For Lisa, my best friend,who has made my life complete ContentsPreface1 Why Don’t Zebras Get Ulcers?2 Glands, Gooseflesh, and Hormones3 Stroke, Heart Attacks, and Voodoo Death4 Stress, Metabolism, and Liquidating Your Assets5 Ulcers, the Runs, and Hot Fudge Sundaes6 Dwarfism and the Importance of Mothers7 Sex and Reproduction8 Immunity, Stress, and Disease9 Stress and Pain10 Stress and Memory11 Stress and a Good Night’s Sleep12 Aging and Death13 Why Is Psychological Stress Stressful?14 Stress and Depression 15 Personality, Temperament, and Their Stress-RelatedConsequences16 Junkies, Adrenaline Junkies, and Pleasure17 The View from the Bottom18 Managing StressNotesIllustration CreditsIndex PrefacePerhaps you’re reading this while browsing in a bookstore. If so, glance over atthe guy down the aisle when he’s not looking, the one pretending to beengrossed in the Stephen Hawking book. Take a good look at him. He’s probablynot missing fingers from leprosy, or covered with smallpox scars, or shiveringwith malaria. Instead, he probably appears perfectly healthy, which is to say hehas the same diseases that most of us have—cholesterol levels that are high foran ape, hearing that has become far less acute than in a hunter-gatherer of hisage, a tendency to dampen his tension with Valium. We in our Western societynow tend to get different diseases than we used to. But what’s more important,we tend to get different kinds of diseases now, with very different causes andconsequences. A millennium ago, a young hunter-gatherer inadvertently wouldeat a reedbuck riddled with anthrax and the consequences are clear—she’s deada few days later. Now, a young lawyer unthinkingly decides that red meat, friedfoods, and a couple of beers per dinner constitute a desirable diet, and theconsequences are anything but clear—a half-century later, maybe he’s crippledwith cardiovascular disease, or maybe he’s taking bike trips with his grandkids.Which outcome occurs depends on some obvious nuts-and-bolts factors, likewhat his liver does with cholesterol, what levels of certain enzymes are in his fatcells, whether he has any congenital weaknesses in the walls of his bloodvessels. But the outcome will also depend heavily on such surprising factors ashis personality, the amount of emotional stress he experiences over the years,whether he has someone’s shoulder to cry on when those stressors occur.There has been a revolution in medicine concerning how we think about thediseases that now afflict us. It involves recognizing the interactions between thebody and the mind, the ways in which emotions and personality can have a tremendous impact on the functioning and health of virtually every cell in thebody. It is about the role of stress in making some of us more vulnerable todisease, the ways in which some of us cope with stressors, and the critical notionthat you cannot really understand a disease in vacuo, but rather only in thecontext of the person suffering from that disease.This is the subject of my book. I begin by trying to clarify the meaning ofthe nebulous concept of stress and to teach, with a minimum of pain, howvarious hormones and parts of the brain are mobilized in response to stress. Ithen focus on the links between stress and increased risk for certain types ofdisease, going, chapter by chapter, through the effects of stress on the circulatorysystem, on energy storage, on growth, reproduction, the immune system, and soon. Next I describe how the aging process may be influenced by the amount ofstress experienced over a lifetime. I then examine the link between stress and themost common and arguably most crippling of psychiatric disorders, majordepression. As part of updating the material for this third edition, I have addedtwo new chapters: one on the interactions between stress and sleep, and one onwhat stress has to do with addiction. In addition, of the chapters that appeared inthe previous edition, I rewrote about a third to half of the material.Some of the news in this book is grim—sustained or repeated stress candisrupt our bodies in seemingly endless ways. Yet most of us are notincapacitated by stress-related disease. Instead, we cope, both physiologicallyand psychologically, and some of us are spectacularly successful at it. For thereader who has held on until the end, the final chapter reviews what is knownabout stress management and how some of its principles can be applied to oureveryday lives. There is much to be optimistic about.I believe that everyone can benefit from some of these ideas and can beexcited by the science on which they are based. Science provides us with someof the most elegant, stimulating puzzles that life has to offer. It throws some ofthe most provocative ideas into our arenas of moral debate. Occasionally, itimproves our lives. I love science, and it pains me to think that so many areterrified of the subject or feel that choosing science means that you cannot alsochoose compassion, or the arts, or be awed by nature. Science is not meant tocure us of mystery, but to reinvent and reinvigorate it.Thus I think that any science book for nonscientists should attempt toconvey that excitement, to make the subject interesting and accessible even tothose who would normally not be caught dead near the subject. That has been aparticular goal of mine in this book. Often, it has meant simplifying complex ideas, and as a counterbalance to this, I include copious references at the end ofthe book, often with annotations concerning controversies and subtleties aboutmaterial presented in the main text. These references are an excellent entrée forthose readers who want something more detailed on the subject.Many sections of this book contain material about which I am far fromexpert, and over the course of the writing, a large number of savants have beencalled for advice, clarification, and verification of facts. I thank them all for theirgenerosity with their time and expertise: Nancy Adler, John Angier, RobertAxelrod, Alan Baldrich, Marcia Barinaga, Alan Basbaum, Andrew Baum, JustoBautisto, Tom Belva, Anat Biegon, Vic Boff (whose brand of vitamins graces thecupboards of my parents’ home), Carlos Camargo, Matt Cartmill, M. LinetteCasey, Richard Chapman, Cynthia Clinkingbeard, Felix Conte, George Daniels,Regio DeSilva, Irven DeVore, Klaus Dinkel, James Doherty, John Dolph, LeroiDuBeck, Richard Estes, Michael Fanselow, David Feldman, Caleb Tuck Finch,Paul Fitzgerald, Gerry Friedland, Meyer Friedman, Rose Frisch, Roger Gosden,Bob Grossfield, Kenneth Hawley, Ray Hintz, Allan Hobson, Robert Kessler,Bruce Knauft, Mary Jeanne Kreek, Stephen Laberge, Emmit Lam, Jim Latcher,Richard Lazarus, Helen Leroy, Jon Levine, Seymour Levine, John Liebeskind,Ted Macolvena, Jodi Maxmin, Michael Miller, Peter Milner, Gary Moberg,Anne Moyer, Terry Muilenburg, Ronald Myers, Carol Otis, Daniel Pearl, CiranPhibbs, Jenny Pierce, Ted Pincus, Virginia Price, Gerald Reaven, Sam Ridgeway,Carolyn Ristau, Jeffrey Ritterman, Paul Rosch, Ron Rosenfeld, AryehRouttenberg, Paul Saenger, Saul Schanburg, Kurt Schmidt-Nielson, CarolShively, J. David Singer, Bart Sparagon, David Speigel, Ed Spielman, DennisStyne, Steve Suomi, Jerry Tally, Carl Thoresen, Peter Tyak, David Wake,Michelle Warren, Jay Weiss, Owen Wolkowitz, Carol Worthman, and RichardWurtman.I am particularly grateful to the handful of people—friends, collaborators,colleagues, and ex-teachers—who took time out of their immensely busyschedules to read chapters. I shudder to think of the errors and distortions thatwould have remained had they not tactfully told me I didn’t know what I waswriting about. I thank them all sincerely: Robert Ader of the University ofRochester; Stephen Bezruchka of the University of Washington; Marvin Brownof the University of California, San Diego; Laurence Frank at the University ofCalifornia, Berkeley; Craig Heller of Stanford University; Jay Kaplan ofBowman Gray Medical School; Ichiro Kawachi of Harvard University; GeorgeKoob of the Scripps Clinic; Charles Nemeroff of Emory University; Seymour
