By Gabor Maté M.D., published by Alfred A Knoopf Canada, a division of Random House

Reviewed by Jan, Alumni

The premise of Dr. Maté’s book When the Body Says No is that our minds and body are not just connected, but are deeply intertwined. Eerily in this book, Maté is suggesting that patients with certain diseases such as breast cancer, ALS and MS, have distinctive personalities installed throughout childhood. And the installed personality is imposed, and stressful.

As a lay person, I did not find this book easy reading although I found some of the case histories fascinating and informative.  Medical terminology like psychoneuroimmunology and scleroderma pop up very soon.  Psychoneuroimmunology, as defined by Dr. Maté, is the science of the interactions of mind and body, the indissoluble unity of emotions and physiology in human development and throughout life in health and illness.  Scleroderma is an autoimmune disease: Autoimmune diseases include rheumatoid arthritis, ulcerative colitis, lupus and, among others, diabetes and multiple sclerosis.

MARY, the subject of Dr. Maté’s first case history, was diagnosed with scleroderma.  She grew up in an alcoholic household, assumed protective roles to her younger siblings, repressed her feelings all through her life and always put others before herself.  Because of these experiences as a child, Mary was not able to say “no”.

Throughout his book, Dr. Maté gives similar examples of caregivers exhibiting difficult behaviours while raising children, resulted in children repressing their emotions to cope as a way to avoid intolerable emotional pain—which ultimately led to imbalance of their psychological-neurological-hormone-immune systems—so they could not stay in balance in a healthy way.

A chapter on Amyotrophic Lateral Sclerosis, Lou Gherig’s disease, speaks to the overwhelming impression that health care workers who diagnose and treat the condition have: that those suffering the disease tend to be the nicest people on the planet, presumably at the expense of their own needs and identity. Technicians doing the muscle analyses could predict who was going to have ALS diagnoses: if they weren’t nice enough, they didn’t have it.  There was even a paper presented at the ninth international ALS symposium in Munich in 1998 called: “Why are Patients with ALS So Nice?”  And Lou Gherig, whose name is synonymous with the disease, was generally thought to be one of the nicest guys on earth.

As another famous example of repressed feelings linked to a disease predisposition, Maté describes the case of the renowned cellist, Jacqueline Du Pré, who died at age 42 of complications from multiple sclerosis. Her story is an example of how experiences in childhood can predispose to later illness—like tree roots. Since her birth (her mother lost her own father while in the maternity ward with Jacqueline) Jacqueline and her mother developed a relationship wherein each depended on the other in an unhealthy way: Jacqueline was not allowed to grow up and acquire her own identity.  She suffered immense repression from her mother but was only able to express her emotions through her cello—and what emotion! Audiences could feel her emotions as she interpreted music in ways which she could never do in early life life, if not playing the cello. Although she was unable to say NO to all the repression during her early life, just prior to her illness robbing her of her ability she allowed her musical voice to break free of its bindings and to speak.   Jacqueline must have indeed felt stress – pain, fear, anxiety, and became, according to her sister Hilary’s autobiography:  “A Genius in The Family”, transformed from a “docile child to a profoundly hostile adult”.  As a child, she predicted her illness to her sister: “ don’t tell Mum—when I grow up, I won’t be able to walk or move”.

Jacqueline had resonated particularly with the composer Edward Elgar, who she felt had had an unhappy life.  In one of his last works, Elgar composed a cello concerto during a fit of despondency after World War I.  Du Pré’s last performance of this work has been unsurpassed. Dr. Maté, in this book, sourcing Hillary’s autobiography, says:

“After her sister’s death, Hillary listened to a 1973 BBC tape of the Elgar concerto, with Zubin Mehta conducting.  It had been Jackie’s final public performance in Britain.
“A few moments of tuning, a short pause and she began.  I suddenly jumped.  She was slowing the tempo down.  A few more bars and it became vividly clear. I knew exactly what was happening.  Jackie, as always, was speaking through her cello.  I could hear what she was saying…I could almost see tears on her face.  She was saying goodbye to herself, playing her own requiem.“

In the above example I feel that Dr. Maté has a very plausible example of his theory that stress and emotional repression together contribute to physical illness.

Toward the end of his book, Dr. Maté introduces us to his seven A’s of healing – Acceptance, Awareness, Anger, Autonomy, Attachment, Assertion and Affirmation.  He states that if we pursue these seven A’s, they will help us grow into emotional competence (the requirements for which are detailed on page 38 of When The Body says NO).  There he maintains that the ”stress that occurs in the absence of this state (of emotional competence) disturbs the feeling of wellbeing and creates hidden stresses”.

Maté dives deeply into his patient’s family histories, finding that life-threatening diseases existed side by side with such things as alcoholism, neglect, anger and repression of emotion.