Why Zebras Don’t Get Ulcers: A Book Review

Did you know most animals do not get ulcers? Or suffer these kinds of physical ailments from stress? To be honest I never really thought about this before reading this book. If you’re not familiar with Why Zebras Don’t Get Ulcers by Robert M. Sapolsky, I can’t say I’m surprised. I only heard about the book when I was taking an 8-hour online course during my practicum. But it sounded interested. The subtitle is The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping. If you have a chronic illness then this may be a good read to get some more understanding.

I bought it off of Amazon, but it should be available at your local bookstore or library as well.

What I liked about the book:
To start off, the subject matter is interesting. We hear a lot about how stress is involved with chronic illness, but how exactly does that work? That’s what this book aims to explain. It also gives anecdotes from the animal kingdom in every chapter, explaining how different animals react to stressors. The primary focus of the book is certainly on the physiological responses to stress, so there is a lot about the brain in their, with a touch of psychological responses (I would’ve preferred more). Overall it uses the biopsychosocial approach, which I definitely stand behind. There is also a chapter on stress-management, which is helpful.
The chapters are as follows: (1) Why Don’t Zebras Get Ulcers? (2) Glands, Gooseflesh and Hormones, (3) Stroke, Heart Attacks and Voodoo Death, (4) Stress, Metabolism, and Liquidating Your Assets, (5) Ulcers, the Runs, and Hot Fudge Sundaes, (6) Dwarfism and the Importance of Mothers, (7) Sex and Reproduction, (8) Immunity, Stress and Disease, (9) Stress and Pain, (10) Stress and Memory, (11) Stress and a Good Night’s Sleep, (12) Aging and Death, (13) Why is Psychological Stress Stressful? (14) Stress and Depression, (15) Personality, Temperament, and Their Stress-Related Consequences, (16) Junkies, Adrenaline Junkies, and Pleasure, (17) The View from the Bottom, and (18) Managing Stress.
If any of this sounds relevant to you, it may be worth checking out this book.

One of my stress management techniques (since childhood).

What I Didn’t Like About the Book: There are a few drawbacks to the book in my opinion. First, it’s pretty sciency. He does try to make it readable for lay people, but even with my masters in counselling psychology, I got a little overwhelmed by the neuroscience aspect of the book, which was a lot of it. So be prepared to wade through if you want to read it. The other thing I didn’t like was his use of language, which was very outdated. For example, he constantly referred to people with depression as “depressives,” which is stigmatizing and just not right in my opinion. He did this with other conditions as well. It brings up with the people first vs. illness first argument, which I’m not going to get into here, but it bothered me, as a person (and as a mental health professional).

Image from: https://theconversation.com/putting-nigerian-neuroscience-research-under-the-microscope-101396

Would I recommend it? Yes. Look, overall I think there is a ton of great and interesting info in there. Will it make you feel better? Not necessarily, but I’m all for having a better understanding of what’s going on in my body, that way I can take appropriate steps to help myself. For example, mindfulness has a large evidence base of helping with stress, and I therefore, practice meditation and other mindfulness techniques on a regular basis.

A mindful moment.

As I keep reading, I’ll keep sharing. And I hope you all keep making the most of it!

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Daily Mindfulness: Urge Surfing

Urges come in all shapes and forms. From substances to food to shopping online to letting our emotions overtake us. In this acceptance practice, we ride the waves of our urges without giving into them. Please read the disclaimer at the beginning of the video, and only partake in this practice if it is safe for you to do so. You are practicing at your own risk.

Keep making the most of it!

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Trauma and Chronic Illness

Today I want to talk about some of the work of Dr. Gabor Mate, because, well, I find it quite interesting. Dr. Mate is an addictions specialist, who has also worked as a family physician and in palliative care. Much of his work and research has been on that body-mind connection between mental health and chronic illness and substance use. He has a lot to say about stress, trauma, and coping and their relationship to chronic illnesses ranging from autoimmune diseases to neurological conditions to skin disorders to cancer. While I’m not sure that I necessarily agree with everything he says, a lot of it does make sense.

