Keeping Score on Stress
Stress Awareness
By Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal
"It’s not stress that kills us, it is our reaction to it."
-Hans Selye
In considering stress, for most of the time, and for most of us, you can’t ignore, dismiss, or wish it away.
While stress comes in waves, like paper cuts that are persevering, they can bring you to tears, or to your knees. Stress and the events, scenarios and possibilities that promote them are inevitable; they are part of the human experience. At one time or another we all will probably lose our car keys, lose a job, lose a loved one and lose an opportunity. Given the time to recover from these critical life events, we all move on. When they come one after another and don’t allow us to exhibit resiliency and recovery, we can easily stumble and fall.
If only if there was a way of predicting the effects of concentrated stress and perhaps having an early warning of its potential consequences, we might be able to fortify our defenses and escape with minor setbacks.
There’s an axiom in science and industry that states “if you can’t measure it, you can’t manage it.” If ever there was something that’s needed to be managed, it’s stress. And thanks to two physicians we can.
In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of life events based on a relative score.
The Holmes and Rahe stress scale, also known as the Social Readjustment Rating Scale, is a list of 43 stressful life events that can contribute to illness. The test works via a point accumulation score which then gives an assessment of risk. The American Institute of Stress, for instance, regards a score of 300 or more as an "80% chance of health breakdown within the next 2 years". While there is good evidence that chronic stress can lead to ill health, there is not much evidence to support the ranking of stressful life events in this manner.
Their results were published as the Social Readjustment Rating Scale (SRRS), known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness. And while you might think it’s a “no brainer,” linking stress with health status prior to the creation of this scale was an unvalidated connection.
Like all original thinking, the Holmes Rahe Stress Scale has had its fair share of criticism. Its scrutiny has been fair and several now obvious (remember the scale was created almost 60 years ago) methodological flaws have been revealed.
An article in Journal of Human Stress (Behavioral Medicine) noted several limitations including: lack of differentiation between favorable versus adverse life events; ambiguity of life events described; confounding dependent and independent variables; and cultural, racial and gender differences not accounted for and adjusted.
Still, it has merit, meaning and application. We must be reminded that a self-inventory of health risks does not necessarily mean that the individual will initiate behaviors to address and mitigate the risk. For example, we have identified risk factors for heart disease, diabetes, and certain forms of cancer. People will either adopt them successfully, ignore them completely or attempt to practice them and all too often fail. The same is true with recognizing that an individual has been exposed to high levels of stress in a concentrated time span. While knowledge is power (thank you Francis Bacon for that reminder) it does not guarantee that the “power” will be acquired and employed.
It is worthwhile noting that stress comes in two flavors: there is the well-known negative stress (distress) that we all recognize (loss of a loved one, loss of a job, personal declining health). There is also positive stress (eustress) that comes from favorable situations (meeting the partner of your dreams, career promotion, having children). Both forms provide opportunities for impacting on your health and wellness, all determined by your reaction to the event.
Here is the Holmes-Rahe Stress Scale:
https://www.stress.org/wp-content/uploads/2024/02/Holmes-Rahe-Stress-inventory.pdf
Total score of 150 or lower
Low Risk
There has been a relatively low amount of life change and a low susceptibility to stress-induced health breakdown.
Total score of 151 to 300
Risky
Implies about a 50% risk of a major health breakdown in the next 2 years, according to the Holmes-Rahe statistical prediction model.
Total score of 301 or more
Severe Risk
Implies about an 80% risk of a major health breakdown in the next 2 years according to the Holmes-Rahe statistical prediction model.
Perhaps, it’s time for including disability specific notions to our “stress score card.” While individuals with disabilities encounter all the listed life events in the Holmes-Rahe scale, there are certain situations that might be considered unique to the disability community. Here are a few examples with an invitation to HELEN Journal readers to add others:
1. Being told you can’t qualify for that program
2. Hearing “you can’t sit with us.”
3. Being denied access to places you want to experience
4. Realizing that you don’t need “special treatment,” just need “equal treatment”
5. The person who told you that is no longer here and we can’t honor that promise
6. We’re not equipped to treat you for that
7. You can be in that class if you aren’t a distraction
8. Hearing, “Do you think that’s in your best interests?
9. Not being invited to a “sleep over”
10. Being told that “we don’t feel you would be safe doing that”
There are countless other disability-specific situations, encounters and scenarios that contribute to the stress, anxiety, despair, and humiliation that people with disabilities experience daily.
One can only imagine the multiple stressors that our journal’s namesake, HELEN, experienced in her life. Her ability to persevere and excel is a testimony to her spirit, and serves as the ongoing inspiration for providing Helen, The Journal of Human Exceptionality, to you every month.
Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal