don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

I would have nobody to control me; I would be absolute; and who but I? Now, he that is absolute can do what he likes; he that can do what he likes, can take his pleasure; he that can take his pleasure can be content; and he that can be content, has no more to desire. So, the matter's over; and come what will come, I am satisfied. Miguel De Cervantes, Don Quixote (1605-1615)

While advocates of self-management, wellness and healthy lifestyles, myself included, sing the praises of personal responsibility as the key to optimal health, there is evidence that another variable may be nearly as influential. This variable, broadly labeled as "control," is much less amenable to the proverbial "bootstraps" approach to change. We all want to be free of control by others and to be absolute, as Cervantes advised, and do what we like, take our pleasure as we choose, be content, moderate our desires and be satisfied. However, life never has been and still seems a very long way from being fair, and the opportunity to exert control varies immensely from one to another.

Control or rather the lack of control is one of the best predictors of heart disease. The absence of any sense of control, especially at the worksite, is more accurate as a predictor of heart attacks than cholesterol levels, diet patterns, genetic history, self-management skills, obesity, smoking or high blood pressure, fitness measures and stress loads (though related). In study after study, it is the workers who believe that they can not control their daily routine, who feel they have too much to do in the time available, who are ordered about relentlessly and otherwise required to endure unmanageable pressure, day in and day out who are found to be the most likely to suffer heart attacks.

One of these studies involved 17,000 British civil servants. In this case, researchers concluded that the status of a person's job was key to predicting adverse health outcomes. THE most reliable predictor of destructive health outcomes was low job control. If you have a low status job, with low pay AND you have a genetic predisposition to heart disease, you are in deep trouble!

Apparently, being ordered around provokes the stress response that releases high levels of cortisol. When this occurs, the hormone cortisol damages the coronary arteries, depresses the immune response and decreases the level of serotonin. These actions in turn lead to poor sleep, fatigue and increased exposure to infections.

Alas, those who suffer most, that is, who have the least job control (status and income), are the very folks least likely to read the studies. These people are also least likely to visit this website (or others), encounter this DR or gain access to the study of British civil servants. They will likely not even know about the importance of having a measure of control in order to avoid premature death and, as important, in order to move toward optimal well-being. As mentioned, life's not fair.

Studies with primates have also demonstrated the affects of low control on our emotional and thus physical well-being. Male baboons exhibited an increase in stress levels (cortisol production) when introduced into a new troop. The males found themselves at the bottom of the pecking order, with little control over food and mate selection. In zoo studies, researchers found an inverse relationship between pecking order and artery constriction. Like us, chimps, monkeys and apes (with which we share about 98% of DNA) are affected by working and living conditions. When human volunteer subjects are organized into two groups and given the same tasks but very different conditions of control, the group with no power or control invariably experiences higher stress hormone, blood pressure and heart rate levels.

So, what shall we make of these findings? What, more specifically, might we want to consider doing as a result of such awareness. There are many possibilities. Be grateful if you can exert a bit of control over your life and work, for starters. Perhaps you can also pass the word about control, in your own fashion. You might, for instance, tell your children about the nature of control, in simple terms, seeking to note that it is a situation that invites a delicate balance of sorts. In addition, you might mention these ideas to others not so fortunate as to understand the power of control and even to employers who might in turn ponder ways to assist those at the lowest rungs on the economic ladder.

At the present time, just weeks after the September 11 attacks on civilization by religious maniacs, the jobs of many in low control job categories are being lost by the tens of thousands. These losses are unrelated to their performance; the crises visited upon the powerless are simply capricious fates wrought by the acts of madmen that dramatically affect a market economy such as ours. The resulting stressors will of course increase exposure to heart disease and other illnesses, and further diminish the likelihood of initiatives for positive lifestyles.

However, the affects can be mitigated by lifestyle factors, particularly those that lower stress and increase the strength of the organism, such as healthy diet, exercise, community support and the like. In addition, the simple recognition of the importance of control might predispose those most affected by too little of it to seek reforms in their life situation, with the help of others more advantaged. This is the key to adaptation and to personal evolution. Even Darwin said as much, when he wrote, "The highest possible stage in moral culture is when we recognize that we ought to control our thoughts." We all need to do this ourselves, and encourage more control for others, many of whom have probably not enjoyed much exposure to the idea that some control can and should be sought at both internal (thoughts) and external levels (job environments.)

One of the nastiest things to say to someone is to call him or her "a control freak." Well, obviously control can, like everything else, be abused and overemphasized. In some quarters, where conditions are most appalling, a healthy degree of such behavior would be an element of, and perhaps THE most important starting point for, a self-managing lifestyle.

All the best, be well and look on the bright side of life.

(Note: This essay will be filed in the archives in the MENTAL DOMAIN under the skill area of stress management. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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