Jackson, M.The Age of Stress: Science and the Search for Stability. Oxford: Oxford University Press. 2013. 328pp, £36.00 (hbk) ISBN: 978–0‐19–958862–6

The discourse of stress is applied to pressured corporate executives as much as to marginalised people with severe mental health problems. But what is stress? Is it something that happens in the body or something that happens to the body? Is it related to a predisposition, the impact of a traumatising event or to accumulating daily hassles? And what should be done about it? Social action or mindful meditation? With funding from the Wellcome Trust, Mark Jackson, Professor of the History of Medicine at the University of Exeter, has used the opportunity to explore Hans Selye's legacy as the centrepiece of his wider investigation in the history of stress research. He visited archives in Canada, interviewed important players in the field and included more peripheral areas such as the archives of research funding by the tobacco industry. Jackson takes the reader on a journey. He writes that ‘the central thesis of this book is that stress is a hybrid phenomenon, the product of both biological and cultural forces rendered visible by the technology and language of biomedical science’ (p.16). As if there were an imaginary helicopter and one could travel back in time, he explores the interactions between research agendas and overarching societal discourses. We see the discourse of stress emerging in the early 19th century, associated with rapid technological and societal change. The hazards of technologically accelerated living and their effects on groups and individuals are highlighted: railway spine includes the experience of dizziness and nervousness; nerves are the pivotal organ system of the time; neurasthenia characterises the bodily response to overloading these assumed places of articulation between the demands of life and the inner workings of the body. Rest cures were the therapy, if the target group could afford it. Tonics were thought to be capable of hardening these feeble key players of adaptation. Contemporary language still harbours these concepts; people experience ‘nervous breakdowns’ and English football players show ‘nerves’ at the penalty spot. It is fascinating to see how the different organs are thought to command the functions of the body over time: during the Restoration the heart was thought to be sovereign, and subsequently this place was give first to the brain and then to the endocrine glands. Contemporary neuroscience lets the brain reclaim the leadership position. Time and again we see cross-talk between wider societal developments and theories about the working of the body, microcosms and macrocosms. Jackson tracks the physiological research tradition and leads us back to Claude Bernard and his milieu interne, the maintenance of internal stability in a changing external environment. This concept of an internal balance of organ systems was further developed by Walter Cannon. His notion of the wisdom of the body alludes to the democratic functioning of body systems, communicating via nerves and chemical messengers (the hormones). Parallels between the inner working of the body and society at large as organisms appear throughout the journey in time Jackson takes us on. And just as individual bodies may run into trouble in the process of adapting to change, society itself becomes sick. We see the discourse of the sick social organism appearing on several occasions in talk of the body. Endocrinological research is at the centre of the book. Hans Selye is the protagonist, and his key concept is the general adaptation syndrome. This journey started with his observation that the end stage of many diseases looked very similar, ‘the syndrome of just being sick’. Laboratory work with rats as animal models was his research method. These rats were exposed to a variety of injuries and were injected with organ extracts. This method helped to identify interactions between the pituitary and adrenal glands in the response to stressors. Abbreviated as ‘HPA axis’ (the chemical communication between the hypothalamus, pituitary and adrenal glands) it still plays a crucial role in contemporary biological psychiatry and stress research. Selye was a pivotal figure in the post-war research landscape. He managed to create a research empire and popularised his model. He was creative in obtaining funding. This generated conflicts of interest, for example, financial arrangements with the tobacco industry. Jackson deals with this controversial figure in a careful and diplomatic way, taking a neutral stance. On several occasions the author explores conflicts in this historical journey, for example the conflict between stress-reduction strategies targeting the individual body and social action. He avoids taking sides in these conflicts and supplies the arguments with richly referenced material. The principal legacy of modern physiological and psychological studies of stress and parallel attempts to soothe troubled minds and bodies or to control the forces of nature is therefore not the attainment of well-being through the conquest of stress, which must remain an illusion, but a heightened appreciation of the shocking transience and instability of life. (p.270) A key issue arising is whether we opt for collective social action, individual strategies or both, to improve resilience. At a level below this overarching polarity more subtle decisions must be made. In the field of medical and social work these decisions are often related to processes of social administration. I would have liked more attention to the administrative consequences of stress-concepts. However, this may be material for another book.

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