When the Body Says No:
Understanding the Stress-Disease Connection
The Vancouver-based Dr. Gabor Maté argues that too many doctors seem to have forgotten what was once a commonplace assumption—that emotions are deeply implicated in both the development of illness and in the restoration of health. Based on medical studies and his own experience with chronically ill patients at the Palliative Care Unit at Vancouver Hospital, where he was the medical coordinator for seven years, Dr. Gabor Maté makes the case that there are important links between the mind and the immune system. He found that stress and individual emotional makeup play critical roles in an array of diseases including cancer, heart disease, diabetes, irritable bowel syndrome, multiple sclerosis and arthritis.
Amy Goodman of www.DemocracyNow.org interviews Dr. Gabor Mate:
Dr. Gabor Maté, Vancouver, Canada-based physician and author. He is staff physician at the Portland Hotel Society, which runs a residence and harm reduction facility as well as Insite, North America’s only supervised safe-injection site. His four books, all bestsellers in Canada, include Scattered: How Attention Deficit Disorder Originates and What You Can Do About It, When the Body Says No, and his latest, In the Realm of Hungry Ghosts: Close Encounters with Addiction.
AMY GOODMAN: Healthcare reform may be stalled in Congress, but we turn now to an issue that rarely comes up in discussions about improving our healthcare system. The relationship between emotional stress and disease, between mental an physical health, more broadly, is often considered controversial within medical orthodoxy. But my next guest argues not all aspects of illness can be reduced to facts verified by the strictest scientific techniques.
Welcome to Democracy Now!, Dr. Maté. Let’s talk about this connection between stress, the mind-body connection.
DR. GABOR MATÉ: You know, the traditional medicines of China for 3,000 years, the ayurvedic medicine of India, and the tribal shamanic medicines of all cultures around the world have always taken for granted that mind and body can’t be separated. Now, Western medicine has cleaved the two apart for, really, 2,000 years. Socrates already criticized the doctors of his day for separating the mind from the body. And the irony—in fact, the tragedy—is that now we have the Western science that shows, incontrovertibly and in great detail, that mind and body can’t be separated, and so that any attempt to do so leaves the medical practitioner short of many tools to help clients. And, of course, it leaves patients short of what they need for their own healing.
The point now is that the emotional centers of the brain, which regulate our behaviors and our responses and our reactions, are physiologically connected with—and we know exactly how they’re connected—with the immune system, the nervous system and the hormonal apparatus. In fact, it’s no longer possible, scientifically, to speak of these as separate systems, as if immunity was separate from emotions, as if the nervous system was separate from the hormonal apparatus. There’s one system, and they’re wired together by the nervous system itself and joined together by chemical messengers that they all secrete, and so that whatever happens emotionally has an impact immunologically, and vice versa. So, for example, we know now that the white cells in the circulation of our—of the blood can manufacture every hormone that the brain can manufacture, and vice versa, so that the brain and the immune system are always talking to one another.
So, in short, we have one system. The science that studies it is called psychoneuroimmunology. And scientifically, it’s not even controversial, but it’s completely lacking from medical practice.
AMY GOODMAN: What do you mean, Dr. Maté, by the mind-body—by the Bermuda Triangle?
DR. GABOR MATÉ: Well, the Bermuda Triangle is that the research is done. For example, let me give you a couple of examples. Three years ago or four years ago, a study presented at the Heart and Stroke Foundation’s International Congress on Women’s Health, a study that was written up in the online version of a major North American medical journal called Circulation, showed that women—over a ten-year period, they followed 1,700 women—over a ten-year period, women who were unhappily married and didn’t express their emotions were four times as likely to die as those women who were unhappily married and did express their feelings. In other words, the non-expression of emotion was associated with a 400 percent increase in the death rate. And this study was done in the States, part of a major population study.
Now, you would think that study would send every physician in North America trying to figure out the mind-body connection. But these studies get published, and they sink without a trace. There was a study two years ago that showed that children of mothers who are stressed and depressed are themselves, the children, are more likely to have asthma. Again, the mind-body connection. You’d think that study alone would send every physician running to figure out the mind-body connection. But again, these studies are done; they disappear without a trace, and they have no impact on medical practice. And that’s what I mean by the Bermuda Triangle, is that we have the research; we just don’t pay attention to it, as like if it never happened.
