Contents

1: The Bermuda Triangle

2: The Little Girl Too Good to Be True

3: Stress and Emotional Competence

4: Buried Alive

5: Never Good Enough

6: You Are Part of This Too, Mom

7: Stress, Hormones, Repression and Cancer

8: Something Good Comes Out of This

9: Is There a “Cancer Personality”?

10: The 55 Per Cent Solution

11: It’s All in Her Head

12: I Shall Die First from the Top

13: Self or Non-Self: The Immune System Confused

14: A Fine Balance: The Biology of Relationships

15: The Biology of Loss

16: The Dance of Generations

17: The Biology of Belief

18: The Power of Negative Thinking

19: The Seven A’s of Healing

1: The Bermuda Triangle

In scleroderma, the immune system’s suicidal assault results in a stiffening of the skin, esophagus, heart, and tissues in the lungs and elsewhere. Medical textbooks take an exclusively biological view. In a few isolated cases, toxins are mentioned as causative factors, but for the most part a genetic predisposition is assumed to be largely responsible.

• A patient of his started out with Raynaud’s, which resulted in the scleroderma. In this situation, he realized that she had emotional trauma and never felt worthy of attention. She also compulsively took the responsibility for the needs of others.
• It’s almost as if her inability to say no was forcing her body to revolt and say it for her.

The more specialized doctors become, the more they know about a body part or organ and the less they tend to understand the human being in whom that part or organ resides.

We can’t deny the benefits of the application of scientific methods. But not all essential information can be confirmed in the laboratory or by statistical analysis. Not all aspects of illness can be reduced to facts verified by double-blind studies and by the strictest scientific techniques. “Medicine tells us as much about the meaningful performance of healing, suffering and dying as chemical analysis tells us about the aesthetic value of pottery,” Ivan Ilyich wrote.

Psychoneuroimmunology: the science of the interactions of mind and body, the indissoluble unity of emotions and physiology in human development and throughout life in health and illness.

Our immune system does not exist in isolation from daily experience. For example, the immune defences that normally function in healthy young people have been shown to be suppressed in medical students under the pressure of final examinations. Also, the loneliest students suffered the greatest hit to their immune system.

Stress is a complicated cascade of physical and biochemical responses to powerful emotional stimuli. Physiologically, emotions are themselves electrical, chemical and hormonal discharges of the human nervous system. Emotions influence—and are influenced by—the functioning of our major organs, the integrity of our immune defences and the workings of the many circulating biological substances that help govern the body’s physical states. When emotions are repressed, this inhibition disarms the body’s defences against illness. Repression—dissociating emotions from awareness and relegating them to the unconscious realm—disorganizes and confuses our physiological defences so that in some people these defences go awry, becoming the destroyers of health rather than its protectors (inflammation and autoimmune disorders I assume).

He observed the same patterns in people treated for multiple sclerosis, ALS, inflammatory ailments of the bowel such as ulcerative colitis and Crohn’s disease, chronic fatigue syndrome, autoimmune disorders, fibromyalgia, migraine, skin disorders, endometriosis and many other conditions. In important areas of their lives, almost none of his patients with serious disease had ever learned to say no.

While all of us dread being blamed, we all would wish to be more responsible—that is, to have the ability to respond with awareness to the circumstances of our lives rather than just reacting. We want to be the authoritative person in our own lives: in charge, able to make the authentic decisions that affect us. There is no true responsibility without awareness.

One of the weaknesses of the Western medical approach is that we have made the physician the only authority, with the patient too often a mere recipient of the treatment or cure.

In healthy mother-infant interactions, the mother is able to nourish without the infant’s having in any way to work for what he receives.

2: The Little Girl Too Good to Be True

Multiple sclerosis is the most common of the demyelinating diseases that impair the functioning of cells in the central nervous system. Its symptoms depend on where the inflammation and scarring occur. The main areas attacked are usually the spinal cord, the brain stem and the optic nerve, which is the bundle of nerve fibres carrying visual information to the brain. If the site of damage is somewhere in the spinal cord, the symptoms will be numbness, pain or other unpleasant sensations in the limbs or trunk. There may also be involuntary tightening of the muscles or weakness. In the lower part of the brain, the loss of myelin can induce double vision or problems with speech or balance. Patients with optic neuritis—inflammation of the optic nerve—suffer temporary visual loss. Fatigue is a common symptom, a sense of overwhelming exhaustion far beyond ordinary tiredness.

Patients burdened by qualitatively extreme stresses, such as major relationship difficulties or financial insecurity, were almost four times as likely to suffer exacerbations.

The French neurologist Jean-Martin Charcot was first to give a full clinical description of multiple sclerosis. Patients, he reported in a lecture in 1868, connect “long continued grief or vexation” with the onset of symptoms. Five years later a British physician described a case also associated with stress: “Aetiologically it is important to mention another statement the poor creature made when giving a more confidential account to the nurse—that the cause of her disease was having caught her husband in bed with another woman.”

Excessive emotional involvement with a parent, a lack of psychological independence, an overwhelming need for love and affection, and the inability to feel or express anger have long been identified as possible factors in the development of the disease. A study in 1958 found that in nearly 90% of cases, patients experienced traumatic life events that “threatened their security system.”

“The common characteristic is the gradual realization of the inability to cope with a difficult situation… provoking feelings of inadequacy or failure,” said the authors of a 1969 study.

The blurring of psychological boundaries during childhood becomes a significant source of future physiological stress in the adult. There are ongoing negative effects on the body’s hormonal and immune systems, since people with indistinct personal boundaries live with stress; it’s a permanent part of their daily experience to be encroached upon by others.

Even people who have all the necessary genes for MS require environmental factors to trigger it.

The fundamental problem is not the external stress, but an environmentally conditioned helplessness that permits neither of the normal responses of fight or flight. The resulting internal stress becomes repressed and therefore invisible. Eventually, having unmet needs or having to meet the needs of others is no longer experienced as stressful. It feels normal. One is disarmed.

Artistic expression by itself is only a form of acting out emotions, not a way of working them through.

3: Stress and Emotional Competence

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, Hans Selye observed. To such persons, stress feels desirable, while the absence of it feels like something to be avoided.

Stress consists of the internal alterations that occur when the organism perceives a threat to its existence or well-being. While nervous tension may be a component of stress, one can be stressed without feeling tension. On the other hand, it is possible to feel tension without activating the physiological mechanisms of stress.

Excessive stress occurs when the demands made on an organism exceed that organism’s reasonable capacities to fulfill them. The stress response can be set off by physical damage, either infection or injury. It can also be triggered by emotional trauma or the threat of it.

Excessive acid production due to stress and disordered neural input from the autonomic nervous system play a role in reflux.

The experience of stress has three components:

• An event, physical or emotional, that the organism interprets as threatening. This is the stress stimulus, also called the stressor.
• The processing system that experiences and interprets the meaning of the stressor. In the case of human beings, this processing system is the nervous system, in particular the brain.
• The stress response, which consists of the various physiological and behavioral adjustments made as a reaction to a perceived threat.

Selye discovered that the biology of stress predominantly affected the adrenal glands, the spleen, the thymus and lymph glands, and the intestinal lining.

On the perception of a threat, the hypothalamus in the brain stem releases corticotropin-releasing hormone (CRH), which travels a short distance to the pituitary. Stimulated by CRH, the pituitary releases adrenocorticotrophic hormone (ACTH).

ACTH is in turn carried by the blood to the adrenals. Here ACTH acts on the adrenal cortex. Stimulated by ACTH, this gland now secretes the corticoid hormones, the chief among them being cortisol.

Cortisol acts on almost every tissue in the body one way or another—from the brain to the immune system, from the bones to the intestines. The immediate effects of cortisol are to dampen the stress reaction, decreasing immune activity to keep it within safe bounds.

Selye’s triad of adrenal enlargement, lymphoid tissue shrinkage and intestinal ulcerations are due, then, to the enhancing effect of ACTH on the adrenal, the inhibiting effect of cortisol on the immune system and the ulcerating effect of cortisol on the intestines.

• People who are prescribed cortisol-type drugs in treatment for, say, asthma, colitis, arthritis or cancer are at risk for intestinal bleeding.
• Cortisol also has powerful bone-thinning actions. Depressed people secrete high levels of cortisol, which is why stressed and depressed postmenopausal women are more likely to develop osteoporosis and hip fractures.

To facilitate fight or flight, blood needs to be diverted from the internal organs to the muscles, and the heart needs to pump faster. The brain needs to focus on the threat, forgetting about hunger or sexual drive. Stored energy supplies need to be mobilized, in the form of sugar molecules. The immune cells must be activated. Adrenaline, cortisol and the other stress substances fulfill those tasks.

All stressors represent the absence of something that the organism perceives as necessary for survival—or its threatened loss. The threatened loss of food supply is a major stressor and for humans there is also the threatened loss of love.

Three factors universally lead to stress:

• Uncertainty
• The lack of information
• The loss of control.

All three are present in the lives of individuals with chronic illness. For some people, it is disease that finally shatters the illusion of control.

Stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart.

• Stressed Alzheimer’s caregiver’s levels of NK cells were suppressed as well as the efficacy of immunization to influenza. There is also a delay in tissue repair.

Emotion III: Subjective experience from within oneself.

Emotion II: Emotional displays as seen by others. Nonverbal signals.

• 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 will be a kind of helplessness.
• 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: Physiological changes triggered by emotional stimuli, such as nervous system discharges, hormonal output, and immune changes that make up fight or flight reaction. Not under conscious control or externally visible.

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;
• 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.

4: Buried Alive

In ALS motor neurons gradually die. Without electrical discharges from the nerves, the muscles wither. 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. About 50 per cent of patients succumb within five years, although some may survive much longer.

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. Microglia serve a protective role in the brain, but when hyperstimulated they may become destructive.

The patient in this example seemed to have frozen emotional expression. She was given up by her birth parents and could never make a connection with her birth mother no matter how she tried. She felt there was a huge cavern where her sense of self should be. She also grew up believing she needed to take care of everyone.

Characteristic of other ALS patients, they attempt to avoid asking for help. Rigidly competent behavior, inability to ask for or receive help, and the chronic exclusion of so-called negative feelings.

“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.” Emotional repression—in most cases expressed as niceness.

Characterizing the personalities of ALS patients are relentless self-drive, reluctance to acknowledge the need for help and the denial of pain whether physical or emotional. All these behaviors and psychological coping mechanisms predate the onset of illness. The conspicuous niceness of most persons with ALS is an expression of a self-imposed image that needs to conform to the individual’s (and the world’s) expectations. The individual seems trapped in a role, even when the role causes further harm. It is adopted where a strong sense of self should be—a strong sense of self that could not develop under early childhood conditions of emotional barrenness. In people with a weak sense of self, there is often an unhealthy fusion with others.

One of the only traits ALSers seem to share is an energetic past. In almost every case, victims were either classic over-achievers or chronic workaholics.

For the child it is no relief to feel sadness or anger if no one is there to receive those emotions and to provide some comfort and containment. Everything had to be held in rigidly. The physical rigidity of ALS may well be a consequence. There is perhaps only so much energy the nervous system can expend pushing down powerful emotions that cry out for expression. At some point in particularly susceptible individuals, it seems reasonable to suppose, nerves may lose the ability to renew themselves. Could ALS be a result of an exhausted nervous system no longer being capable of replenishing itself?

