Free When the Body Says No: The Cost of Hidden Stress by Gabor Maté

method by which they form their opinions,
almost invariably these prove to be correct.”
    “The interesting thing in Munich was that when we presented our paper, everybody came around,” says Dr. Wilbourn. “‘Oh yeah,’ peoplecommented, ‘I’ve noticed that—I’ve just never thought about it.’ It’s almost universal. It becomes common knowledge in the laboratory where you evaluate a lot of patients of ALS—and we do an enormous number of cases. I think that anyone who deals with ALS knows that this is a definite phenomenon.”
    Similar patterns emerge from my personal encounters with ALS patients in private practice and in palliative care. Emotional repression—in most cases expressed as niceness—can also be found on exploring the lives of famous persons with ALS, from the physicist Stephen Hawking, the baseball great Gehrig, to Morrie Schwartz, the professor whose television appearances on Ted Koppel’s show made him a much-admired figure in the last months of his life and whose story and wisdom form the subject of the best-seller
Tuesdays with Morrie
. In Canada, Sue Rodriguez, a person with ALS, gained national prominence with her determined legal battle for her right to assisted suicide. In the end not even a Supreme Court decision could deny her that right. Her story is congruent with what the lives of these others also teach us.
    The life histories of people with ALS invariably tell of emotional deprivation or loss in childhood. Characterizing the personalities of ALS patients are relentless self-drive, reluctance to acknowledge the need for help and the denial of pain whether physical or emotional. All these behaviours and psychological coping mechanisms far predate the onset of illness. The conspicuous niceness of most, but not all, persons with ALS is an expression of a self-imposed image that needs to conform to the individual’s (and the world’s) expectations. Unlike someone whose human characteristics emerge spontaneously, the individual seems trapped in a role, even when the role causes further harm. It is adopted where a strong sense of self should be—a strong sense of self that could not develop under early childhood conditions of emotional barrenness. In people with a weak sense of self, there is often an unhealthy fusion with others.
    The example of New York Yankees first baseman Lou Gehrig is instructive. Gehrig earned the sobriquet “the iron horse” for his implacable refusal to remove himself from the lineup regardless of illness or injury. In the 1930s, long before the days of sophisticated physiotherapy and sports medicine, he set a record for consecutive games played—2,130—that would stand for the next six decades. He seemed to feel thathis prodigious talents and dedicated play when healthy were not enough, and he was too dutiful toward his fans and employers to ever take time off. Gehrig was caught up, according to his biographer, “in his self-designated role as a loyal son, loyal team player, loyal citizen, loyal employee.” 5
    A teammate recalled Gehrig’s participation in a game despite a broken middle finger on his right hand. “Every time he batted a ball it hurt him. And he almost got sick to his stomach when he caught the ball. You could see him wince. But he always stayed in the game.” When his hands were X-rayed, it was found that every one of his fingers had been broken at one time or another—some more than once. Long before ALS forced him to retire, Gehrig had sustained seventeen separate fractures in his hands. “He stayed in games grinning crazily like a macabre dancer in a gruelling marathon,” someone wrote. The contrast between Gehrig’s unsparing attitude toward himself and his solicitude toward others was glaringly evident when a Yankee rookie was weak from a heavy cold. Placating the annoyed team manager, Gehrig took the young man home to be cared for by his mother, who treated the “patient” to hot wine and put him to bed in her son’s