By Kevin Lamb

Besides her painful and swollen joints, Barbara Townsend had endless fatigue and trouble catching her breath. An ordinary stairway looked like a boot camp's obstacle course. A preliminary blood test showed a good chance she had lupus.

But there was no time for rest. Townsend was completing her doctoral dissertation and working a high-pressure job as operations director for Huber Heights schools. Take time off? What did they think she was? Some kind of wimp?

``We don't even notice how hard we're pushing,'' said Janet Byars, a clinical counselor whose A World of Solutions practice focuses on stress relief for people and businesses. ``No wonder her immune system shut down.''

The damage unbridled stress can do to immune systems is way past the theoretical stage. Evidence surfaced 20 years ago that stress was ``an important risk factor for infectious disease,'' and maybe cancer, too, said Janice Kiecolt-Glaser, who has researched the subject for two decades at the Ohio State University. Yet Americans tend to pride themselves on how much stress they can pile on themselves, as if it's a collectable ornament instead of a health hazard comparable to smoking and obesity.

``You see it on people's faces every day,'' said Scott McGohan of the employee benefits support firm McGohan Brabender. ``Companies are doing a lot more with less right now, and people just keep taking their pills for acid reflux or headaches. If you've got chronic headaches, that's a real bad warning sign that something's wrong.''

Stress helps account for two-thirds of family doctor visits and, according to the U.S. Centers for Disease Control and Prevention, half the deaths to Americans under 65. It has been implicated in heart, stomach and mental disorders, along with the more ordinary headaches, backaches and high blood pressure and cholesterol. Kiecolt-Glaser's 10-year study of medical students found decreased levels of the body's natural killer cells, which fight infections and tumors, during even the familiar stress periods of exams.

More recently, imaging research at the University of Florida showed how mental stress can decrease someone's blood flow to the heart. The report last month in ``Circulation: Journal of the American Heart Association'' equated stress with bad cholesterol and smoking as risk factors for coronary heart disease patients.

Nobody seriously expects people to do away with stress entirely. Life without any stress is a scarecrow without its cross. What makes stress toxic, Byars said, is the different ways people process it - just as a body's ability to process sugar makes the difference between being energetic and diabetic.

A common example is when people see they're running late for something. It can prod them to become focused and catch up, or frazzled and later.

Among Kiecolt-Glaser's med students, the ones who practiced relaxation techniques diligently ``showed significantly better immune function during exams'' than those who did not. University of California-Irvine researchers found regular laughter to improve heart attack patients' prospects about as much as beta-blocking drugs. Duke University found a 74 percent reduction in cardiac events among patients who were taught stress management along with their medical care.

``We can do something about stress,'' Byars said. Controlling it isn't just about breathing deeply and moaning odd syllables, either. One of the first things Byars taught Townsend was how to prioritize her overloaded schedule, and how the sun still rose tomorrow if the bottom of her list went undone.

Proper diet, physical activity and rest are part of stress management, too, Byars said, as are forgiveness, filtering out past or future chores and working toward well-defined goals.

``If you have a very clear and definitive focus on what it is you're looking for, then all those distractions that are causing stress aren't distractions anymore,'' said Bruce Stapleton, the Lifegevity health and fitness consultant whose program places stress management at the core. When Stapleton's Elan Vital center was open in Centerville, he found rigorous dieting and exercising alone didn't improve health as effectively as moderate diet and exercise along with stress reduction, replicating 15 years of findings at the Canadian Institute of Stress.

Part of his center was a relaxation room where people could tune out the world. ``We had a guy once who stayed in there a long time, and we were worried so we opened the door and asked if he was about done,'' Stapleton said. ``He said, 'No, I'll be off my phone in a few minutes.'

``I hadn't even thought to ban cell phones from the relaxation room. But the society's basically taught people that they always have to be doing something productive.''

One reason American culture doesn't take stress seriously, Byars said, is that conventional medicine views illness and injury as inflicted externally, not from within a person. ``Patients were seen more as a car needing a tune-up'' after antibiotics were discovered, he said. Yet the immune system's capacity for self-repair is hardly controversial, from torn muscles to paper cuts.

``Most people with lung cancer have been smokers, but the majority of smokers never develop lung cancer,'' Byars said. ``Why don't they? Their bodies did something different.''

On a more everyday level, all people are constantly exposed to germs but few come down with infections. It must not be the presence of germs that causes illness, she said, but the absence of an adequate defense from the immune system. As Kiecolt-Glaser and others have found, stress can be the saboteur.

Byars realized the difference when she lived in Switzerland 10 years ago. ``This is no third-world country, but they took two-hour lunches, they took walks every afternoon and they ate foods that made me think, 0h-my-God-you're-kidding. But they weighed 20 pounds less than us. It's not just about calories. I know one reason so many Americans are fat is we're always rushing.''

What Americans saw as productive multi-tasking, Europeans at the Swiss NCR office saw as wasting time. ``Why are those Americans moving so fast?'' they'd say. ``They're making mistakes.''

They're keeping their edge, they'd say, but it's a state of aroused anxiety. From cardiologist Dr. Herbert Benson a generation ago to psychologist Joan Borysenko in the 1980s, researchers at Harvard Medical School and elsewhere have confirmed the physiology of the fight-or-flight response to heightened stress or alertness. Conditioned through prehistoric millennia that stress signals physical danger, humans react instinctively with increased heart and breathing rates, and higher blood pressure diverting resources to critical muscles.

Among hormones instrumental in that response are adrenaline and cortisol, Borysenko found in lab experiments. Those energy boosters ``are also potent inhibitors of our immune system,'' Byars said. ``This constant activation of the fight-or-flight response causes various systems of the body to develop chronic problems, such as high blood pressure or a strained heart.''

Benson famously developed the relaxation response of focused, deep breathing to counteract the fight-or-flight response. Townsend had heard of the concept when she first met Byars, but frankly, ``I thought it was kind of hocus-pocus stuff. If someone had said I was going to learn to meditate, I would have thought they were crazy.''

How could she possibly make time for such trivial activity? Slowing and focusing her mind and not thinking? What was the point? Who could actually do that?

``When I started, I lasted maybe 15 seconds,'' Townsend said. ``I had to think of something - what am I going to have for dinner, or what did I leave at the office? But now I can get myself into a relaxing mode and just kind of leave the cares of the day behind.''

She found herself getting more things done as she pared back her to-do list. There was time in her week for massages again. She learned what she calls the one-year rule, which says if it won't be important a year from now it's not really so important now. She learned she could take a few deep breaths when someone cut her off in traffic, using oxygen to clear her mind instead of fan her flames.

``When you start examining the reasons stress is coming into your life, you look around at how unimportant they truly are,'' Townsend said. As her temperament yielded from stressed alertness to focused awareness, her stress became intermittent instead of constant. She noticed how it changed her, how she tended to eat when stressful.

By that time, Townsend felt better and a dozen or so blood tests had ruled out lupus, but her joints still hurt and her hands and feet still swelled. ``Janet was the one who suggested I might have food allergies,'' she said, ``and by golly, that's what it turned out to be. As soon as I started laying off corn and yeast, I really started picking up.''

She couldn't have noticed it without the stress relief, she said. She no longer needs two meditations a day, but she wouldn't give up the one after work.