When the Body Says No

by Gabor Maté

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,

For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaninglessness. People may become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed. To such persons stress feels desirable, while the absence of it feels like something to be avoided.

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.

stress effects can be highly active in persons who are fully awake, but who are in the grip of unconscious emotions or cut off from their body responses.

While nervous tension may be a component of stress, one can be stressed without feeling tension. On the other hand, it is possible to feel tension without activating the physiological mechanisms of stress.

excessive stress occurs when the demands made on an organism exceed that organism’s reasonable capacities to fulfill them.

indigestion and heartburn, a symptom of the reflux of stomach acid into the esophagus. The lining of the esophagus is not designed to withstand the corrosive bath of hydrochloric acid secreted in the stomach. A muscular valve between the two organs and complex neurological mechanisms ensure that food can move downward from throat to stomach without permitting acid to flow back upward.

excessive acid production due to stress and disordered neural input from the autonomic nervous system also play a role in reflux.

Selye discovered that 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.

The immediate effects of cortisol are to dampen the stress reaction, decreasing immune activity to keep it within safe bounds.

The functional nexus formed by hypothalamus, pituitary and adrenal glands is referred to as the HPA axis. The HPA axis is the hub of the body’s stress mechanism.

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.

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,” Hans Selye wrote, “that for man the most important stressors are emotional.”7

The research literature has identified three factors that universally lead to stress: uncertainty, the lack of information and the loss of control.

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.

The self-shutdown serves to prevent shame and rejection.

Learned helplessness is a psychological state in which subjects do not extricate themselves from stressful situations even when they have the physical opportunity to do so.

Emotional competence requires • the capacity to feel our emotions, so that we are aware when we are experiencing stress; • the ability to express our emotions effectively and thereby to assert our needs and to maintain the integrity of our emotional boundaries; • the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past. What we want and demand from the world needs to conform to our present needs, not to unconscious, unsatisfied needs from childhood. If distinctions between past and present blur, we will perceive loss or the threat of loss where none exists; and • the awareness of those genuine needs that do require satisfaction, rather than their repression for the sake of gaining the acceptance or approval of others.

Emotional competence is what we need to develop if we are to protect ourselves from the hidden stresses that create a risk to health, and it is what we need to regain if we are to heal. We need to foster emotional competence in our children, as the best preventive medicine.

Characteristic was their attempt to avoid asking for help.”

Studies in psychology—an art trying desperately to dress itself up as a pure science—often find only what the particular researchers have the eyes to see.

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

Strong convictions do not necessarily signal a powerful sense of self: very often quite the opposite. 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.

Assertiveness in defence of our boundaries can and should appear aggressive, if need be.

recovered from Lou Gehrig’s disease by learning to respect all aspects of her body.

she wanted to experience unconditional love for herself at least once before dying. Describing herself as a “bowl of Jell-O in a wheelchair,” she sat every day for fifteen minutes in front of a mirror and chose different parts of herself to love. She started with her hands, because at that time they were the only parts of herself that she could appreciate unconditionally. Each day she went on to other body parts. .

self-love that, little by little, “unfroze” each part of her body.

“There was a two-hour session when Peter was away, and she grieved intensely about her life and about her illness. It made a huge difference to her. The physiotherapist saw her right afterwards and was amazed that her muscle tone was so much better.

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.

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.

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

assumed toward your dad is a maternal role. Which is also why you’ve been taken for granted. Mother is taken for granted. Mother is like the world—she’s just supposed to be there and provide.”

Adults with a history of troubled childhoods may not encounter more serious losses than others do, but their ability to cope will have been impaired by their upbringing.

My mother was a wonderful woman, strong and kind and principled, and she never let me down. She was also a perfectionist, and tried to program us children for perfection. My mother never came to us with her problems, she just shouldered them. And she was my strongest role model, so when I couldn’t shoulder my problems, I lost respect for myself.

“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 or somebody dying, it is actually the internal stress of having to adjust oneself to somebody else.

precocious intellectual development is what happens to bright and sensitive kids when the emotional environment isn’t able to hold them enough; they develop this very powerful intellect that holds them instead.

“She wants to keep peace in the family. That’s not the child’s role.

I’ve always said that I’m not worried my kids will be angry with me, I’m worried they won’t be angry enough.

The people that I see with cancers and all these conditions have difficulty saying no and expressing anger. They tend to repress their anger or, at the very best, express it sarcastically, but never directly. It all comes from the early need to build the relationship with the parent, to work at the relationship.

“Why can’t parents see their children’s pain?” “I’ve had to ask myself the same thing. It’s because we haven’t seen our own.

The Mermaid and the Minotaur. It discusses how the exclusive role that women have in early childraising distorts child development. When the woman is married to an immature man, she is also a mother to her husband, so she hasn’t got the openness and the energy for her kids.

There is no one to blame, but there are generations on generations who had lived to bear a part in the genesis of Barbara Ellen’s breast cancer.

those lung cancer patients who smoked but did not inhale exhibited even greater repression of emotion than those who did.

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,