Dr. Gabor Mate
Retrieved from: https://californiahealthline.org/news/addiction-rooted-in-childhood-trauma-says-prominent-specialist/

The work of Dr. Mate I had heard of before but never looked much into. At my practicum, the other student at my site brought it up. She was interested in his work as someone who wants to work with people who use substances, and she thought I might also be interested as someone who is specializing in working with people with chronic illness (which is currently 40% of my case load!). She was correct that this would be interesting and helpful for my work as a psychotherapist. So let’s talk about some of this work. Dr. Mate asserts that there is a “pathway from stressful emotions, often unconscious, to physical disease” or to break it down slightly differently, “emotional stress if a major cause of physical illness.” Again, he’s talking about a wide range of illnesses, including autoimmune diseases and cancer. There are two parts of this that I found interesting doing some research (and there’s a lot more I want to do yet – there’s a whole book of his that’s on my to read list).

Image from: https://agelessgrace.com/5-ways-improve-body-mind-connection/

The first part is emotions themselves. For instance, Dr. Mate connects repressed anger to the development of autoimmune diseases. Basically, if you’re not letting your anger out (in an appropriate way of course) and instead, you’re holding it in, it bursts out, not in a fit of rage, but in a chronic illness such as RA or lupus and so on. Tied into this is emotional repression in general. So if you’re disregarding your emotions, whatever they may be, and holding them in, this can lead to illness as well. On his website Dr. Mate gives the example of Lou Gehrig and ALS (and according to Mate, every patient he has seen with ALS), who often disregarded both emotional and physical pain he was in throughout his life.

Image from: https://www.baseball-almanac.com/players/player.php?p=gehrilo01

The second part is trauma and trauma response. It is pretty well documented that people who endure trauma, especially early in life, will make adaptive changes either physically or psychologically, in order to survive. Childhood abuse is one often cited with this. It is also well documented that childhood trauma has a huge impact on adult physical and mental health. Dr. Mate states that trauma in another cause of the range of chronic conditions I’ve mentioned.

Image from: https://chronicillnesstraumastudies.com/chronic-illness-trauma-nervous-system/

So wait, does this mean that every person with pretty much any chronic conditions has either a history of trauma and/or a history of emotional repression? Not necessarily. I watched an interview with Dr. Mate, where the interviewer asked just that (because it’s a rather big claim). The response was that of course, this doesn’t apply to everyone, but it does apply to a large portion of this population. Interesting. So my thoughts on it are this: I have an autoimmune disease. I did not have any kind of significant childhood trauma (I have maybe what I’d call minor trauma) and I have usually been good at expressing my emotions (though I have gone through periods where I’ve been less likely to, those are usually short-lived). Basically, I’m not sure I fall into this category. I also know many other Spoonies who would not fall into this category. That being said, especially through my work as a therapist, there are many people who this does make sense for.

It’s not necessarily the case for everyone. Circa 1988/89.

My main takeaway from this is that to help heal from chronic illness (and I’m not saying cure), one really has to take care of their emotional health. See a therapist. If there’s trauma in your background, that likely needs to be worked through (also just in general for your mental health). If it’s emotional repression, then you need to start to learn to open up (part of my work as an acceptance and commitment therapist is to get people to allow their emotions to be there). The body and mind are connected so we need to treat them as such.

Image from: https://post.edu/blog/your-mind-matters-may-is-mental-health-awareness-month/

That’s all for this week. Until next week, keep making the most of it.

