Chapter 2
THIS IS YOUR BRAIN ON STRESS
It’s hard being human. People we love die. Relationships end. Others can be unkind. There are hundreds of ways to miscommunicate or touch on an old wound when interacting with people we care about. We don’t always get what we want or deserve.
Life would be overwhelming if we didn’t come well-equipped with regulatory mechanisms to manage the stress thrown our way. Fortunately, our bodies are biologically wired for survival.
The human survival response spans a wide range. If the stressor is physical—say, an oncoming car that bolts out as you’re crossing the street—your body will be flooded with energy, kicking your muscles into high gear so you can scramble to the curb. If the stressor is social—say, getting picked last for the dodgeball team—it can protect you from immediate pain by dampening your emotions. To protect against future stress, it can also increase your alertness, making you vigilant and more aware of your circumstances.
While those are valuable tools on occasion, the stress response can become maladaptive and hair-trigger in damaging ways. It may be hard to find the “off” switch. Dampened reactions can devolve into chronic depression, while alertness can escalate into chronic anxiety and hypervigilance. Hundreds of other disorders and diseases can also result.
In this chapter, we’ll dive into biochemistry to understand our survival system. We’ll look at how this system gets hijacked by chronic stressors and hard circumstances like oppression. You will become knowledgeable about how your brain works and understand how our unjust culture gets coded inside of our bodies, leaving us vulnerable to a range of ills, from chronic depression to diabetes to drug abuse. Later in the book we’ll build on this scientific foundation, putting our focus on rewiring your brain for optimal resilience, health, well-being, and connection with others. Throughout, we’ll make the connections between how social systems affect brain development—and how you can change those social systems.
THE STRESS RESPONSE
Stress is like a toxin that some of us chronically bathe in. It changes the chemistry of our brains and our bodies.
If you bear the shame of feeling that something is wrong with you, or you’re not good enough, it wears on you.
If you struggle financially, it wears on you.
If you’ve experienced abuse or neglect, it wears on you.
If you’ve experienced a traumatic event, it wears on you.
If you’re otherwise treated poorly, it wears on you.
Scientists use the term “allostatic load” to refer to this cumulative wear and tear on the body. The growing nervous system is particularly vulnerable during childhood, which means that hard times when you were a kid—childhood abuse and neglect, parental substance abuse, and family violence, for example—permeate particularly deeply, especially in the absence of positive, supportive relationships.
The concept of allostatic load helps us understand how the stress of hard life circumstances (such as discrimination or poverty or limited work options), coupled with the feeling that you have no control over these adversities, disrupts your internal survival system. The result is decreased resilience, disrupted well-being, and increased risk for disease. It’s the primary reason why, in every country, people at relative social disadvantage suffer from more disease and die earlier. It also drives higher rates of suicide and alcoholism.
The false belief that you do have control* and that your circumstances are your own fault leads us to internalize the cultural ideology, feel shame, and become our own oppressor—all of which heightens the stress response. If you’re going someplace where you anticipate being treated poorly, if you’re constantly scanning your environment to see if there is a wheelchair ramp or to gauge whether your fat† body will fit in a seat, or if you’re feeling isolated as the only Person of Color in the room, then that hypervigilance, however necessary and useful, can also induce further stress.
When we’re quick to anger or we dive into depression, it can feel like something’s wrong with us. It’s better conceptualized as the way we embody our world. There are smart reasons you do the things you do—it’s about a self-protection system that sometimes goes awry.
So much of our response to our day-to-day lives is rooted in brain chemistry, which adapts in response to coping with stressors like trauma, inequity, and hard circumstances. Depression, anxiety, anger, reactivity, hypervigilance, distrust, and substance abuse are just normal adaptive and self-protective strategies. How we act is a response to the crap we deal with.
Although social injustice contributes to allostatic load, this does not mean that individuals with more privileged circumstances never experience a high allostatic burden and associated maladies. However, there is a clear gradient: A high allostatic burden tracks closely with social power.1 There are undeniable protective benefits of higher social power and undeniable toxic elements of lower social power.
The term “marginalized people” is used to convey the idea that the needs and voices of certain groups of people get set aside while other needs and voices are centered. This book centers the experiences of marginalized people. For those with more privileged identities, I have a hunch that reading this book requires a different mindset than you’re accustomed to. One privilege of having a dominant identity is not having to see that your perspective is but one of many. I’ve heard it said: “When you’re accustomed to privilege, equality can feel like oppression.” It can be challenging to change that mindset; when you are accustomed to everything being about you, sharing space can feel like being left out. For example, the trauma chapter centers on the trauma of oppression and how it affects marginalized people, in contrast to chapters on trauma in the majority of books, which place their emphasis on trauma arising from discrete individual events. This emphasis is merely that: an emphasis. It is not to suggest that trauma is reserved for oppressed people or that discrimination is unharmful to those who simultaneously benefit from it.
In one of her early books, Feminist Theory: From Margin to Center, author, professor, and social critic bell hooks*, who is Black, discusses the experience of living in the margins while white people are living in the center: “To be in the margin is to be part of the whole but outside the main body . . . Living as we did—on the edge—we developed a particular way of seeing reality. We looked both from the outside in and from the inside out. We focused our attention on the center as well as on the margin.”2 In other words, marginalized people have long employed the skill of seeing from both perspectives, by necessity. This book challenges those with dominant identities to learn and adopt the same skill. If you find yourself feeling left out, get curious about what that’s about. Discomfort is not a bad thing. You can take advantage of it as a learning opportunity.
