The Stress Pandemic: Collapse or Cure?

Looking back, it was clear that this crisis was coming, even before the COVID pandemic arrived. An American stress epidemic has been on the rise for at least 40 years, showing up in people’s responses to all manner of surveys, in increases in stress-related disorders and diseases, and even in biomarkers of excess, chronic stress coursing through our bodies. This physical burden of stress – allostatic load is the research term (Fava et al., 2019) – has been increasing in the American population as a whole, with devastating impacts on health and life for many individuals.

Why has this stress epidemic been growing? In many ways, it defies expectations. America is among the wealthiest of the wealthy countries in today’s world, with technology’s progress in many areas leaping toward the future. We’ve written about this as “modernity’s paradox” (Keating & Hertzman, 1999), with the burgeoning success of “the market” combined with sharp increases in individual stress and the social ills that cause toxic stress. We’ve needed for quite some time to unravel modernity’s paradox, or risk suffering from escalating problems in health and human development, perhaps even runaway problems.

And then COVID hit, shining a powerful spotlight on many sources of the stress epidemic, and at the major cracks in our society. Inequalities in who lives and who dies, who thrives and who doesn’t, who succeeds and who fails, followed the well-known pattern of the rich getting richer with increasing misery for the rest. Through a happenstance of history – some might view it as an inevitability – our capacity for self-governance was at an historic low point when the pandemic hit.

Equally devastating, an ideology of white supremacy expressed as white grievance roared to dominance in many sectors – the White House and policing most prominently – revealing more of the cracks and the underlying fragility in what had been taken as foundational for society. The spread of disinformation from the top not only allowed the pandemic to get a running start on devastating the population, it also showed the enormous power of disinformation – the Big Lie, gaslighting (“Just kidding. What I said isn’t to be taken literally.”) – to distort reality for many, and further eat away at our sense that we as citizens are supposed to have the say in how we are governed.

The events of 2020 have ushered in the opening salvos of a stress pandemic, provoking a critical choice point – a cusp – in our national, and even global history. To understand what is happening, why it is happening, and what we can do about it – individually and as a society – is a complex story. So, we need to look at this from multiple levels – the nature of individual stress and resilience, how developmental experiences and exposures create biological health and behavioral development, the societal features that determine those exposures and experiences that amplify stress and obstruct resilience (Keating, 2017).

To do this, we need to “drill down” from health and development into the underlying biology, and “ramp up” to understand the societal pressures generating the stress epidemic, and that have metastasized into our looming stress pandemic (Keating, 2016).

Despite the great complexity that this implies, from cells to society, the reality is that the overall pattern linking stress, health, and development is so robust and straightforward that we actually have the tools to navigate this and find our way to a better future. To do this, we need a road map that is easy to understand, and a narrative travel guide to help us find the way.

The broad outlines of this road map are clear. For individuals, the costs of toxic stress, from the prenatal period forward, are increasingly well known, through processes of biological embedding that impact the brain, the stress response system, and via allostatic load, numerous diseases and disorders across physical and mental health – that is, the full gamut of developmental health (Keating, 2016; Keating & Hertzman, 1999). But we also know much more about the processes that support resilience, the ability to overcome toxic stress: social connection, mindfulness, physical and emotional self-care.

But it is also clear that the harmful effects of stress multiply when the stressors become too toxic, capable of overcoming even the best efforts toward resilience. The “stress-diathesis” model of psychopathology, for example, recognizes this push-pull: Stress has negative effects most clearly for those with a pre-existing vulnerability (Guyer, 2020), but if stressors are strong enough, more and more people are affected.

The threat of a stress pandemic at this point in history is amplified by both the number and magnitude of societal stressors we now confront, in addition to COVID: the climate emergency; the structural and systemic sources of racism and discrimination, the focus of a new research initiative from the National Institute of Health; the rising tide of authoritarianism’s rejection of democracy, encapsulated by the January 6 insurrection at the US Capitol and sustained by the Big Lie of a stolen election.

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As in all dynamic systems, cusp points – or tipping points – can move in two directions: collapse into a more deeply locked system that amplifies the dysfunction; or toward a cure, by replacing the central dynamic with a new approach. Moving toward a cure to the stress pandemic at this juncture requires a new central dynamic that focuses on the developmental health of the population (Keating, 2016). This dynamic would rearrange how we think about and work on the major crises we now confront, from the climate emergency to racism to the neoliberal consensus that prioritizes market success over society's well-being.

To achieve this, we need to focus not only on building and sustaining individual resilience to stress as much as we can in the face of the stress pandemic, but also on addressing its root causes to lower the population burden of excess stress.