When the body says no

Learn the key information from Gabor Matés book ‘When the body says no’ about the hidden stresses of trauma.

Introducing the mindbody

“When we have been prevented from learning to say no’…‘our bodies may end up saying it for us.” (p 3, When the body says no, Penguin Random House, 2019)

So Gabor Maté writes in the beginning of his book. As a doctor he worked with patients with various mental and physical illnesses. Many of them could be traced back to childhood stresses and trauma.

Maté treated patients with all sorts of illnesses: multiple sclerosis, cancer, chronic fatigue syndrome, fibromyalgia, migraine, skin disorders, ailments of the bowel, endometriosis and many others.

Although their diseases and life circumstances seemed very different he found that none of his patients had ever learned to say no. Inability to say no and repression of emotions proved to be a key issue for most of his patients.

Maté realized that the approach to human health of Western medicine is deficient. It focuses on the physical body and its symptoms but if we want to understand our health we need to work with our WHOLE entity. Mind, body and emotions cannot be separated and should be conceived as one; a mindbody.

The PNI super system

How is the mind connected to the body? The immune system, nervous system, hormonal system and emotional centres in the brain are part of the same system, the PNI super system.

Since our emotions are part of this system experiencing and expressing them is vital to our health.

Emotional competence

The less emotionally competent we are the more likely we are to feel stress. We have a harder time setting boundaries and creating emotionally fulfilling relationships.

The role of emotions is to let in what is healthy and nurturing and to keep out what is not. The role of the immune system is the same. Both systems are part of the PNI super system or the mindbody. So when you repress your emotions you also repress your immune system. Your defense against disease goes down and your immune system no longer recognizes what is dangerous and toxic.

We see this in autoimmune disease. According to Maté people with autoimmune disease often have imbalanced stress-regulation with a big release of cortisol. Psychologically, they tend to be emotionally repressed and serve the needs of others before their own. Boundaries between themselves and others are blurred, a blurring that is believed to happen physiologically as well. The immune system cannot separate self from other and starts attacking itself.

Emotional repression and cancer

Cancer occurs if there is failure of DNA repair and impairment of the normal cell death in the body. Emotional repression and chronic stress have a negative impact on both of these processes.

Gabor Maté mentions several studies in which researchers have predicted the occurrence of cancer based on factors of emotional repression alone:

“In one study, psychologists interviewed patients admitted to hospital for breast biopsy, without knowing the pathology result. Researchers were able to predict the presence of cancer in up to 94 per cent of cases judging by such psychological factors alone.” (p 62, When the body says no, Penguin Random House, 2019) 

If we take a disease like lung cancer, smoking is one of the greatest risk factors. But smoking itself does not cause cancer. Other risk factors have to be present – otherwise every smoker would get lung cancer. A big risk factor is emotional repression.

A group of international researchers did a study on the psychological risk factors for cancer mortality. They picked the city Cvrenka for the study because it had a high mortality rate and because the stable population made it easy to follow up. The researchers picked about 1400 healthy adults and interviewed them with a questionnaire. It was about adverse life events, feelings of hopelessness and a hyper-rational, non-emotional coping style. They also recorded physical parameters like height, weight, blood pressure and smoking history.

Ten years later they did a follow-up on the study. They learned that 600 people had died of cancer, strokes, heart disease and other causes. The common denominator among the people who had died – especially of cancer – was a hyper rational, anti-emotional coping style, also called R/A.

Cancer incidence was 40 times higher in those who answered positively to 10 or 11 of the questions for anti-emotional coping style compared to the rest who answered positively to about 3 questions on average. Smokers had no incidence of lung cancer unless they also scored 10 or 11 on anti-emotional coping style.

The study shows that smoking works together with emotional repression to cause lung cancer. Still, all the thirty-eight people in Cvrenka who died of lung cancer were smokers. But for lung cancer to occur, tobacco alone was not enough.

Repression of emotions increases the likelihood for cancer because it exposes the person to more stress. Stress can potentiate cancer by harming the immune system and inner balance of the body.

