There's one major source of illness and I'm talking about any kind of illness - whether that's so-called mental illness or physical illness - and that's childhood trauma. And this is true whether I'm talking about And that seems like a very bold statement Just about everything, not everything but just about everything that we call illness begins is rooted in compensations and adaptations that have to do with childhood trauma. This is from the journal "Pediatrics" which is the official journal of the American Academy of Pediatrics and the article appeared in their journal six years ago now, in February the... February of 2012. And the article is from the Harvard Center on a Developing Child and here's what they say in their abstract: "Growing scientific evidence demonstrates that social and physical environments that threaten human development because of scarcity, stress or instability can lead to short-term physiologic and psychological adjustments that are necessary for immediate survival and adaptation but which may come at a significant cost to long-term outcomes in learning, behavior, health and longevity." In other words what they're saying is that the adaptations that children are forced to resort to in response to early stress help them endure that early duress and difficulty but those same adaptations become sources of pathology later on and even threaten longevity. This article I quoted you from Harvard wasn't published in some fly by night alternative publication. It was in a major medical journal. It's like... it makes no difference whatsoever. And that's why the research is just not incorporated into medical practice despite the fact that it's been published and it's not evencontroversial! Well, now let's look at stress. Let's say that you're stressed about something and you've got high levels of cortisol and adrenalin in your system and you're obsessing about some insult or a loss or some thing that perturbed you you're in a high state of stress, physiologically, but you're not alone because a friend of yours sitting next to you says: "Hey! Do you want to talk about it? I see that you're upset can we talk about it?" What happens to your stress levels? But what if you're isolated? Then you might go on for months stewing about... stewing on your own stress juices. You got nobody to download it to. No wonder then the women who are stressed and isolated had a much higher risk of of a breast cancer. Which tells us something: That cancer is not the disease of an individual. Cancer is the result of a bio-psycho-social process reflecting your lifelong relationships. So there's the physiological... I've been telling you about the physiological stress response. The physiological stress response. But that's not all there is to stress. So stress is really a triad. There's three components to stress: One is the external stressor. That's whatever happens outside you. So that could be a threat, that could be the loss of someone, the loss of a job. So stress is external. Then there's the physiological stress response. Happens in the others. So, stress then... there's the external stressor, there's the internal physiological response and in between them - and this is what you've got to work with in your offices - is the what we call the processing apparatus. And the processing apparatus is that person with their particular interpretations and their understandings and their beliefs. So, then those are the characteristics. There's automatic concern and regard for the emotional needs of others while ignoring your own. Rigid and compulsive identification with duty, role and responsibility rather than the authentic self or the needs of the self. Repression of anger and the beliefs that you're responsible for how people feel and that you must never disappoint anyone. Now, the question is: How do these psychological behavioral characteristics translate into physical illness. Well, before I go to the science of it which has been fairly well worked out and part of my critique of my own profession is that we just don't look at the evidence. So, that we keep talking about evidence-based practice but I'd love to expunge that phrase from the dictionary because it makes me grit my teeth. Because I only wish there was evidence-based practice. So, let me illustrate my point with one particular illness that fascinates me because it's a) well-known b) has been the subject of a public campaign in the recent past and 3) we say that we don't know what causes it and 4) it's almost always fatal. And I'm talking about ALS. Amyotrophic Lateral Sclerosis, known in North America as Lou Gehrig's disease. and it's a degeneration really of the nerves that activate the muscles that move the limbs and also our breathing apparatus and so on so that people with ALS, for the most part, become paralyzed. In the end will have trouble breathing and die of respiratory failure. Also uniformly fatal within 10 years, often much faster than that. Except when it isn't. As in the case of the physicist Stephen Hawking who was diagnosed with it at age 21 and was given three years to live and died 53 years later just earlier this year. In the meanwhile having become the greatest or the best-known scientist in the whole world which ought to at least make us think that maybe we don't know everything? Not to mention other cases that have actually recovered from ALS? A woman came to me for diagnosis once, not diagnosis, for a second opinion because she had been diagnosed with ALS and she'd been told that this will kill her. Which it did within a year. How the disease began is that she noticed that she couldn't held the pen or the chalk - she was a teacher - couldn't hold the pen or the chalk in her fingers anymore because they would slip through. So, how she compensated for that? And she also began experience trouble walking. And how she compensated for that was to get up early in the morning, like five in the morning and of course she took her time to get dressed because everything was much slower and clumsier and she'd get dressed and then drive herself to school, walk into the classroom with her somewhat troubled gate and grasped the chalk in her clenched fist and scrolled the day's lesson on the board for the students. Teach the whole day and repeat the performance the next day. And she did that for months. Didn't ask for any help, didn't go for a medical opinion until she could no longer walk. And that's when... Now, it's an interesting dynamic as to why the husband didn't drag her to the doctor the first day. And that has everything to do with their relationship which is