CORRELATION OF CONCEPTS:
“STRESS”, “EMOTIONAL STRESS”,
“TRAUMATIC STRESS” (APES)

Stress. For the first time the word “stress” emerged in the English language in 1303 when the poet R. Manning wrote: “The Lord had sent manna of heaven for the people in great stress”.

In the late eighteenth – early nineteenth centuries Goya, whose art was distinguished by passionate emotional and social orientation, created a series of paintings that he called “Desastress”. The series includes paintings reflecting the human grief and suffering, among them: “Unhappy mother” (Sheet 50 of the famous etchings), “I have seen it” (Sh. 44), “They are a different breed” (Sh. 61), “This is the worst” (Sh. 37).

The concept “stress”, introduced into biology and medicine, is associated with the name of H. Selye and it was used to refer to a non-specific response of the body to any harmful and subsequently a harmless effect too. It is a natural genetically programmed normal and necessary response of the body to provide its survival and development. The essence of Selye’s teaching is his discovery of the three-phase general adaptation syndrome (GAS).

The first phase (stage), called by Selye the “phase of combat alert” includes orientation reflex accompanied with restructuring of the whole body. It is mainly implemented by an automatic neurobiological mechanism, by the action of a sympato-parasympatic nervous system BSA and has a bioelectric character.

The second phase is the stage of resistance (strain); it is also figuratively referred to as the “stage of fight or flight”. If during the first stage the situation is assessed as dangerous, and anxiety as the expectation of an uncertain danger becomes a “concrete fear”, then through the activation of the endocrine glands the second stage of the stress reaction develops and stress hormones enter the bloodstream. Spread by blood to organ/systems, they put the body into the state of readiness either to flight from danger or to fight with it (muscles tense, heartbeat vigorous, pressure jumps, etc.). Self-preservation mode is triggered throughout the body.

The whole complex is a normal, necessary effect of self-preservation instinct and similar for both types of behavior. The choice of behavior depends on the impulsivity and genetic program; but in human more often on the acquired experience of response in the deadaptation situation. It is stipulated by activation of three endocrine axes. The effects are caused only biochemical or neurobiochemical mechanism, which activates the appropriate organ/systems by hormones.

The third phase is the stage of asthenization. H. Selye has shown that stress accompanies any life activity and corresponds, in certain sense, to the life intensity. It increases with nervous tension, bodily injuries, muscular work, infections, in the situations of joy or sorrow, even with recollection of tragic events of the past and leads to the shift of the internal state of balance to deadaptation.

Let us denote the process of deadaptation – adaptation by one term – stressogenesis. A person in the course of the whole life gets “stress” injections and acquires stress-resistance in the form of behavioral patterns of overcoming stressful state, learns to comprehend and act in a constructive direction. If it does not occur, destructive characteristics of stress trigger. Using the expression: “Stress is the aroma and the taste of life” we should not forget that they are also different as the favorite aroma and taste in different people are different. The classical version of GAS, its evolutionary core, has a discrete nature and represents a unity of three phases. In this embodiment, the GAS came into use as “stress” and became the property of biology.

Revealed opportunities of studying and understanding what is happening in a person for a long time made their way to medicine with difficulty because of the lack of the concept “man in medicine”. Throughout the twentieth century medicine developed as an aid and health improvement of the diseased body, therefore it would not be a mistake to call it “body medicine”. Human health and disease were regarded as structural injuries of different organ/ systems under the impact of various external factors. The role of mental component was reduced to zero or completely ignored in both the questions of etiology, etiopathogenesis of diseases and those of dynamics, therapy and forecast. Psychological principles and laws acting in man, psychosocial component of man were disregarded due to total ignorance of medical sciences – psychology and sociology.

This was promoted by principle of parallelism dominating in neuroscience. Psychiatry should have been exclusion but it was also biologized. The desire of psychiatrists to find a biological substrate in the brain as a cause of schizophrenia, manic-depressive psychosis is still alive, despite the generally accepted by WHO definition of health. According to the Constitution of WHO, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition provokes lots of questions, reprimands and critics and it needs serious correction and specification. But it will be possible only with appearance of the concept “man in medicine”, when the issues of mental health and social well-being are considered from the viewpoint of a triad concept: “man” as a unity of biological, mental and social.

As far back as 1861 I. M. Sechenov suggested that a body without environment supporting its existence is impossible. Man thus is the system with two complex components “body + environment”. Since not only man’s body lives in the world, but rather a personality with the soul lives, acts, suffers and overcomes difficulties of life, this concept of I. M. Sechenov can be expressed using the following formula:

Man =

B (body) + P (personality) + S (soul) + E (environment) and referred to as an

INTEGRITY

Within this integrity, these composites interact with each other via bilateral feedback. Environment, including social medium, affects the body through the data flow of signals in the form of:

• positive – eustressors;

• negative – distressors;

• indifferent.

Among stimulants are identified stimulant signals acting without violating the internal balance. This category of customary signals constitutes the background. An unusual signal of the environment produces an orientation reflex aimed at assessing the environment with regard to the body threat.

If a factor is not threatening, the BE system continues functioning in the same mode. If a factor bears a threatening element, anxiety, fear, the deadaptation mechanisms of stressogenesis are triggered introducing the body into the mode of adaptation and it re-adapts. Thus, the factor containing a threat becomes a distressor causing emotional stress.

