Grant me the serenity to accept the things that I cannot change, The courage to change the things that I can, And the wisdom to know the difference. (Traditional)
We assume in this book that stress is a natural and daily part of life. It occurs when we interact with the world around us and within ourselves. Stress can manifest itself in countless ways. It may appear as a feeling of uneasiness or disquiet, as difficulty falling asleep, or as physical discomfort. Regardless, the presence of stress suggests that some event or change is challenging you. Your stress reaction is an indication that something has happened to require your attention.
It may surprise some readers that we say stress is a natural and daily part of life. But life is unpredictable. It seldom behaves just the way that we prefer. Our interaction with the moment to moment flux of life makes stress commonplace.
There are countless examples of stress in daily life. Just when it looks like you will get your credit card paid up, your car breaks down. The airline goes on strike shortly before your holiday. You go to your doctor for what you expect to be a routine examination. But she tells you that you may have developed an illness or complication. The boss asks you to work late on the night that you had wanted to be home early. You probably can think of countless events in your life that has been more or less stressful. By learning how to approach the tensions of daily life, we prepare ourselves for any greater challenges that may come our way.
There are two root causes of stress. First, the world in which we live is always changing. One moment is never the same as the next. This creates stress because most of us prefer the comfort and security of sameness. Consequently, we strive for consistency and certainty in our lives. This places us in a position of conflict with the reality of life's unpredictability.
Secondly, most of us prefer to have some sense of control over what happens to us. But many of life's changes are beyond our ability for control. Not only are they unpredictable, but we do not have full control over them. These discrepancies between how life works and what we prefer are at the root of stress.
Fortunately, there are times when everything proceeds as we wish. These are the times when we tend to be most at ease. But sooner and usually not later, some upset occurs. Reality intrudes. We lose our sense of contentment. Distress arises. Then we strive again to assert our preferences.
When things do go our way, we can be easily convinced of our potential for control. We wish to believe in our ability to guide our lives. Given the great advances in medicine and other technologies of the past century, it has become easy for many of us to assert a great deal of control. Few truly believe that they know what will happen to them even a few moments from now. But most still live their lives as if they assume that they are fully in control. This is why the occurrence of major illness or other trauma is always a great shock.
Serious physical illness holds great potential to cause stress. It challenges one's wish for stability and control. You can easily think of examples of how illness has disrupted your life. Transplantation can help you to regain your health. It promises a greater degree of control over life and health. But meanwhile, you must wait for and recover from surgery. Before it helps, organ transplant can add many further disruptions and stress, to your life. A common sense approach to dealing with the stress of illness and transplant can be helpful. Table 5.1 shows one way to interact adaptively with change.
When some event or change occurs, you will first react in some automatic or habitual way. For example, your initial reaction may be a feeling of uneasiness, a desire to eat more, or difficulty with sleep. We each have one or more ways of first reacting to stress. A stress reaction says to you that some event or change has given rise to conflict between your preferences and the way things really are. Table 5.2 lists some automatic reactions that people notice with stress. Once you learn to notice your reaction, you can decide what has changed and how best to respond.
The approach we encourage is an optimistic one. Ants are programmed to react to change. They do so without choice. But we need not be like ants. People can reflect upon a new situation. We can take each new opportunity to choose our best response. Unfortunately, people do not always or even often, exercise their potential for choice. Often, people will ignore the reactions that suggest, stress. But the opportunity remains for us to choose an appropriate response to change. Each moment, you have an opportunity to respond to your changing world. Whether we choose to recognize or ignore it, the potential for influence is there.
There are many potential causes of stress for the transplant candidate or recipient. We have discussed these in chapters two, three and four of this book. It doesn't matter if you have yet experienced a few or many of the challenges that we have mentioned in these chapters. This and the next two chapters offer an approach that can enhance your ability to deal with what has or may arise.
Important to remember is that the same event may result in various levels of stress for different people. There are no rules. Something that a friend finds distressing, may not upset you at all, you will automatically assess any occurrence by what it means to you. This assessment largely decides whether you find it stressful. For example, the onset of arthritis will carry a more sinister meaning for a carpenter than for a person that does not work daily with his or her hands. Arthritis will stress a carpenter more than a singer.
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A change around you generally results in some change within you. By habit, you will react immediately in some way to a stressful event. Table 5.2 lists some automatic ways that different people react to stress. We will call these experiences that occur within you, a stress reaction. Your stress reaction is an indication that some event or change is demanding your attention.
One's stress reaction can take many forms. But physical effects of stress are likely the most tricky to deal with. This is particularly true for those with a medical illness. Few appreciate how common it is for stress to mimic the symptoms of a physical condition. In Susan's case, the transplant team diagnosed a heart arrhythmia as the cause of her first episode. But they could find no physical problem to explain the other episodes. Although the symptoms felt the same to Susan, it is highly likely that they were to due stress.
Research has shown that for those with diabetes, it is not uncommon for stress to result in symptoms very similar to those that occur with blood sugar problems. People with arthritis report increased pain when under stress. In those with asthma or emphysema, stress can manifest first as shortness of breath or chest tightness. You should never assume that physical symptoms are due to stress without a thorough examination. But an unexplained worsening of symptoms may suggest that you be under greater stress than you have been aware.
This is the point that can separate the ants from the people. Instincts alone guide ants. They have no choice. Unfortunately, people can act more like ants than we like to think. It is easy to fall into habitual ways of responding to stress. Many respond to any stress with habitual responses that may or may not be appropriate to the situation at hand.
The ability to choose between various options is a hallmark of humanity. Usually, there are more ways to approach a problem than first come to mind. Not all events, even stressful ones, require a response. But, sometimes you must respond to new events or situations in some way. This requires effort at a time when you might prefer to sit quietly and hope for things to resolve themselves. But it can be effort well spent. Even if you decide that the best thing to do is nothing, you have at least asserted your choice.
There are five strategies to consider when a problem arises. You can: try to solve the problem; try to calm or otherwise look after yourself; adjust yourself to fit the new circumstances; ask for help; or do nothing. These options are not mutually exclusive. You may choose one or more strategy when responding to a stressful event.
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I tried progressive relaxation before. It did nothing for me. Is there anything else I should try?
I never feel stressed. Is there any point in me reading this?
