When the Body Says No: The Cost of Hidden Stress (7 page)

Like stress, emotion is a concept we often invoke without a precise sense of its meaning. And, like stress, emotions have several components. The psychologist Ross Buck distinguishes between three levels of emotional responses, which he calls Emotion I, Emotion II and Emotion III, classified according to the degree we are conscious of them.

Emotion III is the subjective experience, from within oneself. It is how we feel. In the experience of Emotion III there is conscious awareness of an emotional state, such as anger or joy or fear, and its accompanying bodily sensations.

Emotion II comprises our emotional displays as seen by others, with or without our awareness. It is signalled through body language—“non-verbal signals, mannerisms, tones of voices, gestures, facial expressions, brief touches, and even the timing of events and pauses between words. [They] may have physiologic consequences—often outside the awareness of the participants.”
¹⁰
It is quite common for a person to be oblivious to the emotions he is communicating, even though they are clearly read by those around him. Our expressions of Emotion II are what most affect other people, regardless of our intentions.

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. As Dr. Buck points out, a child whose parents punish or inhibit this acting-out of emotion will be conditioned to respond to similar emotions in the future by repression. The self-shutdown serves to prevent shame and rejection. Under such conditions, Buck writes, “emotional competence will be compromised…. The individual will not in the future know how to effectively handle the feelings and desires involved. The result would be a kind of helplessness.”
¹¹

The stress literature amply documents that helplessness, real or perceived, is a potent trigger for biological stress responses. Learned helplessness is a psychological state in which subjects do not extricate themselves from stressful situations even when they have the physical opportunity to do so. People often find themselves in situations of learned helplessness—for example, someone who feels stuck in a dysfunctional or even abusive relationship, in a stressful job or in a lifestyle that robs him or her of true freedom.

Emotion I comprises the physiological changes triggered by emotional stimuli, such as the nervous system discharges, hormonal output and immune changes that make up the flight-or-fight reaction in response to threat. These responses are not under conscious control, and they cannot be directly observed from the outside. They just happen. They may occur in the absence of subjective awareness or of emotional expression. Adaptive in the acute threat situation, these same stress responses are harmful when
they are triggered chronically without the individual’s being able to act in any way to defeat the perceived threat or to avoid it.

Self-regulation, writes Ross Buck, “involves in part the attainment of
emotional competence
, which is defined as the ability to deal in an appropriate and satisfactory way with one’s own feelings and desires.”
¹²
Emotional competence presupposes capacities often lacking in our society, where “cool”—the absence of emotion—is the prevailing ethic, where “don’t be so emotional” and “don’t be so sensitive” are what children often hear, and where rationality is generally considered to be the preferred antithesis of emotionality. The idealized cultural symbol of rationality is Mr. Spock, the emotionally crippled Vulcan character on
Star Trek
.

Emotional competence requires

• the capacity to feel our emotions, so that we are aware when we are experiencing stress;
  

• the ability to express our emotions effectively and thereby to assert our needs and to maintain the integrity of our emotional boundaries;
  

• the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past. What we want and demand from the world needs to conform to our present needs, not to unconscious, unsatisfied needs from childhood. If distinctions between past and present blur, we will perceive loss or the threat of loss where none exists; and
  

• the awareness of those genuine needs that do require satisfaction, rather than their repression for the sake of gaining the acceptance or approval of others.
  

Stress occurs in the absence of these criteria, and it leads to the disruption of homeostasis. Chronic disruption results in ill health. In each of the individual histories of illness in this book, one or more aspect of emotional competence was significantly compromised, usually in ways entirely unknown to the person involved.

Emotional competence is what we need to develop if we are to protect ourselves from the hidden stresses that create a risk to health, and it is what we need to regain if we are to heal. We need to foster emotional competence in our children, as the best preventive medicine.