STRESS IN ACTION
Our emotions happen to us much more than we make emotions happen. That’s why one morning, after I went to the gym and was misgendered yet again, I found myself on an emotional treadmill.
At six in the morning, I roll out of bed, still sleepy, and figure I can energize my day with exercise. I arrive at the gym and punch in my code. The front desk person I usually banter with isn’t there. I’ve never seen this new guy before. He glances as my record comes up on his screen, and says, “Enjoy your workout, Ms. Bacon.”
Ouch.
Today’s a sensitive day. I was in low spirits from the get-go, and it’s not so easy to let it slide. Yet another kick-in-the-gut reminder that I’m not truly seen.
You’ve felt this, right? That feeling of being invisibilized is common for those who don’t fit the “mythical norm.” Maybe you’re a queer woman, for example, and you had the familiar experience where the dude at the bar muscled in on your conversation with your girlfriend, hitting on her and ignoring you. The sexual/romantic dynamics between you and your date weren’t seen and respected. Not only was the intrusion on your space angering, but it also made a statement that you weren’t deemed attractive enough to even be noticed.
Or maybe you felt it when a salesclerk asked the stylish white guy behind you if he needed help, obviously thinking you weren’t important enough to warrant attention.
Or maybe a bystander stopped you from administering emergency medical care to a hiker, not anticipating that a Woman of Color might actually be a trained health provider.
Or maybe you were flipping through magazines in the waiting room and couldn’t find anyone who looked remotely like you.
Back at the gym, I speak up.
“Hey, I’m not a woman.”
He’s perplexed. However I explain it, he’s not getting it. I try again and there’s a tiny glint of understanding.
He’s a nice guy. This was just an out-of-his-realm experience. (Oh, what a luxury for cis people to not have to think about gender!) But he’s rising to the occasion.
His coworker chimes in, offering me some words of support. This is good, I know, and better than I usually get. I appreciate being in the progressive bubble of Berkeley, California. But it’s still not enough. I’m holding on to my hurt.
“Sorry,” he says, flipping the screen to show his colleague and me that it says “female,” so it wasn’t entirely his fault for assuming.
Now I’m perplexed. When I signed up there were three options: “male,” “female,” and “not specified.” I chose the last one. Of course, “not specified” doesn’t acknowledge me, but at least it’s better than having to choose “male” or “female.”
I explain this and ask not to be categorized as female. I point out that even my driver’s license doesn’t say “female.” Under “gender,” there’s an X, which signifies “non-binary.” (How progressive are we in California!)
“Ah,” the guy says, “that ‘not specified’ category is for staff only. The system must have bumped you into female.”
“Can you change it?”
“No, we have only ‘male’ or ‘female’ for members.”
Pedaling the stationary bike, I can’t stop thinking about it. Rationally, I know this is a little thing. Can I really blame him? Of course he saw me as a woman; I embody many cultural signifiers that we’re taught to assume mean “woman.” The cultural attachment to the binary makes being genderqueer a constant coming out.
I try not to turn the feelings against my body for sending the wrong messages. I am just so tired of, and infuriated by, these unrelenting microaggressions.* It’s the proverbial paper cut. (“Death by a thousand cuts” refers to a dramatic negative effect that occurs so incrementally and imperceptibly that you don’t give it value as significant at the time of each individual “cut.”* Yet they take their toll additively.)
I go home, but the incident still weighs on me. I try to work, but my mind keeps wandering. My body responds. It responded in the moment, with a flash of pain, and now the internal sequences are in motion. I’m physically shaky. My heart races. I can’t calm down.
The internal dialogue is one I’ve played out many times. Just get over yourself, I admonish. It’s going to happen in our unwoke culture. Rise above it. But the rational understanding doesn’t dissipate the felt experience.
I need to produce several thousand words for an article I promised; my professional livelihood depends on it. Instead of writing, however, I’m distracted. I channel my energy into a project not of my making, chronicling the microaggressions I’ve experienced as a gym member. The project escalates to two painstaking letters; three infuriating phone calls; four fruitless, in-person conversations with gym representatives; and a partridge in a pear tree. It’s a battle I should never, ever have had to take on.
Advocating for myself for the most basic recognition, respect, and access—access I’m entitled to and pay for—steals resources I could be using to grow my relationships, career, writing, volunteering, and parenting. It’s a huge and unnecessary drain on my time and energy. (I’d hazard a guess that oppression is one of the greatest brain drains of all time. Imagine the potential that could be released if we eradicated or diminished it.)
Transphobia steals so much from me. The self-advocacy logistics I’m enlisted into are the least of it. I feel as if I always have to fight for recognition, for my rights, always be adversarial. Advocating for our own personhood and our most basic needs can make us feel burdensome—as if we’re being difficult, or as if it’s our fault. I shouldn’t have to advocate for being treated with respect. The time waste. The emotional energy required. Not to mention that it raises my blood pressure, keeps me irritable and on edge, and contributes to my insomnia.
My friends who are wheelchair users know this all too well. They need to advocate for “special accommodation” when the reality is that the world around them is specifically disregarding their needs and limiting their ability to participate.
A few months later, at the same gym, for amped-up reasons, I have a full-blown panic attack—thankfully, the only one I’ve ever experienced. It feels like I’m having a heart attack, as if I’m about to die. The panic attack is not solely the result of the particular incident. It’s the culmination of a history of misgendering, kind of like the icing on the stress cake.
