The role of the mind in illness

The role of the mind in illness teaser
You feel sick and in pain and go to your GP for a remedy or at least an explanation, and there is none. Perhaps you’ve been to a specialist and had multiple tests to see what’s wrong, but they all come back negative. People tell you it’s “all in your head” but you know it’s real. What’s going on? 

 
Medically unexplained symptoms (MUS) form a surprisingly large part of the GP’s caseload. They can occur in any part of the body, for example the head or the stomach and be anywhere from slightly annoying to really painful, but investigation is unable to identify damage to the affected organ even when it’s obviously hard to function. Sometimes these symptoms follow a known pattern, (as is the case with Irritable Bowel Syndrome and Fibromyalgia), but an anticipated change in the structure of the organ is not found on any scan.

Psychosomatic illness is similar but differs from MUS by applying to actual disease states where there is organ damage that may be made worse by internal conflict and stress. Changes in the immune system then impact the course of disease. This is clearer in some cases than others, but appears to be a factor even with disorders with a genetic component such as Inflammatory Bowel Disease and Multiple Sclerosis. Why?

Firstly, the structural connection between the mind and body is often underestimated. We often see our mind and body as being in separate compartments, when they are in fact integrated. A good example of this is the relationship between the brain and the gut. The gut is now sometimes termed our “second brain” as it has its own neural network which communicates through the Brain-Gut-Axis. Traditionally we have tended to think of the brain as like a city with roads that lead to outlining country towns (in the body). In fact it is more like a network of cities, each with their own government.

Let’s say for example someone has symptoms of diarrhoea. This may be a function of an intolerance to a particular food, or high levels of stress, or an infection which can in turn have an effect on thinking and emotion. Thoughts about the condition being embarrassing, for example, can also impact its course. This complexity makes simple diagnosis impossible, and is often a source of frustration for many people, as they know something is wrong and can’t get the benefit of a clear answer. Since our body is in pain, the idea of seeking evidence in a medical diagnosis makes sense, and a visit to the GP is important to check everything is OK. The trouble is that it’s not that simple, and perhaps in striving to medicalise our pain we neglect the role of the mind, stress, and our underlying emotions.

If an individual’s symptoms are related to chronic stress and conflict in the mind, why do we feel pain in our body? Chronic stress can make our systems overactive and muscles may become painfully tense as a result of changes to blood flow and increased nerve sensitivity.  These nerve fibres start to get wired together, and the brain learns and then remembers new pain pathways. This results in real pain. Our thoughts about the pain, and generalisations we hear from friends and pick up from the media, can then increase our stress and further influence our pain in a vicious cycle.

The human mind is amazing. If certain emotions are deemed unacceptable or too painful to the mind, we sometimes shunt them into our body, completely outside our awareness. For example, we may believe we have long since got over the loss of a loved one, but an association such as an anniversary may bring up a pain in the chest symbolising our ‘heart ache’, or a difficulty swallowing, representing a ‘lump in the throat’. Negative emotions towards others can also be represented in the body at the same time.

These are natural feelings that the mind interprets as threatening, sometimes due to unconscious conflict that has its roots in our formative relationships. For this reason, in addition to stress reduction activities like meditation and exercise, psychotherapy can assist in uncovering and resolving emotional pain which may be impacting our physical pain, and can be helpfully incorporated into our medical care.

360 Health + Community provide a range of mind care services including psychotherapy. Visit www.360.org.au or call us on 9960 6800.
 
Peter Watt
Psychologist & Psychotherapist
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