Dedicated to Judith Lövi (mother) and Dr. Hans Selye (stress researcher), main thesis: “mind and body inseparable and that illness and health cannot be understood in isolation from the life histories, social context and emotional patterns of human beings”; interpersonal biology: our relationships help shape our physiology; trying to find causes of cancer on cellular level ~ trying to understand traffic jam by checking combustion engine; people do not become ill despite their lives but because of their lives (including thoughts and emotions not just diet or physical activity); there is an innate wisdom in our bodies (Walter Cannon)

1. BODY-MIND CONNECTION: Raynaud’s phenomenon can lead to gangrene; scleroderma = “hardened skin” (autoimmune diseases including rheumatoid arthritis, ulcerative colitis, systemic lupus erythematosus - SLE); “when we have been prevented from learning how to say no, our bodies may end up saying it for us”; dualism: dividing into two that which is one; relativity theory: observer influences observation; more specialized doctors become in a body part the less they tend to understand the human being in whom the part resides; discussion about personal life is discouraged in medical profession; personal stories regarded as mere “anecdotal” evidence; rheumatoid arthritis: William Osler suspected to be stress-related in 1892; repressed emotions disarm body’s defences against illness; similar patterns in amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease or motor neuron disease), multiple sclerosis (MS) (Greek “to harden”), Crohn’s disease, chronic fatigue syndrome etc; “in important areas of their lives, almost none of my patients with serious disease had ever leaned to say no; “you shouldn’t blame the victim” -> blame != responsibility; Western medicine: physician is the only authority, people are deprived the opportunity to become truly responsible; in real life mind and body are not separated [<-> God]; personal connection: author is child and survivor of Nazi Holocaust; mother unable to provide security & unconditional love; became mother’s protector, repressing his own anxiety & pain; tendency to disguise limp

2. MULTIPLE SCLEROSIS: “I was the little girl too good to be true. It means that you subjugate your own wants or needs in order to get approval. I was always trying to be who my parents wanted me to be.”; people with chronic illnesses often accuse themselves deserving their illness as punishment; MS cannot be inherited, must be triggered by environmental factors; boundaries are learned in our formative years; common pattern: being exposed to acute and chronic stress in childhood which impaired their ability to engage in fight-or-flight behavior; “why are you treating yourself worse than you would another person?”; Jacquelin du Pré: British cellist, died in 1987 from MS, lifelong resentment toward mother erupted in rage, used cello to express internal aggression, fitting herself to others’ expectations, “she had to be the Jackie the circumstances demanded”; she hid her problems; she impressed others with her music but was deaf to her true self

3. STRESS: chronic daily stresses more harmful than sudden isolated ones (eg death, unemployment); stress can even be addictive if you are used to it from early childhood; stress is not a subjective feeling but measurable set of objective psychological events in the body; you can be stressed without being aware of it; stress (term coined by Selye): internal alterations - visible or invisible - in response to existential threat; feeling nervous and being under stress are independent (one can happen without the other); excessive stress happens when demands » capacities (~ rubber band snaps, spring gets deformed); can be evoked by trauma - even if it’s purely imaginary, even without consciously being aware of it; stress components: stressor (stress stimulus) + processing system (brain) + stress response (psychological/behavioral changes); no universal relationship between stressor and response (depends on personality, personal history & other factors); main affected areas: 1) hormonal system (adrenal glands) 2) immune system (lymph glands) 3) digestive system (intestines); due to higher adrenalin and cortisol; main stress factors: 1) uncertainty 2) lack of information 3) lack of control; acute vs chronic stress: short vs long term; spousal caregivers of Alzheimer postings: inhibited immune system, more susceptible to influenza, longer time to heal wounds; biggest stressors in industrialized societies are emotional (Selye); the more developed we are, the less we are aware of our emotional realities and able to recognize our bodies signals; three levels of emotional responses (Ross Buck): 1) Emotion III: subjective experience, conscious awareness of emotional state; 2) Emotion II: emotional displays seen by others without our awareness, 3) Emotion I: subconscious physiological changes that neither us not others can observe; helplessness (real or perceived): potent stressor (eg being stuck in a stressful job or in an abusive relationship); emotional competence: ability to deal with our own feelings and desires appropriately (capacity to feel & express our emotions, maintain emotional boundaries, distinguish between physiological reactions related to there present vs residues from there past, awareness of genuine needs that need to be satisfied) -> discouraged in society (“don’t be so emotional/sensitive” eg Mr Spock from Star Trek); “Emotional competence is what we need to develop if we are to protect ourselves from the hidden stresses that create a risk to health, and it is what we need to regain if we are to heal. We need to foster emotional competence in our children, as the best preventive medicine.”

