When the Body Says No is Dr. Gabor Maté’s exploration of the connection between stress and disease.
Disease, Maté says, is the body’s way of saying “no” to the stress placed on it by our lifestyles. Published in 2019, this book takes a biopsychosocial approach, arguing that biological, psychological, social, and environmental factors are inseparable for a holistic understanding of illness. Maté argues that modern medicine fails to recognize the devastating effects of chronic stress on our health, in part because of misunderstandings about what stress is and what causes it. (Shortform note: The biopsychosocial model is the primary approach to illness taken by health psychologists, whereas medical doctors tend to take a biomedical approach. Health psychologists argue that as the leading causes of illness shift from infectious diseases to chronic diseases, the biopsychosocial model is more important than ever.)
Rather than periodic external stress events, Maté says humans in modern society tend to experience chronic stress. He says much of the stress we experience is subconscious, so we may not even recognize it as stress; in fact, it’s often those who believe themselves to be the least emotionally troubled who are at highest risk, because it’s suppression of negative emotions that is our worst enemy. Recognizing our unconscious stress is key to resolving it and avoiding the inevitable disease that comes with it.
(Shortform note: Some of the physical signs that you might have unconscious stress include: muscle tension, a clenched jaw, fidgety behaviors, shallow breathing, and overeating.)
Gabor Maté is a psychologist and physician who practiced medicine in clinical and hospital settings for over 30 years. He went on to become an addiction specialist and researcher, and he has written numerous books on the connections between mental and physical health and trauma.
In Part 1 of this guide, we’ll explain how Maté defines chronic stress as distinct from acute stress, explore what chronic stress does to our bodies, and discuss why modern medical practice fails to acknowledge it. In Part 2, we’ll examine the diseases that Maté says are linked with stress and how. In Part 3, we’ll discuss what causes chronic stress and how to recognize it in our bodies. We’ll also look at the psychological coping mechanisms we’ve developed in response to our life experiences. Finally, in Part 4, we’ll outline Maté’s prescription for developing “emotional competence”—the ability to deal with emotions in healthy ways to reduce the risk of stress-related disease.
Throughout the guide, we’ll expand on Maté’s ideas by looking at the research in related fields and at what other experts have to say on the stress-disease connection.
Chronic stress is a psychological condition. But, according to Dr. Maté, modern medical practice is rooted in mind-body dualism, meaning that the body and mind are treated as separate entities with medical doctors treating only the body. He argues that thinking of the mind and body as two separate entities disguises the connection between chronic stress and disease. Researchers tend to miss those connections because of the way they’re defining and understanding stress, as well as their lack of attention to human psychology.
In this section we’ll discuss the problems with mind-body dualism and the predominant definition of stress. We’ll then look at how Maté understands stress and his explanation of what it actually does to our bodies.
Cartesian Philosophy and Medicine
Although the concept of mind-body dualism can be traced back to ancient Greece, much of modern Western medical thought has its roots in Cartesian philosophy of the 17th century. Descartes’ ideas about the mind and body as distinct entities have been regarded by many as a positive historical turn in medicine, because they challenged the prevailing religious dogma that was stalling medical advancement.
Before that time, disease was often attributed to moral failings and supernatural forces, such as demon possession. Human dissection was also forbidden because of religious beliefs that the body had to be preserved intact for the person to ascend to heaven. So, separating the mind and body allowed for these norms and beliefs to be overturned. However, science now shows that the mind and body are inextricably linked. And yet, the practice of treating them separately continues.
Mind-body dualism underlies the modern Western approach to medicine. This is evident in the fact that we distinguish medical doctors from psychiatrists and therapists, and they work independently of one another with little to no communication. This is a flawed practice, Maté argues, because there’s no separation between the mind and body—they’re each part of one interconnected whole. He says that medical researchers and practitioners need to put more emphasis on discovering the entire life history of patients.
Traditional Healing Systems Have Always Been Holistic
Although modern medical practice in the West may routinely ignore the mind-body connection in treatment of illness, many indigenous societies with shamanic traditions have always approached illness from a holistic perspective. Within traditional healing systems around the world, physical, mental, spiritual, social, and environmental aspects of life have long been understood as inextricably intertwined. And they are treated as such by traditional healers, who employ a much more diverse set of remedies and therapies than modern medical practitioners.
For example, in a study of the healing practices of the Māori (the indigenous people of New Zealand), researchers describe an extraordinarily complex understanding of the interplay of a variety of elements of life, including: body, mind, spirit, family, tribe, ancestry, land, and knowledge. All of these elements are incorporated into the healing practices of the “Rongoā Māori”—the traditional healing system.
