When the Body Says No: The Cost of Hidden Stress (40 page)

Spontaneous remission raises two important questions: why, in some people, are such resources not powerful enough to destroy cancerous cells in the first place, before the clinical development of melanoma; and what enables the immune system in some people to overcome this potentially deadly cancer even after it does arise? We have asked the same questions regarding the highly differing outcomes from one person to another of other diseases, despite the apparent similarities of the pathologies involved.

In a series of three studies, researchers in San Francisco looked at the Type C pattern of repressed negative emotion in melanoma patients. During an eighteen-month follow-up, they found a strong correlation between repression and the likelihood of relapse or death. Natural killer cells attack abnormal cells, thus providing a line of defence against cancer. NK cells have a demonstrated capacity to digest melanomas. As in breast cancer, they are less active in emotionally repressed individuals.

One of the studies examined the thickness of the original melanoma in relationship to personality. Thickness of the cancer at first biopsy is correlated with prognosis: the thicker the lesion, the less favourable the outlook. Higher scores on the Type C Melanoma Coping scale were found to be associated with thicker lesions: “Type C Melanoma Coping is characterized by patients’ acceptance of having melanoma, having more concern for family members than for themselves, trying not to think about it, coping by perseverance and trying to keep busy, keeping feelings inside, and being considered strong and capable at handling things.”
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These San Francisco findings confirmed the conclusions of an earlier 1979 study, that melanoma patients who had a harder time adjusting to the diagnosis—in other words, whose responses were less accepting and resigned—were also less likely to suffer relapse.
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Even rudimentary psychological support can make a difference suggests a pilot study conducted at the UCLA, School of Medicine, by the psychiatrist F. I. Fawzy. Thirty-four people with comparable stage 1 melanoma were enrolled in the experimental and control arms of the study, respectively. “Fawzy’s intervention was strikingly minimal. It consisted of only six structured group sessions over a 6-week period, with each session lasting 1½ hours. The group meetings offered (1) education
on melanoma and basic nutritional advice; (2) stress management techniques; (3) enhancement of coping skills; and (4) psychological support from the staff and from other group members” Six years later, ten of the original thirty-four patients of the group that had not received psychological support had died, and three others had had recurrences. In the support group, only three of the thirty-four had died, four had experienced recurrences.
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Earlier in the study, improved immune function had been demonstrated among the patients in the support group.
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It would stand to reason that people with melanoma and other cancers would enhance their ability to reverse the malignant process if they were helped to understand themselves and to become more self-accepting and assertive in their emotional coping styles. Harriette, a fifty-year-old writer, is convinced that her decision to fight the cancer her own way, including with intensive psychotherapy, is responsible for the remission of the malignant melanoma on her right shin.

“I didn’t trust doctors much. I did some research and found this alternative clinic in Tijuana. They treated melanoma as a whole-body condition, which was the first thing I liked. Surgery on the leg and nothing to follow up didn’t feel right to me. I went to Mexico, and they treated me with a whole series of things, including a vaccine, diet, tonic and some herbal pastes that they use to burn it off the leg. I went back every month, and then three months and six months, but I started realizing that there was something wrong with the way I was handling things. For starters, I didn’t have a GP in Canada. I resisted the authority of doctors, yet here I was accepting treatment from doctors in Mexico.

“I thought at least I should get a GP—and that is actually when I met you. You didn’t know me from Adam, but as soon as I mentioned melanoma, you said, ‘You know there is a psychological profile for melanoma patients, don’t you?’ Nobody had ever mentioned it to me before, but when you described it, I completely fitted the picture. You also told me that I should have the surgery and you could arrange it, but that surgery by itself might not help unless I also dealt with my inability to feel my own feelings and with all the other problems.

“So I did therapy for six months. It was very intense. After that, I had the surgery. The plastic surgeon was shocked to see me, because he told me that the biopsy he had originally taken showed that I’d had
invasive malignant melanoma, quite advanced, quite deep. He expected the worst. And yet, when he did the surgery, he found that it was just abnormal pigmented tissue but no longer melanoma.”

I wondered whether it was the treatment in Mexico or the therapy Harriette underwent that had made the difference. Although I was unfamiliar with the details of the Mexican regimen, it had likely included the BCG vaccine to stimulate the immune system—an approach that, in some cases, has been successfully used against melanoma. Harriette believes it was a combination of everything. “I do think that the treatment in Mexico was working, but the thing kept tingling, and I kept feeling there was something still there—a tingling and a darkening under the skin.”

“What did you find out in therapy?”

“I had to go back right to the beginning. My mother died when I was a toddler. I was the middle one of three sisters all under four, two of us in diapers. My younger sister was just eight months old and very colicky. None of us got much attention but what little there was my sister got. We were shuffled around from place to place, because my father was a travelling salesman. Within a year he married somebody who looked a lot like my mother. She was the Wicked Witch of the West. She had her own problems. She was awful to us. Finally, she sent us away to a French-Canadian convent.

“She didn’t like children—she was the eldest of fourteen children and had raised all her younger brothers and sisters. She couldn’t wait to get out of her home. She rose to be a secretary at the Canadian embassy in Costa Rica. She was a very bright woman, but at thirty-three she was becoming a spinster. My father apparently asked every available woman in the English-speaking community of Costa Rica to marry him within the year after my mom’s death, and they all said no. She said yes—she didn’t want children, she didn’t like children, but that was her pact with the devil. And my dad? He was at home fifty-two days the first year they were married. Here she was with three little girls who had all these communicable diseases, one after the other, quarantined. I certainly see her side of it.

“I remember copying out French poems and leaving them outside the bathroom door when she was in there having a shower. She never, ever responded to them. She never acknowledged them.”

“So you were trying very hard to bring her into a relationship with you.”

