16 Sep The Age of Rage
Our sense of who we are, and where we fit in the world, is shaped by both nature and by nurture; genetic/physical factors as well ass emotional ones. There a consistently churning cultural tug of war in regards to which factor is more powerful in terms of sculpting our personalities and predilections. This debate is one that often shifts and changes along with political and social trends. I grew up in an era where the concept of nurture was in ascendency, and given a great deal more attention than nature. I was left with the sense that if we treated young people with love and respect we could help them become “almost anyone they wanted to be“. I developed such a positive view of the power of nurture which in turn diminished my sense of the import of nature’s infulence on shaping who we become as people..
Perhaps it’s because I have a natural inclination towards optimism that this idea stuck with me. Believing in the power of nurture leads to a somewhat expansive view of the world; one in which there is a sense of possibility. This view is more aligned with a “liberal” viewpoint than a “conservative” one. While my awareness has grown more complex I still believe that thoughtful nurturing can have a very positive affect on peoples outcomes in life, However, I also recognize that’s the word “nurture” doesn’t always entail positive reinforcement. Positive intent and positive action are not as intimately linked as we might hope. The truth is that our nurturing skills and abilities are connected to the kind of nurturing we received as young people. While we, like our parents before us, maybe have righteous and loving goals, we don’t always live up to our own expectations. In the end, the ways in which we nurture can also have very negative connotations. On a personal note, while I as aware of things I felt that my parents did badly, and those they did well, in regards to raising me, I wasn’t always as adept at avoiding the pitfalls and traps that they unwittingly set. At one point when my older daughter was about 5 I got very frustrated at her and lost some of my cool. My brother, who was visiting was aghast and said with not a small sense of terror, “you sound like Dad!?”. “I Am Dad!” I shot back. However, his words deflated me and I quickly tried to repair whatever damage I had wrought by apologizing to both my brother and my daughter. I remember feeling lost in that moment, and powerfully aware of how both our genes and our experiences shape our behavior.
While, I have tried to nurture in positive ways to the best of my ability, I have’t always had the social, emotional, or intellectual skills to do so without incident. It’s complicated when we try to figure out the balance between accepting our children for who they are, while also helping them develop the kind of social skills they will need to naviaged the world. Sometimes their “nature” can be challenging to us, and this can be especially true if they are like us. Our natural inclinations can shape the direction we take, and when we are shamed or cajoled into being who our parents or social circle want us to be it can be traumatic for both parties.
As with the word nurture, the word “trauma” can be imbued with a wide range of meanings. One person may conceive of trauma as a wildly dramatic event. For another individual some small incident of shaming may have a profound influence. In this sense, some traumas are clear and obvious. while others are more deeply hidden. In many cases the powerful impact of these traumas are minimized and obscured even from ourselves. For example, when I was little I believe I cried fairly easily, but by second or third grade I cane to understand that this wasn’t acceptable because I got teased for it. I recall tripping and falling in a wooded playground in second grade. I started to cry but by using force of will I stopped it. To an observer this may not have seemed like a major traumatic event. However, it’s been very hard for me to cry since that day nearly 45 years ago, so it’s quite clear to me that the reverberations of being shamed for who I was had long lasting impact. I felt forced to stifle an important part of myself in order to fit into my social world. I think that this clash between being true to our nature and fitting in socially, can lead to interactions that don’t appear particularly traumatic, but have long lasting influence over the flow of our lives.
As I grew up I didn’t have any way to articulate, or integrate, this understanding into my worldview. My parents, a psychologist and a social worker, did their best to be positive and nurturing parents. Yet they also had their own issues that got in the way of being the “perfect” parents that they aspired to be. Their work focused on dealing with emotions so we heard plenty about that, and I got a lot of messages about about the power of positive nurturing at home. At the same time these ideas were growing in prominence culturally. In the 70’s things like the record “Free to Be You and Me” (which was entirely about acceptance and love), “Sesame Street”, and “The Electric Company” projected a very positive view of nurturing. It was the love and peace generation in prime time (at last prime time for kids who got a little TV in the morning). While this has a lot of positive implications, the focus on nurture obscured my sense that nature was as strong of a force as it is. Again, I don’t think that this was by design, it was simply my own experience, and it created a disconnection from understanding just how powerful our genes are.
