Wear and Tear of Everyday Life
H. Khan and Kajalie Shehreen Islam
is more serious than 'desserts' spelled backwards. Stress
is endured and accepted as part of the rat race of modern
living although it is increasingly taking its toll on
the quality of life of its victims. Everyone -- both
children and adults -- suffers from stress, though in
different ways. Doctors the world over are discovering
new and more harmful effects of being stressed affecting
our health, mind and the society we live in. SWM attempts
to find the causes and effects, symptoms and solutions
to this physiological and psychological syndrome.
Let's start from
the basics. Just what is stress? The dictionary defines
this as pressure or tension, or a physical or mental
strain. This six syllable word has, in its grasps, the
ability to control, in a very negative light, all possible
human activities, moods, and physical and mental state
of being. It is a force of some kind, most definitely
a force fabricated by the mind that can distort, stretch,
twist, compress, or deform the body in some manner.
Stress affects not only the parts of the body but also
the unseen and below-the-surface areas such as the cells.
When you're under stress, your attitudes and viewpoints
are changed and things that were clear are seen as through
a glimmering wave of obscure glass, clouding perceptions,
diminishing self-esteem, and changing your manner of
dealing with others. Tension, illness, squabbles, sleeplessness,
frustration, job burnout, marital breakups, fights with
friends, ill-temper, loss of employment, depression
they have all been positively traced back to stress.
What's more, not only does stress cause these problems,
but they in turn cause stress.
something stressful happens, the body instinctively
sees it as a threat and goes into a fight or flight
mode. In stressful situations, the mind tells the body:
danger is imminent, get ready to run or to fight. Your
body, unaware that there may be no real physical danger,
responds to the message.
cost of living, high rates of crime and the general
environment of unrest wears down Dhaka's citizens.
The usual, random picture of
Dhaka City with its crowded markets and jam-packed streets,
black, smoky air and angry, sweating residents is not
a happy one. Roads blocked by political processions,
building traffic, loud, rude tirades on the microphone
outside one's office window, the lack of visual beauty
and peace, the gaps between the rich and the poor and
the lack of confidence on the inefficient chaotic system,
all wear out the minds and bodies of millions of Dhakaites.
Irritability, meaningless swearing, picking fights for
no major reason, rising crime rates and illness are
the results. What do we call this immense, unwanted
pressure on our everyday lives that take such a toll
on our mental as well as physical well being?
“Stress may be physical or mental,”
says Dr. Md. Obaidul Hoque, Senior Consultant and Head
of the Department of Cardiology at Holy Family Hospital.
“Stress tests are conducted to determine the heart conditions
of patients. Through electrocardiograms and other tests,
says Dr. Hoque, the heartbeat rates of patients are
checked. Normally, rates are supposed to rise with physical
exertion. “We conduct these tests on pilots and sports
people, for example, for their physical fitness, as
well as patients suffering from breathing problems or
Mental stress may also create
physical stress, says Hoque. That is, mental stress
may create pressure on cardiac activity, which in turn
causes heart rates to increase, or it may further aggravate
already present physical problems.
Mental or emotional stress may
be caused by the threat of failure or personal humiliation
or by extreme fears of objects or things associated
with physical threats such as flying, snakes or illness.
“There are so many stress factors
in life in Dhaka,” says Nazia Zaman, a university lecturer.
“The traffic, the pollution, the water crisis, the chaos.
Nothing is done straight or on time. Shops are crowded,
banks have huge queues, the ATMs often don't work. I've
taken so many classes without any electricity. It's
worse for the students who have to attend one class
after the next without any lights or fans, and in this
heat too. This city wasn't built with adequate facilities
for so many people. It's just too over-populated and
circumstances that cause stress are called stressors.
These vary in severity and duration and can be ongoing
or long-term such as caused by the illness of a loved
one or mild and short-term as may be caused when stuck
in a traffic jam. Some situations are stressful for
everyone, such as the death of a loved one, while others
may cause stress to one but not another. An example
may be an upcoming exam -- a student who is prepared
for it will not stress over it as much as one who is
queues everywhere are a stressful reality for all Dhakaites.
Different kinds of stress may
be caused by catastrophes, major life changes and daily
hassles. Catastrophes are sudden, often life-threatening
calamities that push people to the outer limits of their
coping capability. They may be natural disasters such
as earthquakes and floods or wars, torture, automobile
accidents, physical attacks and sexual assault -- disasters
that continue to affect the mental health of victims
long after the event has ended.
