Review of "Stress"

Stress is a ubiquitous term nowadays. In Sweden, people's daily conversation concerns how stressed they feel, or how much stress they have in their life, or how one particular daily event has "stressed them out." Balancing work, family and leisure time is a challenge for working men and women in a number of countries, although the workload – and the potential for "stress" – is greater for women (Krantz & Östergren, 2001). Recently, I was on a city bus in Stockholm going home, reading the end of Cooper & Dewe's interesting book on the history of stress, when my concentration was interrupted by a neighboring traveler's loud telephone conversation. I couldn't avoid hearing the details of a problem that had "stressed out" my bus-neighbor. My bus-neighbor described every detail of his attempts to solve the problem with the help of people who had no idea how to solve it and didn't seem to be taking responsibility for finding a solution. The conversation continued with various other descriptions of minor work events, punctuated with the somewhat disconcerting comment that "we actually don't have that much to do." I left the bus with the impression that this man worked in some kind of security-related, logistics-oriented setting, and that he had a relatively high level of decision latitude in his work.

This account illustrates a number of aspects of what stress is about. Cary L Cooper and Philip Dewe, both British professors of organizational psychology with excellent academic reputations, have written a brief history of how the concept of stress developed within scientific research circles into the expansive field it is today. Cooper and Dewe point out in their preface that the book is "a" history, not "the" history. They also define themselves as "lay historians," admitting that they are not experts in the field of stress. The authors do not specify any group of readers for their book. Significantly, Lennart Levi, almost an icon of stress research, certainly in Sweden as well as elsewhere, is quoted on the back of the book praising it as "a fascinating and highly readable account of the long and difficult journey" to the insight that "stress-related disorders are often the cause of early death." Lennart Levi, as a stress researcher, could easily navigate the contents of the book. The less well-prepared reader might find some parts of it rather heavy going. As a history, it is a fascinating summary of the movements of ideas and how research in a specific field takes different directions depending on the persons and currents of thought involved. However, the many direct quotations and quite a few typographic errors suggest that the authors have not had the time to digest their material well enough to describe it fully in their own words, and those involved in the production of the book have not taken the time to proofread it properly. Although the many quotes and the lack of diagrammatic figures to help visualize the movement of ideas make the book an uphill read, undergraduate or even graduate research students doing a course on basic stress research – or in the history of scientific ideas – might find the book quite valuable in conjunction with relevant scientific articles. The main contribution of the book lies in its review of streams of thought that helps clarify which paths of research have been rich lodes of inspiration and which ones have turned into dead ends.

The authors begin by tracing stress research from the seventeenth century, when stress according to Robert Hooke was a term basically applied in industrial contexts to the load that an engineered structure like a bridge could tolerate, to the beginning of the twentieth century, when the schools of functionalism and applied psychology opened up possibilities for the relatively new discipline of psychology to be involved in social engineering projects. Fatigue and mental hygiene were two areas studied in relation to work performance. Another seminal area was psychosomatic medicine, where Walter Cannon's conceptualizations of the mechanism of homeostasis, and the "fight or flight" response to environmental stimuli gave impetus to much later research. Hans Selye was the first to formulate an original theory of stress based on a non-specific physical response to environmental changes. His concept of the "general adaptation syndrome," first outlined in 1936, eventually led to his definition, in the 1970s, of four types of stress – eustress (good stress), distress (bad stress), hyperstress (overstress), and hypostress (understress). Cooper & Dewe also bring up less well-known figures such as Harold Wolff, who connected stress to the development of disease and launched the concept of the "protective reaction response" which could arise in an often maladaptive attempt to protect the organism from an increase in the stress load.

