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When the Body Says No: The Cost of Hidden Stress When the Body Says No: The Cost of Hidden Stress by Gabor Maté
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“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. Stress occurs in the absence of these criteria, and it leads to the disruption of homeostasis. Chronic disruption results in ill health.

In each of the individual histories of illness in this book, one or more aspect of emotional competence was significantly compromised, usually in ways entirely unknown to the person involved. 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.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Dr. Cai Song is an internationally known researcher at the University of British Columbia and co-author of a recent textbook, Fundamentals of Psychoneuroimmunology. “I am convinced that Alzheimer’s is an autoimmune disease,” says Dr. Song. “It is probably triggered by chronic stress acting on an aging immune system.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“The research literature has identified three factors that universally lead to stress: uncertainty, the lack of information and the loss of control.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“Settling for the view that illnesses, mental or physical, are primarily genetic allows us to avoid disturbing questions about the nature of the society in which we live. If “science” enables us to ignore poverty or man-made toxins or a frenetic and stressful social culture as contributors to disease, we can look only to simple answers: pharmacological and biological.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“The salient stressors in the lives of most human beings today — at least in the industrialized world — are emotional. 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.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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. Stress occurs in the absence of these criteria, and it leads to the disruption of homeostasis. Chronic disruption results in ill health.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“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. Negative thinking allows us to gaze unflinchingly on our own behalf at what does not work.

We have seen in study after study that compulsive positive thinkers are more likely to develop disease and less likely to survive. Genuine positive thinking — or, more deeply, positive being — empowers us to know that we have nothing to fear from truth. “Health is not just a matter of thinking happy thoughts,” writes the molecular researcher Candace Pert. “Sometimes the biggest impetus to healing can come from jump-starting the immune system with a burst of long-suppressed anger.” Anger, or the healthy experience of it, is one of the seven A’s of healing. Each of the seven A’s addresses one of the embedded visceral beliefs that predispose to illness and undermine healing.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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. 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. 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. Emotional repression is also a coping style rather than a personality trait set in stone.

Not one of the many adults interviewed for this book could answer in the affirmative when asked the following: When, as a child, you felt sad, upset or angry, was there anyone you could talk to — even when he or she was the one who had triggered your negative emotions? In a quarter century of clinical practice, including a decade of palliative work, I have never heard anyone with cancer or with any chronic illness or condition say yes to that question. Many children are conditioned in this manner not because of any intended harm or abuse, but because the parents themselves are too threatened by the anxiety, anger or sadness they sense in their child — or are simply too busy or too harassed themselves to pay attention. “My mother or father needed me to be happy” is the simple formula that trained many a child — later a stressed and depressed or physically ill adult — into lifelong patterns of repression.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Shame is the deepest of the “negative emotions,” a feeling we will do almost anything to avoid. Unfortunately, our abiding fear of shame impairs our ability to see reality.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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. Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well-self-regulated people are the most capable of interacting fruitfully with others in a community and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism’s chances for long-term survival.

Almost from the beginning of life we see a tension between the complementary needs for security and for autonomy. Development requires a gradual and ageappropriate shift from security needs toward the drive for autonomy, from attachment to individuation. Neither is ever completely lost, and neither is meant to predominate at the expense of the other. With an increased capacity for self-regulation in adulthood comes also a heightened need for autonomy — for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or when the tested animal or human being feels helpless, without meaningful choices — in other words, when autonomy is undermined.

Autonomy, however, needs to be exercised in a way that does not disrupt the social relationships on which survival also depends, whether with emotional intimates or with important others—employers, fellow workers, social authority figures. 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. To minimize the stress from threatened relationships, a person may give up some part of his autonomy. However, this is not a formula for health, since the loss of autonomy is itself a cause of stress.

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 feel 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. The other way of protecting oneself from the stress of threatened relationships is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy. This coping style
may avoid anxiety and block the subjective experience of stress but not the physiology of it. Emotional intimacy is a psychological and biological necessity. Those who build walls against intimacy are not self-regulated, just emotionally frozen. Their stress from having unmet needs will be high.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“The repeated finding that people with happier, less troubled thought patterns can suffer more illness seems to defy common sense. The general belief is that positive emotions must be conducive to good health. While it is true that genuine joy and satisfaction enhance physical well-being, “positive” states of mind generated to tune out psychic discomfort lower resistance to illness. The brain governs and integrates the activities of all organs and systems of the body, simultaneously coordinating our interactions with the environment.