I am trained as a psychotherapist, physiologist, nutritionist, and researcher. For thirty-plus years, I have used this training professionally and personally. I have worked to heal myself of drug abuse and an eating disorder. I have a loving partner who is herself a psychotherapist. I have resources, and I use them. Even so, I am not immune. Having the tools doesn’t protect me from the trigger and the response. It’s biologically wired into me.
It’s vital to understand that triggers, and our biological responses to them, will always exist. This is somewhat at odds with our body positivity and self-help movements, where there is a wealth of material available about practicing self-love as a panacea of life’s ills. I’ve met many people who’ve read the blog posts, taken the courses, and joined the movements. They experienced the life-altering epiphany that our culture is fatphobic and that diet culture (my previous work focus) is a problem. They’re actively working on revaluing themselves, and because of that, many become convinced that it’s necessary to exist in a state of perpetual self-love. Often, they are fine there until something unexpectedly cruel or discriminatory gets lobbed at them. Sideswiped by astonishment—and disappointment—when something happens that plunges them into a maelstrom of anxiety, fear, and shame, they think such things shouldn’t hurt or derail them anymore. “I know better,” they reason, “and I’ve done the work. Where did I fall short?” They’re ashamed of being ashamed. They interpret the pain and grief triggered by a dehumanization or microaggression as evidence that they haven’t been successful at practicing self-love.
If this has ever happened to you, it’s not because you failed to love yourself. No amount of self-love could have prevented the situation, or prevented your own physiological response and emotional reaction. Your reaction resulted from two things: a culture that is hostile to your body and targets you for abuse (which, of course, is going to hurt) and your natural, normal biological response to that painful stimuli. It’s not you, it’s the biology of oppression.
When you start experiencing emotional cascades as a result of triggers you thought you’d deactivated or “should be” immune to, this doesn’t mean you’ve failed to do the work or to move forward. Instead, it means you’re human and your brain and sympathetic nervous system are functioning well and doing their jobs. Their job is to keep you safe, and negative emotions are great for that. Scared of snakes? You’ll back away and stay alive. Experiencing a “they’re a predator” feeling from someone? You won’t let them past the door and you’ll stay alive. People who don’t experience fear or physical pain—and there are some who have a rare genetic defect or brain injury that creates this outcome—have short lifespans. Their broken bones and other health issues go undetected. A painless or fearless life is not something to aspire to. Instead, it’s better to build our capacity for managing and learning from our pain. Fear, shame, anxiety, depression, and hypervigilance can be our friends.
Think of a line of dominoes standing up. If you tip one, it initiates a sequence. This is how your brain and your body work, too. Some event external to you—a microaggression, insult, hostility—kicks off the line of dominos going from your brain straight through to your sympathetic nervous system.
By the way, there’s an update to the gym story. My advocacy efforts did have impact. In their words, “In our future system roll-outs and upgrades, users will be able to select additional categories other than male or female . . . Our Equal Opportunity Policy Statement and Restroom and Locker Room Accessibility policies have already been updated to include references to ‘them’ or ‘they.’ . . . The requests for [gender-inclusive] signage options and lockers in our all-gender bathrooms have been escalated for consideration.”
I am glad to see change happening and don’t want to appear ungrateful. But this particular victory was won at great emotional and biological cost—mine. It would have been a hell of a lot easier if the impetus had come from cis folks. For them, the fight might have been less personal and vulnerable, not triggering as much of a stress response. This is a call for all of us to rise up and champion causes other than our own. To make it easier for you, in the Appendix I’ve provided materials you can use to educate others. Perhaps you will want to supply your favorite café with the fact sheet to help them be more inclusive and inviting with just a simple change in bathroom signage? You might then be more likely to run into me there! Seriously, think about it: These “little” gestures translate to welcoming more people into our communities, making them so much more interesting.
I also want to thank my friends who had my back. Part of my advocacy included convening an impromptu “Social Action Advocacy Coalition” and threatening a social media callout against the gym. I’m not sure the company was sufficiently motivated to do the right thing because it was right. However, they did appear to respond to the threat of negative attention.
And really, I’m settling by seeing this as a victory. I want something better: a culture of inclusion, not accommodation. These problems could be solved with gender-inclusive bathrooms and changing rooms. It seems so simple. But the arguments get hurled back: It’s too late or too expensive or against their religion—and besides, why can’t you be like everyone else, then we don’t have to do all this extra work. I’m asked to be patient. Change takes time, they say. Your anger won’t help anyone understand.
What they’re really saying is I just don’t matter as much. And no matter how good I am at emotional regulation, this imprints on my biological system. Injustice is embodied.
Let’s map it out so you’ll know inside and out that having these physical responses is not a personal failure. It’s just basic human biochemistry.
THE BIOLOGY OF STRESS
I’m a science nerd. Understanding the science that supports an idea gives me a confidence that motivates me to make changes. Some early readers of the book had a different experience and felt a bit overwhelmed by this section. I invite you to consider your style. If scientific detail appeals to you, keep reading. If you want the short synopsis, skip to page 49.
In this chapter we’ll focus on neuroscience (the study of the structure and function of the nervous system and brain) and endocrinology (the study of glands and hormones). We will explore the brain and how it interacts with other systems in our bodies. But don’t be fooled. While we’re focusing on the body, what we’re really looking at is how we embody the outside world.
Your central nervous system is composed of your brain and spinal cord, and your endocrine system is composed of glands. These are the main actors in the communication and regulatory system of your body. Nerves, neurons, and neurotransmitters help conduct information in the nervous system, while hormones are the chemical messengers that conduct information through the endocrine system.
