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Your Emotions and Stress
Ideas on Managing Chronic Disease An Interview with Andrea Schara

by Mary Shomon

There's no doubt that stress can contribute to and aggravate chronic conditions, including thyroid problems. On a purely physical basis, emotional stress can increase the release of stress hormones in the body that makes it harder for the body to heal, repair itself, and fight off infection. At the same time, not feeling well over time can add to stress, and the stress/illness cycle feeds on itself.

Therapist Andrea Maloney-Schara, LCSWA, who practices in the Washington, DC area, researches and practices according to Family Systems Theory, which was developed by psychiatrist Murray Bowen as an outgrowth of his research at the National Institutes of Health. Andrea has some innovative ideas about how people with chronic illness can more effectively manage stress and emotions as part of an overall effort for enhanced wellness.

Q: Thank you, Andrea, for taking the time to talk to me. First, I'd like to start out with a chicken and egg question. In your mind, which comes first, stress or disease?

Just being born has to be stressful. Even if you are in perfect heath, there's a lot of crying that goes on. Life is hard too many days to count for most of us; therefore, I would have to put stress way at the top of my list.

The question behind the question might be why do people think stress is a bad word? Perhaps there is feeling that only bad people get it? Or perhaps there is an unsaid understanding that only the weak are stressed? A lot of negative values are associated with recognizing and understanding stress. It is not like winning the lottery. In fact there are few if any prizes associated with finding that you lost your temper, can't get a good night's sleep, ate all the junk food you could find or worry 27 of the 24 hours in a stressssed out day. All of this bad publicity makes it hard to really be curious about stress.

Chronic diseases -- well there is something that you can find a real reason to get curious about. Diseases are real. People know what you are talking about. There is none of this soft stress stuff. Disease has an honest name. They are respected. Both good and bad people have them and there is not the value judgment, usually. There is fear of course and there is the challenge of learning more about the disease than your physician. Overall when it comes to disease there is a thoughtful, tested course of action and often the possibility of improvement.

Q. According to Bowen Theory, when we experience stress and tension, it will sometimes result in behavior that is designed to somehow get rid of the anxiety. For some people, that unfortunately means they develop physical problems or ailments. Can you explain a bit more in layman's terms how for some people, developing physical problems -- or worsening of existing ones -- can actually "relieve" their anxiety?

Each of us is born with a built in tolerance for stress. Call it the pressure meter. If any of us is subject to enough stress we will pop. It's easy to see if you could imagine that a person was a balloon. Sometimes we can avoid popping by finding ways to let out the air. A physical problem can so that for us. Let us take a behavior problem, as again it's easier to see.

The balloon gets blown up in the following way.

"I go to work and my boss yells at me. I am anxious and stressed out so I stop to get a drink on the way home. I actually start to feel better so I drink more. Eventually I have to take a taxi home. Eventually I have to take a taxi home. My husband is waiting for me. He is mad. He says that I got drunk on purpose and begins to yells at me, just like the boss did. I go to bed wake up with a hang over and can not go to work. My husband feels sorry for me and begins to take care of me and asks me what happened and says that I worried him to death."
You can see where the story is headed. My having a stress attack altered the relationships. It is an extreme example but it's clear that stress and anxiety can trigger a genetic predisposition. Stress leads to behaviors that increase the possibility that they will aggravate a "lifestyle related disease." Replace drinking with poor eating, no exercise, tons of negative worry and any genetic- like predispositions and you see the link the to disease.

The hard part is how becoming symptomatic might also "relieve" anxiety by altering the relationship systems. Now people can focus on the disease. When people are stressed out they do not think as well -- they just want to get out of the line of fire. If I stay home with a headache or other problems then I am off of the pressure line. No one can ask me to help or do more. I just have to take care of myself, for a change.

Many people reported, after being diagnosed with a disease, that they felt it coming. They knew they could not keep up the workload or that they could not stand the continual fighting with the husband or mother etc.

