17 July 2017
Becoming Health Rebels
Corinna Wood interviews Dr. Aviva Romm
In preparation for the annual fall Southeast Wise Women Herbal Conference, Corinna Wood interviews Aviva Romm about her work with supporting women in "overcoming overwhelm" and getting out of S.O.S. (Survival Overdrive Syndrome), as well as some of the root causes of trauma and oppression that contribute to these health issues in the first place. Aviva Romm is a midwife, herbalist, and Yale-trained MD, bridging the best of traditional medicine with good science for over three decades.
Corinna: Aviva, what is SOS, and how does it impact women you see in your practice?
Aviva: SOS is a term I coined which means Survival Overdrive Syndrome, and it's based on a few things: one, it started because so many of my patients were coming in and saying things like, "Aviva, Dr. Aviva, I feel like I'm constantly in overdrive. I feel like I'm always stuck in survival mode. I feel like I'm going from one thing to the next, and I can't turn off the stress. I'm constantly overwhelmed." I started to pay attention to the words women were using and at the same time started looking at the impact of various contributors to health and imbalance on what symptoms that they were exhibiting, for example brain fog, forgetfulness, poor concentration, weight gain, high cholesterol, high blood pressure, hormonal problems, insulin resistance, anxiety, depression, fertility challenges, mood challenges.
Corinna: You seem to view sleep as a form of medicine. I love that. How has your perspective on that developed, and would you share some of your personal and/or professional experience regarding benefits of sleep for women's health?
Aviva: Sleep actually is medicine, and it's particularly important medicine for SOS because much as we like to think of ourselves as modern human creatures, and much as science likes to tell us that nature is unimportant and science can always win over nature, the reality is that as human beings we are hardwired to be in harmony and relationship with our planet, including the 24-hour cycle of the Earth around the sun. That's called our circadian rhythm. Cortisol is released on what's called a diurnal rhythm, which means it's got two 12-hour cycles. Those 12-hour cycles together make up that circadian rhythm. Cortisol should be high in the morning, decrease throughout the day and be much lower at night to where it reaches its lowest point about midnight or 1:00 AM or so and then it starts to go up again.
Corinna: We know that many women and girls today experience trauma, and you're bringing forward to the medical community a greater awareness of some of the health impacts of trauma and false beliefs which often arise out of adaptations to trauma. Can you speak to the links between trauma and SOS?
Aviva: Trauma is any set of circumstances that threaten our survival or cause us to feel threatened, cause us to feel our survival is at risk. That can be anything from overt physical abuse, assault, having been raised in a socioeconomically or racially impacted environment where your food, your shelter, your stability at home, love, belonging and safety were impacted. It could also be sort of indirect trauma. For example, being raised in a home with parents who were fighting all the time or an alcoholic parent who even if you weren't directly abused was abusive to the other parent, for example. There are lots of things that can cause us to experience trauma. Where we experience trauma in our brain is called the amygdala, and it's the part of our brain that picks up and stores any memories. Those can be scent, sight, sound, emotion, any triggers that are related to that trauma. That part of our brain along with another part of our brain called the hippocampus store and catalog all these memories.
What happens is that when you have the initial experience or continued experience of trauma, it activates the amygdala which sends chemical messengers to the hypothalamus which then relays that message to your pituitary gland and onto your adrenal glands, stimulating the production of adrenaline in your adrenal glands and also outside of your adrenal glands. Adrenaline thus is produced and released, and cortisol is produced and released. This is direct downstream effect of any kind of stressor that we experience that puts our primitive survival mode into activation to save us.
In order to protect ourselves, our brains make us go into something called hyper-vigilance. That's when you're super alert and aware of your environment, and it happens in an acute stress. If you're in a parking garage alone, and you're a woman, and it's night, and you hear footsteps behind you, it's not like you're just going to start singing some song from "The Sound of Music." Your back's going to go up, your ears are going to get more sensitized to sound, you're going to start looking around, your heart rate's going to get faster, you're probably going to reach into your pocket or your bag for your keys if you don't have them out already, maybe you're grabbing your cell phone. You're stressed.
When you are primed to be in this SOS response, it's almost like your brain is always hyper-vigilant, and it's affecting your body because cortisol and adrenaline make all those things physically happen in your body. You become on the lookout for danger all the time or most of the time. You might be somebody who tends to think the worst is going to happen to you even when there's no evidence of that in your current life. You may think that other people are always talking about you or looking at you funny because they're making facial expressions that trigger you. You may think that you're never going to be successful or have love or get the job you want.
