ENDEMIC STRESS: : The Psychology of Resignation and the Politics of Scarcity

Amer. J . Orthopsychicit. 52(1) , Junuury 1982

THEORY AND RRllEW

ENDEMIC STRESS: The Psychology of Resignation and the

Politics of Scarcity Marc Fried, Ph.D.

Laboratory of Psychosocial Studies and Department of Psychology, Boston College, Chestnut Hill, Mass.

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Increased attention has been given to the concept of stress recently, focus- ing largely on acute stress. Endemic stress has been relatively neglected despite its widespread occurrence. This paper delineates the origins, phenomenology, processes, and consequences of endemic stress- involving resignation, depression, and diminished levels of expectation and functioning+rom those of acute stress. The social implications of the rampant development and manipulation of endemic stress are discussed.

ost observers of contemporary events would probably agree that,

“These are the times that try men’s souls.” Yet, unlike the period of revolu- tion and postrevolutionary conflict that Thomas Paine described in The Ameri- can Crisis, most Americans experience relatively few catastrophic events in our times. Even crises such as the capture and holding of hostages, the invasion of underdeveloped countries, nuclear plant accidents, precipitous leaps and descents of the stock market, dramatic increases in the cost of energy upon

which our daily lives depend, and rapid incursions into the funding of basic social programs seem quickly to take on an endemic flavor. Not only are such crises recurrent to the point of seeming almost predictable, but the conditions that generate them persist over relatively long periods of time. Moreover, the effects of these events upon the average citizen are largely indirect, which further di- minishes any sense of crisis or catastrophe.

These persisting, repetitive events produce a widespread experience of en-

A revi.ced version of 11 puper presented cit the 1980 unnuul meeting of the Americun Orthopsychiutric Associution, in Toronto.

4 0002-9432/82/010004-16$00.75 01982 American Orthopsychiatric Association, Inc.

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demic stress. Endemic stress is a con- dition of continuous and manifold changes, demands, threats, or deprivations, frequently small in scale and em- bedded in daily life events. These forces may be widespread and affect much of the population, or they may be discrete and personal; they have diverse origins in economic, political, social, physical- environmental, psychological, or physiological conditions and events. Such events readily summate or cumulate to produce a measurable increase in psychosocial strain and a measurable alteration in social behavior.

Much of the stress research that has developed over the last decade and much of our knowledge about the conditions and consequences of stress con- cern crisis or acute stress. This is entirely reasonable in view of the unanticipated nature of such stressful events, the urgency with which they force themselves on individuals and populations, and the necessity for immediate response. In recent years, three separate trends have converged to give the concept of stress great vitality, engendering renewed interest in Selye’s earlier work on stress and the General Adaptation Syndrome.32 These are represented by Brenner’s analysis3 of the stress of economic change, particularly employment rates, as a determinant of changes in rates of mental illness; the development by Holmes and RaheZ3 of a stressful life events questionnaire and the appear- ance of studies indicating the effect of recent life changes on physical illness; and the widespread recognition of the contribution of stressful life situations to heart disease.l93 26 Despite the many residual questions, these studies, along with subsequent research, lend strong support to the thesis that acute stress has severe deleterious consequences.

Although stress can originate in many different spheres, there are now solid empirical grounds for asserting that social conditions contribute substantially to the rise and fall in those forms of human misery associated with numerous types of bodily, mental, and behav- ioral malfunctioning. Much has yet to be learned about different types of stress, about the processes involved, and about the social costs of care and treatment of their sequelae. Moreover, the patterns are often complex and can be exacerbated or diminished by the conditions in which they occur and by intervening social and psychological events. But the basic thrust of the initial findings has proved invaluable. Whether for theory, policy, or practice, they alert our think- ing to major and often neglected stresses that generate increased rates of malfunctioning. They also contribute to a deeper appreciation of the potent effects of social processes on human behavior and the hidden costs that may be involved in macrolevel economic, political, or social events or conditions.

Significant as is the conclusion that acute, stressful social and economic events play a large role in diverse forms of pathology, such events represent only one of several types of stressful social conditions that underlie human misery and malfunctioning. Certainly crisis-like or acute stress is quite different from the continuous or recurrent series of small-scale stresses that operate in the lives of many people and, oc- casionally, among large populations. Although there are many studies in which the stresses involved are either continuous, recurrent, or chronic, no clear distinction has ordinarily been drawn between endemic stress and acute stress. The extensive psychological literature on the effects of the physi-

ENDEMIC STRESS

cal environment5* 6 , 22 and many of the earlier analyses of situational stresses2’ involve recurrent or chronic stress. Yet the phenomenon of endemic stress has not been adequately conceptualized; it warrants closer examination.

