Life is stressful. According to the National Institute of Mental Health, stress is “how the brain and body respond to any demand.” Every challenge faced in life — from learning how to roll over as an infant onward — is stressful. This can be very helpful at times, because it changes the body chemistry to allow for faster thinking and action, to flee or to fight.
That reaction not only helps one escape a rampaging water buffalo, but it also boosts motivation and focus ahead of more likely scenarios, such as athletics and job interviews. Not every stressful situation in the 21st century has as an outlet a stressor as obvious as what a water buffalo could bring.
Stress that doesn’t get released doesn’t go away. Instead, it kicks around, accumulates, and expresses itself through physical or mental symptoms.
After more than a year of living in pandemic conditions, many people have been accumulating more stress than they can release, with a lot of interrelated factors being layered on top of whatever stress already existed. A global pandemic has led to huge lifestyle changes, such as the closure of schools and offices that resulted in people spending much more time together in close quarters. Researchers are already expecting an increase in domestic abuse as a result.
Many people have suffered severe economic consequences, losing jobs as businesses were shuttered. The pandemic has been a time when racial inequities simmering under the surface of society have boiled over, and this time the people who feel most oppressed are not being silenced. The political gulf, both locally and nationally, appears wider than ever. Management of the pandemic is itself being cast as a political issue.
Area doctors and health professionals have provided their views about the different ways that stress can take a toll on a person. We talk about stress with a dentist, a gastroenterologist and a cardiologist, with experts on addiction, with a social worker specializing in youth work, and with a pair of mental-health professionals.
Stress in the mouth
The muscles that operate the joints of the jaw can be conscripted into releasing stress, according to dentist Bruce Jay Milner, the owner of Trancend Dental in Woodstock. Stress is one of the causes of temporomandibular joint disorder, which is usually shortened to “TMD” — possibly because no one wants to say such a mouthful while experiencing jaw pain.
It’s not always obvious that stress is contributing to a condition like TMD. The pain this condition causes isn’t always obviously coming from the mouth.
According to information from the Johns Hopkins Medical website, these are among the most complex joints in the body. “These joints, along with several muscles, allow the mandible to move up and down, side to side, and forward and back,” Johns Hopkins explains. “When the mandible and the joints are properly aligned, smooth muscle actions such as chewing, talking, yawning and swallowing can take place. When these structures (muscles, ligaments, disk, jaw bone, temporal bone) are not aligned, nor synchronized in movement, several problems may occur.”
Milner said that TMD was extremely prevalent in this country. He described the different types of discomfort that may result. TMD may be noticed as recurring pain in the shoulder or neck, radiating outward to those areas instead of immediately being felt at the source, the ball-and-socket joint that is out of alignment in some way. It can also show up as earaches, or a pain in the face. One particularly distressing symptom is called crepatis — that’s a grinding or popping that can be felt or heard in the jaw, which signals a deterioration of the cartilage holding everything together.
Two behaviors contribute to TMD: clenching and grinding. The grinding of one’s teeth — the technical term is “bruxism” — tends to happen during sleep as an unconcious attempt to correct a bite that’s out of alignment. Clenching of the teeth, on the other hand, which happens during the conscious hours, is an attempt to alleviate stress.
Normally, the teeth do not spend a lot of time touching their counterparts on the other jaw. When the jaw is at rest it hangs slightly, with the teeth two or three millimeters apart. As long as the teeth are lined up correctly and there isn’t something like a dental cap that’s slightly higher than it should be, there’s not likely to be contact even during chewing. Teeth do normally touch when a person swallows saliva — which happens about 2000 times a day. Those contacts are inconsequential compared to what happens to teeth of people who clench or grind. During those brief-but-frequent moments, all the teeth should touch at about the same time and with similar force.
Clenching the teeth due to stress becomes an automatic act, over-closing the jaw and exerting constant pressure on the teeth, the jaw muscles, and those complex temporomandibular joints. Even if stress is the only problem affecting the jaw, all that clenching can begin wearing out those balls and sockets. If there’s anything in even slightly out of alignment — a wisdom tooth that didn’t come in straight, or a dental crown that’s a millimeter too tall — the clenching can amplify the imperfection, and lead to a bite that’s out of alignment. Once there’s an imbalance, grinding the teeth during sleep begins as a vain attempt to correct the problem by wearing everything down until it’s even again. It’s a cycle that can even lead to breaking teeth.
