Nearly 2 decades ago I was teaching a class on herbal medicine for women’s health to a small group of women gathered in my home. We were sitting comfortably in a circle on the living room floor, pillows supporting a few babies sleeping next to their moms, all of us with cups of tea in hand's reach, notebooks and pens open expectantly, and information flowing like water. An intimate feeling had developed over the course of the day. During a short late afternoon break, I was taking general questions. One participant, a young, well-put together mother of 3 in her early 30s, raised her hand. “Aviva, I wonder if you can make any recommendations for treating eczema. I keep having this flare and it’s really uncomfortable. I have no idea what to do to treat it naturally.”
In my usual relational manner, I asked her to tell me more. The words that fell out of her mouth landed like an elephant dropping into the room through some cosmic gaping wound in the universe. “I only get it under my wedding ring.”
Now the logical next question would have been to ask her about the metal in her wedding ring and whether she had any allergies to gold, platinum, or silver, or other metals. As a doctor, those would be the first questions I was trained to ask. “Why look for zebras when there are usually horses?” so the diagnosis expression goes. It’s a medical aphorism meaning, “common things are common.” Likely this was simply a metal allergy.
But her response was an elephant, not a horse or a zebra. And because I know that the human body has its own logic, I knew that this isolated, localized symptom was likely more than simply an allergy to a metal in her ring. As the famed Harvard neurologist Martin Samuels, with whom I once had the privilege of spending an hour learning from, said to me in response to a question he asked me directly, “Now, I know you are smart enough to know that there is no separation between mind and body!”
My student’s answer was pregnant. And her voice so quavering that I knew there was more to the story than explained by a reaction to the metal in her wedding ring. So I gently asked her if she’d prefer to wait until the class was over to chat privately, fully anticipating what she might need to share to give me more background on the symptom.
“No,” she said, “I’m comfortable discussing it here.”
Even more gently, and with all the care in my heart, I asked, “How is your marriage?”
The group seemed surprised by my singular and very personal question. I think they were just expecting me to offer her an herbal skin salve recipe. They had no experience with medical elephants.
As soon as the question escaped my lips, the floodgates opened. Her mouth quavered for a second, then tears flowed. Soon she was sobbing freely. The group, now starting to understand my question, responded intuitively and with care, moving in a little closer to support her. There was concern on the faces of this newly formed little community gathered for a day of learning. The woman to her right placed her hand gently on the sobbing student’s shoulder.
“About 6 months ago, shortly after our 3rd baby was born,” her words began pouring out like water from a dam where the levee had just broken after holding back too much weight for too long, “I found out my husband had been having an affair. For over year. That’s about when the eczema started – when I seriously started suspecting something. I’ve never had a skin problem before this. It’s taken me 6 months to get up the courage to leave him. The kids and I are moving back to my parents’ house next week. It’s over a thousand miles from here. I am leaving behind all my friends and support network, but I don’t know what else to do…I’m devastated. I just haven’t been able to admit that it’s over so I keep wearing this ring.” She was too gentile to say “this damned ring.” But I think that’s what she wanted to say.
Broken Heart Syndrome
While medical science might dismiss the notion that my student's symptom was caused by her marital stress, Western medicine does acknowledge one very specific stress-related condition. It’s called “broken heart syndrome.” Takotsubo cardiomyopathy, also referred to as transient apical ballooning syndrome because of the appearance of the heart on echocardiogram, or stress-induced cardiomyopathy, is a sudden temporary weakening of muscles in the heart that can be triggered by emotional stress, including the death of a loved one, a relationship break-up, or even chronic anxiety. It can eventually lead to serious heart disease including congestive heart failure and ventricular rupture, though most commonly it is transient, as the name suggests. The term Takotsubo means an octopus trap in Japanese, and is named such because the heart, in this condition, resembles the shape of one of these traps.
I had the rare experience of a first-hand encounter with a patient with Takostubo syndrome. I was on an emergency room shift in medical school when a 55-year-old Italian-American woman was brought into Yale New Haven Hospital by her son and daughter-in-law. They were in the car on their way home from my patient’s husband’s funeral after his sudden and unexpected death from a heart attack several days prior, when she began having chest pain, massive sweating, and hyperventilation, after which she passed out. They immediately brought her to the closest hospital. Upon her arrival we initially thought it was a psychosomatic stress response. And in the truest sense, it was. Her psycho-emotional state was causing her physical symptoms. And they were very real. Real enough for us to run the tests we use to confirm or rule out a heart attack. So real, in fact, that we saw evidence of her broken heart on her EKG and on her echocardiogram. She truly had a broken heart. Fortunately, as with most cases of this condition, she recovered – at least physically – after a few days of hospital care. Broken hearts can heal.
The Wound Reveals the Cure
Seasoned integrative practitioners know that the body can create some amazingly specific symptoms in response to personal stress. As one of my mentors, the late Jeanine Parvati Baker, a midwife and psychologist once told me, “The wound reveals the cure.”
