past year, and fully 30 percent ever experiencing an anxiety disorder in their lifetime. Most of the research discussed in this book focuses on more modest symptoms, such as nervousness, rather than full-blown anxiety or panic disorders.

Researchers have debated whether anxiety is triggered by the same types of stressors as depression. This debate is difficult to resolve, because many people who experience depression also experience anxiety; this co-occurrence of symptoms is referred to as “comorbidity.” Stressful events and experiences that generate fear and anxiety may also be associated with experiences that trigger depression. For instance, upon the death of a spouse, a widow or widower may feel deep sadness over

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

23

the loss of a beloved partner, yet may also feel anxious about the new challenges that lie ahead as a single person—such as living alone or managing all the household tasks that were previously performed by the spouse.

Psychologists have documented that mild symptoms of anxiety might serve a positive function. Moderate levels of anxiety keep people on their toes, enabling them to juggle multiple tasks and putting them on high alert for potential problems. Just think about the last time you had to give a public talk or had a big exam; a bit of nerves on the days leading up to the event might have pushed you to prepare for the big day. However, extreme symptoms of anxiety are problematic because they make even simple tasks much more difficult. This notion that low levels of anxiety can be beneficial dates back to the early twentieth century, when Harvard psychologists Robert Yerkes and John Dodson hypothesized that “arousal” (or a slight elevation of stress hormones) enhances performance—but only to a point. When anxiety gets too high, performance suffers instead. Contemporary work finds support for what is called the Yerkes-Dodson curve; this is an upside-down U-shaped curve showing a curvilinear association between anxiety and performance on tasks such as learning. However, as we know from our own experiences, when our nerves get the better of us, we become flustered and make mistakes—often making ourselves even more anxious. In this way, living in a constant state of stress-induced anxiety may lead to a spiraling out of secondary stressors as we struggle to maintain order and a sense of competence in our lives.

AngerAnger is an important emotional consequence of stress, although relatively little research focuses on these symptoms. Anger generally encompasses disturbing feelings such as frustration, annoyance, hostility, and even rage. While depression is often a response to stressors involving loss, and anxiety is related to stressors where uncertainty is high, anger is associated with experiences deemed unfair or unjust. For instance, experiences of discrimination in the workplace, such as being fired unfairly, or losing a child to murder, are likely to elicit anger more than sadness. Anger is a particularly harmful reaction to stress, because those who are angry may build a wall between themselves and the very people who can offer them support and assistance. Whereas depression and anxiety symptoms may signal to friends and family that one is in distress and in need of help, the hostility that accompanies anger often pushes away those important sources of support. As we will see in , social support can be an important buffer against the harmful consequences of stress.Chapter 4

Anger, like depression and anxiety, is often measured with symptom checklists. Men are more likely than women to show anger in the face of stress, although it is not clear whether this reflects biological factors (such as testosterone) or gender differences in how people complete anger symptom checklists. Men may be more likely to report feelings of anger and to behave in angry ways, such as aggressing against others. Women, by contrast, may be hesitant to admit feeling angry. Just as men (who are raised to be “strong and silent”) may be reluctant to report crying or feeling sad when asked about their depressive symptoms, women who were raised to be docile and accommodating may not express their anger. As a result, studies may not show a strong association between stress and anger among women, yet these results may reflect only the anger expressed rather than the anger women feel privately and silently.

Specific Outcomes: Grief

The death of a loved one is considered the single most stressful event that individuals experience, as we saw in the Holmes and Rahe SRRS checklist in . Although bereaved persons oftenChapter 1 experience feelings of depression, anxiety, and anger, they also experience the specific mental health outcome of grief. Grief is a collection of emotional symptoms that are related directly to the loss of a loved one. At the core of grief are symptoms of yearning, or longing for and wanting to reconnect with the deceased person. In addition to feelings of sadness and loss, grief also may encompass symptoms such as anxiety about the future, anger, shock, despair, and intrusive thoughts. Intrusive thoughts are symptoms similar to post-traumatic stress disorder (PTSD), in which unprovoked painful thoughts about the deceased haunt the survivor. The specific symptoms are closely tied to the nature

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

24

of the death. Deaths that are deemed unfair, such as those due to medical error, are associated with symptoms of anger, whereas sudden deaths tend to trigger feelings of emotional shock. Widows and widowers who had particularly loving and close marriages tend to yearn more for the deceased than do persons who had problematic marriages.

