Monday, August 12, 2013

This Book Changed My Life: When The Body Says No

When we have been prevented from learning how to say no, our bodies may end up saying it for us.
Why do some people get sick, become disabled, or even die from diseases like cancer, ALS, Alzheimer's, while others with the same exposure to environmental toxins never get sick? Why do some people get cancer that goes into remission, and others, like my mother, die from it?
Studies at the US National Cancer Institute found that natural killer (NK) cells, an important class of immune cells we have already met, are more active in breast cancer patients who were able to express anger, to adopt a fighting stance and who have more social support.... The researchers found that emotional factors and social involvement were more important to survival than the degree of disease itself.

I am still working to absorb and learn the many lessons this book presents, both for myself as a human being, as a daughter trying to come to terms with the death of my mother and of others I've loved, and (probably least importantly) as a writer trying to create believable characters.

We often treat our bodies as if they are separate from our hearts, minds, and emotions, kind of like a biological automobile. As if a health "breakdown" is a purely mechanical problem that can be fixed by diet, exercise, the right pills, and adjusting air pressure in the tires.

Reality: Emotions affect the body.

Watch a scary movie. Even though you are in no physical danger, doesn't your heart pound, your breath get tight in your chest? Read a sexy novel. If it's good enough, you'll feel rigidity in certain body parts, wetness in others. Receive a gift. From your partner, tickets for a dream vacation may make you feel happy and excited; from your cat, a squirming rat may make you feel queasy.

When the Body Says NO examines studies and examples of psychoneuroimmunoendocrinology: the way the body's nervous system, immune defenses and endocrine or hormonal apparatus all work together. (Called the PNI system in short, because psychoneuroimmunoendocrinology is a mouthful.) It looks at patients for whom Dr. Maté has consulted, as well as more famous case studies, from Stephen Hawking (ALS) to Betty Ford (substance abuse, breast cancer) to Gilda Radner (ovarian cancer, bulimia) to Ronald Reagan (Alzheimer's).

Stress - More Than A Feelin'

Stress consists of the internal alterations – physical or not – that occur when the organism perceives a threat to its existence or well-being.
Stress - if a bear appears - can save your life. Stress triggers the PNI system to send, "Let's get the hell out of Dodge!" or "Stand and fight!" messages throughout the body.

Just like circulation to the extremities will shut down in freezing temperatures, because you can survive without a toe, or two, stress (temporarily) shuts down the systems that kill cancer cells or other long-term threats, process food products in the digestive tract, and more. Like Scotty on Star Trek diverting all energies to the warp drive, your body gives "all she's got, Captain" where it thinks it will be needed, on a totally automatic level.
The stress response is nonspecific. It may be triggered in reaction to any attack – physical, biological, chemical or psychological – or in response to any perception of attacker threat, conscious or unconscious. The essence of threat is a destabilization of the body’s homeostasis, the relatively narrow range of physiological conditions within which the organism can survive and function. To facilitate fight or escape, what needs to be diverted from the internal organs and muscles, and the heart needs to pump faster.

Whenever stress occurs, even when we don't consciously feel stressed, changes occur in our bodies.

Stress, as we will define it, it is not a matter of subjective feeling. It is a measurable set of objective physiological events in the body, involving the brain, the hormonal apparatus, the immune system and many other organs. Both animals and people can experience stress with no awareness of its presence.

That whole "with no awareness of its presence" aspect cannot be overemphasized. The physiological effect on the body is the same whether we are aware or unaware of stress. Especially for children who experience recurring stress, the state of being stressed can become the New Normal.
Eventually, having unmet needs or having to meet the needs of others is no longer experienced as stressful. It feels normal. One is disarmed.

Recurring or chronic stress (such as being an abused child, or watching a parent be habitually abused by his/her partner, while being unable to intervene), being neglected, leaves permanent marks, both on the immune system and other bodily defenses (think of the story of the Boy Who Cried Wolf), and in the relationship patterns we form later in life. We are more likely to choose life partners whose behaviors mirror those we knew growing up, whether those behaviors were healthy or unhealthy.
For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaninglessness. People may become addicted to their own stress hormones, adrenaline and cortisol... To such persons stress feels desirable, while the absence of it feels like something to be avoided.
Chronic stress actually changes the way our brains function.
In people who’ve experienced chronic stress, the prefrontal cortex and related structures remain in a state of hypervigilance, on the lookout for danger. Pre-frontal activation is not a conscious decision by the individual; rather, it is the result of the automatic triggering of nerves pathways program long ago.
In situations where the body's balance is continually disrupted in response to a perceived threat, the balance of the body is thrown out of whack, And whenever that happens, cancer, or other long-term diseases, have the perfect opening to take over.

