When the Body Says No: The Cost of Hidden Stress (10 page)

The episode encapsulated the nature of their relationship: she was the ever-available, unspeaking and compliant mother/nanny figure whose services are expected, taken for granted and noticed only in their absence. She travelled the world with her husband, daily confronting and overcoming myriad difficulties that were only much later—and even then only partially—eased once he became an internationally famous and high-earning author. She felt herself gradually disappear as an individual. She was sucked dry, sensing herself becoming a “brittle, empty shell, alone and vulnerable,” and nearly suicidal. Hawking, for his part, reacted to her strivings for independence with disdain and finally with the rage of a child deserted by his mother. The wife was eventually supplanted by a nurse who left her own husband to marry the scientist. Jane, too, had found another love. It was only this outside relationship
that, in the final years of the marriage, allowed her to continue to serve Stephen as long as she did.

Hawking’s vocation and the unstinting support of his wife were accompanied by something else that has probably aided his survival: the liberation of his aggression by his illness. 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.

Assertiveness in defence of our boundaries can and should appear aggressive, if need be. Hawking’s intellectual self-assuredness became the ground for that aggression to manifest itself, particularly after the onset of his physical decline. Jane Hawking notes in her memoir that “curiously, as his gait became more unsteady so his opinions became more forceful and defiant.”

Like that of all the ALS sufferers we have met, Hawking’s personality has been characterized by intense psychological repression. In his family of origin, healthy vulnerability and emotional interaction appear to have been perceived as foreign. At the supper table, the Hawkings would eat without communicating, each head lowered into reading matter. Stephen’s childhood home was in a state of physical neglect that went beyond eccentricity to indicate an emotional distance on the part of both parents. His biographers relate, “Neither Isobel nor Frank Hawking semed to care too much about the state of the house. Carpets and furniture remained in use until they began to fall apart; wallpaper was allowed to dangle where it had peeled through old age; and there were many places along the hallway and behind doors where plaster had fallen away, leaving gaping holes in the wall.”

Of Stephen’s father, White and Gribbin write that he was a remote figure, “significant in Stephen’s childhood and adolescence by his absence.” According to Jane, the Hawkings regarded “any expression of emotion or appreciation as a sign of weakness, as loss of control or a denial of their own importance…. Strangely, they seemed ashamed of demonstrating any warmth.”

After Stephen and Jane married, his family withdrew from active involvement with his care, a fact Jane could barely fathom, let alone accept. Besides her responsibilities toward her husband, she also had full care of their three children. His refusal to acknowledge the pressures
placed on her by his illness—and her compliant subjection to that attitude—meant that she never received any respite. “I was at the breaking-point,” she recalls, “but still Stephen was determined to reject any proposals which might have suggested that he was making concessions to the illness. These were the proposals which might have relieved the children and me of some of the strain.” He simply refused to discuss any problem, relying on Jane’s willingness to absorb all the resultant stress. “He had never liked to admit to emotions,” writes Jane, “regarding them as the fatal, irrational flaw in my character.” Her attempts to gain support from her husband’s family were met with cold incomprehension, even hostility. “You see,” her mother-in-law once told her, “we have never really liked you, Jane; you do not fit into our family.” This after decades of self-effacing service to her son.

Has it been shown in this chapter that ALS is caused by, or is at least potentiated by, emotional repression? That it is rooted in childhood emotional isolation and loss? That generally—even if not always—it strikes people who lead driven lives and whom others consider to be very “nice”? Until our understanding 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.

A mind-body perspective may help those afflicted with ALS who are willing to look at some very painful realities fully and unflinchingly. In rare instances, people do seem to get over symptoms diagnosed as ALS. It would be worthwhile investigating such cases to find out why. One example is reported by Dr. Christiane Northrup in
Women’s Bodies, Women’s Wisdom:

According to Dr. Northrup, her friend healed through the conscious daily practice of emotional self-inventory and of self-love that, little by little, “unfroze” each part of her body. Had I read such a story when I graduated from medical school, I would have dismissed it out of hand. Even now, the scientifically trained physician in me would like to see direct proof that ALS was legitimately diagnosed in this case. In palliative work I once saw a person admitted for “respite care” who had convinced herself and her circle of friends that she suffered from ALS, despite the electrodiagnostic testing and neurological findings having all been, repeatedly, perfectly normal. The friends scarcely believed me when I informed them that the invalid they had been assiduously caring for was, from the narrow physical point of view, as healthy as they were.

