Why Is Everyone in Philadelphia So Stressed?

It’s ruining our health — contributing to insomnia, mental illness, heart disease. It’s making us fat, forgetful and lousy in bed. Now science says it’s afflicting our genes, and altering the futures of our children. Can the key to conquering almighty stress really be as simple as these Philly physicians say?

Illustration by Leslie Herman

Illustration by Leslie Herman

I have a knot.

It lives between my shoulder blades, a little to the right of center. I feel it when I sit at my computer, when I walk through the grocery store, when I’m stuck in traffic on the Schuylkill: a small hard knot, like a kink in a cord. Twenty times a day I bend down and touch the ground, trying to untie it. Twenty times a day I stretch — this way, that way, down and around — to try to work it out.

I know what tied my knot: deadlines, bills, two kids, a leaking roof, that long hard winter. Modern life, in other words. Chances are you’ve got a knot of your own. Or maybe your problem’s in your stomach. Maybe you can’t sleep at night. Maybe you drink too much, or eat too much. Get headaches. Grind your teeth. All of the above.

We call what tied my knot “stress” — the accumulation of worries, fears and doubts that bedevil us daily. We know it isn’t good for us. We’re told we should avoid it. (Yeah, right.) The entire $27 billion-a-year U.S. yoga industry is pretty much one giant stress-coping strategy.

Every day, it seems, science implicates stress in some new bodily disorder — obesity, depression, infertility, not to mention good old-fashioned high blood pressure and heart attacks. Now, research being done here in Philly says our stress-ridden lives are reprogramming us at a cellular level, affecting mankind’s future ability to cope with worries and regrets.

Other local scientists, however, say that conquering stress is surprisingly quick and easy — and that the power lies within our own minds.

I hope so. Because right now, my knot is killing me.

LET’S START WITH A QUICK recap of high-school biology. Remember the fight-or-flight response? Bunny sees fox. All on its own, bunny’s body yanks itself out of its customary equilibrium, drawing resources away from every function except those needed for escape. No sense expending fuel on digestion, reproduction or even cognition at a time like this; all that matters is speed.

Inside bunny, a cascade of nutrients — glucose for energy, endorphins to dull pain — is delivered to the muscles via a circulatory system hyped up by “stress hormones” that quicken heart and breathing rates and increase blood pressure. Once bunny makes it safely back to its burrow, the heartbeat slows and breathing calms via a release of counteracting hormones. The body returns to stasis, and resources can again be allocated to long-term work.

Fight-or-flight is expensive, in terms of bodily fuel. But it worked well enough for our ancestors that we made it through to here. We get into trouble with stress because contemporary life doesn’t offer the same sorts of challenges the Stone Age did. Instead of encountering rare instances of physical danger, we’re bombarded by continual alerts: Phone’s ringing! Email’s beeping! Baby’s crying! Bill’s due! We’re in a perpetual state of “anxiety,” which is what we call an abnormal response to stress. And we’re taking pills for it: We spend $2.1 billion annually on anti-anxiety medications like Xanax. Psychologist Robert Leahy says high-school kids today show the same anxiety levels as psychiatric patients in the 1950s.

Why? Scientists say the human mind simply didn’t evolve to handle the relentless barrage of new information that technology brings us. Under that information flood, says psychologist Steven Hayes, “our attention becomes less flexible, our minds become more chattering, and the next thing we know, we’re frantic.” Coincidentally, in the past century the average American life span went from just over 50 years to just shy of 79. We’re living long enough now to see what happens when the stress response is continually stuck at on .

“I don’t know you,” Michael Baime tells me over the phone, “but if you check right now, your shoulders are probably too far forward.” I check. They are. “You’re holding them up closer to your ears than they need to be. It’s a protective stress reaction. It shields the head and neck. When you tighten your belly, you’re protecting your internal organs. When your hands tense, you’re making fists. This is all very primitive stuff.”

Baime is the founder and director of the Penn Program for Mindfulness, which in 22 years has helped more than 12,000 people learn to cope with stress. For a long time Baime thought he was going to be a Buddhist monk, until his elderly Tibetan mentor told him he’d touch more people’s lives if he got his medical degree. But he never lost his interest in meditation. “What I did was outside the mainstream for 20 years,” he says. “People rolled their eyes. But now there’s been an explosion of research showing mindfulness isn’t just warm and fuzzy.”

