When The Body Says No
From: An interview with Gabor Maté, by Margaret Gunning.
In his latest book, When the Body Says No, Gabor Maté goes out on a medical limb with his passionately-argued thesis that certain types of chronic disease can be triggered by stress. And not the garden variety stress we usually think of (the job, the kids, the mortgage), but internal stress generated by the repression of powerful emotions, particularly anger.
In his many years as a palliative care physician, Maté observed in his dying patients certain eerie similarities in personality. Many of them were cheerful and agreeable to a fault, never seemed angry, placed everyone else's needs above their own, and were harshly critical with themselves. Their personal boundaries seemed fragile and uncertain, as if they did not know where they left off and others began. In many cases, it was nearly impossible for them to say "no," to the point that their bodies had to say it for them.
These personal observations matched up with certain discoveries in the relatively-new field of psychoneuroimmunology, the science studying the intricate interaction between psyche and soma. The mainstream medical idea of a "mind/body split" no longer made sense to Maté, so he set out to probe the mystery of what makes us sick, and how we can guard our health through a better understanding of boundaries, emotional honesty and personal autonomy.
Though the book has been warmly received by readers and is already climbing Canadian bestseller lists, it has not done so well with certain members of the medical community, not to mention some reviewers (the Toronto Globe and Mail was particularly caustic, though they did praise his elegant and graceful expression of complex ideas). Maté's critics claim the author blames people for getting sick, that his ideas are too touchy-feely and that the science isn't there to back up his claims. However, When the Body Says No presents compelling evidence that our psyches and our bodies are so inextricably intertwined that they are inseparable.
As for emotional repression, Maté found it has very long roots. What happened to us when we were kids really does affect us dramatically in the here and now, especially if "negative" emotions like anger were repressed and love was poorly expressed. And early trauma leaves an impact like a wrecking ball hitting delicate crystal.
Maté writes with great poignancy about his own childhood:
I am both a survivor and a child of the Nazi genocide, having lived most of my first year in Budapest under Nazi occupation. My maternal grandparents were killed in Auschwitz when I was five months old; my aunt had also been deported and was unheard-from; and my father was in a forced labour battalion in the service of the German and Hungarian armies. My mother and I barely survived our months in the Budapest ghetto. For a few weeks she had to part from me as the only way of saving me from sure death by starvation or disease. No great powers of imagination are required to understand that in her state of mind, and under the inhuman stresses she was facing daily, my mother was rarely up to the tender smiles and undivided attention a developing infant requires to imprint a sense of security and unconditional love in his mind. My mother, in fact, told me that on many days her despair was such that only the need to care for me motivated her to get up from bed. I learned early that I had to work for attention, to burden my mother as little as possible and that my anxiety and pain were best suppressed.
Roots like these don't lead to tranquil personalities. Though he does exude a kind of calm, Gabor Maté is about as relaxed as a blob of mercury on a hot griddle, a restless, intense individual who speaks so quickly you need to amp up your inner listening setting to max. He is a bundle of contradictions, a walking paradox (are there two of him, I wonder?): his manner gentle and even rather sweet, but with a face that is ascetic and a bit severe. In spite of his frequent lightning-fast zingers, he has the most melancholy dark eyes I have ever seen, eyes that look like they have seen more human suffering than most people could bear.
It's impossible to be guarded with Gabor Maté, for he seems to see through social posturing immediately. Yet, while we spoke, I sensed an odd guardedness about him, a tendency to deflect attention away from himself and on to others. At times I found myself compulsively sharing personal stories with this man I had just met. There is something about him which seems to invite confidences. And he has a tendency to psychoanalyze everyone around him, leading me to jest at one point, "Dr. Maté, do you ever stop?" (His answer: "That'll be $110.00.") Yet in spite of his directness, I noted a certain dodginess, too, a darting out of reach, as if he may in fact be a little uncomfortable with all this attention.