Maté points out that doctors tend to primarily look for biological “causes” of disease. When they can’t find one, as with most cancers and other serious illnesses, they conclude the disease is “of unknown etiology.” Rarely do they consider a causal origin in the psychology of the human being as the host of the disease.
Maté says there’s also too much importance placed on genetic research. Genes are turned on and off by environment, he says, so environment actually plays a bigger role than our genes do in shaping us. So much is invested in genetic research while the environmental and societal causes of disease are ignored. He points out that even where external or biological/genetic risk factors are identified, those aren’t sufficient explanations. If they were, all smokers would get lung cancer and no non-smokers ever would. He says doctors fail to ask bigger-picture questions, like “why does this patient have this disease at this time?”
Your Thoughts Affect Your Cells
In The Biology of Belief, Dr. Bruce Lipton argues that the environment of our cells matters much more than was previously thought, and our thoughts and mental states have the capacity to alter that environment. He discusses the field of epigenetics, which is the study of the bigger picture of how DNA is expressed according to a variety of factors. These factors include your emotional states, your relationships with others, your sleep and diet habits, and the environment you live in. They also include all these factors as they related to your mother while you were in the womb.
In opposition to the strictly biological approach to disease, Maté advocates for a biopsychosocial approach, as mentioned earlier, which entails looking at disease from a biological, psychological, and social perspective. He also advocates for complex interdisciplinary perspectives such as Psychoneuroimmunoendocrinology (PNI): the study of the interconnections between our nervous system, immune system, hormones, and our psychological processes. The interaction between these systems serves to recognize threats, internal and external, and to respond to them in physiological and behavioral ways.
Tension Myositis Syndrome
Maté’s work is influenced by the late Dr. John Sarno, who was a pioneer in research on the mind-body connection in disease and published several books on the topic between 1982 and 2006. Sarno coined the term Tension Myositis Syndrome (TMS) to refer to any condition in which one’s psychological state causes physical symptoms, such as chronic pain or digestive issues. Fibromyalgia, for example, is one of those conditions which has no identifiable physiological cause, but induces chronic symptoms like debilitating fatigue and widespread pain.
Dr. Sarno theorized that TMS symptoms were related to the psychological pressures people live with when they feel the constant need to live up to others’ expectations and then repress their negative emotions.
Although much of Dr. Sarno’s work was disregarded by his colleagues and the larger medical community, some physicians today, like Dr. John Sacks, have followed in his footsteps and are actively treating TMS through a variety of psychological therapies and integrative medicine.
To support his claim that most physicians don’t consider the personal history of their patients, Maté points to a study that found that two-thirds of gastroenterology patients had a history of physical or sexual abuse, and yet their doctor was aware of that history in only 17% of the cases. Additionally, a common theme in the many interviews Maté conducted with his own patients, with a variety of different illnesses, was problematic childhood relationships with parents. This included emotionally distant or unsatisfying relationships, abandonment, sense of loss, and lack of autonomy.
The problem is that these histories take time and diligent attention to extract because the patients are often in denial and have repressed negative memories. In fact, Maté points out, many of them appear to be happy people with wonderful childhoods, so without intentional effort, most doctors will never know about their patients’ painful experiences. (Shortform note: Research also suggests that when doctors encourage patients to tell their life stories, it helps build a relationship of confidence and trust, levels the power dynamic, and allows doctors to develop a more empathetic understanding of the patient. To this end, Columbia University has developed a program in narrative medicine, which trains medical students in this approach to patient care.)
Stress is the body’s response to any kind of threat—real or perceived. In this way, stress response can be seen as a direct link between mind and body. As Dr. Maté describes, a threat must be perceived and interpreted first by the mind, which then sends signals to the body’s systems for a response. Threats can be a multitude of specific things, but the common element is your mind’s perception of the lack (or potential loss of) something necessary for survival. This could be anything from food or shelter to love and connection.
According to Maté, the situational factors that trigger stress are: “uncertainty, conflict, lack of information, and loss of control.”
When the brain perceives “uncertainty, conflict, lack of information, or loss of control,” it activates the threat response, which means the hypothalamus, pituitary, and adrenal glands (“HPA Axis”) secrete hormones, including cortisol. Cortisol is the body’s anti-inflammatory, Maté explains. Inflammation happens throughout the body in response to a threat, and then cortisol resolves it by calming the inflammation. However, problems occur when this “HPA axis” is not functioning correctly and too much or too little cortisol flows through your body.
According to Maté, resolving the threatening situation (i.e. regaining control, or resolving the conflict) is the only way to deactivate the HPA stress response—but we often can’t. Usually, we’re not consciously aware of what the problem is, or we’re not in a position to fix it. This is why many of us live with chronic stress without even knowing.
