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Stress and Gay Men: Beating Back the Beast

By Walter Armstrong

“I can't take it anymore," my friend said when I stuck my head in his office at work. "About 10 minutes ago, I was about to put my head down on the desk and just start crying."

I looked at his desk—clean, shiny, papers in neat piles. I looked at him, the art director of a magazine, staring blankly at his wide-screen computer—a typically bright, smiling gay man on the verge of a major meltdown.

"I've got to get a prescription for something to help me sleep. I lie awake for an hour, I wake up two or three times during the night. Then I come to work, a zombie. Exhausted, irritable. Can't function." His face was flushed, and his eyes welled up with tears.

"The rest of my life is falling apart, too. I don't have the energy to go to the gym, to spend time with my boyfriend. And next week the pressure starts up all over again. It just never seems to end."

I shuffled through my deck of condolence clichés wondering which one to play. "Drugs are definitely the answer," I said.

He didn't laugh. "All I need is one good night's sleep," he finally said. "Is that too much to ask?"

Stress: A Backgrounder
Stress is general, and has yielded a predictable blockbuster industry of goods, services, and information in the quick-fix genre. It's easy to be cynical about the entire concept, at least until you're faced with its raw effects at the breaking point. No foam-rubber Stress Ball or gentle-rain fountain-and-sound machine was going to help my friend. People suffering from stress—people in distress—tend to have more basic survival needs, such as a good night's sleep, which money can't necessarily buy.

That makes sense, because stress is all about survival. Google the word, and among the 200 million entries you'll find the phrase "fight-or-flight response" countless times, along with anecdotes about how the brains of our prehistoric ancestors, when encountering the daily saber-toothed predator, would release a shot of neurons and hormones that triggered a kind of bodywide Code Blue, allowing them to operate on pure animal instinct.

Heart, lungs, and circulation all begin racing, flooding the muscles with oxygen-filled blood that primes the arms and legs. If it sounds like an injection of steroids, that's because it is: Hormones like cortisol and adrenalin are flooring the pedals. Nonessential systems shut down—stress's dry mouth, tight scalp, and cold sweat are the result of saliva and blood being diverted from the skin to more critical organs. Meanwhile, the brain is managing the crisis in its way. Chemical messengers send out alerts to stop wasting any extra energy on high-level functions and to refocus it on storing this life-threatening event in the long-term memory bank—for next time if there is one.

This fight-or-flight response, which served to get hunter-gatherers to fight another day, is now an evolutionary throwback that nature neglected to dial down for our generally less-risky modern lifestyle. As a result, my art-director friend meets his deadline pressures with a biological jujutsu way out of proportion to the actual threat, sending him from zero to 120 in an instant. And he pays the price with insomnia. To be sure, not everyone responds in overdrive to stressors—plenty of laid-back souls are blessed with cooler, calmer inner cavemen. Nor is everyone who does meet daily challenges in hyper mode a mental case. Many Type-A personalities spend their days juiced up on stress at work (and make the rest of us miserable), then go home to a dreamless sleep. So why is someone like my friend—anal in the typical art-director style but otherwise not a Type-A—in distress?

Stress and the Gay Factor
Don't blame it on being gay. "There is no association between homosexuality and mental illness," said Gilbert Herdt, director of the Program in Human Sexuality Studies at San Francisco State University. "On the other hand, gays and lesbians have higher rates of stress-related problems, such as anxiety, depression, mood change, and substance abuse related to alcohol and drugs."

There's even an official name for it: minority stress. "The concept has emerged from mental health research to explain the impact of simple discrimination in a huge range of areas for people," said Herdt. "Discrimination in jobs, housing, health care, and adoption rights that are denied—these losses accumulate over a lifetime. And the traumatic reactions provoke people to cope, often without the necessary means of social support."

Other researchers divide these reactions into three categories: internalized homophobia, or turning society's hostility toward homosexuality against the self; stigma, or expecting such hostility; and experiencing it outright, in acts of discrimination or violence.

Many studies show that the more minority stress you face, the more distress you feel. Gay pride and progress notwithstanding, a case could be made that the symptoms are everywhere in our community. Along with the benchmarks like depression and anxiety named by Herdt are two that are less familiar: body image and HIV risk.

Stress, Body Image, and HIV Risk
Researchers have repeatedly found that gay men have more dissatisfaction with their body, physical symptoms of stress, and eating disorders than straight men, all of which add up to a basic body-image issue. The extent to which gay culture itself only increases this stress with its hypermasculine ideals is an open question. As for HIV, the Polaris seroconversion study in Ontario, Canada, found that 36 percent of positive gay men reported five or more stressful events in the six months prior to their diagnosis, compared with 21 percent of negative guys. Overall, this stress burden caused a two-fold increase in HIV risk, but for gay men under 30 with serious money or security issues it was a shocking four times higher.

