When the Body Says No: The Cost of Hidden Stress (19 page)

I have known Roy and his family since he was eight. I was their doctor for twenty years, until I left my practice in 2000. I discovered that Roy had been treated for testicular cancer when I dropped in for a quick visit to my old office a few months ago. By happenstance it was the same afternoon Roy was there for a checkup. By then I had already read Lance Armstrong’s book,
It’s Not about the Bike: My Journey Back to Life. The
parallels in the lives of Roy and Lance were eerie. Perhaps the similarities in their response to disease were more than coincidental.

Long before his cancer, Armstrong had developed a pattern of emotional repression. One of his close friends described him as “kind of like an iceberg. There’s a peak, but there is so much more below the surface.”

Armstrong never knew his biological father, whom he contemptuously dismisses as his “DNA donor.” His mother, Linda Mooneyham, the daughter of divorced parents, was seventeen and abandoned when she gave birth to Lance, her first son. Linda’s father, an alcoholic Vietnam veteran, gave up drinking, to his credit, the day his grandson was born.

Linda was a spirited and independent-minded young woman but, given her circumstances, also a very needy one, hardly an adult. As Lance was to write, “In a way, we grew up together.” When Lance was three, Linda remarried. The stepfather, Terry Armstrong, is described by Lance as “a small man with a large mustache and a habit of acting more successful than he really was.” He professed Christian principles but, despite them, beat Lance regularly: “The paddle was his preferred
method of discipline. If I came home late, out would come the paddle. Whack. If I smarted off, I got the paddle. Whack. It didn’t hurt just physically, but also emotionally. So I didn’t like Terry Armstrong. I thought he was an angry testosterone geek, and as a result, my early impression of organized religion was that it was for hypocrites.”

As the adolescent Lance was to learn, his stepfather also engaged in extramarital affairs. “I could have dealt with Terry Armstrong’s paddle. But there was something else I couldn’t deal with,” writes Lance, referring to his stepfather’s infidelities. The marriage broke up.

Roy is also the first-born, the child of an ill-tempered and violent man who used to beat his wife and his son. “I remember one thing that my dad did. He tied my wrists and tied my ankles and put me out in the backyard. I don’t remember how long he left me out there, but what really bothered me was the that guy who lived upstairs was looking out the window at me and laughing at me. How the fuck can you do that to a kid? Obviously it bothers me to this day.”

“Was your mom around?”

“I think my mom was at work.” Roy looked upon his mother as his ally. Very early he took on the role of defending her against her husband’s violence.

Lance Armstrong’s mother was also unable to protect her son from being beaten. It is inevitable that a child in that situation would have deep hurt around that failure—and anger not only at the abusive stepfather but also at the mother who could not keep him safe. Lance seems unaware of any such feelings—and that is the source, I believe, of his propensity to deny and ignore his pain. “If it was a suffer-fest,” Lance writes about his teenage attraction to endurance sports, “I was good at it.”

As indicated in the passage quoted above, he had greater difficulty enduring his mother’s betrayal by her husband than his own harsh treatment.

The child of an unhappy mother will try to take care of her by suppressing his distress so as not to burden her further. His role is to be self-sufficient and not “needy”—recall my reflexive suppression of a limp after minor knee surgery. When twenty-five-year-old Lance was given his cancer diagnosis, he was quite unable to tell his mother directly. “I wasn’t strong enough to break it to my mother that I was sick,” he writes. He accepted the offer of a close friend to inform her on his behalf.

Linda rose to the challenge with great strength, love and courage, supporting Lance through the nightmare of a highly uncertain prognosis, the bewildering difficulties of making the appropriate treatment decisions and the travails of brain surgery and chemotherapy. Her son’s automatic reflex to protect her was rooted not in their adult realities but in the childhood experiences that had programmed his coping style.

The result of Roy’s childhood relationship with his parents, he says, was that “in the past I’ve always seemed to put other people’s happiness before my own. My self-esteem was very low, so I thought socially that if I made others happy, then they would accept me. I’d try to satisfy them, doing what I thought they would want me to do.”

“How would you do that?”

