Stressing Yourself Sick

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Though there’s no exact equivalent in the English language, there is no shortage of names given to illnesses that can stem from the stresses of work: heart disease, depression, irritable bowel syndrome and panic attacks, to name a few.

There are plenty of fields that have characteristics that can cause stress levels to skyrocket; the stakes are high in medicine, and social workers deal with situations ranging from complex to tragic. But lawyers are particularly susceptible to such problems because of the unique interplay of the legal profession and the lawyer personality. It’s the adversarial nature of lawyering that sets it apart from other professions, says Amiram Elwork, director of the Law-Psychology Graduate Training Program at Widener University in Chester, Pa. The third edition of Elwork’s book Stress Management for Lawyers comes out this month.

“By definition, the adversarial system is conflict-ridden, and conflict creates certain types of emotions like anger, guilt and fear, which cause stress,” says Elwork. “Emotions have different components to them, including a physical sensation in your body–your heart rate goes up, your pupils dilate–and there is a lot of data to dem­onstrate that chronic negative emotions are bad for you.”

But it’s not just the job. Experts agree that lawyers in general are wired in such a way that makes them more inclined to suffer the ill effects of stress. “Lawyers tend to have personalities in which they are not as aware of their feelings,” says Dr. Steven A. Ager, a psychiatrist who specializes in the treatment of lawyers through his practice, the Lawyer Stress Center, in Cherry Hill, N.J., and Philadelphia. “I give talks to bar associations and law firms about stress, and I once got a question from a lawyer at a company who asked, ‘How do you know if you feel stress?’ This person was so divorced from her feelings that she didn’t even recognize stress.”

Because the majority of lawyers can be characterized as “thinkers” rather than “feelers,” Elwork says, they are inherently not as good as they could be at understanding the emotions of others–or themselves. “Lawyers also tend to suppress and repress their physical feelings, from having to go to the bathroom to not paying attention to stomach pains,” he says. “Many of them think of it as heroic.”

But that approach is a mistake, he says, because it has negative effects on lawyers’ physical health.

Stress And Your Immune System

Experts agree that the key to making a change lies in transforming your relationship to stress so that it no longer overwhelms you. This is a smart move, since chronic stress affects every single system of the body, from your head to your heart. Here is a look at how your work could be harming you, plus practical steps you can take right now to safeguard your physical and mental health.

When you’re placed in a stressful situation, the sympathetic part of the body’s nervous system switches on, triggering the primitive fight-or-flight response.

“When your brain perceives something it hears, or sees, as stress, it releases epinephrine and cortisol–two powerful stress hormones–into the blood,” says Dr. Bruce Rabin, a professor of pathology and psychiatry at the Uni­­versity of Pittsburgh Medical Center. Epinephrine (more commonly known as adren­aline) makes the heart beat faster, while cortisol releases glucose into the bloodstream for energy so you can run faster and fight harder. When the threat dissipates, the parasympathetic nervous system kicks in, triggering the relaxation response and returning hormones to normal levels.

Although modern day stressors are more likely to be discovery deadlines than snarling beasts, the nervous system still acts as it did millions of years ago. That’s fine once in a while, but without adequate relaxation, levels of hormones remain elevated, causing the body to halt or curtail essential functions such as disease prevention. When this happens, immune function is compromised.

Not only does chronic stress make the body more susceptible to minor aches and pains, but it also encourages more serious illnesses and conditions. A team of researchers at the University of California at San Francisco found that stress may even accelerate aging of the body at the cellular level.

The study, which appeared in the Dec. 7, 2004, issue of the Proceedings of the National Academy of Sciences, found that blood cells from women who had spent many years caring for a disabled child were, genetically, about 10 years older than those from peers who had much less caretaking experience.

Although the studies focused on caregivers, researchers say the findings have implications for overworked employees, too, as individuals with other sources of life stress showed similar relationships between their levels of stress and cell aging. How to beat it:

• Structure your day so you feel more in control. Say no to adding another task to your plate if you’re overloaded, but do think twice about canceling with your friends. Studies prove those social relationships boost the body’s stores of oxytocin, which acts as a stress reliever.

• Pay attention to stress signals. Cold sores, coughs, sniffles, and general aches and pains are signs your immune system has hit rock bottom.

Everyone has ups and downs, but short term stress signals such as low self esteem, irritability, guilt, pessimism, procrastination and general grouchiness can be the first steps to more serious health problems.