Major life changes include the death of a spouse or
family member, divorce, imprisonment, losing one's job
and major physical disability or illness. For adolescents,
any of the above happening to a parent or family member
hassles pertain to our daily lives, jobs, personal relationships
and everyday living circumstances. These seem like minor
irritants we face everyday, but building up cumulatively
day after day, they can cause significant stress. Heavy
traffic, disliking one's co-workers, waiting in queues
and misplacing or losing things can all cause stress
that can build up and affect the mood of the person.
Generally, the greater the exposure to hassles, the
worse a person's mood is.
children and adults are exposed to the air and noise
pollution of Dhaka city as well as the lack of visual
Mohsen, a Bangladeshi student living in the US -- in
Dhaka for the summer -- is stressed by two major things
about life in Dhaka. One, the traffic situation, and
two, the power supply. “The bus service is not at all
good,” says Mohsen. “The buses are not always on time
and it takes hours to get from one place to the other.
And the power failure,” he continues, “causes so many
problems -- no lights, no fans, you can't pump up water.
It's a terrible hassle.” Mohsen also has the usual worries
of a student: college, financial aid, whether he will
be harassed at the airport on his way back -- a common
stressor for many foreigners entering the US these days.
Kawser Khan, a Second Year student of Dhaka University,
also stresses about his future and how stable it will
be, financial problems he may have to face. “Academic
pressure also creates stress,” he says, “and add to
it hall politics at the university which creates a lot
of tension, though you do start getting used to it after
in this city is a constant struggle and reasons for
stressing out are innumerable.
Stress factors vary for different people. While one
person stresses over ensuring the next meal for their
family, another worries about whether they should dye
their hair brown or burgundy. While children stress
over math problems for homework and being popular at
school, adults stress over how their children will turn
out, how their parents are feeling today, getting to
work on time and meeting deadlines.
Ashrafuzzaman Julio, a schoolteacher,
believes that the biggest stressor in Dhaka is that
there is no certainty of life, as much as can be ensured
by humans, that is. “Every time you go out on the street,”
says Julio, “there is a possibility of getting mugged.
If you go to the police, they share the spoils with
muggers instead of helping the victims.” Commuting in
Dhaka city is another major stressor, he says. “The
way you have to travel on the buses can very well lead
to spondalitis. Dhaka has one of the highest air lead
levels in the world and its roads are also very accident-prone.
All these create huge stress on the people living here.”
to this the absence of greenery in most areas of the
city, overcrowding, high levels of sound pollution,
visual eyesores like billboards and haphazard urbanisation
-- all these contribute to making Dhaka one of the most
in Dhaka is not only a daily hassle but may also prove
The manifestations of stress
are evident in numerous ways at the workplace. If you
feel exhausted for no reason, if you not only look forward
eager to the week end but dread Sunday morning, chances
are that your are involved with a stressful situation
lack of sufficient number of skilled people in specialised
areas, making those few selected posts in the corporate
offices some of the most stress prone jobs. It often
happens that a person qualified for one sector has to
deal with problems of two or more areas at the same
time and has to work longer hours to maintain his/her
deadlines. Because s/he will be blamed if something
does go wrong, the stress keeps piling up.
The usual random
picture of Dhaka city with its crowded markets and jam-packed
streets, black, smoky air and stressed out residents
is not a happy one.
super achieving student trying to hold on to straight
A's or trying to comply with their parents' ambitions
for them will know only too well the meaning of stress.
The high level of proficiency expected from students
in the international exams that are pre-requisites for
admissions to topnotch universities, both local and
foreign, are also causes of high stress among high school
and undergraduate students. Studies have found weakened
immune responses among students taking final examinations.
A fiercely competitive academic
scenario does not give a student much room but to go
with the flow and hence, they succumb to stress. Often
the outcome is a nervous, stressed young individual
who, in the worst of situations, is prone to have a
nervous breakdown or turns to drugs and bad company
for comfort. Sometimes the stress gets so much that
the young person cannot cope and therefore takes his/her
too, have to cope with the multi faceted demands of
a large number of their students, juggle school/ college
teaching with private tutoring as well as constantly
improve and comply with the general standards.