Increasing Your Stress Threshold
As with all psychological problems, your response to stress is influenced by numerous factors, including early nurturing, personality development, and genetics. Many, if not most, gay men bear the scars of growing up homosexual, whether they experienced physical and emotional abuse or softer, more subtle forms of institutionalized hatred. To make matters worse, minority stress tends to be a chronic condition—you can get sensitized to it, and so can your brain.

"Years of research have told us that people do become sensitized to stress, and that this sensitization actually alters physical patterns in the brain," said Seymour Levine, a stress expert at the University of Delaware. "That means that once sensitized, the body just does not respond to stress the same way in the future. We may produce too many excitatory chemicals or too few calming ones—either way we are responding inappropriately."

The solution to stress—minority or otherwise—begins by identifying what you actually have control over and can therefore change. Everyone's life is packed with eventfulness—work, love, health—that almost by definition involve stressors. Since limiting external stressors may not be an option and rewiring your neurochemical fight-or-flight response is impossible, experts advise developing your ability to dial up your stress threshold, so that fewer stressors trigger the hormonal rush.

This is easier said than done. "Study upon study has shown that simple relaxation does not work in many people," said Mt. Sinai Medical Center's Rachel Yehuda. "Telling someone who has been sensitized to stress to just relax is like telling an insomniac to just fall asleep."

Psychologist Robert Epstein, a stress specialist, agrees. "If you wait until you're feeling stressed before you employ some technique for managing stress," he said, "it's already too late. You need to have a bag of tricks that you can deploy proactively. If you turn to them throughout the day, that changes your stress tolerance."

Among the best tricks, according to Epstein, are meditation, deep breathing, relaxation stretches, and visual imagery, each of which may limit the fight-or-flight instinct in the instant. These have an added benefit: You can practice them while sitting at your desk at work, which is where most stress hits. Still, these tricks require being able to yank yourself out of its grip fast enough to promote relaxation.

Exercise and Stress Reduction
Exercise, of course, is a top prescription for all healthy living, and stress management is no exception. Still, controversy occasionally erupts over the question whether exercise, which has some of the same effects on the body as stress, may be more harm than help.

Ernie Randolfi, associate professor at Montana State University, begs to differ, and has compiled a lengthy list of studies touting exercise's de-stressing benefits. These studies found that by simulating the fighting or fleeing that is the point of the stress response, a workout detoxifies the hormones and other byproducts still circulating in the body. Pumping iron, for its part, releases the tension stored in muscles, allowing them to return to their natural resting potential. Swinging a bat or a racquet at a ball can do the same thing for aggression. Running or swimming can be meditative, calming, and focus you on breathing. A good sweat primes your cardiovascular system, countering the stress effects. You know the drill.

Unlearning Your Stress Triggers
The real trick, of course, is to prevent pressures and frustrations from becoming stressors in the first place. No five-minute meditation or hour-long massage will perform permanent magic. Unlearning negative patterns and relearning healthier ones is hard work. Time management, assertiveness training, and behavior modification can help you deal with specific stressors, while psychotherapy or cognitive therapy can take you down to the root of it all.

Medication can be very effective at treating stress's symptoms, most notably anxiety, depression, and insomnia. Relieving these symptoms may not rewire your brain, but it can give you a leg up on what may otherwise present itself as a hopeless situation that you feel helpless to change. And that leg up can, gradually, help you climb out of the deep pit.

As for my art-director friend, he called in sick for two days, which was worrying. But when Monday morning came, he was back on the job. After a night from hell during which he tossed and turned waiting for the Ambien to knock him out, he finally went to the ER. "I was exhausted but I couldn't sleep, and that scared the hell out of me," he said. "It felt like a switch inside my brain that goes on and off was stuck in the on position. And it was beyond my power to turn off."

At the ER, he got some high-dose Ambien, which finally turned the switch off. Later, his doctor gave him a referral for a sleep therapist, and the standard advice about stretching, meditation, and a hot bath before bed. Since job pressures are his number-one nightmare, the doc suggested that he focus on compartmentalizing work—by limiting his personal emails and phone calls, say, and completing tasks before calling it a day—so that when he leaves at night, he also leaves it behind.

"I never thought of myself as a yoga type, but I'm going to buy a tape and try meditating," he said. "But the most important thing is that I have some hope now—and a prescription for super Ambien." Then he laughed, and meant it.

About Walter Armstrong: Walter Armstrong is a writer and editor in New York who was the editor-in-chief of POZ magazine for six years. Armstrong has also worked at Rolling Stone, Men's Journal, Us, GQ, OutWeek, and numerous other magazines.