Why Do We Get Sick?
The curious and tangled connections between pain, poor health, and the lives we lead
A life out of balance will catch up with you eventually … and everyone is out of balance. We do generate illness (and wellness) in our lives in various ways. This is one of the tenets of medicine: that health and illness are not only things that happens to us, but also things that we do, a kind of behaviour.
Can this be? I have no doubt of it, having personally suffered at least one particularly good example of it.1 Few health care professionals do anymore. Many doctors — often unfairly accused of being blind to this — know quite well that illness may be produced by the kinds of lives that we lead.2 But how does it work? How does lifestyle lead to illness and pain? And how much?
Modern society likes the idea that we can think ourselves better. When we are unwell, we tell ourselves that if we adopt a positive mental attitude, we will have a better chance of recovery. I am sure that is correct. But society has not fully woken up to the frequency with which people do the opposite – unconsciously think themselves ill.
It's All in Your Head, by Suzanne O'Sullivan
A wee bit of science
The interaction of all human physiological systems connects the mind to the body in definite but extremely complex ways. This is new-ish knowledge. It’s hard to overstate how far that “obvious” idea has come.
Pain was regarded as something imposed on the mind by the body until surprisingly recently in history. But pain is not just a message from injured tissues that must be accepted at face value — it’s complex experience that is generated by and thoroughly tuned by your brain. The results are often strange and counter-intuitive, like quantum physics, but the science is clear: every painful sensation is 100% Brain Made®, and there is no pain without brain.3
Also until surprisingly recently, This seems short-sighted to everyone today, even non-scientists. Of course, it was not the nervous and immune systems that weren’t communicating, but neurologists and immunologists! When they finally did start talking to each other, they discovered that their systems of study were interconnected — physically, neurologically, chemically, and electrically.
Since then, mind-body science has expanded to the point where distinguishing it from physiology is unnecessary and there is now a lot of hard evidence showing the many ways that our physical and mental experiences are intertwined. I’ll describe one example here.
Dr. Candace Pert pioneered the study of neuropeptides, molecules produced by the nervous system that turn out to affect all the cells of the body. Her work implies that all of your cells experience emotions, all together, all at once — not just your nervous system. An emotion like sadness produces a characteristic cocktail of neuropeptides that circulate throughout the body, binding to every type of cell and changing their behaviour in a characteristically “sad” way. So, when you are sad, your toe cells and nose cells, gastric glands and hair follicles are sad right along with you.4
Pert was one of the early champions of mind–body science, and many of her findings were initially treated with much skepticism. Today, her experimental results have been widely duplicated, and neuropeptides are now keenly researched around the world… while Pert herself went wandering off into left field before her death in 2013.5 Pert’s story is a microcosm of the topic: there’s something to this mind-body connection stuff…but at the same time it’s easy to take it too far.
So, let’s take it for granted that some genuinely interesting physiological mechanisms are connecting our minds and bodies. What does the interconnectedness of our minds and our bodies mean, practically? How does lifestyle lead to illness in terms other than “neuropeptides”? How can we use the information to heal ourselves? Can we do so at all?
I believe that rigidity — getting into a rut — is a common denominator in most situations where life is “out of balance.” There are many human problems, but they are all about getting stuck in one way or another. And so, when we get sick, it probably means that, whatever we’ve been doing and however we’ve been doing it, we’ve been doing for too long. This may be why illness is so often described by people as a “wake up call.”
That rigidity may be at the heart of illness is not a new idea. It can be stated in many other ways, and it has been. “Use it or lose it” may be the most familiar western expression. Eastern philosophy in general, and Taoism in particular, is bursting with more elegant imagery to this effect. Water and willow trees are often used to poetically express how vitality is derived from adaptability and flexibility.
But don’t get me wrong — when I say that rigidity may lead to illness, I’m not talking about a personality defect. Rigidity is not necessarily expressed in your personality. In fact, an “easy going” person can still be rigid, because every human being is rigid to a greater or lesser degree. Just because you’re easy going compared to other people doesn’t mean that you’ve actually transcended the human tendency to limit your behaviour to a narrow range.
The trouble is that we are an uptight species. Homo sapiens seems tragically prone to finding and sticking to a comfort zone.
First restriction, then inhibition
Starting early in life, we humans begin to restrict ourselves in response to social and emotional forces. We become inhibited. We start out yelling and pooping and crying pretty much as the spirit moves us. As we mature, we rapidly go through a civilizing process. This is desirable, of course … but there is also a price.
