Stress is a major contributor to poor health.  We most commonly associate stress with emotional distress, fatigue, insomnia, worry, anxiety and other common causes of the symptoms of stress.  Annually, SEMTA completes a “stress assessment” on each patient we see.  The reason is that often when the stress is relieved, or addressed, the physical symptoms disappear.  For instance, a patient with diabetes and high blood pressure was not treated to goal.  Try as we could, we were not successful.  Then the patient was asked about stress factors in his/her life.  A significant interpersonal relationship which was creating overwhelming stress in the patient’s life was discovered.  Through multiple agency intervention, the stress was relieved and the patient’s diabetes and high blood pressure responded to treatment. 

Before SETMA began using electronic patient records (EMR) in 1999, we could not effectively tract changes in patient’s vital signs.  For instance, with the EMR, we were able to look at vital signs over time.  We began to see patterns, which were not obvious with paper records.  We noticed that with some patients, their blood pressure would be uncontrolled at the same time every year.  This observation allowed us to address stress factors in the patient’s life, rather than just adding more medication.  Often we found that a personal tragedy had taken place and that each year at that time grief overwhelmed the body’s defense mechanism. With this awareness, rather than adding more blood pressure medication, we were able to deal with the real cause of the physical symptom, stress.

The following is the Stress Questionnaire SETMA uses.  By looking at the elements of this stress analysis, you can see the things which are associated with stress:  inadequate sleep, poor nutrition, sedentary lifestyle, social isolation, weight gain, financial pressures, excessive alcohol consumption, etc.  Some of these are signs and symptoms of stress and some are causes of stress, but the idea is that stress and stress relief are important issues in your health and well-being.

The importance of this score is both its results and its content.  The elements of the assessment alert a healthcare provider and a patient to the things which cause stress and points to means of stress reduction.  Stress is destructive to the human body.  Stress increases blood pressure and pulse, both of which can contribute to heart disease.  Stress increases certain chemicals in the body all of which in excess amounts are harmful to health.  It is often possible to improve the control of diabetes without more medications by the reduction or elimination of stress.  And, it is important that the best stress reduction does not come from a pill but from life-style modification and the elimination of stressors in one’s life.

Prejudice

It is not often discussed in relationship to health but hatred, bigotry and prejudice are major stressors in society and in the lives of those people who are prejudiced.  I grew up in the South and experienced the destructiveness of racial hatred from both the victim’s and the perpetrator’s perspective.  It is story for another day, but I journeyed from being a bigot to the recognition of the dignity and worth of all human beings regardless of race or color. 

The good news is that as I write this article, I have in the forefront of my mind the fact that my grandchildren do not see others through the prism of color.  I have watched them with their African-American or Hispanic friends.  I have listened to their conversations and watched them interact. They don’t see color. I have smiled in appreciation and admiration of this progress.  Yes, there are vestiges of racism in our society, in places more than vestiges.  And, tragically, race is used by liberal and conservative politicians for their own political purposes.  These residual elements of bigotry will not disappear accidently.  Like any physical or mental health improvement, the elimination of bigotry will require intentioned action.  As I have wished to eliminate any semblance of ethnic prejudices from my life, I have looked for ways in which to use the word “black” in a positive context.  “Our company is in the ‘black,’” which is positive and good.  We most often use “black” in a negative context such as “they are the good guys, they wear white hats,” or worse yet, “He was ‘black balled.’”  With a little reflection, you will see how foundational the concepts of “black” and “while” are to our society, and you will see how the last vestiges of bigotry will require our divesting ourselves of this dichotomy.

When I was in college, the great fear was of communism.  As a result, a required subject was added to the curriculum. All students had to take a course in communism.  Communism, by and large, went away, so that course has been dropped from the curriculum.  It occurs to me that the course every high school and college student ought to be required today to take is a course in the Civil Rights Movement.  It is impossible to read of Medgar Evers, Thurgood Marshall, Steve Biko, Martin Luther King, Jr., W.E.B. Dubose, and thousands of other heroes without being grateful for the price which has been paid for my grandchildren to live without the health hazard of bigotry and racism being a part of the fabric of their life.

Do you every wonder whether future generations will have to learn history through movies?  It is a shocking realization to become aware that you have lived so long, to discover that what you learned as personal experience is now the substance of what needs to be taught as history to the generations which have come after you.  With Civil Rights, we are at that point.  We must learn history lest, as one historian opined, we be condemned to repeat it. 

I have recently seen most of the movie, The Help.  It was supposed to be funny from what I had been told, but I was furious throughout the movie.  I grew up in the South and the movie was too close to the truth to be funny.  Throughout the movie I had to keep reminding myself that these were actors.  The main Caucasian character was Hillie.  She played her role so well, she was loathsome to me. Almost all of the vestiges of racism depicted in The Help were familiar to me but there were a couple which had never occurred to me.  One is that housekeepers, domestic workers or whatever classification you apply to people who work in other people’s home are often not covered by Social Security, Medicare, have no paid holidays, vacations, sick leave or health insurance.   It is possible to be a bigot and to pay these fees. But, the providing of employee benefits to those who work in your home, particularly when they are of another race, is one objective way of declaring your recognition of your employee as a person with value as you treat them with dignity and economic equality.