Natural Born Killers - The Body's Best Friend

In a healthy body, there are NK cells, which serve as the body's Angels of Death.

Just like in any factory, the body frequently produces cells which which would be labeled abnormal or flawed, but inside the body, there is no TJ Maxx or Nordstrom's Rack to send "irregular" material.

NK cells track down abnormal cells, such as cancer cells and destroys them, so that the majority of cells in the body are healthy and functional.

There have been many cases where the NK cells have caused full remission of cancer, most significantly in cases of melanoma (skin cancer). Why this cancer and not others? Why in some cases and not others? It can't be wholly attributed to DNA, environmental toxins (or lack thereof), but to family systems and work environment systems.

When the Body Says No refers to several studies in which tiny clumps of cancer are often found in an elderly person's body after death from other causes. Perhaps as we age we all have tiny clusters of cancer growing in our bodies, which our NK cells routinely eliminate before they are large enough to be detected.
In short, for cancer causation it is not enough that DNA damage occur: also necessary is failure of DNA repair and/or an impairment of regulated cell death. Stress and the repression of emotion can negatively affect both of those processes.

The Blame Game

One thing that has made me uneasy in reading similar books, such as Louise Hay's You Can Heal Your Life, is my perception (or misperception, perhaps) that the victim was being blamed for his/her own illness. Dr. Maté debunks that idea:
Blaming the sufferer – apart from being morally obtuse – is completely unfounded from a scientific point of view.
He doesn't even jump on the easy way many shrinks do - it's all the mothers' fault. While he acknowledges that hurts/patterns learned during childhood or generationally may have a lasting effect:
Emotionally draining family relationships have been identified as risk factors in virtually every category of major illness, degenerative neurological conditions to cancer and autoimmune disease. The purpose is not to blame parents or previous generations or spouses but to enable us to discard beliefs that prove dangerous to our health.

The point of doing so is that we can recognize and interrupt those patterns, rather than repeat them.

We are not doomed, the helpless victims of our genes and environmental toxins and terrible childhoods, destined to get sick and not be able to do anything about it. I think that's a good message.

Differentiation: Dance Space of Champions

Remember the wonderful rehearsal scene in Dirty Dancing where Johnny (Patrick Swayze) explains to Baby (Jennifer Grey) "This is my dance space, that is your dance space"? Everyone needs good physical and emotional boundaries to be healthy.

When we are born, we have no boundaries. We assume the whole world, including Mother, revolves around US. We don't understand or realize that Mother is a separate being, that she doesn't feel our hunger, wet diaper, tummy cramps at the same instance we feel them.
A fundamental concept in family systems theory is differentiation, defined as “the ability to be in emotional contact with others yet still autonomous in one's emotional functioning.” The poorly differentiated person “lacks an emotional boundary between himself and others and lacks a ‘boundary’ that prevents his thinking process from being overwhelmed by his emotional feeling process. He automatically absorbs anxiety from others and generates considerable anxiety within himself.”
Later, we realize that when we are scared, hurt, cold, etc., Mother doesn't necessarily share our feelings. Just as we don't share her feelings. But in some cases, we will be emotionally enmeshed with Mother (or Father) and take on the role of protecting her:
The child of an unhappy mother will try to take care of her by suppressing his distress so as not to burden her further. His role is to be self-sufficient and not “needy”...

What it all boils down to is a lack of clear boundaries.

Boundaries are that thing that says: 
This is my dance space, this is your dance space. 

When boundaries get confused within the body itself, when the body cannot recognize, "This is ME; this is Other," then we get diseases where the body's immune system doesn't defend against intruders, but is so confused it attacks its own cells, as is the case in MS, ALS, schleroderma, and other auto-immune diseases.

Anger - The Emotion We Love to Hate

Especially as women, we are socially conditioned to think of anger as a "negative" emotion. If we are "nice girls/women," we won't get angry with people.
“I never get angry,” a Woody Allen character says in one of his movies, “I grow a tumor instead.” Throughout this book we've seen the truth of that droll remark in numerous studies of cancer patients.

Here's the problem: we can't control being angry. Anger, according to this and other research, is the natural reaction of an organism to perceived loss, or threat of loss. Picture an angry wild animal warning another off his/her kill (see the bear, above). Usually animals do not fight to the death over a meal or a mate, but the creature with the biggest display of anger wins. "I won't let you take this from me" is the message.

