I have never read such a dry piece of nonfiction. Robert throws with medical words around as if he is writing to someone who studied medicine instead of the normal person. Am I just the wrong audience?

Though I passively delayed reading this for several years, in part because I was already pretty familiar with the stress literature, I’m glad I finally did read the book. It was more interesting, involved, and nuanced than I expected. I learned some things, and more than that enjoyed the comprehensive and entertaining review of what is and isn’t known in the field and how we might apply a few things practically. I’ll likely return to it someday.

This book is so very good despite it being so very long. Most books mention stress as this bad thing that causes all kinds of ailments, but Robert Sapolsky really goes onto depth and explains the biological mechanisms behind a variety of things that are related to stress, and he does it well scientifically. On top of this feat, he's also a great writer with the talent of making an expository text interesting and hard to put down. Think Bill Bryson but add a ton of scientific rigor. This is astounding - a balancing act of making the text entertaining while keeping it at a high scientific standard is difficult to pull off. Plus, as a scientist myself, I'm normally not interested in reading about science - either it's not rigorous enough, or it's too academic for my leisure time given I already deal with this stuff for work. I also liked that the author was modest, seemingly not an uberego, which as a lady in academia is appreciated - especially at Stanford, where I encountered way too many of these egomaniacs!

Although this reads more like a textbook than a self-help or pop-science book, the author does pepper it with some humor to keep you going. For example: “This is how gratification postponement works—the core of goal-directed behavior is expectation. Soon we’re forgoing immediate pleasure in order to get good grades in order to get into a good college in order to get a good job in order to get into the nursing home of our choice.”


Big Ideas:

+ Acute and chronic stress are different, as are physiological and psychological stress. Humans have a unique capacity to stress about perceived future dangers and to ruminate on past stressors
- “It is not so much that the stress-response runs out, but rather, with sufficient activation, that the stress-response can become more damaging than the stressor itself, especially when the stress is purely psychological. This is a critical concept, because it underlies the emergence of much stress-related disease. That the stress-response itself can become harmful makes a certain sense when you examine the things that occur in reaction to stress. They are generally shortsighted, inefficient, and penny-wise and dollar-foolish, but they are the sorts of costly things your body has to do to respond effectively in an emergency. And if you experience every day as an emergency, you will pay the price. If you constantly mobilize energy at the cost of energy storage, you will never store any surplus energy. You will fatigue more rapidly, and your risk of developing a form of diabetes will even increase. The consequences of chronically activating your cardiovascular system are similarly damaging: if your blood pressure rises to 180/100 when you are sprinting away from a lion, you are being adaptive, but if it is 180/100 every time you see the mess in your teenager’s bedroom, you could be heading for a cardiovascular disaster. If you constantly turn off long-term building projects, nothing is ever repaired”
- “If stress enhances some function under one circumstance and disrupts it under another, think time course, think 30-second sprints across the savanna versus decades of grinding worry. Short-term stressors of mild to moderate severity enhance cognition, while major or prolonged stressors are disruptive”
- “One of the themes of this book is the goal of contrasts. Physical stressor, you want to activate a stress-response; psychological stressor, you don’t. Basal conditions, as little glucocorticoid secretion as possible; real stressor, as much as possible. Onset of stress, rapid activation; end of stress, rapid recovery”

+ As with so many situations in life (so far this is the theme of 2019), when it comes to coping with stress, CONTEXT MATTERS!
- “Sometimes, coping with stress consists of blowing down walls. But sometimes it consists of being a blade of grass, buffeted and bent by the wind but still standing when the wind is long gone”
- Not everything is purely psychological, especially once we have a disease. We can’t psychologically heal ourselves from cancer and it’s dangerous to imply that we can.
= “Stress is not everywhere. Every twinge of dysfunction in our bodies is not a manifestation of stress-related disease. It is true that the real world is full of bad things that we can finesse away by altering our outlook and psychological makeup, but it is also full of awful things that cannot be eliminated by a change in attitude, no matter how heroically, fervently, complexly, or ritualistically we may wish”
= Yet, “there remains a whole realm of health and disease that is sensitive to the quality of our minds—our thoughts and emotions and behaviors. And sometimes whether or not we become sick with the diseases that frighten us at two in the morning will reflect this realm of the mind. It is here that we must turn from the physicians and their ability to clean up the mess afterward and recognize our own capacity to prevent some of these problems beforehand in the small steps with which we live our everyday lives”
- Socioeconomic status impacts which coping methods are most effective. Internal locus of control is more effective for higher SES individuals. When we really can’t control a situation, it’s important to acknowledge that
= “Certain techniques for reducing stress work differently depending on where you dwell in your society’s hierarchy”
= “Always attributing events in life to your own efforts (an internal locus of control) is highly predictive of lifelong health among that population of individuals who are the epitome of the privileged stratum of society—Vaillant’s cohort of Harvard graduates. However, in a world of people born into poverty, of limited educational or occupational opportunities, of prejudice and racism, it can be a disaster to be a John Henry, to decide that those insurmountable odds could have been surmounted, if only, if only, you worked even harder—John Henryism is associated with a marked risk of hypertension and cardiovascular disease”