Rage and anguish exist underneath the veneer of niceness, no matter how sincerely a person mistakes the facade for her true self.

Strong convictions do not necessarily signal a powerful sense of self: very often quite the opposite. Intensely held beliefs may be no more than a person’s unconscious effort to build a sense of self to fill what, underneath, is experienced as a vacuum.

Given the nature of ALS as a disease that destroys the body while leaving the intellect intact, an abstract thinker is in an ideal position to “live a life of the mind.” Prior to Stephen Hawking’s diagnosis and its attendant debility, he had been somewhat aimless, his shining intellectual gifts notwithstanding.

The young Stephen, it appears, was the chosen bearer of the frustrated ambitions of his father who was evidently determined that his son would succeed at educational and social goals he, the father, had never quite attained.

Stephen engaged in a fair bit of indolence and alcohol consumption, with avoidance of classes or studying—those classic forms of passive resistance in college. It was only after his diagnosis that he began to focus his phenomenal intelligence on his work: elucidating the nature of the cosmos, bridging the theoretical gaps between Einsteinian relativity theory and quantum mechanics.

Without the subordination of Jane’s life and independent strivings to his, Stephen likely would not have survived, let alone succeeded to such a spectacular degree. She was the ever-available, unspeaking and compliant mother/nanny figure whose services are expected, taken for granted and noticed only in their absence.

Hawking’s vocation and the unstinting support of his wife were accompanied by the liberation of his aggression by his illness. The “niceness” of most ALS patients represents more than the innate goodness and sweetness of some human beings; it is an emotion in extremis. It is magnified out of healthy proportion by a powerful suppression of assertiveness.

According to Dr. Northrup, her friend healed through the conscious daily practice of emotional self-inventory and of self-love that, little by little, “unfroze” each part of her body.

5: Never Good Enough

Breast cancer patients often report that their doctors do not express an active interest in them as individuals or in the social and emotional context in which they live. The assumption is that these factors have no significant role in either the origins or the treatment of disease. That attitude is reinforced by narrowly conceived psychological research.

Only a small minority of women are at high genetic risk for breast cancer and only a small minority of women with breast cancer—about 7 per cent—acquire the disease for genetic reasons.

One of the chief ways that emotions act biologically in cancer causation is through the effect of hormones. Some hormones, such as estrogen, encourage tumor growth. Others enhance development by reducing the immune system’s capacity to destroy malignant cells. Hormone production is intimately affected by psychological stress.

Natural killer (NK) cells are more active in breast cancer patients who are able to express anger, to adopt a fighting stance and who have more social support. NK cells mount an attack on malignant cells and are able to destroy them. These women had significantly less spread of their breast cancer, compared with those who exhibited a less assertive attitude or who had fewer nurturing social connections. The researchers found that emotional factors and social involvement were more important to survival than the degree of disease itself.

In most cases of breast cancer, the stresses are hidden and chronic. They stem from childhood experiences, early emotional programming and unconscious psychological coping styles. They accumulate over a lifetime to make someone susceptible to disease.

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.

• Researchers were able to predict the presence of cancer in up to 94 per cent of cases judging by such psychological factors alone. In a similar German study, forty women with breast cancer were matched with forty controls similar in age, general health history and lifestyle considerations. Again, on psychological grounds the researchers were 96 per cent successful in identifying who was and who was not diagnosed with breast cancer.

About 1 per cent of breast cancer patients are males. Their emotional histories parallel those of the women with the same disease. David Yeandle, a Toronto policeman, has had four separate cancers: in one of his kidneys, his breast and twice in his bladder. His upbringing was also characterized by a lack of warmth.

• “Dad was never there to talk to, and I certainly wouldn’t discuss it with my mother, because her favourite expression was ‘Oh, you’re being silly.’ I never showed anger with my parents. It was something you just didn’t do. I hold a lot of anger inside me.”
• “Our principal finding was a significant association between the diagnosis of breast cancer and a behaviour pattern, persisting throughout adult life, of abnormal release of emotions. This abnormality was, in most cases, extreme suppression of anger and, in patients over 40, extreme suppression of other feelings.”
• A 1952 psychoanalytic evaluation of women with breast cancer had come to similar conclusions. These patients were said to demonstrate “an inability to discharge or deal appropriately with anger, aggressiveness, or hostility (which, in turn, was masked by a facade of pleasantness).” The researchers felt that patients’ unresolved conflicts were “manifested through denial and unrealistic self-sacrificing behaviours.”

Repression of anger increases the risk for cancer for the very practical reason that it magnifies exposure to physiological stress. If people are not able to recognize intrusion, or are unable to assert themselves even when they do see a violation, they are likely to experience repeatedly the damage brought on by stress. Stress is a physiological response to a perceived threat, physical or emotional, whether or not the individual is immediately aware of the perception.

Even in the small minority of cases where it is a major predisposing factor, heredity cannot by itself explain who gets breast cancer and who does not.

The straightforward connection between childhood experience and adult stress has been missed by so many researchers over so many years that one almost begins to wonder if the oversight is deliberate. Adults with a history of troubled childhoods may not encounter more serious losses than others do, but their ability to cope will have been impaired by their upbringing.

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.

6: You Are Part of This Too, Mom

In the example in this chapter, the mother grew up feeling like she got second hand love because her mother said she seemed emotionally independent, she jumped between relationships, her child was sensitive and often sick, and her daughter also got addicted to narcotics up to her breast cancer diagnosis. Very little stability in either of their lives, despite them both being intelligent.

Their relationship seemed to involve the daughter frequently getting angry at her mother but repressing it out of defeat and frustration. The daughter appeared disappointed in the mother and may have been abused and her mother wasn’t there. Their personalities clashed too. The daughter was quiet and holistic and the mother seen as judgmental and rash.

The nature of stress is not always external stress of war, financial trouble, or somebody dying. It is actually the internal stress of having to adjust oneself to somebody else. Cancer, ALS, MS, and rheumatoid arthritis appear to happen to people who have a poor sense of themselves as independent persons. They can be accomplished in the arts or intellectually and yet still suffer from the poor sense of self. They live in reaction to others without ever sensing who they are.

Some children who have an emotionally deprived upbringing develop intelligence and “adultlike” maturity to survive. Her child was, good, precocious, and intellectually mature. She became her mother’s sounding board upon reaching the age of abstract thought. The mother’s needs become more important so any trauma suffered by the child is hidden to protect the mother. When the reality is, the child’s role is not to keep peace.

The parent needs to address their own pain before they are able to see their child’s. Sometimes a person may feel unloved because they emotionally detach from pain. The mother in this story repressed her own pain to become emotionally independent when she realized she wasn’t getting enough love from her own mother. Her family was big and it seemed the other siblings needed more attention. She also couldn’t confront her mother about her hatred for her father. Didn’t want to rock the boat. Creating a sense of abandonment without realizing it.

When a woman marries an immature man, they spend their openness and energy on mothering the husband and have nothing left for the children.

Nightmares in children are potentially an expression of not feeling protected or connected enough. They are our deepest anxieties.

All these generations of people going through emotional pain can result in the culmination of disease in future offspring.

7: Stress, Hormones, Repression and Cancer

Smoking no more causes lung cancer than being thrown into deep water causes drowning. Smoking vastly increases the risk of cancer, not only of the lung but also of the bladder, the throat and other organs. But logic alone tells that us it cannot, by itself, cause any of these malignancies. If A causes B, then every time A is present, B should follow. If B does not follow A consistently, then A cannot, by itself, be the cause of B—even if, in most cases, it might be a major and perhaps necessary contributing factor. If smoking caused lung cancer, every smoker would develop the disease.

Kissen supported his clinical impressions that people with lung cancer “have poor and restricted outlets for the expression of emotion, as compared with non-malignancy lung patients and normal controls.” The risk of lung cancer, Kissen found, was five times higher in men who lacked the ability to express emotion effectively.

• Those lung cancer patients who smoked but did not inhale exhibited even greater repression of emotion than those who did. Kissen’s observations implied that emotional repression works synergistically with smoking in the causation of lung cancer. The more severe the repression, the less the smoke damage required to result in cancer.

While smoking is a huge risk factor, for lung cancer to occur, tobacco alone is not enough: emotional repression must somehow potentiate the effects of smoke damage on the body.

The immune centers—previously thought of as acted on only by hormones—are extensively supplied with nerves. The so-called primary immune organs are the bone marrow and the thymus gland, located in the upper chest in front of the heart. Immune cells maturing in the bone marrow or in the thymus travel to the secondary lymph organs, including the spleen and the lymph glands. Fibers issuing from the central nervous system supply both primary and secondary lymph organs, allowing instant communication from the brain to the immune system. The hormone-producing endocrine glands are also directly wired to the central nervous system. Thus, the brain can “talk” directly to the thyroid and adrenal glands, or to the testes and ovaries and other organs.

Cytokines, secreted by immune cells, can induce the feelings of fever, loss of appetite, fatigue and increased need for sleep. Distressing as they are, such rapid adaptations are designed to conserve energy, helping us to overcome illness. Inappropriate secretion of the same substances, however, would interfere with normal functioning—for example, by causing excessive fatigue or chronic fatigue.

Lymph cells and other white blood cells are capable of manufacturing nearly all the hormones and messenger substances produced in the brain and nervous system. Even endorphins, the body’s intrinsic morphine-like mood-altering chemicals and painkillers, can be secreted by lymphocytes. And these immune cells also have receptors for the hormones and other molecules originating in the brain.

It is through the activation of the HPA axis that both psychological and physical stimuli set in motion the body’s responses to threat. Psychological stimuli are first evaluated in the emotional centers known as the limbic system, which includes parts of the cerebral cortex and also deeper brain structures. If the brain interprets the incoming information as threatening, the hypothalamus will induce the pituitary to secrete an adrenocorticotropic hormone. ACTH, in turn, causes the cortex of the adrenal gland to secrete cortisol.

Simultaneously with this hormonal cascade, the hypothalamus sends messages via the sympathetic nervous system to the medulla. The adrenal medulla manufactures and secretes adrenalin, which immediately stimulates the cardiovascular and nervous systems.

“Psychological factors such as uncertainty, conflict, lack of control, and lack of information are considered the most stressful stimuli and strongly activate the HPA axis. Sense of control and consummatory behavior result in immediate suppression of HPA activity.”

• Consummatory behavior is behavior that removes the danger or relieves the tension caused by it. We recall that stress-inducing stimuli are not always objective external threats like predators or potential physical disasters but also include internal perceptions that something we consider essential is lacking. This is why lack of control, lack of information—and, as we will see, unsatisfied emotional needs (e.g., lack of love), trigger the HPA axis. Consummation of such needs abolishes the stress response.

The mechanistic view holds that cancer results from damage to the DNA of a cell by some noxious substance—for example, tobacco breakdown products. This perspective is valid but cannot explain why some smokers develop cancers while others do not, even if the amount and type of tobacco they inhale are exactly the same.

• Why are the cells of some individuals more susceptible than those of others? Why does DNA repair occur in some people but not in others? Why do the immune system and other defenses keep cancer at bay in some people but not in others? What accounts for vast differences in cure or disease progression from one person to the next, even when the identical cancer is diagnosed at exactly the same stage and even when all other factors – age, gender, income, general health – are exactly matched.

