How much stress is too much? A psychiatrist explains the links between toxic stress and poor health, and how to get help
Covid-19 taught most people that the line between tolerable and toxic stress — defined as persistent demands that lead to disease — varies widely. But some people will age faster and die younger from toxic stressers than others.
So how much stress is too much, and what can you do about it?
I’m a psychiatrist specialising in psychosomatic medicine, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues.
I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My forthcoming book is titled Toxic Stress: How Stress is Killing Us and What We Can Do About It.
A 2023 study of stress and ageing over the life span — one of the first studies to confirm this piece of common wisdom — found that four measures of stress all speed up the pace of biological ageing in midlife. It also found that persistent high stress ages people in a comparable way to the effects of smoking and low socioeconomic status, two well-established risk factors for accelerated aging. Children with alcoholic or drug-addicted parents have a greater risk of developing toxic stress.
DIFFERENCE BETWEEN GOOD STRESS AND THE TOXIC KIND
Good stress — a demand or challenge you readily cope with — is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit.
Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his book,
The earliest effects of toxic stress are often
No one can escape stress, but sometimes it takes a physical and emotional toll that translates to disease and other health effects. persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own, such as migraine headaches, asthma, diabetes or ulcerative colitis, may surface.
When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort — a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions.
For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviours.
‘TREATING’ STRESS
Although stress neuroscience in recent years has given researchers like me new ways to measure and understand stress, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan.
Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure.
Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during vulnerable periods such as childhood.
Over the past 40 years in the U.S., the alarming rise in rates of diabetes, obesity, depression, PTSD, suicide and addictions points to one contributing factor that these different illnesses share: toxic stress.
Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses.
SUFFERING FROM TOXIC STRESS
Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to four or more adverse events in childhood. This is the threshold for higher risk for illnesses in adulthood.
Research dating back to before the Covid-19 pandemic also shows that about 19% of adults in the U.S. have four or more chronic illnesses. If you have even one chronic illness, you can imagine how stressful four must be.
And about 12% of the U.S. population lives in poverty, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all.
Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in highcrime neighbourhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress.
Exercise, meditation and a healthy diet help fight toxic stress.
RECOGNISING AND MANAGING STRESS AND ITS ASSOCIATED CONDITIONS
The first step to managing stress is to recognise it and talk to your primary care clinician about it. The clinician may do an assessment involving a self-reported measure of stress.
The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, called “lifestyle medicine”, focuses on improving health outcomes through changing high-risk health behaviours and adopting daily habits that help the stress response system self-regulate.
Adopting these lifestyle changes is not quick or easy, but it works.
The U.S. National Diabetes Prevention Programme, the Ornish “UnDo” heart disease programme and the U.S. Department of Veterans Affairs PTSD programme, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programmes help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits.
There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and to expand access to these approaches to treatment.
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Stupid actions can be caused by a defiance of logic or poverty of mind.
Most people, at one time or another, act foolishly. However, truly ignorant individuals exhibit a lack of introspection and stubbornly cling to their opinions, regardless of how irrational they may be.
These people demonstrate unwavering self-assurance and are often oblivious to their own inadequacies. They craft retrospective justifications to validate their beliefs and hold onto them.
Even when presented with opportunities for personal growth and change, they seem incapable of breaking free from their entrenched habits. Reasoning with stubborn individuals can be as perplexing as it is frustrating. Many have written it off as a hopeless task.
AS AMERICAN WRITER MARK TWAIN ONCE CAUTIONED:
“Never argue with stupid people, they will drag you down to their level and then beat you with experience.”
To argue against stupidity only seems to reinforce it. These individuals thrive on power and control, defending their position and denying their foolishness, regardless of counterarguments.
Despite these challenges, it is still possible to sway such people towards more sensible behaviour. It all starts with understanding the roots of stupidity. From a psychological perspective, stupidity is often considered an outcome of cognitive biases or errors in judgment.
WHY BIASES PERSIST
Many prominent psychologists attribute irrational beliefs and foolish actions to our cognitive limitations. Research into human cognition and decision-making has shed light on why these biases persist. It reveals that humans are not purely rational beings. They switch between fast, intuitive thinking and slow, rational thinking, depending on the situation.
Neuroscientists have also weighed in, noting that the brain’s frontal lobes, responsible for rational thinking, can be overridden by the amygdala, a more primitive system for processing threats. In emergency situations requiring quick decisions, the slower, deliberate information processing is often set aside.
Numerous cognitive biases can help explain some of the nonsensical decisions people make.
For instance, individuals can be susceptible to confirmation bias, where they favour information that aligns with their pre-existing beliefs. They may also succumb to “anchoring”, becoming overly influenced by the first piece of information they receive (the anchor), even when this information turns out to be irrelevant or arbitrary.
The overconfidence effect is another potential factor at play, causing people to overrate their abilities and knowledge, and the accuracy of their beliefs. There is also the phenomenon of groupthink, where groups prioritise consensus and conformity over critical evaluation.
Flawed decisions could also be the result of fundamental attribution error. This involves incorrectly attributing others’ behaviour to internal factors, such as personality, rather than to external factors, like situational influences.
Also, the availability heuristic explains the tendency to rely on information that comes to mind quickly and easily when making decisions.
While these cognitive biases don’t inherently imply stupidity, when left unaddressed, they can pose significant risks.
MANAGING THE MISGUIDED
When individuals recognise their cognitive biases, they become more willing to participate in productive discussions and gain deeper insights into their own behaviour. Rather than trying to persuade them through rational discourse, one can encourage them to examine these biases.
To promote reflective thinking, people can be taught how to properly decode the information they encounter. They can learn to discern whether their own observations and beliefs are grounded in accurate evidence.
Advocate greater self-awareness: When people acquire self-awareness, they are able to reflect on their behaviour more objectively.
Keep people grounded: Self-absorbed people often lack interest in the opinions of others. They need to attain a more grounded perspective on life and cultivate their capacity for self-evaluation.
Empathy is another great remedy for foolishness.
Satire as a tool: Satire has the potential to stimulate reflection and critical thinking. It gets people to question their assumptions without attacking individuals personally.
Let them learn the hard way:
Instead of instructing individuals to avoid specific foolish activities, one may encourage them to go ahead. It can be risky, but the hope is that when their actions lead to disastrous outcomes, they will learn.
Lead by example: An effective leader, whether in government, business or any other sector, requires a combination of intelligence, knowledge, wisdom, empathy and compassion. Additional qualities are critical thinking, problem-solving skills, proficiency in handling complex issues and the ability to collaborate with others and distinguish between the wise and the foolish.
A leader like this can set an example that contrasts with the conduct of foolish leaders.
STUPIDITY IN A ‘POST-TRUTH’ ERA
In today’s “post-truth” era we find ourselves grappling with a daily barrage of public discourse that blurs the line between fact and fantasy. We are fooled by errors and lies, and social media appears to be amplifying such stupidity. The rise of social media has made human follies more visible than ever. We tend to underestimate the number of ignorant individuals in our midst, and the influence such people can exert over large groups.
The dangerous combination of power and stupidity can disrupt the lives of countless people. Unfortunately, as long as there are foolish supporters enabling such leaders, people will be trapped in their own collective foolishness. A significant counterforce against collective stupidity is the presence of institutional safeguards. Citizens must cultivate a robust civic culture, fostering a society where they can exert influence on their government. There needs to be laws that discourage misinformation and legal avenues to counter fake news, especially when it causes harm.
Education can lead people to discover and acknowledge their own ignorance, nurturing a more thoughtful and informed society that is better equipped to confront the pitfalls of stupidity.