The year was 1964, and there were good reasons to feel ‘stressed out’. Presidential candidate Lyndon B. Johnson stoked American anxieties. His campaign team broadcast a television commercial that graphically illustrated the predicament of the modern world. In it, an innocent young girl plucks the petals off a daisy as she tentatively counts from one to ten. As she reaches ‘ten’, her cute stammerings are curtly interrupted by a male voice counting back from ten to zero. At ‘zero’, there is a huge nuclear explosion and, as the screen erupts into a mushroom cloud, Johnson presents his message: ‘These are the stakes: to make a world in which all of God’s children can live or to go into the dark. We must either love each other or we must die’.(1)
Love or death: the choice Johnson presented to Americans was taken (albeit inaccurately) from W. H. Auden’s poem, ‘September 1, 1939’. For Auden and many of his contemporaries, the 20th century was the age of anxiety. In the triptych of totalitarianism, total war, and terror was it any wonder that people despaired, curling protectively into themselves and blaming this strangely amorphous thing they called ‘stress’?
Politicians, scientists, journalists, schoolteachers, filmmakers, novelists, and poets competed to identify the ‘objective’ meaning of and contexts for stress. Auden, who had emigrated to New York in 1939, was one of the greatest chroniclers of that ‘Incomprehensible comprehensive dread’ oppressing modern men and women. ‘Who, thinking of the last ten years’, he lamented in New Year Letter (1941),
Does not hear howling in his ears
The Asiatic cry of pain,
The shots of executing Spain,
See stumbling through his outraged mind
The Abyssinian, blistered, blind,
The dazed stare uncomprehending
Of the Danubian despair,
The Jew wrecked in the German cell,
Flat Poland frozen into hell.
The bleakness of his vision – of ‘children afraid of the night/ who have never been happy or good’, as he put it in ‘September 1, 1939’ – resounded with readers’ imaginations. In 1948, he even received a Pulitzer Prize for poetry and his The Age of Anxiety was distributed free to American service personnel.
What poets do best, scientists attempt to emulate in more sturdy prose and through instruments of precision. And no-one tells the scientific story of stress better than Mark Jackson, one of the most influential historians of medicine in Anglo-American worlds and currently the Professor of History of Medicine at the Wellcome-Trust funded Centre for Medical History at the University of Exeter.
Jackson’s task is a difficult one. He wants us to understand the history of a particularly complex, and often elusive, concept: stress. There is always the risk in such ventures that writer and reader become overwhelmed by a tsunami of detail. After all, if we are to follow Auden’s lead (and I am often tempted to), all attempts to understand modernity require us to address issues of stress and anxiety. The history of stress could lead us to meander aimlessly through an entire history of the modern world.
Thankfully, Jackson proves to be a firm guide. He focuses primarily (although not in a myopic fashion) on science and clinical medicine. His central proposition is that ‘stress’ is more than the sum of ‘distressing events’. It is a concept that has been developed, promoted, and legitimized by scientists. Although ‘stress’ is culturally produced and appropriated, it remains a real phenomenon for people who claim to feel ‘stress’. In other words, Jackson is respectful towards the lived experiences of anxious men and women, while still maintaining that in order to understand the specific form this unease takes we need to know much more about the scientific contexts in which it arose.
Indeed, Jackson shows, the English word ‘stress’ has a long history. Etymologically, the word dates from the upheavals of the Renaissance and early modern period, but it has weaved its way through a great many characterizations since that time. Wartime crises saw it being regarded as a kind of failure in adaptation; during the Cold War, stress was presented as a response to the danger of annihilation or as a guilt reaction for threatening such devastation; in the 1980s, when the American Institute of Stress was founded, it entered into colloquial language, as in the phrase ‘stressed out’. Today, there is immense concern about the relationship between stress and the economic downturn: according to the UK Labour Force Survey in 2011–12, out of just over one million work-related illnesses, 40 per cent were caused by stress.
At various periods of the 20th century, attention has been paid to stress not only as a major cause of disease, but also as an illness in itself. In the late 19th and early 20th centuries, stress was characterized as a ‘disease of civilization’, which could cause ‘neuroses of the breast’ (that is, breast cancer). Although strongly contested, conceptions of physiological equilibrium were crucial to such understandings of stress. As with the humoral tradition, balance and self-regulation were intrinsic to the healthy body. Later physiologists turned to laboratory studies to understand adaptations to stress: vasomotor nerves and pancreatic secretions, for example, were crucial in maintaining an ideal ‘internal environment’.
