I received an arc of this title from NetGalley for an honest review. I mostly skimmed this one as I found it a slow and boring read with no real information, in my opinion.

If you are interested in new studies on the effects of chronic stress on your body, Lawson Wulsin answers all your questions. Toxic Stress is describes what chronic stress is and what it does to our bodies. Only in recent years has the medical community realized many of the main indicators of poor health like diabetes and high blood pressure can be attributed to stress that is uncontrolled.

What can you do to not fall victim? Guidelines are laid out on what you can do to relieve your stress. This book would benefit every adult in America. Adjusting your life to reduce stress and live a happier, healthier life is possible, and this book will tell you how.

Some 25% of Americans have a mental illness of some kind, but that doesn’t necessarily count the millions who have real conditions and diseases caused by stress. Worse, most primary care doctors don’t have the time or the training to trace what they find back to the brain. American medicine is all about reductionism; find the deficiency and treat it, and it alone. This is the world Lawson Wulsin has tackled and comfortably explains in Toxic Stress. It will be a confirmation, a relief and a hope for untold millions. Just acknowledging the stress/disease relationship would be huge in this culture.

Right from birth, we beat up our brains. We torture ourselves to fit in, or minimize emotional pain, or just survive in horrific circumstances. This damages the brain, and the payback can come decades later in the form of obesity, diabetes, heart disease and early death. Poverty is the single biggest contributor. Deal with poverty and adult onset chronic diseases will almost certainly shrivel away before they can even begin. And there is only one thing worse than poverty: worrying about poverty. “Even in later life, regardless of their socioeconomic status as adults, those who grew up poor have higher rates of stroke, heart disease, chronic lung disease, and some cancers.”

High stress living is endemic to our complex society. Our brains do better in the relative simplicity of small groups – villages, tribes, families. The demands on our parents are passed on to us, and from us to our children, making for a neurotic population filled with stress diseases like Crohn’s, COPD, asthma, diabetes and numerous others. Wulsin says “the world has created stressors that evolution could not contemplate.”

Unfortunately, the US healthcare system does not yet recognize this disease complex either, except in small pockets of innovative doctors and their studies and treatment centers. The book is therefore a left brain and right brain meld. Wulsin must describe the innumerable ways the brain stressors can result in various diseases and conditions, while at the same time both damning his own profession for its narrowness and examining the handful of cases where doctors help patients overcome their stress and recover their health, using remarkably similar processes to each other. It is an uphill battle, as “only one in ten were even told by their physician” that they were pre-diabetic and had to act immediately. It is a fast-paced read, providing satisfying as well as horrifying revelations, and hopeful outcomes.

Americans have four broad sources of stress, he says: work, money, family and health. The result is multiple disease conditions (co-morbid conditions). Almost one in five Americans has four chronic conditions (more than 60 million people), and 12% live with five or more. Of those over 50, half have a chronic disease, and a whopping 80% of those over 65 have one or more. Nothing seems as widespread as stress-induced diseases. But doctors will prescribe pills to deal with the symptoms of each one, without ever determining that they all sprout from the same seed – stress. About one in six sufferers report four or more traumatic events in childhood. Poverty in the USA stands at nearly 12% (9% for the rest of the world), where such diseases are nearly inescapable.

The diseases they present depend on who they are: “a gut reactor (nausea or heartburn), a vascular reactor (tension headaches or high blood pressure, an immune reactor (allergies or asthma), or some combination?”

The body is equipped to deal with stress, and Wulsin spends a lot of space describing all the strategies and tactics it uses. But people overwhelm their bodies with alcohol, snack food, lack of sleep and worrying, so the resilience of the system fails. Given half a chance, it will regain balance (homeostasis) or some lesser balance it lands on (allostasis) that it creates out of the mess it is given to work with. In medical terms “disease is a reflection of failures in resilience.” But ironically, the vast majority of doctors do not think in those terms. They stop at the symptoms for a quick diagnosis, followed by pills and surgery.

An innovative study Wulsin cites examined heart attack victims. Researcher George Bonanno looked at levels of depression before and after a heart attack. The result was the only group with increased mortality was the one where depression set in following the heart attack. Those patients tended to die within six months. That is the power of the mind over the body. Stress really is an uncredited killer.

One of the ways around depression is simple human contact, even just meeting up and talking. But ironically, Wulsin says “in this age of hyperconnection, loneliness and social isolation remain a major public health problem.” Since the 1980s, when Dean Ornish began his anti-stress programs, loneliness has doubled from 20% to 40%, thanks to “increasing geographic mobility, our growing preferences for texting and email over direct conversation, and the recent shift in work efficiencies and habits that isolate workers from their colleagues.”

Dean Ornish is well known in the nutrition and healthy lifestyle pockets of the country. But this innovative doctor has also put together a program that reduces stress and melts away the chronic diseases people present him with. His program can stop diabetes before it starts, control heart disease, and eliminate stress-related chronic conditions. Yoga, meditation, a plant-based diet and group therapy help people doctors say are inoperable because they are so advanced in their conditions. At bottom, it’s all about facing, controlling and reducing stress.

This was all obvious to Ornish even before he became a physician. Wulsin quotes him complaining to another doctor: “How did we get to a point in medicine where interventions such as radioactive stents, coronary angioplasty, and bypass surgery are considered conventional, whereas eating vegetables, walking, meditating and participating in support groups are considered radical?” Elsewhere, Wulsin points out we have moved on to the point where we perform bypasses of existing bypasses. It is out of control. Ornish and others like him are all about regaining self-control, and avoiding hospital admissions.

Since Ornish, several other doctors have independently figured out the same thing, and have created programs all over the country, run out of clinics and hospitals, documented for research purposes and reported in medical journals. That is, they are proven. They work, and are both life-altering and life-saving. They are all “daily self-management plans (to) retrain dysregulated stress response systems in ways that build resilience.”

Wulsin says “The overlooking of stress in medicine is a phenomenon of cultural blindness that is similar to our culture’s overlooking of global warming. Just as we are waking up to the environmental costs of our high-energy living, we are waking up to the physical and psychological costs as well […] Coping with stress is such a fundamental part of our lives the we forget it is so.” When the doctors themselves get this vocal, it is perhaps worth investigating. Just saying.

David Wineberg

This book confirmed a lot of things I already knew and was a very good read. The author is knowledgeable and did thorough research.

This book really excited me in the good sense and made me very happy.
Lawson's background as a psychiatrist and very imbued on evidence made it credible and the best part of all of it was that he offers solutions, real solutions, proved, and very doable for all of us and our families for dealing with the stress.
Thank you Dr. Lawson for this very needed book about the stress epidemic in our lives!

There is an example of victim blaming on pg.172 of the ARC edition; a woman should be free to drink alcohol with her work colleagues without having to account for the likelihood that one of them will rape her on the way home. Rapists are to blame for their choice to rape, not their victims. Rape is about power and dominance on the part of the rapist, not poor decision making on the part of the victim. If this error is corrected prior to publication, I would be more than willing to change my rating and update my review. As it stands, it is misinformation that contributes to rape myths and is detrimental to survivors.

I received an ARC of this book via NetGalley

This is a really great combination of science and practicality with actual examples of what you can do right now. Suggestions on how to handle the situations described in the book and even how to talk to your doctor about it. Nothing in the text is really that new to me but it's nice to be reminded and have a lot of information in one place.