My mother had a sore neck. Probably from Pilates class, she thought. So she went to her doctor, who ordered an X-ray. Upon reviewing the X-ray, her doctor ordered an MRI for a week later.
My mother asked her doctor why he was ordering more tests. Did he see evidence of osteoporosis? Arthritis? A slipped disc?
Without even making eye contact with her, Mom’s doctor said, “Could be metastatic cancer.” Then promptly left the room.
Unsurprisingly, my phone rang next. It was my mother, who has read my book Mind Over Medicine, asking me to help calm her nervous system.
The Amygdala As Sentry
Here’s what was happening in my mother’s brain when her doctor said the words “metastatic cancer” without offering any comfort.
Mom was married to my father, a radiologist whose job it was to read X-rays, identify any potential abnormalities, and order follow up testing if anything appeared even remotely suspicious. So her thinking, rational forebrain reasoned, “It’s probably nothing and the doctor is just covering his butt by ordering a follow up scan.”
But her amygdala, the scaredy-cat part of her primordial limbic brain, only hears, “METASTATIC CANCER! A CERTAIN DEATH SENTENCE!”
Now being an amygdala is sort of like being one of those meerkat sentries that stands on the top of the mound, surveying the environment for danger in order to protect the whole clan of meerkats. The amygdala’s primary job is to be on the lookout for danger and sound the alarm when it discovers a threat. When it does, it triggers a whole cascade of hormonal activity, and the hormones that get secreted bathe every cell in the body.
The Danger Cascade
When Mom’s amygdala heard the word “cancer,” her amygdala automatically assumes there’s a tiger on the prowl and it’s time to run. The red alert is signaled and what Walter Cannon at Harvard called “the stress response” flips on. The hypothalamus releases hormones that communicate with the pituitary gland, which communicates with the adrenal gland, and BOOM. The body is instantly filled with high levels of stress hormones like cortisol and epinephrine. The whole body is now in “fight-or-flight,” ready to outrun the tiger, even though in reality, the only thing Mom can do is wait a week until her follow up scan.
Mom’s rational forebrain is talking to her amygdala, saying “It’s probably nothing. The doctor is just covering his butt. Chill out, amygdala.” But here’s the kicker. The amygdala is such a part of the lizard brain that the amygdala’s response always trumps reason.
Amygdala 1. Rational forebrain 0.
However, because Mom has been hanging out with me, Mom knows this, and because she has read my book Mind Over Medicine and has been religiously practicing everything I teach ever since. In other words, Mom has tools.
So she called me and said, “Lissa, you have to talk me off the amygdala ledge.” I tried to do just that.
My Call With The Doctor
When I got off the phone with Mom, I called Mom’s doctor. After jumping through hoops to fill out a release of information form so the doc and I could talk candidly, I finally got him on the phone five days later. I resisted the urge to say, “How dare you inflict the nocebo effect upon my poor mother?”
Instead, I said, “Is there any chance this could be anything other than metastatic cancer? What else is in your differential diagnosis?”
Without one word to comfort the now grieving daughter of his patient, the doctor robotically said, “Nothing. I can’t think of one thing it could be other than metastatic cancer.”
He sent me the X-ray. I’m not a radiologist or an oncologist, but even to my untrained eye, it looked worrisome- this big black hole where the bone of her C4 vertebrae in her spine should be.
I said, “Could it possibly be artifact, just some mistake on the X-ray?”
He said no. It was on all the views.
“Could it be a primary bone tumor, rather than Stage 4 cancer?”
Nope. Bone tumors look different than bone metastases.
“Is there any chance at all that it’s benign?”
“Well…” he stalled. “I guess it could be a hemangioma.”
Hallelujah! I called Mom and said, “It could be a hemangioma!” She nearly wept with relief. I can only imagine her amygdala relaxed just the teensiest bit.
Mom and I clung to that wee grain of hope while we waited for the MRI.
The Risks Of “Fight-Or-Flight”
Mom knows as well as I do that when the amygdala gets triggered and the body is in stress response, the body’s natural self-repair mechanisms, the ones responsible for fixing broken proteins, killing cancer cells, fighting infection, and retarding aging, get flipped off.
Only when the nervous system is relaxed in what Herbert Benson at Harvard called “the relaxation response” can the body’s natural self-repair mechanisms do their job.
Now God forbid Mom actually did have metastatic cancer we would try to beat. The WORST thing a doctor could do in this situation is scare his patient and get her amygdala all worked up so that the very mechanisms that can help the body fight its own cancer get deactivated.
Writing The Prescription
During the long wait, Mom focused on relaxing her nervous system so she wasn’t sabotaging her body’s own self-healing efforts.
The first thing Mom and I did was to write The Prescription for how she was going to get through the week without chronic repetitive stress responses. We discussed things that might trigger her amygdala even further, like posting what had happened on Facebook and reading 100 messages from freaked out friends and family members. Instead, she decided to write The Prescription that would flip her nervous system into relaxation responses while she awaited further news.
Here’s Mom’s Prescription: