Handbook of Stress, 2nd Ed

THE FREE PRESS

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Copyright © 1982, 1993 by The Free Press

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Library of Congress Cataloging-in-Publication Data

Handbook of stress : theoretical and clinical aspects/edited by Leo Goldberger and Shlomo Breznitz.—2nd ed.

p.  cm.

Includes bibliographical references and index.

ISBN 0-02-912035-7 (cloth)   —ISBN 0-02-912036-5 (pbk.)

eISBN: 978-1-451-60233-3

1. Stress (Psychology)  2. Stress (Physiology)  I. Goldberger, Leo.  II. Breznitz, Shlomo.

[DNLM: 1. Psychophysiologic Disorders—etiology—handbooks. 2. Stress, Psychological—handbooks.   WM 34 H2364]

BF575.S75H35   1993

155.9′042—dc20

DNLM/DLC

for Library of Congress   92-23125

CIP

This book is dedicated to

Nancy, Zvia, Jessica, Danny, Ruthie, and Nurit

And to the memory of

Eugene Goldberger

Preface to the Second Edition

Preface to the First Edition

About the Contributors

Part I. Introduction

Chapter 1. Shlomo Breznitz and Leo Goldberger: Stress Research at a Crossroads

Chapter 2. Hans Selye: History of the Stress Concept

Part II. Basic Psychological Processes

Chapter 3. Richard S. Lazarus: Why We Should Think of Stress as a Subset of Emotion

Chapter 4. George Mandler: Thought, Memory, and Learning: Effects of Emotional Stress

Chapter 5. Irving L. Janis: Decisionmaking under Stress

Part III. Basic Biological Processes

Chapter 6. Suzanne C. Ouellette: Inquiries into Hardiness

Chapter 7. Bruce S. McEwen and Scott Mendelson: Effects of Stress on the Neurochemistry and Morphology of the Brain: Counter-regulation versus Damage

Chapter 8. Marvin Stein and Andrew H. Miller: Stress, the Immune System, and Health and Illness

Chapter 9. Edward S. Katkin, Susan Dermit, and Susan K. F. Wine: Psychophysiological Assessment of Stress

Part IV. Measurement of Stress and Coping

Chapter 10. Thomas W. Miller: The Assessment of Stressful Life Events

Chapter 11. Bruce P. Dohrenwend, Karen G. Raphael, Sharon Schwartz, Ann Stueve, and Andrew Skodol: The Structured Event Probe and Narrative Rating Method for Measuring Stressful Life Events

Chapter 12. Leonard R. Derogatis and Helen L. Coons: Self-report Measures of Stress

Chapter 13. Rudolf H. Moos and Jeanne A. Schaefer: Coping Resources and Processes: Current Concepts and Measures

Chapter 14. Norma Haan: The Assessment of Coping, Defense, and Stress

Chapter 15. Aron Wolfe Siegman: Paraverbal Correlates of Stress: Implications for Stress Identification and Management

Part V. Common Stressors

A. Environmental and Social Sources

Chapter 16. Leonard I. Pearlin: The Social Contexts of Stress

Chapter 17. Eric Graig: Stress as a Consequence of the Urban Physical Environment

Chapter 18. Leo Goldberger: Sensory Deprivation and Overload

Chapter 19. Robert R. Holt: Occupational Stress

Chapter 20. Rena L. Repetti: The Effects of Workload and the Social Environment at Work on Health

B. Sociocultural and Developmental Sources

Chapter 21. Ayala M. Pines: Burnout

Chapter 22. Paul T. Costa, Jr. and Robert R. McCrae: Psychological Stress and Coping in Old Age

Chapter 23. Marjorie Fiske: Challenge and Defeat: Stability and Change in Adulthood

Chapter 24. Rosalind C. Barnett: Multiple Roles, Gender, and Psychological Distress

Part VI. Common Psychiatric and Somatic Conditions

Chapter 25. Ray H. Rosenman: Relationships of the Type A Behavior Pattern with Coronary Heart Disease

Chapter 26. Judith Godwin Rabkin: Stress and Psychiatric Disorders

Chapter 27. Francis Creed: Stress and Psychosomatic Disorders

Chapter 28. Shelley E. Taylor and Lisa G. Aspinwall: Coping with Chronic Illness

Chapter 29. Herbert S. Peyser: Stress, Ethyl Alcohol, and Alcoholism

Chapter 30. Rand J. Gruen: Stress and Depression: Toward the Development of Integrative Models

Part VII. Extreme Stressors

Chapter 31. Robert S. Pynoos, Susan B. Sorenson, and Alan M. Steinberg: Interpersonal Violence and Traumatic Stress Reactions

Chapter 32. Lars Weisæth: Disasters: Psychological and Psychiatric Aspects

Chapter 33. Leo Eitinger and Ellinor F. Major: Stress of the Holocaust

Chapter 34. Judith T. Shuval: Migration and Stress

Chapter 35. Susan Folkman: Psychosocial Effects of HIV Infection

Part VIII. Treatments and Supports

Chapter 36. Steven E. Hobfoll and Alan Vaux: Social Support: Resources and Context

Chapter 37. Donald Meichenbaum and Deborah Fitzpatrick: A Constructivist Narrative Perspective on Stress and Coping: Stress Inoculation Applications

Chapter 38. Johann M. Stoyva and John G. Carlson: A Coping/ Rest Model of Relaxation and Stress Management

Chapter 39. Mardi J. Horowitz, Nigel P. Field, and Catherine C. Classen: Stress Response Syndromes and Their Treatment

Author Index

Subject Index

A ten-year span between two editions of a general handbook is a long time for most disciplines, but especially in a field such as ours. The proliferation of research in the area of stress makes the attempt to survey its course since the publication of the first edition in 1982 both difficult and rewarding. The volume of stress-related studies is, indeed, staggering and is continuously on the rise. In some ways this reflects the popular belief that ours is the era of stress. It may well be that the fuzziness of the definition of stress is conducive to the spread of stress-focused research, because hardly any aspect of human interaction with the environment is entirely stress free.

We believe that the time is more than ripe for a new edition. While we cannot pretend to have a historical perspective on the main directions of inquiry, we can offer the student of stress a significant cross-section of current developments; a state-of-the-art overview of a number of significant and substantive research areas in the stress/coping domain prepared by some of the most respected authorities in the field.

In planning the new edition of the Handbook of Stress our initial aim was simply to invite each of the original contributors to revise and update their chapters. However, it became increasingly clear that this would not be feasible in most instances, nor did we deem it an optimal choice. For one thing, several of our original authors were no longer alive: the father of the modern stress concept, Hans Selye, was gone; the seminal contributions of Irving Janis, Norma Haan, and Harold Proshansky were now but a legacy as well. By and large, their original chapters—along with a few additional ones—had stood the test of time so well that they could be reprinted without revision as classics. In addition, in some instances our original contributors were no longer active in the field or declined our invitation to update their original chapters, though several of our original authors did write completely new and updated chapters—such as Chapters 4, 11, 12, 15, 25, 29, 34, 37, 38 and 39.

