When the Body Says No: The Cost of Hidden Stress (31 page)

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. “The existence of a mind-body link and a person-person link means that it is possible for
anxiety
in one person to be manifested as a
physical symptom
in another person,” Dr. Kerr writes. “As is the case with the emotional dysfunctions, the one prone to develop symptoms is the spouse who adapts most to maintain harmony in the relationship system.”
¹⁵

Nature’s ultimate goal is to foster the growth of the individual from absolute dependence to independence—or, more exactly, to the interdependence of mature adults living in community. Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well-self-regulated people are the most capable of interacting fruitfully with others in a community
and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism’s chances for long-term survival. Almost from the beginning of life we see a tension between the complementary needs for security and for autonomy. Development requires a gradual and age-appropriate shift from security needs toward the drive for autonomy, from attachment to individuation. Neither is ever completely lost, and neither is meant to predominate at the expense of the other.

With an increased capacity for self-regulation in adulthood comes also a heightened need for autonomy—for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or when the tested animal or human being feels helpless, without meaningful choices—in other words, when autonomy is undermined.

Autonomy, however, needs to be exercised in a way that does not disrupt the social relationships on which survival also depends, whether with emotional intimates or with important others—employers, fellow workers, social authority figures. The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus,
the vulnerability to subjective and physiological stress will be proportionate to the degree of emotional dependence
.

To minimize the stress from threatened relationships, a person may give up some part of his autonomy. However, this is not a formula for health, since the loss of autonomy is itself a cause of stress. The surrender of autonomy raises the stress level, even if on the surface it appears to be necessary for the sake of “security” in a relationship, and even if we subjectively feel relief when we gain “security” in this manner. If I chronically repress my emotional needs in order to make myself “acceptable” to other people, I increase my risks of having to pay the price in the form of illness.

The other way of protecting oneself from the stress of threatened relationships is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy. This coping style may avoid anxiety and block the subjective experience of stress but not
the physiology of it. Emotional intimacy is a psychological and biological necessity. Those who build walls against intimacy are not self-regulated, just emotionally frozen. Their stress from having unmet needs will be high.

Social support helps to ameliorate physiological stress. The close links between health and the social environment have been amply demonstrated. In the Alameda County study, those more socially isolated were more susceptible to illness of many types. In three separate studies of aging people, five-year mortality risks were associated directly with social integration: the more socially connected a person was, the lower their risk of death. “Social ties and support,” a group of researchers concluded, “… remain powerful predictors of morbidity and mortality in their own right, independent of any associations with other risk factors.”
¹⁶

For the adult, therefore, biological stress regulation depends on a delicate balance between social and relationship security on the one hand, and genuine autonomy on the other. Whatever upsets that balance, whether or not the individual is consciously aware of it, is a source of stress.

  R
ACHEL, WHOSE RHEUMATOID JOINT
inflammation first flared on the eve of Rosh Hashanah, is a slight woman, barely five feet tall. Sitting on the sofa in her living room, she is dwarfed by the giant teddy bear propped up beside her. There is something hungry-looking about her, reminiscent of the undernourished and emotionally deprived premature infant she was.

“When I was born, I choked on all the amniotic fluid that had filled my lungs. I spent my first four weeks in a toaster oven of an incubator. Back in 1961 there wasn’t the knowledge that infants in incubators still need to be touched. So my first month of life was needles and pokes and prods. My mother didn’t come because she had to look after my brother. If my father came … I don’t know.”

The consequences of emotional and tactile deprivation during her first month could have been overcome had Rachel enjoyed nurturing relationships subsequently, but that was not to be. She failed in her appointed life purpose almost from conception. Her mother, who had hoped that the pregrancy would keep the marriage together, was abandoned by her husband even before Rachel’s birth. One can imagine the mother’s state of mind, being alone and having the sole care of both a toddler—Rachel’s brother—and the newborn.

Under such circumstances, having to justify her existence became second nature to Rachel—it is nobody’s
first
nature. Her fundamental expectation is that she will be abandoned. “I believe if anybody got to know me, they would leave me for sure,” she says. She was astounded when over the last holiday season she received several invitations from
people just to visit. That anyone would want her without expecting anything is well nigh impossible for her to fathom.

Since her diagnosis with rheumatoid arthritis, Rachel has entered therapy. As a result, she is much more able than before to know what she feels at any moment. Anger is the emotion she still has the most difficulty recognizing. It is usually roused in her by perceptions of being dismissed or demeaned as, for example, recently when her mother criticized her choice of therapist. “She couldn’t understand why I would use a portion of my welfare cheque to pay for therapy rather than go to a psychiatrist funded by the medical plan. So here I have finally found someone I can communicate with, and my mother thinks only about the money part of it.” Yet instead of stating calmly that her decisions are her own to make, Rachel argued and pleaded for her mother’s understanding. The rancorous exchange induced a week of anorexia, her mode of self-directed rage.

When self-assertion is called for, Rachel swallows her anger and tries to justify herself, to placate or to engage in some interaction designed to persuade the other person to “get it.” These efforts are the automatic responses of the vulnerable child who works intensely to bring the parent into alignment with her needs. Her anxiety and fear of abandonment compel her to repress any emotion that may cause her to be rejected.

