November 22, 2001
Oy Vey Iz Mir!
People who keep emotions inside can make themselves sick.
"But mom, I feel too sick to go to school today. My tummy hurts, my throat hurts, I feel hot," moans 7-year-old Adam. His mother kisses his forehead and replies, "Adam, you feel cool as a cucumber! You're probably not sick, you're nervous about making friends at your new school. But I shouldn't take any chances; there is a bug going around. You can have the day off. Maybe I'll take you to the doctor."
Perhaps this is where it all starts, in second grade. I've been a doctor for more than a dozen years now, and a Jewish doctor at that. I've treated people from dozens of countries and countless cultural backgrounds. Over the years I have noticed that Jewish people suffer disproportionately from painful conditions that are ultimately tied to their emotions.
Research supports the concept that Jewish people are more likely to suffer from some psychological conditions, and less likely from some other disorders, than the general population. An article from the Israeli Journal of Psychiatry and Related Sciences, published in 1989, reviews studies that show a lower prevalence rate of schizophrenia, but a higher level of neurosis than non-Jews. The authors also conclude, "Jews tend to internalize aggression."
The relationship of alcohol abuse and psychiatric conditions as it varies among ethnic groups is quite interesting. An article in the American Journal of Drug and Alcohol Abuse in 1989 describes a study of drug and alcohol intake for Jewish and Christian men at UC San Diego. Christian men were more likely to report alcohol-related problems than were Jews.
In a more recent report in the Social Psychiatry and Psychiatric Epidemiology Journal from 1992, data showed that the overall lifetime rate of psychiatric disorders among Jews did not differ from non-Jews. However, Jews were more prone to depression. An article in the American Journal of Psychiatry published in July, 1997, noted that Jewish males had higher rates of major depression than Catholics and Protestants. But, again, rates of alcohol abuse/dependence were lower in the Jewish population and inversely related to rates of major depression.
What's interesting about these studies is that they point out that Jews seem to suffer a higher rate of neurotic illness, more depression and less alcoholism. Of course, this could represent a genetic tendency. However, no one has demonstrated that Jews share the Asian tendency to have a lower level of an enzyme that breaks down alcohol in the system. No one has yet discovered the depression gene or a gene therapy for it, so perhaps we should think about the role of Jewish culture.
It's possible that over centuries of restricted living in the shtetls and ghettoes of Eastern Europe, and elsewhere under the domination of other groups, Jews have learned that directly expressing anger and aggression was a dangerous thing. The alternative to acting out emotions is often to turn these feelings inside. Gradually, this became a learned behavior, passed on culturally from generation to generation.
This self-attack or internalization of anger and aggression may be the cause of a higher rate of depression and certain other conditions such as irritable bowel syndrome, headaches, chronic back and neck pain, and temporomandibular joint syndrome (TMJ). Jewish people internalize emotion, literally experiencing in their bodies the angers, fears and frustrations of everyday life. The oy vey we hear does represent real, physical pain in a patient's abdomen or back. But the origin of the pain may indeed rest in emotional tension rather than a particular structural disorder of the colon or spine.
Many Jewish children, like Adam in the story above, have found that their parents are sensitive to their every ache and pain and much more attentive when they kvetch. The pattern continues as adults when Jews are quite willing to share their aches and pains with one another as a way of bonding and letting off steam, but not really confronting the underlying emotional issues. This indirect style, or repression of emotions, may lead to physical symptoms.
The medical profession is beginning to acknowledge the mind-body connection in a variety of ways. Insomnia, headaches, back pain, fatigue and abdominal pain all can have purely organic causes; but we are learning more and more to connect these symptoms and others with a patient's emotional life. The elderly widow or widower who suffers a well-documented higher rate of death and disease in the first year after losing a spouse is one example of a mind-body effect.
The good news is that Jews are also among my most educated patients, and especially among younger people, much more psychologically aware. It turns out that the key to treating these mind-body disorders is making patients aware of the connection and teaching them to think about their pain less and their feelings more. I tell them: "Think psychologically, not physically."
Jewish people are often among the best at learning to approach their problems this way. And, by the way, these conditions are quite common in all ethnic groups, just more so in Jews.
So the next time one of your parents says, "Oy Vey, my aching back!" think not of dad's bulging disc or mom's bursitis, but instead, the statement beneath: "Why haven't you called?"