When The Body Says No | Reflections & Notes

Gabor Maté. When the Body Says No: Exploring the Stress-Disease Connection. 2003. (306 pages)

“It is not to see something first, but to establish solid connections between the previously known and the hitherto unknown, that constitutes the essence of scientific discovery. It is this process of tying together which can best promote true understanding and real progress.” – Hans Selye, M.D., The Stress of Life

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REFLECTIONS

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This is a hard reflection to write. I finished this book while on a visit with my father. Upon seeing the cover, he inquired and asked if I wanted to share anything about my childhood trauma. (*pause. *sigh. *breathe.) The conversation did not go, well,…well. My stoic response to his defensiveness after my sharing further entrenched me. I was once again perplexed and challenged to take to heart all the lessons and insights I’m learning about trauma, and found that encounter to be a poetic irony and tragedy of the long road that I’ve been on through my life, a journey that I am only now trying to understand. And so, this book—along with others (the deepest well, What Happened To You?, The Body Keeps The Score, and Why Zebras Don’t Get Ulcers)—is at the top of my list as incredibly helpful and insightful to that end, even as it was at times painful. Being informed while being healed in the same read is a gift I do not take for granted.

Here are the key takeaways that are worth pursuing to their fullest:

1. We don’t truly know what disease is. And because we don’t really know, we are far from understanding how to heal.

This is not to say that we don’t know anything. We clearly have made amazing advances in our medical knowledge. As such, to point out our ignorance is not to decry our scientific endeavor but to catalyze it. This is a theme of Harari’s Sapiens, that what launched the scientific revolution was not knowledge, but the discovery of ignorance. For health and disease, we need the same humility.

This was made evident when Maté rightfully elucidates and challenges the prediction—like other scientific predictions—that we’ll be able to “know” how diseases work when we decode the genome. We are now almost two decades after the human genome was sequenced and we’re no closer to curing cancer, heart disease, or a hundred other ailments than we were in the 1990s. It’s past time to embrace our ignorance so we can pursue other options of consideration. Trauma and the body’s stress response is a sensical avenue to continue researching.

2. Still, the thesis feels academically tenous. I find the trauma-disease link compelling (and personally meaningful). Regardless, I confess that much of what Maté records did not have the academic rigor that is perhaps needed to be deemed credible. There were far too many reports and studies that simply observed correlates, rather than confirmed links. Admittedly this is going to be very hard to do. It is my hunch that we may never be able to get to the kind of data we want in this field of research given the complexities of human relationships and the necessary component of one’s environment, a variable that is as diverse as there are seconds lived multiplied by the number of people studied. Still, we can keep trying.

3. Attunement is as important as Attachment. This was an incredibly enlightening insight for me personally, as it described well what I felt growing up, and what I still feel to this day in my close relationships. (Just having words is so healing). I do not ever know if I’ll ever be able to alleviate myself from my ailment of “proximate abandonment.” לא טוב היות האדם לבדו. I pray it comes to pass.

4. The power of differentiation. Elucidated by Edwin Friedman (cf. A Failure of Nerve) who writes on family systems, this powerful tool of “autonomy” was a needed reminder for me in my process of emotional healing.

5. The immune system is about self and non-self. Discussing autoimmune disease as the body’s way of forgetting what is “self,” or being unable to distinguish between “self” and “non-self,” was really amazing, and has tremendous philosophical value. In many ways, the physical disease of the immune system is analogous to our traumatic and psychological disease of self-discovery. Identifying “self” is the pathway to healing for both the psyche and the cells.

6. Stem cells require an environment for expression. And so of course our whole selves require the same. When we consider how in the world the cells “know” what to do, how to develop, what form, shape, or expression they’re supposed to have, it is delinquent to simply appeal to the genetic code, as if that was all that is necessary. Recognizing the influence of environmental factors is exactly the point of all of this, and this cellular truth is a metaphorical truism regarding how we need to think about our bodies and our humanity.

There is a lot more, of course, and so notes and highlights are below. What is most important to say is that you, my dear friend, are not alone in your trauma, disease, pain, and path to healing and wholeness. Consider deeply what “The Wisdom of Trauma” (the title of the documentary, trailer below) might teach us, and how our deepening connection to it and each other could advance our healing.

Thank you, Yasi, for introducing me to the author. Your passion for healing people’s trauma inspires me.

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NOTES

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Preface

…[the book’s] universal thesis is that mind and body are inseparable and that illness and health cannot be understood in isolation from the life histories, social context, and emotional patterns of human beings. (xi)

…attempting to find the cause of cancer on the cellular level is like trying to understand a traffic jam by examining the internal combustion engine. (xi)

This book shows that people do not become ill despite their lives but rather because of their lives. (xii)

1 The Bermuda Triangle

That a specialist would dismiss the link between body and mind was not astonishing. Dualism—cleaving into two that which is one—colours all our beliefs on health and illness. We attempt to understand the body in isolation from the mind. (3)

Unlike many other disciplines, medicine has yet to assimilate an important lesson of Einstein’s theory of relativity: that the position of an observer will influence the phenomenon being observed and affect the results of the observation. (3)

But not all essential information can be confirmed in the laboratory or by statistical analysis. Not all aspects of illness can be reduced to facts verified by double-blind studies and by the strictest scientific techniques. “Medicine tells us as much about the meaningful performance of healing, suffering and dying as chemical analysis tells us about the aesthetic value of pottery,” Ivan Ilyich wrote in Limits to Medicine. We confine ourselves to a narrow realm indeed if we exclude from accepted knowledge the contributions of human experience and insight. (4)

The new discipline of psychoneuroimmunology has now matured to the point where there is compelling evidence, advanced by scientists from many fields, that an intimate relationship exists between the brain and the immune system. … And individual’s emotional makeup, and the response to continued stress, may indeed be causative in the many diseases that medicine treats but whose [origin] is not yet known—diseases such as scleroderma, and the vast majority of rheumatic disorders, the inflammatory bowel disorders, diabetes, multiple sclerosis, and legions of other conditions which are represented in each medical subspecialty… – Noel B. Hershfield

…psychoneuroimmunology…is the science of the interactions of mind and body, the indissoluble unity of emotions and physiology in human development and throughout life in health and illness. (5)

…the immune defences that normally function in healthy young people have been shown to be suppressed in medical students under the pressure of final examinations. Of even greater implication for their future health and well-being, the loneliest students suffered the greatest negative impact on their immune systems. Loneliness has been (6) similarly associated with diminished immune activity in a group of psychiatric inpatients. …many people unwittingly spend their entire lives as if under the gaze of a powerful and judgmental examiner whom they must please at all costs. Many of us live, if not alone, then in emotionally inadequate relationships that do not recognize or honour our deepest needs. Isolation and stress affect many who may believe their lives are quite satisfactory. (7)

Physiologically, emotions are themselves electrical, chemical and hormonal discharges of the human nervous system. … When emotions are repressed…this inhibition disarms the body’s defences against illness. Repression—dissociating emotions from awareness and relegating them to the unconscious realm—disorganizes and confuses our physiological defences so that in some people these defences go awry, becoming the destroyers of health rather than its protectors. (7)

It is a sensitive matter to raise the possibility that the way people have been conditioned to live their lives may contribute to their illness. (8)

While all of us dread being blamed, we all would wish to be more responsible—that is, to have the ability to respond with awareness to the circumstances of our (8) lives rather than just reacting. … There is no true responsibility without awareness. (9)

And here we confront the inadequacy of language. Even to speak about links between mind and body is to imply that two discrete entities are somehow connected to each other. Yet in life there is no such separation; there is no body that is not mind, no mind that is not body. The word mindbody has been suggested to convey the real state of things. (9)

The dynamics of repression operate in all of us. We are all self-deniers and self-betrayers to one extent or another, most often in ways we are no more aware of than I was conscious of while “deciding” to disguise my limp. When it comes to health or illness, it is only a matter (11) of degree and, too, a matter of the presence or absence of other factors—such as heredity or environmental hazards, for example—that also predispose to disease. So in demonstrating that repression is a major cause of stress and a significant contributor to illness, I do not point fingers at others for “making themselves sick.” My purpose in this book is to promote learning and healing, not to add to the quotient of blame and shame, both of which already exist in overabundance in our culture. (12)

2 The Little Girl Too Good to Be True

The cause, or causes, of multiple sclerosis remain unknown. – J. D. Wilson., ed., Harrison’s Principles of Internal Medicine, 12th ed. (New York: McGraw-Hill, 1999), 2039.

