Sociology Essay 221

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CHAPTER 4. WHY SOME CRUMBLE AND OTHERS BOUNCE BACK: RISK AND RESILIENCE IN THE FACE OF STRESS

Calvin, the married father of two sons, is a talented computer programmer and math whiz who can’t hold down a job. A thirty-five-year-old college graduate with a quirky and occasionally off-putting sense of humor, Calvin lost his most recent job as a programmer at a high-tech firm because he regularly dropped the ball on tasks his boss needed done ASAP. Rather than bucking up and vowing to do better on those occasions when his boss scolded him, Calvin would grow more agitated, anxious, and disorganized. He would fall short on his work tasks, hide his mistakes from others, and couldn’t develop a plan for winning back the support and respect of his coworkers. “Why bother,” he’d lament, assuming that he was bound to fail and disappoint. Calvin would unwind each night by smoking a joint, trying to block out memories of his stressful day at the office. After he let down his boss one final time, Calvin was fired. More than two years later, he is still unemployed. Too despondent to exercise and relying on food to uplift his mood, Calvin has gained weight and developed early-onset diabetes. He spends most of the day distracting himself with video games and Facebook. Although he half-heartedly looks for work, he has applied for only a handful of jobs, assuming that he doesn’t have a chance. His inability to get his life back on track and his persistent health woes have placed strains on his marriage. His long-suffering wife, Keshia, a high school teacher, is tired of supporting him emotionally and financially, creating even more stress and feelings of inadequacy for Calvin.

Contrast Calvin’s situation with that of Marcus, also a thirty-five-year-old married father of two children. An analyst and statistician in the volatile industry of finance, Marcus has switched jobs four times in as many years. Twice, he quit because he found the commute and daily tasks to be unappealing. He was fired once because his work approach and personality were a “bad fit” for the new employer, and was laid off once when the start-up he worked for folded. Marcus always lands on his feet, though, quickly securing new work. Between jobs, he’d network at professional association events, reach out to former colleagues using social media, tirelessly sift through online job listings, and read up on the latest financial industry news—all the while retaining his gregarious personality and engaging sense of humor. Although he worried about supporting his wife, Sheryl, a nurse, and two young daughters during his brief stints of unemployment, Marcus remained optimistic that things would resolve successfully. On those days when he felt anxious about his job prospects, he worked through those worries on early morning jogs through his neighborhood.

At first blush, Calvin and Marcus are very similar. Both are college-educated fathers and husbands who work in highly technical and competitive fields. Both lost their jobs against the backdrop of a recession, when hopes of finding new work were slim. Yet the two managed their work stressors and subsequent job searches in entirely different ways. Calvin broke under the pressure of a stressful work environment and subsequent layoff, whereas Marcus rebounded quickly. Why do some people bounce back from—and even thrive—in the face of stress and challenge, whereas others are devastated by it? Researchers recognize that even a single stressor (such as job loss) can affect two people in very different ways. The characteristics that buffer against or intensify the health-depleting stress are referred to as moderators. Dozens of psychological, demographic, interpersonal, biological, and structural factors may intensify or mollify the effects of stress on health. I focus on two main psychological factors (coping strategies and personality), four demographic characteristics (age, sex, race/ethnicity, and socioeconomic status), one interpersonal resource (social support), and one set of biological factors (genetic phenotypes) that have been implicated as a pivotal link in the stress-health equation.

Psychological Influences

Coping Strategies

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 .

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“Coping” refers to our efforts to ward off or manage a stressful situation, and our efforts to minimize the distress that results from these experiences. Our coping strategies typically fall into one of two broad categories: problem-focused or emotion-focused. Researchers typically document a person’s coping style by asking a series of questions about how one usually deals when they have problems. For example, figure 4.1 shows items from the Brief COPE, an inventory designed to identify the specific ways people deal with their problems. Although most people use different strategies to cope with different problems, we also have general tendencies to favor one class of strategies over the other.

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Problem-focused coping (PFC) is directed at the stressor itself; we might take steps to avoid or remove the stressor, or to reduce its impact on our lives in those situations where we can’t make the stressor disappear. If our workplace is downsizing and we know that a layoff is imminent, we might save money, cut back on our spending, apply to many other jobs, learn a new skill, or work hard at our current job so that we’re indispensable to our boss. We tend to use PFC when we see our situation as something we can change or improve. For instance, even after Marcus lost his job, he kept up his knowledge of the financial industry, relied on social contacts, and pounded the pavement to find work.

