Stress without Distress

HANS SELYE

Stress is "the nonspecific response of the body to any demand made upon it,"
that is, the rate at which we live at anyone moment. All living beings are
constantly under stress and anything, pleasant or unpleasant, that speeds up the
intensity of life, causes a temporary increase in stress, the wear and tear exerted
upon the body. A painful blow and a passionate kiss can be equally stressful.
The financier worrying about the stock exchange, the laborer or the baseball
player straining his every muscle to the limit, the journalist trying to meet a
deadline, the patient fighting a fever, all are under stress. But so is the baseball
fan who merely watches an interesting game, and the gambler who suddenly
realizes that he has lost his last cent or that he has won a million dollars.
Contrary to widespread belief, stress is not simply nervous tension nor the
result of damage. Above all, stress is not something to be necessarily avoided. It
is associated with the expression of all our innate drives. Stress ensues as long as
a demand is made on any part of the body. Indeed, complete freedom from
stress is death!

THE SYNDROME OF "JUST BEING SICK"

It was in 1925 that I first suspected the existence of what I later called stress
and the General Adaptation Syndrome (G.A.S.). When studying medicine at the
University of Prague, during one of the initial lectures in internal medicine, we
HANS SEL YE Institut de mMecine et de chirurgie experimentales, Universite de Montreal, Quebec, Canada.
137

G. Serban (ed.), Psychopathology of Human Adaptation

Springer Science+Business Media New York 1976

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were shown several patients in the earliest stages of various infectious diseases.
The professor carefully pointed out all the specific signs and symptoms characteristic of each disease but what struck me most was that each of these patients
felt and looked ill, had a coated tongue, and complained of more or less diffuse
aches and pains in the joints and of intestinal disturbances with loss of appetite
and loss of weight. The patients we had just seen also had a common syndrome,
but the professor attached very little significance to the signs that were common
to all these diseases because they were "nonspecific" and hence "of no use" to
the physician in making a correct diagnosis or prescribing the appropriate
treatment.
Instead of concentrating exclusively on specific manifestations of disease,
would it not be even more important to learn something about the mechanism
of being sick and the means of treating this "general syndrome of sickness"
which appeared to me as being superimposed upon all individual diseases? I
could not understand why our professor did not pay any attention to it.
However, as a student, I accepted the fact that "this is so," just as physicians had
done ever since the dawn of medical history.
Not until ten years later did these same questions confront me again. At that
time I was working in the biochemistry department of McGill University in
Montreal, trying to find a new ovarian hormone in extracts of cattle ovaries. All
the extracts, no matter how prepared, produced the same syndrome characterized by (1) enlargement of the adrenal cortex, (2) gastrointestinal ulcers, and
(3) involution of the thymus and lymph nodes. Although at first I ascribed all
these changes to some new ovarian hormone in my extract, it soon became
apparent that extracts of other organs-in fact, toxic substances of all kindsproduced the same changes. It was only then that I suddenly remembered my
classroom impreSSion of the "syndrome of just being sick." In a flash, I realized
that what I had produced with my impure extracts and toxic drugs was an
experimental replica of this condition.
This simple hunch of a connection between the almost forgotten, purely
speculative, clinical concept of student days and the reproducible, objectively
measurable changes in the animal experiments at hand was the basis for the
development of the entire stress concept.

TRIPHASIC RESPONSE
During this reaction, all the organs of the body showed involutional or
degenerative changes; only the adrenal cortex actually seemed to flourish on
stress. I suspected this adrenal response to play a useful part in a nonspecific
adaptive reaction, which I visualized as a "call to arms" of the body's defense
forces and therefore designated as the "alarm reaction."

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Later, we noted that this alarm reaction was not the entire response. Upon
continued exposure to a stressor capable of eliciting the initial reaction, a stage
of adaptation or resistance ensued, since no organism can be maintained continuously in a state of alarm. If the stressor is so severe that continued exposure
becomes incompatible with life, the animal dies within a few hours or days
during the alarm reaction. If it does survive, the initial response is necessarily
followed by a stage of resistance during which most of the initial symptoms
diminish or vanish. After still more prolonged exposure to the stressor, this
acquired adaptation is lost and the animal enters into a third phase, the stage of
exhaustion, since the "adaptation energy" or adaptability of an organism is
finite.
These three stages are analogous to the three stages of man's life: childhood
(with its characteristic low resistance and excessive responses to any kind of
stimulus), adulthood (during which adaptation to most commonly encountered
agents has occurred and resistance is increased), and, finally, senility (characterized by irreversible loss of adaptability and eventual exhaustion) ending with
death.
Subsequent investigations revealed that a decisive part of this defense mechanism is the excitation of the hypothalamus and, in particular, its most caudal
portion, the median eminence (ME), to discharge a chemical messenger, the
corticotrophin-releasing factor or CRF. It was a great merit of my former
graduate student, Guillemin (in conjunction with Schally and Saffran), to find
quite independently, after leaving our institute, that CRF is produced in the
hypothalamus and increases the secretion of ACTH, of which we had already
k,-;own that it siimulates the adrenal cortex to produce those hormones for
which I introduced the term corticoids. Most important among the corticoids are
the glucocorticoids, such as cortisone, which cause thymus atrophy and influence glucose metabolism, especially by stimulating glycogen formation.
Ever since Cannon described his classic emergency response to threatening
stimuli, it was known that, at least in acute emergencies, the adrenal medulla and
the sympathetic nerves also play a decisive role through the discharge of
catecholamines. These go to various parts of the body and help to adjust
metabolism and the cardiovascular system for conditions of "fight or flight."
They also play an important role in the formation of peptic ulcers which
constitute a part of the alarm reaction triad and for which I therefore suggested
the term "stress ulcers" (Fig. 1).

