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on her porch, writing, and working in her garden. Finally, after her last day on the job, she starting working a job much closer to home—literally two minutes from home—and also started her own business. Her symptoms went away.

      Similarly, I don’t remember exactly when my left eye started twitching, it just appeared and gradually got worse and worse. Like Sarah’s health issues, it happened during a particularly tough time in my life. I was working at a job I hated and living in an apartment I could barely afford. I never complained about it or even sought a professional opinion on my eye twitch. Not because I was against going to a doctor, but I had more pressing issues occupying my attention. Also, just as Sarah had experienced, my symptom went away after I experienced some changes in my life. Unlike Sarah, my relief came from being laid off. I didn’t realize it then, but getting fired from that position was just what the doctor ordered.

      Prolonged exposure to stress can have a negative impact on our physical health and general well-being. Also, stress can affect individuals differently. Sarah suffered bodily pain and headaches from stress; I experienced involuntary muscle spasms in my eyelids (and probably some additional symptoms I was too stressed to notice). But why? As I described earlier, stress is our brain’s reaction to a percieved threat. Why would our response to threat cause us pain and other problems?

      Before I get into that, let me first discuss some of the physical effects of stress. Previously I mentioned how the amygdala, after identifying something as threatening, sends signals via the hypothalamus to activate the sympathetic nervous system. Man, that’s a lot of anatomical terms for one sentence. I’m not sure how technical I can get without turning this into a textbook. Sarah just convinced me that most people have probably heard of this stuff, so I’ll keep it. This is a network of nerves that connect the spinal cord to many bodily organs and when activated, it is responsible for most of the physiological changes that occur. Our eyes dilate, our heart rate increases. Stress can cause us to perspire or cease digestion, and can inhibit erections in males. It makes us sweaty, bloated, and limp.

      The sympathetic nervous system also triggers the adrenal glands to start producing adrenaline, that sweet hormone sought by bungee jumpers and extreme sports enthusiasts. Basically, anyone who owns a GoPro. Adrenaline surges through our body and energizes us. It increases blood flow to the muscles, blood sugar, and the force and frequency of our high fives with our bros. Adrenaline is also released during stress, but we generally don’t think of it as a stress hormone. That honorable distinction goes to cortisol.

      When the hypothalamus receives the stress signal from the amygdala, it activates the sympathetic nervous system as I have just described, and also stimulates the release of a hormone called ACTH into the bloodstream.23 This hormone travels through the arteries down to the adrenal glands and tells them to start cranking out cortisol because something nasty is about to hit the fan. Like adrenaline, cortisol also increases our blood sugar and has a lot of additional effects on the body. The adrenaline and cortisol, now surging through our body, are delivered to our organs faster thanks to the increased heart rate.

      Whether mediated by the sympathetic nervous system or circulating hormones, all of these changes that take place in our body are supposed to be beneficial. They serve to increase our energy and make our body more efficient, two things that may prove to be quite helpful if we are being attacked by a bear. We are mobilized for some form of action, and that action is going to be fight, flight, or freeze. We are going to defend ourselves or attack in some way, flee or try to escape, or in some scenarios we will do nothing.

      Most people are familiar with the standard “fight or flight” dichotomy, and really that is probably all we need to understand, but I like to throw in “freeze” because it is a common behavioral reaction. Think about how many times you may have been so overwhelmed with stress that you became incredibly inactive. Maybe you were sitting at your desk at work, handed an incredibly daunting task with an unrealistic deadline, and instead of diving right in and tackling that bad boy (fight), or asking your boss for an extension or help (flight), you just sat there unable to do anything (freeze). I’ve been there. Remember the job that made my eye twitch?

      It is easy to understand freezing in the bear attack scenario. A lot of people will freeze up when overcome with fear. Even the Black Panther froze (and his sister made fun of him for it) despite the fact that he has super powers and advanced technology!24 Marvel movies aside, my favorite “freeze” story took place during my time in graduate school.

      I had a friend who was given a car by her family. The problem was, it had a standard transmission and she didn’t know how to drive a stick. What a great gift! “Here: it’s a car that you can’t drive!” Being one of her few friends who knew how to drive manual, I offered to teach her. We started off in the parking lot and I explained how the clutch pedal worked, when to press it down, and how to shift gears. Then she practiced a bit. Of course, there were some initial stalls, but after a few minutes she got the hang of it and was shifting all the way up to third gear. I asked if she was ready to hit the streets and she said yes. We left campus, drove a few blocks, and everything seemed fine. We caught a red light, and she slowed down to a stop without incident. She was a little stressed, elevated heart rate and all, but not out of control.

      At a four-way intersection, we were the first car in our lane at the light. As soon as the light turned green, she went to press the gas pedal but did something wrong and the car stalled. Now, in traffic we have cars coming at us from the opposite direction and cars coming up from behind and she freezes. In this context freezing meant letting go of the steering wheel, lifting her feet off the pedals, and covering her eyes! She yelled, “I can’t take this” and threw her arm across her face.

      Suddenly, I too became stressed. My fight response kicked in and from the passenger’s seat I grabbed the wheel, stretched my leg over the center console to work the pedals, and steered us out of traffic. Nobody was hurt and after we calmed down, we had a good laugh about the whole thing. You know, the whole thing where we could have been seriously injured.

      I didn’t realize until much later that her reaction, which I had trouble understanding at the time, was a common response to stress. Remember how I discussed how the brain picks actions based on whichever one has the most potential value given our previous experiences? I believe that if neither option looks appealing, the brain will choose to freeze or do nothing. In the case of a bear attack, for example, successfully fighting off or running from a bear are extremely unlikely outcomes for most people. In the absence of a good option, many people would choose to freeze. Similarly, at that moment sitting in the car in the middle of the intersection, my friend was faced with a choice. In a car, both fight and flight require driving skills, and to a brain that lacks confidence in its ability to drive neither option will likely hold much value . . . so she froze.

      Ever have so much to do that you can’t seem to get out of bed? I’ve been there.

      I will admit that freezing probably does not require an increase in energy so we are safe usually just focusing on fight vs. flight, but it is interesting.

      Now let me get back to why our stress response would cause Sarah to suffer body pain and make my eye twitch. One of the things about our fight or flight response is that it represents a short-term solution to a short-term problem. Danger in nature is usually temporary and if we are successful, it should be resolved quickly. Do you know the nice thing about being attacked by a bear? It doesn’t last very long. One way or another, that bear attack is going to be over fast.

      Elevating our blood sugar or heart rate temporarily so that we can increase our chances of survival is not a bad thing; in fact, stress works toward our advantage during these moments. However, you can imagine that maintaining a high level of blood sugar for an extended period of time can have a negative impact on our health. Similarly, long-term elevation of our heart rate can also cause complications. Unfortunately, most of the stress we experience is not due to actual danger, but perceived threats that have a tendency to linger around. I don’t know how long Sarah was stuck at her difficult contract, but even if she was only contracted for six months, those were six months of feeling on edge. Six months of sitting in traffic every day. Six months of unnecessarily elevated adrenaline and cortisol. Prolonged exposure to stress can, and does, take its toll. My eye-twitch job lasted

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