Emotion-focused coping (EFC), conversely, focuses on allaying our emotional or physical distress when faced with a difficult situation. We tend to use EFC strategies when we believe that nothing can be done to alter our unfortunate situation. Emotion-focused coping encompasses a broad range of strategies; productive ones include expressing our negative emotions (e.g., yelling or crying), soothing our negative feelings (e.g., relaxation techniques, seeking emotional support), finding humor in the situation, or even turning to prayer. However, other EFC tactics impede us from overcoming the stressful situation and may actually worsen it, such as dwelling on our negative thoughts (e.g., rumination), or passive attempts to escape the situation, such as denial, avoidance, and even fantasizing. Calvin exemplified such maladaptive EFC responses to stress; by lighting up a joint to forget about his stressful work day, Calvin simply made himself groggy and inefficient at work the following day, perpetuating his professional troubles.

Rumination, or continually replaying the negative event in our minds and stewing in our own sadness, is a particularly harmful response to stress, according to late psychologist Susan Nolen-Hoeksema. Ruminators prolong their feelings of sadness and loneliness by dwelling on them, and may even intensify their anxiety by fixating on all the things they feel they did wrong. In short, ruminators just can’t “get over it.” New evidence suggests that ruminating may even affect physiological functioning, and ultimately our physical health. In one recent study, a team of researchers brought young women into a laboratory setting, and asked each of them to give a speech explaining why they would be an ideal candidate for a job opening. Their audience consisted of two stern “interviewers” wearing white coats, sitting stone-faced at a nearby table. Although these two interviewers were really study confederates, the young women genuinely believed that the curmudgeons were potential bosses. After giving the speech under clearly nerve-wracking conditions, half of the women were asked to think about their underwhelming performance in the job interview, whereas the other half were asked to think about neutral or pleasant topics such as shopping. Researchers took blood samples from the women before and after the stressful speech, and found that C-reactive protein (CRP) levels were considerably higher among those who were asked to dwell on their speech. Among the ruminators, CRP levels continued to rise for at least one hour after their speech. By contrast, among the women who thought about neutral topics, CRP levels returned quickly to their prestressful event levels. As noted in , CRP is an indicator of inflammation and isChapter 3 associated with one’s risk of illness and infection.

Clearly, ruminating is an unhealthy coping tactic. In general, PFC strategies are considered more effective than EFC strategies. Problem-focused coping is associated with lower levels of psychological distress in the face of life’s adversities, whereas emotion-focused coping is linked to higher levels of sadness, worry, and hopelessness. Many specific tactics encompassed under EFC are considered “disengagement coping,” or passive responses geared toward forgetting or blocking out the stressor. This disengagement hurts one’s chances of recovery from the stressor. For instance, research shows that patients with health problems—ranging from cancer to dental troubles—who relied on avoidance tactics, such as denying that they were ill, deteriorated more quickly than those who faced up to their problems. The latter group devised ways to tackle their symptoms (e.g., getting treatment) and minimize their distress (e.g., seeking emotional support from friends). Effective PFC

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may even heighten psychological well-being, by fostering a sense of mastery, efficacy, and accomplishment. However, there are rare instances in which EFC may be better for us than PFC. Problem-focused coping is ineffective when we’re suffering an irreversible and irreplaceable loss, such as the death of one’s spouse or child. We can’t bring our spouse back to life, but we can soothe our grief by turning to friends for social support, distracting ourselves with happy memories of our late spouse, or finding meaning (or even humor) in the situation.

In sum, how we cope with stress partly determines whether we’ll thrive mentally and physically, or succumb to adversity. But coping strategies are not the only factors that explain why some bend, some break, and others bounce back. Other psychological factors, especially personality, also matter. Our personalities partially dictate whether we cope actively or passively, successfully or unsuccessfully.

You’ve Got Personality: Which Traits Are Protective?

“You’ve got personality” sounds like a terrific compliment; it means that people view us as fun, upbeat, and pleasant to be around. Likewise, when Americans are asked to name the most desirable trait is in a romantic partner, the most popular answer is typically “good personality” (tied with “honesty”), while good looks and money are much further down the list. But what is a “good” personality? And how does it relate to stress?