Over the last year, Milner believes, the stress of pandemic life could well have increased the number of people suffering from TMD, thought that phenomenon has not yet filtered into this dentist’s office. With the exception of a few weeks starting in March 2020, Milner says he hasn’t yet personally noticed in his steady stream of patients more coming in with symptoms of TMD.
How much pain any individual may choose to endure before calling a dentist varies. There are always people who try to avoid dental visits, which themselves cause stress. Coming into any medical office has felt stressful for many, due in part to concerns about becoming infected with the coronavirus. More tragically, the cost of care can itself be very stressful.
A common treatment for TMD is a custom dental appliance that keeps the teeth apart, preventing either grinding or clenching. Those appliances might run $1200, and the mouth is among the most poorly-insured body parts when it comes to medical care.
“I may not see the impact for a while,” Milner said. Recurrent pain in the ear, neck or shoulder, spasms in the jaw, and pain while chewing are all signs that it’s time to see a dentist.
Stress in the gut
Gastroenterologist Kevin Dodd is well aware that there’s a direct line between the brain and the digestive tract. About one in five of the patients that come through Dodd’s Woodstock and Kingston offices are being treated for irritable bowel, which the doctor describes as “a broad-reaching term for stress-related symptoms unrelated to other diseases.” Over the course of the pandemic, Dodd has been inundated with patients complaining of this complex mixed bag of symptoms. Someone with an irritable bowel becomes aware of the peristalsis pushing food down the digestive tract throughout the day. Most people don’t notice it at all.
Readers with a meal before them may wish to skip right over the details about what can go wrong with the gut. Patients with this syndrome suffer from repeated bouts of constipation or diarrhea, and may flip between the two. Bloating and gas are also common symptoms, and this may cause a patient to feel uncomfortably full while or after eating. There can also be mucus or slime in the stool, Dodd said. Higher up, the disorder can show up as stomach pain, heartburn, or indigestion with no discernible cause. There can be reflux, nausea, pain and urgent need to use the bathroom upon waking, or pain in the abdomen after eating. Irritable bowel is a suffering without source: reflux without acid, abdominal pain with a healthy gall bladder, or any number of discomforts without blood in the stool to suggest physical damage to an organ.
Irritable bowel can mimic gallstones, Crohn’s disease and colitis, and eliminating those conditions is often how one zeroes in on the diagnosis. Dodd said that this can help avoid unnecessary invasive tests, but in older patients who are more prone to serious conditions like colon cancer, that’s sometimes necessary just to be sure.
Other than alleviating the stress itself, treatments for an irritable bowel depend on the symptoms. Medications can help speed things up or slow them down, supplements can do the same in some cases, and it might just require a bit more fiber. Diet can be used to eliminate foods that are triggers. However, those triggers are individual, making trigger warnings less helpful than a methodical process of elimination, as it were, supervised by one’s doctor.
Doctor supervision is a tricky subject right now. Dodd believes that far more people have symptoms than are coming in, due to lingering anxiety about all medical procedures. The greater risk is that a more serious issue such as cancer will escape diagnosis. Even the more invasive tests, such as conducting a colonoscopy, can be conducted in the office rather than at a hospital, Dodd pointed out, and initial appointments with a doctor can be conducted virtually.
Stress on the heart
“Stress is tricky,” said Dr. Ellis Lader, director of the Kingston division of the Westchester Medical Center heart health and vascular institute. “We all face it… What’s just as important is how a person reacts to it.” Some people are just more laid-back, while others are quick to reach the boiling point. “During the past year, we were facing double whammy of stress,” explained Lader, “the pandemic right in your face, running the risk of becoming sick and dying on news every single day, and also the election craziness. Even laid-back people started to feel it.”
Stress is an evolutionary reaction to a sense of threat, and it primes the body to for flight or fight. Adrenaline is released, heart rate and blood pressure increase, and more sugar goes into the bloodstream, resulting in someone is who more alert.