illustrated by the fact that after they saw me and her condition worsened and it became clear that she would not live, he started to have an affair with another woman. Which shows you the relationship they had, of his neediness. Physicians would say, with some legitimacy, this is anecdotal, doesn't prove anything. Well, I think anecdotes do prove something if there's enough of them. And it turns out that you'll never read about, meet anybody, look after with ALS who's not like that. And this has showed up no matter what whose life I read about, no matter what patients I interviewed, my own case studies from palliative care, they're all the same. There's difficulty asking for help. There is refusal, this dogged refusal to ask for help. Then I looked up the medical literature and there was a study done at Yale University Medical School quite some years ago now. And what did these researchers find, they found that these patients invariably evoked admiration respect from all staff who came into contact with them. Characteristic was their attempt to avoid asking for help. Hard steady work without recourse to help from others was pervasive. There seemed to have been a habitual denial suppression or isolation of fear, anxiety and sadness most expressed the necessity to be cheerful. Some spoke casually of their deterioration or did so with engaging smiles. And then I looked up the biography of Lou Gehrig. I knew nothing about the man except that he has this disease named after him. As time passes fewer and few people know about him but he was a great baseball player, a teammate of Babe Ruth and New York Yankees in the 1930s. He was one of the all-time greats. He set a record for a number of hits by a yankee that was only broken a few years ago. So, it really was a durably durable record. But he set another record that wasn't broken for 70 years either. He never missed the game, consecutive games played. And it's not that he was never sick. He got sick like everybody else. He just wouldn't take himself out of the game. It's not that he was ever injured either. At one point his hands were x-rayed and it turns out that his fingers had been fractured something like 17 separate times! And his teammates would describe him as grimacing like a maddened monkey in agony as he fielded the ball with a broken finger but he wouldn't take himself out of the game! And yet, on the other hand, when a young rookie on the team got sick with the flu and couldn't play and the manager was very upset with this young player, Gary says:"What are you talking about? He's got a flu! He can't play!" And took the rookie to his own home where he lived with his mother. His mother put the rookie into Garry's bed. Lou slept on the living room couch while his mom nursed his kid back to health. That's just exactly... you'll never meet anybody with ALS who's not like that! So, the woman with the ALS, the teacher, she was an adopted child. And shortly after the adoption, so you understand, any adopted child has got a deep sense of rejection and abandonment that just goes with the territory. that doesn't mean we shouldn't adopt kids. It just means that that's the major factor that then we have to really help to heal. And then shortly after the adoption, the adoptive mother gets pregnant. Now, what do you think the rest of the story is? The adopted child never believes, never perceives that she's loved and appreciated and welcomed and enjoyed like the biological child. And so she develops the coping mechanism: I'll take care of myself. Just love me. I don't have any needs. Just tolerate me. That's how she survives. Now, remember when I quoted that article from Harvard that those early coping mechanisms then become source of pathology later on. Okay, let me give another fact. In the 1930s and 40s, the gender ratio of multiple sclerosis which is an inflammatory, degenerative disease of the nervous system, was 1:1, other words for every man there was a woman diagnosed. You know what the ratio now is? It's three and a half women to every man. Now that immediately tells us a) it can't be genetic because the genes don't change in a population over 7 decades or even 10 decades or longer. Number 2, it can't be diet because that doesn't change for population. It didn't change more for women than for men nor can it be
the climate. There's something going on and whatever it is it can't just be biological. The second point I'm going to make for you is that disease is not a fixed entity. It's a process and that process is not separated from that person's lives. So that all the multiple sclerosis will behave is not simply a characteristic of the disease. It reflects what's happening in the life of that particular individual which is, by the way, why we're seeing three times as much in women right now which i'll talk about later. But it's a process and if it's a process that somehow manifests how are we living our lives then we can actually perhaps do something about it! Why do I think this gender ratio is virgin that way? So, they thend to take on the stresses of their spouses and their families. They still play that role for the most part. But on top of that, since the 30s and the 40s, they've also taken an economic role But they have not given up the other rule. It's not that they haven't given it up. Society hasn't relieved them of it! The men haven't stepped up for the most part to share that emotional burden. So, women are still carrying that. But now they got the economic role as well and they're doing so in the context of less social support because there's all kinds of reasons why in this neoliberal economy and this stressed culture people are more and more isolated. So, you've got more stress, more isolation, of course you're going to have more autoimmune disease. And so about 75% or 80% of autoimmune disease actually happens to women, right. Now, here's a condition which is increasing in the population called high hypertension which is to say high blood pressure. and for the most part about 5% of hypertension cases are secondary, in other words they're caused by some disease in some other organ like the kidney for example or adrenal gland or something but for the most part we call it essential hypertension which basically is a way of saying that we haven't got a clue what causes it. And what if I told you that the blood pressure of American black males is much higher on the average than that of whites and they're more likely to develop hypertension? Much more likely to develop does hypertension? Does this gives you any clueless to the source of hypertension, maybe? As to, as