11 Stress, depression and critical care
A poster in the 1980s said, ‘Don’t ask me to relax – my stress holds me together!’ This is important, as stress is not always negative and a certain amount of stress is needed in order to function efficiently.
Aromatherapy has been regarded by many as an effective means of reducing stress, and now some GPs recommend aromatherapy treatment for those who do not cope well with stress. This is because the use of essential oils is balancing and it is this balance – homoeostasis – that practitioners seek to establish and maintain. Aromatherapy is well established for reducing unwanted stress and is just beginning to be accepted in critical care.
There is no definitive, accepted definition of stress. One definition (Lazarus 1998) is that stress is any influence that disturbs the natural balance of a person’s body or mind, including physical injury, disease, deprivation and emotional disturbance (Wingate & Wingate 1996). Anxiety (a state of apprehension) and worry (an over-anxious state of mind) are often the forerunners of both stressful and depressive states – in fact, the body has the same initial reaction as in the first stage of stress (see stress below). It can be due to:
a) a reaction to a potentially harmful situation; it is natural and healthy to experience anxiety when faced with danger or risk of some kind. Together with fear, it enables the body to deal with the situation by increasing the respiratory and heart rates, so that extra oxygen reaches the brain; it also releases energy and extra adrenaline (epinephrine) to help cope with the situation.
b) a reaction to an ongoing life event; here the anxious feeling or worry may be connected to work, a problematic marriage, illness, a son in the army who is sent into battle, etc. This sort of anxiety, if the situation becomes serious, usually develops into either stress or (and) depression, depending on the personality of the person.
Stress is not necessarily something bad – it all depends on how you take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or rejection is detrimental
The production of adrenaline is one of the positive side effects of stress which is needed to motivate people and give the energy to do even the simplest of tasks. Stress is therefore not necessarily a problem – it only becomes one when we have more stress than we can cope with in the normal run of life; its depth is reflected by the rate of wear and tear in the body caused by life. In the introduction to his book on stress, Selye (1956) said that stress, like the emotions, can be labelled productive and unproductive, or positive and negative. A sportsperson experiences pleasurable, positive stress during a competitive game or when climbing Mount Everest. Positive stress stimulates us, giving us the energy to cope with challenging or demanding tasks, after which both body and mind return to their normal composure without any negative effect on health.
On the other hand, negative stress can cause frustration and irritability to take hold – even moodiness – and if not resolved, can weaken resistance to ill-health. Some people may go through life suffering only mild stresses, with which they can cope, having only minor disorders that do not seriously affect their health.
Everyday stress can cause symptoms such as headaches or tiredness. Some people tense areas of their body, such as fists or shoulders; others may suffer such severe stress that they become physically and mentally ill, depending on the rate of wear and tear the particular stress exerts on their bodies and/or minds. The emotions associated with stress can include deep anxiety, depression, desolation, grief, heartache, pain and mental torment.
Stress is accepted as a medical condition and is generally viewed as a bad thing, with a range of harmful biochemical and long-term effects, but it is a necessary part of being alive: the only unstressed people are dead! Stress makes us competitive and helps us to deal with unfamiliar situations.
Different people cope with different levels of stress in different ways. What to one person is a normal and motivating level of pressure is to another a debilitating and disabling disturbance. Some experience stress when too much is happening, whereas others cannot cope when too little is happening – on the one hand stress may be caused by over-stimulation, and on the other by under-stimulation.