A consideration of the varieties of stress suggests that acute and endemic stress are analytically distinct and require separate consideration. Cata- strophic stress, resulting from disasters that affect an entire region or population, may represent yet a third type of stress.’. 1 3 9 34 Not only do the conditions that generate acute or crisis stress differ from those that produce endemic stress, but their mechanisms of operation, the processes of adaptation, and their consequences appear to differ markedly. Endemic stress, in this con- ceptualization, is the phenomenon of persisting or increasing scarcity, per- during conditions of loss or deprivation, and continuing experiences of inade- quate resources or role opportunities. It may also include repressive conditions that curtail political or social action, and oppressive cultural forces that demean individuals or diminish the possibility of meaningful group identity. However, while many different macrolevel conditions can contribute to endemic stress, the most frequent and most trenchant determinants of endemic, population- wide stress in modern democratic societies are likely to be economic in origin.

Frequently, acute and endemic stress flow into one another so that attributing effects to one or the other becomes difficult. Persisting unemployment becomes an endemic stress following the acute stress of job loss. A continuing decline in real wages due to inflation is an endemic stress at almost all income levels

but, at critical points, may become an acute stress. Regular or small-scale daily events involving periodic family conflicts, frustrations in work or hous- ing, as well as battles with bureaucracies or with income tax forms can all be components of endemic stress and may follow from or precede acute stresses. Certainly, acute stress can be superimposed on conditions of endemic stress. Other combinations of, or interactions between, acute and endemic stress can also occur.

The development of physical pathology, psychopathology, or social pathology can often be traced to such combinations of acute and endemic stress. Nonetheless, one distinction between these two forms of stress that seems warranted is the greater potency of acute stress as an influence on overt pathology. While there is considerable evidence to link recent and past acute stresses to severe difficulties in physical and emotional health and social behavior, it is not as clear that endemic stress has a direct causal influence on major pathological conditions. It may well be, however, that endemic stresses conse- quent to an acute stress are implicated in severe malfunctioning. Thus, the indirect effects of economic change that Brenner3 referred to as “subsidiary issues related to economic loss” may function through the mechanisms of endemic stress, initially generated by the disequilibrating impact of acute stress.

But whether endemic stress results in increased rates of overt, severe pathology or not, its most striking effects emerge in the subtle, ominous, subclinical manifestations of apathy, alienation, withdrawal, affective denial, decreased productivity, and resignation. Acute stress generally invokes a sense of

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shock, followed by anxiety or grief. These, in turn, lead to a gradual process of marshalling adaptive resources. En- demic stress, by contrast, involves rapid, small-scale but relatively passive and resigned coping mechanisms in response to the sense of nagging threat or visible decline. Frequently the coping mechanisms evoked by endemic stress occur below the level of awareness. Even when acute stress involves de- pressive or withdrawal responses, moderately active efforts to compensate for role losses are normally integral components of adaptation. But the characteristic reaction to endemic stress entails pulling back, belt-tightening, and a generalized reduction in role behavior.

Thus, the dominant form of behav- ioral adaptation to endemic stress involves a process that can be conceptualized as role contraction. In a previ- ous effort to develop a model of stress and adaptation specific to acute stress,Z' I extended several role concepts and formulated a concept of role uduptrition. The main dimension of role adaptation deemed prognostic of malfunctioning was a relatively long-term contraction of role behavior. The acute stresses that people experience, it was hypothesized, result in decreases or increases in the number and intensity of involvements in role activities, in the diversity of role functions fulfilled, or in role relationship commitments. Acute stress sometimes leads to a contraction in role behavior but often results in transitions to new role patterns that are equal in extensive- ness and intensity to prior role behavior. Not infrequently acute stress results in role expansion. The vividness and evident impact of acutely stressful events often stimulate small social system processes, encompassed within the term

social support, which can moderate the potential for role contraction in response to stress. Thus, even when role contractions occur, they may be short- lived-although, to the extent that they invade successively higher levels or more complex forms of role functioning, they can lead to major pathological de- velopments.

By contrast, endemic stress has a less striking, less evident effect on the individual or the small social system and is less clearly manifest in short-run changes in role behavior. The role contractions that ensue, with even greater regularity than in response to acute stress, tend to be modest or even, initially, invisible. It is mainly the pervasive nature of endemic stress, the persistence or recurrence of stressful events, and the quasi-automatic coping response that results in many small, successive role contractions that gradually encompass wide spheres of role behavior. Indeed, since endemic stress can often be anticipated either specifically or in a general way (in contrast to most acute stresses), adaptation through role contraction sometimes oc- curs even before new or renewed stresses develop. But it is precisely the slow, gradual, and continuous process of role contraction that represents the major psychosocial cost of adaptation to endemic stress.

