Why Zebras Don't Get Ulcers_ The Acclaimed Guide to Stress, ...
For Lisa, my best friend,
who has made my life complete
Contents
Preface
1 Why Dont Zebras Get Ulcers?
2 Glands, Gooseflesh, and Hormones
3 Stroke, Heart Attacks, and Voodoo Death
4 Stress, Metabolism, and Liquidating Your Assets
5 Ulcers, the Runs, and Hot Fudge Sundaes
6 Dwarfism and the Importance of Mothers
7 Sex and Reproduction
8 Immunity, Stress, and Disease
9 Stress and Pain
10 Stress and Memory
11 Stress and a Good Nights Sleep
12 Aging and Death
13 Why Is Psychological Stress Stressful?
14 Stress and Depression
15 Personality, Temperament, and Their Stress-Related
Consequences
16 Junkies, Adrenaline Junkies, and Pleasure
17 The View from the Bottom
18 Managing Stress
Notes
Illustration Credits
Index
Preface
Perhaps youre reading this while browsing in a bookstore. If so, glance over at
the guy down the aisle when hes not looking, the one pretending to be
engrossed in the Stephen Hawking book. Take a good look at him. Hes probably
not missing fingers from leprosy, or covered with smallpox scars, or shivering
with malaria. Instead, he probably appears perfectly healthy, which is to say he
has the same diseases that most of us havecholesterol levels that are high for
an ape, hearing that has become far less acute than in a hunter-gatherer of his
age, a tendency to dampen his tension with Valium. We in our Western society
now tend to get different diseases than we used to. But whats more important,
we tend to get different kinds of diseases now, with very different causes and
consequences. A millennium ago, a young hunter-gatherer inadvertently would
eat a reedbuck riddled with anthrax and the consequences are clearshes dead
a few days later. Now, a young lawyer unthinkingly decides that red meat, fried
foods, and a couple of beers per dinner constitute a desirable diet, and the
consequences are anything but cleara half-century later, maybe hes crippled
with cardiovascular disease, or maybe hes taking bike trips with his grandkids.
Which outcome occurs depends on some obvious nuts-and-bolts factors, like
what his liver does with cholesterol, what levels of certain enzymes are in his fat
cells, whether he has any congenital weaknesses in the walls of his blood
vessels. But the outcome will also depend heavily on such surprising factors as
his personality, the amount of emotional stress he experiences over the years,
whether he has someones shoulder to cry on when those stressors occur.
There has been a revolution in medicine concerning how we think about the
diseases that now afflict us. It involves recognizing the interactions between the
body 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 the
body. It is about the role of stress in making some of us more vulnerable to
disease, the ways in which some of us cope with stressors, and the critical notion
that you cannot really understand a disease in vacuo, but rather only in the
context of the person suffering from that disease.
This is the subject of my book. I begin by trying to clarify the meaning of
the nebulous concept of stress and to teach, with a minimum of pain, how
various hormones and parts of the brain are mobilized in response to stress. I
then focus on the links between stress and increased risk for certain types of
disease, going, chapter by chapter, through the effects of stress on the circulatory
system, on energy storage, on growth, reproduction, the immune system, and so
on. Next I describe how the aging process may be influenced by the amount of
stress experienced over a lifetime. I then examine the link between stress and the
most common and arguably most crippling of psychiatric disorders, major
depression. As part of updating the material for this third edition, I have added
two new chapters: one on the interactions between stress and sleep, and one on
what stress has to do with addiction. In addition, of the chapters that appeared in
the previous edition, I rewrote about a third to half of the material.
Some of the news in this book is grimsustained or repeated stress can
disrupt our bodies in seemingly endless ways. Yet most of us are not
incapacitated by stress-related disease. Instead, we cope, both physiologically
and psychologically, and some of us are spectacularly successful at it. For the
reader who has held on until the end, the final chapter reviews what is known
about stress management and how some of its principles can be applied to our
everyday lives. There is much to be optimistic about.
I believe that everyone can benefit from some of these ideas and can be
excited by the science on which they are based. Science provides us with some
of the most elegant, stimulating puzzles that life has to offer. It throws some of
the most provocative ideas into our arenas of moral debate. Occasionally, it
improves our lives. I love science, and it pains me to think that so many are
terrified of the subject or feel that choosing science means that you cannot also
choose compassion, or the arts, or be awed by nature. Science is not meant to
cure us of mystery, but to reinvent and reinvigorate it.
Thus I think that any science book for nonscientists should attempt to
convey that excitement, to make the subject interesting and accessible even to
those who would normally not be caught dead near the subject. That has been a
particular 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 of
the book, often with annotations concerning controversies and subtleties about
material presented in the main text. These references are an excellent entrée for
those readers who want something more detailed on the subject.
Many sections of this book contain material about which I am far from
expert, and over the course of the writing, a large number of savants have been
called for advice, clarification, and verification of facts. I thank them all for their
generosity with their time and expertise: Nancy Adler, John Angier, Robert
Axelrod, Alan Baldrich, Marcia Barinaga, Alan Basbaum, Andrew Baum, Justo
Bautisto, Tom Belva, Anat Biegon, Vic Boff (whose brand of vitamins graces the
cupboards of my parents home), Carlos Camargo, Matt Cartmill, M. Linette
Casey, Richard Chapman, Cynthia Clinkingbeard, Felix Conte, George Daniels,
Regio DeSilva, Irven DeVore, Klaus Dinkel, James Doherty, John Dolph, Leroi
DuBeck, 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, Ciran
Phibbs, Jenny Pierce, Ted Pincus, Virginia Price, Gerald Reaven, Sam Ridgeway,
Carolyn Ristau, Jeffrey Ritterman, Paul Rosch, Ron Rosenfeld, Aryeh
Routtenberg, Paul Saenger, Saul Schanburg, Kurt Schmidt-Nielson, Carol
Shively, J. David Singer, Bart Sparagon, David Speigel, Ed Spielman, Dennis
Styne, Steve Suomi, Jerry Tally, Carl Thoresen, Peter Tyak, David Wake,
Michelle Warren, Jay Weiss, Owen Wolkowitz, Carol Worthman, and Richard
Wurtman.
I am particularly grateful to the handful of peoplefriends, collaborators,
colleagues, and ex-teacherswho took time out of their immensely busy
schedules to read chapters. I shudder to think of the errors and distortions that
would have remained had they not tactfully told me I didnt know what I was
writing about. I thank them all sincerely: Robert Ader of the University of
Rochester; Stephen Bezruchka of the University of Washington; Marvin Brown
of the University of California, San Diego; Laurence Frank at the University of
California, Berkeley; Craig Heller of Stanford University; Jay Kaplan of
Bowman Gray Medical School; Ichiro Kawachi of Harvard University; George
Koob of the Scripps Clinic; Charles Nemeroff of Emory University; Seymour