When stress is chronic, it can be a cause of depression. Many depressive – and highly stressful – states are brought about by a severe life event (such as the death of a loved one) or a long-lasting bad situation (e.g. living with an incompatible partner) – in other words, a provoking factor; whether or not this turns to depression depends on the vulnerability of the person concerned and the number of difficulties arising together at any one time. In severe cases of stress and/or depression, mental exhaustion or fatigue can set in. Long-term stress can raise blood pressure and damage the body’s immune system, and it is linked to problems such as heart disorders, stomach ulcers and cancer. Highly stressed people are also more likely to have accidents (Haughton 1995 p. 6).
|Death of spouse||100|
|Death of a close family member||63|
|Personal injury or illness||53|
|Fired from work||47|
|Change in health of a family member||44|
|Gaining a new family member||39|
|Change in financial state||38|
|Death of a close friend||37|
|Change to a different line of work||36|
|Change in number of arguments with spouse||35|
|A large mortgage or loan||30|
|Foreclosure of a mortgage or loan||30|
|Change in responsibilities at work||29|
|Son or daughter leaving home||29|
|Trouble with in-laws||29|
|Outstanding persona achievement||28|
|Spouse begins or stops work||26|
|Beginning or end of school or college||26|
|Change in living conditions||25|
|Change in personal habits||24|
|Trouble with boss||23|
|Change in work hours or conditions||20|
|Change in residence||20|
|Change in school or college||20|
|Change in recreation||19|
|Change in church activities||19|
|Change in social activities||18|
|A moderate loan or mortgage||17|
|Change in sleeping habits||16|
|Change in the number of family gatherings||15|
|Change in eating habits||15|
|Minor violation of the law||11|
Aromatherapy is particularly beneficial to both stress and depression, as one of its main aims is to bring balance and harmony to the mind; essential oils generally are balancing substances (especially those containing esters) and can, as such, help the whole person to adjust to their particular situation in life.
In the tradition of aromatherapy, specific essential oils are stress reducing, whereas others are energizing, and still others can have either effect, depending on the user’s state of mind/body interaction (Warren & Warrenburg 1993).
The body deals with all stress (positive or negative) by releasing extra energy from its nutritional ‘store’; at the same time, extra oxygen is transported to the brain and extra adrenaline produced. These changes prepare us to cope with the situation causing stress. There are three stages in the development of the body’s response to stress (Selye 1956):
2. The second, resistant stage is the action taken using these extra resources, where the extra oxygen, energy and adrenaline act to enable the body to cope with the unacceptable situation. Lacking relief from the situation, the responses in stage 1 continue as the body tries to adapt and reach a balanced state. If the level of stress becomes chronic and continues without help, the body reaches the third stage.
3. With excess build-up of stress stage three commences and true (clinical) stress is experienced. This can occur because of an emotional disturbance like the above, severe physical injury, illness or work overload. There is exhaustion, resulting eventually in health problems. These may manifest as headaches, insomnia, digestive problems, skin disorders and susceptibility to infection owing to the gradual closing down of immune responses (Price & Price 2007 p. 252).
|Physical problems||Psychological problems||Social problems|
|Tiredness during the day||Vivid dreams||Increased arguments at home|
|Difficulty going to sleep||Lack of interest in the world||Tendency to avoid people|
|Frequent waking at night||Lack of motivation||Abuse of alcohol, tobacco or other drugs|
|Aches and pains||Listlessness||Increased aggression – particularly in young men|
|Increased number of infections||Irritability||Inappropriate behaviour|
|Palpitations||Tearfulness||Over-reaction to problems|
|High blood pressure||Anxiety||Ignoring problems|
|Heart attacks||Poor performance at work||Loss of libido|
|Stroke||Eating problems – too much or too little|
|Diarrhoea||Poor self image|
|Constipation||Lack of patience|
|Irritable bowel syndrome||Depression|
|Dental problems (often due to teeth grinding)|
In stage 3, people may become irritable, aggressive, critical, restless, inefficient, withdrawn, moody. They may find that coffee, cigarettes or alcohol give temporary relief to the mental stress or they may resort to tranquillizers, any of which may eventually add to their discomfort.
The combination of several ongoing stressors can result in a nervous breakdown, or what is sometimes termed ‘burnout’. The nervous system, influenced so strongly by the mind, is unable to cope, and lethargy, inactivity, apathy and indifference set in. It is important to be able to recognize the danger signals and find a natural method of combating them, so that severe consequences can be avoided.
