We do not all mirror one another in how we are physiologically affected by social and interpersonal stressors or other external pressures. What, apart from inborn temperament, accounts for these individual differences?
A key factor is emotional development. Should {a} child ... require a further operation at twenty-five, she will no longer need her mother and father to hold her hand while the anaesthetic is administered. She will have enough self-regulation that neither her neurotransmitter activity nor her stress hormones would go out of balance without her parents' immediate proximity. We cannot take it for granted, however, that with chronological adulthood we automatically attain emotional independence. At any age, our responses to potential stressors are deeply influenced by the degree to which our emotional functioning continues to be dominated by our attachment needs, fears and anxieties.
According to the family systems theory articulated by the late American psychiatrist Dr. Murray Bowen, illness is not a simple biological event in a separate human being. A family systems view recognizes the moment-to-moment interrelatedness of the physiological functioning of individuals. Self-evident in the relationship of mother and fetus, this physiological interrelatedness does not end with birth or even with physical maturation. As we have seen, relationships remain important biological regulators throughout a whole life.
A fundamental concept in family systems theory is differentiation, defined as "the ability to be in emotional contact with others yet still autonomous in one's emotional functioning." The poorly differentiated person "lacks an emotional boundary between himself and others and lacks a 'boundary' that prevents his thinking process from being overwhelmed by his emotional feeling process. He automatically absorbs anxiety from others and generates considerable anxiety within himself."
The well-differentiated person can respond from an open acceptance of her own emotions, which are not tailored either to match someone else's expectations or to resist them. She neither suppresses her emotions nor acts them out impulsively. Dr. Michael Kerr... distinguishes between two types of differentiation: functional differentiation and basic differentiation. The two types may superficially appear to be identical, but from the perspective of health and stress they are worlds apart.
Functional differentiation refers to a person's ability to function based on his relationships with others. For instance, it may be that I can do my work well only when other people - my employees, my spouse, my children - can absorb my unresolved anxieties by putting up with my bad temper, unreliable habits, lack of emotional engagement, even abusive behaviour. Were they to reject the roles I assign them, I might fall apart. That would be an example of functional differentiation. On the other hand, if my ability to function is independent of other people's having to do my emotional work for me - that is, if I can remain engaged with others while staying emotionally open to them and to myself - then I would be said to have basic differentiation. The less basic differentiation a person has attained, the more prone he is to experience emotional stress and physical illness. {...}
Greater differentiation means better health. {...}
The less powerful partner in any relationship will absorb a disproportionate amount of the shared anxiety - which is the reason that so many more women than men are treated for, say, anxiety or depression. (The issue here is not strength but power: that is, who is serving whose needs?) It is not that these women are more psychologically unbalanced than their husbands, even though the latter may seem to function at higher levels. What is unbalanced is the relationship, so that the women are absorbing their husband's stresses and anxieties while also having to contain their own.
We recall that Nancy, wife of a man with ulcerative colitis, was exasperated at the stress triggered for her by her husband's obsessive an rigid controlling attitudes. (Chapter 10). Tim's disease has been in reasonable control over the years. Nancy has effectively absorbed much of his anxiety, but at her own expense. Nancy is now being treated for depression and anxiety and says she is nearing the end of her rope. "It has felt like I have another child," she says, "because he is very high maintenance. I now understand that I have four children I have been responsible for. I'm the parent for both of us. I've repressed my emotional needs for a very long time, without realizing it. It's frightening to think now that I wasn't even aware of that, until I had a mini-breakdown." If Nancy lets go of her one-sided nurturing role in the relationship, Tim may experience a flare-up of his colitis - unless he learns to take more emotional responsibility for himself.
The partner who must suppress more of his or her own needs for the sake of the relationship is more likely to develop physical illness as well - hence the greater incidence, for example, of autoimmune disease and of non-smoking-related cancers among women. "The existence of a mind-body link and a person-person link means that it is possible for an anxiety in one person to be manifested as a physical symptom in another person," Dr. Kerr writes. "As is the case with the emotional dysfunctions, the one prone to develop symptoms is the spouse who adapts most to maintain harmony in the relationship system."
Nature's ultimate goal is to foster the growth of the individual from absolute dependence to independence - or, more exactly, to the interdependence of mature adults living in community. Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well-self-regulated people are the most capable of interacting fruitfully with others in a community and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism's chances for long-term survival. Almost from the beginning of life we see a tension between the complementary needs for security and for autonomy. Development requires a gradual and age-appropriate shift from security needs toward the drive for autonomy, from attachment to individuation. Neither is ever completely lost, and neither is meant to predominate at the expense of the other.
With an increased capacity for self-regulation in adulthood comes also a heightened need for autonomy - for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or when the tested animal or human being feels helpless, without meaningful choices - in other words, when autonomy is undermined.
Autonomy, however, needs to be exercised in a way that does not disrupt the social relationships on which survival also depends, whether with emotional intimates or with important others...
The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus, the vulnerability to subjective and physiological stress will be proportionate to the degree of emotional dependence.
To minimize the stress from threatened relationships, a person may give up some part of his autonomy.... the loss of autonomy is itself a cause of stress. The surrender of autonomy raises the stress level, even if on the surface it appears to be necessary for the sake of 'security" in a relationship, and even if we subjectively feel relief when we gain "security" in this manner. If I chronically repress my emotional needs in order to make myself "acceptable" to other people, I increase my risks of having to pay the price in the form of illness.
The other way of protecting oneself from the stress of threatened relationships is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy. This coping style may avoid anxiety and block the subjective experience of stress but not the physiology of it. Emotional intimacy is a psychological and biological necessity. Those who build walls against intimacy are not self-regulated, just emotionally frozen. Their stress from having unmet needs will be high.
Social support helps to ameliorate physiological stress. The close links between health and the social environment have been amply demonstrated. {...]
For the adult, therefore, biological stress regulation depends on a delicate balance between social and relationship security on the one hand, and genuine autonomy on the other. Whatever upsets that balance, whether or not the individual is consciously aware of it, is a source of stress.