At a phenomenal level, therefore, we find a number of clear differences between the two stress conditions: I ) Acute stress is generally a vivid occurrence, in contrast to the almost imper- ceptible quality of endemic stresses taken individually. 2) Acute stress is usually a singular, marked event; endemic stress is characterized by many sub-acute, recurrent stressful situa-

8 ENDEMIC STRESS

tions. 3) There is great clarity to situations of acute stress, but the sources of endemic stress-and even the endemic stresses themselves-are often em- bedded in ambiguities and complexities. 4 ) Acute stress can rarely be anticipated adequately, while endemic .stress is often predictable and, even when barely visible, may evoke anticipatory, uncon- scious responses. 5 ) Acute stress is characterized by intense and relatively short-lived responses, such as anxiety or grief; endemic stress involves a slower, longer-term set of reactions, in- cluding role contraction and resignation. 6) Adaptation to acute stress often involves role transitions, sometimes toward pathological solutions and sometimes to new levels of achieve- ment; adaptation to endemic stress involves slow, gradual retrenchment in which most of the maladaptive consequences are hidden or of a subclinical nature.

Newspaper reports are hardly suffi- cient evidence for asserting so large a set of propositions. Yet, a quotation from the Boston Globe captures nicely a number of components of the sense of scarcity and the psychology of resignation in response to the endemic stress associated with rampant inflation. Based on several interviews, the Bosfon Globe of March 27, 1980, presented a story called “You Hope for a Draw, Learn to do Without,” from which these fragments are drawn:

Confronting the ravages of inflation, Bay Staters are summoning a native resourcefulness and re- vising the way they live, work and play. In Greater Boston, many families are learning to do without, to cope. They are giving up amenities they have taken for granted most of their lives. Even items long considered necessities are being sacri- ficed . . .

One of the dreams of many Americans is to own a home in the suburbs. Bill and Maureen Ruff had to abandon that dream. Last July they sold their 300-year old home in Marshfield and moved into a Boston townhouse. Inflation was the reason. [They] walk to work each day . . . Their car is used an average of once a week. Betty Cahoon of South Weymouth doesn’t bargain shop for food . . . She says, “I feel the money I spend on gasoline hopping around from store to store would more than offset the savings in price.” Her husband, Donald, has given up his $25 a week allowance for lunches. She makes the lunch he takes to work. . . . They needed a new refrigerator but refused to buy it until they could pay cash. . . . In the meantime, Betty picked up a second-hand refrigerator for $25. “It was adequate .” There are no luxuries in the life of Gloria Shavers of Roxbury . . . She food shops at a grocery ware- house. “Originally I didn’t like it. I didn’t want to bag my own groceries. 1 couldn’t get everything I wanted.” Economics changed her mind. She buys clothes at discount and factory outlet stores. Do her children mind wearing second-hand clothes? “I try to teach them sacrifice is a part of life.”

THE SENSE OF SCARCITY: ECONOMICS, POLITICS, AND HUMAN ADAPTATION

Some people live their entire lives or long periods of their lives with a sense of economic scarcity because they are truly poor even by minimal standards in our society. Many people experience scarcity from time to time either because of a temporary decline in income or an increased demand on their resources. Some people experience scarcity regardless of their objective economic circumstances because of earlier experiences of deprivation which they have been unable to resolve. In an in- egalitarian society, with affluence and luxury highly visible and almost within reach, all but the very rich periodically are affected by that sense of scarcity which is more properly a sense of relative deprivation. And almost everyone

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develops a sense of scarcity when the trajectory of costs rises more steeply than the trajectory of incomes. The contemporary economic situation, which couples inflation and recession and which has persisted for nearly a decade, evokes this sense of scarcity- although for many it is superimposed on still other feelings of scarcity.

But it is even more than scarcity. It is a sense of insecurity, of the threat of continuing or increasing incursions into our lives, of a slowly declining standard of living projected into an unknown future. This is exacerbated by political frustrations with little expectation of resolution from public officials. The necessity for developing tolerable personal coping methods often leads to ac- cepting conditions that previously would have appeared intolerable. Thus, the sense of scarcity is compounded of a series of successive economic and life- style deprivations, of political ambiguities and discouragements, and of uncertainties about the future trajectory of one’s life. This compound of a low- level sense of perpetual decline would indeed be intolerable if it were con- fronted as such. However, we have almost all learned the rudiments of short-term coping and of longer-term adaptation to the conflict between economic resources and personal desires and between planning directions for the future and responding to immediate situational pressures and opportunities.