An overriding concern was our attempt to increase the usefulness of the current handbook by including at least some representation of newer conceptions, methodological and measurement issues, and overviews of some of the more specialized areas, deemed to be at the cutting edge, in our field. In addition, for some of the topics treated in the first edition, we chose to broaden the perspective by inviting a completely fresh chapter by another expert.

Consequently, the current Handbook of Stress is a substantially new book. Though the chapters are still organized around the seven major headings in the 1982 edition, the reader will confront an array of new chapters and, in most instances, new contributors. In fact, with the exception of the half dozen classic chapters, this handbook might well be regarded as a companion rather than a replacement for the original volume.

As in the first edition, the choice of topics for inclusion in the current handbook is constrained by the inevitable space limitation of a one-volume reference work. Had we striven for genuine comprehensiveness, we would undoubtedly be faulted by critics as too sketchy. It is clearly impossible to cover the entire panoply of the stress field and do justice to each topic. Consequently, some topics were left by the wayside. For example (and most obviously) chapters on infancy, childhood and family stressors, and the vast domain of sociocultural variables are clearly missing in the handbook. Equally obvious is the fact that the achievement of organic unity by imposition of some sort of shared conceptual scheme for each contributor to follow is artificial, if not unwise. In our view, the vitality of the field inheres precisely in its theoretical diversity, multiple levels of complexity, and potential for emergent ideas as a function of cross-disciplinary fertilization.

The opportunity to take a broader look at one’s field of inquiry is rare. The publication of the second edition of the handbook presents such an opportunity. In order to illustrate the contrast between stress research as it appeared a decade ago and as it appears today, we decided to keep our introductory chapter in its original form, but we wish here, in the Preface, to draw the reader’s attention to some important recent themes that characterize the stress field as a whole and that have found representation in the current volume as well. The themes do not signal a dramatic departure from earlier trends, but may perhaps be viewed as shifts in emphasis and as pointers to the road ahead.

Issues of definition, so central to most discussions of stress just a decade ago, now appear to be of lesser import. This change is not to be understood as a reflection of greater clarity of the concepts, nor does it suggest an emerging consensus. We would like to think that, as our discipline begins to mature, there is a corresponding growth in the tolerance of its inherent ambiguities.

Yet another indication that the stress field is gradually leaving behind the naive quest for simplicity are the models that are being used by most of the researchers in the field. Gone is the simple environmentally induced stressor and its equally simple corresponding stress response. A host of mediators and intervening variables have now replaced those earlier formulations. For example, one can note a renaissance of interest in personality and individual differences. Researchers have also begun to distinguish between and specify antecedent variables, immediate and long-term reactions within their conceptual and causal flowcharts. The prevalent working assumption is that a multilevel, multidimensional approach is a must.

Furthermore, Lazarus’s call for transactional models is certainly gaining support; much of current stress research follows his formulations. Specifically, there is a growing awareness of the need for process-oriented research design, with multiple measures of the key variables.

The methodological sophistication of a significant number of studies appears now to be much greater. This increased rigor reflects awareness of the pitfalls of response contamination, social desirability, and the overall shortcomings of a single-source methodology. Internal reliability of the multitude of measures used, either as independent or dependent variables, is another concern that is being addressed more seriously than before.

Life events scales, so abundant in stress research, are becoming increasingly refined by using the respondents’ subjective appraisal of event stressfulness or by taking into consideration situational and personal factors that influence the context of the threat and the variability within event categories. This trend has gone a long way toward bridging the initial, pure stimulus conception and the in-depth clinical interview approach. There has been a corresponding increase in the strength of the correlations found between life events and disorders.

Perhaps the most notable change in emphasis is the growing impact of the biological sciences. Two prominent examples of that influence are the emergence of psychoneuroimmunology and the study of stress-related brain chemistry. Recent technological developments of brain imaging techniques, specifically those like PET and SPECT that allow online study of physiological changes in the active brain, may well turn out to be the next bridge between neuroscience and stress research (and a good candidate for a new chapter in the next edition of the Handbook of Stress).

Finally, we should mention the apparent resurgence of interest in the traditional topic of emotions and its manifold spectrum. This new popularity suggests that, in the future, stress (essentially comprising the so-called negative emotions) will no longer be viewed as a peculiarly isolated rubric of uncertain conceptual lineage, but will find its appropriate location as a subset of emotions in the scaffold of knowledge. We hope that, as our field makes further progress, the challenges of its complex nature will be matched by the richness of the data in what promises to be an important part of the story of human adaptation.

Above all, we wish to thank our contributors, new and old, for their willingness to participate in this project, particularly because we know full well their crowded schedules. Their generosity in contributing their work to our Handbook is deeply appreciated.

Our appreciation is also extended to our editor at The Free Press, Susan Arellano, for her splendid guidance and warm support throughout the project, to Lilian Schein, director of the Behavioral Science Book Service and a good friend, for her interest and encouragement, and to Anne Stubing for her cheerful secretarial assistance.

Leo Goldberger

Shlomo Breznitz

The concept of stress and, indeed, research on stress have reached an all-time peak in popularity during the past few years. An ever increasing number of books and journals devoted exclusively to stress are being published, courses and seminars are being offered in this area, and references to stress in the mass media abound. With this heightened awareness of stress—meaning here essentially all that is unpleasant, noxious, or excessively demanding—a concomitant interest in stress reducing techniques, or stress management, has given birth to a new specialty in the health sciences.

The tremendous proliferation of stress literature has made a single, comprehensive text on the subject a forbidding undertaking. Instead, the time seems more than ripe for this handbook, the aims of which are to gather within one volume a wide array of authoritative articles on the many facets of stress; provide researchers and clinicians in the field with a forum for critical reflection on the perennial definitional and conceptual problems and methodological complexities peculiar to stress research and stress treatment; and, ideally, to provide readers with a state of the art overview of those areas in which a body of solid findings exists.

The stress field is a sprawling one, characterized by unevenness and lack of coordination (not unlike many other domains within the behavioral and mental health sciences), with pockets of substantial development separated by faddish, superficial, or one-time forays. We believe there is much to be gained by the student of stress in confronting a cross-section of current developments in the field as a whole.

