Ep. 01 Dr. Lydia Temoshok
[00:00:00] Kathy Washburn: Welcome Lydia Teak. I am so grateful to have you here today. From Maryland, and I believe it's sunny and beautiful there as it is in Woodstock, Vermont here. Is that, is that true? Yes. Sunny, beautiful, perfect weather.
[00:01:24] Finally, finally, exactly. This is what we all wait for. I'm gonna read a reference to something called Type C. This reference is found in the Oxford Dictionary of Psychology, and I'm doing this as a way to introduce my guest to Lydia Teak, and we'll launch from there. The reference reads, type C is a style of coping with stress or a behavior pattern, theorized to be associated with relatively poor prognosis in patients with various types of cancer.
[00:02:00] This was first described in 1981 and a paper that was presented at the American Psychological Association's Annual Conference by the US psychologist, Lydia Tamasha. The Type C pattern reflects a fragile means of coping. It's characterized by repression or, and a decreased recognition of one's own needs and feelings, anger and sadness with reduced emotional expression and concomitant psychological dysregulation.
[00:02:37] A relation between this pattern and relatively poor prognosis in patients with malignant melanoma, which is skin cancer. Was first reported in an article by Tamasha and colleagues in the Journal of Psychosomatic Research in 1985, and another paper authored by Tamasha was published the same year in the Journal, social Science and Medicine on mechanisms of psycho neuroimmunology that might explain the medical effects.
[00:03:13] Now, I would read that again and I won't, but I would invite listeners to rewind and listen into that again, because this is such a an interesting and magnificent concept about the influence of our own behavior patterns and what they, what those influences are to our own health and healing. So I'd like to just land us here.
[00:03:39] Lydia, if you would be so kind and maybe elaborate on how you arrived at your conceptualization of Type C way back in 1981, and then maybe introduce us to some subsequent research. There are so many That have converged, they've come together, they've overlapped in my life. I'm, I'm trying to organize it in a way that makes sense with the timeline.
[00:04:07] Let's start with the timeline. The fall of 1969 Yale College opened its doors for the first time to women. A small group of women, 535 of which I was honored and lucky to be. One of the people was admitted to Yale College, along with 4,000 men who were already there. so. We had a great ratio of Jenny, but it was a very exciting time.
[00:04:38] There were a number of things that I learned there. and one of them was I, in this major that I was, again, fortunate enough to be able to be selected for, it's called Culture and Behavior. It, and it combined biology, psychology, sociology, and anthropology. And that made a whole lot of sense. So there were professors from these four areas who were teaching this.
[00:05:05] For my time at Yale. And, and the intrinsic connections between these areas, culture and behavior, biology, psychology, anthropology, and sociology. These, these things are in intrinsically overlapping. my psychology professor there was Richard Nisbet who has gone on to an illustrious career in social psychology. He, he then left for University of Michigan, Ann Arbor after being at Yale and I went to graduate school there. So I worked with professor Nisbet and in social psychology and also I decided to do clinical psychology because psychology is, is kind of separate from a lot of these. This research psychology is separate from, you know, what are the clinical outcomes.
[00:05:53] So I was always interested in clinical outcomes, and I thought it was very important that I get training as a clinical psychologist. So that's what I did there too. The other influence from professor Disbe from the University of Michigan was I worked with him in a small group of people on a paper that he, he published with Tim Wilkson called Telling More Than We Can Know.
[00:06:19] And it's a very influential people, Betty people cite this as being one of the most influential papers in their career. And I didn't realize how, how critical it was to my thinking, which was saying that if you ask people a question like how are you feeling? Or, you know, does this bother you? Or something like that, that going to answer, not necessarily by looking down into their, the depths of their, of their own feelings.
[00:06:45] They're gonna answer to what makes sense. Does it, is it, is it a socially desirable thing to say, I feel fine? Is it socially desirable? In the context that, that this person is asking the question to say something else. So to me, this cast a whole skepticism about. Self-report scales. Mm-hmm. And, and again, that's, that's been a criticism of psychology.
[00:07:09] They say you rely on self-report. Well, I think that this, this also, how do we know that a person is actually feeling something that they just report it, no, I'm not depressed or whatever. So those were some of the influences. I'm, I'm, I'm coming into fast forward a little bit to 1978. I'm hired as an assistant professor.
[00:07:30] Again, incredibly fortunate enough to go to the beautiful city of San Francisco in the Department of Psychiatry, the Langley Porter Psychiatric Institute. And I was working in the stress unit there. At the same time, there are other influences that are coming to bear in the zeitgeist of the time.
[00:07:51] There, there is the whole movement of, of behavioral medicine. It was the dawn of behavioral medicine, which is looking at behavioral in the context of medicine. You know, what, what, how, how, how did these things intersect and can behavior, influence outcomes potentially. And that, and one of the main influences at that time in this new field was the work of Friedman and Roseman on the type A behavior pattern.
[00:08:22] And they called it the type A behavior pattern for a real, really good reason, which is, first of all, they were physicians and they had noticed for. The first time, I guess, that a upholsterer in their waiting room called their attention to the fact that the fronts of the seats in the waiting room were worn down.
[00:08:46] The pollster had never seen this. He says, well, I'll, I'll recover the whole thing. But, you know, you've got the front of the seats. So who, what kind of patients are you seeing here? That they're sitting on the edges of their chairs? And, and, this influenced Freeman Roseman to develop this structured interview to assess type A behavior.
