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We have been given powerful tools that support our resilience and help us cope with severe emotional stress. These tools enable us to avoid potentially overwhelming emotions, but those unfelt emotions do linger and, though no one realizes it, affect our health. In my new book ‘Hidden Within Us’, which will be launched in April 2022, I discuss how our ability to repress emotions without conscious effort or awareness is a gift of evolution that often is a cornerstone of resilience. However, my clinical experience teaches me that it has both upsides and downsides that need to be recognized and studied. This blog highlights a new understanding of the role of repression in both our resilience and in medical illness, and how it offers new pathways to understanding and treating medical illnesses.

The Gift of Repression

Although repression of emotion is often considered, and can be, a psychological problem, it actually is a built-in defense mechanism that is crucial to our resilience. We would be emotionally naked without the cocoon of resilience it provides.

Studies indicate that a history of trauma can be found in anywhere from 15-30% of Americans, or even more, depending on how trauma is defined. Childhood abuse or trauma is common (De Bellis MD, 2014); in a recent report, over 60% report having experienced at least 1 adverse childhood event (ACE), and over 25% report 3 or more (Hustedde C, 2021). And childhood events are clearly associated with an increased likelihood of psychological problems in adulthood, such as anxiety and depression (Vila-Badia R, 2021; Kuzminskaite E, 2021)

Yet, although many survivors of childhood trauma suffer emotional consequences in adulthood, many don’t, and can be considered to be resilient. In my clinical practice I was surprised by how many patients had moved on in life without overt psychological sequellae from severe childhood trauma or losses, whose emotional survival was largely attributable to the blessing of repression. And they didn’t just survive; they thrived.

In this era of the ascendance of psychology, we are taught to feel our feelings. However, some events, depending on their severity and the circumstances in our life, are just too painful for most of us to be able to deal with and at the same time function normally. This is particularly true in childhood, and in the absence of adequate emotional support. Here, repression is crucial, and is a true gift to so many.

In dealing with extremely stressful events, being “tough,” being resilient, can be understood in two ways. It can mean experiencing and dealing with severely painful emotion and eventually healing and moving on. Or it can mean exactly the opposite, repressing, not feeling, and moving on.

Many resilient individuals deal consciously with painful emotions linked to severe stress or trauma, and heal. And it is optimal if we can confront those emotions in this manner. However, my patients’ stories have conveyed to me that in dealing with truly overwhelming stress or trauma, with emotional distress that could challenge our capacity to consciously cope, the best option often lies in our ability to not feel. The patients whose stories indicate repression of overwhelming emotion didn’t consciously “decide” to block off that emotion; it is their unconscious mind that remarkably, without conscious effort or awareness, kept those emotions from awareness.

Ideally, at a later time, when the threat to emotional and/or physical survival has passed, conscious emotional healing is possible. However, there are barriers that stand in the way of healing. In many, the opportunity for healing goes unnoticed because of the absence of awareness of the burden of repressed emotions. And in many others, the lifelong partitioning through repression of severely painful emotion often is the best path. The reaction of the patient, or reader, is perhaps the best guide of the path to be taken.

Given our ability to repress, why then do so many suffer psychologically? Clearly we do not repress all emotion. We consciously deal with emotions in our day-to-day life. Being able to repress does not provide an emotion-free life. And the human ability to repress does not prevent everyone from being overwhelmed or from suffering chronic emotional consequences. The ability to repress differs from person to person, due to many factors such as genetics, childhood experience, connectedness and emotional support and the events that we encounter. Nevertheless, the ability to repress plays a key protective role in human resilience.

The Downside of Repression

Repression has an upside; it also has a downside. Though rarely recognized, in many, the ability to repress is essential to emotional survival. However, my experience, and evidence from published studies, has taught me that the lingering burden of repressed emotions is also associated with an increased risk of medical consequences. In this way our genetically-favored ability to repress emotions is a mixed blessing.