Is this shyness? He can suddenly turn self-effacing, which is a bit unexpected in light of the fact that he is not at all shy about promoting his own work. But at the same time, he is more than generous in giving credit where it is due. Married for 35 years, he speaks often and with great fondness of his wife, Rae, a painter who does the cover art for his books. He calls her his soul-partner in the acknowledgments of When the Body Says No, and claims, "Much that should not be in this book has been deleted thanks to her emotional courage, love and wisdom. Much that I cherish is present in my life owing to the very same qualities."
Interviewing Gabor Maté was absorbing, even compelling, but hardly relaxing. It took me some time to get used to his unusual intensity, for there is a sense of wheels within wheels, all of them spinning exceptionally fast. His humor can jump out of left field and be startling, if not confusing: I didn't always know when he was joking, as his delivery is both rapid-fire and totally deadpan. He describes this in Scattered Minds: "My humor ... can break from any odd angle and leave people laughing or leave them cold, my joke bouncing back at me, as the Hungarians say, like 'peas thrown at a wall'."
But I found it fascinating, if not compelling, to sit in the presence of a mind like this, a kind of nosebleed intelligence combined with a scalpel-like ability to cut through human disguise. So I amped up my listening speed, found myself getting a headache, amped it up still more, gave it one last mighty crank, and almost kept up with the blazing meteor shower of ideas.
When the Body Says No is just out. What kind of responses are you getting from readers?
Somebody wrote that they read the first two chapters and had to put it down because their heart was palpitating too much. It hit too close to home.
The book goes very deep. The word "stress" normally indicates things like financial stress, job and marital trouble ... but you're going way beyond that. And it does grab people who have ears to hear.
As Jesus said: He that hath eyes shall see, he that hath ears shall hear. You either get it or you don't get it. Most of the positive thinking books avoid anything that's going to trigger people's resistance. The problem with self-help books is that they don't tell you what is in the way of personal growth, what's blocking it. What wakes people up is paying attention to what doesn't work, whether it's in your family or in yourself. For me, it was trouble with my kids. That was the big impetus to start looking at myself. The question to ask is: If this isn't working, why not?
You have to get to the point that you accept it's not working.
Why do you think there's so much resistance to your ideas?
There's very little resistance in the public. It seems to come from the profession. As you've seen, the book has already been on the Maclean's bestseller list for two weeks. Intuitively, the material fits with people's experience. But the more you're into your head, the less you will be able to cope with that kind of message. Doctors are into their head: by training, by inclination, by the nature of their work. And they're not into looking into themselves.
What has happened to medicine? When I was young, we had the family doctor who saw generations of the same family. Surely a doctor like that would see illness in context.
The family doctor is an endangered species now. When I left my practice, I found somebody to take my place, but most physicians can't find anyone to take over, so they just close their doors. What happened is that technology and pharmaceuticals have taken over where wisdom used to be. Instead of coming alongside traditional wisdom, they've replaced it. There's nothing wrong with advances, but science can't take the place of wisdom. And then there is specialization.
Someone once put it to me this way: people keep digging themselves into a deeper and deeper hole, but the deeper you go into one thing, the less you know about the whole. And the [Canadian medical] system rewards [doctors] for not spending time with patients. If I spend one hour talking to a patient about cancer, I get paid one-eighth as much as if I saw eight patients in the same hour and diagnosed eight ear infections, which takes three minutes. The patient pays the penalty, but the doctor also pays a penalty in loss of job satisfaction in making connection with the patient.
In the book, you talk about the disease-prone personality.
No personality causes disease. So there's no cancer personality. However, there are some common traits that, if they are present in exaggerated degrees, will make you more predisposed to the disease. They don't cause it, but make you more likely to get it because they increase the amount of physiological stress you've got inside you. So people who don't know how to say no, people who are rigid and compulsive, perfectionistic, expecting themselves to be perfect in everything, people who don't know how to express their experience of anger in a healthy way, people who compulsively and automatically take care of others and don't think of their own needs, these people are physiologically stressed, whether they know it or not. So it's not that the person causes the disease. Stress is the thing that leads to disease or leads to conditions for it, but certain personalities are more prone to this stress. Because their boundaries will be invaded but they won't know it, they'll be extending themselves and they won't know it, they will work when they should be resting. So only in that broad sense can you speak of personalities, not in the sense that a particular personality causes a particular disease.
