Sunday, April 29, 2007

When the Body Says No

This week a new Breast Diagnostic Assessment Unit was officially opened at the hospital where I work. It provides a facility where digital mammography, ultrasound and biopsies can be done efficiently at one site. Until now, a woman (or man) could wait three or four weeks for results of a breast biopsy, undoubtedly a very stressful delay.

While dignitaries gave speeches and staff dressed in bright pink looked on, I thought about the many people who will be referred to this unit in the months and years ahead. My family history puts me at higher risk for developing this disease, and my three daughters have a positive history on both sides of the family. I am sure that every reader of this post knows someone with cancer. As deaths from infectious diseases have decreased in the past 50 years, the proportion of deaths from cancer has risen. Many cancers can be linked to environmental and genetic risks, but what is more uncertain is the trigger that causes the abnormal cells that we all have to multiply in an uncontrolled manner.

Another group of illnesses that has increased dramatically in recent years is autoimmune disease. For some reason, the immune system attacks its own tissues, seeing them as an invader to the body. This is a large group including rheumatoid arthritis, fibromyalgia and other connective tissue diseases, type one diabetes, multiple sclerosis, ALS, and similar degenerative neurological disorders.

A few years ago I read a book written by Gabor Mate, a Canadian palliative care physician from Vancouver. When the Body Says No: The Cost of Hidden Stress explores the idea that stress and repressed emotions are triggers for the development of cancer and chronic diseases. Dr. Mate gives many case histories of people who have hidden their painful pasts, or who have lived a lifetime unable to say "NO" to the wishes and demands of others. We can push beyond our emotional limits, but at some point, the body will break down and demand that we take a break.
We all know intuitively that this is true, but it is a difficult thesis to prove scientifically. It is often easier to recognize these traits in others than in ourselves.

I met a lady who has severe autoimmune disease and a recent diagnosis of cancer. She was a highly anxious person, relying on Ativan to get her through her day. I was working with her recently and she said,

"I don't want to disappoint anyone. I have always tried to please everyone."

She was doing strengthening exercises to please her daughter, who daily chides her about not working hard enough to get better. Women are especially prone to making efforts to keep everything together, and aiming to please everyone at the same time. They also suffer from autoimmune diseases at a much higher rate than men do.

I heard Dr. Mate speak at a book reading, and was impressed with his presentation. His book is worth reading, and I have recognized the truth in what he says over and over again in my patients. I have tried to re-evaulate my priorities and responses to stress and have talked to my daughters about their own self care.

We tend to admire and commend people who are extraordinarily involved in work and volunteering, people who seldom complain or take time for themselves. These people are often unable to decline any request for help and are over-involved to their own detriment. This is not an argument for selfishness, but for a balance and honesty that will ultimately lead to healthier, happier and more productive lives.


  1. Dear Ruth,

    I hung on every word in this post. It's terrific.

    Stress seems to be the cause of many illnesses but is hard to beat. My Mom was the description of the lady who needed Ativan to get through the day but unfortunately my Mom was not allowed to have it. Her lung disease was aggravated by her stress and anxiety.

    I think I want to read that book you linked us to. I bookmarked it.

    Thanks for your knowledge on a very important subject.

  2. Excellent blog bss.
    20 years ago following an emergency hysterectomy my doctor gave me these words of advice "listen to what your body is saying. Rest when it tells you to rest." I took his advice and feel no guilt when I need to power nap or say no. It was some of the best advice I've ever received. At 72 I'm blessed with good health and take no medications even though I've dealt with many stressful situations though the years.

  3. Anonymous6:14 am GMT-4

    I have always been a strong believer in the idea that your body is full of wisdom and will communicate to you when you need it! I also relate to what you are saying about women being people pleasers. I am happy to say that my photography and blogging I do just for me and for nobody else. We all need a passion... something we do just for us.

  4. Anonymous6:16 am GMT-4

    P.S. Christiana Northrup's books are great, too.

  5. I so agree Ruth. Dr. Christiane Northrup also talks about how our transition into menopause is affected by just this... it's when the effects of all that "other care" focus comes to critical mass. The mind, body, spirit connection is so very clear to me. Autoimmune diseases have exploded... our bodies are responding to the pressure, no doubt. Wonderful post!

  6. Mary- Stress is hard to beat. I wrote this post for myself as I need to reminded frequently to re-evaluate my responses to stress in my life.

    OmaLois- To be taking no medication at 72 is rare indeed. Your doctor gave you good advice. Unfortunately, many doctors are quick to dispense pills but slow to discuss emotional issues with their patients.

    Jennifer- I think your "passion for nature" is a great outlet for stress. Being outdoors and appreciating the rhythms of nature helps us recognize our own rhythms and needs.

    Jayne- You and Jennifer both mentioned Dr. Northrup's books. I have them and they are referenced in Dr. Mate's book as well. C. Northrup's books have loads of good information and I use them as a textbook, but Dr. Mate's smaller book reads more like a story.

  7. Like the song says--you gotta know when to hold 'em, know when to fold 'em.
    Too many of us hang on to what we should let go, and let go what we should hang on to!

  8. Ruth,

    Your daughters are fortunate to have a mother who can share the wisdom of years of observing patients and the effect of stress.

    My husband is on the breast biopsy team here in Toledo. The good news is that early diagnosis and treatment saves lives.

    My heart breaks for your patient who revealed her need to please everyone. I'm glad she's got you to listen - to help and comfort her.

  9. This post hits home on more than one level. Both my sister and mother had cancer.-My mother survived it but my sister Michelle died 2 years ago at age 48. (My last good memory was of a day we went birding before she died-I had no idea she would be gone 3 weeks later).

    I came up with so many theories as to what might have caused it, but there are so many possibilities.

    It has also taken me years to learn not to over do it at work. You just have to say no some times.

    Thanks for this great post!

  10. KGMom- How appropriate! So many of us carry unnecessary baggage.

    Cathy- I don't think I listened much to my mother's advice in my 20's. But her words and my grandmother's words come back to me frequently now. I just read back in your blog (good reading!) to see that your husband is a doctor/radiologist- an important member of the diagnostic team.

    Larry- How difficult it has been for your family. It must be hard to look back and try to see how things might been different for your sister. She was my age, and I really notice things like that now. I don't think we can judge people and say,"If you had controlled your stress better, you wouldn't have been sick". But managing stress and setting personal limits is as important as having good physical health habits and getting good medical screening.


Note: only a member of this blog may post a comment.