References:
https://drgabormate.com/culture-good-health/
https://drgabormate.com/topic/mindbody-health/

Pain Scales – The Enemy of Chronic Pain Warriors

Literally my least favourite question when I go into any doctor or specialist appointment is, “what is your pain like today?” or “on a scale of 1 to 10, 10 being the worst ever, how’s your pain right now?” To someone with chronic pain, these are the most useless, arbitrary questions. Here’s the thing, I understand why doctors and other healthcare professionals ask the question. They want to get a gauge on if your pain is better or worse than it has been in the past. It totally makes sense. However, there are a few things about chronic pain (and pain in general) that aren’t taken into account with this questions.

1. My perception of what a “10” is may be higher or lower than your perception of what that is.
2. I’m not always entirely sure what number I should give. Like really, what is the difference between a “6” and a “7”?
3. Often pain changes throughout the day, so just because I give it a “4” right now, doesn’t mean that it won’t be an “8” in half an hour.

Hm… I’m smiling and happy in both pictures and yet my pain is a “0” on the left, and a “7-8” on the right.

And yet, this is always the first question asked at any appointment. Sometimes I literally just want to say “I don’t know.!” How many of you feel this way to? Plus, sometimes there is this need to want to give a higher number so that the pain is taken more seriously and not just dismissed. Here’s the thing that healthcare professionals often miss – there are better ways to describe pain than using a 1-10 scale. For example, “what type of pain are you experiencing/do you experience?” “What times of day are worst for pain?” “What activities or circumstances do you notice more pain or less pain?” “Are there any points in the day when you feel little to no pain?” And so on. These questions are easier to answer, and honestly, give a more realistic perspective of my pain than me guessing at a number to give my doctor.

Just gonna throw in the random deer visiting a retirement home across the street from me.

The main model used in medicine (and psychology) right now is the biopsychosocial model (except sometimes doctors forget to use it when talking about chronic pain it seems). For those of you not familiar with this, it is the interplay between biological and psychosocial causes (or maintenance) of a medical (or psychological condition). When applying this model to chronic pain, we look at the biological causes of an illness or injury, and how psychosocial factors maintain or increase the physical sensations of pain. It’s that mind-body connection. Here’s an example: the hypothalamic-pituitary-adrenocortical (HPA) system in your brain has been associated with several chronic pain syndromes including fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, and MS. It is one of the biological causes of pain (though not necessarily the only). Psychological factors that can maintain or increase this pain include feelings of helplessness and hopelessness. Social factors and behaviours that maintain and increase pain include door diet and nutrition, lack of exercise, and substance use (including smoking). Stress is another major psychosocial factor associated with chronic pain. So, rather than asking what are pain is on a scale from 1-10, looking at these factors is likely more productive in both understanding and managing pain!

Image from: https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach
The paragraph on the biopsychosocial model is cited from this article.

Let’s talk about pain management. Whether you do this on your own, or with the help of your healthcare team, here are some ways to improve your pain management (because let’s face it, chronic pain is unlikely to magically go away):

• medication compliance – taking all medication as prescribed!
• addressing psychological factors – such as anxiety – this could be through relaxation and meditative techniques or even exercise, or going to see a psychotherapist
• utilizing interdisciplinary healthcare teams – do you have a family doctor? A specialist for your illness or injury? A psychotherapist? A physical and/or occupational therapist? Anyone else who can help you with your pain? (I also have a naturopath and chiropractor for example).

Make a therapist part of your healthcare team! We’re here to help!
(just noting that I’m a therapist-in-training right now)

For anyone reading this who is not a chronic pain warrior, please remember that pain isn’t in our heads, and telling us to just deal with it isn’t helpful. In fact it can be stigmatizing, and people with chronic pain always face stigma because of a lack of understanding. We may laugh, smile and have fun, and yet be in pain at the same time. The things are not mutually exclusive. I’m going to link a few episodes of my podcast that complement this post below. For now, keep making the most of it everyone!

Mental Health and Chronic Illness

The “I Suck” Feeling

Locating Our Inner Strength

How Stress and Anxiety Manifest in the Body

Holistic Approaches to Chronic Pain