The Three Stages of Threat Response
In The Body Keeps the Score, Dr. Bessel van der Kolk discusses the effects of trauma on health. He explains that in terms of stress reaction, there are three stages of threat response wired into us.
Call for help: This can include verbally calling for help in an immediate crisis situation; in everyday situations, it can simply be reaching out to a friend for support, or giving subtle non-verbal cues that you need something.
Fight or flight: If nobody is available to help, or you need to act immediately, your body responds by activating the sympathetic nervous system and the resulting physiological responses, such as releasing adrenaline and cortisol.
Freeze: If you can’t fight or flee the threat, your body goes into freeze, or “collapse,” mode. In this state, many of your body’s systems begin to shut down, and you may experience dissociation, where you may be unaware of pain.
In applying these stages to Maté’s theory, when a person is unable to resolve a “threat” situation, such as when a child has no escape from an abusive parent, their body remains over long periods of time in either stage 2, resulting in hypervigilance, or stage 3, resulting in detachment and repression of emotion. In both cases, remaining chronically in such a physiological state is extremely destructive to the body’s organs and systems.
When we think of stressful events, we often think of things like a car accident, a divorce, or loss of a loved one. When we experience these sorts of events, we feel the stress consciously and intensely. Maté defines this as acute stress. He acknowledges that too much of this kind of stress can be harmful, but says the more harmful form of stress is chronic—a low-grade constant stress reaction happening in our bodies throughout our lives. Much of this chronic stress is a product of our lifestyles.
Maté says stress response is evolutionarily built into us because it’s functional and necessary for our survival. But the kinds of “threats” we tend to perceive in the modern world are not the same ones we’re built to respond to. We’re evolutionarily built to respond to threats such as predators or famine, but we typically don’t have those threats now. So according to Maté, our bodies respond to other kinds of perceived threats that we don’t consciously think of as threats; for example, if we’re overworked or we don’t have satisfying relationships.
Activate Your Internal Locus of Control
The need for control is an evolutionary survival mechanism in humans. The greater control our ancestors had over their environments, the more likely they could avoid starvation or predation.
However, as Maté points out, our instinct to want to control our environments can actually be counterproductive for life in modern society, in which there are numerous facets that we can’t possibly have control over, such as traffic or a micromanaging boss. In these cases, psychologists argue that it’s crucial that we learn to respond appropriately to the stress caused by lack of control.
When you shift to a perspective of an “internal locus of control,” you’ll decrease the amount of stress you experience from these situations. In other words, remember that even when an external situation isn’t within your control, you can still control your reaction to it.
Now that you understand how Maté defines stress, and what chronic stress does to the body, you may see why understanding psychology is so important for making the connection between stress and disease. Next, we’ll take a look at some of the research Maté cites, in which connections have been made between peoples’ life histories, psychological profiles, and specific diseases.
MS (multiple sclerosis) and ALS (amyotrophic lateral sclerosis, or “Lou Gehrig's Disease”) are both diseases of the nervous system that can cause wide varieties of symptoms. According to Maté, both have also been associated with specific kinds of life experiences and personality characteristics.
It’s well known that MS flare-ups can be correlated with stress. But according to the research cited by Maté, doctors as far back as the late 1800s have also suggested a connection between life stressors and onset of the disease. Many studies since have found that people with MS are far more likely than average to have experienced trauma early in their lives, to have dysfunctional emotional issues relating to their parents, and to have other acute stressors.
(Shortform note: MS is characterized by lesions on the brain, which can come and go over the course of the disease; but the number of new lesions indicates progression of the disease. Strengthening the link between stress and the progression of MS, a 2012 study found that MS patients who participated in a weekly stress management program developed fewer new brain lesions than those who did not. One of the components of the program was to help participants assess and manage their responses to perceived threats.)
Additionally, research shows that ALS patients have some striking commonalities in personality characteristics. Maté describes this personality type as fiercely independent and driven, reluctant to ask for help, and in denial of negative emotions and pain. These qualities are considered highly admirable by others, thus Maté says he has noticed that ALS patients are particularly likable, pleasant people, and he says this is something that’s widely recognized in the medical community. Maté argues that this personality trait is a result of emotional repression formed by childhood experiences, and that these individuals often have parents who never allowed them to express themselves, either emotionally or in terms of identity. So they had to create an identity based on others’ expectations and cultivate a facade of emotional toughness.
(Shortform note: The namesake of ALS disease, Lou Gehrig himself, is described as having this personality type. He suffered several life traumas, including three siblings who died as children, as well as having an alcoholic father and an overbearing and controlling mother.)
