When the Body Says No: The Cost of Hidden Stress

The incidence of Alzheimer’s disease, whereby nerve fibers in the hippocampus are replaced with fibrils and plaques, causing memory and language loss and mood changes, is increasing alongside the aging population. Maté suggests that emotional repression and, therefore, lifelong stress, predisposes individuals to Alzheimer’s. He cites a study of rats, whereby rats that received gentle handling in their infancy suffered no loss of hippocampal cells in advanced age compared to those that were not handled. Poverty of language in youth was also connected to hippocampal decline, as was ascertained through a longitudinal study of a group of nuns.

Maté looks at the case study of author Jonathon Swift, who was abandoned by his mother but suppressed his feelings of rage and hurt. His relationships with women later, as well as his misogynistic writing, suggests sexual and emotional repression. He developed Alzheimer’s, as he eerily predicted he would earlier in his life: “I shall die first at the top” (161). Maté believes that the stress of his childhood abandonment, as well as not having a trusted adult, caused repression and thereby chronic stress, resulting in the development of Alzheimer’s.

Autopsies of healthy, deceased individuals reveal that tell-tale tangles and plaques of the brain have been found in the brains of adults who did not develop Alzheimer’s. Increasingly, the disease is being classified as an autoimmune disease, whereby the body attacks the self. Arthritis drugs have been successful in slowing Alzheimer’s-related brain inflammation. Imbalances in the body’s stress-regulation system, such as excessive production of cortisol, have been found in Alzheimer’s patients, suggesting that the disease is “probably triggered by chronic stress acting on an aging immune system” (163).

Ronald Reagan, the 40th American president, shut down his own connection to his emotions due to an unloving family of origin; the relationship was typified by emotional poverty and coldness. In adult life, he was known for exhibiting a kind of “self-induced paralysis” (164). An actress observed that, in his comment to her that he wished as a child that he had someone to love, that the opposite could be understood: He wished that someone had loved him. Maté suggests that his long life of repression culminated in an Alzheimer’s diagnosis.

Chronic and prolonged periods of stress have often been noted to preempt rheumatoid arthritis, although this long-acknowledged finding is absent in recent medical texts and diagnosis conversations. Also common in individuals with rheumatoid arthritis is a stoic tolerance of pain and hyper-independence. Maté suggests that this is a coping mechanism developed in childhood to avoid the emotionally painful acknowledgement that their needs cannot be reliably attended to by a parent. In particular, the reversal of roles between parent and child (a parent relying on their child to care for them in some way) predisposes that individual to later psychological stress and therefore physical illness.

Maté identifies parallels between the way that anger is turned inwards in a psychological sense in children with a disturbed parent-child relationship, and the way that autoimmune disorders, like rheumatoid arthritis, involve the body’s defenses attacking the self.

Maté suggests that anger plays an important role in keeping the body safe; the individual must decide whether to display anger as part of a fight-or-flight response. The inability to distinguish self from non-self in anger expression likely has an immune consequence. In a study, higher levels of antibodies directed at the self (rather than to a foreign threat) were found in individuals who rated highly on scales of compliance.

Rachel, a woman who had an antagonistic relationship with her brother, whom her parents favored, had a rheumatoid arthritis flare-up as she prepared a Rosh Hashanah feast at her parents’ house that she would not be attending so as not to antagonize her brother.

Gila, the subject of another case study, was always criticized by her parents. As an adult, she ran around after her children and husband as well as working a night shift job. She felt that she needed to maintain an immaculate house and garden and only slept a handful of hours each night. Her habits and behaviors typify the self-flagellation that seems to create conditions for autoimmune disorders.

The pro-inflammatory molecules that cause the swelling of rheumatoid arthritis are thought to come from hyperactive immune cells. This hyperactivity is initiated by the PNI system: in particular, the release of cortisol. In rheumatoid arthritis, there are actually lower than normal cortisol responses to legitimate stress, suggesting the overreaction of this system on a regular, inappropriate basis that, in turn, weakens it. Synthetic analogues of cortisol are effective in treating autoimmune conditions. This illustrates the way that required anti-inflammatory responses are weakened and ineffective by chronic activation of stress responses.

Maté points out that joint tenderness through arthritis flare-ups result in the individual reducing their participation in stressful activities; it may therefore serve a protective function.

This is analogous to the case study of overworked labor movement employee Robert, whose stress culminated in ankylosing spondylitis. The freezing of his ribs from the disease forces him to use his diaphragm to breathe, helping him to maintain calm and to not lose his temper. Maté suggests that this is an instance of the body “saying no” and forcing the individual to engage in more sustainable ways of being.

Children who were nurtured as children, and who were then offered increased opportunities for independence, should develop independent self-regulation. Maté notes that the parents of children with asthma tended to be more critical than controls, and the asthmatic children tended to have less secure relationships with their parents. He also cites a study whereby children with eczema or asthma have a diminished production of cortisol in response to stress, and another where children with asthma showed an abnormal respiratory response to their mother’s voice (more labored breathing).

Joyce, who has asthma, always has a flare-up when she takes on more tasks than she can handle. She struggles with saying no. She remembers growing up in an angry household. She attempted to please her family in order to keep the peace but feels a low level of anger at all times.

Childhood attachment continues to shape stress levels, as people who have poor differentiation cannot maintain autonomous emotional functioning without absorbing anxiety from others. The less differentiation a person achieves, the more prone they are to experience emotional stress and physical illness. In a study of the Epstein-Barr virus, military cadets were more susceptible to contracting the virus if they were ambitious and if they had fathers who were high achievers.

In married women, low marital quality was correlated with lower immunity. In women who had broken up with spouses, less emotional dependence on the past relationship was correlated with health improvements: “Greater differentiation means better health” (195). On the other hand, perceived isolation is correlated with the onset of cancer in numerous studies. Women tend to absorb their husbands’ stress and anxiety while having to contain their own; anxiety in one spouse may emerge in a physical malady in the other.

Self-regulated individuals can participate best in society and are most capable of rearing children who will grow into self-regulated adults. Children who don’t develop self-regulation in infancy will struggle to maintain homeostasis in adulthood; they will depend on relationships.

Rachel, mentioned in Chapter 14, explains that, as a premature baby, she wasn’t handled by parents in her first month of life. Rachel feels innately unlovable. Anger is the emotion she finds the hardest to recognize; her pet rabbit—which resists her touch or her attempts to pick it up when it senses Rachel is angry—helps her to recognize when she is feeling unacknowledged anger.

The biology of adult illnesses is rooted in childhood, as is suggested in the self-reported histories of deprived childhoods in adults with serious illnesses. Neglected children have HPA axis impairment, as tested through lower cortisol on saliva tests. Parental love is a biological condition essential for healthy physiological and psychological development. This allows the PNI system and HPA axis to develop properly. Emotions are the filter through which people interpret their basic needs. “Reading” and incorporating the emotional messages of parents is part of this process. Hormones related to mood stability, serotonin, norepinephrine, and dopamine are stimulated by the child’s relationship with their caregivers. Hostility creates anxious hypervigilance in children. Studies on animals suggest that early attachment disturbances create unbalanced stress-response capacities in adults.

Attunement, the level to which a parent is “tuned in” to their child’s needs, can be absent even in very loving homes. These children, even as adults, may be trained to present only their “acceptable” side to their parents. They feel chronically alone with their emotions. Many adults continue this pattern in their adult relationships, seeking out romantic relationships where their needs are not truly seen or understood.