This regulating function depends on the clear recognition of negative influences, danger signals and signs of internal distress. In children whose environment chronically conveys mixed messages, an impairment occurs in the developing apparatus of the brain. The brain’s capacity to evaluate the environment is diminished, including its ability to distinguish what is nourishing from what is toxic.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Despite the intervening six decades of scientific inquiry since Selye’s groundbreaking work, the physiological impact of the emotions is still far from fully appreciated. The medical approach to health and illness continues to suppose that body and mind are separable from each other and from the milieu in which they exist. Compounding that mistake is a definition of stress that is narrow and simplistic. Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary. 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. When people describe themselves as being stressed, they usually mean the nervous agitation they experience under excessive demands — most commonly in the areas of work, family, relationships, finances or health. But sensations of nervous tension do not define stress — nor, strictly speaking, are they always perceived when people are stressed. 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 is not simply nervous tension,” Selye pointed out. “Stress reactions do occur in lower animals, and even in plants, that have no nervous systems…. Indeed, stress can be produced under deep anaesthesia in patients who are unconscious, and even in cell cultures grown outside the body.” Similarly, 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. The physiology of stress may be triggered without observable effects on behaviour and without subjective awareness, as has been shown in animal experiments and in human studies.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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.

We see immediately that the definition of a stressor depends on the processing system that assigns meaning to it. The shock of an earthquake is a direct threat to many organisms, though not to a bacterium. The loss of a job is more acutely stressful to a salaried employee whose family lives month to month than to an executive who receives a golden handshake. Equally important is the personality and current psychological state of the individual on whom the stressor is acting. The executive whose financial security is assured when he is terminated may still experience severe stress if his self-esteem and sense of purpose were completely bound up with his position in the company, compared with a colleague who finds greater value in family, social interests or spiritual pursuits. The loss of employment will be perceived as a major threat by the one, while the other may see it as an opportunity.

There is no uniform and universal relationship between a stressor and the stress response. Each stress event is singular and is experienced in the present, but it also has its resonance from the past. The intensity of the stress experience and its long-term consequences depend on many factors unique to each individual. What defines stress for each of us is a matter of personal disposition and, even more, of personal history. 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. Rats autopsied after stress had enlarged adrenals, shrunken lymph organs and ulcerated intestines.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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. Discharges of nervous system, hormonal output and immune changes constitute the flight-or-fight reactions that help us survive immediate danger. These biological responses are adaptive in the emergencies for which nature designed them. But the same stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart. There is extensive documentation of the inhibiting effect of chronic stress on the immune system.

In one study, the activity of immune cells called natural killer (NK) cells were compared in two groups: spousal caregivers of people with Alzheimer’s disease, and age- and health-matched controls. NK 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. The NK cell functioning of the caregivers was significantly suppressed, even in those whose spouses had died as long as three years previously. The caregivers who reported lower levels of social support also showed the greatest depression in immune activity — just as the loneliest medical students had the most impaired immune systems under the stress of examinations. Another study of caregivers assessed the efficacy of immunization against influenza. In this study 80 per cent among the non-stressed control group developed immunity against the virus, but only 20 per cent of the Alzheimer caregivers were able to do so. The stress of unremitting caregiving inhibited the immune system and left people susceptible to influenza. Research has also shown stress-related delays in tissue repair.

The wounds of Alzheimer caregivers took an average of nine days longer to heal than those of controls. Higher levels of stress cause higher cortisol output via the HPA axis, and cortisol inhibits the activity of the inflammatory cells involved in wound healing. Dental students had a wound deliberately inflicted on their hard palates while they were facing immunology exams and again during vacation. In all of them the wound healed more quickly in the summer. Under stress, their white blood cells produced less of a substance essential to healing. 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.

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. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress or no awareness at all.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Like stress, emotion is a concept we often invoke without a precise sense of its meaning. And, like stress, emotions have several components. The psychologist Ross Buck distinguishes between three levels of emotional responses, which he calls Emotion I, Emotion II and Emotion III, classified according to the degree we are conscious of them. 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. Emotion II comprises our emotional displays as seen by others, with or without our awareness. It is signalled through body language — “non-verbal signals, mannerisms, tones of voices, gestures, facial expressions, brief touches, and even the timing of events and pauses between words. [They] may have physiologic consequences — often outside the awareness of the participants.”

