When the Body Says No: The Cost of Hidden Stress (5 page)

All her life, until her illness, Jackie would hide her feelings from her mother. Hilary recalls a chilling childhood memory of Jacqueline’s intense expression and secretive whisper, “Hil, don’t tell Mum but … when I grow up, I won’t be able to walk or move.” How are we to understand that horrific self-prophecy? Either as something uncanny or as the projection of exactly how, in her unconscious depths, the child Jackie already felt: incapable of moving independently, fettered, her vital self paralyzed. And “don’t tell Mum”? The resignation of someone already aware of the futility of trying to convey her pain, fear and anxiety—her
shadow side—to a parent unable to receive such communication. Much later, when multiple sclerosis struck, all Jackie’s lifelong resentment toward her mother erupted in bursts of uncontrolled, profane rage. The docile child became a profoundly hostile adult.

As much as Jacqueline du Pré loved and craved the cello, something in her resisted the role of cello virtuoso. This virtuoso persona pre-empted her true self. It also became her only mode of emotional communication and her only way of keeping her mother’s attention. Multiple sclerosis was to be her means of casting off this role—her body’s way of saying no.

Jacqueline herself was incapable of refusing the world’s expectations directly. At the age of eighteen, already in the public eye, she was wistfully envious of another young cellist who was then experiencing a crisis. “That girl is lucky,” she told a friend. “She could give up music if she wanted to. But I could never give it up because too many people have spent too much money on me.” The cello enabled her to soar to unimaginable heights and it shackled her. Terrified as she was of the toll a musical career would take on her, she succumbed to the impositions of her talent and her family’s needs.

Hilary speaks of Jackie’s “cello voice.” Because Jackie’s direct means of emotional expression had been stifled early on, the cello became her voice. She poured all her intensity, pain, resignation—all her rage—into her music. As one of her cello teachers astutely observed when Jackie was an adolescent, she was forcing the instrument to express her internal aggression through her playing. When engaged in music, she was fully animated by emotions that were diluted or absent everywhere else in her life. This is why she was so was riveting to watch and so often painful to listen to—“almost scary” in the words of the Russian cellist Misha Maisky.

Twenty years after her childhood debut, now ill with MS, Jackie told a friend what she had felt on first finding herself on stage. “It was as if until that moment she had in front of her a brick wall which blocked her communication with the outside world. But the moment Jackie started to play for an audience, that brick wall vanished and she felt able to speak at last. It was a sensation that never left her when she performed.” As an adult she was to write in her diary that she had never known how to speak in words, only through music.

Her relationship with her husband, Daniel Barenboim, dominated the last phase of Jacqueline du Pré’s life before multiple sclerosis ended her cello playing. A charming, cultured and cosmopolitan Argentine Jew who had grown up in Israel, Barenboim by his early twenties was a supernova in the international musical galaxy. He was a sought-after concert pianist and chamber musician and was also making a name for himself as a conductor. When du Pré and Barenboim met, the musical communication between them was spontaneously electric, passionate, even mystical. A love affair and marriage were inevitable. It seemed a fairy-tale romance; they became the glamour couple of the classical music world.

Unfortunately, Jackie could no more be her true self in her marriage than in her family of origin. People who knew her well soon noticed that she spoke with a curious, “indefinable” mid-Atlantic accent. This unconscious adoption of her husband’s mode of speaking signalled the merging of her identity with that of another, more dominant personality. Hilary writes that once more Jackie was fitting herself to someone else’s needs and expectations: “The wide-open spaces of her personality had little chance for expression except through their music-making.
She had to be the Jackie the circumstances demanded.”

When her yet-undiagnosed progressive neurological disease began to cause serious symptoms like weakness and falling, she followed a lifelong pattern of silence. Rather than alarm her husband, she hid her problems, pretending that other causes had slowed her down.

“Well, I can only say that it doesn’t feel like stress,” Jackie said one time, early in her marriage, when Hilary asked how she coped with the strain of both a personal and professional relationship with her husband. “I find myself a very happy person. I love my music and I love my husband and there seems to be ample time for both.” A short while later she fled husband and career. She came to believe that her husband stood between her and her true self. She briefly left the marriage, acting out her unhappiness through a sexual affair with her brother-in-law—a further example of her uncertain boundaries. Deeply depressed, for a while she wanted nothing to do with the cello. Soon after she returned to both marriage and music, she was diagnosed with MS.

Jacqueline du Pré’s cello voice remained her only voice. Hilary called it her sister’s salvation. It was not. It worked for audiences, but it
did not work for her. People loved her impassioned music making, but no one who mattered ever truly listened. Audiences wept and critics sang her praises, but no one heard her. Tragically, she, too, was deaf to her true self. Artistic expression by itself is only a form of acting out emotions, not a way of working them through.

After her sister’s death, Hilary listened to a 1973 BBC tape of the Elgar concerto, with Zubin Mehta conducting. It had been Jackie’s final public performance in Britain. “A few moments of tuning, a short pause, and she began. I suddenly jumped. She was slowing the tempo down. A few more bars and it became vividly clear. I knew exactly what was happening. Jackie, as always, was speaking through her cello. I could hear what she was saying…. I could almost see tears on her face. She was saying goodbye to herself, playing her own requiem.”