[00:09:06] So in other words, you couldn't just ask them, let's just say, you could ask them, you know, how, how do you feel? Are you, do you feel angry? Do you feel irritated? Do you feel this? But more. Valid in terms of predicting things was how the style in which they responded to this. So they came up with this structured interview that still is what is the, is much more pro predictive of outcomes in the cardiac realm any self-report instrument.
[00:09:37] And so they would be asking questions like do you play games with your children? Yes, of course I do. Well, do you always let them win? And, and the, and the interviewer is trying to be provocative, and which usually makes. Type A people who are, who are known for being on edge they, they get riled up about that.
[00:09:59] Or you say, well, what happens if you are in a car and it, it's, and, and there's a car in front of you and it's going much too slowly? And, and they, and they, and the very type A person will interrupt the interview and say, well, I, I would, I would my horn, what does he have to be going so slowly I have to get to my appointment?
[00:10:20] You know, and so on and so forth. So I, I was very, by reading this literature, the type A literature and it was it was an influence. At the same time, I'm at University of California, San Francisco and the great psychologist Paul Eckman is there. you might have heard of Paul Eckman. I, I, again, I, I have, I have a very fortunate life.
[00:10:43] I call myself the Forest Gump of, of, of behavioral medicine and, and the psychosocial understanding of how things operate because I, I. Co-taught a course on emotions with Paul Eckman, and what he showed is the universality of emotions across cultures, so that no matter what culture you're in an angry face can be recognized, a sad face can be recognized particularly for the, for the primary emotions, maybe the complex emotions, you're not gonna see.
[00:11:14] And that for these primary emotions, you're going to have a physiological response that is, Connected to that. So with anger there, there comes, you know, the increased heart rate. There, there comes, you know, the changes in, in dilation of the eyes. There comes breathing and, and all of these factors come in.
[00:11:38] For sadness. There's another set. Of physiological reactions. And these have a, according to act, but according to the Darwinian theory that he was based on have evolutionary significance. it's important for people to be able to recognize their emotions. if you feel happy, if you feel joy, that's a good thing.
[00:11:59] You wanna be around the people who make you feel happy. Enjoy. If you are much earlier in human development, a haid and you're, and you're, and you're different things you're, you're tasting a bitter berry, you spit it out, but you're tasting something sweet that's nutritious, that's going to help in your, in your biologic.
[00:12:21] Then, then you feel, Hey, this is great. I'm gonna do that. And the same with sexuality. You can make a whole argument about how, how that involved with those same feelings. So I was very. Influenced by that. And particularly with the notion that it's not just the positive emotions that make a difference.
[00:12:41] It's the negative emotions, negative emotions tell us a great deal. You know they, they te you know, if, if we always felt fine when we touch a hot iron, I go, oh yeah, we, we, we burned. and that if you somehow dull our natural response it's going to be a problem. So that if a racehorse is given a medication that's illegal, you know that to help the him or her race on faster, in spite of feeling pain, that horse is gonna break its leg and it's gonna be really bad.
[00:13:17] Pain tells us something. It's not a bad thing. It tells us. Pay attention to this anger can be a good thing. It says, pay attention. This person is doing something that's, that's wrong for you. They're, they're harming you. Yes, you should be angry. Now the question of how to respond to that is something else, but it's very important to be conscious of that.
[00:13:42] The third influences happening at this time is a whole new field also in addition to behavioral medicine of psycho neuroimmunology, which is saying how much psychology is connected with neurological connections. And also immunology that are, there's immune signaling. All the way up and down between the blind and the body.
[00:14:07] And there, there's more and more evidence that was being amassed than in animal studies as well as some human studies. And George Solomon, one of the great pioneers in psycho immunology, was also at the University of San Francisco school of Medicine at the same time. And he was older than I was and I, but I took a, a lecture from him and I said, you, you are fantastic.
[00:14:30] I, I've read your, your work and this is wonderful. might we get together in terms of a new. Effort to understand HIV aids, which had just been recognized around that time, 1982. and I, called it the biopsychosocial aids project. Mm-hmm. So saying, okay, there's going to be an influence.
[00:14:54] Behavioral medicine tells us, the biopsychosocial model tells us psycho neurology tells us of, of the mind, behavior, patterns, physiology connected to potentially the prognosis and the progression of disease. Could that be the case for h hiv aids? At the same time, again, I've, I, I've started this clinic on behavioral medicine and I was asked by the.
[00:15:23] In the same building, the the physicians who were and Scott Boys and, and, and Richard Sabil if I were interested in coming to their malignant melanoma clinic because they had an idea that there was some difference that was related to stress, that had some people who had really good prognosises for the progression of malignant melanoma.
[00:15:49] In other words, their, their tumors were really thin, is if you catch melanoma early you know, it can progress very slowly and you can excise the tumor and it's. It's gone. And you, you have a very good, excellent chance of survival. However, if, if, if it's not noticed and it, it goes deeper, then into the other layers of the der of the dermis and, and so on, it gets into the bloodstream and goes to other organs.
[00:16:19] And that's why Malone has such a poor prognosis. So, and he said some of our people who had really poor Prognosises this had gone to the deeper levels. So it's stage four, you know, and so far, but they end up doing well. Why is this? And at the same time, I'm seeing the people with a, with AIDS who were in the AIDS clinic that I was consulting for, and, and the psychosocial AIDS project where I got one of the first grants to study the progression of H I V aids.