Mindfulness, inspired by Eastern mysticism, is a form of therapy that teaches you to focus on emotions and feelings in the moment. Earlier this year, Kate Pickert began a Time magazine story on mindfulness by eating a raisin:

I notice that the raisin’s skin glistens. Looking closer, I see a small indentation where it once hung from the vine. Eventually, I place the raisin in my mouth and roll the wrinkly little shape over and over with my tongue, feeling its texture. After a while, I push it up against my teeth and slice it open. Then, finally, I chew. …

Mindfulness may not make for scintillating reading, but it was shown in a recent meta-analysis of clinical studies to lessen anxiety, depression and chronic pain — conditions that millions of us suffer from. Americans are willing, Baime says, to spend a fortune tracking blood pressure and cholesterol and making tiny incremental adjustments. We happily ingest 44.4 million monthly prescriptions for Xanax, which can be dangerous and addictive. But when it comes to the stress-fighting strategies that mindfulness teaches, we resist. This despite the fact that stress impairs working memory, concentration, our ability to learn new information, a normal libido, our regulation of caloric intake. …

And what do we offer the stress-ridden among us instead? “We tell them to relax,” Baime says, and laughs.


Dekunchak, a masseuse whose company is called Hands at Home, comes to our office every week or so to give staffers 10-minute chair massages. “It feels like a knot,” she tells me about the one in my back. “It’s a myofascial trigger point caused by injury or overuse. There’s literally a buildup of protein and lactic acid. It feels completely different from a muscle that’s relaxed.” The shoulder-hunching Michael Baime intuited has done this to me.

When Dekunchak was little, her mom used to pay her a dollar to rub her neck. “It was just the two of us,” Dekunchak remembers. “She worked two jobs. Instinctively I was like, let me touch you, let me rub you.”

The healing power of touch may be as primitive as the stress response itself. Scientists have shown that the more licking and grooming rats receive when they’re young, the better able they are to cope with stress. But knowing how to break up a knot doesn’t make you immune to stress. “I own my own business,” Dekunchak says. “I’m connected to my cell phone all day. So I do yoga. I get my massages. Someone has to come help me.”

Taking care of your stress is smart; the American Medical Association estimates that stress is the basic cause behind 60 percent of all human illness and disease. Which raises the question: How much of my stress comes from worrying about how stressed I am? To try to tease apart the threads, Daniel Monti and Andrew Newberg, two physicians at Jefferson Hospital’s Myrna Brind Center of Integrative Medicine, have been running a series of experiments on patients who’ve been diagnosed with cancer.

Having cancer, as you can imagine, is highly stressful. When you hook stressed cancer patients up to an fMRI machine and have them relive, say, the moment of their diagnosis, you can see the results. “The amygdala lights up like crazy,” says Newberg. Monti describes the amygdala as “the fear center of the brain — it sends out a red alert to the rest of the body when there’s a threat.” High emotion intensifies neural connections. And once event and emotion carve a pathway in the brain, “It won’t go away until you address it,” Monti says.

To counteract stress, Monti and Newberg provide cancer patients with a form of mindfulness training called Neuro Emotional Technique, or NET, designed by (of course) a Californian — “a combination of cognitive behavioral principles, acupuncture and biofeedback,” Monti explains. After the training, patients’ amygdalas no longer light up when they’re reminded of the stressful event. The amygdalas of control groups who don’t get NET do.

Which is impressive enough that I’m willing to try some DIY mindfulness. I buy a book on the subject, written by a doctor at the Mayo Clinic. He suggests I begin each day by thinking about five people I’m thankful to have in my life. He says I should put pictures of them up on the wall of my bedroom, so they’re the first thing I see every morning.

Thinking about doing this — do I even have five people I’m thankful for? — is highly stressful for me.

The thing is, I’m not mystically inclined. My tolerance for mumbo jumbo is extremely low. I don’t like yoga. I’m not a think-happy-thoughts kind of person; I prefer cynicism and bitterness. When Michael Baime starts talking about mindfulness as a practice that “changes something deep within ourselves” and the benefits of “nonreligious spirituality” and “a drastic increase in the depth of meaning in relationships,” I get really anxious. My relationships are fine the way they are. Why would I want to change?

