Emotions and health

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Emotion always serves the function of giving information. It can be extreme, unusual, debilitating, painful, and so on, but information is always being provided. Emotional reactions are always simply emotional reactions; they can never be abnormal. However, traditionally, emotions have been seen as contributing to the neuroses, the psychoses, to the affective disorders (such as bipolar disorder), to psychopathy and to excessive (or minimal) eating, alcoholism and drug abuse. But even in psychiatric conditions, emotions are perfectly normal with respect to what brings them about. They are just what they are, with no values attached to them. However, it is reasonable to say that emotions can be dysfunctional or dysregulational.

Stress

A core concept in emotion dysregulation is stress. Stress has been defined in very many ways, but the general way of looking at it nowadays is that it involves an interaction between the individual and the environment. So, some people might be more prone to stress reactions than others but these reactions are prompted by particular types of environmental stressors.

The person who has done most to further our understanding of stress is Richard Lazarus (1991, 1993, 1999), who makes his far-reaching exposition of emotional in general through an analysis of stress and coping. He regards stress as an unfavourable person-environment interaction that can take the form of harm (psychological damage from, say, loss), threat (the anticipation of harm) and challenges (demands that we feel able to cope with).

In general, if we are stressed by something, then our aim is to alter either the circumstances or our interpretation of them, in order to make them more comfortable. This is coping. Coping can be either and/or problem-focused or emotion-focused. For example, we might be stressed by a situation at work that we think about and decide is due to some miscommunication. We determine that we might be able to sort it out through discussion. This would be problem-focused coping. On the other hand, the problem might be insoluble in this way because one of the people involved is impossible to communicate with, whatever attempts are made. This might be because there is a huge difference in power. Then, all we can do is attempt to deal with the emotional impact of the stress - emotion-focused coping. In practice, many instances of stress are dealt with by a mixture of problem-focused and emotion-focused coping.

Stress, then, is always followed by attempts at coping. It depends on an appraisal that either something can be done about the situation or that nothing can (and so the focus must be on emotion regulation). Some of the coping strategies that people use are stable and some are not (thinking positively, for example, seems to be stable), and, interestingly, there are no female/male differences in reaction to similar stressors. The particular strategies that people use in stressful situations change from time to time. For example, problem-focused coping might work well for a while and then have to be replaced by emotion-focused coping. Most important of all, the precise form of coping strategy used (and hence a determinant of emotional reactions) depends on the stressor, the individual's personality and the area of life involved (e.g. well-being, health, social functioning, and so on). For a more extended discussion of stress and health in general, see Chapter 17.

Psychosomatics

Psychosomatics is a loose heading under which to consider the important links between emotion and physical illness. A core example concerns the relationship between emotion and pain. A common reaction to pain is fear. What does this pain mean? What are its implications? Is this the beginnings of a heart attack? Have I got lung cancer? This prompts a hyper-vigilant way of paying attention to whatever happens in the body and a keen concern to escape from it all. Then, if the pain becomes chronic, general emotional distress results and, if it continues unrelieved, one result can be anger. From quite a different perspective, pain can sometimes relieve guilt. 'I have done some wrong to these members of my family and so I am now suffering the pain I deserve.'

Emotion can be involved in any medical condition. For example, a broken leg can lead to anger and frustration, anxiety, fear, sadness, and so on. Or it may be that one's emotional condition was a precipitating factor in whatever led to the leg being broken in the first place. But the most problematic circumstance comes with the idea of psychosomatic disorders, in which the disorder is clearly physical (migraine, skin rashes, indigestion, peptic ulcers, asthma, genito-urinary conditions, and so on) but the causative factors seem to be emotional. The emotion most commonly implicated is anxiety. The extent of the emotional is hard to determine, one view being that all illness has an emotional component, causa-tively. For example, long-term stresses may well have a deleterious impact on the efficacy of the immune system and thus leave a person more vulnerable to infection.

One of the basic views of how links between emotion and physical illness might work is that severe or prolonged environmental events interact with factors internal to the person (such as particular weaknesses in one's bodily system) to produce high arousal and hence intense emotion. With such high arousal, the usual adaptive responses become less efficacious. This process can become self-perpetuating and if it continues for long enough, there can be anatomical changes with resultant illness.

Added to these ideas is the notion that if particular organ systems are affected by specific emotions, this eventually produces wear and tear on these organs. Moreover, a person's belief system might simultaneously affect their emotional reactions and their health. Furthermore, if particular emotions are either expressed or suppressed, this may also affect health. (This is in accord with the general view that it does one's health little good to constantly suppress emotional reactions.) Perhaps the most important factor here, however, is time. Changes in health are to do with long-term changes in organ systems; long-term aspects of emotion are clearly linked to personality and so this must also be taken into account when considering effects on health.

Writing and narrative

In the past few years, Jamie Pennebaker (e.g. Pennebaker & Segal, 1999) has produced a fascinating and important series of research findings on the links between health and narrative as mediated by emotion. They have significant implications not only for possible types of therapy but also for self-care. The basic assumption of this work is that to tell stories is natural and assists us in understanding, organising, remembering and integrating our thoughts. It makes the emotional effects of life's events more manageable and so improves predictability and feelings of being in control.

The generic experimental procedure is straightforward. It involves bringing participants into a laboratory and inviting them to write about a topic for 15 minutes a day for four days. They are assured that the writing will be anonymous and that they will be neither assessed nor given feedback about it. Members of the experimental group are asked to write about one or more traumatic experiences they have had and members of the control group are asked to write about something non-emotional such as the decor in their living-room. The general and much repeated finding that results from this simple procedure is that, in comparison with the control group, the experimental group has many fewer visits to medical services during the following months, their general physical health is improved, and, if they are students, their grades are higher. In general, their life changes for the better.

People from many walks of life seem to benefit from this writing exercise. It has been shown to lower the use of medication, reduce pain and improve the immune system. The precise content of the writing is unimportant, although it is important to use it to explore emotions and thoughts about emotions.

Pennebaker's preferred explanation of these results is that the conversion of emotions and the images associated with emotions into words changes the organisation of thoughts and feelings into something that is more coherent than previously. This is supported by the fact that the more positive emotion words used in the narrative and the more moderate negative emotion words, the better the outcome. This is, perhaps, all based on the perennial search for meaning and understanding that seems to be part of the human condition.

We ask questions of ourselves constantly. Why did he look at me like that? What did she mean by that? Why do I feel so uptight today? Why am I so averse to religion? Why do I become so uneasy if I am asked a direct question in public? Why don't I like to be told that I have done something incorrectly? Why doesn't anyone seem to like me? Why can't I seem to form a steady relationship?

Creating a story or narrative from the answers to such questions, particularly a story based on our own experiences, helps to organise and simplify them. This increases our understanding of the issues and makes everything more coherent. So, a sense of closure comes and we can move on. In the end, writing such emotionally based personal narratives appears to lead to increased insight, self-reflection, optimism and an increased sense of self-esteem. In other words, it provides a very adaptive coping strategy. It can be used as a form of everyday therapy that could be extremely beneficial.

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