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Jackie the circumstances demanded.”
    When her yet-undiagnosed progressive neurological disease began to cause serious symptoms like weakness and falling, she followed a lifelong pattern of silence. Rather than alarm her husband, she hid her problems, pretending that other causes had slowed her down.
    “Well, I can only say that it doesn’t feel like stress,” Jackie said one time, early in her marriage, when Hilary asked how she coped with the strain of both a personal and professional relationship with her husband. “I find myself a very happy person. I love my music and I love my husband and there seems to be ample time for both.” A short while later she fled husband and career. She came to believe that her husband stood between her and her true self. She briefly left the marriage, acting out her unhappiness through a sexual affair with her brother-in-law—a further example of her uncertain boundaries. Deeply depressed, for a while she wanted nothing to do with the cello. Soon after she returned to both marriage and music, she was diagnosed with MS.
    Jacqueline du Pré’s cello voice remained her only voice. Hilary called it her sister’s salvation. It was not. It worked for audiences, but itdid not work for her. People loved her impassioned music making, but no one who mattered ever truly listened. Audiences wept and critics sang her praises, but no one heard her. Tragically, she, too, was deaf to her true self. Artistic expression by itself is only a form of acting out emotions, not a way of working them through.
    After her sister’s death, Hilary listened to a 1973 BBC tape of the Elgar concerto, with Zubin Mehta conducting. It had been Jackie’s final public performance in Britain. “A few moments of tuning, a short pause, and she began. I suddenly jumped. She was slowing the tempo down. A few more bars and it became vividly clear. I knew exactly what was happening. Jackie, as always, was speaking through her cello. I could hear what she was saying…. I could almost see tears on her face. She was saying goodbye to herself, playing her own requiem.”
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The portal vein is the major vessel conveying blood from abdominal organs to the liver
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Stress and Emotional Competence
      A PERENNIAL GIVE-AND-TAKE has been going on between living matter and its inanimate surroundings, between one living being and another, ever since the dawn of life in the prehistoric oceans,” wrote Hans Selye in
The Stress of Life. 1
Interactions with other human beings—in particular, emotional interactions—affect our biological functioning in myriad and subtle ways almost every moment of our lives. They are important determinants of health, as we will see throughout this book. Understanding the intricate balance of relationships among our psychological dynamics, our emotional environment and our physiology is crucial to well-being. “This may seem odd,” wrote Selye. “You may feel that there is no conceivable relationship between the behaviour of our cells, for instance in inflammation, and our conduct in everyday life. I do not agree.” 2
    Despite the intervening six decades of scientific inquiry since Selye’s groundbreaking work, the physiological impact of the emotions is still far from fully appreciated. The medical approach to health and illness continues to suppose that body and mind are separable from each other and from the milieu in which they exist. Compounding that mistake is a definition of stress that is narrow and simplistic.
    Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakupor the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary.
    For those