Volume 2 Number 4,1989

More on Job StressDue to Lack of Control

A study of 4800 men with a history of heart attackreviewed records and information obtained fromnational health data bases and governmentemployee services. The men's jobs were rated toprovide scores that would rellect certain psycho-logical demands, These included the need to workquickly or excessively, as well as the degree ofdecision-making authority and intellectual chal-lenge. We typically tend to think of heart attacksdue to job stress as occurring in ambitious, hard-driving, competitive individuals at executive orupper management levels. However, the results ofthis study showed that most heart disease occurredat lower echelons such as assembly line personnel,garment district workers, waiters, and cooks. Theseare allhigh-stress occupations because they combinea high degree of demand with little control. Theheart atiack rate for the totalsample was only 1.5per cent, However, the rate for men in high-stressjobs was nearly three times as much. There was noevidence of increased risk for "high status, pre-sumably success-oriented, managerial or professionaloccupations." As one sociglogist noted, "anassem-

bly line worker, for instance, has virtually no controlover the methods and tools he uses, whom he

ALSO INCLUDED IN THIS TSSUEDepression and Complications of Coronary Heart Disease-,..-2Stress and Dentists ....,............2Does the Stress of Day.Care Centers Contribute to lllness?...-2Kangaroo Stress.,. . . . . . . . . . . . . . . . . . .3Cancer Survival Time Improved with Stress Reductionand Social Support. . . . . . . . . . . . , , , . . .3Does Hospital Staff Stress Threaten Patient Care?................. 3Health Insurance for Treating Stress-Related Disorders? .........4Stress Due to Fear of AIDS Worth $21.7 Million....................4Stress and Clinical AIDS in HlV-Infected Patients .................. 4More on Stress and Aging....Stress-Related Hypertension I,inked to Dietary

5

cSodium/Potassium Ratio ...,......Pavlov, The Immune System and Cancer ,........6Does Stress of Hearing Impairment Contribute

to Alzheimer's? ....................5More on Stress Recuction Effects of Pets ....................,,,,....7

works with, when he works, or in the design of theproduct . . . lawyers and doctors, on the other handhave control over almost everything they do." Interest-ingly enough, the percentage of men in high-stressjobs appeared to decrease with age, suggesting thatthey possibly move out of stressfuljobs as they getolder, or somehow adapt to the situation. Otherstudies suggest that workers in low-controljobs arealso more likely to smoke and have higher bloodpressures than those engagedin occupations wherethey can make decisions. Data from the Framing-ham study also reveal that women in low-controljobs have more heart attacks. Heart disease risksare twice as great among women in low-controlclericaljobs as compared to housewives and self-employed females. These concerns and other obser-vations have been responsible for the markedlyincreased interest in stress management training inthe workplace on the part of corporations andunions'

psychorogy Today, April, 1989)

'Man needs not only knowledge but ignorance too.Knowledge alone, or ignorance alone, leads himinto darkness . . . The world is so filled with thematterof knowledge that menwouldgo mad if theywere to attempt to cram all of it into their heads.Theability to forget isjust as necessaryas the abilityto remember.

Vinoba Bhave

For further information on the original source of abstracts and otherreprints available on similar subjects, please send a self-addressedstamped envelope to: Reprint Division, American Institute of Stress,124 Park Avenue, Yonkers, NY 10703.

The Newsletter of THE AMERICAN INSTITUTE OF STRESSNEWSLETTER is published monthly by The American Instituteof Stress. Subscription rates: $35.00 annually. Copyright@ 1987by The American Institute of Stress. All rights reserved.

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

THE AMTRICAN INSTITUTT OF

Paul J. Rosch, M.D., F.A.C.P'Editor-in-Chief

Stress and DentistsA recent survey of dentists revealed that the majorstress associaied with their profession wete tte'quent {eelings of being discouraged and disil'lusioned. "More than4?o/oindicated that they wouldswitch to another cateer if an opportunity arose'"Complaints included a generalsentiment that theirserviies were undervalued or unappreciated bytheir patients. The problem of low professionalselfesteem did not appear to be compensated for byany improved economic status' Trouble staying onschedule or seeing an appointment book with a lotof openings werebther major stresses' Additionalfrusirations were the difficulties of running a busi-ness along with its associated financial and timedemands. Many dentists complained of their "second'