Jackson’s ‘history of science’ approach to stress eschews simplicities. Because of his aversion to wild generalisations, Jackson always presents counter-arguments and dissenting views. The result is a carefully nuanced and guarded argument, which often requires close reading.
Time and again, however, he returns to one of his central themes: that the concept of stress as it was espoused by scientists and clinicians was profoundly influenced by political contexts, economic realities, and social ideologies. He notes that the very idea of homeostasis was a political one. This does not mean that it could be dismissed as simply reflecting socially conservative views or as merely mirroring a desire to promote liberal social democracy. For instance, Lawrence J. Henderson (one of the founders in 1927 of the Harvard Fatigue Laboratory) developed a concept of stress as that of adaptive stability. For him, the study of stress was part and parcel of his conservative commitment to scientific management in times of economic crisis. Equally, however, physiologist Walter Cannon wrote about stress from the vantage point of his commitment to the liberal values of freedom and democracy. ‘Sick individuals’ were the product of societies characterized by industrial unrest and social disequilibrium. Stress was something that could be quantified; it could be used as a barometer to test the efficacy of social reform. Scientists and clinicians needed to tackle ill-health in holistic fashion, paying as much attention to people’s emotional well-being as to their pathological bodies. This was what led the Scottish physician James Lorimer Halliday, for instance, to promote ‘integrated medicine’, which was as committed to healing psychological, spiritual, and environmental malaise as to physiological imbalance.
Perhaps the most enlightening chapter in The Age of Stress is the one entitled ‘The cathedral of stress’, which focuses on anxiety after the Second World War. Jackson notes that although clinical interest in anxiety had flourished in the interwar years – notably, with concerns about frustrated housewives and ‘suburban neurosis’ in the 1930s – it soared to unprecedented heights in the 1950s. The international arms race, the continued aftermath of grief following war-deaths, and the subsequent struggles of survivors to readjust to civilian life lead to a surge in anxiety-related disorders. There was widespread agreement that anxiety was a product of specific, unique stresses in the modern world. The effects on society were also regarded with consternation: absenteeism from employment, an unwillingness of women to have children, and suicidal university students attracted frenzied attention, as did the rise of a host of stress-related illnesses such as depression, heart disease, gastroenteritis, and rheumatoid arthritis. ‘Stress’ was no longer being conjured up simply to draw attention to people’s responses to external ‘bad events’ but was increasingly being portrayed as a normal part of modernity. By definition, the ‘modern self’ was a stressed self.
One of the leading figures in the construction of the ‘cathedral of stress’ was the endocrinologist Hans Selye. His Institute of Experimental Medicine and Surgery at the University of Montreal became a formidable centre for the development of anti-stress drugs and for the investigation of the neurohormonal regulation of stress reactions. As Selye argued in the British Medical Journal in 1950, stress was ‘the interaction between damage and defence, just as in physics tension or pressure represents the interplay between a force and the resistance offered to it’. Those factors that triggered stress became known as ‘stressors’. Selye self-consciously aligned his work with the ‘exact sciences’ such as physics and engineering while still keeping a strong spotlight on the social and political contexts in which people actually experienced stress. In Jackson’s words, this approach to stress enabled Selye to ‘expand his physiology of disease into a fully fledged philosophy of life’. ‘Stress is a part of life’, Selye declared in his 1956 book entitled The Stress of Life, adding that ‘[i]t is a natural by-product of all our activities; there is no more justification for avoiding stress than for shunning food, exercise, or love’.
Jackson warns against prioritizing Selye over other scientists, especially Harold Wolff and Stewart Wolf, and he dismisses any crude assumptions about the ‘trickling down’ of ideas. Nevertheless, Jackson maintains that Selye was influential in spreading the trope of stress to a wider public around the world. Jackson also convincingly shows that the concept of stress proved popular not simply because of the intellectual labours of scientists, but also because it had resonance for many commentators in the media and amongst the general public who were seeking to understand why their everyday lives were so distressing.
In The Age of Stress, Jackson shows that the ‘stress’ was a complex, flexible concept, which could be profoundly helpful in imposing some kind of stability and meaningfulness in an often chaotic world. As in Auden’s dramatic poem, ‘The Age of Anxiety’, stress was a most useful analogy for the 20th century. Jackson’s book promises to become a classic for anyone curious about how the language of stress became the lingua franca of our times.
The author is delighted to accept this review and is grateful to Professor Bourke for her close reading of the book and for her constructive comments.