When the Body Says No: The Cost of Hidden Stress (42 page)

If a person unconsciously fears the power of his aggressive impulses, there are various forms of defence available to him. One category of defence is discharge, by which we regress to an early childhood state when we dealt with the intolerable buildup of anger by acting it out. “You see, the acting-out, the yelling, the screaming and even the hitting, all that a person does, serves as a defence against the experience of the anger. It’s a defence against keeping the anger inside where it can be deeply felt. Discharge defends against anger being actually experienced.”

The other way we can avoid the experience of anger is through repression. So repression and discharge are two sides of the same coin. Both represent fear and anxiety, and for that reason, both trigger physiological stress responses regardless of what we consciously feel or do not feel.

The paralyzing difficulty many people have with anger toward loved ones is illustrated repeatedly in the interviews we have seen. Jean, unable to tell her parents about being molested at age eleven, idealizes her relationship with them rather than acknowledge her anger. Her husband, Ed, has a corrosive resentment toward what he regards as controlling behaviour from his wife but cannot experience anger openly and directly. Jill, with ovarian cancer, is upset with her doctors for having missed the diagnosis but not at her husband, Chris, for having failed to notice her pain and weight loss over several months. Leslie, with ulcerative colitis, “swallowed” his anger toward his first wife. “No question about it. I couldn’t fight because then she would
say, ‘You see, this is a bad marriage.’” He is delighted to find himself in a marriage now where the experience of anger does not threaten the relationship.

The anxiety of anger and other “negative” emotions like sadness and rejection may become deeply bound in the body. Eventually it is transmuted into biological changes through the multiple and infinitely subtle cross-connections of the PNI apparatus, the unifying nexus of body/mind. This is the route that leads to organic disease. When anger is disarmed, so is the immune system. Or when the aggressive energy of anger is diverted inward, the immune system becomes confused. Our physiological defences no longer protect us or may even turn mutinous, attacking the body.

“It may prove valuable to regard cancer less as a disease than as a disorder in the body’s biochemical signals,” writes the psychotherapist Luis Ormont, who has worked with mobilizing people’s anger in group therapy with cancer patients. “To alter these signals is to produce an impact on the body’s immunological defenses. It would follow that any form of intervention designed to restore the body to physical health must use more than physical means. Since emotions dramatically influence the biochemical system, one way of providing immunotherapy is by giving psychotherapy to patients.”
⁸

People diagnosed with cancer or with autoimmune disease, with chronic fatigue or fibromyalgia, or with potentially debilitating neurological conditions, are often enjoined to relax, to think positively, to lower their stress levels. All that is good advice, but impossible to carry out if one of the major sources of stress is not clearly identified and dealt with: the internalization of anger.

Anger does not require hostile acting out. First and foremost, it is a physiological process to be experienced. Second, it has cognitive value—it provides essential information. Since anger does not exist in a vacuum, if I feel anger it must be in response to some perception on my part. It may be a response to loss or the threat of it in a personal relationship, or it may signal a real or threatened invasion of my boundaries. I am greatly empowered without harming anyone if I permit myself to experience the anger and to contemplate what may have triggered it. Depending on circumstances, I may choose to manifest the anger in some way or to let go of it. The key is that I have not suppressed the experience of it. I may choose
to display my anger as necessary in words or in deeds, but I do not need to act it out in a driven fashion as uncontrolled rage. Healthy anger leaves the individual, not the unbridled emotion, in charge.

“Anger is the energy Mother Nature gives us as little kids to stand forward on our own behalf and say
I
matter,” says the therapist Joann Peterson, who conducts workshops on Gabriola Island, in British Columbia. “The difference between the healthy energy of anger and the hurtful energy of emotional and physical violence is that anger respects boundaries. Standing forward on your own behalf does not invade anyone else’s boundaries.”

Illness not only has a history but also
tells
a history. It is a culmination of a lifelong history of struggle for self.

