You spend months, maybe years, trying to get pregnant, watching in despair as friend after friend accomplishes this most elemental of biological tasks with apparent ease.
Sooner or later, one of these blissfully fertile souls will look you in the eye and, with the best of intentions, diagnose your problem: stress.
Or perhaps you cough a bit too much on the phone one night or let loose with a few impressive sneezes. Chances are, your telephone buddy will pause in mid-sentence to say: "That sounds like a bad cold. You must be under too much stress."
Worse yet, you may do this to yourself, perhaps at the worst possible time, such as when you've just been told you have cancer. Even as the doctor tries to explain the problem, you may tune out and leap to your own "obvious" conclusion: stress.
In the past decade or two, we seem to have swung from a technocentric culture that barely acknowledged the possibility of a mind-body connection to the nearly mindless assumption that everything that goes wrong in our bodies is caused by our minds.
Stress has become our hypothesis of first resort, an oversimplified world view that is not just an insult to rationality but a not-so-veiled way of blaming the patient, of at least seeming to say, "You brought this on yourself."
Now don't panic, mind-body fans. We're not about to throw out the baby with the bathwater. In fact, there's growing evidence that stress can play a role in some medical problems, including raising the risk that you'll catch a cold.
Nor is anybody suggesting that we should abandon useful stress management tricks that make many people feel better, including meditation, relaxation training, yoga or exercise. Quality of life counts, and anything that enhances it is all to the good.
But the complex truth is that while stress -- and just defining that is difficult because one person's stress may be another's gratifying challenge -- does appear to be linked to some health problems, but not to others.
Breast cancer study
Earlier this month, for instance, University of Wisconsin researchers led by Felicia Roberts published an intriguing study on stress and breast cancer. Newly-diagnosed breast cancer patients, Dr. Roberts says, are often convinced their cancer is linked to a stressful time in the recent past -- a messy divorce, perhaps, or a husband's death.
In fact, last December, British researchers thought they had found such a link, though their study involved only 100 women, looked at negative life events for just one year before diagnosis and had other methodological flaws.
In the Wisconsin study, researchers gave a modified version of a common stress questionnaire to 258 breast cancer patients and 614 women without cancer who were selected at random.
The questionnaire asked whether any of 11 events had occurred in the past five years, including the death of a husband, family member or close friend; a divorce or retirement, and such positive but stressful events as marriage or moving in with a new partner.
To her surprise, Dr. Roberts says, the team found no significant difference in stress levels between cancer patients and healthy women.
This is music to the ears of Barrie Cassileth, a Duke University psychologist and medical sociologist whose editorial accompanied the Wisconsin study in Cancer, a journal of the American Cancer Society.
"This is the era of stress causing everything in the world. It's very unfortunate," says Ms. Cassileth. "There certainly is a mind-body link, but I don't think the mind causes cancer and I don't think the mind can cure it."
In fact, there's plenty of evidence that people can suffer tremendous stress with no increased cancer risk.
In military studies, for instance, soldiers discharged for neuroses during World War II had no higher cancer rates 24 years later than their mentally healthier comrades. Nor have POWs studied turned out to be more cancer-prone than other soldiers. Even concentration camp survivors show no excess cancer many years later, says Ms. Cassileth.
All of which means it is "absolutely foolish" to attribute complex medical problems to a single factor like stress, says Dr. Herbert Benson, president of the Mind/Body Medical Institute at Deaconess Hospital in Boston.
In treatment as in diagnosis, what makes more sense, he says, is to "view health and well-being as akin to a three-legged stool. One of the legs is pharmaceutical, a second is surgery and procedures, and the third is self-care, which includes nutrition, exercise, stress management and the mind-body belief stuff."
But while stress does not appear to cause cancer, there is evidence it may contribute to some problems.
A 1993 Framingham (Mass.) Heart Study of more than 1,000 people, for instance, showed that high levels of anxiety predicted future high blood pressure for middle-aged men, though not for women.
And a 1991 study of nearly 400 people by researchers in Britain and at Carnegie Mellon University in Pittsburgh showed that psychological stress raises the risk of getting a cold. Volunteers filled out a stress questionnaire and were assessed on personality traits. Researchers also took samples of their blood, then gave volunteers either nose drops containing one of five viruses known to cause respiratory infections or harmless salt water drops.
After the volunteers were quarantined for a week, the results were clear: The more stress in a person's life, the higher the risk of catching a cold, regardless of other factors, such as age, sex, education, personality, quality of sleep, smoking, alcohol consumption, exercise, diet, even baseline counts of white blood cells in the immune system.
Other researchers have come to similar conclusions, including an Ohio State University husband-and-wife team, Janice Kiecolt-Glaser, a psychologist, and Dr. Ronald Glaser, an immunologist.
Last fall, in a study published in Lancet, the Glasers compared the rate of wound healing in 13 family caretakers of dementia patients and 13 control subjects. Other research by the Glasers had previously shown that caring for someone with dementia is stressful and has measurable effects on immunity.
Under anesthesia, all 26 subjects in this study were given small puncture wounds on their arms. The difference in healing was "much bigger than we expected," says Ms. Kiecolt-Glaser. Wounds took an average of 47 days to heal in the caretakers, vs. 38 days in the controls, a huge difference.
To be sure, not every temporary dip in immunity, whether triggered by stress or not, translates to a decrease in health.
But evidence is growing, Ms. Kiecolt-Glaser says, that stress can affect resistance to disease, especially among older people, whose immune systems often decline with age anyway. The best way to offset this stress, she adds, is to maintain strong emotional relationships with other people.
And what of the controversial link between stress and infertility? That's a tough one.
About 90 percent of infertility is caused by physical problems such as blocked fallopian tubes or problems with sperm or eggs, says Alice Domar, a psychologist at Deaconess Hospital.
"But there is a subgroup of patients in whom stress may play a role," she says.
One Belgian study of women receiving healthy, donor sperm found that the more anxious a woman was about conceiving, the longer it took to get pregnant. Another study showed that infertile women who finally did conceive had a spontaneous decline in anxiety before conception.
Pub Date: 3/26/96