Experts say that if left unchecked under times of chronic stress, these feelings can spiral into more serious mood conditions, such as depression and anxiety.

Stress And Mood

People whose personality types tend to be less “stress hardy” appear to be most at risk. “Certain individuals just don’t seem to be affected by what other people would consider stressors,” says Dr. Beverly Thorn, a professor of clinical psychology at the University of Alabama in Tuscaloosa. “There’s a lot of individual variability, of course. Where one person might see something as a great challenge and rise to the occasion, another will feel threat­ened. Ultimately, something isn’t stressful unless a person judges it to be that way.”

Thorn sees many professionals with generalized anxiety disorder, a condition that can’t be pinned on anything in particular. “These people startle easily, worry a lot, have a rapid heartbeat and shallow breathing. Sometimes, they have full blown panic attacks,” she says.

It’s a description that once perfectly fit Victoria Sica, a third-year law student in Miami. “In 2004, I was sitting in torts class and all of a sudden I couldn’t breathe, I was sweating, and my heart was racing,” she recalls. “As I made my way toward some sofas in the library, the entire left side of my arm went completely numb, then my face, and all of my fingers and toes.”

Although that first panic attack quickly subsided, it wouldn’t be the last. To make matters worse, this spring Sica developed shingles, a painful skin condition caused by the dormant chicken pox virus that can come roaring back to life during times of extreme stress.

Today, Sica takes every opportunity to stave off stress before it starts–and urges her classmates to do the same. “I’ve become much more aware of what my body is telling me. Now, when I need rest, I take it,” she says. “When I start to feel anxious, I take a moment to sit and breathe deeply.” Her efforts have paid off: Sica hasn’t had a panic attack in nearly eight months.

How to beat it:

• For one week, keep track of your daily stressors and how they affect your mood. Then review the diary and look for patterns. Next, formulate a strategy that will help you respond better to the stressors you can anticipate. Make your goals specific and achievable, and reward yourself when you’ve achieved them. For example, instead of drinking coffee when you’re tired, make a date with a co-worker to go to an exercise class during your lunch hour.

• Learn to recognize negative thoughts as they occur. Jumping straight to conclusions or generalizing a single setback into something that will occur over and over are examples of cognitive distortions–and can be the quickest routes to a bad mood. Take time to isolate your thoughts and ask yourself, “Is this really true?”

• Cut out high sugar snacks. Many of us crave carbohydrates when we’re feeling down, but heavily processed sweets send a spike of sugar to your bloodstream. Al­though you might feel better immediately, your mood will plummet quickly, leaving you lower than you were before. If you must have something sweet, reach for a piece of fruit instead, as your body will digest it more slowly.

Stress And Sleep

When Jennifer Schlatter of Denver started practicing law seven years ago, she found herself unprepared for the intensity of her job–and unable to sleep. “I’d lie awake until 2 or 3 in the morning, staring at the ceiling,” she says. “On the weekends, I’d have marathon sleeping sessions to catch up.”

It’s not surprising, since cortisol causes a heightened state of alertness and arousal. So if high levels of the stress hormone remain in the bloodstream at night, getting restful sleep becomes almost impossible.

A study at the Sleep Research and Treatment Center at Pennsylvania State University’s College of Medicine in Hershey, Pa., found chronic insomniacs had much higher levels of cortisol than their well rested counterparts. (More­over, experts say serotonin and melatonin, the chemicals that regulate the body’s natural 24 hour sleep cycle, often are among the first chemical messengers to fail during times of stress. If they aren’t at optimum levels, sleep can be interrupted.)

The best way to flush out those nasty hormones? The very thing that many of us neglect: exercise. “Thirty minutes of aerobic exercise per day–the kind that gets your heart pumping–uses up the cortisol,” says Pierce Howard, director of research at the Center for Applied Cognitive Studies in Charlotte, N.C., and author of The Owner’s Man­ual for the Brain: Everyday Applications From Mind Brain Research. “If you don’t metabolize the hormone, it can stay in your system up to two and a half days.”

To reap the most benefit, Howard suggests working out soon after your most stressful period. If morning client meetings get you riled up, head to the gym before lunch; if it’s afternoon hearings that make your stress levels rocket, go for an early evening run. (But try not to work out after 6 p.m. The temporary boost in your metabolism that comes after a stint at the gym can make it hard to sleep.)

Schlatter says her sleep problems thankfully dissipated as she became more accustomed to her job. These days, she helps keep her stress levels down by fencing at least an hour a day, an activity that she describes as “physical chess.”

