Societal Factors at play in Alzhiemer’s.

22 Jul Societal Factors at play in Alzhiemer’s.

Sometimes the answer to a question is staring us in the face and we can’t see it simply because it doesn’t fit neatly within our limited belief system. However, once that answer has been revealed to us, evidence of its validity seems to pour out of the woodwork; often times to such a degree that it becomes infuriating that others around us don’t see it as we do. For example, many people who have suffered with pain for years and find a fast and effective cure after reading Dr. Sarno’s book “Healing Back Pain“, start to sound like Saul after he was struck down on the way to Damascus; the become proselytizers like Howard Stern, telling anyone and everyone about the important link between emotions and pain.

I think that we are at a unique moment in history in which this process of realization of obvious issues like racism, classism, sexism, as well as the import of emtions in relation to these issues, is taking place on many levels of our society. While some people hoped that Obama’s election signaled the end of a long history of racism, a steady stream of dashcam and bodycam footage belies that fact, and the #blacklivesmatter movement is trying desperately to get us to become aware of it. The profound realities of institutionalized privilege and power are being made more clear by data everyday, and surprising coalitions are rising to combat problems like mandatory sentencing and the prison industrial complex, a system which negatively affects primarily minorities and poor people in disturbing ways that also make the lives of their children much more difficult.

These structural inequalities don’t only land people in jail, but also in hospitals at alarming rates. There is a great deal of evidence that being a woman in our society is stressful. When that stress is coupled with the stress of being African American or another minority, then the negative effect is heightened. However, when the medical community has looked for answers to the problem of why women and minorities are more likely to get a certain disease the first place they look for are genetic factors. There aren’t as many studies that look at other causes like social status, the emotional effect of lower pay for equal work, and profoundly repressive expectations in relation to both looks and interactions. However, the landmark ACE study shows that adverse childhood events like parents with alcohol or drug problems, sexual abuse, divorce, or a family member in prison leads to negative health outcomes. The ACE study had 10 questions and if an individual faced 4 or more adverse affects they are 4 times more likely to get cancer or heart disease. Unfortunately, until recently this awareness has not even begun to translate into widespread treatment or prevention strategies.

The profound effect that our emotions have on our health has been largely ignored by the medical community for many years. However, in the past few years, while working on “All The Rage”, I have seen an increasing cultural awareness of the import of stress on our health outcomes. For example, though the ACE study was published in 1999, it has only recently become talked about in mainstream circles. As Dr Nadine Burke Harris points out in the below TED talk, when she noticed that she was mostly treating the symptoms of stress in her clinic she went looking for answers and quickly found the ACE study.

In the mid-’90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of 10 of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy. And yet, doctors today are not trained in routine screening or treatment. Now, the exposure I’m talking about is not a pesticide or a packaging chemical. It’s childhood trauma.

She was shocked when no one was really doing anything about this awareness and it sent her on a path to spread the word about the profound effect that childhood trauma has on health*. The clinic she worked in was in a high poverty area so its not surprising to find that her patients were faced with a lot of stress. However, she found that when she gave them ways of dealing with the stress, of acknowledging it and learning to cope with it more successfully, their health outcomes improved.

When we started this film 10 years ago it was very difficult to even suggest that repressed emotions might be a causative factor in back pain. Now I find that very few people doubt this idea. In fact, it’s become a somewhat generally accepted concept. However, there are only a handful of medical doctors that treat back pain with this understanding. As Dr. Sarno predicted in “Healing Back Pain”, the cost of care has risen exponentially (way faster than other health care issues) because the true cause, the repression of our emotions, has not been embraced by doctors.