  A
LEXA AND HER HUSBAND, PETER
, wanted a second opinion. A death sentence had been pronounced on her, and they hoped I would be able to repeal it. Alexa was an elementary teacher in her early forties. In the year preceding our meeting, the small muscles in her hands had begun to shrivel up and she had increasing difficulty grasping objects. She also suffered inexplicable falls. She sought advice from Dr. Gordon Neufeld, a noted developmental psychologist in British Columbia whom she had come to know through his consulting work in the school system. Believing it was “only stress,” she avoided considering a medical explanation.

Alexa forced herself to carry on with her professional duties; she struggled to maintain her routine beyond any reasonable point, well past the line most people would draw in taking care of themselves. “She worked incredibly long hours and was overextended,” Dr. Neufeld recalls. “I’ve never seen anybody push herself to the extent that she did.” Because she could barely hold pen or pencil, Alexa often stayed up long after midnight to complete her daily marking of student assignments. In the morning she would arise at five-thirty, in order to arrive at school early enough to scrawl the day’s lesson on the blackboard, the chalk gripped in her closed fist. As her condition deteriorated further, she finally accepted a referral to an international authority on amyotrophic lateral sclerosis, Dr. Andrew Eisen. Electrophysiological testing and clinical examination left no doubt in Dr. Eisen’s mind that the patient had ALS. At this point Peter and Alexa asked me to review the medical evidence, hoping I would discover something to challenge the specialist’s opinion—or, more precisely, hoping I would support their belief that
the symptoms were purely stress related. The diagnosis was irrefutable—as Dr. Eisen said, “a classic case.”

In ALS the motor neurons, nerve cells that initiate and control muscle movement, gradually die. Without electical discharges from the nerves, the muscles wither. As the Web site of the ALS Society explains: “
A-myotrophic
comes from the Greek language. ‘A’ means no or negative. ‘Myo’ refers to muscle, and ‘trophic’ means nourishment—‘No muscle nourishment.’ When a muscle has no nourishment, it ‘atrophies’ or wastes away. ‘Lateral’ identifies the areas in a person’s spinal cord where portions of the nerve cells that nourish the muscles are located. As this area degenerates it leads to scarring or hardening (‘sclerosis’) in the region.”

Initial symptoms depend on the area of the spinal cord or the brain stem where the disease first strikes: people may experience muscle twitching or cramps, loss of normal speech or difficulties swallowing. Mobility and limb movement are eventually lost, as is speech, swallowing and the capacity to move air in and out of the lungs. Despite a few reported cases of recovery, early death is usually inevitable. About 50 per cent of patients succumb within five years, although some may survive much longer. The British cosmologist Stephen Hawking, author of
A Brief History of Time
, has lived with the diagnosis for decades—for reasons that may emerge when we come to study his example. In contrast with other degenerative diseases of the nervous system, ALS patients lose muscle control without suffering intellectual decline. As a research paper by Suzannah Horgan, a Calgary psychologist, puts it, “Most stories from patients convey the strains of having to manage the combination of an intact mind and an impaired body.”
¹

What causes the neurological degeneration from ALS is not known. There is some evidence there may be immune system involvement, including a dysfunction of the cells in the nervous system that have an immune role. A class of cells called
microglia
serve a protective role in the brain, but when hyperstimulated they may become destructive. An article in
Scientific American
in 1995 cited tantalizing preliminary data pointing to microglia as possible participants in multiple sclerosis, Parkinson’s disease and ALS.
²

Alexa and Peter were striking in their desperation to think their way past their tragic situation. Peter, a retired engineer, would get
bogged down in arcane details of muscle electrophysiology, quoting research of dubious significance and proposing theories that would have made an expert’s hair stand on end. He would often interrupt his wife when I asked her a question; she, in turn, would cast sidelong glances at him, as if for approval, as she gave her answers. It was evident that he found the prospect of Alexa’s death unbearably frightening, and also that she appeared to deny the diagnosis more for his sake than her own. I felt as though I was engaged in conversation not with two separate individuals, but with one possessed of two bodies. “Alexa could not afford to think a separate thought,” says Dr. Neufeld. “She could not afford to say anything about Peter that would have indicated she was a separate person from him.”

