Yves here. It’s frustrating to see an article start to get to the essence of a major issue and then pull up short. Here, author Dana Becker discusses how discussions of and suggested remedies for stress typically look only at immediate conditions and not underlying, societal drivers. Presumably, Becker gives a more comprehensive treatment in her book, so perhaps I am being unfair. However, this discussion gives the strong impression that she has utterly overlooked the biggest force changing the structure of advanced societies, the march of neoliberalism. It greatly widened inequality and that has negative health outcomes. We cited this section of a Financial Times article by Michael Prowse in the very early days of this website, and it appears it can’t be repeated often enough:
But recent epidemiological research suggests that finance ministers, too, may some day be required to issue health warnings. There are good reasons to believe that policies that promote greater economic inequality – such as budgets that slash top tax rates – cause higher rates of sickness and mortality….
In Britain, these new arguments are most closely associated with Richard Wilkinson, a professor at Nottingham University’s medical school. Wilkinson has spent much of the past two decades painstakingly assembling the evidence for a link between inequality and sickness. But researchers elsewhere, such as Ichiro Kawachi and Bruce Kennedy of the School of Public Health at Harvard University, have independently confirmed many of his claims.
Those who would deny a link between health and inequality must first grapple with the following paradox. There is a strong relationship between income and health within countries. In any nation you will find that people on high incomes tend to live longer and have fewer chronic illnesses than people on low incomes.
Yet, if you look for differences between countries, the relationship between income and health largely disintegrates. Rich Americans, for instance, are healthier on average than poor Americans, as measured by life expectancy. But, although the US is a much richer country than, say, Greece, Americans on average have a lower life expectancy than Greeks. More income, it seems, gives you a health advantage with respect to your fellow citizens, but not with respect to people living in other countries….
Once a floor standard of living is attained, people tend to be healthier when three conditions hold: they are valued and respected by others; they feel ‘in control’ in their work and home lives; and they enjoy a dense network of social contacts. Economically unequal societies tend to do poorly in all three respects: they tend to be characterised by big status differences, by big differences in people’s sense of control and by low levels of civic participation….
Unequal societies, in other words, will remain unhealthy societies – and also unhappy societies – no matter how wealthy they become. Their advocates – those who see no reason whatever to curb ever-widening income differentials – have a lot of explaining to do.
Social stratification increases stress because it becomes more important to hang onto your rung on the economic ladder than in a more equal system. A hit to income often times means moving (at a minimum out of your house and thus probably your school district) and giving up activities at your level (less expensive restaurants, no more ski trips, less use of hired help, fewer or no charity functions). That makes it stressful or impossible to mix with former “friends”. Further down the food chain, a loss of income can lead to a scramble to meet expenses, bankruptcy, or even homelessness. And in a neoliberal society that has encouraged employers to treat employees as disposable and where job tenures are short, even people with high incomes can be savings poor and vulnerable to shocks.
I’m also skeptical of her view that working long hours at the office is a macho display, “like felling trees or killing bear in pioneer days.” Help me. Plenty of women invest heavily in careers. At least for professionals, the dirty truth is that as messy as office life is, many find it more rewarding that dealing with their families. They hang out with colleagues who are often from similar backgrounds, get to travel on the company dime, and are distracted from things like disobedient kids, budget stresses, and home repairs.
brought my 81-year-old husband home from the hospital on Thursday. He had suffered a mild heart attack in March. This time he was in the hospital for three days and no one could figure out what was wrong. At home the next morning, he had symptoms identical to those he had had the day we had left for the Emergency Room. I, on the other hand, felt worse; my throat was scratchy and that night I developed a fever. Since we moved from Philadelphia to Ann Arbor following my 96-year-old mother’s stroke last year, my husband has been depending on me more and I have assumed the role of my mother’s sole decision-maker and advocate. As I coughed and tossed at night I tried not to think about the great unravelling that might occur if I became really sick, or even died.
Was I ‘stressed out’ in the vernacular of our time? I suppose the answer is yes. It is customary these days to describe reactions to difficult situations this way. We now rely on stress to explain the effects of everything from war to too much mail in our inbox. From 1970 to 1980, there were over 2,000 academic publications with stress in the title; from 2000 to 2010 there were over 21,000. As the historian Charles Rosenberg has pointed out, since the advent of industrialism Americans have had various ways of explaining the relationship between the fast pace of life and disease, a story of progress and pathology. Stress is now at the center of those explanations. Biomedical research focuses on the impact of stress on the immune system even though there is as yet no solid evidence of a cause-and-effect relationship between the two.
When the eighteenth-century philosopher and statesman Alexis de Tocqueville travelled to America he praised American individualism, but he also expressed the fear that eventually Americans might come to believe that “their whole destiny is in their own hands.” Many of us seem to have swallowed that belief along with our kale smoothies. In 1980, the political economist Robert Crawford coined the term “healthism” to describe how, for the middle classes, maintaining their health was fast becoming a universal responsibility and an overarching moral value.