AMY GOODMAN: You talk about emotions like anger sharing with our immune system the same role of defending our boundaries, saying when we repress emotions, we may also repress our immune defenses. How does that play out in various diseases?
DR. GABOR MATÉ: Well, when I looked at the kind of people that would be coming under my care in palliative care, but also the kind of people who would get sick when I was in family practice, a number of salient characteristics presented themselves. One was the repression of anger. People didn’t know how to express negative emotion. They were afraid to do so or did not know when they were angry. People who were pleasers, they tried to always not to disappoint other people. They never knew how to say no. They took on everything without a murmur, because they saw their role as always being the caregivers and the caretakers. And they had an exceedingly powerful sense of duty, role and responsibility.
Now, if you look at the role of healthy assertion of boundaries and anger, for example, it’s actually there to protect you. I’m talking about healthy anger. It’s not there to attack anybody; it’s just there to protect your boundaries. That’s the same role as the immune system have. The immune system also functions like a brain. It has memory, it has reactive capacity, and it has learning capacity. In fact, the immune system has been called the “floating brain.” And it’s in interaction with the brain up in our heads.
Now, women, for example, with breast cancer, who don’t know how to express anger, they’ve been shown to have diminished activity of a group of immune cells called natural killer cells. Natural killer cells attack foreign bacteria, virus and also malignant cells. have been able to increase the natural killer cells. In other words, they protect our boundaries. Women who don’t know how to express their boundaries emotionally, they suppress their boundaries immunologically, and therefore they’re more likely to develop disease. The same is true, of course, of men, so that the immune system is in constant interaction with our emotional responses.
In another study with the immune system, medical students under the stress of examination were found to have diminished activity of their natural killer cells, these immune cells. But those students who were emotionally isolated were most likely to have diminished activity of their immune system. In other words, another fact that’s important is our relationship with other people. And the Los Angeles UCLA psychiatrist, Dr. Daniel Siegel, has coined a phrase “interpersonal neurobiology,” to indicate that our biology of our brains, but indeed of our whole bodies, is in interaction with our personal relationships. So how we express ourselves in those relationships, or how we suppress ourselves, has a lot to do with our health.
AMY GOODMAN: You talk particularly about autoimmune diseases and their connection—well, that mind-body connection, like, for example, rheumatoid arthritis.
DR. GABOR MATÉ: A case example I give in the book is a young woman who was preparing Rosh Hashanah dinner one night for the family, Rosh Hashanah being the Jewish new year that falls in September. I called her “Rachel” in the book. And she was working very hard. She was at her mother’s place cooking dinner, and she was in a real hurry, because she had to finish by 5:00, when her brother was going to arrive with his family, and he didn’t like her. He didn’t want to be at the dinner. So she had to finish the dinner and leave before he arrived. And I asked her, “Are you serious? You’re making dinner for a family that you’re not going to take part in yourself? Why?” And she said, “Well, because the family should be together for Rosh Hashanah, shouldn’t they?”
Well, she never finished the meal. Her body said no. She came down with severe inflammation in all her joints, and she was rushed to the hospital with her first malignant outbreak of rheumatoid arthritis. And that self-suppression is typical for people that develop rheumatoid arthritis.
It’s also typical for people that develop ALS, amyotrophic lateral sclerosis. I talk about the example of Lou Gehrig, if I may tell you about that. Lou Gehrig was this great baseball player, a teammate of Babe Ruth’s on the New York Yankees. And he set a record for consecutive games played that stood for nearly sixty years. Now, Gehrig wasn’t just a great athlete. He was also dutiful. He—it’s not that he was never hurt. At one point, his hands were x-rayed. It turns out his fingers had been fractured seventeen separate times. And his teammates described him as grimacing like a mad monkey in agony when he fielded the ball. But he never took himself out of a game, because he was too dutiful to his own self-image and also to the fans and to the owners. Now, that sense of responsibility, and not looking after yourself, is totally typical of everybody who develops ALS.