class citizenship status" in comparison with phy:i'cians. It is sometimes true, or more frequentlyassumed, that the choice of a dental career is theresult of not being able to gain admission to medicalschool or some other institute of higher learningthat would have provided a more pestigious profession'As noted, the iocktail party comment, "l thoughtyou were a real doctor" becomes an anxietystimulating trigger.In addition, professional isolation, boredom, andphysicaland mental fatigue c-an also contribute toihe stress of dentalpractice. Such problems can bealleviated or prevented by participation in supportgroups, learning time management and stress-ieduttion strategies, and engaging in other activi'ties which promote a sense of self esteen andsatisfaction.(Bulletin of the Society for Professional Well'Being, December, 1988)

Does the Stress of DaY'CareCenters Contribute to lllness?

Contributing Editors from The Board of Trustees ofThe Arnerican lnstitute of Stress

Robert Ader, Ph.D., Rochester, NYHerbert Bengon, M.D., Boston, MANorrnan Cousinc, Los Angeles, CAMichael E. DeBakeY, M.D., Houston, TXJoeI Elkes, M.D., Louisville, KYJohn Laragh, M.D., New York, NYJames J. Lynch, Ph.D., Baltimore, MDKenneth B. Pelletier, Ph.D., M.D., Berkeley, CARay H. Rosenman, M.D., Menlo Park, CA ^-Ch-arles F. Stroebel, Ph.D., M.D., Hartford, CTAlvin Toffler, New York, NYSue Thonae, RN, Ph.D., Baltimore, MD

Depression and ComplicationsOf Coronary Heart Disease

Much has beenwritten about howType Abehaviorand various components such as hostility and angercan contribute to heart attacks. And it has longbeen appreciated that acute anxiety can cause avariety of disturbing cardiovascular symptoms'However, recent research suggests that majordepression may be the best predictor of futurecomplications in patients with coronary heart disease'A siudy of 52 individuals, diagnosed as havingcoronaiy heart disease, were evaluated for signifi'cant depression. Seventeen per cent of the patientsmet thscriteria for this disorder as compared to lessthan three per cent in an age matched controlsample. Almost 807o of the depressed patients wenton to experience some adverse cardiac event in the12 monihs following diagnosis, in contrast to only35o/o of the non-depressed patients. Major depres'sion proved to be the strongest predictor of subse'quetti cardiac problems including heart attacks,need for cotonary by-pass surgery, death, andincreasing medication requirements. This correla-tion was irore significant than that associated withage, smoking, and even severity of disease' Depres'siin has been linked with an increase in the activityof the sympathetic nervous system. This couldpredispole to a greater likelihood of insufficientblood supply to the heart, disturbances in heartrhythms, and possibly progressio-n. of arterio-sclerosis. Researchers suggest that if depression isdetected and treated early enough, further complica'tions could be significantly reduced in patients withcardiovascular disease . (OmniLonsevitv, Apfl 1989)

In a study of 843 children under the age of three, itwas found that those who were in day'care centerswere 4r/2times more likely to be hospitalized for anillness ihan those brought up in other settings' Theday-care center group wls compared with a matchedpo-pulation who were being cared for by relatives orin private homes. The most iignificant factor appearedio'be the number of children cared for in a singlesett ing. Upper respiratory and ear-. infectionsrequiring sufgical driinage were a significant prob'lem. It iJconieivable that parentalseparation andthe strange environment might be stresses thatwould lower immune system defenses against bac'teria and viralpathogens. It was noted that "407o ofparental absenteeism from work was because of athild's illness." Many authorities feelthat employersand insurers might save money by financing day'care centers in the workplace where child'parentrelationships could be maintained'

Today, Aprit rz, 1984)

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Kangaroo StressIt has been well established that the death of aspouse is at the top of the list of stress-rating scales.Widowed individuals die at rates much higher thanage matched controls following bereavement for allthe leading causes of death, including cancer, heartattacks, and suicide. While stress-rating scales forthe animal kingdom have not been established, arecent ltalian newspaper headline, "Kangaroo killshimself after losing his lady companion," is ofinterest. According to the story, a female kangarooat a zoo in Brescia, Italy, had to be destroyed afterbreaking a leg. "Within a week, the dead kangaroo'smate either fellor threw himself into the deep ravinesurrounding the compound" and the act was apparentlyviewed by zoo workers as a deliberate act ofsuicide. One employee described the kangaroo as"deeply depressed. Its state of mind certainly contribu-ted to its death." This is not an isolated finding.Finches often apparently die for no apparent reason,shortly after the death of a mate, We have allheardstories about how a dog willrefuse to eat following amaster's death, sometimes leading to starvation.One official at Florida's Bush Gardens noted "l

know of examples where one animal dies and theperfectly healthy mate dies shortly thereafter." Wehave frequently commented on the health effects ofa strong social support system in the Newsletter,and since this appears to have a biological basis,there is everyreason to assume that it applies to theanimalkingdom.