The researchers of the Cvrenka study had also predicted who among their nearly fourteen hundred subjects would develop cancer and die of it. They based their predictions on characteristics of rationality/anti-emotionality and a long-lasting sense of hopelessness. Checking the death records ten years later, they had been right in 78 per cent of cases.

“It seems to us’, they commented, ‘that the importance of psychosomatic risk factors is likely to have been grossly underestimated in many studies.” (p 99, When the body says no)

What is stress?

Stress can be many things. It can be obvious stressors such as war, job loss or death in the family. But it can also be more subtle stressors that can be hard to detect.

Violation of boundaries and over-adjusting yourself to other people’s expectations causes internal stress. So does having a poor sense of yourself as an independent person. If you have a hard time sensing who you are it is difficult to get your needs met and set boundaries. It can also be difficult to form meaningful, supportive relationships, leading to loneliness, anxiety and overwhelm.

Healthy relationships and self-differentiation

In order to thrive we need healthy relationships with others. Emotionally fulfilling relationships in adult life require the ability to self-differentiate.

Self-differentiation:
Self-differentiation is the ability to define yourself as separate from others and autonomous in your emotions, whilst remaining in emotional contact with others. You are able to express your needs and emotions without tailoring them to fit other people’s needs. You neither repress emotions nor act them out impulsively.

A self-differentiated person is better able to self-regulate and self-soothe in case of stress or conflict. Suffice to say self-differentiated people are less stressed out and enjoy better overall health.

The less self-differentiated we are the more likely we are to experience stress in relationships. Conflict or separation can be very stressfull to a less self-differentiated person.

Lack of self-differentiation can lead to co-dependent relationships with others. These relationships lack boundaries and each person subconsciously wants the other to fulfill their needs without asking for it directly. It might even be difficult for each individual to know what they want.

Less self-differentiated individuals often have a great dependence on others for emotional regulation. The greater the dependence the greater the fear to lose someone or to make them upset. Therefore a person might try to please others to avoid stress and lose some of his autonomy in the process. But loss of autonomy is itself a source of stress and does not create healthy relationships. You will even have increased risk of illness due to the constant repressing of emotions and over-adapting to others.

Becoming independent and self-differentiated is a natural and important process. It is the process of becoming a healthy adult able to look after himself in a mature, confident way.

Childhood development sets the stage

Learning self-differentiation occurs – or fails to occur – during childhood.  

The human brain develops in the earliest years of childhood. By reading and interpreting the parents the child learns how safe or unsafe, how relaxed or stressful the world is. They carry that template with them into their life. The child ‘downloads’ the circuit of his parents into his own nervous system. If a child downloads a stressed out and dysregulated circuit, then that becomes the template of their own nervous system.

Vital for the healthy connection between parent and child is the process of attunement.

Attunement:
A process in which the parent ‘tunes in’ to the child’s emotional needs. It is an instinctual emotional connection where the parents read the signals of the child and respond to them adequately. Attunement regulates the nervous system of the child, signaling safety and connection.

If a parent cannot adequately attune to the child it can have long-term consequences such as attachment issues or heightened stress responses. This can bring about physical and mental illness. In fact, much childhood trauma comes not from hardcore abuse but from lack of attunement during those formative years.

Most parents do what they can to care for their child in a loving way. But they might be unable to attune to the child because of their own stresses or because they themselves were never attuned to by their parents. You cannot teach something you do not know. If you have never felt safe and relaxed in the world, you can unknowingly pass stress and attachment issues on to your children.

The family system

Many of Gabor Matés patients had a family history with generations of disease and of members of the same generation suffering from disparate illnesses. A primary cause is stress and trauma passed down through the generations. 

Physical and mental illnesses can be seen as disorders of the family emotional system. That system includes past and present generations. Each member of the family system has its own way of managing the disorder and hence its own disease: some suffer from autoimmune disease, others from cancer, another from alcoholism, some from depression and other mental health issues.

Disordered or dysfunctional family systems often have four characteristics: enmeshment, overprotectiveness or control, rigidity and lack of conflict resolution.