DISEASES OF ADAPTATION
Various derangements in the secretion of these hormones can lead to
maladies which I called "diseases of adaptation," because they are not directly

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PRESSURE
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INFLAMMATION
OTHER SYNTOXIC REACTIONS

Fig. 1. Principal pathways mediating the response to a stressor agent and the conditioning
factors which modify its effect. As soon as any agent acts upon the body (thick outer frame
of the diagram) the resulting effect will depend upon three factors (broad vertical arrows
pointing to the upper horizontal border of the frame). All agents possess both nonspecific
streIBor effects (solid part of arrow) and specific properties (interrupted part of arrow). The
latter are variable and characteristic of each individual agent; they will not be discussed here
more than to state that they are inseparably attached to the stressor effect and invariably
modify it. The other two heavy vertical arrows, pointing toward the upper border of the
frame, respectively represent exogenous and endogenous conditioning factors which largely
determine the reactivity of the body. It is clear that since all stressors have some specific
effects, they cannot elicit exactly the same response in all organs; furthermore, even the
same agent will act differently in different individuals, depending upon the internal and
external conditioning factors which determine their reactivity. (From StreIB in Health and
Disease, courtesy of Butterworths, Reading, Mass.)

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caused by any particular pathogen but indirectly by a faulty adaptive response

to the stressor effect of some pathogen. In this sense, many ailments, such as
various emotional disturbances, schizophrenia, migraine headaches, insomnia,
hypertension, peptic ulcers, certain types of asthma, as well as cardiovascular
and renal diseases appear essentially to be initiated or enhanced by the body
itself because of its faulty adaptive reactions to only potentially injurious agents.
Apparently, conditioning (particularly hereditary predisposition, diet, environmental factors) determines which organ or system is weakest and breaks
down most readily under the influence of systemic stress, that is, a nonspecific
demand made upon the organism as a whole.
Among the derailments of the G.A.S. which may cause disease, the following
were the first to be recognized:
1. An absolute excess or deficiency in the amount of corticoids and somatotrophic or growth hormone (STH) produced during stress.
2. A disproportion in the relative secretion, during stress, of ACTH and glucocorticoids on the one hand, and of STH and mineralocorticoids on the
other.
3. Production by stress of metabolic derangements, which abnormally alter the
target-organ's response to STH, ACTH or corticoids (through conditioning).
4. Finally, we must not forget that although the hypothalamushypophysis-adrenal mechanism plays a prominent role in the G.A.S., other
organs which participate in the latter (e.g., the nervous system, liver, kidney)
may also respond abnormally and become the cause of disease during
adaptation to stress. Indeed, stress occurs even in unicellular organisms when
they are faced with demands for adaptation.

CATATOXIC AND SYNTOXIC RESPONSES

Numerous studies on stress have shown that the internal stability of the
human body (homeostasis) is maintained by two types of reactions: syntoxic
(from "syn," meaning together, as in syndicate) and catatoxic (from "cata,"
meaning down, against). The former defend the organism by ordering the cells to
put up and coexist peacefully with the intruders. In many cases, the aggressors
(indirect pathogens) are harmless and damage is caused only by our own
uncalled-for defense reactions. Hence, it is wise to suppress this hostility. But
when the agents are inherently harmful (direct pathogens), the body must
protect itself by destroying them. In essence, these scientific observations show
that there are two roads to survival: tolerance and fight. The former, of course,
is generally more advantageous. Flight is possible only if the aggressor (drug,
antigen, microbe) has not entered the body.

