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It
could be the most perfectly designed killing machine
of our time. It is usually implicated but
never convicted; usually present,
but leaving no physical trace.
In
the rigorous world of epidemiology, nobody dies of stress. Stress, of itself,
will not send you from this world to the next. But epidemiologists will tell you
that this curse of modern life is a constant presence behind other more familiar
diseases, such as heart disease, stroke and cancer. It may be the furred
arteries or the malignant tumour that ultimately gets you. but the journey to
your grave is more likely than not to be quickened by chronic worry.
 Stress
may soon, however, step out the shadows as a killer in its own right. The
parents of Alan Massie, a junior doctor who collapsed and died after working an
86-hour week at a Cheshire hospital, say that their 27-year-old son was worked
to death. A coroner ruled that he died from natural causes and attributed it to
Sudden Adult Death Syndrome, a rare heart abnormality that claims otherwise fit
and healthy young victims (see
panel). There have been numerous reports of young people,
particularly men, suddenly dropping dead, with post-mortems revealing nothing.
Dr Massie complained of feeling unwell; he then collapsed and died in front of
his girlfriend, despite frantic attempts by a doctor flatmate to revive him.
George
and Margaret Massie reject the coroner’s verdict, saying that it was stress
alone that led to his death. There have been newspaper reports that the Massies
will sue the health trust that employed their son. They reject such talk as
premature but, in a conversation with The Times, they refused to rule out the
possibility of legal action. Mr Massie says that his son’s death certificate
should have read “death by overwork” instead. The Massies insist that if
Alan was not a junior doctor, he would still be alive today.
“Alan
used to come home and tell me he’d worked 127 hours,” his
mother says. “He said he felt like throwing his bleeper at the wall.
“On
the last day of his life he became so forgetful. But I never expected him to
die. He was far too dedicated to his work. We feel his work cost his life. Our
daughter feels that way, as do our sons. His friends feel like that. It’s a
dreadful waste of a life. Nobody needs to ask me whether stress cost his life -
could
anyone work night and day without sleep?”
Whatever
happened to Dr Massie, it was a tragic aberration. Overwork is common among
junior doctors, while sudden death is not. However, the unnerving possibility
remains that, in a handful of unlucky individuals, stress will trigger an untimely
demise. There is a weight of anecdotal evidence to suggest that
stress is a more pernicious and direct adversary than previously thought.. As
one junior cardiologist, who wished to remain anonymous, says: “My gut
feeling is that stress is a primary factor in causing heart disease. When you
have the luxury of time to delve into a patient’s history, you can usually
find a stressful event that triggered angina pains or a heart attack, or even an
asthma attack.
“The
problem is the quality of evidence
- it’s
anecdotal. But you can’t just dismiss it. You can measure packs of cigarettes,
cholesterol level and blood pressure, but how do you reliably measure stress?”
By
most measures, our lives are more stressful than ever. Britons work longer hours
than other Europeans, averaging almost
44 hours per week. Company lay-offs are becoming a staple of news bulletins,
subtly turning up the stress levels in corporate offices up and down the land.
Then there are the “lucky” ones left behind, pleased to have survived the
axe but quietly dreading the extra work bequeathed to them by their unwanted
colleagues. The masters of the work ethic -
the
Japanese - are
in no doubt that work-related stress is a killer. Their language even has a name
for it
-
karoshi,
which means death by overwork. Most of its estimated 10,000 victims a year die
from heart failure; a few are driven to suicide. The phenomenon of karoshi is
sufficiently recognised to appear routinely on death certificates; families of
victims have filed hundreds of claims for compensation. Many succeed, although
no company has yet been successfully prosecuted for working an employee to
death.
Occupational
psychologists suggest that it cannot be long before the idea of stress-induced
death is tested in the courts in Britain. Employees are already successfully
dragging employers through the courts for illnesses brought on by job pressures.
“I don’t know if people are dying from stress but we know it is a risk
factor in disease,” says Cary Cooper, a professor at the University of
Manchester Institute of Science and Technology, who helped to pioneer the study
of stress in the workplace. “We are certainly under more stress these days. We
work long hours, our jobs are insecure, we no longer have the social support of
friends and family living close by. What troubles me is seeing people in their
forties have heart attacks.”
