When the Body Says No: The Cost of Hidden Stress

  P
EOPLE HAVE ALWAYS UNDERSTOOD INTUITIVELY
that mind and body are not separable. Modernity has brought with it an unfortunate dissociation, a split between what we know with our whole being and what our thinking mind accepts as truth. Of these two kinds of knowledge the latter, narrower, kind most often wins out, to our loss.

It is a pleasure and a privilege, therefore, to bring in front of the reader the findings of modern science that reaffirm the intuitions of age-old wisdom. That was my primary goal in writing this book. My other purpose was to hold up a mirror to our stress-driven society so that we may recognize how, in myriad unconscious ways, we help generate the illnesses that plague us.

This is not a book of prescriptions, but I do hope it will serve its readers as a catalyst for personal transformation. Prescriptions come from the outside, transformation occurs within. There are many books of simple prescriptions of one sort or another—physical, emotional, spiritual—that appear each year. It was not my intention to write yet one more. Prescriptions assume that something needs to be fixed; transformation brings forth the healing—the coming to integrity, to wholeness—of what is already there. While advice and prescriptions may be useful, even more valuable to us is insight into ourselves and the workings of our minds and bodies. Insight, when inspired by the quest for truth, can promote transformation. For those seeking a healing message here, that message begins on page one with the very first case study. As the great physiologist Walter Cannon suggested, there is
a wisdom in our bodies. I hope
When the Body Says No
will help people align with the inner wisdom we all possess.

Some of the case examples in this book are derived from published biographies or autobiographies of well-known persons. The majority are taken from my clinical experience or from taped discussions with people who agreed to be interviewed and quoted regarding their medical and personal histories. For privacy reasons, names (and, in some instances, other circumstances) have been changed.

To avoid making this work prohibitively academic for the lay reader, notes have been used only sparingly. References are provided for each chapter at the end of the book.

Italics, unless otherwise noted, are mine.

I welcome comments at my e-mail address:
[email protected]
.

  M
ARY WAS A NATIVE WOMAN
in her early forties, slight of stature, gentle and deferential in manner. She had been my patient for eight years, along with her husband and three children. There was a shyness in her smile, a touch of self-deprecation. She laughed easily. When her ever-youthful face brightened, it was impossible not to respond in kind. My heart still warms—and constricts with sorrow—when I think of Mary.

Mary and I had never talked much until the illness that was to take her life gave its first signals. The beginning seemed innocent enough: a sewing-needle puncture wound on a fingertip failed over several months to heal. The problem was traced to Raynaud’s phenomenon, in which the small arteries supplying the fingers are narrowed, depriving the tissues of oxygen. Gangrene can set in, and unfortunately this was the case for Mary. Despite several hospitalizations and surgical procedures, she was within a year begging for an amputation to rid her of the throbbing ache in her finger. By the time she got her wish the disease was rampant, and powerful narcotics were inadequate in the face of her constant pain.

Raynaud’s can occur independently or in the wake of other disorders. Smokers are at greater risk, and Mary had been a heavy smoker since her teenage years. I hoped that if she quit, normal blood flow might return to her fingers. After many relapses she finally succeeded. Unfortunately, the Raynaud’s proved to be the harbinger of something far worse: Mary was diagnosed with scleroderma, one of the autoimmune diseases, which include rheumatoid arthritis, ulcerative colitis, systemic lupus erythematosus (SLE) and many other conditions
that are not always recognized to be autoimmune in origin, such as diabetes, multiple sclerosis and possibly even Alzheimer’s disease. Common to them all is an attack by one’s own immune system against the body, causing damage to joints, connective tissue or to almost any organ, whether it be the eyes, the nerves, the skin, the intestines, the liver or the brain. In scleroderma (from the Greek word meaning “hardened skin”), the immune system’s suicidal assault results in a stiffening of the skin, esophagus, heart and tissues in the lungs and elsewhere.

What creates this civil war inside the body?

