Commentary: Stress can make you stronger if you learn to identify when extra attention is needed

SINGAPORE: The last few weeks have seen growing apprehension as the cases of serious COVID-19 infections and deaths rise nationally.

At our hospital, the national institution for the mentally unwell, we have faced our own coronavirus outbreak. 

The anxiety over whether we could cope with the numbers, which rose rapidly for patients and the staff around them, had my heart pounding every time I thought of the situation. 

This is stress. Stress is the internal reaction to threats to the status quo.

It’s one of the most talked about feelings since COVID-19 struck. About 9 per cent surveyed by the Institute of Mental Health (IMH) between May 2020 and June 2021 reported mild to severe stress while 13 per cent experienced symptoms of anxiety or depression.

WHEN STRESS BECOMES TOXIC

While stress has been thought of as something destructive that we struggle with and makes us ill, it plays a critical, even healthy, role in preparing our minds and bodies for a difficult situation.

Yes, toxic stress can take a toll on our minds and bodies when extreme emotions and symptoms take over, continue for a long time and begin to extend beyond an individual’s control. 

This is especially true during this pandemic in which individuals are isolated, families separated, and work disrupted. Added stress has come from managing kids while working from home and the uncertainty of whether businesses can reopen over these two years.

But chronic stress is slightly different. It can be caused by difficult relationships like when couples fight constantly, or a parent loses their temper with their child regularly. These problems can become associated with abuse and trauma which amplifies the stress. 

Such forms of stress leave people vulnerable to physical and mental illnesses. The body tries to deal with this through releasing chemical messengers called hormones and individual behavioural changes such as trying to escape from their problems and finding ways to defuse the stress. This mechanism is called allostasis.

It’s the same way your body strives to regulate body temperature when you catch a fever or how your stomach maintains its acidic juices.

But like suffering from a long bout of a pernicious virus, longstanding chronic stress can change your biological response. Overloading of your system can lead to a nervous breakdown and physical illness.

WHEN STRESS IS NORMAL AND WHEN IT ISN’T

The reality is that most stress is neither good nor bad. These feelings merely set up a physiological response in our bodies to cope with it.  

The study of stress started with a medical researcher Hans Selye in the 1930s tinkering with rats and observing their hormonal changes when “stressed” with unpleasant environmental manipulation such as drastic changes to temperatures. 

His discovery led the application of this understanding to humans and that the body’s physiological responses after exposure to a variety of stressors can make a person sick if they remain in a persistent state of heightened stress.

However, the body and the brain try to return to the status quo first by using internal body-wide mechanisms to establish control. 

When there is a sensing of danger, we breathe faster, allowing more oxygen to get into our blood stream. Our heart pumps harder to get this oxygen delivered to all vital organs.

This “fight or flight” response prepares us to deal with a coming crisis. This bodily reaction is good for the short term because it prepares us for the coming danger, but if prolonged, will become a problem as the hormones may wear down our organs and literally make us sick.   

Stress is an inevitable part of all life. Famed neuroscientist Robert Sapolsky in his book, Why Zebras Don’t Get Ulcers, explained that a zebra when faced with its natural predator, the large cats, either ends up escaping or being eaten. Both events are short termed.

On the other hand, humans, tend to subject themselves to long-term stress, by over worrying and continuing to subject the body and mind to the stress response.

The immediate dangers are often prolonged in constant worrying and looking out for signs of trouble. This normal physiological response to acute stress becomes prolonged and can result in peptic ulcer disease.   

For example, in a rating scale of student stress, the stress of an increased workload and having a new boyfriend or girlfriend had the same weightage. Yet, young people don’t shy away from relationships just because they are stressful.

HOW STRESS HELPS BUILD RESILIENCE

What distinguishes good stress from bad ones is how it affects people. Good, tolerable stress tends to motivate us and keep us alert to things around us, reaping positive outcomes such as motivating students to study for exams.

Such forms of stress help develop resilience. A well-known study of Romanian children adopted from neglectful and abusive situations go on to have a variety of outcomes.

Some do badly while others do well despite having similar stressful childhoods. Resilience is the result of recovering from stress and becoming stronger. 

Dealing with normal amounts of stress should be a cinch, requiring us to learn to manage challenges in bite-sized packages. Stress comes along, our body recognises it, reacts to it and copes. Our brains may tell us to perhaps take a deeper breath or go for a walk.

Still, as this pandemic demonstrates, there may be novel microbes that surprise our system. For example, we may experience a tragic, traumatic event for which we did not anticipate – a fatal accident, the sudden loss of livelihood that plunges a family into financial distress, or losing a loved one to suicide.

This overwhelms our natural coping mechanisms and we can succumb to its severe effects.

WE NEED TO PROTECT OURSELVES FROM STRESS

Like the COVID-19 vaccine which protects us from SARS-COV-2, we need a type of inoculation to protect us from novel but toxic stress.

Studies around mental resilience show three main ways we can build our defences against the detrimental effects of stress to bounce back from difficult experiences.

First, understanding ourselves better, knowing what our strengths and weaknesses are as well as how we feel about ourselves. 

The introduction of social emotional learning into the curriculum in schools so that every child has the necessary skills to negotiate social situations and relationships beyond the family is underway and will evolve further in 2022.

Mental health education has been included in the curriculum for secondary schools this year to help students understand common mental health issues and how to seek help for themselves and others. An improvement in help-seeking behaviour would be a sign this is working.

Second, focusing on our relationships with others, starting with the family and then extending to our friends and colleagues, helps us build stronger connections to people around us who we can seek help from.

In a study of family resilience, we were able to show that family resilience results in individual resilience. 

Family resilience was shown in the care and concern members had for each other as well as how feelings are managed at home, the sense of meaning and purpose in life and the sharing of common values and beliefs. These are important factors in coping with stress.

Third, we should encourage our personal development, and establish interests, hobbies and ways we achieve a personal sense of meaning and purpose. 

This is in fact one of the sustainable development goals of the United Nations, that of “ensuring healthy lives and promoting wellbeing for all ages”.

Creating supportive community ecosystems that encourage the social compact, neighbourliness, and love for one another can be facilitated by the teaching of emotional literacy in schools and workplaces. 

Emotion regulation, problem solving, mindfulness, interpersonal skills and even stress management training are competencies that can be built on the foundational values of care and concern for one another. 

We can take small steps to remind ourselves of our incredible fortitude and fortunes.

When I worry about what will happen in this next phase of the pandemic, and seeing the stress and burnout reported in the surveys of our workers, I remind myself of our healthcare teams as they do their utmost to contain the infections, manage their lives and turn to each other for care and support. 

In my regular chats with staff, I ask them who they go to for help and invariably, they point to the colleagues around them. 

And then I realise, what doesn’t kill you will indeed make you stronger. 

Daniel Fung is CEO of IMH.