by Marcelle Pick, OB/GYN NP
This is probably the single most important article on our website. Please make time to read it.
The conventional theory of medicine says that your health is a matter of your genetics, exposure to infection and lifestyle. But with rare exceptions, your emotional experience is a greater factor than any of those. That’s not just our assertion — there’s now solid science behind the correlation of emotional experience and a host of diseases and health conditions, from heart disease and depression to obesity and chronic pain.
At Women to Women, we learned long ago that no one can really be well without dealing with their emotional health. This may seem like a radical idea, but for so many women with intractable health problems, there won’t be any progress on a physical level — no matter what therapy is used — until there is progress at the emotional level. As Alice Miller expresses it in the title of her book, The body never lies — even if the emotional problem developed 50 years ago.
The good news is that you can do so much to heal your emotional self. And if you are at mid-life, you should know that in menopause your body is asking you to deal with unresolved emotional issues. This is the time to work on your emotional and physical health — together. So let’s explore the role of your emotional experience and how to use it to reclaim your self.
Proof of the link between emotions and health
While there are hundreds of studies that explore the emotional roots of disease, the most insightful place to start may be the breakthrough ACE Study.
In the 1990’s over 17,000 patients of a large health plan were enrolled in a study to assess the link between emotional experience and adult health. (The Federal Centers for Disease Control co-designed the study). The results were stunning; as the authors wrote, “…they have given us reason to reconsider the very structure of primary care medical practice in America”.
Participants were asked whether they had experienced any of eight forms of personal abuse or dysfunctional family behavior before the age of 18 (each called an “adverse childhood experience,” or ACE). More than half of the patients had one ACE or more.
Even more surprising was the correlation to health outcomes: those who had experienced an ACE were between 4 and 50 times more likely to have an adverse health condition or disease as an adult. The adverse health outcomes covered a surprisingly wide range, including heart disease, fractures, diabetes, obesity, alcoholism, and more.
The authors concluded that the ACE Study “…documents the conversion of traumatic emotional experiences in childhood into organic disease later in life”. How does that conversion occur? Before we explore that central question, let’s dwell a moment on just what we mean by adverse emotional experience.
We’re all affected by adverse emotional experience
The ACE Study focused on a relatively narrow set of easily-measured adverse emotional experiences from childhood and found that half of the adults in the study had suffered one. But if we include all dysfunctional family behaviors, plus other emotional traumas (such as death of a loved one) and adult experience, it’s obvious that virtually everyone has suffered an adverse experience by the ACE standard.
So if the ACE Study found that adverse emotional experience was the biggest single factor in predicting adult health, and virtually all of us have had such experiences, what does that say about our approach to preventative health?
The truth is that all emotional experience affects our health, whether positive or negative, and whether it occurs in the past or the present. But negative experiences appear to have more lasting health effects, perhaps because we don’t deal with them.
Let’s back up a step. A feeling is the body and mind’s response to any given situation. Some psychologists and scientists believe we have five basic feelings: joy, fear, anger, grief and love, with other feelings being variations on these five states. An emotion is what your body does with one of these feeling states.
What we all learn from our families, abusive or dysfunctional or loving, is how to take action with our feelings. If our mothers responded to grief or loss by withdrawing, or dealt with suppressed anger by becoming hypercritical of those they loved, chances are our own responses will be similar. We tend to model our own emotional habits after our parents’ or family’s emotional habits.
What’s the health significance of this emotional modeling? Consider the subject of stress. That’s something we all have, right? The Center for Disease Control estimates that 90% of all visits to the doctor are stress-related, and there are hundreds of medical studies linking stress to a host of diseases. But what exactly is stress?
Most women think of stress as the demands on them that they can’t do anything about, like an unreasonable boss or taking care of an aging parent. But why do some women find those factors stressful and others don’t?
I believe it’s because stress is personal — I find something stressful because of my personal emotional history. So do you. Moreover, each of us tends to recreate stressful emotional situations in our lives — at least until we resolve the old emotional issues that give the stress its power over us.
There’s a commonplace idea that women have greater emotional health than men because women surface and talk about their feelings so much more. That’s true, but it doesn’t mean women’s emotional patterns are healthy. My patients (all women!) have almost all been conditioned to put others ahead of themselves, to “stuff” their emotions (especially anger), to feel unworthy of love, to feel responsible for making others happy, to demand perfection of themselves, and so on. None of those patterns are good for our emotional wellbeing or our physical health.
