Healthy people, healthy planet

A Field Guide to Stress

[A leading stress researcher describes the discovery that there is a natural and effective way to deal with stress—and that to find it we need to look no further than our own nerve cells or heart muscle.]

Dr. Pelletier holds a Ph.D. in clinical psychology from the University of California at Berkeley. He is Assistant Clinical Professor, Department of Psychiatry, Langley Porter Neuropsychiatric Institute of the University of California School of Medicine, San Francisco, and Director of the Psychosomatic Medicine Clinic (2510 Webster Street, Berkeley, California 94705, 415-548-1115). He is co-author (with Charles Garfield) of Consciousness East and West (New York: Harper & Row, 1976) and the author of Mind as Healer, Mind as Slayer and Towards a Science of Consciousness (New York: Delta/Delacorte, 1975). He is an Advisory Editor of Medical Self-Care Magazine.

Ken has spent most of the past ten years teaching people to prevent stress disorders. As he answers the front door of his redwood shingled house in the Oakland Hills on a bright June morning, he looks as if he’s been following his own advice.

He waves aside my apologies for being late and leads me into a spacious, spotless office overlooking a lower level of the house. There is a wide, deep desk with an answering machine and a long bookcase full of perfectly straightened books arranged by subject. When I compliment him on his impeccable workspace, he smiles and leads me down a short hallway to his “working” office—a cramped, messy little room strewn with books and papers.

As we’re settling in, I notice a framed print of St. George killing a dragon, prominently displayed. Ken tells me that he has recently returned from a two month sailing trip to the Galapagos Islands off the coast of Ecuador, the home of the giant Galapagos tortoises. They are strikingly tame and curious, he says, and will come up and rub against you like a cat. They are totally silent except when making love (“imagine two boulders mating”). Then they let out a roar “like somebody starting a diesel engine.”

TF: How did you first get interested in the ways the mind and body interact?

KP: I guess it was when I took a meditation course on the Berkeley campus in 1967. We read the Bhagavad Gita and the Autobiography of a Yogi, and did a lot of meditation. It got me interested in what optimum health was and how it could be achieved.

Most of your writings since then have cantered around stress. How did you get from meditation to stress?

The meditation interest led me to some research at the University of California School of Medicine in San Francisco. This was back in the days when we weren’t sure if people really could regulate their autonomic nervous system.

We decided to look at people who seemed to have an unusual degree of control of autonomic functions— yoga adepts and experienced meditators. We hooked them up to our machines and found that they really could control their brain waves, their heart rate, their blood pressure. At that point, it struck me that many of the disorders I was seeing clinically might be problems in which a person’s autonomic nervous system is just completely out of control.

You thought the same kind of training might help your patients?

Yes. We asked the yogis and meditators how they’d learned to control their pulse and so on. They said it was just a matter of practice—like learning a new sport or a musical instrument.

What other things could they control?

Brain waves, blood pressure, heart rate, skin conductance, muscle tension, peripheral circulation, and respiration pattern and rate. Besides just looking at these individually, we fed all these simultaneous readings into a computer and looked at the relationships between them.

We were struck at the degree to which our subjects’ patterns were very coherent—when one went up, they all went up. When one went down, they all went down. The systems that controlled all these very different functions were very highly integrated.

How does that compare to a normal person’s response?

Non adept individuals were much more fragmented. Their heart rate would increase, yet their muscle tension would be very low; or their skin conductance would show a big change, but their brain waves would remain the same.

As though their different regulatory systems were out of touch with each other.

Exactly.

If the adepts were more coherent than normals, how did normals compare to people who already had illness problems?

I think it’s mostly just a matter of degree. People who’ve become ill have gotten even more disrupted in their level of functioning. In this context, the adepts could be seen as people who were physiologically superhealthy. So, recently I’ve gotten interested in how one can move from a state of average good health—and all that really means is that you’re going to get sick, grow old, and die along with everyone else of your age, sex, and weight—to a state of more than average health.