The brain structure known as the hypothalamus connects these two communication systems, playing a pivotal role in activities essential for day-to-day survival of the individual and for the continuing survival of our species. Its overall role is to collect and integrate information from the body by organizing neural and endocrine responses that help keep our internal conditions in a healthy range, known as homeostasis. For example, the hypothalamus senses when our temperature moves out of homeostasis and sends hormones to the sweat glands to slow or facilitate heat loss through evaporation. Much homeostatic regulation is, like temperature regulation, automatic and below our awareness.
The hypothalamus communicates with the rest of the body through the autonomic nervous system. The autonomic nervous system controls involuntary body functions, including breathing, blood pressure, heartbeat, and the dilation or constriction of blood vessels and airways in the lungs. It has two components, the sympathetic nervous system and the parasympathetic nervous system, which have somewhat opposite roles.
The sympathetic nervous system acts like a gas pedal, triggering the “fight or flight” response and providing the body with a burst of energy to respond to perceived dangers. The parasympathetic nervous system serves as a brake, prompting a “rest and digest” response that calms the body.
In addition to these automatic functions, our hypothalamus also triggers our conscious awareness to motivate us to help in regulation. It acts behind the scenes, so, for example, if you feel discomfort with the temperature, you may put on a sweatshirt or strip down.
Pleasure, pain, and distress are important aspects of the regulatory system as they motivate us to act in ways that support homeostasis and survival. The distress we feel may come softly, perhaps as a vague sense of unease, or loudly, in the form of anxiety, a panic attack, or depression. The point of distress is to mobilize you to take action to get out of your discomfort and back into balance.
It may be hard to recognize anxiety, panic attacks, and depression as attempts at health and mobilization, but stay with me. My hope is to help you to see these as gifts and to support you in accepting and heeding them, so that in the long run, you will ultimately become happier, healthier, and more connected. Pain and distress may not be fun to experience, but as we accept them as part of our humanity, we can value and appreciate their role not just in our survival, but in making us better and more resilient people. The usefulness of pain can be difficult to come to grips with, especially when you are going through it. Yet painful experiences can be regarded as lessons that enable us to better handle similar occurrences in the future. They can also lead to greater capacity for compassion, love, empathy, and connection with others.
We are wired for survival. That’s why you feel hungry: to motivate you to eat and acquire the energy and nutrients you need. It’s why food can taste good, to reward you for eating. It’s why sex can be pleasurable, to motivate human connection and procreation. Of course, these systems can get messed up because of difficult personal experiences and our cultural baggage around sex, food, and weight. Yet, healthy systems are wired into us, and we have the capacity to restore and heal those connections.
The anatomy of the brain is most easily understood from the perspective of evolutionary history, using the triune brain model, which divides the brain into three regions representing the gradual acquisition of the brain structures through evolution. While this model is undoubtedly an oversimplification—in reality there is no such neat division—it provides a helpful overview of functioning.
The three regions are as follows:
•Reptilian brain: your primal or instinctual brain
•Limbic system: your emotional brain
•Cortex: your rational or thinking brain
These three sections of the brain are connected to each other and to the remainder of the body through neural pathways and hormones.
The most primitive part of the brain includes the main structures found in a reptile’s brain: the brainstem and the cerebellum. This part of the brain controls the body’s survival functions such as heart rate, breathing, body temperature, and digestion and is the main coordinator of the fight-or-flight survival response. The brainstem connects the brain to the rest of the body through the spinal cord. Its main job is to keep you safe.
The limbic area, which sits atop the reptilian brain, is composed of the hippocampus, amygdala, thalamus, and hypothalamus. Referred to as the “emotional brain,” the limbic area plays a role in how we feel, remember things, and interact with others. Its main job is to keep you connected to others.
The cortex, the last primary structure to evolve, is often referred to as the “thinking brain.” It’s involved in language, rational and abstract thought, imagination, and creativity, to name just a few functions. Its main question is “What can I learn?” Of special interest is the prefrontal cortex, which connects to both the emotional and instinctual areas of your brain.
A well-developed and well-connected prefrontal cortex is critical to making good decisions and managing emotions and bodily functions. It’s what allows you to pause, consider the emotional and bodily messages you are getting from the limbic system and brainstem, obtain insight into what’s going on, and have empathy for others. It regulates impulsive desire, helps you do the right thing, and controls the reactive impulses that may solve a problem temporarily (saying “Shut up” when someone is driving you nuts) but create long-term consequences in the end (goodbye, friendship). It also allows you to have healthy digestion, preventing the instinctive triggering of the digestive tract that could result from unchecked anxiety.
A less developed and less connected prefrontal cortex, on the other hand, a hallmark of a high allostatic load, means that you get stuck in survival mode and your instinctual brain rules. Your ability to regulate your emotions is reduced, and you are quickly triggered and reactive, unable to make thoughtful decisions. You are also more vulnerable to being triggered by the environment, such as a food advertisement driving you to eat even if you’re not hungry. Normal social anxiety can lead to drinking too much or other “reactive” behaviors, such as overexercising, gambling in a destructive way, compulsion, hoarding, anxiety, rage, violence, and overachieving in work or with other goals at great cost to relationships and well-being. You are also more prone to a range of diseases, from depression to diabetes to irritable bowel syndrome.
The prefrontal cortex is the last part of the brain to fully develop and isn’t completely developed until about age twenty-five. That’s one reason why kids may lack good judgment and need mature adults to guide them. Of all our brain structures, the frontal cortex is least constrained by genes and most shaped by the environment.