Personality refers to our enduring emotional or temperamental traits; some of us are low-key, while others are intense and competitive. These traits are partly genetic, partly a product of how we were raised as children, and partly an outcome of formative experiences throughout our lives. Our personalities may change slightly with age; most of us are more confident and outgoing as adults than we were as awkward teens. Workplace obligations often make us more conscientious, while taking on roles such as parent, spouse, or caregiver to aging parents may make us more nurturing and compassionate. Likewise, our personalities may change slightly in different settings; we may be warm and funny with friends, yet more serious and rigid with coworkers. On the whole, though, how outgoing, cynical, nervous, or cheerful we are relative to other people stays fairly constant over time and across settings. The personality traits we possess (or lack) are an important resource (or liability) when it comes to dealing with stress. Some become flustered and angry when they misplace their car keys, whereas others keep a stiff upper lip and a level head even when they’re in the throes of military combat.

Personality affects whether we experience a stressful situation, the extent to which we view a particular event or experience as stressful, our selection of a particular coping strategy, and how effectively we employ this coping strategy. Personality researchers, typically psychologists by training, have developed dozens of inventories that measure and assess our personality traits. I focus on three personality measures that are considered particularly important for understanding our reactions to stress: Type A versus Type B; optimism versus pessimism; and attributes of the Big 5 personality scale.

Type A versus Type B. Early research suggested that there were two main personality types that differ starkly in how they respond to stress. Type As are tightly wound, competitive, and intense. They perpetually feel a sense of time urgency—walking and talking quickly, getting frustrated while waiting for an elevator, and checking their watch every ten seconds for fear of being late to their next appointment. Type As also score high on the personality trait of hostility, or becoming angry, upset, and even aggressive when things don’t go their way. Type Bs, by contrast, are more relaxed and better able to roll with life’s punches. In general, Type Bs tend to have better overall health than Type As; their laid-back approach to life allows them to handle stress without cracking under the pressure. This equanimity translates into a higher quality of life, better emotional well-being, lower risk of heart disease, and less duress on one’s immune and gastrointestinal systems.

The two personality types also manage stress in different ways. Type As are more likely to pursue

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challenge—climbing mountains rather than napping on mountainsides, as the cartoon in figure 4.2 suggests. They may also gravitate toward situations that are inherently stressful, such as deadline-intensive competitive jobs or romantic partners with a combative streak. Type As who invest their time and energy more heavily in work challenges than in personal relationships are prone to social isolation, a major risk factor for poor health. Type Bs are more likely than Type As to seek and welcome support from others during their time of distress; social support is among the most effective buffers against the health-depleting effects of stress. Type As may also find that their natural intensity and competitive spirit can be heightened by situational stress; a person who feels constant time pressure will be even more stressed when faced with work deadlines, financial pressures, or work-family demands.

Optimism versus Pessimism. Winston Churchill famously proclaimed, “The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty.” Churchill’s words mesh closely with laypersons’ notions of optimists, who “view the glass as half-full,” while their pessimistic counterparts “view the glass as half-empty.” Optimists and pessimists also approach stress and challenge in different ways. Optimists, like financial analyst Marcus, possess great confidence that they can overcome the stressors in their path, while pessimists like Calvin tend to be filled with doubt about both their own capacities to overcome hurdles, and the likelihood that their situation will ever change for the better. The former, not surprisingly, is more closely linked to effective (and health-enhancing) problem solving.

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Figure 4.2. What’s the Difference between Type A and Type B?

How one copes is shaped, in part, by traits such as optimism and pessimism. One theory of how we manage stress is called “expectancy-value theory.” This perspective says that our success in meeting our goals depends on two main factors: our evaluation of how much we want to meet our goal (that is, how desirable or undesirable the goal is), and our sense of confidence that we can successfully attain it. Let’s say that we lose our job and the thing we want most is a new job. Most people might agree that a new job is highly desirable, even necessary, and something we should pursue with zeal. Yet the extent to which we pursue that job hinges on how likely it is that we think we’ll get it. An optimist like Marcus approaches such challenges with self-assuredness and hope (“Someone has got to get the position; it might as well be me!”), whereas a pessimist like Calvin sees his chances as dim (“I’ll never get the job, so why bother applying?”). This confidence pushes the optimist to cope proactively, which is linked to better health. Studies show that cancer patients who are optimistic have better survival outcomes, in part, because they seek out social support, are more vigilant about getting effective medical care, may comply with doctors’ recommendations, and may find meaning and purpose even in the face of health threats.