“You’re ready to save your life,” Lader said. If there’s imminent danger, “That’s a good thing.” But on the other hand, “If you’re angry because someone ahead of you is paying by check, and you sit there fuming, that’s not an adaptive response.”
Mix in a pandemic that not only amplifies opportunities for stress but undercuts opportunities for exercise, and Lader expects that many people emerging from their isolation will find their bodies are not adapted as well to activity. People have gotten out of shape, and the older someone is, the harder getting back into shape becomes. Experiencing a sudden drop in exercise tolerance, like walking to the mailbox, is an indicator that the cardiovascular system may be involved.
Stress is a factor in coronary disease. This can show up as shortness of breath, pain in the chest, and high blood pressure — but that last is a symptom that cannot be reliably measured expect with a monitor. More unusual symptoms that may point to a heart problem are pains provoked by activity and relieved by rest, especially those in the jaw, across the shoulders, in one arm, or across the back or upper abdomen. Yes, these symptoms overlap with stress symptoms of gastrointestinal and dental conditions, which means that anyone experiencing them really ought to see one of these doctors as soon as possible to start unraveling the mystery before it gets worse.
Lader knows that in the pandemic some people have been fearful of seeing doctors, and hopes that the increasing number of vaccinations will ease those worries and allow people to feel safe getting examined and treated for all manner of symptoms.
There have been reports of people dying of heart attacks in their homes. The WMC offices in Kingston have been reorganized to keep patients safe.
Stress and addiction
People who are facing a lot of stress but lack the tools to manage or release it may find themselves caught in a cycle of addiction. Maya Hambright, medical director at the Nuvance Health recovery center in the Herzog Plaza in Kingston, has seen these problems getting worse in recent months. Hambright is focused on pain management for people who are already struggling with opioid addiction or are at risk, She has been working closely with David McNamara, the executive director of Samadhi Recovery in uptown Kingston.
“Getting worse” doesn’t accurately convey how addiction has exploded during this pandemic. McNamara has seen two to three times the number of people reaching out for help at Samadhi, including some who have been in recovery for 15 or 20 years. Due to the uncertainty of not knowing what’s coming next, they have now returned to using one substance or another. According to Hambright, people try to find relief from the spike in physical and emotional stress created by these pandemic conditions.
Hambright explained that many people first encounter opioids as a means to get relief from physical pain, but due to the nature of these drugs they become less effective over time, leading to or exposing emotional stress and underlying trauma. The desire to avoid all these forms of pain can put a person into a cycle of addiction. McNamara has found that 95 percent of patients at Samadhi have some sort of untreated trauma, and may easily find themselves trapped in a pattern of becoming re-traumatized. Risky and illegal behavior evolves into complex trauma, setting the individual up for being arrested and returned to treatment — sometimes through a judge’s order — with the whole process likely to repeat again once they are released from the program.
McNamara and Hambright are working together to try to get at and heal the trauma at the core.
Addiction doesn’t always show up as a dangerous prescription or street drug, either. “People will say they have no experience of addiction while staring at their phone,” noted McNamara. “We look for the nearest thing that makes us feel better.”
“We turn to many things when we are not feeling safe,” Hambright agreed. “It’s not necessarily a heroin needle.” A lot of stress response is about responding to the perception of danger, and recovery involves recognizing when there’s no actual danger in the moment.
Stress and addiction increase levels of cortisol in the body, Hambright said. This chemical acts similar to a steroid like prednisone, and it puts the body in a state of perpetual stress. This can lead to a gain of weight, loss of sleep, and the reduction in the body’s ability to heal. Ways to reduce cortisol levels include smiling and human connection. “It’s how we’re built.”
Isolation itself is stressful, as humans are a communal species. Isolation, correlated with poor coping mechanisms such as drinking, cuts people off from the group programs that are central to substance-use recovery. “One of the first things they tell you in recovery is, Don’t isolate yourself, and all of a sudden everyone was in instant isolation,” said McNamara. Meeting on a screen just won’t do, either. The secret sauce that makes human connection powerful requires physical proximity to work at its best.
“The long-term goal is learning how to handle stress without running from it,” Hambright believes.
