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.