Samuel J. Mann, M.D., presently associate professor of clinical medicine at the Hypertension Center of New York Presbyterian Hospital - Cornel Medical Center has formulated a theory of why many of us have developed essential hypertension. The prefix means that its cause is unknown.
Healing Hypertension contains chapters and material about the physiology/physicality of various types of high blood pressure as well as information about medication. This review, however, will be limited to the author's hypothesis of its psychological origins.
Although many researchers have theorized that high blood pressure is the result of emotional stress, Dr. Mann writes that the real answer is more complicated than that. He believes that the real source of such hypertention is from repressed early trauma. The emotions we feel, no matter how stressful, do not cause our high blood pressure to remain upwardly fixed. Rather, it is the emotions we don't feel - the ones we automatically squirreled away from access by our conscious mind, during our infancy and childhood, which hold the key to the real origins of this very common disease.
I dare to say it happened even earlier than when the author believes. Incredibly, it begins during traumas at birth and inutero which also was when our personality was created. Sounds kooky, doesn't it?
I will repeat again , as the author often repeats, that the emotions we feel in the here and now, are not the cause of essential hypertension. It's the emotions we don't feel, the ones we don't even know we have; these are the feelings which cause our hypertension.
In a chapter on high blood pressure included in a recent book written by his colleague, Dr. John E. Sarno, (The Divided Mind), Mann writes that we're in a catch-22 predicament as "(t)oo little attention has been paid to what the conscious mind cannot report." (p. 226)
Appropriately enough, Sarno correctly recognizes the feeling component of this early repressed material is typically severe early rage (See on this website, a review of The Divided Mind - The Epidemic of Mindbody Disorders ).
Dr. Mann believes that sometimes simple empathetic listening to what his patients are saying has helped some uncover their repressed emotions. He soon learned that just because his patients did not feel that they were upset did not mean that that they were without early traumas hidden away from their conscious mind. He writes that, to the contrary, these patients were some who had the most powerful emotions, which became inaccessible because they were sometimes too powerful and (too hurtfully disturbing) to be processed when the trauma originally happened.
Very few of Mann's patients had originally believed that their early traumas were the source of their present misery and symptoms, but then I think that Dr. Mann might not believe that the original traumas are even earlier than he presumes! Invariably, even when his clients are able to remember some aspects of their traumatic events, they often felt that the hurts had long ago been put "behind them."
The author has found that all of us share a history of early traumas, but that their presence is often overlooked, denied and defended against. One way we can defend against their surfacing is by rationalizing away their existence. By doing so, we conceal them from both ourselves and others. In some, there may be an inborn susceptibility to hypertension and when added to repressed traumas the pain becomes more easily expressed as symptoms.
Developmental psychologist, Bruno Bettelheim, is quoted: "What cannot be talked about can also not be put to rest; and if it is not, the wounds continue to fester from generation to generation." But to dispell the effects we need more than just talking about what happened to us - we need to feel the traumas themselves. Talking about and thereby acknowledging our feelings, however, is the first step.
In Chapter 9, Hidden Emotions in Other Disorders, Dr. Mann discusses irritable bowel syndrome, colitis, insomnia, migraine, back pain, heart arrhythmias and chronic fatigue. While he does not recognize these disorders as originating in birth and intrauterine traumas, he does attribute their source as early repressed trauma. And as those with essential hypertension, he believes that recognized emotions are not their real source. He writes of another catch-22 position: ". . . emotions we do not feel can provide an explanation, but physicians rarely consider them." (p. 115)
Blood pressure can rise when we are discussing a topic which upsets us even when we don't feel or acknowledge the upset. This is because our brain can often protect us from even feeling any discomfort. (Dr. Arthur Janov writes in a number of his books, that some, because of porous defenses, do indeed feel the upset and the discomfort or acting-in behavior which is often what brings them into psychotherapy).