While it is possible to inherit a genetic susceptibility to MS, it is not possible to inherit the disease. … And even people who have al lth necessary genes do not necessarily get MS. The disease, experts believe, must be triggered by environmental factors. – L. J. Rosner, Multiple Sclerosis: New Hope and Practical Advice for People with MS and Their Families (New York: Fireside Publisers, 1992), 15.

The fundamental problem is not the external stress, such as the life events quoted in the studies, but an environmentally conditioned helplessness that permits neither of the normal responses of fight or flight. The resulting internal stress becomes repressed and therefore invisible. Eventually, having unmet needs or having to meet the needs of others is no longer experienced as stressful. It feels normal. One is disarmed. (20)

Of course stress does not cause multiple sclerosis—no single factor does. The emergence of MS no doubt depends on a number of interacting influences. But it is true to say that stress does not make a major contribution to the onset of this disease? Research studies and the lives of the persons we have looked at strongly suggest that it does. (22)

Artistic expression by itself is only a form of acting out emotions, not a way of working them through. (26)

3 Stress and Emotional Competence

A perennial give-and-take has been going on between living matter and its inanimate surroundings, between one living being and another, ever since the dawn of life in the prehistoric oceans. – Hans Selye, The Stress of Life

Interactions with other human beings—in particular, emotional interactions, affect our biological functioning in myriad and subtle ways almost every moment of our lives. They are important determinants of health, as we will see throughout this book. (27)

You may veel that there is no conceivable relationship between the behavior of our cells, for instance in inflammation, and our conduct in everyday life. I do not agree. – Selye

When people describe themselves as being stressed, they usually mean the nervous agitation they experience under excessive demands…. Stress, as we will define it, is not a matter of subjective feeling. It is a measurable set of objective physiological events in the body, involving the brain, the hormonal apparatus, the immune system and many other organs. Both animals and people can experience stress with no awareness of its presence. (28)

Stress consists of the internal alterations—visible or not—that occur when the organism perceives a threat to its existence or well-being. (28)

…stress,…had long been used in common English, and particularly in engineering, to denote the effects of a force acting against a resistance. – Selye

The stress response can be set off by physical damage, either by infection or injury. It can also be triggered by emotional trauma or just by the threat of such trauma, even if purely imaginary. Physiological stress responses can be evoked when the threat is outside conscious awareness or even when the individual may believe himself to be stressed in a “good” way. (29)

The experience of stress has three components. The first is the event, physical or emotional, that the organism interprets as threatening. This is the stress stimulus, also called the stressor. The second element is the processing system that experiences and interprets the meaning of the stressor. In the case of human beings, this processing system is the nervous system, in particular the brain. The final constituent is the stress response, which consists of the various physiological and behavioural adjustments made as a reaction to a perceived threat. (31)

| We see immediately that the definition of a stressor depends on the processing system that assigns meaning to it. (31)

Equally important is the personality and current psychological state of the individual on whom the stressor is acting. (31)

…the biology of stress predominantly affected three types of tissues or organs in the body: in the hormonal system, visible changes occurred in the adrenal glands, in the immune system, stress affected the spleen, the thymus, and the lymph glands, and the intestinal lining of the digestive system. (32)

When a chemical is secreted into the circulation by one organ to influence the functioning of another, it is called an endocrine hormone. (32)

The functional nexus formed by the hypothalamus, pituitary and adrenal glands is referred to as the HPA axis. … Because the hypothalamus is in two-way communication with the brain centres that process emotions, it is through the HPA axis that emotions exert their most direct effects o the immune system and on other organs. (32)

Many people who are prescribed cortisol-type drugs in treatment for, say, asthma, colitis, arthritis or cancer are at risk for intestinal bleeding and may need to take other medications to protect the gut lining. This cortisol effect also helps to explain why chronic stress leaves us more susceptible to developing intestinal ulcers. Cortisol also has powerful bone-thinning actions. Depressed people secrete high levels of cortisol, which is why stressed and depressed postmenopausal women are more likely to develop osteoporosis and hip fractures. (33)

The essence of threat is a destabilization of the body’s homeostasis, the relatively narrow range of physiological conditions within which the organism can survive and function. (33)

…the stress response may be understood not only as the body’s reaction to threat but also as its attempt to maintain homeostasis in the face of threat. At a conference on stress at the National Institutes of Health (U.S.), researchers used the (33) concept of the stable internal milieu to define stress itself “as a state of disharmony or threatened homeostasis.” According to such a definition, a stressor “is a threat, real or perceived, that tends to disturb homeostasis.” (34)

| What do all stressors have in common Ultimately they all represent the absence of something that the organism perceives as necessary for survival—or its threatened loss. The threatened loss of food supply is a major stressor. So is—for human beings—the threatened loss of love.

It may be said without hesitation, that for man the most important stressors are emotional. – Selye

The research literature has identified three factors that universally lead to stress: uncertainty, the lack of information and the loss of control. All three are present in the lives of individuals with chronic illness. (34)

It may seem paradoxical to claim that stress, a physiological mechanism vital to life, is a cause of illness. To resolve this apparent contradiction, we must differentiate between acute stress and chronic stress. Acute stress is the immediate, short-term body response to threat. Chronic stress is activation of the stress mechanisms over long periods of time when a person is exposed to stressors that cannot be escaped either because she does not recognize them or because she has no control over them. (35)

NK [natural killer, immune] cells are front-line troops in the fight against infections and against cancer, having the capacity to attack invading micro-organisms and to destroy cells with malignant mutations. (35)

The oft-observed relationship between stress, impaired immunity and illness has given rise to the concept of “diseases of adaptation,” a phrase of Hans Selye’s. The flight-or-fight response, it is argued, was indispensable in an era when early human beings had to confront a natural world of predators and other dangers. In civilized society, however, the flight-fight reaction is triggered in situations where it is neither necessary nor helpful, since we no longer face the same mortal threats to existence. The body’s physiological stress mechanisms are often triggered inappropriately, leading to disease. (36)

| There is another way to look at it. The flight-or-fight alarm reaction exists today for the same purpose evolution originally assigned to it: to enable us to survive. What has happened is that we have lost touch with the gut feelings designed to be our warning system. … Just like laboratory animals unable to escape, people find themselves trapped in lifestyles and emotional patterns inimical to their health. The higher the level of economic development, it seems, the more anaesthetized we have become to our emotional realities. We no longer sense what is happening in our bodies and cannot therefore act in self-preserving ways. The physiology of stress eats away at our bodies not because it has outlived its usefulness but because we may no longer have the competence to recognize its signals. (36)

The psychologist Ross Buck distinguishes between three levels of emotional responses,… (36_

Emotion III is the subjective experience, from within oneself. It is how we feel. In the experience of Emotion III there is conscious awareness of an emotional state, such as anger or joy or fear, and its accompanying bodily sensations. (37)

| Emotion II comprises our emotional displays as seen by others, with or without our awareness. It is signalled through body language—… (37)

Emotion I comprises the physiological changes triggered by emotional stimuli, such as the nervous system discharges, hormonal output and immune changes that make up the flight-or-fight reaction in response to threat. These responses are not under conscious control, and they cannot be directly observed from the outside. They just happen. (37)

Self-regulation, writes Ross Buck, “involves in part the attainment of emotional competence, which is defined as the ability to deal in an appropriate and satisfactory way with one’s own feelings and desires.” (38)

Emotional competence requires (38)

• the capacity to feel our emotions
• the ability to express our emotions effectively
• the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past
• the awareness of those genuine needs (38)

4 Buried Alive

…In a 1970 research article, two psychiatrists at the Yale University School of Medicine, Walter Brown and Peter Mueller, recorded dramatically similar impressions of ALS patients:

They invariably evoked admiration and respect from all staff who came into contact with them. … Characteristic was their attempt to avoid asking for help.

The authors concluded that people with ALS seemed to have two lifelong patterns distinguishing them: rigidly competent behaviour—that is, the inability to ask for or receive help, and the chronic exclusion of so-called negative feelings. (42)

“Why Are Patients with ALS So Nice?” (42)

The conspicuous niceness of most, but not all, persons with ALS is an expression of a self-imposed image that needs to conform to the individual’s (and the world’s) expectations. (43)

The problem was not a lack of feeling but an excess of painful, unmetabolized emotion. (51)

Intensely held beliefs may be no more than a person’s unconscious effort to build a sense of self to fill what, underneath, is experienced as a vacuum. (52)

[via: This sounds exactly like the religious axiom of a “God-shaped hole” inside each of us.]

