I kept getting these bills. There was one from the hospital and one from Labcorp, and together they said that I owed $700 for a routine checkup and a diagnostic test. I had just started a new job — my first out of grad school — and I hadn’t even gotten my first paycheck yet. I was exhausted from seeing my new therapy patients, meeting my new coworkers, and getting the hang of my new duties. Needless to say, the surprise bills did not come at a great time.
I knew my insurance covered both the checkup and the test. So I did what I had to do: I called up the hospital to try to get to the bottom of it. After a hold, I got through, but I was told that the issue was with the payer, not the provider. So I called my insurance company. But they told me the opposite: I needed to call the provider. So I called the hospital back. But they told me again that the issue was my insurance company. And so on. There were long holds. I was bounced around to different departments.
Unfortunately, all these offices kept business hours, which were almost identical to the hours I reported to work. So I squeezed in phone calls before and after work, often while dodging rush-hour traffic on the highway. Or I’d call during my lunch break, or when one of my patients cancelled. The process dragged on for days, which turned into weeks. Meanwhile, the bills kept coming, now stamped red with “PAST DUE” notices. My mind raced. Would they send me to a collections agency? Would these bills damage my credit? It wasn’t my fault that the hospital made a mistake and I couldn’t get through to fix it. Maybe I should just pay it and be done with it.
It was around this time I started misplacing my keys — which for me these days is not typical behavior. I was leaving for work without my phone and having to drive back home to get it. I was parking on the wrong street at the wrong time and getting a $32 ticket, even though I knew better. At one point, I lost my health insurance card and had to order another one — no easy feat with the constant holds and department transfers. Cumulatively, my life was becoming more and more stressful, a downward spiral.
Finally — after weeks — I settled the issue. Shortly afterward, I started to feel more like myself. In other words, I stopped losing my keys.
I am telling this story not to discuss US health care policy (though it’s terrible), nor to illustrate the trap of poverty (a temporary liquidity issue is not the same as poverty) or the problems with regressive municipal revenue collection based on fines and fees. I am providing this personal anecdote to explain, concretely, the way that stress impairs cognitive function in the short term.
According to the American Psychological Association, cognitive function is “the performance of the mental processes of perception, learning, memory, understanding, awareness, reasoning, judgment, intuition, and language.”
“Psychological stress can affect cognitive function in the short term (e.g., as when an individual’s thoughts are occupied with an argument that happened earlier in the day resulting in reduced ability to pay attention to, keep track of, or remember steps in the task at hand),” according to a 2015 article in the journal BMC Psychiatry. “In the short term, minor daily stressors can produce transient effects on cognition by reducing the amount of attentional resources available for information processing.”
But a lifetime of accumulated stress can also have detrimental long-term effects — particularly when it comes to aging. “Those who experience chronic stress show accelerated cognitive decline compared to their less-stressed peers of the same age,” the article said.
That study and others have even suggested a link between increased stress and Alzheimer’s disease. “Stress management may reduce health problems linked to stress, which include cognitive problems and a higher risk of Alzheimer’s disease and dementia,” says an article from the Harvard Health blog.
The article suggests “protect[ing] your brain” from these problems by reducing stress: getting a good night’s sleep, making a to-do list, and reaching out for help and support. These are all great ideas, ones that I implement in my own life and suggest to my patients who feel overwhelmed by daily hassles.
But these stress management solutions will always feel like swimming upstream in a society that is engaged — in the words of Mark Fisher — in “the vast privatization of stress.” Why is it, exactly, that managing the stress caused by austerity-addled public services, oppressive working conditions, and racism, sexism, and other bigotries fall to the individual?
I explain the privatization of stress to patients after we talk about sleep, to-do lists, and asking for help. I tell them not to beat themselves up, especially because the problem is systemic. But even that is insufficient. In therapy, we work on identifying real solutions to patient problems. So we talk about how things could be different.
What if stress management is really about making society run in a way that is less stressful for everybody? We could reduce the administrative burden placed on individuals by hiring more people and making services easy to use (this goes for both public and private services). The government could fully fund efficient transportation. The government could mandate higher wages, more job security, and more paid time off, so that people could take care of themselves and relax.
Stress reduction should be treated as a serious public health issue. It’s an issue of equity, too. As with any social disease, the poorest people are the most exposed and have the worst outcomes. If we really want to reduce stress, the only solution is a system built to serve people — not the other way around.