For most bereaved persons, grief symptoms typically fade within the first six to twenty-four months after the loss, although the death of a child or a particularly traumatic death (such as a suicide or murder) is associated with much-longer-lived and intense symptoms. Roughly 5 percent of bereaved persons suffer from a severe and prolonged cluster of symptoms called “complicated grief”; these persons are incapable of resuming normal activities and responsibilities, and may be at a heightened risk for physical health problems.

Extreme Outcomes: Suicidality and Post-Traumatic Stress Disorder

In rare cases, stress has devastating and even lethal consequences. One of the most dire outcomes of stress is suicide, or taking one’s own life. Suicides are relatively rare in the United States, so stress researchers often study suicidal ideation, which refers to one’s frequent thoughts about suicide or the desire to take one’s own life. Although suicide rates are low in the United States, they have risen dramatically in recent years, especially among middle-aged adults belonging to the Baby Boom cohort. In 2010, the number of deaths due to suicide was roughly equal to the number of deaths due to automobile accidents (roughly 38,000 each). Men typically have much higher rates of suicide than do women.

Can stress trigger an outcome as extreme as suicide? The answer is complex. One of the most powerful precursors of suicide is MDD (major depressive disorder). Although MDD is often caused by stress, it may also be caused by biological factors related to brain chemistry. Depression, and subsequently suicide, may also be a consequence of incurable terminal illness, which may lessen one’s desire to live. Suicide is also closely linked to drug and alcohol use. Persons who drink heavily, use opiates, or take intravenous drugs have suicide rates anywhere from three to eighteen times higher than those who do not abuse substances. Of course, one reason why users turn to opioid drugs like OxyContin is that they are under tremendous stress and hope to soothe their pain with medication. Given how intricately tied stress, depression, substance use, and suicide are, it is difficult for researchers to definitively say that stress “causes” suicide.

However, mental health researchers and historians alike have documented one clear-cut trend: suicide rates tend to increase during times of economic recession, as they did during the Great Depression of the 1930s and the recent recession of the 2000s. As we saw in , Rob, theChapter 1 forty-seven-year-old repairman, shot and killed himself after struggling emotionally with a two-year bout of unemployment. Those facing persistent unemployment, especially men whose identities are tied to the “good provider” role, may feel hopeless and suicidal after searching fruitlessly for work and struggling to support their families. Yet there are millions of Americans who lose their jobs or suffer financial devastation who do not kill themselves. Research shows that having the means to take one’s life is an important factor in whether stress ultimately leads to suicide. Imagine that Rob was a gun aficionado and avid hunter; access to guns in his home would place him at a much higher risk of suicide than a peer who didn’t have such means.

Another extreme outcome that has captured the interest of stress researchers in the past decade is post-traumatic stress disorder (PTSD). Those who go through extreme trauma, such as sexual assault, military combat, persistent child abuse, or even witnessing a devastating event at close hand—such as the collapse of the Twin Towers on 9/11—may experience fear and terror even when they are in safe situations. Symptoms of PTSD include reliving the traumatic events and associated physical symptoms (e.g., flashbacks and cold sweats), emotional numbness and avoidance, and being nervous and continuously “on edge.” Not all people who experience severe trauma go on to experience PTSD; those at greatest risk may have a particular genetic predisposition, a history of mental health problems, or other traits that make them particularly vulnerable. Risk of PTSD is also linked to how

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

25

intense the trauma was; particularly brutal or bloody bouts of combat would be more distressing to a soldier during wartime than having a desk job would be.

Not surprisingly, PTSD rates vary widely based on one’s personal experiences. An estimated 4 percent of men and 10 percent of women have ever experienced PTSD, while roughly 2 and 5 percent, respectively, have had PTSD symptoms in the past year. In stark contrast, roughly one in three veterans of the Iraq and Afghanistan wars has been treated for PTSD. However, some critics of the PTSD diagnosis question whether actual rates of PTSD are increasing, or whether we live in a world today where people (and especially soldiers) are more likely than in the past to openly discuss their fears, feelings, and anxieties.

