The myth of normal, p.5
The Myth of Normal, page 5
After the birth father abandoned the family early, a stepfather abused the boys both physically and emotionally. “I was very lonely and scared and feeling trapped,” Helen recalled. That she would lack the gut-sense not to choose such men and that she would not assert herself and protect her sons in the face of abuse were themselves the marks of trauma sustained in Helen’s own childhood. Apart from being physically hit on her bare bottom by her father up until age ten, Helen endured emotional torment. “I was ashamed a lot for my feelings as a child,” she recalled. “I was very sensitive, and I cried a lot.”
Trauma is in most cases multigenerational. The chain of transmission goes from parent to child, stretching from the past into the future. We pass on to our offspring what we haven’t resolved in ourselves. The home becomes a place where we unwittingly re-create, as I did, scenarios reminiscent of those that wounded us when we were small. “Traumas affect mothers and mothering and fathers and fathering and husbanding and wifeing,” the family constellations therapist Mark Wolynn told me. “The repeated traumas continue to proliferate from that—as a result, they never get healed.” Wolynn is the author of the aptly titled It Didn’t Start with You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle. Trauma may even affect gene activity across generations, as we will see.[*]
It is no surprise, then, that Helen’s eldest grandchild has faced problems with substance use and behavior and learning difficulties. Because of all she has learned and despite her unfathomable losses, she is able to be present for him much more warmly and effectively than she ever could be for her own sons. Note, too, the absence of self-judgment in Helen’s description of the situation: she speaks of “understanding” rather than castigating herself for what she didn’t—nay, couldn’t—understand way back when. The act of blaming herself, its gravitational center planted permanently in the past, would only divert her from showing up for her loved one in the here and now.
Blame becomes a meaningless concept the moment one understands how suffering in a family system or even in a community extends back through the generations. “Recognition of this quickly dispels any disposition to see the parent as villain,” wrote John Bowlby, the British psychiatrist who showed the decisive importance of adult-child relationships in shaping the psyche. No matter how far back we look in the chain of consequence—great-grandparents, pre-modern ancestors, Adam and Eve, the first single-celled amoeba—the accusing finger can find no fixed target. That should come as a relief.
The news gets better: seeing trauma as an internal dynamic grants us much-needed agency. If we treat trauma as an external event, something that happens to or around us, then it becomes a piece of history we can never dislodge. If, on the other hand, trauma is what took place inside us as a result of what happened, in the sense of wounding or disconnection, then healing and reconnection become tangible possibilities. Trying to keep awareness of trauma at bay hobbles our capacity to know ourselves. Conversely, fashioning from it a rock-hard identity—whether the attitude is defiance, cynicism, or self-pity—is to miss both the point and the opportunity of healing, since by definition trauma represents a distortion and limitation of who we were born to be. Facing it directly without either denial or overidentification becomes a doorway to health and balance.
“It’s those adversities that open up your mind and your curiosity to see if there are new ways of doing things,” Bessel van der Kolk told me. He then cited Socrates: “An unexamined life is not worth living. As long as one doesn’t examine oneself, one is completely subject to whatever one is wired to do, but once you become aware that you have choices, you can exercise those choices.” Notice that he didn’t say “once you spend decades in therapy.” As I will present later, we can access liberation via even modest self-examination: a willingness to question “many of the truths we cling to” and the “certain point of view” that makes them seem so real—as a famous Jedi master’s Force ghost told his dispirited young apprentice at a pivotal moment in a galaxy far, far away.[*]
* * *
—
Although this chapter has focused on its personal dimensions, trauma exists in the collective sphere, too, affecting entire nations and peoples at different moments in history. To this day it is visited upon some groups with disproportionate force, as on Canada’s Indigenous people. Their multigenerational deprivation and persecution at the hands of colonialism and especially the hundred-year agony of their children, abducted from their families and reared in church-run residential schools where physical, sexual, and emotional abuse were rampant, has left them with tragic legacies of addiction, mental and physical illness, suicide, and the ongoing transmission of trauma to new generations. The traumatic legacy of slavery and racism in the United States is another salient example. I will have more to say about this painful subject in Part IV.
Chapter 2
Living in an Immaterial World: Emotions, Health, and the Body-Mind Unity
Unless we can measure something, science won’t concede it exists, which is why science refuses to deal with such “nonthings” as the emotions, the mind, the soul, or the spirit.
—Candace Pert, Ph.D., Molecules of Emotion
“I was thirty-six when they told me it was a very early breast cancer,” said Caroline, a resident of the Pocono Mountains of Pennsylvania. That diagnosis occurred more than three decades ago, in 1988. The tumor was treated with surgery and radiation. A few years later, when a new malignancy showed up in her left hip and femur, Caroline required emergency joint replacement; the surgeons had to remove a large part of her thigh bone as well. “At that time, they gave me a timeline of one to two years,” she recalled. “My boys were very young, only eight and nine. I’ve just turned fifty-six, so I’ve beaten all their records.”