This volume allows the reader to take stock of where we are and to discern links and overlaps among the several disciplinary lines; cross-fertilization of the multiple perspectives on stress is necessary if the field is to maintain its vitality. The idea for the Handbook of Stress, born in our recognition of timeliness of such a reference work, surely would have failed to materialize had it not resonated with our colleagues—the distinguished group of authors whom we invited to contribute chapters summarizing topics closest to their current concerns. Their enthusiasm and ready acceptance of the task testified to the shared purpose of our venture.

In choosing the topics included in the handbook, we faced the obvious constraint of space. We could neither cover all disciplinary perspectives and broad categories—biological, psychological, and sociological—nor be exhaustive within a given perspective or category. The reader will undoubtedly compose his/her own list of missing chapters. Clearly, we had to make choices and though these choices were inevitably biased by our professional training as psychologists, we tried to provide a balanced view at least within the field of psychological stress. In other words, we set out to achieve a balance among theoretical viewpoints, as well as a balance between theory and research. Although not all topics covered in the Handbook of Stress have reached the level of maturity that permits a state of the art overview, some were nonetheless included because they have significance for the field.

The volume begins with a brief outline of our own perspective on stress and suggestions for future directions of investigation. Dr. Hans Selye—the pioneer in the field of stress whose ideas and influence are discernible in many of these chapters—provides an appropriate historical introduction. The main body of the handbook consists of seven parts. The headings for each part are self-explanatory and reflect our concern for a balanced treatment of stress. The reader should note that quite a few chapters deal with several aspects of their particular topic—theory, research, and/or clinical issues—and some areas are addressed in more than one chapter, for example, the measurement of both stress and coping and the use of life events scales. Our purpose was to provide more intensive treatment of issues that have a singular, pragmatic value for the stress investigators who would, we thought, welcome ready access to this material.

The Handbook of Stress is intended for the professional and the student in the behavioral and mental health fields actively working or interested in the stress area. It should have considerable utility as a reference work—as an aid in locating significant bodies of research; as a guide to metrics, tests, scales, and questionnaires in the stress-coping field; and, for the practicing clinician, as a guide to some of the increasingly popular techniques for the prevention and treatment of stress related disorders. The volume also should be useful as a reference work for general readers who wish to gain familiarity with the current scientific yield in the field of stress.

Finally, it should be noted that the contributors were discouraged from being as expansive as they might have wished and from using an overabundance of tables, figures, and references—this decision reflected our concern with conserving space to allow a wide representation of topics. We are grateful for having had such an impressive group of colleagues cooperate with us and give of their time and expertise in preparing their chapters and we appreciate their forbearance in regard to space constraints and editorial cuts.

Our appreciation also goes to a number of other people whose help was invaluable. At New York University our thanks go to Roberta Gordon, Nancy Koch, Bettie Brewer, and William T. Francis for administrative and secretarial help; at Haifa University, our thanks to Ruth Maos and Dinah Katz. Kitty Moore, senior psychology editor at The Free Press, has our warm gratitude for her advice, support, and enthusiastic interest throughout this project.

Leo Goldberger

Shlomo Breznitz

LISA G. ASPINWALL is an assistant professor at the University of Maryland at College Park. She obtained her Ph.D. in social psychology from the University of California, Los Angeles, in 1991. In 1987, she was awarded a National Science Foundation Fellowship and a Firestone Medal for Excellence in Research from Stanford University. Her interests include social comparison theory, self-regulation under threat, and preventive health behavior.

ROSALIND C. BARNETT is a senior research associate at the Wellesley College Center for Research on Women. She is the director of the Adult Lives Project, a longitudinal study of work and nonwork stressors and stress mitigators in a sample of dual-earner couples. She received her Ph.D. in clinical psychology from Harvard University. Dr. Barnett co-authored Lifepoints: New Patterns of Love and Work for Today’s Women (with Grace Baruch and Caryl Rivers), and she is the co-editor of Gender and Stress (with Lois Biener and Grace Baruch). She is also the recipient of the Radcliffe College Graduate Society Distinguished Achievement Medal.

SHLOMO BREZNITZ is the Lady Davis Professor of Psychology and founding director of the R. D. Wolfe Centre for the Study of Psychological Stress at the University of Haifa, Israel. He has written extensively in the area of anticipatory fear, false alarms, and health psychology. He is the author of Cry Wolf: The Psychology of False Alarms, and editor of Stress in Israel and Denial of Stress.

JOHN G. CARLSON received his Ph.D. in psychology from the University of Minnesota. Formerly department chairman, he is professor and Director of Health Psychology in the Department of Psychology at the University of Hawaii. He is also Health Sciences Specialist at the Veteran’s Administration Medical Center in Honolulu Stress Disorders Laboratory. He is the co-author of Psychology of Emotion and co-editor of International Perspectives of Self-regulation and Health. He was a Cumberland College Research Fellow at the University of Sydney, Australia, and is a member of the editorial board of Biofeedback and Self-regulation.

CATHERINE C. CLASSEN is a postdoctoral fellow at the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. She received her Ph.D. from York University, Toronto. Her doctoral research involved a theoretical and empirical investigation of insight into psychotherapy.

HELEN L. COONS is an assistant professor in the Department of Mental Health Sciences, Hahnemann University, Philadelphia. She received her Ph.D. in clinical psychology from Temple University. Her research focuses on psychosocial aspects of chronic or life- threatening physical conditions for adults and their family members. Dr. Coons currently chairs the Committee on Women and Health, Division of Health Psychology, American Psychological Association.

PAUL T. COSTA, JR., is chief of the Laboratory of Personality and Cognition, Gerontology Research Center, National Institute on Aging. He has served as president of Division 20, Adult Development and Aging, of the American Psychological Association, and has published widely on aging, health, and personality. He is co-author of the NEO Personality Inventory.

FRANCIS CREED is professor of community psychiatry at Manchester University, England. His M.D. thesis involved the life events method, and he worked with Professor George Brown at Bedford College, London. He has extended his life events research to several physical and psychiatric conditions. Other research interests include the use of hospital day treatment for acute psychiatric illness and work in primary care.

SUSAN DERMIT is assistant professor of psychiatry and behavioral sciences at the School of Medicine at the State University of New York at Stony Brook, where she received her Ph.D. in clinical psychology. Her research has focused on an empirical and behavioral approach to the analysis of individual differences in proneness to coronary heart disease.

LEONARD R. DEROGATIS is professor of Mental Health Sciences and director of the Division of Clinical Psychology at Hahnemann University. After graduate study at Columbia University, he received his Ph.D. from Catholic University. In addition to Clinical Psychopharmacology and Anxiety and Depressive Disorders in the Medical Patient, he has written over 90 papers and monographs. He has also authored ten psychological tests, including the Hopkins Symptom Checklist (HSCL), the SCL-90-R, the Brief Symptom Inventory (BSI), the Psychosocial Adjustment to illness Scale (PAIS), and the Derogatis Stress Profile (DSP). His major research interests include clinical measurement, psychopharmacology, and clinical health psychology.