(Omni, February, 1989)

*lt is impossible for anyone to begin to learn what hethinks he already knows."

- Epictetus

Cancer Survival Time ImnrovedWith Stress Reduction and

Social SupportPrior Newsletters have emphasized the powerfulstress reduction properties and therapeutic effectsof a strong social support system. This is mostevident in organizations such as Alcoholics Anony-mous, Gamblers Anonymous, Weight Watchers,and other self-help groups. Such stress reductionapproaches and others have been reported toprolong the life expectancy of cancer patients inseveral studies, such as those reported by Eysenckat our last Montreux Congress. Most accounts areanecdotal, however, and considerable controversycontinues about the role of psychologicalfactors inmalignancy and other diseases, A recently reportedten-year study of women with metastatic breastcancer, does, however, appear to provide consider-able support for the stress-cancer link. Eighty-sixmiddle-aged women were randomly assigned to a

medicaltreatment group alone with matched controlsreceiving the same treatment in addition to weeklygroup support activities which included instructionin self hypnosis and other techniques to assist incontrolling pain, stress and loneliness. After oneyear of the program, a questionnaire revealed thatwomen in the support group significantly "experi-

enced fewer mood swings and less fear and painthan their counterparts." A follow-up study, tenyears later, revealed that 83 of the 86 women in thestudy had died. However, the women who had beeninvolved in group therapy stress reduction activitieslived an average of 36.6 months compared to only18.9 months for those receiving only the samemedicaltreatment. It was theorized that this greaterlongevity was related to the benefits afforded by theopportunity to openly express and share feelingswith others, therapy and the strong sense of socialsupport provided by group activities, both of whichare powerful stress buffers. It was also suggestedthat such activities may have "nourished" a sense ofhope, enabling the women to comply better withmedicaladvice, Other research also suggests that apositive attitude and purposeful group activitiesmay improve immune system defenses againstcancer. (Los Angeles Times, May 11, 1989)

"Life is a shadow, saith the Scripture, but is it the shadowof a tree or a tower that standeth? Nay, it is the shadow ofa bird in its flight. Away flieth the bird, and there is neitherbird nor shadow."

- quoted from the Talmud by John Morley inthe last chaoter of his "Recollections."

Does Hospital Staff StressThreaten Patient Care?

According to researchers at one California hospital,overworked interns and residents have created a"crisis" situation that can seriously affect patientcare. They state that "Sleep deprivation is probablythe greatest source of stress in residency," Severalother studies were cited including one which foundthat 407o of the residents questioned were "so

depressed or anxious for four or more weeks duringtraining that their performance was impaired." Itwas noted that the airline industry is wellaware ofthe problems associated with sleep deprivation andhas established Suidelines to insure that pilots getadequate rest. Legislation in severalstates, includ-ing New York, has been recently enacted to insurethat interns and residents do not work for exces-sively long periods of time because of evidence thatthis can lead to fatalerrors. However, the research-ers suggest that changes should "come from withinthe training programs rather than from externalmandates that could impose arbitrary restrictionson programs." (Physician's Financial News, March 15, 1989)

'l

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Health Insurance for Treating Stress Due to Fear of AIDSStress-Related Disorders? Worth $21.7 Million