Also painfully obvious was Alexa’s inability to speak emotional language. She simply had no vocabulary to express her feelings directly: any question related to emotion would be answered by thoughts, delivered in a hyperarticulate but confused fashion. She seemed to perceive the world through abstract ideas instead of felt experience. “All of the emotions seemed completely frozen,” confirms Neufeld.

What froze Alexa was her overwhelming fear of abandonment. Given up by her birth parents, she had never established a connection with her adoptive mother. “There was nothing in that relationship; it never worked,” says Dr. Neufeld, who came to know Alexa closely in her last three years of life. “The adoptive mother had another child whom she favoured, and there was nothing Alexa could do, try as she might. She became estranged as an adolescent, finally, because she gave up. Until then, she worked desperately to make a connection with her adoptive mother and couldn’t. It was a total vacuum. Alexa felt like there was a huge cavern where the sense of self should be.” Her first marriage quickly fell apart. She grew up believing she had to take care of everybody. “There was never any respite in her,” says Neufeld. “There was no internal resting place.”

In a 1970 research article, two psychiatrists at the Yale University School of Medicine, Walter Brown and Peter Mueller, recorded dramatically similar impressions of ALS patients. “They invariably evoked admiration and respect from all staff who came into contact with them,” wrote Drs. Brown and Mueller.
“Characteristic was their attempt to avoid asking for help.”
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This Yale study of ten patients employed
interviews, clinical evaluations and self-administered psychological tests. The authors concluded that people with ALS seemed to have two lifelong patterns distinguishing them: rigidly competent behaviour—that is, the inability to ask for or receive help, and the chronic exclusion of so-called negative feelings. “Hard, steady work without recourse to help from others was pervasive,” the study notes. There seemed to have been a “habitual denial, suppression or isolation of … fear, anxiety, and sadness…. Most expressed the necessity to be cheerful…. [Some] spoke casually of their deterioration or did so with engaging smiles.” The conclusions of this 1970 Yale paper were not confirmed by a study seven years later, at the Presbyterian Hospital in San Francisco. One might say the jury is out, except that the Yale study is consistent with everything that can possibly be read about ALS patients, observed about them, or told by clinicians working with them. Studies in psychology—an art trying desperately to dress itself up as a pure science—often find only what the particular researchers have the eyes to see.

“Why Are Patients with ALS So Nice?” was the title of an intriguing paper presented by neurologists from the Cleveland Clinic at an international symposium in Munich a few years ago.
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It discussed the impression of many clinicians that people with Lou Gehrig’s disease nearly all seem to “cluster at the MOST PLEASANT end” of the personality spectrum, in contrast to persons with other diseases.

At the Cleveland Clinic, a major referral centre for amyotrophic lateral sclerosis, the protocol for suspected ALS patients begins with electrodiagnostic testing (EDX). By measuring electrical conductivity, EDX detects the viability or death of motor neurons, the nerve cells that act on muscle fibres. Niceness is commonly perceived by staff to be a feature of the ALS personality, reports Dr. Asa J. Wilbourn, senior author of the paper. His article noted: “This occurs so consistently that whenever the EDX technologists have completed their work and deliver the results … they usually accompany it with some comment [e.g., ‘This patient cannot have ALS, he (or she) is not nice enough…. ’] In spite of the briefness of their contact with the patients, and the obvious unscientific method by which they form their opinions,
almost invariably these prove to be correct.”

“The interesting thing in Munich was that when we presented our paper, everybody came around,” says Dr. Wilbourn. “‘Oh yeah,’ people
commented, ‘I’ve noticed that—I’ve just never thought about it.’ It’s almost universal. It becomes common knowledge in the laboratory where you evaluate a lot of patients of ALS—and we do an enormous number of cases. I think that anyone who deals with ALS knows that this is a definite phenomenon.”