'This Is Us': Toxic stress on TV is reality for many
Science says persistent troubles from youth may manifest into biological conditions into adulthood. Such as Kate, Kevin and Randall who suffer with obesity, addiction and anxiety in ‘This is Us.’ USA TODAY
A well-drawn and relatable family, an inventive time-shifting narrative and plenty of plot twists make NBC's This Is Us one of television's most popular dramas. But fans probably don’t realize the biggest twist of all: The program isn’t just a family drama; it’s a medical one, too.
The three Pearson children, whose alcoholic father died when they were teenagers, were left to cope with the demons of a loving yet troubled family. Science is now telling us that those demons are likely the cause of conditions that affect each adult Pearson child: addiction, obesity and anxiety.
It’s no stretch to suggest that the adult Pearson children may be living with the consequences of what the American Academy of Pediatrics calls “toxic stress,” one of the most underrecognized and harmful conditions we face.
An estimated 34 million children in the United States could be at risk for toxic stress. White kids, black and brown kids, rich, poor, urban, rural — it can affect anyone and it can happen anywhere.
The science behind toxic stress is straightforward: When kids from infants to teens are exposed to serious adversities, the emotional impact can transform into a physical one. The kinds of experiences that can trigger toxic stress include physical and emotional abuse, neglect, witnessing violence at home, or having parents with addiction or serious mental health issues. The science shows that these experiences literally get under our skin and change our biology.
Imagine you’re in the forest and you see a bear. Your heart rate and blood pressure increase as the body releases stress hormones and activates the fight-or-flight response. This temporarily mobilizes our brains, hormones and immune systems to focus on one thing — survival. And that’s healthy, if you’re in the forest and there’s a bear.
What if that bear comes home every night in the form of abuse, violence or addiction? That’s when our fight-or-flight response can go into overdrive in ways that damage our health. Because children’s brains and bodies are just developing, they are especially vulnerable to the overactivity of that stress response. Toxic stress in children harms brain development, damages the immune system, changes hormonal levels, and can even compromise the integrity of DNA.
Without treatment, these changes make kids dramatically more susceptible to developing all kinds of diseases both in childhood (such as asthma, poor growth and difficulty with learning) and in adulthood (such as obesity, heart disease, cancer and stroke). For folks with very high doses of childhood adversity, the risk for developing America’s leading killer, heart disease, is like eating 33 strips of bacon a day.
On This Is Us, I recognize symptoms of toxic stress when Beth goes to style foster daughter Deja’s hair and finds bald patches, which come back every time her mom goes to jail. I also see its impact in the adult Pearson children as they grapple with some of the most common and well-known effects of toxic stress. For instance, most shows begin and end with Kevin's substance dependence and Kate's overeating, both of which are exacerbated by stressful or traumatic experiences. This show does particularly well at highlighting some of the medical manifestations of toxic stress, such as Deja’s alopecia and Randall’s breakdown, when he literally couldn't see.
Whether intentionally or by coincidence, the writers on the show are connecting the dots of a public health crisis that has been hidden in plain sight for far too long.
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At the end of the hour, after a good cry, most of us turn off the TV and go back to what we were doing. But millions of Americans with toxic stress don’t get to turn it off.
For many watching the show, this is us.
The good news is that when the risk factors for toxic stress are identified early, getting kids the right kind of support from doctors, educators and caregivers can be effective at healing the physical damage.
The first step on the path to a solution is ambitious, but simple: universal pediatric screening for toxic stress. There’s a quick and easy screening that asks pediatricians to look at 10 factors and assigns a risk score for toxic stress. The higher the score, the more likely a child will have health problems in the near and long term. According to the American Academy of Pediatrics, only 4% of pediatricians are screening for the risk of toxic stress.
If the Pearson kids had been screened when they were young, they might be leading much healthier adult lives. I don’t know what that would do for ratings, but in real life, the stakes are high.
The ripple effect of childhood adversity affects how we learn, how we parent, how we react at home and at work, and what we create in our communities. What starts out as the wiring of one brain cell to another ultimately affects all of the cells of our society.
New discoveries about the biological link between toxic stress and health risks are giving us the very real opportunity to rewrite the ending for millions of Americans. We must do everything we can to ensure that people tune in.
Nadine Burke Harris, a San Francisco pediatrician, is founder and CEO of the Center for Youth Wellness and author of the new book The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. Follow her on Twitter: @DrBurkeHarris