Do You Have GAS?

If so, it could be killing you. Too much struggle for too long under stress can be lethal. We are conducting a Resiliency Retreat in March for 85 Emergency Physicians and Residents that is designed to disrupt this lethal syndrome.

BY ASKING ABOUT GAS, I’m not talking about the aftereffects of a big bowl of chili, and I’m not just trying to be cute; I’m talking about the General Adaptation Syndrome (GAS), a term coined by the late, great Hans Selye, an endocrinologist at the University of Montreal and the father of modern stress research.

The GAS tells how and why sustained stress can literally kill you. The long and short of it is that any organism—a cell, a zebra, a person—will pay a price when it undergoes chronic stress. The graphic below shows why:

General Adaptation Syndrome.jpg

First, there is a shock (Alarm Phase, above), then a period of toleration (Resistance Phase), then we pay the piper (Exhaustion, above).

Hans Selye, who authored over 1,000 research papers, is perhaps best known for his popular book, Stress Without Distress, in which he pointed out that stress is not our enemy per se, but rather it's chronic, unabated stress that makes people sick, gives them ulcers, heart attacks, etc.

One of Selye’s devotees, now the best known stress researcher in the world, Robert Sapolsky (professor of biology at Stanford), wrote about the ill-effects of stress, too, in a series of popular books. One of them, Why Zebras Don’t Get Ulcers, suggests by title why chronic and episodic stress are entirely different things: Zebras—and other wild animals—don’t get ulcers because while they periodically have very high levels of stress when the lions come around, their stress levels drop as soon as the lions go away.

Humans are often under chronic stress. People who live their lives in poverty, clinical depression, or abusive relationships live difficult—and usually short and unhealthy—lives.

Ironically, the practice of medicine can put some practitioners into a state of chronic stress, too, and subject them to the GAS. There is growing evidence that chronic stress is invading all fields of medicine (including veterninary medicine where suicide rates are soaring), but there is little debate that the Critical Care and Emergency Medicine docs are at the highest risk of the ill-effects of the GAS.

Here is one such data point, a chart from the 2017 Medscape Physician Lifestyle Report:


This blog is not the place to try to offer a fulsome approach to reducing your elevated cortisol levels if you are living in a state of chronic stress, but here is a general tip that can improve your life in many ways: cultivate a frequent awareness of your inner state, i.e., your emotional state, your tension level, and the quality of your thinking about your life (positive or negative). Awareness of one’s emotions is a component of emotional health and figures into all models of emotional intelligence.

How can being aware of my inner state be a benefit, especially if my inner state is one of misery? Because only if I know I am miserable can I have a chance of taking some deliberate action to better my state and circumstances.

If you live in a state of chronic stress, here is the most important word you don’t know that you need to know: alexithymia. Look it up in a medical dictionary and it will say something like, “Alexithymia is a marked inability to know and describe one’s inner experience and feelings.” Don’t be alexithymic! Forgive me, but the solution to the GAS, might be BEANO! (Better End Alexithymia NOw!) Know thyself, especially if thou art chronically stressed.

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