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WHEN THE BODY SPEAKS, WHO LISTENS?
With attention to the body at an all-time high, we are increasingly likely to
express emotional discomfort in a physical rather than verbal language.
By Berney Goodman, M.D.
One day, a young man, a psychiatrist in his early thirties, entered a
neurologists
office, accompanied by his pregnant wife. The psychiatrist had for some months,
noticed
twitching in the muscles of his legs and ripples of muscular activity cascading
down his
calves. At first he had tried to ignore these twitches, but in time they
increased in
frequency and could not be overlooked. Now he was convinced they were the
symptoms of
Lou Gehrig's Disease, a slow, but progressive, degeneration of the nervous
system that
leads to paralysis and an agonizing death.
The neurologist, a brilliant but gruff man in his sixties, listened intently to
the
psychiatrist, but after a thorough neurological examination abruptly exclaimed
in a
loud and disagreeable tone, "There's nothing wrong with you. Get out of here."
If the psychiatrist's muscular twitches had no medical cause, did they have a
psychological one? If so, what was going on in his head that resulted in those
alarming twitches? It seems to me that as a prospective father, he had been
under a
particular stress: the anticipation of a first child. Until his wife's
pregnancy, he
must have been the exclusive beneficiary of her care, attention, and love. Now
he was
to share it with another child who was twitching and kicking in his wife's womb.
Though he must have expressed his joy to his wife and others, down deep he may
have
suppressed negative feelings that he was now expressing, not in words, but in
physical
language. The rippling of his leg muscles was his way of saying "I'm just as
important
as that other twitcher."
This explanation may sound glib and crudely Freudian, but I have a special
insight into
this patient's problem. You see, I am that psychiatrist In fact, that experience
in the
neurologist's office and my attempts to clarify my thoughts about it profoundly
affected
both my professional and personal life.
Professionally, I developed a lifelong interest in somatization, a process
through which
people express emotional discomfort in a physical rather than verbal language.
Instead
of words, this language consists of unwelcome physical sensations, symptoms, and
preoccupations with medical illness. For example, after a grueling day at the
office or
an argument with a spouse, a headache or a stiff neck may express our feelings.
Somatization is a way of saying, "I am emotionally overwhelmed." In place of
putting a
feeling of emotional discomfort into words such as "I'm feeling anxious
because..."
or "I feel under the weather because...," we communicate through physical
discomfort
or symptoms or worry about sickness. It is a common language, used by almost all
of us
at one time or another. Somatization symptoms are not imagined or feigned. They
are
genuinely, and often painfully, experienced.
From a personal point of view, it was sobering to realize that, despite my being
a psychiatrist, I was just as susceptible as the next person to expressing my
emotional
discomfort in physical symptoms. In fact, 60 to 80 percent of Americans have at
least
one somatization symptom per week. Research has provided powerful evidence that
most of
us express emotional discomfort physically far more often than verbally.
Indeed, we all experience occurrences of somatization, whether or not we are
aware of
them. For the most part, these are related to stress and are normal. We usually
identify
the physical feelings as stress induced and may say, "I had such a bad day at
the office,
my stomach is still tied up in knots," or "I'm tense and I feel it in my neck"
These
sensations are usually relieved by a drink, a hot bath, a good dinner, exercise,
or a
good night's sleep.
Likewise, when under pressure to complete a project, confront a new social
situation, or
start a new job, we may experience heartburn, palpitations, or urges to go to
the
bathroom frequently. In these forms of somatization, we are aware of the
relationship
between stress and our physical sensations and do not impart medical
significance to
them.
But sometimes if our symptoms persist, we conclude these changes must mean
something
is physically wrong. We visit a doctor. And most often, the physician, having
taken a
careful history and done some basic testing, calmly reassures us that there is
nothing
physically wrong. Though certain illnesses are notoriously difficult to diagnose
in
their early stages and doctors may lack the diagnostic skill to detect them,
generally
speaking, when a thorough investigation finds no evidence of disease, a doctor
can
reasonably attribute such symptoms to somatization.
When the somatization symptoms persist despite a physician's reassurances and,
more
important, interfere with daily functioning, they require more serious
attention. For
instance, if we continue to complain of the same symptoms and consult many
specialists,
take days off from work, and preoccupy ourselves and our families with our
complaints,
we may indeed have an emotional disorder and require psychiatric diagnosis and
treatment
Those who have persistent somatization symptoms that markedly interfere with
their
functioning have what we call somatoform disorders.
The commonest somatoform disorder is hypochondria. But isn't hypochondria what
we
have been talking about all along? Not as far as doctors, particularly
psychiatrists,
are concerned. Hypochondria is a particular variety of somatization in which the
symptoms
have persisted for longer than six months and in which the person has
unrealistic fears
of disease.
I am not talking here about psychosomatic illness either. In psychosomatic
illness,
such as duodenal ulcer and ulcerative colitis, an identifiable physical illness
is always
present; the pathology is recognizable to the naked eye, through instruments, or
through
laboratory testing, or all three. In somatization, despite the reality of the
pain
that people feel, they have no physical illness. Somatization also must not be
confused
with the intermittent worries about illness we all have. Likewise, intense
attention to
particular bodily functions, such as bowel habits, while common, is not
somatization.
Somatization is not very well understood or recognized. Nonetheless, it
constitutes a
major public health-care problem, adding significantly to health-care costs
becauseof the extensive and repetitive testing that patients, their physicians, and
their
symptoms call for. A study done over 10 years ago put the bill for physicians
seeing
people with somatization symptoms at $20 billion, or 10 percent of the nation's
total
annual health-care outlay. We can easily assume that this figure has matched the
nation's rising healthcare costs since that time.
And, depending on which figures you believe, between 20 and 84 percent of people
who
consult a doctor do so for some form of somatization. Hypochondria alone is said
to be present in 9 percent of patients who consult their family physicians.
Peering ahead, I think the number of people with somatization symptoms will
increase
dramatically as we enter the next century. Their individual dramas will be
played out
on a stage dominated by an increasingly stress-filled world and a backdrop of
frequent
family disruption, rapid cultural change, and increased attention to, and care
of, the
body.
Body awareness is at an all-time high. And although we cannot assume that our
current
preoccupation with our body and its health will cause us to have more
somatization
symptoms, I think that it may do so for those, like myself, who are already
sensitizedand susceptible to it.
from, When the Body Speaks Its Mind, by Berney Goodman, M.D., reprinted by
Psychology Today
Wilmes-Reitz Psychological
23632 Calabasas Rd., Suite 202
Calabasas, California 91302
(818) 591-8270
wrpsych@aol.com
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