“When you’re sparring with another fencer, there’s nothing like the sound and feel of clashing steel. Every bruise received during a match is a badge of honor. The stress of the day just pours out of me and I feel energized,” Schlatter says. “Fencing is something I’ll never give up. I’ve found my true calling in exercise.”

How to beat it:

• Take an afternoon brain break. Simply putting your head down on your desk or lying down on the floor in your office for five to 10 minutes can help restore your mind to alertness, particularly if you’re not getting enough sleep.

• Put pen to paper. Take five minutes at the end of your working day to jot down any thoughts, concerns or action items for the next day. Then forget about them. Taking work home or discussing work issues during the evening can trigger a stress response that will make sleep difficult.

• Make your bedroom a restful place, and only use the bed for sleeping and sex. Avoid watching television, working or eating in bed.

Stress And Digestion

When your stomach churns and burns, it isn’t necessarily due to something you ate. The queasiness, bloating and stomach upset you feel likely stems from the aggravation resulting from a difficult morning conference call or the anticipation of an afternoon of back-to-back meetings.

“For many people, stress manifests itself most frequently in the gastrointestinal tract,” says Dr. Joseph Brasco, a gastroenterologist at the Colon and Digestive Disease Cen­ter in Huntsville, Ala. Although stress often plays out in the stomach, the large intestine is where most of the action takes place. Food stays in your stomach for just 30 minutes, but it can take 48 to 72 hours for partially digested particles to work through the entire length of the intestine. The presence of stress hormones slows digestion further, so when you’re under pressure, food can ferment and stagnate, leading to diarrhea and constipation.

These symptoms, says Brasco, can be part of the continuum that includes irritable bowel syndrome, a condition that affects as many as one in five Americans. IBS is characterized by extra sensitive nerves and muscles in the bowel and often results in painful stomach cramping. Al­though doctors aren’t exactly sure what causes IBS, stress is believed to trigger the symptoms. Dairy products, alcohol, caffeine and fatty foods can also make it worse.

Robert S. Gerber, an intellectual property attorney in San Diego, developed IBS six years ago. At the time, he was in the middle of a divorce and settling into a new life, plus feeling the new pressures related to becoming partner at the large firm where he works. He laughs at the notion held by associates that once you become partner, your stressors disappear. “When I got promoted, one of my partners told me, ‘Con­­­grat­ulations, you’ve won the pie-eating contest. The prize? More pie.’ ”

Pie, literally or figuratively, was the last thing Gerber needed on his plate. To help alleviate the painful cramps that would last anywhere from a few hours to a few days, he overhauled his diet, cutting out his seven-cups-a-day coffee and iced-tea habit, avoiding rushed meals and junk food, and avoiding dairy products. “My diet gets a little challenging at times,” he admits, “but I bring snacks during the day. And when you’re out at a function you tell the staff your dietary needs, and they can usually accommodate you.”

In addition to the dietary changes, Gerber meditates for 20 minutes each evening and has tried to scale back his pro bono and community affairs efforts where possible. “Today, I try to carefully weigh the value that I’m either getting or giving in the activities I’m involved in,” he says. “It seems better to do a few things well, with devotion and full attention, than do a lot of things poorly.”

How to beat it:

• Eat more fresh fruits and vegetables, especially bananas, onions, leeks and garlic, which are known to alter the components of existing gut flora.

• Watch your alcohol intake because it can irritate the stomach lining.

• Take antibiotics sparingly. Overusing them to treat every minor infection can upset the delicate balance of gut flora (the microorganisms that help break down food) since they kill off all kinds of bacteria indiscriminately.

• Eat plenty of yogurt with live cultures and consider taking a daily probiotic liquid or supplement to help boost good bacteria and flush out bad ones. Although probiotics can’t cure stress, they might help shore up gut health.

Stress and Your Heart

Your heart is a powerful muscle, pumping tirelessly each day. But it’s also vulnerable to the effects of stress. In the late 1990s, researchers at Duke University Medical Center in Durham, N.C., examined 107 people with heart disease and found a reduction in cardiac events, including death, heart attacks and bypass operations, in the group that did stress-management training. Another study, published in the June 2001 issue of Stroke, a journal of the American Heart Association, found that men who had large increases in blood pressure with stress had an increased risk of stroke.

