Stress? It's as old as the hills

Stress, what stress? More than half the adult population claims to be suffering from it. Michael Barrymore has just checked himself into hospital because of it. Bookshops hold shelves of self-help manuals devoted to this so-called modern disease. From victims of rising crime to exhausted working mothers, from tightly squeezed professionals to the despairing unemployed, we are all supposed to be suffering from stress. It makes us tense, irritable, and affects our concentration. Worse, it damages our health, causing everything from heart attacks to asthma, from chronic fatigue to spots.

Cynics are quick to dismiss the phenomenon as fashionable Nineties hype. And they have a point. After all, we are living longer lives than any generation before us. Most of us have more cash, more foreign holidays, more consumer durables, and more choices in our lives than ever before. Bob Cratchit, the hard-working, poorly paid clerk for Ebenezer Scrooge in Dickens's A Christmas Carol, was lucky to get a day off on Christmas day. Imagine the Cratchit family ever having the chance to spend a couple of weeks in August getting away from it all on a Spanish beach.

The prospect of a period on the dole is hardly as terrifying as it was in the 1930s. And the risk of losing your home if you can't keep up the mortgage repayments is surely less stressful than the fear that your home might collapse upon you and your family in the middle of the blitz.

Faced with the historical evidence of human survival, triumph and even happiness, against far greater odds than we experience today, talk of stress, the modern disease, just sounds like whingeing.

Yet for Jane Bebbington, stress is real enough. She has spent 15 years working in victim support, helping and counselling people who have ongoing physical and psychological reactions to the violence that they or their relatives have experienced.

Jane's experience of stress became deeply personal last year. In the space of five years she has watched her marriage break up, been involved in a bad car accident, experienced the suicide of both parents, and started a new, high-pressure job.

"At the time, I coped with it all terribly well, as one does." But then, after taking a much-needed holiday, Jane found herself overwhelmed by fatigue. The final straw came when a colleague took an overdose. Suddenly she was haunted by flash-backs to her parents' suicide, by anxiety and panic attacks. Unable to sleep, continually exhausted and distressed, her doctor finally diagnosed stress.

Faced with this catalogue of traumatic events, it's easy to see why Jane started to show the strain. The effects of sudden and shocking events on physical and mental health have been well documented. Last December the British Medical Journal published research which showed that women who developed breast cancer were far more likely to have experienced bereavement, redundancy, homelessness, violent crime or family crises within the past five years than their healthy counterparts.

Crises are not the only things to damage our health. Our everyday lives appear to be a problem, too. Professor Ben Fletcher, psychologist and Dean of the Business School at the University of Hertfordshire, argues that the work people do has a huge effect on their risk of physical disease. High demands, combined with low control, lack of support, and especially with monotonous work, are stressful and increase our chances of an early death. The evidence is persuasive. Danish bus drivers who faced the worst traffic lived shorter lives than their colleagues on quiet country roads. Meanwhile, civil servants who feared unemployment during a Whitehall reorganisation were more likely to report health problems than more secure colleagues. And the unemployed - those with most boredom, least control over their lives, and greatest anxiety about finding new work - are more likely than any other group to commit suicide.

But does it make sense to sweep all these conditions under one title, "stress"? The boredom of the unemployed is very different from the frustration of the bus driver, and the grief of the recently bereaved. Yet professionals, as well as the general public, persist in using the term.

"It is an umbrella concept," admits Cary Cooper, professor of organisational psychology at the University of Manchester Institute of Science and Technology. While cause, context and response all vary, the underlying model is the same. Hans Selye, founder of modern research into stress, described it as "the rate of wear and tear on the body". The analogy emerges out of physics. Subject a bridge to repeated stress - perhaps the waves against the pillars, or steady vibrations from soldiers marching across in step - and it will start to exhibit strain.

But stress is not entirely malign. A certain amount of pressure - Professor Cooper distinguishes pressure from stress - and we thrive. We keep going, we keep interested in the world and we stay alive. Too much and we get tense, troubled, breathless and run down. For example, the hormones produced by the "fight and flight" mechanism - including adrenaline - while inspiring us to react properly to crises, can also damage our bodies. All it takes is one final stressful straw and the camel's back will crack.

Of course it will crack in different ways depending on the form of stress we are exposed to, our own genetic make-up and the support we have to help us cope. Personality matters too - even if scientists can't quite agree which personality traits are at fault and why. In the late Sixties Dr Friedman and Dr Ray Rosenman claimed that aggressive extrovert achievers were more likely to die of heart attacks than calmer people (see right). Now the pendulum has swung the other way. Research reported in the February edition of the Lancet shows that people who bottle up their emotions are more likely to die early, and in particular to have heart attacks.

So stress is real. The answer to the cynics who point to historical evidence is that our ancestors suffered from stress too. Richard Napier, a sixteenth century physician, recorded that around a third of his patients were "troubled in mind". As the psychiatrist Dr Anthony Clare points out, this is almost exactly the same as the proportion of visitors to today's GP surgeries who are recorded as experiencing mental health problems. We are no more wimpish than the Cratchits or the blitz survivors; the stress they suffered probably contributed to their ill health and lower life expectancy.

Of course the stresses we face today are different - and may genuinely be greater for many people than 30 years ago.

Compared with the Fifties and Sixties, we are all working far longer hours. The middle classes in particular are having to compete, where in the past their positions were guaranteed. Changing gender roles are difficult to adjust to as well.

Professor Cooper argues that we have less support today to help us deal with the inevitable stresses that arise: "We no longer have the communities and extended family that acted as our natural counsellors." So counselling networks and services have had to grow in their place.

But the big test to decide whether our futures will be consistently more stressful than our past, is how human beings manage to adapt to change. As we move from one job to another, acquiring new skills, meeting new people, we will have to cope with constant fluidity in our lives. Will this always be tough to cope with or will the next generation, brought up on a diet of rapid movement, get used to continual change?

Professor Fletcher suspects not; "Uncertainty is inherently stressful." No one knows, but the academics look forward to finding out. As Professor Cooper puts it, with glee in his voice, "this is the future of research."