STRESS, EUSTRESS, DISTRESS, STRESSORS. SEMANTIC CONSIDERATIONS

The article emphasizes the fact that, after starting from is basic meaning of physiological and psychophysical reality, in time, the word stress has changed its coverage area tacitly and inexplicitly. Thus, its major meaning has moved with priority towards the idea of pathological phenomenon and it has also switched from effect to cause. This fact not only ignores the necessary semantic distinctions between eustress (state of eustress), distress (state of distress), eustressor and distressor. It has also generated undesirable confusion between causes and effects but, more importantly,  between normal and abnormal. It is true that the substitution of the above mentioned terms with the global word stress, as it is often done, facilitates the confusion between the state of eustress and that of distress as well as that between these and eustressors and distressors. From the point of view of  the child and adolescent psychiatry what we find disturbing is the easiness with which any discomfort becomes too quickly a distressor and the hiperprotective education – a solution destined to prevent distress.

The term stress has a long history, being used in many fields. It was Hans Selye’s merit (1907-1982) to have given this term a specific content and to have imposed it to the attention of the medical world since 1936. However, today, the word stress is a synthesis of too many meanings, which would impart it a polysemous character. Unfortunately, the acknowledgement of this situation is not always explicit or strong enough, which leaves open the possibility to adhere freely to one meaning or the other, while the choice often creates confusion.

Stress is primarily a general and common physiological and psychophysical reality being both necessary and beneficial. This is the original meaning of the concept of stress conferred by Selye. Indeed, because to Selye, stress is primarily a physiological phenomenon and it is understood as a psychophysiological phenomenon, too, since he defined stress as “nonspecific response of the body to any demand made upon it” (quoted by Alexandrescu – 2000). In this way, he starts from the fact that all living beings are in interaction with external or internal environment and that any such interaction that aims at homeostasis (understood as a dynamic phenomenon), is a stress. As such, stress refers to the response generated by any attempt to destabilize homeostasis, irrespective of the nature of the stimuli, namely to the phenomenon of restoring a disrupted balance.

The emphasis laid by Selye on the physiological and psychophysical aspects of the concept of stress is attested by his representation of what he called “General Adaptation Syndrome”, a nonspecific complex of dynamic events that develops in three stages: alarm, resistance and exhaustion. It is understood that the first two stages are the most important: not only are they always present but they are also the most representative and most common, being, at the same time, both necessary and beneficial. This is because they are represented by a wide range of exercise and training means not only of defence but also of learning in general. Thus, conditioned reflexes are fixed, new coping techniques are learned, behaviour patterns are acquired, body conditioning is achieved, in other words, higher quality equilibrium is reached. These means are the foundation of adaptation and resilience, basic conditions of survival, competitiveness and biological evolution.

The third stage is also a form of defence. However, it is the exception because it represents failure that is completed either with a lower level balance (healing with sequelae) in case it is temporary, or with chronic suffering or even with death.

The meaning of stress as psychophysiological phenomenon is recognized and maintained by all who, in essence, consider that stress is what I mentioned before, namely the response generated by any attempt to destabilize the homeostasis of living organisms, irrespective of the nature of the cause. It is true that while some authors talk about threatening stimuli or agents, their formulations being superimposable to that used by Selye, others prefer to focus on the character of assault of the cause, in its broadest sense, of course.

Stress as a slippery term (Dinsdale et al. 2000) with great popularity, multiple meanings and a source of ambiguities (Garm and Rutter 1990), marked by exaggeration and confusion (Floru-1974). This is the reality today. In truth, although the term is widely used, as many authors emphasize (among them Moal -1997 and Alexandrescu -2000), there is no universally accepted definition. It is the consequence of the term’s long history, of the particular complexity of the designated phenomenon, of the lack of uniform acceptance of the meaning and, of course, of trivializing it colloquially and transforming it into a good for common usage.