4. ALS: motor neurons (nerve cells controlling muscles) gradually die; amyotrophic lateral sclerosis: a (negative) myo (muscle), tropic (nourishment), atrophy (wastes away), lateral (spinal cord area), sclerosis (hardening); distinguishing characteristics: 1) inability to ask for or receive help 2) chronic exclusion of so-called “negative” feelings; hard, steady work without recourse to help from others; habitual denial, suppression or isolation of fear, anxiety, sadness; necessity to be cheerful/nice/congenial; “this patient cannot have ALS, he is not nice enough”; emotional deprivation/loss in childhood; relentless self-drive; no respite/internal resting place; reluctance to acknowledge the need for help; denial of pain (physical or emotional); “The conspicuous niceness of most, but not all, person’s with ALS is an expression of a self-imposed image that needs to conform to the individual’s (and the world’s) expectations.”; individual seems to be trapped in a role; strong sense of self couldn’t develop under early childhood conditions of emotional barrenness; weak sense of self; often unhealthy fusion with others; Lou Gehrig: “the iron horse”; refusal to skip game despite injury or illness; 2130 consecutive games played; caught up “in his self-designated role as a loyal son, loyal team player, loyal citizen, loyal employee”; hard on himself <-> caring for others; “mama’s boy”; Stephen Hawking: diagnosed at 21; mostly shunned any assistance; Dennis Kaye: ALS personality: over-achiever, workaholic (anything but lazy) -> later realized he’d been driven by his father’s goals not his own; people with ALS find it impossible up let to of self-imposed responsibilities long after their bodies have signalled rebellion; feeling guilty to say no to other people’s perceived needs; “I resented not being able to go with my friends to a show on Saturday afternoon”; recurring dream of being buried alive; problem is not lack of feelings but an excess of painful, unprocessed emotions; “Strong convictions do not necessarily signal a powerful sense of self: very often quite the opposite. Intensely held beliefs may be no more than a person’s unconscious effort to build a sense of self to fill what, underneath, is experienced as a vacuum.”; Sue Rodriguez: “who owns my life?”; fight for right to die; Stephen Hawking: physical illness didn’t hinder him intellectually (on the contrary, this seems to be the turning point) & had emotional support through her wife who selflessly (literally) devoted her life to caring for him; they didn’t join as equal partners but rather fused into one body; she gradually disappeared in the relationship; became nearly suicidal; Hawking “reacted to her strivings for independence with distain and finally with the rage of a child deserted by his mother”; another aiding factor: liberation of his aggression; remote father without emotion; Stephen never liked to express emotions; some people did recover from ALS (eg. Dana Johnson through practice of self-love which “unfroze” her body parts, “it took a life-threatening disease for her to learn that self-service through self-sacrifice is a dead end” [<-> Jesus Christ])

5. BREAST CANCER: emotional stress major contributing cause; more likely if person was emotional disconnected from parents as a child, tend to repress emotions (particularly anger), altruistic/compulsively caregiving type; “take job too seriously”, don’t relax enough, do other people’s job; lack of warmth and emotional affection (this has nothing to do with achievement); extreme suppression of anger & other feelings; passive/stoic response style; unrealistic self-sacrificing behavior; role of mother: taken for granted, supposed to be there and provide just like the world; father’s teaching: “wife should never say no when husband wants sex because if she does, he has the right to get it somewhere else”; can’t say “I don’t want to”; Betty Ford: former US first lady, “allowed myself to be a doormat”, “the more important Jerry became the less important I became”; measuring herself against impossible ideals and coming up short; harsh self-judgment; perfectionism

