How to Build a Culture of Good Health | Gabor Mate, MD

Of Yes! Magazine“‘I never get angry,’ says a character in one of Woody Allen’s films. “I’m developing a tumor instead.” Much more scientific truth is captured in this amusing remark than many doctors would acknowledge. Traditional medical practice largely ignores the role of emotions in the physiological functioning of the human organism. Yet scientific evidence overwhelmingly shows that people’s emotional experiences over the course of their lives profoundly influence health and disease. And, since emotional patterns are a response to the psychological and social environment, illness in an individual always tells us about the multigenerational family of origin and the larger culture in which that person’s life unfolds.

We human beings are biopsychosocial creatures whose health or illness reflects our relationship to the world we inhabit, including all variables of family, class, gender, race, political status and religion. physical ecology of which we are a part. A recent paper from the National Institutes of Health called for a new foundational theory for medicine, based on a “biopsychosocial-ecological paradigm.” Given the ideological limitations of traditional medicine, this forward-looking initiative is unlikely to be listened to anytime soon.

As early as the second century, the Roman physician Galen noted the link between emotional burden and disease, an observation repeated by many other clinicians over the centuries. The journey from stressful, often unconscious emotions to physical illness has often been reminded of me as a family physician and palliative care practitioner, although nothing in my medical training has suggested such links. People I’ve seen with chronic illnesses of all kinds – from malignant tumors or autoimmune diseases such as rheumatoid arthritis or ulcerative colitis to persistent skin conditions such as eczema and psoriasis, and disorders neurological conditions such as Lou Gehrig’s disease (ALS), multiple sclerosis, Parkinson’s disease and even dementia – were characterized by certain unmistakable affective life patterns. Among these were the chronic repression of so-called negative emotions, especially healthy anger, as in the ironic confession of Woody Allen’s character; a predominant sense of duty, role and responsibility; excessive preoccupation with the emotional needs of others while ignoring one’s own; and, finally, a core belief – again, often unconscious – that one is responsible for how others feel and that one should never let others down. The phrase “the good die young” unfortunately has more validity than we sometimes appreciate.

Illustrating the hallmark of an overworked sense of duty, role and responsibility, New York Times contributor Julia Baird recently reported her diagnosis of ovarian cancer. “I have always been healthy and strong,” she wrote in a recent column. “I regularly do hot yoga and swim two kilometers in a bay teeming with fish near my home in Sydney, while taking care of my two small children, hosting a TV show, writing columns and contributing latest edits to the book I am writing.’ Inadvertently, Baird accurately portrays the multitasking “I can do anything, I’ll be anything for everyone” persona that I’ve found in everyone I’ve met with his particular malignancy People don’t know, and their doctors rarely know how to inform them, that such self-imposed stress is a major risk factor for all kinds of diseases.

But is it purely self-imposed? It is not correct to see it that way. A materialistic culture teaches its members that their value depends on what they produce, achieve or consume rather than on their human being. Many of us believe that we must continually prove and justify our worth, that we must continue to have and do to justify our existence.

. . . During our dependent and vulnerable childhood, we develop the psychological, behavioral and emotional composite that we later confuse with ourselves. This composite, which we call personality, often masks a real person with real needs and wants. Personality is not a flaw – in stressed environments it evolves primarily as a defense, a defense that can become sabotaging.

The separation of mind and body is an erroneous view, incompatible with science. Personality traits, i.e. psychological patterns, lead to disease because the brain circuits and systems that process emotions not only exert a profound influence on our autonomic nerves, as well as our cardiovascular systems, hormonal and immune: in reality, they are all conjoined. The recent, but newer, discipline of psychoneuroimmunology has defined the many neurological and biochemical mechanisms that unite all of these seemingly disparate systems into a single supersystem.

. . . It is impossible to overstate the impact of childhood trauma on adult mental and physical health. A myriad of studies have shown that suffering in early life potentiates many illnesses, from mental “diseases” such as depression, psychosis or addiction to autoimmune diseases to cancer. A Canadian study showed that childhood abuse increased the risk of cancer by almost 50%, even when taking into account lifestyle habits such as smoking and alcohol.

Addictions, in particular, are responses to early trauma. Whether it’s drugs, food, gambling, or whatever form they take, all are attempts to ease stress and emotional pain. The first question is never why addiction, but why pain? We cannot understand the addictions that beset our society without acknowledging the pain and stress they aim to alleviate, or the childhood trauma at their source. In this light, the obesity epidemic we face primarily reflects an epidemic of pain and stress.

Amazing to say, most medical students never hear the word “trauma” in all of their formative years, except in the sense of physical injury. “The medical profession is traumaphobic,” a well-known colleague in San Francisco once told me. The results for patient care are devastating, whether in the treatment of physical or psychiatric conditions – a distinction which, given the body/mind unity, is in itself misleading.

Helen D. Jessen