We use to call this a secondary reward, getting out of the system's intense focus or need, but I think it's a reflection of the role that stress has in becoming the straw that breaks the camel's back. If one wants to understand then the relationship process is more important to see than the so-called reward part.

You might think of stress as a kind of emotional pressure that people unwittingly put on one another. We sometimes need each a bit too much. The other issue is that we may need to be too great within ourselves. We may need a vacation from our own expectations. Since there can be no such vacation, one may over work and over do for others till the camel's back breaks and the genetic vulnerability springs forth in the form of a chronic disease. The anxiety is really a feeling state that something is wrong. It may be below our level of awareness. When relationships are disturbed it may indicate that one person is doing too much. This imbalance in the relationships is some part of any disease.

If people are unaware of the relationships then there is no need to go back and deal with the husband, wife, mother, boss or even one's own demanding self. The most obvious thing is to take care of the disease. It just so happens that by doing this one will alter the expectations of self or others.

I think about how relationships can give us some immunity from disease processes when all things are at their best. We can fight and love and talk our way through a lot of stressful stuff. Sometimes people are too sensitive to use the relationship system as a way to deal with anxiety and so the stress goes into the body or the mind. Then we must live out the stress.

Q. An important concept in Bowen Theory is the idea of "differentiation of self," which refers to how autonomous a person is in relationship to others. When you are "differentiated," you can have relationships with others based on neutral and constructive thinking -- rather than highly charged and negative emotions. (More on differentiation can be found at") Based on this theory, in some cases, chronic illness may be a signal that someone is becoming more undifferentiated. Can you explain why and how this is?

I gave a lead to this mystery in the above story. People differ in their ability to make mature or good judgments. There are different kinds of social reinforcements for emotional maturity. Many career paths and family backgrounds do not lead people to value "neutral and constructive thinking." These are values that may not have a high social reward. They are probably very good for maintaining social relationships and for dealing thoughtfully with chronic diseases but they are not good for everything. For example, people who are impulsive in love may do well in business. But the way people manage in business, (scrambling for the top position,) may not offer a strong foundation for marriage. Donald Trump has talked about the fact that he is no good at marriage but he is great at business. He sees the problem. Winning a spouse and managing a marriage are different things.

Autonomous people have fewer relationship problems, especially with control issues. They can let the other person be and not put as much pressures them. People become undifferentiated when too much pressure is applied and they are unsure as to how to handle the pressure. One can get reactive as the pressure sneaks up on us (emotional blindness) or at the other extreme one can knowingly take a stand in the relationship to others and state what they will or will not do and the system will react, creating pressure.

There is plenty of evidence that people are making poor life style judgments when they are under stress. "Undifferetiation" simply means that one can give into demands from the system without knowing the cost. People give up parts of self and they are vulnerable to something. We are also vulnerable when we try to increase our functioning by taking a stand and changing ourselves. What is the saying, "no pain no gain." It is possible for people to alter the level of sensitivity and reactivity that they have to others but it is not easy to do. A disease process will make people change. Now one has to say no or something different to the relationship system or one will get more symptoms. The ability to be more open, valuing "neutral and constructive thinking and speaking," about what one can and can not do will often make a big difference in living with a chronic disease.

Q. Sometimes, people who are suffering from hyperthyroidism can experience panic attacks, extreme anxiety, heart palpitations, and become very agitated emotionally. In some cases, this extreme state can be damaging to family relationships, marriages, and cause tremendous stress not only in the person suffering from the hyperthyroidism, but also to the family. Once diagnosed, these patients will typically begin to receive various treatments to help relieve these symptoms, but this process can take some time. Do you have some advice or thoughts on additional ways -- in addition to following their prescribed treatments -- to help someone diagnosed with hyperthyroidism to can help "calm down," and thoughts on how family members can cope as well? If one has knowledge one has answers.

If one has knowledge one has answers. I would hope that the family is told and given the true facts about the challenges that they will face. Knowing what you are up against any person in the family can begin to develop a plan to handle the required changes. It may be that the person has to have more rest or change the diet etc. If people can write down what they think the hardest and easiest part of the required changes will be for them this helps. Its more thoughtful and calm when people write things to one another first rather than trying to talk out in the open when people are all ready raw with emotions. I like for there to be a family plan about who is willing to take responsibility for what.

