PDF Summary:When the Body Says No, by Gabor Maté

When you’re unable or unwilling to say “no” to pressures in your life, your body may do it for you by creating illness. Many chronic illnesses have been linked to stress caused by our lifestyles, our conditioning as children, and our psychological coping mechanisms.

When the Body Says No is Dr. Gabor Maté’s exploration of the connection between stress and disease. Rather than just occasional external stress events, which are normal, Maté says that humans in modern society tend to experience chronic stress, which has a devastating effect on our bodies. He argues that much of our chronic stress is subconscious, so we may not even recognize it as stress.

This guide examines the research and theories Maté presents, as well as his prescriptions for healing and avoiding stress-related disease. We’ll expand on Maté’s ideas by looking at additional research and exploring what other experts have to say on the stress-disease connection.

(continued)...

Rheumatoid Diseases

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.)

Cancers

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

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.)

Prostate Cancer

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.

Lung Cancer

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.)

Part 3: Ultimate Causes of Disease

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.

Self vs. Other: Differentiation

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.”)

Parental Nurturing

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.

Personality vs. Positionality

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.

Removing Blame

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.

Part 4: Prescription for Healing

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.

Avoid Toxic Positivity

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.

Listen to Your Body

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.)

Be Your Authentic Self

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.)

Connect With Others

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.

Tend to Your Spirit

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:

• Your creative impulse: Maté emphasizes that everyone has some sort of creative urge; this doesn’t just refer to art. It could be any way in which you express yourself—for example, through writing, dancing, gardening, cooking, or building. Whatever your avenue of expression is, Maté urges you to explore it and incorporate more of it into your life.
• Your connection with the universe: Whatever this means for you personally, Maté suggests that you try to connect with something greater than yourself. For some people this is religion, or God, while for others it may be connecting with nature, practicing meditation, studying astronomy, or anything else that makes you feel like you’re part of a greater whole.

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.