Towards a Process-Oriented Understanding of Stress
I once read an amusing anecdote. The joke stated:
“How many psychologists does it take to change a light bulb?”
“One, but only if the light bulb really wants to change.”
I found the joke amusing for two reasons. First, “change” opens a wide array of professional, clinical, and diagnostic questions. Of course, clinicians would like to think of the client a “new” or “changed” person. Of course at glance, one would consider that the light bulb needs changing. It would make perfect sense to suggest that the bulb need be discarded to completely switch with another. On the other hand, I need to consider the light bulb and its relation to the surrounding world. After sustaining a prolonged period of stimulation, the light bulb burned out. It could no longer expend the same energy as the bulb fresh from the package. If we were to label the bulb with specific qualifiers, we could say it is drained, depleted, unable to perform, weak, broken, defective, and powerless. As such, change then transitions to the notion that we need to diagnose, label, and fix the problem.
Second, what are we actually treating? Is the light bulb really the focal point of treatment or should we consider alternative areas of treatment? This occurred to me as I fiddled with my light bulb. I realized that the “broken” light bulb was not broken as I originally hypothesized. In fact, when I turned the bulb at the precise spot, the room was again illuminated. I am then faced with the choice to decide whether the light is weak, therefore attempt replacement; or assume the problem solved given illumination. However, considering the need for adjustment, environment and wiring comes to question.
Of course, such thoughts derive from the mind of a clinician. The anecdote reveals some interesting parallels to clinical work, diagnostics in particular. The client, like the light bulb, enters the office depleted, drained, broken, weak, or powerless. Also, the clinician would have to consider whether the “change” is the desired goal or a necessity. Like the light bulb, change may be unnecessary. The root of the problem may reside in the internal wiring (biological factors) or the ability to manage surrounding factors (ecological factors).
Human complexity expands the concept to a larger degree. Consider another anecdote passed through a philosophy graduate department.
“Rene Descartes walks into a bar to get a drink. The bartender asked Descartes if he wants another. Descartes responded I think not. He then vanished.”
As a philosophy student I understood that Descartes existence relied to the nature of continual introspective and circumspective cognition. As a clinician, I began to consider (1.) why Descartes continues to ponder to the point of sleep deprivation, (2.) what brought him into the bar and whether habits have formed due to continued stress or tradition, and (3.) was his disappearance a result of isolation or some other harmful dysfunction?
The difference between Descartes and the light bulb evolves from the person’s complexity. In reference to the light bulb, illumination evolves from appropriate wiring and connections. Descartes, on the other hand, continues to have thoughts, feelings, social status, interpersonal relationships, responsibilities, normative expectations, political views, culture, and other experiences. Such experiences develop an intricate nexus of meaning that a person must process. Mental processing consists along the continuum between dogmatic acceptances to obsessive thought. The former refers to the principled thinker that has little to no desire to engage in such issues. The latter, however, involves the thinker that continues to ponder the issue continually.
Certainly the laundry list of experiences becomes extensive. Due to socio-economic status, environmental concerns, and other surrounding micro to macro-level influences, thought processing introduces a robust scheme to that the person must cope in some way. To add to the puzzle, a given person processes these different experiences in various ways (Sapolsky, 1994). For example, there is a large body of literature to demonstrate the connection between the effects of social status and negative stress responses in both animals and primates (Sherman, Lee, Cuddy, Renshon, Oveis, Gross, and Lerner, 2012; Sapolsky 2006; Sapolsky, 2005; Sapolsy 2004; and Sapolsky, 1996). Among other issues, diminished feelings concerning power or control also contribute to a sense of psychological disharmony (Anderson, John, and Keltner, 2012).
Stress, Mental Health, and the Role of the Clinician:
Far too often clients visit the consulting room to discuss life’s complexities. The clinician is likely to hear about relationship problems, troubles with work and finances, feelings of anxiety, loss of control, feelings of depressed mood, and an amalgam of problems. However, within the depths of everyday existence shrouded by the vagaries of uncertainty, the clinician attempts to dismantle the complex puzzles of the mind only to develop a clouded and murky image of the mind. Hidden behind theory, research, clinical expertise, and clinical tools, the picture becomes relatively transparent.
