When the Body Says No: The Cost of Hidden Stress

“Mary described herself as being incapable of saying no, compulsively taking responsibility for the needs of others. Was the scleroderma her body’s way of finally rejecting this all-encompassing dutifulness?”

Through Mary’s case study, Maté highlights The Relationship Between Chronic Stress and Disease as well as The Power of Early Conditioning in Forming Coping Mechanisms. Mary internalized the need to care for others as a very young child. As part of this caretaking, she repressed her own needs. Maté suggests that this caused chronic stress in Mary’s physiology, which eventually expressed itself via scleroderma, an autoimmune disorder.

“Repression—dissociating emotions from awareness and relegating them to the unconscious realm—disorganizes and confuses our physiological defenses so that in some people these defenses go awry, becoming the destroyers of health rather than its protectors.”

Maté continues to explore the relationship between chronic stress and disease in his explanation of the physiological effect of repression on the body’s defense systems. The power of early conditioning is also relevant here; Maté suggests that childhood conditioning forms the milieu of one’s physiology in terms of either promoting repression or promoting the healthy recognition and expression of emotional states.

“As I opened the door to my mother’s room, I automatically walked with a nonchalant, normal gait to her bed to greet her. The impulse to hide the limp was not conscious, and the act was done before I was aware of it.”

Maté reveals that repression is relevant in his own life; he unconsciously disguises his limp from his elderly mother and later considers that this was an act of emotional repression in order to protect his mother from anxiety. This has its roots in Maté’s infancy in Nazi-occupied Hungary; he learned not to demonstrate his emotions because his mother was too overwhelmed to properly attend to his needs. Through this anecdote, Maté highlights that patterns of emotional repression conditioned in childhood continue into adulthood.

“They were exposed to acute and chronic stress by their childhood conditioning, and their ability to engage in the necessary flight-or-fight behavior was impaired.”

Maté sees a trend in the childhoods of patients with MS; they tended to have been environmentally conditioned toward helplessness by inattentive or harsh parental figures, both of which encourage repression of emotional states. Maté believes that the chronic stress caused by repression in these individuals created a compromised internal state that, combined with biological factors, caused the onset of MS.

“To facilitate fight or escape, blood needs to be diverted from the internal organs to the muscles, and the heart needs to pump faster. The brain needs to focus on the threat, forgetting about hunger or sexual drive. Stored energy supplies need to be mobilized, in the form of sugar molecules. The immune cells must be activated. Adrenaline, cortisol and other stress substances fulfill these tasks.”

Maté describes physiological stress as triggered within the body. Stress can be either acute (short-term) or chronic (long-term). Through emphasizing the complex and multifaceted nature of physiological stress, Maté builds an argument that chronic stress—an inherently unnatural state—strains and disrupts these systems.

“A child’s displays of Emotion II are also what parents are least able to tolerate if the feelings being manifested trigger too much anxiety in them. As Dr. Buck points out, a child whose parents punish or inhibit this acting-out emotion will be conditioned to respond to similar emotions in the future by repression. This self-shutdown serves to prevent shame and rejection.”

Children whose parents are too anxious to tolerate children’s demonstrative emotional experiences, especially demonstration of unpleasant or unhappy emotions, will learn—often at an unconscious level—to repress these feelings and their expression in order to avoid the perceived rejection of presenting unmet needs. This leads to adults who engage in constant repression, leading to chronic stress. Maté continues to explore the power of early conditioning in forming coping mechanisms, particularly in conditioning individuals toward patterns of chronic stress.

“With the incident of that boy trying to climb on her, she protects you from her emotional pain by not telling you. She doesn’t let you know about it. She is taking care of you.”

Maté discusses the relationship between a mother and daughter, Betty and Barbara Ellen, emphasizing Barbara Ellen’s tendency to repress stressful or unpleasant experiences in order to manage her mother’s anxiety. The power of early conditioning in forming coping mechanisms is alluded to here; Barbara Ellen learns to manage her mother’s anxiety by disguising her distress. Furthermore, Maté implies that this pattern of repression, causing chronic stress with Barbara Ellen’s body, contributes to her cancer diagnosis. This alludes to the important and recurring theme The Relationship Between Chronic Stress and Disease.