Caroline had multiple courses of chemotherapy over the intervening years. By the time of our conversation, the cancer had reached the palliative stage, having spread to her right hip and thigh. As we spoke, she could not expect to outpace her current prognosis by much;[*] still, this mother of two radiated deep satisfaction with how things had gone. She had, after all, gained two unforeseen decades to raise her kids. “You know,” she mused, “looking at my own mortality, and them telling me I had twelve to twenty-four months . . . I got extremely profane with the doctor and said, you know, sorry, I need ten years to raise them to be men. I will do anything in my power to raise them to be men.”
“‘Profane,’” I repeated. “What exactly did you say?”
“I used the f-word. I said, ‘Fuck your statistics.’”
“Good for you,” I offered. “That probably helped extend your life.”
“Well, that’s what I said to him.” Caroline laughed. “I said, ‘Fuck your statistics. I need those years to raise them to be men.’ He walked out of the room. He didn’t appreciate my language. He thought I was a crazy, vulgar woman. I’ve often wanted to look for that doctor—he has since moved to California—and tell him that my boys are now twenty-four and twenty-five. One’s in grad school at Princeton. The other one went through a difficult period, pulled himself up, and will be graduating with three degrees, on the dean’s list.”
Caroline’s outburst at the unsuspecting physician was out of character. All her life she had fit the profile of the nice person who avoids confrontation. “My way was always being the caretaker, being needed, always coming to somebody’s rescue, a lot of the time to my own detriment,” she told me. “I never wanted to have conflict with anyone. And I always had to be in charge, making sure everything was okay.” Caroline had exhibited what has been called “superautonomous self-sufficiency,”[*] which means exactly what it sounds like: an exaggerated and outsize aversion to asking anything of anyone.
A quick note: Nobody is born with such traits. They invariably stem from coping reactions to developmental trauma, beginning with self-abnegation in early childhood. Such suppression takes a lasting toll, a process we’ll explore more fully in chapter 7.
“I’ve come to believe that virtually all illness, if not psychosomatic in foundation, has a definite psychosomatic component,” the pioneering neuroscientist Candace Pert wrote in her 1997 book, Molecules of Emotion. By “psychosomatic,” Pert did not imply the modern, often derisive dismissal of disease as a neurotic figment. Instead she meant the word’s strict scientific connotation: having to do with the oneness of the human psyche (mind and spirit) and the soma (the body), a oneness she did much to measure and record in the laboratory. Her discoveries, as she justly claimed, would help fuel “a synthesis of behavior, psychology, and biology.”[1]
There is nothing novel about the notion of the mind and body being intricately linked; if anything, what is new is the belief, tacitly held and overtly enacted by many well-meaning doctors, that they are separable. Traditional healing practices the world over, while lacking the wondrous technology and scientific know-how developed in the West, have long understood this unity implicitly. Despite Western medicine’s artificial cleaving of the two, most people still know—if only on a gut level—that what they think and how they feel have everything to do with each other. It is run-of-the-mill, for instance, to speculate about which life stresses have contributed to one’s ulcer, what mental strain is behind a headache, or what unprocessed fears lead one to experience panic attacks. The same principle applies when we look not just at individual symptoms but at most types of diseases. Emotional perturbances stemming from relationship troubles, financial worries, or any other source of chronic upset impose physiological burdens that can result in illness.
Pert coined the term “bodymind” to describe this oneness. The official website dedicated to her work and legacy takes care to note that this expression was “intentionally written without a hyphen in order to emphasize unity of its component parts.” Body and mind, while not identical, cannot be understood separately from each other. We can ignore or deny this paradox, but we cannot escape it. Since Pert’s groundbreaking work, the biological impacts of emotions—those “nonthings” whose non-recognition she lamented—have been extensively researched and documented in many thousands upon thousands of ingenious studies. It’s worth looking at a few of these, bearing in mind that each is only the tip of an iceberg of similarly compelling findings.
A 1982 German study presented at the fourth international Symposium on the Prevention and Detection of Cancer in London found certain personality traits to have a strong association with breast cancer. Fifty-six women admitted to hospital for biopsy were evaluated for characteristics such as emotional suppression, rationalization, altruistic behavior, the avoidance of conflict, and the superautonomous self-sufficiency we saw embodied by Caroline. Based on the interview results alone, both the interviewers and “blind” raters who had no direct contact with the women were able to predict the correct diagnosis in up to 94 percent of all cancer patients, and in about 70 percent of the benign cases.[2] In a previous British study at King’s College Hospital in London, it had also been shown that women with cancerous breast lumps characteristically exhibited “extreme suppression of anger and of other feelings” in “a significantly higher proportion” than the control group, which was made up of women admitted for biopsy at the same time but found to have benign breast tumors.[3]
In 2000 the publication Cancer Nursing surveyed the relationship of anger repression and cancer, often noted by, among others, the cancer nurses themselves: “Somehow, nurses had an intuitive understanding that this ‘niceness’ was deleterious. [This] view now is being supported by research.”[4] The nurses’ insight reminded me of a paper on amyotrophic lateral sclerosis (ALS)[*] presented by two Cleveland Clinic neurologists at an international congress in Bavaria in the 1990s.[5] Their staff, too, found that their ALS patients were extraordinarily nice—so much so, that the staff could in most cases accurately predict who would be diagnosed with the condition and who would not. “I’m afraid this person has ALS, she is too nice,” they would jot on the patient’s file. Or, “This person cannot have ALS, he is not nice enough.” The neurologists were dumbfounded. “In spite of the briefness of [the staff’s] contact with the patients, and the obvious unscientific method by which they form their opinions, almost invariably they prove to be correct,” they remarked.