A lot of the people you spoke with in the book did not seem to be in touch with their own distress until you began to probe a little bit deeper. It moved me very much how people opened up to you. But I got the feeling that this was the first time they've been listened to.
Nobody had asked. Listening isn't just a passive thing, as people think it is. You have to feed it back to them a little bit. Because we often use words to cover the truth from ourselves. If somebody does that, I'll say: Here's what I hear you saying. And they'll say: Oh yeah, I didn't realize I was saying that.
You have to listen in an active sense. I had a case recently where I had to do a medical legal report, the person had been seen by a psychiatrist, and the psychiatrist said so-and-so "describes a happy childhood." I spoke to the guy and asked if he had a happy childhood, and he said: Yeah. I said, what were your parents like? He said: Well, my father was a horrible man, he yelled at us all the time. So I wrote in my report that this man did not describe a happy childhood, he reported a happy childhood. He was actually describing a very difficult childhood. But the psychiatrist never made that distinction.
But a psychiatrist -- you'd think this would be his stock in trade, getting to the root of things. You'd think they'd have a role to play in keeping people well.
No! That's the last thing they know about. They never learned normal human development. They only learned about disease. If people go to psychiatrists expecting to be understood, that's a huge mistake. If they go and expect to be put on medication, that's great, that's what they do. But most of them don't understand. Some of them do, but if they do it's not because of their training, but because they've made themselves open to that themselves.
I have to confess I never really saw disease as a boundary issue before. Once it was laid out for me, it made such deep sense.
I talk about people, for example, who don't experience and express anger in a healthy way. Anger is a necessary boundary protection. If something or somebody transgresses your boundaries, you express anger, not necessarily to hurt them, but simply to keep them out of your space. That's a healthy response. More generally, the role of emotion is to keep out that which is dangerous or threatening, and to permit that which is nurturing and helpful. So we have anger, we have love, we have attraction, we have revulsion, the whole thing. But that's exactly the role of the immune system. It's to keep out that which is noxious and unhealthy, and to attack it if necessary, and to allow in that which is nurturing and supportive.
Because of the physiological unity of mind/body, because of the physiological unity of the brain's emotional centers, the immune system, the hormonal and nervous systems, when you suppress something in one area you are risking suppressing it in another area, so when you suppress your boundaries emotionally, you are also suppressing your immune responses. And therefore your body is not as able to fight back against malignancy or, just as anger can turn against the self, so can the immune system. The boundary issues are clear.
It surprises me that this is considered a controversial idea.
Only to people who don't know what they're talking about. You can say that "the earth revolves around the sun" is a controversial issue. It was a controversial issue, because people didn't know anything about it. To say that something is controversial doesn't say anything about the merit of it, it just says that a lot of people resist it. What else is new? And there is a whole cultural mindset, the drivenness of doctors themselves. That whole cult of authority.
The problem with medical practice is not that we don't know a lot of things, the problem is that what we don't know is perceived as not worth knowing. So when a patient says: I heard such-and-such, the response is: Oh, no, that's nonsense, rather than saying: I haven't looked at that, I don't know anything about that. It's as if what I don't know is not worth knowing.
Was all this a revelation to you, or did it develop over time?
It was a revelation to me much more than it should have been, because I wasn't the first one to think of it. A lot of people had done research that hadn't quite been put together yet. This role of the emotions in the immune system I don't think has been pointed out before. But the actual research and the awareness of lack of assertion and repression of emotion has been there for decades. So it shouldn't have been a revelation. I should have been taught it in medical school.
So there's a disconnect there. That leads me to something that haunts this book -- a sort of spirit hanging over it: Mother. The disconnect with mother came up in various forms, from the story of Gilda Radner feeling alienated from her mother, to the case of Betty, the environmental activist whose 26-year-old daughter died of ovarian cancer.
