When the Body Says No: The Cost of Hidden Stress by Gabor Maté Read Free Book Online Page A

system.
    Alan’s lower esophagus has been removed, along with the upper portion of the stomach where the tumour had invaded. Because the cancer had spread to several lymph nodes outside the gut, he received five courses of chemotherapy. His white blood cells became so depleted that another round of chemo would have killed him.
    A non-smoker or drinker, he was shocked by the diagnosis, since he always considered that he lived a healthy life. But he has thought for a long time that he has a “weak stomach.” He often suffered indigestion and heartburn, a symptom of the reflux of stomach acid into the esophagus.The lining of the esophagus is not designed to withstand the corrosive bath of hydrochloric acid secreted in the stomach. A muscular valve between the two organs and complex neurological mechanisms ensure that food can move downward from throat to stomach without permitting acid to flow back upward. Chronic reflux can damage the surface of the lower esophagus, predisposing it to malignant change.
    Not being one to complain, Alan had only once mentioned this problem to doctors. He thinks fast, speaks fast, does everything fast. He believed, quite plausibly, in fact, that his habit of eating on the run was responsible for the heartburn. However, excessive acid production due to stress and disordered neural input from the autonomic nervous system also play a role in reflux. The autonomic part of the nervous system is the part not under our conscious control, and—as the name implies—it is responsible for many automatic body functions such as heart rate, breathing and the muscle contractions of internal organs.
    I asked Alan if there had been any stresses in his life in the period preceding the diagnosis. “Yes. I had been under stress, but there are two kinds of stress. There is stress that is bad and stress that is good.” In Alan’s estimation the “bad stress” was the complete lack of intimacy in his ten-year marriage to Shelley. He sees that as the main reason the couple have not had children. “She just has some very serious problems. Because of her inability to be romantic, intimate and all the things that I need, my frustrations with our marriage were at their absolute peak at the point I got the cancer. I’ve always felt that that was a really major thing.” The “good stresses,” in Alan’s view, came from his work. In the year prior to his diagnosis he worked eleven hours a day, seven days a week. I asked him if he has ever said no to anything.
    “Never. In fact, I love being asked. Almost never have I said yes with deep regret. I like doing things, I like taking things on. All somebody has to do is ask me and they got me.”
    “What about since the cancer?”
    “I’ve learned to say no—I say it all the time. I want to live! I think saying no plays a big role in getting better. Four years ago they gave me a 15 per cent chance of survival. I made a conscious decision that I wanted to live, and I set a timeline somewhere between five and seven years.
    “How do you mean?”
    “Five years is supposed to be the magical thing, but I know it’s just an arbitrary timeline. I figure I’ll cheat and get two more years. Then, after seven …”
    “Are you saying that after seven years you can go back to living crazily again?”
    “Yes, I might. I don’t know.”
    “Big mistake!”
    “Probably—we’ll talk about that. But right now I’m a good boy. I really am. I say no to everybody.”
    The experience of stress has three components. The first is the event, physical or emotional, that the organism interprets as threatening. This is the stress stimulus, also called the
stressor
. The second element is the processing system that experiences and interprets the meaning of the stressor. In the case of human beings, this processing system is the nervous system, in particular the brain. The final constituent is the stress response, which consists of the various physiological and behavioural