Positive Psychological Consequences of Stress

Can stress have positive consequences for our emotional health? The bulk of evidence shows that stress undermines well-being, yet emerging research on “post-traumatic growth” suggests that in some instances stress may give rise to positive outcomes, especially personal growth, as individuals recognize that they can survive and thrive in the face of difficulties. A case in point is Eric LeGrand, a twenty-year-old football player at Rutgers University who collided with an opponent when playing Army in a game in October 2010. The injury paralyzed LeGrand from the waist down, and doctors doubted that he would regain movement and functioning. While this loss would be devastating to many, LeGrand fought his way through treatment, regained some upper-body movement, and is now an author and motivational speaker who seeks to inspire others—all while confined to his wheelchair.

LeGrand’s inspiring story raises the question of how and why some people can thrive in the face of life-changing adversity. A special 2004 issue of the journal focused on thePsychological Inquiry then-new concept of post-traumatic growth (PTG), and clarified that PTG is distinct from resilience. Resilient people may withstand a major stressor and suffer no psychological harm, or may experience mental health symptoms in the short term, but eventually return to their precrisis level of psychological health. By contrast, PTG involves suffering in the face of a crisis but ultimately enjoying psychological, interpersonal, and spiritual well-being levels that may be superior to one’s precrisis levels.

Researchers have identified five positive changes associated with PTG. First, people surviving major crises may develop a sense that new opportunities have emerged from the struggle, and may envision new possibilities for their future. Second, personal relationships may be strengthened, where some feel an increased sense of connection to and empathy toward others who have suffered. Third, “survivors” may recognize their own psychological strength. For example, people who survive cancer often say things like, “If I can survive cancer, I can face anything.” Fourth, those who withstand profound stress may develop a fuller appreciation of the “small” things in their lives, including personal relationships. Finally, individuals may undergo a change in their beliefs, especially their spiritual or religious views, in such a way that helps them to cope with future stressors.

Although theoretical arguments regarding post-traumatic growth are intuitively appealing, empirical evidence to date is limited. If positive effects of stress are detected, they typically are not evident until significant time has elapsed since the stressful period. For example, studies of bereavement have found that older widows who had been most dependent on their spouses during marriage had the greatest increases in self-esteem and personal growth post-loss, yet this did not emerge until nearly two years after the death.

How and Why Does Stress Affect Us?

How and why does stress make us depressed, anxious, angry, or grief-stricken? There is no silver-bullet answer. Explanations vary widely based on scientists’ disciplinary training. Sociologists

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

26

and epidemiologists tend to focus on the strain inherent in particular social roles, statuses, and relations. Psychologists emphasize cognitive processes and individual-level strengths and vulnerabilities. And biological scientists and neuroscientists focus on physiological pathways linking stress to mental health. No one perspective offers a complete explanation of the well-documented linkages between stress and mental health. Rather, a complex set of methodological, social, psychological, and biological factors explain these associations. In this section, I describe some of the most widely accepted explanations for why stressful events and experiences impede individuals’ mental health, even if only in the short term.

Methodological Explanations

Hundreds of studies show that people who experience frequent and intense stressors experience more mental health symptoms than those living under less stressful conditions. But does this mean that stress necessarily “causes” mental health woes? Social scientists are embroiled in a long-standing debate referred to as the “selection versus causation” puzzle. The crux of the controversy is whether a stressor such as job loss, poverty, divorce, or difficult caregiving demands causes depression, anxiety, and other mental health conditions, or whether people who are depressed, anxious, or angry are more likely than their healthier counterparts to experience those stressors in the first place.

For example, many studies have found that divorced people have more frequent depression symptoms and drink alcohol more frequently than their married counterparts. Does that mean that the stress of divorce drives people to drink or leaves them heartbroken and emotionally devastated? Perhaps. But another equally plausible explanation is that people who are depressed or who are problem drinkers are more likely to get divorced in the first place; that is, they are “selected” into divorce due to their preexisting problems. Studies show that excessive drinking (especially husbands’ drinking) can cause marital strain and, ultimately, marital dissolution. Likewise, research shows that marriage to a depressed partner can be difficult and unrewarding; as such, depressed people are more likely than their happier counterparts to see their marriages fall apart. If a population-based study shows a statistical association between divorce and mental health indicators such as depression or substance use, we cannot necessarily say that divorce “causes” such outcomes. This is what sociologists mean when they say that “correlation does not equal causation.” Just because two conditions co-occur does not necessarily mean that one triggers the other. Dozens of scholarly studies have tried to untangle this vexing puzzle, and most conclude that that both selection and causation factors are at play; depression and drinking both increase one’s risk of divorce, but divorce in turn increases symptoms of depression (especially for women) and frequency of drinking (especially for men).

