Inflammation has always been a medical mystery, but now it has become an enemy of long-term health.
Deepak Chopra, md, and Rudolph E. Tanzi, PhD,
coauthors of The Healing Self
It’s hard to fathom the possibility that an internal defense mechanism that could save your life also could turn against you and threaten your health and well-being. It sounds like a fictional form of biological mutiny, but it can happen, and it does with inflammation. Normally, inflammation, which is triggered by the immune system, is beneficial because it helps your body fight off disease-causing germs and repair injured tissue. When the battle has been won, inflammation is supposed to cease and desist. When it doesn’t, chronic, low-grade inflammation, which is invisible to the naked eye, can occur and have a harmful effect on your organs, blood vessels, and cells. Chronic systemic inflammation corrodes the body’s tissues, creating a degenerative spiral such that the more inflammation you have, the more at risk you are for developing chronic diseases such as heart disease, diabetes, and certain forms of cancer. In addition, systemic physical inflammation can impair your cognitive processes, impeding your ability to think and reason clearly, exercise good judgment, and access your memory bank. Over the long term, it has even been linked to dementia, while in the short term, it can affect your mood states. Indeed, inflammation in the brain is closely associated with a number of emotional conditions, including depression, anxiety disorders, bipolar disorder, PTSD, and others. Although depression is not an inflammatory disorder per se, a substantial body of literature shows the two are related. Mounting evidence suggests that the two conditions are not only closely connected, but they also may actually fuel each other. That’s the story with hidden physical inflammation.
As I’ve seen in my practice, a similar downward spiral can happen with emotional inflammation. No matter what kind of reactor type you are, exposure to your personal triggers and the emotional inflammation that results can incite a flood of ill effects that can eat away at your well-being. Life in the modern world is challenging enough, so when people hear about the latest political scandal, human rights violation, environmental threat to human health, or metastatic climate issues that are threatening already fragile world states, they start to wonder, How and where can we be safe? Who is going to take care of us? What kind of legacy are we leaving our children? The images and thoughts that come to mind as you try to answer these questions can trigger a cascade of negative thoughts and emotions that may ricochet off each other. Or they can lead to anger, despair, or a state of behavioral or mental paralysis where you might feel unable to take action to improve matters.
Emotional inflammation stems from responses that are physiological and psychological. Physiologically, the sympathetic nervous system (SNS) and parasympathetic nervous system (PSNS) are like a teeter-totter—each is weighted according to the body’s needs at any given time. In times of threat, the SNS dominates because it prepares us to fight or flee. In contrast, the PSNS takes over when the effort to restore or maintain calm is called for. Their interplay contributes to our internal equilibrium. When this particular system of checks and balances between the SNS and the PSNS works well, you’re likely to feel good, physically and emotionally. In times of acute peril—if you were to encounter a potential threat, say, a rattlesnake ready to strike in the woods, a menacing driver on the highway, or someone following you on a dark street—your body is designed to optimize your chances of survival, thanks to its inherent stress response. This is the commonly referred to fight-or-flight response where your heart and respiration rates shoot up, your blood flow and blood pressure increase, and your muscles contract so that you can fight or run for your life. Optimal energy is delivered to the parts of the body that need it most, while bodily functions that aren’t critical in the fight for survival are put on hold.
Meanwhile, key areas of the brain, including the amygdala (which assesses and reacts to threats), are activated to appraise the severity of the threat you’re facing and race to throw a plan into action. In life-threatening (or what may feel like life-threatening) instances, the prefrontal cortex—which is usually in the driver’s seat as the brain’s chief command center, keeping our impulses and snap judgments in check—starts to go dark, as the fired-up amygdala gets the upper hand and takes the wheel. The brain’s neural circuitry is hijacked, greatly ratcheting up your fear, anxiety, and aggression, making it even harder to think clearly. Careful planning and measured thoughts are sacrificed in this time of urgency. Decisions are neither carefully weighed nor reviewed. When this happens, responses are primal. These physiological changes are part of the inherent survival mechanisms that allow us to react to emergencies, stand up to threats, and defend ourselves and our loved ones with swift action.