Today I do not find Dr. Northrup’s report impossible to credit. It accords with my understanding of this disease. There was an intriguing incident in the story of Alexa, the teacher whose husband, Peter, could not accept the diagnosis of ALS. It revealed the potential of something that, perhaps, may have been. The psychologist Gordon Neufeld managed on only one occasion to see her alone, without her spouse. “It was absolutely clear to me that her emotions were tied up, that she had lost her vitality,” Dr. Neufeld says. “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. But I could never meet with her alone again, and I could never get her to that place again. The window just shut.”

  F
OR SEVEN YEARS, MICHELLE
had a lump in her breast. Periodically, it grew or shrank, but it never caused her or her physicians any concern. “Then all of a sudden it got really hard, got hot and started to grow almost overnight,” the thirty-nine-year-old Vancouverite says. A biopsy revealed that the tumour was malignant, and Michelle believes she knows why: stress. “It wasn’t until I shocked the hell out of my life that it changed,” she says. “I quit my job, without any income to go to…. My emotional state was horrible at the time. A lot of things hit me all at once, not only financial.” Michelle had a lumpectomy and was relieved to learn that her lymph glands were free of cancer. The surgery was followed by chemotherapy and radiation, but no physician ever asked her about what psychic stresses she might have suffered before the onset of her malignancy or what unresolved issues she had in her life.

Breast cancer patients often report that their doctors do not express an active interest in them as individuals or in the social and emotional context in which they live. The assumption is that these factors have no significant role in either the origins or the treatment of disease. That attitude is reinforced by narrowly conceived psychological research.

An article in the
British Medical Journal
reported on a five-year study of more than two hundred women with breast cancer that aimed to determine whether a recurrence of cancer can be triggered by severe life events, such as divorce or the death of someone close. The authors concluded that “women with breast cancer need not fear that stressful experiences will precipitate a return of their disease.”
¹
Dr. Donna Stewart, a professor at the University of Toronto and chairwoman of
women’s issues for the University Health Network, commented that the study’s results “made sense.”

Dr. Stewart was the lead author of a study published in 2001 in the journal
Psycho-Oncology
. Nearly four hundred women with a history of breast cancer were asked what they thought had caused their malignancy. Forty-two per cent cited stress—much more than other factors such as diet, environment, genetics and lifestyle.
²
“I think it reflects what’s going on in society in general,” Dr. Stewart says. “People think stress causes everything. The evidence for stress is pretty low. And the evidence for hormones and genetics is pretty high.”

Yet Michelle and the many other women who suspect a strong relationship between stress and their breast cancer have science and clinical insight on their side. No other cancer has been as minutely studied for the potential biological connections between psychological influences and the onset of the disease. A rich body of evidence, drawn from animal studies and human experience, supports the impression of cancer patients that emotional stress is a major contributing cause of breast malignancy.

Contrary to the assertions of the Toronto researchers, the “evidence for genetics” is not high. Only a small minority of women are at high genetic risk for breast cancer and only a small minority of women with breast cancer—about 7 per cent—acquire the disease for genetic reasons. Even for those genetically predisposed, environmental factors must be involved, since far from everyone with one of the three genes known to be associated with breast cancer will actually develop a malignant tumour. In the vast majority of women or men diagnosed with breast cancer, heredity makes little or no contribution.

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.

Hormone production is intimately affected by psychological stress. Women have always known that emotional stress affects their ovarian
function and their menstrual cycles—excessive stress may even inhibit menstruation.

The body’s hormonal system is inextricably linked with the brain centres where emotions are experienced and interpreted. In turn, the hormonal apparatus and the emotional centres are interconnected with the immune system and the nervous system. These are not four separate systems, but one super-system that functions as a unit to protect the body from external invasion and from disturbances to the internal physiological condition. It is impossible for any stressful stimulus, chronic or acute, to act on only one part of the super-system. What happens to one will affect all. In
chapter 7
we will examine the workings of this supersystem more closely.

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. NK cells mount an attack on malignant cells and are able to destroy them. These women had significantly less spread of their breast cancer, compared with those who exhibited a less assertive attitude or who had fewer nurturing social connections. The researchers found that emotional factors and social involvement were more important to survival than the degree of disease itself.
³

Many studies, such as the one reported in
The British Medical Journal
article, fail to appreciate that stress is not only a question of external stimulus but also of individual response. It occurs in the real lives of real persons whose inborn temperament, life history, emotional patterns, physical and mental resources, and social and economic supports vary greatly. As pointed out in
chapter 3
, there is no universal stressor.

In most cases of breast cancer, the stresses are hidden and chronic. They stem from childhood experiences, early emotional programming and unconscious psychological coping styles. They accumulate over a lifetime to make someone susceptible to disease.