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George S. Everly - A Clinical Guide to the Treatment of the Human Stress Response

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A Clinical Guide to the Treatment of the Human Stress Response
Author:
George S Everly / Jr and Jeffrey M Lating
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Springer New York, New York, NY
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Books / Science
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Part 1
PART1

George S. Everly, Jr. and Jeffrey M. Lating A Clinical Guide to the Treatment of the Human Stress Response 3rd ed. 2013 10.1007/978-1-4614-5538-7_1 Springer Science+Business Media New York 2013

1. The Concept of Stress

George S. Everly Jr. 1 and Jeffrey M. Lating 2

(1)

School of Medicine, The Johns Hopkins University, Severna Park, MD, USA

(2)

Loyola University Mayland, Baltimore, MD, USA

Jeffrey M. Lating

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Abstract

Scientists investigating human health and disease are now reformulating the basic tenets upon which disease theory is based. For generations, the delivery of health care services was built upon the one-germ, one-disease, one-treatment formulations that arose from the work of Louis Pasteur. Although clearly one of the great advances in medicine, yielding massive gains against the infectious diseases that plagued humanity, the germ theory of disease also represents an intellectual quagmire that threatens to entrap us in a unidimensional quest to improve human health.

To study medicine without reading is like sailing an uncharted sea.Sir William Osler, M.D.

Stress, Behavior, and Health

The germ theory of disease ignores the fact that by the year 1960, the primary causes of death in the USA were no longer microbial in nature. Rather, other pathogenic factors had emerged. Even four decades ago, it was noted, New knowledge has increased the recognition that the etiology of poor health is multifactorial. The virulence of infection interacts with the particular susceptibility of the host (American Psychological Association, , p. 264). Thus, in addition to mere exposure to a pathogen, ones overall risk of ill health seems also to be greatly influenced by other factors. Recent evidence points toward health-related behavior patterns and overall lifestyle as important health determinants.

The significance of health-related behavior in the overall determination of health status is cogently discussed by Jonas Salk () in his treatise The Survival of the Wisest. Salk argues that we are leaving the era in which the greatest threat to human health was microbial disease, only to enter an era in which the greatest threat to human health resides in humanity itself. He emphasizes that we must actively confront health-eroding practices such as pollution, sedentary lifestyles, diets void of nutrients, and practices that disregard the fundamentals of personal and interpersonal hygiene at the same time that we endeavor to treat disease.

Stress! While this word is relatively new in the English lexicon, few words have had such far-reaching implications. Evidence of the adverse effects of stress is well documented in innumerable sources. Homers Iliad describes the symptoms of posttraumatic stress as suffered by Achilles. In The New Testament , Acts, , describes what may be the sudden death syndrome as it befell Ananias and his wife Saphira, after being confronted by Peter the Apostle, for withholding money intended for missionary service.

Excessive stress has emerged as a significant challenge to public health. More than 30 years ago, the Office of the US Surgeon General declared that when stress reaches excessive proportions, psychological changes can be so dramatic as to have serious implications for both mental and physical health (US Public Health Service, ) revealed that mental illnesses represent a significant contributor to the burden of global disease in high-income and low- and middle-income countries. The disability-adjusted life year (DALY) represents the number of years of life lost to premature death and disability; the disease burdens are listed by selected illnesses for high-income countries:

Ischemic heart disease	12.39 DALY
Cerebrovascular disease	9.35 DALY
Unipolar depressive disorders	8.41 DALY
Alzheimers disease and other dementias	7.47 DALY
Trachea, bronchus, lung cancers	5.40 DALY
Hearing loss, adult onset	5.39 DALY
Chronic obstructive pulmonary disease	5.28 DALY
Diabetes mellitus	4.19 DALY
Alcohol use disorders	4.17 DALY
Osteoarthritis	3.79 DALY
Ten leading causes of burden of disease (DALYs) by high income group, 2001

It should be noted that mental illnesses not only rank as the third most burdensome disease process but also consistent with the observations of Salk ( underscores the role that stress may play as a public health challenge.

Table 1.1

Stress and trauma as public health challenge

Recent evidence suggests that 82.8% of adults in the USA will be exposed to a traumatic event during their lifetime (Breslau, )

Suicide rates in the military seem to be increasing (Kang & Bullman, )

Twelve-month DSM-IV disorders are highly prevalent in the USA, with 14% experiencing moderate to severe cases (Kessler, Chiu, Demler, & Walters, )

Suicide was the tenth leading cause of death in the USA in 2007 and an estimated 11 attempted suicides occur per every suicide death

An elevated rate of major depression was equal to the rate of PTSD in New York City residents several months after the attacks on the World Trade Center of September 11, 2001 (Galea et al., )

Rates of trauma occurrence related to violence, injury/shock trauma, trauma to others, and unexpected death peaked sharply at age 1620 years (Breslau, )

The lifetime prevalence of criminal victimization was assessed among female health management organization patients and found to be about 57%

In 2001, the terrorist attacks against the World Trade Center and the Pentagon focus terrorism against the USA

Of 2050 American Airlines (AA) flight attendants, 18.2% reported symptoms consistent with probable posttraumatic stress disorder (PTSD) in the aftermath of the September 11 attacks (Lating, Sherman, Everly, Lowry, & Peragine, )

Clearly, trauma and stress are at epidemic proportions in the USA. It seems clear that such conditions represent a clear and present danger to the psychological health of American society

Perhaps of greatest concern, from a public health perspective is the realization that veterans returning from military service in Iraq and Afghanistan are returning home with a high prevalence of PTSD and PTSD-like syndromes. A recent review of 29 published studies revealed varying estimates of PTSD. Among previously deployed personnel not seeking treatment, most prevalence estimates range from 5 to 20%. Prevalence estimates are generally higher among those seeking treatment: As many as 50% of veterans seeking treatment screen positive for PTSDCombat exposure is the only correlate consistently associated with PTSD (Ramchand et al., , p. 59)

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