Bill Schubart: Preventing 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.

Toxic stress, 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 a critical part of the natural world, human-induced 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 future generations.

Much of the current focus is on adverse childhood experiences known as “ACEs.” ACEs are indeed a major contributor of 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.

According to the CDC, almost two-thirds of Americans have reported experiencing at least one form of ACE before age 18. About one-sixth have reported experiencing four or more ACEs.

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.

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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, Blue Cross Blue Shield and the Green Mountain Care Board.

By the 2021-22 session, the group and any effort lay dormant .

Although we’ve been professionally aware of toxic stress 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 toxic stress and ACEs at our peril.

Today, the emerging science of epigenetics is filling in the medical knowledge gap around the physiological impact of 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 example cited by the CDC 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 toxic stress on hundreds of thousands of children and adults that will endure for generations to come, while any health care 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 trauma?

So here at home…

There are two critical factors in addressing toxic stress: one is early diagnosis and the other is how and where it’s treated.

Only when our entire health care infrastructure is fully integrated to deploy the legally mandated parity between mental and physiological health will we be able to minimize the impacts of toxic stress in our communities.

Toxic stress 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 toxic stress 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 Vermon 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 health care professional who for years has treated families struggling with the stress of ACEs and toxic stress. 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.

Another successful treatment for toxic stress is transcendental meditation, 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. U.S. Surgeon General Vivek Murthy encourages meditation .

I discovered transcendental meditation 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 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 offer the best health care outcomes to our children and succeeding generations. Mitigating the cost of toxic stress before it does wholesale damage that can persist for generations is the very best use of our local health care systems.

Read the story on VTDigger here: Bill Schubart: Preventing toxic stress in our communities .