What Do Hans Selye and Potter Stewart Have in Common?

Going back to the American Institute of Stress' page on definition of stress, we find the following reminiscence about Dr Hans Selye, the "father" of stress theory:

In his later years, when asked to define stress, he told reporters, "Everyone knows what stress is, but nobody really knows."

This is in many respects quite similar to Supreme Court Justice Potter Stewart's famous concurring opinion in Jacobellis v Ohio, 378 U.S. 184 (1964), where he wrote:

I have reached the conclusion ... that under the First and Fourteenth Amendments criminal laws in this area are constitutionally limited to hard-core pornography. I sall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that.

Stress, then, is like pornography: hard to define, but people "know it when they see it." And let's take it one step further: people's interpretations may vary-- what one person may find harmful, another may find beneficial.

Good Stress, Bad Stress (cont): Does "Crisis" Really = "Opportunity" + Danger"?

The American Institute of Stress has a nice biographical essay on Hans Selye, the "father" of stress theory and research. If you scroll about halfway down, you'll see a little blurb about how the closest Chinese word to signify stress is a composite of the characters for "danger" and "opportunity" which can be translated as "crisis." (Interestingly enough, it runs immediately to the right of a photo of a postcard that Hans Selye sent to Paul Rosch in-- well, you can't tell what year it was, but it was likely before 1963, because there's no ZIP code on the destination address-- and the text is "In Japan the word for stress is..." followed by a kanji character. Japanese, Chinese-- whatever.)

Now this concept of stress = crisis = (danger + opportunity) is kinda neat, isn't? (In fact, I distinctly remember, in the mid 1980's, how an Atlanta-based consultancy marketed materials around technology and organizational change that incorporated the logograph for "crisis" (wēijī) and made extensive reference to things like "opportunity ratings" and "danger ratings." Heck, a couple of years later, I even worked a reference to this into a paper I wrote for an advisory committee I was on at the time.)

Well, it may be neat, but is it accurate? Evidently not, according to these articles (here and here) originating either directly or indirectly from the UPenn Chinese language faculty.

Too bad. Don't you hate it when facts get in the way of nifty constructs?

Good Stress, Bad Stress

I came across this press release ("Well-Being of Workforce Influenced by Employers, Job Duties. Something to Think about on Labor Day: Research Shows a Good Boss Can Help Make Weekdays Feel Like Weekends, but a Bad Boss May Lower Employees' Well-Being") last week on the Healthways website. (Healthways partners with Gallup on the Gallup-Healthways Well-Being Index, which I'll be writing more about over the next few days).

There's a lot of good material here, but for now I'd like to pick out one paragraph that particularly resonated with me:

Research from the Well-Being Index also reveals that people in a negative work environment are less psychologically resilient and are more vulnerable to stress from economic downturns. Some stress in life is good stress, necessary to motivate through deadlines and often a driver of success. However, people in negative work environments report a high percentage of stress and worry without happiness and enjoyment, a feeling that negatively affects overall well-being.

There are several meaty themes in that paragraph-- pyschological resilience, the concept of "good stress," the role of the work environment in mediating (or aggravating) psychological distress, the measurement of "happiness"-- and I'd like to deal with all of them at some point, but for now (drip, drip, drip), let's stick with just one: the notion that some stress in life is good stress.

There's a great article ("Stress, Definition of Stress, Stressor, What is Stress?, Eustress?") on the website of the American Institue of Stress(AIS) that addresses the notion of "eustress" (good stress). The article's author (who I assume is AIS president Dr Paul Rosch) makes reference to the Human Function Curve, which was first articulated by cardiologist Dr Peter Nixon at least 25 years ago. Unfortunately, I haven't figured out how to paste images into my blog post, so I'll have to ask you to look at the graphic as it exists on the AIS website (I'm sure Dr Rosch will appreciate the increased click-thru traffic ;-)

The main idea of the Human Function Curve is that a certain amount of stress is beneficial and leads to improved performance and productivity-- but only up to a point. Beyond that point, stress becomes negative and leads to decreased performance and productivity (and increased wear and tear on a person's body, mind, and spirit). So, the challenge is to make sure you stay on the right-hand side of the curve. And the way you do that is by (a) modulating your environment or your response to it, or-- actually: and/or-- (b) improving your capacity-- your resilience, if you will-- and moving the "hump" on the curve further to the right. This latter approach really resonates with me, and in future points I'll elaborate some more on how and why that's the case.

Is it Really a "Fat Tax"?

A couple of days after I put up my last post on this blog, one of my work colleagues circulated a link to this Fox News article about the proposed change to Alabama's state-employee health insurance plan that could require certain obese employees to pay more for their coverage.

I have to admit, there's something catchy about the concept of a "fat tax," especially if it's associated with the state that ranked #2 in obesity prevalence in 2007. But are Fox News and scads of other commentators using this term accurately describing what's being proposed?

Well, let's take a look at the actual proposal by the Alabama State Employee Insurance Board.

• What they (the state) say they are doing is charging (for the first time,apparently) for health insurance-- to the tune of $25/month, beginning 1/1/10.
• At the same time, they're offering a $25/month "wellness premium discount." What do employees have to do to get the discount? Submit baseline readings for blood pressure, cholesterol, glucose, and BMI. Employees have until 11/30/09 to submit the baseline data. They can do so either through participating in a state screening program or they can get their own physician to certify the info.
• Starting in 2011, employees deemed not at risk based on baseline data (remember, this includes blood pressure, cholesterol, and glucose as well as BMI) continue to receive the credit. Those deemed at risk can also continue to get the credit if they do one of three things: (1) get their physician to state that they've been counseled (that's all; nothing about treatment) regarding their health risk factor or else has a medical condition preventing them from improving the health risk factor (whatever that means); (2) "participated [in] and/or completed" a state-approved wellness program (the "and/or" is key); (3) "reported acceptable improvement in the health risk factor(s)" (whatever that means).
• Not sure exactly what's meant by this statement: "At risk employees are eligible for a physician referral waiving the copay." I haven't researched plan details, but I'm guessing that (a) employees always (or at least for several years now) have had a copay (even though they haven't had to pay premiums), and (b) this traditional copay is going to be waived for at-risk employees, to remove a dis-incentive for receiving care

Bottom line, this seems to be a fairly benign and not totally unreasonable proposal. And in fact, that's how some news coverage-- see Birmighmam News here or Wall Street Journal here-- has presented it. Using the term "Fat Tax" may make for spectacular headlines, but it doesn't really help us make sober assessments of programs based on the merits.