When you go through an annual physical and your doctor pronounces you healthy, that only means you’re average. The really exciting question, and one that a lot of people are beginning to ask, is how can you become more highly integrated than average, in the way that the adepts and meditators certainly were.

Can you give an example of how someone might develop an illness as a result of the kind of imbalance you’re talking about?

Whew! It took me a whole book to try to do that! What I tried to do in Mind as Healer, Mind as Slayer, was to show how we move from a state of relative health to a manifest disorder. That’s where stress comes in.

What we found in our research is that there are two kinds of stress, short-term and long-term. Short term we can take. That’s the kind we share with every other biological organism. We react in a certain way when we’re in a threatening situation.

Like when I came to the branch in the freeway on the way over here and didn’t know which war to go.

Exactly! So what was your experience at that point?

Well, I realised I didn’t know which turn to take, so I decided just to stay in the lane I was in. After I was past the junction, I let out a long breath.

You had a feeling of relief, of release?

Yes. The point was passed. Even though, as it turned out, I’d chosen the wrong turn.

That’s what happens with short-term stress. You encounter a stressor, you deal with it, and then there’s a period of relaxation.

Point 1 is your baseline level before the stress. Point 2 is the stress reaction that’s been so well described by Selye (The Stress of Life). It corresponds to the firing of the sympathetic nervous system. Point 3 is the period of compensatory relaxation after the stress has passed. This corresponds to the firing of the parasympathetic nervous system. Point 4 is the return to baseline.

So that’s the normal, healthy way of reacting to stress.
Yes. The long-term kind is what gives us trouble. This is a kind of stress that doesn’t go away as easily as a turn on the freeway: job stress; family stress; emotional conflicts; money difficulties. All the vague but ever present problems and worries. There’s no end point, no clear resolution to that kind of stress.

What happens physiologically is that all the bodily functions accelerate as though your life were in danger, and they stay elevated, without release. We experience it as anxiety, frustration, tension, and worry. If we were to hook someone in this kind of worry pattern up to a monitor, we’d see something like this:

They continue at a level of high excitation without the compensatory relaxation phase. This is the kind of biological stress pattern that leads to disease.

So what would the yogi or meditator do in the same situation?

What they’ve learned is to more clearly identify when the reaction is no longer necessary. They
would experience the same stimuli as a series of discrete short-term stresses:

The striking thing about this pattern is that it looks almost exactly like the EKG tracing of a series of heartbeats. What’s missing in the chronic worry pattern is the parasympathetic rebound, the relaxation phase. What the yogis have learned to do is to induce this phase. To let go of those excess levels of self-stressing neurophysiological activity and simply quiet themselves down.

They can intentionally produce the “Whew!” phase of the short-term stress reaction.

Yes. Then it is possible to come back to the baseline level and continue on. When we get into the chronic stress pattern it feels like there’s not going to be any end point.

You can think of your body as being naive. It can’t tell if your life is really in danger or if you’re just thinking as if your life were in danger. The fear of losing your job might feel just as threatening as if a speeding truck were coming at you. You might react this way to a nagging creditor or to your income tax coming due. Whatever the cause, you go up above the line, and before you can come back down, the next stressor hits—a job deadline, a family problem. And you go right back up again.

How long can that pattern go on?

A long time! In someone with a real chronic stress pattern, the only thing that’s going to break the cycle is some kind of illness experience. You then see a very sharp drop:

This represents a state of complete nervous exhaustion, a nervous breakdown, a heart attack, a debilitating headache, an alcoholic binge—it can be any number of things.

Everybody has his or her own favorite way to break the pattern.

Exactly—and it’s very often illness, because when you’re sick there is a very different set of demands placed upon you. It’s now okay to stay in bed and just take it easy.

How possible is it to predict who will get what diseases?

