15

The Forgotten Victims of Inner-City Stress

West Oakland, California, was "Miami Vice" in the mid-1980s, caught-as were so many other impoverished inner cities-in an epidemic of drugs, alcohol, and violent crime. Murder rates soared as whole families were destroyed.

Who took the brunt of it? "Everyone was a victim," says Frank Staggers, Jr., M.D., who, at the time, was the director of alcohol, drug and methadone programs at the West Oakland Health Center, one of the largest health centers in the U.S. to provide health care to an urban black population. But the forgotten victims, he says, were the elderly, the grandparents who had to absorb the loss, bury the pain, and then shoulder the enormous responsibility of raising a family all over again when their sons or daughters, grandchildren, or friends had been killed.

Dr. Staggers also carried a heavy patient load in general medicine at the Health Center. Many of the people he saw were elderly, and most of them had seriously high blood pressure. In the inner city, high blood pressure can be like a death warrant. It strikes blacks twice as often as whites. It's the leading cause of death among older African Americans. But because conventional wisdom among doctors at the time discounted any significant link between stress and hypertension, modern medicine offered little in the way of effective stress management to patients. Treatment then-and it's still true today-was through medication. Dr. Staggers believed otherwise. He saw that his patients' blood pressures were highest when they were under the most stress. He tried something. He would ask his patients to sit quietly in a chair in his office for a few minutes after he had taken their blood pressure. A few minutes later he would check again. Down. Not much, but down. A good sign.

Despite an almost back-breaking case load, he felt compelled to venture in a new direction: research. What would happen, he wondered, if his patients were practicing something that really gave the body a deep rest? There was an urgency to find out the answer.

"Hypertension among black Americans is a much more malignant disease than in white Americans," he says. "It tends to come on earlier, tends to be more severe, and tends to create more organ complications-more strokes, more heart complications. It requires much more potent approaches to treat it."

First, Dr. Staggers looked for techniques to study.

"We looked for techniques that were standardized, which meant that they were taught the same way every time, everywhere. If it's taught a thousand different ways, then the study can't be replicated by another researcher. We also looked for techniques with a track record, something that had research to back it up. And finally, we wanted to answer a very simple question: Is it better to have the mind relax first and have the body follow suit, or is it better to have the body relax first and have the mind follow suit." After careful investigation of scores of procedures they settled on two, one of each type: the Transcendental Meditation technique and Progressive Muscle Relaxation (PMR), which is a widely practiced, well-researched physiological approach to relaxing the mind and body.

Next Dr. Staggers looked for funding. He contacted scientists at Maharishi University of Management for help in the search. Together, the researchers spent several months in early 1987 applying for grants and being refused for a "faulty hypothesis." No one linked stress to hypertension, it was a very controversial idea. They finally received $200,000 from the Retirement Research Foundation in Chicago. Dr. Staggers recruited 200 older African Americans who suffered from mild high blood pressure, and the study was underway.

The experiment was set up like this: participants would be randomly selected to learn either the TM technique, PMR, or join a control group. Each participant would be matched with one from the control group for age, gender, weight, etc. Each participant would be involved in the program for three months. Blood pressure would be monitored regularly and compared before and after the three-month study. The entire project took Dr. Staggers and his colleagues almost 18 months complete.

The results were striking. The TM group did the best-the technique proved to be about twice as effective as PMR-while the control group was the least effective. But perhaps even more significantly, the TM technique reduction was as deep as that of high blood pressure medication-but without the often harmful side-effects of such drugs.

Dr. Staggers and his colleagues wrote up two studies based on the experiment. Both studies were accepted for publication in the American Heart Association's journal, Hypertension-the first in March 1995, the second in August 1996.^1,2 Both studies received considerable national and international publicity in the medical and public press. But even before the publicity had kicked in, the mainstream scientific community was catching on: Stress was finally being recognized as a risk factor in hypertension, and stress reduction was seen to be an viable potential antidote. In fact, the results have proven so promising that the National Institutes of Health have given more $5 million to continue the TM research on African Americans, to look at its effects over a full year, not just three months, and to evaluate its influence on other risk factors for heart disease.

Today, Dr. Staggers, 46, is the medical director of the Haight Ashbury Free Clinic Drug Detoxification Center in San Francisco, and the medical director of a methadone program at SAACS-Successful Alternative for Addiction and Counseling Services-in Hayward, California. And he also continues to see patients at the West Oakland Health Center.

For Dr. Staggers, the implications of these findings go far beyond a 12-point drop in systolic blood pressure,

"Most Americans can't comprehend the amount of stress in these poorer, inner-city communities," he says. "Most of my younger patients are either stressing themselves to death, drinking themselves to death, or drugging themselves to death. They need something to break the vicious cycle."

Dr. Staggers would like to see many such proven preventive approaches made widely available, and reimbursable, by Medicare and other third-party providers.

"There are two types of medicine-restorative and preventive. Why do we wait for Johnny to overdose on drugs, have a heart attack or a stroke, or get shot-and then come up with all these high-tech mechanisms to restore him to life? It makes more sense to put the money into preventive medicine. Why not prevent the pathology from occurring in the first place?"