Books: Designer disease? Tell that to those who suffer from it

Rather than releasing people from the fear of stress, which this author dismisses as an 'intellectual construct', she is taking us back to a darker age, says Angela Clow.

by Dr Angela Clow, professor of psychophysiology at the Universityof Westminster
Last Updated: 31 Aug 2010

The Truth About Stress sets out 'to release people from fear', yet introduces a new pathology: stress phobia. Angela Patmore claims that the stress industry 'has poisoned whole populations as though it had put something in the drinking water'. Apparently, stress is a 'mythical malaise based on an intellectual construct', and an unwitting public is being conned and exploited by the 'dark dangers' of the stress industry.

Unfortunately, this approach misinterprets or overlooks key evidence linking stress with health problems, and, I fear, it contributes to the sensationalist stress industry that it sets out to lampoon.

Much of the book is preoccupied with the lack of an agreed set of words to describe stress. According to Patmore's logic, unless we can all agree a sentence that accurately describes stress, it quite simply cannot exist (by the way, no definition of 'stress phobia' is provided, but this does not seem to represent a problem). The real truth is that regardless of how we choose to define it, stress can potentially have a substantial impact on our health and wellbeing.

Some of the most widely known and convincing evidence on work-related stress arises from studies on thousands of Whitehall civil servants. This work is briefly reviewed by Patmore, but described merely as 'interesting but hardly alarming'. The evidence showed that a range of diseases were related to job demands, job strain, job insecurity, poor coping skills and lack of control, all of which construe a poor and 'stressful' working environment. There was no evidence of a 'mythical malaise' and the participants did not suffer from 'a designer disease' originating in the minds of the investigators.

There is a great deal of other evidence, derived from well-designed studies, that doesn't get mentioned in this book. These studies (all carried out on humans) show that the ability to mount an antibody response to vaccination, susceptibility to infection, wound-healing time, myocardial ischemia, clinical depression and mortality itself are all associated with stress and stress responding.

Instead of using her expertise to guide the reader through the complexities of the stress literature, difficulties are exploited and confusion nurtured. In truth, the experience of stress is a complex phenomenon, as it results from the interaction between the individual and the environment. Individual differences in responses to stress can be determined by a range of factors and, in contrast to Patmore's thesis, are the very reason why it is important for individuals to be informed. Awareness of the role of the self in vulnerability to stress empowers individuals to manage their perceptions and thus take control.

The idea of stress management is more than relaxation training, and the aim is to help avoid (not promote, as suggested) the GP's surgery, the psychiatrist's chair and psychotropic drugs.

The book is right, however, to point out occasional confusion associated with the sometimes interchangeable terminology: stress, arousal and resignation. The negative impact of stress on an individual usually depends on the duration of exposure. Short periods of challenge and arousal (eg, being busy) may well be beneficial and drive creativity and accomplishment. Longer-term stress is entirely negative in its outcomes and leads to the sort of helpless resignation associated with harmful health outcomes. Surely this is not so very difficult a phenomenon to understand and explain?

Another important finding to emerge from the Whitehall studies, and not covered in this book, is that the most stressful working environments were those characteristic of the lower grades of civil servants, not the high-flying (but busy) top executives. This book criticises stress audits and stress management strategies designed to identify and address factors known to increase stress in the workplace. These interventions are most likely to benefit the least advantaged in the society and help reduce social inequalities in health.

To ignore the evidence that stress in the workplace is associated with poor health outcomes is tantamount to negligence and would set us back to darker ages where smoking was encouraged for one's health.

The science of stress is in its infancy: the detailed mechanisms by which psychological and physiological processes interact need clarification. However, the point that is missed in this book is that evidence is available to us now that these interactions exist and are important for health. The most disadvantaged in society are the most vulnerable to the effects of stressful living and this contributes to health inequalities. To deny this is to deny the most vulnerable the knowledge and power to change.

The Truth About Stress Angela Patmore Atlantic Books £12.99 MT price £10.00 To order, visit


All the books reviewed are available from the MT bookshop. To order, call 08700 702 999 or visit P&p at £1.95 will be added to each order.

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