She's a gutsy lady. Her story was extremely moving. The mother to the infant is the whole world. Just because we've been expelled from the body doesn't mean that we lose the need for connection. Contrary to tribal primitive societies, where the connection with the mother is maintained for years and is culturally encouraged by the society of the tribe, in civilized society the mothering task of connecting with the child is not supported. In fact, it's actively undermined so that, for reasons that have nothing to do with personal failure, parents have more difficulty staying connected to their children. When you look at people with illness, you can always distinguish patterns of deep emotional loss in childhood, some of them because the parents died, some because they were abandoned, but mostly because they were really emotionally cut off from the parent. And it's not because any parent wishes to do that. It's the nature of our culture that it no longer supports the connection with mother. If you lose connection with mother, you lose connection with the world.
When I had my children in the 1970s, I took a lot of flak for staying home. Everybody else in the building would go off to work, and I was the only person left in the place.
That's what I mean by lack of cultural support. Ordinarily there would have been a whole community there. It's totally unnatural. We used to live in tribes and villages.
In being the sole nurturers, we don't want women to let go of their whole selves.
No, but the problem is that in this society people identify themselves with their external roles. People think that when they let go of that for a while, they'll disappear. If other people don't perceive me, I don't exist. And it's very addictive.
Your book had some subversive ideas in it, such as "The Power of Negative Thinking." I loved that.
I've seen so many positive thinkers in palliative care who say: In all my life I've never had a negative thought. How come I have cancer? The answer is, they have cancer because they never had a negative thought. Not having negative thoughts is not allowing reality to intrude on your perception of the world. You never see how things are. You have to always maintain a sunny, falsely rosy view of the world so that you can't see what doesn't work. Lots of studies show that people who are sunny and positive die quicker of their disease. If you're a woman with breast cancer and you're a positive thinker, you're guaranteed to die much quicker.
I've heard that feisty women live longer. I think of the example of Carol Shields, who has suffered from breast cancer for a long time but has lived longer than anybody thought. But she has a raison-d'Ítre in her writing, and also has wonderful family support.
She would be an interesting interview. What is it exactly that has helped her survive, and what is it that led to her illness?
In public, she can seem very like the smiling, pleasant l950s housewife. Yet when you read her novels, particularly the last one Unless, it's like a volcano.
She has an outlet, but unless she distinguishes that she is talking about herself, and she actually applies it in her life, it doesn't help.
You write about the life of Jacqueline Du Pré. Surely this is an example of someone who was in touch with her emotions. But you're saying no.
She talked about having this "cello voice" into which she poured all her anger and aggression. When she was 11 years old, one of her teachers said: You have to stop expressing your aggression through the cello. The teacher had the insight to see she was doing that. Jacqueline never got in touch with her own feelings until she was very sick with MS, and then she became very angry with her parents. All her rage started pouring out of her. But it wasn't appropriate, it was rage about the past, not the present. And it didn't help her. Her artistic expression was very passionate, but she didn't make the connection with her own emotions.
So art is no substitute for emotional authenticity.
No, it's not.
One of the quotes that grabbed me from the book is: We have to look inside, where it is dark and murky. How much resistance is there to looking inside? You might have a family history that's agonizingly painful. And it also involves seeing one's parents as less than ideal.
And also seeing the interpretations that we put on our parents' behaviors. Let's say your mother doesn't make you cookies. You can conclude that your mama doesn't love you. Maybe your mother loves you, maybe she didn't make cookies for a whole lot of other reasons. So sometimes it's not what the parents do, but the interpretation that we then hold on to for the rest of our lives unconsciously. So the child's mother doesn't make cookies, and he concludes that he's not lovable. And he has to work to be loved. I'm not blaming either the child or the mother, I'm saying it's our interpretations that do us in.
So how do you get past it?
There's no specific how-to. But it begins with recognition. In the book, the Seven A's of Healing -- Acceptance, Awareness, Anger, Autonomy, Attachment, Assertion, Affirmation -- are all about getting a sense of yourself back, knowing what your boundaries are, knowing how to defend those boundaries, knowing how to open up to others while having boundaries, attachment. If you shut off from others emotionally, you're still stressing yourself. Then you create not a boundary, but a prison.