opposed to their genetic relatives in Africa who don't have high blood pressure at all? And all you have to do is: say hypertension a few times. Like hyper tension, hyper tension, hyper tension - anything spring to mind? Maybe there's too much tension in these people's lives? And of course James Baldwin, the American black writer, famously said that to be an American black male is to live in a state of suppressed rage all the time. The first fact is a study that was done in the United States last year or I should say two years ago now that showed that the more episodes of racism an American black woman experiences the greater her risk for asthma. Now you can't explain that on molecular grounds. You just can't. The racism-induced asthmatic attack we can see that obviously emotional factors must be playing a role here. And not just emotional factors because the black woman who experiences racism isn't an isolated particle responding to nothing in the environment. She's affected by a social circumstance. Now, what's interesting is that when you look at how you treat asthma is you give to open up the airways and to suppress the inflammation that happens in the asthmatic airway, you give inhalers or medications by mouth which are copies of adrenaline and cortisol. Adrenaline and cortisol are the stress hormones of the body. I'll talk about them later. They're secreted by the adrenal gland in response to a threat. So, there's adrenaline in cortisol. So, we're treating asthma with stress hormones. How do we treat multiple sclerosis? If you have a flare-up of your multiple sclerosis you're going to get an infusion of this stress hormone cortisol. If you've ever been to a dermatologist with a skin flare-up, some kind of chronic psoriasis or eczema most of the time you're going to get a steroid cream, a copy of cortisol. If you go to a rheumatologist with inflamed joints or connective tissues, guess what they're going to give you? Steroids, cortisol. In all autoimmune diseases. We're treating all these conditions across medicine with stress hormones but we're not asking ourselves a simple question: Is it possible that stress may have something to do with the onset of this condition? Has something happened to the body's stress apparatus that we have to give people now larger quantities of stress hormone to keep them from having symptoms? Skill testing question: What is the role of the immune system? It's exactly the same thing. It's to maintain your boundaries, to keep out what is unhealthy, dangerous, unwelcome. Allowing what is nutritious and healthy. And the immune system has been called the floating brain. It has a memory capacity. It can react and it can learn, just like the brain. When you're suppressing your emotions, you're suppressing your immune system. And what happens to anger that you suppress? Does it evaporate, go to the moon? What happens to it? Who does it turn against it turns against? It turns against you. Now you've got autoimmune disease where the immune system turns against you, like rheumatoid arthritis, multiple sclerosis. Hodgkin's is a cancer. So, Hodgkin's is a response also to the suppression of immune system where the immune system is no longer protecting you. But in the case of autoimmune disease the immune system actually turns against you. So, in the long term that's what it'll do. And in the long term cortisol will thin your bones, give you osteoporosis. Now, when the osteoporosis society does its public education they talk about sunshine vitamin D and weight-bearing exercise. They never talk about stress which is the most important cause. For example, women who've been depressed are much more likely of osteoporosis because in depression there's elevated cortisol levels which thin the bones. And medical ideology is interesting. Ulcers were the one thing where doctors always knew that it had to do with stress. Until three or four decades ago where an Australian, very clever Australian scientist found this bacterium called helicobacter pylori. And now if you give antibiotics to wipe out the the bacteria the ulcer goes away. So. there goes the stress theory or does it? Because here's a fact that you have to account for: At age 50, 50% of the population will have helicobacter pylori in our intestines, 50% don't have don't have ulcers. At age 80, 80% will but 80% of 80 year olds don't have ulcers. What is it that makes the person susceptible
to that bacteria? That's the question. Guess what? It's stress. By the way, there's another mechanism by which stress and early childhood, negative experiences lead to disease which is simply through inflammation. So, we know for example that the more trauma a child experiences the greater the level of inflammatory particles in their bloodstream as adults. You can measure inflammatory proteins in the bloodstream. And the more stress you had as a kid the higher they're going to be. And the more stress you have there's another structure. I mean, the information is just coming in all the time. It's hard to even keep up with it. There's a structure called telomeres. Telomeres are structures at the end of your chromosomes. Like the shoe lace has a glue at the end to keep the strands together, telomeres keep the chromosome together. Telomeres shorten with stress. They also shorten with age. So, children who are traumatized, for example, have shorter telomeres which means that they're chronologically older than their peers. Depression is something I've certainly dealt with in my life. And what I'm really saying to you.. and this is... I'm not going to prove this right now... is that virtually everything that happens to us later on in life begins as a coping mechanism in childhood. So, you know, I've talked about these coping mechanisms to maintain our attachment relationships and so as a result we suppress ourselves. Now, if you look at the word depression itself what does it actually mean to depress something? It needs to push it down. In depression something is pushed down. What is usually pushed on and depression? It's anger and the problem is when we pushed on one of our emotions it's hard to experience the others. And now there's this joyless, negative, hopeless experience of depression. It does begin as a coping mechanism in childhood when the environment could not tolerate your emotions so you learn to push them down. And then later on you'll be diagnosed with depression. Now you might ask: Am I saying depression is not physiological? Sure it is. But the part of this process is that these early experiences don't only affect their emotions, they also affect our brain