The first time we traveled to Cuba, we went hiking around a lush, thickly forested rural township. It was one of the areas that had been very intentionally replanted with all sorts of tropical trees and flowering plants, after having been savagely razed and devastated by decades of colonial sugar cane traders in the nineteenth and early twentieth centuries. Now it was gloriously alive with exotic birds, fragrant, spectacular flowers, and even some goats. I was entranced. We happened to meet a young doctor on our path, and chatting with him, I learned a bit about Cuba’s health care system. He was on his way back from making a home visit.
Much of Cuba’s routine medical care, as he described it, is delivered via home visitation. He proceeded to explain to me, “When we examine people’s health, we want to see the whole picture: work-life balance, emotional tone, how family members relate to each other, how they treat their children, how they treat their pets,” and so on. All sorts of quality-of-life factors: mental, emotional, and relational together – comprised their holistic assessment of general health; Cuban healthcare is clearly more than calculations of numbers, weights, and measures hurriedly taken, scored, and typed into electronic charts. I was reminded of that brief exchange while listening to the keynote delivered by luminary physician and best-selling author Gabor Maté at TRF’s 34th Annual International Trauma Conference last month in Boston. Maté was without question the high point of the conference for me.
As he began his talk, Maté wryly took an informal poll of the conference audience, inquiring as to how many of us in the past year had been asked questions similar to those in our various medical appointments, routine, or otherwise; questions that would have included the whole person in a medical exam. Barely a handful of us in the packed auditorium responded with “yes.” What a contrast! And, here we are in a time of alarming and many-faceted western medical crises. I am not referring to COVID, or the opioid epidemic, which are copious topics in themselves, but rather some of the other rampant complaints and illnesses: diabetes, a spectrum of autoimmune disorders, and of course, cancer. How narrowly, hurriedly, and superficially we view the human organism.
Those of us who work with trauma, particularly developmental trauma, and neglect, are all too accustomed to seeing and hearing of seemingly savage dismissal and neglect from all manner of autoimmune complaints. Many of them are unspecific and nameless, and I have routinely heard of patients hearing that their pains and ailments are “all in their heads,” slapped onto psych meds, and/or scooted off to psychiatrists or therapists like us. Patients are not only not helped but shamed, blamed, and confused by such mistreatment.
However, Mate’s talk (and his recent bestselling book, The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture) went far beyond naming and describing the embarrassment of today’s western healthcare system; he made some profoundly interesting connections that I for one, had never heard nor considered before, and that makes so much sense.
The emotional system in mammals develops before cognition in the brain and body, rooted in survival. Emotional expression is designed to attract what is needed and to exclude what is toxic, harmful, or dangerous. Anger is a signal or demonstration of boundary protection when something or someone threatening gets too close. It is a way of ejecting or blocking the entry of what is unwanted. Similarly, joy and love are means of drawing in what is nourishing and safe.
The immune system is designed to impede the entry of what is harmful and toxic and to encourage what is healthful and life-sustaining. In effect, the emotional and immune systems and functions are identical. They are a pair of twins, or as the Cubans say, “two wings of the same bird.” I had never drawn nor even heard of that exquisite parallel before.
No wonder the traumatized, with a thwarted capacity to cry or yell, who cannot fight and successfully keep danger out, are bombarded not only with the familiar variations of dysregulation but with disabling, even disfiguring agents of poison and disease. And the numbers of women, people, and especially women of color, are staggering and dramatically higher than their male, white, and more privileged counterparts. So, we trauma therapists have our work cut out for us, even more than we knew. We must be able to recognize and legitimize not only the emotional expressions but the bodily counterparts of an overwhelming experience, help our clients and patients give them a voice, and also find and familiarize ourselves with medical allies who “get it” and who like Maté will teach, hear and treat the cry. Thank you, Dr. Maté, and thank you to the creators of the Conference, who continue to enlighten and assist us all!