Tobacco smoke has a directly damaging effect on the genetic material of lung cells. It is estimated that for the initiation of cancer, the lung cells must acquire as many as 10 separate lesions or points of damage to their DNA. However, most lesions are transient and eliminated by DNA repair or cell death.

Ohio State University College of Medicine wrote: “Faulty DNA repair is associated with an increased incidence of cancer. Stress may alter these DNA repair mechanisms; for example, in one study, lymphocytes from psychiatric inpatients with higher depressive symptoms demonstrated impairment in their ability to repair cellular DNA damaged by exposure to X-irradiation.”

• Apoptosis ensures normal tissue turnover, culling older cells with weakened genetic material, leaving room for their healthy and vigorous offspring. “Dysregulated apoptosis contributes to many pathologies, including tumor production, autoimmune and immunodeficiency diseases, and neurodegenerative disorders.”

Perpetually abnormal steroid hormone levels can interfere with normal programmed cell death. Also participating in cell death are NK cells. Depression—a mental state in which repression of anger dominates emotional functioning—interacts with cigarette smoking to lower the activity of NK cells.

In short, for cancer causation it is not enough that DNA damage occur: also necessary are failure of DNA repair and/or an impairment of regulated cell death. Stress and the repression of emotion can negatively affect both of these processes.

Hormone-dependent cancer cells bear on their membranes receptors for various hormones capable of promoting cell growth. It is generally understood that many breast cancers are estrogen dependent, this being the rationale for the use of the estrogen-blocking drug tamoxifen. Less well known is that some breast cancers have receptors for a broad array of other “information substances,” including androgens (male sex hormones), progestins, prolactin, insulin, vitamin D and several more—all of them secreted by the HPA axis or regulated by it.

Cancers of the female gynecological organs such as the ovaries and the uterus are also hormone related. Ovarian malignancy is only the seventh most common cancer in women, but it is the fourth leading cause of cancer deaths. Of all cancers, it carries the highest tumor-to-death ratio.

• Since infertility is one of the known risk indicators for ovarian cancer, hormonal factors are obviously important. Unfortunately, the picture is confusing. Early menses and late menopause increase the risk of developing ovarian cancer, while pregnancies and the birth control pill decrease it. This pattern would suggest that the more women ovulate, the more susceptible they become to the disease. On the other hand, infertility—when no ovulation takes place—also adds to the risk. U-shaped curve like all stress responses.

Eating patterns are directly connected with emotional issues arising both from childhood and from current stresses. The patterns of how we eat or don’t eat, and how much we eat, are strongly related to the levels of stress we experience and to the coping responses we have developed in face of life’s vicissitudes. In turn, dietary habits intimately affect the functioning of the hormones that influence the female reproductive tract. Anorexics, for example, will often stop menstruating.

Malignancies of the hematological (blood-cell producing) system such as leukemia and lymphoma are also hormone dependent, being profoundly affected by cortisol produced in the adrenal gland. Adrenal corticoid hormones inhibit the division and spread of leukemia and lymphoma cells. Thus, hematological malignancies may, in part, result when blood and lymph cells escape from normal inhibition owing to a chronically unbalanced HPA system.

• A fifteen-year study of people who developed lymphoma or leukemia reportedly found that these malignancies were “apt to occur in a setting of emotional loss or separation which in turn brought about feelings of anxiety, sadness, anger or hopelessness.”
• The amount of cortisol-like hormone needed to block the replication of leukemic cells is only a little higher than what should normally be functionally available in the body. In the case of leukemia, episodes of acute stress in which the cortisol levels temporarily rise are sometimes enough to induce a remission.

It is customary to conceive of cancer as an invader against whom the body must wage war. Such a view, while perhaps comforting in its simplicity, is a distortion of reality.

• First, even when there is an external carcinogen like tobacco, the cancer itself is partially an outcome of internal processes gone wrong. And, of course, for most cancers there is no such identified carcinogen.
• Second, it is the internal environment, locally and throughout the entire organism, that plays the major role in deciding whether the malignancy will flourish or be eliminated.
• The malignant transformation of normal cells, in other words, is a process determined by many factors that have at least as much to do with the biopsychosocial state of the organism as with the type of cancer itself.

Once a cancer reaches the stage where its cell surfaces display molecules different from the normal body proteins, it should be destroyed by the immune system. T-cells should attack it with noxious chemicals; antibodies should be formed against it; specialized blood cells should chew it up. Under conditions of chronic stress, the immune system may become too confused to recognize mutated cell clones that form cancer or too debilitated to mount an attack.

The cancer cell itself may even secrete growth factors, inhibitory substances, and messenger molecules to promote tumor growth.

For a tumor to become clinically noticeable, even on an easily accessible body tissue like the skin or the breast, it has to become about half a gram in size, comprising about five hundred million cells. A single cell with a malignant mutation would have to double about thirty times to reach such dimensions.

• In breast cancer, doubling time has been calculated to range from a few days to one and one-half years, with an average of about four months. “If a tumour cell were to grow constantly at the last rate, it would take about eight years to become clinically evident, and some sources suggest an even longer doubling time with a time span of about 15–20 years to become clinically evident.”
• There are broad fluctuations in growth rate depending on what is happening in the life of the host.
• Microscopic spread of malignant cells seems to happen in many cases of breast cancer without ever causing clinical problems. In other cases, the metastatic deposit may lie dormant in distant tissues for years and then, unexpectedly, declare itself in the form of symptoms. The same dynamic operates with prostate cancer, which is why spread has already occurred in 40 per cent of prostate malignancies by the time the diagnosis is made.

In numerous studies of cancer, the most consistently identified risk factor is the inability to express emotion, particularly the feelings associated with anger. The repression of anger is not an abstract emotional trait that mysteriously leads to disease. It is a major risk factor because it increases physiological stress on the organism. It does not act alone but in conjunction with other risk factors that are likely to accompany it, such as hopelessness and lack of social support. The person who does not feel or express “negative” emotion will be isolated even if surrounded by friends, because his real self is not seen. The sense of hopelessness follows from the chronic inability to be true to oneself on the deepest level. And hopelessness leads to helplessness, since nothing one can do is perceived as making any difference.

8: Something Good Comes Out of This

The three major types of treatment currently offered for prostate cancer: surgery, radiation, or chemotherapy. Some get through without harm, others suffer unpleasant consequences such as urinary incontinence and impotence.

The loud public campaigns urging men to undergo screening tests for prostate cancer by means of the rectal digital exam or the prostate specific antigen (PSA) blood tests have no proven scientific basis.

• In places where screening is widely practiced, the incidence of diagnosed prostate cancer goes up, and the number of men being treated increases, but the death rate from prostatic malignancy remains unchanged. If anything, prostate cancer mortality rates were slightly higher in the intensely screened areas.
• Also disturbing are findings published in The Journal of the National Cancer Institute, that men aggressively treated for prostate cancer had a higher chance of dying of other cancers than men who did not receive any medical intervention.

Few doctors are willing to let nature take its course in the face of potential disease, even if the value of intervention is questionable. And men, even if well informed, may choose to “do something” rather than tolerate the anxiety of inaction. But patients always deserve to be told what is known about prostate cancer—and, just as important, all that remains unknown.

Orchidectomy, the surgical removal of the testicles, remains part of the treatment arsenal, as does the administration of powerful medications blocking the effects of the male hormones.

By their thirties, many men will have some cancerous cells in their prostate, and by their eighties, the majority are found to have them. By the age of fifty, a man has a 42 per cent chance of developing prostate cancer. Yet relatively few men at any age will progress to the point of overt clinical disease. In other words, the presence of cancerous prostate cells is not unusual even in younger men, and it becomes the norm as men get older. Only in a minority does it progress to the formation of a tumor that causes symptoms or threatens life.

As with estrogen receptors in breast cancer, it appears the sensitivity of tumor cells to normal concentrations of testosterone must have been altered.

Gonadal function is affected by psychological states in both men and women. In depressed men, the secretion of testosterone and other hormones connected with sexual function were significantly diminished. As were those who were fans of a losing football match vs the rising testosterone in the fans of the winning team.

A holistic approach that places the person at the center, rather than the blood test or the pathology report, takes into account an individual life history. It encourages people to examine carefully each of the stresses they face, both those in their environment and those generated internally. In this scenario the diagnosis of prostate cancer could serve as a wake-up call rather than simply a threat. In addition to whatever treatment they may or may not choose to receive, men who are encouraged to respond reflectively, taking into account every aspect of their lives, probably increase their chances of survival.

Lance Armstrong first noticed a slight swelling of his testicle in the winter of 1996 and began to feel uncharacteristically short of breath next spring. His nipples felt sore, and he had to drop out of the 1997 Tour de France owing to a cough and low-back pain. “Athletes, especially cyclists, are in the business of denial,” Armstrong writes. It wasn’t until September, when he coughed blood and his testicle became painfully enlarged, that he finally sought medical attention. By then the cancer had spread to his lungs and brain.

• Long before his cancer, Armstrong had developed a pattern of emotional repression. One of his close friends described him as “kind of like an iceberg. There’s a peak, but there is so much more below the surface.”
• 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.”

9: Is There a “Cancer Personality”?

Malignant melanoma, is a life-endangering tumor of melanocytes, the pigmented cells in the skin. A deadly disease with a ready tendency to spread to other organs, melanoma often strikes people in the prime of life.

The exposure of fair-skinned individuals to ultraviolet radiation is the major physical risk factor for malignant melanoma. People of Celtic origin appear to be especially vulnerable, particularly if they have light-colored hair, freckles and blue or grey eyes. Dark-skinned ethnic groups are at little risk for skin cancer—in Hawaii, skin cancer is forty-five times less common among non- Caucasians than in Caucasians.

Patients with malignant melanoma displayed coping reactions and tendencies that could be described as indicating ‘repressiveness.’ These reactions were significantly different from patients with CVD, who could be said manifest the opposite pattern of coping.

Type A individuals are seen as “angry, tense, fast, aggressive, in control”—and more prone to heart disease. Type B represents the balanced, moderate human being who can feel and express emotion without being driven and without losing himself in uncontrolled emotional outbreaks. Type C personalities have been described as “extremely cooperative, patient, passive, lacking assertiveness and accepting…. The Type C individual may resemble Type B, since both may appear easygoing and pleasant, but … while the Type B easily expresses anger, fear, sadness and other emotions, the Type C individual, in our view, suppresses or represses ‘negative’ emotions, particularly anger, while struggling to maintain a strong and happy facade.”

“When people are diagnosed with a disease—whether cancer or cardiovascular—they do not precipitously change their usual ways of coping with stress or suddenly develop new patterns…. Under stress, people usually mobilize their existing resources and defences.”

Hormonal factors likely account for the fact that the number of melanoma tumors is increasing in bodily sites not exposed to sunlight. Researchers have suggested that hormones may be overstimulating the pigment-producing cells.

Cancer patients, to a statistically significant degree, were more likely to demonstrate the following traits: “the elements of denial and repression of anger and of other negative emotions… the external appearance of a ‘nice’ or ‘good’ person, a suppression of reactions which may offend others, and the avoidance of conflict. The colorectal cancer findings were independent of the other risk factors they found (diet, beer intake, and family history). Self-reported childhood or adult unhappiness was also more common among the bowel cancer cases. We have already noted similar traits among patients with breast cancer, melanoma, prostate cancer, leukemias and lymphomas, and lung cancer.

