April 8 , 2003
Healing Force Within
by Gabor Maté
never get angry, says a Woody Allen character in one of
the director’s movies, “I grow a tumour instead.”
Much more scientific truth is encapsulated in that droll
remark than many doctors would recognize.
For all its triumphs and technical progress, mainstream
Western medical practice militantly dismisses the role
of emotions in the physiological functioning of the human
organism. Its rejection of the mind/body unity is a classic
case of denial.
In over two decades of family medicine, including seven
years of palliative care work, I was struck by how consistently
the lives of people with chronic illness are characterized
by emotional shut down: the paralysis of “negative”
emotions--in particular, the feeling and expression of
anger. This pattern held true in a wide range of diseases
from cancer, rheumatoid arthritis and multiple sclerosis
to inflammatory bowel disorder, chronic fatigue syndrome
and amyotrophic lateral sclerosis (ALS). Sufferers from
asthma, psoriasis, migraines, fibromyalgia, endometriosis
and a host of other conditions also exhibited similar
inhibitions. People seemed incapable of considering their
own emotional needs and were driven by a compulsive sense
of responsibility for the needs of others. They all had
difficulty saying no.
One of the terminally ill patients under my care was a
middle-aged man, chief executive of a company that marketed
shark cartilage as a treatment for cancer. By the time
he was admitted to our palliative care unit his own recently
diagnosed cancer had spread throughout his body. He continued
to eat shark cartilage almost to the day of his death,
but not because he any longer believed in its value. It
smelled foul–the offensive stench was noticeable
even at some distance away-- and I could only imagine
what it tasted like. “I hate it,” he told
me, “but my business partner would be so disappointed
if I stopped.” I convinced him that he had every
right to live his last days without carrying the burden
of someone else’s disappointment.
As a workaholic physician, needing the whole world to
love and admire me—and, above all, to need me--I
also found it impossible to say no. No matter how busy
I was, I always accepted one more patient, one more counseling
client, one more difficult case. As I did so, there was
less and less space for myself in my own life. The result
was chronic back pain and a constant, low-grade depression.
It was when my own difficulties finally dragged me into
therapy--kicking and screaming in resistance, of course--that
I began to recognize the same traits in others.
The observation that the inefficient processing of emotions
predisposes to illness of all kinds has been noted by
many clinicians in the past. It has been the subject of
much research, all of it published in mainstream medical
and psychological journals. In several studies in a number
of different countries psychologists interviewing thousands
of patients have been able to predict with overwhelming
certainty who would and who would not develop cancer based
simply on the degree to which an individual suppressed
their feeling and expression of anger. Long term studies
of medical students at Johns Hopkins and of Harvard undergraduates
have confirmed that certain emotional traits in youth
tend to be associated with illness later in life, quite
apart from lifestyle influences such as smoking or drinking
or exercise habits.
Science has now given us an understanding of how the interplay
of emotions and physiology affects health. A new discipline,
pscyhoneuoroimmunology, studies the connections between
the brain areas that process emotions, the hormone-secreting
glands, the nervous system and the immune apparatus. And
here we confront the inadequacy of language. Even to speak
of connections implies that, somehow, separate entities
are linked to each other. Reality knows no such separation.
There is no emotional system distinct from the hormone-producing
organs, no nervous system divided from the immune defenses.
One can make these divisions only in the laboratory, in
autopsy specimens or in textbooks. There exists in living
persons one super-system of which the emotional centres,
neurological pathways, hormonal glands and immune organs
are all aspects. They are all wired together electrically
by nerve fibers and they also speak the same chemical
language. They do not and cannot function in isolation
from each other.
A cursory visit to medical libraries or to online sites
is enough to show the advancing tide of research papers,
journal articles and textbooks discussing the new knowledge.
Information has filtered down to many people in popular
books and magazines. The lay public, ahead of the professionals
in many ways and less shackled to old orthodoxies, finds
it less threatening to accept that we human beings cannot
be divided up so easily and that the whole wondrous human
organism is more than simply the sum of its parts.
How does emotional repression predispose to illness? Since
there is only one system, not four separate ones, whatever
happens in any one part of it will affect the other parts.
The repression of anger leads to the chronic secretion
of stress hormones, such as cortisol, that suppress the
immune system. The body’s defenses are disarmed
against infection from the outside or malignant changes
from within. When anger turns against the self, as it
does in people unable to express it in a healthy way,
hormonal imbalances can induce the immune system to mutiny
against the body. Inflammatory autoimmune diseases of
the joints, blood vessels and internal organs may follow,
and even conditions like diabetes and Alzheimer’s.