This view of the world, in which nurture held more sway than nature, had a major impact on the way that I made decisions. As mentioned earlier, I developed an inclination towards liberal policies which were presented as more nurturing. In addition I became a sperm donor, in large part because I didn’t think my genes mattered so much. As a young person, who lived far away from close relatives, I also didn’t have a sense of how powerful our connection to family can be. However, 20 years later, when I had two children of my own, I was dumbstruck by just how powerful genes were in shaping who they were before they were even a few days old. I was also overcome by the intensity of my feelings of connection to them. 15 years later, when I met my daughter Holly, who was the product of my sperm donation, I wasn’t so much shocked, as I was overwhelemed with a sense of connection when we met. In other words I knew that I would feel connection to her, but the immediate intensity of that feeling was more powerful than I had imagined. Our relationship is different from that of the children I raised, and possibly less fraught, because I wasn’t involved in her early nurturing. The mistakes I made raising my own children were undoubteldy traumatizing to them. This doesn’t diminish the positive things I did well, and I know that they feel loved and supported. However, the effects are complex and will take some work to unwind. With Holly there’s less of that baggage, but also a less nurtured connection. Instead we have the opportunity to create a more emotionally informed relationship, and that’s a profound gift. In fact it is Holly’s thoughts on the first draft of this piece that sent it skittering off in a new direction.
When I started to write this post the other day, it was not personal. Instead I was trying to think more deeply about how different people perceive the power that emotions have to impact our health. This is not a new subject for me. In fact, it’s something that I write about on a regular basis. Sometimes I’m teasing out new ways of getting people to be aware of how much we resist being present with our emotions, why that is, and what we might do about it. My partners and I made a film about the mind body connection called “All The Rage (Saved by Sarno)” which focuses on the work of Dr John Sarno. As with this post, the movie did not start out with a personal bent, but over time it became clear that it was important to weave that in in order to communicate the information in a way that helped people to relate to it.
The subject of how much our emotions affect our physical health can be fraught and difficult to talk about. This is especially true if we have learned that emotions are unacceptable, scary, or taboo in some way. The reason we started the film with Dr Sarno was that my family has a long history with is work, his books, and his ideas. My father, brother, and myself, were all helped immeasurably by him. Still, for the first 6 years of trying to make the film I wasn’t a part of the story. We also couldn’t figure out how to make the film. In some ways the same thing happened with this post.
Again, I didn’t start this post because I wanted to write about myself our my work, but instead because I am struggling to articulate how powerfully rage has been affecting our culture for the past many years. Rage has a lot to do with power (ours relative to others), expectation, judgement, and fear. Many of us go through our days reacting to the world around us. When things don’t go as we expect, when we feel disrespected, or when things feel unsafe in some way, we might have an urge to respond with rage. If it doesn’t feel safe to express that rage, we might then repress that feeling. If we feel powerless then the pressure to repress our feelings feels even greater because we can often be punished for expressing them. This is especially true when there is a profound power imbalance. In this case, the people with power are often less aware of that imbalance than those who have more limited agency.
My brother is a social psychologist who ends up getting a lot of press about his studies. He’s good at framing them in very relatable ways. In one study, that he ran with his friend Joe Magee, they had people write the a capital “E” on their forehead. What they found was that people who have more power tend to write the “E” from their own perspective. In other words, for the person looking at them the “E” looks backwards. It may not surprise you that almost all CEO’s wrote the “E” in this manner. People who have less power tend to take other people’s viewpoint into more consideration.
When we talk about things like systemic racism we can see this pretty clearly. People who have more power due to this system have a much harder time seeing it, while those who do not benefit (i.e. they suffer from it) are much better at describing and articulating the effects of it. Those who benefit the most have the hardest time accepting that even if they don’t feel personally responsible for it, they can reap the rewards of it. When we look at systemic racism through the lens of data, rather than what we think about it, we can see how suppressed rage possibly manifests as increased levels of illness.
