The Story of Stress: Part 1

I was intermittently aware of experiencing stress back in my school days: talking in front of a class, waiting outside the principal’s office, working feverishly to finish a class project on time. In university I took a course in psychoneuroimmunology, which offered a more academic look at stress and its impacts on the body. In research papers we read about rats and other unfortunate captive creatures being shocked or otherwise stressed, with various adverse impacts on their physiology then measured.

However, it was not until I landed in the full-time working world that stress and stressors become more of a frequent and relevant topic of discussion. I worked in a medical/health library and our collection of stress management books, for both employees and researchers, seemed to grow by the year. There was also a burgeoning focus on employee well-being, and I remember many employees being handed a slim booklet titled: “Adapting to Stress: Start Taking Charge,” created in 1988 by the Hope Heart Institute (I still have it). It was fairly comprehensive document, with a focus on stress management strategies to reduce negative health impacts, including heart disease.

Since that time, I have read many books and papers on the topic. I think the topic continues to hold my interest because the experience of stress is universal, and has important—even life-saving—utility in some circumstances, although more so for our ancestors who dealt with greater physical demands and threats, like the proverbial sabre-toothed tiger. In the modern world, demands are now more likely to be psychological, but they create the same cascade of bodily responses. And, while the stress response is universal, what triggers a stress response in one person, may not for another. Fascinating stuff.

So, I thought I would delve into my stress library and choose two books that have made an impact in the field, albeit with slightly different takes on the topic. In this post I will focus on the book: When the Body Says No: The Cost of Hidden Stress, by Gabor Maté, a well-known Canadian physician.

Early in this book, Maté cites the work of Hans Selye, considered the founder of stress theory as well as the originator of the term. Selye states that stress consists of internal/physiological alterations--visible or not--when an organism perceives a threat to its existence or well-being. As well, this stress response is heightened when the demand made on an organism (which can be a positive or negative event) exceeds that organism’s capacity, or perceived capacity, to deal with that demand.

Maté draws on medical research, as well as his decades of clinical experience as a family physician, to advance the concept of a mind-body connection and its role in various conditions and diseases, including autoimmune disorders. In this context, he explores the link between stress and disease, examining how early emotional experiences (as well as current ones) impact the body’s immune system and ultimately lead to illness. Reflecting the book’s title, and through multiple case studies, Maté attempts to illustrate how disease can be a consequence (or a way of the body saying no/enough) when the mind cannot or will not acknowledge and or cope with certain emotional issues or traumatic content.

Despite my comments to follow, I think this is an important book to read. In western medicine, the mind-body link is still a relatively new idea, and not regularly reflected in medical practice in many sectors. As well, Maté worked for many years in a Downtown Eastside medical practice, which no doubt influenced and or solidified his trauma-informed perspective. Trauma at any stage in life, can have profound implications for physical and mental health, including the behavioural choices that influence these. Again, this is an idea that is just beginning to take hold in a variety of health fields, including those related to addiction and mental health treatment. In both these realms, Maté remains a crucial voice.

That said, the book is weighty with medical disorder cases that seem to be explained a little too conveniently (or dare I say simplistically) by Maté’s central theories. I think the cases he presents are real, and there may be an emotional/traumatic component to illness manifestation or continuation in a portion of these. But it feels like an over-assertion to say this is a factor in all cases: one that may be under-emphasizing or under-reporting other known or unknown factors. Related to this is the danger of blaming the victim. Maté insists this is not his intention, but that’s sometimes how it reads, and it doesn’t feel very helpful, particularly as the book is very light on practical ways forward for impacted patients. In the case where deep-seated trauma may be a legitimate factor in a current medical condition, many do not have access to specialized and typically costly trauma assessment/treatment. That just sounds like a recipe for more stress. 

In fact, it is not until the final (19th) chapter that Maté outlines how the reader might "heal" or mitigate some of the health threats he talks about in the previous 18 chapters. He outlines the seven “As”: acceptance, awareness, anger, autonomy, attachment, assertion, and affirmation. While he explains these in more detail, with examples, they still feel more conceptual than practical, and too little too late.

Again, When the Body Says No covers important ground, particularly in reminding us about the mind-body connection and the real impacts of unaddressed trauma (big and smaller) on well-being. I recommend reading it with an attitude of curiosity, and in full knowledge that Maté has a strong point of view to share.