57 pages • 1 hour read
Gabor MatéWhen the Body Says No: The Cost of Hidden Stress
Nonfiction | Book | Adult | Published in 2003A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
The Shortcomings of Western Medicine: Mindbody Dichotomizing and Rejection of Anecdotal Evidence
Maté critiques the normalized medical model of diagnosing disease through the framework of a physical origin and physical expression of ill health. Instead, Maté points out that the mind and body are literally and conceptually inseparable and that they should be treated as such, as reflected in the semantics of expressing “mindbody” as a single word. Maté posits that important learning has been lost and dismissed in modern medicine’s overreliance on verifiable data and on symptoms that can be verified as apparent through investigative procedures or through examinations by physicians.
Maté believes that the dismissal of the connection of mindbody blinds physicians to imperative qualitative data that can inform the diagnosis and treatment of patients: “Dualism—cleaving into two that which is one—colours all our beliefs on health and illness” (3). Maté seeks to redress this dichotomizing through presenting a number of case studies that suggest the interconnectedness of individuals’ lived experiences and their health outcomes.
Maté opens his text with the case study of Mary, problematizing the fact that “none of [Mary’s physicians] expressed curiosity about her psychological state before the onset of the disease” (2); instead, the team simply “treated each of her physical symptoms as they presented themselves” (2). Maté believes that Mary’s treatment failed to ignore the holistic causes of health conditions, as is illustrated when he interviews Mary and finds that “beneath her meek and diffident manner was a vast store of repressed emotion” (2). This leads Maté to conclude that Mary’s traumatic childhood, which caused habitual repression of stress, unpleasantness, and her own needs, is eventually expressed in a cascade of diseases: gangrene, Raynaud’s syndrome, and scleroderma are (in part) the outcomes of Mary’s maladaptive emotional coping mechanisms. Maté believes that doctors should reorient their understanding of health conditions as partially caused by conditioning, lived experiences, and trauma, rather than just being caused by biological or genetic factors; he calls this a biosocial model of disease (as opposed to a purely biological, genetic model of disease, which he believes rules the current medical establishment).
Through additional case studies, Maté further establishes anecdotal evidence of patients’ lived experiences being connected to disease processes. Barbara Ellen, who died of breast cancer at 27, repressed her emotional reality from her judgmental; she continued this established pattern of emotional repression into adulthood. Maté suggests that this intense repression increased Barbara Ellen’s susceptibility to the cancer that eventually took her life. To support this assertion, Maté stresses that many healthy individuals have cancerous cells that do not form into malignant tumors. Similarly, autopsies reveal that many healthy adults have the plaques and tangles that characterize Alzheimer’s disease but do not develop the disease.
Maté thus urges readers to acknowledge that so many diseases are of “unknown etiology” and to therefore be curious about when diseases and conditions arise; he stresses the role of trauma and repression in his case studies, urging readers to consider chronic stress from repression as a causal factor in disease onset. Furthermore, chronic stress can only be ascertained by gathering anecdotal evidence from patients, and its relevance in terms of disease onset can only be considered through a biosocial model of mindbody interconnectedness.
The Power of Early Conditioning in Forming Coping Mechanisms
Maté draws on attachment theory, postulating that children with healthy attachments learn that their needs can be reliably met by parental figures: “In healthy mother-infant interactions, the mother is able to nourish without the infant’s having in any way to work for what he receives” (11). Secure attachment leads to individuals who are able to emotionally self-regulate as adults; they gradually replace their parent figure by interpreting their own internal states and responding appropriately to their needs or discomfort.
On the other hand, those whose needs were unmet—or inconsistently met—in childhood through neglect or proximate abandonment learn to repress their needs, as the experience of presenting needs and having them be overlooked feels like a kind of rejection: “The self-shutdown serves to prevent shame and rejection” (37). These children develop avoidant or ambiguous attachment styles. Children might additionally learn that the emotional expression of their needs or discomfort (Emotion II) causes discomfort in their parental figure, so they will avoid these expressions: “[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” (37).