From a simple biological perspective, it may appear that the survival of the physical organism ought to be nature’s ultimate goal. It would seem, however, that the existence of an autonomous, self-regulating psyche is nature’s higher purpose. Mind and spirit can survive grievous physical injury, but time and again we see that the physical body begins to succumb when psychic integrity and freedom are jeopardized.

Jason has been an insulin-dependent diabetic since he was five.
Diabetes mellitus
derives its name from the Greek for “sweet urine,” for in this disease excess sugar is filtered by the kidneys from the bloodstream into the urine. In diabetes the gland cells of the pancreas are unable to produce enough insulin, the hormone required to help sugar from digested food to enter the cells. Apart from the immediate physiological risks of high glucose levels, diabetes involves potential damage to many organs of the body.

Now twenty-three, Jason is blind in his right eye from diabetes-induced vascular injury. He also suffers from weakened cardiac muscles, a leaking heart valve and malfunctioning kidneys. At times he is unable to walk, owing to a reversible nerve inflammation called diabetic neuropathy. Jason and his mother, Heather, were my patients for about ten years. In the past twelve months, he has had to be rushed to emergency repeatedly for medical crises including heart failure and meningitis. He
may not have many more years to live. According to his internal medicine specialist, his prognosis is “guarded.”

Heather is in a chronic state of anxiety and exhaustion mingled with resentment, which she believes are due to Jason’s stiff-necked refusal to take care of himself when it comes to eating the right kinds of food, paying close attention to his insulin requirements, attending medical appointments and having a healthy lifestyle. Of course, for a mother, the stakes are high. Her experience has been that when she does not take charge, Jason becomes ill. She has lived many years with the very real possibility that were she to relax her guard, even for a day, Jason could end up in a coma, or worse.

His most recent hospitalization followed a several-week bout of vomiting that left him weak, dehydrated and in convulsions. Heather was by his bedside one day when Jason had another seizure. “Nurses, residents and specialists came running,” she relates. “Jason’s eyes were rolling backward, and his arms and legs were shaking. They were injecting medications through the IV in his arm when he sat straight up, opened his eyes and looked straight at me. In a loud voice he said, ‘Let go!’ But I can’t let go. I will not let my son die.”

Jason does not recall the incident. “I must have been really out of it,” he says.

“Any idea what you might have meant?” I ask.

“The first thing that springs to mind is just to let me go. My saying ‘let me go’ would not have meant to let me die, just ‘stop being so overbearing. Let it go. Let me do what I’m going to do.’ It’s my life. I’ll make my mistakes, but my mom has got to let me do that. Being diabetic and having somebody else try to control me has been such a large part of my life.”

Whatever his mother’s motivation, and no matter how much he has manipulated her into taking care of him, Jason’s salient experience is of a lack of autonomy. He has had no capacity to assert himself openly. His yearning for an autonomous self and his anger towards his mother have taken the form of resistance—including resistance toward his own physical health. “It was always like suffocation,” he told Heather. “No matter what I did, it seemed to be wrong. When I said ‘let go,’ it would have meant ‘just back off. Let me live the way I’m going to live. I’m going to live my way, and of course I’m going to
make mistakes—everybody does. I never felt free to make my own mistakes.”

If there is one lesson to draw from the history of Jason and Heather, as from all the personal stories and all the studies we have considered in this book, it is that people suffer when their boundaries are blurred. By treating Jason all his life like a child for whom she must assume all responsibility, Heather has helped to hold him back from real person-hood. By reacting like a child, Jason has held himself back.