While doctors like Howard Schubiner and Dr. David Clarke are doing yeoman’s work to spread the message that there is a great deal of scientific evidence that supports the emotional basis of pain as well as gut issues, there is still great resistance to the idea that our emotions affect other aspects of our health, especially areas in which there are pathological changes to tissue as in cancer, MS, and Alzheimer’s. However, in this realm there is also a great deal of evidence that supports the connection between repression and illness. Dr. Gabor Mate points out that for the most part, because these studies don’t fit with conventional medical understandings they are largely ignored. Dr. Mate has been writing about the connection between stress/repressed emotions and auto-immune disease for a decade, and he has gained a very wide following outside of the medical community. However, despite his many decades working as a family physician, in palliative care, and with addition his colleagues have not been quick to embrace his findings or his work.

As he points out in the clip above, most of the studies, like one entitled “Why Are ALS Patients So Nice?” don’t make much of a dent on practice. This study was started when a doctor picked up a nerve conductivity test from a technician who said “there’s no way he has it, he’s not nearly nice enough”. The doctor was taken aback and asked the tech to explain and he was told that all of the patient’s who have it seem to be the nicest most conscientious people. So he ran a study to test this theory and found that it had validity. Dr. Mate talks about this idea below.

While niceness as well as conscientiousness are valued attributes, they are often correlated to the repression of emotions. If my interest in making sure that you are happy is out of balance with my own awareness of what I need to be happy then it’s likely I am repressing my own thoughts and feelings to protect you. While this smooths the cogs of social interaction it many not be all that good for the person doing it. In Dr. Mate’s book “When the Body Says No” he argues that if we lack the ability to say no then our body says it for us, with auto-immune response. What he describes, and how he describes it, dovetails with the observations of Dr. Sarno.

After studying these ideas for the past 10 years, I have become acutely aware of the way in which people often acknowledge this connection and then downplay its significance; many times within the same sentence. Yesterday the airwaves started to crackle with stories about a new report on Alzheimer’s disease that found that women are twice as likely to develop it, and when they do it progresses twice as fast. As expected most of the discussion was based around looking for medical interventions that might explain the problem. My first thought was that women are paid 2/3 what men are and they are expected to be quiet, pretty, and docile. In short, in order to function in society without constant conflict, they are forced to repress their emotions to a much greater degree then men. It doesn’t surprise me at all that they are more severely affected by Alzheimer’s. Without talking about this disease or this study, the always eloquent Kareen Abdul Jabar hit on some of these ideas today with an article about how “Body Shaming Black Athletes Is Not Just About Race”.

Serena Williams won her 21st Grand Slam title at Wimbledon this month. This marks the 17th time in a row that she has defeated Maria Sharapova. Yet Williams, who has earned more prize money than any female player in tennis history, is continually overshadowed by the woman whom she consistently beats. In 2013, Sharapova earned $29 million, $23 million of that from endorsements. That same year, Williams earned $20.5 million, only $12 million of that from endorsements. How’s that possible? Because endorsements don’t always reward the best athlete. They often reward the most presentable according to the Western cultural ideal of beauty.

If I was Serena Williams I would be enraged by this idea. While none of the articles about the surprising Alzheimer’s study mentioned race and class my partner Suki heard a discussion on the Diane Rhem show that confirmed my suspicion that stress played a role and further that minority women were likely affected even worse than white women. Early in the conversation the presenter asked about the role of stress and the researchers confirmed that stress was indeed a factor, as was lonliness and depression. Later in the discussion it came out that African American women were twice as likely as women of European ancestry, and Latino women were 1 and half times more likely to get the disease.

Unfortunately, as Dr. Sarno points out, emotions are messy and hard to design studies around. Further it’s hard to see how these studies would lead to clear care directives or drug therapies. However, if we accept the idea that social structures, and the way that they affect our health, are a causal factor in everything from pain to Alzheimer’s then we can do things like learn how be aware of when we are repressing our emotions, and we can work to bring more balance to our society. The good news is that I was speaking to a friend the other day who works in public health and she pointed out that in academic circles the connection between stress/emotions and health is widely accepted. Now we just need to turn around the several trillion dollar health care system. It’s not going to be easy but it does feel inevitable.

*we have repeatedly asked Dr. Burke Harris to be in our film but her office has declined numerous times in the last 4 years.