Psychosocial Pathways

Sociologists and psychologists propose a range of theories to explain why and how stress affects mental health, broadly defined. I provide a brief overview here, as well as examples to illustrate how stress dampens our emotional health.

Role Theory.Role theory holds that most of our everyday activities involve carrying out social roles, such as worker or parent. Each social role is accompanied by a set of expectations that guide how we carry out our roles. Researchers in the 1970s were interested in the impact of women’s paid employment on their well-being, especially as women balanced paid work with demands on the home front. Some scholars believed that juggling multiple roles caused stress for women, and that this juggling act partly accounted for why women are twice as likely as men to be depressed. Researchers

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

27

drew attention to the stress created by simultaneously holding multiple roles that taxed one’s coping resources (role overload) or that were viewed as being in opposition to one another, such as devoted mother and competent worker (role conflict).

Contemporary research counters that juggling multiple roles is not necessarily stressful, nor does it have uniformly detrimental effects on health. First, recent studies emphasize the salience (or importance) of the role to the individual. Trying to soothe a screaming baby and discipline a surly teenager may be particularly distressing to parents who hold the role of “competent parent” as their most important role in life. Parents who have other salient identities, such as worker or volunteer, may be better equipped to roll with the punches of parenting. Second, multiple roles are most distressing when they are involuntary; as a case in point, surveys have found that for women who wanted to both work for pay and raise children, multiple roles were not particularly distressing. However, full-time mothers who wanted to work for pay or employed women who wanted to be stay-at-home mothers had elevated psychological distress because they felt trapped by their lack of choice. Entrapment, or the feeling that one is stuck in an untenable situation without the capacity to change it, is a powerful predictor of psychological distress.

Researchers have also found evidence for role enhancement processes; those who hold multiple roles may find that stressors in one role are counterbalanced—rather than amplified—by successful experiences in another role. Being passed over for a big work promotion may sting less if one has other roles from which one can derive feelings of competence, such as community volunteer or dedicated friend. Yet the benefits of role accumulation are not universal and reflect structural factors, including access to high-quality and desirable roles. For example, studies of racial differences in stress have found that holding the multiple roles of parent, spouse, and worker provided psychological benefits for whites but not for blacks and Puerto Ricans, due to the poorer-quality jobs held by racial minorities and other work-related stressors, such as discrimination or tokenism.

Role accumulation can also be stress-provoking when people feel that they don’t have the time to do all that is expected of them. A recent Gallup Poll found that roughly half of all Americans say that they “do not have enough time” to do what they need to do each day. Of those who reported such time pressures, more than half said that they frequently felt stressed, whereas only 27 percent of persons not operating under time pressures reported feeling stressed. These statistics suggest that it’s not necessarily multiple roles that are stressful but the lack of sufficient time to carry out those roles effectively.

Cumulative Disadvantage Theories.We’ve all met someone who just can’t catch a break. Take Lynn, a thirty-three-year-old home health aide, for instance. Lynn grew up in a troubled home with emotionally abusive parents. As a result, she struggled with her course work in high school, bounced around different low-paying jobs after graduation, and eventually landed a permanent part-time job caring for sick older adults in their homes. Lynn married young, partly to escape her miserable childhood home. Her rocky marriage lasted just four years before she divorced. Along the way, Lynn battled depression, anxiety, and drinking troubles as she struggled with financial stress and hurtful personal relationships. Lives like Lynn’s are not merely a product of bad luck; these difficult lives, marked by multiple chronic and acute stressors, illustrate an important sociological theory called “cumulative disadvantage theory.” This perspective proposes that adversity (or stress) gives rise to subsequent adversity, whereas advantage gives rise to advantage. Children like Lynn who grow up in financially and emotionally insecure households often cannot focus on their schoolwork, and thus have poorer grades and lower rates of college attendance, which give rise to less stable professional and family lives in adulthood. These difficulties, in turn, heighten their risk of divorce, job loss, and other mental-health-depleting stressors in adulthood. As such, an event, experience, or characteristic that has adverse effects in the short term may take on increasingly vast implications over time, leading to a greater divide between the “haves” and “have-nots.”