Studies on socioeconomic status show that by kindergarten, disadvantaged kids already display differences in their prefrontal cortex that result in difficulties in emotional regulation. This partly explains why some kids have trouble controlling their impulses (“acting out”).
While challenges around emotional regulation are part of being human, your degree of reactivity tells a lot about the functioning of your prefrontal cortex. For instance:
•How good are you at emotional regulation?
•When things go wrong, are you quick to anger?
•When circumstances are beyond your control, do you become stressed and anxious?
•When you don’t get what you want, do you feel sad and dejected?
•When your kid doesn’t do what you want, do you become irritable and crabby?
Our brain’s primitive stress response is intended to help us survive stress in our environment. Stress is a biological response to threat that triggers your sensory organs to send a message to the brain structure known as the amygdala. The amygdala, often called the “fear center,” interprets the sensory information and considers stored memories (like what happened the last time we were in a similar situation), judging whether the situation is stressful.
If the situation is determined to be stressful, the amygdala quickly alerts the hypothalamus, which activates the sympathetic nervous system by communicating through your nerves to the adrenal glands. The adrenal glands then release the hormone epinephrine (also known as adrenaline) into the bloodstream.
Epinephrine has several effects: Your heart will beat faster, increasing blood flow to your muscles and other vital organs, including your heart. This will raise your pulse rate and blood pressure. You will breathe more rapidly. Airways in your lungs will open more widely so you can take in more oxygen. You become more alert as your brain receives extra oxygen. Your sight and hearing, as well as your other senses, become sharper. Epinephrine also causes sugar and fat to be released from storage sites into your bloodstream, making energy readily available throughout your body.
After the initial surge of epinephrine slows, and if your brain perceives that the threat is still present, your hypothalamus secretes corticotropin-releasing hormone (CRH), which triggers the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH then travels to the adrenal glands, prompting the release of the hormone cortisol. Cortisol keeps your body revved up and on high alert, releasing a flood of glucose (sugar) to keep you energized while tamping down insulin production to ensure that the glucose doesn’t go into storage. It also narrows the arteries, while the epinephrine increases heart rate. The combined effect forces blood to pump harder and faster. Cortisol also suppresses the immune system and the gastrointestinal system so as not to “waste” energy on less essential functions.
Once the threat dissipates, the parasympathetic nervous system—the “brake”—dampens the stress response, causing cortisol and epinephrine levels to fall.
Sometimes, instead of the fight-or-flight response, a “freeze” response, wherein you dissociate or otherwise feel numb and disengaged, gets triggered. During freezing, the two counteracting components of the autonomic nervous system, the sympathetic and parasympathetic nervous systems, are activated.
Your past experiences team with your biology to dictate why certain circumstances trigger a fight-or-flight versus a freeze response. Evolutionary biologists maintain that a big driver is the degree of hope you have about your ability to activate change, such as ever getting out of debt or finding a partner, and that this is often below the level of conscious control.
Typically when we think of stress, we think primarily of the pathways leading up to and ending with the cortisol response, but there is now evidence that in certain stressful situations, a hormone called oxytocin is released along with cortisol. Oxytocin, nicknamed the “cuddle hormone,” initiates what’s been called a “tend-and-befriend” response to stress, elevating feelings of attachment, connection, trust, and intimacy and helping you get out of your stressful situation.
The tend-and-befriend response drives us to pay more attention to what we can do for others and encourages us to reach out for support when we feel that what we’re going through is more than we can fix on our own—be it financial problems, an illness, or the loss of a loved one. It’s not as well-honed in most people as the fight-or-flight response.
From an evolutionary perspective, tending or nurturing oneself and others, along with befriending others and expanding and maintaining social networks, is advantageous. We’ll focus on developing the tend-and-befriend reaction in chapter 8, on Connection.
SHORT-LIVED STRESS CAN BE GOOD
Moderate, short-lived stress is valuable and energizing, often improving alertness and performance. As an example, I feel stressed before I teach. This low-level stress response makes me alert and focused, without many negative effects. Stress can also boost memory. From an evolutionary perspective, memory strengthening makes sense because remembering stressors from the past can help you respond to similar future situations.
Stress is good when it is moderate and transient, and when it happens in a relatively safe setting.
Stress is problematic when it persists for a long time or is chronically activated, adding to your allostatic load. It’s also more likely to be problematic if you can’t predict the onset, how bad it will be, or how long it will last.
Why does predictability result in dampening the stress response, including reduced cortisol and epinephrine secretion? It takes more energy to process something that is new. If something is predictable, the brain can use the information to minimize cost and effort and act more quickly. Also, if you have a warning, you can plan coping strategies. When I was told that I’d have a surgical drain for a week post-surgery and that I would be much more comfortable once it was removed, I planned for it by taking time off work, being prepared with binge-worthy Netflix ideas, and having my partner available to take care of me. By planning my coping strategy, I was able to manage the stress more easily. In contrast, if I thought it was never going to change, I wouldn’t have taken care of myself and wouldn’t have modulated the stress.
The biggest challenge to your stress system comes from the situations where you feel that you have no agency (control) in your life. The more agency you have, the better you are at mitigating the damages of a stress response. (That’s largely why, contrary to popular thought, executives are less likely to have heart attacks than janitors.)
CHRONIC STRESS CAN BE BAD
Chronic, as opposed to occasional, stress imposes a very different experience.
With chronic stress, you can become hypervigilant, acting as if the world is unsafe, regardless of whether it actually is. This makes sense if experience has shown you that you can’t trust your environment. Then, even if there’s no monster under the bed, you’re on high alert.