Fair skin alone cannot be the cause of this cancer, since not everyone with fair skin will develop melanoma. Ultraviolet damage to the skin by itself cannot be sufficient, since only a minority of light-complexioned persons who suffer sunburns will end up with skin cancer. Emotional repression is not sufficient either. The combination, however, is deadly.

Repression, the inability to say no and a lack of awareness of one’s anger make it much more likely that a person will find herself in situations where her emotions are not expressed, her needs are ignored and her gentleness is exploited.

It is stress—not personality per se—that undermines a body’s physiological balance and immune defenses, predisposing to disease or reducing the resistance to it. Physiological stress, then, is the link between personality traits and disease. Certain traits—otherwise known as coping styles—magnify the risk for illness by increasing the likelihood of chronic stress. Common to them all is a diminished capacity for emotional communication.

The emotional contexts of childhood interact with inborn temperament to give rise to personality traits. Much of what we call personality is not a fixed set of traits, only coping mechanisms a person acquired in childhood. There is an important distinction between an inherent characteristic, rooted in an individual without regard to his environment, and a response to the environment, a pattern of behaviors developed to ensure survival.

What we see as indelible traits may be no more than habitual defensive techniques, unconsciously adopted. People often identify with these habituated patterns, believing them to be an indispensable part of the self. They may even harbor self-loathing for certain traits—for example, when a person describes herself as “a control freak.” In reality, there is no innate human inclination to be controlling. What there is in a “controlling” personality is deep anxiety. The infant and child who perceives that his needs are unmet may develop an obsessive coping style, anxious about each detail. When such a person fears that he is unable to control events, he experiences great stress. Unconsciously he believes that only by controlling every aspect of his life and environment will he be able to ensure the satisfaction of his needs. As he grows older, others will resent him and he will come to dislike himself for what was originally a desperate response to emotional deprivation. The drive to control is not an innate trait but a coping style.

Emotional repression is also a coping style rather than a personality trait set in stone. Gabor has never had a patient with cancer or any chronic illness say they were able to talk to somebody about their negative emotions.

• Many children are conditioned in this manner not because of any intended harm or abuse, but because the parents themselves are too threatened by the anxiety, anger or sadness they sense in their child—or are simply too busy or too harassed themselves to pay attention.

10: The 55 Per Cent Solution

Crohn’s is one of the two major forms of inflammatory bowel disease (IBD). Ulcerative colitis is the other. Both are characterized by inflammation of the bowel but in different patterns. In ulcerative colitis the inflammation begins in the rectum and spreads upward. The entire colon may become involved. The inflammation is continuous but confines itself to the mucosa.

In Crohn’s disease, the inflammation extends through the entire bowel wall. Most often the ileum, which is the third and final part of the small intestine, and the colon are affected, but Crohn’s may appear in any part of the tract. It will skip areas of the alimentary canal so that normal tissue alternates with diseased segments. IBD may be associated with inflammation in the joints, eyes, and skin.

The symptoms of IBD depend on the site of involvement. Diarrhea is common in both diseases, along with abdominal pain. Patients may need to defecate many times during the day or even find themselves incontinent. When the colon is affected, there will be bloody stools or hemorrhaging. Patients may experience fever and weight loss. Sometimes fistulas created by inflammation.

IBD is usually a disease of young people. Although it may occur at any age, most commonly onset happens between the years from fifteen to thirty-five.

Medical science considers IBD to be “idiopathic,” of unknown causation. Heredity plays a role, but not a major one. About 10 to 15 per cent of patients have a family history of IBD. The risk is estimated to be from 2 to 10 per cent if a first-degree relative has been diagnosed. Research shows that “most people with inflammatory bowel disease believe that stress is a major contributor to illness.”

A 1955 survey of ulcerative colitis patients found that “colitis patients’ mothers were controlling and had a propensity to assume the role of martyr.” No one sets out consciously to be a martyr to her children or to be controlling. A less judgmental way to put this would be that the child perceived himself to be responsible for his mother’s emotional suffering.

• The 1955 study, which looked at over seven hundred people with ulcerative colitis, concluded that a high proportion of these patients “had obsessive-compulsive character traits, which included neatness, punctuality, and conscientiousness. Along with these character traits, guarding of affectivity (emotional expression), over-intellectualization, rigid attitudes toward morality and standards of behavior.

Inflammation is an ingenious process invoked by the body to isolate and destroy hostile organisms or noxious particles. It does so by tissue swelling and the influx of a host of immune cells and antibodies. To facilitate its defensive function, the lining, or mucosa, of the bowel is in a “state of perpetually controlled or orchestrated inflammation.”

A diminished capacity by the gut to mount an inflammatory response would invite life-threatening infections. On the other hand, an inability to dampen inflammation exposes the gut tissue to self-injury. The central abnormality in inflammatory bowel disease would appear to be just such an imbalance of what one journal article calls the “pro-inflammatory and anti-inflammatory” molecules in the bowel lining. Emotional influences acting through the nerve and immune pathways of the PNI super-system could tip the balance in favor of inflammation.

Substance P is a powerful stimulator of inflammation because it induces certain immune cells to release inflammatory chemicals such as histamine and prostaglandins, among many others.

Although induced by thought or emotion, the placebo effect is entirely physiological. It is the activation of neurological and chemical processes in the body that serve to reduce symptoms or to promote healing.

As Dr. Hershfield implies, not the latest technology or miracle drug but encouraging the patient’s capacity to heal may provide the ultimate answer to inflammatory bowel disease. The 55 per cent solution.

11: It’s All in Her Head

Medical terminology calls IBS a functional disorder. Functional refers to a condition in which the symptoms are not explainable by any anatomical, pathological or biochemical abnormality or by infection. Doctors are accustomed to rolling their eyes when faced with a patient who has functional symptoms, since functional is medical code for “all in the head.”

Although abdominal pain is a prominent feature of irritable bowel syndrome, by the current definition of the disorder, pain itself is not sufficient for the diagnosis. A person is considered to have IBS if, in the absence of other pathology, she experiences abdominal pains along with disturbances of bowel function, such as diarrhea or constipation. The symptoms may vary from person to person, or even for the same individual from time to time.

It is not unusual for IBS patients to describe stool that is lumpy or small and pellet-like or, on the other hand, loose and watery. They may find themselves having to strain and feeling they have not completely evacuated their bowels. They frequently describe passing mucus with their stool. A sensation of bloating or abdominal distension is also common.

Irritable bowel syndrome is said to affect 17% of the population in the industrialized world and is the most frequent reason for which patients are referred to a gastroenterologist.

In such cases, the complainant finds her symptoms dismissed by doctors. Worse, she may be accused of drug-seeking behavior, of being neurotic, manipulative, of “just looking for attention.” IBS patients, as well as people with chronic fatigue syndrome and fibromyalgia, often find themselves in that situation.

With rectal distension, or even the anticipation of rectal distension, IBS patients activated the prefrontal cortex, an area not activated in normal people. The prefrontal cortex is where the brain stores emotional memories. It interprets present stimuli, whether physical or psychological, in light of past experiences, which can date as far back as infancy. Activation in this part of the brain means that some event of emotional significance is occurring. In people who have experienced chronic stress, the prefrontal cortex and related structures remain in a state of hypervigilance, on the lookout for danger. Prefrontal activation is not a conscious decision by the individual; rather, it is the result of the automatic triggering of nerve pathways programmed long ago.

There is a high incidence of abuse in the histories of patients with intestinal diseases and especially in those patients with IBS and other functional disorders.

• In a more recent investigation at the same center, two-thirds of the women interviewed had experienced abuse of a physical or sexual nature, or both. Again, abused patients were more likely to undergo various surgeries, such as gallbladder operations, hysterectomies, and laparotomies. They also had “more pain, non-gastrointestinal somatic symptoms, bed disability days, psychological distress, and functional disability compared to those without sexual abuse.”

The brain relays to the gut data from sensory organs such as the eyes, the skin or the ears—or more correctly, relayed to the gut is the interpretation of such data by the brain’s emotional centers. The resulting physiological events in the gut then reinforce that emotional interpretation. The signals sent back to the brain give rise to gut feelings that we can apprehend consciously. If we lose touch with gut feelings, the world becomes less safe.

When there are too many “gut-wrenching” experiences, the neurological apparatus can become over-sensitized. Thus, in the spinal cord the conduction of pain from gut to brain is adjusted as a result of psychological trauma. The nerves involved are set off by weaker stimuli. The greater the trauma, the lower the sensory threshold becomes. Normal amounts of gas in the lumen and normal tension in the intestinal wall will trigger pain.

• At the same time, the prefrontal areas of the cortex will be in a heightened state of vigilance, responding with distress to normal physiological processes. Along with increased pain, IBS patients report higher levels of anxiety, arousal and fatigue during rectal distension than do healthy people. During emotional stress, activity of the cortical regions amplifies the perception of distress.

Dr. Lin Chang: “Both external and internal stressors contribute to the development of IBS. External stressors include abuse during childhood and other pathological stresses, which alter stress responsiveness and make a predisposed individual more vulnerable to developing IBS. Later in life, infections, surgery, antibiotics and psychosocial stressors can all contribute to IBS onset and exacerbation.”

The medical name for the distressing chronic experience of stomach acid flowing upward into the esophagus is gastroesophageal reflux disease (GERD).

• While the perception of reflux-associated heartburn by these patients was markedly increased during the stressful stimuli, the objective measures of acid levels were unchanged from one stimulus to another. Stress, in other words, lowered the pain threshold.
• The decreased efficiency of the sphincter muscles permitted more episodes of reflux.

The activity of the vagus is influenced by the hypothalamus. The hypothalamus, as we have seen, receives input from the emotional centers in the cortex that are susceptible to stress. Thus, in GERD, a lower pain threshold is combined with excessive relaxation of the sphincter—both phenomena that can be related to stress.

The downward calibration of the nervous system’s pain “thermostat” does not require abuse; chronic emotional stress is sufficient to diminish the pain threshold and to induce hypervigilance in the brain. While abuse would be a major source of such stress, there are other potential stresses on the developing child that are subtle, less visible, but harmful nonetheless. Such strains are present in many families, with parents who love their children and would be horrified by any thought of hurting them.

Gut feelings are an important part of the body’s sensory apparatus, helping us to evaluate the environment and assess whether a situation is safe. Gut feelings magnify perceptions that the emotional centers of the brain find important and relay through the hypothalamus. Pain in the gut is one signal the body uses to send messages that are difficult for us to ignore. Thus, pain is also a mode of perception. Physiologically, the pain pathways channel information that we have blocked from reaching us by more direct routes. Pain is a powerful secondary mode of perception to alert us when our primary modes have shut down. It provides us with data that we ignore at our peril.

The source of trauma does not necessarily have to be caused by something extraordinary. Some people may have a lack of self-worth or unacceptability due to not receiving the care they needed as a child. A sense of not belonging. These people may begin to care for others to their own detriment and also repress their own anger and pain. Often displayed as IBS, esophageal reflux, migraines, etc.

There is encouraging research evidence that even minimal psychological intervention can be of benefit: “In one controlled study of cognitive-behavioral treatment for patients with irritable bowel syndrome, eight 2-hour group treatment sessions over a 3-month period led to an increase in the number of effective cognitive and behavioral strategies and concurrent reduction in abdominal complaints.”

