These are stressful times for many of us, and the difficult truth is that our responses to external events: severe anxiety, anger, or even fear; may be negatively impacting our health. The United States is seeing a simultaneous DECREASE in healthspan, the portion of our life that we spend in good health and free from chronic disease and disability, and a sharp INCREASE in the percentage of adults who suffer from two or more chronic diseases. In fact, the United States has the highest percentage of adults over the age of eighteen with multiple chronic illnesses of any country in the advanced economies of the world.
This significant outlier status is in part a result of harm caused by unresolved or ongoing trauma and toxic stress.
Surprisingly to many people, a relatively small proportion of our health outcomes…life expectancy, healthspan, disease-free years, and quality of life, are due to the medical care we receive. Current scientifically derived estimates hold that a mere 10-20% of our overall health outcomes are related to medical care, while our genetic makeup, our lifestyle choices, our social interactions and relationships, and importantly, our mental well-being account for the major share of our health outcomes in life. Among the most important of these factors is our experience of potentially traumatic or stressful events, and how we heal, resolve, and cope with these life circumstances.
The study of the impact of adverse childhood experiences (ACEs) most clearly delineates the impact of trauma and chronic stress on physical health. Children with high ACE scores (a measure of the exposure level to potentially traumatic experiences) suffer not only from mental health and substance abuse disorders, but experience a higher incidence of neurologic diseases, immune system disorders, heart disease, cancer, obesity, and metabolic disorders like diabetes. The causal mechanisms underlying these findings are complex and have not been fully elucidated. Children with high ACE scores are, for example, more likely to make behavioral choices (smoking, substance abuse, unhealthy diet) that impact disease incidence. But it is also clear that traumatic experiences directly impact epigenetic control (the mechanisms that regulate gene expression) of neurologic development, physiologic systems regulating the stress response, inflammatory pathways, and the immune system, likely leading to increased disease incidence.
As in children, adults with unresolved trauma and toxic stress also experience a higher incidence of a number of different diseases. Toxic stress and trauma are associated with an increased risk of several cancer diagnoses—women who have experienced intimate partner violence and sexual abuse, for example, are more likely to subsequently be diagnosed with cancer than women who did not experience this type of abuse. Likewise, unresolved trauma and toxic stress are strongly associated with an increased risk for autoimmune disease, severe infection, heart disease, neurologic disease, as well as mental health conditions and a long list of other illnesses. The mechanisms by which stress leads to an increased incidence of physiological disease are clearly complex, but extensive research links changes in epigenetic regulation of gene expression, changes in neurohormonal systems and immune function, as well as alterations in health behaviors to unresolved trauma and stressful life events.
In short, it is by no means a stretch to posit that traumatic life events, severe and ongoing stress, and likely even uncontrolled and persistent afflictive emotions such as anger, fear, and hatred pose a threat to our health and well-being. Not only are our minds and physical bodies not separate, but they are a completely integrated whole. The way our genes are encoded into proteins, the way our nerve cells connect with one another, and the manner in which we extract nutrients from food and defend ourselves against disease are completely interrelated with our sensory and emotional relationship with the world and each other, and vice versa. This makes it all the more important for us to do the work of developing self-awareness and seeking help to deal with emotional states that are not just distressing, but harmful.
Healing from trauma and toxic stress are both possible and beneficial. And this starts with seeking help. As trauma and addiction expert Dr. Gabor Mate so aptly states, “Trauma is not what happens to you but what happens inside you” in response to a severe psychic injury. And whether dealing with horrific traumas of child abuse, war and combat, abusive relationships, or the crippling fear and anxiety that arises from being a member of a minority or disenfranchised group in a society that at times seems disparaging and even overtly hostile to racial minorities, immigrants, LGBTQ individuals and women, reaching for help is essential. This could be a professional therapist or counselor, but efforts may start with workplace employee assistance programs (EAP) or wellness initiatives, as well as physicians and other providers practicing lifestyle or holistic medicine, professional coaches, clergy, support groups, or our dear and supportive friends and loved ones.
The good news is that positive models of well-being both exist, and provide evidence that adoption of beneficial practices can improve both the quality of our lives and our health. For example:
- Ample evidence suggests that contemplative practices such as the many forms of meditation and centering prayer can reduce stress and improve our resilience and cognitive resources.
- Fostering social connections and intimate relationships also improves resilience and is strongly associated with both longevity and quality of life.
- Improved sleep hygiene results in better immune and cognitive function, and decreases the risk and severity of hypertension, heart disease, type 2 diabetes, stroke, and can help with weight management.
- A healthier diet, smoking cessation, as well as moderation or even elimination of alcohol intake are all associated with improvements in many indicators of health such as improved blood pressure control, but also reduce the risk of heart disease and cancer, and are clearly associated with improvements in life expectancy.
- Finally (and in no sense is this an exhaustive list), improved activity levels are associated with numerous physical and mental health benefits, including beneficial effects on depression and anxiety, as well as the better understood benefits related to weight control, cardiovascular health, and diabetes management.
We live in divisive times. Many are fearful, anxious, and concerned about the society that is evolving around us. Individuals living with unresolved trauma may be experiencing a compounding of their injuries as societal forces increase the sources of stress in our daily lives. Families and friends, some of our most important sources of comfort and resilience, may be in conflict due to deeply held beliefs and values.
Diving headlong into the fight for justice may seem like the ethical and wise choice, but we must also skillfully evaluate the impact of these times on our emotional state, and indeed, upon our health. Fostering self-awareness, seeking help and support, fostering community and connection, and tending to our own wellness practices may be the most important responses we can make to difficult times. Our various faith and wisdom practices unanimously hold that only love can successfully overcome hatred and anger. But to move forward with love in these challenging times, we must start by attending to our own well-being with tenderness, knowledge, and self-compassion.