BRUCE P. DOHRENWEND is Foundations’ Fund for Research in Psychiatry professor at Columbia University and chief of the Department of Social Psychiatry at the New York State Psychiatric Institute. He received his Ph.D. in social psychology from Cornell University and conducts research on adversity, stress, and other risk factors in the field of psychiatric epidemiology under a Research Scientist Award and other grants from the National Institute of Mental Health. His other awards include the 1980 Distinguished Contributions Award of the Division of Community Psychology, American Psychological Association (with Barbara Snell Dohrenwend); the 1981 Rema Lapouse Award, American Public Health Association (with Barbara Snell Dohrenwend); and the 1990 American Association for the Advancement of Science Prize for Behavioral Science Research.

LEO EITINGER, is professor emeritus at the University of Oslo. He holds both an M.D. and a Ph.D. and has been president of the Norwegian Psychiatric Association and the Scandinavian Psychiatric Congress. He was also a Corresponding Fellow of the American Psychiatric Association. A survivor of the Auschwitz and Buchenwald concentration camps, after the war he returned to Norway to do hospital work. The author of more than 150 publications, Dr. Eitinger was awarded the King’s Gold Medal by Olso University for his paper The Influence of Military Life in Young Norwegian Men’s Psychic Life. He has published extensively on the subject of concentration camp survivors.

NIGEL P. FIELD is a postdoctoral fellow with the John D. and Catherine T. MacArthur Foundation’s Program on Conscious and Unconscious Mental Processes at the University of California, San Francisco. He received his Ph.D. from York University, Toronto. His publications include, with Richard M. Sorrentino, Emergent Leadership Over Time: The Functional Value of Positive Motivation, and, with Mardi J. Horowitz and Charles H. Stinson, National Disasters and Stress Response Syndromes. His research utilizes thought sampling and cognitive methodologies to study intrusion in post-traumatic stress disorder.

MARJORIE FISKE is emeritus professor of social psychology and the former director of the Human Development and Aging research and doctoral program at the University of California, San Francisco. Among her publications are Four Stages of Life, Middle Age, and some 100 articles and chapters in professional books and journals. She holds or has held office in the American Sociological, Psychological, and Gerontological Societies and serves as advisor or board member to several journals and educational organizations. Professor Fiske’s major research interests are personal/social change and stress/adaptation in adulthood.

DEBORAH FITZPATRICK is a graduate student in clinical psychology at the University of Waterloo, Ontario. She received her B.A. from McGill University, Montreal.

SUSAN FOLKMAN is professor of medicine at the University of California, San Francisco, and senior scientist at the Center for AIDS Prevention Studies. She received her Ph.D. from the University of California, Berkeley. She worked with Richard Lazarus at Berkeley through 1987, and with him co-authored Stress, Appraisal, and Coping. She is conducting research on stress and coping in the context of AIDS.

LEO GOLDBERGER is professor of psychology at New York University and a former director of the Research Center for Mental Health. Following graduate study at McGill University, Montreal, he completed his Ph.D. in clinical psychology at New York University. Dr. Goldberger was the recipient of a National Institute of Mental Health Research Career Development Award in 1960, and he has published extensively in the area of sensory deprivation, personality, and cognitive style. He is the editor of Psychoanalysis and Contemporary Thought and the Stress and Health series and a co-editor of The International Library of Critical Writings on Psychology.

ERIC GRAIG is a lecturer in the sociology department at Queens College in New York City and a doctoral candidate in environmental psychology at the Graduate School and University Center of the City University of New York. His primary interest is in the sociology of knowledge, in particular as it relates to knowledge about social and environmental problems.

RAND J. GRUEN is an assistant professor of psychology, a member of the Center for Neural Science, New York University, and an adjunct assistant professor of psychiatry at New York University Medical Center. After receiving his Ph.D. from the University of California, Berkeley, he completed a three-year fellowship in psychiatry and pharmacology at Yale University School of Medicine. His research involves the psychosocial and biochemical bases of depression and anxiety and the interaction between transmitter systems in the central nervous system.

NORMA HAAN (now deceased) was research scientist at the Institute of Human Development, University of California, Berkeley. She was the author of Coping and Defending: Processes of Self-Environment Organization and a number of papers concerned with the accommodation to life stress and stress produced by moral conflict and political dissent. She was co-editor of Past and Present in Middle Life.

STEVAN E. HOBFOLL is professor of psychology at Kent State University and director of the Applied Psychology Center. He received his Ph.D. from the University of South Florida. He was formerly on the faculty of Tel Aviv University and Ben Gurion University in Israel. He is a fellow of the American Psychological Association and author of The Ecology of Stress. Dr. Hobfoll is editor of Anxiety, Stress, and Coping: An International Journal and editor-in-chief of Series in Applied Psychology: Social Issues and Questions.

ROBERT R. HOLT received his Ph.D. from Harvard University. He was a clinical psychologist in the Veterans Administration and the director of psychological staff at the Menninger Foundation. He was also director of the Research Center for Mental Health at New York University, where he is emeritus professor of psychology. For many years he held a Research Career Award from the National Institute of Mental Health.

MARDI J. HOROWITZ is professor of psychiatry at the University of California, San Francisco, where he directs the Center for the Study of Neuroses and the John D. and Catherine T. MacArthur Foundation’s Program on Conscious and Unconscious Mental Processes. He has received the foundation’s Fund Prize, the Strecker Award, the Royer Award, and various outstanding achievement or distinguished scientist awards. His books include Stress Response Syndromes, States of Mind, and Introduction to Psychodynamics: A New Synthesis.

IRVING L. JANIS (now deceased) was emeritus professor of psychology at Yale University. He was a leading contributor to research on psychological stress, attitude change, and decisionmaking. Janis was author of the well-known book Stress and Frustration and co-author (with L. Mann) of the highly influential book Decision Making. In recognition of his many theoretical and empirical contributions to scientific psychology, the American Psychological Association presented its Distinguished Scientitic Contributions Award to Professor Janis in August 1981. Among Janis’s other special honors and awards were the Hofheimer Prize of the American Psychiatric Association (1958), the American Association for the Advancement of Science Socio-Psychological Prize (1967), and election to the American Academy of Arts and Sciences (1974).

EDWARD S. KATKIN is professor of psychology at the State University of New York at Stony Brook. He received his Ph.D. in clinical psychology from Duke University. His research has focused on investigating individual differences in psychophysiological components of emotions, psychopathology, and visceral self-perception and self-control. He is a past president of the Society for Psychophysiological Research and is co-editor (with S. B. Manuck) of the two-volume series, Advances in Behavioral Medicine.