Being angry is not about being a Mean Girl. It is not about going into a rage.
If you ask in physical, physiological terms what they are experiencing in their body when they feel rage, for the most part, people describe anxiety in one form or another.

Allowing oneself to feel angry in the appropriate circumstances can be an empowering experience.
The repression of anger and the unregulated acting out of it are both examples of the abnormal release of emotions that is at the root of disease.... The real experience of anger “is physiologic experience without acting out. The experience is one of a surge of power going through the system along with the mobilization to attack. There is, simultaneously the complete disappearance of all anxiety.”
I had just finished reading When the Body Says No, when in October 2012, my super-kind, beautiful friend Sidney Patrick died of a heart attack, in large part due to cirrhosis of the liver. She was 43.

She epitomized the disease-sufferer profiled within this book; swallowing feelings with food, drugs, or alcohol, always being kind and supportive of everyone but herself.
The inability to process and express feelings effectively, and the tendency to serve the needs of others before even considering one’s own, are common patterns in people who develop chronic illness. These coping styles represent a blurring of boundaries, the confusion of self and non-self on the psychological level.

I remember telling Sid's mother, shortly after Sid passed, "I am so angry." I was hurt, I was grieving, but over all, I felt so angry at the waste, at being deprived of my friend, who I loved and needed.

I remember so many conversations with Sid; whenever the subject would turn to her, she would divert the conversation as swiftly as possible to other people. She was wholly uncomfortable addressing her own needs, hurts, and dreams. Her long-term boyfriend was mentally ill, often called her names and verbally abused her, even when she was in the hospital, yet she did not want to be cruel enough to "abandon" him.

She did, belatedly, realize that something had to change. After being released from the hospital in August 2012, she told me,"If I stay with him, it's going to kill me."

That is the exact same feeling I had, after being diagnosed in 2009 with "unusual" breast lumps and cysts, which spurred me to break with my then-boyfriend in 2010.

Sadly, Sid was right. She left him in September 2012. If only she had left a month or two earlier...

Betty Ford, Betty Koschin Diehl, and Breast Cancer

Betty Ford was, of course, the first Lady of the United States of America, wife of a fairly ambitious politician. My mother, Betty Koschin Diehl was, comparatively, a nobody; eldest daughter in a family of four children. She signed up to serve in the military (Coast Guard) during WWII, as did many women. Besides the name, both women were diagnosed with breast cancer in the same approximate era, and received similar medical treatment.
Research has suggested for decades that women are more prone to develop breast cancer if their childhoods were characterized by emotional disconnection from their parents or other disturbances in their upbringing; if they tend to repress emotions, particularly anger; if they lack nurturing social relationships in adulthood; and if they are the altruistic, compulsively caregiving types.
Betty Ford's mother was a perfectionist; Betty never felt as though she measured up to her mother's standards. Betty Koschin's mother: also harsh and demanding.
The emotional repression, the harsh self judgment and the perfectionism Betty Ford acquired as a child, through no fault of her own, are more than a “good recipe for alcoholism.” They are also a “good recipe” for cancer of the breast.
Both Betty's had husbands whose professional and emotional needs came first. My mother suppressed anger, definitely, though her husband was a "rager." Altruistic, compulsively caregiving - yep. Additionally, in her last year of life, my father decided to transplant our family to another state, away from my mother's supportive network of family and friends.

My mother's breast cancer, which had been in remission, returned, and killed her. She was 49.

Emotional Competence - Who Dat?

The goal of When the Body Says No, and life, isn't to whine about what a raw deal we got (think about that scene in Slumdog Millionaire where the way out is through the outhouse), but figure out what tools we do have, and work toward becoming emotionally competent. Regardless of how we were raised, we can do this.

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 the situations 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 the repression for the sake of gaining the acceptance or approval of others.

We may have had little control about what happened to us as children, but we can take control of how we handle our emotions now. By taking control, that doesn't mean pretending life is all kittens and rainbows, or suppressing "negative" emotions like anger or fear, but learning to recognize what we feel, when we feel it.

When the Body Says No closes with seven specific "A" areas of healing:Acceptance, Awareness, Anger:
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, where 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.
Autonomy, Attachment, Assertion, and Affirmation.

As I stated, I am working to institute these changes in how I deal with emotions in my own life, and looking to integrate this kind of emotional journey in my fictional characters.

Have you read this book? What did you think?
How do you deal with anger?
Do you suppress any emotions (that you know of)?