The “niceness” of most ALS patients represents more than the innate goodness and sweetness of some human beings; it is an emotion in extremis. It is magnified out of healthy proportion by a powerful suppression of assertiveness. (56)

Until our understand of the mind/body complex is more advanced, this must remain an intriguing hypothesis but a hypothesis one would be challenged to find any exceptions to. It seems far-fetched to suppose that such frequently observed associations can be all a matter of pure coincidence. (57)

[via: An important qualifier.]

5 Never Good Enough

It is artificial to impose a separation between hormones and emotions. While it is perfectly true that hormones are active promoters or inhibitors of malignancy, it is not true that their actions have nothing to do with stress. In fact, one of the chief ways that emotions act biologically in cancer causation is through the effect of hormones. Some hormones—estrogen, for example—encourage tumour growth. Others enhance cancer development by reducing the immune system’s capacity to destroy malignant cells. (60)

The body’s hormonal system is inextricably linked with the brain centres where emotions are experienced and interpreted. (61)

Emotions also directly modulate the immune system. Studies at the U.S. National Cancer Institute found that natural killer (NK) cells, an important class of immune cells we have already met, are more active in breast cancer patients who are able to express anger, to adopt a fighting stance and who have more social support. … The researchers found that emotional factors and social involvement were more important to survival than the degree of disease itself. (61)

Research has suggested for decades that women are more prone to develop breast cancer if their childhoods were characterized by emotional disconnection from their parents or other disturbances in their upbringing; if they tend to repress emotions, particularly anger; if they lack nurturing social relationships in adulthood; and if they are the altruistic, compulsively caregiving types. (62)

“Extreme suppression of anger” was the most commonly identified characteristic of breast cancer patients in a 1974 British study. (64)

The research conducted by Dr. Sandra Levy and her associates at the U.S. National Cancer Institute on the relationship between natural killer cell activity and emotional coping patterns in breast cancer concluded that “suppression of anger and a passive, stoic response style seem to be associated with biological risk sequelae.” (65)

| Repression of anger increases the risk for cancer for the very practical reason that it magnifies exposure to physiological stress. If people are not able to recognize intrusion, or are unable to assert themselves even when they do see a violation, they are likely to experience repeatedly the damage brought on by stress. (65)

6 You Are Part of This Too, Mom

“The nature of stress is not always the usual stuff that people think of. It’s not the external stress of war or money loss of somebody dying, it is actually the internal stress of having to adjust oneself to somebody else. (78)

You come from a mother’s body and you relate to the mother. The mother is the universe for us. It’s the universe that lets us down. (82)

[via: The ουροβορος. This is a sentiment at the conclusion of Richard Tarnas’ The Passion Of The Western Mind, and one of the pillars of Erich Neumann’s The Origins and History of Consciousness.]

7 Stress, Hormones, Repression and Cancer

Smoking no more causes cancer of the lung than being thrown into deep water causes drowning. Fatal as immersion in deep water can be to the unprotected non-swimmer, for someone who swims well or is equipped with a life jacket, it poses little risk. A combination of factors is necessary to cause drowning. It is the same with lung cancer. (85)

| Smoking vastly increases the risk of cancer, not only of the lung but also of the bladder, the throat and other organs. But logic alone tells that us it [sic] cannot, by itself cause any of these malignancies. If A causes B, then every time A is present, B should follow. If B does not follow A consistently, then A cannot, by itself, be the cause of B—even if, in most cases, it might be a major and perhaps necessary contributing factor. If smoking caused lung cancer, every smoker would develop the disease. (85)

In a number of studies, [David] Kissen supported his clinical impressions that people with lung cancer “have poor and restricted outlets for the expression of emotion, as compared with (85) non-malignancy lung patients and normal controls.” The risk of lung cancer, Kissen found, was five times higher in men who lacked the ability to express emotion effectively. Especially intriguing was that those lung cancer patients who smoked but did not inhale exhibited even greater repression of emotion than those who did. (86)

By 1976, ten years later, over six hundred of the study participants had died of cancer, heart disease, stroke or other causes. The single greatest risk factor for death—and especially for cancer death—was what the researchers called rationality and anti-emotionality, or R/A. The eleven questions identifying R/A measured a single trait: the repression of anger. “Indeed cancer incidence was some 40 times higher in those who answered positively to 10 or 11 of the questions for R/A than in the remaining subjects, who answered positively to about 3 questions on average. … We found that smokers had no incidence of lung cancer unless they also had R/A scores of 10 or 11, suggesting that any effect of smoking on the lung is essentially limited to a “susceptible minority.'” (86)

| These findings do not absolve tobacco products or cigarette manufacturers of responsibility in the prevalence of lung cancer—on the (86) contrary. All the thirty-eight people in the Cvrenka study who died of lung cancer had been smokers. The results indicated that for lung cancer to occur, tobacco alone is not enough: emotional repression must somehow potentiate the effects of smoke damage on the body. But how? (87)

| PSychological influences make a decisive biological contribution to the onset of malignant disease through the interconnections linking the components of the body’s stress apparatus: the nerves, the hormonal glands, the immune system and the brain centres where emotions are perceived and processed. (87)

Psychoneuroimmunology—or more comprehensively and accurately, psychoneuroimmunoendocrinology—is the name of the discipline that studies the interrelated functions of the organs and glands that regulate our behaviour and physiological balance. (87)

It has been estimated that for the initiation of cancer, lung cells have to acquire as many as ten separate lesions or points of damage on their DNA. Yet, no matter where in the body, such genomic damage “seldom leads to tumour formation. This is principally due to the fact that most primary lesions are transient and are readily eliminated by DNA repair or cell death.” In other words, DNA repairs itself or the cell dies without replicating its damaged genetic material—which, no doubt, accounts for the fact that most smokers do not develop clinical lung cancer. Where cancer does arise, either DNA repair or the normal process of cell death must have failed. (91)

Faulty DNA repair is associated with an increased incidence of cancer. Stress may alter these DNA repair mechanisms; for example, in one study, lymphocytes from psychiatric inpatients with higher depressive symptoms demonstrated impairment in their ability to repair cellular DNA damaged by exposure to X-irradation [X-rays].

Apoptosis is the scientific term for the physiologically regulated death necessary for the maintenance of healthy tissues. Apoptosis ensures normal tissue turnover, culling older cells with weakened genetic material, leaving room for their healthy and vigorous offspring. “Dysregulated apoptosis contributes to many pathologies, including tumour production, autoimmune and immunodeficiency diseases, and neurodegenerative disorders.” (91)

In short, for cancer causation it is not enough that DNA damage occur: also necessary are failure of DNA repair and/or an impairment of regulated cell death. Stress and the repression of emotion can negatively affect both of those processes. (92)

The chronic psychological status of the individual may play an important role either in facilitating tumour promotion or in dampening or accentuating the impacts of environmental stress. … The human endocrine system provides one critical mediator of interaction between psyche and tumor. … It seems inescapable that psychic factors which can evoke endocrine changes will have effects on actual tumour biology. – Dr. Marc E. Lippman

What we do know about the hormones of female reproduction is that they are exquisitively [sic] sensitive to women’s psychological states and to the stresses in their lives. (94)

The stresses that create the problems with self-nurture are also stresses that predispose to ill health. The authors of the Pittsburgh study write that “women with FHA report more concerns about dieting and weight, fear of weight gain, and tendencies to engage in binge eating.” (95)

We need to recall here that the temporary elevation of cortisol that occurs in episodes of acute stress is healthy and necessary. Not healthy are the chronically elevated cortisol levels in chronically stressed persons. (96)

It is customary to conceive of cancer as an invader against whom the body—like a country under foreign attack—must wage war. Such a view, while perhaps comforting in its simplicity, is a distortion of reality. First, even when there is an external carcinogen like tobacco, the cancer itself is partially an outcome of internal processes gone wrong. And, of course, for most cancers there is no such identified carcinogen. Second, it is the internal environment, locally and throughout the entire organism, that plays the major role in deciding whether the malignant will (96) flourish or be eliminated. (97)

In popular mythology, cancer has to be “caught early” before it has a chance to spread. The biological reality is quite different: by the time a tumour becomes detectable, spread has, in many cases, already occurred. (97)

The issue, therefore, is not simply the prevention of spread, but why and under what conditions in some people already existing dormant deposits convert into clinical cancer. Tumour dormancy is affected by many hormonal and immunological influences, all of them functions of the PNI system and all of them highly susceptible to life stresses. (98)