Not all researchers agree that optimists deal with stress more effectively, however, or that optimists fare better in the face of threat. Barbara Ehrenreich, author of Bright-Sided: How Positive Thinking Is

, argues that Americans’ emphasis on optimism dupes people into believingUndermining America

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that simply “thinking positive thoughts” will melt away our stressors and cure our health woes. Rather, Ehrenreich notes, some people are optimistic precisely because everything has gone their way in life; they have the money, friendships, good jobs, comfortable homes, and other resources that predispose them to health and happiness. These fortunate people would fare just fine even if they did not possess perpetually sunny outlooks. By focusing on fixing one’s temperament rather than repairing the social inequalities that generated the stressor in the first place, practitioners and policy makers are neglecting the real root of stress and its accompanying health effects, says Ehrenreich.

A handful of scholars even suggest that optimism taken to the extreme (called “unrealistic optimism”) is associated with ineffective coping. Dreamy-eyed Pollyannas may underestimate their risk of a stressor such as job loss or divorce, and do not take adequate steps to prepare. Likewise, those who are overly optimistic about their health may turn a blind and blithe eye to potentially dangerous symptoms, or may engage in unhealthy behaviors because they can’t foresee a downside of doing so. For instance, smokers with unrealistically high levels of optimism are less likely than their pessimistic counterparts to quit smoking, while highly optimistic college students underestimate their chances of developing drinking problems and then experience more alcohol-related woes such as hangovers or missed classes. Those who are more pessimistic, by contrast, engage in more proactive coping to forestall what they see as quite realistic and likely consequences of drinking. In sum, while optimists generally cope better than pessimists, a rosy outlook—taken to the extreme—can prevent productive actions.

Big Five. Most Americans have heard of Type A and Type B personalities, and nearly all know the difference between an optimist and a pessimist. However, they may not know that one of the most widely used measures of personality is called the “five factor model,” which encompasses the traits of neuroticism, extraversion, openness to experience, agreeableness, and consciousness. According to Oliver John, who designed the Big Five personality scale, these traits are associated with how people cope with stress, and consequently help us to understand why some fall ill in the face of stress, whereas others can weather such storms easily. (See figure 4.3 for traits capturing each of the five attributes.)

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Neuroticism is one of the most frequently studied personality traits in the stress literature. People high in neuroticism are prone to emotional distress, depressive symptoms, anxiety, somatic complaints, and negative mood, and are likely to view the world around them as stressful and unsafe, often conjuring up mental images that are far worse than reality. The classic neurotic personality type is Woody Allen’s film character Alvy Singer. Singer, the antihero of , spent his childhoodAnnie Hall worrying that the universe was going to explode, while in adulthood his exaggerated worries about everything from sex to political conspiracies to anti-Semitism threatened his romantic relationships. Off the silver screen, highly neurotic people tend to alienate those friends and family members who can help them cope with stress, and their exaggerated worries derail them from devising sensible solutions to the stressors they face. People high in neuroticism often rely on the least effective EFC strategies, such as wishful thinking, escapist fantasy, self-blame, withdrawal, and passivity. Neurotics like Calvin also tend to hide from their troubles, turning to unhealthy forms of denial such as alcohol or drug use. Some neurotics also carry around anger and hostility, and are at greater risk of cardiovascular disease and slower recovery from illness when faced with insurmountable stressors.

Extraverts tend to have outgoing and optimistic personalities and are sociable, carefree, and proactive in their activities and relationships. Those high in extraversion enjoy spending time with people, an attribute that benefits them in times of stress. Introverts are at the opposite end of the spectrum, and are quieter, more thoughtful, controlled, and careful. They tend to withdraw socially after a stressful encounter, which exacerbates the harmful consequences of the stress. For these reasons, extraverts tend to have better physical and mental health than introverts, including lower levels of depression, anxiety, suicidal ideation, and eating disorders. Extraverts also tend to rely on PFC approaches—developing constructive ways to overcome stress and shifting their mindset to minimize the emotional distress linked to the stressor.

Agreeableness is closely related to yet distinct from extraversion. Agreeableness encompasses traits that foster close and rewarding relationships with others, including being friendly, helpful, empathetic, and able to keep one’s negative feelings in check. Agreeable people tend to have less stress in their lives, if only because they tend to find themselves in (or consciously create) situations marked by low levels of interpersonal conflict and stress. They also tend to become less upset by others’ misbehavior than their less agreeable counterparts, thus dulling the effect of stressors such as marital strain on health and well-being. Agreeableness is associated with help seeking, problem solving, and positive reappraisal, and lower levels of reliance on avoidant and ruminative EFC strategies. As we saw in the case of Marcus, the ability to maintain a positive outlook and sustain warm friendships during times of stress is a key element in adapting to strains such as persistent unemployment.

