Why People Pleasers Are More Likely to Get Autoimmune Disease — What Gabor Maté's Work Tells Us

People pleasers are more likely to develop autoimmune disease not because of weakness or bad luck but because chronic self-abandonment — the lifelong pattern of suppressing your own needs, emotions, and limits to maintain relationships and approval — creates a sustained physiological stress response that dysregulates the immune system over time. This is the central argument of Gabor Maté's work, and it has significant implications for how we understand illness, identity, and the cost of never learning to say no.

What Gabor Maté actually argues

Gabor Maté is a Hungarian-Canadian physician who spent decades in clinical practice before publishing “When the Body Says No” in 2003. The book draws on psychoneuroimmunology — the science of how the nervous system, immune system, and emotional experience interact — to argue that chronic illness and emotional patterns are not separate phenomena.

He offers a stark central argument. The chronic suppression of authentic emotional expression — particularly anger, grief, and the capacity to say no — does not just produce psychological discomfort. It produces disease. Autoimmune disorders. Multiple sclerosis. Rheumatoid arthritis. Lupus. Cancer.

What connects many of the patients Maté writes about is not a single dramatic event but a long, quiet pattern. A person who was always described as selfless, warm, giving. Who never complained. Who put everyone else first so consistently that by the time the illness arrived, the people around them were genuinely surprised — because this person seemed fine.

The physiology of self-abandonment

Maté's argument rests on a specific physiological mechanism. When a person chronically suppresses emotional experience — when they habitually override their own needs, feelings, and limits to maintain relationships or avoid conflict — the body registers this as sustained stress. Not the obvious, acute stress of a crisis. The quieter, more insidious stress of a nervous system that is never fully allowed to respond authentically to what is actually happening.

That sustained stress activates the body's inflammatory response. As Maté has noted, when people feel chronically threatened or insecure, the body turns on inflammatory genes. Inflammation, over time, becomes a condition in which the immune system loses its capacity to distinguish accurately between self and other — between what belongs to the body and what does not. In autoimmune disease, the immune system attacks the body's own tissue. Maté's reading of this is precise and confronting: the body is attacking the self that was abandoned emotionally long before the diagnosis arrived.

This is not a metaphor. It is a physiological process. The nervous system, the immune system, and the endocrine system are not separate — they are one integrated system, and what happens at the emotional level has consequences at the cellular level.

Why this disproportionately affects women

Approximately 80 percent of people with autoimmune conditions are women. Maté and others who have built on his work argue that this is not coincidental. Women in most cultures, including Singapore, are socialised from early childhood to prioritise others' needs over their own — to be warm, accommodating, relationally attuned, and emotionally available. To suppress anger. To maintain connection at significant personal cost.

In Singapore this socialisation has particular texture. The expectation of filial piety — of children, and especially daughters, absorbing family emotional labour without complaint. The cultural valuing of self-sacrifice as virtue. The specific pressure on women to manage the emotional climate of the home, the marriage, the family, while continuing to perform professionally. The message, explicit or not, that having needs is a burden on others.

These are not just social patterns. They are nervous system patterns. A child who learns early that expressing needs creates conflict, that anger is dangerous, that approval depends on self-effacement — that child's nervous system adapts. It learns to suppress. And that suppression, sustained over decades, has a cost the body eventually names.

What people pleasing actually is

People pleasing is often described as a personality trait or a social habit. Maté's framework positions it differently — as a survival strategy that developed in response to early relational experience.

A child who grows up in an environment where love is conditional, where approval must be earned, where expressing authentic emotion creates distance or conflict — that child learns to manage the environment by managing themselves. By becoming agreeable. By anticipating what others need. By making themselves small enough not to cause problems.

This is not weakness. It is intelligence applied to a specific relational environment. The difficulty is that the strategy does not turn off when the environment changes. The adult continues to suppress, to accommodate, to override their own signals — not because the original threat still exists but because the nervous system does not know that it has passed.

In Singapore, this pattern is so culturally normalised that many people do not recognise it as a pattern at all. It is simply how you are. How you were raised to be. The good child, the responsible one, the person everyone can rely on. The one who never makes things harder than they already are.

The body, over time, keeps the record.

The connection to childhood and attachment

Maté is explicit that people pleasing does not develop in a vacuum. It develops in relationship — specifically in early caregiving relationships where the child's authentic emotional expression was not welcomed, tolerated, or responded to safely.

A child whose anger was met with withdrawal, whose sadness was dismissed and needs were framed as inconvenient. Whose role in the family was to manage the emotional climate rather than to be cared for within it. These experiences do not just shape personality. They shape the nervous system's default responses to stress, threat, and the need for connection.