Mental and emotional health go hand in hand with certain attitudes to life. People who are happy-go-lucky remain mentally and physically fitter than those who are negative or who have too much stress in their lives to cope with rationally.
Health professionals should recognize stress, both within themselves and in their patients/clients, as the commonly held belief is that emotional and physical stress eventually leads to emotional and physical dysfunction (disease).
[These] occur in individuals without any other apparent psychiatric disorder, in response to exceptional physical or psychological stress. While severe, such reactions usually subside within hours or days. The stress may be an overwhelming traumatic experience or an unusually sudden change in social circumstances.
In an attempt to identify and treat stress, healthcare practitioners need to be able to recognize the symptoms. Since almost everyone suffers from some sort of stress discretion is needed; most people do not discuss medical stress comfortably, as stress is essentially being out of control of your own personal situation, relationships and work environments. During periods of stress, emotions are out of proportion to what situations warrant.
Left untreated, stress can lead to self-destructive or harmful behaviour towards others. Stress-related disease is not only on the increase (Seaward 2000), but has a pathogenic effect on the immune function (Hori et al. 2003), appearing to exert an effect on the immune system similar to ageing (Hawkley & Capioppo 2004).
When an organism experiences a shock or perceives a threat, hormones are released which help cope with the situation. In times past this reaction was valuable in protecting life and limb, but today it is experienced frequently in a modern civilization, and it is not only life-threatening events that trigger this reaction.
Case study 11.1 Stress and depression
Mr M was so emotionally pressured that on his first visit he had difficulty in articulating his condition. His speech was stilted and often the words were confused and incorrectly pronounced. He had been made redundant 2 years previously and had suffered from cystitis periodically during that time. The antibiotics had lowered his resistance and the cystitis had taken self-confidence away from him. He was difficult to talk to and the taking of his case history was prolonged and uncomfortable.
Mr M felt depressed, tired, listless, apathetic, and did not want to face the world. He suffered from dizziness and disorientation, which was believed to be related to his stress condition and to fear of going out and meeting people.
Massage was not an option as Mr M felt too embarrassed to be touched, so a blend of essential oils in a vitamin E base was made for him to apply every day, together with the same essential oils in a bath foam. The aim was to strengthen the immune system and to bring the stress under control.
The same essential oils were blended 3% in an organic bath foam base for use in the bath (1 dessertspoonful). Mr M had a bath every evening before bed and was encouraged to spend 20 minutes in it so that the oils could penetrate effectively.
With the self-help treatments and the essential oils, Mr M began to improve. Progress was slow, as his confidence also had to be rebuilt, and he was referred to a local self-help group near his home. However, within 2 months his speech had improved and he had experienced no further infections. Over the following 3 months Mr M continued to improve and has now reduced his treatments to a 1% blend in the bath foam in the evenings.
When the threat is small, the response is small and can pass unnoticed among the many other distractions of a stressful situation. This mobilization of the body for survival has negative consequences: people are excitable, anxious and irritable, less able to work effectively, more accident prone and less able to make good decisions (www.mindtools.com/pages/article). The fight-or-flight response is discussed in Ch 7.
Prescription medication, usually tricyclics and SSRI antidepressants, may be given by a medical practitioner. Such a course of action is to be avoided if possible because the side effects can outweigh any benefits and may present difficulties at first when discontinued.
For many, hospitalization is the most stressful thing that could happen (Jamison, Parris & Maxon 1987). Patients lose their identity and become a number, exchanging their daily attire for nightwear and taking on a new role as a ‘condition’ in a bed (Buckle 1997 p. 165). However, despite being intimidated by the high-tech environment, the state of mind can be calmed by the use of essential oils (Mullen 2005 personal communication). Stress connected with hospitals is not confined to patients – they are tended by nurses and doctors who are also under stress.
Aromatherapists working in hospitals often have to treat the staff to help relieve the pressures they are under. Tysoe (2000) conducted a study to discover the effect on staff of essential oil vaporizers