You may also be distrusting, constantly anticipating and scanning the world for threats. If someone turns you down for a social event, you leap to the interpretation that they don’t like you, not even considering that they may have had previous plans.
You may be easily triggered, reacting in ways that seem inappropriate or out of proportion.
You may get lost in ruminations. This is your brain reviewing information to make sure you’re alert and safe.
You may have difficulty sleeping, because you are thinking too much and sometimes feel a sense of dread. This is about keeping you prepared in case something terrible happens.
Chronic activation of the stress response also amps up neural connections and activity in the amygdala, which, if you remember, is considered our “fear center.” High levels of stress make the amygdala larger, resulting in more fear and anxiety and heightened excitability.
As cortisol levels rise, signals in your hippocampus (the area of the brain associated with learning and memory) deteriorate.
Sustained high levels of cortisol can also cause your brain to shrink, resulting in a reduction of synaptic connections between neurons and a smaller prefrontal cortex. (In case you don’t remember, the prefrontal cortex regulates “thinking” behaviors like decision-making, concentration, and judgment.) In addition, fewer new brain cells are produced in the hippocampus, meaning that chronic stress might make you struggle to learn and remember things, in addition to setting up an environment of vulnerability to disorders like depression and Alzheimer’s disease.3
Excess cortisol also suppresses the immune and digestive systems, making energy available for more essential functions. On a long-term basis, suppressing the immune system can result in increased vulnerability to viruses like colds, increased cancer risk, susceptibility to developing food allergies, and possibly a higher risk of autoimmune disease, among other maladies. Suppressed digestive and absorptive functions also means you are more vulnerable to digestive problems like diarrhea, constipation, irritable bowel syndrome, and colitis. It could also exacerbate ulcers.
What’s more, high cortisol levels can deplete you of dopamine, the “feel-good” hormone. When your brain is low in dopamine, you may feel lethargic, unmotivated, and unenthusiastic. It’s as if low dopamine sucks the fun out of life. You may try to compensate with mood and energy boosters, like coffee or methamphetamine.
An increase in cortisol can also lead to a decrease in serotonin production—that’s the hormone that helps give you a sense of well-being. A decrease in serotonin can make you feel anger and physical pain more readily while also contributing to depression.
People who have had repetitive activation of their stress response also experience spikes in the stress hormones epinephrine and cortisol more quickly and disproportionately to a situation and take much longer to return to baseline than those who haven’t.
THE STRESS OF INJUSTICE
I want to pay particular attention to the stress of injustice, as it can take a silent toll on your body. It isn’t easy dealing with ongoing poverty, misgendering, ageism, ableism, or racism, whether you’re facing overt discrimination or microaggressions, which are subtler and thus harder to identify and address. You may be “dealing with it” and getting by, but not without consequence. Each emotional (or physical) blow adds to your allostatic load. While a single blatantly traumatic event bumps up your allostatic load substantially, so too does the accumulation of small, less explicit stressors over time.
Perhaps you hear “microaggressions” and dismiss them as insignificant, “just little things that hurt people’s feelings.” Don’t be fooled; these regular, subtle cuts inflict much damage. Feeling dismissed, alienated, insulted, or invalidated has a biological impact.
Each emotional insult may not stand out, but their accumulation over a lifetime is in part what defines a marginalized experience. It can be difficult for someone who doesn’t share an identity to understand the severity of a particular individual microaggression without having that historical experience. It can even be difficult for those of us who are victims of those microaggressions. I get that “kicked in the gut” feeling sometimes for little things. If someone doesn’t smile at me, for instance, and I get upset, the intensity of my response (hurt) may have little to do with what’s happening in the moment. That missing smile may have triggered a lifelong sense that I’m disregarded. Even so, I may blame myself for my physical response and for blowing things out of proportion.
We are all also guilty of laying microaggressions on others at times. Here are some common examples of things I’ve done (and learned from):
•Clutching my backpack more tightly when passing a Black man on the street (signaling that Black men are a threat)
•Asking someone who isn’t white “Where are you really from?” (signaling that People of Color are not “real” Americans)
•Assuming a female physician is a nurse (signaling that women can’t achieve advanced education)
•Assuming that a Latinx customer in a posh store is a salesclerk (signaling that Latinx people aren’t affluent enough to shop there)*
I may not have intended to hurt people, but my actions still cause pain. Each time we experience one of these slights, our body reacts, producing a stress response. In this way, being subjected continually to microaggressions turns into trauma in our bodies.
I don’t want to be that person harming others in this way. I’m learning to listen more and to be more attentive to the impact of my words and actions rather than cling to my innocent intentions. Our intentions don’t really matter if we’re hurting someone else.
We don’t know what we don’t know, which is part of why we need to listen more. What we heard may be very different from what the other person thought was said. We express ourselves within the context and history of a racialized and otherwise deeply discriminatory society. Focusing on intention diverts attention from the harm being done. Even if harm isn’t intended, consequences are inevitable, and wrongs will need to be rectified. We need to reflect on these problematic interactions and find the learning so we can take responsibility and try to do better next time.
Learning opportunities become derailed when we focus on our intent. Jay Smooth, a radio host and social commentator, articulates this well when he explains the difference between the “What They Did” conversation and the “What They Are” conversation.4 Smooth points out that if you focus on intent, the conversation revolves around whether you are a good person. If we apply it to the above examples, it turns the conversation to whether I’m racist or sexist. By focusing instead on the person who is hurt, I call my actions into question, not my character. This provides better opportunity to learn and grow.