Children with anxious parents avoid demonstrating their own discomfort as a form of caretaking: “A child whose parents punish or inhibit this acting-out emotion will be conditioned to respond to similar emotions in the future by repression” (37). These children feel responsible for causing anxiety in their parents through their emotional expressions, so they learn to mask their feelings and discomfort as a coping mechanism. This is illustrated when Maté disguises his limp from his mother, not wanting to worry her; in doing so, he commits a form of self-betrayal in hiding his emotional truth: “We are all self-deniers and self-betrayers to one extent or another, most often in ways we are no more aware of than I was conscious of while ‘deciding’ to disguise my limp” (11).
This self-betrayal conditions individuals to become disconnected from their internal landscapes. Eventually, they may be unable to interpret their perception of uncomfortable, exploitative, or unpleasant situations, and therefore tend to remain in relationships and situations that do not serve them, only increasing their unacknowledged distress and cognitive dissonance: “The result would be a kind of helplessness” (37).
Habitual repression, which means having constant and chronic unmet needs, creates chronic stress. This chronic stress is often experienced by adults who claim to have had very happy childhoods. Maté suggests that looking with honesty at childhood conditioning is the only way to overcome deeply ingrained, maladaptive ways of being, which includes the repression of feelings, but may also involve enmeshed, unhealthy relationships with parental figures, self-sacrificial helpfulness, and deep-seated insecurity.
The Relationship Between Chronic Stress and Disease
Throughout the book, Maté emphasizes that stress caused by repression, which has its roots in childhood conditioning and maladaptive coping strategies, is strongly linked to disease. Maté explores the way that emotional stress is experienced on a physiological level through the activation of the HPA axis, which results in a cascade of hormonal and systemic changes. While short-term stress has an important evolutionary function—to allow one to save themself in life-threatening situations—the most significant stress people experience, Maté suggests, is emotional. The surge of adrenaline and cortisol that increases the heart rate and blood pressure and disrupts digestion is not helpful in situations of emotional stress; in fact, it only weakens the regular operation of one’s stress response through chronic and long-term activation. Maté notes that cortisol release is inhibited in people who are experiencing chronic stress.
Chronic stress also weakens the immune system: “There is extensive documentation of the inhibiting effect of chronic stress on the immune system” (35). This is illustrated in the study whereby spousal caregivers were less likely to develop resistance to an influenza strain after receiving vaccinations compared to a control group. The immune systems of these caregivers, compromised by chronic emotional stress, were inhibited.
Maté identifies characteristics in individuals who tend to suffer from disease; these characteristics, explored through a number of case studies, conform to his theory on the role of emotional repression in causing physiological stress, which compromises health. For instance, people with ALS are infamously (and, Maté argues, maladaptively) “nice,” in a way that involves suppression of their own needs in favor of attending to the needs of others. They are also hyper-independent: “Characteristic was their attempt to avoid asking for help” (41).
Furthermore, the “chronic stress of blurring boundaries” was echoed in all of Maté’s patients (19). These blurred boundaries have their roots in childhood conditioning, which trained individuals to suppress their own needs. This is exemplified in Véronique, who has MS. She not only experienced enormous stresses in her life, including a breakup with a boyfriend who had alcoholism, financial stress, and the strain of MS, but she dismisses these significant challenges as “not necessarily bad” (21). Véronique has a controlling and enmeshed mother who encouraged a pattern of repression in childhood: “[I]t’s always easier to give in to my mom’s demands than argue about it” (21). Maté sees Véronique’s repression, which causes her to tolerate and dismiss significant discomfort, and blurred boundaries as causative factors in her MS diagnosis.
Maté urges people to establish firm boundaries to protect their needs and wellbeing, in conjunction with becoming more aware of their bodies’ physiological expressions of discomfort and stress, warning that “when we have been prevented from learning how to say no, our bodies may end up saying it for us” (3).
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