> Emotional and Mental Health > Stress

Swallowing Emotions
by author Gabor Maté, MD

From the mind/body perspective, physical illnesses may be expressions of basic psychological wounds, developing out of the emotional defences we construct to avoid feeling pain.
The most common psychological defence is repression–forcing down our feelings below the level of consciousness.

Repression is a primitive brain mechanism developed to protect us from an overwhelming awareness of our vulnerability. From the Latin vulnerare, to wound, vulnerability is simply a condition of life. All living creatures are profoundly vulnerable, and none more so than human beings, with our utter helplessness in the first few years of life. The brain cannot defend us against our vulnerability, but if need be, it can blind us to awareness of it.

Rachel’s Story

Rachel, a young woman with rheumatoid arthritis, is a poignant case example. Rachel’s first episode of joint inflammation occurred in response to an event that revived a childhood emotional trauma. Rachel had grown up in conflict with her older brother who she perceived to be the favoured sibling. Their parents separated and she felt especially rejected by her father.

“I was always the second-class citizen,” she says. “It was my brother he wanted. I still remember walking halfway down the block by myself behind them, my father with his arms around my brother.” As a child Rachel says she was “a good little girl who never caused problems.” Being co-operative and cheerful were ways she made herself lovable.

Four years ago, on Rosh Hashanah, the Jewish New Year celebration, Rachel was at her mother’s home, preparing dinner for the family. She hurried through the visit so she could leave in time to avoid meeting her brother who had decided to join the family at the last moment. “He didn’t want me there, so we’d made an agreement that I would go early to my mother’s house and help her cook. At four o’clock I would leave so he and my sister-in-law and niece could spend Rosh Hashanah with my mother.” She was still the good, co-operative, cheerful little girl.

Four o’clock did not find Rachel in her mother’s kitchen but at the emergency ward screaming in pain with severely inflamed hips and knees. The emotional pain she dared not speak became transmuted into illness and unbearable physical pain. Rachel had no past history of rheumatic disease, nor did her family have a history of it.

We Are Not Alone

An intensive US medical-psychiatric study conducted in 1969 of people with rheumatoid arthritis, and published in Psychosomatics volume 10, concluded that “despite the diversity in the group, the patients’ psychological characteristics, vulnerabilities, and life conflicts were remarkably similar.” The traits identified in this and other studies of rheumatics included a pseudo-independence (the belief that they were completely self-sufficient), perfectionism, fear of one’s own angry impulses, denial of hostility, and low self-esteem. Similar characteristics are reported in studies of people with cancer and other illnesses such as multiple sclerosis.

These traits originate in the need of the emotionally wounded child to defend against his sense of vulnerability. If the emotional wounding occurs in the family, as it usually does, the child is in no position to escape or to fight. Above all, he must maintain the relationship with his caregivers. If the parents, for whatever reason, such as their own stresses and their own unresolved emotional problems, are unable to tolerate the child’s anger or sadness or expressions of unhappiness, the child’s brain must repress such feelings. The child subsequently loses awareness of them.

The emotions we repress–anger and sadness–are not luxuries. They are natural responses to life events, necessary for survival. Healthy anger helps protect our boundaries; healthy sadness tells us of loss and helps us to come to terms with it. In the absence of anger, we no longer recognize when our boundaries have been violated. Had Rachel been able to feel genuine sadness about the schism in her family and accepted the futility of trying, at her own expense, to make everyone else happy, she may not have exposed herself to the humiliating self-abnegation that led to her outbreak of joint inflammation.

The Immune Response

As modern science now clearly shows, the centres in the brain that process emotions are part and parcel of a mind/body system that also includes our immune organs and cells, our hormonal glands, and our nervous system. Whatever happens in one part of this super-system also affects the other parts. Consequently, repression unbalances more than just the emotions because it has many physiological effects.

Nervous system activity, hormone levels, and immune function all become disorganized under the impact of chronically repressed emotions. There are other influences in disease: genetics, allergies, dietary factors, and environmental toxins are some of them. Yet common to all chronic conditions–from arthritis to cancer, from chronic fatigue to migraine headaches–is emotional repression.

Prevention begins in the cradle. Parents need to welcome and facilitate their children’s emotional expression from the very beginning. As parents, we don’t have to like the emotions our child manifests, but we have to accept them as legitimate. Adults who wish to stay healthy must pay as much attention to their emotional selves as to exercise, diet, and nutritional supplements, paying attention to what they feel, and sometimes, to what they don’t feel.

People suffering from chronic symptoms or illness can look upon their disease not only as a burden but also as a warning and a teaching. It is a tough way to learn, not to be wished on anyone, but many have found meaning and even health through facing, for the first time in their lives, the painful emotions they had to repress as young children.

Gabor Maté, MD, is a Vancouver physician and the author of When the Body Says No: The Cost of Hidden Stress (Vintage Canada, 2004).

Source: alive #271, May 2005