In numerous studies of cancer, the most consistently identified risk factor is the inability to express emotion, particularly the feelings associated with anger. The repression of anger is not an abstract emotional trait that mysteriously leads to disease. It is a major risk factor because it increases physiological stress on the organism. It does not act alone but in conjunction with other risk factors that are likely to accompany it, such as hopelessness and lack of social support. The person who does not feel or express “negative” emotion will be isolated even if surrounded by friends, because his real self is not seen. The sense or hopelessness follows from the chronic inability to be true to oneself on the deepest level. And hopelessness leads to helplessness, since nothing one can do is perceived as making any difference. (99)

8 Something Good Comes Out of This

Given the strong connection between hormone levels and emotions, it is striking how completely medical research and medical practice have ignored psychological influences on the causation of prostate cancer and have eschewed more holistic approaches to its treatment. There has been virtually no investigation of personality or stress factors in prostate malignancy. (105)

By their thirties, many men will have some cancerous cells in their prostate, and by their eighties, the majority are found to have them. By the age of fifty, a man has a 42 percent chance of developing prostate cancer. Yet relatively few men at any age will progress to the point of overt clinical disease. In other words, the presence of cancerous prostate cells is not unusual even in younger men, and it becomes the norm as men get older. Only in a minority does it progress to the formation of a tumour that causes symptoms or threatens life. It is worth asking how stress may promote the development of malignant disease. What personality patterns or life circumstances may interfere with the body’s defence mechanisms, allowing the already-present cancer cells to proliferate? (105)

One of the puzzling features of prostate malignancy is that while testosterone—the hormone people have been led to believe is responsible for male aggression—seems to promote its growth, this cancer is most typically a disease of older men. Yet the body’s production of testosterone declines with aging. (107)

…male destructiveness and hostile aggression are frequently blamed on testosterone. In actual fact, high levels of the hormone are more an effect than a cause. (108)

Most importantly, this research has clearly demonstrated…that it is the behavioural changes [i.e., the attainment of dominant status] that lead to the subsequent physiologic changes.

“Dr. [James] Dabbs tested fans before and immediately after the 1994 World Cup of Soccer final between Italy and Brazil. In what Dr. Dabbs considers proof of the axiom ‘basking in the reflected glory,’ testosterone levels swelled among the victorious Brazilians and sank among the dejected Italians.” Not surprisingly, then, gonadal function is affected by psychological states in both men and women. (109)

I strongly suspect that repression plays a role in the onset of testicular malignancy. … One aspect deserving attention would be the patients’ level of closeness to and identification with their mothers. (116)

9 Is There a “Cancer Personality”?

…people can experience emotional stresses with measurable physical effects on their systems—while managing to sequester their feelings in a place completely beyond conscious awareness. (124)

Could it be disease itself that changes someone’s personality, affecting his coping style in a way that may not reflect how he had functioned in life before the onset of illness? (125)

Cancer patients, to a statistically significant degree, were more likely to demonstrate the following traits: “the elements of denial and repression of anger and of other negative emotions…the external (125) appearance of a ‘nice’ or ‘good’ person, a suppression of reactions which may offend others, and the avoidance of conflict. … The risk of colorectal cancer with respect to this model was independent of the previously found risk factors of diet, beer intake, and family history.” Self-reported childhood or adult unhappiness was also more common among the bowel cancer cases. (126)

Our results appear to agree with findings that cancer patients ‘tend to deny and repress conflictual impulses and emotions to a higher degree than do other people.’ – 1946 Johns Hopkins University study.

Does that mean there is a “cancer personality”? The answer is neither a simple yes nor a no. (126)

While we cannot say that any personality type causes cancer, certain personality features definitely increase the risk because they are more likely to generate physiological stress. Repression, the inability to say no and a lack of awareness of one’s anger make it much more likely that a person will find herself in situations where her emotions are unexpressed, her needs are ignored and her gentleness is exploited. Those of situations are stress inducing, whether or not the person is conscious of being stressed. Repeated and multiplied over the years, they have the potential of harming homeostasis and the immune system. It is stress—not personality per se—that undermines a body’s physiological balance and immune defences, predisposing to disease or reducing the resistance to it. (127)

| Physiological stress, then, is the link between personality traits and disease. Certain traits—otherwise known as coping styles—magnify the risk for illness by increasing the likelihood of chronic stress. Common to them all is a diminished capacity for emotional communication. Emotional experiences are translated into potentially damaging biological events when human beings are prevented from learning how to express their feelings effectively. That learning occurs—or fails to occur—during childhood. (127)

| The way people grow up shapes their relationship with their own bodies and psyches. The emotional contexts of childhood interact with inborn temperament to give rise to personality traits. Much of what we call personality is not a fixed set of traits, only coping mechanisms a person acquired in childhood. There is an important distinction between an inherent characteristic, rooted in an individual without regard to his environment, and a response to the environment, a pattern of behaviours developed to ensure survival. (127)

| What we see as indelible traits may be no more than habitual defensive techniques, unconsciously adopted. People often identify with these habituated patterns, believing them to be an indispensable part of the self. They may even harbour self-loathing for certain traits—for example, when a person describes herself as “a control freak.” In reality, there is no innate human inclination to be controlling. What there is in a “controlling” personality is deep anxiety. The infant and child who perceives that his needs are unmet may develop an obsessive coping style, anxious about each detail. When such a person fears that he is unable to control events, he experiences great stress. Unconsciously he believes that only by controlling every aspect of his life and environment will he be able to ensure the satisfaction of his needs. As he grows older, others will resent him and he will come to dislike himself for what was originally a desperate response to emotional deprivation. The drive to control is not an innate trait but a coping style. (128)

10 The 55 Per Cent Solution

On the basis of clinical reports, on appraisal of the existing research literature, and clinical experience, I believe there is at least indirect evidence that psychosocial factors do affect disease susceptibility and activity. The most likely mechanism for this to occur would be through psychoimmunological pathways. – Dr. Douglas Drossman

The gut, or intestinal tract, is much more than an organ of digestion. It is a sensory apparatus with a nervous system of its own, intimately connected to the brain’s emotional centres. Everyone intuitively understands the meaning of the phrase “gut-wrenching” as a description of emotionally upsetting events. Many of us can recall experiencing the sore tummy of the anxious child. Gut feelings, pleasant or unpleasant, are part of the body’s normal response to the world—they help us to interpret what is happening around us and inform us whether we are safe or in danger. (138)

[Dr. Noel Hershfield] pointed out that in clinical trials of medications for inflammatory bowel disease, there have been instances of placebo response in the range of 60 per cent and that in others comparing narcotics with placebo drugs for pain control, the number of patients who obtained the placebo effect was consistent at 55 per cent of the response. The 55 per cent figure has been seen in trials of anti-depressant drugs as well. It has been called “the 55 per cent rule.” (139)

Although induced by thought or emotion, the placebo effect is entirely physiological. It is the activation of neurological and chemical processes in the body that serve to reduce symptoms or to promote healing. (139)

As Dr. Hershfield implies, not the latest technology or miracle drug but encouraging the patient’s capacity to heal may provide the ultimate answer to inflammatory bowel disease. The 55 per cent solution. (140)

11 It’s All in Her Head

The nervous system of the gut contains about one hundred million nerve cells—we have as many in the small intestine alone as there are in our entire spine! … The gut responds to emotional stimuli by muscle contractions, blood flow changes and the secretion of a multitude of biologically active substances. Such brain-gut integration is essential for survival. Large volumes of blood, for example, may need to be diverted from the intestines to the heart and to the muscles of the limbs at a moment’s notice. (146)

| In turn, the gut is abundantly supplied with sensory nerves that carry information to the brain. Quite to the contrary of what was believed until recently, nerve fibres ascending from the intestines to the brain greatly outnumber ones descending from brain to gut. (146)

Pain in the gut is one signal the body uses to send messages that are difficult for us to ignore. Thus, pain is also a mode of perception. Physiologically, the pain pathways channel information that we have blocked from reaching us by more direct routes. Pain is a powerful secondary mode of perception to alert us when our primary modes have shut down. It provides us with data that we ignore at our peril. (152)

When you don’t pay attention to emotional signals, your body says, ‘Okay, here are some physical signals for you.’ If you don’t pay attention to them either, you really are in deep trouble. (153)

12 I Shall Die First from the Top

It is well known that chronically high levels of the stress hormone cortisol can shrink the hippocampus. (158)