Enmeshment:
Enmeshment means weak boundaries between individuals or a lack of appreciation of individuality itself. Needs are met through control or manipulation instead of open communication

An enmeshed family coerces each member to give up their own individual needs and preferences in order to ‘serve’ the family system. The family system controls the individual and decides what is good and bad and which values you should live by. This happens in subtle, often subconscious, ways and can be hard to detect.

Consequently, individuals in enmeshed families mostly have poor self-differentiation. It can be hard for them to lead emotionally fulfilling lives causing increased risk of stress and disease.

Understanding the family system is not about placing blame. It is about understanding ourselves as part of a larger whole. Only then can we have a full picture of why we are struggling. The main goal is to create balance and understanding so that we can help ourselves in the best way possible.  

The power of (negative) thinking

According to Maté thinking negatively is an important part of healing. If we want to heal we need to look at the parts of our lives that are not working.

Positive thinking has a tendency to exclude the negative and unwanted. But genuine positivity needs to include our WHOLE being – including the difficult and the messy. So negative thinking is actually just thinking – without the adjective ‘positive’ in front.

Thinking negatively is not about being a pessimist or an eternal complainer. It means having the courage to look at every part of who we are. Negative thinking helps us understand how our life circumstances have shaped us.

One of the main aspects we need to look at is our relationships. This can be difficult because there can be conflicting emotions at play. We love our family but what if some of our family dynamics are unhealthy or downright abusive? How do we set boundaries with our loved ones while staying in a loving connection with them?  

In his medical practice Gabor Maté has seen how emotionally draining family relationships are a primary risk factor in most major illnesses. As part of a healing process it is therefore important to examine our close relationships of the past and the present. Not to blame our family members but to recognize unhealthy patterns in our relationships that are damaging to our health.    

The dilemma of anger

If we start to look at our close relationships we will encounter feelings of anger and aggression. Anger is a normal human emotion necessary to protect our boundaries. But the expression of anger towards loved ones can fill us with guilt and anxiety because it co-exists with feelings of love and the desire to stay connected. That is the big dilemma of anger. Perhaps it is the reason why so many people struggle to express it. 

But it is very important to be in touch with anger. If you cannot react when your boundaries are violated, you will likely experience a lot of stress over the years. On the other hand, you can do much damage to others by exploding with uncontrolled rage in moments of stress or conflict.

But what are we supposed to do then? How to resolve the dilemma of anger?

We need to find healthy ways to cope with anger. Repression of anger and the uncontrolled acting out are both imbalanced release of emotions. They represent the same thing: a fear of the genuine experience of anger.

Healthy anger is an experience of power and a mobilization to attack. It is a necessary experience that tells you that something is off. A boundary may have been violated or there may be some other threat. Allowing yourself to experience the anger gives you a chance to think: What has triggered the anger? How should I react?

You can choose to display the anger in some way or you can choose not to. The importance of healthy anger is that it leaves the individual – not the emotion – in charge.

Anger is an important tool in the toolbox of being a human. It is a friend not an enemy, as this quote beautifully expresses it:      

“‘Anger is the energy Mother Nature gives us as little kids to stand forward on our own behalf and say I MATTER,’…. ‘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.” (p 274, When the body says no)

The path to healing

Many factors work together in the causation of disease. Even when there are risk factors like biological heredity or unhealthy habits, no disease happens in isolation from its environment. Disease is a dynamic process between biological, psychological and social factors. We all live in an interchange of energy between these factors. If we want to heal we need to find new and healthier ways to relate to our environment and to others. 

According to Gabor Maté healing is about creating balance and becoming more whole. It is a holistic process that takes into account our whole life history and our life circumstances.

Healing can only happen as a free and informed choice and cannot be forced or pressured. We can choose the treatments we prefer. It can be conventional medicine, complementary healing, alternative methods like mind-body techniques, ancient Eastern practices like Ayurvedic medicine, yoga or acupuncture, meditation techniques, psychotherapy – the list could go on.

Ultimately, the wish to heal and the ability to change comes from within:

“Whatever 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.” (p 238, When the body says no)

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Learn more about how to heal and thrive in Gabor Matés Seven A’s of healing trauma