The common diseases of the gut (IBD/IBS and GERD) are what Maté refers to as “functional” diseases, meaning the symptoms are unexplained by any biomedical explanation. He says that it’s well known that they’re often stress-triggered, and it’s also been found that sufferers of these conditions have a higher rate of abuse in their past than did the controls. He attempts to explain these diseases by looking at studies on the relationship between trauma and pain response.
According to Maté, experiencing physical or sexual abuse lowers one’s pain response threshold, especially in the gut, because of the sensitive gut-brain relationship and the abundance of nerve cells there. Maté says that “pain is a mode of perception” and because of the gut-brain relationship, our “gut feelings” help us know when we’re safe or unsafe.
(Shortform note: One of the personality characteristics that has been linked to Inflammatory Bowel Disease is alexithymia, which is defined as a difficulty with processing and describing one’s emotions. Individuals with alexithymia struggle to understand what they’re feeling, and they find it difficult or impossible to put those feelings into words. Not surprisingly, considering Maté’s research presented here, alexithymia has been linked to childhood trauma and neglect.)
In autoimmune diseases, such as rheumatoid arthritis, lupus, scleroderma, and ankylosing spondylitis, the immune system attacks one's own body because it can’t distinguish between healthy and unhealthy tissues. According to Maté, studies have connected psychosocial factors to the onset, flare-ups, and severity of rheumatic diseases. Like ALS, he says, these people have a characteristic personality trait: what Maté calls “compensating hyper-independence”—often due to early loss of a parent or a role-reversal relationship with a parent. Flare-ups and pain are a signal that the body is saying no, Maté says. They cause people to slow down and avoid stressful situations.
Autoimmune disease most strongly illustrates Maté’s theory that disease may be connected to one turning against oneself, or inability to distinguish between self and other, both psychologically and physiologically, which we’ll discuss later. (Shortform note: A UK-based study showed that rheumatoid arthritis patients differed from control subjects on several personality characteristics, which would make them more vulnerable to stress-reaction dysfunction. Specifically, they rated lower than others on: adaptability, stress management, emotion management, self-esteem, sociability, assertiveness, well-being, and impulsiveness.)
In looking at cancer, we can also see some commonalities in personal characteristics. Maté explains that all humans have damaged and abnormal (even malignant) cells in our bodies. The vast majority never become cancer, however, because the immune system works to repair the damage, or the cells die off before they replicate. According to Maté, this means that for any cancer to occur, cell damage alone is not enough; there must also be some failure of the immune system that allows the damaged cells to continue replicating unchecked.
Maté cites research that shows that stress inhibits immune processes. The PNI (psychoneuroimmunoendocrine) system creates conditions that either facilitate or inhibit the growth of cancer cells, and we know that psychological processes and emotion affect the PNI system. Several studies on psychosocial factors related to cancer have found the biggest risk factor is repressed emotions, specifically feelings of anger.
(Shortform note: As evidence for Maté’s claim that medical research and practice don’t substantially address the psychosocial histories of patients, the comprehensive historical overview of cancer, The Emperor of All Maladies, focuses almost entirely on the biological makeup and treatment of the disease. Although the author does address failure of the immune system as a direct contributor to tumor growth, he does not substantially investigate psychological contributors to immune suppression.)
Breast cancer, ovarian cancer, and prostate cancer are all hormone-related cancers. Maté describes research in which no link was found between stress and breast cancer, so the conclusion was that there was no correlation. However, Maté raises an important critique that calls this conclusion into question: In the conclusions, it was stated that the risk factors are primarily genetic and hormonal. But, Maté points out that only 7% of breast cancer patients are genetically high-risk, so that can’t be considered a strong link. And perhaps more importantly, it is well-documented that hormones are influenced by stress.
In other research described by Maté, psychosocial factors have been linked to breast cancer, including: emotional distance from parents as children; repression of emotions, especially anger; lack of supportive relationships; and, “compulsive caregiving” tendencies (self-sacrifice). He cites two different studies in which researchers could predict with 94-96% accuracy which women would be diagnosed with breast cancer based only on these psychosocial factors. Similar results have been shown with studies on ovarian cancer.
(Shortform note: A 2001 study of breast cancer patients in China showed that those who scored the highest for positive relationships with spouses, families, and friends had a 38% lower incidence of mortality and a 48% lower incidence of recurrence of the disease than those who had poorer relationships. Additionally, the researchers were surprised by the finding that physical well-being was less important than supportive relationships in the women’s survival and continued health. This effect was strongest in the first year or so after diagnosis.)
