When the Body Says No: The Cost of Hidden Stress (41 page)

“You can’t force yourself to say no any more than you can force someone else to say no, but you can be compassionate toward yourself.”

“I would hold someone else’s hand to help them say no—but I wouldn’t hold my hand to help me say no.”

“And if they didn’t know how to say no, you’d still accept them. You’d say. ‘Look, I understand that it’s really hard for you—you’re not ready.’”

“But I don’t say that about myself—I get angry at myself.”

“The thing that would help you the most, I believe, is that quality of compassionate attention toward yourself. You can work on that.”

“Will it give me back the energy that I seem to be feeling is zapped from me?”

“So much of your energy goes into looking after others, and so much of what remains goes into self-judgments. Being this harsh on yourself takes up a lot of energy.

“The objective fact is that you’re facing many serious medical problems. You are at risk—there’s no question about it. I don’t know how things will go. But with all that you have to deal with, the more compassionate you can be toward yourself, the more able you are to give yourself the best possible chance.”

Compassionate curiosity
about the self does not mean liking everything we find out about ourselves, only that we look at ourselves with the same non-judgmental acceptance we would wish to accord anyone else who suffered and who needed help.

All those seeking to heal—or to remain healthy—need to reclaim the lost capacity for emotional truth-recognition, which is wonderfully illustrated by the neurologist Oliver Sacks in his book
The Man Who
Mistook His Wife for a Hat
. Sacks relates an anecdote about a group of aphasic patients responding to a televised address by then-president Ronald Reagan.

Aphasia—from the Greek
a
(for “not”) and
pha
(“to speak”)—is the loss of the ability to speak or to understand spoken language. It is the result of focal brain damage, as from a stroke. “There he was, the old Charmer, the Actor, with his practised rhetoric, his histrionisms, his emotional appeal—and all the patients were convulsed with laughter. Well, not all: some looked bewildered, some looked outraged, one or two looked apprehensive, but most looked amused. The President was, as always, moving—but he was moving them, apparently, mainly to laughter. What could they be thinking? Were they failing to understand him? Or did they, perhaps, understand him all too well?”
⁶

Sacks’s aphasic patients were reacting to Reagan’s unconscious expressions of Emotion II—tone, body language, facial mannerisms. They found his emotions incongruent with his spoken message: in other words, they saw through his dissembling, conscious or unconscious. They read the emotional reality, not the word-reality Reagan was able to conjure up in his own mind and that he was so adept at conveying to those who, like him, were themselves emotionally shut down.
“Either he is brain-damaged or he has something to conceal,”
one of Sacks’s patients said. Recall the words of Reagan’s biographer:
He feels the opposite of what he says
.

Animals and young humans are highly competent at picking up on real emotional cues. If we lose that capacity as we acquire language, it is only because we receive confusing messages from our immediate world. The words we hear tell us one thing, the emotional data say something different. If the two are in conflict, one will be repressed. In the same way, when a child’s eyes diverge, the brain will suppress images from one eye in order to avoid double vision. The suppressed eye, unless corrected, will become blind. We repress our emotional intelligence in order to avoid an ongoing war with the crucial people in our lives, a war we cannot possibly win. And so we lose our emotional competence even as we gain verbal intelligence. Aphasiacs, it would appear, go through the reverse process. Much as a blind person will develop an extraordinary capacity to hear, the aphasiac develops an enhanced ability to perceive emotional reality.

“People are usually no better than chance at detecting lies from a liar’s demeanour, even when clues to the deceit are evident from facial expression and tone of voice,” a group of psychiatric researchers reported in
Nature
magazine in May 2000. “People who can’t understand words are better at picking up lies about emotions.”

Full awareness would mean that we would regain our lost capacity to perceive emotional reality and that we are ready to let go of the paralyzing belief that we are not strong enough to face the truth about our lives. There is no magic to it. The blind person learns to pay more attention to sound than the sighted. The aphasiac learns to notice his internal reactions to words, since the cognitive parts of the brain can no longer tell him what the message is. Those internal reactions, gut feelings, are what we lost as we “grew up.”