In autoimmune illness, there is a blurring between what is self and non-self—foreign matter to be attacked. (162)

If the shutting-down of emotion occurs early enough, during the critical phases of brain development, the capacity to recognize reality may become permanently impaired. (164)

Stress-induced healthy expression of emotion is itself stress-reducing. Stress-induced chronic hormonal and immune changes prepare the physiologic ground for diseases like Alzheimer’s. (166)

The life histories of all the Alzheimer’s patients I looked after during my years of family practice were characterized by repressed emotion. I interviewed several adults who are now taking care of aged parents suffering with Alzheimer’s. They all reported early loss or emotional deprivation in their parents’ lives. (166)

13 Self or Non-Self: The Immune System Confused

I have also been impressed by the frequency with which chronic or prolonged stress may precede the development of (169) rheumatoid disease. … I think that the emotional and psychological aspect of many rheumatoid patients is of first importance. – C. E. G. Robinson

Characteristic of many persons with rheumatoid diseases is a stoicism carried to an extreme degree, a deeply ingrained reticence about seeking help. People often put up silently with agonizing discomfort, or will not voice their complaints loudly enough to be heard, or will resist the idea of taking symptom-relieving medications. (170)

The non-complaining stoicism exhibited by rheumatoid patients is a coping style acquired early in life. (171)

…despite the diversity in the group, the patients’ psychological characteristics, vulnerabilities and life conflicts were remarkably similar. – 1969 conclusion, Maryland Chapter of the Arthritis and Rheumatism Foundation

One common characteristic was a pseudo-independence, described by the authors as a compensating hyperindependence. (171)

The reversal of roles between child, or adolescent, and parent, unless very temporary, is almost always not only a sign of pathology in the parent, but a cause of it in the child. – John Bowlby, Attachment

Role reversal with a parent skews the child’s relationship with the whole world. It is a potent source of later psychological and physical illness because it predisposes to stress. (172)

Like compensatory hyperindependence, the repression of anger is a form of dissociation, a psychological process originating in childhood. The young human being unconsciously banishes from awareness feelings or information that, if consciously experienced, would create unsolvable problems. Bowlby calls this phenomenon “defensive exclusion.” “The information likely to be defensively excluded is of a kind that, when accepted for processing in the past, has led the person concerned to suffer more or less severely.” (172)

Not infrequently anger is redirected away from an attachment figure who aroused it and aimed instead at the self. In appropriate self-criticism results. – Bowlby

In autoimmune disease, the body’s defences turn against the self. In the life of a society—the body politic—such behaviour would be denounced as treason. Within the individual organism, physical mutiny results from an immunologic confusion that perfectly mirrors the unconscious psychological confusion of self and non-self. In this disarray of boundaries, the immune cells attack the body as if the latter were a foreign substance, just as the psychic self is attacked by inward-directed reproaches and anger. (173)

Emotions—fear, anger, love—are all necessary for the organism’s survival as nerve impulses, immune cells or hormonal activity. Early on in the process of evolution, primitive responses of attraction or repulsion became essential to the life and reproduction of living creatures. Emotions, and the physical cells and tissues that make them possible, evolved as part and parcel of the apparatus of survival. It is no wonder, then, that the basic molecules that connect all the body systems of homeostasis and defense also participate in emotional reactions. Messenger substances, including endorphins, may be found in the most primitive of creatures who lack even a rudimentary nervous system. It is not that the organs of emotion interact with the PNI system—they form an essential part of this system. (173)

In the animal world, anger is not a “negative emotion.” An animal experiences anger when some essential need is either threatened or frustrated. (174)

For anger to be deployed appropriately, the organism has to distinguish between threat and non-threat. The fundamental differentiation to be made is between self and non-self. If I don’t know where my own boundaries begin and end, I cannot know when something potentially dangerous is intruding on them. The necessary distinctions between what is familiar or foreign, and what is benign or potentially harmful, require an accurate appraisal of self and non-self. Anger represents both a recognition of the foreign and dangerous and a response to it. (174)

| The first essential task of the immune system, too, is distinguishing self from non-self. Thus immunity also begins with recognition. Recognition (174) is a sensory function, performed in the nervous system by the sensory organs. We may rightly say that the immune system is also a sensory organ. … Another function of the nervous system is memory. The immune system must also have memory: it needs to recall what in the external world is benign and nourishing, what is neutral and what is potentially toxic. (175)

Immunity is also a matter of learning. Memory is stored by the immune system in cells programmed to recall instantaneously any threat previously encountered. And just as the nervous system must retain its potential for learning throughout the lifetime, so the immune system has the capacity to develop new “memories” by forming clones of immune cells trained specifically to recognize any new threat. (175)

| With immune cells found in the bloodstream and in all tissues and spaces of the body, we may think of the immune system as a “floating brain” equipped to detect the non-self. … The self is identified by means of so-called self-antigens on the membranes of the body’s normal cells, molecules that the immune receptors infallibly recognize. (175)

The point to grasp here is the shared functions of immunity and emotion: first, the “awareness” of the self accompanied by an awareness of non-self; second, the appreciation of nourishing inputs and the recognition of threats; finally, the acceptance of life-enhancing influences paralleled by a capacity to limit or eliminate danger. (176)

[via: Are we basically all suffering from disassociative identity disorder?]

| When our psychological capacity to distinguish the self from non-self is disabled, the impairment is bound to extend to our physiology as well. (176)

…the weight of evidence from a variety of studies strongly suggests a role for psychologic stress in inducing, exacerbating, and effecting the ultimate outcome in rheumatoid arthritis.

Not only are the onset and flare-ups of rheumatic diseases related to stress but so is their severity. (178)

14 A Fine Balance: The Biology of Relationships

The traditional hospital practice of excluding parents ignored the importance of attachment relationships as regulators of the child’s emotions, behaviour and physiology. The child’s biological status would be vastly different under the circumstances of parental presence or absence. (187)

Life is possible only within certain well-defined limits, internal or external. We can no more survive, say, high sugar levels in our bloodstream than we can withstand high levels of radiation emanating from a nuclear explosion. The role of self-regulation, whether emotional or physical, may be likened to that of a thermostat ensuring that the temperature in a home remains constant despite the extremes of weather conditions outside. (188)

Children and infant animals have virtually no capacity for biological self-regulation; their internal biological states—heart rates, hormone levels, nervous system activity—depend completely on their relationships with caregiving grown-ups. Emotions such as love, fear or anger serve the needs of protecting the self while maintaining essential relationships with parents and other caregivers. Psychological stress is whatever threatens the young creature’s perception of a safe relationship with the adults, because any disruption in the relationship will cause turbulence in the internal milieu. (188)

Independent self-regulation may not exist even in adulthood. … Social interactions may continue to play an important role in the everyday regulation of internal biologic systems throughout life. – Dr. Myron Hofer

Our biological response to environmental challenge is profoundly influenced by the context and by the set of relationships that connect us with other human beings. (188)

Adaptation does not occur wholly within the individual.

…asthma, from the Greek root “breathe hard,”… (190)

Separation anxiety has been observed in children with asthma to a greater degree, not only in comparison with healthy controls but also when matched with children suffering from cystic fibrosis, a congenital lung disease, more serious by far. (191)

Under test conditions, one study examined the breathing patterns of asthmatic children between two and thirteen years of age, using a comparison group of healthy controls. Each child listened to recordings of his or her mother’s voice and that of a stranger. “Regardless of the tone of the voice, asthmatic children showed more abnormal respiratory patterns when listening to their mother’s voice than when listening to that of a strange woman. This interesting result suggested a specific emotional effect on breathing that was contrary to what one would have predicted if the child had seen the mother as being reassuring.” (191)

According to the family systems theory articulated by the late American psychiatrist Dr. Murray Bowen, illness is not a simple biological event in a separate human being. A family systems view recognizes the moment-to-moment interrelatedness of the physiological functioning of individuals. Self-evident in the relationship of mother and fetus, this physiological interrelatedness does not end with birth or even with physical maturation. As we have seen, relationships remain important biological regulators throughout a whole life. (194)

| A fundamental concept in family systems theory is differentiation, defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” The poorly differentiated person “lacks an emotional boundary between himself and others and lacks a ‘boundary’ that prevents his thinking process from being overwhelmed by his emotional feeling process. He automatically absorbs anxiety from others and generates considerable anxiety within himself.”

