When Being the Strong One Comes With a Cost

There is a particular kind of person I meet often in the therapy room.

They are dependable. Thoughtful. Responsible. The person everyone calls when something goes wrong.

They notice when someone else is uncomfortable before they notice their own discomfort. They feel guilty saying no. They can tell you exactly what everyone around them needs, but sometimes struggle when I ask a much simpler question:

What do you need?

There is an interesting conversation happening at the intersection of psychology, chronic stress, and autoimmune disease. And before we go any further, an important distinction needs to be made.

There is no "autoimmune personality."

Being a people-pleaser does not cause lupus. Suppressing anger does not cause rheumatoid arthritis. Setting better boundaries is not a treatment for autoimmune disease.

Autoimmune diseases are complex medical conditions influenced by genetic, biological, hormonal, environmental, and other factors.

But our emotional lives and our physical bodies aren't operating in separate buildings either.

Stress doesn't only happen in your thoughts

Psychoneuroimmunology is the study of how psychological processes, the nervous system, endocrine system, and immune system interact.

Researchers have found associations between significant or chronic stress and changes in immune functioning. Large studies have also found associations between stress-related disorders, childhood adversity, and the later development of some autoimmune conditions.

That does not mean stress is the singular cause.

It does mean the mind-body relationship deserves considerably more nuance than "it's all in your head."

And there are four emotional patterns that I think are particularly worth talking about in therapy.

1. You are more tuned into everyone else's emotional state than your own.

You walk into a room and immediately take its emotional temperature.

Is Mom upset?

Is my partner irritated?

Is my child okay?

Did my boss sound annoyed?

Does everyone have what they need?

Meanwhile, your own internal experience barely makes the list.

This kind of hyper-attunement can develop for many reasons. Sometimes it was adaptive. Perhaps understanding other people's moods helped you feel safe, connected, loved, or prepared.

The problem is that becoming exceptionally good at monitoring everyone else can make it remarkably difficult to recognize your own limits.

2. Your responsibilities have become part of your identity.

There is a difference between:

"I have responsibilities."

and

"I am the person who holds everything together."

The second one is much harder to put down.

When competence, caregiving, productivity, or reliability becomes part of our identity, resting can start to feel irresponsible.

Delegating feels uncomfortable.

Asking for help feels like failure.

Someone else's disappointment feels like evidence that we've done something wrong.

So we keep going.

Sometimes long after our bodies have started asking us to stop.

3. You don't really "get angry."

Sometimes I hear this said almost proudly.

"I'm just not an angry person."

Maybe.

But anger is a normal human emotion. It gives us information about boundaries, injustice, frustration, violation, exhaustion, and unmet needs.

Healthy anger doesn't require screaming, aggression, or hurting someone.

Sometimes healthy anger sounds like:

"Actually, that wasn't okay."

"I can't do that."

"I'm frustrated."

"I need help."

"No."

When someone has learned that anger is dangerous, selfish, disrespectful, or unacceptable, the emotion doesn't necessarily cease to exist. They may simply become incredibly skilled at disconnecting from it.

4. You feel responsible for how other people feel.

This is the big one.

If someone is disappointed, you need to fix it.

If someone is uncomfortable, you accommodate.

If someone is upset with you, you replay the interaction until you figure out what you did wrong.

If saying no might hurt someone's feelings, saying yes feels safer, even when the yes costs you something.

Over time, this can create a life organized around preventing other people's discomfort.

And that is exhausting.

So what does any of this have to do with autoimmune disease?

This is where we need to resist an appealingly simple explanation.

The research does not tell us that these four personality characteristics cause autoimmune disease.

What it does tell us is that psychological stress has physiological effects.

The stress response involves communication between the brain, autonomic nervous system, endocrine system, and immune system. Chronic or significant stress can affect inflammatory signaling and immune regulation. Research has also found associations between major stressful life events, trauma-related disorders, childhood adversity, and autoimmune disease.

Association is not destiny, and it is not proof of causation.

But it gives us a compelling reason to stop treating emotional stress as something that exists exclusively between our ears.

Your body participates in your experience of your life.

And this is where therapy becomes interesting.

The goal isn't to tell someone with autoimmune disease:

"You need to stress less."

Please don't.

Aside from being reductive, it places responsibility for a complicated medical illness onto the person experiencing it.

Instead, I become curious.

What happens inside you when someone is disappointed in you?

How easily can you identify that you've reached your limit?

Can you experience anger without immediately converting it into guilt?

Can someone you love be upset without you believing it is your responsibility to make the feeling disappear?

Who are you when you aren't taking care of everyone else?

Those aren't questions because answering them correctly will cure an autoimmune disorder.

They're questions because you deserve a life in which your own emotional wellbeing gets a seat at the table too.

And sometimes the person who has spent a lifetime asking, "Is everyone else okay?" needs someone to finally ask:

But are you?