Here’s one example. Lupus is an auto immune disease that has no know cause or cure. Interestingly women get it twice as much as men. I think we can all agree that women have less power than men in our culture. If we follow the logic that those with less power have more need to repress their feelings than those with power, this makes a lot of sense. While we could simply chalk it up to “different hormones”, genes, or some other gender focused response, once we add in a little bit more data things get more complex; and frankly more clear. It turns out that Black women get it 4 times as much as white women, Latina women get it 3 times more than white women, and Asian American women get it twice as much. I hope that we can agree that this looks like a chart of relative cultural privilege; Men>Women>Asian American W> Latina Women >Black Women. While this isn’t definitive proof that the repression of one’s emotions can be causative factor in this auto immune disease, then we can look at the vast trove of data on relative health disparities among these groups. When we look at groups of people by gender and race we can tease out some small genetic differences (sickle cell comes to mind), but we rarely study medical issues by looking at race and class as causative factors, at least in the sense of finding cures for them. Instead the medical system, as practiced, focuses much more on drugs, and other physical interventions rather than the kind of social or economic interventions that might make much more difference.
I think about this a lot because I’m interested in both understanding emotional issues and political ones. Through those two lenses it is clear that they are intertwined when it comes to health. This is where things get particularly fraught and tricky. On one level we can recognize that these increased pressures lead to worse outcomes. Once we recognize that we can think about how to address this problem. Clearly there are policy decisions that cam be made which can help; and we can call these outside factors, as in outside of the individual. However, there are also inside factors, actions that the individual can take to address the issues. Some of these are emotional responses and some are action, or physically oriented. For example, people might exercise, meditate, or change their diet. They can also address the emotional stressors through actions like journalling, therapy, and again meditation. However, these more internal actions are not disconnected from the physical ones as those physical activities require “buy in” or “agency oriented action”- in other words the fortitude, belief, and willingness to make the kind of changes needed to move towards better health. These are complex issues with complex and individual solutions.
As our film focused ore on pain that auto immune issues (though I believe they are deeply connected), I will start by looking at pain. One of the problems with trying to help people who are in pain by suggesting the mind body connection, or Dr Sarno’s approach to his awareness, as a possible pathway to healing, is that from a social perspective we place a great stigma on talking about emotions. We can take a sick day if we can’t get out of bed due to back pain, but we are hard pressed to find a job that will accept “I feel too sad to get out bed today” as an excuse to skip work. We understand this implicitly and explicitly, and know that it’s not safe to discuss how we feel emotionally in most social or professional situations. This should make it clear that our culture stigmatizes the expression of emotions. Unfortunately, this means that many of us have a hard time even being connected to what we feel, and if challenged to think about it we can become quite defensive. This is a shame because that defensiveness keeps us from being able to access these kind of mind body aware treatment methods.
Here is where I want to be painfully clear (pun semi-intended). When I talk about the connection between emotions and health I am not implying, nor suggesting, that the illness is all in one’s head, nor that the illness is not real, nor that there is nothing physical going on. As I stated earlier, I have suffered from these issues myself, and have struggled to get better even though I understand what is going on. I think that one of the main problems is linguistic. It is also a problem connected to the kind of binary thinking that leads to a denial of complexity. People want things to be clearly good or clearly bad, wrong or right, emotional or physical. When it comes to medicine some of this goes back to Desecrate. When he tried to incorporate feelings or thoughts into medicine he was given a choice leave the head to God or give his head to the State to put on a stake. From that time on (with a slight diversion towards the mind after Freud) the mind and the body have been seen as separate entities. However there is no emotion that does not have a physical reaction. Shame, fear, joy, anger, sadness, and any other emotions can be described in relation to their physical responses. It is also true that our aches, pains, and other illnesses also have feelings that correspond to the physical events. In fact the definition of pain is “a physical and emotional response to tissue damage, or the perception of tissue damage.” It doesn’t say a physical OR emotional response. The two are not separate. This is important to think about when we try to break down how we look at causes and cures.
Earlier, I talked about where this article started. I was inspired to write after reading an article about the fact that Hypothyroidism is severely under diagnosed. The article argued that this under awareness of the problem is essentially a form of medical gas lighting of patients. The author makes some very strong points in regards to patient/ provider power dynamics that are important for everyone to understand, and it is also indisputably true that failing to recognize this thyroid problem, which is treatable with hormones, is highly problematic. However, the narrative of the piece made no room for awareness that emotions might be a factor in either the disease or its treatment.