But what about situations that simply feel threatening? Threats that trigger our survival mechanisms come in a variety of sizes and shapes, and few are as dramatic as those just described. That sort of stress response would be way over the top if, for example, you got into another political argument at work, received a sky-high bill you can’t cover, or witnessed some repugnant or disrespectful behavior. With everyday sources of upset such as these, your body’s stress response can overreact; it can jump the gun to deliver an over-the-top response. The more often this happens, the more damaging it is to your health and well-being. In his book The End of Stress as We Know It, Bruce McEwen, PhD, notes, “The human mind is so powerful, the connections between perception and physiological response so strong, that we can set off the fight-or-flight response by just imagining ourselves in a threatening situation.”
The body is not designed to handle chronic emotional stress. Living in a persistent or frequently triggered state of high anxiety, fear, or dread causes your body’s fight-or-flight response to get stuck in the “on” position. When this happens, your sympathetic nervous system stays revved up, flooding your mind and body with the stress hormones cortisol and adrenaline. Your heart rate, breathing, blood flow, and blood pressure may stay elevated, and white blood cells go on a search-and-destroy mission that can end up attacking your own tissues and organs—which accounts for widespread inflammation. Chronic stress also pulls resources away from needs that become relegated to second tier status, such as digestive and reproductive functions. (This is why fertility and sex drive often drop when someone is under chronic stress.)
In addition to straining your cardiovascular system and disrupting your immune, endocrine, neural, and metabolic functions, chronic stress can even amp up your pain response. That’s how the very system that was evolutionarily designed to protect you from harm can become a threat in itself. As molecular biologist John Medina notes in Brain Rules, “Our stress responses were shaped to solve problems that lasted not for years, but for seconds . . . when moderate amounts of stress hormones build up to large amounts, or hang around too long, they become quite harmful.”
As described earlier, the term allostatic load refers to the stress-induced wear and tear on the brain and body that can accelerate the aging process and lead to a range of health problems. Allostatic load can occur in a number of ways: when psychological stress continues unabated, when your mind or body doesn’t adjust to an ongoing source of stress, or when the stressful event has ended but your body and mind haven’t calmed down. In circumstances where the stress response is unable to shut down, your brain and body are subjected to continuous waves of alarming messages, including surges of stress hormones.
People who suffer substantial accumulations of psychological, social, or environmental stress are at risk for having the regulation of their physiological stress response disrupted. Some people seem to be more vulnerable to a heightened reactivity to stress than others are. This may be because of their genetic makeup or their experiences with previous traumas. Some lifestyle factors such as insufficient sleep and taking certain medications can increase stress. Stimulants, steroids, antiseizure drugs, and certain antidepressants can all magnify angry or aggressive feelings. Exposure to certain chemicals such as PBDEs (polybrominated diphenyl ethers), flame retardants that are in many consumer products, can amplify the activation of the sympathetic nervous system during stress. On the other end of the spectrum, beta-blockers, other antihypertensives, and Parkinson’s drugs can make you feel more depressed or fatigued. The point is, it’s wise to be aware that, on a regular basis, unknown and unexpected exposure to many substances can heighten your reactivity to stress.
The upshot of all this is that walking around with a swirling case of emotional inflammation—anxiety, a sense of foreboding, or a state of hyperarousal—can take a toll on your body and mind in just about every conceivable way. It can have enduring ripple effects—physically, mentally, emotionally, behaviorally, socially, and spiritually.
Feeling unsafe, hyperreactive, and fearful about the future can lead to a continuous loop of peril that plays in your head, cognitively and physiologically. These feelings are not only symptoms of chronic stress, they can be drivers of it by perpetuating the stress response. After all, prolonged surges of cortisol and other stress hormones can increase feelings of anxiety and depression. This continuous stress reaction can trigger an array of emotions including anger, grief, sadness, or worry, that can turn into impotent rage, fear, or despair. It can lead to disturbing intrusive thoughts or sleep troubles and nightmares. For some, it leads to burnout and withdrawal. It can compromise your ability to focus or concentrate, learn or remember essential information, and function at your cognitive best in other ways.
It also can throw you into a state of rumination, where you brood, mull, or obsess over an issue so that these thoughts play like a broken record in your mind. Or it can lead to anticipatory anxiety, where you worry about something that could, but might not, happen in the future, or to emotional drift, whereby one anxiety ignites another. It can also cause you to catastrophize, where you imagine worst-case scenarios that could happen. Any way you slice it, this is a crippling way to live and work.