[00:16:53] That there were some people, even though AIDS is a then a invariably fatal disease, some people lived a lot longer. Why is that? So that was the, that was the, the scope of, of our, of our grant. So I okay, to Dr. Segal and Place, I just need, I don't know anything about cancer. I dunno anything about melanoma.
[00:17:19] I'm gonna read up on everything you've ever written and I'm going to just interview. I. They, the patients, an observation is where science begins. so I began to interview the, the patients in the, in the clinic. And I was struck by a number of things. First of all, they were enormously willing to help me.
[00:17:40] I mean, they, they would miss rides. They would miss lunch. They'd go, oh, wow. You're asking us questions. Oh, I wanna help you. You're a young researcher. And they, and they, they were really helpful. I I decided, well, what I'm gonna do is I'm going to, I'm going to ask them the same structured interview that Friedman Roseman did, the type a behavior pattern interview.
[00:18:02] So I would ask the same questions. What would happen if you're in a car and there's a car in front of you and it's going much too slowly? What would you do? And melanoma patients would say things like, oh, I'm sure that person has a reason for going slowly. Maybe they don't know the area, maybe they're older.
[00:18:22] Oh, I would just hang back and, and wait. Maybe if there's a good time to pass, I, I might, but I would, I might, I would be concerned about them. Maybe I, I could see if they need some help. That is totally unusual. Cause Friedman Roseman had never noted that in any of their, in their interviews. There were other, other questions that were, that revealed that these melanoma patients who I was interviewing were totally different from the type A patients that Freeman and Roseman described as being coronary prone.
[00:18:54] and one of the key. Factors here is the pathological core. So you might have a lot of characteristics of something. In other words, type a type a's are conscientious. Well, that's not a bad thing. Type a's are, ambitious. That's not necessarily a bad thing, you know, but what the, the pathological core for Type A was this hostility that they react to any situation, not only with anger, but with hostility and the hostility persists.
[00:19:23] And that you could see if physiologically you are being aroused all the time. So that, you know, the, you would ask a type a patient, you know, when's the last time you were angry? And they would say, well, first of all, you know, I was waiting for the elevator. I don't know why they have buildings with elevators like that, that are so slow.
[00:19:40] And then your receptionist didn't have my, my, information here and I was, you know, and they, they just go on and on and on. So when you ask a type. What I ended up calling Type C who had asked the melanoma patients tell me about the last time you were angry. And they would say things like angry.
[00:20:00] Hmm. I don't know. I don't, huh? I I can't remember a time. And I, and I would press them on this bit and, and they would say, oh, Well, I, I, you know, I, I can't say anger per se, but I, I'd say, well, how about annoyed? How about irritated? I wouldn't use a number of other words. It might be more socially acceptable to them if they didn't wanna use the word anger and, and they would say things like, oh, there was this time, it was five years ago.
[00:20:31] This person rear-ended me, and then left. It was a hidden run. I, I, I was irritated and it, it did inconvenience me. Or, or you ask, what, what was the, what's the worst thing about having malignant melanoma? And they would say, well, actually not for me, but it's for, yeah. I, I, I can't take the kids on, on appointments cuz I'm, I'm, I'm doing things or I, I've missed a lot of work going to other, other appointments that I can't, make those.
[00:21:01] And my boss has been inconvenienced and so for me, there, that's not, that's not a problem really. I mean, the people here are so wonderful. Everybody's nice, you're nice, everybody's nice. but it's, it's really my family and I, the people who I'm working with, and this would hold for both men and women, even though it sounds like a typical suppressed woman.
[00:21:20] Melanoma is equally divided between men and women. And so that you could have a man who has also some of these characteristics and it's, and that's why I don't, I don't call it as Freeman Rose did call it personality. Hmm. I call it a coping style. You know, and, and over time I began to develop this, well, not over time, over a period of of a year, develop this idea, this concept of type C.
[00:21:52] They, they were not just the absence of type A, which is how Friedman and Roseman defined type B. Type B is the person. You ask them how do you feel and they tell you, I mean, they're very expressive. They have candor kind of like me, which gets, which sometimes gets you into trouble, but you, you have to learn to be a little bit diplomatic about things.
[00:22:12] And the people who were the type you know, did. Coped in this particular way, which was not to express anger. And they, it opposite in all these respects, especially the pathological core, which was just anger for Type A. I said, well, okay. They, they don't wanna express anger. In fact, they're not even aware of anger and they seem to not be aware of their own needs.
[00:22:39] So again, I'm asking them what's the worst thing about having mil malignant melanoma? And they say as I said, you know, it's not me, it's somebody else. So it, it they, they would not be aware. They were not tapping into their own. Feelings about having a need for something. you know, to the point where again, they'd be missing appointments as they're continuing the interview with me and I'm saying, I'm, this is getting very long.
[00:23:06] Are, aren't you getting tired? Oh, no, I'm fine. Well, I did miss my ride, but I mean, that's okay. It's okay. It was not something that they wanted to talk about. So the interesting thing that I then decided to do was to put all these influences together, the emotions influence that I learned from Paul Ekman and the biopsy psychosocial model, the psycho neuroimmunology and, and and conduct a study.
[00:23:35] And that's where some of these first papers were, were published in 1985, where we looked at the prognosis and the the, prognostic factors for malignant melanoma, you have to have a, an endpoint that's measurable. I mean, one of the criticisms of a lot of psychology and especially the previous work that had been done in cancer was people would be saying, oh yes, we think there's a connection.