Let’s return to how adverse emotional experience translates into health problems. Then we’ll talk about how to turn things around.
Your biography becomes your biology
Our language is filled with expressions of how emotion affects the body: tension and stress gives me a knot in my stomach, overwhelming sadness makes me feel all choked up, a difficult person is a pain in the neck.
More seriously, a recent study showed that sudden emotional shock can cause heart attacks even in healthy people. Called “broken heart syndrome,” these heart attacks were related to the loss of a loved one, fear of an event or activity, or sudden accidents. Notably, most of the sufferers were women.
How does a fleeting feeling have lasting health effects? Research on this is still in its infancy, but there are at least four paths we already know about.
First is the general effect of stress, which triggers the adrenals to produce cortisol and adrenaline. Cortisol is very helpful in small doses (as part of the fight or flight response) but sustained high cortisol levels (the result of unremitting stress) have very destructive effects on the body, including weight gain, high blood pressure, high cholesterol, suppression of immune function and acceleration of aging. (For more on cortisol, read our full article on adrenal fatigue).
Second is the effect of unresolved emotional issues on systemic inflammation. Medical research has recently implicated inflammation as a contributing factor in a host of diseases, including cancer, heart disease and Alzheimer’s. (For more on systemic inflammation, read our full article).
Third is the effect of emotions on particular organs. Many alternative practitioners attribute illness in a specific organ to a specific cause. While this is controversial in Western medicine, it has been well documented in medical literature that “Type A” personalities have much higher rates of heart disease, and that women who suffered childhood sexual abuse have higher rates of dysmenorrhea and pelvic pain. The mechanism of action may be peptide chains formed as part of the biochemistry of emotion that bind to receptor sites in specific organs, a concept pioneered by the renowned biochemist Dr. Candace Pert. We believe many more links will be discovered as research in this area continues.
Fourth is the effect of emotions on behavior. The ACE Study revealed a cause and effect link between adverse childhood experience and negative health habits like drinking, smoking, overeating, and sexual promiscuity. The authors recognized these negative habits as self-medication for unresolved emotional pain. But over time the suppression of all that pain through these self-destructive habits has terrible consequences.
The myopia of Western medicine regarding emotions
Despite research like the ACE Study and hundreds of others, conventional medicine is blind to the causal role that emotional experience plays in the development of illness and disease. Instead of looking at root causes, it only treats symptoms. No wonder so many patients find themselves going steadily downhill despite the best conventional treatment.
I was once asked in what percentage of my patients were the problems purely physical, that is, lacking any emotional component. After a moment’s thought, I answered “about one percent.” That’s not a statistic, but it conveys the truth: very, very few women’s health problems are just about a physical problem.
Western medicine insists on dealing with each disease or condition as a separate and distinct issue. But that is just not how the body works. That’s why at Women to Women it takes two hours for your first appointment — we need to know your full history — including a full hour with your practitioner.
Western medicine used to emphasize the full history. But specialization has pushed us to dissociate each aspect of the body from the whole, and managed care has pushed the average appointment time down toward six minutes — and too many people don’t get even that.
Like conventional doctors, many of my patients are so conditioned to think of health as a purely physical issue that they are floored when I suggest their symptoms may have an emotional component. I hope this article helps you connect the dots. Like so many other parts of your life, you are going to have to take responsibility for your emotional health. And if you are at mid-life, this is the perfect time to deal with it.
Menopause and emotional health
It has been said that menopause is largely about “the reclaiming of self.” After a lifetime of taking care of others, “stuffing” our emotions, finding fault with ourselves, and ignoring our feelings of hurt and anger, our biology requires us in menopause to straighten things out, to find our voices, and to reclaim our lives. That’s one reason why so many women are motivated to take control of their health at this time.
Let me give you an example. A patient came in to see me describing constant heavy bleeding (menorrhagia). We tried dietary changes, supplements and other purely physical approaches, with only minimal improvement. I began to probe for the emotional basis of her condition. She shared a description of her marriage to a man who did not support her emotionally and was often verbally abusive. I helped her see the connection between her relationship and her symptoms. One day a few months later, she came into my office and told me she had finally found the courage to leave the relationship. Her heavy bleeding stopped the next day, and has not returned. It was tough to face — but she took control of her life and reclaimed her self.