“Smoking no more causes cancer of the lung than being thrown into deep water causes drowning. A combination of factors is necessary to cause drowning. It is the same with lung cancer.”

In terms of lung cancer, Maté points out that not all smokers develop lung cancer. Therefore, Maté argues, there seem to be other mediating factors. He uses the metaphor of deep water not causing drowning to illustrate that, as in drowning, a combination of causative factors cause cancer. He suggests that chronic physiological stress (caused by emotional repression) works in conjunction with damage caused by smoking to create conditions whereby cancerous cells multiply rather than get destroyed by the bodies’ antibodies.

“Without any knowledge of the results of the Pap smear, the researchers ‘were able to predict with almost 75 per cent accuracy those individuals who had early cancer, simply by utilizing a questionnaire which differentiated between various emotional states. They found that cancer was most apt to occur in these women with a “helplessness-prone personality.”’”

Maté presents findings on the onset of cervical cancer being correlated with “helplessness-prone personalities.” The author thus suggests that psychological risk factors should be considered in terms of cancer onset, in particular the role of repression of emotional states (as is illustrated by a feeling of helplessness, as individuals struggle to identify their feelings and act to resolve discomfort). This alludes to the important and recurring theme The Relationship Between Chronic Stress and Disease.

“In places where screening is widely practiced, the incidence of diagnosed prostate cancer goes up, and the number of men being treated increases, but the death rate from prostatic malignancy remains unchanged.”

Maté draws on statistics that highlight the ineffectiveness of modern prostate cancer diagnosis and treatment, which is invasive and framed around a physical cause-and-effect model. Maté suggests that the identification and reduction of chronic stress would be more beneficial in reducing the death rate from prostate cancer. He critiques the overreliance of modern medicine on invasive procedures and purely biological understandings of disease. This is part of the broader theme The Shortcomings of Western Medicine: Mindbody Dichotomizing and Rejection of Anecdotal Evidence.

“Although Ed had told me previously that he had had a ‘very great upbringing,’ it soon became evident that he had felt controlled by his parents and full of guilt if he failed to meet their expectations.”

Ed, who has prostate cancer, conforms to Maté’s theory of childhood conditioned repression. Furthermore, Maté tends to find that these individuals are often unaware or unwilling to acknowledge the damaging aspects of their upbringing. Maté suggests that Ed’s chronic stress plays a role in disease.

“The type C individual suppresses or represses ‘negative’ emotions, particularly anger, while struggling to maintain a strong and happy facade.”

Maté draws on research that indicates that certain personality traits (which Maté groups as repression) are associated with developing cancer. This supports his theory surrounding the relationship between chronic stress and disease.

“The practical exclusion of people’s life histories from the medical approach to illness deprives doctors of powerful healing tools. It also leaves them vulnerable to grasping at the latest pharmacological miracle.”

In terms of bowel diseases, such as Crohn’s disease or IBS, doctors are often unable to offer solutions. Maté suggests that chronic stress is causational, but that this information is ignored due to doctor’s reliance on verifiable data over anecdotal evidence. He critiques the overreliance on pharmaceuticals, which the genetic/biological model (as opposed to the biosocial model) creates.

“It turned out that those who had expressed a paucity of ideas and had used less vivid language in their youthful memoirs were proportionally more likely to have developed clinical Alzheimer’s as they grew older, along with the characteristic pathological findings in the brain. Richness or poverty of language is determined by many factors, but dominant among them is the quality of early emotional relationships.”

The combined evidence of autopsies of the brains of a group of nuns, matched with their youthful memoirs, suggested a correlation between the development of Alzheimer’s in late age and insecure or neglectful childhood experiences. The power of early conditioning in forming coping mechanisms is alluded to here as well as the relationship between chronic stress and disease; repression from childhood proximate abandonment or literal abandonment caused chronic stress, which Maté argues left these women more susceptible to Alzheimer’s.

“In the first edition of his classic Principles and Practice of Medicine, published in 1892, William Osler suggested that rheumatoid arthritis has ‘in all probability, a nervous origin.’”

Maté suggests that previously accepted medical knowledge, such as Osler’s identification of a “nervous origin” of rheumatoid arthritis, has been forgotten or abandoned in the current medical model of biological origins and causes of disease.

