When the Body Says No

Review

Gabor Maté is someone I’ve heard about occasionally over the years, probably for the first time when I read Bessel van der Kolk’s “The Body Keeps the Score,” which I’m pretty sure mentions him. I’ve never looked closely into his writing or speaking. His name was mentioned to me in therapy recently and like any good student I bought a book and went to reading.

The book was published in 2003, so parts of it do feel a bit dated. GM introduces the term biopsychosocial in this text as though it is a new thing, and possibly it would be for the lay reader. As a social worker, it’s a term I’ve heard and practiced around for years. Much of GM’s theory on stress—disease connection would feel comfortable in the social work practice, I think. Many of the stories within feel familiar to experiences from my life, and the logic of it generally tracks for me.

I say generally because there are some places where I scratch my head. First, GM spends a lot of time telling stories, and these get repetitive fast. Some of these stories also happen to be projecting GM’s ideas onto historical figures or people he otherwise has not personally examined. Presumably there is some version of the Goldwater Rule for physicians, and though I am not the world’s biggest fan of this rule, I do find it strange for GM to go through these ‘examples.’ They feel strange, and to me feel distracting. At least with the somewhat repetitive interviews, he is speaking with people that he has personally treated, sometimes for many years, and they are actually in front of him. I ended up skipping any of these sections as I did not think they had any worth.

My second bug was a line on page 86: “Smoking no more causes cancer of the lung than being thrown into deep water causes drowning.” GM believes strongly in—and makes compelling, evidence-based cases for—the idea that illnesses like cancer, multiple sclerosis, etc., are developed not only via genetic predisposition or external factors, but also through the result and consequence of long-term chronic stress. I don’t know if the relationship between chronic stress and health outcomes was as clearly known in 2003 as it is today, but the relationship exists and is significant. However, I think some of GM’s broad, sweeping statements like that on page 86 fall dangerously close to careless fallacy and probably open up these ideas to criticism that’s less thoughtful than it’d have to be otherwise.

I’m not sure who I would recommend the book to, but I did think it was worth reading.

Notes

• p9 - One of the weaknesses of the Western medical approach is that we have made the physician the only authority, with the patient too often a mere recipient of the treatment or cure.
• p28 - People may become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed. To such persons stress feels desirable, while the absence of it feels like something to be avoided.
• p29 - That “good stress” not only helped undermine his health, but it also served to distract him from painful issues in his life that were themselves constant sources of ongoing physiological disturbance in his system.
• p34 - The research literature has identified three factors that universally lead to stress: uncertainty, the lack of information and the loss of control.
  • TB: italics in original. Cites S. Levine and H. Ursin “What Is Stress?” in Psychobiology of Stress.
• p38 - Emotional competence requires . . . the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past. What we want and demand from the world needs to conform to our present needs, not to unconscious, unsatisfied needs from childhood. If the distinctions between past and present blur, we will perceive loss or threat of loss where none exist; . . .
• p48 - “What’s that like for you to get emotional?” “Annoying, because it doesn’t do any good.”
• p51 - The problem was not a lack of feeling but an excess of painful, unmetabolized emotion.
  • TB: Italics in original. I really like the phrase, “unmetabolized emotion.”
• p78 - . . .I think her precocious intellectual development is what happens to bright and sensitive kids when the emotional environment isn’t able to hold them enough; they develop this very powerful intellect that holds them instead.
• p86 - Smoking no more causes cancer of the lung than being thrown into deep water causes drowning.
  • TB: So, GM has a recurring theme in the book that most chronic illnesses are not caused by one thing alone. Okay, I’m willing to go there. But this statement is one of several that seem to be really challenging. I have a long handwritten note in here… GM says the logic is simple. If A → B, then A must always → B. If not, then A cannot itself, alone, cause B. But that’s a bit of a logical fallacy, right? It reminds me of the latin from episode 2 or whatever of the West Wing, post hoc ergo propter hoc, after it therefore because of it. GM contends that he has never seen a cancer patient (or w/e) with a perfectly healthy childhood. Did he not ever see pediatric cancer patients? Very odd. I think the rest of his book and theory are quite good, but things like this seem like low hanging fruit for critics.
• p90 - Consummatory behavior—from the Latin consummare, “to complete”—is behavior that removes the danger or relieves the tension caused by it.
• p107 - He recalled he had received what he called “deserved spankings,” which, on further inquiry, turned out to have been beatings witha belt administered by his father, from about the age eight on. . . . “Well, now, I don’t think that was the best thing he [his father] could do, but you really don’t have much choice when you’re a young child. I wanted to be a good person. When you’re a child looking at your father, you don’t know what he’s supposed to be, because you want your dad to be perfect, and you want to be a perfect child.”
• p115 - The child of an unhappy mother will try to take care of her by suppressing his distress so as not to burden her further.
  • TB: Always good to feel represented in a book!
• p145 - The prefrontal cortex is where the brain stores emotional memories. It interprets present stimuli, whether physical or psychological, in light of past experiences, which can date back as far as infancy.
• p172-173 - In other words, the angry child got into trouble and experienced rejection. The anger and the rejection had to be deflected inside, against the self, in order to preserve the attachment relationship with the parent. That, in turn, leads to the “strong feelings of inadequacy and a poor self-concept” researchers have recognized in people with rheumatoid disease. “Not infrequently anger is redirected away from an attachment figure who aroused it and aimed instead at the self,” Bowlby explains. “Inappropriate self-criticism results.”
• p194 - A fundamental concept in family systems theory is differentiation, defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.”
• p207 - In the parent-child interaction is established the child’s sense of the world: whether this is a world of love and acceptance, a world of neglectful indifference in which one must root and scratch to have one’s needs satisfied or, worse, a world of hostility where one must forever maintain an anxious hypervigilance. Future relationships will have as their templates nerve circuits laid down in our relationships with our earliest caregivers.
• p207 - For the satisfaction of attachment needs in human beings, more than physical proximity and touching is required. Equally essential is a nourishing emotional connection, in particular the quality of attunement. Attunement, a process in which the parent is “tuned in” to the child’s emotional needs, is a subtle process. . .