Gerry Gajadharsingh writes:
“A very interesting article from The Times, much of which I agree with except the bit “The next taboo is surely psychosomatic illness (or functional disorder, to use the term doctors prefer).”
It’s always interesting looking at some of the online comments posted in relation to some of these articles, I’ve selected a few below.
“I’ve done 20 years in the Ambulance Service and undoubtably the number one problem is health anxiety. I find it interesting that we live in the best time in human history for health, life expectancy is at it’s highest, medical care is available to all, we’re affluent, eat the finest foods have abundant free time and ability to exercise and yet the GP surgeries and hospitals are rammed packed with the ‘ill’. Calls to the Ambulance Service are literally incessant, day and night, 365 days a year these days yet actual 999 emergencies have fallen due to factors such as improved awareness and treatment for heart attacks, better safety and less accidents, less respiratory problems due to less smoking etc. In my opinion it is the medical profession that is to blame, stoking fear by diagnosing new syndromes and mental illnesses almost every day it seems and then convincing patients that its NOT in their heads and leading them on a traumatic path through the health system (at massive cost) to help them find the elusive ‘cure’, which of course, they never do. Of course, it doesn’t hurt the old bank balance to increase the customer base like this and the pharmaceutical companies aren’t saying no either. So thanks to the doctors for ‘discovering’ Long Covid as we’ll now have even more people ringing 999 convinced they have a new, terrifying illness that only the errrr…. doctors can help them with!
“This is a surprisingly ignorant article from a really excellent writer. Yes, psychosomatic illness exists, but it is wrong to assume, as some medics lazily do, that everything without a diagnosable physical cause is psychosomatic. Multiple Sclerosis used to be thought of as psychosomatic, as did stomach ulcers, before specific causes were found. In some cases of chronic physical symptoms there may be a psychological element but it doesn’t mean the patient doesn’t have a real physiological process causing difficult symptoms, that are not fully controllable by their mind. I don’t think medicine has got to grips with the fact that there is just an awful lot in biology that is not yet understood, or treatable. The way to deal with this is not to label everything that isn’t yet fully understood or isn’t treatable as psychosomatic.”
“This is a brilliant article and I can completely relate to it as a reasonably intelligent person had a bout of it 3 years ago relating to health anxiety caused by a job move (which at the time I didn’t realise). A very rare disease was in the news and I started thinking about it and began getting physical symptoms such as twitching which made me google even more…neurologist later and reading Suzanne o Sullivan’s book “it’s all in your head” I began to realise that my head had created these incredible symptoms which I had no idea it could do. By this time I was in pieces, had lost nearly a stone and health anxiety therapy got me back…it took about a year for all these symptoms to disappear. Do not belittle this story…if we understood a bit more we could treat people and save the NHS money…I ended up paying privately for neuro exam as I was so desperate….glad to see this article thank you.”
So, an ignorant article to one person and a brilliant article to another. Not surprisingly a lot of understanding and beliefs regarding health and ill-health are very inconsistent.
I think the article below is actually a very good one, but here are the points that I think need clarification.
Just because a physical illness may not show up in scans or blood tests does NOT mean it’s “all in the head”. I spend my life on functional diagnosis of complex health problems and there is no doubt that when you have a better understanding of function, as a clinician you can certainly help many patients with complex health problems.
All illnesses exist somewhere on a spectrum of psychological and physical causes, something people have trouble “wrapping their heads around because of dualistic ways of thinking and language”. This is not just me saying this, the quote is from Prof Jon Stone, Consultant Neurologist.
Many patients presenting with physical symptoms will not be found to have obvious pathology (an actual disease process). This does not mean the symptoms are purely psychosomatic. In my experience, as alluded to in the paragraph above, there is often an interplay between the psychological and physical function within each of us.
The sad and frustrating thing, from my perspective as a clinician is that there are patients who simply refuse to believe that that their psychology and behavioural patterns both conscious and subconscious, can have a profound effect on their physiology and thus generating many symptoms. In my experience these patients suffer worse outcomes, they are the ones who tend to climb onto the merry-go-round of numerous investigations and consultants/specialists trying to find the magical cure to their problem.
Perhaps the article below is correct and perhaps there is a stigma attached to “not finding a physical/medical cause to a series of symptoms”. I suspect that if patients were willing to accept that there may well be heh psychological component towards their illness/problems and clinicians were willing to accept the perhaps there are other underlying functional reasons for the change in the patient’s physiology the outcomes in many of these complex health problems could be improved.”