RICHARD S. LAZARUS is professor emeritus of psychology at the University of California at Berkeley. His many years of leadership in the research field of stress and coping and his influential conceptual contributions have won him worldwide recognition and honors, including the American Psychological Association’s Distinguished Scientific Contribution Award in 1989. Among his numerous publications is his most recent book, Emotion and Adaptation (1991).

ELLINOR F. MAJOR is a research psychologist investigating Norwegian non-Jewish concentration camp survivors and their children at the Division of Disaster Psychiatry, University of Oslo/The Norwegian Armed Forces, Joint Medical Services. She graduated from the University of Oslo.

GEORGE MANDLER received his Ph.D. from Yale University. He taught at Harvard University and the University of Toronto before moving to the University of California, San Diego, as founding chair of their Psychology Department. He has been a fellow of the Center for Advanced Study in the Behavioral Sciences, a J. S. Guggenheim Fellow, and he received the William James Award of the American Psychological Association. His books include The Language of Psychology (with W. Kessen), Thinking: From Association to Gestalt (with J. M. Mandler), Mind and Emotion, Mind and Body: Psychology of Emotion and Stress, and Cognitive Psychology: An Essay in Cognitive Science.

ROBERT R. MCCRAE is research psychologist in the Section on Stress and Coping, Gerontology Research Center, National Institute on Aging. His research interests include personality structure and assessment, psychological well-being, and aging. He is the co-author (with Paul T. Costa, Jr.) of Personality in Adulthood.

BRUCE S. MCEWEN is head of the Laboratory of Neuroendocrinology at The Rockefeller University, where he received his Ph.D. in cell biology. After postdoctoral work in Sweden in neuroscience, he returned to Rockefeller University to work as a neuroscientist with the psychologist, Neal Miller. His research interests center on the neurobiology of stress.

DONALD MEICHENBAUM is professor of clinical psychology at the University of Waterloo, Ontario. He received his Ph.D. from the University of Illinois. One of the founders of Cognitive Behavior Modification, he is the author of several books, including Cognitive Behavior Modification, Coping with Stress, and Stress Inoculation Training. He is the editor of the Plenum Series on Stress and Coping and serves on the editorial boards of a dozen journals, including Cognitive Therapy and Research. Dr. Meichenbaum is a fellow of the Royal Society of Canada and the recipient of the Izaak Killam Fellowship.

SCOTT MENDELSON is a fellow in the Medical Scholars Program at the College of Medicine of the University of Illinois. He received his Ph.D. in psychology at the University of British Columbia. In his doctoral dissertation he evaluated the roles of subtypes of serotonin receptors in the modulation of sexual behavior. He also has been a National Research Service Award Fellow in the Laboratory of Neuroendocrinology at The Rockefeller University.

ANDREW H. MILLER is an assistant professor of psychiatry at the Mount Sinai School of Medicine. He holds an M.D. and was given a Research Scientist Development Award from the National Institute of Mental Health. Dr. Miller has conducted both basic and clinical research on the relationship between the hypothalamic-pituitary-adrenal axis and the immune system. He has also investigated immune function in patients with depression and recently edited a book entitled Depressive Disorders and Immunity.

THOMAS W. MILLER is a professor in the Department of Psychiatry and Department of Psychology, University of Kentucky, and chief of the Psychology Service, at the Veterans Administration and University of Kentucky Medical Centers. Dr. Miller received his Ph.D. from the State University of New York at Buffalo, and is a diplomate in clinical psychology of the American Board of Professional Psychology. He is the author of more than 80 articles and several books, including Stressful Life Events. His research investigations have addressed child abuve, domestic violence, divorce and separation, airline disasters, and wartime experiences and natural disasters.

RUDOLF H. MOOS is research center scientist and director of the Center for Health Care Evaluation at the Department of Veterans Affairs and Stanford University Medical Centers in Palo Alto, California. He also is a professor in the Department of Psychiatry at Stanford University. He has written extensively about life stressors and coping processes, has conducted long-term evaluation projects on substance abuse and depression, and has developed a set of scales to measure social environments.

SUZANNE C. OUELLETTE is professor of psychology at the Graduate School and University Center of The City University of New York. She is a faculty member in the Social/Personality Psychology Doctoral Program and directs the Health Psychology Research Training Program at CUNY. She holds graduate degrees in theology (Yale University) and psychology (University of Chicago). She is currently leading two stress research projects, one examining the association between stress and lupus flare in women with lupus and the other on the stress and stress-resistance of volunteers in AIDS work.

LEONARD I. PEARLIN is a research sociologist and professor in the Human Development and Aging Program at the Center for Social and Behavioral Sciences, University of California, San Fransisco. For many years, he has been conducting a program of research in the social origins of stress and coping.

HERBERT S. PEYSER is consultant psychiatrist to the Smithers Alcoholism Center of St. Luke’s-Roosevelt Hospital Center, and assistant clinical professor of psychiatry and associate attending psychiatrist at The Mount Sinai Medical Center, New York City. He is chairman of the Committee on Addiction Psychiatry of the New York State Psychiatric Association and is chairman of the Committee on Mental Health of the Medical Society of the State of New York. He received his M.D. from the Columbia University College of Physicians and Surgeons and is a Diplomate of the American Board of Psychiatry and Neurology. Among his publications is Alcoholism: A Practical Treatment Guide, to which he both contributed and edited (with S. Gitlow).

AYALA M. PINES is a research associate in the psychology department at the University of California, Berkeley. The co-author of Experiencing Social Psychology and Burnout: From Tedium to Personal Growth. Dr. Pines has studied and written extensively about burnout.

ROBERT S. PYNOOS is Director, Program in Trauma, Violence and Sudden Bereavement at the UCLA Department of Psychiatry and Biobehavioral Sciences. He was the 1991-1992 President of the International Society for Traumatic Stress Studies. He is co-editor of Post-traumatic Stress Disorder in Children and Preventing Mental Health Disturbances in Childhood. Dr. Pynoos holds M.D. and M.P.H. degrees and has been chair of the American Psychiatric Association’s Corresponding Task Force on Psychiatric Dimensions of Disasters and the William T. Grant Consortium on Adolescent Bereavement. He is the recipient of many awards, including the 1991 National Organization for Victim Assistance, Stephen Schafer Award for outstanding contributions in the field of research.

JUDITH GODWIN RABKIN is research scientist, New York State Psychiatric Institute, and associate professor of clinical psychology, in psychiatry, College of Physicians and Surgeons, Columbia University. She received her Ph.D. in clinical psychology from New York University in 1967 and her M.P.H. degree in epidemiology in 1978 from the Columbia University School of Public Health. In addition to publications in the area of stress research in Science and Psychological Bulletin, she has published a study of ethnic density and risk for psychiatric hospitalization in the American Journal of Psychiatry and is co-editor (with D. F. Klein) of a volume on research in anxiety.

