When the Body Says No: The Cost of Hidden Stress

Maté problematizes the assertion that smoking causes cancer, using the analogy of the false statement that swimming in deep water causes drowning; a combination of factors is necessary for both drowning and lung cancer. As in the case of breast cancer studies, research suggests that “patients with lung cancer were frequently characterized by a tendency to ‘bottle up’ emotions” (85). This observation is mirrored in a study of people from Crvenka, Serbia; “anti-emotionality” was correlated with cancer death, as well as heart disease, stroke, and other causes of death.

Maté continues to make the point that psychological processes are not removed from biological processes, as biochemical changes are triggered by emotions. The brain, nervous system, immune organs and immune cells, and the endocrine glands are linked through numerous pathways. The secretion of chemicals by immune cells that cause “sickness behavior” (fever, fatigue, need for sleep) illustrates the direct effect that the immune system has on the brain, and thereby the body.

Messenger molecules deliver constant messages to hundreds of thousands of receptors present on every cell; Maté likens this molecular communication system to a “giant switchboard.” This “switchboard,” the psychoneuroimmunology (PNI) response system, is triggered by the hypothalamic-pituitary-adrenal (HPA) axis in response to perceived threat. Triggered by this is the release of cortisol from the adrenal gland into circulation, as well as adrenaline from the medulla, which stimulates the cardiovascular and nervous systems. The HPA is especially sensitive to psychological factors such as loss of control, uncertainty, lack of information, and conflict. HPA behavior is only suppressed when the perceived danger is removed.

Maté identifies unsatiated emotional needs (namely, a lack of love) as a trigger of the HPA axis. Individuals experiencing this may experience constant activation of the HPA system. Maté further suggests that the constant occurrence of this reaction, which suppresses the immune response, might explain why some smokers contract lung cancer, while others do not: because chronic stress creates “an unnatural biochemical milieu in the body” (92). Stress and repression of emotion inhibits DNA repair and regulated cell death; the inhibition of these processes increases an individual’s cancer risk.

Cancerous tumor growth, particularly ovarian cancer and testicular cancer, is often affected by hormones. The release of hormones from the HPA axis is directly affected by stress, as is illustrated by suppressed reproductive function in stressed monkeys. Inexplicable abnormal menstruation (triggered by hormones or lack thereof) in women was strongly correlated with “persons vulnerable to depression, such as perfectionist standards and concern about the judgment of others” (94). Therefore, emotional stress seems to inform HPA systems in women, which can lead to irregular menstruation.

Similarly, lymphoma and leukemia are more likely to occur in individuals experiencing “anxiety, sadness, anger or hopelessness” (96). On the other hand, a relief from stress is sometimes associated with remission, such as in the case of Bela Bertok, an exiled Hungarian composer struggling without work, whose leukemia went into temporary remission when he was called on to compose a new piece for the Boston Symphony Orchestra. Therefore, stress may inhibit the body’s ability to launch an effective attack against cancer cells or to prevent metastasis (spread) of cancerous cells, as the intricate biochemical process which either promotes or suppresses malignant cell growth or suppression is profoundly influenced by the PNI system. Helplessness-prone personalities were highly predictive of ovarian cancer; researchers could predict with 75% accuracy who would have cancer based simply on a personality questionnaire.

Gilda Radner, an actor and comedian, epitomizes Maté’s portrait of a personality prone to cancer. She was rejected by her mother and lost her father at a young age, suppressed her needs throughout her life in favor of trying to impress a series of men, and felt no true sense of identity. After Radner developed ovarian cancer, she continued focusing on pleasing others, even during her treatment, attempting to be a “model” patient. Only shortly before her death did she realize that she needed to prioritize her own needs and take care of herself.

Ed, a case study of Maté’s, was diagnosed with prostate cancer. Ed likens the processes of surgery, radiation, and chemotherapy to “slash,” “burn,” and “poison,” respectively. Instead, he turned to hypnotherapy, naturopathy, and talk therapy. Ed conforms to the lifestyle and history that Maté identifies in previous chapters; he was beaten as a child for transgressions and therefore felt pressured to be a “perfect child.” As an adult, Ed struggles with maintaining boundaries, preferring to say yes to people’s requests even when he feels tired or reluctant, rather than conserving his time and energy. He has depended on substances throughout his life.