+ Some potentially universal principles of stress management
- “I would apply the 80/20 rule to stress management: 80 percent of the stress reduction is accomplished with the first 20 percent of effort”
- “This business about the calm amid the arousal isn’t just another way of talking about ‘good stress’ (a stimulating challenge, as opposed to a threat). Even when the stressor is bad and your heart is racing in crisis, the goal should be to somehow make the fraction of a second between each heartbeat into an instant that expands in time and allows you to regroup. There, I have no idea what I’m talking about, but I think there might be something important lurking there. Enough said”



Other Ideas:

+ The placebo effect is important and real. It operates in some areas but not others and involves endorphins
- “Believing you’ve received an effective medical treatment when you actually have not has no beneficial effects for epilepsy, elevated cholesterol levels, infertility, a bacterial infection, Alzheimer’s disease, anemia, or schizophrenia… [And there is] a clear indication that placebo effects are highly effective against pain”
- “[Placebos] work by releasing endogenous opioids. As but one example of the evidence for that, block opiate receptors with naloxone, and placebos no longer work”

+ Hostility, rather than “type A personality,” increases the risk of disease. This may be due to underlying time-pressuredness and insecurity that lead to hostility
- “More recent studies have shown that hostility is associated with a significant overall increase in mortality across all diseases, not just those of the heart. Friedman and colleagues stuck with an alternative view. They suggested that at the core of the hostility is a sense of ‘time-pressuredness’... and that the core of being time-pressured is rampant insecurity. There’s no time to savor anything you’ve accomplished, let alone enjoy anything that anyone else has done, because you must rush off to prove yourself all over again, and try to hide from the world for another day what a fraud you are. Their work suggested that a persistent sense of insecurity is, in fact, a better predictor of cardiovascular profiles than is hostility”
- “The 'executive stress syndrome' is mostly a myth—people at the top give ulcers, rather than get them. 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”

+ Trying to avoid our emotions may actually amplify them physiologically
- “Repressing the expression of strong emotions appears to exaggerate the intensity of the physiology that goes along with them”
- “A lesson of repressive personality types and their invisible burdens is that, sometimes, it can be enormously stressful to construct a world without stressors”

+ Male erections don’t always signal sexual arousal. This is especially important information for male victims of sexual assault who had an erection during the incident
- “Among many social mammals, males have erections during competitive situations as a sign of dominance. If you are having a dominance display with another male, you get an erection and wave it around in his face to show what a tough guy you are. Social primates do this all the time”



Potent Quotables:

“In the face of strong winds, let me be a blade of grass. In the face of strong walls, let me be a gale of wind.” Quaker saying

As a physiologist who has studied stress for many years, I clearly see that the physiology of the system is often no more decisive than the psychology… [There are] things we all find stressful—traffic jams, money worries, overwork, the anxieties of relationships. Few of them are “real” in the sense that a zebra or lion would understand. In our privileged lives, we are uniquely smart enough to have invented these stressors and uniquely foolish enough to have let them, too often, dominate our lives. Surely we have the potential to be uniquely wise enough to banish their stressful hold.

Por fin me leo algo de Sapolsky de cabo a rabo. Si bien este libro es de una temática distinta a la biología del comportamiento, que es lo que principalmente le ha llevado a su fama mundial, "¿Por qué las cebras no tienen úlceras?" es su libro clásico, aquel con el que se hizo conocido como divulgador.