6. FAMILY ROLES: Betty Krawczyk: permission to let her daughter die; “Cancer and ALS and MS and rheumatoid arthritis and all these other conditions, it seems to me, happen to people who have a poor sense of themselves as independent persons. On the emotional level, that is - they can be highly accomplished in the arts or intellectually - but on an emotional level they have a poorly differentiated sense of self. They live in reaction to others without ever really sensing who they themselves are. […] I think her precarious 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. Hence their intellectual maturity and their ability to relate to adults. People would tell me as a child how mature I was. I always thought I was, because in that mode you can seem highly mature. But then when I look at myself emotionally, I’ve been very immature. I’m fifty-eight now and still trying to grow up.”; keeping peace in the family is not the child’s role; “I’m not worried my kids will be angry with me. I’m worried they won’t be angry enough.”; “Why can’t parents see their children pain? - It’s because we haven’t seen our own.”; The Mermaid and the Minotaur by Dorothy Dinnerstein: feminist book: exclusive role of mother in early childraising distorts child development, mother is married to an immature man, she is also the mother of the husband and doesn’t have energy for the kids

7. LUNG CANCER: not only caused by smoking (otherwise every smoker would develop it); but also by emotional repression; smoking causes cancer ~ falling into deep water causes suffocation; the more severe the emotional repression the less smoking is needed to have lung cancer; psychoneuroimmunoendocrinology (PNI): discipline studying interrelated functions of the organs and glands; PNI system ~ giant switchboard; hub: HPA axis; Béla Bartók: exile from Hungary, leukemia, asked to write a new piece (Concerto for Orchestra) -> temporary remission; tumor: doubling rate in not constant in real life, it can metastasize before is clinically detectable; most consistent risk factor: inability to express emotion (esp. anger); Gilda Radner: “it is important to realize that you have to take care of yourself because you can’t take care of anybody else until you do”

8. PROSTATE CANCER: major treatments: “slash” (surgery), “burn” (radiation), “poison” (chemotherapy); mortality rates slightly increased; common view: earlier detection increases likelihood of recovery; stress factors excluded from textbooks; behavioral changes (attainment of dominant status) leads to physiologic changes; emotional states can rapidly alter testosterone production; family factors: increases risk but no major factor; marriage decreases likelihood; Rudy Giuliani (further Mayor of New York City): 4 hours sleep, had to be in control; cancer changed his perspective; Lance Armstrong (Tour de France): emotional repression (~ iceberg) successfully recovered from testicle cancer; common sign: delay in seeking medical advice; abusive father, mother couldn’t protect him; “The child of an unhappy mother will try to take care of her by suppressing his distress so as not to burden her further”; tendency to put other people’s happiness before his own; low self-esteem; pleasing others; not being honest to them

9. CANCER PERSONALITY?: melanoma: most likely to deny any awareness of being anxious/upset; personalities: Type A: angry, tense, fast, aggressive, in control; Type B: balanced, moderate, can feel/express emotions without outbreaks; Type C: extremely cooperative, looks easygoing and pleasant like Type B but supresses negative emotions (particularly anger), tries to maintain a happy face, avoiding conflict, cancer personality? no single yes/no answer; certain traits increase the risk; physiological stress is the link between personality traits and disease; much of personality not fixed set of traits but coping mechanisms acquired in childhood; inherent characteristic != response to environment (people might believe they are the same); being controlling is not a trait but coping style (underlying emotion is deep anxiety); repressing emotions isn’t one either (but: children couldn’t talk about their negative emotions with parents, “my mother and father needed me to be happy”)

10. CROHN’S DISEASE: inflammatory bowel disease (IBD); other major form is ulcerative colitis; typical traits: child thinks he is responsible for his mother’s emotional suffering, obsessive-compulsive behavior (neatness, punctuality, conscientiousness), being self-critical; gut (intestinal tract): more than digestive organ, sensor with its own nervous system; 55 percent rule: consistent response to placebo

11. IRRITABLE BOWEL SYNDROME (IBS): functional disorder (cannot be explained medically - “all in the head”); positron emission tomography (PET): measures activity of brain regions by analyzing bird r flow; prefrontal cortex: where the brain stores emotional memories; high incidence of abuse (but: not necessary) -> gut becomes oversensitized; gastroesophageal reflux disease (GERD); pain: also a mode of perception