Why not? After all, various surveys show thatstress-related complaints and disorders account for75 to 9Qo/o of all visits to primary care physicians.Headache, backache, anxiety, insomnia, hyperten-sion and even obesity are often stress related. Drugtherapy may provide some benefits, but often haveundesirable side effects or cause problems relatedto dependency. As a consequence,there has beenincreased interest in behavioral therapies designedto get at the root of the problem, rather than simplyprovide symptomatic relief, Biofeedback, medita-tion, muscular relaxation techniques, and behavior-al modification have all been demonstrated toprovide lasting relief for many patients with suchcomplaints. And compared to drug treatment, theyare safer and often more cost eflective in the longrun. Another frequently reported bonus is increasedproductivity and an improved quality of life. A vividexample is provided by one report indicating thatbehavioral modification was 507o e ffectivein prevent-ing a recurrent heart attack in Type A patients.At present, some fiscal intermediaries will reim-burse for "stress reduction" therapies, but not atrealistic rates or only if it is described in other terms,such as "psychotherapy." However, many patientsresent this labeland their primary care providers donot qualify as psychiatrists, In addition, even whenreimbursement is provided for this, or for biofeeed-back, it is usually only for $20-925 per session. Overthe same amount of time, the reimbursementreturned for the 4-6 patients that could have beenseen for-routine office visits would have producedsix to ten times more income! Insurance companiesshould recognize that investingin appropriate andqualified stress-reduction strategies would havenot only saved them money over that time period,but also in reducing future medicalcosts down theline. That's part of the problem, since such servicesare difficult to monitor qualitatively and quantita-tively, creating the potential for abuse. One possiblesolution would be the establishment of criteria toqualify and certify stress reduction activities andproviders, and this is currently being pursued by theAmerican Institute of Stress and other agencieswith the cooperation of interested consumer andprovider organizations'

(Advances, vorume 5, No. 4, r9g9)

"When we consider the reasons we have to thinkthat what lies within our ken is but a small part ofthe universe, we shall discover a huge abyss ofignorance."

- John Locke

In a recent court decision, the late Rock Hudson'slover, Mark Christian, was awarded 21.7 milliondollars because the former movie star allowed theirintimate relationship to continue although he knewthat he had contractedAIDS. In addition, it was alsodisclosed that although Hudson's personal secretaryaiso knew of this serious medical problem and itslife-threatening potential consequences, no attemptwas made to warn Christian of the dangers ofcontinuing the relationship. The situation came tolight after Hudson's death, Although Christiantested negative for the AIDS virus, he was neverthe-less awarded 7.2 million dollars for punitive dam-ages, and 14.5 million dollars in compensatorydamages. A recent news report indicated that thejudge had reduced to 3 million dollars theT .2 millionfor punitive damages, but it was not clear as towhether the 14.5 million dollar award against theestate would also be reduced. There is increasingevidence that stress may influence how quickly anHlV-infected patient develops clinical AIDS, asnoted in the following article.lt is believed that theincubation period for AIDS may be as long as eightor nine years, and should Christian develop thedisorder, it could be argued that the emotionalstress sustained as a consequence of his continuingrelationship with Hudson, long after it should havebeen halted, could have played a contributory role.

"Science is the topography of ignorance."- Oliver WendellHolmes

Stress and Clinical AIDS inHlV-Infected Patients

As noted in previous issues of the Newsletter,positive thinking, social support, and stress reduc-tion measures may prolong the length of time ittakes for an AlDS-infected patient to developclinicalsymptoms, and possibly may even preventtheir appearance. As its name implies, AIDS ischaracterized by a deficiency in immune systemfunction. Since stress can also lower immunesystem defenses, it seems plausible that it couldaggravate the illness, as well as hasten its clinicalappearance in symptom-fuee infecled patients. Inone recent survey of 40 homosexual males, thosewho had contracted the virus but who had notprogressed to clinicalAIDS, had much less stress intheir lives, more socialsupport, and more ellectiveways of coping with stress than those with obvioussigns and symptoms of the disease. The researchersurged that a positive attitude and sense of control(continued on page 5)

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Stress and Clinical AIDS inHlV-Infected Patients(continued from page 4)should be strongly encouraged, suggesting that "it

may even help for HlV-infected patients to deny tosome extent the idea of their eventualdisability anddeath." Community support groups can be helpfulby providing social support. Cognitive therapyapproaches which emphasize positive, rational think-ing techniques may be of particular value in patientswho are depressed or anxious and tend to resort tovarious medications that may have undesirable sideeffects. Under any circumstances, such approachesclearly improve the quality of life, if not its duration,in AIDS-infected patients.