12: I Shall Die First from the Top

One of the first structures to deteriorate in Alzheimer’s is the hippocampus. The hippocampus is active in memory formation and has an important function in stress regulation. It is well known that chronically high levels of the stress hormone cortisol can shrink the hippocampus.

• Non-handled rats are more likely to suffer shrinkage of the hippocampus and also exhibit greater memory impairment in old age.
• In humans, the widely reported Nun Study found that low linguistic ability in early life had a strong association with dementia and premature death in late life.
• The author of the world classic Gulliver’s Travels hardly appears to have been deprived of linguistic capacity. On a closer look, Jonathan Swift’s life and writing both manifest a poverty of felt emotional experience and of direct emotional expression. His skillsets were largely confined to intellectual ideas and to an acerbic wit so dry that his humor often escaped less sophisticated readers.
• Swift’s lifelong abhorrence of intimacy and his underlying fear of emotional contact or vulnerability are the defensive responses of a child deprived of emotional nurturing, a child who had to learn quickly to fend for himself. “There was, it seems, no one adult who particularly cared for Jonathan, or for whom he particularly cared.”

From diagnosis to death, life expectancy in Alzheimer’s averages eight years, regardless of the age when the disease first strikes. In rare instances, that may be as early as the sixth decade.

An international scientific consensus is steadily gaining ground that points to Alzheimer’s as one of the diseases on the spectrum of autoimmune conditions, along with multiple sclerosis, asthma, rheumatoid arthritis, ulcerative colitis and many others.

The autoimmune diseases all entail imbalances in the body’s physiological stress-regulation system, in particular the hormonal cascade set of by the hypothalamus. This surge of hormones culminates in the release of cortisol and adrenalin by the adrenal glands. Many studies have shown dysregulated physiological stress responses in Alzheimer’s, including abnormal production of hypothalamic and pituitary hormones and cortisol. In human beings with Alzheimer’s and in animal models of dementia, there is excessive production of cortisol, which is paralleled by the degree of damage to the hippocampus.

A typical warning sign of Alzheimer’s, as with Swift’s case, is the lack of genuine emotion. If the shutting-down of emotion occurs early enough, during the critical phases of brain development, the capacity to recognize reality may become permanently impaired.

• Reagan would often confuse fact from fiction and his memory was quite selective. He was also “sheathed in a strange calm.” His mother was emotionally unavailable and his father was a raging alcoholic. The result was a child that could feel no resentment and rage that was buried deep beneath his consciousness.

Such instances do not indicate that the person has no emotions; someone truly lacking attachment could at least pretend to possess some fellow feeling. On the contrary, the emotions can be too overwhelming to be experienced consciously—but they are physiologically all the more active. Once more we witness that avoiding the experience of emotion in fact exposes people to greater and longer-lasting physiological stress. Because they are unaware of their own internal states, they are less able to protect themselves from the consequences of stress. Furthermore, the healthy expression of emotion is itself stress-reducing. Stress-induced chronic hormonal and immune changes prepare the physiologic ground for diseases like Alzheimer’s.

13: Self or Non-Self: The Immune System Confused

The rheumatic diseases include rheumatoid arthritis, scleroderma, ankylosing spondylitis and systemic lupus erythematosus (SLE). In these disorders, a disturbed immune system reacts against the body’s own tissues, particularly against connective tissues like cartilage, tendon sheaths, the lining of joints and the walls of blood vessels. These illnesses are characterized by various patterns of inflammation that strikes the joints of the limbs or the spine; or surface tissues like skin or the lining of the eyes; or internal organs such as the heart or the lungs or—in the case of SLE—even the brain.

Characteristic of many persons with rheumatoid diseases is a stoicism carried to an extreme degree, a deeply ingrained reticence about seeking help. People often put up silently with agonizing discomfort, or will not voice their complaints loudly enough to be heard, or will resist the idea of taking symptom-relieving medications.

• The non-complaining stoicism exhibited by rheumatoid patients is a coping style acquired early in life. Sometimes developing anxiety for the health of others, despite being abused themselves. The sufferer feels like they can somehow manage and rationalize issues so that they can minimize the felt pain.
• An intensive medical-psychiatric study of people with rheumatoid arthritis conducted for the Maryland Chapter of the Arthritis and Rheumatism Foundation in 1969 concluded that “despite the diversity in the group, the patients’ psychological characteristics, vulnerabilities and life conflicts were remarkably similar.” One common characteristic was a pseudo-independence, described by the authors as a compensating hyper-independence.
• A child may lie to themselves in survive dire situations, about not requiring assistance.

In 1969 the British psychiatric researcher John Bowlby published Attachment, the first volume of his classic trilogy exploring the influence of parent-child relationships on personality development. “The reversal of roles between child, or adolescent, and parent, unless very temporary, is almost always not only a sign of pathology in the parent,” he wrote, “but a cause of it in the child.” Role reversal with a parent skews the child’s relationship with the whole world. It is a potent source of later psychological and physical illness because it predisposes to stress.

Other traits identified in the psychological investigations of people with rheumatoid disease include perfectionism, a fear of one’s own angry impulses, denial of hostility and strong feelings of inadequacy. As we have seen, similar traits are said to be associated with the “cancer personality” or with personalities at risk for MS, ALS, or any other chronic condition. None of these traits represent innate features of a person, nor are they irremediably fixed in the individual.

Another finding was the loss of one or both parents being a contributing factor. Effectively emotional deprivation.

Like compensatory hyper-independence, the repression of anger is a form of dissociation, a psychological process originating in childhood. The young person unconsciously banishes from awareness feelings or information that, if consciously experienced, would create unsolvable problems. Bowlby calls this phenomenon “defensive exclusion.” “The information likely to be defensively excluded is of a kind that, when accepted for processing in the past, has led the person concerned to suffer more or less severely.”

• In other words, the angry child got into trouble and experienced rejection. The anger and the rejection had to be deflected inside, against the self, in order to preserve the attachment relationship with the parent. That, in turn, leads to the “strong feelings of inadequacy and a poor self-concept” researchers have recognized in people with rheumatoid disease. “Not infrequently anger is redirected away from an attachment figure who aroused it and aimed instead at the self,” Bowlby explains. “Inappropriate self-criticism results.

Emotions safeguard the organism from external threat; like the nervous system and the hormones, they assure the satisfaction of indispensable appetites and needs; and, like all these systems together, they help maintain and repair the internal milieu.

An animal experiences anger when some essential need is either threatened or frustrated. Although animals lack conscious knowledge of emotional phenomena, they do feel emotion and experience the physiological changes of Emotion I. And, of course, they manifest the behavioral displays classified as Emotion II. The specific purpose of Emotion I biological changes is to prepare the creature for fight or flight responses. But since fight or flight both demand great expenditures of energy and impose risks of injury or death, the Emotion II displays serve a crucial intermediary function: they often settle the conflict without any of the participants having to get hurt.

• When two creatures approach each other (over territory or some sort of resource), instead of immediately fighting, they have the option of displaying threatening signs of anger to give the other creature a chance to avoid harm and so the angry creature can reduce its own potential harm.
• Anger represents both a recognition of the foreign and dangerous and a response to it.

The first essential task of the immune system is distinguishing self from non-self. Thus, immunity also begins with recognition. Recognition is a sensory function, performed in the nervous system by the sensory organs. Any failure of the immune system in its responsibility of recognition would expose us to as much danger as we would face if our capacities to see, hear, feel or taste were impaired. Another function of the nervous system is memory. The immune system must also have memory: it needs to recall what in the external world is benign and nourishing, what is neutral and what is potentially toxic.

• Under the watchful eyes of the parent, the infant and toddler explore the environment, learning what is edible and what is not, what is comfortable or a source of pain, what is hazardous or safe. The acquired information is stored in the developing brain’s memory banks. Immunity is also a matter of learning. Memory is stored by the immune system in cells programmed to recall instantaneously any threat previously encountered. And just as the nervous system must retain its potential for learning throughout the lifetime, so the immune system has the capacity to develop new “memories” by forming clones of immune cells trained specifically to recognize any new threat.

When our psychological capacity to distinguish the self from non-self is disabled, the impairment is bound to extend to our physiology as well. Repressed anger will lead to disordered immunity. The inability to process and express feelings effectively, and the tendency serve the needs of others before considering one’s own, are common patterns in those who develop chronic illness. Representing a blurring of boundaries, confusion of self and non-self on the psychological level. This extends to the cells, tissues, and organs. The immune system becomes unable to distinguish self from other or is too disabled to defend against danger.

One of the laboratory hallmarks of rheumatoid arthritis is the finding of an antibody directed against the self by the confused immune system. It is called rheumatoid factor, or RF. Found in over 70% of patients with rheumatoid arthritis, RF may also be present in people without the condition.

• The RF-positive group scored significantly higher on psychological scales reflecting the inhibition of anger and concern about the social acceptability of behaviors. They also scored higher on a scale that indicated traits such as “compliance, shyness, conscientiousness, religiosity and moralism.”
• The presence of the antibody in these subjects suggests that emotional repression had already initiated immune reactivity against the self, although not to the point of clinical disease. One might expect that should additional stressful events occur in the lives of these women, they could further incite the immune mutiny, activate inflammation and trigger frank disease. “Emotional disturbances in conjunction with rheumatoid factor may lead to rheumatoid disease,” the researchers concluded. It is also possible to develop rheumatoid arthritis without the anti-self-antibody RF.

In women with rheumatoid arthritis, the immune system has shown increased disturbance during periods of stress, but those who enjoyed better marriage relationships were spared exacerbations of disease activity like inflammation and pain. Another study found that increases in relationship stresses were associated with increases in joint inflammation.

There are several potential pathways by which overwhelming psychological pressures could become manifested as inflammation in joints, connective tissues and body organs.

• Discharges originating in the brain can stimulate faraway nerve endings to release powerful pro-inflammatory molecules capable of inducing joint damage through hyperactivity of the immune cells. Some nerve-derived chemicals are also potent irritating agents for inducing pain. In autoimmune diseases, elevated levels of some of these substances are found in the fluid of inflamed joints as well as in the circulation.

Normal cortisol secretion by the adrenals regulates the immune system and dampens the inflammatory reactions triggered by the products of immune cells. In rheumatoid arthritis, there are lower than normal cortisol responses to stress: we can see why, then, there would be disordered immune activity and excess inflammation. On the one hand, the immune system escapes from normal control and attacks the body to cause inflammation, and on the other, the required anti-inflammatory responses are weakened and ineffective.

14: A Fine Balance: The Biology of Relationships

Children and infant animals have virtually no capacity for biological self-regulation; their internal biological states—heart rates, hormone levels, nervous system activity—depend completely on their relationships with caregiving grown-ups. Emotions such as love, fear or anger serve the needs of protecting the self while maintaining essential relationships with parents and other caregivers. Psychological stress is whatever threatens the young creature’s perception of a safe relationship with the adults, because any disruption in the relationship will cause turbulence in the internal milieu.

Human beings did not evolve as solitary creatures but as social animals whose survival was contingent on powerful emotional connections with family and tribe. Social and emotional connections are an integral part of our neurological and chemical makeup. From such a biopsychosocial perspective, individual biology, psychological functioning and interpersonal and social relationships work together, each influencing the other.