The ability to repress emotions, whether in the context of overwhelming stress, or as a repressive coping style, can and should be viewed as a survival advantage in a world where humanity faces overwhelming emotional challenges. It is associated with reduction in psychological distress and prevention of psychiatric illness. However, the burden of repressed emotions, though unfelt, persists within us. And our repressed emotions, though we are unaware of them and legitimately insist that we don’t feel them, can be far more powerful than the emotions we experience and focus on. And, though a gift, our genetically conferred ability to repress emotions can ultimately affect our health, manifesting either with emotional symptoms that don’t make sense unless one takes the past into consideration, or with physical manifestations that medical science cannot otherwise fully explain. That cost, however, remains hidden from the annals of medicine as mind-body research has focused almost exclusively on the day-to-day stress and emotional distress that we experience.

My clinical experience strongly indicates that the burden of repressed emotion, though unfelt, leaves a legacy as an unsuspected factor in medical and emotional conditions whose cause is otherwise unclear. And ironically, those adverse effects on health can become evident even at times when life circumstances are very stable, when one would least suspect a mind-body link.

Decades of mind-body research have focused almost entirely on the link between medical illness and the day-to-day emotional distress we feel and acknowledge; emotions such as anger, anxiety, and depression that are quantifiable by questionnaires. Unfortunately, the impact of that research on our understanding or treatment of medical conditions has been limited. In contrast, there is a paucity of awareness of, or studies concerning, the link between repressed emotions and medical illness. Further challenging such research, research questionnaires cannot readily quantify emotions that we don’t feel.

Few realize that we can be affected more by the burden of repressed emotions than by the distressful emotions that monopolize our attention. What needs to be examined is the role of that burden in the genesis of a list of common, incompletely understood medical conditions. Evidence suggests that it plays a significant role. And the question that also needs to be asked and addressed is whether this understanding offers new pathways for medical healing.

Studies link a repressive coping style to a number of medical conditions. It is associated with increased blood pressure reactivity and hypertension (Gleiberman L, 2007; King AC, 1990; Rutledge T, 2003; Grossman P, 1997). Studies have linked coronary heart disease to both a repressive coping style and also to adverse childhood experience (Denollet J, 2008, Felitti VJ; 1998; Dong M, 2004). Emotional defensiveness has also been associated with bronchoconstriction in patients with asthma (Feldman JM, 2002). Cancer has also been associated with adverse childhood experience and with a repressive coping style (Felitti VJ, 1998; Jensen MR 1987; Watson M, 1984).

Clinical psychologists regularly interact with patients who are suffering from emotional distress. However, it is important to recognize that patients who by virtue of repression are not experiencing psychological distress do not tend to see psychologists. Clinical psychologists, therefore, are less likely to write about the extraordinary resilience linked to repression, or about the unexplored link between the burden of repressed emotions and subsequent development of medical conditions whose cause, to this day, remains inadequately explained.

In April 2022 my new book ‘Hidden Within Us’ will present evidence that points to a link between repressed emotions and various medical conditions. It starts with observations involving patients with forms of hypertension that opened my eyes to the silent role of repressed emotions, and to their unnoticed role in many other medical conditions, such as colitis, migraine, chronic pain disorders and possibly many others that otherwise remain inadequately explained.

In my new blog series, entitled Beyond Mainstream Medical Thinking, I will present down-to-earth, valuable information from my new book Hidden Within Us which will be launched in April 2022.
It reflects the art of practicing medicine and is backed by my clinical experience as well as published studies and by what we know about physiology and pharmacology. While rooted in logic and common sense, much of it is unknown to most patients and physicians.

I plan to issue one blog per month with insights from my new book as well as from my ongoing practice and observations from developments in my field of expertise. I believe the information will be relevant to the health and treatment of millions of people treated by conventional medical wisdom who are ready to look beyond the limitations of standardized approaches to treatment. I am confident that you will enjoy reading these articles and find them meaningful.

About Samuel J. Mann, M.D.

Dr. Mann is a physician, author and researcher, specializing in the management of hypertension at New York Presbyterian Hospital and Weill Cornell Medical College.

While Dr. Mann is from a prestigious medical institution at the forefront of heart health and traditional medicine, he has powerful alternative views that go beyond mainstream schools of thought. He believes in ‘individualized treatment’ and has better ways to understand and treat hypertension.

He has released two pioneering, well reviewed books on hypertension, and his soon to be launched book Hidden Within Us will highlight a new understanding of the mind-body connection as it pertains to other medical conditions as well.

He has published numerous papers in leading medicine, hypertension and psychology journals and received national media and broadcast coverage on the subject matter.

Beyond Mainstream Medical Thinking

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