On the other hand, intent matters a great deal in how we choose to respond to someone who hurts us. Intent influences whether we respond in anger, shrug our shoulders and walk away, or risk a discussion that could ultimately deepen understanding. Context matters; all are valid responses!
YOUR BRAIN ON DIET CULTURE
When it comes to fat people, the cultural narrative suggests that microaggressions are somehow a service to fat people, that expressing health concerns is beneficial “tough love.” Fat bodies are portrayed as diseased and wrong, capable of becoming healthy and thin if only the individual exerts enough effort. The relentless judgment of fat bodies is a good thing, the argument goes, as it can spark incentive for change.
No. No. No. We need to see these “health” admonishments as the microaggressions they are, promoting disease, not health. Stereotyped assumptions about someone’s weight are oppressive. Think about what it must be like for larger people—that is, most people living in the United States—to confront daily in the media, doctors’ offices, workplaces, and even their homes that their bodies are unattractive and constitute a horrifying public health crisis. That stigma shows up in the health of fat bodies. An opinion piece coauthored by psychologists, sociologists, and behavioral scientists in the journal BMC Medicine made a convincing argument that bias against fat people is actually a driver of the so-called obesity* epidemic, reviewing and citing seventy studies as evidence.5
Our bodies are not meritocracies. Some people will never be thin, even if they turn down that cheesecake or regularly run marathons. Furthermore, nobody has complete control over their health, regardless of the lifestyle that they lead. Healthism—the belief system that identifies health as the responsibility of the individual and ranks pursuit of health above all else—is harmful and misguided. By positioning health at the level of the individual, it neglects the social determinants of health and obscures the reality that some people have better access to high-quality health care and are more able to engage in health-promoting behaviors, such as getting regular exercise. The result is that people who are sick, disabled, or “unhealthy” feel that the absence of health is the result of their individual failure, wearing away at feelings of self-worth and giving others license to stigmatize them. It also requires people to continually strive for better health to be deemed worthy, and serves as the foundation for many moralizing and restrictive ideas about life choices. Eating nutritious foods is portrayed as being good, while chocolate is sinful. The idea that everyone is morally obligated to engage in this quest for “health” hurts more people than it helps.
To return to our discussion of hypothalamic control, let’s delve deeper by examining the hypothalamus’s role in managing our weight—or, more precisely, our body fat. What follows is an example of how diet culture has put us at odds with our own hypothalamic control.
You’ve heard the common “wisdom” that weight management is “a simple matter” of calorie control, right? What doesn’t get mentioned is that what’s in control is your hypothalamus, not your conscious mind. The system is not so simple after all.
This is why: Diets. Don’t. Work.
There’s irony when we consider that dieting has probably contributed to why we’re fatter these days than ever before. Dieting is actually a well-established predictor of weight gain, as shown repeatedly in research.6
When we examine the body’s regulatory mechanisms, it shouldn’t be surprising that few people sustain weight loss from calorie reduction diets or exercise routines. Scientists have found that our bodies will trigger numerous physiologic pathways to ensure that our weight stays the same.7 Our bodies’ internal system for managing weight compensates for conscious actions like reducing calorie intake. For example, dieting triggers a reduction in the hormone leptin. Less leptin binding to receptors in the hypothalamus, which tracks that sort of thing, triggers a cascade of reactions, including an increase in neuropeptide Y. What does neuropeptide Y do? It increases your appetite and decreases your metabolism—the opposite of what you’re shooting for if you’re trying to lose weight!
Chronic dieting results in chronically lower leptin release, spiking hunger and slowing metabolism, which could easily explain why most people with a history of dieting gain weight over time. Our bodies are (deliberately) overriding the “dysregulation” of our weight-loss efforts.
Check out what happened to contestants on TV’s The Biggest Loser. Six years after their hyped weight loss, most contestants had not only regained almost all their weight, but a study found that their metabolisms had also slowed dramatically.8 In other words, changes in their brain circuitry meant that, for them, eating less now resulted in weight gain. They had employed what are often called extreme weight loss methods, but even “normal” dieting could have led to the same result. Hypothalamic control exists to resist change (bringing us back to homeostasis), so as extensive research demonstrates, the same process happens any time body fat stores are reduced, regardless of how the weight was lost.
If you’ve dieted, think about your own experience. You reduced your calories and maybe you also started or amped up an exercise routine. Whether you went low-carb, low-fat, or low-sugar, the beginning stages probably were pretty heady as you watched the needle drop on the scale. But then it probably got harder to maintain. Most likely, you found yourself thinking about food all the time. You started to feel desperate, and even foods that never appealed to you before were suddenly calling out to you.
What diet plans don’t tell you is that biology lies behind that drive to break your diet. It’s not your “lack of willpower” that derails you. Your body’s physiologic mechanisms underpin every one of the symptoms you’ve felt. Even your taste buds are affected when you diet, as your leptin drop inspires you to find a wider than usual range of foods appealing. Biology can be powerful, and no matter how much willpower you think you have, it may be no match for the biological mechanisms triggered by your diet.
If you gave in and went off your diet, don’t blame yourself. It doesn’t mean you’re a glutton or a weakling. In fact, most dieters show extraordinary self-restraint, persistence, and determination. You didn’t fail; the diet did.