(Dr. Carl Goodkin, University of Texas,

Southwestern Medical Center. Dallas

"Progress is man's ability to complicate simplicity."- Thor Heyerdahl

More on Stress and AgingAs noted in previous issues of the Newsletter,increased stress appears to be associated with anincrease in certain facets of the aging process.Anecdotal reports of individuals whose hair turnedgray "overnight," following a stressful encounter,are commonly cited. Age appears to be equatedwith a declining ability to cope with stress. AGerman colloquialism which translates as "You arelooking old," means you have failed or stand littlechance of solving a problem. In one recent survey,145 residents of an old people's home completed adetailed questionnaire asking details concerningtheir feeling about old age, and more specifically,their personal chronological age. Three years later,a check of the same population revealed that acomputerizedevaluation of responses to the question-naire was 92o/o cofiect in predicting who wouldsurvive. As the senior investigator noted, "we

naturally can't conclude from a questionnaire whowillbe alive in three years'timeandwhowon't, but itdoes seem quite clear that anyone who has anegative attitude about his or her age, and sees noviable future, seems to age faster and stand a muchpoorer chance of survival." These findings ap-peared to be true regardless of whether or not theindividual was ill or healthy. It also appears thatpeople who stay active, and react to the stimuli oftheir surroundings are the ones most likely to keeptheir minds busy and survive to a meaningful oldage, The investigators injected a note of caution,warning that too much activity can be as detrimen-tal as not enough. Thus, you must strive "to beactive, but be aware of your limitations and keepwithin them."Often it is not the individual, but the surroundings

that are most important. Another survey splitresidents of an old people's home into a group whocontinue to be cared for along institutionalizedguidelines, and another who were encouraged tomake their own decisions and act upon them. Aftera year and a half, both nurses and doctors foundthat the second group were healthier and enjoyed abetter quality of life. Over that same time period,nearly 30o/o of the regimented residents died, incontrast to only 157o of those who were permitted toexercise their own decisions about life activities.Such studies confirm other reports of nursing homeresidents who showed greater longevity and bettelhealth when they were allowed to enter into deci-sions about their daily activities and had the oppor-tunity to express their emotions, The researchersnoted that "many old people are institutionalizedmereiy because society no longer gears its require-ments to the abilities of older people. Feelinguseless and unable to remedy the situation, oldpeople, who are cast aside, sink into a vicious circleof decline." Many older individuals are capable of"establishing a much deeper, richer and morehumane relationship with other people than thevouns - ir onrv th"'u#"zy:::\:,:I:nr;^

D. ls's)

"The thing of which I have most fear is fear."- Montaigne

Stress-Related HypertensionLinhed to Dietary

Sodium/Potassium RatioThe effect of salt or sodium on blood pressureseems to vary considerably in different individualsand the same may be said for stress. In a recentreport, the blood pressure response to a stressfulmathematical task was measured in 57 healthyvolunteers. The average systolic rise was 14 mm. ofmercury and 9 mm. for the diastolic. These findingswere then corre lated Wi th ur inary sodium/potassium ratios which were assumed to reflectthe dietary intake of these elements, The resultsrevealed that the higher the ratio, the greater themagnitude of elevation of blood pressure followingmental stress. The practical significance of theseobservations is not clear, since there is no goodevidence that cardiovascular hyperreactivity in thelaboratory predicts future sustained hypertension.The pattern of sodium/potassium urinary ratiosnoted may reflect genetic as wellas dietary influen-ces, However, the study does suggest that dietaryhabits must be taken into account in evaluating theresuits of laboratory procedures that deal withstress-related hypertension.

(lntemal Medicine News, Iv[ay 1-4, 1989)

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Pavlov. The Immune Svstem' And Cancer

