When the Body Says No: The Cost of Hidden Stress (27 page)

The non-complaining stoicism exhibited by rheumatoid patients is a coping style acquired early in life. Celia’s anxieties have always been focused on others. Although she herself was abused as a child, her concern was to protect her mother from a series of abusive partners. She was afraid the family would not have enough money or that the outside world would find out about the family violence.

“Mostly I was very worried about my brother becoming a juvenile delinquent or horrible things happening to him.”

“What about you?”

“I always felt I somehow could manage it and get through it. I don’t want to accept how really upsetting things are. I rationalize it to a point where I can accept it and deal with it. I minimize.”

An intensive medical-psychiatric study of people with rheumatoid arthritis conducted for the Maryland Chapter of the Arthritis and Rheumatism Foundation in 1969 concluded that “despite the diversity in the group, the patients’ psychological characteristics, vulnerabilities and life conflicts were remarkably similar.”
²
One common characteristic was a pseudo-independence, described by the authors as a
compensating hyperindependence
. Celia’s rigid belief that she could get through everything by herself was a coping mechanism, a compensation for emotional needs ignored in childhood. A child in her situation survives by pretending to herself, and to the world, that she has no needs she cannot take care of herself. One aspect of that pretence is to reduce the perception of emotional stresses to a child-friendly size, a habit that may then last for a lifetime.

Compensating hyperindependence originating in early role reversal between parent and child also explains Celia’s teeth-gritting endurance
of physical pain, to the point that a friend had to drag her to the emergency ward with “Do you give up yet?”

In 1969 the British psychiatric researcher John Bowlby published
Attachment
, the first volume of his classic trilogy exploring the influence of parent-child relationships on personality development. “The reversal of roles between child, or adolescent, and parent, unless very temporary, is almost always not only a sign of pathology in the parent,” he wrote,
“but a cause of it in the child.”
³
Role reversal with a parent skews the child’s relationship with the whole world. It is a potent source of later psychological and physical illness because it predisposes to stress.

Other traits identified in the psychological investigations of people with rheumatoid disease include perfectionism, a fear of one’s own angry impulses, denial of hostility and strong feelings of inadequacy. As we have seen, similar traits are said to be associated with the “cancer personality” or with personalities at risk for MS, ALS, or any other chronic condition. None of these traits represent innate features of a person, nor are they irremediably fixed in the individual.

“In the developmental history of these patients a striking finding was the early
effective
loss of one or both parents,” according to the Maryland study. The reader will have noticed how often in the personal histories related in this book there was early separation of the parents, abandonment or even the death of a mother or father. Even more universal is
emotional deprivation
, another commonly repeated theme in the research literature. A 1967 Australian study of people with systemic lupus erythematosus reported that: “More patients than controls reported emotional deprivation in childhood associated with a disturbed parent-child relationship within ‘unbroken’ families.”
⁴

Like compensatory hyperindependence, the repression of anger is a form of
dissociation
, a psychological process originating in childhood. The young human being unconsciously banishes from awareness feelings or information that, if consciously experienced, would create unsolvable problems. Bowlby calls this phenomenon “defensive exclusion.” “The information likely to be defensively excluded is of a kind that, when accepted for processing in the past, has led the person concerned to suffer more or less severely.”
⁵

In other words, the angry child got into trouble and experienced rejection. The anger and the rejection had to be deflected inside, against
the self, in order to preserve the attachment relationship with the parent. That, in turn, leads to the “strong feelings of inadequacy and a poor self-concept” researchers have recognized in people with rheumatoid disease. “Not infrequently anger is redirected away from an attachment figure who aroused it and aimed instead at the self,” Bowlby explains. “Inappropriate self-criticism results.”
⁶

In autoimmune disease, the body’s defences turn against the self. In the life of a society—the body politic—such behaviour would be denounced as treason. Within the individual organism, physical mutiny results from an immunologic confusion that perfectly mirrors the unconscious psychological confusion of self and non-self. In this disarray of boundaries, the immune cells attack the body as if the latter were a foreign substance, just as the psychic self is attacked by inward-directed reproaches and anger.

The cross-confusion reflects disruptions of the interconnected body/mind mechanisms within the emotional-nervous-immune-hormonal super-system, which we have called the PNI system.

Emotions precisely parallel and complement the other components of the PNI network: like the immune and nervous systems, emotions safeguard the organism from external threat; like the nervous system and the hormones, they assure the satisfaction of indispensable appetites and needs; and, like all these systems together, they help maintain and repair the internal milieu.

Emotions—fear, anger, love—are as necessary for the organism’s survival as nerve impulses, immune cells or hormonal activity. Early on in the process of evolution, primitive responses of attraction or repulsion became essential to the life and reproduction of living creatures. Emotions, and the physical cells and tissues that make them possible, evolved as part and parcel of the apparatus of survival. It is no wonder, then, that the basic molecules that connect all the body systems of homeostasis and defence also participate in emotional reactions. Messenger substances, including endorphins, may be found in the most primitive of creatures who lack even a rudimentary nervous system. It is not that the organs of emotion
interact
with the PNI system—they form an essential part of this system.

In
chapter 7
we noted that cytokines, messenger molecules produced by immune cells, can bind to receptors on brain cells to cause changes
in body states, mood and behaviour. That emotions induce changes in immune activity is only the other side of the same coin. To illustrate the parallel and complementary protective duties of the emotional system and the immune apparatus, we can compare the role of immune cells with that of an emotion such as, say, anger.