And it goes back to their childhoods, because, just like with the woman with rheumatoid arthritis, she was a failure the moment she was born, because her mother conceived her to keep the marriage together with the father. The marriage broke up, and she never had the feeling that she was accepted and liked for who she was, therefore she had to become this dutiful caregiver. Lou Gehrig’s father was an alcoholic, and Gehrig learned very early in life that he had to take care of others, as the children of alcoholics often do. And that then became his pattern until he could no longer drag himself around the baseball diamond because of the ALS, which in North America, of course, is known as Lou Gehrig’s disease.
AMY GOODMAN: We’re talking to Dr. Gabor Maté, the author of four bestselling books. His most recent isIn the Realm of Hungry Ghosts: Close Encounters with Addiction, which we talked about two weeks ago onDemocracy Now! Today we’re talking about an earlier book, When the Body Says No: Understanding the Stress-Disease Connection.
Can you talk about children, when it comes to this? And then expand, because, Gabor, a few weeks ago we were talking about addictions, and that’s both, what, heroin addiction, but expanding it to other addictions, as well, and the role of childhood. And in doing this, though you talked about it before, talk about your own.
DR. GABOR MATÉ: Well, again, in the book When the Body Says No, I give the example of my visiting my mother one day in a nursing home. My mother had muscular dystrophy, which is a degenerative disease of the muscles. It’s hereditary, runs in our family. And so, she could no longer walk, get out of bed, even feed herself very well, so she was in a nursing home, mentally completely with it and emotionally very strong.
So I’m walking down the hall of the nursing home that day, and I’m limping a little bit. And why am I limping? Because that morning I had arthroscopic surgery on my knee, which I had to have because I tore up cartilage in my knee jogging on cement. So I have a little bit of a limp that afternoon. When I get to my mother’s room, I suppress the limp. The limp disappears. I walk to her bed nonchalantly, greet her, we have a lovely visit. I walk out of the room with a perfectly normal gait, and when I shut the door behind me, my limp begins again.
And only later on did I think, “What am I doing here?” It wasn’t conscious. I didn’t do it deliberately. Of course, clearly, I was trying to protect my mom from the awareness of my pain. Now, my mother, at age seventy-eight, did not need to be protected from the fact that her middle-age son had to be with a limp the day of surgery. It was a childhood-ingrained mechanism going back, again, to my first year of life in the ghetto of Budapest, when, as I mentioned in my first visit to your program, we lived under Nazi occupation, a Jewish family. My father was away in forced labor. My mother was a highly stressed woman, trying to do her best to ensure my and her survival, which she was barely able to do. I learned as an infant to suppress my pain to protect her from it, because she already had too much, in order to protect my relationship with her. Now, those emotional patterns are ingrained in children from early on. And although I have no recollection of that time in my life, the memory of it lives in my cells and lives in my brain and shows up in my interactions with people, including in that example of trying to protect my mother.
So, the point is that human beings are shaped very early by what happens to them in life. As a matter of fact, they’re shaped already by what happens in uterus. After 9/11, after the World Trade disasters in those terrorist attacks, some women who were pregnant suffered PTSD, post-traumatic stress disorder. And depending on what stage of pregnancy they suffered the PTSD, when they measured their children’s cortisol levels—cortisol being a body stress hormone—at one year of age, those kids had abnormal cortisol levels. In other words, their stress apparatus had been negatively affected by the mother’s stress during pregnancy. Similarly, for example, when I looked at the stress hormone levels of the children of Holocaust survivors with PTSD, the greater the degree of PTSD of the parent, the higher the stress hormone level of the child.
So, how we see the world, whether the world is a hostile or friendly place, whether we have to always do for ourselves and look after others or whether we can actually expect and receive help from the world, whether or not the world is hostile or friendly, and indeed our stress physiology, is very much shaped by those early experiences. And that’s then what we act out much of our lives, and that’s then what interferes and affects our health later on.
