Psychosomatic Disorders

Illnesses of the kind sometimes called psychosomatic arise through the emotions, but they are not imaginary. All people are subject to stress, both from within and without.

We have main ideas, drives, fears, and fantasies that may conflict with what we have come to accept as normal for us. Some may be personally unpleasant or hostile to society.

If we have come to terms with them and can channel our thoughts into mentally healthy ways, then we can cope with ourselves. But if we find that these inner drives well up and dominate our thinking, then we may react by becoming anxious.

Anxiety may be a normal emotion, as is fear when it is appropriate to the precipitating factors. It becomes abnormal when it is inappropriate or is so severe as to interfere with our normal functioning.

When we meet external stress we either cope or we don’t: when we are not coping we experience fear and anxiety. Stress is not in itself necessarily bad. It can provoke a bodily reaction that keys us up and may make us perform better.

The body has a normal reaction to fear or stress. When danger is seen there is an emotional reaction and a nervous impulse is sent to the adrenal glands, which lie above the kidneys. The medulla, or inner part of the adrenal gland, produces the hormone called adrenalin, which is pumped out into the general circulation and acts on many organs.

This is called the “fight or flight” reflex. The adrenalin keys the body for action to stand and fight or else to escape from the danger. The pupils of the exes dilate, muscles tense, digestion stops, and blood is diverted from the gut and from the skin. As well the pulse quickens, blood pressure rises and breathing deepens. This is normal. We all know that sinking feeling in the stomach, the tight feeling in the throat, and the exhausted relief when it all passes.

However, when we are anxious and this anxiety becomes abnormal it may provoke bodily responses by stimulating the adrenal gland but they are inappropriate as there is no external threat.

The autonomic nervous system governs all those functions of the body not under voluntary control. Our hearts beat, our kidneys filter, and our gut digest, all independent of our will. This system itself is governed by a special center in the brain, and this center can be influenced by the emotions.

Nervous tension may provoke the full bodily response as in the “fight or flight” reaction or it may only pick out one or two systems. Thus we can have nervous palpitations or diarrhea, or our stomach may get “tied in a knot” and we produce so much acid that it eats a hole in the stomach or duodenum and we have an ulcer.

Most people believe that nerves mean imagination, and yet they know well that the symptoms they have are real. Because of this they may believe there is something organically wrong with them. This causes further anxiety and more stimulation of the autonomic nervous system and so more symptoms.

This state where there is a bodily dysfunction due not to physical disease in the organ but to altered function is often called psychosomatic illness. “Psyche” means the mind and “soma” is the body. There are two other words, dystonia or dyspraxia, which mean malfunction, and those disorders are often called autonomic dyspraxia.

They are real illnesses but the disorder is due to altered function rather than to degeneration or infection or cancer. And the diagnosis should be made on positive evidence and not as a last resort when no physical cause can be found for the symptoms. To label symptoms as due to nerves because no other diagnosis can be made is the refuge of the diagnostically destitute.

But it may be important to carry out special investigations such as blood tests or X-rays to exclude the presence of physical illness. These tests can be reassuring both for the doctor and the patient.

Once the diagnosis is made then treatment can begin. The most important part is to explain exactly what is wrong. The average patient has little knowledge that nervous tension can cause the symptoms of which he complains. Explanations may need to be repeated and reinforced at each consultation.

Along with the explanation must go reassurance. This can allay the fear that there is some serious underlying disorder or that the patient may be going mad; many people wrongly think that emotional illness may lead to madness.

It may be necessary to use drugs as well. The medication may be directed to the target organ, such as prescribing antispasmodic drugs when the symptom is diarrhea; or tranquilizer drugs may be used to reduce the anxiety or its effects.

In the past, the barbiturate drugs were used for the treatment of anxiety states and also as a hypnotic to induce sleep. But the minor tranquilizer drugs, most of the benzodiazepine group, act as well as the barbiturates and are much safer. They rarely lead to dependence, and large doses taken in a suicide bid may not be fatal.

The physician should be a teacher as well as a healer and it is appropriate to discuss with the patient with autonomic dyspraxia the learning of relaxation techniques. Physical exercise, yoga, meditation, or hobbies may all be of use. Some tension-prone people may find that hypnosis can lead to relaxation.

All of this may deal with the patient’s presenting symptoms but unless the patient learns to deal with his reactions to stress and to cope with life in a mentally healthful way, then with the next stress he is likely to be back at the doctors with a new set of symptoms.

We are all after the peace of mind and this comes not by being free of problems but by coming to terms with them. We need to learn to cope with life as it is, not as we want it to be.

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