I think it’s possible to some degree. The Friedman and Rosenman book (Type A Behavior and Your Heart) looks at the relation between personality and heart disease and cancer, respectively. I’ve reviewed the relationships between these two diseases as well as migraine and arthritis in Mind as Healer.

So people do have their own favorite illnesses.

Oh, yes. The same stress level that might produce a headache in one person might produce a heart attack in another or gastrointestinal trouble in a third. Certain families, both genetically and behaviorally, will predispose to certain illnesses. Your environment will predispose you one way or another. So will your lifestyle.

One thing that’s struck me about your work, Ken, is that many people with similar interests have become interested in ways of working that have taken them a long way from the research lab or the traditional medical clinic. You’ve chosen to stay very close to the approaches and techniques of traditional research and clinical practice. Could you comment on that?

One of the things I’ve been trying to do, almost insidiously, is to stay very conservative in my approach. The data is there, in the psychological research literature. You don’t have to go look at far-out things. You don’t have to guess; you don’t have to speculate. You don’t need to have far-out theories. This area is easily approached with the traditional tools.

So I’ve limited myself to citing from the Journal of the American Medical Association, Annals of Internal Medicine, Archives of General Psychiatry, or Science—which, by the way, has devoted an entire issue (May 26, 1978) to health maintenance and contains some of the best articles and most radical statements you will ever see on the need for a new way of looking at medical care.

I’ve tried to stay within the scientific medical tradition to see whether medicine really is incapable of dealing with these kinds of issues or whether there’s simply a huge body of literature that has been ignored.

By and large, it comes down to the fact that the information is there in the journals, and it’s been largely ignored and overlooked. This stuff is as compatible with medical practice as anything you can imagine—that’s what makes me so optimistic that this is a valid direction for medicine. We’re not trying to set up some wild alternative. In fact, it’s probably more consistent with the roots of medicine than the biomedical fixation of the last thirty or forty years.

The most exciting thing about this work is that once you get people moving in the direction of health, they don’t want to stop at just being ‘`normal.” They keep going toward becoming much healthier than average.

What are some of the ways to break the chronic stress pattern?

I think the main ways are stress management, diet, and exercise. There seems to be a real synergistic effect among these three. If you start exercising, it breaks up both physical and mental tension. There’s a slide I use that shows all the supposed effects of drugs that lower blood pressure on one side and the effect of light exercise on the other. The physiological changes produced by exercise are comparable if not greater than those brought about by the drug.

As any runner could tell you.

Right! That’s the kind of thing that we, living in the Bay Area, have somehow picked up; but do you know that it’s never mentioned in the literature? It’s not taught in medical schools—and that’s really the status of most of this information. It’s there, but it’s not known. There are damn few doctors that will put a newly diagnosed hypertensive on a running program.

There’s a kind of conceptual shift that a person can undergo, so that afterward, things that were considered highly stressful are no longer perceived as so potentially perilous. Friedman mentions that a good proportion of post-heart-attack patients spontaneously go through such a shift after their heart attack. When he has asked them what kind of process it was, they say something like, “I just looked at all the things that used to bug me, and I said to hell with it.”

I hear that from patients all the time. That’s the kind of change we’re trying to learn to produce—how to help people learn to decide whether a given event is life-threatening or not. If it is a life-threatening event, you’d better be glad you’ve got all these psycho-biological mechanisms. If a car is coming at you, they give you the energy to jump out of the way.

It’s a mistake, then, to think that all stress is bad.

Right. The error comes in when you start interpreting relatively nonthreatening situations—like balancing your checkbook or dealing with a certain person—as though they were life-threatening. Then you are creating the crisis in that life-event. All the same responses take place as if a car were coming at you at eighty miles an hour.

I think you can achieve that conceptual shift in any number of ways, one of which is through the painful, involuntary way of a severe illness that forces you to look at your values. That’s why I think illness can be a very creative experience—a potential source of regeneration and renewal instead of just a breakdown.