In describing some individuals, undergoing clinical testing, Dr. Samuel J. Mann quotes from James Lynch's, Language of the Heart,
One chapter in Healing Hypertension, is entitled, The Enigma of Episodic Hypertension, and discusses hypertensive attacks which seemingly arise "out of the blue." I believe this mystery can be solved merely by thinking of defenses as likewise episodic, being triggered responses to life's upsets. This allows variability to defenses and hence to symptoms. Dr. Mann does not consider this explanation for a sudden hypertensive effect and instead considers its occurrence as a "medical mystery."
But how can you tell if your particular hypertension is or is not related to repressed trauma? An important guide is to notice if you are able to be emotionally involved in your close, intimate relationships.
The source of the material in this paragraph is not from the author of the book. It's from me, the author of this book review. Are you shutting down? avoiding sex? have an urge to 'get out'? need 'room to breathe'? Oftentimes relationships trigger early unconscious memories. (Remember, the word trigger does not refer to cause!) If you feel distress commensurate or in proportion to the situation you are in is evidence that your hypertension is not from hidden emotions. Overreaction or underreaction is a key to naming the hypertension as essential - as psychosomatic, and not, for example, from a kidney tumor.
Another way of expressing this idea is that if you stay on an even keel perhaps your hypertension is not related to repressed trauma, but not necessarily so, because the level of your defenses must be taken into consideration once again. However, the author does not write about this aspect of the problem. Summing up: If you are keeping your wits when everyone else is losing theirs, well . . . you just might have some repressed early trauma. You could be inappropriately shut down and therefore just don't feel what is happening. And conversely, losing your wits when others are keeping theirs may also presents evidence that your hypertension is of mindbody origin.
Sometimes we need an emotional jolt to begin our emotional healing -- like a spouse threatening to leave - that will do it! If you are feeling well and enjoying life you will have no incentive to explore your repressed early feelings. And its more difficult then because your defenses are more encased. More often than not, suffering is needed to begin the healing process. Without sufficient psychological or somatotropic pain, we may never begin the exploration path as we will lack an incentive to do so. That's unfortunately so.
It is only when we begin to explore our past hurts that we will begin to understand why we originally hid this material (from ourselves). Someone could enter a deep feeling therapy for the sole reason of examining the origins of his personality, or because he is interested in learning about the unconcious determinants of his motivations and behaviors, but that would be very untypical. With support, in therapy, we become able to handle these avalanches of feelings by giving them permission to connect to our conscious mind. Feeling the repressed material eventually will take away their energy to affect our blood pressure and a host of other conditions. For some, it can take decades.
What kind of therapy? Choose a deep experiential type of therapy.
Dr. Mann does not claim that the process of uncovering hidden emotions is easy. It is painful and many prefer not to feel what is pressing for release by becoming conscious. Indeed, as it was mentioned, because of one's defenses, many don't even know the pain is there.
The distress we feel in the present becomes re-connected to our past, as one actually regresses in time to the age when the hurt was experienced. It is not comfortable, but bearable as we did not die the first time we repressed these memories and neither will we die by feeling them in the very same young ego-state when the feelings were originally repressed. We're adults now and can tolerate the discomfort; knowing the truth in the here and now will not kill us. But I'll admit, getting there can be scary! I realize that I'm always reluctant to attend therapy sessions - willing, but at times, hesitant.
The presence of a "witness" when we access these heretofore blocked pains will help us immeasurably to process and deepen these newly loosened memories. Most of us cannot feel these revelations without such help. We're social beings so its difficult or impossible to feel our early hurts without another's support of our journey into ourselves. The author writes, "To heal, we need to know at a gut level, that we can handle our difficult emotions, and then choose to face them." (p. 170) Unfortunately, the final catch-22 which stops us from our journey into these unmapped areas of our brain because "(m)any people will not accept that they harbor and are affected by emotions they do not feel." (p. 187)
"Even while their blood pressure surged into hypertensive ranges, and their hearts began to pound rapidly, many of these individuals appeared absolutely calm, typically smiling as they spoke . . . It appeared that the greater the cardiovascular change when one spoke, the less likely was one to report being aware of any internal changes whatsoever."