We start to stick to a certain way of doing things — a way of breathing, of moving, of making sounds, and so on. We make these choices not because we are greatly in tune with what we actually need and want from moment to moment, but because our great big brains give us a lot of complex ideas about what we think we need and want. The product of this process is our comfort zone — a region of behaviour and experience we are loathe to leave, more so with every passing year. If the borders of the comfort zone were more organic, more intuitive, it might serve us quite well — but it tends to be incredibly arbitrary, defined as much by pop culture as by self-awareness.
In spite of this overall trend, many people remain highly experimental for some time. The young at heart may remain experimental for life. But even these people have a relatively limited repertoire of behaviour compared to what we are actually capable of. In fact, it’s quite incredible how narrow the range of “normal” is when you realize that we are biologically capable of virtually any kind of behaviour. Even within human nature, behaviour can be as wildly different as that of Carl Sagan, Osama bin Laden, the Queen of England, and a South Pacific cannibal.
We are sabotaged by our great big brains. We live lives with a fraction of the variety that is actually possible. This rigidity eventually manifests as illness.
Illness and blame
What good is this idea? It sounds dangerous. Many people feel defensive about it, in fact. If rigidity leads to illness, then doesn’t that mean that it’s our fault? Shouldn’t we be able to fix it? And why can’t we fix it? If rigidity leads to illness, how come a little whimsy and carpe diem won’t make it go away?
It is important to understand that we are not to blame for our illnesses. Just as our personalities are defined by both genetics and environment, our illnesses are defined by both inside forces and outside forces. We are involved in the generation of our illnesses, but we don’t do it deliberately, and we can’t undo it deliberately any more than we stop a headache in ten seconds by “relaxing”; the process is insidious, complex, and oblique. There is no connection between “pent up anger at my father” and “tumour in my prostate.”6 The connection may be there in some sense, but it is not simple. A trio of reality-check quotes:
A positive attitude does not cure cancer, any more than a negative one causes it.
Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer, 2011
There is simply no evidence that psychological interventions can slow progression of cancer or extend life. Claims to the contrary serve to burden cancer patients with an unrealistic responsibility for the outcome of their medical condition.
Dr. James Coyne, Questioning Whether Psychotherapy and Support Groups Extend the Lives of Cancer Patients, ScienceBasedMedicine.org, 2012
Cheerfulness, up to and including delusion and false hope, has a recognized place in medicine.
Barbara Ehrenreich, Smile or Die: How positive thinking fooled America and the world, 2009
Nor would any connection between illness and a way of life and happen overnight. Illness is probably among the last signs of an enduring pattern in life. By the time you get sick, it’s probably because you’ve already been entrenched in a way of being for years or decades. So it does not logically follow that we can put our house back in order when we get sick just with “mind over matter.” Yet this is the frequent assumption of holistic medicine: that merely being aware of a mind-body connection somehow gives us power over illness. I don’t believe it’s that easy. My observation and experience is that healing is an extremely challenging process.
It’s also crucial to understand that our habits and rigidity are usually more functional than they seem on their surfaces, not necessarily dysfunctional, and many if not most of them have benefis that make them worth the risks. For instance, we cannot actually avoid rigidity at the cost of being sociopathically “free” with our behaviour. Most of how we behave is well-chosen to serve us in the short term, and often in the long term as well. Even emotional patterns that ultimately do prove to be dysfunctional usually have their roots in a creative and necessary response to a real threat, such as an abusive parent. Yesterday’s creative survival strategies often turn out, thirty years later, to have more downside than up. Can you be “blamed” for this? Of course not. You do what you gotta do.
A story about oversimplified mind-body connections and blaming the victim (and blaming, and blaming…)
A colleague and I discovered a shared experience: we both had some nasty health problems while attending a 28-day “encounter group” type workshop called “Phase I” at Haven and neither of us got any sympathy.
This story needs just a little bit of context. Haven is a school on Gabriola Island that trains counsellors in counselling … and trains people in living. You could call it a “personal development” school. Workshops are experiential, hands-on, highly social and interactive — a modern version of which involved a lot of nudity, screaming, and granola in 1977. I can hardly imagine anywhere on earth with a greater concentration of direct, practical interest in mind-body connections.
While I was there, I got a terrible head cold, maybe the flu: I had fevers and wracking coughs and extreme congestion, one of the most memorable and disgusting infections I’ve ever had. Yet the workshop leaders and participants were “unimpressed,” and regularly challenged me to examine the psychological issues underlying my illness.
I understood the point, but I was also too sick to care, and by the end of the month I was just about ready to punch the next person who asked me, “So what is that cold about?” or said, “You’re probably just afraid of all this intimacy.” I was particularly irritated when this kind of thing came from one of the other participants, who were total amateurs, really just imitating the attitude of the workshop facilitators.