I interviewed Dr. Asa J. Wilbourn, senior author of the paper. “It’s almost universal,” he told me. “It becomes common knowledge in the laboratory where you evaluate a lot of patients with ALS—and we do an enormous number of cases. I think that anyone who deals with ALS knows that this is a definite phenomenon.” Such anecdotal observations have since been reaffirmed by more formal research, as seen in the title of a recent paper from a neurological journal: “‘Patients with Amyotrophic Lateral Sclerosis (ALS) Are Usually Nice Persons’—How Physicians Experienced in ALS See the Personality Characteristics of Their Patients.”[6]
In a study of men with prostate cancer, anger suppression was associated with a diminished effectiveness of natural killer (NK) cells—a frontline immune system defense against malignancy and foreign invaders. These cells play a key role in tumor resistance.[7] In previous research, NK cell activity was reduced in healthy young people in response to even relatively minor stresses—especially for those who were emotionally isolated, a significant source of chronic stress.
Grief, too, has a powerful physiological dimension. An illuminating study from the British journal Lancet Oncology described the impact of psychological factors on the intricate pathways linking the immune system, the hormones, and the nervous system in, for example, bereavement. Among parents who lost an adult son to an accident or military conflict, the authors reported increased occurrence of lymphatic and hematological malignancy—cancers of the blood, bone marrow, and lymph nodes—along with skin and lung cancer.[8] War kills, and so, it seems, can deep emotional loss. As for cancer, so with other illnesses. In a Danish nationwide study, grieving parents had double the risk of multiple sclerosis.[9]
(Despite such compelling evidence, I do not believe the loss of a loved one, howsoever tragic, by itself necessarily poses a health risk. I believe the latter depends on how people are able to process their loss, including what support they may reach out for and receive. It’s not only events as such but also our emotional responses and how we process them that affect our physiology.)
One 2019 study alone in Cancer Research should set every clinician on a fast-track exploration of bodymind medicine. Women with severe post-traumatic stress disorder (PTSD) were found to have twice the risk of ovarian cancer as women with no known trauma exposure.[10] The Daily Gazette, published by Harvard University, where the study was done, reported, “The findings indicate that having higher levels of PTSD symptoms, such as being easily startled by ordinary noises or avoiding reminders of the traumatic experience, can be associated with increased risks of ovarian cancer even decades after women experience a traumatic event.” The more severe the trauma symptoms, the more aggressive the cancer proved to be.
This Harvard research provided further striking evidence that emotional stresses are inseparable from the physical states of our bodies, in illness and health. Already in previous work, depression had been associated with elevated ovarian cancer risk. The impact of stress had also been studied: among lab mice with ovarian cancer cells injected into their abdominal cavities, those subjected to emotional aggravation such as being physically restrained or isolated had much greater incidence of tumor growth and spread than socially housed animals that were not restrained.[11] The Harvard scientists theorized that stress can “promote ovarian cancer development by inhibiting key defenses against unrestrained cell growth.” In other words, stress may disable our immune systems’ capacity to control and eliminate malignancy.
The implications extend far beyond PTSD, since, in our culture, stress and trauma affect many people who do not qualify for that diagnosis. Finnish researchers, writing in the British Journal of Psychiatry in 2005, found, quite remarkably, that people undergoing “life events”—relatively ordinary stresses and emotional losses such as relationship issues and work problems that would not qualify them for a formal diagnosis—suffered more PTSD-like symptoms such as bad dreams or emotional numbing than more obviously traumatized people who had endured war or disaster.[12]
The Harvard paper on ovarian cancer pointed to some promising possibilities for treatment, suggesting that women whose PTSD symptoms had abated, perhaps due to effective psychotherapy, had less risk for malignancy than women with active symptoms. It is exciting to contemplate the preventive and healing potentials, as well as the social implications, of a wellness perspective that treats emotions like the real and relevant “things” they are.
While all this is timely and the science freshly minted, the principles are not new. In a 1939 lecture to a graduating medical class, published in the Journal of the American Medical Association ( JAMA), Dr. Soma Weiss informed his audience that “social and psychic factors play a role in every disease, but in many conditions, they represent dominant influences.”[13] The revered Hungarian-American clinician added that “mental factors represent as active a force in the treatment of patients as chemical and physical agents.” He made these comments not as a psychoanalytic theoretician, but as a respected practitioner of pathophysiology and pharmacotherapy—the use of medications in treating illness. At Harvard Medical School, Weiss’s memory is kept alive by a yearly research day in his honor, yet his integrative perspective, and the extensive scientific literature now supporting it, still elude conventional medical thinking. “The mind-body stuff is historically something that one pursues at great peril to their career at Harvard,” a leading physician and academic at that hallowed institution told me recently. “That’s starting to change, but it’s a very difficult thing.”[14]