Yet the current situation of endemic stress due to economic conditions involves both political denial and political manipulation of economic forces. Eco- nomic realities can and do produce endemic stress. But the widespread recognition that the current situation is not entirely necessary, that it involves sins

of commission and sins of omission of a political nature, evokes an even more serious sense of helplessness and futility about seeking active solutions. Despite many differences of view about the causes of present economic conditions, it is increasingly clear that much of the actual economic scarcity and of the profound sense of scarcity is dominated by past and present political maneuvers. This is not to say there is no economic basis for the decline in real income or for the sense of scarcity. There has been a gradual deterioration of the economic position of the United States in the world economy and a decline, both ab- solute and relative, in American standards of living. But the decline in tech- nological superiority, in relative productivity, and in economic progress is fostered by political decisions about al- locating the costs of economic and tech- nological change.33 As recent and re- peated federal budget discussions indi- cate, those in greatest need will continue to suffer disproportionately from economic retrenchment: a decline in programs and benefits for the poor and needy is to be accompanied by policies designed to induce recession-or at least to give less weight to the devastat- ing effects of recession on the poorest segments of the population-in the interest of developing politically attrac- tive methods of curbing inflation.

Many factors have been implicated in the economic analysis of the current in- flationary situation, although there is hardly any real agreement about causal sequences and priorities of determinants. It is clear enough, however, that even if we consider only such factors as the increasing cost of energy, the blame can hardly be attributed to the out- group, to the OPEC nations alone. A

10 ENDEMIC STRESS

very large part of the increase in the cost of crude oil stems from the actions of multinational oil companies. Despite the general tendency of the population to avoid confronting such issues, a tendency fostered by both public officials and the media, it is apparent that the OPEC nations and the multinationals suffer no dearth in the supply of oil and that their profits have skyrocketed. Moreover, as Arthur Schlesinger, Jr., has recently pointed out, although West Germany relies even more heavily on OPEC oil than does the United States, the inflation rate in Germany is one- fourth that of the United States.3o But this is only one of many instances that undermine public belief that the government is doing all it can, or even doing anything very useful, to ameliorate the situation or modify its consequences. And for those who are sensitive to the need for increasing social benefits in the face of these conditions, the decline in these benefits from federal, state, and local sources is another politically- fostered determinant of the stresses that encourage a psychology of resignation.

It is these and a host of other forms of political failure, political error, and political manipulation that superimpose themselves on the basic economic problems. And while the economic difficulties are not inexorable results of natural processes, their contamination by the deficits of political action and inaction (to put the kindest face on it) create an atmosphere similar to conditions that evoke “learned helplessness.”)’ Marris2s pointed out that “stress seems to be more bearable when we can accept its inevitability. Once suffering is given purpose, we can find reasons to live in spite of it.” But in spite of the traditional optimism of Ameri-

cans, in spite of widespread efforts of the media and of public officials to create a false sense of the inevitability of the current economic crisis, few people truly accept its inexorability. Nonethe- less, most have little choice in the face of great discomfort but to seek the least painful solutions to endemic stresses. The widespread view that politicians and political forces have engendered these conditions produces individual forms of coping that are partial solutions to the composite of a sense of persisting deprivation and feelings of helplessness. Not only are there increasing constraints on daily behavior and on economic choices but the range of political options seems to grow progressively narrower as conditions of endemic stress grow more pervasive.

The current form of endemic stress is a striking example of long-term conditions of declining role opportunities. Endemic stress is by no means limited to economic conditions nor even to external, situationally-induced difficulties. But the form of endemic stress linked to inflation coupled with recession is so striking because it is so widespread and is permeated by so strong a political flavor. Moreover, its development during the 1970s followed a decade of widely-improving conditions and a sense of optimism that fostered both individual and collective struggles to im- prove life circumstances. Marris has characterized Americans as unique in their denial of difficulty. American ideology, he noted, involves “a secular, pragmatic refusal to accept the necessity of suffering. No other people seem so unreconciled to ill health, unhappi- ness, even mortality itself.”28 Ameri- cans have certainly not had as much familiarity with disaster as have many

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other populations: with long-term battlegrounds, with severe political re- straints, with persisting economic hardship and bare subsistence living. But while there may be a difference from other nations in the extent of disaster and acute stress, endemic stress has been a familiar phenomenon in United States history.

Not least among the endemic stresses that have characterized American society over decades and even centuries are those conditions of chronic deprivation from which large segments of the population have suffered. Although the geo- graphical frontiers and the long period of economic expansion and world economic hegemony mitigated the impact of deprivation in the United States, they hardly precluded conditions of vast and endemic suffering. Minority status, physical and emotional disability, the position of the aged, sex inequalities, and, most of all, poverty and powerless- ness are among the many forms of persisting deprivation and stressful experience that the United States has shared with other industrial societies. And since the psychological, social, and physical consequences of these conditions are better known than the sequelae of other forms of endemic stress, they provide a prototype for clarifying otherwise ambiguous or unclear patterns and effects of endemic stress. Among other matters, the sense of persisting scarcity and the inadequacy of most social and political solutions to these problems of deprivation lead to a conviction of political chicanery. Sub- sequent reactions of hopelessness and withdrawal from political involvement provide an ominous forecast of the large-scale social consequences of endemic stress.