My colleague had a similar experience. In addition to some bronchitis, she developed a fairly dramatic case of exczema during her stay. Like me, she didn’t get much sympathy: “Boundary issues!” people kept chiming smugly at her, comfortable in their certainty that skin disorders arise from an inability to “define” yourself or say “no.” She also became fairly irritated with the lack of sympathy, and did not have a particularly uplifting or educational experience.
The question I want to answer in this article is: can you blame “boundary issues” for exczema, or “fear of intimacy” for head colds?
Honestly, I doubt it. I just don’t think that there are many straight lines between health problems and psychosocial factors. That there are connections I have no doubt. I am sure that both my colleague and I were experiencing some kind of reaction to the intensity of the social experience. But I saw the all-too-human tendency to oversimplify in the kinds of judgements that people made about us — the desire to try to express something fiendishly complex in terms of a single, tidy cause.
If we are going to mature in our understanding of mental and physical health, this is something we are going to have to get over, this tendency to think of mind-body connections as formulaic, as though specific mental states have specific health effects. Rather, we need to treat them like the unknowably complex connections that they are: as impossible to pin down to a single idea as it is to know both the location and the velocity of an atom. Mental states certainly mediate and influence our health in many ways, but they almost certainly do not lead to highly predictable outcomes.
Consider this final example. One of my clients has a sister who survived a rare form of cancer, something that afflicts only a few people around the world every year. Apparently she has the idea that her cancer was caused by an “excess of heartbreak” in her life, that a series of extremely disappointing relationships was the literal cause of her disease. Perhaps now I am the one oversimplifying her story, but it’s not an uncommon sort of idea … and it is a tragically illogical one, for one very simple reason: if being unlucky in love caused that sort of cancer, it would not be rare!
It may be too late!
I would never discourage anyone from trying to restore balance to life, but I do think anyone trying to heal should understand that doing so may be difficult or impossible, and may not have an effect on an established illness. Spontaneous remissions from serious diseases are not called “miracles” for nothing!
We are all students of life — but the skills required to reverse a disease process, once it is started, are probably several grades beyond us, if they exist at all. In fact, when we are sick, it is usually an indication that it’s too late for us, and we do not have the emotional and spiritual equipment to undo the damage. If we did, it’s quite likely that we wouldn’t have gotten sick that way in the first place.
That said, miracles do happen. The passionate individual, determined to overcome, will take those discouraging words as a challenge to excel, to learn enough about the self to heal, or to (quite literally) die trying. I did the very same thing myself once, and set out to change personal habits that were literally destroying me. Somehow, I succeeded. And I have met dozens of other people over the years who have achieved something similar.
If rigidity leads to a life out of balance and then to illness, then it suggests a way of preventing illness and extending life, more than a healing method. We must step outside of our comfort zone, and choose to leave behind the many small fears and preconceptions that defined it so long ago. We must stretch ourselves.
There are probably as many ways to do this as there are people. For some, it might be a climbing of mountains. For others, eye contact, new furniture, or reconciliation. But for almost everyone, above all, it means really deep breathing and fresh movement, components of every interesting spiritual discipline that ever was. We must strive to become permanent dancers, freely embodying every impulse, wriggling happily through our days, impulsive, exploratory, and uninhibited.
Even if it is too little, or too late, it will still be worth it.
What’s new in this article?
2017 — Added brief discussion of the role of the mind in pain.
- Globus is the unexplained sensation of a lump in the throat, which is common and often alarming. Although many cases are “all in your head,” many cases probably have subtle physical causes, basically anything that irritates the throat (tonsil stones, acid reflux, Eagle syndrome, cysts, etc). For more information, see A Lump in My Throat: A globus hystericus story, with a side of science.BACK TO TEXT
- Maté G. When the body says no: the cost of hidden stress. Alfred A. Knopf Canada; 2003. With clarity and passion, Vancouver physician Gabor Maté tells the stories of people whose pain and illnesses emerged from lives filled with stress, anxiety and depression, illuminating the next frontier in medicine: the elusive mind-body connection. BACK TO TEXT
- PS Ingraham. Pain is Weird: Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it. PainScience.com. 11108 words. BACK TO TEXT
- Pert CB. Molecules of emotion: the science behind mind-body medicine. Touchstone; 1999. Classic account of Candace Pert’s discovery of neuropeptides — as much a story of a woman in science as it is about neuropeptides. BACK TO TEXT
- Regrettably, Pert’s ideas and book were significantly co-opted by alternative medicine and vitalists, and she herself eventually endorsed many pseudoscientific ideas, books, and projects. For instance, she appeared several times in awful “documentary” film What the Bleep Do We Know!? — one of the most notoriously pseudoscientific films ever made (see Scerri). BACK TO TEXT
- ScienceBasedMedicine.org [Internet]. Coyne J. Questioning Whether Psychotherapy and Support Groups Extend the Lives of Cancer Patients; 2013 Jul 23 [cited 13 Jul 23].