[00:24:02] I mean, they've been saying for centuries there's a connection between a particular way, a particular personality and the development of cancer. Well, it's very hard to study the development of cancer. You'd have to have a huge population and look at them and so on. But the prognosis is, is something that you could do.
[00:24:24] You could follow them once they're diagnosed, which was the case in this melanoma clinic. And that's again why it was extremely fortunate that I was doing that. And Sayville voice collaborated with me on defining what would be prognostic indicators. In other words, you know, how do, how do they decide that something is important for saying, okay, we we're giving you this prognosis.
[00:24:48] Well, one of them is how, how deeply the tumor goes in, into the skin and just get into the bloodstream and so on. Another one was the number of disease fighting tumor cells at the side of the melanoma. I decided to use that one. And that was what we found was, wow, there's a u there's a very strong connection between the type C behavior pattern that I'm defining, you know, by, by these other means.
[00:25:20] Of looking at h how. How they are responding to questions and having ha getting readers to rate that and, and having, having a scale for that. So it's not a questionnaire, because if you ask them, how are you doing? They're, they're gonna say, fine, I'm fine. You can't ask them how they're doing. They're not gonna respond.
[00:25:41] It's like, it's like as, as this, but Anne Wilson said in their article, people will just answer how they think you, you want them to answer. Or, or, or particularly people who are very, very type C will do that. You know, people who are type B will, will answer truthfully, authentically, and that's why I'm, I'm, I'm getting to a lot of what I'm arriving at as, as the importance for health is authenticity. Mm-hmm. That it's, you have to be yourself. The more you are yourself, the more you, you know, you're going to be in balance with. Culture with your environment with other people. if you just say, oh, everything's fine. You're gonna put up with a spouse who's abusive, you're gonna, if you say everything's fine, you're gonna put up with a job that's that you don't like you're gonna do a lot of things that are gonna be injurious to your health.
[00:26:39] You're gonna sacrifice going to get this suspicious lesion checked out because you're paying more attention to other people's needs and their needs than your own. So That was what we found again and again. It's study after study after study, and we have published this research in a number of peer reviewed publications.
[00:27:02] And the, I summarized it in my 1992 book, the Type C Connection behavioral Links to Cancer and Your Health are published by Random House. I wanted to make it a popular book. And so I had the science writer Henry Drayer collaborate with me on this. But it would be explaining the research and explaining the implications and explaining how in the second half of the book, what this looked like for patients in the melanoma clinic and, and how they did.
[00:27:34] And so the, the, the book has been very, very well received. It got a terrible review in the New York Times, somebody who didn't like it, but, but other than that, that was generally thought to be ahead of its time. and there's people who don't like that or the other thing that would, that this New York Times reviewer criticized it for was saying, oh, you're, you're blaming the person who has cancer for their personality.
[00:28:02] I say, first of all, it's, I, I say on, basically, I have a disclaimer on every single page. First of all, it's, a Behavior and, and, typically doing that over time is a contributing factor. It depends on the type of cancer. There's, you know, there's genetic influences, there's other influences.
[00:28:22] As it happened, again, I was extremely lucky. Melinda, melanoma is, is probably the most immune influence of cancers. Wow. Where that is, that is the most important influence. Over time. and you saw how, how president Jimmy Carter, he's still alive at 98, after having diagnosed with malignant melanoma.
[00:28:47] they said it had metastasized to his brain. I, I don't believe it had metastasized. I believe it, it, it originated there. Why did it originate there? first of all, he, he got a number of treatments immune related, so that was, that was terribly helpful to him. But he also expressed himself.
[00:29:06] On, on tv. He gave a number of interviews after he was diagnosed and he was relaxed and he said, well, you know, there were these four things that I regret doing in my life that I, and I wish I had sent it another helicopter. I wish I had done this. I wish I did. Now, is it a coincidence that there were four melanoma spots in his brain?
[00:29:29] It's, it's a, you know, again, I, I, I, don't write that up because someone would say, oh, that's ridiculous, you know, you're saying, well he's, he's alive and he's at 98, having undergone that, having had the brain. He had a terrible prognosis. And look at him. He's, he's doing, he's doing well. They say he's on hospice.
[00:29:49] Well, he's, he's home. He's doing what he wants. He's with his beloved wife, Rosalyn, of all these years. Mm. Okay. So that's kind of the that also weaves in a number of these themes. And is there something that I, I have not explained fully or you'd like me to elaborate on? No, you, you just put the puzzle.
[00:30:10] All these puzzle pieces just snapped into place for me as an outsider kind of stumbling on your research. First, that paper from 1985 and you know, really just being in awe of the fact that this information was out there that I sensed and lived personally inside of myself 20 years ago. When I went through cancer and as a type C personality, smiled my way through perfect patient syndrome.
[00:30:45] I had it all. Like, don't look at, look away people don't look at me. How can I help you? And, and really throwing myself into. I, as I reflect back, my sons were five and seven and it was really just turning every ounce of me into these two little humans that I felt I needed to be alive for, And that's how I think I survived a stage four cancer diagnosis as a type C personality. But it wasn't until my marriage ended that all bets were off because whole ship crumbled. There was nothing for me to stand behind and realizing that something inside of me needed to change if I was gonna move forward.
