Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping

by Robert M. Sapolsky

If each day is filled with cardiovascular provocations that everyone else responds to as no big deal, life will slowly hammer away at the hearts of the hostile. An increased risk of cardiovascular disease is no surprise.

“If you want to know if the elephant at the zoo has a stomachache, don’t ask the veterinarian, ask the cage cleaner.”

wrong with your patients? People don’t wear out chairs this way.” It was only the front-most few inches of the seat cushion and of the padded armrests that were torn to shreds, as if some very short beavers spent each night in the office craning their necks to savage the fronts of the chairs. The patients in the waiting rooms all habitually sat on the edges of their seats, fidgeting, clawing away at the armrests.

Headquarters—“Nope, you don’t see that wear pattern in the waiting-room chairs of the urologists, or the neurologists, or the oncologists, or the podiatrists, just the cardiologists. There’s something different about people who wind up with heart disease”—and the field of Type-A therapy takes off.

Now we’ve gotten somewhere. Being tickled doesn’t feel ticklish until there is an element of surprise.

The stranglehold of addiction is when it is no longer the issue of how good the drug feels, but how bad its absence feels.

The capacity to induce that craving doesn’t necessarily decline with time; as many drug abusers in that situation will say, it is as if they had never stopped using.

Stress a pregnant rat and her offspring will have an increased propensity for drug self-administration as adults. Give a rat an experimentally induced birth complication by briefly depriving it of oxygen at birth, and you produce the same. Ditto if stressing a rat in its infancy. The same works in nonhuman primates—separate a monkey from its mother during development, and that animal is more likely to self-administer drugs as an adult. The same has been shown in humans.

Once, during a concert of cathedral organ music, as I sat there amid that tsunami of sound getting gooseflesh, I was struck with

a thought—way back when, for a medieval peasant, this must have been the loudest human-made sound they would ever experience, something that would be awe-inspiring in ways we can no longer imagine. No wonder they signed up for the religion being proffered.

But unnaturally strong explosions of synthetic experience and sensation and pleasure evoke unnaturally strong degrees of habituation. This has two consequences. As the first, soon we hardly notice anymore the fleeting whispers of pleasure caused by leaves in autumn, or by the lingering glance of the right person, or by the promise of reward that will come after a long, difficult, and worthy task. The other consequence is that, after awhile, we even habituate to those artificial deluges of intensity and moment-ness.

Instead, it is the concrete state of how often your own nose is being rubbed in that instability.”*

Most studies have shown that it is middle management that succumbs to the stress-related diseases. This is thought to reflect the killer combination that these folks are often burdened with, namely, high work demands but little autonomy—responsibility without control.

Consider the following fascinating example: guys who win at some sort of competitive interaction typically show at least a small rise in their circulating testosterone levels—unless they consider the win to have come from sheer luck.

For example, poverty early in life has adverse effects on health forever after—harking back to chapter 6 and the fetal origins of adult disease. One remarkable study involved a group of elderly nuns.

It’s not about being poor. It’s about feeling poor, which is to say, it’s about feeling poorer than others around you.

So it’s not about being poor. It’s about feeling poor.

when you’re past the realm of worrying about having adequate shelter and food, being poor is not as bad for you as feeling poor.

the more income inequality there is in a society, the worse the health and mortality rates.

Neither literature has given a clear answer yet, but both seem to suggest that it is one’s immediate community that is most important.

What makes for social capital? A community in which there is a lot of volunteerism and numerous organizations that people can join which make them feel like they’re part of something bigger than themselves. Where people don’t lock their doors. Where people in the community would stop kids from vandalizing a car even if they don’t know whose car it is. Where kids don’t try to vandalize cars. What Kawachi shows is that the more income inequality in a society, the lower the social capital, and the lower the social capital, the worse the health.

A second variable had to do with denial. When a child went into remission, which frequently happened, did the parent look at him and say to the doctor, “It’s over with, there’s nothing to worry about, we don’t even want to hear the word ‘remission,’ he’s going to be fine”? Or did she peer anxiously at the child, wondering if every cough, every pain, every instant of fatigue was a sign that the disease had returned? During periods of remission, parents who denied that relapse and death were likely and instead focused on the seemingly healthy moment had lower glucocorticoid levels (as we will see shortly, this facet of the study had a very different postscript).

The researchers found that if you can look at your child having cancer and decide that God is choosing you for this special task, you are likely to have less of a stress-response (the larger issue of religious belief and health will be considered shortly).

It was tried with cancer patients and postsurgical patients, and it turned out that the patients did just fine when they self-medicated. In fact, the total amount of painkillers consumed decreased.

Exercise enhances mood and blunts the stress-response only for a few hours to a day after the exercise session.

The twelfth-century philosopher Maimonides constructed a hierarchy of the best ways to do charitable acts, and at the top was when the charitable person gives anonymously to an anonymous recipient.