It is known that, once introduced into medical language, the concept of stress has aroused great interest, which expanded quickly beyond the boundaries of medicine. Nevertheless, in the process, its boundaries were erased, and its centre of gravity has shifted tacitly from the idea of a mainly physiological and psycho-physiological phenomenon to its pathological facet and from effect to cause. Thus, the term ‘stress’ came to be identical with the cause and especially with the one generating abnormal or adverse effects. It is the aspect explicitly stated by DEX (1998) where stress is defined as a “name given to any environmental factor (or to a set of factors) that generate an abnormal reaction in the human body.” It is clear that, in the above definition, the emphasis is on stressors and only on those pathogenic ones and that solely disorders that are determined by them are targeted, namely the consequences of negative connotation. This option is not unique . The transfer of attention towards the particular but negative aspect of the concept of stress was largely the result of its natural complexity and of its acceptance especially by medical professionals who are particularly interested in pathology. The rest was done by the mass media that is less concerned with the required nuances of scientific rigor. Moreover, in everyday language, the concept of stress concerns especially its mental side, which was only hinted at by Selye.

Eustress and distress, sound concepts that did not come into prominence on the extent of their importance. All those outlined above occurred in parallel with efforts to deepen the knowledge discovered by many authors including Cannon and Lazarus. Here distinction between eustress and distress should be mentioned, a separation initiated by Selye (quoted by Fischer and Riedesser -2001).

In Selye’s view, the first term, that is equivalent to the condition of eustress, is intended to cover the physiological component, respectively the psychophysiological or main component of stress, while the second one, which is synonymous with the state of distress, refers to the abnormal side, respectively secondary or non- compulsory. They are sensible notions since they prove to be very useful not only in terms of retrospective scientific research, respectively of assessment of the final outcome of confrontation between a living organism and an external or internal factor and the identification, in this way, of the pathogenic stressors (distressors ) with determinant role, be it a weakening, triggering, or supporting one. They are also useful in terms of curative medicine concerned on the one hand, to know and to combat general causal factors of the disease process and, on the other hand, to understand and accept the great individual differences which clinical practice provides.

However, one should point out that the dichotomy eustress – distress is not as functional as in the case of preventive medicine. This is because it claims to identify in advance the situations in which we have to deal with future distress but mostly from what point an existential situation becomes pathogenic, a prerequisite of early intervention and prevention of such developments. Otherwise, during the preventive actions, there is a serious risk of eliminating also those confrontations between the individual-environment that are essential and beneficial. The difficulty of eliminating the risk has at least one cause. It consists in the fact that the separation of the environmental factors into positive and negative ones does not work. This is because the beneficial factors may become pathogenic if they exceed certain limits (Whatever is good, if it is too much, it hurts. -Milea -2006), just as many of those factors that are generally considered negative, up to a point and in certain circumstances, have a favourable role by training and developing adaptive and defensive systems. In fact, outside what is known to have a determining pathogenic role, the everyday reality is constituted mostly of realities, which, by their nature, do not automatically or certainly constitute a danger. Among them, besides all factors that are part of normal development, there are numerous other existential circumstances, which, by themselves, do not constitute effective threats. For their pathogenic potential to become a reality, however, either adjuvant combination of conditions, some unpredictable, some insufficiently known, or quantitative aspects are required. Of course, we have a series of criteria out of which, limiting ourselves to psychic eustress and distress, together with Mc. Garth (quoted by Botezat -1992) we retain the situations where:

• a marked imbalance between demand and response takes place;
• impossibility of an adequate response is expected (subjective factor);
• consequences of failure are important for the subject;
• requests are ambiguous or contradictory
• response options are restricted artificially.

To these one may add high resistance, tolerance or, conversely, vulnerability and under straining. The latter is worth emphasizing because it provides a special type of negative factors that affect the process of identification, expression and stimulating of certain functions and activates the apoptotic phenomenon.

Moreover, it emphasizes both the fact that eustress is a prerequisite of normality and that due to exaggerated caution, a hyper- protective education, whether lenient or authoritative, (Milea -2006) substitutes the baby in its constructive interaction with the environment, which is a significant distress.