Conscientious people tend to be reliable, hard-working, future-oriented, and self-disciplined—often turning their noses up at impulsive or reckless behavior. These level-headed people are particularly effective at coping because they anticipate and plan for predictable stressors. For instance, they may prepare financially for a spouse’s eventual death and thus do not face the same financial distress that other widows or widowers face. Conscientious people also tend to avoid irrational actions that can compromise their health or well-being. Not surprisingly, they enjoy longer life spans than their less diligent counterparts, in part because they have fewer high-risk behaviors and are more compliant with doctors’ orders. A further benefit of conscientiousness is that these people carry great confidence that they can handle future stressors, given their past record of success. As a result, they tend to employ active strategies for managing stress, relying on tactics such as seeking support, proactive problem solving, and cognitive restructuring—and avoiding passive techniques such as denial, substance use, and dwelling on negative emotions.

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The fifth factor, openness to experience, encompasses curiosity, open-mindedness, flexibility, and tolerance for novel ideas and situations. Although stress researchers have paid less attention to openness than to the other four factors, some studies suggest that individuals who are open to experience tend to use humor when dealing with stress, and are particularly creative problem solvers. Openness is distinct from the other four scales, however, in that it is closely tied to one’s level of education. As we will see later, education is an important coping resource because it is linked not only to thoughtful and creative problem solving but also with having the economic resources to seek out support and to restructure one’s stressful environment.

Demographic Factors

The types of stressors we experience, the resources we have to deal with them, and their effects on our health and well-being are closely tied to our social and demographic characteristics, such as age, sex, race or ethnicity, and socioeconomic status. Most societies are stratified or hierarchicalized in some way, where those who possess more power and economic resources are best equipped to both alter the stress-inducing situation and to ward off the harmful consequences of the stress. In the United States, women, ethnic and racial minorities, and those with fewer economic resources historically have held less power, been exposed more directly to health-depleting stressors, and possessed fewer resources for coping relative to their more advantaged counterparts. Today, however, studies find that each group has its own distinctive sources of strength and challenge as they manage stress.

Older and Wiser? The Impact of Age

We might think that when problems strike, they would exact a more harmful toll on older adults than on younger persons, because aging is associated with natural (albeit gradual) declines in physical vigor, strength, and mental sharpness. For some, old age is also linked to a shrinking social support system, as one’s peers die or become too sick to provide support. Yet mounting research shows that older adults may be less susceptible than younger people to some of the physical and psychological blows that accompany stress. First, older adults are less likely to turn to unhealthy behaviors as a coping strategy. Persons in their sixties and older don’t drown their sorrows in sweets and other unhealthy comfort foods because their dulled senses of smell and taste make eating less satisfying. Likewise, an older adult who has never smoked cigarettes or drunk alcohol will not likely hit the bottle or light up a Marlboro for the first time, whereas a younger person may take up bad habits anew when hit with a rough patch.

Second, the ups and downs of life are less emotionally devastating to mature adults than to younger persons. Older adults have lived through it all—deaths, divorces, wars, floods, and recessions. As such, they have years of experience coping with stress, and possess the knowledge that they can survive (almost) anything, and the emotional equanimity that comes with having done and seen it all. They’re also less likely to be surprised by major stressors; while a younger person may be shocked and devastated by the unexpected death of a spouse, most older adults have at least some expectation that their spouse will die in the not-too-distant future. Some also rely on the advice and support of peers who have gone through similar losses.

Emotional reactivity also changes with age. As we grow older, we develop a greater capacity to manage or “regulate” our emotions, meaning that the highs are never as euphoric as those experienced during our heady teen years, but the lows are never as bleak. Older adults report less extreme levels of both positive and negative mood, and shorter-lived mood dips when a major negative event strikes. This more balanced emotional response to life’s rhythms has both biological and social components,

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including decreases in autonomic arousal, adherence to cultural expectations that the elderly should not be “too emotional,” and the attainment of wisdom, which may help older adults to respond to major stressors and daily nuisances with acceptance and perspective.

Yet older adults are not immune to the physical and mental health decrements that accompany stress. They are more likely than younger people to experience stress “pile-ups,” or the accumulation of difficulties that can weaken our immune systems and threaten our cardiovascular systems. Older adults are more likely than younger persons to experience cognitive and physical declines, financial strains, multiple deaths of friends and loved ones, and the loss of important social roles, such as worker, spouse, and sibling. Age-related physical declines such as mild cognitive impairment, muscle weakness, fading vision and hearing, and sleep troubles may make them all the more susceptible to the health-depleting effects of stress.

