When the Body Says No: The Cost of Hidden Stress (37 page)

“Just the fact that I was depressed and that the job was making me sick was not enough, in my mind. I was so concerned about what other people would think—most important, my family.”

The support system Angela has found since being diagnosed with cancer has enabled her to face her issues. “I have felt a safety I have never felt before,” she says, “especially when I was going through all that stuff about detaching from Revenue Canada. And I’ve had a lot of encouragement to do things, loving things for myself, to do the things I have a passion for.”

Although with human beings anything is possible, it would be hard to accept that Gilda’s mother, Henrietta, truly did not want her daughter to exist, or that Leslie’s mother ever consciously wished to make her son responsible for her happiness, or that Alan’s parents wished to convey to him that he is only lovable when he is not angry. Most parents feel unconditional love for their children, and that is what they hope to get across to them. That is important to know, but it is not what matters.
What matters are the child’s unconscious perceptions, based on his innermost interpretations of his interactions with the world. Those interpretations, embedded at the cellular level, constitute the biology of belief that governs so much of what we feel, what we do and how we react to events.

A major contributor to the genesis of many diseases—all the examples we have looked at—is an overload of stress induced by unconscious beliefs. If we would heal, it is essential to begin the painfully incremental task of reversing the biology of belief we adopted very early in life. Whatatever 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. That means rethinking and recognizing—re-cognizing: literally, to “know again”—our lives.

Whichever modality of treatment people choose—conventional medicine with or without complementary healing; alternative approaches like energy medicine or various mind-body techniques; ancient Eastern practices like Ayurvedic medicine or yoga or Chinese acupuncture; the universal practice of meditation techniques; psychotherapy; nutritional healing—the key to healing is the individual’s active, free and informed choice. There are many different ways to find that innate human capacity for freedom, outlined in many teachings, books and other sources. Liberation from oppressive and stressful external circumstances is essential, but that is only possible if we first liberate ourselves from the tyranny of our ingrained biology of belief.

  T
HE
V
ANCOUVER ONCOLOGIST
Karen Gelmon does not favour the war metaphors often applied to cancer. “The idea is that with enough might you can control, with enough might you can expel,” she says. “It suggests that it’s all a battle. I don’t think that’s a helpful way of looking at it. First, it’s not valid physiologically. Second, I don’t think it’s healthy psychologically.

“What happens with our body is a matter of flow—there is input and there is output, and you can’t control every aspect of it. We need to understand that flow, know there are things you can influence and things you can’t. It’s not a battle, it’s a push-pull phenomenon of finding balance and harmony, of kneading the conflicting forces all into one dough.”

What we might call the military theory of disease sees illness as a hostile force, something foreign that the organism must battle and defeat. Such a view leaves an important question unanswered, even in the treatment of acute infections where we are able to identify the micro-organisms invading the body and to kill them with antibiotics:
why will the same bacterium or virus spare one person but fell another?
An organism such as streptococcus, responsible for the so-called flesh-eating disease, lives in many people but triggers illness in only a few. Or it may be present in an individual at one time without leading to problems but mount a lethal attack at another time in the person’s life. What accounts for the difference?

The nineteenth century saw a heated debate on this subject, conducted for decades between two outstanding figures in the history of medicine, the pioneer microbiologist Louis Pasteur and the physiologist Claude Barnard. Pasteur insisted that the virulence of the microbe decided the course of illness, Barnard that the vulnerability of the host body was most responsible. On his deathbed Pasteur recanted.
“Barnard avait raison,”
he said.
“Legerm n’est rien, c’est la terrain qui est tout.”
[Barnard was right. The microbe is nothing, the ground (i.e., the host body) is everything.]

The dying Pasteur may have swung too far in the opposite direction, but perhaps he had an eye toward the future. Since his days, and especially with the coming of the antibiotic era in the mid-twentieth century, we have all but forgotten that the terrain for illness is a particular human being at a particular time of his life history. “Why does
this
patient have
this
disease
now?”
George Engel, a researcher of mind-body unity in medicine asked in 1977.
¹
To all intents and purposes, modern medical practice has adopted a simplistic “cause-and-effect” perspective. When no obvious external agent is found—as is the case with most serious illnesses—it throws up its hands and declares the cause unknown. “Of unknown etiology” may be the most common phrase in textbooks of internal medicine.

While scientific humility is welcome, a cause-and-effect model of disease is itself a source of misperception. It cannot portray the ways that health is transmuted into illness or how illness may be turned toward health. Sufi tradition tells the famous story of the twelfth-century fool and sage, the mullah Nasruddin, on his hands and knees searching under a street light. “What are you looking for?” his neighbours ask. “My key,” he replies. The neighbours all join in the search, carefully and systematically perusing every inch of ground in the vicinity of the lamp. No one finds the key. “Wait, Nasruddin,” someone finally says, “just where did you lose this key?” “In my house.” “Then why are you looking out here?” “Because, of course, I can see better here, under the light.” It may be easier (and financially more rewarding) to research isolated causes such as microbes and genes, but as long as we ignore a broader perspective, diseases will always be of unknown etiology. A search outside where the light shines will not yield us the key to health; we have to look inside, where it is dark and murky.

