When the Body Says No: The Cost of Hidden Stress (26 page)

Dr. Cai Song is an internationally known researcher at the University of British Columbia and co-author of a recent textbook,
Fundamentals of Psychoneuroimmunology
. “I am convinced that Alzheimer’s is an autoimmune disease,” says Dr. Song. “It is probably triggered by chronic stress acting on an aging immune system.”

The emotional centres in the brain profoundly influence the neurological and hormonal processes of the stress response, as we have seen. The repression of negative emotion—for example, the unconscious grief, anger and loathing Jonathan Swift experienced as a result of early deprivation—is a chronic and significant source of damaging stress. Researchers at the Ohio State University have suggested that in Alzheimer’s, as in the other autoimmune conditions, negative emotions provide a major risk factor for the eventual onset of disease.
¹⁰

The world’s most famous Alzheimer’s sufferer is Ronald Reagan. When Reagan was first diagnosed at the age of eighty-three, six years after the end of his second presidential term, he wrote poignantly in his farewell message to the American people, “I now begin the journey that will lead me into the sunset of my life.” It has been a long, sad decline.

Like Swift, Reagan suffered trauma early on. His father, Jack, was an alcoholic. “At four, he could hardly comprehend that his father had been arrested for public drunkenness,” avers Edmund Morris in his unorthodox biography,
Dutch: A Memoir of Ronald Reagan
. “Dutch, a dreamy, mild-mannered boy, remained oblivious to the high cost of alcoholism. He did not understand why he and Neil [his brother], on baseball afternoons, were festooned around the neck with sacks of freshly-popped corn and told to ‘go sell it down in the amusement park.’”
¹¹

Morris, a perceptive biographer, was wrong this time—or only partially right. While a young child may not be
cognitively
aware of family disgrace,
emotionally
he is absorbing all the negative psychic vibrations of the stressed family system. An emotional shutdown, a tuning-out of reality, is his brain’s most readily available defence. In consequence, the Great Communicator could speak the language of sentiment but not that of
genuine emotion. “Really, there are no words” became Reagan’s mantra, “his standard cliché to express emotion required of him,” writes Morris.

If the shutting-down of emotion occurs early enough, during the critical phases of brain development, the capacity to recognize reality may become permanently impaired. Reagan had lifelong difficulty telling fact from fiction. “He had an inability to distinguish between fact and fancy,” a former fiancée recalled—an indication that in the child’s mind, and later in the adult’s, fancy replaced painful fact. “Reagan’s memory was selective,” writes the publisher and editor Michael Korda in his own autobiography,
Another Life
, published in 1999:

Similar anecdotes about Reagan abound, as do stories of his poor interpersonal memory. “Dad, it’s
me
. Your son. Mike,” his first-born child once pleaded with him as Reagan blinked at him uncomprehendingly among a group of fellow students.

The then-future president once described himself as “the calm vacant center of the hurricane.” Morris writes that there was always about Ronald Reagan’s personality an “immense insularity …, the child was already sheathed in a strange calm … [a] paralysis of sensibility.” The purpose of that defensive and self-induced paralysis is clear. As another woman who rejected the young Reagan’s advances said, “I’ve always known Dutch can’t be hurt.”

Dutch—Reagan’s early nickname from his radio announcer days—
could
be hurt. He buried the pain and anger deeply. His resulting emotional repression is nowhere more clearly demonstrated than in Reagan’s description of an incident when, at age eleven, he arrived home to find his father outdoors, inebriated. “It was Jack lying in the snow, his arms outstretched, flat on his back. He was drunk, dead to the world. I stood over him for a minute or two…. I felt myself fill with grief for my father. Seeing his arms spread out as if he were crucified—as indeed he was—his hair soaked with melting snow, snoring as he breathed, I could feel no resentment against him.”

“I could feel no resentment”
reveals the young man’s rage at his father. In psychotherapy one often sees this kind of “confirmation by denial”: the speaker spontaneously reports
not
feeling a certain emotion—usually anger—that he had not been asked about in the first place. This self-report would be more valid than he knew. While it is true that he could
feel
no resentment, that was so only because his awareness of feeling had been impaired long ago. He would be reporting, albeit unwittingly, that his rage lay beyond the bounds of consciousness. The negative assertion—“I could feel no resentment”—represented an internal conflict between that rage and the forces of repression.

Reagan’s mother was apparently too self-absorbed and overwhelmed by the stresses of marriage to a philandering and alcoholic husband. She was unavailable to her children—just as, later, Ronald Reagan would be unavailable to his children. Often the child’s antidote to his anger at being ignored is to idealize his mother, which is what Reagan likely did. The depths of his denial become most evident when his mother-substitute, his devoted second wife and caregiver, Nancy, developed breast cancer. Their physician, John Hutton, was given the duty of informing the president. Edmund Morris’s notes, from October 1987:

Such instances do not indicate that the person has no emotions; someone truly lacking attachment could at least pretend to possess some fellow feeling. On the contrary,
the emotions can be too overwhelming to be experienced consciously
—but they are physiologically all the more active. Once more we witness that avoiding the experience of emotion in fact exposes people to greater and longer-lasting physiological stress. Because they are unaware of their own internal states, they are less able to protect themselves from the consequences of stress. Furthermore, the healthy expression of emotion is itself stress-reducing. Stress-induced chronic hormonal and immune changes prepare the physiologic ground for diseases like Alzheimer’s.

