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.
-Dr. Gabor Mate
I can fully attest to these words.
Being both a recovering people-pleaser and someone living with a chronic illness, I am the prototype of which Dr. Gabor Mate speaks of.
In 2012 I developed an autoimmune disease that turned my entire life upside down and that sent me on a quest to understand what caused this life-altering illness to appear.
What eventually led me to look at how I responded to the stressors in my life and their impact on my body was the fact that the onset of my disease, at the age of 36, made no sense at all.
There was no family history of autoimmune disease or genetic factors, and my own DNA testing had revealed a decreased risk for development of such conditions.
Add to that the fact that I led one of the healthiest lifestyles possible (going so far as switching careers - from microbiologist to personal trainer and yoga teacher as a result of my passion) and you can see why I've been in pursuit of answers to my situation.
After years of poring over scientific journals, deep self-inquiry and reflection, along with the ongoing experience of living with disease, I began to see a link between these two seemingly disparate topics, people-pleasing and chronic illness.
Let's begin with a brief definition of each.
People-pleasing is the habitual act of putting others needs above one's own, and is typically a reflexive coping mechanism, learned in early life. It is marked by automatic suppression of emotions, inhibition of self-expression and assertiveness, along with a genuine difficulty saying 'no'.
For a list of signs you may be a people-pleaser, visit here.
Chronic illness, on the other hand, is any condition or disease that is not curable and that persists for a long time.
Some examples of common chronic illnesses include diabetes, fibromyalgia, multiple sclerosis (MS), chronic fatigue syndrome (CFS/ME), irritable bowel syndrome (IBS), Crohn's disease, rheumatoid arthritis (RA), etc.
Chronic illness can also apply to those dealing with cancer, or experiencing recurring bouts of depression and anxiety, and although these conditions are not normally thought of as 'chronic', the term does apply.
So how can these two seemingly disparate topics, people-pleasing and chronic illness, possibly be linked?
For the answer we need to look at how people-pleasing increases the chronic stress an individual experiences and how that, in turn, impacts physical health.
The inability to say 'no', suppression of emotions, and a continual pressure to do things one doesn't want to do, are all highly stress-inducing - whether one feels stressed or not.
Some of the ways a people-pleaser tries to care for others is by hiding their own distress and never directly expressing anger.
They do this in an attempt to preserve 'the peace' in family, work or social situations.
They also try to lessen the burden on others by ensuring they are always self-sufficient, never 'needy', and stoic at all times.
These tendencies also make it more likely that one will find themselves in situations where their 'niceness', and propensity for being 'overly accommodating', is exploited.
This means that people-pleasers tend to carry a double load - the stress of suppressing their own emotional states, coupled with the added onus of looking after other's emotional needs rather than their own.
All this, takes a toll on the body.
It is this repeated activation of the stress response, multiplied over years and decades, that can have harmful effects on the body and contribute to disease.
How are the immune system, hormonal system, nervous system and stress apparatus directly impacted by emotions?
The link becomes clear when one sees these not as four separate systems, but as one big super-system, also known as the PNEI (psycho-neuro-endocrino-immunology) system.
Within this super-system, there is a constant dialogue between the emotional centers of one's brain, situated in the prefrontal cortex, and their immune, hormonal and autonomic nervous systems.
The relationship between psychological processes and physical health is highly complex and connected via a number of pathways, yet the key takeaway remains the same: it is impossible to separate emotions from hormones, or immune and nervous system function. To do so would be like trying to separate a wave from the ocean.
In other words, when you impact one area, you affect all the others.
The result can be hyper-activation of the immune response but not only that; chronic stress can also manifest as immunosuppression and a decreased activity of the immune response.
One simple example of how chronic stress can negatively impact the body is by looking at two of the key stress hormones: cortisol and adrenaline.
In the short term, these hormones offer a protective function, increasing our heart rate and releasing glucose into our bloodstream, allowing us to 'fight or flee' danger…
These same stress hormones, if chronically elevated, can be harmful and damaging.
The good news is that the medical and scientific communities have begun to realize that the functions of our different organ systems do not work in silos, and that the psychosocial component of an individual's life plays an equally important role in one's health and ultimate well-being.
It's also important to understand that there is never just one cause for an illness to arise.
Chronic stress, by itself, does not cause disease; if it did, every human would be ill, however experiencing stress chronically means you are more likely to develop physical illness.
It is chronic stress, not people-pleasing per se, that undermines health and increases the risk of illness.
So, what does all this mean for the self-professed, recovering people-pleasers like myself?
Are we doomed to being more susceptible to disease because of our self-sacrificing ways?
The answer is no, we are not destined to a stress-prone life.
Change is possible, but it's not as simple as saying 'no' or selecting a different response when faced with the choice of choosing self over others.
It requires time, awareness and work to rewire lifelong emotional patterning and to alter the non-conscious physiological components of 'yes' behaviour.
Be sure to sign up to on top receive the next article in this series where I'll be delving further into this topic and discussing The Science Behind Your Difficulty Saying 'No'.