Even within more recent history, there have been numerous instances of major forms of stress that have widely affected the American experience. The most serious of these, it seems, are either intercurrent endemic stresses or those that have followed on acute stress. It is sometimes easy to forget that as the Great Depression moved beyond its catastrophic character in 1928, 1929, and 1930, it began to take on the attributes of endemic stress. Those who lived through the Great Depression in their youth experienced life-long conse- q u e n c e ~ . ' ~ One would suspect that it was the endemic nature of the long-run depression, rather than the short-term catastrophe, that affected people most deeply. Similarly, the McCarthy and Nixon eras in the United States were relatively short-lived but led to long- term increases in constraints on political freedom and to increased bureaucratic control. From a very different vantage point, the history of the United States is characterized by widespread and persistent oppression of ethnic minorities and cultural repression of differences among people beyond the more familiar forms of chronic deprivation. These and their manifestation in discrimination, segregation, and other forms of in- equality have certainly been sources of endemic stress for millions in the United States and, not infrequently, of more acute crises as well. In spite of these factors, however, it may well be the case that the American ideology, affecting even the underprivileged and op- pressed, emphasizes optimism and a perpetually enlarging future. But while the sense of threat and deprivation may be less potent, persistent endemic stress tends to undermine such confident expectations, particularly when the

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sources of stress are unequally distrib- uted and not wholly explicable.

While the sphere of political involvement and political action is not a primary focus for the analysis of psychosocial phenomena such as stress, it becomes particularly germane when the stress is so intimately linked to the operations of the political system. Real scarcity alone, persisting over time, might well produce some of the effects of political withdrawal, declining involvement, and a sense of futility. But when the scarcity, no matter how well-founded in real economic structures and processes, is further manipulated, unequally distrib- uted, and pervades all levels of the political system, it appears to produce a more fundamental hopelessness and helplessness. It should come as no sur- prise that, in the face of such resignation and retreat, there is a strong predisposi- tion to conservative political behavior. While much research remains to be done in this area, it seems likely that such conservative trends are fairly direct results of role contraction and the psychology of resignation-of a willing acceptance of simple solutions-rather than implying any major shift toward a widespread, conservative ideology. *

MODELS AND PROBLEMS IN THE ANALYSIS OF STRESS

Stress is defined in many different ways in the literature, a circumstance that leads to considerable confusion. The different definitions of stress fall into three broad categories: those that refer to an event or stimulus;3* l o * 23

those that refer to the response pattern itself;29. 32 and those that specify in-

teractions between stimulus and response mediated through perception.' Stimulus-based definitions assume that events and conditions, external or internal, vary in their average stressfulness. Since different people perceive and respond to these events and conditions differently, the level of stress they experience as individuals (or the subjective strain) will vary around this average. Based on aggregate data and average effects, stress probabilities can be attributed to any stimulus. The impact on the individual is thus seen as the interplay between generalized stress probabilities and individual (psychological and situational) differences.

Response-based definitions adopt contrasting assumptions. They assume that whether a situation is stressful or not is mainly a function of individual rather than of situational differences. Indeed, in the formulations of S e l ~ e , ~ ~ the basic analysis starts with a specified response pattern viewed as an indicator of stress. Variations among stimuli are treated as irrelevant (albeit germane to specific forms of stress-related illnesses) beyond their capacity to induce the generalized set of stress responses. Interactional definitions take greater cog- nizance of differences in environmental attributes, but are close to response- based conceptions in their primary con- cern with the subjective perception of stress. As a consequence, while recog- nizing variations in the stressfulness of different stimuli, they view the conditions that generate stress in broad categories and concentrate their efforts on processes of perception, coping, and response.

* During the short time since this was written, we have witnessed further manipulations of economic conditions which are prototypes for conditions of "learned helplessness." This is one of the more ominous threats to our democratic society in view of the political passivity it induces.

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In discussing the concept and phenomena of endemic stress, I have adopted a stimulus-based definition, one that involves internal or external events, conditions or processes that im- pinge on an organism and have a high probability of producing In making these and other distinctions, it becomes possible to disentangle, to de- compose for analytic purposes, a set of issues that would otherwise result in a theoretical morass because they are so closely linked empirically. The same principles of operation seem to apply regardless of the source of the endemic stress. While particular emphasis has been given to external, societal conditions and events that are stressful, stress can arise from many different sources. At the individual level, stress may be due to intrapsychic, physiological, or interpersonal sources. If we generalize from a psychoanalytic model,20 intrapsychic conflict may be viewed as a primarysource of stress. Affects such as anxiety or depression are, in these terms,indicators of the stress of internal conflict. While internal conflicts may be acutely stressful, particularly when pre- cipitated by an external event, more often than not they produce endemic stress. It is these persistent internal conflicts and psychologically-generated endemic stresses that have received the greatest attention in clinical studies. Stress may, of course, also have biological origins, as is evident in the work of Selye3* and other experimental, physiological, and medical r e ~ e a r c h . ~ Illness itself may be viewed as a response to physiological or to psy- chosomatic stress, which produces further stress on social role behavior.I2 While the acute phases of many illnesses and injuries stem from acute stress stimuli, most of these give way to

longer-term endemic physiological or physical stress. And many adults live with, and have learned to cope with, recurrent endemic physiological or physical stress, often at considerable biological, psychological, or social cost.