[00:31:36] That this way of being, this, this constant suffering silently and not being able to express myself It. I couldn't, I couldn't do that anymore. So when I first started into this work, my first foray was in positive psychology. I googled, well, I don't remember exactly what I put into the, the search bar, but what came up was the science of happiness course at the Greater Good Science Center in at Berkeley.
[00:32:10] And it was through this form called edX, where I could actually take the course as if I was attending Berkeley. I just wouldn't get credit for it. And that first night, I stayed up until three o'clock in the morning because I was so enamored by this idea that positive emotions had this way of opening us up into the world.
[00:32:37] And what I realized in that moment, what it they were talking about. And I remember watching Barbara Frederickson on this video was real positive emotion and her idea of real, authentic, positive emotion, not the fake smile, I'm fine kind of emotion was what was able to open you up. And in that moment I realized, a, that I was living very inauthentically and b, I actually was only able to feel myself through other people's feelings.
[00:33:16] And when I did that, I was able to contort and serve others, still bypassing myself. It was just this crazy loop that I thought, wow. So fast forwarding, I, I sign up for this course, I have to do my capstone project, and then I stumble on your work and all of the pieces, just like what happened when you were just explaining your, your history and how this is all tied together.
[00:33:47] I had that same similar moment where all these strands and this perfect placement of me in this ideal environment of positive psychology. Learning how to be authentic in a positive way opened me up to be able to be authentic to my negative feelings and finally actually feel what it feels like to be angry.
[00:34:16] And I worked with. therapists that thank goodness for them really helping me to touch that, that little hotspot of anger in a safe place order to express myself to, so to relearn these ways of being. And I used to say I was a type, I was a reformed type C and I, I take that back now because those skill sets are enormously powerful.
[00:34:45] My ability to empathize and to read the room and to understand somebody else's feelings, but no longer do I, I take them on and try to fix other people. Instead, I'm just using that skillset to. Fuel my own inner authenticity in order to express myself. So I'm not using them against me, which is what I spent a whole life doing, but I'm using them for me, and as I have walked down this path and he hopes to help other cancer survivors.
[00:35:27] First of all, everybody that comes to me have these very same you called them psychological, or how did you refer to that Psychosomatic? No there's, it's a coping style that has its benefits. As you say, yes, compassion to other people, but it also can, in many circumstances, be maladaptive. It's not adaptive.
[00:35:56] And we're talking now at least then the Surgeon General just put out this paper, the Epidemic of Loneliness. Well, how is that connected to this and how, how so many people, it was fueled, of course, by the Panem Pandemic where everyone's isolated and so on. But it, but it's, it's more than just being isolated.
[00:36:14] It's that you're, you're lonely. Well, part of that is you are not known. can be in a group and we've all experienced that. We're with our family. We're, we're with a, a, a church group or with some other group, and we, we just feel like these people don't know who I am and you feel lonely. you should not be in that group then.
[00:36:33] Or you, you could do an intervention on yourself, an investment in yourself to Express yourself. Talk about, you know, who you really are. The more you talk about who you are, you get feedback from another person saying, oh yeah, I had that too. Or, I had those feelings, and then you suddenly do not feel as lonely anymore.
[00:36:56] And, and you get ideas and you get thoughts about how you can develop a certain way or seek a certain kind of of treatment. You know, again Information is a, is a, is a terribly important thing. If, if no, nobody knows that you have cancer, cuz you're hiding it. Cuz you don't want them to be burdened.
[00:37:16] Right. Well, you, you're gonna miss out on their potentially good advice mm-hmm. About a doctor who's good for that. Or if you, if you, if you're talking about the problems and getting to appointments, you're, you're, you're missing out on the other person saying, well, hey, I could take care of your kids, you know, anytime you want me.
[00:37:36] And, and people are more than happy to help. I've found they're more than happy if you just explain, you know what, what you're going through and, and what, what would be helpful. And, and I think it. I, I resonate a lot with what you're saying about the feeling happy, authentically. That's a terribly important No. Well, one of the questions that we asked for actually it was a study of people with aids. And again, we're predicting long-term survival. We're not predicting how you got it. We're predicting longer-term survival was how much are you able to say no to an unwanted favor? And we explained that in in detail.
[00:38:21] We said, if, if you wanna do something, it makes you feel good. And it's a positive thing. However, if you don't really wanna do it that's about. that, that can be something. That's why we're asking you, how often do you end up saying no to none? One favor, and the people who could say no, were the ones who.
[00:38:41] Did better. This led to a study that we did, a forgiveness, because again, we have, there are religions, we have all sorts of people saying, oh, you should forgive the other person. Well, it, it's, they say if not for the other person, then do it for yourself. And well, if, if it's not authentic, then it's, it doesn't work.
[00:39:01] You can't just say, oh, I forgive you. Because you think you should. That's the right thing to, to do. But you need to explain, Hey, hey, you know, you really hurt me when you did that. You know, you really did something to me. And I, I'm not here to blame you. I'm just here to explain what I am feeling and, and what this did to me.
[00:39:24] Explaining your feelings and explaining that is what makes a big difference. A lot of times I see these blocks, these roadblocks or obstacles on the way to a type C transformation, towards authenticity is that the, very type C coping person, and I, I won't call 'em personalities cuz coping is, is really what's going on here.