Recently we’ve accepted the idea that the suffering of mental illness, though different from a broken leg or a virus, is real. The next taboo is surely psychosomatic illness (or functional disorder, to use the term doctors prefer). These are the physical illnesses that do not show up in scans or tests, whose causes appear to be “all in the head” but whose symptoms can be severe and terrifying: seizures, fainting, terrible pain, paralysis — even blindness.
A third of outpatients in neurology and gastroenterology suffer from psychosomatic illnesses and it has been estimated that in the US they cost more to treat than diabetes. Treatments are often unsuccessful, and many patients find themselves shunted from specialist to specialist in search of the one thing in modern medicine that will buy you respect: a label for a disease and proof of its biological cause.
Social stigma persists; sufferers from psychosomatic illnesses are widely considered to be faking it or seeking attention. These, of course, are the same sort of prejudices that were once associated with mental illness.
Strangely, the pandemic may help us break this next taboo. Though not everybody I know has had Covid-19, nearly everybody has at one time or another wondered whether they have it. The train of thought that runs “Do I have a cough? A fever? A headache?” is almost universally familiar. So is the niggling doubt: “Is this just in my head?”
These glancing encounters with the fact that it is possible to experience physical symptoms because you’ve been worrying about them or because there are signals in your cultural environment (alarming news reports, government adverts) that lead you to expect them might be the push we need to get our heads around psychosomatic illness.
After all, there is surely no special reason why our sympathy for a person’s pain or distress should be extended or withheld depending on its cause. Suffering is suffering.
People with psychosomatic illnesses are unfortunate in the fact that their condition offends western ideas not just about illness but who we are. Dualism — the idea that mind and body are distinct — has a long history in western philosophy and is fundamental to the way most of us think about ourselves. Our minds are airy, ethereal, separate; our bodies are a sort of machine for which the doctor is a mechanic.
But as almost every medic I spoke to for this piece was keen to point out, this assumption fails to pass even the most cursory examination of our day-to-day lives. Spraying water from your eyes in response to bad news is an example of a psychological state causing a physical one. So is the phenomenon of staving off a bout of illness until after you’ve completed an exam or an important piece of work.
In fact, as the neurologist and expert in functional disorders Professor Jon Stone explains, all illnesses exist somewhere on a spectrum of psychological and physical causes, something people have trouble “wrapping their heads around because of dualistic ways of thinking and language”.
Stone points out that sufferers from Parkinson’s disease, a physically manifested illness with an identifiable biological cause, respond dramatically to placebos. This means the psychological experience of a physical illness (in this case whether or not you believe you’re being treated) affects the way that illness manifests itself. Stone says, for Parkinson’s patients, “the relationship between the severity of the disease and the experience of disability is not as close as they or many doctors think”.
In fact, he says, it’s possible to argue that psychological illnesses such as depression and anxiety are the ones that are “a bit weird”, focusing as they do on “cognition and emotions in an abstract way”. In a world where psychological and physical causes are entwined, psychosomatic illnesses don’t look so strange.
Another challenge to our understanding of functional disorders is our individualism. Though universal in human beings, psychosomatic illnesses are rooted in cultures and societies. Resignation syndrome, a disorder that causes children to fall asleep for years, occurs almost exclusively in asylum-seeking families in Sweden. The illness seems to be spread by reports of its existence. In France, you can buy remedies for a common minor syndrome called “heavy legs” in most pharmacies. No other country seems to experience “heavy legs”.
This is not something that makes much intuitive sense to western citizens, who are accustomed to thinking of themselves as isolated units moving alone through the world. Not only are the causes social but so are cures. The neurologist Suzanne O’Sullivan points out that a functional disorder called grisi siknis (crazy sickness), which is common among girls of the Nicaraguan Miskito people and causes hallucinations, tremors and superhuman strength, is successfully treated with rituals and the community “rallying around”.
Secular, atomised western society has no equivalent treatment. In the West, illness — especially psychosomatic illness — is likely to make you even more isolated.
One social change that might help is the removal of stigma. As Stone says, the important first step towards a cure (which might involve, for example, a combination of physiotherapy and psychological therapy) is for the patient to accept the diagnosis — not something that is always easy in a culture that so readily associates real disease with biological causes. Now that stigma against mental illness is breaking this could be our next big battle.