In the streets, whenever there
is a dispute about something said or something done,
fists are quick to follow. Violence is all too often
a reflex mechanism. In a city where the law enforcers
are easily bribed, and major or minor law breakers go
scot-free, most people carry a feeling of insecurity
and numb tension that causes a huge amount of stress
in them. It eventually leads to a violent mob mentality
where the offender, if caught by the people, is brutally
tortured and beaten to death by them. The public takes
the law in their own hands as the eventual outlet of
Stress is a normal, adaptive
reaction to threat, signalling danger and preparing
us to take defensive action. We may avoid things we
fear altogether, or we may be motivated to deal with
them better, overcome them and achieve something or
fuel creativity. Uncontrolled stress, however, can lead
to more serious problems. Exposure to chronic stress
can contribute to both physical illnesses such as heart
disease and mental illnesses such as anxiety disorders.
who are stressed remain anxious and have difficulty
concentrating or remembering. Stress may also be apparent
in outward behaviour such as teeth clenching, hand wringing,
pacing, nail biting and so on. Physical differences
such as butterflies in the stomach, cold hands and feet,
dry mouth and increased heart rate are all physiological
effects of stress associated with the emotion of anxiety.
It is being increasingly acknowledged
by physicians that stress is a contributing factor in
a wide variety of health problems including cardiovascular
disorders such as hypertension (high blood pressure);
coronary heart disease (coronary atherosclerosis, or
narrowing of the heart's arteries); and gastrointestinal
disorders, such as ulcers. The release of stress hormones
has a cumulative negative effect on the heart and blood
vessels. Cortisol, for example, increases blood pressure
which can damage the inside of blood vessels while also
increasing the free fatty acids in the bloodstream,
which in turn leads to plaque buildup on the lining
of the blood vessels. As the blood vessels narrow over
time, it becomes increasingly difficult for the heart
to pump sufficient blood through them.
may also be a risk factor in cancer, chronic pain problems
and many other health disorders. Many studies have also
linked stress with decreased immune response. This may
occur in two ways. Stress may alter the immune system
directly through hormonal changes. In addition, people
experiencing stress often engage in behaviour that have
adverse effects on their health such as cigarette smoking,
drinking alcohol or taking drugs, sleeping and exercising
less and eating poorly.
commuters there is no end to stress caused by innumerable
irritants on the streets.
Stress affects mental as well
as physical health. People who experience high levels
of long-term stress and who cope poorly with it may
become irritable, socially withdrawn and emotionally
unstable. People under intense and prolonged stress
may start to suffer from extreme anxiety, depression
or other severe emotional problems. Anxiety disorders
caused by stress may include phobias, panic disorder
and obsessive-compulsive disorder. Survivors of catastrophes
may develop an anxiety disorder called post-traumatic
stress disorder, re-experiencing the traumatic experience
over and over again in dreams or disturbing memories
or flashbacks during the day.
People with certain personality
types seem to be physiologically overresponsive to stress
and therefore more vulnerable to heart disease. For
example, when the so-called Type A personality -- characterised
by competitiveness, impatience and hostility -- experience
stress, their heart rate and blood pressure climb higher
and recovery takes longer than with more easygoing people.
The most “toxic” personality traits of Type A people
are frequent reactions of hostility and anger. These
traits are correlated with an increased risk of coronary
with stress means using thoughts and actions to deal
with stressful situations and lowering one's stress
levels. Psychologists distinguish two broad types of
coping strategies: problem-focused coping and emotion-focused
coping. Problem-focused coping is taking some action
to modify, avoid or minimise the threatening situation
while emotion-focused coping refers to directly moderating
or eliminating unpleasant emotion, for example, by positive
rethinking, relaxation, denial and wishful thinking.
When stressed over an exam, for example, a student may
decide that he needs to relax and collect himself for
a while (emotion-focused coping) before taking action
like organising his notes or a study group to proceed
with studying for the exam (problem-focused coping).
though seen as a stress reliever by many, can actually
aggravate stress in the body.
Studies have shown that social
support systems, that is, close ties with family and
friends help people cope with stress. Biofeedback, a
technique in which people learn voluntary control of
stress-related physiological responses, relaxation and
meditation are all ways to lower stress levels.
Aerobic exercise such as running,
walking and biking can also help keep stress levels
down. An aerobically fit person will have greater endurance
of the heart and lungs and lower heart rate at rest
and blood pressure, less reactivity to and quicker recovery
from stressors. Studies have also shown that people
who exercise regularly have higher self-esteem and suffer
less from anxiety and depression than people who are
not aerobically fit. Healthy diets also aid to keep
stress levels under control. Caffeine, alcohol, nicotine
and sugar can put one's body under chemical stress and
their consumption should be controlled.
People can also take steps to
control their stress levels by avoiding stressful circumstances
altogether or by keeping them in perspective when they
are faced and not giving them too much importance. A
well-balanced diet and exercise, avoiding or eliminating
stress factors such as pollution and untidiness and
having a positive approach towards life in general will
help to keep stress under control. A certain degree
of stress, say the doctors, actually help people to
perform their best.