Even though it’s known that prostate cancer is inextricably linked to hormones, and hormone balance to stress, Maté says there have been no studies investigating the link between psychosocial factors and prostate cancer. But it has been linked to environmental factors—Black American men are twice as likely to get prostate cancer as white American men. In seeking to explain why this might be the case, Maté says it can’t be racially genetic, because Black American men are six times more likely to get it than men in Nigeria. Therefore, he theorizes that it’s likely due to the social pressures of being a Black man in America, including the chronic stresses of dealing with racism, as well as a lack of community and family support networks that tend to be more common in Black American communities.
Racial Health Disparities in America
A number of health disparities exist between racial and ethnic groups in the United States. Black, Hispanic, and Native American populations are more likely to suffer from chronic diseases, such as cancer, diabetes, heart disease, and asthma. Research hasn’t shown a biological or genetic factor that can account for these disparities, so the cause for this has been attributed to:
Access to health care: Minority groups in America are more likely to live in poverty and therefore have less access to health care.
Poor nutrition: Those groups are also less likely to have access to a healthy, nutritious diet.
Exposure to toxins: Disadvantaged communities are more likely to have poor air quality and housing conditions that could lead to exposure to contaminants, such as lead.
Stress: Not only does poverty create stressful conditions, but daily experience of (or even the anticipation of) discrimination associated with being a person of color in America can cause low-grade chronic stress reactions.
Prevailing theories state that cancers result from damage to the DNA of cells. In the case of lung cancer in smokers, some of that damage is caused by the tobacco product. Maté says that we know this damage happens, but it doesn’t explain why some smokers get lung cancer and others don’t. So, he says, there have to be other factors at play.
Maté cites two different studies that showed a link between lung cancer and repressed emotion, especially anger. Particularly compelling is a long-term study described by Maté that was done in former Yugoslavia. Around 1,400 participants were given extensive medical and psychological testing. Of the 1,400, over 600 were dead 10 years later, at which point the researchers analyzed causes of death along with the psychological profiles. In the conclusions described by Maté, the #1 risk factor for death, especially for cancer, was “rationality and anti-emotionality” (R/A)—meaning those who repressed emotions.
Furthermore, cancer death was 40 times higher in those who scored the highest in the category for repressed emotion. Researchers were able to correctly predict which people would die of cancer in 78% of cases based on just their scores on R/A and feelings of hopelessness. (Shortform note: Since the Yugoslavian study, similar research has been undertaken in Japan, with the opposite findings. In Japan, rationality/anti-emotionality was associated with lower prevalence of all categories of disease. This suggests that there may be a cultural difference at play regarding expectations of emotional display.)
Considering the links that have been observed between these diseases and stress, personality, and life experiences, Maté argues that there are clearly contributing causes beyond the biological. He says that doctors often look primarily for “proximate” causes but fail to look for “ultimate” causes. Proximate causes include the immediate observable causes, while ultimate causes are the bigger-picture explanations.
With all the diseases discussed, Maté is looking for the ultimate cause in the psychology of the human host. In this section, we’ll look at how chronic stress is ultimately caused by childhood experiences of perceived threat that go unresolved. You’ll learn what kinds of parent-child relationships contribute to these experiences in children, and how modern society creates the conditions for these parenting patterns. You’ll also see why Maté says that nobody is to blame for this, so assigning blame is meaningless.
Integration of Traditional and Modern Medicine
Anthropologist Hank Wesselman says that within shamanic traditions, physical illnesses are the effects of disease, while “the ultimate causes of virtually all illnesses are to be found within the imaginal realm.” Thus, treating illness with medications only simply alleviates symptoms without addressing the cause. He identifies three causes of illness, from the traditional shamanic perspective:
Disharmony: This is when a person finds themself in a state where they have lost some amount of purpose, meaning, or connection in life. For example, when a person loses a loved one or has a dysfunctional relationship.
Fear: living with chronic anxiety
Soul Loss: This is considered the most serious diagnosis and is what we might think of as severe depression resulting from trauma. When a person has essentially lost the will to live, traditional cultures would say that they’ve “lost their soul.”
Considering this traditional view in light of the research we now have on the stress-disease connection, we can see why some Western medical practitioners, including Gabor Maté, are beginning to see the importance of learning from indigenous cultures and integrating traditional and modern medicine for a more holistic approach to healing.
One of the areas where childhood development can go awry is in the process of differentiation. Maté explains that humans are naturally meant to develop from a state of total dependence toward an interdependent independence—meaning we should develop our own sense of self as separate from others and be able to self-regulate our emotions, but also have interdependent supportive relationships. Any dysfunction in the parent-child relationship, Maté says, can cause problems with the internal processes that regulate the child’s survival mechanism. This can result in the individual staying too dependent on others and not learning to self-regulate, or becoming too independent and not developing supportive relationships.