You talk about the role of creativity with regards to healing, but also in your own process as a writer. Let me quote a paragraph from your book:
The first value is our own creative self. For many years after becoming a doctor, I was too caught up in my workaholism to pay attention to myself or to my deepest urges. In the rare moments I permitted any stillness, I noted a small fluttering at the pit of my belly, a barely perceptible disturbance. The faint whisper of a word would sound in my head: writing. At first I could not say whether it was heartburn or inspiration. The more I listened, the louder the message became: I needed to write, to express myself through written language not only so that others might hear me but so that I could hear myself.
When did you first hear that whisper?
In university I wrote a column for the student newspaper, but when I became a high school teacher and got married and went to medical school, I gave that up altogether. And then it started coming back to me. I've always wanted to write books, but I was over 50 before my first book was published. When the Globe and Mail dropped my medical column, I wrote a final column about the mind/body connection. Somebody wrote to me saying: Thanks for the great column. When is the book coming out?
So now you have two bestsellers. Can you tell me about the next one?
It's not my book, it's Gordon Neufeld's book Hold on to Your Kids. I just did the writing. Too often the only face-to-face contact children are getting is with their peers, and the book is about how stressful that is for kids. Because kids can't accept each other unconditionally. By nature kids have to pretend to be something else to be accepted by other kids. It's only their parents that can give them that unconditional evaluation. When they lose that, it is a constant dance of pretend. It's a brilliant book.
Have you ever thought of writing a memoir? The parts of your life that you have written about have been fascinating. And your wife could do the cover art.
First I have to do something.
Here I am sitting with the hyper-achiever of all time, and he's saying: Well, first I've got to do something.
But the answer is yes. I have thought of it. And thank you for the encouragement. But the self-censoring thought that immediately came up was that I wouldn't be good enough at writing it.
Was medicine your first ambition? And was that in your family?
My grandfather was a doctor. He was killed in Auschwitz. I grew up always wanting to be a doctor, and only later on did I think that maybe it was because I wanted to be my mother's father. Maybe I wanted to replace her loss. But obviously, it also was something that was in me anyway. Because I had ADD and didn't know how to study sciences and didn't want to work that hard, I drifted into teaching, because English and literature came much easier to me. But whenever I went in a hospital I always had a sense that I belonged there. So by the time I was 28 I was ready for medical school.
You also gave up a comfortable and satisfying family practice to go work on the Downtown Eastside. What was behind that?
That was heroic self-sacrificing in the service of suffering humanity. Sheer altruism.
Are you Brother Teresa?
No. You talk about comfortable and satisfying, but I felt stultified by it. I didn't have enough time for writing. And I didn't want to take on all the stuff that goes with family practice, all the paperwork. And it's very hard to strike a balance between being there for your patients and being there for yourself. I'd had enough of it, and I'd done it, and was still young enough where I wanted to experience other things. And I really had a desire to work on [Vancouver's] downtown east side. ... So it wasn't altruism, it was just the next step.
I'd argue with that, but never mind. You talk about being diagnosed with ADD in your first book. It's obvious from the interviews in When the Body Says No that people unburden their souls to you. There's something about you. It seems to me this has to do with a quality of attentiveness.
Ask my wife and kids. But even when I was in medical school, I got the prize for psychiatry because I always listened to people.
There's a sign on your forehead that says: Tell me your troubles.
What's really amazing -- it's frightening, really -- do you want to know about psychiatrists? I'm being watched through this one-sided mirror by residents and psychiatrists, to evaluate my interviewing skills, and I'm talking to the patient who at some point says something poignant and I touch his knee and say: Tell me more about that. This was the frightening part. [The evaluator said]: Why did you do that? Touching his knee? It was brilliant! You make contact with somebody on a human level, and they think it's a brilliant technique: Where did you learn this? It's just something that any human being would naturally do. | April 2003
Margaret Gunning has been reviewing books for many years but never gets tired of the grand adventure of reading. Her poetry has appeared in Prism International, Capilano Review and Room of One's Own. Her novel, Better Than Life, will be published in 2003. She lives in Vancouver with one fat cat named Murphy and one nice husband named Bill.