There is a category of adult experience that the available research has been mapping in increasing empirical detail across the last three decades. The pattern is one of long-term emotional accommodation to circumstances that, on careful examination, were never quite reasonable, paired with the slow accumulation of physical effects that the person did not, at any point along the way, connect to the accommodation. The two patterns run in parallel. The person registers them, for years or decades, as separate facts of their life. The research suggests they are, in most cases, more connected than the person realizes while it is happening.
This is one of the more carefully documented areas in contemporary psychophysiology, and the empirical work has, in the last twenty years, produced enough convergent evidence to make the general pattern reasonably well established. The specifics for any one person are not, in the research, predictable. The general pattern is.
We are writers and parents, not clinicians, physicians, or health researchers. What follows is a reading of the empirical work on chronic stress and physical health, not medical advice. The article describes a pattern documented in the research; it does not diagnose any one person’s physical symptoms or attribute them to any specific cause. Anyone with health concerns should consult a medical professional.
What “being reasonable” actually means in the research
The kind of reasonableness the title points at is not, in the research, a personality flaw or a moral failure.
It is the small daily accommodation a person makes to circumstances they have decided, often implicitly, to accept. The reasonable response to a partner whose anger is occasionally directed at the person. The reasonable response to a workplace that requires sustained tolerance of behaviors that would, in another context, be untenable. The reasonable response to a family of origin whose ongoing patterns are difficult but, on balance, not bad enough to leave. The reasonable response, more broadly, to a long stretch of life in which the person has concluded, often correctly, that the cost of objecting exceeds the cost of accommodating.
The empirical work on this kind of long-term emotional accommodation, particularly the work of Janice Kiecolt-Glaser at Ohio State University across nearly forty years of psychoneuroimmunology research, has documented that the accommodation is rarely cost-free. In a 1998 paper she published with colleagues in the Annals of the New York Academy of Sciences, Kiecolt-Glaser and colleagues showed that even brief episodes of hostile marital conflict produced measurable changes in immune, endocrine, and autonomic function in newlywed couples. The effects were not trivial. They were sustained for at least 24 hours after the conflict. The pattern has been replicated and extended across hundreds of subsequent studies, establishing that ongoing interpersonal stress produces ongoing physical effects, whether or not the person experiencing it registers the effects at the time.
The body’s slow accounting
What allows these small daily costs to accumulate into the bill the title points at is a process the research literature calls allostatic load. The term was introduced by Bruce McEwen at Rockefeller University in 1993 to describe the cumulative wear and tear that chronic activation of the body’s stress-response systems produces across years and decades.
The mechanism is reasonably well understood.
The body’s response to acute stress, including the release of cortisol, the activation of the sympathetic nervous system, the changes in immune function, is adaptive in the short term. It is what allows the person to handle the immediate situation. The same response, sustained or repeated across years, produces measurable effects on multiple body systems. In a widely cited review by McEwen, the empirical evidence is summarized that allostatic load is associated with impaired immune function, accelerated cardiovascular disease, abnormalities in fat metabolism, bone demineralization, and changes in brain structure, including in the hippocampus and prefrontal cortex.
The accounting is slow. The body does not, in most cases, send a visible bill in any one year. It sends, instead, a gradually accumulating set of small effects across decades, each of which the person typically attributes to age, lifestyle, or bad luck. The cumulative effect of the small accommodations to unreasonable circumstances is, in the research, real. The connection between the two is, in most cases, harder to see.
How the bill arrives
The bill does not, in the research, arrive in a single dramatic moment.
It arrives, in most cases, as the gradual onset of conditions that the person did not, at the time, connect to anything in particular. The chronic pain that started somewhere in the late forties. The cardiovascular issues that emerged in the early fifties. The autoimmune flare that did not have an obvious trigger. The insomnia that has been present for the last decade. The exhaustion that does not respond to rest. None of these is, in any one person’s case, necessarily caused by long-term emotional accommodation. Many causes are possible, and the research does not allow the article to claim otherwise. But the pattern, across populations, is consistent. People who spend decades in chronically stressful interpersonal situations show, on average, measurably worse physical health outcomes than people who do not.
The research is also clear, in Kiecolt-Glaser’s work and in the broader literature, that the effects are not evenly distributed. Some people show substantial physical consequences from chronic stress. Others, with similar exposure, show fewer. The relevant variables include genetics, the specific stressors involved, the availability of supportive relationships outside the stressful one, and many factors the research has not yet fully mapped.
What the research suggests
None of this is, in the research, an argument for refusing to accommodate. Some accommodation is, in most relationships and most working lives, simply how the relationships and the working lives function. The research is not telling readers to leave the marriage, quit the job, or cut off the family of origin. It is naming a pattern.
What the research does suggest, with reasonable consistency, is that long-term accommodation to circumstances that are not, on examination, reasonable, is more physically costly than the person doing the accommodating typically registers. The body keeps an accounting that the conscious mind, in most cases, is not party to. The bill, when it arrives, is real, even when the connection to the accommodation is not obvious.
Adult readers who are experiencing health changes that they suspect may be connected to long-term stress, particularly in close relationships or working lives, may benefit from speaking with a primary care doctor about the physical symptoms and, separately, with a therapist about the stress. The two conversations, on the available evidence, are most useful when they happen in parallel rather than as substitutes for each other.
The cultural conversation about midlife health still tends to focus on lifestyle factors that the individual can adjust, such as diet, exercise, sleep, and screen time. The empirical work on chronic stress and physical health suggests these factors are real but incomplete. The factors that operate in the background of a person’s daily life, including the small accommodations that have become invisible to them, are also doing work. The research has not given the article the tools to disentangle the two for any one person. It has given enough to suggest that the disentangling is, in many cases, worth attempting.