But it’s not just stress hormones that take a toll; adrenaline also contributes. “Adrenaline is the growth hormone for the heart muscle,” says Dr. Cleaves M. Bennett, a clinical professor of medicine at Harbor-UCLA Medical Cen­ter in Torrance, Calif. “On the one hand, it’s good to have a big, strong heart, but at the same time that the heart is getting bigger and stronger, the arteries are narrowing to protect the tissue.”

High blood pressure, or hypertension, also makes the heart work harder than normal, causing it to enlarge and weaken over time. It can also damage the delicate linings of the vessels, leading to increased plaque deposits. When coupled with obesity, smoking, diabetes or high cholesterol levels caused by poor diet, the risk of heart attack increases. Attorney Carol Chang, a family lawyer in Mount Holly, N.J., was diagnosed with hypertension in 1996. A few months ago, she decided to make some major lifestyle changes to reduce her need for medication to treat the condition.

As part of these changes, Chang has enrolled in a weight-loss plan and is trying to reduce stress at its source: her office. “I’m now very, very careful when I meet a new client. There was a time in my practice when I’d drop everything for a rush job,” she says. “Today, however, I tell them you’ve got to find someone else to handle your case.” Chang’s efforts have already produced results: At her most recent medical checkup, her blood pressure was lower. And she’s determined to bring it down even further.

How to beat it:

• Stop smoking. While that cigarette might calm you down, every drag of nicotine and carbon monoxide reduces the amount of oxygen in your blood, damages vessel walls and may trigger stroke inducing blood clots to form. Plus, if you’re smoking, you’re probably avoiding the very things–fruits, vegetables and low-fat foods–that will help keep heart disease at bay. Visit the American Legacy Foundation’s Circle of Friends Web site at www.join the circle.org, where you’ll find a list of state telephone quit lines, as well other national smoking cessation resources.

• Eat less animal protein and consume more fish and plant based sources. Fatty fish, such as lake trout, salmon and herring, are rich in DHA and EPA, two omega 3 fatty acids known to improve heart function. Similarly, nuts and seeds contain plenty of alpha-lino­lenic acid, which the body can convert to omega-3 fatty acid.

• Nurture your emotional health. Heart health specialists at Scripps Hospital in La Jolla, Calif., say that taking the time to write about 10 things you are grateful for each day can help decrease stress hormones and increase your sense of well-being. In addition, a gratitude journal can begin to help change the way you perceive situations and the way you ultimately live your life.
Jennifer Pirtle is a London based freelance journalist who specializes in health and wellness issues.
Reading Up To Calm Down

How Stressed Are You?

To help evaluate your own levels of perceived stress and the as­­so­ciated health risks, visit the University of Pittsburgh Medical Cen­ter’s Healthy Lifestyle Program Web site at http://healthylifestyle. upmc.com.

Click on “Stress Coping” to take the stress evaluation test (“Dis­cover Your Stress Level”). Then visit “Relaxation Techniques” to view a video on deep breathing, listen to guided imagery sequences and learn about other stress coping techniques.


Assistant managing editor Steven Keeva discusses his top five titles for learning more about coping with stress.

  1. The Lawyer’s Guide to Balancing Life and Work: Taking the Stress Out of Success by George W. Kaufman (ABA Publishing, 1999). There aren’t many stress management resources written specifically for lawyers, and this one is outstanding. And because Kauf­man is a lawyer, this lesson based book has particular resonance.

  2. Stress Management for Lawyers: How to Increase Personal & Professional Satis­fac­tion in the Law by Amiram Elwork (The Vorkell Group, 1995). Elwork not only knows the science behind lawyers’ physical and emotional challenges, but he also demonstrates a kind and caring concern.

  3. Transforming Practices: Finding Joy and Satisfaction in the Legal Life by Steven Keeva (Contemporary Books, 1999). I don’t want to be self promoting, but lawyers across the country have contacted me about the book to tell me how it changed the way they approach their work, allowing them to more successfully and more mindfully integrate their personal and professional lives. That was definitely my goal in writing it.

  4. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness by Jon Kabat-Zinn (Delta, 1990). Kabat-Zinn is the founder of the Stress Reduction Clinic at the Un­i­ver­sity of Massachusetts Medical Center, and he is a titan in the field of meditation and dealing with stress and illness. In this book, he approaches meditation in a very straightforward and accessible way, without using touchy feely language or religion.

  5. Love & Survival: 8 Pathways to Intimacy and Health by Dr. Dean Ornish (HarperCollins, 1999). This book has more of a general appeal. Ornish uses good interviews and interesting people to illustrate the relationship between health and humanity.

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