“Characteristic of many persons with rheumatoid arthritis is a stoicism carried to an extreme degree, a deeply ingrained reticence about seeking help. People often put up silently with agonizing discomfort, or will not voice their complaints loudly enough to be heard, or will resist the idea of taking symptom-relieving medications.”

The power of early conditioning in forming coping mechanisms is alluded to here as well as the relationship between chronic stress and disease; a tendency toward repression, likely formed in childhood, causes people to suppress their needs and discomfort. Maté suggests that in these individuals, repression—which causes chronic physiological stress—eventually expresses in disease, such as the autoimmune disorder rheumatoid arthritis. As with other conditions, Maté highlights personality traits or emotional tendencies that people with rheumatoid arthritis have in common.

“In German studies, asthmatic children were more likely than their healthy counterparts to engage in long, escalating, mutually negative interactions with both their mothers and fathers. Their parents tended to exhibit more critical behaviour toward them than the parents of other children.”

The link between chronic stress and disease, whereby an inflammatory response is triggered in the body after prolonged stress, is supported by the German study. Repression, which causes chronic physiological stress, has its roots in childhood conditioning; the parents in the study conform to controlling and critical models of parenting that tend to lead to enmeshment and repression in children.

“The partner who must suppress more of his or her own needs for the sake of the relationship is more likely to develop physical illness as well—hence the greater incidence, for example, of autoimmune disease and of non-smoking-related cancers among women.”

Maté suggests that repression, which causes chronic physiological stress, occurs more frequently in women, as women are more likely to be societally trained to be self-sacrificial caregivers, a pattern that is often reflected in relationships between men and women. The power of early conditioning in forming coping mechanisms is alluded to here, as well as the relationship of chronic stress and disease.

“Children in non-attuned relationships may feel loved but on a deeper level do not experience themselves as appreciated for who they really are. They learn to present only their ‘acceptable’ side to the parent, repressing emotional responses the parent rejects and learning to reject themselves for even having such responses.”

Maté continues to explore the power of early conditioning in forming coping mechanisms in terms of the impact of non-attuned parental relationships and their link to lifelong repression. Non-attuned parents are not necessarily neglectful and may indeed love their children, but a lack of emotional attunement still results in the child’s repression of emotions perceived to be uncomfortable or unwelcomed by the parents. These individuals feel constantly inadequate for unacceptable feelings or behaviors, as these were the attachment patterns and thought schemas that were formed early in life.

“In the adult children of Holocaust survivors with post-traumatic stress disorder (PTSD), disturbances of the HPA axis and cortisol production were found.”

The disrupted neuroendocrine reactions of adult children of Holocaust survivors alludes to the way that anxiety and repression can be passed down through learned behavior from parents. This finding alludes to the power of early conditioning in forming coping mechanisms as well as the role of intergenerational patterns and trauma in shaping physiological responses.

“Highly adaptive people and families, on the average, have fewer physical illnesses, and those illnesses that do tend to occur tend to be mild to moderate in severity.”

Just as anxiety and repression are correlated with disease, adaptiveness (the ability to respond to challenges flexibly and resiliently) is correlated with better health outcomes. The familial aspect of this finding continues to suggest that anxious tendencies (or a lack thereof) can be passed on generationally.

“Whatever external treatment is administered, the healing agent lies within. The internal milieu must be changed. To find health, and to know it fully, necessitates a quest, a journey to the centre of our own biology of belief.”

Given the relationship between chronic stress and disease, and the fact that chronic stress has its roots in childhood conditioning, Maté suggests that the path to healing lies in uncovering and correcting one’s maladaptive thinking patterns. Only by freeing oneself of repression can a person achieve health.

“Many people are blocked from self-knowledge and personal growth by the myth they feel compelled to hold on to, of having had a ‘happy childhood.’ A little negative thinking would empower them to see through the self-delusion that helps keep them stuck in self-harming behavioural patterns.”

Maté condemns many people’s adherence to the myth of a purely happy childhood; he urges honest self-reflection, rather than giving in to fear by avoiding any negative thoughts. Only through an honest evaluation of learned coping mechanisms can people begin to rewrite their thought patterns to relieve chronic stress and thus promote health.