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Sunday, Feb. 24, 2002

No end to stress in modern Japan

Staff writer

Thirty-year-old Hiroko Sato was having her hair done, just as she had every month for the past several years, when suddenly she began to feel ill. First, she felt dizzy, then nauseous, then her hands started to go numb. She tried to shrug it off, but when she rose from her chair, she fainted.

The next thing she knew, she was in hospital, her symptoms now including shortness of breath and heart palpitations. A tranquilizer drip offered relief, so much so that the next day Sato was able to round up her baby and small child to make the planned move to the Tokyo home where she started living with her husband's parents.

But her recovery didn't last. A week later, Sato (not her real name) suffered a similar experience and, from that day on, began having difficulty performing the most routine tasks. It got so bad that going shopping, driving, taking the train and even staying home alone became almost out of the question for fear of another attack.

Her doctor's prognosis? Panic disorder, a condition whose exact causes are unclear, though it is believed to be connected to major life changes -- in other words, stress.

"I was very busy at the time preparing for a new life while caring for my baby and young son. I was feeling tired both physically and mentally, but I was unaware that I may have been piling up stress to the point that it has triggered the illness," Sato recalls.

The diagnosis is in

Until about 50 years ago, Japan was "stress-free." Sure, there was kutsu (pain), kurushimi (agony), fuan (anxiety) and hiro (fatigue), but it was only in the wake of World War II that the term "sutoresu (stress)" entered general usage here to describe a physiological condition.

Credit for popularizing the term outside the ranks of engineers and physicists goes to Hans Selye, a Canadian endocrinologist who in the 1930s developed a theory of biological stress to explain people's ability to cope with and adapt to the pressures of injury and disease. Stress, in his definition, was the sum of nonspecific changes in the body caused by outside forces.

His theory was developed further over the decades, and today we have a clearer definition of physiological stress. Put simply, it is an imbalance in the body resulting from powerful hormones released by the brain to cope with an emergency. When danger is perceived, these chemicals shut down what is not necessary in the body to deal with it and intensify what is necessary. When the threat has subsided, the brain releases different types of biochemicals to help the body quickly restore its normal, nonemergency state.

The reason for these opposing chemicals is that if the body experiences the emergency state or the "come-down" state for too long without relief, either may cause a variety of problems.

The heavier breathing, increased heart rate and blood pressure that sharpen your senses and mind when, for example, you are cramming for a test, may lead to sexual dysfunction and sickness if not soon relieved: While they're in overdrive, your growth, reproductive and immune systems are in a state of deprivation.

What really gets your goat

The accepted term for these stress-inducing stimuli is "stressors." In ancient times, these could have been wild animals or a violent enemy, for which the intense response was completely appropriate. Today, stressors can be found almost everywhere and vary from individual to individual -- from extremes of temperature and noise to human relationships and living and working environments -- though they are not always really so important (do we really need to get so upset over spilled milk?).

On top of this, experts claim that modern society offers more potential causes of stress than ever before. And it would be hard to contradict such claims in light of round-the-clock lifestyles affecting people's biorhythms, the demands of the IT revolution, social changes such as Japan's foundering lifetime-employment system, or the shift from extended- to nuclear-family living. And, of course, the more stressors, the more stress and the more sickness.

Shizuo Machizawa, a psychiatrist and professor at Rikkyo University in Tokyo, says the growing number and variety of illnesses classified in his field gives a clear indication of the multiplied stress factors today. As well as the panic disorder Sato suffered, he cites the rise of stress-related illnesses such as anorexia, alcohol dependence syndrome and depression.

"About 30 years ago in Japan, we had a few cases of such disease as anorexia," Machizawa said. "But the number of patients has increased so sharply that it has become a common disease."

As well as causing psychiatric disorders, stress is also having a major negative impact on physical health. In their book "The Stress Solution," physicians Lyle H. Miller and Alma Dell Smith wrote that stress is linked to the six leading causes of death -- heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide.

But stress can manifest itself in less-obvious ways. Some people become irritable, others feel burned out. Some may start smoking and/or drinking more -- even lapse into outbursts of violence.

Why me, why now?

Machizawa believes that the reason why stress has become so detrimental to this nation's health is that people are becoming more vulnerable to stressors. Traditionally, he says, social and cultural conditioning used to help Japanese people accept, or at least put up with, unwelcome situations, regarding them as being in some way "inevitable." From infancy, too, children were taught -- much more so than they generally are now -- to control their desires, he says.

But with the drastic changes in social values and lifestyles amid the postwar economic growth, Japanese people became somewhat spoiled. More people had the means to maintain a comfortable existence, expectations became higher and patience, adaptability and forbearance declined.

This can be held partly responsible for the rise in stress levels among children. Parents, as they prospered, put more priority on satisfying their children's needs, material and otherwise, and thus making them more accustomed to comfort and less tolerant of anything less.

According to a survey conducted by the Health, Labor and Welfare Ministry in June 2000, 35 percent of boys and 43 percent of girls aged 12 to 14 said they had recently felt stress. Of course, the suffering affects more than just the younger generations.

In the same poll, 54 percent of all respondents -- aged 12 and up -- said they had felt stress. Cited sources of stress included human relations at either the workplace or school (23 percent), the family budget (24 percent), health issues (27 percent) and work in general (31 percent).

Machizawa notes the effect that the end of the life-employment system had on middle-aged company employees.

Men in their 50s taught to dedicate their lives to the company, he says, must now contend with colleagues for whom work is simply a means to earn money. They're also faced with the looming threat of corporate restructuring. These working circumstance can, in some individuals, create so much stress as to lead to suicide, which has risen steadily over the last several years to its current level of about 100 a day.

The impact of work-related stress is nowhere more clear than in the phenomenon of karoshi, whereby seemingly healthy individuals die suddenly due to overwork. Though stress usually kills its victims through heart attack or stroke, even suicide is sometimes included in the category. Two years ago, the Supreme Court found the employer of a 24-year-old suicide victim liable for his death, which it ruled was triggered by overwork. This has become such a big issue that the Health, Labor and Welfare Ministry in December proposed revising labor standards to expand criteria for recognizing karoshi to facilitate the payment of insurances and other benefits.

So now what do we do?

We are indeed living in hard times. So, how best to fight stress? Calling a friend to unload? Doing aerobics to sweat it off? Having a drink to escape? Soaking in a bath to relax?

Well, you won't find the answers here. As the physical and mental response to stress varies from person to person, no one way will work for everyone. For Sato, it took medication to relieve the chemical imbalance.

What you need to do, of course, is find your own way of dealing with it, says Kikunori Shinohara, an expert in physiological anthropology and an assistant professor at Tokyo University of Science, Suwa in Nagano Prefecture. Shinohara's research has found that one person's stressor is another's relief.

Take pachinko, for example. A noisy game often played in cramped, smoky aisles, it can bring on stress for many. But Shinohara's research has found that regular pachinko players have lower levels of cortisol, a hormone secreted when people feel stress, when they play.

"We can discuss general ways of relieving stress for people based on [for example] their physical reaction to stress and their personal history of having dealt with it," Shinohara says. "But, more simply, I suggest people do something they like and want to do repeatedly. That should be your way of relieving stress."

Social anthropologist Roderick Kaim has even more straightforward advice for coping. Throughout human history, he says, stress tends to be created in situations where people try to control something they cannot. "So," he says, "it's important to try not to have a feeling of being too much in control."

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