It was about 100 years ago that lvan Pavlovdeveloped the concept of the "conditioned reflex"by ringing a bellat the same moment that he fed hislaboratory dogs. After repeating this combinedactivity several times, he discovered that simplyringing the bell, without providing any food, stillcaused the dogs to salivate and exhibit characteris-tic gastrointestinal changes normally associatedwith digestion. In the last decade, Ader and cowork-ers demonstrated that similar conditioning effectscould be induced in the immune system of rats bysimultaneously administering a saccharine solutionand a chemotherapeutic agent that alters immunesystem reactivity. After a suitable period of time,drinking the saccharine solution alone producedthe same immune system responses as if the drughad been given. In a German study, subjects weregiven a daily injection of a small amount of adrena-lin, which increases the activity of naturalkiller cellsthat attack and destroy invading pathogens. Theadrenalin injections were accompanied by the inges-tion of sweet sherbet. After the fifth day, a commonsalt solution was substituted for the adrenaiininjections, and it was again found that simply eatingthe sherbet had the same positive etlect on naturalkiller cellactivity. In other research, bone marrowcells were transplantedfrom one mouse into another,to determine whether this would also effectivelytransfer the donor mouse's immune system, Thesurface structure on the cells of the immunesys tem, known as the ma in h i s tocompa t -ibility complex, also produces a characteristic bodyodor. This is important because male rodents matewith females primarily because they have an attractive-ly distinct and different odor than their own. Theseexperiments revealed that the bone marrow trans-plantation not only successfully transferred intrin-sic genetic and immunologic properties and character-istics, "but also the typicalodor and pref,erenceforcertain partners," The fact that mice can literally"smell" the immune system of another animal, andrelay this information to the brain, provides furtherevidence of the strong links between the mind andthe immune system. Other support comes from alarge body of research demonstrating that stressreduces immune system defenses against cancerand can significantly influence tumor growth."As noted in prior issues of the Newsletter, suchresearch may have important implications for cancerpatients. Attempts to uncover the mechanisms ofaction involved in brain-immune system interactionssuggest several pathways. Immune responses canbe affected by brain neuropeptide and various otherhumoral secretions, In addition, hard-wired, directnerve connections to lymphatic tissues can beclernonstrated to influence the maturation and repli

cation of B and T lymphocytes. Stress and variousemotions can influence the level and activity ofbrain neurotransmitters, such as the endorphins,and a variety of other stress-related hormones alsoinfluence immune system function. Adrenalin inhibitsthe production of antibodies in B cells, and cortisone-like hormones, which are remarkably increasedduring stress, also interfere with the body's defensemechanisms. A similar eflect can be seen withprogesterone. On the other hand, insulin andgrowth hormone appear to stimulate the defensiveproperties of B and T cells. The originalstimulus forallthese activities appears to arise in the hypothal-amus which has the ability to detect a substancereleased when cells of the immune system are calledinto action. As part o{ the response, the pituitary isstimulated to make ACTH, resulting in the secretionof hormones like cortisone. Other pituitary trophichormones stimulate additionaltarget glands. As inother regulatory body systems, a complex series ofchecks and balances seems to exist, such that thesame hormone canexert oppositeeffects on differentparameters of immune system function. Thus,while adrenalin increases natural killer cell activity,it suppresses the efficacy of B and Tcells. Similarly,the effect of stress on tumor growth depends uponits nature, magnitude, duration and timing. Anidenticalstressor can increase or decrease experi-mentaltumor growth depending upon whether it isadministered before or after the inoculation ofmalignant cells. Further research into how sucheffects are achieved may ultimately lead to thedevelopmen t of effectiv e psychological and pharmaco-logic strategies to enhance the body's naturalimmune system defenses against cancer and viralinfections'

(The German Tribute, Aprits0, 1989)

"Time crumbles things; everythinggrows under thepower of Time and is forgotten through the lapseof Time." - Aristotle

Does Stress of HearingImpairment Contribute to

Alzheimer's?We have previously reported on research demon-strating that the stress of hearing impairment cancontribute to psycholosical difficulties, especially inolder individuals, Studies of patients in mentalinstitutions revealthat schizophrenics have a muchhigher incidence of significantly impaired hearingthan age matched healthy individuals or patientswith other psychiatric diagnoses. In another experi-ment, college students were given the posthypnoticsuggestion that they would have hearing difficulties(continued on page 7)

The Newsletter of THE AMERICAN INSTITUTE OF STRESS

Does Stress of HearingImpairment ContributE toAliheimer's?