No disease has a single cause. Even where significant risks can be identified—such as biological heredity in some autoimmune diseases or smoking in lung cancer—these vulnerabilities do not exist in isolation. Personality also does not by itself cause disease: one does not get cancer simply from repressing anger or ALS just from being too nice. A
systems model
recognizes that many processes and factors work together in the formation of disease or in the creation of health. We have demonstrated in this book a
biopsychosocial
model of medicine. According to the biopsychosocial view, individual biology reflects the history of a human organism in lifelong interaction with an environment, a perpetual interchange of energy in which psychological and social factors are as vital as physical ones. As Dr. Gelmon suggests, healing is a phenomenon of finding balance and harmony.

We cannot remind ourselves too often that the word
healing
derives from an ancient origin, meaning “whole”—hence our equation of wholesome and healthy. To heal is to become whole. But how can we be more whole than we already are? Or how is it that we could ever be less than whole?

That which is complete may become deficient in two possible ways: something could be subtracted from it, or its internal harmony could be so perturbed that the parts that worked together no longer do so. As we have seen, stress is a disturbance of the body’s internal balance in response to perceived threat, including the threat of some essential need being denied. Physical hunger may be one such deprivation, but in our society the threat is most often psychic, such as the withdrawal of emotional nourishment or the disruption of psychological harmony.

“I cannot understand why I have cancer,” one woman with ovarian cancer said. “I’ve led a healthy life, eaten well, exercised regularly. I’ve always taken good care of myself. If anyone should be a picture of health, it’s me.” The area she overlooked was invisible to her: the stress connected with emotional repression. Her conscientious (and conscious) best efforts to look after herself properly could not extend to an arena she did not know existed. That is why knowledge and insight have the power to transform, and why insight is more helpful to people than advice. If we gain the ability to look into ourselves with honesty, compassion and with unclouded vision, we can identify the ways we need to take care of ourselves. We can see the areas of the self formerly hidden in the dark.

The potential for wholeness, for health, resides in all of us, as does the potential for illness and disharmony. Disease
is
disharmony. More accurately, it is an
expression
of an internal disharmony. If illness is seen as foreign and external, we may end up waging war against ourselves.

The first step in retracing our way to health is to abandon our attachment to what is called positive thinking. Too many times in the course of palliative care work I sat with dejected people who expressed their bewilderment at having developed cancer. “I have always been a positive thinker,” one man in his late forties told me. “I have never given in to pessimistic thoughts. Why should I get cancer?”

As an antidote to terminal optimism, I have recommended the power of negative thinking. “Tongue in cheek, of course,” I quickly add. “What I really believe in is the power of
thinking.” As
soon as we qualify the word
thinking
with the adjective
positive
, we exclude those parts of reality that strike us as “negative.” That is how most people who espouse positive thinking seem to operate. Genuine positive thinking begins by including all our reality. It is guided by the confidence that we can trust ourselves to face the full truth, whatever that full truth may turn out to be.

As Dr. Michael Kerr points out, compulsive optimism is one of the ways we bind our anxiety to avoid confronting it. That form of positive thinking is the coping mechanism of the hurt child. The adult who remains hurt without being aware of it makes this residual defence of the child into a life principle.

The onset of symptoms or the diagnosis of a disease should prompt a two-pronged inquiry: what is this illness saying about the past and present, and what will help in the future? Many approaches focus only on the second half of that healing dyad without considering fully what led to the manifestation of illness in the first place. Such “positive” methods fill the bookshelves and the airwaves.

In order to heal, it is essential to gather the strength to think negatively. Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden.

Even more fundamentally,
not posing those questions is itself a source of stress
. First, “positive thinking” is based on an unconscious belief that we
are not strong enough to handle reality. Allowing this fear to dominate engenders a state of childhood apprehension. Whether or not the apprehension is conscious, it is a state of stress. Second, lack of essential information about ourselves and our situation is one of the major sources of stress and one of the potent activators of the hypothalamic-pituitary-adrenal (HPA) stress response. Third, stress wanes as independent, autonomous control increases.

One cannot be autonomous as long as one is driven by relationship dynamics, by guilt or attachment needs, by hunger for success, by the fear of the boss or by the fear of boredom. The reason is simple:
autonomy is impossible as long as one is driven by anything
. Like a leaf blown by the wind, the driven person is controlled by forces more powerful than he is. His autonomous will is not engaged, even if he believes that he has “chosen” his stressed lifestyle and even if he enjoys his activities. The choices he makes are attached to invisible strings. He is still unable to say no, even if it is only to his own drivenness. When he finally wakes up, he shakes his head, Pinocchio-like, and says, “How foolish I was when I was a puppet.”

Joyce, the university lecturer with asthma, finds it impossible to say no. Her lungs say it for her. Joyce’s fear of the no is not a fear of others but of an emptiness she feels when she is not pushing herself. “The emptiness,” she says, “is about this terror that if I don’t fulfill demands, I won’t really exist.” If she invoked her power of negative thinking, she could accept that fearsome void within herself. She would explore the experience of the void rather than attempt to fill it with positive deeds.

Michelle, diagnosed with breast cancer at age thirty-nine, used to seek relief in her lifelong habit of daydreaming. “No wonder I lived in a fantasy world,” she said as she recalled her childhood unhappiness. “It’s safer. You make up your own rules, and you can make it protective and as happy as you want it to be. The outside world is completely different.”

One study conducted over nearly two years found that breast cancer patients with a propensity to engage in pleasant daydreams had a poorer prognosis than their more reality-based counterparts. So did women who reported fewer negative feelings.
²

According to another report on women with recurrent breast cancer, “Patients who reported little in the way of [psychological] stress … and who were rated by others as ‘well adjusted,’ were more likely to be dead at the one year follow-up.”
³