In November 2017, two eye surgeons from a hospital in Beirut reported an intriguing case of vision loss in a colleague. A retina specialist had suddenly developed a blur of blurred vision in one eye only a day or two after an intense, intense day in the operating room. This was not the first time it had happened. The surgeon has experienced four such episodes in just one year, each preceded by a stressful day of surgery.
The retinal surgeon has been diagnosed with central serous chorioretinopathy (CSCR). A small amount of fluid had accumulated beneath the tiny area of his retina, causing it to temporarily secrete. The condition resolved in a few weeks and a strict stress management plan prevented another episode from recurring.
First described in 1866, the CSCR has been linked in advance to stress since World War II, when several military cases were recorded. Although subsequent studies have linked CSCR to stress-related mechanistic pathways, it is often referred to as "idiopathic" (arising from unknown cause) unless a trigger other than stress is detected. Deviating from the convention, surgeons noted the status of "Operation Room CSCR", identifying stress as their cause.
Reflecting on what made their colleague vulnerable to stress, surgeons noted that new surgical techniques, made possible with better technology, have stretched the physical boundaries of what a surgeon can do. While this advancement had expanded the scope of surgery, surgery within those limits had placed tremendous mental strain on the surgeon.
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In 1959, Peter Draker's manager predicted a dramatic transition in the nature of work 50 years later. He coined the term for this new kind of work, the "work of knowledge," and suggested that change would involve a transition from physical to mental effort. He later wrote that the center of gravity of the work would shift to "a man who works for the work of what he has between his ears and not the skill of his hands."
The evolution of eye surgery has confirmed some of Drucker's predictions. As technology improves, it translates the physical skills of the surgeon's hands into the mental skills of analysis and concentration.
The evolving nature of work requires less of the body and more of the mind – meaning that the mind becomes a greater victim of occupational hazards
The operating room for ophthalmic surgery is to some extent a microcosm of today's global workplace, where the evolving nature of work requires less of the body and more of the mind. Therefore, the mind becomes an increasing victim of occupational hazards.
According to the UK Health and Safety Executive (HSE), stress, depression or anxiety accounted for 57% of all hospital days in 2017/2018. The increasing leverage of the mind on productivity arouses interest in what may hinder its work. The focus has fallen on stress.
Janos Hugo Bruno "Hans" Celie, a Canadian-Hungarian doctor, laid out the first definition of "stress" in the 1930s. He borrows the word from 17th-century English physicist Robert Hook, whose law of 1658 describes the link between physical stress on material and its aftermath, tension. According to reports, Selye regrets using the word "stress" rather than "stress", which left a legacy of stress with some confusion. It occupies a rare niche in the English language in terms of both cause and effect – itself.
The stress of limiting for several hours increased the number of brain cells of the "newborn" in part of the rat brain
Sally's research has revealed a severe stress reaction built on a rich process tapestry. We know today that bungee jumpers become insulin resistant immediately after a bungee jump, and the stress of teaching 200 students raises inflammatory markers in college educators. These processes offer the advantage of surviving under threat. Temporary insulin resistance, for example, ensures that sugar reaches the brain under duress, while inflammation holds a protective shield against unwanted visitors entering through battle wounds.
The effects of a healthy, acute stress reaction are mostly temporary, ceasing when the stressful experience is over, and any lasting effect can sometimes leave us better than we were before. Studies in rats, for example, have found that the stress of limiting it for a few hours can increase the number of "newborn" brain cells in a part of the rat brain, which may be more consistent with certain types of memory tests.
Stress, which is too frequent, too intense, or constantly present, puts us in prolonged stress. Many participants in the stress response have so-called "dose-dependent" nonlinear actions, which means that their effects alter the course with prolonged activity. As a result, chronic stress causes a gradual, persistent shift in psychological and physiological parameters, which directs the scales towards the disorder in different ways.
The sympathetic and parasympathetic hands of the autonomic nervous system – the neural network controlling involuntary processes such as blood pressure, breathing and digestion – play a major role in orchestrating the acute stress response. During fear or anger, sympathetic activity (responsible for the fight-or-flight response) temporarily increases and parasympathetic activity (emphasizing responses to "rest and absorption") declines. However, if this pattern of activity continues in the absence of stress, it can tilt us to hypertension and other diseases. Similarly, while temporary emotional reactivity in acute stress helps us to predict danger, a sustained change in the dynamics of emotion regulation can direct us to mood disorders.
Chronic stress is suspected to play a role in the increasing global burden of hypertension and type 2 diabetes and is pushing rats into major depression. Confirming observations from animal studies and early human studies suggest that chronic stress may even alter the structure of the brain.
In a first-of-its-kind study, Ivanka Savic and colleagues at the Karolinska Institute in Sweden and Stockholm University recently compared the brains of people with chronic work-related stress to healthy, less stressed colleagues using structural magnetic techniques resonant image. They found a difference in regions active in attention distribution, decision-making, memory, and emotion processing. In stressed faces, the prefrontal cortex appeared thinner, the amygdala appeared thicker, and the caudate nucleus smaller. Thinning in the prefrontal cortex correlates with poorer regulation of emotions.