There is simply no evidence that psychological interventions can slow progression of cancer or extend life. Claims to the contrary serve to burden cancer patients with an unrealistic responsibility for the outcome of their medical condition.BACK TO TEXT
As kids return to school, debate is heating up once again over how they should spend their time after they leave the classroom for the day.
The no-homework policy of a second-grade teacher in Texas went viral last week, earning praise from parents across the country who lament the heavy workload often assigned to young students. Brandy Young told parents she would not formally assign any homework this year, asking students instead to eat dinner with their families, play outside and go to bed early.
But the question of how much work children should be doing outside of school remains controversial, and plenty of parents take issue with no-homework policies, worried their kids are losing a potential academic advantage. Here’s what you need to know:
For decades, the homework standard has been a “10-minute rule,” which recommends a daily maximum of 10 minutes of homework per grade level. Second graders, for example, should do about 20 minutes of homework each night. High school seniors should complete about two hours of homework each night. The National PTA and the National Education Association both support that guideline.
But some schools have begun to give their youngest students a break. A Massachusetts elementary school has announced a no-homework pilot program for the coming school year, lengthening the school day by two hours to provide more in-class instruction. “We really want kids to go home at 4 o’clock, tired. We want their brain to be tired,” Kelly Elementary School Principal Jackie Glasheen said in an interview with a local TV station. “We want them to enjoy their families. We want them to go to soccer practice or football practice, and we want them to go to bed. And that’s it.”
A New York City public elementary school implemented a similar policy last year, eliminating traditional homework assignments in favor of family time. The change was quickly met with outrage from some parents, though it earned support from other education leaders.
New solutions and approaches to homework differ by community, and these local debates are complicated by the fact that even education experts disagree about what’s best for kids.
The most comprehensive research on homework to date comes from a 2006 meta-analysis by Duke University psychology professor Harris Cooper, who found evidence of a positive correlation between homework and student achievement, meaning students who did homework performed better in school. The correlation was stronger for older students—in seventh through 12th grade—than for those in younger grades, for whom there was a weak relationship between homework and performance.
Cooper’s analysis focused on how homework impacts academic achievement—test scores, for example. His report noted that homework is also thought to improve study habits, attitudes toward school, self-discipline, inquisitiveness and independent problem solving skills. On the other hand, some studies he examined showed that homework can cause physical and emotional fatigue, fuel negative attitudes about learning and limit leisure time for children. At the end of his analysis, Cooper recommended further study of such potential effects of homework.
Despite the weak correlation between homework and performance for young children, Cooper argues that a small amount of homework is useful for all students. Second-graders should not be doing two hours of homework each night, he said, but they also shouldn’t be doing no homework.
Not all education experts agree entirely with Cooper’s assessment.
Cathy Vatterott, an education professor at the University of Missouri-St. Louis, supports the “10-minute rule” as a maximum, but she thinks there is not sufficient proof that homework is helpful for students in elementary school.
“Correlation is not causation,” she said. “Does homework cause achievement, or do high achievers do more homework?”
Vatterott, the author of Rethinking Homework: Best Practices That Support Diverse Needs, thinks there should be more emphasis on improving the quality of homework tasks, and she supports efforts to eliminate homework for younger kids.
“I have no concerns about students not starting homework until fourth grade or fifth grade,” she said, noting that while the debate over homework will undoubtedly continue, she has noticed a trend toward limiting, if not eliminating, homework in elementary school.
The issue has been debated for decades. A TIME cover in 1999 read: “Too much homework! How it’s hurting our kids, and what parents should do about it.” The accompanying story noted that the launch of Sputnik in 1957 led to a push for better math and science education in the U.S. The ensuing pressure to be competitive on a global scale, plus the increasingly demanding college admissions process, fueled the practice of assigning homework.
“The complaints are cyclical, and we’re in the part of the cycle now where the concern is for too much,” Cooper said. “You can go back to the 1970s, when you’ll find there were concerns that there was too little, when we were concerned about our global competitiveness.”
Cooper acknowledged that some students really are bringing home too much homework, and their parents are right to be concerned.
“A good way to think about homework is the way you think about medications or dietary supplements,” he said. “If you take too little, they’ll have no effect. If you take too much, they can kill you. If you take the right amount, you’ll get better.”