[00:39:48] Mm-hmm. You know, it's a coping style which can change. And, and they people need to be able to express in a diplomatic way that something is bothering them. The same with anger. You don't just all of a sudden go out and, and dump your anger on somebody. I mean, that, that's gonna cut off the relationship.
[00:40:08] You, you begin with the preface. So I would go, I would work on social scripts with some of these people. Hmm. Who I was counseling and I, I continued to counsel people at University of California, San Francisco, and then people with hiv aids in, in in Baltimore in, in terms of forgiveness. And the, the idea was the more I could.
[00:40:29] I get them to have a script that they've thought about. You are a very important person to me. I really, I really value your friendship, but you know, when you say these kinds of things, this is what it does to me. And it makes me, it makes it difficult for me to wanna talk to you about things. So can you understand how I wanna be connected with you, but can we talk about how, how we can do our relationship better so that, you know, we both get something out of it.
[00:40:59] And in, and in terms of the unwanted favors, I, I have a friend who has a. T-shirt. He's a very type B person, and it says, yes, I have a truck. No, I won't help you move. and and he's, he's already, he's already broadcasting what he won't do because people were constantly asking him to help him, including me.
[00:41:19] That's a beautiful idea. The social scripts and that safety that you as a psychologist, were providing these people to be able to voice themselves in a safe environment. Practice that with you, have it reflected back from another human that you're not mad at them, that you're not angry, that you're not gonna reject or abandon them because I believe it's my own personal experience that those ways of being were formed when we were really little, where we did try to express and we were shut down.
[00:41:59] You know, knowingly, unknowingly, consciously, subconsciously from those people that loved us into being in the best way they could, and the only way they knew how. And so to experience it outside of ourselves in a safe place is the, the like broken opening towards the Type C transformation. Finding that person or those people that it is safe to say, Hey, you know, I really value our friendship and what you just did didn't make me feel very good.
[00:42:36] Yes, so important. And so type C coping people are often reluctant to go to that therapist, that counselor. Find that group because of their type C. So I'm, sometimes I'm try, I, I interview, I offer a 30, 30 minute free consultation. And I have become pretty adept at identifying type C coping people just because of your work.
[00:43:10] Because I use questions that are not tell asking somebody, so tell me how you feel, because that's not gonna get us anywhere. They're, they're a little removed from their feelings. So I, I use questions like you do that reveal something a little different and I can't quite seem to get to the point of people realize that they're worthy of this work.
[00:43:42] Of being in a safe place to express themselves, to transform from this type C. So I'm trying to, have any recommendations for people that maybe identify with type C coping on how to get over that hurdle of I'm not worthy? Well, I, I have done research and in a number of venues using a number of methods and one of the most striking methods is not for everybody because you might not have the equipment, is to show people how their typical way of coping has physiological.
[00:44:24] Ramifications in their body. So we, I mean, again, this is a, this is a long research protocol. It's get approved it to get funded and all of this. But we would set up a, an interview on, on videotape and simultaneously be recording physiologically what it's doing to their heart, what it's doing to their galvanic st skin response, which is showing anxiety and, and other things.
[00:44:51] And showing that the, that the people who are very, very type C in terms of the coping you know, they, they are not connected. To their physiology. And so they will be saying on tape, oh, I feel fine, everything's fine. And meanwhile I'm showing them, oh, by the way, when you said you feel fine, this is what your heart rate is doing.
[00:45:17] This is what your given skin response, which is off used for the lie so-called eye lie detectors, which are, which are revealing stress. And that's do, do, do you understand what that could be doing to your physiology all day long? Mm-hmm. And that's the problem that I have noted as the connection for why type C is so damaging to people's health, whether it's cardiac health or cancer or hiv aids progression.
[00:45:51] It's that people are maintained at this level of stimulation, which people are. Researchers are now showing is connected with inflammation. And inflammation is one of the most harmful biological when it goes on unabated. Now inflammation is good. I mean, your body is telling you there's something wrong.
[00:46:14] and there's a, there's a germ here, there's a cut here, or there's something here and it responds with sending in immune cells and there's, and there's inflammation. However, it, it needs to get resolved. Once that's resolved, that those levels of ES and stimulation and the cytokines that are producing this i l six, which is linked to depression, it's linked to a lot of other things.
[00:46:41] You know, tho those levels are maintained over time. You have perseveration of that response. And perseveration of this, of these cytokines that are engaging an unhealthy inflammatory, inflammatory response. We have to be balanced. We have to have a inflammatory response and an anti-inflammatory response.
[00:47:04] You know, once the problem is taken care of, you need to go back to baseline. You can't always be at that level of, oh my God, oh my God, there's a problem here. Here's a problem here, there's a problem. You know, and again, the type C copper is divorced psychologically. Mm-hmm. From feeling that there's a problem here.
[00:47:25] They, they won't report that there's a problem here, but their body is showing that. Their physiology is showing that. And that's why when I do these demonstrations, you know, hooked up to all these machines and, and well, not all these machines, it's a, it's a very easy thing to do actually. But it's, it's basically saying this is, this is your physiology.
[00:47:45] And, and, and imagine you're doing this all day long and this is doing it to your body. It gotta change that, you know, it has an effect. And they go, whoa, I had no idea. And that, that did make a difference for a number of people. I can imagine it would make a difference. And wouldn't you wanna know that before it turns into cancer?