This is where Maté's work connects directly to attachment theory. The same early relational experiences that produce insecure attachment — the anxious monitoring, the self-erasure, the inability to trust that needs will be met — are the same experiences that produce the emotional suppression patterns he associates with chronic illness. They are not separate problems. They are the same nervous system response to the same early environment, showing up in different domains of life.

Understanding anxious attachment and the way it trains people to prioritise others' emotional states over their own is directly relevant here. So is understanding what self-abandonment costs relationally — because the relational and the physical costs are not separate. They are expressions of the same underlying pattern.

I live with an autoimmune condition myself. What Maté describes is not abstract to me — the connection between chronic self-suppression, nervous system stress, and immune dysregulation is something I understand both professionally and personally.

What this means for people living with autoimmune conditions

Maté is careful to say that he is not blaming people for their illness. The point is not that you caused your disease by being too nice. The point is that the emotional patterns that preceded and accompanied the illness are part of the picture — and that a medical model that treats only the physical manifestation while ignoring the emotional history is missing something important.

This has specific implications for people in Singapore living with autoimmune conditions. Many will have received thorough medical treatment — rheumatologists, immunologists, medication to manage the immune response. What tends to be absent from that treatment is any attention to the emotional and relational history that the body has been carrying.

Counselling for autoimmune and chronic illness is not a replacement for medical care. It is an addition to it — one that addresses the nervous system, the emotional patterns, and the relational history that medical treatment alone does not reach. For many people, understanding the connection between their illness and their lifelong pattern of self-abandonment is not just intellectually interesting. It is the beginning of something different.

What Maté says healing requires

Maté proposes that healing — not just symptom management but genuine physiological recovery — requires something more than medication. It requires the development of what he calls autonomy, the capacity to know what you need and value and to act from that knowledge rather than from compulsive accommodation of others. Assertion — the ability to state that you exist, that you have needs, that you do not need to justify your presence. And authentic emotional expression, including the emotions that were suppressed for decades in the service of maintaining relationships and approval.

This is not a quick process. The nervous system that learned to suppress learned it early and reinforced it across a lifetime. It does not update through insight alone. It updates through new relational experience — through the repeated experience of expressing authentic emotion and finding that the relationship survives it. Through the experience of having needs and finding that they can be met without everything falling apart.

Somatic attachment therapy works at this level — with the body's stored patterns of suppression, with the nervous system's learned responses to emotional experience, and with the relational context in which new responses can develop. For people living with autoimmune conditions who recognise themselves in Maté's work, this is where the counselling dimension of healing begins.

Frequently Asked Questions

Can people pleasing cause autoimmune disease? Gabor Maté's research and clinical work argues that chronic emotional suppression — including the habitual pattern of prioritising others' needs over your own — creates sustained physiological stress that dysregulates the immune system over time. This does not mean people pleasing directly causes autoimmune disease, but that the emotional patterns associated with it are physiologically costly in ways that increase vulnerability to immune dysregulation.

Why do women get autoimmune disease more than men? Approximately 80 percent of people with autoimmune conditions are women. Researchers including Gabor Maté point to socialisation patterns that require women to suppress anger, prioritise others' needs, and maintain relational harmony at personal cost — patterns that produce chronic nervous system stress over time. The gender disparity in autoimmune conditions reflects, in part, the biological cost of chronic self-disconnection.

What does Gabor Maté say about autoimmune disease? In When the Body Says No, Maté argues that autoimmune disease is often connected to a lifelong pattern of emotional suppression and self-abandonment. He proposes that the immune system's attack on the body's own tissue reflects, at a physiological level, the self that was abandoned emotionally — and that healing requires addressing the emotional patterns alongside the physical symptoms.

What is psychoneuroimmunology? Psychoneuroimmunology is the scientific study of how the nervous system, immune system, and emotional experience interact. It provides the physiological basis for Maté's argument that chronic emotional suppression has immune system consequences — demonstrating that the mind and body are not separate systems but one integrated whole.

Can counselling help with autoimmune disease? Counselling does not treat autoimmune disease directly. What it can address is the emotional and relational history that the medical model tends to leave untouched — the patterns of self-abandonment, emotional suppression, and nervous system dysregulation that Maté associates with immune vulnerability. For many people living with autoimmune conditions, this dimension of their experience has never been addressed in any clinical context.

Is this about blaming people for their illness? No. Maté is explicit on this point. The argument is not that people cause their illness by being too accommodating or too self-sacrificing. It is that the emotional patterns associated with chronic illness are part of the picture — and that a complete approach to healing needs to include them. Understanding the connection is not blame. It is a more complete account of what happened.

If something here resonated and you're wondering whether therapy might help, you can read more about how I work and book a session on the Services and Booking page.

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