“Yes, and it never worked…. My sisters were terrified of her. She locked herself up in her bedroom and would leave us with the maids. I remember when we needed something—and this is a scene that happened over and over again—the three of us would sneak up to her bedroom door and practice trying to say “M …” Finally after standing there for twenty minutes or however long it was and not having the courage—not one of us—to say “Mommy,” we would sneak away again.

“The sense was that we couldn’t ask for anything. That’s what I learned. I learned not to need or want, not to ask because it wasn’t there, and when we did, we were ridiculed.

“One of my earliest memories is from around age three or four—sitting in a dress by myself playing with a doll. I was fine playing, but the sense was that there was no connection. There was nobody around; I was completely isolated. This was safe, but there wasn’t a sense of happiness, only that I had figured out how to protect myself.”

“By being alone.”

“By being alone and yes … without feeling contact.

“There are other fragments that come up. For a long time I’ve had this image of lying in what felt like clouds; I was on a bed of clouds with a grey and colourless sky above me and this one ray of sun hitting me, but it was cold. The sense of really being completely alone, that even this ray, which might be love, wasn’t. I saw that learning not to feel was what I had to do in order to survive.”

Such experiences—or the conclusions Harriette drew from them—left her isolated in life, or in relationships that, she felt, depleted her more than they nurtured her. Her intensive therapy was aimed at developing emotional competence. Emotional competence is the capacity that enables us to stand in a responsible, non-victimized, and non-self-harming relationship with our environment.
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It is the required internal ground for facing life’s inevitable stresses, for avoiding the creation of unnecessary ones and for furthering the healing process. Few of us reach adult age with anything close to full emotional competence. Recognizing our lack of it is not cause for self-judgment, only a call for further development and transformation.

Pursuing the seven A’s of healing will help us grow into emotional competence.

Acceptance is simply the willingness to recognize and accept how things are. It is the courage to permit negative thinking to inform our understanding, without allowing it to define our approach to the future. Acceptance does not demand becoming resigned to the continuation of whatever circumstances may trouble us, but it does require a refusal to deny exactly how things happen to be now. It challenges the deeply held belief that we are not worthy enough or “good” enough to be whole.

Acceptance also implies a compassionate relationship with oneself. It means discarding the double standard that, as we have seen, too often characterizes our relationship with the world.

As a physician, I have seen much human suffering. It may be futile, attempting to select one patient who has suffered in more ways than any of the others. Yet were I pushed to such a choice, I know immediately which patient that would be. Her story never made it into any of the chapters in this book; her illnesses would have put her in almost every chapter. I will call her Corinne. She’s in her early fifties and has had the following diagnoses: Type II diabetes, morbid obesity, irritable bowel syndrome, depression, coronary vascular disease with two heart attacks, high blood pressure, lupus, fibromyalgia, asthma and—most recently—cancer of the bowel. “I have enough medication,” Corinne says, “that I don’t have to have breakfast; I just have to take all the pills. There are thirteen pills at breakfast time alone.”

Corinne was my patient for twenty years. Much of what I learned, I learned from her, and from my other patients who, like Corinne, shared their stories with me. As a child, Corinne experienced every sort of boundary deprivation and violation one can imagine. As an adult, she has been a chronic caregiver not only to her husband, children, siblings and friends but to anyone brought into her home. Until recently, saying no has been impossible. It is still painful even now, despite her dire health status and despite the fact that she can only get around by means of a motorized scooter.

“I see myself as a big blob. There is no shape. I can see people’s auras. Mine looks black and grey, and there is no definition. It’s like you’re looking at someone in the fog, and you can sort of see part of an outline, but nothing whole.”

“If you saw somebody else who had difficulty establishing boundaries, would you dismiss them as a big blob?”

“No. I know several people who are overweight and I don’t classify them as big blobs. It’s more my own self-image of who I am as a person. I feel like Jell-O when it comes to emotional things.”

“So who’s talking to me now? Is this the big blob talking to me? Is there no sense of somebody real at home?”

“I guess maybe a little bit. I can’t say 100 per cent, no.”

“Let’s just look at that ‘little bit,’ then.”

“The little bit wants to be in control and not allow other people to decide and make decisions for her without her consent.”

“What more can you say about yourself? What are your values?”

“That I don’t sleep around, I don’t cheat and I don’t lie and I obey the law of the land and I try to be the best person that I can be to other people.”

“Is that only because you don’t know how to say no, or is it genuine caring?”

“It’s both. The majority is genuine caring.”

“So how can you say you’re just a big blob?”

“Because I’m Jell-O when it comes to saying no to my mother. Only a few days ago I couldn’t say to her, ‘No, it would be better for you to come in the summer, not now.’ I couldn’t say that to her. I wasn’t willing to make the decision.”

“If somebody else told you that they had difficulty making such a decision, what would you say?”

“I’d say that you have a lot of difficulty telling your mom what you want to tell her … and that you need to be stronger.”

“Without necessarily telling them what to do, what would you understand about them?”

“I would understand they’re scared that if they assert themselves, they’re going to be rejected.”

“If you cannot say that about yourself, it’s only because you are not paying the kind of compassionate attention to yourself that you would automatically grant somebody else. You cannot force yourself to say no if you don’t know how to.
But at least you can give compassionate attention to the individual who is having trouble saying no
.

“Let’s look at the bind you put yourself in,” I continued. “On one
hand, you don’t know how to say no; on the other hand, you condemn and judge yourself for not being able to say no. You end up calling yourself a big blob. With compassionate attention, you will see yourself as clearly as you see that other person—as someone who’s scared. And you will say that not as a judgment but as a compassionate observation—
that person is really scared. That person is really hurt
. She has—
I have
—a hard time saying no, because that brings up the immediate risk of rejection.