12. ALZHEIMER’S DISEASE: baby boomers nightmare; Jonathan Swift (17th century writer); linguistic ability in early life strongly associated -> depends on early emotional relationships; slowly being considered as autoimmune disease; Ronald Reagan (former US president): cannot express emotions, inability to distinguish facts from fiction

13. RHEUMATOID ARTHRITIS: associated with shock, worry and grief; rheumatic diseases: scleroderma, ankylosing spondylitis, systemic lupus erythematosus (SLE); extreme stoicism; no complaining; focus on others instead of self; compensating hyperindependence (“I can do this by myself”): originates from role reversal between parent and child; perfectionism; feeling inadequate; effective loss of one or both parents; emotional deprivation; immunity ~ emotion: shared functions: 1) awareness of self & non-self 2) responding to threats; ankylosing spondylitis: helps better control anger (have to breath using diaphragm) -> allows to control temper

14. ASTHMA: children unable to self-regulate; individual and interpersonal work together; asthma (“breathe hard” Greek); family patterns: enmeshment (intrusion of personal boundaries, poor differentiation of self and family), being overprotective/controlling, rigidity, lack of conflict resolution; absence of social support (real or felt); differentiation: ability to connect emotionally with others while being emotionally autonomous; functional vs basic differentiation: ability to function based on relationship with others (eg employees, spouse, children -> functional) vs ability to engage with others while staying emotionally open to them (-> basic); worse marriage -> worse immune system; less powerful partner will absorb more stress (-> women absorbing husband’s stresses while having to contain their own); the partner who must suppress more of his/her needs for the sake of relationship is more likely to develop physical illness as well; development: moving from external -> self-regulation; vulnerability to stress: proportionate to degree of emotional dependance; giving up part of autonomy -> risk of having to pay the price in the form of illness; emotional shutdown -> high unmet needs; social isolation increases susceptibility to illnesses

15. LOSS: pet rabbit can sense anger even if owner is unaware; feelings of being loved significantly related to health status; touching is important; person can suffer not just because something negative was inflicted on them but because something positive was withheld -> biology of loss; 3/4 of brain growth, ~90% of brain development takes place in first 3 years; this requires nurturing emotional interactions with the parent; disrupted attachment in infancy leads to exaggerated physiological stress responses in the adult; attunement: parent is “tuned in” to the child’s emotional needs; attachment may exist without attunement: child may feel loved but on a deeper level not feel being appreciated for who they are -> proximate separation: physical closeness but emotional separation -> increasingly the norm in our hyperstressed society

16. PARENTING THROUGH GENERATIONS: failed parenting: child receives parent’s love not as the parent wishes but as it is refracted through the parent’s personality; parenting responses: reflects our own experience as children; child doesn’t learn parenting styles by imitation but based on his own emotional attachment and relationship to his parents; amygdala: main regulator of fear and anxiety response; anxious mothers likely to raise anxious kids; Strange Situation experiment: avoidant infants: no distress when mother left -> pseudo-autonomy (belief that they must depend on themselves) -> but: infant’s performance could be predicted even before they were born; Adult Attachment Interview (AAI): way to assess adult’s childhood attachment with parents -> AAI is the most powerful predictor of his infants become attached to their parents (=what the adult unconsciously reveal about his own childhood will predict his own attachment with his children); -> parenting is a dance of generations; blame becomes meaningless if you understand how family history stretches back through generations [<-> Bible on personal responsibility, you cannot trace back everything indefinitely]; central issue: not blame but unintentional transmission of stress and anxiety across generations; author supports women’s right for abortion; family lies never protect the child from pain; adaptation energy (Selye): hidden reserves of adaptibility, when we run out -> exhaustion/death follows; adaptiveness: capacity to respond to external stressors without excessive anxiety and being overwhelmed by emotions, depends a lot on previous generation’s adaptivity & external stressors; highly adaptive people/families -> fewer/milder illnesses; physical illness is a symptom of a relationship process that extends beyond the boundaries of the individual -> “cancer position” better description than “cancer personality” (looks beyond individual); industrialized society solved many problems but also created many new ones: stressed taken granted as inevitable part of human life, urbanization has hidden costs (eg autoimmune diseases), undermine of family structure (children spend less time around nurturing adult); replacing communities with institutions -> nuclear family under intolerable pressure; “dying” became synonymous with “useless” <-> people don’t need to be useful in order to be valued; mind & body separated in medical practice; socio-economic factors neglected as “part of the equation” despite evidence