Neither psychogenic nor physical stress need operate entirely as individual stress. Not only may external events evoke or precipitate internal conflicts or physical difficulties, but the effects of such stress on role behavior must frequently affect other persons or other systems. This is even more evident, however, in stress that stems directly from interpersonal relationships and organizational systems. In such conditions of interpersonal or organizational difficulty, the impact of stress tends to reverberate through small or large role systems, to be communicated from one person or unit to another, often increasing as it moves on to include larger numbers of people or roles. This holds true for both acute and endemic stress. But while it is overt and clear with acute stress, perhaps even catastrophic in the short-term, it is more likely to persist undetected, and thus to be more insidi- ous, in the case ofendemic stress. Thus, an explosive situation can be resolved in family life but reciprocal antagonisms of a more modest nature are more likely to extend, to pervade all family role relationships, and to influence the very coping devices that can make the family role system impervious to modification.

The many different potential sources of stress, and their objective and subjective influences upon one another, introduce complexities into the theoretical and empirical analysis of stress. Be- yond that, however, the impact of stress on an individual or a population involves a sequence of events and processes that entails further complexities. For pur-

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poses of research, it is possible to assign average stress scores to potential stressors, particularly to external events and conditions, and even to consider individual deviations from these average stress scores. However, a number of measurement problems are posed by the necessary but difficult task of distin- guishing the contribution of the stimuli themselves, coping responses, concur- rent conditions (supportive or exacer- bating), and indirect pathways leading to residual sequelae.21 The greatest such problem, however, stems from the ex- traordinary resilience of human beings and their capacity for tolerating, coping with, and adapting to a wide range of types and degrees of stress. The ex- treme adaptability of human beings means that rapid coping devices almost immediately diminish the full, visible impact of stress. Since all analyses of stress must ultimately be traced to individual responses to stimuli, the rapidity of coping results in an underestimate of the stressfulness of the event or stimulus. This is the case even when we aggregate subjective evaluations of the stressfulness of eventsz3 or use judges' ratings1 * in assigning severity scores to stressful events. We may be able to compare individuals with one another, with themselves over time, or with a population norm. But the basic scoring of stress, involving as it does some modification of the level of strain due to immediate coping, is likely to err on the side of undervaluing the impact.

This dfliculty may be even more serious for the study of endemic than acute stress. Since the impact of acute stress is often sudden and massive, the objective changes in role behavior and the subjective strain are strikingly evident and measurable in spite of rapid coping. .. . _ -

With endemic stress, the very coping process itself is likely to be sociosyn- tonic, and may even become routinized. Thus, subsequent coping, adaptation, and their attendant costs are likely to be less apparent and often are taken for granted as the only way of handling a no-win situation. In order to observe and measure these effects, it is essential to obtain diachronic data on changes in objective role behavior and subjective experiences. Cross-sectional data and aggregate analysis can only provide ap- proximate and implicit evidence and, at that, only if carefully controlled internal comparisons are possible.

Because of the clear-cut differences in the nature of acute and endemic stress and the distinctive consequences of the different kinds of stress, another meth- odological problem arises. In the bur- geoning literature on life stress events, there is a frequently noted dilemma. While most of the studies report positive relationships between high levels of stress and malfunctioning, most of the results are relatively modest.lo It would appear that stress does not account for a great deal of the variance in adaptational success. Studies of stress, however, generally make no distinction between acute and endemic stress; if the effects of acute and endemic stress differ con- siderably and are often contradictory, the modest aggregate results could well be due to counteracting trends from the two types of stress. While it is not possible to draw a definitive conclusion from this consideration, a more careful distinction in the analysis of data on acute and endemic stress may reveal more sharply the consequences of different types of stress.

Two recent studies lend provisional SUDDOI? to the view that acute stress

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evokes more visible, measurable strain and symptomatology than does endemic stress. Croog and Fitzgerald* reported the analysis of panel data on”subjective stress” among wives of men who have suffered a first myocardial infarction. Their measure of “subjective stress” is equivalent to the concept of strain used in the present formulation. For most of the women, interviewed one month after their husbands had been hos- pitalized and again a year later, levels of strain were quite constant across this time period. Thus, a stress that had become endemic produced a constant level of strain. However, those women whose husbands were rehospitalized for heart disease during the same time period of a year experienced another acute, overt stress and showed higher levels of strain. In a different vein, EatonI4 reanalyzed data originally reported by Jerome Myers and col- laborators concerning the effects of stress on symptomatology. The main observation germane to an understand- ing of endemic stress is that life events appear “more stressful for those not ac- customed to them” (p. 232). That is, individuals who undergo high levels of persistent or recurrent stress show a lower symptom level than do those for whom the incidence of stress has sud- denly increased.