(continued from page 6)which would significantly interfere with theircompre-hension of group conversations for the next fewmonths, This resulted in significant and progressivepsychological problems in those individuals whoresponded positively to this posthypnotic sugges-tion of partial deafness. Diminished vision andhearing are naturalconsequences of growing older.However, hearing problems aren't as troublesomeas problems associated with not being able to read.In addition, many patients quickly adapt to gradualhearing loss by lip reading and learning to interpretthe communicative signals of facial expressions andbody language. And hearing aid devices are muchmore annoying and unattractive than glasses. Allofthese factors may help to explain why so manyindividuals fail to take corrective measures whentheir hearing becomes impaired.A common scenario is an elderly individual whocannot comprehend a conversation carried on by anearby group. It is often assumed that the "whisper-

ing" is deliberate because the individuai is thesubject of discussion. Over a period of time, thismay lead to feelings of paranoia causing changes inpersonality and behavior, and progressive socialisolation. Eventually, such antisocial behavior canlead to concern on the part of family and friendswho indeed begin to whisper or talk about theindividual - and there is nothing worse than beingparanoid and being right! Further corroboration ofthese relationships and tendencies comes from arecent report on hearing impairment in 100 patientswith Alzheimer's-type dementia and an equal numberof age, sex and education-matched controls. Theprevalence of a hearing loss of 30 dB (decibels) ormore was significantly higher in the dementialpatients than in controls. In addition, the greater thehearing loss, the greater the likelihood of dementia,cognitive dysfunction and depression. The authorsdo not suggest that hearing impairment "causes"

Alzheimer's disease, but rather that it quite likelyaggravates the symptoms of dementia, thus makingits diagnosis more obvious. Correcting the impair-ment with a hearing aid or surgicalprocedure mightnot "prevent the progression of the disease but itcould significantly improve the associated problemsof confusion, depression, and social *ij2jiy,i!i*,

"Knowledge isuice-versa."

the raw material of ignorance and- Marlys Witte

More on Stress ReductionEffects of Pets

A strong social support system has been found tohave powerful stress-reducing properties. Having apet can provide pleasureable companionship, and,unlike humans, they tend to give unconditionalloveand affection. Pets can also have a very positiveeflect on psychologicalwell-being. In one study of50 patients who had not responded to psychother-apy for depression, 47 subsequently improved afterclose and caring contact with various pets. "Pet

therapy" has been found to provide significantbenefits for nursing home residents, and as previ-ously reported in the Newsletter, having a pet canreduce a patient's blood pressure and feelings ofstress, and improve the survivalrate of heart attackvictims, In one survey of pet owners in elevenstates, "877o considered their pet a member of thefamily . . . and that pets were most important whenthe owners were sad, ill, or going through someother crisis." In a Psychology Today survey,respondents ranked pets behind friends and rela-tives, and ahead of their jobs, when asked to rateseven aspects of their lives in order of importance.Having a good relationship with a pet may provideseveral benefits including:

- companionship- something to care for- something to keep a person busy- something to touch warmly and fondle- something to watch- something to make you feel safe- something to privide a stimulus for

socializationandexercise' (HeatthLine.4.89)

ilIore Benefitsfrom illeditation

Meditationcanproduce a state of deep relaxation thatis the antithesis of the many harmful "fisht or flight"responsesto conternporary stress. It might be anticipated,theretore, that practiced meditators might enjoybetter health. A variety of research reports appear toconfirm this. One study of regular meditators reportedup to 50 percent reduction in the need for medicalcare. In another, there were 80 percent fewer hospitaliza-tions, especially for heart disease, mentalillness andviral infections. All of these problems have beenshown to be linked to stress. Such findings haveapparently impressed health officials in the SovietUnion, They are currently opening a MaharishiAyurveda medicalclinic in Moscow and expect thatsimilar medical centers will be established throughoutRussia beforethe end of the year. In the Netherlands,Silver Cross, a major health insurance company,"gives a 30 percent rate reducton to TM practi-tioners." (Gannett News Service 5/23/89)

