05 Sep Cancer and Stress?

For years we have been working on a film about the connection between stress and pain.  Recently it has expanded to include the connection between stress and overall health.  While the film is about the science of healthcare, it’s also about social science – how ideas move through the world – and it’s about framing.  When a carpenter looks at a house, he or she tends to look at the structure.  Whereas a plumber might look at the layout of the pipes, an electrician notices how many circuits there are and how the lines are run.  When I look at the healthcare system through the frame of mind body interaction, I see patterns that are uncomfortable to talk about because they run counter to strongly held cultural ideas.  However, after spending nearly a decade looking at the connection between mind and body and how stress and the autonomic nervous system interact, the connection between stress and illness is the frame that I see many stories through.

The process of making the film began by focusing on the connection between repressed emotions and pain.  Dr. John Sarno realized the connection in the mid ‘70’s and began treating his patients with this understanding.  He’s had incredible success, and his books have sold millions of copies with no press or publicity to speak of.  As we worked on the film, I started to see that doctors in other fields were making very similar connections between health and repression of emotions and feelings. Dr. David Clarke, a gastroenterologist in Portland, wrote a book called “They Can’t find Anything Wrong,” which detailed how he came to understand the profound connection between repressed emotions and gut problems.  Dr. Gabor Mate wrote “When the Body Says No,” about the direct connection between the repressing of one’s emotions and auto-immune diseases (ALS, MS, and cancer). The connection between the hypotheses of all of these doctors is the way in which emotions interact with, and affect, the autonomic nervous system (fight or flight) and how this in turn plays havoc with the normal functions of the body.

These are complex processes that don’t lend themselves to clear-cut, “scientific” answers.  Yet, as Dr. Mate points out in his book, there are plenty of longitudinal studies that make it clear that stress and repressed emotions have a profound effect on health.  All of the above mentioned doctors noticed behavior, personality traits, and patterns that are shared by all of their patients.  As mentioned, these people tend to repress their emotions in such profound ways that they are often not consciously aware that they are doing so.  Oftentimes these behaviors and feelings that were learned in very early childhood are so ingrained that they feel like a part of the person’s personality, which in fact they are.

Dr. Sarno describes what he calls the “goodist”.  He noticed that many of his patients are extreme people-pleasers who push themselves to be perfect and good.  They work hard and often are very successful.  They tend to care deeply about making sure that all of the people around them are taken care of, and it’s important to them that people view them in a positive light.  These people find it nearly impossible to turn down a request for help and equally as difficult to ask for help themselves. Inside however, in ways that they often don’t consciously feel, they are enraged about having to do so much for others while nobody seems to notice if they are in pain.  Dr. Sarno uses a Freudian frame to discuss how this process works.  He postulates that the subconscious mind, afraid that shameful thoughts and feelings might escape into the realm of the conscious mind, works with the autonomic nervous system to cause pain in order to distract the consciousness from these scary thoughts.  While Freud may have fallen out of favor in some circles, the general idea behind this process makes sense on many levels, and dovetails with the discoveries of the other doctors discussed.

As the song says, “Only the good die young”. After working as a family physician for over 25 years, and then in palliative care, working to keep the dying comfortable, Dr. Mate noticed that his patients that were getting auto-immune disease tended to be ones that didn’t complain, or show their emotions much.  As he looked at the data the connection between stress and illness became more clear to him.  In order to clarify, he pointed out that while some medical textbooks flatly state that smoking causes cancer, only a small percentage of smokers actually develop the disease.  However, those smokers that do get lung cancer tend to be people who are highly repressive of their emotions.

Last night I read an article about how Katie Couric’s husband died of colon cancer at the age of 41.  It should come as no surprise to anyone reading this post that he was an extremely high achiever.  His sister described him:

“Jay was so vital and energetic, extremely disciplined, an early riser, careful eater, fastidious dresser, physically fit and regular exerciser.  He never smoked and rarely drank but was the life of any party who had a wonderful Irish tenor voice, was the best dancer, and talented pianist.  I know he sounds too good to be true but he had all of these qualities and more: he was an excellent student; college athlete; naval aviator; brilliant lawyer; television legal commentator; avid horseman; a Civil War re-enactor and amateur historian.”

Through the frame that I have been talking about, Jay appears to be an extreme goodist and repressor.  From a societal standpoint these are qualities that we all value.  However, if one studies the work of Sarno, Clarke, and Mate, the patterns and behaviors associated with achieving to this extreme degree appear to be related to the onset of his illness.  While this may sound like “blaming” the victim, it is not.  Instead it is an attempt to look for connections that might prove valuable in preventing illness.  “While all of us dread being blamed, we would all 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,” Dr. Mate once wrote.  And as Dr. Sarno points out in the forward of his book “Healing Back Pain,” if people had understood the connection between bacteria and illness during the Black Plague by simply washing their hands and drinking clean water, the epidemic would have ended quickly.  I believe that if we simply recognize the profound connection between repressed emotions and illness, we might have a chance of turning around our healthcare system.