(Shortform note: Hyper-independence may be encouraged in particularly individualistic cultures. This means that if a dysfunctional parent-child relationship results in poor individuation, a child’s tendency to overcompensate with hyper-independence may be consistently rewarded throughout their life in such a culture. In a collectivist culture, since hyper-independent behavior is frowned upon, such a person may tend more toward hyper-reliance on others, or “learned helplessness.”)
Another dynamic that can cause stress-related developmental problems in children is the amount of nurturing affection given by the parent to the child. Maté says that in addition to feeling safe as children, we also need to feel loved.
Maté explains that almost 90% of brain development takes place in the first few years of a child’s life, and this development is a product of inherited genetic factors and environmental conditions. He says that loving emotional interaction with a parent, or the lack thereof, affects the release of hormones, and the amount and balance of those hormones affect brain development. When a child’s brain is not getting consistent messages of love and nurturing, it develops in such a way that it can’t correctly distinguish between threats and non-threats. This is why physical touch by the mother is important for proper development in all mammals and crucial for humans to be able to develop healthy relationships. Research on premature babies, Maté says, shows how powerfully affectionate touch impacts development.
The Effects of Early Child Psychology
Perhaps one of the most destructive trends in causing an intergenerational dysfunction in child-parent bonding was the child psychology advice that became prominent in the late 19th and early 20th centuries. A number of pioneers in the field believed that mothers shouldn’t show affection to infants, that babies’ cries should be ignored, that they shouldn’t be held, and that corporal punishment was necessary for raising well-behaved children.
American behavioral psychologist John B. Watson wrote a book called Psychological Care of Infant and Child in 1928, in which he called motherly love “a dangerous instrument” that would result in disastrous effects on children and on their life chances in adulthood. He advocated for never kissing, hugging, or giving any affectionate touch to children.
Although contemporary psychologists consider this advice to be patently wrong, its widespread influence (coming from “experts” in the field) may have had devastating effects on American and European cultures that continue to be unconsciously passed down through the generations in parenting patterns today.
Maté points out here that it’s not only abuse and trauma that cause stress-related illness— some people have the same stress problem not because of what was done to them, but because of what was withheld from them. Children don’t just need physical touch, affection, and safety; they also need “attunement,” which means a parent being “tuned in” to the child’s needs. Even parents who really love their children, and whose children know they’re loved, are sometimes lacking attunement, Maté says.
Attunement Is Emotional and Physiological
The Body Keeps the Score gives further insight into the issue of attunement. In this book, Bessel van der Kolk explains that when a baby’s needs and distress are consistently attended to and soothed by a caregiver, they grow to understand that they’re in a relatively safe world where threats can be resolved, and they’ll ultimately learn to resolve those situations for themselves. Children who are neglected, however, will be unable to effectively manage their own distress throughout life and will become adults who become overwhelmed and give up in the face of difficulty.
He also says that attunement has both an emotional and a physical component. When the parent is emotionally attuned and physically present, the child’s distress can be soothed by the calm physical presence of the parent, and their own bodies will respond physiologically with lowering stress hormone levels, slowing the heart rate, and calming the breath.
Beyond early childhood development dynamics, there are also situational factors in families and societies that can lead to individuals adopting certain personality characteristics that are correlated with chronic stress. We’ve seen that some personality traits do contribute to greater stress. But Maté explains that these personality traits aren’t simply individual attributes; they are a result of larger family dynamics–our “position” in a multigenerational family–and those families are positioned within a culture and society.
Maté points out that changes in social structure due to modernity have destroyed much of the foundational social connections humans evolved with. Previous humans lived in extended families and communities with multiple nurturing adults caring for children. Now, he says, with nuclear families and the socioeconomic structure (particularly in capitalist societies), parents have to work while children are put into daycare and schools separated from extended family. Hence, many of the diseases discussed here, Maté says, are products of more recent civilization.
Diseases of Modernity
Sociologist David Matthews analyzes the relationship between modern capitalism and mental health, noting that among monopoly-capitalist nations today, “mental-health disorders are the leading cause of life expectancy decline behind cardiovascular disease and cancer.” He points out that such nations also tend to take a purely biomedical approach to mental illness, such as the “chemical imbalance” theory often espoused in psychiatry. However, this approach doesn’t consider the way the modern lifestyle affects mental health.
As underlying causes of mental health decline, he points to such cultural norms as: emphasis on materialism, high degree of social inequality and oppression, social alienation and loneliness, overemphasis on work and repression of creativity, and denial of our innate human natures.
In light of the strong connection between parenting dynamics, personality traits, and chronic stress, we might naturally conclude that parents are to blame for their children’s illness. Maté also points out that he has received criticism for his theories based on the accusation that pointing out the connection between individuals’ personality traits and their disease is “blaming the victim.” However, Maté says recognizing that illness may be caused in part by a person’s psychological state, personality traits, or environment is not “blaming the victim.” Rather, he says pointing out that the person may actually be able to do something about it empowers them to take responsibility for their own health.