Why do we have anger? In the animal world, anger is not a “negative emotion.” An animal experiences anger when some essential need is either threatened or frustrated. Although animals lack conscious knowledge of emotional phenomena, they do feel emotion and experience the physiological changes of Emotion I. And, of course, they manifest the behavioural displays classified as Emotion II. The specific purpose of Emotion I biological changes is to prepare the creature for fight or flight responses. But since flight or fight both demand great expenditures of energy and impose risks of injury or death, the Emotion II displays serve a crucial intermediary function: they often settle the conflict without any of the participants having to get hurt.

A cornered animal turns to face his pursuer with a fierce display of rage. Anger may save his life, either by intimidating the hunter or by enabling the prey to resist successfully. Or anger is aroused in an animal when a stranger of the same species, from outside the family or pack or troop, intrudes on his territory. If the two creatures immediately engaged in physical battle over the disputed territory, one or both would likely become injured. Nature provides a resolution by prompting both of them to mount anger displays: teeth bared, menacing bodily motions, threatening sounds. The more convincing display often wins the day, avoiding harm to either contestant.

For anger to be deployed appropriately, the organism has to distinguish between threat and non-threat. The fundamental differentiation to be made is between self and non-self. If I don’t know where my own boundaries begin and end, I cannot know when something potentially dangerous is intruding on them. The necessary distinctions between what is familiar or foreign, and what is benign or potentially harmful, require an accurate appraisal of self and non-self. Anger represents both a
recognition
of the foreign and dangerous and a
response
to it.

The first essential task of the immune system, too, is distinguishing self from non-self. Thus immunity also begins with
recognition
. Recognition
is a sensory function, performed in the nervous system by the sensory organs. We may rightly say that the immune system is also a sensory organ. Any failure of the immune system in its responsibility of recognition would expose us to as much danger as we would face if our capacities to see, hear, feel or taste were impaired. Another function of the nervous system is memory. The immune system must also have memory: it needs to recall what in the external world is benign and nourishing, what is neutral and what is potentially toxic.

Under the watchful eyes of the parent, the infant and toddler explore the environment, learning what is edible and what is not, what is comfortable or a source of pain, what is hazardous or safe. The acquired information is stored in the developing brain’s memory banks. Immunity is also a matter of learning. Memory is stored by the immune system in cells programmed to recall instantaneously any threat previously encountered. And just as the nervous system must retain its potential for learning throughout the lifetime, so the immune system has the capacity to develop new “memories” by forming clones of immune cells trained specifically to recognize any new threat.

With immune cells found in the bloodstream and in all tissues and spaces of the body, we may think of the immune system as a “floating brain” equipped to detect the non-self. The sensory apparatus—the eyes and ears and taste buds—serving this “floating brain” are receptors on the surfaces of immune cells, configured to know benign from noxious. The self is identified by means of so-called
self-antigens
on the membranes of the body’s normal cells, molecules that the immune receptors infallibly recognize. Self-antigens are proteins found on every cell type. Foreign organisms and substances lack such self-markers, making them targets for attack by the immune system. The diversity of self-antigens is just beginning to be discovered. “Chances are that a lot more self-markers will pop up in the future,” according to an article in the journal
Science.
⁷

The lymphocytes whose job it is to “remember” foreign antigens are the T-cells that reach maturity in the thymus gland. There are up to a million million of them in human beings. They and their fellow immune corpuscles “must learn to tolerate every tissue, every cell, every protein in the body. They must be able to distinguish the hemoglobin found in blood from the insulin secreted by the pancreas from the vitreous humor contained in the eye from everything else. They must
manage to repel innumerable different kinds of invading organisms and yet not attack the body.”
⁸

It is beyond the scope of this book to discuss the mechanisms by which the various immune cells recognize hostile micro-organisms or other noxious substances and how squadrons of immune cells become programmed to eliminate such invaders. Much has yet to be discovered, and what is already understood involves an extraordinarily complicated sequence of biochemical events, interactions and effects. The point to grasp here is the shared functions of immunity and emotion: first, the “awareness” of self accompanied by an awareness of non-self; second, the appreciation of nourishing inputs and the recognition of threats; finally, the acceptance of life-enhancing influences paralleled by a capacity to limit or eliminate danger.

When our psychological capacity to distinguish the self from non-self is disabled, the impairment is bound to extend to our physiology as well. Repressed anger will lead to disordered immunity. The inability to process and express feelings effectively, and the tendency to serve the needs of others before even considering one’s own, are common patterns in people who develop chronic illness. These coping styles represent a blurring of boundaries, a confusion of self and non-self on the psychological level. The same confusion will follow on the level of cells, tissues and body organs. The immune system becomes too confused to know self from other or too disabled to defend against danger.

Ordinarily, immune cells that react against a self-product are immediately killed or inactivated. If immune cells that turn against the self are not destroyed or made harmless, they will attack the body tissues they were meant to guard. Allergic reactions or autoimmune diseases may result. Alternatively, if healthy immune cells are destroyed by radiation, drugs or, say, the HIV virus, the body is left without protection against infections or against the unchecked growth of tumours. Disabling the immune system through chronic emotional stress may have the same effect.

The relationship between self-suppression and immune mutiny was illustrated in a 1965 study of the
healthy
relatives of women suffering from rheumatoid arthritis. Antibodies are normally produced only in response to invasion by microbes or potentially harmful foreign molecules. One of the laboratory hallmarks of rheumatoid arthritis is the finding of an antibody directed against the self by the confused immune
system. It is called rheumatoid factor, or RF. Found in over 70 per cent of patients with rheumatoid arthritis, RF may also be present in people without the condition. The purpose of this particular research was to find out whether certain personality characteristics were associated with the presence of the antibody, even in the absence of disease.