17. BELIEFS: human genes cannot explain complex characteristics & behaviors; they are just plans but realization depends on environment (they can be turned on/off by them); unacknowledged assumptions of science will limit & define what will be discovered (Selye); even in Genesis God created the environment before human beings; cell’s fate is controlled by environment and not by self-contained genetic program [<-> control is limited by genetic makeup]; unconscious beliefs control our behaviors at the cell level (processing system); wrong perceptions: 1) “I have to be strong” 2) “It’s not right for me to be angry” 3) “If I’m angry, I will not be lovable” 4) “I’m responsible for the whole world” 5) “I can handle anything” 6) “I’m not wanted - I’m not lovable” 7) “I don’t exist unless I do something. I must justify my existence” 8) “I have to be very ill to deserve being taken care of”; what matters is not what you hope to get across your children but rather how the child interprets it unconsciously

18. NEGATIVE THINKING: military disease theory: illness = hostile force we must defeat -> unanswered question: why a bacteria/virus attacks some but not others? 19th century debate: course of illness determined by microbe (Pasteur) vs host body (Barnard) -> on his deathbed Pasteur recanted; no disease has a single cause (no person gets ALS simply by being nice); healing (derived from “whole”): finding balance & harmony, to become whole; potential is in all of us; disease = expression of internal disharmony; positive thinking: blinds us from part of reality, binds anxiety by avoiding to confront it, assumes we are not strong enough to handle reality -> focus instead on the power of negative thinking: willingness to admit what is not working; autonomy is impossible as long as it is driven by anything (hunger for success, fear of boredom etc); general belief: happier thoughts -> less illness vs reality: positive thoughts can tune out discomfort -> lower resistance to illness; “When one lacks the capacity to feel heat, the risk of being burned increases”; “Do I live my life according to my own deepest truths, or in order to fulfill someone else’s expectations? How much of what I have believed and done is actually my own and how much has been in service toa self-image I originally created in the belief it was necessary to please my parents?”; guilty: for many people a signal that they chose to do for themselves -> negative thinking welcomes guilt; “If you face the choice between feeling guilt and resentment, choose the guilt every time.” -> resentment is soul suicide

19. 7 A’S OF HEALING: help us grow in emotional competence: 1) Acceptance: willingness to accept as things are; compassionate curiosity: not liking everything about ourselves but we look at ourselves with the same non-judgmental acceptance like we would look at others who need help 2) Awareness: reclaim lost capacity for emotional truth-recognition (if our words we hear are in conflict with the emotional data, one will be repressed); learning the signs of stress in our own bodies; 3) Anger: “I never get angry. I grow a tumor instead.” (Woody Allen); how to express anger so it doesn’t hurt others (eg children)? healthy, genuine anger: surge of power, mobilization to attack, complete disappearance of all anxiety <-> repression, rage: both represent fear of genuine expression of anger, not experienced just being acted out; anger doesn’t require hostile acting out, it’s a primarily a physiological process to be experienced; healthy anger leaves the individual, not the emotion in charge; 4) Autonomy: development of internal center of control; people suffer when boundaries are blurred - disease itself is a boundary question; enmeshment: lack of differentiation; 5) Attachment: our connection with the world; seeking connections is necessary for healing; 6) Assertion: declaration to ourselves and to the world that what we are and that we are who we are; it is not action or reaction - it is being, regardless of action; opposite to action: not only in the narrow sense (refusing to do something we don’t want) but to letting know the very need to act; 7) Affirmation: positive statement, moving toward two basic values: a) our own creative self: what is in us must come out otherwise we may explode at the wrong places b) universe itself: our connection with all that is.