Preventing chronic toxic stress in our communities
Life is stressful. No amount of wealth or privilege protects us from stress. In fact, there’s reason to believe that privilege, insofar as it isolates us from a shared humanity, may even bring on stress. Plentiful food and a roof over our heads does not protect us from heartbreak, abuse, or tragedy.
Stress occurs naturally in the world. It’s an embedded response in human and animal psyches as it enables survival. The natural stress response to seeing a coiled rattlesnake, a curious grizzly, or a shark fin may well save a life.
Chronic toxic stress (CTS), however, has life-changing consequences that ripple down through society and cost billions of dollars to our families, mental and physical health systems, schools, and criminal justice systems.
Although stress is by design a critical part of the natural world, human-induced chronic toxic stress is preventable or at least curable if caught early. We can and must make a much better world for ourselves, our children, and for future generations.
Much of the current focus is on adverse childhood experiences known as “ACEs.” ACEs are indeed a major contributor to chronic toxic stress. They may include:
- Experiencing or witnessing physical violence or emotional, physical or sexual abuse.
- Childhood neglect or the effects of extreme poverty.
- Having a family member attempt or die by suicide.
- Growing up in a household with substance use, mental health problems, instability due to parental separation, or having an incarcerated parent.
Nationally, the first in-depth analysis of and reporting on ACEs occurred between 1995 and 1997, conducted by the CDC and Kaiser Permanente. It involved some 17,000 Health Maintenance Organization (HMO) members from Southern California who, during routine physical exams, completed confidential questionnaires regarding their childhood experiences, current health status, and behaviors.
Here in Vermont, we first began taking ACEs seriously in 2014, and in the 2015 legislative session integrated ACE-Informed Practice into the Blueprint for Health in Act 144, Section 16.
In the Vermont 2017-18 legislative session, an Adverse Childhood Experiences Working Group was established by Act H.508. This effort was supported by the National Education Association (NEA-VT), Blue Cross Blue Shield (BCBS-VT), and the Green Mountain Care Board (GMCB)
By the 2021-22 session, the group and any effort lay dormant.
Although we’ve been professionally aware of CTS and ACEs for well over two decades, we’ve made remarkably little headway addressing their impact on society. Nor have we made much headway in our ability to diagnose and treat them due to the lack of trauma-informed counseling training and treatment resources integrated into primary and pediatric care.
We ignore the personal and societal cost impacts of CTS and ACEs at our peril. When the legislature first showed interest in 2017, data submitted indicated an annual cost to Vermont of some $800M in remediation.
Today, the emerging science of epigenetics is filling in the medical knowledge gap around the physiological impact of chronic toxic stress on our physical health. Epigenetics analyzes how one’s behavior and environment can cause changes in how the genes function. But unlike actual genetic mutations, epigenetic changes are reversible and don’t affect DNA.
One cited example is the Dutch Hunger Winter Famine at the end of World War II. Children born of mothers who lived through the famine were statistically more prone to developing diseases like heart disease, schizophrenia, and type 2 diabetes.
Another example focused on the succeeding generation of Holocaust survivors. Scientific study showed for the first time in humans that epigenetic changes caused by exposure to trauma can be passed on to children born after the event—in this case Holocaust survivors and their adult post-war children.
Another indication of the relationship between stress and physiology is called “takotsubo syndrome,” or, more commonly, “broken heart syndrome.” This occurs following severe emotional stress and causes a temporary weakening of the muscular portion of the heart.
We are coming to understand that our minds and our bodies function as one organism.
Watching the accelerating chaos in the Middle East, I can only imagine the impact of rampant CTS on hundreds of thousands of children and adults that will endure for generations to come, while any healthcare infrastructure that might be used to mitigate the disaster lies in rubble. How many generations will it take to heal the ensuing generations of this chronic toxic trauma?
So here at home…
There are two critical factors in addressing CTS, one is early diagnosis and the other is how and where it’s treated.
Only when our entire healthcare infrastructure is fully integrated to deploy the legally mandated parity between mental and physiological health will we be able to minimize the impacts of CTS and ACEs in our communities.
CTS diagnosis and triage is integral to primary care and belongs in our communities, where it originates. There’s no more expensive or complex place to try and manage CTS than in an urban emergency room where many presenting children and adults end up either parked on gurneys or in inpatient beds awaiting unavailable help.
Community organizations such as parent/child centers, NFI Family therapy centers, elementary schools, addiction support groups, and local primary care clinics are the resources closest to the problem and most effective at addressing it.
Work is beginning now with families expecting a child on how to prevent or minimize the impacts of stress on their newborns.
Kimberley Pierce is a Central Vermont healthcare professional who for years has treated families struggling with the stress of ACEs and CTS. Her pioneering care integrates the latest in neuroscientific studies on the family impacts of trauma and stress. This had led her and her team to initiate The Vermont Kindness Project to enable healing outside the exam room through education, music and arts, and community-building.
A periodic navigational source of valuable information on the emotional wellbeing of our families and children called Mental Health Initiative is available by signup from the United Way of N.W. Vermont.
By far, the most successful and ubiquitous source of support for mental health and recovery for people of all ages is the Howard Center, on the ground where they are needed most, in our schools, communities, and on our streets, meeting the need where it lives. Enabled by funding and space from UVM Medical Center, Howard Center and its partners are opening a new Mental Health Urgent Care Facility at 1 Prospect Street on October 28.
Another successful treatment for CTS is transcendental meditation (TM), widely available in Vermont and around the world. It is medically recognized as a practical means of managing toxic stress, improving resilience, finding peace and improving physiological health. The U.S. Surgeon General Vivek Murthy has long been a champion of meditation to reduce stress.
I discovered TM several years back and have been a grateful and consistent practitioner. My own struggle was the compulsion to overeat when stressed or anxious and my regular TM practice has led to major weight loss and maintenance for a number of years as well as a degree of inner peace.
We know that education, detection, and prevention at home and in our communities offers the best healthcare outcomes to our children and succeeding generations. Mitigating the cost of chronic toxic stress before it does wholesale damage that can persist for generations is the very best use of our local healthcare systems.