This nonstop stress reaction is also associated with a state of learned helplessness and feelings of powerlessness that can throw you into a state of behavioral paralysis. It can lead you to try to avoid situations or activities that remind you of what you’ve come to fear, or it can cause you to feel unable to take constructive action to improve matters. On the other hand, some people have a tendency to push themselves to go faster—to cram their lives with more activities or to seek more stimulation—in an effort to distract themselves or get away from the angst. It’s almost as if they believe subconsciously that rushing through life will help them avoid the discomfort of fully processing or existing in these frantic, unstable times.
Whichever reaction styles resonate with you, the effects are similar. When your brain’s prefrontal cortex takes a backseat to the amygdala during ongoing sensations of stress, the neurotransmitters that would normally keep your emotions in check are not sufficiently available, and you can end up, instead, experiencing an overwhelming tide of uncomfortable emotions.
In his compelling book The Body Keeps the Score, Bessel van der Kolk, MD, refers to the “emotional brain,” whose primary task is to protect your welfare. That sounds helpful enough, but the emotional brain assesses information in a very general way and often “jumps to conclusions based on rough similarities.” Within the emotional brain, he notes, “these reactions are automatic, set in motion without any thought or planning on our part, leaving our conscious, rational capacities to catch up later.” His book is about the effects of serious psychological trauma (from, say, engaging in combat or being the victim of violence or abuse), but these effects also occur with more mundane but persistent sources of anguish or distress. It’s just a matter of degree.
A priming effect can occur such that when you’re in the throes of emotional inflammation, you become much more sensitive to the next crisis or stressor that comes along, both physiologically and psychologically. What this means is that a less intense stimulus or stressor can elicit a stronger physical and/or emotional response than it would normally. In a study in Switzerland, healthy participants were shown microsecond bursts of images of a fearful face or an emotionally neutral face while they looked at color words. The exposures were so brief that they were “subliminal stimuli”; that is, the participants were not consciously aware of the images. After viewing the color words and the faces, the participants performed a stressful task. Those who were shown the fearful face experienced a significant increase in cortisol levels after the stressful task, while those who saw the neutral face did not! In essence, a form of fear priming, below the level of conscious awareness, increased the participants’ responses to subsequent stressful stimuli.
Similarly, researchers from the University of Utah did an experiment to gauge whether subliminally activating people’s thoughts of their personal relationships—including supportive, indifferent, aversive, and ambivalent ones—would influence their stress responses to challenging math and speech tasks. The answer turned out to be a resounding yes. Those who were primed with random, forty-three-millisecond flashes of the names of people with whom they had negative relationships exhibited greater feelings of threat, lower feelings of control, and higher diastolic blood pressure reactivity during the stressful task. Those who were primed with the names of people they felt ambivalent about had the highest heart rate reactivity during the stressful task. These effects were true for both men and women.
When you’re experiencing emotional inflammation, a similar phenomenon can occur: you can become more sensitive and/or react more strongly to the next threat or piece of bad news that comes along, or you might react to something that you wouldn’t normally react to at all. In these instances, the subconscious mind takes the wheel, and more often than not we don’t even realize that we’ve been primed to become upset. Once you’re on the nervous edge, if you lose your footing, you can fall into the “stress abyss.” Over time, swimming in a pool of toxic emotions can shrink the prefrontal cortex (the command post for self-awareness, self-control, foresight, and planning) and increase the size of the amygdala (the brain’s fear and aggression center), changes that can make the brain even more reactive to stress.
Andrea, a forty-nine-year-old strategy and operations manager for a national nonprofit based in New York, became personally familiar with the priming effect, though she didn’t know the name for it at the time. It started after the 9/11 terrorist attacks. She’d often start the day with the unsettling thought, Is this the morning it happens again? But her level of distress increased dramatically after the 2016 presidential election. “I felt so depressed by the whole dialogue, the vile nature of political discourse, the climate of intolerance and divisiveness we’re living with,” she said. “It’s had a negative cascade effect on me: I’m tripped up by things like navigating technology or having difficult conversations at work that didn’t used to give me anxiety. I’m not an obsessor by nature, but I often end up anxiously ruminating these days.”
Andrea also said that since the election she had been drinking wine “twice as much, twice as often” as she used to, to try to numb her anxiety. She’s hardly alone: alcohol consumption has increased dramatically in the US in recent years, with high-risk drinking (defined as four or more drinks in a day for women, five or more in a day for men) rising by 30 percent.