[00:48:08] Like the idea this suppression, I, by the way, your book is one of my bibles. I have somebody asked me to borrow it and I said, you can't because I have so many markings and underlinings and notes on there. It's almost embarrassing. I was like, you must get your own copy. You cannot borrow mine. But I remember reading this description of our cancer defense system.
[00:48:37] I think it was in, it's on page six. It's the type seek connection actually in part two of the book. And you go through this and I could viscerally feel just the. The recognition of, oh, that was what was happening in my body all of those years. Yes. And I could feel like when I finally learned how to express and not repress my emotions, I said once to my therapist, I, I felt like I was so kind of going against my own grain, like I did feel it inside my body that something wasn't right and I would not say something and I would keep it quiet and it would just grate inside of me that I, I joked to my therapist that if I had turned around, there would've been a little line of sand, which was actually me just degrading myself and, and not being able to articulate what was happening inside me.
[00:49:48] And I've often referred to it as a ghost in my throat, like it gets here and it just couldn't come out here. So I would stuff it back in. And these ghosts were just swirling around wanting to be released. So when I read in your book like that first your, your recommendation of that type C transformation is express it, get it outta you, you know, write it down, speak it, share it.
[00:50:19] And it was just so revolutionary to me to understand that those times when I thought I was protecting people or helping people by not saying anything, and instead trying to do everything for others, I was really hurting myself inside. it it wa it didn't look like a broken bone. I didn't have a cast on it.
[00:50:46] There was no scar or bandaid. But there was lots of damage happening inside. And, and you're also hurting the relationship. Yeah. Because you, you are not being your authentic self with this person. And, and, and at some level you're gonna be aware of, oh, this, this person doesn't understand me, this person doesn't care about me.
[00:51:07] And kind of hoping that that person would, and again, it's, it's not, it's not a conscious thing. We have levels of consciousness, you know, why didn't they do that? Well, it's cause you didn't explain it. But but you're hurting the relationship, but the relationship is necessarily going to deteriorate if there is an unattended problem.
[00:51:28] Those so-called negative emotions. Are, Are, really signals that something is wrong. Let's, let's solve the problem. And that's where some of the mindfulness movement, you know, which is a big thing. I, and I I'm totally in favor of that. It's paying attention to yourself. What are you doing? But they, they stop there.
[00:51:49] You're just mindful. You say, I'm I'm aware of this, sorry, this, this food tastes good now that I'm mindful of what I'm eating. But you have to say, well, okay, let's go onto the next step. How do we solve the problem? If you're, if you are aware that you are angry, well, what do you do next? And that's, and that's where again, you have to kind of embrace your, your, your full range of emotions.
[00:52:17] The sadness, the anger and everything else. They just say, Hey, they're, it's trying to tell me something. My body is my friend. These emotions are my friends. They're trying to tell me something's wrong. Do something, please. And they're, and we have to engage our upper mind, our, our, our, you know, cortex as opposed to the amygdala and other things that are, that are in the brain stem and emotions come from, but the emotions are trying to signal to us something is wrong.
[00:52:47] Do something about it. Use your brain, you know, use everything that you have. And that's why the, the, the scripts and the understanding that helps because, you know, some people may, may kind of naively think, well, I'm just gonna, we're just gonna blurt it all out. Well, maybe it doesn't work. Or in some context, I mean, you know, if. If you realize that if I, if I were to say what I really think about this job, I would be fired. Well, you probably would be. It's time you got another job. You know, that's, that's telling you, I mean, don't even go through that. Just don't. It's gonna be, but, but you have to realize, you know, what, what, what is the best way to solve this problem, you know?
[00:53:29] Or, or I'll, I'll keep on until, you know next year when I, when I'm fully, when when my health insurance is fully paid for, something like that, right. And then I will leave when you, you know, you don't have to do everything immediately, but it's a problem solving. And I think that's the part that's been missing from a lot of the.
[00:53:50] Mindfulness movement, people who, who just say, well, as long as you pay attention to yourself and look inwardly and think about stuff, oh, you're, you're just lost a thought. Right. And if you don't have the skill, if you, if you can not yet skillfully communicate that to the world in which you live, and, and we, I, I think you'll agree with me, and this has been my experience for me as as I transform my type C personality, for me to go into old relationships at the very beginning and just be the new version of me, that was not gonna happen.
[00:54:29] It was gonna put me right back into old type C behaviors because it wasn't gonna be received, because that's not how the relationship had been forming. I was A A doer and a fixer and a and now I was saying, no, I don't wanna do that. That's not gonna make me feel good. And that really affected other people in a way that they wanted to defend.
[00:54:55] So it, I had to actually practice this new way of being in these safe spaces because I, I, I often group it in very generally into two groups. My ground crew and my co-pilots. My ground crew are the people that have loved me into being that version of me that I was. They are the people that I'll call at 2:00 AM with good news or bad.
[00:55:24] But they often wanna keep me grounded. They wanna keep me as myself, this, these new realms. And there's lots of other ways to describe them. Tedeschi and Calhoun describe them as like knowledge experts or expert companions where you can go and try that new version of yourself in these safe spaces of therapists, counselors, coaches where, where you build the sense of confidence so that you can enter your world of ground crew skillfully.
[00:56:02] Mm-hmm. Using your type C traits in a positive way to kind of read the room and know like, okay, this isn't gonna land if I come in all ho whole hog and try to change the world in a moment. But skillfully doing so, being able to, you know, use social scripts in a way that opens people up instead of shuts them down.