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Tolerance is the simplest, but by no means the best form of adaptation. It is

useful because it prevents friction and conflicts, but it does just that and no
more; it cannot protect, for instance, against overcrowding, shortages of essential
materials, etc. Therefore, disciplined, mutually advantageous collaboration and
teamwork are far more suitable. During evolution from unicellular organisms to
man, the billions of individual cells in our body have learned to work as a team
for the benefit of the whole person. Breakdown of such cooperation is best
illustrated by the growth of a cancer, which lives off the other parts of the body
until it kills its host. It destroys itself by its uncontrolled egoistic development.
Teamwork between various animal species manifests itself usually in the
form of an ecological group which becomes an individual entity. In human
society, this cooperation is evident in the family, tribe, corporation, federation,
and even in the United Nations. The strength of the team depends upon
collaboration between its individual units.
This is what we should try to achieve through the philosophy of "altruistic
egoism," as outlined later.

MAN MUST WORK

Can the scientific study of stress help us to formulate a precise program of
conduct? Can it teach us the wisdom to live a rich and meaningful life which
satisfies our needs for self-expression and yet is not marred or cut short by the
stresses of senseless struggles?
I think we have to begin by clearly realizing that work is a biological
necessity. Just as our muscles become flabby and degenerate if not used, so our
brain slips into chaos and confusion unless we constantly use it for some work
that seems worthwhile to us. The average person thinks he works for economic
security or social status, but when, at the end of a most successful business
career, he has finally achieved this, there remains nothing to fight for-no hope
for progress, only the boredom of assured monotony.
Do not listen to the tempting slogans of those who keep repeating, "There is
more to life than just work," or, "You should work to live, not live to work."
This sounds pretty convincing, but is it really? Of course, these statements are
true in themselves, yet your principal aim should be not to avoid work but to
find the kind of occupation which, for you, is play. The best way to avoid
harmful stress is to select an environment (wife, boss, friends) which is in line
with your innate preferences-to find an activity which you like and respect.
Only thus can you eliminate the need for frustrating constant readaptation that
is the major cause of distress.
The Western world is being wrecked right now by the unsatiable demand for

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less work and more pay. Less work to get more time for what? More pay to do
what? Few people give much thought to what they will do with their free time
and extra money after they have reached a comfortable minimum income. Of
course, there is such a thing as a minimum living standard; but in practice, the
urgency of the clamor for improvement does not depend so much upon the
number of working hours or the salaries earned, as upon the degree of dissatisfaction with life. We could do much-and at little cost-by fighting this dissatisfaction.

THE NEED FOR SELF-EXPRESSION

"No wind blows in favor of the ship that has no port of destination. "
(Montaigne).
After a pilot has left the ground in a plane he cannot stop his motor before
he gets back to earth again. He must complete his mission back to earth. Yet
there is very much he can do, through voluntary choice of conduct, to get as far
as possible with a given airplane and fuel supply under given climatic conditions.
For instance, he can fly at a speed and on a course best suited to his machine
under the prevailing weather conditions. The two great limiting factors over
which, once in flight, he has no control are the fuel supply and the wear and tear
that the weakest vital part of his plane can tolerate.
When a human being is born he cannot stop either before he has completed
his mission on earth. Yet he too can do much, through voluntary choice of
conduct, to get as far as possible with a given bodily structure and supply of
adaptation energy, under given social conditions. For instance, he can live an~
express his personality at a tempo and in a manner best suited to his inherited
talents, under the prevailing social conditions. The two great limiting factorswhich are genetically fixed when a man is born-are his supply of adaptation
energy and the wear and tear that the weakest vital part of his body can tolerate.
So, actually, we can accomplish a great deal by living wisely in accordance
with natural laws. We can determine our optimum speed of living, by trying
various speeds and finding out which one is most agreeable. We can determine
our course by the same empirical method, keeping in mind, however, that
occasional deviations have a virtue of their own: they equalize the wear and tear
throughout the body, and thereby give overworked parts time to cool down.
Man certainly does not get the feeling of happiness, of having completed his
mission on earth, just by staying alive very long. On the contrary, a long life
without the feeling of fulfillment is very tedious. And yet, when (and if) they
analyze their lives, most people get the feeling of merely muddling through, of

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drifting aimlessly, from one day to another. Just staying alive, no matter how
comfortably and securely, is no adequate outlet for man's vital adaptation
energy. Comfort and security make it easier for us to enjoy the great things in
life, but they are not, in themselves, great and enjoyable aims.