Menopause provides a natural venue for this work of exploring your emotional environment and your history. It’s like adolescence in reverse: your body asks you to question who you are, what you’re passionate about, and what’s working or not working in your life. All the pieces that haven’t been resolved come up now for healing and transformation. Depression, mood swings, hot flashes, and other symptoms of menopause have a physical origin but also an emotional root — and you need to deal with both at the same time.
The intractable medical condition — no such thing?
The role of the emotions is a big reason for two problems we see every day: the woman who goes to a conventional doctor for her symptoms and is given antidepressants; and the woman with a condition that resists conventional treatment. Many of these women are not going to feel better until they begin to deal with the emotional root of their illness.
In a monograph on the long-term medical consequences of childhood trauma, Stephanie Dallum, FNP talked about the connection between emotional experience and unexplained physical symptoms. The medical term is somatization — physical symptoms with no medical diagnosis. But the insomnia, headaches, obesity, gastrointestinal distress, palpitations, chronic pain and fatigue caused by adverse emotional experience in her study are very real.
With new patients at our medical practice, we generally begin with the physical issues and treat with dietary changes, nutritional supplements, exercise and other lifestyle changes. We tend to use prescription drugs as a bridge to a more balanced natural state, rarely as an ongoing solution. The more severe or intractable the symptoms, and the more receptive the patient, the sooner we introduce the connections to emotional issues. The good news is that those who are willing to tackle both the physical and emotional aspects of their health almost always see the improvement they want.
Mapping your emotional inheritance
At Women to Women we have a shorthand expression for this process of exploring your emotional inheritance and resolving issues — we call it “your work,” as in, “She’s just begun to do ‘her work’ but she’s already feeling so much better”.
There is a tool called a genogram that therapists use that may be helpful to you as well. A genogram is a specialized family tree that lets you explore the patterns and relationships running through your family history. We’ve found free genogram software on the internet if you’d like to try it.
As you use the genogram to map out your emotional inheritance, ask yourself questions to find the parallels between you and your family members. For example, if certain interactions with your husband affect you badly, ask yourself who he is being like in your family — and who are you being like? What emotional patterns can you see from generation to generation? What family conflicts or secrets have never been resolved — and why not? What emotions have been “stuck” — like grief or anger or pain — and how might they be dealt with now?
How do you heal past emotional experience?
There’s plenty of evidence, both from our clinical experience and from medical research, that emotional healing creates positive physical changes in the body. So how to accomplish that?
In a perfect world we would all be able to afford a few years of therapy — and with the right therapist! We do ask women to view that cost as an investment in their health. We especially recommend therapies based on family of origin. But not all of us can make that investment.
There are group therapy options that are affordable and can be helpful. You may be able to make progress with a like-minded friend or family member. The Emotional Freedom Technique (EFT) has been helpful for many women; there is free on-line information about EFT as well as reasonably-priced EFT workshops.
Yoga, meditation, exercise and other stress-relieving techniques are helpful as part of your overall health plan, but unfortunately they are not a substitute for “your work”.
You may also benefit greatly from books. We recommend No One Is to Blame, by Robert Hoffman, creator of the Hoffman Process that underlies the therapeutic method now known as the Quadrinity Process. We also suggest using The Whole Person Fertility Process by Niravi Payne as a workbook for exploring your emotional inheritance.
Unfortunately reading is not a very emotional experience, and thinking about your emotional issues isn’t going to resolve them. That’s why therapy — one on one, in a group, or with a self-help method like EFT — is so important. We suggest you think of this as an ongoing process, just like the other parts of your health program.
Deal with the past and move on
It may take courage and faith to examine your own life, to face the past with kindness and gentleness for the person you have been and the people who have caused you pain, and to support the person you feel yourself becoming. Healing your past emotional experience helps create a joyful, healthy present moment and opens the doors to the life you want for yourself.
We love the study of centenarians (those who live to be 100+) done at Harvard Medical School a few years ago. The oldsters were found to be surprisingly healthy and active. Dr. Margery Silver, one of the authors, said in an interview, “…there is a particular characteristic that is typical of centenarians. And that is that they are able to manage stress very well. And this doesn’t mean that they’ve had stress-free lives…some of them have had really very difficult, and even traumatic lives. There are holocaust survivors, there are women who were widowed at an early age and scrubbed floors to raise their children, and yet they seem to have the ability to roll with the punches…they seem to accept their losses, grieve them and then move on.”
This is a vision of emotional health we wish for all of us — to face our emotional pain with honesty and openness, and get on with our lives.