Corinna: How do you see endemic sexism of modern culture - and racism for women of color - contributing to stress levels and SOS for women today?
Aviva: That's such a big question. I can speak for myself based on socioeconomics and also being a woman. While I can also speak to the racism that is impacting women’s health from a statistical and human perspective, I cannot, and would not ever assume to speak to the experience of being a woman of color. That would inappropriate. My job is to listen and understand, and call out racism in any way I can. But I'm a Caucasian woman and though I grew up in a housing project in New York City with a single mom in the 1970s, the additional stress on women of color is incomparable.
There are so many ways that sexism and SOS challenges impact our stress response. Speaking for myself, and this is a big impetus for me in the book that I wrote, was coming up in an environment where you always kind of wonder what was coming next. Was there violence? Was there going to be enough food?It really can set up a very lower threshold for activation of your stress response.
A big reason that I wrote my book for women - men have thyroid problems, men have autoimmune diseases, men struggle with overweight and depression and anxiety, but here's the thing: women are more likely to be underdiagnosed, misdiagnosed, completely unseen and unheard to the point that 5,000 more women die a year in the hospital of a heart attack than men in the hospital because when men report chest pain, they're more likely to get a cardiac workup. When women report chest pain, they're more likely to get an anxiety medication, a sleep medication or a pain medication. They're not going to get the cardiac workup.
On average, it takes about five years for a woman to find a doctor who will properly diagnose her for an autoimmune disease. That does not usually happen with men. On top of it, women are 8 to 1 times more likely to have an autoimmune disease than men. Eighty or ninety percent of all Hashimoto's in the United States is women. Five of the top surgeries done in the United States are done on women, and two of those hysterectomies and Cesarean sections are done unnecessarily more than half the time. Women are getting major abdominal surgery, and this is all sexism. We need to look at the confounding factors that impact women getting a diagnosis, getting treated properly, being seen and heard.
Even on the most simple level for example, women who are in relationships with men - it's only been studied in heterosexual couples to my knowledge – and who come home from work and tell their partner what a crappy day she had, his cortisol levels don't go up. When the male partner tells the woman if he had a crappy day, her cortisol levels go up. Women who sleep next to men that they're in unhappy relationships with, their cortisol goes up and their sleep is disrupted. This doesn't happen so much for men. Stress also has a bigger impact on us. We know that women experience at least 30 to 40% more physical health problems, headaches, digestive changes, anxiety, depression, sleep problems than men as a result of stress.
Corinna: You encourage women to be health rebels. What does that look like?
Aviva: Okay, so there's a few things here. The 24/7 world we're living in is based on a very western model of achievement, productivity and capitalism. If you look at other countries, let's say some of the Scandinavian countries, they have a different value system that they're operating under. They value health, happiness, time off, social time, and family. They work shorter days, and some of these countries have four-day work weeks, and up to 18 months of maternity leave for women. You just put that right on the overlay of everything, and you're going to see lower stress. We live in a culture that is demanding more of us than we are evolutionarily capable of delivering, and it is killing us.
One of the ways that we can be a health rebel is by saying, "No, you can't have my health. You can't have my life. You can't have my mind, my mood, my body, my hormones," to the dominant culture. We do that by staking a claim for reevaluating what our priorities are, what our needs are, how we define success and within that how we create lives that keep us supported, replenished, nourished and healthy. We're redefining success as health, satisfaction, time to breathe, time to be well, and we're defining how we get to health as feeling replenished, nourished and having reserves. That means eating well, sleeping well, making time for being with the people we love, being creative. It does means making some decisions about what's important you. That's one thing.
Another thing is that as women, we have been taught to be nice, be good, play it small, be seen and not heard, be good girls. This can literally kill us. In fact, if you will, please link over to one of my blogs called, "How Being a Good Girl can be Hazardous to Your Health." Being a good girl can literally kill you. How do I mean? Well, let's say you go to the doctor's office and your doctor is saying, "No, I don't think you have a medical problem. You're just actually stressed, or you're a new mom," and it turns out that you actually do have a medical problem. You have an autoimmune disease or you have Lyme disease or you have something else going on, and you don't get that taken care of. What's the outcome?
What's the outcome if you are at a job and you're never getting the promotion that you deserve? Every guy around you is getting promoted, or you're being treated differently, or you're experiencing sexual harassment at work and you don't speak up. This can kill you short term or long term. We have to learn to smartly, wisely and safely of course - because we don't want to get assaulted or hurt - use our voices and speak up. We have to be rebellious.