There are many medically unexplained symptoms or conditions which cause problems between doctors and patients.
A client said to me: I wish they would just tell me that there is no medical explanation for my daughter’s problem, then I would know I had to take her to a psychotherapist or counsellor. They will tell you ‘stress’ but they won’t put it in writing so you aren’t sure. But I’ve had enough of all the tests; they are such a waste of time.
Doctors and patients seem to have difficulty communicating over what are called ‘medically unexplained’ or ‘functional’ symptoms. These symptoms make up a large part of the general practitioner’s caseload.
The diagnosis of fibromyalgia is made when no other medical expanation can be found for pain which ‘moves around the body’. The webpage: http://www.nhs.uk/Conditions/Fibromyalgia/Pages/Diagnosis.aspx has this illustration of the difficulties faced by patients – and doctors.
crazydaisy99 said on 03 May 2014
I have been suffering with back pain and pain in my knees, hips, elbows and wrists for around three years now. I have been back and forth to my GP more times than I can remember. I was referred o pain clinic where the consultant told me that, he sees people like me all day every day, people who suffer with depression and anxiety who conjure up pain when there is no pain. I was devastated by this, When i started crying he asked me if that wasn’t what I expected to hear! I was 34 at the time and my husband was having to help me shower and take care of myself because the pan was so bad. I stopped going to my GP and was struggling through on over the counter medication because they mad me feel like I was loosing my mind. It took a lot for me to finally go back to a different GP this week who has referred me for x-rays and physio and has given me some new pain killers to try. He seemed genuinely concerned when i told him my situation, I am having to cut my hours at work as i’m constantly exhausted and in pain. He has made an appointment to see me again in a month and has said he will get me sorted one way or another. After reading other comments on here I feel I relate to what a lot of you are saying, I wonder if I should mention FM to my GP when i see him next?
Debbie41 said on 04 June 2014
crazydaisy99 it is wrong and unprofessional for any health professional to suggest that it is in your head, they have done tests and discovered that you can NOT imagine pain, it is not possible to think your in pain when you are not. please report this person for even suggesting this to you,
In Germany there are clinics for what is still called ‘psychosomatic’ pain. However, it is not just the British who have difficulty talking about it and confuse it with being ‘crazy’ or ‘making it up’. Doctors can be as confused as patients, though patients can also misunderstand what doctors say.
The pain of fibromyalgia is real; the person is not pretending or imagining the pain. The problem arises in discussing the cause of the pain, or what holds it in place. (There are people who pretend to have symptoms; I am not writing about them here. They do not have fibromyalgia nor are their symptoms psychosomatic.)
There are many symptoms, including pains, which express emotions, conflicts or thoughts. Many are very common and normal; they do not mean someone is ‘mad’. Anxiety stomach aches; diarrhoea before an interview; a headache at the thought of visiting someone you don’t like; a weakness in the knees at the thought of meeting a lover: these are all normal examples of our bodies expressing our feelings. It is also possible to get a ‘pain in the neck’ because someone you know is being a ‘pain in the neck’; or to get a physical ‘lump in the throat’ when you have something you want to howl about but cannot, for some reason. Tears spilling down the face sometimes appear when you do not know you need to cry; some spots, as I was told as a child, can represent ‘your badness coming out’ – when you don’t even know you feel bad. Back pain is sometimes a sign of being overburdened, or in need of support, perhaps like your mother was; cystitis can be a sign of secret fury. Such pains sometimes enable people to recognise the need to stop what they are doing and make some changes.
Thinking about asthma may help. If someone is susceptible, an asthma attack can be brought on either by actually walking through a field of hay or by imagining walking through a field of hay. The attack is real and equally life-threatening, but the cause in the one case arises outside the body; in the other, it arises from something in the mind. Both causes trigger a physical reaction in a susceptible body. The pain and paralysis of a ‘psychosomatic’ or ‘functional’ condition is real; but the cause may be a very painful emotional conflict, rather than physical damage to a muscle or a joint or a nerve. Sometimes it originates in a physical injury; but it simply does not heal or go away over time as it would be expected to.