  A
PERENNIAL GIVE-AND-TAKE
has been going on between living matter and its inanimate surroundings, between one living being and another, ever since the dawn of life in the prehistoric oceans,” wrote Hans Selye in
The Stress of Life.
¹
Interactions with other human beings—in particular, emotional interactions—affect our biological functioning in myriad and subtle ways almost every moment of our lives. They are important determinants of health, as we will see throughout this book. Understanding the intricate balance of relationships among our psychological dynamics, our emotional environment and our physiology is crucial to well-being. “This may seem odd,” wrote Selye. “You may feel that there is no conceivable relationship between the behaviour of our cells, for instance in inflammation, and our conduct in everyday life. I do not agree.”
²

Despite the intervening six decades of scientific inquiry since Selye’s groundbreaking work, the physiological impact of the emotions is still far from fully appreciated. The medical approach to health and illness continues to suppose that body and mind are separable from each other and from the milieu in which they exist. Compounding that mistake is a definition of stress that is narrow and simplistic.

Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup
or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary.

For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaninglessness. People may become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed. To such persons stress feels desirable, while the absence of it feels like something to be avoided.

When people describe themselves as being stressed, they usually mean the nervous agitation they experience under excessive demands—most commonly in the areas of work, family, relationships, finances or health. But sensations of nervous tension do not define stress—nor, strictly speaking, are they always perceived when people are stressed. Stress, as we will define it, is not a matter of subjective feeling. It is a measurable set of objective physiological events in the body, involving the brain, the hormonal apparatus, the immune system and many other organs. Both animals and people can experience stress with no awareness of its presence.

“Stress is not simply nervous tension,” Selye pointed out. “Stress reactions do occur in lower animals, and even in plants, that have no nervous systems…. Indeed, stress can be produced under deep anaesthesia in patients who are unconscious, and even in cell cultures grown outside the body.”
³
Similarly, stress effects can be highly active in persons who are fully awake, but who are in the grip of unconscious emotions or cut off from their body responses. The physiology of stress may be triggered without observable effects on behaviour and without subjective awareness, as has been shown in animal experiments and in human studies.

What, then, is stress? Selye—who coined the word in its present usage and who described with mock pride how
der stress, le stress
and
lo stress
entered the German, French and Italian languages respectively—conceived of stress as a biological process, a wide-ranging set of events in the body, irrespective of cause or of subjective awareness. Stress consists of the internal alterations—visible or not—that occur when the organism perceives a threat to its existence or well-being. While nervous
tension may be a component of stress, one can be stressed without feeling tension. On the other hand, it is possible to feel tension without activating the physiological mechanisms of stress.

In searching for a word to capture the meaning of the physical changes he observed in his experiments, Selye “stumbled upon the term
stress
, which had long been used in common English, and particularly in engineering, to denote the effects of a force acting against a resistance.” He gives the example of changes induced in a stretched rubber band or in a steel spring under pressure. These changes may be noted with the naked eye or may be evident only on microscopic examination.

Selye’s analogies illustrate an important point: excessive stress occurs when the demands made on an organism exceed that organism’s reasonable capacities to fulfill them. The rubber band snaps, the spring becomes deformed. The stress response can be set off by physical damage, either by infection or injury. It can also be triggered by emotional trauma or just by the threat of such trauma, even if purely imaginary. Physiological stress responses can be evoked when the threat is outside conscious awareness or even when the individual may believe himself to be stressed in a “good” way.

Alan, a forty-seven-year-old engineer, was diagnosed with cancer of the esophagus—the swallowing tube that carries food from the throat to the stomach—a few years ago. He spoke of “good stress” when he described the relentless, self-driven existence he had led in the year before he was diagnosed with his malignancy. That “good stress” not only helped undermine his health, but it also served to distract him from painful issues in his life that were themselves constant sources of ongoing physiological disturbance in his system.

Alan’s lower esophagus has been removed, along with the upper portion of the stomach where the tumour had invaded. Because the cancer had spread to several lymph nodes outside the gut, he received five courses of chemotherapy. His white blood cells became so depleted that another round of chemo would have killed him.

A non-smoker or drinker, he was shocked by the diagnosis, since he always considered that he lived a healthy life. But he has thought for a long time that he has a “weak stomach.” He often suffered indigestion and heartburn, a symptom of the reflux of stomach acid into the esophagus.
The lining of the esophagus is not designed to withstand the corrosive bath of hydrochloric acid secreted in the stomach. A muscular valve between the two organs and complex neurological mechanisms ensure that food can move downward from throat to stomach without permitting acid to flow back upward. Chronic reflux can damage the surface of the lower esophagus, predisposing it to malignant change.

Not being one to complain, Alan had only once mentioned this problem to doctors. He thinks fast, speaks fast, does everything fast. He believed, quite plausibly, in fact, that his habit of eating on the run was responsible for the heartburn. However, excessive acid production due to stress and disordered neural input from the autonomic nervous system also play a role in reflux. The autonomic part of the nervous system is the part not under our conscious control, and—as the name implies—it is responsible for many automatic body functions such as heart rate, breathing and the muscle contractions of internal organs.

I asked Alan if there had been any stresses in his life in the period preceding the diagnosis. “Yes. I had been under stress, but there are two kinds of stress. There is stress that is bad and stress that is good.” In Alan’s estimation the “bad stress” was the complete lack of intimacy in his ten-year marriage to Shelley. He sees that as the main reason the couple have not had children. “She just has some very serious problems. Because of her inability to be romantic, intimate and all the things that I need, my frustrations with our marriage were at their absolute peak at the point I got the cancer. I’ve always felt that that was a really major thing.” The “good stresses,” in Alan’s view, came from his work. In the year prior to his diagnosis he worked eleven hours a day, seven days a week. I asked him if he has ever said no to anything.