In addition to consuming alcohol, some people end up trying to numb their distressed feelings with medications, food, and other substances, or empty activities like endlessly shopping or playing video games. They seek instant relief or gratification with these behaviors in an instinctive effort to try to tamp down, mask, or undo their emotional distress. But seeking immediate relief compromises the sophistication of the choices you make. Behavioral myopia—taking action based on what feels good right now without considering the possible consequences—can keep people in denial about what’s really going on with them. This is true with alcohol consumption, for example. Because having a glass of wine or two (or three) impairs someone’s perception and thought processes to some degree, drinking can reduce anxiety by making it harder for the individual to focus on the thoughts and issues that provoke that angst; instead, the person’s thoughts become narrowed.
Sometimes, too, pervasive fear and anxiety might cause you to avoid going to public places that had brought pleasure in the past, such as concerts, museums, or even shopping malls or nightclubs, or engaging in experiences such as demonstrations or marches. The hidden agenda might be to encapsulate yourself in a protective bubble or to avoid stimulation that might set you off emotionally. Or, if you continue to go to these venues, you might find yourself engaging in compulsive checking behaviors.
Recently, Stephen, a fifty-nine-year-old lawyer in Washington, DC, realized that he had adopted a habit of immediately looking for the exits when he enters museums, airports, theaters, department stores, conference halls, and other public places. He also mentally rehearses reacting to a threat if one were to occur and thinks about ways to try to mitigate the perpetrator’s ability to harm people. “It has become automatic for me to do this—I don’t consciously think about it,” he says, “but it impedes my ability to fully enjoy what I’m seeing or doing.” He added that these changes in behavior were a response to the increased gun violence and mass shootings in the US.
Whether you’re in hypervigilance mode or denial, or you’re acknowledging how you’re really feeling, the insidious effects of emotional inflammation can harm your physical and emotional well-being in ways that sneak up on you. Your lifestyle practices, including what you eat and drink, whether you smoke, how often you exercise, and whether you get enough good quality sleep, also can stimulate the production of adrenaline, cortisol, and other elements of the stress response (the hypothalamic-pituitary-adrenal, or HPA, pathway axis). These dynamics contribute to a round-robin of distressing thoughts and feelings that can alter your behavior and damage your health, which in turn upsets your emotional equilibrium. And the effects don’t stop there.
By nature, human beings are social creatures, although some of us are more so than others. We have the capacity to relate to and care for each other, and to cooperate and support each other. And we benefit from these connections. Indeed, numerous studies have demonstrated the positive effects of social support on physical health and emotional well-being, including resilience to stress.
Unfortunately, emotional inflammation can take a toll on this aspect of our lives too. The harm from living in a state of high alert, helplessness, restlessness, or emptiness can seep down to our unconscious, unsettling our social proclivities and even our very souls. When there are big problems—as there are with the significant issues that are upsetting people these days—and no easy answers, the inclination to take action may become blunted. This can manifest in what social psychologists call the “bystander effect,” in which a throng of people may witness something dreadful and instead of taking action, they just stand around or at most simply wring their hands. On a greater scale, the bystander effect is in play when large segments of the population observe social, political, and environmental wrongdoing but take little or no action. This anxiety-laced inaction, denial about the gravity of the situation, and relinquishing of responsibility can become the social norm—the expected, accepted behavior. But this paralysis ends up making us feel even more traumatized, as it stands in the way of behaviors that, driven by empowering actions, can reduce anxiety.
Living in a time of disgraced heroes—where professional athletes and coaches, politicians, military leaders, actors and producers, writers, and other people we once admired are taking a spectacular fall from grace due to their personal misconduct—adds to a feeling of bewilderment, cynicism, and loss. For young and old alike, having mentors, role models, heroes, or people we look up to can be uplifting and inspiring, encouraging us to dig deeper to find our best selves and aspire to greatness. So it’s understandable that wondering how to reconcile admiring someone professionally while disapproving of his or her personal conduct can lead to the mental discomfort of cognitive dissonance (a term you may remember from Psych 101). These stressors can have destabilizing effects and can rob us of our joie de vivre—with unsettling ramifications both in our personal lives and in our deeper spiritual selves.