The emotional poverty, disguised by sentiment, in Reagan’s autobiographical writings in his college years is in dramatic contrast to the rich emotional language of the nuns who survived into old age without Alzheimer’s. The correlation between the richly affective accounts written by some young nuns and their later freedom from dementia was remarkable. The ones who wrote with emotional paucity similar to Reagan’s ended up with Alzheimer’s.

The life histories of all the Alzheimer’s patients I looked after during my years of family practice were characterized by repressed emotion. I interviewed several adults who are now taking care of aged parents suffering with Alzheimer’s. They all reported early loss or emotional deprivation in their parents’ lives. “My mother’s father died when she was quite young,” one person told me. “I think she was about ten or eleven. The family was living in Vancouver, but her parents sent her up to Gibsons to work in a household that summer. This was back in the thirties.

“My mother was working in Gibsons when her father died. My mom’s older sister came up and brought her back to Vancouver. When they arrived home, her mother said to the sister, ‘What did you bring her back for?’ In front of my mother. It was an astoundingly cruel thing to do.”

“A huge amount of tension was always there when I was growing up,” a man whose mother also has Alzheimer’s recalled. “Things were
under the surface. Everything my mother stated was always super-fine, but the body language was ‘go away.’ She didn’t reveal anything. I always felt growing up that I didn’t know what was going on.”

Other people can observe what the emotionally repressed person holds back from himself. A well-known Hollywood actress who knew the rising movie star Ronald Reagan but remained unmoved by his charms was, nevertheless, “touched by the despair behind his incessant, nervous jocularity,” Morris claims.

Morris once asked the president what he had most longed for as a young man. “There was a long silence as he tried to escape the question,” the author writes. Reagan finally replied that what he most regretted was not the lack of someone to love him. Rather, he said, “I missed not having someone to love.” Morris notes, “I wrote the words down and followed them with a spiral curlicue useful to biographers, meaning,
He feels the opposite of what he says
[italics his].”

  I
N 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.” In present-day language, Osler was referring to psychoemotional stress. He noted “the association of the disease with shock, worry, and grief.”

No obscure theoretician, William Osler was the best-known medical doctor in the English-speaking world. According to Sherwin B. Nuland, himself a physician and author, Osler “may have been the greatest clinical teacher of any day, and any country.” He taught at McGill University in Montreal, Johns Hopkins University Medical School, Baltimore, and at Oxford. In England he was knighted for his contributions to the healing arts. His widely used textbook underwent sixteen editions—the last one in 1947, twenty-eight years after his death.

In 1957 C. E. G. Robinson, a Vancouver internal medicine specialist, cited Osler’s words in a brief article in the
Canadian Medical Assocation Journal
. “I have also been impressed,” he wrote, “by the frequency with which chronic or prolonged stress may precede the development of
rheumatoid disease…. I think that the emotional and psychological aspect of many rheumatoid patients is of first importance.”
¹

Dr. Robinson’s medical education was still informed by Osler’s humane and holistic approach. Now, at the beginning of the twenty-first century, one may search in vain through the mainstream medical texts for any mention of stress in relationship to rheumatoid arthritis or to its fellow autoimmune conditions, all of them characterized by a civil war of the immune system against the body. The omission, tragic for millions of human beings suffering rheumatoid disease of one type or another, is all the more unjustifiable since research has long since established the stress-autoimmune connection and has given us an understanding of many of its potential physiological pathways.

The large and overlapping set of medical conditions called rheumatic diseases include rheumatoid arthritis, scleroderma, ankylosing spondylitis and systemic lupus erythematosus (SLE). In these disorders, and in many others, a disturbed immune system reacts against the body’s own tissues, particularly against connective tissues like cartilage, tendon sheaths, the lining of joints and the walls of blood vessels. These illnesses are characterized by various patterns of inflammation that strikes the joints of the limbs or the spine; or surface tissues like skin or the lining of the eyes; or internal organs such as the heart or the lungs or—in the case of SLE—even the brain.

Characteristic of many persons with rheumatoid diseases 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.

Celia, a woman in her thirties, experienced an episode of arteritis, or generalized inflammation of the arteries, another autoimmune process. Her pain was severe. “For two days I was in so much pain that I was throwing up from the amount of Tylenol and Ibuprofen I was ingesting. My girlfriend said, ‘Do you give up yet?’ and she took me to emergency.”

“‘Do you give up yet’—what does that mean?” I wonder.

“I’m stubborn. Whenever I’m sick, I always have this underlying fear that I won’t be believed or that I’ll be seen as a hypochondriac.”

“So here you are, not able to move because of agonizing pain, and you’re worried people will think you’re a hypochondriac. Let’s reverse this situation for a moment. Imagine it was a friend, or your husband, or your child who was suffering such pain. Would you not have acted much more quickly?”

“Yes.”

“Why the double standard?”

“I don’t know. It goes back a long way, probably. Back to the way I grew up.”