When the Body Says No: The Cost of Hidden Stress

When the Body Says No is a 2003 work of nonfiction written by Canadian physician and author Gabor Maté. In his text, which is a critique of the limitations of modern Western medicine, Maté explores the role of chronic stress in causing disease and illnesses, including cancer, autoimmune diseases, bowel diseases, and inflammatory illnesses. Maté suggests that chronic physiological stress often has its roots in childhood; even loving parents can inadvertently make their child feel that love is conditional and that negative emotional expressions are undesirable. This causes repression, which leads to the disruption of regular physiological stress functions. Maté suggests that individuals need to honestly consider their childhoods and their resultant coping mechanisms in order to begin healing deeply ingrained and maladaptive ways of interpreting and responding to the world.

This Study Guide references the 2012 Vintage Canadian edition of the text.

Plot Summary

Gabor Maté became interested in the cascading health problems of his patient Mary, whom he treated in palliative care. As he spoke to her about her life—something that none of her other treating physicians had done—Maté began to consider the impact of Mary’s childhood and engrained ways of being on her chronic health conditions. He saw links between Mary’s disrupted and stressful childhood in and out of foster care, where she always felt hyperaware of needing to care for her two younger sisters, even as a very young child herself, and Mary’s tendency as an adult to prioritize the needs of her husband and children above her own. Maté hypothesized that Mary’s repression of her needs, resentments, and feelings—a strategy developed due to the absence of a reliable and secure caregiver—led to chronic physiological stress. Long ignored, Mary’s body eventually “said no” to her pattern of self-repression, expressed through the chronic health problems—gangrene, Raynaud’s syndrome, and scleroderma—that eventually led to her death.

Maté problematizes the “blinkered” approach of doctors to their own systems or organs of specialty; he believes that this normalized approach disregards the inherently interconnected nature of the human body with all of its systems, including the mind. Mindbody connection is usually overlooked by modern physicians; Maté critiques this, as the two systems cannot operate in isolation of the other and therefore are intrinsically inseparable.

Maté suggests that repression, borne out of a childhood where a child’s emotional needs weren’t adequately met or acknowledged, disrupts the regular functioning of the hypothalamic-pituitary-adrenal (HPA) axis, the pathway center that regulates the release of important hormones, such as cortisol. This leads to chronic stress on the body’s systems, which—when combined with other biological predispositions—can lead to illness or disease.

Maté reflects that everyone participates in patterns of self-denial and self-repression to an extent, noting that he disguises a limp from his own mother. He presents a series of case studies of his own patients as well as of public figures to elucidate his hypothesis on The Relationship Between Chronic Stress and Disease. He first looks at autoimmune diseases, like amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS), suggesting that people with these conditions conform to the pattern of overachievers who suppress their needs or any perceived weakness; Maté sees repression as an essential part of these personality expressions and an important causative factor in the expression of disease. Next, Maté explores case studies of cancer patients; he concludes that these people are often self-sacrificial, highly anxious types. This is echoed in Maté’s case studies of those with bowel diseases, Alzheimer’s disease, scleroderma, and rheumatoid arthritis. Children with asthma were more likely to have insecure or dysregulated parental relationships, further elucidating Maté’s model on lifelong repression of needs borne from childhood leading to inflammatory and injurious responses of one’s body toward its own systems.

Maté urges readers to consider disease through the framework of a biosocial model, which considers the impact of an individual’s environment and lived experiences in conjunction with the diagnosis and treatment of their physical symptoms. Within this disease model, Maté stresses the importance of parenting and intergenerational patterns of anxiety and repression in causing the expression of disease in descendants of traumatized individuals. He also looks at the role of society as a whole in terms of creating systems of loneliness, poverty, and chronic stress that contribute to disease.

In order to achieve healing from chronic stress caused by repression, Maté suggests an honest inspection of one’s childhood experiences and belief systems and the resultant schemas developed about oneself and one’s place in the world. Through this process, a person can achieve acceptance, the first of seven “As” of healing. Maté then suggests fostering an awareness of one’s feelings of stress as expressed physiologically, encourages the healthy expression of anger, and encourages autonomy through the maintenance of self-protecting boundaries. He also urges readers to form healthy and loving attachments, to assert their needs and self-worth, and to affirm themselves through creative expression and spiritual belief systems.