Quarterly Stress Rehabilitation Program Turns Thin to Prefrontal Cortex
To determine whether chronic stress is simply related to change or caused changes in stressed individuals, the researchers scanned their brains again after a three-month program of stress rehabilitation based on cognitive therapy and breathing exercises. The thinning in the prefrontal cortex was reversed. Although the study had limitations (there was no “untreated stress” control group), this reversal suggested that chronic stress might have worsened. Other studies have found that high circulating levels of the hormone cortisol correlate with poorer memory and thinning in parts of the brain, even at a relatively young age.
These changes may in part be due to the plastic nature of our brains, a manifestation of the brain's exceptional talent for adapting to whatever is required of it. In the midst of battle, for example, increased emotional reactivity is an advantage for survival, while higher cognitive functions become redundant. Re-calibrating the brain's initial state of performance in this way can save the life of a combat soldier. However, in a workplace setting that relies on focus and complex decision-making, however, compromised regulation of emotions and a decline in working memory will limit productivity. The change in the structure of the brain is inadequate.
Chronic stress is often struck psychosocially and is affected by perception. While this makes the empirical study of chronic stress challenging, it also opens up a potential avenue for managing chronic stress: an enriching experience.
One example is the effect of the Romanian. Reproducing the memory of a stressful experience, once it is over, can activate similar pathways in the brain as the actual experience. This can keep the stress response "on" even if the stressor is no longer there and cause the perception of the experience to be more severe than it actually is. Preventing people from experiencing lowers their blood pressure faster after acute stress. Chronic stress is associated with hypertension, and in a small, randomized study, American researchers, including Lynn Klemov of the University of Columbia Medical Center, used stress management training (based on a seminar for cognitive-behavioral groups) to effectively reduce systolic blood pressure in patients with hypertension. The pressure drop correlates with the depression of depressed Romanian.
The perceptual element of stress may be the cause of some body-mind interventions, such as yoga, breathing techniques, and focused mindfulness can benefit from stress management through effects on improving emotional regulation, reducing stress reactivity and accelerating recovery from stress. It may also be explained why some techniques such as mindfulness meditation have shown mixed results in controlled trials. The meditative meditation technique may invite blush and recurrent negative thoughts in some individuals but not others. Perceived stress can vary depending on genetic and epigenetic factors, individual traits, patterns of thinking and behavior, and the journey of life so far.
Condition and control
In some ways, the brain imitates a prediction machine that actively outputs its environment to create a perceived representation of reality. The perception of insecurity, unpredictability or lack of control can signal a flaw in his model of reality and promote stress.
A practical demonstration of this theory lies in the way that stress is moderated by social status. Having a high social status dampens your reaction to psychological distress, but if you think your social status may be challenged, a lower social status may be better. This effect is due to the fact that it is not controlled and may play a role in why competition, inequality and the assessment of feelings can generate stress.
In a predictable world over which you have perfect control, the cause must lead to a predictable effect. The frequent discrepancy between the effort you put in and the reward you get for the effort frustrates that sense of control. Therefore, the 'reward of imbalance of effort' is a source of chronic workplace stress. It is linked to high blood pressure in cleaning rooms at a Las Vegas hotel, burning in police in Buffalo, New York, and metabolic syndrome in a state of Genoa state police officers. The effort to deal with the mismatch between effort and reward on the workday is emotionally exhausting every day and takes away your tax returns. In a study of Australian horse jockeys experiencing high levels of effort-reward imbalance during intense stress related to a decision-making disorder, comparable to that associated with an 8% blood alcohol concentration.
Not only the nature of our social interactions can exacerbate stress. The impact of some aspects of urban life on stress reactivity may also be underestimated. Obviously a "soft" factor such as exposure to nature can accelerate recovery from stress and lower markers of stress. Bright light or blue night exposure late in the evening from the use of LED screens can delay the release of melatonin, a hormone that has been shown to reduce anxiety. Low-intensity exercise reduces circulating cortisol levels, but the need for frequent movement is unnecessary.
Urbanization increases the consumption of processed foods and the ultra-processed diet is associated with the incidence of depressive symptoms in at least two large cohorts. Our eating habits alter the micro-organisms living in the digestive tract, and these micro-organisms through cross-talk with immune cells and other pathways can influence how the mind responds to stress.
There is some evidence that modulating the gut microbiota with specific foods or ingesting probiotics may help reduce anxiety symptoms. Early results suggest that taking one strain or combination of probiotics can reduce mental fatigue and improve cognitive performance during stress – but not in the absence of stress.
At an exhibition in 2015 at the Petit Palais Palace in Paris, Belgian artist Thomas Leroy presented a striking visual metaphor of mental distress in an exhibit cleverly called "Not enough brains to survive." The bronze sculpture depicted a classically beautiful body weighed down by a grotesquely enlarged, rather sad-looking head.
Unlike the Lerooy piece, the human head does not expand and sink on the ground as the stress load increases. Mental fatigue after a complex ophthalmic procedure is invisible. The surgeon does not gasp for air or sweat. The picture, drawn from mental exhaustion, is strikingly abstract compared to the well-known signs of physical exertion.
Mental stress is a factor limiting productivity in an age where physical exertion is increasingly turning into mental exertion. As we move further into the information age, it is time for the chronic stress enigma to finally go into the spotlight.
Mitu Parties have trained as an eye surgeon and studied diseases affecting the visual brain before writing proof of stress: The Ultimate Guide to Living a Stress-Free Life (Hodder / Yellow Kite).