KAREN G. RAPHAEL is assistant professor of public health (epidemiology) in psychiatry at Columbia University. She received her Ph.D. in psychology from Hofstra University. She is currently involved in a family study on stress, chronic pain, and depression. Additional research interests include issues of mood-congruent recall and reporting biases.

RENA L. REPETTI received her Ph.D. in clinical psychology from Yale University and is an assistant professor in the Department of Psychology at the University of California, Los Angeles. Her research is in the area of stress and coping in the family and, in particular, she has studied the effects of occupational stressors on health and family functioning. Among her recent publications are an article in the Journal of Personality and Social Psychology describing the effects of daily workload on marital interaction and an American Psychologist article, with Karen Matthews and Ingrid Waldron, on the effects of employment on women’s health.

RAY H. ROSENMAN received his A.B. and M.D. from the University of Michigan. At present, he is associate chief of medicine at Mount Zion Hospital in San Francisco and director of cardiovascular research at SRI International in Menlo Park. He has devoted half of his time to clinical cardiology and half to research, and he is co-founder of the type A behavior pattern concept. His studies have been widely published in journals and books, he is author or co-author of four books, and he holds membership in many clinical, research, and honorary societies.

JEANNE A. SCHAEFER is a research health scientist, Department of Veterans Affairs and Stanford University Medical Centers, Palo Alto, California. She is involved in a study of stressors and coping among staff in long-term care. She has authored and co-authored articles that focus on life crises and personal growth, coping with physical illness and life crises, and the evaluation of health care work settings.

SHARON SCHWARTZ is assistant clinical professor in epidemiology at Columbia University, where she received her Ph.D. in sociology and M.S. in epidemiology. Her research focuses on the relationship between social factors and psychiatric disorders.

HANS SELYE (now deceased) was professor at the University of Montreal and president of the International Institute of Stress and the Hans Selye Foundation. His famous and revolutionary concept of stress opened countless new avenues of treatment through the discovery that hormones participate in the development of many degenerative diseases. He was the author of 38 books and more than 1,700 technical articles.

JUDITH T. SHUVAL received her Ph.D. in sociology from Harvard University. She is the Louis and Pearl Rose Professor of Medical Sociology at the Hebrew University of Jerusalem, where she directs the Programme in Medical Sociology at the School of Public Health. She has served as chair of the Israel Sociological Association, on the executive committee of the European Society for Medical Sociology, as consultant to the World Health Organization, and on the editorial board of Social Science and Medicine and other professional journals. One of her manny books, Immigrants on the Threshold won the prestigious Israel Prize for the Social Sciences. She is also the author of Social Functions of Medical Practice (1970), Entering Medicine: The Dynamics of Transition (1980), Newcomers and Colleagues: Soviet Immigrant Physicians in Israel (1983), and Social Dimensions of Health: The Israeli Experience (1992).

ARON W. SIEGMAN is currently professor of psychology and Director of the Behavioral Medicine Program at the University of Maryland, Baltimore County. He has also been on the faculties of Bar-Ilan University and Ben-Gurion University in Israel. He received his Ph.D. from Columbia University in 1957. He is co-editor (with Stanley Feldstein) of Non-verbal Behavior and Communication, (with Theodore M. Dembroski) of In Search of Coronary-Prone Behavior, and (with Timothy W. Smith) of Anger, Hostility, and the Heart. His recent publications concern the control of emotions and their physiological manifestations.

ANDREW SKODOL is associate professor of psychiatry at the Columbia University College of Physicians and Surgeons and research psychiatrist at the New York State Psychiatric Institute. He is a graduate of Yale University and holds an M.D. from the University of Pennsylvania School of Medicine; he trained as a resident at the Albert Einstein College of Medicine. His research focuses on psychiatric diagnosis and issues of classification, including assessment methods, multiaxial evaluation, and personality disorders. He is the author of Problems in Differential Diagnosis: From DSM-III to DSM-III-R in Clinical Practice and co-author of the DMS-III-R Casebook.

SUSAN B. SORENSON earned her Ph.D. in clinical psychology at the University of Cincinnati, received post-doctoral training in psychiatric epidemiology, and now teaches and conducts research at the School of Public Health at the University of California, Los Angeles. Her research focuses on public health views of violence prevention and victimization, including homicide, suicide, sexual assault, battering, and child abuse. Since 1986, Dr. Sorenson has taught a graduate-level course on family and sexual violence, and in her clinical practice she works with individuals who have been victimized in some way or who have lost a loved one in a sudden violent manner. In 1990, Dr. Sorenson received the Chaim Danieli Young Professional Award for excellence in service and research in the field of traumatic stress from the Society for Traumatic Stress Studies.

MARVIN STEIN is the Esther and Joseph Klingenstein Professor of Psychiatry at the Mount Sinai School of Medicine. After chairing the department for over 15 years, he resigned to devote his efforts to research. A medical doctor, he is a pioneer in the investigation of brain, behavior, and the immune system, and he has published extensively in this area. He has chaired and served on numerous committees of the National Institute of Mental Health, and he has been president of the American Psychosomatic Society and the Academy of Behavioral Medicine Research.

ALAN M. STEINBERG is a member of the faculty at the Department of Developmental and Cell Biology, University of California, Irvine. He received his Ph.D. from the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. In addition to his theoretical and empirical contributions to the field of stress research, he teaches biomedical ethics, including legal and ethical issues related to treatment and research with traumatized children and adolescents.

JOHANN M. STOYVA is an associate professor of psychology in the Department of Psychiatry at the University of Colorado Health Sciences Center. He received his B.A. and M.A. at the University of British Columbia and his Ph.D. in psychology at the University of Chicago. His worked has focused on biofeedback and behavioral techniques as applied to stress-related disorders, and he has also studied of sleep, dreaming, and hypnosis. He is a former president of the Biofeedback Society of America and was editor of the society’s journal, Biofeedback and Self-regulation.

ANN STUEVE is assistant professor of public health, epidemiology, at Columbia University and Research Scientist at the Research Foundation for Mental Hygiene at New York State Psychiatric Institute. She received her M.A. in human development from the University of Chicago and her Ph.D. in sociology from the University of California, Berkeley. Her research interests focus on the relationships among stress, social support, and psychopathology and on the impact of mental illness on families.