It is quite common for a person to be oblivious to the emotions he is communicating, even though they are clearly read by those around him. Our expressions of Emotion II are what most affect other people, regardless of our intentions. A child’s displays of Emotion II are also what parents are least able to tolerate if the feelings being manifested trigger too much anxiety in them. As Dr. Buck points out, a child whose parents punish or inhibit this acting-out of emotion will be conditioned to respond to similar emotions in the future by repression. The self-shutdown serves to prevent shame and rejection. Under such conditions, Buck writes, “emotional competence will be compromised…. The individual will not in the future know how to effectively handle the feelings and desires involved. The result would be a kind of helplessness.” The stress literature amply documents that helplessness, real or perceived, is a potent trigger for biological stress responses. 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. People often find themselves in situations of learned helplessness — for example, someone who feels stuck in a dysfunctional or even abusive relationship, in a stressful job or in a lifestyle that robs him or her of true freedom.

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. They may occur in the absence of subjective awareness or of emotional expression. Adaptive in the acute threat situation, these same stress responses are harmful when they are triggered chronically without the individual’s being able to act in any way to defeat the perceived threat or to avoid it. 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.” Emotional competence presupposes capacities often lacking in our society, where “cool” — the absence of emotion — is the prevailing ethic, where “don’t be so emotional” and “don’t be so sensitive” are what children often hear, and where rationality is generally considered to be the preferred antithesis of emotionality. The idealized cultural symbol of rationality is Mr. Spock, the emotionally crippled Vulcan character on Star Trek.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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. How”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“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. Her neurochemical output, the electrical activity in her brain’s emotional centres, her heart rate, blood pressure and the serum levels of the various hormones related to stress would all vary significantly. 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. When the environment becomes too cold, the heating system is switched on. If the air becomes overheated, the air conditioner begins to work.

In the animal kingdom, self-regulation is illustrated by the capacity of the warm-blooded creature to exist in a broad range of environments. It can survive more extreme variations of hot and cold without either chilling or overheating than can a coldblooded species. The latter is restricted to a much narrower range of habitats because it does not have the capacity to self-regulate the internal environment. 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. Emotional and social relationships remain important biological influences beyond childhood. “Independent self-regulation may not exist even in adulthood,” Dr. Myron Hofer, then of the Departments of Psychiatry and Neuroscience at Albert Einstein College of Medicine in New York, wrote in 1984. “Social interactions may continue to play an important role in the everyday regulation of internal biologic systems throughout life.” 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. As one prominent researcher has expressed it most aptly, “Adaptation does not occur wholly within the individual.”

Human beings as a species did not evolve as solitary creatures but as social animals whose survival was contingent on powerful emotional connections with family and tribe. Social and emotional connections are an integral part of our neurological and chemical makeup. We all know this from the daily experience of dramatic physiological shifts in our bodies as we interact with others. “You’ve burnt the toast again,” evokes markedly different bodily responses from us, depending on whether it is shouted in anger or said with a smile. When one considers our evolutionary history and the scientific evidence at hand, it is absurd even to imagine that health and disease could ever be understood in isolation from our psychoemotional networks. “The basic premise is that, like other social animals, human physiologic homeostasis and ultimate health status are influenced not only by the physical environment but also by the social environment.” From such a biopsychosocial perspective, individual biology, psychological functioning and interpersonal and social relationships work together, each influencing the other.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Interactions with the world program our physiological and psychological development. Emotional contact is as important as physical contact. The two are quite analogous, as we recognize when we speak of the emotional experience of feeling touched. Our sensory organs and brains provide the interface through which relationships shape our evolution from infancy to adulthood. Social-emotional interactions decisively influence the development of the
human brain. From the moment of birth, they regulate the tone, activity and development of the psychoneuroimmunoendocrine (PNI) super-system. Our characteristic modes of handling psychic and physical stress are set in our earliest years.

Neuroscientists at Harvard University studied the cortisol levels of orphans who were raised in the dreadfully neglected child-care institutions established in Romania during the Ceausescu regime. In these facilities the caregiver/child ratio was one to twenty. Except for the rudiments of care, the children were seldom physically picked up or touched. They displayed the self-hugging motions and depressed demeanour typical of abandoned young, human or primate. On saliva tests, their cortisol levels were abnormal, indicating that their hypothalamic-pituitary-adrenal axes were already impaired.