Eczema is an inflammatory condition, often triggered by an allergen. The source of inflammation in my student’s life was her marriage – and it manifest under her wedding ring which had become the foci of her stress. She was experiencing a different form of broken heart syndrome. Less dramatic perhaps. Not apparent on an EKG. But one that no herbal salve – or even steroid cream – could have healed. She had prescribed her own cure for her broken heart. A divorce.
Being an integrative physician, I don’t just offer pills and capsules. I seek to understand my patient's life. I listening to the whole story of what is influencing her health. I pay close attention to the language a patient uses to describe her health – because in the story, sometimes in the very words a patient uses, can be powerful clues that guide me to both a diagnosis and a prescription. In retelling the story to the patient, a technique I use to confirm my understanding of her concerns and situation before I offer my assessment, remarkable insights can arise as my patient reflects on what she may have just said to me.
Some time ago I was taking care of a patient who came to see me for a number of health concerns, most notably, an autoimmune condition that was developing after a long period of out-of-control weight gain, sleep problems, stress, chronic anxiety, and a persistent skin rash. As part of my routine intake, I asked my patient about many aspects of her life from her diet and bowel habits, to her exercise and relaxation practices. Because all of these aspects of how we live can influence our inflammatory and immune responses. Upon me asking about her happiness and relationships she burst into tears and said, “My husband is a huge source of inflammation for me. I’m miserable.”
This particular patient had a BMI of nearly 35 – making her especially high risk for diabetes and heart disease. Her blood pressure on exam, and repeat exam, was exceptionally high. Was her marriage contributing to very real heart disease for her? Was her emerging autoimmune condition – an inflammatory state – a reflection of the inflammation she described in her marriage? She wanted to leave the marriage, reclaim her joy, and feel empowered and excited about life again. Now in her early 50s, with 2 children still in their teens and at home, she felt stuck. I'm all about seeing long-term marriages work out whenever possible. I suggested personal counseling, marriage therapy, and all the possible options I could think of to help her work it through to heal her marriage. But she clearly stated that she knew in her heart that she did not want to be with her husband anymore. She felt her marriage had run its course. Sometimes a divorce is a part of the prescription. For this particular woman it may be part of preventing heart disease. Quite literally, a potential lifesaver.
Preventing Heart Disease
I’ve been married for a long time. Nearly 30 years. I know full well that most long-term relationships, my own marriage included, can go through some very tough times. Sometimes these are short-lived. A fight that leads to few hours or days of nasty comments, glares, ordeafening silence. Sometimes there are profound issues and hurts to work through, and these can take months or more. I also know up close and personal, that when we’re in a rough patch, we suffer. We can’t focus as well, we don’t eat or sleep as well, and underneath it all, we can feel emotionally toxic because our worst rises to the top like a noxious gas when we engage in the negative interactions that infuse these deadlocks. There is a schism that develops between who we want to be and how we are being. This disconnect can lead us to feeling imbalanced, out of sorts, unwell. Marriage problems can lead us into all sorts of dynamics ranging from powerlessness and victim to abuser. It’s never good.
When a rough patch is past, it feels that a heavy cloud that has been hovering, with a ten-ton weight, has passed and like Dorothy seeing Oz, life regains full living color. I’m all for working on long-term relationships – when they work.
But too often, I see women stuck and suffering. The cloud doesn’t lift. The relationship takes a toll not just on the spirit, but also on the body. We gain weight, eating out of depression and stress. We lose weight because we can’t eat. Sometimes health conditions develop. Like eczema under wedding rings and autoimmune conditions. Some women live like this for their whole lives not knowing how to break free – either within or without the marriage. Many of us have mothers or grandmothers who did just this. And we wish we could have told them a divorce is ok. You deserve to be happy. To be healthy. Sometimes it’s not a marriage or long-term relationship we see a friend or loved one stuck in – it’s a job. Health problems can arise when we feel unhappy, disempowered, and stuck.
As a physician, a major part of what I do is prevent heart disease. My medical training taught me to do this primarily by controlling cholesterol, reducing blood pressure, and preventing diabetes – all important. But sometimes matters of the heart require looking past the obvious physical causes, for example, unhealthy fats and lack of exercise, or even inadequate folate leading to elevated homocysteine and increased intravascular inflammation, to emotional and even spiritual root causes. Sometimes deeper stressors are preventing a patient from eating well, sleeping restfully, and exercising. Sometimes in spite of the healthiest lifestyle, there is relationship unhappiness that is still affecting health. As with my student so long ago, I continue to create a safe space in which my patients can look deeply and honestly into how their life experiences might be affecting their health. It takes courage to do this. Because what I do know is that health requires taking care of our whole selves. This is not always easy. It can require great courage.
Courage means heart in Latin and is used to denote inner strength. Sometimes the wound reveals the cure.
To your total health, happiness, and courage.