Case study 2: Stressed physicist

• Peripheral circulation: autonomic and hormonal control,
• Receptors: adrenergic, cholinergic.

• Screening: e.g. hypertension,
• Adherence to treatment,
• Stress and illness (V): treatment methods.

• Psychosexual dysfunction,
• Anxiety/phobia,
• Cerebrovascular disease.

A 51 year old university lecturer, Dr Newton is socially acquainted with his GP's family and with several consultants at the teaching hospital. His hypertension is discovered incidentally when he sees the GP about vague symptoms that may be stress-related. Dr Newton stops taking his blood pressure medication because it makes him impotent. His relationship with the GP becomes strained and his hypertension proves difficult to control. He dies of a stroke and the post-mortem findings are summarised.

• Nature of stress and how people react to it,
• Interaction with care services.

• Work related expansion of general themes.

In this case, there is a combination of physical and mental illness. It illustrates how both elements can interact, causing, aggravating and masking each other. Often these things are complicated, there is no right answer and, possibly, no solution at all.

There is an apparent epidemic of work-related mental illness much of it reported as "stress" and indeed, in the most reliable UK reporting system of work-related illness of this type (SOSMI), mental illness has overtaken work-related upper limb disorders in frequency.

The THOR project contains information on a number of reporting schemes including SOSMI and OPRA.

We tend to wave ideas like "stress" and "stress of work" around in a fairly general way and they are often treated similarly in the media. When one digs just a bit deeper though, the ideas are very hard to define and it becomes clear that stress means a lot of different things to different people. This makes looking at the problems in any given area, such as the workplace, rather more difficult and you rapidly come to the conclusion that a lot of unfounded assumptions are being made and worked with. If one is being scientifically minded this is very unsatisfactory and one has to troll out the old cliché about 'more research being badly needed'.

So, how would you define stress? Does it come from within you? or from outside? or both? The UK Health and Safety Executive which addresses workplace health and safety has had a go at defining it. Have a look at the relevant web pages and see if you agree with their ideas.

There is no mystery about where the concept of stress comes from. It derives from the work of a man called Hans Selye in the 1950s. He defined stress as situations producing a basic primal reaction of “fight or flight”, evolutionarily a necessity for survival. This produces a series of physiological changes such as increased heart rate, increased arousal, increased muscle tone, etc which are preparatory to the “fight or flight”. The basic theory goes that we increasingly experience this physiological response where it is not needed or has to be suppressed because it is socially inappropriate, with the resultant distress and illness that we experience.

In the workplace we are put under pressure and put ourselves under pressure to get things done. Some of the things we are asked to do we do not like. These are barriers to be overcome in reaching our work objectives. Some of this we enjoy, some we don't. Each individual has a different set of likes and dislikes and a different tolerance level. From this sort of thinking comes the concept of differentiating “pressure” which is a natural and normal part of life from "stress" which is a range of adverse responses to pressure. This is a useful practical way of thinking conceptually.

When we start doing scientific research on a new and difficult area, as we have begun to do with stress, we tend to nibble away at small bits of the issue and in occupational studies it is common at the early stages to identify a range of "risk factors"; that is, elements of work which may particularly contribute to the adverse pressures that we call stress (in this case).

Quite a lot of risk factors have been identified now. Common ones include:

• High workload,
• Lack of control over work (not being able to organise it the way you would prefer, etc).

There is a full list of "risk areas or domains" on the HSE website you have already visited. You may well think that a lot of what it says is common sense, and it is. However, common sense can lead you astray and so it is best to back it up with formal research, as is being done.

Turning now to our patient, we see an unhappy, tragic set of events which are facts of life which we will regularly enough have to deal with. It is worth reflecting on the things that happened that could have gone differently and may be (and no more than maybe) might have prevented the tragedy. Here is a list of points to consider:

• Self awareness - some personalities cope better with pressure than others; some self knowledge might have empowered our patient to resist some of the pressures he was put under and put himself under,
• Self awareness - knowledge of early signs of stress,
• "Work-life balance" - balancing the pressures (and pleasures) of work, home and other "life-compartments",
• "Treatment" - medication, counselling, psychological support,
• "Medical management" - proper GP consultations rather than "corridor consultations", etc,
• Draw in the hospital occupational health department - this tends to be particularly focused and experienced with these sorts of issues and is often best placed to take the appropriate managerial, medical overview,
• "Duty of care" - effective workplace risk assessment and identification of at risk individuals (a legislated duty! - but hard to discharge!)

Finally, look around at your colleagues and managers - do you think that some of them may be stressed? Write down which of the above bullet points would be helpful to them and what difficulties you might encounter in getting effective care for them.