Oakland Effect: the profound physical effect of toxic stress

Posted: April 14, 2012

Oakland Tribune

By Scott Johnson Oakland Tribune

This is an excerpt from reporter Scott Johnson’s blog, which focuses on the impact of violence and trauma on the community. Go to www.oaklandeffect.com for updates on his reporting.

APRIL 2012

The nonprofit Youth Alive hosted the annual National Network of Hospital-Based Violence Intervention Programs Conference this week in Oakland. The network brings together mental health care specialists, trauma experts and outreach workers from across the country to discuss ways to improve treatment for victims of physical and psychological violence in American cities. More and more, I’ve noticed that the theme of trauma and trauma-informed therapy is dominating these discussions as a growing body of research, informed practice and best practices begin to coalesce around this theme.

Toxic stress, which experts define as the repeated and consistent exposure to things like physical or emotional violence, substance abuse, street violence, gang warfare or bad parenting, has a physical expression in our bodies, which, despite modern technological advances, are essentially still relics of our past, when primal survival instincts were more important than they are today.

Stress produces a chemical called cortisol. In small quantities, cortisol is good — it helps us get through difficult events. Too much of it, however, is terrible. Stress also produces epinephrine and norepinephrine, which are adrenaline-like chemicals that also help us survive and cope with extreme situations. In large doses, these two chemicals negatively alter our thinking and behavior.

Similarly, stress can produce something called a beta-endorphine, which is similar to morphine or opium. It’s good for pain, but when there’s too much of it, our bodies can become addicted. That’s, in part, why toxically stressed people seem to find themselves in the same self-destructive patterns over and over again.

They’re not thinking clearly because they have too much cortisol and epinephrine, and they seek out risky behavior, or make thoughtless choices because their bodies are conditioned to some extent.

“With chronic hyperarousal, your body may never calm down,” said Sandra Bloom, a psychiatrist from Drexel University in Philadelphia, who spoke at the conference. “If your central nervous system changes, you literally can’t calm down.”

Experts say this is important for everybody. Bloom says recent data suggest that between 50 percent and 90 percent of people will experience some form of trauma in their lifetime. Stress and trauma, in turn, affect longevity and overall health. And there is an increasing body of evidence suggesting health has far more to do with things like place, race and self-perception than previously thought.

This is a fairly radical idea. Americans tend to think of themselves as rugged individualists, after all, capable of overcoming insurmountable odds to reach the greatest heights. But what if the history of stress and trauma in our lives plays a far greater role than we would like to admit?

For therapists, this means that anyone showing symptoms of trauma must be approached with an understanding that some form of trauma may lie at the root of whatever symptom is manifesting. Tips for how to do this include: recognize the fight/flight response; take steps to reduce the threat; increase safety; minimize hyperarousal; promote trust and encourage mastery and self-help.

“Many people who have been traumatized have a foreshortened sense of their own future,” said Linda Rich, another Drexel University researcher. “You don’t have to be a therapist or doctor to do this model effectively.”

There is no accounting for how different people will deal with the same levels of trauma. Some sail through unscathed; others retain much more significant damage. Some of this may have to do with genes. Outside events affect our genetic makeup.

But there is some evidence that these situations create genetic variations that can be passed on generationally.

“Violence may affect people’s genes,” Bloom said. “If we can alter people’s environments, we may be doing a lot more than we can measure, we may be changing intergenerational patterns.”