Severe illness is one way to get that conceptual shift, or you can take a more preventive approach—become aware of the problem and make conscious changes.

How about paying attention to early symptoms, before an illness gets to a serious stage?

Definitely. There are usually many symptoms before the heart attack. The one thing you can count on is that if you ignore the symptoms, the body will up the ante. The next symptom will be more serious if the first is ignored, until finally, the body can do nothing but give out.

Most people think the symptom is the illness. It’s not. The symptom is often very useful, telling you that you’ve pushed yourself beyond a level of healthy functioning. Too many people miss the early signals and get the opportunity to examine their lives—perhaps for the first time—at the cost of a serious illness.

To get back to what people can do . . . what can people do?

Aha, the big question! What can you do other than becoming ill? Well, I guess some kind of centering or meditation—in a very wide meaning of the term.

Any activity that you have in your life can be used as a meditation. It can be looking at a mandala, doing a mantra, sex, prayer, walking, running—it can be anything.

Listening to Bach?

Exactly. Any activity that you can invest with prolonged and focused attention can be a form of meditation. Biofeedback is simply machine-assisted meditation.
Would you say that meditation is a way of intentionally inducing this post-stress period of relaxation that brings you hack to normal tension levels?

Yes. The upswing is the sympathetic component. The dip, which corresponds to the S component of an EKG recording of a heartbeat, is the parasympathetic rebound. It’s a compensatory period of relaxation or deactivation that’s characteristic of every single nerve cell, every single muscle cell in the body. That cycle of up, down, and return to baseline almost exactly describes the electrical activity of the heart during one heartbeat. To me, this pattern is a source of real wisdom, because it gives us, with every beat of the heart, with the firing of every nerve cell in the body, a demonstration of the optimum response to the environment.

It’s all very consistent with the Zen philosophy in which you perceive an event, react to it, and then let it go. The neurological pattern is a perfect correlate to this philosophical view, which I think is really fascinating.

It’s nice when so many things start coming together. Everything in this kind of work keeps coming back to some idea of individual . . . I don’t know quite what to call it responsibility is laden with so many unfortunate connotations.

Self-care.

Self-care! That’s it. It’s just paying attention to a beneficial way of living your life so that your exchanges and interactions with other people are loving and caring, and your attitudes to your self are that way, too. The kind of meditation we’ve been talking about is a fine way to come at it—although people come to it by very different roads. For some people, paying attention to nutrition leads to paying attention to other areas of their life. Others come at it through exercise. They realize that they can’t even run around the block if they’re feeling tense, and they get interested in meditation. Another person might start meditating and then realize, “Wow, I really don’t like that gut hanging over my belt.” Suddenly this person is into considerations of diet and weight. It’s really a very organic, unified process of discovery.

Paying attention.

Paying attention. Investing your life with attention. Was it Socrates who said, “The unexamined life is the unlived life,” or something like that?

That’s it. Meditation, biofeedback, relaxation methods, autogenic training—they all allow you to take a break from a cumulative, destructive cycle and to induce the parasympathetic rebound with all its attendant- slowing down and relaxing effects. On a psychological level, it’s taking that break, taking time to see why you’re involved in a particular phase of the rat race and whether you want to stay involved.

Another thing, too—all these things should be fun. Too many people are so dour. They’re going to be healthy if it kills them. The person who drives himself to jog and hates it. The person who eats so austerely and with such a restricted diet that it’s really masochistic. The person who insists on meditating half an hour twice a day whether it really fits into his life or not.

They’re equally not paying attention.

Yes, because when you’re doing it right, there’s a spark, an element of vitality, of discovery, that makes it really exciting. You’ve got to follow the little messages from inside that tell you what’s right for you, no matter what any expert says. If that spark’s not there, you’re sunk. no matter what you do.

Tom Ferguson MD Written by Tom Ferguson MD