The implication of this, Amy, for treatment is that when somebody comes in with a first episode of rheumatoid arthritis or multiple sclerosis, or even a diagnosis of cancer, it’s not enough to give them pills. It’s not enough to give them radiation or offer them surgery. They should also be talked to and invited to and encouraged to investigate how they live their lives and how they stress themselves, because I can tell you from personal experience and observation that people who do that, who take a broader approach to their own health, they actually do a lot better. And I know people who have survived supposedly terminal diagnoses simply because they’ve taken their own mind-body unity, and I would say spiritual unity, as well, seriously, and they’ve gone beyond a narrow medical model of treatment. And I’m not here to disparage the value of the medical approach in which I was trained. I’m just saying that it’s hopelessly narrow, and it leaves many people without appropriate treatment and appropriate support.
AMY GOODMAN: Dr. Gabor Maté, you talk about adverse childhood—adverse childhood stresses as ACEs—
DR. GABOR MATÉ: Yes, there was a—
AMY GOODMAN: —and their connection also to addiction, this latest book that you have written, In the Realm of Hungry Ghosts.
DR. GABOR MATÉ: There was a number of large-scale studies in the United States done by very brilliant researchers called the ACE studies, A-C-E, adverse childhood experiences. An adverse childhood experience is a child being abused or violence in the family or a parent being jailed or extreme stress of poverty or a rancorous divorce, a parent being addicted, alcoholic and so on.
When it comes to addiction, these effects are addictive, so that if a child has a number of these adverse childhood experiences, his chance of becoming a drug addict later on, or any kind of an addict, go up exponentially. So a male child with six such adverse childhood experiences has a 4,600 percent increase in the risk of him becoming an injection-using substance addict than a male child with no such experiences—in other words, a forty-six-fold increase in the risk.
And interestingly enough, those adverse childhood experiences also exponentially increase the risk of cancer and high blood pressure and heart disease and a whole range of other diseases, as well as suicide, of course, and early death. In other words, there’s a real connection between early childhood adversity and how a person lives their lives and a later appearance of addiction and diseases, physical and of course mental illnesses at the same time.
And if we don’t take this into account in medicine—most of the time, people are not asked about these things in doctors’ offices, and they’re not explored. They’re not encouraged to explore their childhoods and the kind of impact that the childhood has on their adult behaviors.
AMY GOODMAN: As we wrap up this part of our discussion, what do you think are the most useful ways people can deal with stress, with the mind-body connection, both people themselves and also what doctors should be telling their patients, or what patients should be telling their doctors?
DR. GABOR MATÉ: The body has many ways of saying no: almost any symptom, a stomach ache, a back spasm, a headache, nausea, dry mouth, poor sleep, muscle tension. I’m talking about relatively minor symptoms. These are all ways of the body saying no. As of course are the more severe conditions, like psoriasis or ulcerative colitis, all the ones that I’ve already mentioned. These are all ways of the body saying no.
We need to, first of all, to say and pay attention to what the body is saying to us. So if we have a symptom, don’t just go to the doctor and say, “Take this symptom away from me”—yeah, ask for help—but also explore what the body is saying no to. Usually you’ll find that in your life you’ve taken on too much, you’re suppressing yourself, you’re trying to please others too much. You’re living life along patterns that don’t express who you really are. So the symptom or the disease ought to be not just something that you want to get rid of; it ought to be the beginning of an exploration and investigation of how you live your life and how you might possibly live your life differently, in a more healthy fashion.
AMY GOODMAN: And do you think modern medicine is dealing better, Western medicine, with this, with the mind-body connection?
DR. GABOR MATÉ: There are encouraging signs. There’s certainly people like Jon Kabat-Zinn, who talks about stress and mindfulness, and Andrew Weil, who talks about the importance of nutrition and a more holistic approach. So there are many people doing great work.
But if I look at the profession as a whole, we’re doing a dismal job. And we’re spending billions of dollars on researches into cancer and so on that are never going to get us anywhere, because we ignore the life stresses that very often, if they don’t by themselves cause, they certainly contribute in a major way to the onset of disease. But we’re not looking at them. We’re not dealing with them. And we’re leaving people without the appropriate tools to restore their own health.
AMY GOODMAN: Dr. Gabor Maté, I want to thank you for being with us again, from Vancouver today, as we break the sound barrier. He is a bestselling author in Canada, now bringing him to the United States. The book we’re talking about, When the Body Says No: Understanding the Stress-Disease Connection. His most recent book, just out, is called In the Realm of Hungry Ghosts: Close Encounters with Addiction.