It is important to observe the different sources from which endemic stress, like acute stress, can stem, since stress from different sources can summate or cumulate. The existence of widespread endemic stress due to persisting inflation may be analytically independent of individual-level or interpersonal-level endemic stresses. But people who experience them simultaneously respond to the totality and not to the fact that they

are independent. And since endemic stress, like acute stress, finds its way rapidly into changes in role behavior affecting larger numbers of persons, the potentiality for exacerbated effects increases with the persistence of endemic stress.

PSYCHOSOCIAL IMPLICATIONS

Despite occasional references to the fact that some stress may become chronic, no clear distinction has ordinarily been made between the phenomena, the processes, or the consequences of acute and endemic stress. Nonethe- less, it is possible to develop a few hypothetical implications about the psychosocial significance of endemic stress. Three issues in particular warrant further consideration: the psychological processes linked to endemic stress, small social system dynamics in response to endemic stress, and some of the social welfare consequences.

It has been suggested above that the most striking manifestation of endemic stress in social behavior is extensive role contraction. From a psychological point of view, this is paralleled by subjective feelings of resignation. Resigna- tion refers to an acceptance of reduced role opportunities and reduced options, and a sense of futility in trying to alter restrictive conditions. Affectively, it is generally linked to a sense of helplessness or hopelessness, if not to a pervasive, low-level depression. While anger, resentment, and an altered self-concept are provoked by endemic stress, they are easily concealed by feelings of resignation, of diminished expectation, and by an awareness of the necessity of living within constraint. Frequently, these feelings of resignation are denied, a denial that is bolstered by a willing suspen-

16 ENDEMIC STRESS

sion of belief about existential causes and by an escape into trivialities. The bedroom comedy was a prime development of escapist cinema during the Great Depression. The renewed en- thusiasm for musical comedies, home- spun soap operas, romantic or fantastic adventure stories, and pink-candy realism in art and politics may well be signs of a desire to beguile our senses and distract us from the dialectical interplay of stress and resignation. Nonetheless, regardless of concealment and denial, a major consequence of social resignation is that people begin to desire what is attainable rather than striving to attain what is desirable.

Another distinction between acute and endemic stress concerns the psychological effects of anticipation. Al- though people may become"adapted" to crisis, as do the chronically deprived, specific crises cannot ordinarily be anticipated. When acute stress can be foreseen, either realistically or as a form of vigilance fantasy, the impact of the stressful event is likely to be softened. Janisz4. z5 has studied individual differences in response to the anticipation of acute stress and has pointed out that such anticipation results in superior levels of post-stress adaptation. It seems likely that the disturbing nature of unanticipated, acute stress leads many people to prepare (or even overprepare) themselves psychologically for stressful events that have a moderately high chance of occurring; thus they seek to reduce the subsequent impact. Dohrenwend9 has also begun to explore the effects of anticipation and control on the outcomes of stress experiences, although the results remain uncertain. The potential significance of ambiguity and uncertainty on responses to stress

has also been noted,I8 but the evidence is similarly indeterminate. In the ab- sence of more adequate data concerning the effects of anticipation and clarity of expectations on the experience and consequences of acute stress, it is difficult to establish useful comparisons with endemic stress. Indeed, it may well be that the anticipation of acute stress helps to transform that experience into one closer to endemic stress. In contrast to acute stress, endemic stress can more often be anticipated; although many ambiguities may attend the subsequent course of events, such anticipation does seem to render the experience itself less distressing. The corresponding costs of this anticipatory coping are not apparent, but they may involve either a gener- alization of feelings of resignation or the relinquishing of realistic goals because of manifest constraints.

Social processes are also set in motion by the widespread occurrence of endemic stress, processes that differ from those engendered by acutely stressful conditions. One of the remarkable and distressing observations in the literature on the Great Depression is the frequency of self-blame for job loss or for being unable to find a job in the face of massive unemployment.2 The irration- ality of this guilt is so patent that we might be startled were it not that guilt generully is part of the reaction to acute stress. The death of a loved one, unanticipated divorce or rejection, job loss, even hurricanes and other natural disasters all seem to call forth a sense of responsibility. If the occurrence is not considered a fault of commission, it is conceived as a fault of omission, a result of the things one didnot do to prevent or ameliorate the event.