physiology. So, childhood stress is actually will have an impact on how much serotonin is going to be available in my brain. Serotonin being one of the mood chemicals. So, when you take fluoxetine or prozac you're elevating your serotonin levels. Now, I am my personality kind of a depressive. So, that's my baseline. You might think: This jolly fellow, how could he depressed? But you know that is kind of my baseline, that's my default setting. Less and less as I learned to deal with it. But I know that I'm challenged in terms of serotonin but that does go back to early childhood because early childhood actually programs the brain physiologically. And as one becomes more self-aware and self-compassionate you can reverse that. Because those early coping patterns, here's the problem with them: They're meant to be temporary states. We're meant to adopt these patterns... I mean if you're familiar with my idea about ADHD - which I've been diagnosed with - it's a coping mechanism of young infants when there's stress around them and they can't escape, fight back or change the situation, ask for help. They tune out as a way of coping but then it gets wired into their brain and not goes from a temporary state which is meant to be to a long-term trait. And the coping mechanisms become problems when they go from state to trait. There's nothing wrong with her coping that way if she could drop it once she no longer needed to be that way. But of course that's not how it works. These coping mechanisms are unconscious. Therefore they're not chosen deliberately. Therefore they cannot be released deliberately either. We're not even aware of them. The problem is that as children we all face a dilemma. In Australia there was a study. They looked at 500 women with breast lumps that needed to be biopsied. To make sure that it wasn't malignant. And before the results were in, the women underwent a psychological questionnaire. And what they found was that if a woman was emotionally isolated that by itself didn't increase the romp, the chance of the lump being cancerous. If a woman was highly stressed or on the outside of that lump that by itself also didn't increase the chance of the lumping cancers. But if a woman was emotionally isolated AND stressed the chance of the lumping cancers was 9x as great as the average. And the researchers being medical scientists, who think from up here, they couldn't figure this one out because they said: How does 9 plus... how does 0 plus 0 add up to 9? If the 0 effect here, 0 effect there, what's happening? Well, of course it's obvious what's happening is... For example, in the front row person at the very aisle seat here if you're very stressed then you have these high levels of stress hormones which are affecting your immune system. And if you're all alone with it for months you might be in trouble. But if there's a friend of yours sitting next to you and says: "Hey friend, hey sweetheart, hey buddy, you seem upset. Do you want to talk about it?" What happens your stress hormones? Your nervous system relaxes, your heart rate decreases, your intestinal muscles in the gut relax and you... and your stress hormone levels go way down. We're bio-psycho-social creatures. And so these patterns of emotional self-suppression they promote illness in part because they leave us completely alone. Because whether we're alone or not does not depend on how many friends we have. And again, I'm quoting Bessel van der Kolk. He says: "Social support is not the same as being merely in the presence of others. The critical issue is reciprocity. Being truly heard and seen by the people around us. Feeling that we're held in someone else's heart and mind. But if I'm suppressing who I am, nobody's ever gonna see me." And I might be very nice and there might be a thousand people who love me. But none of them know me. And I'm totally isolated really at heart. I'll give you one more example which is actually a British one. It's from the TV series "The Crown" which I'm sure many of you have seen. It's a wonderful soap opera about the Windsor Family. And as you know the current Queen's father, King George VI, ascended to the throne in 1936 when his brother Edward abdicated to marry his divorced American sweetheart. He was... his name wasn't George. His name was Albert. Bertie. He did not want to become king. He did not. When his mother, Queen Mary, told him about the coming abdication and it be up to him not to assume the royal throne, he writes in his diary... I'm sorry... : "When I told her what had happened I broke down and sobbed like a child", she says, he said. He didn't want to do it. Now, in the in The Crown, in the TV series, there's a conversation between his mother, Queen Mary, and his wife, the now deceased Queen Mother Elizabeth. And the mother says... no, of course he died of cancer. He was a smoker and he died of lung cancer. There was a British surgeon in the 1960s called David Kirsten who noticed - just like I noticed and as many physicians have noticed these patterns in their clients - and he noticed that... he was operating on people with lung cancer and of course the more you smoke the greater the risk of lung cancer and now Bert, or King George, who became King Georgia VI was a smoker. But Kirsten also noticed that these people also suppress their emotions, particularly their anger. And he did some studies and he actually found that the more you suppress your emotion, the less cigarette smoke it took to trigger the cancer in you. Now, going back to The Crown, so here's the Queen Mother, I should say King George's, Albert's mother, talking to his wife. And he said, she says, the mother says: "One can only be thankful for the years one had with him. So wonderfully thoughtful and caring. An angel to his mother, wife and children. I honestly believe he never thought of himself at all. He really was the perfect son." Wanna be the perfect son in the British Royal Family? Don't think about yourself! Don't think about yourself! A Canadian study showed that if you were abused as a child your risk of cancer goes up by nearly 50%. And this is even after you've factored in or factored out things like smoking and drinking which abused people are more likely to do. The Globe and Mail, for which I wrote a medical column for a number of years, and these stories from the paper illustrate aspects of what I call the disease-prone personality. The first is a first-person story written by a woman called Donna who's diagnosed with breast cancer and she goes to her doctor and she's describing the experience of the diagnosis. What you need to know is