[via: cf. A Failure of Nerve by Edwin H. Friedman]

| The well-differentiated person can respond from an open acceptance of her own emotions, which are not tailored either to match someone else’s expectations or to resist them. She neither suppresses her emotions nor acts them out impulsively. Dr. Michael Kerr…distinguishes between two types of differentiation: functional differentiation and basic differentiation. (194)

Functional differentiation refers to a person’s ability to function based on his relationship with others. (194) …if my ability to function is independent of other people’s having to do my emotional work for me—that is, if I can remain engaged with others while staying emotionally open to them and to myself—then I would be said to have basic differentiation. The less basic differentiation a person has attained, the more prone he is to experience emotional stress and physical illness. (195)

The less powerful partner in any relationship will absorb a disproportionate amount of the shared anxiety—which is the reason that so many more women than men are treated for, say, anxiety or depression. (195)

The existence of a mind-body link and a person-person link means that it is possible for anxiety in one person to be manifested as a physical symptom in another person. … As is the case with the emotional dysfunctions, the one prone to develop symptoms is the spouse who adapts most to maintain harmony in the relationship system. – Dr. Kerr

Nature’s ultimate goal is to foster the growth of the individual from absolute dependence to independence—or, more exactly to the interdependence of mature adults living in community. (196)

The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus, the vulnerability to subjective and physiological stress will be proportionate to the degree of emotional dependence. (197)

The surrender of autonomy raises the stress level, even if on the surface it appears to be necessary for the sake of “security” in a relationship, and even if we subjectively eel relief when we gain “security” in this manner. If I chronically repress my emotional needs in order to make myself “acceptable” to other people, I increase my risks of having to pay the price in the form of illness. (197)

Those who build walls against intimacy are not self-regulated, just emotionally frozen. (198)

For the adult, therefore, biological stress regulation depends on a delicate balance between social and relationship security on the one hand, and genuine autonomy on the other. Whatever upsets that balance, whether or not the individual is consciously aware of it, is a source of stress. (198)

15 The Biology of Loss

Stress timuli…indicate that something is missing or about to disappear and that this something is highly relevant and desirable to the organism. – S. Levine and H. Ursin

The straightforward anatomical reason for entering the world so neurologically challenged is the size of our head. (204)

Decades of neuroscientific research have established that an indispensable requirement of human brain development is nurturing emotional interactions with the parent. (205)

A fundamental goal of human development is the emergence of a self-sustaining, self-regulated human being who can live in concert with fellow human beings in a social context. Vital for the healthy development of the neurobiology of self-regulation in the child is a relationship with the parent in which the latter sees and understands the child’s feelings and can respond with attuned empathy to the child’s emotional cues. Emotions are states of physiological arousal, either positive—”I want more of this”—or negative—”I want less of this.” Infants and small children do not have the capacity to regular their own (205) emotional states, and hence are physiologically at risk for exhaustion and even death if not regulated by the interaction with the parent. Closeness with the parent, therefore, serves to preserve the infant’s biological regulation. (206)

Cortex means “bark,” as in the bark of a tree, and refers to the thin rim of grey matter enveloping the white matter of the brain. … Much of the regulating work of the cortex involves not the initiation of actions but the inhibition of impulses arising int he lower brain centres. (206)

| Mediating between the regulatory processes of the cortex and the basic survival functions of the brain stem is the limbic emotional apparatus. (206)

Emotions interpret the world for us. They have a signal function, telling us about our internal states as they are affected by input from the outside. Emotions are responses to present stimuli as filtered through the memory of past experience, and they anticipate the future based on our perception of the past. (206)

| The brain structures responsible for the experience and modulation of emotions, whether in the cortex or the midbrain, develop in (206) response to parental input, just as visual circuitry develops in response to light. (207)

Equally essential is a nourishing emotional connection, in particular the quality of attunement. Attunement, a process in which the parent is “tuned in” to the child’s emotional needs, is a subtle process. It is deeply instinctive but easily subverted when the parent is stressed or distracted emotionally, (207) financially or for any other reason. … Children in non-attuned relationships may feel loved but on a deeper level do not experience themselves as appreciated for who they really are. They learn to present only their “acceptable” side to the parent, repressing emotional responses the parent rejects and learning to reject themselves for even having such responses. (208)

| Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.” We are speaking here not of a lack of parental love, nor of physical separation between parent and child, but of a void in the child’s perception of being seen, understood, empathized with and “got” on the emotional level. The phenomenon of physical closeness but emotional separation has been called proximate separation. Proximate separation happens when attuned contact between parent and child is lacking or is interrupted due to stresses on the parent that draw her away from the interaction. (208)

In proximate separations the parents are physically present but emotionally absent. … Proximate separation affects the young child on the unconscious physiological levels rather than on (208) the conscious thought-feeling levels. (209)

They may, for example, choose partners who do not understand, accept or appreciate them for who they are. Thus the physiological stresses induced by proximal separation will also continue to be repeated in adult life—and, again, often without conscious awareness. (209)

[via: 😧]

16 The Dance of Generations

Parenting styles do not reflect greater or lesser degrees of love in the heart of the mother and father; other, more mundane factors are at play. Parental love is infinite and for a very practical reason: the selfless nurturing of the young is embedded in the attachment apparatus of the mammalian brain. (211)

| If a parent’s loving feelings are constricted, it only because that parent has himself or herself suffered deep hurt. (211)

Where parenting fails to communicate unconditional acceptance to the child, it is because of the fact that the child receives the parent’s love not as the parent wishes but as it is refracted through the parent’s personality. If the parent is stressed, harbours unresolved anxiety or is agitated by (211) unmet emotional needs, the child is likely to find herself in situations of proximate abandonment regardless of the parent’s intentions. (212)

The biggest influence on the future parenting style of the child is the development of his emotional and attachment circuits in the context of his (212) relationship with his parents. The same is true of the development of the child’s stress-response apparatus. (213)

“Maternal care during infancy serves to ‘program’ behavioural responses to stress in the offspring by altering the development of the neural systems that mediate fearfulness.” In short, anxious mothers are likely to rear anxious offspring, down through the generations.

Already at one year of age the infants were exhibiting relationship responses that would characterize their personalities and behaviours in the future. The Strange Situation experiment has been duplicated hundreds of times, in many countries. The observations at one year are accurate advance indicators of behaviour at adolescence, including such features as emotional maturity, peer relationships and academic performance. On all these measures, children who had been securely attached as infants scored consistently better than insecurely attached ones. (214)

| However, as Daniel Siegel explains in his book The Developing Mind, the most crucial finding concerning the intergenerational transmission of parenting was that the infant’s performance in the Strange Situation could be accurately predicted even before the child was born. (215)

[Professor Mary Main’s] technique considers primarily not what a person said in response to questions but how he said it. The patterns of people’s speech and the key words they “happen” to employ are more meaningful descriptors of their childhoods than what they consciously believe they are communicating. … The real story is told by the patterns of the narrative—fluent or halting, detailed or characterized by a paucity of words, consistent or self-contradicting, along with Freudian slips, revealing asides and apparent non-sequiturs. (215)

It turns out that “the AAI [Adult Attachment Interview] is the most robust predictor of how infants become attached to their parents.” In other words, what an adult unconsciously reveals about his own childhood during the course of the attachment interview will predict his own attachment patterns with his children. Thus, AAIs conducted with the parent before the birth of an infant was able to forecast accurately how the infant would behave in the Strange Situation at one year of life. (215)

Thus, the adult’s AAi narrative of his own childhood will often predict how he will nurture his future child, and therefore how his child, at one year, will respond in the Strange Situation. And, the child’s behaviour in the Strange Situation will foretell the type of narratives she, in turn, will give about her childhood twenty years later! (215)

Parenting, in short, is a dance of the generations. (216)

The generations are boxes within boxes: inside my mother’s violence you find another box, which contains my grandfather’s violence, and inside that box (I suspect but do not know), you would find another box with some such black, secret energy—stories within stories, receding in time.