A characteristic reaction also devel-

MARC FRIED 17

ops in the small social systems sur- rounding the victim of crisis. In these social networks, great sympathy is generated. The ritualized social responses involve efforts to compensate for short-term role contractions and personal deficits, to focus on the loss, and to introduce small escapes (e.g. , in the form of humor). The entire sense is one of supplementing or even exaggerating the congealing of social bonds around the victim to counteract the sense of loss, and perhaps to alleviate the feeling of guilt. This constellation differs markedly from the reactions to endemic stress. There is, indeed, a phenomenon akin to guilt, but it is not so much self- blame as a declining sense of self-esteem in response to endemic stress. The difi- culty of finding realms for mastery, the constant retreat from prior goals, the impossibility of gearing motives to ob- jectives all encourage a decline in self- esteem. As in other conditions of low self-esteem, particularly declining self- esteem, other people can help to supply the esteem one cannot generate within oneself. Informal in-group social par- ticipation becomes a natural route for seeking such support and facilitating the denial of difficulty. One might expect, for example, an increase in the number of people frequenting neighborhood bars, as well as an increase in the amount of time they spend there. Simi- lar informal small group activities may also increase in frequency; the shared views and shared activities help to compensate for declining self-esteem. At the same time, through the mechanism Fes- tinger” has described as “social com- parison processes,” the sharp edge of any sense of victimization is diminished. Everybody is in the same boat, traveling to an unknown downstream.

Economic analysis gives great weight to the juxtaposition of costs and benefits in evaluating policies. However, relatively little attention is devoted to es- timating whose costs and whose benefits are involved. As we move toward an evaluation of psych5logical and social costs and benefits, the importance of this issue becomes even greater since the distribution of psychological and social costs and benefits may not exactly parallel the distribution of economic costs and benefits. Lower income groups are already acclimated to a psychology of scarcity. The personal and social detriment manifest in their con- tracted role behavior, resignation, and aggression becomes stabilized. Eco- nomic decline and lowered real incomes generally have the most deleterious economic effects on this poorest seg- ment of the population. Yet the most severe, overt psychological distress is likely to occur among those with persisting aspirations. In objective terms alone, they may suffer a less serious loss. Their role contraction as well as feelings of resignation may be more transitory. But the impact of endemic stress on the frustration of anticipated goals, especially for those on a rising trajectory of careers and incomes, is bound to be a very painful experience with considerable costs to the society.

Finally, the implications of endemic stress for human service delivery must be considered. Some of the changes that have taken place at the national level are already evident and have had effects on the delivery of service at local levels. If this is, indeed, the beginning of a long- term trend, its full import has barely been recognized. Cutbacks in many human services are evident in the most recent federal budget. More cutbacks

18 ENDEMIC STRESS

are promised. Legislation of the Propo- sition 13 type, placing limits on real es- tate taxes, and thus on municipal ex- penditures, is a national issue although its fate has varied across the country.

It is not merely the enforced scarcity and its direct effe?ts that warrant attention. Cutbacks in funding constrain but do not entirely eliminate administrative and service options. However, conditions of endemic stress, operating at various system levels, create an atmosphere with more ominous constraints. In acutely stressful or catastrophic situations, bureaucratic controls tend to diminish and become more responsive to the crisis, more sympathetic to the victims. In conditions of endemic stress, the sense of helplessness and resignation results in narrowed vision, selective inattention, and a ready denial of the special needs of those in distress. Since this orientation has sanction at the high- est levels of government and is rein- forced by bureaucracies suffering declining fortunes, it readily filters down through entire systems of human services. Thus, it is likely to result in a more massive disregard of the human strains entailed by endemic stress than even the politicized realities would require.

To the extent that the sequelae of endemic stress are, as has been suggested, mainly hidden or latent or subclinical, they are readily denied. This denial is facilitated by the complex routes through which endemic stress may be linked with overt pathological conditions. It was noted above that acute stress may give way to endemic stress, may precipitate endemic stress, and may be an integral component of the time-lagged sequence by which acute stress leads to overt pathology. Alongside the many possible combina-

tions of acute and endemic stress, a pattern that seems particularly portent- ous, the development of clinical pathology often appears to involve acute stress superimposed on endemic stress. Thus, while endemic stress alone may not produce the overt symptoms of pathology so often linked to acute stress, it is likely to be indirectly implicated in many instances of malfunctioning and increased service demands.

To the extent that endemic stress is indirectly implicated in overt pathology, along with its subtler and hidden costs, widespread conditions of endemic stress are bound to create an expanded need for human services and sympathetic service orientations. But it is precisely the organizational conditions for providing such responsiveness to distress that are in demise. The price tag for society is likely to be enormous but undetected or improperly attributed. Only if we confront the human costs of coping with endemic stress, of dealing with the economic realities and politics of scarcity, can we recognize the massive consequences inherent in widespread social role contraction and in a psychological disposition to resignation on the part of our people.

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ENDEMIC STRESS: : The Psychology of Resignation and the Politics of Scarcity