Stress

The Wear and Tear of Everyday Life

Imran H. Khan and Kajalie Shehreen Islam

It 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.

When 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.

Increased 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 chest pain.”

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 too stressful.”

The 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 not.

Long 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 is stress-causing.

Daily 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.

Both children and adults are exposed to the air and noise pollution of Dhaka city as well as the lack of visual beauty.

Tariq 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 some time.”

Life 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.”

Add 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 stressful cities.

Commuting in Dhaka is not only a daily hassle but may also prove dangerous.

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 at work.

The 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.

Any 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 own life.

Teachers 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 pent-up stress.

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.

People 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.

Stress 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.

For women 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 heart disease.

Coping 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).

Smoking, 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 mind.

Bangladesh Society of Hypertension

S.G.M. 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.

According 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.

At 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 entire treatment.

Dr. Khandker Shahidul Quader, Chief Medical Officer, feels that the main reason for most of the stress related problems is the depressed economy.

Dr. 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 type.

The 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 clinic.
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.

Fees at the Centre

- Registration fees for high blood pressure (new) Tk.150
- Registration fees for high blood pressure (renew) Tk.130
- Family Problem Consultants fee (per visit) Tk. 30
- Consultants fee for registered patients (per visit) Tk. 10
- Charge for ECG for registered patients Tk. 80
- For other Illnesses Tk.140
Registered patients will get a 15% discount on lab tests.

What 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.