that her doctor's name is Harold and her husband's name is High. Now, High's first wife died of breast cancer and now Donna, the second wife, is diagnosed with the same condition. And Donna writes: "Harold tells me that the lump is small and most of surely not in my lymph nodes. Unlike that of High's first wife whose cancer had spread everywhere by the time they found it. You're not gonna die, he reassures me. But I'm worried about High, I say. I won't have the strength to support him." Now, anything, what's wrong with this picture? So, here she is diagnosed with a potentially serious condition and her first and she's the one who might need radiation, surgery and / or chemotherapy. And the first thought that she has is: How will I look after my husband's emotional needs? for reasons that I'm going to tell you. When you don't get the attention that you needed as a child, as an infant you'll be consumed by attracting attention. And now you're going to be very attractive. How many times have you passed a mirror without wondering if you're attractive enough? You're just looking for love. If you didn't get the approval that you needed as a child just for existing, just for being who you were, you will want to be winning approval all the time. You'll be a winning personality. If you weren't valued, you want to measure up. If you weren't made to feel special just goes for who you were, you might be demanding. In which case you'll run for the leadership of the conservative party If you if you weren't esteemed for who you were then you might want to impress people. If you weren't made to feel important for just who you were then you go to medical school like I did. And you want to make yourself important. If you weren't liked for who you were you're going to be very nice. So that people will like you. So that you can have this similar kind of love. If you weren't loved, you'll be very charming and people say: "What a charming guy or what a charming woman this person is." But all of this demands that you have to suppress your own feelings. Now, how does that lead to illness? It leads to illness because it's very stressful always to be playing a role. It's actually stressful. And there's always the fear behind it. It's fear driven. And fear is a state of being in stress. Now the stress hormones. If I were to scream at you right now and frighten you, you would have a stress response. By the way, just to indicate how inseparable the mind is from the body that's how simple it is. I could change your physiology in this room. I could change the physiology of 1500 people in this room without touching them simply by generating a credible threat. If I a weapon for example and screamed at you your physiology would change in a split second. And obituaries are fascinating because they tell us not just about the person who died but also about what we as a society value in one another. And what we value in one another is often what kills people. This is a physician who died at age 55 in Toronto. Never for a day that he'd contemplated giving up the work he so loved at Toronto's sick children's hospital. He carried on under his duties throughout his year-long battle with cancer, stopping only a few days before he died. Now, again. If a friend of yours is diagnosed with a malignancy is that what you would say to them? Go back to work and keep working till you drop? So, there's this rigid and compulsive identification with duty role and responsibility rather than the needs of the self is another risk factor for illness. Second obituary is about a woman called Naomi. This is written by her grateful husband. And she died of breast cancer at age 55 and the husband writes: In her entire life she never got into a fight with anyone. The worst she could say was fool, you or something else along those lines. She had no ego. She just blended in with the environment in an unassuming manner. Now, my wife Ray I think is in the audience and we've been married 50 years this year. And believe me, there have been many times when I wish that she would blend in with the environment in an unassuming manner. As I'm sure many of you have who have partners or spouses of any type. But if your partner wants to stay healthy they will not blend in with the environment. And really what's been described here is the repression of healthy anger. And the repression of healthy anger we know suppresses the immune system. All right this is a man called Sydney. He was the physician died at age 72 of cancer. Sydney and his mother had an incredibly special relationship. A bond that was apparent in all aspects of their lives until her death. As a married man with young children, Sydney made a point to have dinner with his parents every day as his wife Roslyn and their four kids waited for him at home. He would walk in, greeted yet by another dinner to eat and to enjoy. Never wanted to disappoint either woman in his life, Sidney kept having two dinners a day for years until gradual weight gain began to raise suspicions. And this is presented as a wonderful example of loyalty to the parent. And what is actually being described here is a poor man who suffered from two fatal beliefs. And when I say fatal I mean literally fatal. 1) is that he's responsible for other people feel and 2) that he must never disappoint anybody. Now, at this point the question comes up: Are we blaming the person for the disease? Are we saying that they're responsible for their illness? The answer is no and the answer is yes. No, we're not blaming anybody. Yes, they're responsible. But responsible here doesn't mean a sense of blame. It simply means that how they live their lives has a lot to do with with their illness. The reason is... and not only that. If we're bringing the question of responsibility we're actually empowering the client. We're saying that you're, you know this, you've heard this version before of responsible as "response-able". If we're not respons-able then what the heck are we? Then we're victims. So, the whole idea is to make people respons-able. And for that they have to be responsible. They have to look at, well, how was I living my life? And how did that contribute to the illness? Why are we not blaming people though is because these patterns are completely unconscious. Nobody's aware of it. Nobody decides to be this way. What does it have to do with? Well, for that you have to go back to childhood in every single case. What I'm saying is difficult for people. People often perceive themselves as being blamed. They're not being blamed but they perceive themselves as being blamed. And Dr. Christine