In chapters 3 and 4, the authors cover the 1950s and 1960s, focusing primarily on the influential work of Richard Lazarus at Berkeley. One main impetus to Lazarus' work was the expansion of psychosomatic medicine to two causal relationships: that between life events and illness, and that between individual and personality variables and illness. An interesting figure in this work was Adolf Meyer, who developed a "common-sense psychiatry" that included a life chart relating life events to physical illnesses or disorders. Later work focused either on the effects of single events or types of events or on aggregated effects of a number of life events. Meyer's work eventually led to the development instruments to measure life events and stress. An instrument that Cooper & Dewe describe at length is Holmes and Rahe's Social Readjustment Rating Scale (1967), listing 43 key life events that either reflected a person's life style or occurrences that affected him or her. A Life Change Unit (LCU) could then be calculated to measure whether a cluster of events constituted a crisis. The introduction of such instruments elicited fierce debate centering around the question of whether it was the event itself that was the problem, or the person's perception of the event. The Hassles Scale, including 117 hassles and 135 uplifts, was meant to measure everyday difficulties in life that would better reflect stress- and illness-related processes rather than single events with great impact. The measurement of daily events versus life events elicited another area of debate that concerned confounding of these two types of stressors.

Richard Lazarus is described as the major stress scholar, and the whole of chapter 4 is devoted to his work. His contribution was in the area between the stimulus (the stressor) and the response (the individual's way of coping with the stressor). Lazarus emphasized the need to take into account individual motivational and cognitive differences in responding to events, whether daily or unique. Lazarus' work on appraisal of events eventually led to the conceptualization of emotions as the underlying template influencing appraisal and thereby coping. An important instrument – the Ways of Coping Questionnaire – provided an empirical means of measuring cognitive and behavioral strategies in coping with stressors.

Cooper and Dewe conclude their history with a chapter on work stress and occupational health psychology. The discussion of work stress includes concepts like role conflict, role ambiguity and overload. In the area of intervention the authors discuss coping, self-help and stress management as methods to enhance individual coping strategies. Their background in organizational psychology partly explains the richness of detail in this chapter. Cooper's development of the Occupational Stress Indicator for monitoring organizational health and encouraging engagement in preventive stress management strategies is a convincing example of a state-of the-art instrument in applied psychology. Cooper and Dewe point out that the now relatively mature area of work stress research has provided a framework for the evolution of "creative and ecologically sensitive methods" for measuring and intervening in the area of stress in order to enhance occupational health. In the final chapter, the authors attempt to define what we mean by stress, and what the future of this research can hold. Their final note to the reader concerns the importance of maintaining high ethical standards in research and practice.

In sum, this book provides an interesting overview of the area of stress research, good for the student or scholar interested in the history of scientific ideas. If we return to my bus-neighbor, he clearly suffered from role ambiguity and some sort of inability to cope with this stress. His individual idiosyncrasy in broadcasting his problems to the bus-riders might reflect a coping deficiency. He seemed comfortable with his earphones and warm winter jacket, in a way that would lead me to conjecture that he was not suffering the stress brought on by a life event, but rather an inadequate way of dealing with his daily hassles. Perhaps he did not have enough uplifts, or the fact that he stated a low level of intensity at work left him feeling inadequate. Or else, there was an underlying emotion (depression following his girlfriend having left him recently?).

Cooper & Dewe's book could certainly be used as one of the books in a course on stress research; from a psychological point of view I missed practical information on the body-mind relationship, specifically the effects of psychological factors on physical health, such as that provided in a recent book by a prominent Swedish researcher does (Lundberg & Wentz, 2004). But the authors' ambition has been to provide a history of stress, and that they have done, more than adequately. If the book should be published in a second edition, I would appreciate the enlisting of an expert proofreader, the development of diagrams to make the streams of thought described easier to envision, and the elimination of the numerous quotes that interfere with the smoothness of the reader's experience. I would recommend the authors to try writing in their own words!

 

References

Krantz, G. & Östergren, P.-O. (2001) Double exposure: the combined impact of domestic responsibilities and job strain on common symptoms in employed Swedish women. European Journal of Public Health, 11, 413-419.

Lundberg, U. & Wentz, G. (2004). Stressad hjärna, stressed kropp: Om sambanden mellan psykisk stress och kroppslig ohälsa. [Stressed brain, stressed body: On the relationship between mental stress and bodily ill-health]. Stockholm: Wahlström & Widstrand.

 

© 2004 Anne H. Berman

 

Anne H. Berman, Ph.D., Division of Forensic Psychiatry, Neurotec Department, Karolinska Institutet, Sweden