When I sent a first draft of this piece to my daughter Holly she keyed in on the fact that it made her feel a bit defensive. Like millions of other people, she has often struggled with unexplained illnesses that, on some level, she recognized had to do with her emotions. So, I started over, and made it more personal. I also had to sit with the impulse I had to respond to it, and perhaps the frustration I felt while reading an article that negated the important impact of emotions on our health. I’ve found that sometimes I have to erase a sentence I wrote while frustrated, and re-type it- sometimes with exactly the same words, but with a different energy, in order to cleanse it of the energy I wrote it with originally.
From my work on “All The Rage” I was aware that emotional factors affect the functioning of the thyroid gland. When I googled about Hypothyroidism the first articles I found all mentioned that emotional factors can make they symptoms of thyroid issues more severe. This one contains the quote “Stress alone will not cause a thyroid disorder, but it can make the condition worse”. In general all of the “medical” websites definitively say that stress can’t cause the hypothyroidism (or any other auto immune disease). At the same time I haven’t found an article that cites a specific cause of the issue, or any auto immune issue. However, the articles from less accepted medical sources deal with the fact that the cause is complex and multi-factoral. Articles like this rarely dismiss the physical issues that play out, but instead connect those physical realities to an interaction with the emotional ones.
Again, we know that our emotions can affect how our thyroid delivers hormones to our body. In fact it helps to deliver cortisol and adrenaline into our system, and these are stress related hormones that regulate how we feel and how we act. The treatment for hypothyroidism is one hormone and Hyperthyroidism is another. We can use external hormones to bring the body back into balance. However, these hormones have some very powerful side effects. So exploring emotion-focused treatments can be useful partly because they involve less “side effects”.
If we read these statements with an awareness that there is a stigma against connecting illness to emotional factors it’s easier to understand this narrative. Again, every medical discussion of auto immune issues recognizes that stress exacerbates them, clarifies that there is no know cause, and also definitively states that emotional factors are not causative, without offering any argument as to why we know this is true.
We know that auto immune issues often have to do with an over active immune response. It is made clear that for an “unknown reason” the body becomes hyper vigilant and that the immune system begins to attack the body when no harmful invaders like a bacteria or a virus are presenting a comparable threat. Many auto immune issues begin with the bodies response to a bacteria or virus like Lyme. However, once the virus is defeated the immune response continues. Why might that be? Some scientists postulate that anxiety or hyper emotional vigilance plays a role. Many others look to traumatic events that lead to this kind of hyper vigilance as a factor.
Ashok Gupta, who dropped out of medical school due to chronic fatigue system, healed himself from the condition by coming to a deeper understanding of the physical and emotional connection in relation to anxiety and striving for perfection. As he explains it, the amygdala, an almond size section at the center of the brain which is responsible for our fight or flight response, cannot differentiate between a physical and an emotional threat. Once activated it connects to our frontal cortex, the thinking brain, to see if something is dangerous so that it can be on the lookout for it. For example, he explains that if the amygdala pulls us back on the curb to save us from being hit by a bus, it checks in with the cortex to see if buses are scary. If the cortex responds “BUSES ARE SCARY”, then every time it recognizes one, the body is supplied with fight of flight hormones. However, if the cortex responds that busses are not scary, but walking around mindlessly is, this response is diminished. If we extrapolate this hyper vigilant response across a range of “threats” such as school work that needs completing, a sense of self that needs to be fitter, stronger, prettier, more successful, more loved, less alone, etc etc, we can see how chronically active stress responses can lead to chronic dis-ease – or disease.
Everyone is going to respond to traumatic events differently depending on how they are primed to respond. Some of this is genetic and some of it is developed through experience. Understanding this allows us to develop tools that can help us train the brain to be less vigilant of emotional threats. Increasingly, the role that trauma plays in shaping our response to the world is seen as an underlying factor in a myriad of health issues. However, the stigma against this kind of discussion is still quite strong, as evidenced by the popular article that started this post. That article makes a profoundly important point. Patients need to be listened to, treated with respect, and given proper care. However, the system can’t change without some shifts in power. Patients need to be given more agency and understanding, not just from doctors, but through a social system that is not so wildly out of balance. Patients and doctors need to be able to communicate more directly about what’s going on in both of their lives. It’s important that doctors be professional, but they also need to be seen as human, with their own failings viewpoints, and powers.
