An interview with Aaron T. Beck, M.D.
Q. Dr beck, what is stress?
A. The word itself is borrowed from physics and engineering, where it has a very precise meaning: a force of sufficient magnitude to distort or deform when applied to a system. In psychiatric practice, we see two major types of stress: the stress involved in loss- of a loved one, say, or of a job, or of self-esteem that comes when a person’s level of aspiration is impossibly high; and the stress involved in threats-to the individual’s status, goals, health, security. Such stresses can generate symptoms of depression or anxiety, or both. And statistics indicate that severe depression or anxiety may involve 20 percent of American’s at one point or another in their lives.
Q.Is any particular period in a person’s life most stressful?
A. Each period has its own set of stresses. In early life, the child has to cope with the immediate family group and the demands of school. Adjusting to the personality of the teacher and to the other children can be very stressful, as can the problem of boy-girl relationships in later adolescence. Then there are the academic stresses of college years and worries over career choice. After college, for most there are the problems of the first years of marriage. These can be quite serious and often lead to early divorce. The problems of having children bear heavily on women, while men have early career problems.
Q. How do the stress symptoms differ in each phase?
A. The actual symptoms maybe the same, irrespective of the external stress factor. People seem to have a personal way of reacting to problems-obsessions, anxiety, alcohol, or various other responses.
Q. Ulcers, too?
A. Yes, ulcers are a symptom that can develop at any stage. We even see them in children. But the typical ulcer personality is probably in the middle executive level, where the individual not only has external job pressures but-what is more important-internally generated pressures to get ahead. Such a person drives himself all the time to do his job well. But as soon as he reaches one level of success, he raises his level of aspiration higher, so there is never any letup.
Q. What are the stresses of early marriage and motherhood?
A. the young mother runs into what I call the “give-get” imbalance. In these years she is putting out much more, in terms of housework and child rearing, than she’s getting in return, in terms of the satisfactions she once had in school, in the social whirl, from seeing teachers everyday, joining clubs, dating and so on. At the time, her husband is preoccupied with his career and is able to give her only a minimum of support.
Q. Do young wives worry about whether they can keep their husbands?
A. Yes, and the worry is fed constantly by statistics which show marriages breaking up at an increasing rate in almost every era of married life.
Q. Weren’t husbands and wives better able to cope with marriage stresses in the days when it was taken for granted that they had to “tough it out,” so to speak?
A. In the past, there was a naïve – or perhaps it was realistic-belief that a marriage would sustain itself. No longer. At the first sign of difficulties, people today are more likely to turn to their lawyer than to a marriage counselor. Whatever coping mechanisms they have within themselves just aren’t tested.
Q. Does this difficulty in coping apply to the broad range of stresses that Americans experience?
A. Yes, Life, generally, is much easier for young people today than it was for their parents. In childhood and adolescence, the parents are around to protect them-more so than ever before. The youngsters haven’t learned to put up with a great deal of frustration; they haven’t learned to sweat out periods of anxiety; they haven’t had long periods of adversity. This means they haven’t learned how to manage when stress develops.
Q. What are Some of the things that can help people cope?
Some of the mechanisms consist simply of not doing the kinds of things that cause “uptightness.” For instance, a youngster who has gone through loneliness may think it’s a rather bad, even terrible, thing-since he is sure that he’s the only one who has gone through it, that there is nothing he can do about it, that the loneliness will last forever. Later, if another attack of loneliness comes along, the memory of having had it before and of learning that eventually it disappears tends to become a coping mechanism. He learns not to indulge in the misinterpretations and exaggerations that aggravated the problem before.
Q. What about an older person? Can a middle-bracket executive, for example, learn to cope with frustration in not getting ahead as fast as he wants to?
A. His trouble is an outgrowth of the notion that a person’s self-worth is dependent on how much he achieves. If he can develop a healthier attitude about achievement-learn from experience that it’s a nice thing to have, but not an absolute essential for existence or self-worth-then he is less likely to feel the stress of striving for a goal. I would tell the “uptight” executive simply that he is trying too hard. And I would recommend a variety of recreational pursuits. Depending on his social class and income, these could be bowling, playing tennis, gardening, going on vacations and so on. Such pursuits tend to balance out his life, give him more perspective.
The problem in cases of stress is that the individual loses objectivity about his or her situation. Often just talking to a psychiatrist or a counselor allows such a person to look at things from a distance and develop coping mechanisms.
Q. where a specific external factor triggers the stress, can it be identified and handled with relative ease?
A. Not always. Some external situations develop slowly and are discernible only when something brings them into the open. I can give you an example-a woman who was depressed because she felt her husband wasn’t giving her as much affection as previously. In fact, she suspected that he might be unfaithful to her. The husband denied this, and I wasn’t able to help hr much. Then one day she discovered that he had, indeed, been unfaithful to her. Once she established this and they “had it out,” she was able to cope with the problem I was able to help her much more effectively, and within a few weeks she was over the depression.
Q. What can parents do to provide children with better defenses against depression and anxiety in later years?
A. While it’s good to give the child lots of love, its not enough. Many kids can grow up straight and strong without getting more than the minimal daily requirement of love. What they do need is the opportunity to confront various problems when they’re young and learn to cope with them. The parents, by intervening prematurely, may prevent the child from developing tolerance for problems or acquiring problem-solving mechanisms.
Q. Suppose a family member is under stress that he or he may not be aware of, but others can see. Is the next step to get that person to a psychiatrist?
A. No. getting a good medical examination is always standard procedure-and it gives the patient a chance to tell the doctor about his inner worries or feelings. Often, the doctor can give general words of advice to be implemented by the patient himself or through help from friends or other persons, such as a clergyman. It’s only the more difficult cases-the ones that don’t respond at that level- that should get psychiatric attention.