In asthma, from the Greek root “breathe hard,” there is a reversible narrowing of the bronchioles, the small airways in the lungs, because the muscle fibers that encircle them begin to tighten. At the same time, the lining of the bronchioles becomes swollen and inflamed. All the various components of the PNI apparatus are involved in asthma: emotions, nerves, immune cells and hormones. Nervous discharges can narrow the airways in response to many stimuli, including emotions. The immune system is responsible for inflammation of the bronchiolar lining, the other characteristic feature of asthma. Swelling of the airway lining and the accumulation of inflammatory debris in the bronchioles are the final consequences.

• It is not inhalation but the outflow of air from the narrowed bronchioles that is impaired in asthma. The asthmatic has difficulty exhaling and feels his chest begin to tighten. The lungs attempt to clear the clogged airways by activating the cough reflex. In acute episodes, the labored exhalations produce the well-known wheezing noise from the narrowed bronchioles, as from lips puckered for whistling. In milder cases, the only symptom may be an irritating cough. For some people asthma is chronic, while others experience it only intermittently.
• Depending on individual predisposition, asthmatic attacks may be set off by allergens, exercise, cold temperatures, medications like Aspirin, crying, laughing, viral respiratory infections, and emotional arousal.
• Emotions can play a major role in making a person susceptible, no matter what the immediate trigger may be—Aspirin or cold air or anxiety. Chronic emotional stresses sensitize the immune system, so that it becomes overly reactive to any number of triggers.

Children known to suffer from atopic dermatitis (eczema, itchy allergic rashes) or from asthma have a diminished production of cortisol in response to stress.

Researchers who looked at the interactions between parents and asthmatic children have identified characteristic patterns of insecure attachments. Separation anxiety has been observed in children with asthma to a greater degree, not only in comparison with healthy controls but also when matched with children suffering from cystic fibrosis. Suggesting that the severity was not the cause of the anxiety.

“Regardless of the tone of the voice, asthmatic children showed more abnormal respiratory patterns when listening to their mother’s voice than when listening to that of a strange woman. This interesting result suggested a specific emotional effect on breathing that was contrary to what one would have predicted if the child had seen the mother as being reassuring.

On objective measures, when asthmatic children felt frustrated or criticized, the flow of air from their lungs diminished, indicating airway narrowing. Decreased airflow has also been documented when children with asthma were asked to recall incidents of intense anger or fear.

“Women experiencing a stressor objectively rated as highly threatening and who were without intimate emotional social support had a ninefold increase in risk of developing breast carcinoma.”

A seventeen-year follow-up study of residents of Alameda County, California, looked at the possible links between people’s social connectedness or sense of isolation and the onset of cancer. In this prospective study, none of the adults enrolled at the start had cancer. “The risk factor of major interest for women appeared to be social isolation, not only being isolated, but also of feeling isolated…”

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.”

• The well-differentiated person can respond from an open acceptance of their own emotions, which are not tailored to match or resist another’s expectations. Emotions are neither suppressed or acted out impulsively.

Functional differentiation: a person’s ability to function based on their relationship with others. They may only be able to do their work well when others put up with their bad temper, unreliable habits, lack of emotional engagement or abusive behavior.

On the other hand, if my ability to function is independent of other people’s having to do my emotional work for me—that is, if I can remain engaged with others while staying emotionally open to them and to myself—then I would be said to have basic differentiation. The less basic differentiation one has attained, the more prone they are to experience emotional stress and physical illness.

In a study with military cadets, those most susceptible to contract Epstein Barr Virus or to develop clinical disease had the following in common:

• They had high ambitions for themselves
• They were struggling academically
• They had fathers who were high achievers.

We can see here the relationship between the stress and the perceived need to live up to parental expectation—that is, between the internal biological milieu and the child’s continuing need to gain acceptance.

Poorer marital quality was “strongly and positively” related to poorer immune response.

• In the divorced or separated group, the two psychological factors most closely associated with diminished immune functioning were the time elapsed since the breakup (the more recent the marriage failure, the greater the immune suppression) and the woman’s degree of attachment to the former spouse (the greater the emotional attachment, the worse the immune function).
• Women who were more self-regulated, less emotionally dependent on a relationship that failed to work for them, had stronger immune systems. Greater differentiation means better health.

The less powerful partner in any relationship will absorb a disproportionate amount of the shared anxiety—which is the reason that so many more women than men are treated for, say, anxiety or depression. (The issue here is not strength but power: that is, who is serving whose needs?) It is not that these women are more psychologically unbalanced than their husbands, even though the latter may seem to function at higher levels. What is unbalanced is the relationship, so that the women are absorbing their husband’s stresses and anxieties while also having to contain their own.

• The partner who must suppress more of his or her own needs for the sake of the relationship is more likely to develop physical illness as well—hence the greater incidence, for example, of autoimmune disease and of non-smoking-related cancers among women.
• Dr. Kerr writes. “As is the case with the emotional dysfunctions, the one prone to develop symptoms is the spouse who adapts most to maintain harmony in the relationship system.”

Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well self-regulated people are the most capable of interacting fruitfully with others in a community and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism’s chances for long-term survival.

With an increased capacity for self-regulation in adulthood comes a heightened need for autonomy—for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or the person feels helpless, without meaningful choices (when autonomy is undermined).

• The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus, the vulnerability to subjective and physiological stress will be proportionate to the degree of emotional dependence.
• To minimize the stress from threatened relationships, a person may give up some part of his autonomy. However, this is not a formula for health, since the loss of autonomy is itself a cause of stress. The surrender of autonomy raises the stress level, even if on the surface it appears to be necessary for the sake of “security” in a relationship, and even if we subjectively feel relief when we gain “security” in this manner.

The other way of protecting oneself from the stress of threatened relationships is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy. This coping style may avoid anxiety and block the subjective experience of stress but not the physiology of it. Emotional intimacy is a psychological and biological necessity. Those who build walls against intimacy are not self-regulated, just emotionally frozen. Their stress from having unmet needs will be high.

“Social ties and support,” a group of researchers concluded, “… remain powerful predictors of morbidity and mortality in their own right, independent of any associations with other risk factors.” For the adult, biological stress regulation depends on a delicate balance between social and relationship security on the one hand, and genuine autonomy on the other. Whatever upsets that balance, whether or not the individual is consciously aware of it, is a source of stress.

15: The Biology of Loss

People and their pets connect via shared brain structures that predate the development of the human frontal cortex with its apparatus of language and rationality. Animals and humans interact from their respective limbic systems, the brain’s emotional parts. Unlike people, animals are acutely sensitive to messages from the limbic brain—both their own and that of their owners. Some pets are able to detect repressed anger and identify it as blatant expression, refusing to interact with their owners during this period. Childhood conditioning may cause the owner to not realize they are feeling this pain until the animal detects it.

Cancer, multiple sclerosis, rheumatoid arthritis and the other conditions we examined are not abrupt new developments in adult life, but culminations of lifelong processes. The human interactions and biological imprinting that shaped these processes took place in periods of our life for which we may have no conscious recall.

In an Italian study, women with genital cancers were reported to have felt less close to their parents than healthy controls. They were also less demonstrative emotionally.

A large European study compared 357 cancer patients with 330 controls. The women with cancer were much less likely than controls to recall their childhood homes with positive feelings. As many as 40% of cancer patients had suffered the death of a parent before age seventeen.

Ashley Montague (Touching: The Human Significance of the Skin): “The various forms in which the newborn and young receive it is of prime importance for their healthy physical and behavioral development. It appears probable that, for human beings, tactile stimulation is of fundamental significance for the development of healthy emotional or affectional relationships, that ‘licking,’ in its actual and in its figurative sense, and love are closely connected; in short, that one learns love not by instruction, but by being loved.”

In a study of premature babies, incubated infants were divided into two groups. All their nutritional and other conditions were identical, except for one variable: one group was given fifteen minutes of tactile stimulation three times a day over a period of two weeks. “Providing this form of stimulation to these babies resulted in significant acceleration of weight gain, increased head circumference, and improved behavioral indices,” compared with the control group.

Parental love is not simply a warm and pleasant emotional experience, it is a biological condition essential for healthy physiological and psychological development. Parental love and attention drive the optimal maturation of the circuitry of the brain, of the PNI system and of the HPA axis.

When “happy” events are experienced by the infant, endorphins are released. Endorphins encourage the growth and connections of nerve cells. Conversely, in animal studies, chronically high levels of stress hormones such as cortisol have been shown to cause important brain centers to shrink.

A fundamental goal of human development is the emergence of a self-sustaining, self-regulated human being who can live in concert with fellow human beings in a social context. Vital for the healthy development of the neurobiology of self-regulation in the child is a relationship with the parent in which the latter sees and understands the child’s feelings and can respond with attuned empathy to the child’s emotional cues. Emotions are states of physiological arousal, either positive — “I want more of this”— or negative — “I want less of this.” Infants and small children do not have the capacity to regulate their own emotional states, and hence are physiologically at risk for exhaustion and even death if not regulated by the interaction with the parent. Closeness with the parent, therefore, serves to preserve the infant’s biological regulation.

The prefrontal cortex modulates our responses to the world not in terms of primitive drives but in terms of learned information about what is friendly, neutral or hostile and what is socially useful and what is not. Its functions include impulse control, social-emotional intelligence and motivation. Much of the regulating work of the cortex involves not the initiation of actions but the inhibition of impulses arising in the lower brain centers.

• The limbic system is essential for survival. Without it the regulatory and thinking capacities of the cortex would function like the brain of an idiot savant: intellectual knowledge would be disconnected from real knowledge of the world. Emotions interpret the world for us. They have a signal function, telling us about our internal states as they are affected by input from the environment. Emotions are responses to present stimuli as filtered through the memory of past experience, and they anticipate the future based on our perception of the past.
• The brain structures responsible for the experience and modulation of emotions, whether in the cortex or the midbrain, develop in response to parental input, just as visual circuitry develops in response to light. The limbic system matures by “reading” and incorporating the emotional messages of the parent. The centers of memory, both conscious and unconscious, rely on the interaction with the parent for their consolidation and for their future interpretations of the world. The circuits responsible for the secretion of important neurotransmitters like serotonin, norepinephrine and dopamine — essential for mood stability, arousal, motivation and attention—are stimulated and become coordinated in the context of the child’s relationship with his caregivers.
• Within the parent-child interaction the child’s sense of the world is formed: whether this is a world of love and acceptance, a world of neglectful indifference, or a world of hostility where one must be hypervigilant.
• We will understand ourselves as we have felt understood, love ourselves as we perceived being loved on the deepest unconscious levels, care for ourselves with as much compassion as, at our core, we perceived as young children.

Attunement, a process in which the parent is “tuned in” to the child’s emotional needs, is a subtle process. It is deeply instinctive but easily subverted when the parent is stressed or distracted emotionally, financially or for any other reason. Attunement may also be absent if the parent never received it in his or her childhood. Strong attachment and love exist in many parent-child relationships but without attunement. Children in non-attuned relationships may feel loved but on a deeper level do not experience themselves as appreciated for who they really are. They learn to present only their “acceptable” side to the parent, repressing emotional responses the parent rejects and learning to reject themselves for even having such responses.

Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.” We are speaking here not of a lack of parental love, nor of physical separation between parent and child, but of a void in the child’s perception of being seen, understood, empathized with and “got” on the emotional level.

Proximate separation happens when attuned contact between parent and child is lacking or is interrupted due to stresses on the parent that draw her away from the interaction.

• An example of an attunement break occurs when the parent looks away first from the child during one of their intensely pleasurable eye-to-eye gaze interactions. Another attunement break occurs if the parent insists on stimulating a resting child because he (the parent) desires the mutual engagement, even if the child at that moment needs some respite from the intensity of their interaction.
• In proximate separations the parents are physically present but emotionally absent. Such parent-child interactions are increasingly the norm in our hyper-stressed society. The levels of physiological stress experienced by the child during proximate separation approaches the levels experienced during physical separation.
• Proximate separation affects the young child on the unconscious level rather than on the conscious thought-feeling level. It will not be recalled later, but it is entrenched in the biology of loss.
• People “trained” in this way in childhood are likely to choose adult relationships that re-enact repeated proximate separation dynamics. They may, for example, choose partners who do not understand, accept or appreciate them for who they are. Thus, the physiological stresses induced by proximal separation will also continue to be repeated in adult life— and, again, often without conscious awareness.

16: The Dance of Generations

If a parent’s loving feelings are constricted, it only because that parent has suffered deep hurt. Where parenting fails to communicate unconditional acceptance to the child, it is because of the fact that the child receives the parent’s love not as the parent wishes but as it is refracted through the parent’s personality. If the parent is stressed, harbors unresolved anxiety, or is agitated by unmet emotional needs, the child is likely to find herself in situations of proximate abandonment regardless of the parent’s intentions.

The intergenerational transmission of parenting style is largely a matter of physiological development, of how the limbic circuits of the brain become programmed in childhood and how the connections within the PNI super-system are established.

• The child does not learn the parenting styles of his mother and father by imitation—or only in part. The biggest influence on the future parenting style of the child is the development of his emotional and attachment circuits in the context of his relationship with his parents. The same is true of the development of the child’s stress-response apparatus.
• As a group of Canadian researchers have written, “Maternal care during infancy serves to ‘program’ behavioral responses to stress in the offspring by altering the development of the neural systems that mediate fearfulness.” Anxious mothers are likely to rear anxious offspring.

Infants who had received attuned attention from their mothers at home showed signs of missing their mothers on separation. They greeted their returning mothers by initiating physical contact. They were soothed easily and returned quickly to spontaneous play. This pattern was called secure. There were also a number of insecure patterns, variously named avoidant, ambivalent or disorganized. Avoidant infants did not express distress on separating from the mother and avoided or ignored the mother on reunion. Such behavior did not denote genuine self-reliance but the pseudo-autonomy that we noted, for example, in rheumatoid patients: the belief that they must depend only on themselves, since trying to obtain help from the parent was useless. Internally, however, these avoidant infants were physiologically stressed when the parent returned, as measured by heart rate changes. The infants falling into the insecure categories had been subjected to non-attuned parenting in the home. They had received implicit messages of maternal emotional absence, or mixed messages of contact alternating with distance.

The patterns of people’s speech and the key words they “happen” to employ are more meaningful descriptors of their childhoods than what they consciously believe they are communicating. The intended meaning of words reflects only the speaker’s conscious beliefs, from which painful memories are often excluded. The real story is told by the patterns of the narrative—fluent or halting, detailed or characterized by a paucity of words, consistent or self-contradicting, along with Freudian slips, revealing asides and apparent non-sequiturs.

The test developed by Mary Main is called the Adult Attachment Interview (AAI). Just as the responses of infants in the Strange Situations, the narratives of adults could also be classified along lines that reflected the degrees of security they had experienced in their early interactions with their parents.

• The adult’s AAI narrative of his own childhood will often predict how he will nurture his future child, and therefore how his child, at one year, will respond in the Strange Situation. And, the child’s behavior in the Strange Situation will foretell the type of narrative she, in turn, will give about her childhood twenty years later.
• Blame becomes a meaningless concept if one understands how family history stretches back through the generations. “Recognition of this quickly dispels any disposition to see the parent as villain,” wrote John Bowlby, the British psychiatrist whose work threw scientific light on the decisive importance of attachment in infancy and childhood.

Some random examples:

• NATALIE: multiple sclerosis. Her oldest brother was an alcoholic who died of cancer of the throat. Her younger sister is schizophrenic. Her uncles and aunts were alcoholics. Her maternal grandfather was alcoholic. Her husband, Bill, died of bowel cancer. Her son has attention deficit (hyperactivity) disorder and has struggled with drug addiction.
• VéRONIQUE: multiple sclerosis. She believes she was conceived during an incestuous rape. In her adoptive family, the maternal grandfather was an alcoholic and her maternal grandmother developed Alzheimer’s disease in her sixties. Among other medical problems, her father has early-onset high blood pressure.
• SUE RODRIGUEZ: ALS. Her father died of alcoholic liver disease; one of her aunts died of a brain aneurysm, another in a house fire.
• ANNA: breast cancer. Both her mother and maternal grandmother died of breast cancer—but neither through genetic transmission. Anna inherited a breast-cancer gene on her father’s side. She has two sisters: one is living with an alcoholic; the other is mentally ill.
• GABRIELLE: scleroderma, with features of rheumatoid arthritis. Her parents were alcoholics. Her brother has had a colectomy for cancer of the bowel, and her sister was recently diagnosed with breast cancer.
• JACQUELINE DU PRé: multiple sclerosis. Her grandmother was traumatized by the death of other children about the time her mother was born. Jacqueline’s mother predeceased her with cancer, and her father developed Parkinson’s disease.
• RONALD REAGAN: Colon cancer, Alzheimer’s disease. His father and brother were alcoholics; his second wife developed breast cancer. His daughter died of metastatic malignant melanoma.

Lies, however innocently intended, never protect a child from pain. There is something in us that knows when we are lied to, even if that awareness never reaches consciousness. Being lied to means being cut off from the other person. It engenders the anxiety of exclusion and of rejection.

Adaptiveness is the capacity to respond to external stressors without rigidity, with flexibility and creativity, without excessive anxiety and without being overwhelmed by emotion. People who are not adaptive may seem to function well as long as nothing is disturbing them, but they will react with various levels of frustration and helplessness when confronted by loss or by difficulty. They will blame themselves or blame others. A person’s adaptiveness depends very much on the degree of differentiation and adaptiveness of previous generations in their family and also on what external stressors may have acted on the family.

Children who become their parents’ caregivers are prepared for a lifetime of repression. And these roles children are assigned have to do with the parents’ own unmet childhood needs—and so on down the generations. “Children do not need to be beaten to be compromised,” researchers at McGill University have pointed out. Inappropriate symbiosis between parent and child is the source of much pathology.

As Dr. Kerr suggests, it is much more illuminating to think of, say, a cancer position than a cancer personality. “The concept of a cancer personality, although certainly having some validity, is based in individual theories of human functioning. The concept of a cancer position is based in a systems theory of human functioning. In a family system the functioning of each person is influenced and regulated by the functioning of every other person.”

The main effect of globalization has been to undermine the family structure and to tear asunder the connections that used to provide humans with a sense of purpose and belonging. Children spend less time around nurturing adults and their “extended family” (village, community, neighborhood) has been replaced by daycare and school, where children are oriented towards peers than reliable parents or family.

• In many families now, both parents are having to work to assure the basic necessities one salary could secure a few decades ago. “[The] separation of infants from their mothers and all other types of relocation which leave few possibilities for interpersonal contact are very common forms of sensory deprivation; they may become major factors in disease,” wrote the prescient Hans Selye.

The element of control is the less obvious but equally important aspect of social and job status as a health factor. Since stress escalates as the sense of control diminishes, people who exercise greater control over their work and lives enjoy better health.

Discarding blame leaves us free to move toward the necessary adoption of responsibility.

17: The Biology of Belief

Genes alone cannot possibly account for the complex psychological characteristics, the behaviors, health or illness of human beings. Genes are merely codes. They act as a set of rules and as a biological template for the synthesis of the proteins that give each particular cell its characteristic structure and functions. They are, as it were, alive and dynamic architectural and mechanical plans. Whether the plan becomes realized depends on far more than the gene itself. Genes exist and function in the context of living organisms. The activities of cells are defined not simply by the genes in their nuclei but by the requirements of the entire organism—and by the interaction of that organism with the environment in which it must survive. Genes are turned on or off by the environment.

If “science” enables us to ignore poverty or man-made toxins or a frenetic and stressful social culture as contributors to disease, we can look only to simple answers: pharmacological and biological. Such an approach helps to justify and preserve prevailing social values and structures. It may also be profitable.

The milieu of the individual cell is the cell’s immediate surroundings, from which it receives messenger substances that originate in nearby cells, in nerve endings controlled from afar and in distant organs that secrete chemicals into the circulatory system. The information substances attach to receptors on the cell surface. Then, in the cell membrane—depending on how receptive the cell is at that moment—effector substances are produced that go to the nucleus, instructing genes to synthesize particular proteins to carry out specific functions. These receptor-effector protein complexes are called perception proteins. They act as switches that integrate the function of the cell with its environment.

When early environmental influences are chronically stressful, the developing nervous system and the other organs of the PNI super-system repeatedly receive the electric, hormonal and chemical message that the world is unsafe or even hostile. Those perceptions are programmed in our cells on the molecular level. Early experiences condition the body’s stance toward the world and determine the person’s unconscious beliefs about herself in relationship to the world. Dr. Lipton calls that process the biology of belief.

1. I Have to be Strong

The core belief in having to be strong enough, characteristic of many people who develop chronic illness, is a defense. The child who perceives that her parents cannot support her emotionally had better develop an attitude of “I can handle everything myself.” Otherwise, she may feel rejected. One way not to feel rejected is never to ask for help, never to admit “weakness”—to believe that I am strong enough to withstand all my vicissitudes alone.

2. It’s Not Right for me to be Angry

Emotional distancing as a means of survival.

3. If I’m Angry, I Will Not be Lovable

The desire to be liked often makes one repress anger because it’s believed that people don’t like angry people.

4. I’m Responsible for the Whole World

Conflict is believed to be an indicator of a bad relationship so it is avoided and the sufferer sucks it up, taking responsibility for the other. A failure to acknowledge vulnerability and obsession with perfectionism. It helps to say, “I should be a guide, not a god.”

The person in this example associated his clients’ failure as his own. Meaning he had to work harder, learn more, and go to more workshops.

5. I Can Handle Anything

Taking pride in being able to handle obscene workloads.

6. I’m Not Wanted – I’m Not Lovable

7. I Don’t Exist Unless I do Something. I Must Justify My Existence

8. I Have to be Very Ill to Deserve Being Taken Care Of

Accepting punishing roles in life until sickness rescues them from it.

Whichever modality of treatment people choose—conventional medicine with or without complementary healing; alternative approaches like energy medicine or various mind-body techniques; ancient Eastern practices like Ayurvedic medicine or yoga or Chinese acupuncture; the universal practice of meditation techniques; psychotherapy; nutritional healing—the key to healing is the individual’s active, free and informed choice.

