In the latest installment of American medicine’s sadistic habit of piling on, researchers have found that older unemployed people not only have to endure an uncertain financial future but also are at increased risk of having a heart attack. These sorts of studies seem to surround the chronically miserable—persons living in polluted air or with lousy housing—perhaps to remind people that there is no real escape from the clawlike reach of disease. And furthermore, that we, your purveyors of health and happiness, hold the key to your future.
The newest work is a direct descendent of that granddaddy of all misery-death investigations, the famous Holmes and Rahe stress scale. You know this one from some college course or other you tried to avoid. Life events are assigned a number. For example, death of spouse, 100; trouble with in-laws, 29; Christmas, 12. (Loss of employment, by the way only rates a 47.) Using simple arithmetic, you quickly can find out if you’re about to croak. But remember that unlike the stock market or a holiday bonus, a high number here spells trouble. Holmes and Rahe used 300 (ding ding ding) as the cutoff to predict a high risk of illness. Math and reality, together again. Nate Silver meets the Grim Reaper, without all the confusing actuarial tables.
The new study is a good one. The researchers followed a large group of semi-oldsters (median age, 62) for about 12 years through life’s twists and turns then, once 8 percent of the group had suffered a heart attack, they froze the data and went to work analyzing the whys and wherefores. The unique aspect of this study, which is one of many over the decades to find a connection between unemployment and poor health, is that the investigators established a large group of 13,000 volunteers and followed them going forward, in prospective fashion. This approach allowed them to avoid the countless statistical problems created by a look-back, or retrospective, study, which previously had been the type most frequently performed.
The design also allowed the researchers to control for other factors associated with heart attacks, including diabetes, obesity, and smoking. Putting all the numbers together, they found that “job separation” increased the risk of heart attack about 35 percent and that furthermore, the risk was higher yet for the group that had lost more than one job. In addition, researchers demonstrated that most of the heart-attack increase was seen in the first year of unemployment, the sort of alignment between the statistical and the intuitive that makes for a more convincing study.
The study is yet another in the long line of investigations that seek to define the magical, mystical mind-body connection and establish the centrality of emotion to physical well-being, with the Homes and Rahe stress scale serving as the local guidebook. The scientific notion that stress in all its varieties might cause physical illness is less than a century old, the brainchild of the Hungarian-Canadian endocrinologist, Hans Selye, who studied the adrenal gland, the body’s big-time purveyor of the hormone adrenaline (also known as epinephrine). Subjecting a person to an ongoing assault of too much of this hormone might be expected to wear that person down—just ask anyone who has needed an EpiPen to prevent illness after a bee sting. The rush of excitement is always overwhelming—but nowhere near as harsh as the crash that surely follows. So too, the theory goes, with the slings and arrows of daily life. Too much stress means too much illness— emotional, physical, and everything in between.
Or maybe not. As with all pat theories, the anti-pat inevitably has arisen. Writing in Newsweek in 2009, Mary Carmichael laid out the argument in support of the salutary aspects of stress, a notion Salye referred to as eustress. This is a belief system planted firmly in the “necessity is the mother of invention” school of production. For example, stress may improve pain tolerance and brighten alertness; so too are those who have experienced real stress, not “oh my God will the movie be sold out before I get there” stress, better prepared than the untested the next time they are confronted with stress.
So, although the current study demonstrates clearly that unemployment is indeed a risk for heart attack, it did not show that the increase is due to the stress of the unemployment. Perhaps people without jobs become more sedentary, eat more junk food, lose the urge to exercise, or are too busy looking for work to pay attention to basic health matters. Perhaps they no longer choose to spend their money on medications. Those true believers in the theory that stress is the root of all evil surely will seize the moment (and every moment) to hammer home their point yet again.
To do so, however, would miss the point of this study and of countless works from Selye and many others. Unemployment is disruptive, dispiriting, and potentially catastrophic; stress on the other hand is all over the place, working across the aisle. Nature is far too parsimonious to assign a single good-guy or bad-guy tag to any participant in the unimaginably complex workings of the human body, stress included. Too much rummaging around after the one awful thing that, if corrected, will lead to eternal happiness finally accomplishes nothing for anyone—except perhaps to stress everyone out.