Modern medicine has given us a lot of advances recently that our grandparents would call miracles. Your worn out knee joint can be replaced in under an hour. You can save your brother’s life--if you’re a good match—by donating your bone marrow, or your kidney, or part of your liver. Miraculous, and yet these miracles happen every day.
But modern medicine knows a lot more about how our bodies work than about how our minds work. I’m a psychiatrist at the University of Cincinnati and I’ve spent much of my career working in primary care clinics. About 25 years ago I started a program that trains residents to be both family doctors and psychiatrists. One lesson I’ve learned over these years is that most good doctors don’t know how our bodies and minds work together to manage the stresses of daily life. Or the stresses of a COVID pandemic. We talk about stress every day. Most of us believe that too much stress is bad for our health. So, it’s curious how little our good doctors know about how toxic stress makes us sick.
How can that be? When was the last time your doctor or nurse measured your stress levels? One reason most good doctors don’t know much about how stress affects our health is we don’t often measure it. Surprising but true.
And stress can be hard to measure because it’s complicated. Think of stress as the process by which we meet the demands of daily life with the resources we have—physical, psychological, and social resources. The best stress measures assess all three of these kinds of demands and resources. For most demands we have plenty of resources—for hunger we have food, for sex we have a lover, for a bill we have money, for an itch we can scratch. These kinds of stressors are good for our health. They keep us fit.
But toxic stressors wear us down: the impossible boss, the spouse from hell, the back pain that won’t quit, bills that eat your paycheck. Have you ever felt like you were drowning in a whirlpool of demands, month after month?
Like global warming, toxic stress is all around us, yet hard to see. Most of us hide it. One in every five of us has been exposed to toxic stress. It takes the form of trauma or neglect in childhood for about 16% of all kids in the US. It takes the form of chronic physical and mental illnesses, which are stressors themselves made worse by toxic stress. Add all those who live under the threats of unemployment, poverty, harassing relationships, and discrimination. Toxic stress and stress-related conditions add up to as big a problem in our country as diabetes, almost as big as obesity. Good research has shown that toxic stress shortens our lives by ten to twenty years. Abusive relationships, severe mental illness, and poverty, and can be as deadly as smoking, obesity, and high cholesterol.
The good news is our stress response system is the toughest thing we’ve got. And it’s been on auto-pilot since the day we were born. Our stress response system is actually a complex set of about nine organ systems, all self-regulating and orchestrated by our marvelous brain. This orchestra is playing all the time, and yet when it’s playing well, we neither see, nor hear, nor feel it—more of a miracle than replacing your knee in under an hour.
The bad news is that when our stress response systems do not play well over many years—starting in childhood or early adulthood--we end up later with clogged arteries and a heart attack, or an exhausted pancreas and diabetes, or auto-immune disorders, or a depleted limbic system and clinical depression.
The better news is that we now know how to retrain a dysregulated stress response system and how to reverse these stress-related disorders, or prevent them. Most of the people I treat in primary care clinics have a mental illness, a physical illness, and toxic stress—and in time most get better. We now have a number of national programs that reverse heart disease, depression, pre-diabetes, PTSD, and chronic pain syndromes within six to nine months, without surgery or high-powered medications. These programs are not quick or easy, because they all rely on intensive change of high-risk health behaviors. That takes practice. This is lifestyle medicine at its best.
My point is that toxic stress, like global warming, is something we can now measure and reverse. Most of us would rather look the other way for as long as we can, but ignoring toxic stress, like ignoring global warming, will eventually burn us. If you or someone you care about is struggling with toxic stress, start the conversation. It’s a step on the road to another kind of medical miracle.