Understanding the intricate relationship between emotional trauma and its physiological manifestations is a vital variable to consider when thinking about how we approach the treatment, management, and impact of diseases. The connection between what happens inside our bodies as a reaction to what happened to us, such as the connection between stress, trauma, emotional repression, and disease, has been extensively researched in scientific study.1,2 Psychoneuroimmunology is a discipline that studies the relationship between the brain, nervous system, and the immune system, which identifies an individual as “a complex product of cognition, emotion, and other central nervous system (CNS) functions”.3 Therefore, it is imperative to have a holistic approach when it comes to healing. When we look specifically at autoimmune diseases, we see that 80% of patients who are diagnosed are women. This compels us to investigate the question: is a woman’s social conditioning to prioritise duty over her needs increasing her chances of developing an autoimmune disease?4
Gendered Relationship of Chronic Stress and Autoimmune Diseases
Autoimmune diseases occur when instead of defending the body against diseases, the immune system starts attacking its own healthy tissues, cells, and organs. The most well-known autoimmune diseases are type 1 diabetes, multiple sclerosis, lupus, and rheumatoid arthritis.5 The majority of scientific research suggests that chromosomes and drastic hormonal shifts are major contributors to autoimmune diseases in women.6 Doctors believe that drastic hormonal shifts such as menopause or childbirth lead to inflammation, adding stress to the body and leading to an exaggerated response by the immune system.6 While that is scientifically accurate, the New York Times bestselling author, Dr Gabor Mate in his book ‘When The Body Says No’ highlights how physiologically, emotions too are “electrical, chemical, and hormonal discharges of the human nervous system.”7 He emphasises the connection between our major organs and our emotions, as well as the influence they have on our body’s physical state.7 In his article ‘Mental Health: The Inflammation Connection’, my colleague Peter explores the association between early life trauma and chronic inflammatory conditions such as arthritis.8 Drawing a connection between inflammation, and autoimmune diseases, in this article I will explore how the gendered training of women to repeatedly prioritise the needs of others over taking care of themselves leads to self-abandonment and can cause extreme stress. This can then push the body towards inflammation, diminishing the immune system and potentially transmuting it into an autoimmune disease.
Woman’s Gender Role
Humans have been traditionally categorised into two primary genders: male and female. Infants learn the societal norms associated with ‘masculinity’ and ‘femininity’ through the various institutions they interact with. This often starts with training from their family on specific and binary ways of expression, such as what clothes they wear and the toys they are allowed to play with.9 While we are witnessing a shift towards a more inclusive approach towards gender, these traditional gender roles still hold western culture within a firm grip. The expectations and assumptions remain that masculinity is the embodiment of strength and provision while femininity is about being submissive and nurturing.
It is no secret that women are raised to be more likeable, agreeable, and selfless than men. People-pleasing refers to the “habitual act of putting others’ needs above one's own, and is typically a reflexive coping mechanism, learned in early life”.10 Chronic people pleasing involves suppression of one’s emotions, lack of boundaries, perfectionism, and loss of self. Dr Mate identifies people pleasing as a trauma response which causes stress and explains that the mere prospect of conflict can trigger the response without an external stressor present.7 He discusses in detail the inescapable pattern of the repression of healthy anger among people with autoimmune diseases such as multiple sclerosis; when a body repeatedly prioritises other people’s needs over its own, it is creating stress for itself.7 This stress caused by the need of others’ approval negatively affects the body’s defence, causing it to become its own destroyer instead of being its protector.7 Research on personality types of people with amyotrophic lateral sclerosis (ALS) has also suggested the existence of underlying people pleasing tendencies among ALS patients, especially in female respondents.11
Conclusion
It is imperative to have scientific testing such as blood tests and cardiograms to understand autoimmune diseases, but investigating a patient’s life experience and past trauma is just as crucial for their healing.7 The brain is a part of the body and, therefore, when we talk about treatment, the healing of the mind and body should not be considered independently. The patient’s whole experience as a human – their trauma, relationships, and circumstances matter and require us to have a broader view of diseases. It does not mean blaming patients for their disease but applying curiosity, looking at their human experience, and questioning the systemic social institutions of society. The evident gender bias in the prevalence of autoimmune diseases makes one wonder if there is a systemic failure in how we train our girls to operate in society.
As new therapies arise with the increase in research about psychoneuroimmunology and the immune to brain pathway, effective communication will be one of the foremost challenges. At TVF we always strive for strategic excellence for our clients, while always keeping the patient and their lived experiences front of mind.
By Ishita Sharma
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