Sapolsky es un gran comunicador, y además es un científico al que le gusta revisar sus trabajos y la actualidad, y en esta edición, creo que la tercera que modifica, añade más información y cambia elementos del libro que han quedado obsoletos o entredichos.

He de decir que lo he leído más lento de lo que leo normalmente porque venir de trabajar y estudiar, tratando temas de fisiología, para encontrarme de vuelta con ellos en el libro se me podía hacer pesado, pero es un libro que está escrito genialmente, con un tono de humor que me encanta y una atención al detalle y los ejemplos sistemática y genial.
El libro además contrapone continuamente todos los datos, teorías y resultados, para que no confiemos nunca en una inmutabilidad y perfección religiosa de la ciencia.

En definitiva, un libro de primera línea para aprender de una manera holística sobre el funcionamiento del estrés.

This manifestation of stress is going to my 'books to give friends as a gift' list. The topic is morbid but written in a way that makes it a must read for anyone interested in managing their own well being and avoiding brain shrinkage.

Brilliant. Absolutely brilliant. Mr. Sapolsky attacks a very scientific subject with wit and charm. If you're a biologist or anthropologist or like me, just a reader who's interested in finding out more about our bodies and about my disease, multiple sclerosis, you will greatly enjoy this book. I took it in chunks and that was probably the best thing to do but I do recommend it for anyone who's curious about how chronic stress affects the human body.

This guy is very good at explaining the science behind stress to a layman, but ultimately I didn't like it and wouldn't recommend it. There are times when the author is pretty full of himself. It was annoying. And the random sexual references that are totally unnecessary are also a deterrent from recommending it to others. (There were times when sexual subjects were an appropriate topic and relevant to the discussion. I obviously don't mind those.) I read this book to find help and just got more of a "you're already screwed" vibe.

Another book from Robert Sapolsky, it talks about stress (the stimulating and the chronic one), and you won’t believe the extent of damage caused by the chronic stress, from cardiovascular diseases to diabetes , depressions, hypertension , mental illnesses etc. . this book should be your guide to understand stress and manage it.

This is a book packed full of information on how stress can cause our body to go haywire. You will find explanation for how stress affects your weight, sleep, and health in general.
Although there are still lots of jargon and terms in the book that you will find alien, the explanation is given in the most simple way possible, making it an accessible material in general.

However, after reading through all the chapters on how stress can wreak havoc to our body, you don't actually get a lot of materials on how you can counter them.
So, this is a book on how stress can cause damage to your body. If you're looking for a solid book on recommendations to deal with stress, this might not be it.
To the author's credit, he is trying to be as accurate as possible, and therefore I believe he is trying his best to recommend the most scientifically accurate practice to deal with stress; and sadly, there may not be many, although there is a few practical one such as exercise and meditation.

This is an excellent and thorough outline of all the ways that stress impacts health. The author writes scientifically yet colloquially, making the read worthwhile. While there is a general theme that too much stress is bad, I still found it amazing how stress specifically affects every specific domain that he mentions, and how other things affect how we experience stress. He goes into themes like depression, cancer, relationships, and many kinds of diseases, all while citing studies and trying to be funny lol. I can’t wait to apply this all in my new job in the biofeedback clinic!!

A brilliant and incredibly well-written book.

Every time I read something by Sapolsky I get amazed with how prodigious he is. No matter what he's talking about, everything he says is interesting and engaging. That summarises my feelings with this book. I don't find the stress subject very interesting, just because I often suffer from it, therefore I prefer to act like it doesn't exist, but unexpectedly, this helped me realize that I've been doing the entirely wrong thing (want to know why? read this book). However, don't come to this book expecting to get advice for your stress problems. This book will teach you about how your body reacts to stress, why it happens, the biology and chemistry behind it and also, how it could end up killing you. Just in the last chapter, Sapolsky will specifically talk about what could you do about it, though repetively saying that it's an entirely subjective thing. This summarizes it:

By now, if you are not depressed by all the bad news in the preceding chapters, you probably have only been skimming. Stress can wreak havoc with your metabolism, raise your blood pressure, burst your white blood cells, make you flatulent, ruin your sex life and if that's not enough, possibly damage your brain. Why don't we throw in the towel right now?

One of the greatest things about Sapolsky's books, it's that though some things are difficult to get, he will continually repeat what you have learned and how everything it's connected. Some topics may be hard, but he will do everything to make it clear for you.