As we have seen, disruptions of the HPA axis have been noted in autoimmune disease, cancer and other conditions. It is intuitively easy to understand why abuse, trauma or extreme neglect in childhood would have negative consequences. But why do many people develop stress-related illness without having been abused or traumatized? These persons suffer not because something negative was inflicted on them but because something positive was withheld.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“The core belief in having to be strong enough, characteristic of many people who develop chronic illness, is a defence. The child who perceives that her parents cannot support her emotionally had better develop an attitude of “I can handle everything myself.” Otherwise, she may feel rejected. One way not to feel rejected is never to ask for help, never to admit “weakness” — to believe that I am strong enough to withstand all my vicissitudes alone.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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?”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“Compassionate curiosity about the self does not mean liking everything we find out about ourselves, only that we look at ourselves with the same nonjudgmental acceptance we would wish to accord anyone else who suffered and who needed help.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Attachment is our connection with the world. In the earliest attachment relationships, we gain or lose the ability to stay open, self-nurturing and healthy. In those early attachment bonds, we learned to experience anger or to fear it and repress it. There we developed our sense of autonomy or suffered its
atrophy. Connection is also vital to healing. Study after study concludes that people without social contact—the lonely ones—are at greatest risk for illness. People who enjoy genuine emotional support face a better prognosis, no matter what the disease.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“We sometimes find it easier to feel bitterness or rage than to allow ourselves to experience that aching desire for contact that, when disappointed, originally engendered the anger. Behind all our anger lies a deeply frustrated need for truly intimate contact. 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. Seeking connections is a necessity for healing.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“Everyone has an urge to create. Its expression may flow through many channels: through writing, art or music, through the inventiveness of work or in any number of ways unique to all of us, whether it be cooking, gardening or the art of social discourse. The point is to honour the urge. To do so is healing for ourselves and for others; not to do so deadens our bodies and our spirits.”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“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 lives rather than just reacting. We want to be the authoritative person in our own lives: in charge, able to make the authentic decisions that affect us. There is no true responsibility without awareness. One of the weaknesses of the Western medical approach is that we have made the physician the only authority, with the patient too often a mere recipient of the treatment or cure. People are deprived of the opportunity to become truly responsible. None of us are to be blamed if we succumb to illness and death. Any one of us might succumb at any time, but the more we can learn about ourselves, the less prone we are to become passive victims. Mind and body links have to be seen not only for our understanding of illness but also for our understanding of health.

Dr. Robert Maunder, on the psychiatric faculty of the University of Toronto, has written about the mindbody interface in disease. “Trying to identify and to answer the question of stress,” he said to me in an interview, “is more likely to lead to health than ignoring the question.” In healing, every bit of information, every piece of the truth, may be crucial. If a link exists between emotions and physiology, not to inform people of it will deprive them of a powerful tool. 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. Not even in the West is mind-body thinking completely new. In one of Plato’s dialogues, Socrates quotes a Thracian doctor’s criticism of his Greek colleagues: “This is the reason why the cure of so many diseases is unknown to the physicians of Hellas; they are ignorant of the whole. For this is the great error of our day in the treatment of the human body, that physicians separate the mind from the body.” You cannot split mind from body, said Socrates—nearly two and a half millennia before the advent of psychoneuroimmunoendocrinology!”
Gabor Maté, When the Body Says No: The Cost of Hidden Stress
“You see, the acting-out, the yelling, the screaming and even the hitting, all that a person does, serves as a defence against the experience of the anger. It’s a defence against keeping the anger inside where it can be deeply felt. Discharge defends against anger being actually experienced.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“The other way we can avoid the experience of anger is through repression. So repression and discharge are two sides of the same coin. Both represent fear and anxiety, and for that reason, both trigger physiological stress responses regardless of what we consciously feel or do not feel.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection
“Emotional interactions stimulate or inhibit the growth of nerve cells and circuits by complicated processes that involve the release of natural chemicals. To give a somewhat simplified example, when “happy” events are experienced by the infant, endorphins—“reward chemicals,” the brain’s natural opioids—are released. Endorphins encourage the growth and connections of nerve cells. Conversely, in animal studies, chronically high levels of stress hormones such as cortisol have been shown to cause important brain centres to shrink.”
Gabor Maté, When the Body Says No: Understanding the Stress-Disease Connection

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