A Weaker Sex? Gender, Stress, and Health

Men and women react to stress in different ways. In general, women are more likely to become depressed, whereas men are more likely to turn to drinking or even aggressive behavior when stressed out. Women also are slightly more likely than men to rely on emotion-focused than problem-focused coping, although this partly reflects social context and is changing rapidly over time. In past decades, women often lacked the financial resources to tackle some problems head-on, and instead might have turned to rumination, but these gender differences have attenuated over time. Studies consistently show that men and women adopt coping tactics that are consistent with gender-typed expectations regarding emotional display. Men are more likely than women to use PFC, control their emotions, accept the stress-inducing problem, not think about the situation, or show emotional inhibition or a “bottling up” of emotions. Women, by contrast, tend to seek social support, and use EFC tactics such as distracting themselves, releasing their feelings (e.g., crying or talking it out), or turning to prayer.

Yet is there a “weaker sex” when it comes to stress reactivity? The simple answer is no. No evidence shows that either men or women uniformly deal with stress less capably than the other; rather, each responds differently. Early writings suggested that women were more vulnerable to stress, yet these studies were often focused on female-typed responses to stress only (i.e., depression rather than aggression), or they failed to consider that women had fewer economic resources than men to resolve their problems. It’s not surprising that a stressful event such as divorce would be more devastating to women than to men, especially in the mid-twentieth century. The word “divorcee” was whispered behind closed doors, revealing how shameful divorce was for women. Likewise, a woman who married young, had children, and lacked marketable career skills would be understandably distressed if she were forced to provide financially for her children postdivorce.

Current studies, by contrast, show that neither men nor women fare systematically worse in the face of divorce, yet the sources of their distress differ. Women still face some financial troubles and work-family strain following divorce, which compromises their sense of control and heightens feelings of depression. Men, by contrast, lose an important source of emotional support and social control, and may self-medicate their emotional pain by drinking. In sum, there is little evidence that there is an innate “his” and “hers” approach to stress and coping; rather, gender differences reflect larger social forces such as access to economic resources and socialization processes that “teach” men and women to respond to stress with very different emotions.

Minority Stress: Race and Ethnicity

Surprisingly little research explores racial and ethnic differences in responses to stress. This partly reflects the fact that there is wide within-group variation in how whites, blacks, Latinos, and Asians cope with stress. In other words, there is no “white” or “black” way of managing stress. The majority of studies explore the complex ways that race and social class intertwine, given that blacks and

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Latinos tend to hold fewer economic resources than whites and Asians in the United States. Most studies concur that ethnic minorities are more likely than whites to be exposed to stress, and that they also face an entirely separate set of stressors from which whites are spared. This “minority stress,” as psychiatric epidemiologist Ilan Meyer calls it, includes exposure to race-based discrimination, prejudice, tokenism, and struggles to balance one’s own cultural practices with those of the majority white society. These stressors, along with socioeconomic-status-based stressors, such as economic strain, dangerous neighborhoods, limited access to high-quality health care, heightened risk of divorce, and network events (such as children’s imprisonment or unemployment), conspire to put blacks in particular at a heightened risk of developing health problems.

Given this onslaught of stressors, some blacks and Latinos may cope by turning to high-fat comfort foods and alcohol, which further increase their risk of illness, especially cardiovascular disease and diabetes. Epidemiologist Sherman James also observed a harmful coping style in African Americans that he dubbed “John Henryism.” Named after the American folklore hero who worked himself to death while building a railroad tunnel, John Henryism refers to the process whereby some blacks expend very high levels of effort to succeed against all odds and to “prove themselves” in a majority white society. Unfortunately, this coping tactic exacts a physical toll. James and his colleagues found that blacks with high scores on John Henryism scales have an elevated risk of symptoms including high blood pressure. Just as John Henry died clutching his hammer, some African Americans may slowly suffer by working tirelessly to succeed in untenable and high-pressure situations.

However, Meyer and others argue that ethnic minorities also possess distinctive coping resources that help them to overcome stress and deflect some of the health assaults that accompany stress. For instance, African Americans may benefit from resources such as support from their religious community, protective religious beliefs, and high self-esteem. A strong sense of racial identity also protects against stress, especially racial discrimination. Ethnic pride, strong ties to one’s ethnic community, and a sense of commitment to one’s ethnic group protect against psychological distress in the face of discrimination. However, public policies to eradicate race-based discrimination may ultimately enhance African Americans’ health more effectively than would an intervention geared toward enhancing ethnic pride.