Book Reviews o Meetings and ltems of InterestBooh Reviews

Dic_tionary of Behavior Therapy Techniquea,Bellast, &S. eq{ Hereen, M., eds. Pergarnon press,Inc., Elmcford, New York, 1985,234pp., eoftbound$22.O0This volume is now in its third printing, which attests to itsdemand, and the apparent lack of any suitable supersedingreplacement in the past five years. As the editors correctlypoint out, the area of behavioral medicine has expanded in anexplosive fashion, with various offshoots having their ownseparate lingo, utilizing terminology and verbiage that is notuniversally understood and may be interpreted as having asomewhat different denotation for those working in differentbut allied disciplines. There are well over 150 different articlesdealing with every phase of behavioral therapy. These rangefrom well known authenticated techniques such as Rational-Emotive Thenpy, Assertiveness Traini ng, Cogn itive Res truc fu r-ing, Deep Muscle Relaxation, Biofeedback, and OperantConditioning, to comparatively "far out" approaches likeLemon Juice Treatment, Directed Maturation,and Sex Therapy.The latter is not yet covered by fiscal intermediaries, althoughothers may be if claims are presented in an innovative andadroit fashion. Many of the authors are well acknowledgedexperts in their respective fields but the expertise and qualifica-tions of others is less obvious. The important topics of SlressInoculation and Stress Management Traininghad a combinedtotal of only nine paragraphs, and probably should have beencovered in a more authoritative and comprehensive fashion.There is no Subject Index, which is an annoying drawback,although the Table of Contents does tend to serve thispurpose. Despite such deficiencies, this compact volume doesserve a useful purpose for workers in the field of behavioralmedicine.

_Biodiversity, Wileon, E.O., ed., National AcadernyPress, Washington, D.C., 1988, 520 pp., $32.50hardbound, $19.50 softbound.This book stems from the 1986 National Forum on Bio-Diversity, sponsored by The National Academy of Sciencesand The Smithsonian Institution. It is quite remarkable, and isreviewed here because it vividly portrays the destructiveinfluence "Civilization" has had upon the earth's flora andfauna, which parallels the disorders it has also inflicted onmankind. Few of us have any appreciation of the unknownbiodiversity that exists on earth in terms of plant and insect lifethat have never been categorized, or how fast they aredisappearing. We do, however, recognize how closely ourexistence depends on the maintenance of the homeostasis of

the environment, and how much the medicinaluse of plants hascontributed to modern pharmacology. Perhaps 25% of drugscurrently in use come from the earth's flora, but it is clear thatwe have not explored the properties of hundreds of thousandsof other possible sources that might provide similar benefits.The tragedy is that hundreds of these are disappearing daily atan alarming rate, not because of natural processes, but as aresult of the insensitive and wanton intrusion of civilization.There are numerous other syllogisms and comparisons whichhave important implications for our health and quality of life,among the superb contributions to this volume. The role ofenvironmental and social support as a buffer against illness isbeing increasingly acknowledged, but it may extend far beyondmere human relationships. As Jay Gould noted, "This is themost comprehensive book, by the most distinguished group ofscholars, ever published on one of the most important subjectsof our (and all) times."

Meetings and ltems of InterestJune 8.11, Creativity and Addiction, Cleveland (216) 494-a200,Ext.225.June 8-ll, Healing, Change of Heart, June 8.11, Flat Rock, N.Carolina, (704) 258-0615.June 23, Well-Being of Human Primates, Washington, D.C., (301)6s4-6390.June 26.Sept. l, Tenth Cape Cod Institute (Daily morning series oflecfures on Neuropsychology, The Relaxation Response, Diagnosisand Treatment of Sexual Problems, Children of Divorce, Adolescentsin Trouble, Clinical Hypnosis, Marital Therapy, etc.) Cape Cod, MA.Contact Dr. Michael Peters, Albert Einstein Colleg of Medicine, 1303Belfer Bldg., Bronx, NY 10461(212) 430-2307.June 27-30, First Intemational Congress of Behavioral Medicine,Uppsala, Sweden. Contact Ulla Wallin, Dept. of Clinical Psychology,Univ. of Uppsala, P.O. Box L225,5.75142 Uppsala, Sweden.July 2-7, First European Congress of Psychology, Amsterdam. Tel.No. 020-548385 1/ 5487 36],July9-14, International Congress of PhysiologicalSciences, Helsinki.Tel. No. 358-31-551.740.July 10.f6, Laughter Therapy Trainings, Santa Barbara, CA, (805)965-W25.July 16.21, 14th National Wellness Conference, Stevens Point,Wsconsin. (7 L8\ 346-217 2.Aug. 7-13, Laughter Therapy Trainings, Santa Barbara, CA. (805)966-W25.Qct.29-25, The Ecology of Work: Improving Productivity and theQuality of Work Life. Toronto, Ontario. Contact Tom Chase, R.R. f2,Box 44a, Northwood, NH 03251.Dec. 3.7, Intemational Round Table on Silent Myocardial Ischemia.For detailed information contact the Congress Secretariat, Tel Aviv;contact Kenes Ltd., P.O. Box 50005, Tel Aviv 61500.

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