If any family member can so this for self, then they are a good example. This is not the time to put pressure on others to change. One idea is to keep the plan out in sight to remind the family and the person that things have changed. Letting people see the plan is way to encourage responsibility and clear thinking, as there are consequences. At last there should be if the plan is not followed. Make the consequences clear too. Like, no rest then one must confess. Change is hard on people and so it makes it a bit better if they can see who is trying to make a difference by being different. Eventually others may sign up with their own plan. It may be as simple as the children being quiet or helping to wash dishes may. Often it is little things that one does for other that can make for a healing and hopeful atmosphere at home.

Q. The condition of hypothyroidism, an underactive thyroid, is frequently accompanied by ongoing fatigue, exhaustion and often varying levels of depression. When people feel particularly discouraged or debilitated by this lack of energy and depression, what sorts of practical things do you suggest they do to help shift from a negative to more positive mindset, and reduce the stress they are facing?

I often tell people that if they could think of their minds as gardens and negative thoughts as weeds they would have the right idea. Not much can grow in a garden of weeds. How does one monitor the amount of negative worry time? It may be a simple as writing down how often and how long one stay with a negative thought. Another useful idea has been for people to say I will let myself worry about this problem for ten min., after those no more worry time for today. If one realizes that thoughts are digging literal ditches in our brains then we would be a lot more careful about how deep and how much time we spend in the ditches.

I like it if one has the energy to change the home by putting up visual remainders: pictures from vacation spots, friends, dreams, or any thing that sparks a visual positive mood around the house. Music and flowers also helps crate a positve mood for people. Having a spot to meditate is very useful. Please see my web site for details on how to relax and alpha training. Visualizing is great for changing the brain. See the issue and see yourself solving it. Do it before bed and as you wake up. Focused concentration allows us to build a more flexible brain.

Your brain will take you much more seriosuly when you take actions. When you write your plan down you are activating many more neurons in the brain then when you just think about it. Thinking can be like day dreaming.. Whatever one does just keep track of it. It no good if you do it and can not give yourself the credit for changing. Remember how parents reward the children by putting their drawings on the wall. Well they knew then that positive reinforcement enables people to grow and change. We need at least 50% positive reinforcement to change old habits. There is tons of new research on the brain and how to change by using the bodyas a grounding point for the mind. In the future I think we will see much more integration of the mind and bodyand the relationship system in dealing wiht all chronic illnesses. it just gives us more opportunity to be able to alter the course of a disease or to put it into remission. No one knows why 30% of peopel do better with certin conditions (the placebo effect) so be free experiment and see what works for you.

Q. For some people, they have a doctor treat their thyroid problem with conventional drug treatments, but they are still left with residual anxiety or depression that drugs don't relieve. In that case, many people have found that therapy can be helpful as part of the overall strategy for wellness. If someone was going to pursue therapy, what sorts of general advice would you have on choosing a type of therapy, and finding the right therapist?

I like the idea of a coach. But no matter what find someone that you are comfortable with. I would advise people to find someone who is trained in systems thinking as I think that disease and stress and family and work dynamics are an interacting part of the issues that one has to deal with so enjoy your thinking time with someone interesting to you. It difficult when one is compartmentalized, and this often must happen in medicine as the field requires specialization but in finding a therapist your re not limited. There are hundreds of different theories that people follow. Eclectic is mixed bag. I would find out how the person decided to enter the profession and what they really think about human behavior. You are the consumer. You should be the one in charge. Therapy should not be a mystery (my simple opinion.)

* * *

Many thanks to you Mary for the time and great questions. I loved the challenge to try and think and still have fun.

Andrea Maloney Schara

Andrea Maloney Schara, LCSWA
Web site:
Georgetown Family Center
4400 MacArthur Blvd. #103
Washington, D.C., 20007
Phone: 202-965-0730

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