Emotional stress. The term appeared when the concept “stress” was transferred from biology to psychic (mental) reactions occurring under critical conditions. These reactions were called “emotional stress” which includes emotional reactions to stress (anxiety, fear) and somatovegetative symptoms caused by sympato-parasympatic nervous system. Actually, the emotional stress implied affective experiences separating them from non-specific stressor sympatocomplex of physiological changes in human body. “Intellect or feelings”, “mind or emotions”, “please, no emotions” – that is an incomplete list of common expressions reflecting different attitudes to emotionality and intelligence.

G. Hegel rightly noted that for intellect “…the difficulty is to get rid of the once loosely admitted by it division between the feeling and the thinking spirit and to come to the view that in man there exists only a single intelligence in feeling, will and thinking”.

With the lapse of time the term “emotional stress” has undergone a series of transformations. Thus, the second half of the last century was marked with descriptions of psychosocial models of stress, the models of response not only by the body, but by man as a whole, not only to the changing environment, but also to the psychosocial stressors. It was all about the search for a “medical” model of stress (H. Wolff, 1953), to substantiate the association between social changes and the health of population. This conformity is nowadays considered universal. The social-psychological approach to the medical model of stress is represented by several theories. The theory of loss by P. Marris (1974) assumes that each of us is a holder of some fundamental and universal beginning aimed at sustaining everything that regularly occurs in our environment attaching to it a subjective and personal meaning. Social changes are experienced as losses, disrupting the structure of interpreting the environment, thereby deeply hurting the personality. The traumatic situation (from Latin trauma – injury, wound) mentally traumatizes a person and provokes a storm of emotional experiences often in the form of affects. Therefore, the mental stress is conventionally considered to be the emotional sphere. Such view on its nature is due to the specificity of perception of stressor. At the first moment of perception anxiety and fear come to the fore limiting a judgment about the occurring and the gnostic (from Latin gnosis – cognition) and volitional components are negligible. This link is provided by activation of the autonomous neural axis as bioelectrical effect.

Some medical models of emotional stress development are described: the model of “biosocial resonance” by G. Moos (1973); the formalized model of the effect of social disintegration on health by D. Dodge, W. Martin (1970); the linguo-structuralist theory by R. Totman (1979); the theory of salutogenesis by A. Antonovsky (1979). It can be assumed that researchers of stress pursued one goal: to convince people living in the epicenter of stressful life and professionals in medicine (and they are men in their majority) that there exists the dependence of human health and longevity on the psychosocial structure of life and peculiarities of its perception. As a result emotional experiences have shifted to the category of the causes of developing stress. Thus the term “emotional stress” appeared.

Traumatic stress. It is not just a terminological kaleidoscope around the same phenomenon, but rather an understanding of the difference between diverse emotional, behavioral, somatic reactions of man on different stressors. The knowledge accumulated in the field of stress study has shown that not always the intensity of the stressor is of primary importance.

Lazarus and Folkman while delimiting the field of stress aftermath, considered only moderate stress. Different comprehension of the role of stress “intensity” (that might be light, moderate and traumatic) led researchers to different findings. Furthermore, for a long time, studies of post-stress disorders in human developed independently of stress studies. The whole problem rested on the stereotype approaches that had been adopted as the stress theory developed for the body, while the post-stress disorders were considered responses of the personality involving the body, psyche, consciousness and will. Man responds to environment with his conscious psycho-bodily unity and the aftermath effects are a vector complex systemic response to traumatic events. The generalization of multiple research results of different aspects of traumatic stress described as the structure of self (Laufer); a cognitive model of the world of the individual (Yanov-Boulemane); the affective sphere (Kristal); the neurological mechanisms controlling the processes of learning (Kolb); the memory system (Pittman); emotional learning (LeDoux Romanski) are obvious proofs that the post-stress process involves the entire complex system of man. The leading element is the human ability to attach meaning to any, sometimes even indifferent stimulus (a phone call, the night phone call, a special knock on the door, sleep, crow’s cry). Stress becomes “traumatic” when the meaningful significance of what has taken place results in disorders in the psychosomatic sphere, which is similar to the physical injury – hence is the name (mental injury, mental crash-syndrome). However, in contrast to a physical injury a mental wound can be invisible; it does not impress bystanders with a bloody mash of muscles, vessels and nerves. A spiritual crash-syndrome is a “silent volcano” that can burst at any time, at any place, by any kind of suffering.

In the concept of traumatic grief of Linderman (1944) and “syndrome of stress reaction” of Horowitz (1986) a factor of “time” after trauma during which a person experiences mental discomfort, anxiety, aggression and grief, occupies a special place. As a result the term “chronic stress” appeared alongside with the term “acute stress”. Chronic stress assumes remote aftermaths occurring after disappearance of stressor effect.

Opponents of the concept of a unified mechanism of stress and post-stress disorder, being aware of the affinity of these concepts, suggest using the term “stress” for correctness, to denote the immediate response to stressor and the term “post-traumatic mental disorders” for delayed reactions to the traumatic stress. We think that such “correctness” would adversely affect the understanding of an integral process.As a result, comparison would be done to quite differing conditions, for stress in its classical meaning is a normal response of the body to a stressor, while PTSD is a disease. They are however connected via the integral mechanism of stressogenesis, which changed its function; the function of protection became the function of destruction. It is here that an “impassable” barrier to see the unity of stress and post-stress disorders appears, the emergence of which is connected with the fact that stressogenesis as a normal adaptation reaction becomes a pathogenesis of post-stress disorders. Flashbacks, imagination stipulate transition from acute stress to chronic depriving it from the main peculiarity – discrecity, moving to the category of permanent processes entailing conversion from the norm to pathology.