Money Can Buy Health and Happiness: Socioeconomic Status

Socioeconomic status (SES), or one’s level of education, occupation, income level, and the assets one possesses is one of the most powerful influences on our lives. As noted earlier, those with fewer economic resources face a litany of stressors from which their wealthier counterparts are spared, and they also lack the economic and political resources necessary to change the stressful situation. It’s difficult, if not impossible, to move away from a poor crime-plagued neighborhood if you don’t have the money for a downpayment on a new apartment. Quitting a miserable job isn’t an option for those living paycheck to paycheck. Those with little education may lack the cognitive flexibility to devise creative solutions to their problems, nor have they learned how to wrangle the social resources needed to fix a pressing problem. Although people who lack economic resources may have deep and emotionally rewarding social relationships, members of those social networks may be overburdened by requests for help and support. As sociologists Leonard Pearlin and Carmi Schooler have observed, “The groups most exposed to hardship are also the least equipped to deal with it.”

This unrelenting stress, combined with a dearth of coping resources, has direct effects on physical health, and leads to sustained activation of stress-related autonomic and neuroendocrine responses, which leads to weakened immune systems. Low SES also exacerbates the health consequences of a stressor, whereas high SES minimizes these consequences. For example, a team of researchers at the University of Michigan examined whether middle-aged smokers who suffered a heart attack would be more likely to quit smoking, relative to their counterparts who did not suffer the stress of a heart attack. They found clear evidence that a heart attack triggered smoking cessation, yet this effect was considerably larger for highly educated smokers. More highly educated persons have a deeper

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understanding of the link between smoking and heart disease, a greater sense of control over their environment, and a stronger belief that they can effect healthy change through their own behaviors.

Despite the overwhelming evidence that those with fewer SES resources fare poorly in the face of stress, studies still show great variety in how poorer people cope. A series of fascinating studies by Iowa State researcher Carolyn Cutrona found that living in a poor, dangerous neighborhood that lacked basic amenities such as good grocery stores and high-quality health care facilities is linked to depression. However, residents possessing personality traits associated with effective coping are far less likely to be depressed, despite their persistent neighborhood strain. For example, women with low levels of neuroticism, high levels of optimism, and a strong sense of personal efficacy were relatively immune to the depressing effects of neighborhood disorder. Taken together, these studies show how powerfully SES affects our lives, yet they also underscore that no single risk factor predetermines our health and well-being.

Lean On Me: Social Support as Source of Strength

If stress researchers were asked to name the single most important factor that distinguishes those who break versus those who merely bend in the face of adversity, most would immediately say “social support.” Hundreds of studies document the importance of social ties as a resource that helps to ward off the health-depleting effects of stress. A core component is emotional support, such as having a confidante to listen to our problems, and feeling that our family and friends love, support, and listen to us in our times of need. Just as important, though, is instrumental and informational support. This refers to the practical support we receive when we’re down. Instrumental support may include a loan so that a financially strapped friend can make her rent payment, or offering to babysit when an overwhelmed parent needs a break from their demanding children. Informational support includes recommending a good lawyer to a coworker going through a divorce, or sharing information within a sibling who is looking for a new job.

The benefits of social support are not limited to our mood and coping skills; it carries direct and indirect implications for our physical health as well. Close friends, family members, and significant others encourage their loved ones to engage in healthy behaviors (and kick bad habits) in the face of stress, helping them to forestall illness and infection. Close emotional ties also provide direct physiological benefits. As we saw in , oxytocin is a chemical released when we haveChapter 3 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.

It’s no surprise that having loved ones who support us through thick and thin protects against stress-related health threats. But can short-term or fleeting support also help us to survive stress? The evidence is mixed, but generally yields the answer “no.” One study by researchers at UCLA brought subjects into a laboratory and had them deliver a five-minute speech followed by a five-minute mental arithmetic test (i.e., the Trier Social Stress Test, described in ). Before engaging in the twoChapter 3 stressful activities, the subjects were administered a small skin wound, so that researchers could investigate how quickly subjects healed. One half of the subjects were assigned a companion to help them with their speech. The subjects were told that the companion was available to help and to talk, if they wanted to. They also received support, advice, and words of encouragement from this companion when they were done with their tasks. The other half of subjects were not offered this support. The social support intervention had no effect on wound healing, blood pressure, or other physiological indicators. However, studies using a similar experimental design that had real-life spouses or best friends (rather than a research confederate) provide support to the research subjects do show a positive effect on health outcomes. Thus, social support is most protective when it’s received in the context of long-term, high-quality relationships.

