‘This is Us’: Toxic stress is real for many

NBC TV show spotlights a public health crisis

A well-drawn and relatable family, an inventive time-shifting narrative and plenty of plot twists make NBC’s

This is Us one of TV’s most popular dramas. But fans probably don’t realize the biggest twist of all: It’s a not just a family drama; it’s a medical one, too.

The three Pearson children, whose alcoholic father died when they were teenagers, were left to cope with the demons of a loving yet troubled family. Science is now telling us that those demons are likely the cause of conditions that affect each adult Pearson child: addiction, obesity and anxiety.

It’s no stretch to suggest that the adult Pearson children might be living with the consequences of “toxic stress.” An estimated 34 million children in the U.S. could be at risk. It can affect anyone and it can happen anywhere.

The science is straightforward: When kids are exposed to serious adversities, the emotional impact can become physical. Experiences that can trigger toxic stress include physical and emotional abuse, neglect, witnessing violence at home, or having parents with addiction or serious mental health issues. These experiences literally get under our skin and change our biology.

Imagine you’re in the forest and you see a bear. Your heart rate and blood pressure increase as the body releases stress hormones and activates the fight-or-flight response. This temporarily mobilizes our brains, hormones and immune systems to focus on one thing — survival. And that’s healthy, if you’re in the forest and there’s a bear.

What if that bear comes home every night in the form of abuse, violence or addiction? That’s when our fight-or-flight response can go into overdrive in ways that damage our health. Children’s developing brains and bodies are especially vulnerable. Toxic stress harms their brain development, damages the immune system, changes hormonal levels, and can even compromise their DNA. Without treatment, these changes make kids dramatically more susceptible to all kinds of diseases both in childhood (such as asth- ma, poor growth and learning difficulties) and in adulthood (such as obesity, heart disease, cancer and stroke).

On This is Us, I recognize symptoms of toxic stress when Beth goes to style foster daughter Deja’s hair and finds bald patches, which come back every time her mom goes to jail. I also see its impact in the adult Pearson children as they grapple with substance dependence and overeating. This show does particularly well at highlighting medical manifestations such as Deja’s alopecia and Randall’s breakdown, when he literally couldn’t see.

Whether intentionally or by coincidence, the writers are connecting the dots of a public health crisis that’s been hidden in plain sight for far too long.

At the end of the hour, after a good cry, most of us turn off the TV and go back to what we were doing. But millions of Americans with toxic stress don’t get to turn it off. For many watching the show, this is us.

When the risk factors for toxic stress are identified early, getting kids the right kind of support from doctors, educators and caregivers can be effective at healing the physical damage. The first step on the path to a solution is ambitious, but simple: universal pediatric screening for toxic stress. According to the American Academy of Pediatrics, only 4% of pediatricians are doing it now.

If the Pearson kids had been screened when they were young, they might be leading much healthier adult lives. I don’t know what that would do for ratings, but in real life, the stakes are high. Childhood adversity affects how we learn, how we parent, how we react at home and at work, and what we create in our communities. What starts out as the wiring of one brain cell to another ultimately affects all of the cells of our society.

New discoveries about the biological link between toxic stress and health risks are giving us the very real opportunity to rewrite the ending for millions of Americans. We must do everything we can to ensure that people tune in.

Pediatrician Nadine Burke Harris is founder and CEO of the Center for Youth Wellness and author of The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.