“By not being honest with myself or others. Always going along with what they wanted to do, or not being honest with them if they said something that hurt. I would just let that go.

“A few years ago I had a business with two partners. As far as I was concerned, we were all equal, but it seemed like the way they were running the show, it was all them. They were in charge. My opinion didn’t matter. Things like that hurt, but I just suppressed it and kept it in and didn’t say anything. I didn’t know how to deal with it.”

The crucial difference, I believe, between Lance Armstrong and Roy on the one hand, and Francis on the other, is that the first two had had enough love in their lives to hold on to the part of themselves that allowed for the development of a fighting spirit. Unlike Francis, they also both received powerful caring and support from family and friends when they were diagnosed.

I strongly suspect that repression plays a role in the onset of testicular malignancy. It would be worthwhile for someone to undertake a study in which men with the disease were carefully interviewed about how they experienced their lives emotionally. One aspect deserving attention would be the patients’ level of closeness to and identification with their mothers. There is—I don’t believe coincidentally—an uncanny resemblance in looks between Lance’s mother, and his wife, Kik. In a photograph of the three of them in Armstrong’s riveting memoir, one can hardly tell the two women apart.

One of the lessons Roy spontaneously drew from his experience of cancer was to refuse to orient his behaviour any longer to pleasing others
without considering the cost to himself. “Whatever I do now, it is definitely not to please anyone else,” he says. “What is going to make me happy? Is this what I want to do? I’ve tried it the other way in the past, and it didn’t work out for me.”

Francis was admitted to palliative care, in the end. The cancer eventually spread to his liver, causing a painful distension of that organ. He died quite soon, sooner than we doctors had anticipated.

  I
T WAS LATE AUTUMN OF
1990 when Jimmy married Linda. The wedding took place in the chapel of Vancouver Hospital’s palliative care unit, five days before he died of the skin cancer that had invaded his spine. The bride was eight months pregnant. Except for his father, all Jimmy’s family had gathered to witness the ceremony and to be with him in his final weeks. A month and a day after I pronounced Jimmy’s death, I attended the birth of their daughter, Estelle, just as I had helped deliver Linda’s two older children from her first marriage.

Jimmy wasn’t much for doctors. Although he and Linda had been together five years, I had met him only that summer when he visited the office with persistent back pain. It turned out to be the sign of spinal metastases from a skin cancer that had been excised from his leg some years before. The original condition, malignant melanoma, is a life-endangering tumour of melanocytes, the pigmented cells in the skin. A deadly disease with a ready tendency to spread to other organs, melanoma often strikes people in the prime of life.

I did not get to know Jimmy very well, but from our first meeting he impressed me as extraordinarily likeable. He was thirty-one years old, polite and friendly, with sandy-coloured light brown hair, blue eyes, a complexion sprinkled with freckles and a broad, Irish, open-faced look about him.

The exposure of fair-skinned individuals to ultraviolet radiation is the major physical risk factor for malignant melanoma. People of Celtic origin appear to be especially vulnerable, particularly if, like Jimmy, they have light-coloured hair, freckles and blue or grey eyes. Dark-skinned ethnic groups are at little risk for skin cancer—in Hawaii, skin cancer is forty-five times less common among non-Caucasians than in Caucasians.
¹
Local dermatologists conduct a “sunscreen patrol” on the beaches of Vancouver in the summertime as a public service, warning sunbathers of the danger they are courting. It is unfortunate that repression is not as easily remediable a problem as inadequate sunscreen. Malignant melanoma has been the subject of some of the most persuasive research evidence linking repression and the development of cancer.

Jimmy’s condition deteriorated very quickly, and the chemotherapy and radiation made him feel worse. “I’ve had enough,” he finally said. “This is crazy. I’m dying, and I don’t need to be dying as sick as I am.” Soon after that, his legs became paralyzed, triggering his admission to palliative care. Death followed within a few weeks. Until I left my practice two years ago, Linda and her children remained my patients. When I called her recently, she agreed to be interviewed for this book, as did Donna, Jimmy’s older sister.