All these criteria have but an approximate character, because they either aim at vaguely defined quantitative aspects or involve a high degree of subjectivity or they claim individualizations, which does not exclude the risk of exaggeration because of excessive caution. Surely, that all these difficulties do not diminish the value of delimiting the notions of eustress and distress within the boundary of preventive medicine. On the contrary, in practice, they sustain the necessity of effort required to treat them with great care and caution, necessary to avoid abuse.

Stress, eustress, distress, eustressor, distressor (factors that trigger stress and eustress). It goes without saying that it is beneficial to explicitly define the different meanings of the concept of stress because thus the possibility of unwanted confusions is excluded. Of all the uncertainties arising from the meaning area of the word stress, the most troublesome is that the original meaning of the term as a primarily physiological and psycho-physiological phenomenon and its main dimension are often minimized even ignored, while the abnormal component is especially retained. Drisdale et al. (2000) noted that, in this case, the effect is mistaken for the case, that the subject overlaps the predicate. This is why those authors believe it is probably wise to avoid using the word stress forever and they opt for different terms corresponding to each of its basic meanings. This is what Riga and Riga (2008) suggest, too. In this context, it seems justified to subscribe to the opinion of those who speak about:

• Eustress, or state of eustress. It is a particularly important reality by its dimension and value as it covers the entire process of normal growth and development of the individual and the usual confrontation of the individual with the reality, of the phenomena of resilience and adaptation. It is equivalent to the physiological and psychophysical component in Selye’s description. Minimizing it, the users ignore the fact that the human beings are obliged not only to adapt but rather to master the reality that surrounds them. Moreover, normality is the space where all public means of intervention for primary prevention develop, and this is a specific approach of modern medicine.
• Distress, or state of distress. It is an expression of failure, the ineffective confrontation between pathogen factors and the individual, i.e. the substrate of exogenous pathology.
• Eustressor, or factor generating a state of eustress.
• Distressor, or factor that is the basis of a state of distress.

We believe that such semantic clarification has many benefits.

Among them, the most important one focuses on the reduction of the ease with which distress can replace eustress and the distressors can replace the eustressors. Otherwise, in terms of child and adolescent psychiatry, stress not just a general concept. There is always the risk of believing that almost everything around us that makes demands on us is stressful; that any greater effort is an undesirable condition; that any discomfort is a pathological condition and that hyper protective type of education is a solution aimed at preventing distress.

1. 1. Psychological stress was the underlying meaning of Selye and in the following paragraphs, we will make particular reference to this meaning. 
   2. Acute state of tension of the organism that is obliged to summon all its means of defence in order to face threatening situations (Deley -1965); 
   3. State of an organism threatened by unbalance following the action of certain agents that threaten its homeostatic mechanisms (Sillamy -1995);
   4. Assembly of reactions triggered by aggression (R. Lafon -1973);
   5. Mental stress means, in the first place, the threatening significance of stressful stimuli – threat, frustration, conflict – straining individuals up to or even beyond their adaptive limits (Floru -1974);
   6. Nonspecific response of the body to any demand made upon it “(Popescu Neveanu -1978);
   7. Condition translated by a specific syndrome corresponding to all nonspecific changes induced in a biological system, Rusu 1991 (quoted by Alexandrescu, 2000);
   8. Adaptation syndrome that the individual achieves because of environmental aggressions (Wikipedia).
   9.  

1. Any perceived request that cannot be controlled in a reasonable period of time, (Werkman – 1980);
   – By psychical stress one may understand any transitory or persistent emotional state, simply or complexly structured, which interferes with the individual’s functioning or (adequate) adaptive response capacity, be it immediate or at a distance, due to exceeding the transient or sustainable, integrative adaptive possibilities of that individual. Alexandrescu (2000);
   – Stress is “when one feels overwhelmed or threatened by many more requirements than one can stand” (Katz -1986 –quoted by Dobrescu and Petrovai -2004)

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