Maybe for my kids. My son and daughter are young adults now; they don’t live at home. But they’re as stressed-out as I am. My son grinds his teeth at night, just like I do. My daughter regularly calls when she’s worked herself into a frantic state — over her student loans, her mother-in-law, her job. I always figured they were bad at handling stress because they grew up watching me handle stress badly. But the latest science shows something more at play.

THE CONVENTIONAL ARGUMENT about how we develop our individual character has been nature vs. nurture. Some people say our destinies lie within the double helix. Others say nature be damned; it’s how you’re raised that counts. Now there’s a further wrinkle: “epigenetics,” a process by which what happens to you while you’re alive affects the genetic material you pass on.

Sound impossible? Consider this: If you expose male mice to the smell of cherry blossoms and then shock their feet, the mice pups they father exhibit anxiety and fear the first time they ever smell cherry blossoms. So do the children of those pups. It’s not the mice daddies’ DNA that’s directly affected by the linkage of shock and smell; instead, the stress creates “repressor marks” that cause the DNA to be expressed differently, via a process called “methylation.” And those methylation marks can be inherited.

Tracy Bale, a neuroscientist who teaches at both Penn’s medical school and its veterinary school, studies epigenetics. She’s also the mom of a 14-year-old son. And she’s deeply worried about kids today. According to a massive report from the American Psychological Association last year, young people now report higher stress levels than adults. “You know Penn has had four suicides this year?” Bale says when we meet in her cramped Penn office. “We haven’t done our kids any favors. We shield them. We don’t build confidence or grit. You get 20-somethings who don’t deal well with stress.”

Bale’s research has shown that if you expose male mice to chronic stress, they create sperm containing an epigenetic marker that blunts the expression of mouse stress hormone. This causes their pups to be born with lessened reactions to stress. “That makes sense evolutionarily,” Bale says; if you’re going to grow up in a stressful environment, it’s good to be less sensitive to it. But such irregular stress responses can lead to stress-related illnesses like depression, schizophrenia and anxiety disorders. The inappropriate levels of hormone throw the whole system out of whack.

Besides, not all stress is bad, Bale points out. Let’s say you stress some mice. (It’s not hard to do; you can put marbles in their cages, or wet their bedding.) Let some of the stressed mice return to their mothers, but don’t let the rest go back to Mom. “There’s a big difference in how they cope in life,” says Bale. “The ones who get to go back to Mom perform better even than non-stressed animals. They get through. They pick themselves up.”

Bale is also researching the effects of a mother’s vaginal “microbiome” — the combination of bacteria inside her body — on her offspring. When a baby pushes through the birth canal, the microbiome is ingested: “That sets up the whole immune system of the baby’s gut. We think that may be why C-section babies are more prone to immune issues like asthma and allergies” — they never get exposed to that vaginal microbiome. So researchers are looking for other ways to transfer it — for instance, by taking samples from the mother and administering them to the babies orally.

Infections and changes in nutrition alter a mother’s microbiome. So does stress. In a study on mice, Bale showed that stress caused changes in the levels of a bacterium in the microbiome that’s associated with brain development. Throwing off those levels, she says, could predispose offspring to an increased risk of neurodevelopmental disorders.

But the damage caused by stress continues throughout our lifetimes. A constant bath of stress hormones “eats away” at the hippocampus, says Bale — the seat of memory. That’s why you can’t remember where you put your keys when you’re stressed. Studies show more methylation of the genes in the hippocampi of those who commit suicide than in the hippocampi of people who die suddenly of other causes. Bale just landed a grant for a new study of women who have experienced stressful early life events like sexual abuse; such women are more likely to develop affective disorders such as depression, eating disorders and ADHD. “We’re following these women as they get pregnant,” Bale says, “to see about their children.”

Not everyone who experiences trauma develops a disorder, of course. Animal research shows that a doting mother gives you a better chance of coming through unscathed. What is it that a good mom passes on to her offspring that helps them cope?