Medical textbooks take an exclusively biological view. In a few isolated cases, toxins are mentioned as causative factors, but for the most part a genetic predisposition is assumed to be largely responsible. Medical practice reflects this narrowly physical mindset. Neither the specialists nor I as her family doctor had ever thought to consider what in Mary’s particular experiences might also have contributed to her illness. None of us expressed curiosity about her psychological state before the onset of the disease, or how this influenced its course and final outcome. We simply treated each of her physical symptoms as they presented themselves: medications for inflammation and pain, operations to remove gangrenous tissue and to improve blood supply, physiotherapy to restore mobility.

One day, almost on a whim, in response to a whisper of intuition that she needed to be heard, I invited Mary to make an hour-long appointment so that she would have the opportunity to tell me something about herself and her life. When she began to talk, it was a revelation. Beneath her meek and diffident manner was a vast store of repressed emotion. Mary had been abused as a child, abandoned and shuttled from one foster home to another. She recalled huddling in the attic at the age of seven, cradling her younger sisters in her arms, while her drunken foster parents fought and yelled below. “I was so scared all the time,” she said, “but as a seven-year-old I had to protect my sisters. And no one protected me.” She had never revealed these traumas before, not even to her husband of twenty years. She had learned not to express her feelings about anything to anyone, including herself. To be self-expressive, vulnerable and questioning in her childhood would have put her at risk. Her security lay in considering other people’s feelings, never
her own. She was trapped in the role forced on her as a child, unaware that she herself had the right to be taken care of, to be listened to, to be thought worthy of attention.

Mary described herself as being incapable of saying no, compulsively taking responsibility for the needs of others. Her major concern continued to be her husband and her nearly adult children, even as her illness became more grave. Was the scleroderma her body’s way of finally rejecting this all-encompassing dutifulness?

Perhaps her body was doing what her mind could not: throwing off the relentless expectation that had been first imposed on the child and now was self-imposed in the adult—placing others above herself. I suggested as much when I wrote about Mary in my very first article as medical columnist for
The Globe and Mail
in 1993. “When we have been prevented from learning how to say no,” I wrote, “our bodies may end up saying it for us.” I cited some of the medical literature discussing the negative effects of stress on the immune system.

The idea that people’s emotional coping style can be a factor in scleroderma or other chronic conditions is anathema to some physicians. A rheumatic diseases specialist at a major Canadian hospital submitted a scathing letter to the editor denouncing both my article and the newspaper for printing it. I was inexperienced, she charged, and had done no research.

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. We want to describe human beings—healthy or otherwise—as though they function in isolation from the environment in which they develop, live, work, play, love and die. These are the built-in, hidden biases of the medical orthodoxy that most physicians absorb during their training and carry into their practice.

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. The unexamined assumptions of the scientist both determine and limit what he or she will discover, as the pioneering Czech-Canadian stress researcher Hans Selye pointed out. “Most people do not fully realize to what extent the spirit of scientific
research and the lessons learned from it depend upon the personal viewpoints of the discoverers,” he wrote in
The Stress of Life
. “In an age so largely dependent upon science and scientists, this fundamental point deserves special attention.”
¹
In that honest and self-revealing assessment Selye, himself a physician, expressed a truth that even now, a quarter century later, few people grasp.

The more specialized doctors become, the more they know about a body part or organ and the less they tend to understand the human being in whom that part or organ resides. The people I interviewed for this book reported nearly unanimously that neither their specialists nor their family doctors had ever invited them to explore the personal, subjective content of their lives. If anything, they felt that such a dialogue was discouraged in most of their contacts with the medical profession. In talking with my specialist colleagues about these very same patients, I found that even after many years of treating a person, a doctor could remain quite in the dark about the patient’s life and experience outside the narrow boundaries of illness.

In this volume I set out to write about the effects of stress on health, particularly of the hidden stresses we all generate from our early programming, a pattern so deep and so subtle that it feels like a part of our real selves. Although I have presented as much of the available scientific evidence as seemed reasonable in a work for the lay public, the heart of the book—for me, at least—is formed by the individual histories I have been able to share with the readers. It so happens that those histories will also be seen as the least persuasive to those who regard such evidence as “anecdotal.”