Maybe you had great willpower. I was at times a great dieter, able to “just say no” despite my gnawing hunger. I even found that after a while hunger signals dissipated and dieting got easier. There was physiology behind that, too, as my body turned off the appetite signals rather than waste the energy if I was ignoring them anyway. So your willpower is fine. But that still doesn’t mean you’re going to lose weight if you diet. To compensate, your body could slow your metabolism, burning fewer calories over time. This explains why some people actually gain weight in response to cutting those calories. And that anxiety that triggered you to break your diet? What you thought of as “emotional eating” was more likely a response to a normal biologic regulatory drive.
Bottom line: Diets. Don’t. Work.
Or maybe another way of saying this is that diets do work, remarkably well, triggering your internal weight management system to kick into gear and protect your precious energy stores.
Don’t fall for the hype about exercise as a means to sustained weight loss, either. Research shows that while we can influence our size in small ways, for most of us, our size doesn’t change dramatically when we engage in regular exercise. Steven Blair, an exercise physiologist who has served as president of the American College of Sports Medicine, the American Academy of Kinesiology and Physical Education, and the National Coalition for Promoting Physical Activity, likes to say, “I was short, fat, and bald when I started running, but after running nearly every day for more than thirty years and covering about seventy thousand miles . . . I am still short, fat, and bald.” Blair’s extensive study of the research leads to the inevitable conclusion that one’s conscious mind can rarely outwit hypothalamic control.
Your body is enormously powerful and successful in managing your weight, thanks largely to the hypothalamus. So don’t fight it. Revel in it. You can relax about eating and enjoy your food. Let your body do what it does best. Trust yourself, pay attention to helpful signals like hunger and fullness, and everything will be okay. The best way to win the war against fat is to give up the fight. Let your body guide you to a weight that’s right for you.*
This isn’t about giving up. All you’re giving up is an ineffective way to get what you’re really looking for. It’s about moving on. It’s about body respect and body trust, not body shame. These are what help you make better choices about what to eat and how to eat and other self-care practices.
THE SHORT SUMMARY
The human body has self-protective mechanisms in place to help us survive. Our fight-or-flight survival response is designed to mobilize our brain and body to fight an enemy or run from danger. We also have a freeze response that can help us hide from a predator. Both fight-or-flight and freeze can also be triggered by social stress.
A fight-or-flight response starts when a brain structure known as the hypothalamus senses threat and initiates a sequence of events that results in the release of neurotransmitters and hormones like epinephrine and cortisol into our bloodstream. These trigger dramatic changes: Our breathing rate increases. Blood is redirected away from our digestive tract and into our muscles and limbs, which require extra energy. Our awareness and vision sharpen, impulses accelerate, and perception of pain is blunted. We become prepared for fight or flight, both physically and psychologically. We also become hypervigilant and distrustful, on the lookout for the enemy.
When activated, our fight-or-flight system triggers us to perceive everything around us as a potential threat to our survival. It’s built to bypass our rational mind. This alertness causes us to interpret almost everything and everyone in our world as a potential threat. As a result: We may overreact to the slightest comment. Our fear is exaggerated. Our thought process is distorted. Our focus is narrowed to things that can harm us.
When we’re stuck in survival mode, our heart shuts down, our rational mind is disengaged, and we’re focused on fear. This prevents us from making thoughtful choices and recognizing the consequences of those choices. We can no longer relax and appreciate the moment. Relationships suffer.
Chronic activation of our stress system also increases our allostatic load, which ups our risk for a long list of conditions and maladaptive behaviors, including anxiety attacks, metabolic disorders, and yeast infections, to name but a few.
BRINGING IT HOME
Being treated poorly, being oppressed, is painful not just materially and emotionally, but also physically. Being excluded, rejected, insulted, demeaned—or, in my case, misgendered—contributes to a physiologic stress response, making stress not just biological, but inherently political.
Reading this stuff isn’t easy, is it?
The good news is you always have opportunity to rewire your brain to better support you. Just as stressful events can forge neural pathways, so can healing practices. You can harness this phenomenon—called neuroplasticity—to build new and better neural pathways in your brain and come out stronger and better for the adversity you’ve weathered. We’ll learn how in chapter 10. But first, we should talk more specifically about trauma and how it alters your brain.
*One familiar example of this is the bootstrap myth, the idea that people, if properly motivated and willing to work hard, can pull themselves up by their “bootstraps” and become successful. This belief denies the inequity in opportunity.
†Reminder: I use the word “fat” as a neutral descriptor, stripped of pejorative connotations.
*bell hooks does not capitalize her name in an effort to place emphasis on her work rather than her name.
*Microaggressions are the daily indignities, slights, and insults, whether intentional or unintentional, that have to do with a person’s membership in a group that’s discriminated against or subject to stereotypes. We’ll discuss these in more detail later in this chapter.
*The term actually has gruesome roots, referring to a type of torture and execution previously practiced in China and Vietnam that involved using a knife to methodically remove portions of the body over a prolonged period of time, until death resulted.
*Latinx is a gender-neutral word that refers to people of Latin American cultural or racial identity in the United States. The -x suffix replaces the standard -o/-a that is typically used in Spanish to denote male or female.
*I use the language “so-called obesity epidemic” to draw attention to my discomfort with the word obesity. As you will read later in the text, I consider obesity to be a stigmatizing term. Hereafter, the word obesity will occur in quotation marks, signifying that I am using the term to refer to others’ usage.
*Body trust isn’t something you intellectually understand and then quickly implement. It takes time, effort, and practice to dump diet culture thinking and regain body trust. That’s why I wrote an entire book about it, Health at Every Size, with more updated ideas in the coauthored Body Respect.