Psychosomatic part 1

Is a term that is often used to mean it’s not real. In much the same way that someone presenting with unexplained chronic digestive troubles may be told “You’ve just got depression” when tests come back normal, people with physical pain or problems who have normal test results may be informed “There’s nothing wrong with you, it’s psychosomatic”. Quite understandably, people suffering from chronic, painful physical problems find this pretty hard to take. Using the term psychosomatic in this way is terribly unhelpful and inaccurate. For the person rushed to hospital afraid they were having a heart attack, the news that they are experiencing panic attacks is good news or bad news, often depending on how it is delivered. The good news is that hopefully, their ticker is going well, and they don’t require invasive surgery or procedures. The bad news is discovering they are dealing with a debilitating mental health problem, which can be very embarrassing and stressful. When mental health problems are presented as if they are insignificant, we feel humiliated by how difficult they can be to manage. Sometimes in a very busy medical setting, a diagnosis of a mental health problem is given is very offhand and dismissive way – you’re no longer their problem. This can leave the poor person involved actually wishing they had been having a heart attack! Sometimes people are referred for information and support, sometimes they are just sent home to try and deal with the problem by themselves.

Anyone who has a mental illness knows that just because it’s in your head, doesn’t mean it isn’t real. Your head is actually pretty important and a lousy place for an illness to be! Mental illnesses can be extremely disabling and in sadly too many cases, terminal. Having them treated as if they are less important than ‘real’ physical problems can cause so much distress and embarrassment that people don’t go for help, don’t get support, don’t learn how to manage it appropriately, and become very overwhelmed and hopeless.

I have a couple of chronic health problems that are of unclear origin (as well as others with a clear physical origin). As a result, medical and psych doctors have been debating with enthusiasm whether they are physical or psychological problems. This happens with every health problem while the cause is uncertain. It’s my understanding that tuberculosis was linked to having a type A, driven and high achieving personality until the bacteria responsible were identified. This can cause a huge amount of stress for people with these conditions, as they bounce between specialists with different theories and opinions.

One of the tricky things about health and sickness, is that to some extent, they are both psychosomatic. Now, let me be super clear here – I’m NOT saying that you get cancer because of feeling bitter, or demeaning rubbish like that. But, our emotional state does have an impact on our health. Feelings of grief, fear and anguish can be measured in changes in our bodies. One of the areas we’ve done the most study on is the effects of fear. Because feeling fear is geared to keep us safe, the effects are often really fast. Hormones kick in quickly, we feel changes such as our heart rate increasing, our blood flow restricts somewhat to stay around our brain and vital organs so our hands may feel cold or tingly, energy is diverted away from non-essential functions like digestion, so we feel our mouth go dry. These responses are all geared for the fight-or-flight response so we defend ourselves or get away as quickly as possible from whatever is frightening us. And they could all be called psychosomatic, because they are caused by how we are feeling.

Psychosomatic simply means that the problem you’re dealing with is being caused or exacerbated by your emotional and psychological state, rather than purely physical issues. In some cases, emotional pain is being expressed as physical pain, or psychological blocks are expressed as physical disability. If this happens in a really severe or disabling way, you may be diagnosed with a Somatoform Disorder. If it happens in milder forms, such as sleeping problems, disturbances in your senses, rashes clearly related to emotional distress etc., you may be diagnosed with a Dissociative Disorder. The line between these kinds of conditions is rather blurry and difficult to distinguish. It may be that the psychosomatic disorders are more severe forms of the kinds of distress seen in dissociative conditions, at least in some cases. It’s such a difficult area to make sense of because we don’t know all the causes of physical sickness yet, and because our emotions always impact on our health. Most of us get some kind of physical symptoms when we’re stressed – headaches, back pain, a sore mouth from teeth grinding, flaring of skin problems like dermatitis. On a mild level, that’s a psychosomatic reaction. Most of us have also experienced how our psychological state affects how we cope with physical problems. Have you ever been in pain from a tummy bug or headache and suddenly received some great news? The pain recedes to the back of your mind and you feel warm and happy and like you can cope.

For a while, some doctors thought that people with mental health problems would need less physical care because their issues were psychological. Lately it’s being shown that people with chronic mental health problems often have chronic physical issues that are not being attended to. Some of these are a direct result of the mental illness; for example some people with an anxiety disorder suffer from chronic dry mouth and as a result need extra dental care. Sometimes they are the result of unfortunate side effects of treatment, such as increased cardiovascular problems due to weight gain associated with certain medications. Also, physical health problems can cause mental health problems like depression to develop as people struggle to cope with the demands of chronic pain and disability. So the divide between mental and physical is not very clear. Our head is attached to our body, and stressors and problems in one do affect the other.

part 2 of this discussion can be found here. 🙂