Clearly, we do not need to lose language skills in order relearn emotional perception. To develop awareness, though, we do have to practise, pay constant attention to our internal states and learn to
trust
these internal perceptions more than what words—our own or anyone else’s—convey. What is the tone of voice? The pitch? Do the eyes narrow or open? Is the smile relaxed or tight? How do we feel?
Where do we feel it?

Awareness also means learning what the signs of stress are in our own bodies, how our bodies telegraph us when our minds have missed the cues. In both human and animal studies, it has been observed that the physiological stress response is a more accurate gauge of the organism’s real experience than either conscious awareness or observed behaviour. “The pituitary is a much better judge of stress than the intellect,” Hans Selye wrote. “Yet, you can learn to recognize the danger signals fairly well if you know what to look for.”

In
The Stress of Life
, Selye made a compilation of physiological danger signals. He listed physical signs such as pounding of the heart, fatigue, sweating, frequent urination, headaches, backaches, diarrhea or dryness of the mouth; emotional signs such as emotional tension or overalertness, anxiety, loss of joie de vivre; and behavioural expressions such as unusual impulsivity or irritability and a tendency to overreact. We can learn to read symptoms not only as problems to be overcome but as messages to be heeded.

“I never get angry,” a Woody Allen character says in one of his movies, “I grow a tumour instead.” Throughout this book we have seen the truth of that droll remark in numerous studies of cancer patients. We have also seen that the repression of anger is a major risk factor for disease because it increases physiological stress on the organism.

Not only does the repression of anger predispose to disease but the experience of anger has been shown to promote healing or, at least, to prolong survival. People with cancer who have been able to muster anger at their physicians, for example, have lived longer than their more placid counterparts. In animal experiments the expression of anger has been found to be less physiologically stressful than the suppression of it. In rats who fight others when caged together, slower growth of tumours has been found than in more docile animals.

Studies apart, we have seen that every one of the interviewees in the previous chapters acknowledged difficulties around the communication of anger, no matter what their disease or condition. “The way my stepmother raised me, I think I’m not supposed to be angry,” said Shizuko, with rheumatoid arthritis. “I was short-circuiting my visceral expression of anger,” said Magda, with severe abdominal pain.

Here the issue of anger becomes confusing and raises many questions. How can we encourage people to be angry when we see that children suffer from their parents’ outbursts? In many of the patient histories we have seen a similar pattern: a raging parent, a repressed child. Should Magda’s father have suppressed his anger? “I kept thinking of all the times my father raised his voice,” said Donna, whose brother Jimmy died of malignant melanoma. “I remembered his voice and the screaming and the yelling, and I thought, This is not how you should live. This is not what we should have experienced.”

On the surface, it seems like a paradox. If the expression of anger is “good,” Magda’s father and the father of Jimmy and Donna were only acting in a healthy fashion. Yet the effect of their anger was corrosive to their children’s self-concept and health. Suppressing anger may have negative consequences, but should we encourage its expression if it harms others?

The mystery only deepens. Not only is the unbridled outpouring of anger harmful to the recipients or bystanders but it can also be deadly to
the one who rages. Heart attacks can follow upon outbursts of rage. In general, high blood pressure and heart disease are more likely to happen in persons who harbour hostility. A study of nearly two hundred men and women conducted at the Johns Hopkins School of Medicine, Baltimore, in 2000 found that hostility and a drive for dominance were “significant independent risk factors for coronary heart disease.”
⁷
A great volume of research has connected hostility with high blood pressure and coronary disease.