Stress and children
Adults may sometimes lack the coping mechanisms to deal with stress in a health manner, but children have the odds stacked against them because they lack experience. The youngest among us lack even the ability to talk about what they are feeling.
Being young does not make anyone immune to stress, but it can make it more difficult to manage. Tanya Neimann, a licensed master social worker who worked in child services before joining Ulster County’s mobile mental-health team late last year, has seen a lot of those problems.
“Kids are exhibiting a lot of symptoms due to stress and isolation,” Neimann said. Learning online instead of in person has left them yearning for the classroom in many cases, in part because they have been cut off from time with their friends.
For some, this situation has led to what Neimann describes as “extreme behaviors,” violence against siblings and even parents, ranging from tantrums in the youngest through more threatening encounters when the subject is in the later teen years. The bulk of Neimann’s experience has been with the smallest of kids, who may find that biting and kicking are the only tools they have to express their frustration and stress. Once a child is old enough to be able to walk, that child is old enough to exhibit stress by throwing a tantrum.
Once a child has developed language, it’s possible to find other ways to let their feelings out, but this assumes an environment where it’s safe to find healthy ways to express feelings. Not everyone lives in such a place, meaning that stress may show up in other ways.
Stress during this pandemic “has probably affected every aspect of everyone’s mental health.” Children with underlying conditions may be especially ill-equipped to deal with the additional stress that close family living and isolation from all other people may bring. Neimann named depression, anxiety, and the autism spectrum as factors that can be easily compounded by the change of circumstances brought on by attempts to control this coronavirus.
“There’s also a big increase in kids who are experiencing suicidal ideation,” or thoughts of ending their own lives. Depression does not have to be diagnosed or even present for a child to be pushed to the brink, either. “They’re really struggling,” said Neimann, who expects that the long-term impacts of this period on the mental health of children will be studied closely for years to come.
Stress and the mind
Shortness of temper, road rage, substance use, and violence toward loved ones are among the many poor ways that people deal with their stress mentally. Mental health is perceived as being separate and distinct from physical health, despite the mounting evidence showing complex human systems connected in multiple ways.
Neimann expressed frustration that mental health is not treated with the same importance as other health issues, and believes that there is correlation between stress and a broad array of mental issues up to and including schizo-affective disorders. “We get sick, we go to the doctor,” she said, “but there’s a lot of resistance for people in the medical system to see mental health and the brain as part of the body.’
It’s not only people with diagnoses, Neimann said.
“Being under more stress or a lack of treatment” for other issues such as anxiety or depression can also lead to instances of paranoid thinking and even hallucinations. Mental symptoms of stress can include headaches, anger, sadness, and irritability in addition to specific diagnosed conditions such as depression, according to information from the National Institute of Mental Health. A list of symptoms on the Mayo Clinic website includes feeling overwhelmed, lack of motivation or focus, and trouble sleeping or restlessness.
More people are experiencing mental-health crises. Neimann believes some of these crises could be avoided by trying to address issues when they are less serious. “Maybe you’re arguing more with your partner, or getting triggered more, or you get more angry in the car and it comes out in road rage.”
Intense or unexpected emotions are a sign that it’s time to seek help. Stress doesn’t just make people cranky, after all. It can break teeth, wreak havoc on digestion, and take a toll on the all-important heart, too. Nearly all medical professionals are now able to conduct telehealth appointments, which lowers the barrier to getting help, no matter how stress is manifesting in one’s life.
Trees reduce stress
There is nothing like that feeling of going on a hike, pulling into the parking lot, getting out of the car, and heading into the woods to escape from it all. Maybe it is a moment away from work, away from the messes at home, or maybe, just maybe, it is the presence of the trees themselves.
The state Department of Environmental Conservation contends there are countless benefits to just simply being amongst the trees. “Spending time around trees and looking at trees reduces stress, lowers blood pressure and improves mood. Studies show that exercising in forests or simply sitting and looking at trees reduce blood pressure as well as the stress-related hormones cortisol and adrenaline.”
The Hudson Valley region is fortunate enough to have a plethora of places outside our own backyard, including hundreds of miles of rail-trails and numerous mountain trails.