Many people have no difficulty recognising that their symptoms might be caused by ‘something in the mind’. (In particular, some people with Multiple Sclerosis prefer this thought to the idea that their symptoms are caused by the effect of MS on their neurones.) However, other people are totally opposed to any exploration of possible emotional conflicts which might underly their symptoms.
Severe chronic pain, or some kinds of paralysis, can be a symptom of an ongoing conflict: some idea or thought being encapsulated in part of the body and not allowed into the mind. Unfortunately, it seems that not wanting to know about the conflict, or really hating it, may be part of the mechanism which creates it or sustains it. It almost seems that the whole point of these symptoms is to ‘say’ that the problem is in the body, not the mind.
Sometimes it is possible to ‘translate’ a pain from the body into the mind, but if the emotional conflict is too painful the person may find it impossible to put their mind to it. However bad the physical pain is, the pain of recognising and owning the emotional conflict may seem worse.
The trouble with many symptoms is that we may not know how much is caused by an illness and how much is caused by some such emotional conflict. Where a conflict is ultimately bearable, we may be able to ‘translate’ physical symptoms into emotional conflicts and reduce the symptom in the process, but if we cannot bear to know about the emotional conflict, we would have to work on this first. A certain level of pain caused by arthritis or Multiple Sclerosis may be unalterable: however, these pains (or other symptoms) may also be increased (or decreased) by the way someone moves, or thinks or feels, or keeps still for long periods of time. Sometimes people know they have some control over the level of pain they suffer. People around may feel manipulated if the pain is exaggerated; if it is played down they may not recognise it is there at all. Either situation can cause social conflict and hidden resentments – which can cause more physical (or emotional) pain.
Psychotherapy or counselling may be able to help, if the therapist can help the person to feel less scared of an emotional conflict, more able to bear becoming aware of it. As a counsellor I have sometimes been able to diagnose a hidden conflict fairly quickly and enable a client to make the translation; but I have also met people who have found the idea of counselling quite unbearable. Even though they had serious physical symptoms which had no medical explanation, and said they wanted relief, these people were unable to explore whether they had any emotional conflicts at all. I imagine that, for these people, the emotional pain was more frightening than the physical. For others there is less at stake.
One of my clients had mysterious problems with one of his legs. The way he described it made me ask if there was anyone he wanted to kick. After a moment he laughed, and it became clear that there was someone, but for various reasons he had not wanted to admit how angry he was with them.
Freud wrote about a patient, Fraulein Elisabeth von R. (Case 5, Studies on Hysteria; SE vol 2) who developed pains in her legs – real pains, note, not imaginery ones. After many weeks of psychoanalysis Freud discovered that they first came on when she was at her sister’s deathbed, when an idea came into her mind which totally horrified her. Freud was able to help her recognise that she had had the thought ‘Now I can marry my brother-in-law’. It was the horror at this thought which Freud thought caused her problems; her legs pains were partly a self-punishment. (They also caused her to have to ask the brother-in-law for help with walking. This Freud would later call the ‘secondary gain’ from such an illness.) Once she had been able to admit her feelings to Freud (and herself) the pains ‘joined the conversation’. Freud and Elisabeth were able to detect thoughts or feelings which brought them on, and he could help her to bear the terrible humiliation and self-blame. Through this process, after a time the physical pains disappeared.
In the UK and the USA there are psychotherapists and physiotherapists who work with psychosomatic pain, for example followers of John Sarno. He invented the term ‘tension myoneural syndrome’ or ‘tension myositis syndrome’ (TMS) and wrote about curing back pain. Wikipedia says that ‘The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community’ in spite of at least one peer-reviewed study which demonstrated its effectiveness.
As I said, this is an area which causes conflict between doctors and patients – reflecting, perhaps, the conflict within the patient’s own mind?