As we can readily deduce by now, the relationship between rage and cardiovascular disease is also a function of the psycho-neuro-immune apparatus. The sympathetic nerves are activated in rage states. Narrowing of the blood vessels occurs with excessive sympathetic flight-or-fight activity, increasing the blood pressure and decreasing oxygen supply to the heart. The hormones secreted during the stress response in rage states raise lipid levels, including serum cholesterol. They also activate clotting mechanisms, further heightening the risk of blockages in the arteries.

“It was blind rage, I was sure, that had gotten me into this fix with my heart, as well as genetics,” wrote the journalist Lance Morrow in his memoir of heart disease. The blind rage that later triggered Morrow’s heart attacks was the volcanic eruption of the anger a child learned to repress in his family of origin.

How then to resolve the dilemma of anger? If the expression of anger is harmful and so is its repression, how do we hope to attain health and healing?

The repression of anger and the unregulated acting-out of it are both examples of the
abnormal release of emotions
that is at the root of disease. If in repression the problem is a lack of release, acting out consists of an equally abnormal suppression of release alternating with unregulated and exaggerated venting. I had a fascinating conversation on these two seemingly opposite ways of coping with Allen Kalpin, a physician and psychotherapist in Toronto. He points out that both repression and rage represent
a fear of the genuine experience of anger
.

I found Kalpin’s description of genuine anger surprising, even as it rang completely true to me. His explanation made me realize the confusion in our commonly received ideas about this emotion. Healthy anger, he says, is an empowerment and a relaxation. The real experience
of anger “is physiologic experience without acting out. The experience is one of a surge of power going through the system, along with a mobilization to attack.
There is, simultaneously, a complete disappearance of all anxiety
.

“When healthy anger is starting to be experienced, you don’t see anything dramatic. What you do see is a decrease of all muscle tension. The mouth is opening wider, because the jaws are more relaxed, the voice is lower in pitch because the vocal cords are more relaxed. The shoulders drop, and you see all signs of muscle tension disappearing.”

Dr. Kalpin’s mode of therapy works along the lines first developed by Dr. Habib Davanloo of McGill University, Montreal. Davanloo made a practice of videotaping his clients during therapy encounters so that they themselves could see their bodily manifestations of emotion. Kalpin, too, tapes some of his psychotherapy sessions.

“In a tape of one of my clients, he describes powerful surges of electricity going through his body—and he talks about them as they’re happening—but outwardly he’s just sitting there describing it. If you’re watching the tape without the sound on, you’ll see a person looking quite focused and quite relaxed, but you wouldn’t necessarily even guess that the person was angry.”

If anger is relaxation, what then is rage? When I am in a rage, my face is tight, my muscles are tense and I am sure I look anything but relaxed. Here Dr. Kalpin makes a crucial distinction. “The question is, What do people really experience when they experience rage? It’s fascinating to ask people. If you really ask, the majority of people will describe anxiety. If you ask in physical, physiologic terms what they are experiencing in their body when they feel rage, for the most part, people will describe anxiety in one form or another.”

“It’s true,” I said, “tightening of the voice, shallow breathing, muscle tension are signs of anxiety, not of anger.”

“Exactly. Their anger is not physiologically experienced, it is only being acted out.”

Acting out through bursts of rage is a defence against the anxiety that invariably accompanies anger in a child. Anger triggers anxiety because it coexists with positive feelings, with love and the desire for contact. But since anger leads to an attacking energy, it threatens attachment. Thus there is something basically anxiety-provoking about the
anger
experience
, even without external, parental injunctions against
anger expression
. “Aggressive impulses are suppressed because of guilt, and the guilt exists only because of the simultaneous existence of love, of positive feelings,” says Allen Kalpin. “So, the anger doesn’t exist in a vacuum by itself. It is incredibly anxiety-provoking and guilt-producing for a person to experience aggressive feelings toward a loved one.”

Naturally, the more parents discourage or forbid the experience of anger, the more anxiety-producing that experience will be for the child. In all cases where anger is completely repressed or where chronic repression alternates with explosive eruptions of rage, the early childhood history was one in which the parents were unable to accept the child’s natural anger.