Blame becomes a meaningless concept if one understands how family history stretches back through the generations. “Recognition of this quickly dispels any disposition to see the parent as villain. – John Bowlby

The central issue is the unintentional transmission of stress and anxiety across the generations. (217)

…adaptation energy. (221)

It is as though we had hidden reserves of adaptability, or adaption energy, throughout the body. … Only when all of our adaptability is used up will irreversible, general exhaustion and death follow. – Hans Selye

Central to any understanding of stress, health and disease is the concept of adaptiveness. Adaptiveness is the capacity to respond to external stressors without rigidity, with flexibility and creativity, without excessive anxiety and without being overwhelmed by emotion. People who are not adaptive may seem to function well as long as nothing is disturbing them, but they will react with various levels of frustration and helplessness when confronted by loss or by difficulty. They will blame themselves or blame others. A person’s adaptiveness depends very much on the degree of differentiation and adaptiveness of previous generations in his family and also on what external stressors may have acted on the family. (221)

Since one important variable in the development of physical illness is the degree of adaptiveness of an individual, and since the degree of adaptiveness is determined by the multigenerational emotional process, physical illness, like emotional illness, is a symptom of a relationship process that extends beyond the boundaries of the individual “patient.” Physical illness, in other words, is a disorder of the family emotional system [which includes] present and past generations. – Dr Michael Kerr

Cancer and the autoimmune diseases of various sorts are, by and large, diseases of civilization. (223)

“[The] separation of infants from their mothers and all other types of relocation which leave few possibilities (223) for interpersonal contact are very common forms of sensory deprivation; they may become major factors in disease. – Hans Selye

No human being is “useless,” whether the helpless infant or the helpless ill or dying adult. The point is not to prove that dying people can be useful but to reject the spurious concept that people need to be useful in order to be valued. (224)

One of the most important life conditions that determine whether individuals stay healthy or become ill is their income. In addition, the overall health of North American society may be more determined by the distribution of income among its members rather than the overall wealth of the society. … Many studies find that socioeconomic circumstances, rather than medical and lifestyle risk factors, are the main causes of cardiovascular disease, and that conditions during early life are especially important. – Dennis Raphael

Recognizing the multigenerational template for behaviour and for illness, and recognizing, too, the social influences that shape families and human lives, we dispense with the unhelpful and unscientific attitude of blame. Discarding blame leaves us free to move toward the necessary adoption of responsibility,… (225)

17 The Biology of Belief

“I truly feel this is going to revolutionize medicine because we are going to understand not only what causes disease but what presents disease. – Dr. Stephen Warren

The actual results of the genome project are bound to be disappointing. (228)

First, there are many technical problems still to be solved. Our current state of knowledge about the genetic makeup of human beings may be likened to using a copy of The Concise Oxford English Dictionary as “the model” from which the plays of William Shakespeare or the novels of Charles Dickens were created. (228)

Second, contrary to the genetic fundamentalism that currently informs medical thinking and public awareness, genes alone cannot possibly account for the complex psychological characteristics, the behaviours, health or illness of human beings. … Genes exist and function in the context of (228) living organisms. The activities of cells are defined not simply by the genes in their nuclei but by the requirements of the entire organism—and by the interaction of that organism with the environment in which it must survive. Genes are turned on or off by the environment. For this reason, the greatest influences on human development, health and behaviour are those of the nurturing environment. (229)

The genome hype is not only poor science, it is also suspect as theology. In the Book of Genesis creation story, God fashions the universe first, then nature, and only afterward does He shape humankind from the substance of the earth. He knew, even if Bill Clinton did not, that from their very earliest beginnings humans could never be understood apart from their environment. (229)

| The milieu of the human organism is the physical and psyhco-emotional environment that shapes our development and affects our interactions with the world throughout the lifetime. (229)

… The controlling influence of the environment is underscored in recent studies on stem cells. Stem cells do not control their own fate. The differentiation of stem cells is based upon the environment the cell finds itself in. … The cell’s fate is “controlled” by its interaction with the environment and not by a self-contained genetic program. – Bruce Lipton

Our perceptions of the environment are stored in cellular memory. When early environmental influences are chronically stressful, the developing nervous system and the other organs of the PNI super-system repeatedly receive the electric, hormonal and chemical message that the world is unsafe or even hostile. Those perceptions are programmed in our cells on the molecular level. … Dr. Lipton calls that process the biology of belief. (230)

…some of these viscerally held perceptions…

1. I have to be strong. (231)
2. It’s not right for me to be angry. (232)
3. If I’m angry, I will not be lovable. (233)
4. I’m responsible for the whole world. (233)
5. I can handle anything. (235)
6. I’m not wanted—I’m not lovable. (236)
7. I don’t exist unless I do something. I must justify my existence.
8. I have to be very ill to deserve being taken care of. (237)

Most parents feel unconditional love for their children,… That is important to know, but it is not what matters. (238) What matters are the child’s unconscious perceptions, based on his innermost interpretations of his interactions with the world. Those interpretations, embedded at the cellular level, constitute the biology of belief that governs so much of what we feel, what we do and how we react to events. (239)

18 The Power of Negative Thinking

The Vancouver oncologist Karen Gelmon does not favour the war metaphors often applied to cancer. “The idea is that with enough might you can control, with enough might you can expel,” she says. “It suggests that it’s all a battle. I don’t think that’s a helpful way of looking at it. First, it’s not valid physiologically. Second, I don’t think it’s healthy psychologically. (241)

| “What happens with our body is a matter of flow—there is input and there is output, and you can’t control every aspect of it. We need to understand that flow, know there are things you can influence and things you can’t. It’s not a battle, it’s a push-pull phenomenon of finding balance and harmony, of kneading the conflicting forces all into one dough.” (241)

Such a view leaves an important question unanswered, even in the treatment of acute infections where we are able to identify the micro-organisms invading the body and to kill them with antibiotics: why will the same bacterium or virus spare one person but fell another? … What accounts for the difference? (241)

The microbe is nothing, the ground (i.e., the host body) is everything. (342)

Why does this patient have this disease now?

To all intents and purposes, modern medical practice has adopted a simplistic “cause-and-effect” perspective. When no obvious external agent is found—as is the case with most serious illnesses—it throws up its hands and declares the cause unknown. “Of unknown etiology” may be the most common phrase in textbooks of internal medicine. (242)

| While scientific humility is welcome, a cause-and-effect model of disease is itself a source of misperception. It cannot portray the ways that health is transmuted into illness or how illness may be turned toward health. (242)

No disease has a single cause. … A systems model recognizes that many processes and factors work together in the formation of disease or in the creation of health. (243)

…the word healing derives from an ancient origin, meaning “whole”—hence our equation of wholesome and healthy. To heal is to become whole. (243)

That which is complete may become deficient in two possible ways: something could be subtracted from it, or its internal harmony could be so perturbed that the parts that worked together no longer do so. (243)

…knowledge and insight have the power to transform, and why insight is more helpful to people than advice. If we gain the ability to look into ourselves with honesty, compassion and with unclouded vision, we can identify the ways we need to take care of ourselves. We can see the areas of the self formerly hidden in the dark. (243)

Disease is disharmony. …it is an expression of an internal disharmony. If illness is seen as foreign and external, we may end up waging war against ourselves. (244)

…compulsive optimism is one of the ways we bind our anxiety to avoid confronting it. That form of positive thinking is the coping mechanism of the hurt child. The adult who remains hurt without being aware of it makes this residual defence of the child into a life principle. (244)

[via: Embrace the power of affirmative thinking.]

Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden. (244)

| even more fundamentally, not posing those questions is itself a source of stress. First, “positive thinking” is based on an unconscious belief that we (244) are not strong enough to handle reality. Allowing this fear to dominate engenders a state of childhood apprehension. … Second, lack of essential information bout ourselves and our situation is one of the major sources of stress and one of the potent activators of the hypothalamic-pituitary-adrenal (HPA) stress response. Third, stress wanes as independent, autonomous control increases. (245)

…autonomy is impossible as long as one is driven by anything. (245)

Inevitably, negative thinking of the honest sort will lead into areas of pain and conflict we have shunned. It cannot be otherwise. The overwhelming need of the child to avoid pain and conflict is responsible for the personality trait or coping style that later predisposes the adult to disease. (246)

“My father had a very short leash on his temper, and when he got angry, you never knew what was going to happen. Dishes could fly, somebody might get kicked.” … “I disappeared. I developed that ability early in life.” (252)

[via: I both appreciated and hated that this hit too close to home.]

…when infants are born, they have no capacity to hide feelings whatsoever. (254)

Somehow people are trained—some more than others—into unknowingly taking care of other people’s emotional needs and minimizing their own. They hide their pain and sadness, even from themselves.