SHELLEY E. TAYLOR is professor of psychology and director of the Health Psychology Program at the University of California, Los Angeles, She received her Ph.D. from Yale University. Her research interests are social cognition and health psychology. Professor Taylor has received several awards for her work, including the American Psychological Association’s Distinguished Scientific Award for an Early Career Contribution to Psychology and a Research Scientist Development Award. In addition to her journal articles, she is the author of Health Psychology and Positive Illusions and a co-author of Social Cognition.

ALAN VAUX is associate professor of psychology at Southern Illinois University. He earned a Ph.D. in psychology from Trinity College, Dublin, and an M.A. and Ph.D. in social ecology at the University of California, Irvine. He is the author of Social Support: Theory, Research, and Intervention and a fellow of the American Psychological Association.

LARS WEISÆTH, is professor of disaster psychiatry at the University of Oslo and director of the Department of Psychology of the Joint Norwegian Armed Forces Medical Services. He holds an M.D. and has done extensive research on human responses to dangerous situations, the etiology and psychopathology of post-traumatic stress disorder, and preventive psychology, particularly in the area of traumatic stress. He has studied stress among peace-keeping troops in Lebanon and participated in World Health Organization mental health missions to countries at war.

SUSAN K. F. WINE is a graduate student in clinical psychology at the State University of New York at Stony Brook. She has been engaged in research on individual differences in visceral self-perception and on the effects of anti-adrenergic drugs on cardiovascular reactivity to psychological stress.

ORIENTATION TO STRESS

The proliferation of research on stress over the past two decades makes it difficult to penetrate the universe of discourse in this area. Nonetheless, we shall try to identify the basic themes in the literature.

Stressors are external events or conditions that affect the organism. The description of stressors and their impact on behavior is an open-ended task, and current research considers an increasing number of events and conditions to be stressors. Most of this effort is still in the qualitative domain and parametric investigations are by and large rare.

The stressors themselves impinge on an organism that has specific characteristics of its own. Thus, another open-ended challenge is the systematic exposure of different species to a particular stressor. Such research can provide insight into phylogenetic and evolutionary processes, as well as into the general themes that cut across species boundaries. Within the same species it is, of course, possible to investigate the impact of a given stressor on different organisms, and the study of individual differences is a rapidly growing branch of stress research. The individual differences of most relevance in human research have to do with the cognitive appraisal of stressors. In line with Lazarus’s (1966: Lazarus & Launier, 1978) formulation, cognitive appraisal plays a major role in the transaction between the person and the potentially stressful environment. Accordingly, researchers have sought to uncover the differential effects of a variety of cognitive styles upon the impact of stressors.

Another central element in the adaptational equation relates to coping. After appraising the Stressor, the organism will use one or more coping strategies in an attempt to adjust to the situation. A relatively large body of stress research addresses various coping strategies. Here, again, the issue of individual differences and predispositions plays a key role.

Finally, investigators are interested in stress effects themselves. Ranging all the way from minor changes in behavior to dramatic clinical symptoms, such effects are often viewed as the raison d’être for stress research and stress management approaches.

Somewhere between the Stressor and its effects lies the subjective, phenomenological experience of stress itself. Although from the individual’s point of view experiencing stress is the most germane factor in confronting stressful conditions, such experience lies outside the realm of objective inquiry.

Accordingly, behaviors classified as stress effects can also be categorized as the effects of anxiety, the effects of conflict, etc. Insofar as expressions of emotion, performance deterioration, or symptom manifestations are concerned, stress is interchangeable with these other concepts. Its unique features thus have to be more specifically elaborated.

As this volume illustrates, there is substantial disagreement over the definition of stress. Different scholars have different definitions and oftentimes abide by those most suitable to the pursuit of their particular interests. Thus, for instance, Selye’s (1956) focus on the nonspecific general adaptation syndrome forces an extreme response based definition, and the exact nature of the Stressor becomes largely irrelevant. By contrast, Lazarus’s (1966) focus on cognitive appraisal presumes that specific kinds of information are operative in appraising a particular stimulus as a stressor. Although this lack of agreement on the definition of stress is seen by some as indicative of a paradigm crisis, the absense of consensus more properly reflects the rapid expansion of stress research in many divergent directions and may be more conducive to future theorizing than a premature closure (see Kaplan, 1964, for a cogent argument on tolerance of ambiguity in the conduct of inquiry).

Whereas diversity in definition and emphasis may be helpful, such is not the case, however, with research tools. One of the main reasons that many basic questions relating to the effects of stress on adjustment remain unresolved is the lack of standardization in choosing the stressor, measuring its parameters and effects, and selecting the subjects for specific experiments. The absence of an adequate taxonomy of stressful situations and the paucity of parametric research in this area make it difficult to compare results from different studies. The systematic accumulation of knowledge cannot proceed without comprehensive, longterm research.

FUTURE DIRECTIONS

Reviewing the state of the art from the vantage point of the Handbook of Stress, we can trace some major ideas and biases in stress research. The following review points out broad themes and suggests possible directions for scientific inquirys in the future.

Repeated Exposure to Stressors

From Selye’s initial formulation of the general adaptation syndrome to the diametrically opposite notion of stress inoculation, the analysis of the potential impact of repeated stressors is at the core of many theories (e.g., Breznitz, 1980; Frankenhaeuser, 1980). Investigators are interested in learning whether repeated exposure to the same stressors will result ultimately in immunization, habituation, or breakdown.

Duration of Exposure to Stressors

Our understanding of adaptation will be seriously deficient as long as we are unable properly to estimate the impact of duration of exposure to stressors on behavior. This need is particularly critical in the analysis of chronic versus acute stressors. In both epidemiological and clinical research on risk factors conducive to somatic as well as psychiatric problems, the relatively minor but everyday stressors seem to be emerging as the main culprit.

Pacing of Stressors

A question related to repetition and duration of exposure is the interstressor interval. What is the rate at which stressors follow one another? Is there a critical threshold in terms of pacing? The recent life changes paradigm is a case in point. Proponents of this view argue that different kinds of events produce a cumulative deleterious impact only if they follow one another at a rate above a certain critical level (Breznitz, 1972; Cleary, 1979; Holmes & Masuda, 1974; Lloyd, Alexander, Rice, & Greenfield, 1980).

Recovery from Stress

A crucial but neglected area in understanding stress concerns the temporal characteristics of recovery from stressful encounters. Repeated exposure, duration, and pacing are intimately associated with the recovery function.