And,
says Cooper, it is those in middle age, rather than the old or young, who must
bear the brunt. “If you’re 55, you can retire early. You don’t have to put
up with it any more. But if you’re 45, you can’t retire. I suspect it’s
this group the 35 to 45-year-olds —
who
are more vulnerable than they were 30 years ago.”
Proof
that stress can influence lifespan comes from one of the most famous large-scale
epidemiological projects conducted. The Whitehall II
study is a survey of more than 10,000 civil servants, conducted by
epidemiologists at University College London. Started in 1985 and still going,
it built on an earlier study of civil servants in the Sixties and Seventies. This
original Whitehall investigation showed that top civil servants enjoyed better
health arid lived longer than those on lower grades.
This discrepancy exists today. Civil servants at the
bottom of the hierarchy are three times more likely to suffer heart attacks than
those at the top. Dr Eric Brunner, senior lecturer in epidemiology and public
health at UCL, says that stress can definitely trigger a condition, for example heart
disease, that is already there. He also believes that stress can cause
behaviours that put people at greater risk of heart disease. In other words, a
seriously stressed person is more likely to neglect a healthy diet and seek
refuge in cigarettes and alcohol.
‘There's a strong statistical association between
how in control of your life you feel, and the risks to health,” says Brunner.
“If you feel you’ve lost control, and are chronically stressed, you are much
more likely to develop such conditions as coronary heart disease or angina.
It is wrong. he says. to equate seniority with with
stress: “Even though the executives at the top have great
responsibilities, they also have the power to set their own agenda. They can buy
luxury holidays, get their secretaries to book them a nice lunch, and afford to
take early retirement.”
Brunner says that the “really big question’ is
whether stress really is a direct killer and, if so, how does it claim its
victims. Others are now asking the same question. While emphasising that a family
history of heart disease and smoking are demonstrably greater perils than
stress, the British Heart Foundation has appointed a professor of
psychology to investigate the “psychosocial” factors underlying heart
disease. Resuits from elsewhere are trickling in — Professor John Deanfield at
Great Ormond Street Hospital recently found that when volunteers were put under
extreme mental stress, by doing arithmetic exercises, the dilation of their
blood vessels changed. His study, reported in Circulation, was one of the
first to show a physical link between what happens in the mind and what happens in the arteries.
There are other anecdotes that, taken together, hint
at the apparent power of the psyche to decide whether we live or die. Isn’t it
strange how devoted spouses often die “of a broken heart” within a short
time of each other? Isn’t it curious that far more people expire just after
their birthdays than before them? Is it something in the soul, something about
the excitement of the occasion. that kept them alive?
Studies have shown that people with an irregular
heartbeat tend to suffer their most abnormal heart rhythms on a
Monday. This is in addition to the grim observation that, overall, heart attacks
happen more frequently on a Monday than on any other day. “It is tempting to
speculate that arrhythmias are triggered by the stress of returning to work.”
mused one scientist in the pages of Circulation, the premier heart
journal.
So, unstartlingly, workplaces are stressful. But is
there other medical evidence that stress is the signpost to an early grave?
People in difficult personal situations appear to die
earlier than those in less stressful circumstances. Single parents expire
earlier than their married counterparts. Only last week the Office of National
Statistics provided more confirmation of the health benefits of married lite.
A
30-year study of 250,000 men showed that single men
aged over 45 are 23 per cent more likely to die prematurely than married men. divorce
carried a 31 per cent risk of death within ten years of parting, and widowers
were 20 per cent more likely to die early. Tying the knot, statisticians
speculate, means pooled finances, better social support and healthier behaviour.
Research also consistently bears out the fact that the
higher your social status, the longer you will live. Professionals live nine
years longer than unskilled manual workers. The death rate in Newham, London’s
poorest borough, is 11 per cent above the average; in Richmond, the most
prosperous, it is 21 per cent below the average. Why the discrepancy? It is
probably fair to say that a single parent residing in Newham is burdened with
more stress than a single parent living in leafy Richmond. Money may not buy you
love, but it can buy a nice house, childcare, decent food and relaxing holidays.
If, as all these statistics suggest, stress can rob the poor of the right to
live, then it cannot be long before it is convicted
as a killer.
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