People often experience spiritual distress when they’re battling life-threatening illnesses or facing end-of-life decisions. Military combat veterans who have seen or participated in morally injurious events suffer more from anxiety, depression, and PTSD than most people do; they also have higher-than-average levels of spiritual or religious turmoil. These connections are not surprising. What’s more startling and more concerning is that increasing numbers of people who haven’t experienced objectively traumatic events are also grappling with spiritual distress, existential dread or angst, or weltschmerz, which means “world pain” in German. (It describes a world weariness that stems from the discrepancy between how one wants the world to be and how it really is.)
I am seeing these struggles of the soul increasingly in my practice. In addition, it’s becoming more common to encounter climate activists, media professionals, political types, office workers, and others who feel disengaged or want to escape the turmoil of the modern world. In my work with Our Children’s Trust, I became sensitized to and started working more broadly with young people who are grappling with deeply traumatizing issues related to the climate crisis and the future they will be inheriting. Many young people do not want to have children because of the cost to the planet of adding another person and the fear of bringing a child into a chaotic world. Our government’s unwillingness to protect our planet, despite the scientific consensus on the dangers, has unleashed a profound sense of cynicism. A feeling of futility is seeping into the lives of some young people during what should be an uplifting time of idealism and discovery and dreams for the future. Many lament the irresponsibility of adults and feel angry about the mounting responsibilities that are being heaped on them. Is it any wonder research suggests a correlation between problematic alcohol consumption and spiritual struggles among college students?
To be clear, I do not view these struggles of the soul as crises of religious faith but as struggles to maintain hope, empathy, compassion, and a sense of meaning and purpose in a world that feels to many like it is falling apart or going to hell. Having the feeling that life has no inherent value or significance or that your personal actions really don’t matter can be either a driver or an amplifier of emotional inflammation. It can also be the result of emotional inflammation. When all three of these dynamics occur simultaneously, it’s easy to become more fearful, angry, withdrawn, or agitated.
If anyone knows this, it’s Catherine, a fifty-eight-year-old lawyer who has spent her entire career fighting for social and restorative justice, particularly for women, immigrants, and other disenfranchised people. A mother of four and a former foster parent in Chicago, she became a lawyer to try to make the world a better place, but in recent years she has increasingly questioned her ability to do so. “I spend a lot of time on social media because I’m afraid I’ll miss something critical about what’s happening in the world,” she says. In particular, the discordant political climate and rampant human rights violations that have been grabbing headlines have ramped up her anxiety about the state of the world. Besides leading her to question her chosen life path, she has begun to lose hope for the future: “Many days, I’m not sure there will be a world that I’d want my grandchildren to live in,” she says.
This kind of bleak outlook can penetrate the deepest parts of a person’s psyche, affecting his or her thought patterns and actions, often unconsciously. When people lose a sense of meaning or purpose in their lives, they frequently stop looking for opportunities to expand their engagement with the world or to solve problems in their own lives and the world at large. They might stop taking care of their health or planning for the future because they don’t want to (or can’t) imagine it. Instead, they become focused on just getting through the day, handling challenges that arise in life as if they were playing a continuous Whac-a-Mole game.
Religion is becoming less important in the US and in other countries. In a 2017 survey of more than 5,000 adults in the US, 27 percent said they think of themselves as “spiritual” but not “religious,” a 42 percent increase from 2012; in 2017, an additional 18 percent indicated they are neither religious nor spiritual. These changes have occurred among people from all walks of life—men and women, Republicans and Democrats, and those of different races, ages, and education levels. Is this an era characterized by a crisis of faith and hope? The doubts and losses are there; whether this reflects the chaos and turmoil in the world, a deep-down cynicism, or other factors, we can’t know for certain.
By any moniker—spiritual emptiness, existential angst, weltschmerz, or another term—it’s clear that more and more people feel they’re missing a connection to something important, to something larger than themselves. This spiritual void can be disorienting, perhaps making you feel aimless or rudderless in the world. But you don’t have to accept this as the inescapable status quo, nor do you need to be at the mercy of the physiological and psychological stress processes inside you. In the chapters that follow, you’ll discover myriad ways to dial down your hyperreactivity, calm your body and mind, and reclaim a sense of purpose, hope, and connection to others—despite living in a turbulent world. By using the right strategies and techniques, you’ll be able to slow the emotional inflammation cascade and work your way instead toward a state of steady calm.