March 22, 2003 Saturday
The Gazette (Montreal, Canada)
Author Gabor Mate combines cautionary tales, biology lessons and scientific research reports in an attempt to show how our stress-driven society helps generate our illnesses.
Some of the research he cites is dated, but there are some good descriptions of neurobiological processes, anecdotes from his own practice and interesting tidbits about the lives of famous people, like Gilda Radner, Betty Ford and Ronald Reagan, and how, at least in Mate's view, their life experiences played a role in their diseases.
Mate is a Vancouver family physician with special interests in palliative medicine and psychotherapy. He is the author of a best-selling book on attention deficit disorder and a columnist for the Vancouver Sun and the Globe and Mail.
Mate attempts to prove that there is a link between emotions and personality and the emergence of cancer, multiple sclerosis, ALS, rhumatiod arthritis and other diseases. In each chapter, he takes us on a tour of a particular disease. Information on its biology and brain physiology is interspersed with personal narratives of his own patients and of famous people inflicted with these illnesses. The best writing in the book comes out in the stories about public figures that he relates to us.
In his biography of Jacqueline du Pre, a gifted cellist who died of multiple sclerosis at the age of 42, Mate provides us with a veritable symphony on her life. He describes her concerts as passionate communications with her audiences, where people often wept. Her communication in real life, however, was blocked, a condition Mate suggests originated from a pathological, symbiotic relationship with her mother. He ends the chapter eloquently when he writes that her cello voice was her only voice and although her audience and critics adored her, no one heard her, even as she played her own requiem, in what was to be her final performance in Britain.
In Chapter 7, the chapter on repression and cancer, Mate explains fascinating notions such as psychoneuroimmunology. His medical background and lucid writing style make complex biological processes accessible to non-scientific readers. Embedded within the pages of description of the brain, nervous system, immune system and endocrine gland pathways, are the cancer narratives of Bela Bartok and Radner, and references to several scientific studies. He quotes, for example, a 15-year study from the University of Rochester (published in 1981), which found the development of lymphoma or leukemia was apt to occur in a setting of emotional loss or separation. Armed with this type of information, Mate leaps to the stunning conclusion that, "In numerous studies of cancer, the most consistently identified risk factor is the inability to express emotion, particularly the feelings associated with anger." This wild assertion is easily confused with fact.
Unfortunately, Mate presents a one-sided view of the scientific literature. His numerous claims are hard to take seriously. According to Mate, breast and prostate cancer stem from emotional incompetence; perfectionism and strong feelings of inadequacy might be at the root of rhumatoid arthritis; emotional poverty leads to Alzheimer's; and people with melanoma have a "Type C" personality.
The difficulty I have with this book is the sweeping psychological conclusions Mate sprinkles on almost every page. Although no one would argue that psychological stress does not have a negative effect on the body, current scientific data from mind-body studies are contradictory and don't support the notion that distress causes cancer. Stress does affect the neuro-immune response in controlled laboratory conditions, but it is very difficult to research the long term, clinically relevant effects of psychological distress.
In the chapter on ALS (amyotrophic lateral sclerosis), Mate suggests that those who get the disease are often overly nice but essentially out of touch with their emotions. He uses a patient's story, as well as stories about Lou Gehrig, Sue Rodriguez and Stephen Hawking to conclude the chapter with what he calls an intriguing hypothesis "one would be challenged to find any exceptions to." He states that ALS is caused by emotional repression rooted in childhood emotional isolation and loss and is seen in too-nice people leading driven lives.
In the book's first chapter, he states his intent is not to blame these unfortunate patients for the negative outcomes of their diseases but to promote healing and learning. Among the more than 20 patient stories scattered in 19 chapters, I found only one story of healing, and this was a case of spontaneous remission of a malignant melanoma, an unlikely scenario for most cancer victims. Despite Mate's stated goal, this book is not a manual for teaching people how to cope with stress in a positive way, nor is it filled with inspirational accounts of how people with chronic and terminal diseases somehow come to live out the rest of their lives with dignity and meaning.
In palliative medicine, healing is more broadly defined to include healing on a spiritual plane even as a cure eludes us and death approaches.
The author's constant goal of trying to prove his thesis scientifically is an annoying interruption in what might have otherwise been an interesting and informative read. Cancer, after all, is a common disease, one that strikes people from all walks of life, with all personality types.
The hidden cost of this book is the worry some readers will be left with as they wonder whether their lives are threatened with yet another health hazard.
Maureen Rappaport is a Montreal family physician.
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When the Body Says No: The Cost of Hidden Stress
By Gabor Mate
Random House Canada, 308 pages, $36.95
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