• Comments:Off

Stress and Psychoneuroimmunology

What is stress?
More importantly, what is stress to you? What is your stress at the moment?
The word ‘stress’ is such an all-encompassing word. A single word for the effects the world is having on different people in monumentally different circumstances at the same time.
These people might be working in a busy veterinary hospital, they may be the owners of the pets in that hospital, they may be crossing the channel in an inflatable dinghy, they may teachers in the US worried about gun crime, they may be hospital patients themselves.
In his book Full Catastrophe Living, Jon Kabat-Zinn tells the story of how he tried and tried to change the title of the first draft of the book over a decade ago. He just couldn’t find a name for the vast array of difficult experiences and stresses a human will come across in their life apart from ‘The Full Catastrophe’.

In Buddhist teachings, we learn about The Four Noble Truths which contain the essence of the Buddha’s teachings. It was these four principles that the Buddha came to understand during his meditation under the bodhi tree.

  1. The truth of suffering (Dukkha)
  2. The truth of the origin of suffering (Samudāya)
  3. The truth of the cessation of suffering (Nirodha)
  4. The truth of the path to the cessation of suffering (Magga).

Suffering, The Full Catastrophe and Stress, these are all words which by their nature will describe complex scenarios and emotions.
But the simplicity of at the heart of this word search is apparent: we are trying to unify a multitude of human experiences and responses in life and describe them with a single word or phrase. We’re communicating a distress.

Being stressed is neither right nor wrong. Feeling like you shouldn’t be stressed about work when others are less stressed about their life difficulties is being judgmental and self-deprecating and not helpful.

Stress can originate from a huge variety of sources and can be felt in our head, our stomach, our chest our mind. It will revisit us many times a day in all its various forms.
If we accept that life will have stressful events, we can work with it effectively rather than exhausting ourselves trying to fix it, avoid it or prevent it.
If the Buddha was able to break down the human existence into four truths, maybe we can look at stress in this way too. Most of us like flow charts, spider diagrams and spreadsheets.

Chicken and egg question
So, is stress the cause of our rapid heart rate? Or is stress our rapid heart rate in response to something that is happening?
In other words, which came first? Do I feel stressed which makes my case difficult? Or is that case a stressful case causing me distress?
In realty, the stress and the stressors are interconnected and inseparable.
So, in order to decrease the discomfort, maybe we need to identify and face the event or the fact (the stressor) and then examine our responses to it (the stress).

To make it a bit more complicated, sometimes the stressor comes from within us rather than being an external event or situation. For example, my ruminations may be causing stress. My thoughts may be rational, or irrational (based on statistics) and cause me stress.
It can take a bit of work to identify what’s what. It can take days with our eyes closed, sitting on the cushion to untangle the plethora of stressors, catastrophes and sufferings.

Using mindful curiosity, along with a willingness to explore with fresh eyes, we can untangle the stressors, the responses, the internal and the external. The untangling in itself is a valuable and fruitful exercise.
Some people, me included, find it easier to triage the stressors and identify the stressful emotions with pen and paper. The flow diagrams, strategies, pros and cons lists are some methods which can help.

If you enjoy running on adrenaline and caffeine, and many of us do, what’s the appeal of leading a less ‘stress-filled’ life when we’re happy as we are?


Hans Selye said “Between stimulus and response there is a space. In that space lies our freedom to choose our response, and therein lies our freedom”.

He also proposed that long-term exposure to stressors without our learning how to alleviate their effects on our bodies and our minds could compromise our immunity and therefore lead to decreased resistance to viruses and bacteria.
We now know so much more in the field of Psychoneuroimmunology, (PNI), but Hans Selye said it first.

The upside of this is that if we learn to adapt to the inevitable and varied stressors in our lives, if we manage to experience joy despite experiencing hassle at the same time, we will feel less daunted by the shock of the next stressor coming around the corner at us and the one after that and the next one etc.

We will also fight off viruses, SSI’s and the debilitating effects of arthritic pain better than if we don’t learn to adapt.

“We cannot stop the waves, but we can learn how to surf” Jon Kabat-Zinn

Psychoneuroimmunology (PNI) is a novel interdisciplinary scientific field that examines the relationship of the mind to the patient’s neurologic, endocrine, and immune systems by examining critical parameters such as the effects of mental stress on wound healing and infection rates. Techniques that modify a patient’s emotional and mental responses to illness and surgery have positive effects on their physiology resulting in improved recoveries and higher patient satisfaction rates.(1)

A young friend of mine was recently diagnosed with chordoma of C1-C2: a locally invasive tumour expanding rostrally into her pharynx from her upper cervical spine.
The statistics for this don’t exist, just a few case reports it’s so rare.
She was given the choice of having her upper cervical spine removed through her mouth or allowing the tumour to progress.

It would involve many teams of surgeons and anaesthetists, a day and night in theatre, fusion of her remaining cervical spine to her skull, tube feeding, maybe a tracheotomy. Heart attack, stroke and death were all possibilities.
Why was she encouraged to go through this by the surgical, oncological and anaesthetic teams?
It was because they had got to know her. This woman is strong, determined, unshakeable. They new her life story and realised that she had been surfing the waves of life her whole life. Ironically, when we swim in the sea, she prefers to stay in the shallows.
But whatever life had thrown at her, she had faced it with profound self-awareness and the ability to accept stress as part of the normal human existence without detracting from her happiness and enjoyment of life running beside the stressors in parallel.

Once she had decided to go ahead with the surgery, word of her courage and determination got around the London medical world.

The world-renowned surgeon who had written and co-written those few case-reports heard about this woman who takes on stress and challenges and surfs with them, and he decided he would cherry-pick this case for himself. He swooped in and took it from the original surgeons. He knew that attitudes like hers get results.
It’s a happy story about an amazing woman who defied all the odds, came through the most ambitious of surgeries, and stunned the medical teams with her rate of recovery.

We’re not all built like that. Her grit and determination to fight for life and to be there for her family is legendary and inspirational.
The moral of the story, however, is that, if we can allow our stressors to be recognised and acknowledged, if we can accept that they may cause us stress, suffering and the full catastrophe, we can learn to surf the waves without being shocked or surprised that they keep on coming like a good beach in Cornwall.
That will subconsciously build up our resilience and inner strength, so that when bigger stressors come along, we might be pulled under temporarily only to resurface nearer to the beach, rather than succumb to a tsunami and go under for ever.

  1. Tagge EP, Natali EL, Lima E, Leek D, Neece CL, Randall KF. Psychoneuroimmunology and the pediatric surgeon. Semin Pediatr Surg. 2013 Aug;22(3):144-8. doi: 10.1053/j.sempedsurg.2013.05.002. PMID: 23870208.