Decades of research have shown that people who face more stressors over the course of their lives tend to have poorer mental and physical health; adversities snowball over time, and many people succumb emotionally to the wear and tear. Yet recent research shows that it’s not just the

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

28

accumulation of major events such as deaths and financial insecurity that threaten us. Social scientists using data from daily diary studies such as the National Study of Daily Experience show that our emotional well-being can plummet even when small and nagging microstressors build up throughout the day. A pending work deadline, unpaid bill reminders piling up in the mailbox, sitting in a traffic jam, a burdensome chore, or a spat with a loved one or colleague can add up to symptoms of depression or anxiety.

At first blush, research in the cumulative adversity tradition suggests that people who are beat up by life’s difficulties just can’t bounce back. That bleak conclusion is not necessarily true. Scholars also have discovered that some individuals are resilient in the face of modest build-ups of adversities, as they develop coping skills or a worldview that helps them to take stress in stride. One recent study tracked more than 2,500 Americans over three years and found a “curvilinear” or upside-down U-shaped association between number of stressors experienced and depression and anxiety symptom levels. People who experienced very high levels of stress and also those experiencing faredno stress the worst emotionally. Those who suffered a modest—though not overwhelming—amount of stressors developed coping skills that helped them to deal with new challenges that came their way. Those at the very low end of the stress-exposure curve hadn’t developed such skills, whereas those at the very high end of the scale faced multiple adversities that were difficult to overcome, especially given their lack of emotional and financial resources. However, as we will see in , some areChapter 4 more likely to thrive or succumb than others. Subgroups of people, occasionally referred to as “Teflon” and “Velcro,” let stress either roll off them or stick to them in harmful ways.

Stress Process Models.The stress process model proposes that most stressors are rooted in social positions that are based, in part, on the characteristics such as age, race, and gender. Exposure to stress is not randomly distributed throughout the population but is highly structured and reflects patterns of inequality. Poor persons tend to be exposed to more stress than wealthier people, whereas blacks and immigrants are more likely than whites and native-born Americans to face stressors related to their social position. A key theme of the stress process model is the launching point of Chapter 4 —that the impact of stress on health varies widely based on one’s other risk factors and resources, such as social support, coping strategies, and economic resources.

For example, discrimination is a persistent stressor that can take a toll on emotional well-being. Those with limited social and economic power are at an elevated risk of experiencing discrimination, and also may have few resources to draw on when managing this stress. Persistent experiences of prejudice and discrimination related to low socioeconomic status, racism, sexism, homophobia, or even body weight (e.g., obesity) require daily adaptations. However, mounting research also shows that while members of historically stigmatized groups may have less social or economic power than others, they may have distinct resources to draw on as they manage stress, including ethnic pride, a sense of solidarity with one’s community, close friendships, and an ability to deflect discriminatory experiences as a consequence of others’ prejudice rather than one’s own shortcomings. These personal resources may help to buffer against the strains that psychiatric epidemiologist Ilan Meyer refers to as “minority stress.”

Discrepancy Theories.Failure and disappointment don’t feel good. Although feel-good mantras tell us to pick ourselves up and try again when we fail to achieve a personally important goal, most of us know just how hard that is. Many stressors leave us depressed and anxious because they represent some gap between the “real” and “ideal.” Social psychologists dating back to William James have developed different theories that hinge on one key point: you can’t always get what you want, and not getting what we want makes us feel bad. Many of the stressors we’ve already touched on represent some type of discrepancy or gap. At the smallest level of daily hassles, failing to meet a work deadline indicates a gap between what we hoped to do and what we’ve actually accomplished. Job loss and divorce represent the loss of a desired role or a feeling of failure that one could not sustain a career or a marriage. Even existential strains, such as the realization that one will never achieve their youthful goals of wealth and success, may leave us sad, anxious, or even angry.