THE OPTIMISTIC BIAS

Although stress research is concerned mainly with maladjustment, interest in successful coping is increasingly apparent in the field. The major displacement of focus from the concept of anxiety, which relates primarily to an internal, personal problem, to the concept of stress, which is basically an external, environmental problem, deserves analysis. In our view, this shift indicates a tendency toward the denial of major and often unmanageable difficulties. Advocates of the new approach argue that since stress is caused by factors out there, it is necessary only to devise ways to change the stressful features of the environment and all will be well. This view may to a certain extent account for the proliferation in Western societies of simplistic techniques of stress management. In any event, the domain of stress research now puts heavy emphasis on coping. Interest in coping strategies and predispositions, as well as in the teaching of coping skills, indicates an essentially optimistic bias. Whether pursued in the military or in the wide variety of stress inoculation programs, these practices rest on the assumption that given the right tools, one can cope effectively with most sources of stress.

Another sign of this optimistic outlook is the importance accorded the idea of control. Many workers in the field make the value judgment (implicitly or explicitly) that an internal locus of control is preferable to an external one; they argue that self-control can be used effectively to combat the potentially deleterious effects of stress. However, many critical stressors do not leave room for control, and passive acceptance may be the most appropriate coping strategy in such situations (e.g., Lazarus, 1982; Selye, 1956).

THE PSYCHOLOGY OF HEALTH

We suggest that stress research and theory are about to undergo a major change in emphasis—a change that may be yet another expression of the optimistic bias just noted. Concern with the negative, illness related impacts of stress will gave way to consideration of stress as a force conducive to health. Although health is still defined primarily as the lack of illness, the absence of symptoms is a very limited and unsatisfactory criterion of well-being. A concept denoting the opposite of stress would enrich our way of looking at person-environment interactions. In other words, can the active influence of positive factors in principle enhance health? Just as Lazarus and Launier (1978) posited daily uplifts as the opposite of daily hassles, some events may act as antistressors. Indeed, stress itself may produce positive effects. Selye (1974) saw the need to coin the concept of eustress essentially to account for certain seemingly harmless or even beneficial stressors. In Chapter 14, Haan, referring to her own research (1977), makes the point that stress can lead to gains as well as losses. (This issue has been examined by Breznitz and Eshel [1982] and by Yarom [1982].) Unless our sense of direction is off the mark, psychology and medicine will see an upsurge of interest along the above lines, and the field of stress will significantly increase its relevance.

REFERENCES

BREZNITZ, S. The effect of frequency and pacing of warnings upon the fear reaction to a threatening event. Jerusalem: Ford Foundation, 1972.

_____. Stress in Israel. In H. Selye (ed.), Selye’s guide ßïstress research, vol. 1. New York: Van Nostrand, 1980.

BREZNITZ, S., & ESHEL, J. Life events: Stressful ordeal or valuable experience? In S. Breznitz (ed.), Stress in Israel. New York: Van Nostrand, 1982.

CLEARY, P. J. Life events and disease: A review of methodology and findings. Stockholm: Laboratory for Clinical Stress Research, 1979.

FRANKENHAEUSER, M. Psychoneuroendocrine approaches to the study of stressful person-environment transactions. In H. Selye (ed.), Selye’s guide to stress research, vol. 1. New York: Van Nostrand, 1980.

HAAN, N. Coping and defending: Processes of self-environment organization. New York: Academic, 1977.

HOLMES, T. H., & MASUDA, M. Life changes and illness susceptibility. In B. S. Dohrenwend & B. P. Dohrenwend (eds.), Stressful life events: Their nature and effects. New York: Wiley, 1974.

KAPLAN, A. The conduct of inquiry: Methodology for behavioral science. San Francisco: Chandler, 1964.

LAZARUS, R. S. Psychological stress and the coping process. New York: McGraw-Hill, 1966.

_____. The costs and benefits of denial. In S. Breznitz (ed.), The denial of stress. New York: International Universities, 1982.

LAZARUS, R. S., & LAUNIER, R. Stress-related transactions between person and environment. In L. A. Pervin and M. Lewis (eds.), Perspectives in interactional psychology. New York: Plenum, 1978.

LLOYD, C., ALEXANDER, A. A., RICE, D. G., & GREEFIELD, N. S. Life change and academic performance. Journal of Human Stress, 1980, 6, 15-25.

SELYE, H. The stress of life. New York: McGraw-Hill, 1956.

_____. Stress without distress. Philadelphia: Lippincott, 1974.

YAROM, N. Facing death in war: An existential crisis. In S. Breznitz (ed.), Stress in Israel. New York: Van Nostrand, 1982.

NOWADAYS, EVERYONE SEEMS TO BE TALKING about stress. You hear about this topic not only in daily conversation but also on television, via radio, in the newspapers, and in the ever increasing number of conferences, centers, and university courses devoted to stress. Yet remarkably few people define the concept in the same way or even bother to attempt a clearcut definition. The businessperson thinks of stress as frustration or emotional tension; the air traffic controller, as a problem in concentration; the biochemist and endocrinologist, as a purely chemical event; and the athlete, as muscular tension. This list could be extended to almost every human experience or activity, and, somewhat surprisingly, most people—be they chartered accountants, short-order cooks, or surgeons—consider their own occupation the most stressful. Similarly, most commentators believe that ours is the age of stress, forgetting that the caveman’s fear of attack by wild animals or of death from hunger, cold, or exhaustion must have been just as stressful as our fear of a world war, the crash of the stock exchange, or overpopulation.

Ironically, there is a grain of truth in every formulation of stress because all demands upon our adaptability do evoke the stress phenomenon. But we tend to forget that there would be no reason to use the single word stress to describe such diverse circumstances as those mentioned above were there not something common to all of them, just as we could have no reason to use a single word in connection with the production of light, heat, cold, or sound if we had been unable to formulate the concept of energy, which is required to bring about any of these effects. My definition of stress is the nonspecific (that is, common) result of any demand upon the body, be the effect mental or somatic. The formulation of this definition, based on objective indicators such as bodily and chemical changes that appear after any demand, has brought the subject (so popular now that it is often referred to as stressology) up from the level of cocktail party chitchat into the domain of science.

One of the first things to bear in mind about stress is that a variety of dissimilar situations—emotional arousal, effort, fatigue, pain, fear, concentration, humiliation, loss of blood, and even great and unexpected success—are capable of producing stress; hence, no single factor can, in itself, be pinpointed as the cause of the reaction as such. To understand this point, it is necessary to consider certain facts about human biology. Medical research has shown that while people may face quite different problems, in some respects their bodies respond in a stereotyped pattern; identical biochemical changes enable us to cope with any type of increased demand on vital activity. This is also true of other animals and apparently even of plants. In all forms of life, it would seem that there are common pathways that must mediate any attempt to adapt to environmental conditions and sustain life.

HISTORICAL DEVELOPMENT

Even prehistoric man must have recognized a common element in the sense of exhaustion that overcame him in conjunction with hard labor, agonizing fear, lengthy exposure to cold or heat, starvation, loss of blood, or any kind of disease. Probably he soon discovered also that his