It could be as simple as self-confidence. How much control you feel you have impacts the effects of stress. Put a rat in a cage, deliver electrical shocks, and train it to press a lever to avoid the shocks. If you then take away the lever, the animal’s stress shoots through the roof. If you give back the lever but it doesn’t affect the shocks — if it’s not even connected to anything — the rat’s stress response still goes down, simply because it’s there . Believing you’re the master of your fate builds resiliency.

But you know what else makes a big difference? Socioeconomic status. Those at the top of society’s ladder have more resources with which to come at problems. And the stresses of poverty may account for the shorter life spans of the poor, as well as their high rates of stress-related illnesses like depression, diabetes and heart disease. Penn neuroscientist Martha Farah has mapped the socioeconomic status of children against their ability to pay attention and tune out distractions in school. Her findings: The rich don’t just have more money; their brains are better able to learn.

I find it stressful to think that a child’s ability to cope with stress may be dictated by how stressed her parents were at the time she was conceived. When I mention this to Michael Baime, he shrugs: “Some people are just born anxious. Some are born happy. Some are born depressed. Some of us are born good-looking. Life isn’t fair.”

CLEARLY, STRESS IS SERIOUS STUFF. But it’s also a sort of badge of honor: “God, I’m so busy!” “I have so much to do!” Who isn’t stressed? Babies. Retirees. Bums. Look at the latest list of the most stressful jobs: airline pilot, military general, senior corporate executive. Least stressful? Librarian and audiologist. Which camp would you rather be in?

As Michael Baime says, “If you look at the relationship between stress and performance, it’s a rising curve: As stress increases, your performance increases” — right up to the point where you tumble over the edge.

You could even make an argument that stress drives our economy. A recent study of an Israeli town threatened by terrorists’ rockets, conducted by researchers from Temple University, found they bought more stuff than a cohort from a town that wasn’t under siege. Their purchases were an attempt, the researchers said, to “control their destiny.”

Mindfulness, Michael Baime says, is another means of taking control. Whatever your response to stress is — whether you overeat, get bitchy, get panicky, get sad — mindfulness lets you see that what seems externally imposed is really internal. You learn to attend to what happens in the moment, slow it up and say, “That thought is ridiculous.” You realize that what you fear won’t really occur.

Mindfulness programs have proliferated wildly of late. (See our sidebar for a few of the best local options.) When I ask super-scientist Tracy Bale about mindfulness, I expect her to pooh-pooh the idea. Shows what I know. “Look, you can’t change stress,” she tells me. “But you can change how you perceive it. If you control that, the brain isn’t going to respond the same way.”

Even so, it’s my car radio that really convinces me about mindfulness.

A year ago, the radio in my 2007 Honda started going out. And NPR or Dierks Bentley or Beyoncé didn’t just quietly stop. They stopped with a big, loud electronic POP that made my heart stop, too. I found myself driving Route 422 and the Schuylkill Expressway in a constant state of tensed fearfulness: Now? Is that POP coming now?

The dealer wanted $900 for a new radio. I don’t have $900. And so at some point, I began turning the radio off preemptively, before it had a chance to pop. No more Beyoncé or Dierks. But … no more Ed Cunningham, either. No more Sam Clover warning about bumper-to-bumper. No more “Holy Jesus, more Katy Perry?” accompanied by irritable stabbing at presets. Hey, doesn’t the sun look pretty going down behind those hills?

Now, I ride an hour and a half each way, every day, in silence. My kids think I’m insane. But I find I’m calmer when I get to work, and when I get home, too.

Even without car-radio stress, I still have my knot. I’ve got plenty of other anxieties. This article is a week late, for instance. And with the radio off, I hear all the other noises my car makes. Was that the alternator?

What’s startling even to those who teach mindfulness is how little it takes to stop the stress-hormone cascade. Remember the cancer patients in the Jefferson program? They don’t commit to a months-long treatment regimen. They go to three to five classes that are each less than an hour long. That’s all it takes to rewire their brains. And these are people who have cancer . Sort of puts a broken car radio into perspective, doesn’t it?

For the un-touchy-feely among us, science is sure to come up with new and better ways of blocking stress hormones medicinally (although, Baime points out, mindfulness has no side effects). Whatever new methods lie ahead, the next challenge will be how to regulate these hormones that give us heart disease and diabetes and anxiety disorders — but also spur us to excel and create.

Originally published in the May 2014 issue of Philadelphia magazine.

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