Self-discrepancy theory is a useful frame for understanding how gaps between what we want and

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

29

what we have (or who we are) can compromise our emotional health. Psychologist E. Tory Higgins developed this theory to show how different types of discrepancies affect mental health. He proposed that each of us has an “actual self”—this is who we are. Yet we also have an “ideal self” (who we aspire to be) and an “ought self” (who we feel we should be). Our beliefs about our “ideal” and “ought” selves reflect not only our own hopes and expectations but also our perceptions of what

want and expect of us. Each discrepancy leads to particular mental health outcomes. A gapothers between our “actual” and “ideal” selves leads to sadness over dashed dreams, whereas a discrepancy between “actual” and “ought” may lead to anxiety or guilt about disappointing others.

Discrepancy theories cannot explain all stressors, especially not traumatic ones, yet they do help us to understand strains related to the self and to the many identities we hold. For example, obesity can be distressing because of the rigid expectations placed on Americans (especially white middle-class women) to maintain a slender physique. Women (even slender women) who perceive a gap between their “actual” and “ideal” weight are at a heightened risk of compromised body image and depressive symptoms, whereas overweight and obese women whose “actual” weight is higher than what their significant others believe they “ought” to weigh are subject to interpersonal mistreatment that may lower their psychological well-being. Threats to one’s sense of masculinity may be distressing to men. One fascinating study of prostate cancer patients found that distress levels were highest among men who staunchly believed that men should be strong and virile. Even nonevents, described in

, can be distressing because they represent a gap between what we are and what we want orChapter 1 expect for ourselves. Sociologists have found that singlehood and childlessness are most distressing for people like Dawn—those who want to reach the milestones of getting married or having a family yet have not done so. By the time people reach old age, most make peace with who they are, yet a minority carry the psychological scars of falling short of their dreams and expectations.

Biological Pathways

In the past decade, biological scientists including neuroscientists and geneticists have generated physiological explanations for why and how social stressors affect our emotional health. Stress affects several physiological systems, including our cardiovascular, endocrine, immune, metabolic, and sympathetic nervous systems. Evidence is much stronger for the biological pathways linking social stressors with physical illness (as we will see in ), although emerging evidence suggestsChapter 3 several plausible biological pathways through which stress affects our mental health. It is important to point out that much of this research has been done on animals or in laboratory settings, and fails to consider all of the complexities of human social life. Still, a brief review of recent research provides provocative insights into the ways that physiological responses to stress may affect our emotional health. I focus briefly on hormonal systems and molecular biology.

Stress Hormone Pathways.Stress activates the hypothalamus adrenal axis (HPA) as well as the central nervous system (CNS). When we are in situations that we perceive as being dangerous or distressing, our bodies release stress hormones such as cortisol, dopamine, serotonin, and norepinephrine. When we are in relatively stress-free situations and our chemical systems are working normally, they regulate biological processes such as sleep, appetite, energy, sex drive, and normal moods and emotions. However, when we live under chronically stressful situations, elevated levels of these chemicals may be linked with psychological responses such as depression and anxiety.

Cortisol (also referred to as the “stress hormone”) is released in response to stress; in the short term, a spike in cortisol has protective effects for our mind and body because it helps us to survive immediate threats. The release serves as an anti-inflammatory hormone, and increases levels of circulating glucose and energy storage. However, when we live under conditions of constant stress, such as extreme poverty or an abusive marriage, we have prolonged levels of cortisol in the bloodstream, which may elevate our risk of exhaustion, depression, and a range of physical symptoms.

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

30

Dopamine (or the “pleasure hormone”) levels also are dysregulated in the face of stress, which compromises the ability to feel pleasure, impedes memory and concentration, and creates an inadequate blood flow to the brain. Excessive levels of norepinephrine may trigger anxiety. Serotonin is known as being a “feel-good chemical” that brings us feelings such as joy and enthusiasm. Too much serotonin, however, may produce anxiety, while a deficiency produces poor sleep and exhaustion.

Just as social theories of stress recognize that not all stressors affect our minds and bodies in similar ways, biological studies also reveal that stress does not uniformly make us depressed or anxious. Stressors that are uncontrollable, threaten our physical safety, or that involve trauma tend to generate a cortisol profile consistent with compromised mental health. By contrast, controllable stressors tend to produce a cortisol profile that is associated with better psychological and physical adjustment. Similarly, just as survey-based studies show that the effects of stress tend to decline with time, biological studies show that stress hormone release tends to decline gradually after the onset of an initial stressor occurs.

