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11 March 2009STRESS AND SLEEP: EXTRAORDINARY STRESS

So much for ordinary everyday stress, but what about extraordinary stress. This is like a hammer hitting an apple. We do not expect much of this stress in our lifetime, but when it comes, even if we are coconuts, we cannot help feeling the impact of the stress.

Loss of loved ones, loss of possessions, tragedies of any kind, or any events of similar magnitude are extraordinary and we are expected to feel the stress badly and most of us will be hurt. The normal biological and psychological reaction to stress as outlined earlier still applies, but is of much greater magnitude and lasts much longer. We call this grief reaction.

When we are hit with a stress hammer, there are two phases: the injury phase and the healing phase.

Injury phase

During the injury phase, we feel the pain. This pain can be in our head as headache or in our chest not unlike a heart attack. Of course, the pain is hurting most of all in the mind. It is a normal defence mechanism of the body to protect the psyche, and the immediate reaction is denial. What has happened is not true, we hope we are dreaming. There is a sense of disbelief: ‘Can somebody tell me this is not true’. This is a form of protection for us from the sudden shock of the extraordinary stress.

Healing phase

The healing phase starts when the body begins to react. We are angry at what has happened; we may be angry at ourselves or angry at the one we have lost. The biological reaction sets us on a chain of tension, anxiety, and depression all mixed up, until we feel exhausted. We are at battle stations all the time, but there is really no enemy. The enemy is ourselves. Some of us feel guilty and question whether there was anything we did wrong that may have led to this loss. We may cry and feel tired and exhausted. This may go on for days.

We need to let this energy out. Hysterical crying and weeping is common. Sharing this locked up energy with someone is sometimes useful; just talking about it, airing our thoughts can be helpful. Some like taking long walks, some like rearranging and cleaning out their desks, or just doing something that may be purposeful but relaxing.

Unresolved grief reaction

Is there anything we can do to ease the grief reaction? Not really. In fact grieving is to be encouraged, so that the locked up energy generated from the stress reaction can be expressed and shared. A person can be affected in the future if this locked up energy is allowed to remain inside. This is called unresolved grief reaction and can be damaging. One patient who was referred to me, a young lady, had agoraphobia after the death of her father. She was using up all her time to help her grieving mother and did not grieve for herself. Her mother was depressed and suicidal. The patient was young and just married, she moved in with her mother to comfort her, and was afraid to show her own emotion, as she was afraid this could harm her mother. Her mother got better, but the daughter fell ill and this lasted for many years afterwards.

Acceptance

The next phase of healing is acceptance of what has happened. A homeostatic peaceful rearrangement or a new balance of the psyche is reached. The person may be badly scarred, but may find life has a different meaning or that his feelings and experiences may now be in a different level of existence. Extraordinary stress sometimes changes a person for the better. Things that he used to take for granted are now treasured. Happiness is now more like a spice in life, a gift rather than a necessity.

Insomnia

Sleep may be a problem in the initial phase. But most patients do not want any sleeping medication. They want to feel the pain and want the wound to heal in its natural way. There will always be a scar. But they treasure the experience and look back on it occasionally. Once an equilibrium state is reached, most people are able to continue their normal life. They will never forget this kind of extraordinary stress and the loss they can never replace. Somehow life goes on and the sun is always up the next day.

We normally cope adequately with most stresses, but there are occasions when the coping mechanisms fail. We call this a nervous breakdown, and in such cases professional help is called for, as medications and other forms of treatment are sometimes indicated.

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