In the decades since, stress has been considered a chief adversary in the fight to stay healthy, and everything from cancer to too much texting is deemed stressful. This has been a boon for advertisers and self-help gurus. ‘Relax, buy a massage chair, eat better, focus on your breath and buy a pastel yoga mat.’ The commodification of stress comfortably molds itself to capitalism, and the emphasis on individual solutions to social and political problems fits conveniently with an historical attachment to American individualism and its twentieth-century shape-shifting cousin, self-actualization.
In my book, One Nation Under Stress: The Trouble with Stress as an Idea, I have defined stressism as the “belief that the tensions of contemporary life are primarily individual lifestyle problems to be solved through managing stress, as opposed to the belief that these tensions are linked to social forces and need to be resolved primarily through social and political means.” By focusing on the stress we ‘feel,’ we train our attention on how to ‘de-stress’ at the expense of examining and trying to transform the underlying conditions that cause us to experience stress in the first place.
In this way stress serves a malign social purpose. Once I say that I’m ‘stressed’, I’m advised to meditate or take a walk or light aromatic candles or steep in a bubble bath. Any of these, of course, could certainly make me feel better in the short run, and I’m not suggesting we stop trying to take care of ourselves if we have the time and means to do so, but these are superficial remedies to deep-rooted structural problems.
When psychologists consistently describe poverty as stressful, they encourage interventions at the level of the individual. As Andrew Solomon proposed in the New York Times magazine some years back, since poverty is depressing and many poor people are depressed, why not just treat poor people for depression? In our therapeutic culture, at a time when many problems of living are defined as mental illnesses, it is not surprising that problems like poverty is are medicalized in this way. Poverty can certainly be depressing, but antidepressants are no remedy for poverty.
Another example of how our current focus on stress obscures the social conditions that produce it is revealed when we consider how discussions of working mothers’ stress inevitably raise the need for the ever-elusive ‘work/family balance.’ Such balance is deemed essential if women are to avoid screaming at their children or denying sex to their partners. ‘Take care of yourself and deal with your stress so you can continue to care for others’ is the message that began to emerge in the 1980s when middle-class white women joined the workforce in ever larger numbers.
This was a period when the tropes of ‘Superwoman ‘and ‘Supermom’ were the order of the day. Talk of women and stress boiled over in 1990s when women’s magazines were full of articles warning that attempts to ‘juggle’ or ‘balance’ the demands of home and work were apt to wreck women’s physical and/or mental health unless they ‘managed their stress.’
Apart from an occasional reference to the need for ‘family-friendly’ workplace policies, such discussions failed to describe the social forces that bore down on women who tried to ‘have it all’, forces that included – and still include – the gendered nature of caregiving and the phallocentric nature of the workplace. And of course, although poor women have been working outside the home for centuries, their ‘stress’ has been systematically neglected as a subject of public interest.
Joan Williams, the director of the Center for Worklife Law, has pointed out how today’s white-collar workplace is still tailored for the ‘ideal’ (male) worker who has a wife handling domestic life and its backstage dramas, and historian Michael Kimmel has suggested that, for men, putting in maximum hours at the office is the contemporary analog of felling trees and killing bears in pioneer days. Overwork is the new macho activity, and if women are ‘stressed out’ in trying to manage expanding workplace expectations on top of the twenty-first century demands of intensive parenting, they had better find quick ways of relieving it so as not to disturb the status quo.
A central problem with these discussions of work/life balance is that they place ‘work’ and ‘life’ on opposing sides of the scale, and women in their destined position at the fulcrum. The ‘stress’ experienced in working families of all socioeconomic groups would be greatly alleviated if care-giving were valued in moral, political and economic terms. This kind of valuation would direct policy so that responsibility for care of the young, the elderly and the disabled, now assumed primarily by women, would be properly supported.
The restructuring of the workplace would enable a level of ‘work/life balance’ for families that can now only be dreamt of, at least in the United States. Paid family leave would no longer be a figment of the popular imagination. Care workers would earn higher wages, making it possible to hope that there might be enough paid caregivers to serve the growing number of elderly people who will need them.
The idea of stress offers one way of talking about our vulnerability, but it doesn’t help us do much more than moan about middle-class pressures and grasp at temporary solutions. It offers ballast to the status quo and keeps us as a society from undertaking the potentially more destabilizing work of structural social change that is needed in order to reduce the human distress that is created by adverse social conditions.
What if, as a society we adopted the idea of universal vulnerability, which the legal scholar Martha Albertson Fineman defines as “an enduring aspect of the human condition that must be at the heart of social and state responsibility?” Embracing this principle would necessarily limit our efforts to re-engineer ourselves at the expense of truly altering the fabric of society.