In the final analysis, disease itself is a boundary question. When we look at the research that predicts who is likely to become ill, we find that the people at greatest risk are those who experienced the most severe boundary invasions before they were able to construct an autonomous sense of self. In 1998,
The American Journal of Preventive Medicine
published the results of the Adverse Childhood Experiences (ACE) study. There were over ninety-five hundred adult participants in this research project. Childhood stressors such as emotional or sexual abuse, violence, drug use or mental illness in the family were correlated with adult risk behaviours, health outcomes and death. There was a “strong graded relationship” between dysfunction in the family of origin and adult health status—that is, the greater the exposure to dysfunction had been in childhood, the worse the health status was in the adult and the greater were the chances of untimely death from cancer, heart disease, injury or other causes.
⁹

Most commonly in the lives of children, boundaries are not so much violated as simply not constructed in the first place. Many parents cannot help their child develop boundaries because they themselves were never enabled to do so in their own formative years.
We can only do what we know
.

Without a clear boundary between himself and his parent, the child remains enmeshed in the relationship. That enmeshment is later a template for his way of connecting to the rest of the world. Enmeshment—what Dr. Michael Kerr called a lack of differentiation—comes to dominate one’s intimate relationships. It can take two forms, withdrawal and sullen and self-defeating resistance to authority, like Jason’s, or chronic and compulsive caretaking of others, like Heather’s. In some people the two may co-exist, depending on with whom they happen to be interacting at the moment. Since the immune confusion that leads to disease
reflects a failure to distinguish self from non-self, healing has to involve establishing or reclaiming the boundaries of an autonomous self.

“Boundaries and autonomy are essential for health,” said the therapist and group leader Joann Peterson during our recent conversation on Gabriola Island. She is director of education at PD Seminars, a holistic healing and psychological growth centre. “We experience life through our bodies. If we are not able to articulate our life experience, our bodies speak what our minds and mouths cannot.”

“A personal boundary,” according to Dr. Peterson, “is an energetic experience of myself or the other person. I don’t want to use the word
aura
because it is a new-age kind of word, but beyond where skin ends we have an energetic expression. We not only communicate boundaries verbally, but I think we have an energetic expression that is non-verbal.” In her book
Anger, Boundaries, and Safety
, Dr. Peterson explains this concept in greater detail: “Boundaries are invisible, the result of a conscious, internal felt sense defining who I am. Asking yourself, ‘In my life and relationships, what do I desire, want more of, or less of, or what don’t I want, what are my stated limits?’ begins the process…. In this self-definition, we define what we value and want in life at this particular time from a place of internal self-reference;
the locus of control is from inside ourselves
.”

Autonomy, then, is the development of that internal centre of control.

Attachment is our connection with the world. In the earliest attachment relationships, we gain or lose the ability to stay open, self-nurturing and healthy. In those early attachment bonds, we learned to experience anger or to fear it and repress it. There we developed our sense of autonomy or suffered its atrophy. Connection is also vital to healing. Study after study concludes that people without social contact—the lonely ones—are at greatest risk for illness. People who enjoy genuine emotional support face a better prognosis, no matter what the disease.

Ever since a small nodule was found on his prostate fourteen years ago, seventy-one-year-old Derek has had annual PSA tests done. Two years ago he had a biopsy showing cancerous cells. “The oncologist said
I was high risk, and he scared me. So I agreed to take six months of hormone therapy, which reduces the tumour. It kills your testosterone completely. You have to get a shot every three months. After the hormone treatment, the oncologist wanted to start radiation for seven weeks. I said no, I don’t want this, because I’ve read so much about it. Radiation and surgery temporarily fix the problem, but after three to five years, it often comes back. And the radiation destroys so much … so many good cells in your body, besides the bad ones.”

“What did you go through emotionally when you were diagnosed?”

“Well, you see, that has been the problem with me. I didn’t tell anybody. I didn’t tell any of my friends. I kept it all to myself, except for my wife and my two daughters.

“Before, I was a recluse. I was very private. Now, I’m very open. I love lots of people around me. Before, I didn’t. I was perfectly happy to find a cave with a lock on the door, and I could live there happily for the rest of my life. My priorities have all changed. Before, I built steam locomotives for a hobby. I used to spend sixteen hours a day in my workshop doing that, and I was absolutely happy. Now, I haven’t been in my workshop for two years, since I got cancer.