Rachel’s pet rabbit, on the other hand, is acutely sensitive to her owner’s emotional states. When Rachel is angry, the rabbit simply refuses be picked up by her. “If I know I’m angry I’ll leave her alone. If I am angry but don’t know it, she won’t let me touch her—she tells me and I’ll check in inside, and sure enough I’m angry about something.” Although this seems strange to some people, the explanation is straightforward. People and their pets connect via shared brain structures that predate the development of the human frontal cortex with its apparatus of language and rationality. Animals and humans interact from their respective limbic systems, the brain’s emotional parts. Unlike people, animals are acutely sensitive to messages from the limbic brain—both their own and that of their owners. In Rachel’s unconscious anger the rabbit senses a threat.

How does it come about that a human being would need a rabbit to let her know when she is upset? The simple answer is childhood conditioning. No infant is born with a propensity to repress the expression
of emotion—quite the contrary. Anyone who has ever tried to force a baby to swallow foods he disliked or to induce a toddler even to open her mouth when she did not wish to eat can testify to the young human’s inherent capacity to resist coercion and to express displeasure. So why do we start swallowing food we do not want or feelings our parents do not want? Not out of any natural inclination but from the need to survive.

Only some aspects of childhood experiences are available to conscious retrieval. Rachel, for example,
recalls
the sense of rejection and humiliation she felt following her father and brother at a distance as the two walked ahead in an embrace. She is also aware of her birth history, although she cannot recall it directly. Yet even without such information, we have infallible testimony about her experience of early childhood: her hopelessness about intimacy; her continued pleas for understanding from her mother, despite nearly forty years of futility; and her reliance on the rabbit as an anger sensor. These behaviours represent an exceedingly accurate memory system, one that was imprinted in her brain in the early stages of her development. That memory system has guided her behaviour all her life and eventually prepared the terrain for the onset of autoimmune disease.

The biology of potential illness arises early in life. The brain’s stress-response mechanisms are programmed by experiences beginning in infancy, and so are the implicit, unconscious memories that govern our attitudes and behaviours toward ourselves, others and the world. Cancer, multiple sclerosis, rheumatoid arthritis and the other conditions we examined are not abrupt new developments in adult life, but culminations of lifelong processes. The human interactions and biological imprinting that shaped these processes took place in periods of our life for which we may have no conscious recall.

Emotionally unsatisfying child-parent interaction is a theme running through the one hundred or so detailed interviews I conducted for this book. These patients suffer from a broadly disparate range of illnesses, but the common threads in their stories are early loss or early relationships that were profoundly unfulfilling emotionally. Early childhood emotional deprivation in the histories of adults with serious illness is also verified by an impressive number of investigations reported in the medical and psychological literature.

In an Italian study, women with genital cancers were reported to have felt less close to their parents than healthy controls. They were also less demonstrative emotionally.
¹

A large European study compared 357 cancer patients with 330 controls. The women with cancer were much less likely than controls to recall their childhood homes with positive feelings. As many as 40 per cent of cancer patients had suffered the death of a parent before the age of seventeen—a ratio of parental loss two and a half times as great as had been suffered by the controls.
²

The thirty-year follow-up of Johns Hopkins medical students was previously quoted. Those graduates whose initial interviews in medical school had revealed lower than normal childhood closeness with their parents were particularly at risk. By midlife they were more likely to commit suicide or develop mental illness, or to suffer from high blood pressure, coronary heart disease or cancer. In a similar study, Harvard undergraduates were interviewed about their perception of parental caring. Thirty-five years later these subjects’ health status was reviewed. By midlife only a quarter of the students who had reported highly positive perceptions of parental caring were sick. By comparison, almost 90 per cent of those who regarded their parental emotional nurturing negatively were ill.
“Simple and straightforward ratings of feelings of being loved are significantly related to health status,”
the researchers concluded.
³

Tactile contact is the newborn’s earliest experience of the world. It is how we first receive love. Mammalian mothers invariably provide tactile stimulation to their offspring, for instance, rats by licking their pups, primates by stroking them. Ashley Montague writes in his superb book
Touching: The Human Significance of the Skin
, “The various forms in which the newborn and young receive it is of prime importance for their healthy physical and behavioural development. It appears probable that, for human beings, tactile stimulation is of fundamental significance for the development of healthy emotional or affectional relationships, that ‘licking,’ in its actual and in its figurative sense, and love are closely connected; in short, that one learns love not by instruction, but by being loved.”

From animal experiments, it is known that physical touching induces growth-hormone production, promoting better weight gain and development. These findings also apply to human beings. In a study
of premature babies, incubated infants were divided into two groups. All their nutritional and other conditions were identitical, except for one variable: one group was given fifteen minutes of tactile stimulation three times a day over a period of two weeks. “Providing this form of stimulation to these babies resulted in significant acceleration of weight gain, increased head circumference, and improved behavioural indices,” compared with the control group.
⁴
The lack of touching that Rachel experienced impaired her physical development and at the same time gave her the first inkling that she was not desirable or lovable. Later events reinforced those earliest impressions.