Here’s what a government web site says about the causes of autoimmune disorders, “The exact cause of autoimmune disorders is unknown. One theory is that some microorganisms (such as bacteria or viruses) or drugs may trigger changes that confuse the immune system. This may happen more often in people who have genes that make them more prone to autoimmune disorders.”. This explanation clarifies that emotional factors are not even being considered as one of the causes. If we can’t see it then we can’t address it.
Getting back to the article; when people go to the doctor with complaints, and those complaints aren’t taken seriously it can be enraging. The power dynamic between a patient and a medical provider can be profound. When a doctor either can’t find a physical cause, or suggests that the issue might have emotional connections it can be both disheartening and enraging to a patient, especially when they are highly resistant to this possibility. Given the power dynamic the patient often has no means of expressing or addressing those feelings in the moment, and even that repression can exacerbate the symptoms. Feeling powerless to start with is difficult. When a doctor invalidates what we feel it can be both further disempowering and enraging. It’s a problematic situation both physically and emotionally. Doctors need to do better at figuring out how to discuss these issues; the medical system needs to do better. However, the problem is larger than just the medical system or the patients.
Blinding ourselves to the possibility that emotional realities might be a part of a complex awareness of causation makes it impossible for us to see the entire picture. To say that emotional factors are one of the causes of health problems does not mean that physical issues are not at play, but instead that emotional ones are as well. In fact as Ashok Gupta points about in the clip above, every emotional response has a physical response in the body, but this is something that we don’t fully recognize when we think about healthcare.
Again, I am not writing about these ideas with a sense of distance, but instead from the perspective of my own journey to deal with chronic pain issues related to the repression of my emotions. Even though I understood this was the cause of my back pain I didn’t have a “miraculous recovery”. Instead I faced even deeper frustration because, while I understood what was going on, I often felt powerless to stop it. These issues are varied, complex, and deeply intertwined with our own physical and emotional stories. As I moved through my own journey I came to see that the solutions, for me, were both achingly simple and wildly complex. The last line of our film shows Dr Sarno states, “It all comes down to one simple idea, that the mind and body are intimately related. That’s it, that’s the whole story.” That line when stated at the beginning of the film has very little meaning. However, by the end of the film it resonates profoundly with many people. A simple understanding can often take a lot of work to uncover.
When I started to have a bout of chronic leg pain in 2004 it felt connected to endless days shooting video outside in icy conditions as we began our film “Battle for Brooklyn“. I knew that emotional factors played some role so I focused on that but the problem got so bad I could barely walk let alone shoot for the film. I finally went to my primary care doctor because I could barely function. Dr Sarno’s book had saved me from frequent episodes of my “back going out” a decade earlier. However reading his book wasn’t helping. I told the doctor about my previous experience with Dr Sarno and he completely dismissed it as nonsense. He didn’t ask me what as going on in my life at the time. If he had I would have explained that I had a wild three year old daughter, a run down house I was trying to make a home, that I was also fixing up a gutted vacation home (with no construction skills and almost no money), working on several unfunded documentaries, and struggling to find a footing in my professional life. In other words my possible causes of emotional distress were through the roof.
He also dismissed the community I was following for the film project that I was working on. I was documenting a broad group of people who were fighting an arena project that would take homes and businesses and transfer the property to a billionaire. He thought it was good project because he believed that it would “improve the area”. He had recently bough his apartment in the area and hoped it would go up in value. When I tried to explain what I knew to be transpiring, he rejected all of the more complex information I presented. This was incredibly frustrating because he was repeating the PR points of the developer that had been amplified by the press. but refusing to hear counter factual information that I had gleaned from obsessive work on the project for the previous 3 months.