Northrup who's a women's physician and best-selling author. I was talking to her and she said that this kind of conspiracy between the doctor and the patient not to talk about such stuff. For the doctor it's easier to hand out the pill and it's much quicker and for the patient. It doesn't bring up uncomfortable questions. But the biggest barrier is actually an emotional one, I think. On the part of physicians. We haven't dealt with our own pain. We haven't dealt with their own stresses. There's a high rate of suicide and depression and burnout amongst doctors. Somebody once said that if you want to start a cult what you do? Well, you give people a uniform, you have special jargon, you isolate them from their families, you subject them to authority and leaders and you sleep deprive them. In other words:You send them to medical school. It's a stressful thing! And people survive it by shutting... people entered or like people like me really driven and you know, I will, I would have done anything to get into medical school and to get through it. And so you really are already driven and then nothing education prepares you for it. Anything I'm telling you, not a word of this, is breathed in any of the medical schools. And then there's the emotional defense of the physician against his or her our own pain. So, these are the factors that I think all go into it. They're social and individual. And by the way, when I said childhood trauma probably some of you are at least internally shaking your heads because you're looking at your life and:I never had any trauma. But trauma is not what happens to you. It's what happens inside you as a result of what happens to you. And things can happen inside you for which you don't need very dramatic events. But trauma essentially is a restriction of your capacity. It's a limitation. It's a constriction in the body. It's a constriction in your mental capacity to respond in the present moment from your authentic self. Essentially, trauma is a restriction of your authentic self in the present moment. That's what trauma is. Because the day you were born you were connected to your gut feelings. At some point you learned not to be. Why did you learn that? For survival. So, a child has two basic needs: The one need is for attachment. Now attachment is the, as my friend Gordon Neufeld defines it, is the drive, is the biological, psychological, emotional drive for closeness and proximity with another human being for the purpose of being taken care of or for the purpose of taking care of the other. So there's an attachment drive between parents and children. Between parents and children of of any species. Beginning with birds and upwards. It's a biological drive to connect for the purpose of being taken care of or to take out We can't live without it and least of all no creature beyond reptiles can live without it. And least of luck in human beings because we're the most dependent, the most helpless and the least mature of any creature at birth. So, the attachment drive is very very powerful in our brain and it explains much of human behavior, virtually everything that you deal with in your offices relate to disturbances of attachments. And a lot of the people that you see in your offices they have difficulties because they're still choosing attachment over authenticity. And attachment on any at almost at any cost. And it's killing them on some level Got brain connection... the gut is not just a digestive organ. The gut is actually an immune organ. It's got many immune centers. And the gut is an organ of sensation. Serotonin, the chemical in the brain that we enhance by giving people prozac for their depression... the gut has more serotonin than the brain does. And so the gut is an emotional organ. Therefore gut feelings are actually magnifications of impressions that the brain gets and the gut amplifies them so that you can really know that they're there. And the gut and the brain are totally connected. In fact the gut sends many more nerve fibers to the brain than the brain stents to the gut. And the brain is reading the internal organs all the time. So, there's that connection as well. As traditional science... as traditional medicinal practices have always known: You can't separate the mind from the body. You can't actually separate the mind from the body except in medical school - but not in real life. I was in Fort Francis, Ontario for a couple days earlier this week speaking to a mostly native audience. And there's the native medicine wheel with its four quadrants of mind and body and emotions and spirit. And they say that for health you have to have a balance between those four quadrants. And traditional shamanic medicinal practices, ayurvedic medicine of India, the Chi medicine of China, all the medicine men and women of traditional cultures have always assumed and known about the mind body. They just didn't know the science but they knew it. Now we have the science but we no longer know it. Turns out that it's not even that these separate systems are connected together they're not even separate systems. They're one system with different manifestations. I mean, think about it. First of all, evolution begins with a single celled organism. That cell then differentiates and becomes a multi-celled organism. But the basic functions of defense, nourishment and survival have to be carried on by the organism. It's just that now you have different cells that are... that are specialized in certain duties so that some cells become digestive cells other cells become brain cells but they all have the same DNA. And even as human beings we still begin with one cell at the union of sperm and egg and then we differentiate and we separate. But that doesn't mean we get disconnected! And so it turns out that the nervous system wires together all these systems. Turns out that it's not even that these separate systems are connected together. They're not even separate systems! They're one system with different manifestations! I mean think about it! First of all, evolution begins with a single celled organism. That cell then differentiates and becomes a multi-celled organism but the basic functions of defense nourishment and survival have to be carried on by the organism. It's just that now you have different cells that are specialized in certain duties so that some cells become digestive cells. Other cells become brain cells. But they all have the same DNA. And even as human beings we still begin with one cell at the union of sperm and egg. And then we differentiate and we separate but that doesn't mean we get