Maté points out that, concerningly, a treatment approach continues to be lauded by the medical profession in response to prostate cancer, despite the fact that death rates from prostate cancer seem unaffected by the rates of diagnosis and treatment. Maté continues to stress the importance of the potential links between stress, emotions, and prostate cancer. Cancerous prostate cells are in fact far from unusual; most do not progress to the formation of a tumor. Maté points to the role of stress in modifying hormonal release; tumor cells seem increasingly sensitive to testosterone, which increases tumor growth (although men with prostate cancer don’t seem to have unusually high levels of testosterone).

Maté notes that Japanese men who migrated to the US were far more likely to develop prostate cancer than those who stayed in Japan, suggesting a causal link between stress and the development of inactive malignant cells into tumors (both groups had similar levels of inactive malignant cells prior to one group immigrating). Furthermore, the higher incidence of prostate cancer in Black American men as opposed to white American men seems to suggest a stress origin of tumor development, given the systemic racism and historical and present disparities this group faces.

Lance Armstrong and Roy, a long term patient of Maté’s, developed testicular cancer. Both men had unloving father figures in their lives, who frequently and unpredictably administered harsh physical and psychological discipline on the boys. Both recovered from their cancer. On the other hand, Francis, a devout Christian man who believed that he should endure his diagnosis without any intervention because God had wished it on him, died of his cancer.

An adult patient of Maté’s, Jimmy, was extremely, problematically “nice” but had “a lot of sadness in him” (120). Jimmy’s mother was extremely attached to him; he felt a responsibility to manage her emotions and had trouble telling her about his cancer diagnosis. Meanwhile, Jimmy’s father was emotionally explosive. Jimmy’s sibling was shocked that his father was critical and rude even as Jimmy was dying.

Maté explores the relevance of these parental figures in creating Jimmy’s stress and sadness as an adult. He cites a study using three groups: a control group, patients with melanoma, and patients with heart disease. All three groups were presented with hurtful statements. Researchers measured their physiological response as well as their subjective awareness of hurt. People with melanoma were the most likely to repress their feelings of distress—they denied awareness of feelings that were physiologically revealed as being present. Similarly, a longitudinal study of medical students linked repression of conflict impulses and emotions to the development of cancer. Maté stresses that repressive tendencies (which cause chronic physiological stress) alone cannot cause cancer, but that it is one of a number of causational factors (fair skin is another). Maté also stresses that emotional repression is a coping style that is often inadvertently conditioned in children by parents who are well-meaning.

In another case study, Maté explores the role of stress in the disease process of Jill, who had ovarian cancer. Jill continued to prioritize the comfort of her controlling mother and her anxious husband, even when she was very sick. None of Martha’s physicians expressed interest in her personal life; Martha believes that this is problematic, as she sees a significant connection between her level of stress and her disease.

Martha, who has Crohn’s disease, describes the onset of her disease as an overworked young mother with a harsh and unsupportive partner who was often absent. Tim, who has ulcerative colitis, has an “obsessive need to please” (136), which he prioritizes above his own wellbeing. A 1955 study found that the mothers of people with ulcerative colitis tended to be “martyrs” who made their children feel guilty and responsible for their own emotional suffering. A psychoimmunological origin of intestinal diseases, which involves an unnecessary, oversensitive, and inflammatory response of the bowel, was first proposed in 1998. Maté reminds readers that the nerve and immune pathways are highly sensitive to stress levels and that these same pathways provide information to activate proinflammatory molecules. Maté also points out that anxiety is often subjectively felt by people in their gut, illustrating the role of the system in interpreting and reacting to stress. Maté therefore problematizes the exclusion of patients’ lived experiences from doctors’ diagnosis and management of intestinal diseases.

A friend of Maté’s, Tibor, experienced an episode of ulcerative colitis in a time of heightened stress after the death of his father. After learning of the theory that the disease was stress related, Tibor focused on learning and practicing physiological relaxation techniques, which resolved the ulcerative colitis.