Any doctor worth his/her salt will tell you that unmanaged daily stress is bad for your health. But while traditional mind-body research continues to focus on this link, a much lesser known yet very important connection exists between severe stress, trauma or abuse encountered long ago and the development, even years or decades later, of any of a number of chronic medical conditions. Losing a parent at a young age…growing up amid a dysfunctional family…even surviving a serious accident or disease are just a few examples of experiences that can affect our health decades down the line—without our even realizing it.
Bottom Line Personal spoke with Samuel J. Mann, MD, professor of clinical medicine at New York Presbyterian Hospital–Weill Cornell Medical Center. He has spent years studying how powerful emotions related to past stress or trauma that have been repressed can cause or contribute to current health conditions such as hypertension, inflammatory bowel disease, chronic migraine, chronic fatigue syndrome, fibromyalgia (chronic widespread pain) and more…
Health-care providers rarely consider the relationship between long-ago stress or trauma and a patient’s current health. Reason: Physicians generally don’t inquire about adverse events from the past, and patients who have repressed those emotions don’t feel or report the emotional effects related to them.
It is surprising how many patients, no matter how rough their stories, feel they are doing just fine…believe they have experienced no lasting psychological consequences…and have never considered a possible link between their past experiences and their current ills. For many, recognizing this link offers a new direction in successfully treating many chronic medical conditions.
Physical and emotional stress stimulate the sympathetic nervous system (SNS)—the “fight-or-flight” branch of the nervous system that pumps adrenaline (epinephrine) into the blood. This is helpful when confronting a threat. But during periods of prolonged stress—such as during a divorce, an illness or while grieving the loss of a loved one—our stress hormones can contribute to insomnia, anxiety, tension headaches, stomachaches and more. This is one aspect of the mind-body connection that we often hear about.
What is rarely recognized, though, is that many of us make it through severe stress or trauma without experiencing overwhelming emotional distress. We do that by repressing…and not being aware of…those powerful and potentially overwhelming emotions. This may sound unhealthy, but it’s actually a miraculous coping mechanism—a gift of evolution—that allows us to focus on survival. Problem: Even though we are unaware of them, these powerful repressed emotions persist within us and can cause otherwise unexplained hormonal and other effects, such as elevation of SNS activity or inflammation, that can manifest sooner or later…even decades later…and they eventually can lead to all manner of chronic health conditions.
Here are examples of how these repressed emotions can fuel the development of medical conditions whose causes have otherwise remained poorly understood…
More than 100 million Americans have hypertension, a disorder that many incorrectly think is related to day-to-day stress. In most patients today, it can be attributed to genetics and/or poor health habits such as high sodium intake, being overweight and/or lack of exercise. But recent clinical observations suggest that long-repressed emotions can be the unsuspected cause in perhaps 5% to 10% of patients with any of three atypical forms of hypertension—paroxysmal (episodic) hypertension…severe resistant hypertension…and unexplained hypertension in young patients.
Real-life example: For five years, Cindy, age 56, had been experiencing sudden, severe headaches and skyrocketing blood pressure every few weeks. Despite multiple ER visits and physician consultations for her paroxysmal hypertension, no cause was found and antihypertensive drugs failed to prevent the recurring attacks.
When asked about her personal history at a doctor appointment, Cindy mentioned a divorce from a “drinker and drug user who never grew up.” Though happily remarried, she had spent years struggling as a single parent while working two jobs and finishing college. When asked if she ever cried or felt depressed during those tough years, she said, “Never”—she’d simply soldiered on.
Result: At her follow-up visit a month later, Cindy reported having cried every day about those tumultuous years. Remarkably, without medication, she has suffered no further hypertensive attacks.
Diagnosis: Repression of those emotions had served Cindy well, but ultimately they were causing her hypertensive attacks. Allowing herself to experience those emotions now, when her life was in order, enabled both emotional and physical healing.
Real-life example: A 48-year-old patient who suffered uncontrolled and severe “resistant” hypertension for many years experienced rapid normalization of her blood pressure after acknowledging for the first time in more than 30 years that she had been raped when she was 14. She obtained further counseling from a rape counselor.
Some patients with these forms of hypertension are able to heal even without psychotherapy. Others have found psychotherapy to be helpful in processing long-repressed emotions. Trauma-informed therapists are especially helpful—you can find one by doing an online search for “trauma-informed therapist near me.”
While emotional healing is the ideal outcome, many patients who have repressed trauma-related emotions might need to maintain that protective barrier of repression. For these people, getting in touch with those emotions is not an option, whether due to the severity of the trauma or turbulence in their current life…or simply because of the power of the barrier of repression.
Real-life example: David, a Holocaust survivor who was suffering from bouts of severe blood pressure elevation, insisted that he “was not affected emotionally” by that experience. The invisible—and necessary—barrier of repression was evident in his words. Fortunately, for someone like David, there is an alternative. A trial of treatment with an antidepressant to further distance the repressed emotions resulted in a complete cessation of his recurrent attacks. Two recent published studies have reported cessation of recurrent paroxysms in 80% to 90% of patients treated with an antidepressant.
Repressed emotions play an often-unrecognized role in other chronic medical conditions as well…
Real-life example: Robert, age 79, a retired widower and self-described optimist, came to my office for routine hypertension. He described a prior history of severe ulcerative colitis, a form of inflammatory bowel disease (IBD). Diagnosed at age eight, he had frequent diarrhea and gastrointestinal bleeding and had been hospitalized several times in his teens and 20s. He also explained that his mother had been highly critical of him as a child. The colitis ceased suddenly when he was 28, after he moved away from his mother and married. But his wife pointed out that every time his mother visited, his symptoms flared. Encouraged by his wife, Robert told his mother that if she didn’t stop criticizing him, she would no longer be welcome in his home. His mother stopped criticizing, and his colitis ceased…for good!
Many studies report a significant association between IBD and childhood abuse or trauma and also confirm the beneficial effect of treatment with an antidepressant. The connection: The gut and the brain communicate with each other via an information highway called the gut-brain axis, which is why nervousness can lead to stomach butterflies or diarrhea. This communication also may explain the link between repressed emotions and IBD.
If you have a disorder that might be linked to repressed emotions, consider exploring those emotions by yourself or with a psychotherapist. Understand that your mind did what you needed years ago to get you through a rough time. And today there is an opportunity to experience the long-repressed emotions and heal.