Additionally, Maté says that there is no call for blaming our parents, or for blaming ourselves for our children’s illnesses. After all, the parent’s brain developed in response to their own childhood relationship with their parents.
From Victimhood to Empowerment
Psychologists point out that it’s important for victims of trauma and abuse to reframe their experience from one of victimhood to one of empowerment. This involves confronting the struggles with self-esteem and helplessness they’ve acquired as victims, and learning to believe they have the ability to determine what happens to them in the future. One approach to this is logotherapy, developed by Holocaust survivor Viktor Frankl. Logotherapy involves helping the trauma survivor find a new sense of meaning and purpose in life using the Socratic method of philosophical inquiry. Through a series of questions, the patient is able to reimagine their life’s purpose in a way that empowers them to move beyond the trauma.
So, now that we’ve examined the multifaceted “ultimate causes” of chronic stress, and therefore disease, you may be tempted to feel resigned, knowing these patterns are embedded in your psyche from early childhood. However, Maté emphasizes that at any point in your life, you can take control of your chronic stress and cultivate a healthier disposition and lifestyle. In this final section, we’ll take a look at Maté’s advice for developing emotional competence as a way to counteract and alleviate the effects of chronic stress on your mind and body.
The first piece of advice Maté offers for counteracting the effects of chronic stress on our bodies is to reject the common overemphasis on “positive thinking.” He says this approach to dealing with negative emotions only makes people repress them. Maté says healthy thinking includes acknowledging all of our genuine feelings. Focusing on only the positive and denying the negative is a defense mechanism developed by those who are hurt. But it doesn’t fix it.
In his suggestion to embrace “the power of negative thinking,” Maté doesn’t mean to dwell; he means be willing to look at what’s wrong. Pay attention to the “negative” signals your body is giving you. Have the courage to ask, “What is my body saying no to?” instead of deploying your coping mechanism to avoid the pain. Maté says that when you avoid what’s “wrong” and focus only on what’s “right,” you’re being controlled by others. You’re not an autonomous being when you live to please others, when you’re acting out a role based on expectations, and when you never say “no.”
To be clear, Maté affirms that genuine positive feelings do contribute to health—love, joy, and happiness increase our well-being. The problem is the insincere positive feelings people use to cover up negative feelings.
Positive Psychology and Toxic Positivity
Maté’s use of the phrase “the power of negative thinking” is likely a reference to the classic self-help book The Power of Positive Thinking. While this book does have some helpful suggestions for calming down your negative reactions to situations, it puts a heavy emphasis on ridding yourself of negative emotions by “deciding” to be happy. This could be considered an unhealthy denial of negative emotions.
“Toxic positivity” is the overemphasis on a positive attitude to the point where it invalidates any negative emotion. While the field of positive psychology is centered on approaches to mental health involving an emphasis on cultivating optimism, psychologists in the field make a clear distinction between that and a “toxic” approach. Positive psychology encourages finding contentment through exploring what makes you feel fulfilled in life, while a “toxic” approach to positivity involves encouraging and offering positivity in any and all situations; including situations in which it’s insincere and unhelpful. Positive psychologists say offering positivity in inappropriate situations devalues others’ emotions, and shows a lack of empathy.
To generate genuine positive feelings, try some of the following techniques suggested by positive psychologists:
Practice gratitude: Try writing in a gratitude journal daily, or expressing gratitude to others around you each day.
Do random acts of kindness: Psychology research shows that doing kind things for others gives you a boost of happiness.
Write a happy life story for yourself: Envision the future you would like and actually write it out, envisioning it as if it were true.
Practice mindfulness: Self-love and mindfulness meditation has been shown to increase confidence, self-esteem, and contentment.
Becoming aware of all of your true feelings means learning to trust your gut and recognize the signs of stress in your body. Maté says that you should start tuning in more consciously to what your body is telling you. Some signals of underlying stress include: rapid heartbeat, frequent urination, excessive sweating, digestive issues, and unexplained pain such as frequent back pain or headaches. He also says to watch for emotional and behavioral signals, such as: depression, anxiety, hypervigilance, hypersensitivity, over-reactivity, and impulsivity. If you recognize these signs, see them as messages from your body, meant to make you aware of an underlying issue.
(Shortform note: According to The Body Keeps the Score, yoga can help you get in tune with your body’s signals and strengthen areas of the brain that help you stay calm. By focusing on the breath and body, and slowing down into a contemplative practice, yoga can help you attune to the messages your body might be sending you. Not only do you become more consciously aware of the physical sensations in your body, you can become more aware of the emotions that are associated with them.)