18: The Power of Negative Thinking

No disease has a single cause. Even where significant risks can be identified—such as biological heredity in some autoimmune diseases or smoking in lung cancer—these vulnerabilities do not exist in isolation. Personality also does not by itself cause disease: one does not get cancer simply from repressing anger or ALS just from being too nice. A systems model recognizes that many processes and factors work together in the formation of disease or in the creation of health.

Disease is disharmony. It is an expression of an internal disharmony. If illness is seen as foreign and external, we may end up waging war against ourselves.

As soon as we qualify the word thinking with the adjective positive, we exclude those parts of reality that strike us as “negative.” That is how most people who espouse positive thinking seem to operate. Genuine positive thinking begins by including all our reality. It is guided by the confidence that we can trust ourselves to face the full truth, whatever that full truth may turn out to be.

• As Dr. Michael Kerr points out; compulsive optimism is one of the ways we bind our anxiety to avoid confronting it. That form of positive thinking is the coping mechanism of the hurt child. The adult who remains hurt without being aware of it makes this residual defense of the child into a life principle.
• “Positive thinking” is based on an unconscious belief that we are not strong enough to handle reality. Allowing this fear to dominate engenders a state of childhood apprehension. Whether or not the apprehension is conscious, it is a state of stress.
• Lack of essential information about ourselves and our situation is one of the major sources of stress and one of the potent activators of the hypothalamic-pituitary-adrenal (HPA) stress response.
• Stress wanes as independent, autonomous control increases.

Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden.

One cannot be autonomous as long as one is driven by relationship dynamics, by guilt or attachment needs, by hunger for success, by the fear of the boss or by the fear of boredom. The reason is simple: autonomy is impossible as long as one is driven by anything.

While it is true that genuine joy and satisfaction enhance physical well-being, “positive” states of mind generated to tune out psychic discomfort lower resistance to illness.

Emotional scars are most often invisible. But scars of any type are less strong and less resilient than the tissue they replace: they remain potential sites of future pain and disruption, unless they are recognized and tended to.

Tuning out by daydreaming, for example, enables the child to endure experiences that otherwise may trigger reactions that would land him in trouble. This kind of dissociation is in play when a person retains conscious recall for events in the past but not for their traumatic emotional resonance. It explains many “happy childhoods.”

If an infant is uncomfortable or unhappy, she’ll cry, show sadness, show anger. Anything that we do to hide pain or sadness is an acquired response. It may make sense to hide negative emotion in some circumstances, but so many of us do it all the time, and we do it automatically.

Developing the courage to think negatively allows us to look at ourselves as we really are.

There is a remarkable consistency in people’s coping styles across the many diseases they have considered:

• The repression of anger, the denial of vulnerability, the “compensatory hyper-independence.”
• No one chooses these traits deliberately or develops them consciously. Negative thinking helps us to understand just what the conditions were in our lives and how these traits were shaped by our perceptions of our environment.

Emotionally draining family relationships have been identified as risk factors in virtually every category of major illness, from 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 have proved dangerous to our health.

“The power of negative thinking” requires the removal of rose-colored glasses. Not blame of others but owning responsibility for one’s relationships is the key.

The power of negative thinking requires the strength to accept that we are not as strong as we would like to believe. Our insistently strong self-image was generated to hide a weakness—the relative weakness of the child. Our fragility is nothing to be ashamed of. A person can be strong and still need help, can be powerful in some areas of life and helpless and confused in others. We cannot do all that we thought we could.

If a refusal saddles you with guilt, while consent leaves resentment in its wake, opt for the guilt. Resentment is soul suicide.

Negative thinking allows us to gaze unflinchingly on our own behalf at what does not work. We have seen in study after study that compulsive positive thinkers are more likely to develop disease and less likely to survive. Genuine positive thinking—or, more deeply, positive being—empowers us to know that we have nothing to fear from truth.

19: The Seven A’s of Healing

Although it accounts for only 1% of all cancers, malignant melanoma provides for 11% of spontaneous cancer remissions.

• Spontaneous remission raises two important questions: why, in some people, are such resources not powerful enough to destroy cancerous cells in the first place, before the clinical development of melanoma; and what enables the immune system in some people to overcome this potentially deadly cancer even after it does arise?
• Natural killer cells attack abnormal cells, thus providing a line of defense against cancer. NK cells have a demonstrated capacity to digest melanomas. As in breast cancer, they are less active in emotionally repressed individuals.

Emotional competence is the capacity that enables us to stand in a responsible, non-victimized, and non-self-harming relationship with our environment. It is the required internal ground for facing life’s inevitable stresses, for avoiding the creation of unnecessary ones and for furthering the healing process. Pursuing the seven A’s of healing will help us grow into emotional competence.

1. Acceptance

The willingness to recognize and accept how things are. It is the courage to permit negative thinking to inform our understanding, without allowing it to define our approach to the future.

It challenges the deeply held belief that we are not worthy enough or “good” enough to be whole. Acceptance also implies a compassionate relationship with oneself. It means discarding the double standard that, as we have seen, too often characterizes our relationship with the world.

“You can’t force yourself to say no anymore than you can force someone else to say no, but you can be compassionate toward yourself.”

Compassionate curiosity about the self does not mean liking everything we find out about ourselves, only that we look at ourselves with the same non-judgmental acceptance we would wish to accord anyone else who suffered and who needed help.

2. Awareness

All those seeking to heal—or to remain healthy—need to reclaim the lost capacity for emotional truth-recognition.

Animals and young humans are highly competent at picking up on real emotional cues. If we lose that capacity as we acquire language, it is only because we receive confusing messages from our immediate world. The words we hear tell us one thing, the emotional data say something different. If the two are in conflict, one will be repressed.

We repress our emotional intelligence in order to avoid an ongoing war with the crucial people in our lives, a war we cannot possibly win. And so, we lose our emotional competence even as we gain verbal intelligence. Aphasiacs, it would appear, go through the reverse process. Much as a blind person will develop an extraordinary capacity to hear, the aphasiac develops an enhanced ability to perceive emotional reality.

• The aphasiac learns to notice his internal reactions to words, since the cognitive parts of the brain can no longer tell him what the message is. Those internal reactions, gut feelings, are what we lost as we “grew up.”

Full awareness would mean that we would regain our lost capacity to perceive emotional reality and that we are ready to let go of the paralyzing belief that we are not strong enough to face the truth about our lives.

To develop awareness we have to practice, pay constant attention to our internal states and learn to trust these internal perceptions more than what words—our own or anyone else’s—convey. What is the tone of voice? The pitch? Do the eyes narrow or open? Is the smile relaxed or tight? How do we feel? Where do we feel it?

Awareness also means learning what the signs of stress are in our own bodies, how our bodies telegraph us when our minds have missed the cues.

3. Anger

Not only does the repression of anger predispose to disease but the experience of anger has been shown to promote healing or, at least, to prolong survival. People with cancer who have been able to muster anger at their physicians, for example, have lived longer than their more placid counterparts.

However, not only is the unbridled outpouring of anger harmful to the recipients or bystanders but it can also be deadly to the one who rages. Heart attacks can follow upon outbursts of rage. In general, high blood pressure and heart disease are more likely to happen in persons who harbor hostility.

• The sympathetic nerves are activated in rage states. Narrowing of the blood vessels occurs with excessive sympathetic fight-or-flight activity, increasing the blood pressure and decreasing oxygen supply to the heart. The hormones secreted during the stress response in rage states raise lipid levels, including serum cholesterol. They also activate clotting mechanisms, further heightening the risk of blockages in the arteries.

If in repression the problem is a lack of release, acting out consists of an equally abnormal suppression of release alternating with unregulated and exaggerated venting.

Healthy anger, Allen Kaplin says, is an empowerment and a relaxation. 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 a mobilization to attack. There is, simultaneously, a complete disappearance of all anxiety.

Acting out through bursts of rage is a defense against the anxiety that invariably accompanies anger in a child. Anger triggers anxiety because it coexists with positive feelings, with love and the desire for contact. But since anger leads to an attacking energy, it threatens attachment. Thus, there is something basically anxiety provoking about the anger experience, even without external, parental injunctions against anger expression.

• “Aggressive impulses are suppressed because of guilt, and the guilt exists only because of the simultaneous existence of love, of positive feelings,” says Allen Kalpin. “So, the anger doesn’t exist in a vacuum by itself. It is incredibly anxiety-provoking and guilt-producing for a person to experience aggressive feelings toward a loved one.”

Naturally, the more parents discourage or forbid the experience of anger, the more anxiety-producing that experience will be for the child. In all cases where anger is completely repressed or where chronic repression alternates with explosive eruptions of rage, the early childhood history was one in which the parents were unable to accept the child’s natural anger.

• If a person unconsciously fears the power of his aggressive impulses, there are various forms of defense available to him. One category of defense 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 defense against the experience of the anger. It’s a defense against keeping the anger inside where it can be deeply felt. Discharge defends against anger being actually experienced.”
• Repression and discharge 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 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 defenses no longer protect us or may even turn mutinous, attacking the body.

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.”

4. Autonomy

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.

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.

Childhood stressors such as emotional or sexual abuse, violence, drug use or mental illness in the family were correlated with adult risk behaviors, 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.

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.

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.

Dr. Peterson (Anger, Boundaries, and Safety): “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 center of control.

5. Attachment

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.

We sometimes find it easier to feel bitterness or rage than to allow ourselves to experience that aching desire for contact that, when disappointed, originally engendered the anger. Behind all our anger lies a deeply frustrated need for truly intimate contact. Healing both requires and implies regaining the vulnerability that made us shut down emotionally in the first place. We are no longer helplessly dependent children; we no longer need fear emotional vulnerability. We can permit ourselves to honor the universally reciprocal human need for connection and to challenge the ingrained belief that unconsciously burdens so many people with chronic illness: that we are not lovable. Seeking connections is a necessity for healing.

6. Assertion

Beyond acceptance and awareness, beyond the experience of anger and the unfolding of autonomy, along with the celebration of our capacity for attachment and the conscious search for contact, comes assertion: it is the declaration to ourselves and to the world that we are and that we are who we are.

In our fear we falsely equate reality with tumult, being with activity, meaning with achievement. We think autonomy and freedom mean the liberty to do, to act or react as we wish. Assertion in the sense of self-declaration is deeper than the limited autonomy of action. It is the statement of our being, a positive valuation of ourselves independent of our history, personality, abilities or the world’s perceptions of us. Assertion challenges the core belief that we must somehow justify our existence.

It demands neither acting nor reacting. It is being, irrespective of action. Thus, assertion may be the very opposite of action, not only in the narrow sense of refusing to do something we do not wish to do but letting go of the very need to act.

7. Affirmation

When we affirm, we make a positive statement; we move toward something of value. There are two basic values that can assist us to heal and to remain whole, if we honor them.

• Everyone has an urge to create. Its expression may flow through many channels: through writing, art or music, through the inventiveness of work or in any number of ways unique to all of us, whether it be cooking, gardening or the art of social discourse. The point is to honor the urge. To do so is healing for ourselves and for others; not to do so deadens our bodies and our spirits.
• We are a part of the universe with temporary consciousness, but never apart from it. Not by coincidence is the word seeking so frequently employed in relation to spiritual work. Some people seek religion, meditation, nature, or other spiritual practices.

Health rests on three pillars: the body, the psyche and the spiritual connection. To ignore any one of them is to invite imbalance and dis-ease.