Researchers recognize, however, that social contexts also shape the ways that stress affects physiological responses and, consequently, our mental health. For example, experiences of workplace discrimination are generally associated with less healthy daily cortisol profiles. A “healthy” or typical cortisol profile is one where levels are highest in the early morning (6 to 8 a.m.), and lowest at midnight. However, one exploration by researchers at the University of Michigan found the least healthy cortisol profiles (i.e., flattest levels of decline throughout the day) among whites who perceived that they were discriminated against, relative to blacks, who evidenced steeper levels of cortisol decline throughout the day. Furthermore, blacks of higher socioeconomic status (SES) showed more harmful (i.e., flatter) daily cortisol profiles than did lower SES blacks. The authors reasoned that blacks, especially those with low levels of education and low-status jobs, might expect mistreatment as part of their daily lives, and thus might be less ruffled by these unjust encounters than their more privileged counterparts.

Although most research on the physiological pathways linking stress to mental health focuses on maladaptive chemical reactions, scientists have recently focused on chemical reactions that may be protective, or that counterbalance the harmful ones. Oxytocin is a chemical that is released when we have comforting physical contact with a significant other, whether a hug from a friend, or satisfying sexual relations with one’s partner. The release of oxytocin, in turn, has a protective effect that counterbalances the health-harming effects of other stress hormones. As we will see in ,Chapter 4 people who have close and supportive relations fare well in the face of stress, because they have both emotional and instrumental help, and they also may experience high levels of the chemical oxytocin, which suppresses other potentially harmful changes in the HPA axis.

Molecular Studies.Molecular biologists have recently discovered that stress levels may affect one’s corticotropin releasing factor receptor 1 (CRFR1), which in turn affects serotonin receptors (5-HTRs). In short, CRFR1 works to increase the number of 5-HTRs on cell surfaces in the brain, which can cause abnormal brain signaling. Since CRFR1 activation leads to anxiety in response to social and environmental stressors, and 5-HTRs are associated with depression, researchers are beginning to uncover ways that brain processes link stress to anxiety and depression. Although this work is in its nascent stages, scientists are optimistic that drugs may someday be developed to block 5-HTRs that link stress and mental health troubles, thus minimizing the effects of stress on well-being. Likewise, antidepressant medications are now routinely prescribed to regulate HPA axis function, and ultimately lessen some symptoms of depression and anxiety. Critics caution, however, that drugs alone are not sufficient to alter the social situation causing the distress; we will delve into these issues more fully in

.Chapter 5

In sum, our emotional well-being is powerfully linked to the stressors we face in everyday life. Acute, chronic, and even seemingly insignificant stressors of everyday life may elevate our symptoms of sadness, anxiety and anger, while the death of a loved one is typically accompanied by grief symptoms, and trauma may give rise to post-traumatic stress disorder. The most profound and

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

31

extreme psychological reaction to stress, suicide, is statistically rare in the United States, but is often an end product of multiple risk factors, including stress, preexisting mental health conditions, substance use, and the means to take one’s life. Despite the generally harmful effects of stress, researchers are beginning to document the ways that modest levels of stress can “toughen” people up, help them hone their coping skills, and even promote emotional and spiritual growth following the crisis.

Social scientists have many explanations for how and why stress affects us. Their theories focus on the complex ways that stressors accumulate over time, are based on social characteristics such as race and class, and reflect our feelings of failure (or competence) as we strive to fulfill multiple social roles or achieve the personal goals and expectations we hold for ourselves. Biological scientists, by contrast, focus on the ways that stress triggers chemical and hormonal responses that compromise our emotional well-being. What is clear from theoretical writings and empirical studies is that we should no longer ask the question “Does stress affect mental health?” but rather “When, why, and for whom does stress affect mental health?” As we have begun to see, the effects of stress are neither uniform nor universal, and there is not a “one size fits all” approach to minimizing the harmful effects of stress. We will next delve more fully in the questions of when, why, and for whom stress affects our physical health.

EBSCOhost - printed on 12/10/2020 4:39 PM via CUNY LEHMAN COLLEGE. All use subject to https://www.ebsco.com/terms-of-use