Maté encourages you to get in touch with your repressed anger and explore what it means. Anger is toward something—some perceived threat. Identify what that is, and then allow yourself to feel the anger, to sit with it, and contemplate it until it dissipates, and/or you can get help with it through therapy. (Shortform note: If you need help processing feelings of anger, the Headspace app offers anger meditations and a 10-day “transforming anger” program.)
Maté emphasizes authentic living. Reflect honestly on the relationships in your life. Take off the “rose colored glasses” and ask where your own needs haven’t been met, where you’ve put aside your needs for others, or suppressed your feelings and felt unsupported and unseen. Do so with compassion, recognizing that others are just acting from their own conditioning. Refrain from blame. What matters, Maté says, is your responsibility for yourself to change things going forward. So, he suggests you ask yourself whether you’ve lived your life according to who you truly are, or if you’re trying to live up to others’ expectations.
Find Your Worth
In The Gifts of Imperfection, Brené Brown offers advice for accepting yourself for exactly who you are, rather than trying to please others by being someone else. She says this involves finding your sense of worthiness, by:
Accepting yourself unconditionally, exactly as you are, flaws and all
Rejecting the idea that you need to fit into any societal standards
Recognizing that your self-worth is not dependent on others’ approval. It’s in who you are, not what you do.
Believing that you deserve love and acceptance
Tackling your feelings of shame, as those are antithetical to self-worth
Maté says to watch for guilt—guilt is often a sign that you’re doing something for yourself instead of others. If you recognize this, learn to embrace the guilt and use it as a signal that you’re actually doing something right. If saying “no” to something makes you feel guilty, but saying yes causes resentment, Maté says you should always choose the guilt. The resentment will be much more damaging.
(Shortform note: If you feel guilty about setting boundaries, it’s possible what you’re really feeling is discomfort because it’s not something you’re used to doing. To accustom yourself to setting boundaries, begin by setting ones that only you have to honor, such as restricting your access to social media or junk food. Starting with saying “no” to yourself will ease you into being able to set boundaries and stick to them.)
Maté says we all need to develop healthy support networks. Copious research shows that lonely, disconnected people are at greater risk for illness, while social support alleviates stress and decreases risk of disease. So seek out stronger social support networks. Reach out and make connections. Especially if you’re suffering, find others to connect and form emotional attachments with.
Lost Connections
In Lost Connections Johann Hari takes a deep dive into the social causes of anxiety and depression. He argues that the lack of meaningful connections due to lifestyles in modern society are major drivers of mental health disorders, and therefore, our medical model of psychiatric care is insufficient for treating the problem at its root. His solutions mostly focus on large-scale systemic social changes, but he also suggests that on an individual level, it’s important to recognize that making online connections isn’t enough.
Modern humans tend to think we’re more connected than ever because of our online networks and constant interactions, but despite this, levels of anxiety and depression and loneliness are higher than ever. This clearly indicates that we need to actually get out and talk to people, face to face, as our evolutionary urge to be in connection with others depends on that physical presence.
Finally, Maté offers advice for tending to not just your mind and body but your spirit. He says this means connecting with something beyond yourself, and he suggests two major avenues for this:
A truly holistic approach to health, Maté says, must involve all three dimensions of the whole person: body, mind, and spirit.
Spirituality Is for Everyone
If you’re not a religious or spiritual person, that doesn’t mean you have no way of tapping into something beyond yourself. Spirituality can be understood as cultivating a sense of “awe” for the world around you, which can be practiced by simply observing and connecting with nature. Science writer Chet Raymo, in his book When God is Gone, Everything is Holy, describes his religious naturalist approach to the world. He claims that when you abandon a supernatural explanation for the natural world, it becomes even more awe-inspiring. If you don’t have a spiritual belief system or practice, try connecting with nature and contemplating the interconnectedness of it, to feel yourself as part of a larger whole.
Now that we know repressed anger is possibly the biggest risk factor for disease, getting in touch with any anger you’re repressing is your first step in preventing and healing illness.
Start an anger exploration journal. Begin by freewriting your life story—just write anything that feels significant in your life, focusing on your relationships from as early as you can remember up to now.
Next, go back and reread your story and try to pick out any areas where you sense some negative emotions.
Once you’ve identified areas of negativity, write out those specific stories in more detail, digging into the emotions that surface around the people, relationships, and events. What is it about these situations that makes you feel angry or hurt? Do you see any common themes emerging? (For example, uncertainty, conflict, lack of information, or loss of control?)
How can those negative situations be resolved? If they can’t (due to the death of the other person, for example), how might you resolve a similar situation in the future?