The Science of Stress

Stress Cover

The Science of Stress, subtitled “Living Under Pressure”, is a gorgeous volume from the University of Chicago Press that I’ve had on my desk for the past year, fully underlined and highlighted.  My favorite passage is on page 49, under the heading “The Performance Edge”:  Managing stress is to the brain what building muscle through exercise is to the body.  Of course finding the right balance between pumping too much or too little weight and running too little or too much is key.  So it is with stress: not enough stress leads to boredom and lethargy; too much stress leads to reduced performance and damage.

Stress is implicated in just about everytying these days and Elliott Forrest’s seminal book on Stress and Vision was, in many ways ahead of its time.  What the U. of Chicago book emphasizes in rather artsy fashion, without mentioning vision specifically, is the confluence of bottom/up and top/down interactions.  This mind/body flow is something we all too often pay lip service, but ignoring its implications can result in excessive wear and tear in any of our physiological or psychological systems.  Forrest addressed this wear and tear in terms of allostatic load, the outcome of crossing the boundary between eustress (positive stress, or a healthy cognitive load) and distress (counterproductive overload).

Eustress Distress

Heavily influenced by Hans Selye, Forrest masterfully addressed the eustress/distress continuum as it relates to accommodative/convergence interaction with a spring analogy.  Along with his colleague, Marty Birnbaum, Forrest postulated that most visual disorders have their origin in nearpoint stress and specifically in the disruption between sympathetic and parasympathetic responses at near.  This results in secondary adaptive responses in the vergence system that can be expressed at any distance and at a variety of levels.  This dovetails nicely with more mechanistic models of visual system balance.

Before Forrest & Birnbaum, and Hung & Ciuffreda, modelling of stress in the visual system was done by Leo Manas in his classic work on Visual Analysis.  It was a book I discovered serendipitously as a student hanging around in the PCO library, and it changed my entire outlook on vision and on life.  Manas depicted visual demand and performance as the inverted “U” curve, setting the stage for what is now commonly known as the Yerkes-Dodson Human Performance and Stress Curve.


While we have plenty of references in the literature on how Yerkes-Dodson applies to patients, we need occasional reminders of how this continuum helps us as providers to stay centered.  For more on this, I’ll direct you to a recent blog by one of my favorite vision therapists, Robert Nurisio.

5 thoughts on “The Science of Stress

  1. I was very fortunate to be in one of the last classes that Leo Manas taught at ICO, before retiring. I am so glad now (not then) that he made us read and tested us on almost every word in his book, “Visual Analysis.” I’ll never forget our discussions about my my patients that I was working with, in the ICO VT Clinic.
    I still find myself using many of his ideas today. He was responsible for making the VT Clinic at ICO, at the time, one of the largest VT Clinics in the country.

  2. Thank you for your kind words, Dr. Press!

    As an aside, your post is quite timely. Just yesterday, we were discussing (as a staff) the manifestations and management of stress in some of our patients. I’ll be sure this is shared with the crowd! 🙂

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