Developing the courage to think negatively allows us to look at ourselves as we really are. (254) … The purpose is not to blame parents or previous generations or spouses but to enable us to discard beliefs that have proved dangerous to our health. (255)

Most of our tensions and frustrations stem from compulsive needs to act the role of someone we are not. – Hans Selye

A person can be strong and still need help, can be powerful in some areas of life and helpless and confused in others. We cannot do all that we thought we could. (255)

Do I live my life according to my own deepest truths, or in order to fulfill someone else’s expectations? How much of what I have believed and done is actually my own and how much has been in service to a self-image I originally created in the belief it was necessary to please my parents? (256)

For many people, guilt is a signal that they have chosen to do something for themselves. (257)

A therapist once said to me, “If you face the choice between feeling guilt and resentment, choose the guilt every time.” It is wisdom I have passed on to many others since. If a refusal saddles you with guilt, while consent leaves resentment in its wake, opt for the guilt. Resentment is soul suicide. (257)

19 The Seven A’s of Healing

Emotional competence is the capacity that enables us to stand in a responsible, non-victimized, and non-self-harming relationship with our environment. It is the required internal ground for facing life’s inevitable stresses, for avoiding the creation of unnecessary ones and for furthering the healing process. Few of us reach adult age with anything close to full emotional competence. Recognizing our lack of it is not cause for self-judgment, only a call for further development and transformation. (263)

1. Acceptance

Acceptance is simply the willingness to recognize and accept how things are. It is the courage to permit negative thinking to inform our understanding, without allowing it to define our approach to the future. Acceptance does not demand becoming resigned to the continuation of whatever circumstances may trouble us, but it does require a refusal to deny exactly how things happen to be now. It challenges the deeply held belief that we are not worthy enough or “good” enough to be whole. (264)

| Acceptance also implies a compassionate relationship with oneself. (264)

Compassionate curiosity about the self does not mean liking everything we find out about ourselves, only that we look at ourselves with the same non-judgmental acceptance we would wish to accord anyone else who suffered and who needed help. (266)

2. Awareness3

Full awareness would mean that we would regain our lost capacity to perceive emotional reality and that we are ready to let go of the paralyzing belief that we are not strong enough to face the truth about our lives. There is no magic to it. The blind person learns to pay more attention to sound than the sighted. The aphasiac learns to notice his internal reactions to words, since the cognitive parts of the brain can no longer tell him what the message is. Those internal reactions, gut feelings, are what we lost as we “grew up.” (268)

To develop awareness, though, we do have to practise, pay constant attention to our internal states and learn to trust these internal perceptions more than what words—our own or anyone else’s—convey. What is the tone of voice? The pitch? Do the eyes narrow or open? Is the smile relaxed or tight? How do we feel? Where do we feel it? (268)

| Awareness also means learning what the signs of stress are in our own bodies, how our bodies telegraph us when our minds have missed the cues. In both human and animal studies, it has been observed that the physiological stress response is a more accurate gauge of the organism’s real experience than either conscious awareness or observed behaviour. (268)

The pituitary is a much better judge of stress than the intellect. – Hans selye

In The Stress of Life, Selye made a compilation of physiological danger signals. He listed physical signs such as pounding of the heart, fatigue, sweating, frequent urination, headaches, backaches, diarrhea or dryness of the mouth; emotional signs such as emotional tension or overalertness, anxiety, loss of joie de vivre; and behavioural expressions such as unusual impulsivity or irritability and a tendency to overreact. We can learn to read symptoms not only as problems to be overcome but as messages to be heeded. (268)

3. Anger

I never get angry. I grow a tumour instead. – Woody Allen

Not only does the repression of anger predispose to disease but the experience of anger has been shown to promote healing or, at least, to prolong survival. People with cancer who have been able to muster anger at their physicians, for example, have lived longer than their more placid counterparts. In animal experiments the expression of anger has been found to be less physiologically stressful than the suppression of it. In rats who fight others when caged together, slower growth of tumours has been found than in more docile animals. (269)

[via: But then the stress is transferred and the cycle continues, yes?! (WTF!) This is also called the “anger paradox.”]

How then to resolve the dilemma of anger? If the expression of anger is harmful and so is its repression, how do we hope to attain health and healing? (270)

| The repression of anger and the unregulated acting-out of it are both examples of the abnormal release of emotions that is at the root of disease. If in repression the problem is a lack of release, acting out consists of an equally abnormal suppression of release alternating with unregulated and exaggerated venting. … He points out that both repression and rage represent a fear of the genuine experience of anger. (270)

Healthy anger, he says, is an empowerment and a relaxation. The real experience (270) of anger “is physiologic experience without acting out. The experience is one of a surge of power going through the system, along with a mobilization to attack. There is, simultaneously, a complete disappearance of all anxiety. (271)

If anger is relaxation, what then is rage? (271)

The question is, What do people really experience when they experience rage? It’s fascinating to ask people. If you really ask, the majority of people will describe anxiety. If you ask in physical, physiologic terms what they are experiencing in their body when they feel rage, for the most part, people will describe anxiety in one form or another. – Dr. Kalpin

Naturally, the more parents discourage or forbid the experience of anger, the more anxiety-producing that experience will be for the child. (272)

…repression and discharge are two sides of the same coin. (272)

Anger does not require hostile acting out. First and foremost, it is a physiological process to be experienced. Second, it has cognitive value—it provides essential information. Since anger does not exist in a vacuum, if I feel anger it must be in response to some perception on my part. It may be a response to loss or the threat of it in a personal relationship, or it may signal a real or threatened invasion of my boundaries. I am greatly empowered without harming anyone if I permit myself to experience the anger and to contemplate what may have triggered it. Depending on circumstances, I may choose to manifest the anger in some way or to let go of it. The key is that I have not suppressed the experience of it. (273)

Healthy anger leaves the individual, not the unbridled emotion, in charge. (274)

4. Autonomy

Illness not only has a history but also tells a history. It is a culmination of a lifelong history of struggle for self. (274)

| From a simple biological perspective, it may appear that the survival of the physical organism ought to be nature’s ultimate goal. It would seem, however, that the existence of an autonomous, self-regulating psyche is nature’s higher purpose. Mind and spirit can survive grievous physical injury, but time and again we see that the physical body begins to succumb when psychic integrity and freedom are jeopardized. (274)

Diabetes mellitus derives its name from the Greek for “sweet urine,” for in this disease excess sugar is filtered by the kidneys from the bloodstream into the urine. (274)

In the final analysis, disease itself is a boundary question. When we look at the research that predicts who is likely to become ill, we find that the people at greatest risk are those who experience the most severe boundary invasions before they were able to construct an autonomous sense of self. (276)

Enmeshment—what Dr. Michael Kerr called a lack of differentiation—comes to dominate one’s intimate relationships. It can take two forms, withdrawal and sullen and self-defeating resistance to authority,…or chronic and compulsive caretaking of others,… (276)

Boundaries are invisible, the result of a conscious, internal felt sense defining who I am. Asking yourself, ‘In my life and relationships, what do I desire, want more of, or less of, or what don’t I want, what are my stated limits?’ begins the process. … In this self-definition, we define what we value and want in life at this particular time from a place of internal self-reference; the locus of control is from inside ourselves. – Dr. Peterson, Anger, Boundaries, and Safety

5. Attachment

Attachment is our connection with the world. (277)

Healing both requires and implies regaining the vulnerability that made us shut down emotionally in the first place. We are no longer helplessly dependent children; we no longer need fear emotional vulnerability. We can permit ourselves to honour the universally reciprocal human need for connection and to challenge the ingrained belief that unconsciously burdens so many people with chronic illness: that we are not lovable. (279)

6. Assertion

…it is the declaration to ourselves and to the world that we are and that we are who we are. (279)

We think autonomy and freedom mean the liberty to do, to act or react as we wish. Assertion in the sense of self-declaration is deeper than the limited autonomy of action. It is the statement of our being, a positive valuation of ourselves independent of our history, personality, abilities or the world’s perceptions of us. Assertion challenges the core belief that we must somehow justify our existence. (279)

| It demands neither acting nor reacting. It is being, irrespective of action. (279)

| Thus, assertion may be the very positive of action, not only in the narrow sense of refusing to do something we do not wish to do but letting go of the very need to act. (279)

7. Affirmation

When we affirm, we make a positive statement; we move toward something of value. (280)

The first value is our own creative self. (280)

Everyone has an urge to create. … The point is to honour the urge. (280)

What is in us must out otherwise we may explode at the wrong places or become hopelessly hemmed in by frustrations. The great art is to express our vitality through the particular channels and at the particular speed Nature foresaw for us. – Hans Selye

The second great affirmation is of the universe itself—our connection with all that is. (280)

Physically it is easy to see that our sense of separateness from the universe is false: we do not go “from dust to dust,” we are dust enlivened. (280)

[via: We could say “Genesis, not Job.”]