If you’ve just come to this page, it will make more sense if you start with part 1. 🙂
Too much emphasis on the physical:
Many people in my position with what seem to be physical illnesses are very upset if a doctor suggests that the condition may be psychosomatic. Sometimes they fight very hard to have the illness considered physical and refuse any approach that is geared to reduce stress or anxiety. When physical illnesses are characterised as ‘real’ and mental illnesses are seen as ‘weakness of character’, faking a problem for attention, or other demeaning ideas, we would all fight to have our problem seen as physical. When you add in issues such as trouble getting insurance for mental illnesses, doctors being dismissive of psychosomatic problems, and an emphasis on mindless optimism in the general culture that says everything is a case of ‘mind over matter’ and if you stay positive you’ll be fine, you can understand why the debate gets pretty heated.
Here’s the downside, even assuming that the condition is a physical one, treatments that aim to lower stress, anxiety, fear, depression and emotional pain will be helpful. Good doctors offer these kinds of treatments to people experiencing all kinds of debilitating physical health problems! If you’re going through cancer, arthritis, or heart disease, reducing stress is a great idea! In my experience, many of the treatments you try for your illness are quite inconvenient or even physically painful. I’ve done detox diets, skin scrubs, and all kinds of things it was hoped would help that actually increased my day to day pain level. Add to that a regular battery of tests, and life becomes pretty miserable.
In my case, I’ve got a fairly high tendency to somatize – that is, I often express overwhelming emotional pain as physical pain or illness. That’s very common for people who’ve experienced chronic trauma and who have dissociative conditions. Sometimes being chronically distressed and disrupted lowers your immune function so you catch everything going around. Other people are very prone to tension headaches or stress-induced skin conditions. Engaging as if these problems were physical actually made me worse, partly for the reasons outlined above, partly because I was always really scared that the next test would reveal something life-threatening, and partly because many of the treatments were geared to get me to ignore or drug my pain. If your physical pain is an expression of emotional pain, than ignoring it can make it worse. It just shouts louder as you try to tune it out. Some people in this situation end up dependent on high doses of pain medication, or symptom swapping, where as they learn to ignore one symptom, a new one takes it’s place. I now concentrate on healthy options that don’t hurt. Walks on the beach, going swimming, eating well, painting. Taking care of myself emotionally helps me give me the strength to manage all my conditions, whatever their cause. If we ignore our emotional well-being we don’t look after ourselves and we get tired and worn out when dealing with issues like chronic pain. Even scarier – if our problem really is psychosomatic, we won’t ever deal with heart of the problem and get better. I work hard now on expressing emotional distress through art, talking, journaling instead of waiting for it to get my attention through rashes, headaches, and muscle pain.
Too much emphasis on the emotional:
Swinging too far in the other direction also has problems. In the extreme, people do a complex blame-the-victim idea that puts the source of all illness squarely in the realm of unresolved emotional conflict. Any of us who’ve lost someone kind, caring, loving, and deeply alive to an illness knows how unfair those ideas are. Assessing all our problems as being psychological also leaves us vulnerable to the development of dangerous physical health problems that go undiagnosed. There is currently a lot of work being done by many people to address this misconception that people with mental illnesses don’t need regular assessments of their physical health. Many physical health issues like hormone troubles, thyroid problems and digestive issues can present like a mental illness. Assuming a psychological problem without proper investigations can leave someone struggling with chronic illness that doesn’t respond well to anything they try, when what they need is an accurate diagnosis and physical treatment. Some people discover they have food allergies or intolerances, trouble regulating their sugar levels, or sensitivity to lack of sleep. People who experience palpitations and chest pain as part of an anxiety issue still need to have their heart health checked! It becomes even more important to check physical health when emotional stress may mask the symptoms of a developing problem.
I’ve had personal experience with this too, I went through a year where I suffered random attacks of acute stomach pain. At the time this was presumed to be psychosomatic, caused by emotional distress. So each time it happened, I would wrack my brains trying to work out what was upsetting me. I would journal or talk about everything I could think of that might be causing such severe pain. Each attack lasted a number of hours before subsiding enough that I could sleep it off. One of them became so severe and lasted so long that I went to emergency. I explained that I’d had an incredibly stressful week and very little sleep so the problem was probably stress. They agreed until blood tests revealed a major infection, at which point I was scheduled for surgery. It turned out that I had been experiencing attacks of chronic appendicitis. The pain was not presenting in a typical way, so no one had thought to run a blood test. My manky appendix was removed and I learned a very important lesson about the dangers of making assumptions when it comes to health!
I hope that this may be of some help to you if you’re trying to work out what’s causing your troubles and how to react to them. Assuming that both physical and psychological factors might be at play may be safest route and treating for both can give you the best chance of quality of life. And don’t let anyone tell you that psychosomatic means it isn’t real!