Lawson Wulsin, University of Cincinnati – What Is Toxic Stress?

The Academic Minute

Being stressed is common today.

Lawson Wulsin, professor of psychiatry and family medicine at the University of Cincinnati, examines why and what to do about it.

Lawson Wulsin, MD, is professor of psychiatry and family medicine at the University of Cincinnati. His subspecialty is psychosomatic medicine, and he has focused his research and teaching on various mind-body questions, such as depression and heart disease, and more recently stress and metabolic disorders. In April 2024 his book Toxic Stress: How Stress Is Killing Us and What We Can Do About It was published by Cambridge University Press. He has devoted much of his career to training physicians to practice both family medicine and psychiatry, and he has served in leadership roles for several professional organizations and academic journals related to the integration of medicine and psychiatry.

What Is Toxic Stress?

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Toxic stress is a fascinating medical and social mystery because, like pollution or global warming, it’s all around us, yet too often invisible. Toxic stress is hard to measure. And most of us prefer to ignore it until we have to face it.

Good and tolerable stress is good for us. It keeps us fit. But toxic stress over months and years can make us sick, accelerate aging, and cut years off our lives.

Toxic stress is common—about one in five of us (20%) have experienced it—but doctors and our health care systems usually don’t measure it or treat it.

Stress is hard to measure because our stress response system is a complex system of systems. Think of an orchestra of organs playing effortlessly under the conductor, your central nervous system, for your survival day and night, from the day you’re born to the day you die. Imagine trying to measure how well or poorly an orchestra plays!

Each of us develops a unique stress response system, and our thresholds for toxic stress are specific to the adversities we face, our resources for coping, and our age.

After months or years of toxic stress, first come persistent symptoms such as headaches, fatigue, or chronic pains. Then come stress-related conditions like obesity, high blood pressure, diabetes, or depression.

The good news is it’s now possible to treat toxic stress and to reduce or reverse stress-related conditions through a variety of approaches and programs, currently called lifestyle medicine. In addition to whatever medications and procedures are needed, these approaches combine the daily practice of health behavior changes over six to nine months with the help of weekly small group meetings with other people working on the same goals. It’s not quick or easy, but it works, it feels good, and it can save your life.

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