disconnected And so it turns out that the nervous system wires together all these systems. So there's a part of our nervous system called the autonomic nervous system which is the part of our nervous system that is not under your conscious control. So it's autonomic which is to say autonomous nervous system. You can call it. As opposed to the voluntary nervous system that allows me to snap my fingers if i want to. There's the autonomic nervous system and that is what in and innervates our viscera, our heart, our guts, our lungs. It's responsible for the tension of our muscles... The autoimmune... nervous system connects the brain to the bone marrow where the red and the white cells are manufactured. And it sends messages from the bone marrow to the brain. It connects the brain to the hormonal glands, to the immune organs, to the spleen where the red cells are stored, to the thymus where the white cells mature. And it sends messages from all of these organs back up to the brain. So there's a constant... So, the nervous system is like a giant electrical grid that wires together all these systems. And the anatomical connections have been worked out. That's one form of connection. The other form of connection of course is through the hormones themselves. So, the hormones from the hormonal glands in the brain, the pituitary and the hypothalamus and and elsewhere in the body, the gonads you know, the ovaries, the testes, the thyroid gland in the neck, the adrenal gland on top of her kidneys. Adrenal top of kidney. These all also send secretions hormones to other organs and they have an impact on each other. They're constantly talking to each other. That's the second form of connection. The third form of connection is that each of these systems, including the immune cells, can manufacture messenger substances that are circulated through the blood to the other systems. So, it turns out that the white cells in your circulation can manufacture every hormone that the brain can manufacture. So, the brain is talking to the immune system and the immune system is talking to the brain. So, when something happens in one system it happens in the other system. But this is rather obvious, actually, when you think about it. It's just that the the implications are not obvious to us. So, I could clearly and trivially to truly obviously change your physiology. I could change the physiology of virtually everybody in this room in a split second. And I could do so without touching you, without giving you any kind of a substance, without in any way physically interacting with you. What would I have to do? I simply would have to utter a piercing blood curling scream and brandish a weapon at you and your physiology would change like that. Your hormonal gland would start behaving differently, your intestines would stop digesting, your lungs would function differently, your heart would beat faster, your blood vessels would behave differently, more blood would flow to your muscles, there'd be more sugar pouring onto your system, so that you could have more energy and you'd be ready for flight or fight. Now that's an obvious example, where the emotion changes the physiology in a split second. Well, guess what that goes on 24x7. So, that interaction between the physiology and the emotions is constant. It's just that for the most part we're not aware of it unless it's dramatic. But that's the only difference. It's no less constant and important. In 2017 a fellow Canadian physician, Dr. Norman Deutsch, also an author writes about brain and neuroplasticity, said that modern scientific medicine has taken a fundamentally materialistic approach and it is analytical, meaning that it divides holes into parts. It often proceeds by reducing complex phenomena to their more elementary chemical and physical components, viruses, genes molecules. And that's how it is. And this isn't a new perception about western medicine. In 1977 Dr. George Engel, an American physician, internist and psychiatrist said that the dominant model of medicine today is biomedical with molecular biology it's basic scientific discipline. And what I'm trying to say to you here is that the critique that I'm going to make tonight of western medicine and providing an alternative it's not new actually. People have been saying this for a long long time. So here's George Engel saying that the dominant model of medicine today is biomedical with molecular biology. It's basic scientific discipline. It assumes disease to be fully accounted for by deviations from the norm of measurable biological variables. It leaves little room in its framework for social psychological and behavioral dimensions of illness. The biomedical model embraces mind-body dualism, the doctrine that separates the mental from the somatic. And let me just give you three medical facts here and you'll see immediately how inadequate and insufficient the western medical perspective is in explaining these facts that i'm about to give you. Now in order to understand the basis of that we have to consider how we look at human beings. So and how we look at disease. Now western medicine looks at disease from a particular perspective and you have to understand something about medicine. It's science, all right! But it's also ideology! And there's a difference in science and ideology. There's a lot of science in it and it's great science. But there's also ideology. An ideology is a point of view, as the Germans say: It's a "Weltanschauung", it's a world view that you're not conscious of. That you have hidden beliefs that you don't question. And people that question the hidden beliefs are seen as outliers or mavericks. And that's an ideology. And that exists in all realms whether politics or or science or medicine or history or economics or any field of human thought or investigation. So there's always ideological biases hidden in any system. But the hidden biases are, #1 that diseases have either physical causes, in a sense of genes or external forces like bacteria or viruses or toxins or we don't know what the causes are. So the causes are either physical or the disease, is what we call idiopathic, we don't know what the source of it is. So that's one bias. The #2 bias is that diseases happen to organs. So you have heart disease and you have lung disease and you have diseases the connective tissue or the liver or whatever. And then there's specialties designated to study in depth the diseases of these organs. But that, except for obvious lifestyle, so-called lifestyle proclivities like smoking or drinking we don't really think that the life of an individual