Yet can there be situations in which social support dampens our ability to bounce back from stress, perhaps by rendering us helpless or dependent? A handful of studies provides some evidence for this

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notion. Social support can heighten one’s distress if the help provided is not what the recipient needs, if the recipient is distressed by the lack of reciprocity in his or her relationship, or if the support is delivered in a condescending or ham-fisted way. One study, aptly titled “The Way to Console May Depend on the Goal,” shows that support needs to be consistent with the recipient’s needs in order for it to be helpful. If the recipient feels guilty or indebted, then the support might even intensify the recipient’s distress level. In sum, social support is protective if it’s delivered in a way that is sensitive to the needs of the recipient.

Orchids and Dandelions: The Role of Genetics

Genetics play an important role in our hair and eye color, how easily we gain or lose weight, our risks of illness, and even our personalities. When centenarians talk about their long life spans (or supermodels explain their slender physiques or high cheekbones), they often thank their “good genes.” Genes alone do not shape our destinies. Rather, our genes interact with the social situations we find ourselves in, and these combined forces have powerful effects on our physical and mental health. In recent years, researchers have identified specific genes that make us more or less susceptible to the harmful effects of stress. Researchers have developed a framework called the diathesis-stress model, which views some people as carrying genetic traits (called risk alleles) that make some wilt in the face of stress, while others blossom.

The model proposes that some people carry a gene that renders them highly sensitive to social and environmental factors. Those who are most vulnerable to negative social factors also benefit most from protective factors or positive events. These context-sensitive people have been referred to as “orchids.” Just as an orchid needs the proper sunlight, water, and loving care to thrive, these context-sensitive people may blossom most successfully when provided with supports, such as encouragement, a positive childrearing environment, or a strong role model. The dark side is that they may be emotionally devastated by a stressor, such as childhood abuse or parental death. By contrast, “dandelions” are people whose behaviors and feelings are not highly affected by social environment. Although they may be saddened or depleted by a stressful situation, their reactions will not be as severe as that of the orchids. By the same token, they are also less amenable to the potential healing powers of resources like social support.

What makes someone a “dandelion” versus an “orchid”? Researchers have identified several genetic factors that amplify the effects of stress on health and well-being. The serotonin transporter gene (also known as SERT or 5-HTTLPR), has a particular variant (i.e., the “short” variant) that is implicated in depression and anxiety disorders. Another gene, DRD4-7R, is a variant of a dopamine-processing gene called DRD4 and is linked to several self-destructive behaviors, including conduct disorder, drinking, bullying, aggression, and sexual promiscuity. Advocates of gene-environment perspectives hold that if a person has a particular genetic vulnerability, he or she may respond all the more strongly to a particular stressor. The stress of law school may drive any student to drink, but the risk is even greater for students with the DRD4-7R gene. Likewise, a bad breakup may make us all sad and despondent, but the risk of major depression is even higher for those with the short SERT allele.

Research on gene-environment interactions is still in its nascent stages, but mounting evidence based on both survey data and lab studies finds that genes shape our stress responses. For example, one laboratory study at Stanford University found that teenage girls with the 5-HTTLPR allele experienced much higher levels of the stress hormone cortisol than did girls without the allele, following the completion of a stressful arithmetic task. Similarly, a large survey based on five hundred twins found that persons with the “short” allele variant of the 5-HTTLPR gene reported higher levels of depression in the face of stressful life events, relative to their counterparts without the allele. These studies are provocative, yet most scholars interpret these results cautiously. There are so

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many variants of our genes that scientists are certain to find a few that are linked to stress reactivity in some contexts and some studies. But will this particular risk allele be linked to reactivity in other contexts?

Others critics worry that the current scholarly emphasis on genes will lead some to throw up their hands and just assume that ill health and depression are predetermined for those who are born with a particular genetic predisposition. The narrow emphasis on genetic vulnerabilities may also detract attention from social vulnerabilities—such as poverty and lack of social support. The jury is still out, but evidence suggests that neither the biological nor social nor psychological alone is sufficient to help us understand stress responses. Although there is strong evidence that economic resources, social support, adherence to problem- rather than emotion-focused coping strategies, and possessing protective personality traits such as optimism or conscientiousness help buffer the health effects of stress, none of these resources singlehandedly explains all the variance in health or well-being in contemporary U.S. society. Our answers are best found by considering the complex array of factors that make our lives full. The proposed solutions to both stress exposure and reactions, highlighted in

, recognize that there is never a single bullet—biological or social—that accounts for theChapter 5 stress-health link. We now turn to some of those solutions.

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