Of course, one could ask, “relative to what”? The nature of transparency finds relativity given the client’s capacity to interpret and reinterpret life events. The cyclical nature of predominating and ruminating thoughts plagues the mind with harmful conjectures that threatens the client’s equanimity. As an example, consider a single woman with three children, a low wage job, and little skills or time to develop a skill, receiving government benefits to provide housing in neighborhood consumed by crime and devastation. Assume further that sleep continues to elude her given perpetual thoughts of “how can I feed my family”, “I feel like a failure”, or “I don’t have anyone to turn to” with the occasional frustration-aggression response to family, friends, and employers. I would think this meets the criteria of Wakefield’s’ (1992) notion of disorder as a harmful dysfunction. However, in what way can the clinician further explicate this perspective to consulting colleagues or to the client that conveys a sense of empathetic understanding?
Given the role of external influences, individual processing and response vary greatly. While there are many issues to consider, conscious thought consumes the client’s life-narrative (Beck, 1979). Such narratives operate as an instrumental communique riddled with mystery and shrouded with meaning. However, the clinician and the client confront an interesting problem. On the one hand, should we probe to gain insight concerning meaning and mystery? On the other hand, should we promote sound coping and mental organization?
If we consider the examples of client statements, it becomes evident that people harbor both conscious awareness and unconscious thoughts concerning external and internal influences. The nature of these internal and external stressors consists of strict narratives mandated by the individual. There is no doubt that given the same scenario, people react in a number of ways. As such, how can a clinician make sense of these introspective and circumspective constraints?
Towards a Process Oriented Concept of Stress:
At this point, I have discussed the various internal and external factors of stress. These factors consist of fallacious thinking, social (real and perceived) influences, socioeconomic status, and the like. Conceptualizing stress suggests a need to understand the structure and process of psychological stress. At this point, biological research provides insurmountable evidence of the physiological factors associated with stress. However, it is not too often that psychotherapists, counselors, or many other psychologists have the resources to check cortisol and norepinephrine levels. As such, the clinician is required (either theoretically or due to resources) to discuss the ecological factors of stress.
In examining the psychological functions of stress, it seems that a process oriented understanding produces a reasonable conceptualization. A Process-Orientation of Stress is reasonable for two reasons. First, given that many diagnostic categories (with the exception of developmental and neurological dysfunction) have a stress reaction as its foundation, identifying the mechanisms of dysfunction provides a robust array of symptom points rather than diagnostics prima facie. Like the light bulb, the notion of dysfunction represents several aspects of possibility.
Second, Process-Oriented methods are eclectic given that it draws from a multitude of psychological and psychotherapeutic perspectives. For example, consistent with CBT perspectives, conscious thoughts contribute to pathological behaviors (Beck, 2011). It is empathetic to external factors that contribute the narrative of conscious thoughts. Process-Orientation takes into account unconscious motivation repressed or cut-off from conscious thought. Process-Orientation takes into account the ubiquity of conflict (Brenner, 1994) emerging from one’s mental and physical ecology. Finally, feeling attuned to feelings associated with culture and social status. For example, if a woman is in conflict between religious values and choice to engage in an activity contrary to values, Process-Orientation enables the person to clear the clutter to illuminate the underlying meaning of the value and foundation of thought.
In reference to stress, the process of psychological stress consists of all of the factors described above. There evolves a multitude of stressful events, feelings, thoughts, interpersonal influences, cultural considerations, and political pressures that continuously intrudes on an overall sense of wellbeing. We can think about the individual’s approach to stress as a mental compatibility to physical events. In the case that mental and physical conceptions are not compatible, the sense of equanimity becomes disrupted.
Anderson, C., John, O. P., & Keltner, D. (2012). The Personal Sense of Power. Journal of Personality, 80(2), 313-344.
Beck, A. T. (1979). Cognitive Therapy and Emotional Disorders. Maddison, CT: Meridian Books.
Beck, J. S. (2011). Cognitive Behavior Theory: Basics and Beyond. New York: The Guilford Press.
Brenner, C. (1994). The Mind as Conflict and Compromise Formation. Journal of Clinical Psychoanalysis, 3, 473-488.
Sapolsky, R. (1994). Individual Differences in the Stress Response. The Neurosciences, 6, 261-269.
Sapolsky, R. (2004). Social Status and Health in Humans and Other Animals. Annual Review of Anthropology, 33, 393-418.
Sapolsky, R. (2005). The Influence of Social Hierarchy on Primate Health. Science, 308, 648-652.
Sherman, G. D., Leea, J. J., Cuddy , A. J., Renshon, J., Oveis, C., Gross, J., et al. (2012). Leadership is Associated with Lower Levels of Stress. Proceedings of the National Academy of Sciences, 109(44), 1-5.
Social Cultures among Nonhuman Primates. (2006). Current Anthropology, 47(4), 641-65.