Richard OConnor - Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21stCentury Illness

Table of Contents

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Copyright 2005 by Richard OConnor.

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Library of Congress Cataloging-in-Publication Data

OConnor, Richard, Ph.D.

Undoing perpetual stress : the missing connection between depression, anxiety, and 21st century illness / by Richard OConnor. p. cm.

Includes bibliographical references and index.

eISBN : 978-1-101-09916-2

1. Stress management. 2. Stress (Psychology) 3. Anxiety. 4. Civilization, Modern21st centuryHealth aspects. I. Title.

RA785.O296 2005

155.9042dc22

2004057081

I owe a very real debt to two very good friends and skilled therapistsHope Payson and Helen Bray-Garretsonwho read early versions of the manuscript and gave me valuable encouragement and direction. In fact, many of the ideas in this book were initially hatched during case discussions with them, and they deserve more credit than I can really give here. I also owe a great deal to Irwin Hoffman and Paul Lippmann, who, at different times in my life, helped me keep going through dark periods but did it in such a way that it stimulated my own search for answers.

My agent, Jim Levine, has become a friend, critic, and independent source of valuable ideas; not bad for one guy. Christine Zika, my editor at Berkley, has been very patient and helpful; once she finally saw the manuscript, her evident and sincere liking for the book has helped sustain me through the last dreary stages of cutting and polishing; and her editorial advice was good too. Sheila Moody, the copyeditor, did an outstanding job on a complicated book.

My biggest source of inspiration is my patients. Youll meet some of them in these pages, in disguised form. Their storiesand those of all my patientsare profoundly moving. Its not that I attract a rare breed, but that the process of therapy brings two people close in such a way that they cant help but be moved. Most of my patients these days suffer from depression; I find these people so courageous, so generous, so kind and loving that I truly wish they could see themselves through my eyes. Writing a book like this is an attempt.

Since the time of my first book and this one the Internet has arrived, making the unaffiliated authors life a lot simpler; so I would like to express my gratitude to PubMed and MedLine, the American Psychological Associations online database, Amazon, and the United Parcel Service.

Im not a neurologist, nor even a biological scientist, so there may be some mistakes in the way I present the brain, nervous system, and stress response system. Ive relied on some new giants in these fieldsRobert Sapolsky, Allan Schore, Antonio Damasio, Joseph LeDoux, Bruce McEwen, Daniel Siegel, Jeffrey Schwartzfor the best information I could obtain. If there are errors they are mine alone, and I hope they are not fatal to the points Im trying to establish here. I feel slightly more confident of my skills as a social scientist, but of course my ideas are based on or influenced by manyPhilip Cushman, David Buss, Martin Seligman, Daniel Goleman, Mihalyi Csikszentmihalyi, Judith Herman, David Myers, Deborah Tannento name only the most prominent influences. I dont expect that all these individuals will agree with every idea of mine in relation to their work but I sincerely hope that I have understood their positions and treated them fairly. Finally, I should be most confident of my skills as a therapist, but here again I feel that Im standing on the shoulders of giants: Irwin Hoffman, Marsha Linehan, Stephen Mitchell, Zindel Segal, Jeremy Safran, Barry Magid, James Mann, Jerome Frank, Paul Wachtel, Mark Epstein are some. I think Ive stated their ideas clearly, but some of the conclusions Ive drawn are, again, strictly my own.

My wife, Robin, has been my biggest cheerleader, source of support and structure, and skilled editor and wordsmith. Shes been extremely patient as I spent long winter nights shut up in the study. In our earlier days together, when it was necessary, she literally kept me alive. What more can you say?

THIS is a long book, and some parts of it are complex, but the major ideas are simple. Let me state them first, explain them a little, and then give the reader some orientation about how this book is organized.

There are two major ideas.

The first major idea is that our nervous systems are not built for the stresses of the twenty-first century. This is a result of exponential change in both the nature of the stresses we face and how we are trained (by parents, schools, mass media, popular culture) to face them. At the same time, there are powerful influences that keep telling us this is a wonderful world and we ought to be happy and healthy. The result is a conflict between how we really feel and how we think we should feelwhich is another major stress. In an effort to cope, we develop what I call the Perpetual Stress Responsethe fight-or-flight response stuck in the on position. We become caught in a vicious circle in which the effects of stress on our minds damage our bodies and brains in a measurable, physical way; and these physical changes further affect our mindsthe way we think, feel, and relatein an invisible, unconscious way. Physical and mental, observable and unconsciousthese injuries reinforce each other, trapping us in a cycle from which there seems to be no escape. We feel the effects of perpetual stress in many different ways: as depression and anxiety; as physical symptoms; as motivations for addictions; as dysfunctional relationships; and as empty, unhappy lives.