It would be rare to find an individual with any of these
diagnoses whose lifelong emotional coping patterns are
not stamped by difficulty with anger.
As far as orthodox medical practice is concerned, the
mind-body research all falls into some Bermuda Triangle,
lost without a trace. The medical system continues to
operate as if the new science did not exist. Psychoneuroimmunology
has yet to enter the curricula of most medical schools.
Illnesses are looked at only from the perspective of their
physical manifestations. That they occur in the context
of the real lives of real people is rarely considered.
It’s as if a person’s relationships, emotional
life and day-to-day stresses had nothing to do with how
his or her body functions on the biological level. Patients
may see specialists for years without the scientifically
proven unity of mind and body ever being brought to their
Why this neglect?
Prior to the development of powerful medications, instruments
and diagnostic tools in the past century, physicians had
to rely on awakening the healing forces within the patient
if treatments were to succeed. That meant having to know
people as individuals, cultivating a relationship with
them, becoming acquainted with their lives. The advent
of modern pharmacology and medical technologies vastly
increased the capacity of physicians to help their patients,
but reliance upon the new modalities has caused an atrophy
of the age-old human wisdom that used to inform medical
practice. At the beginning of the twentieth century Sir
William Osler, the Canadian who is considered to be one
of the greatest clinicians and medical educators of all
time, was highly conscious of the mind-body unity. Osler’s
name is still honoured but the spirit of his teachings
has long vanished from the practice of medicine. Instead
of coming along-side the traditional insights, modern
medical science has completely displaced them.
The education of doctors leaves them ill-prepared to counsel
patients on the relationship between stress and illness.
On a more personal level, medical training is an intensely
stressful experience. The men and women who undertake
it are highly capable but often highly driven individuals.
They are all too willing to ignore their own needs as
they learn and practice their craft. Like I have been,
many of them are workaholics whose professional lives
fill up the spaces where a deeper, more rounded personal
existence should be. From such a vantage point, they are
not likely to have awareness of other people’s emotional
stresses, or empathy for them. And, from a purely financial
perspective, our fee-for-service system actively discourages
physicians from spending the time with patients that an
empathic and thoroughgoing discussion of emotional issues
Finally, at the heart of the denial is the desperate fear
humans have of being blamed for their own troubles. It
was a vogue in the New Age 1970’s to speak of people
having “invited” diseases into their bodies
as “guides.” Owing to such nauseatingly self-righteous
attitudes patients felt they were being held culpable
for the very fact of having fallen ill. In her famous
1978 essay, “Illness As Metaphor,” the writer
Susan Sontag—then herself suffering from cancer—wrote
that "The current myth(s) about cancer propose that
one is responsible for one's disease. But the cancer imagery
is far more punishing. There is mostly shame attached
to a disease thought to stem from the repression of emotion.
The view of cancer as a disease of the failure of expressiveness
condemns the cancer patient; it evinces pity but also
conveys contempt." Thus was the baby thrown out with
the bathwater. Living in a culture of blame, we are obsessed
with blame. The fear of it makes us afraid to embrace
“You may feel that there is no conceivable relationship
between the behaviour of our cells, for instance and inflammation,
and our conduct in everyday life,” wrote the outstanding
Czech-Canadian physician and researcher, Hans Selye. “I
do not agree.” Selye, who coined the word stress
in its modern usage, described with mock pride how der
stress, le stress and lo stress entered the German, French
and Italian languages respectively. He understood stress
as a set of physiological events in the body, in response
to any loss or threat, real or perceived. He attached
no blame to it, any more than Osler did when he suggested
in 1892 that rheumatoid arthritis “had a nervous
origin.” Selye also recognized that in modern life
the most important stressors acting on human beings are
The omission of stress from the medical lexicon has unfortunate
consequences. Patients often feel frustrated, not listened
to, their most intimate concerns ignored. There is plenty
of evidence that psychological interventions can have
positive effects in the healing of a wide range of conditions.
Mind and body links have to be seen not only for our understanding
of illness, but also for our understanding of health.
In healing, every bit of information, every piece of the
truth may be crucial. Not to inform people of the links
between emotions, stress and physiology is to deprive
them of a powerful tool.
The issue is responsibility without blame. All of us dread
being blamed, but we would all would wish to be more responsible--to
have the ability to respond with awareness to our circumstances,
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. None of us are to be blamed if we succumb
to illness and death. Any one of us might succumb at any
time, but the more we can learn about ourselves, the less
prone we are to become passive victims.