I asked Linda to describe her late husband’s personality. “Jimmy was easygoing, laid-back and relaxed. He loved to be around people. I had to think when you asked me about what kind of stresses there were in his life. He wasn’t a very stressed out kind of person. Now, he was a drinker. He had to drink pretty much every day. That’s why I wouldn’t marry him all those years, because of the drinking. He had beer every day—at least four or more.”

“Did it change him at all?”

“Only if he had a lot more than that…. Then he became this very big, lovable bear who wanted to tell everybody how much he loved them. When he drank, he just wanted to hug people. Guys, too, like they were his big brothers. He needed to say to a guy, ‘You’re my buddy,’ and then he would cry.

“He wasn’t a violent man, he wasn’t angry or frustrated. He was sad. He had a lot of sadness in him, and I don’t know why.

“There’s only one thing I can think of, some secret that he had about
his father that he didn’t want to tell me. He couldn’t talk about it. He did not talk about his emotions. He did not share anything, really.”

“What kind of a childhood had he had?”

“He grew up in Halifax. He always said he was a happy kid. His parents stayed together. Both his parents were alcoholics—the father, from what I understand, drank a lot for a long time. I think the mother started when Jimmy was a teenager.”

As I found out later from Jimmy’s sister, Donna, his senior by two years, their father had been a heavy drinker throughout their childhood. Donna and I had two conversations. “I felt very comfortable with my childhood,” she told me at first. “My younger siblings have a different perspective … but I believe we had a very good upbringing. Very happy household …

“Jimmy was a real little boy, a happy kid. We’d play all the time. We’d go out into the backyard and have water fights—you know, those little spray guns. I just see him as a kid with a real happy face.”

“How do you recall your parents?”

“My father was the nicest, friendliest man around. He was a very funny man. He was always joking around with us, play-fighting with us, tickling. He used to mimic, used to talk like Donald Duck. People would come over and say, ‘Get your father to talk like a duck.’

“He was a comical person, but you had to listen to him. We’d joke around with him, but when Dad spoke, the ground shook…. When he was annoyed or angry, when enough was enough—that was it. If he told us to do something, you did it.”

“Why?”

“Because if not, you’d be punished and yelled at.”

Donna married and moved to a different town when she was nineteen. Jimmy stayed with his parents until the age of twenty-two. On what was to have been a brief trip to Vancouver, ostensibly to see a friend, he called to tell his parents he would not be back. He did not return, except for a rare visit.

“He just called and said he wasn’t coming home. He left a letter in his top drawer, explaining it.”

“He escaped.”

“He did. And the reason why, I remember him saying to my parents, ‘Hey, I couldn’t tell you, because I didn’t want to hurt you…’”

“So Jimmy had the feeling that it would hurt his parents for him to be an independent person.”

“All of us were made to feel that way. For our mother, her children were her world. They were her everything. She tried to do the best she could, but she was very attached to us—even to my detriment but especially to Jimmy’s. In retrospect, I realize we were far too attached, to an unhealthy degree. I think at some point you have to let your children go. I think emotionally, she didn’t let go. I felt obligated, and many times Jimmy did, too. Normally your parents would try to understand and accept your separateness as you got older.”

“Jimmy’s escape to the West Coast physically doesn’t mean that he liberated himself internally.”

“Of course he didn’t, no. He felt terrible. He felt very, very bad. He did it, but he also had to live with the feelings.”

According to Donna, Jimmy found the burden of his parents’ emotional pain unbearable even at the end of his life. “Just before the Labour Day weekend, my brother phoned me. He told me what was going on with the melanoma, but he said, ‘You know, Donna, I can’t phone Mom and Dad, because emotionally I can’t handle it. Could you do it for me?’ I said sure, I’ll do it. So he said, ‘Just make sure that they don’t call me all upset and crying and everything, because I couldn’t take it.’”

I suggested to Donna that perhaps what she had recalled as Jimmy’s childhood “real happy face” might not have been a genuine face at all. At least in part, it could have been a coping mechanism Jimmy adopted in reaction to his parents’ anxieties and anger. It was a way of avoiding the painful impact of their emotions on himself. Soothing his parents’ feelings was accomplished by negating his own.