The Help refers to the Murder of Medgar Evers, which reminded me of the movie Ghosts of Mississippi which documents Evers’ assassination June 12, 1963 and the trial of his assassin three decades later.  It reminded me of Mississippi Burning which documents the murder of three civil rights workers in Philadelphia, Mississippi.  Michael Schwerner, a 24-year old from Brooklyn, New York, and 21-year old James Chaney from Meridian, Mississippi, were working in and around Neshoba County, Mississippi, to register blacks to vote, opening "Freedom Schools" and organizing black boycotts of white-owned businesses in Meridian.  It reminded me of Cry Freedom, which tells the story of Steve Biko being murdered by the South African Government.  We cannot leave to Hollywood the moral education of our children.  It must be done in home, church and school.

Hatred and Bitterness

The real health tragedy of racism, prejudice and hatred is experienced by the children who grow up being treated like second class citizens, where success is the exception rather than the rule.  The harm to the health of the bigot is not the great tragedy, but those who consider themselves to be neutral - neither a bigot nor an activist against bigotry - must be reminded of the famous truth, “All that is required for evil to prevail is for good men and women to do nothing.” 

Whether it is the plagues of alcohol, tobacco, illicit drugs, violence, inaccessibility to preventive and screening health care, medications or routine healthcare, poverty, or illiteracy, all members of our society pay a tragic price for the perpetuation of the evils of bigotry, racism, prejudice, bitterness and anger.  And. the price to which we refer is not essentially economic.

It is faith which makes the past of significance; it is love which makes the present joyful and fulfilling; it is hope which makes the future a positive expectation. It is the past which gives meaning to the present, and it is the future which gives purpose to the present. It is the present which connects the past and the future. And, it is the knowledge and the sense of all three regardless of our geographical location which makes us human.

As we make decisions about our healthcare, it is not just so that our bodies will continue to function - that is the biology of all mammals. As we make decisions about our health, it is because of the voices, the eyes and the hands of those we love and care for, as our experience of them and with them connects all of our senses in a web of "common sense."

Some years ago, a lady worked for my wife and me as a housekeeper. Our children did not call her by her first name, as they would not any adult. We introduced her as Mrs. ______, when we had guest. She was reliable and hardworking. She did a task which some would call menial but we did not. In addition to caring for our home, she often cared for our children, which was no menial task, as they are our greatest treasures. I remember when we attended a family celebration in her church. This lady who had served us for years, morphed into an elegant lady who was articulate, who was looked up to by others. She was the "queen bee," being served by others and the day was not even in her honor but she was deferred to and addressed with respect. This server was being served. Our respect for her grew as we saw her through the eyes of others.

Seeing Others Through the Eyes of Another

SETMA employs several hundred people. Often I kibitz with those with whom I work every day, but I always do it with the knowledge that to a little girl, to a little boy, or to several children, they are the world. I want to make sure that when they go home in the evening, it is with a spring in their step and a smile on their face for the little ones to whom their services is vastly more important than what they do for me.

As each of us are at once the served and again the server it reminds me of the ultimate example of the dichotomy of, at one time being the served, and at another being the server. Jurgen Moltmann wrote a book entitled, The Crucified God. Grappling with the Gospel of Christ he argued that Christ went to those who were "other" than Himself. He, Who could lay claim to being the Ultimate Served, became the Server. He saw us through the eyes of Another, Who loved us and to Whom we are the world.

In the same context Ernst Kasemann addressed the concept of worship in his Commentary on Romans, where he said:

"...Paul takes the guiding theme of spiritual worship as may be seen from what is said about the living and well-pleasing sacrifice...Yet, Paul also parts company with mysticism by incorporating all life and stressing corporeality as the...sphere of this worship... Christian worship does not consist of what is practiced at sacred sites, at sacred times, and with sacred acts. It is the offering of the bodily existence in the otherwise profane sphere. As something constantly demanded this takes place in daily life, whereby every Christian is simultaneously sacrifice and priest. Here the universal priesthood of all believers is proclaimed of which I Peter 3:8 can even speak in terminology taken from sacral law."

Complex language perhaps, but the basic concepts are, for Moltmann, that we act divinely when we see those who appear different from us as the same as us, i.e., when we see the server as one worthy of our service. Thus perceiving them so, we serve them by our kindness and graciousness in their service to us. For Kasemann, worship of God is most clearly done as we serve others with our acceptance, kindness and graciousness, even when they are the server and we are the served.

Wealth and Worth

In this world, there will never be equality of wealth, but there must be equality of worth.  If we are to be healthy, mentally, emotionally, spiritually, and physically, we must purge ourselves of bigotry, prejudice, hatred and bitterness.  The steps in successfully doing that are so ordinary and so simple they may seem insignificant. It can be done and it must be done.  And, it must be done now.

We must no longer depend upon our “religious” fervor for evidence of our spiritual worth; we must find our truth worth in how we care for our fellow man, and particularly when that fellow man, woman or child looks, lives, and even acts differently