[00:56:29] You know, I love how you described that. Just saying to somebody, I really value this relationship. You know, that, that positive sandwich, open up with a positive, bring in, bring in your feelings and close it with a, a positive that is a skillful way to communicate instead of completely shutting down. I just am so grateful for this work and, and I have such a deep reverence for how it was all formed.
[00:57:03] How you, from your very beginning, opening the doors of Yale a college that, you know, opened the doors for new beginnings for women, and being able to weave all of that in. This bio psychosocial model of health. Really having the components to help us help ourselves. Well, what you say is so important, and I completely agree with everything you're saying.
[00:57:34] If I could just have one little other thing, which is in all my. Interviews with the melanoma patients and also with the H hiv V AIDS patients formed a basis of my later work or still type C. The idea is that a lot of these coping patterns, and that's why I call 'em coping styles or coping patterns, you know, were formed early on and they were very useful early on.
[00:58:01] Un unfortunately, I mean, what I kept on saying time and time again was that there was often a pattern of people being not believed either the parents were very sep separate from, separate from their own emotions and they didn't even recognize that or they were potentially abusive. So that sometimes there would be a situation where, you know, the, the child, imagine the seven year old child is, or you younger is saying, I, I'm very hungry.
[00:58:32] And the. Parent will say, oh no, you can't be hungry. You're not hungry. Dinner is not until six o'clock. That's when we have dinner. That's where our family has dinner at six o'clock. Or or, or forcing the child to, to, to push these emotions down or not recognize them, not, not give the child the validation for those feelings.
[00:58:55] And that's where I saw unfortunately that a lot of the folks with ENT melanoma came from, a abusive family. Situations where there would be usually a father who, who would be inappropriately doing something with a, with a child and would say, no, no, this is good. And the child is saying no, thinking, no, this is terrible.
[00:59:17] This is bad. Look, we, we don't sit tell anyone. This is good. I'm your, I'm your, I'm your father. This is, this is, this is good. And, And, they, and not expressing it was the way to keep, a child, this important parent who basically controls your whole life from punishing you from doing anything bad to you.
[00:59:41] And so you just, you hang on and you survive. So I have. Huge respect for people who develop these types c coping patterns from, you know, neglectful or, or even to the point, the extreme point of being abusive family situations where being type C was functionally adaptive, but then p it's very hard for the, for these folks to, to then come, come forth in, in later life and, to see, oh no, you survived that.
[01:00:17] Great. But you know, right now it's, it's hurting you. It's not adaptive anymore. And that's, that's the last thing I wanted to, point I wanted to make is that, that it's not, that's not the case for all, all folks who are, who are having the, the type C coping is dominant or even a, you know, a main part of their repertoire. I mean, you wanna have a broad coping rep repertoire. What's appropriate in this situation is, is to be assertive. What's appropriate in this situation is to be compassionate and to listen, you know, and, and, and to have a repertoire that you could pull from. Not always. Relying on, oh, I'm gonna repress my feelings.
[01:00:57] I'm not gonna be myself, I'm not gonna talk about this cause oh, it's gonna get me in trouble, into trouble. Mm-hmm. So and then to recognize that there are some things that can only change from leaving the situation. It's not just changing yourself. Getting the divorce, it's quitting the job, and, and that may be the, the solution to the problem.
[01:01:18] Right. But it start, started the solution to the problem. Right. Gosh, it's such an important thing to note because some of these changes are so big that we can't even think about doing them at the same time. In my case, it happened. You know, the marriage ended and then happened, or cancer is diagnosed and then you decide to leave the job or do the work.
[01:01:47] So sometimes it's opens. I think the harder way is to do the work while you're in that environment, culture situation. Yes. And for that, I really think that there's the need for a new kind of a new way of looking at wellbeing where yes, you should be going or yes, go to a therapist to help you work through those younger coping and how they became and understanding, and then also working with.
[01:02:27] Other groups are to help you grow outside and change your way of being. So it's like this model of wellbeing where you are working on the inner self and then also working with coaching on what's good and right within you in this moment and how you can move forward. So doing those two things combined, I think is what boosts like that positive psychology and the psycho psychology of how we became ugh.
[01:03:01] So there's so much here. I, I could talk for days. I just noticed it's even already past the hour and I'm grateful for you staying on with me. I do have one last question that I would love to ask you. And that is, if I were to crush you up and put your essence into pill form, what effect would you have on someone taking that pill?
[01:03:25] Well, first of all, I would not sugarcoat the pill, obviously. I would, I would be the it would, there'd be an essence of spiciness. There'd be an essence of freshness. There'd be an essence of multiple dimensions of flavors in that, in that pill. And you chew it up. Don't just swallow it you know, chew it up, but taste it and try to see, you know, the essence of that.
[01:03:52] And and the key phrases I think I would use is you know, be kind, not nice. That includes being kind to yourself. SAR with being kind to yourself, you know, and to be authentic to be search constantly. I mean, it's an evolving process. I mean, what, you know, how, how you were authentic at age 25 is gonna be different at, at age 50 and so on and so forth.
[01:04:18] And so it's an evolving process. Don't just be static. Be open and curious and, and enthusiastic about exploring the world and, and, and who you are are becoming. Ah, thank you for that. And I do believe I've taken that pill by bursting myself into your work. It has been such a gift to the world, and I'm so grateful for you taking your time to talk with me today.
[01:04:45] It's just an honor. Thank you for the opportunity.