ALTRUISTIC EGOISM
A world in which each creature refuses to protect itself is unimaginable, but
so is a world in which uncontrolled egoism, with total disregard for the interests
of others, is the leading principle of behavior. To my mind, the only philosophy
which necessarily transforms all aggressive egoistic impulses into altruism, without curtailing any of their self-protecting values, is altruistic egoism. It has amply
proved its value throughout evolution from the simplest multicellular organism
to man. In lower animals, whenever it developed, it was of considerable help but,
being unpremeditated, could arise only through the power of its survival value.
Wherever it developed-be it even by accident-it created new strengths which
increased resistance.
Single cells combined into multicellular organisms and these into larger
groups on the basis of this principle, although they were not aware of it.
Similarly, individual people have formed the cooperative "mutual insurance"
groups of the family, tribes, and nations within which altruistic egoism is the key
to success. It is the only way to preserve teamwork, whose value is ever
increasing in modern society.
Each person must find a way to relieve his pent-up energy without creating
conflicts with his fellow men. Such an approach not only ensures peace of mind
but also earns the goodwill, respect, and even love of our fellow men, the highest
degree of security, the most noble "status symbol" to which man can aspire.
This philosophy of hoarding a wealth of respect and friendship is merely one
reflection of the deep-rooted instinct of man and animals to collect. It is as
characteristic of ants, bees, squirrels, and beavers as of the capitalist who collects
money to put away in the bank. The same impulse drives entire human societies
to amass a system of roads, telephones, cities, fortifications, that strike them as
useful means of accumulating the ingredients of future security and comfort.
In man, this urge first manifests itself when children start to amass match
boxes, shells, or stickers; it continues when adults gather stamps or coins. The
natural drive for collecting is certainly not an artificial, indoctrinated tradition.
By collecting certain things, you acquire status and security in your community.
The guideline of earning love merely attempts to direct the hoarding instinct
toward what I consider the most permanent and valuable commodity that man

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can collect: a huge capital of goodwill which protects him against personal
attacks by his fellow men.

"EARN THY NEIGHBOR'S LOVE"

"Love thy neighbor as thyself," one of the oldest guidelines for purpose and
conduct, was propounded (even before Christ) to please God and thereby offer
security to man. Since our philosophy is based on natural laws, it is perhaps not
surprising that, for centuries, throughout the world, so many of its elements
have turned up again and again-in the most diverse religions and political
doctrines-though usually supported by mysticism and blind trust in an infallible
authority rather than by science. The people in whose cultures one or the other
of these elements appeared were quite unrelated and often did not even know of
each other's existence. Their creeds had only one thing in common: they were
acceptable to the human brain and reflected the natural evolution of its functional mechanism.
This is perhaps why we felt we should update the guideline by rephrasing it
to "Earn thy neighbor's love." In this form, it is biologically sound and cannot
conflict with any religion or philosophy; in fact, ardent believers in anyone of
these can use our code to complement their own. In it, they will find scientific
support not only for one of the most deep-rooted and generally accepted
religious precepts of the brotherhood of man but also for that of atheistic
communism, with its avowed goal: "From each according to his capabilities, io
each according to his needs," a slogan which otherwise might only encourage
laziness. The laws of Nature, which we have used to construct our doctrine,
apply to everybody, irrespective of his formalized and labeled creed.
Viewed from the pinnacle of the eternal general laws governing Nature, we
are all surprisingly alike. Nature is the fountainhead of all our problems and
solutions; the closer we keep to her the better we realize that, despite the
apparently enormous divergences in interpretation and explanation, her laws
have always prevailed and can never become obsolete. The realization of this
truth is most likely to convince us that, in a sense, not only all men but all living
beings are brothers. To avoid the stress of conflict, frustration, and hate, to
achieve peace and happiness, we should devote more attention to a better
understanding of the natural basis of motivation and behavior. No one will be
disappointed if, in daily life, he learns to follow the guiding light of "Earn thy
neighbor's love."
So the whole translation of the laws governing resistance of cells and organs
to a code of behavior comes down to three precepts:

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1. Find your own natural stress level. People differ with regard to the
amount and kind of work they consider worth doing to meet the exigencies of
daily life and assure their future security and happiness. In this respect, all of us
are influenced by hereditary predispositions and the expectations of our society.
Only through planned self-analysis can we establish what we really want; too
many people suffer all their lives because they are too conservative to risk a
radical change and break with traditions.
2. Altruistic egoism. The selfish hoarding of the goodwill, respect, esteem,
support, and love of our neighbor is the most efficient way to give vent to our
pent-up energy and create enjoyable, beautiful, or useful things.
3. EARN thy neighbor's love. This motto, unlike love on command, is
compatible with man's natural structure and, although it is based on altruistic
egoism, could hardly be attacked as unethical. Who would blame him who wants
to assure his own homeostasis and happiness only by accumulating the treasure
of other people's benevolence toward him? Yet, this makes him virtually unassailable, for nobody wants to attack and destroy those upon whom he depends.
I myself have tried to follow this philosophy as best I could, and it has made
my life a happy one. Let me frankly admit that, in looking back, I realize that I
have not always succeeded to perfection, but my failures were due to my own
shortCOmings, not to those of the philosophy itself.
As I have said in Stress without Distress, the builder of the best racing car is
not necessarily its best driver.

ACKNOWLEDGMENT
This contribution is based largely on the author's various lectures, articles, and
books, especially his latest publications, Stress without Distress (1. B. Lippincott) and Stress in Health and Disease (Butterworths).