He sent me to a physical therapist who suggested some stretching and used electric stimulation. It was bullshit and of course it didn’t help at all. In fact it made things worse and I had trouble even walking out of the therapists office. I went to a healer in chinatown and the acupuncture and herbs helped a little, but my leg got so bad that I eventually collapsed in mind blowing pain while I was working on the house upstate. I had to take 4 Vicodin to calm it enough for my friend to pick me up and put me in a car for the long drive back to my home. I was bed bound for two weeks. Finally, after an MRI, a chiropractor, and several other medical attempts to address the problem I reached out to Dr. Sarno. My wife carried me into Sarno’s office. He scoffed at the MRI I showed him, and very clearly told me that the issues were emotional and that no amount of physical focus would fix my problem. I knew he was right and I redoubled my efforts to think emotionally. I needed to hear him say it though. Slowly I healed.
We started to make the film about Dr Sarno but it stalled because we couldn’t get funding for it, and we also couldn’t figure out how to do his story justice. While I largely got over the bout of insane pain, I wasn’t in great shape. Frankly, I was unwilling to face my emotional challenges with as much presence as I needed to. So, it shouldn’t surprise anyone that I had a second collapse at the end of making that Brooklyn film 7 years later. As I hit the floor I screamed grab the camera because I instantly knew that it was time that we restarted the Sarno film, and that my own journey would have to be a part of it. That experience led to a more profound emotional reckoning that continues to unfold in useful ways.
That doctor I went to was an asshole, and I knew it. I never went to him again, and I was angry. In fact, the anger I felt when I left his office made the pain spike, which could, and should, have alerted me to how profoundly my emotions were related to the pain. I could have used this awareness to ask the kind of emotional questions I needed to. Still, my pain was no more “my fault” than it was the doctors. Over time I’ve learned the value in not seeing from the perspective of blame but instead of acceptance. At the time, my unconscious avoidance of emotional factors was so profound that I couldn’t see it. I don’t think that was my fault as much as it was my limitation. Had my doctor had more emotional awareness he might have helped me to see something that was pretty apparent. He couldn’t see it either because he had blinded himself to the import of emotions. He’s not alone, and the assignation of blame won’t change that.
The point is not that he shouldn’t have done better, and listened more (he should have), but that the avoidance of dealing with our emotions is a complex systemic issue that has profound consequences for our culture and our health. Placing the blame on a single doctor only leads to distraction from the lager issue. Rage is a blinding emotion; hence the term “blinding rage”. Given that awareness, we can see that anger is a lot less likely to lead to resolution than compassion is. The reality of the patient/doctor power dynamic makes it much less likely that the doctor would listen to me, or that any doctor (as currently trained in the allopathic system) will be able be able to easily integrate that awareness into their practice. Power dynamics are not random. They are situational and often unconsciously formed. Sometimes the people with the lowest levels of unconscious self-esteem seek the highest levels of power. Hitler comes to mind;). While many doctors enter the field out of an abundance of compassion, it’s also clear that some do so for reasons more related to money, status, and power. This is not to say they are awful people, but instead that those who gravitate towards positions of power aren’t all blindly altruistic. We are all complex emotional beings, and our position in society doesn’t negate that.
I believe that one solution to improving emotional awareness is compassion. In my case, I was pushing myself way beyond my own capacity both physically and emotionally. I didn’t have enough compassion for myself to ask for the emotional support I needed. When the doctor expressed only contempt for my ideas and my work I didn’t have enough compassion for myself to act. I should have have left, laughing at what a fool he was, but instead I left in a rage at how dismissed I felt. At the time I had profound compassion for others but too little for myself.
I understand why the author of the post about medical gas lighting wrote it. I have empathy for the pain she felt at being dismissed. I can also see that she is still suffering from a sense of betrayal. Hypothyroidism can be measured, as can hyperthyroidism. This imbalance in the system is a physical problem and it can be addressed with a hormones. However, those hormones have side effects. Rather than bring the body back into balance, they work to offset that imbalance. There are ways of addressing trauma and emotional responses that also help to restore balance. These are not easy tasks emotionally. I know this well. I spent a good couple of decades both knowing that I needed to do that emotional work and strenuously avoiding doing that work. Now that I have begun that process I’m well aware of the fact that I have a lot more work to do. At the same time I can also see profound progress. I also know that I have helped thousands of people see how to get on that path through my writing and my film. Sometimes this effort can feel a bit pointless, or enervating. However, when I lean into it with a spirit of awareness I find that it helps me to go deeper into my own understanding, and that makes it all worthwhile.