is a whole lot to do with the disease of the organ. So you know cancer strikes somebody who doesn't smoke. We don't know what causes it, so we separate the organ from the the whole person. And then we separate the person from the environment, so that the social environment... we might acknowledge the role of the physical environment but we certainly not acknowledge the role of the social environment. I mentioned that I worked in family practice for 32 years, 12 of them with hardcore drug addicts, the other 20 in a straightforward family practice where I helped to deliver a lot of babies. And in palliative care where I helped a lot of people die - and everything else in between. And in those years I found that the people who got sick and didn't get sick they had certain patterns, certain characteristics that kept cropping up over and over and again till I just couldn't ignore it anymore. And there's a significant difference between... In experience being a family physician and a specialist in that especially certainly does know and blessedly so a lot about a certain organ and a certain system but they don't know the patient. And by the time you see the patient, the patient's already sick and usually they already have a diagnosis. At least we know what area the disease is. As the family physician you get to see people before they get sick. So you know what their personalities are like for years before they get sick and also you get to see them in the context to their families, including their multi-generational family or origin. So, George Engel in 1977 called for what he termed a bio-psycho-social approach for medicine and the boundaries between health and disease, between well and sick are far from clear and will never be clear because they're affected by cultural, social and psychological considerations. That was 1977. And that was a new either. In 1940, another American physician said that social and psychic features play a role in every disease but in many conditions they represent dominant influences and that mental factors represent an active force in the treatment of patients, as active force in between the patients as chemical and physical agents. And that wasn't new either! Because back in Roman times the Greek physician Galen already pointed out that women who have... who are depressed are more likely to have breast cancer. And now we have the actual studies to show why and I'll refer to them later. So what I'm saying is that this awareness this intuitive awareness that you can't separate the mind from the body and you can't separate the individual from the environment it's not new in medicine. What is new is that now we have the science to actually prove it. And what is remarkable and lamentable at the same time is that despite the scientific evidence, medical practice still doesn't take into account! In Britain, in London, presenting at the Breath of Life conference and one of the co-speakers was the great trauma psychiatrist and my friend of mine Dr. Bessel van der Kolk and Bessel says in his book: "The body keeps the score. Our culture teaches us to focus on personal uniqueness but on a deeper level we barely exist as individual organisms. Our brains are built to help us function as members of art, of a tribe." And that's not new either because if you go back 2500 years to the Buddha he said, he thought, the Buddha talked about what he called the interdependent core rising of phenomena. He said that every phenomenon arising relationship to every other phenomena. You can't separate anything from anything else. And so the perspective I will propose this for you, proposed here for you, is that bio-psycho-social perspective and from that perspective illness is not an entity in itself. It is actually the manifestation of a person's life in a certain context. To which many factors contribute but the psychological cannot be separated from the physical and the physical and the psychological aspects of the individual cannot be separated from his or her social connections and existence. And therefore from the culture that they live in. And if we're going to be fully inclusive about human beings I'll have to bring in another dimension - which of course is heresy in medical terms - which is the spiritual one. And so basically we're bio-psycho-social-spiritual creatures. And spiritual simply means that there's more to us than the little ego that many of us are hung up on and which rules this particular society. We're bio-psycho-social creatures and so these patterns of emotional self-suppression they promote illness in part because they leave us completely alone. Because whether we're alone or not does not depend on how many friends we have. And again I'm quoting Bessel van der Kolk. He says: "Social support is not the same as being merely in the presence of others. The critical issue is reciprocity, being truly heard and seen by the people around us, feeling that we're held in someone else's heart and mind. But if I'm suppressing who I am nobody's ever going to see me. And I might be very nice and there might be a thousand people who love me but none of them know me and I'm totally isolated, really at heart. And that's what's going on. And from that perspective illness is not just meant to be battled. It's meant to be come to terms with, understood, inquired into as to what its messages is. And from that perspective illness is a potential
teacher. And that invites and actually necessitates an inquiry. So I'm going to read you a quote from one of my favorite teachers. And unfortunately as much as I've told you there's so much I haven't told you. Well here's a quote i like from Susan Griffin who says: "Because we think in a fragmentary way, we see fragments. And this way of seeing leads us to make actual fragments of the world. But the quote I wanted to give you was written by A.H. Almaas, otherwise known as Hamid Ali who said that: "Your conflicts, all the difficult things, the problematic situations in your life are not chance or haphazard. They're actually yours. They're specifically yours designed specifically for you by a part of you that loves you more than anything else. The part of you that loves you more than anything else has created roadblocks to lead you to yourself. You're not gonna go in the right direction unless there's someone pricking you on the side telling you: Look here, this way. That part of you loves you so much that it doesn't want you to lose the chance. It will go to extreme measures to wake you up. It will make you suffer greatly if you don't listen. What else can it do? That is its purpose."