Laughter, too, is an unsung hero
in the de-stressing process. Watching comedies, reading
humorous writing or just having a good old giggle with
friends can do wonders in smoothing out the stressful
frowns and feelings of being overwhelmed with life.
The idea is to take some time out from our hectic, stressful
lives, to do what gives us pleasure whether it is reading,
listening to music, playing with the dog or just doing
absolutely nothing at all. Stress is most certainly
a mental state and so can be kept under control by the
Society of Hypertension
Chowdhury was the first person to take the initiative
to start and found an experimental 'hypertension clinic'
at the PG Hospital in 1980 while working as a professor
of medicine at the Institute of Post Graduate Medicine
and Research medicine (IPGMR). He realised the seriousness
of the quick spread and the consequences of high blood
pressure, leading to hypertension. In 1982, he shifted
the clinic to Dhaka Medical College Hospital (DMCH)
with the help of some other devoted and enthusiastic
doctors. He treated his patients there free of cost
at that time. He then realised that this disease could
be prevented and controlled through timely consultation
and checkups. In order to expand its reach, the clinic
was finally shifted to the present address 64E Green
Road, Dhaka, and was named Hypertension Centre. In 1996
the centre was renamed S.G.M. Chowdhury Memorial Hypertension
Centre after its late founder.
to the centre hyper pressure is one of the 10 major
reasons of death in Bangladesh. The death rate for this
reason is even greater than that caused by tuberculosis,
diarrhoea and malaria.
the Hypertension Centre the patients are placed in a
one-month programme during which their problems are
identified, analysed and treatment is given. They try
to assess the problems that the patient is facing, their
sources, etc. They also get feedback from their family.
Unfortunately, points out one of the physicians at the
centre, often when patients start to feel a little better
about themselves, they drop out, not completing the
Khandker Shahidul Quader, Chief Medical Officer, feels
that the main reason for most of the stress related
problems is the depressed economy.
Khandker Shahidul Quader, Chief Medical Officer, says,
“The main reason for most of the tension related problems,
which eventually lead to stress is because of the economy.”
Taking inflation as an example, he goes on to say that
the price of things keeps increasing every six months.
The only thing that does not increase to meet with the
increase in prices is the salary of people, especially
the working class. What are the people to do? They have
to manage themselves. In the case of families, the parents
have to think about education and future of their children.
The parents end up sacrificing for their little ones.
Sometimes, it is common that the parents care so much
for their children that they have little time for each
other,” he continues. These too cause stress of a different
clinic is one of a few clinics that give free treatment
to many of its patients. They work according to a budget,
planned yearly for all the work that is done in this
The centre also has its own pathological lab. The bills
for the re-agents (chemicals) that this centre needs
for their test purposes are taken care of by the Rotary
Club. The centre is affordable for people in lower income
groups. Those who cannot afford it are given free treatments.
Everything is done here except for surgery.
Dr. Javed Imam, one of the Medical
Officers at the centre, feels that this centre needs
more recognition and funds to serve the people better.
The centre has about 12,000 patients
registered, with only about 3,000 members still active.
The others have dropped out, “probably being able to
handle their own stress now.” The time for appointments
should be from 9 am to 2 pm. The centre is closed on
Fridays and on government holidays.
The former President of this
Centre is Professor Moniruddin Ahmed. Every Sunday,
a group of people are selected and Prof. Moniruddin
gives them free sessions.
Other medical practitioners who
give their valuable time here are Dr. Azizul K. Chowdhury,
Dr. Javed Imam, Medical Officer, Dr. Imon Sultana, Medical
Officer and many more. Abdul Wajid Chowdhury, one of
the new consultants, is the Gold Medal Winner for Cardiology.
The centre's success is also largely due to the tireless
efforts of its former Honorary Secretary Dr. Ruhul Amin
who died last year. When it comes to expertise, this
place is far ahead compared to other medical centres.
at the Centre
- Registration fees for high
blood pressure (new) Tk.150
- Registration fees for high blood pressure (renew)
- Family Problem Consultants fee (per visit) Tk. 30
- Consultants fee for registered patients (per visit)
- Charge for ECG for registered patients Tk. 80
- For other Illnesses Tk.140
Registered patients will get a 15% discount on lab tests.
should be done to relieve
Hypertension (related to pressure)?
- Keep your weight within limits.
- Walk, play or do activities that work up a sweat.
- Decrease the level of salt in your diet.
- Keep your mind light. Don't worry unnecessarily.
- Don't smoke.