Psychosomatic symptoms: are they all in the mind?

‘Psychosomatic illness’ and ‘psychosomatic symptoms’ are commonly-used terms. In everyday language, they are typically used to dismiss both the symptoms and the person, with phrases such as ‘It’s all in the mind’, often meaning, ‘It isn’t real: this person is imagining it’. This article outlines why such ideas are mistaken, and the importance of understanding the unity of mind and body.

 

Visceral experiences

We’ve all had those visceral experiences when we feel physical sensations in our body, associated both with thoughts and strong emotions.

  • The sweaty palms and thumping heart of the job interview, associated with the fear of being on the spot, needing to prove ourselves, with our employment future depending on our performance during a single day.
  • The physical shakiness and dry mouth of the first date. What will I think of him/her? What will s/he think of me?
  • The knot in the stomach and fast breathing while waiting for potentially life-changing news about the safety of a loved one, or a serious medical diagnosis, or the birth of a baby.

These examples are common psychosomatic responses. Some reactions depend more obviously on a person’s individual life experience, as we will see below. Whether someone has, for example, a track record of being supported in their decisions or constantly criticised will have a physical, cognitive and emotional impact, affecting the whole trajectory of a life.

Psyche and soma: the unity of mind and body

The word psychosomatic comes from the Greek words psyche, meaning mind, and soma, meaning body. Something which is psychosomatic therefore affects both mind and body and, in this sense, all significant life events are psychosomatic. A negative emotional impact, such as anger, sadness, shock, or fear, can be accompanied by physical responses, such as insomnia, constipation, loss of appetite, fatigue, chest pain, and so on. Such responses are magnified and repeated in responses to trauma where the event is retriggered and replayed in the body and emotions (commonly called post-traumatic stress).

The connections between mind and body are important to understand.

  • In physical as well as mental tasks, attitude affects outcome. A series of studies shows that being in the presence of someone who is unsupportive, critical and rude has a significant negative effect on the ability to perform any mental or physical task. (1) A survey of surgeons engaged in operations following the unexpected death of a patient during an operation showed that the subsequent physical functioning of the surgeon was significantly affected, enough for patients to need longer stays in intensive care and on the hospital ward. (2)
  • Our emotional connectedness affects our physical health to such an extent that it influences our lifespan: lonely people have a shorter life. (3)
  • Not only does our emotional connectedness to others affect our life chances, our emotional connectedness to ourselves does, too. All illness has a psychosomatic element, and ill people with a positive attitude recover more quickly. (4) (5) Those who have difficulty expressing themselves emotionally, who are more likely to hide their true feelings and ‘not make a fuss’, compromise their immune systems by holding in their feelings, and this has a significant impact on physical health outcomes. (6)

Trauma: the split of mind and body

Traumatic emotional experiences can leave their mark on the relationship between mind and body, splitting the two. Such traumatic events typically involve the early absence of love and nurturing by being ignored, or the presence of physical or emotional abuse. The person at the centre of events has to adapt to survive, and this adaptation tends to lead to the ‘decision’ at a deep level not to be in touch with the body.

This is not simply a psychological matter: biochemicals and physical networks are involved, including in the brain. Emotional stress releases hormones. If the traumatic triggering event is not resolved quickly enough, or at all, these stress hormones can cause lasting damage. This is especially so if the event is repeated and if there is no escape from it. The key biochemical is cortisol, produced by the adrenal gland. Cortisol sets off a series of reactions in the body, including in the brain’s alarm system, the amygdala. This alarm slams the brakes on the immune system in order to fight the current danger. This is known as the fight, flight or freeze response. If resolution and reassurance is speedy, all returns to normal, and cortisol is safely absorbed and dispersed. If resolution and reassurance are absent, cortisol floods the system, the brain’s ability to process is marred, and the immune system is compromised. The longer the events go on, the more profound the lasting effect. (7)

The result is a variety of responses, including:

  • Hypervigilance: always on the lookout for danger, as the amygdala, the brain’s alarm system, is jammed in the ‘on’ position. This means responses to everyday stimuli can be magnified and understood in terms of the trauma. For a soldier, a car backfiring can be ammunition, and he has to dive for cover. For an adult abused in childhood, raised voices can be a sign of an imminent beating, and she may feel the physical punches in the here and now.
  • Self-alienation or depersonalisation: a feeling that someone is not quite real, that they are a walking head without a body, losing connection with their physicality.
  • Compromised memory and learning: stress hormones in the body make new information difficult to take in, and old information difficult to retain.
  • Cutting out: as a result of emotional overload, escape from stressful situations is achieved by becoming cognitively and emotionally absent. At a deeper and prolonged level, this cutting out, this absence, becomes emotionally deadening and shows itself as depression, which is the inability to process emotion.
  • Compromised immune system: leading to an increased prevalence of illness, more likelihood of succumbing to germs and viruses, and of developing autoimmune conditions.
  • Physical manifestations. Since the body has been physically traumatised and denied nurture, it can protest, asking for attention by amplifying physical symptoms. Such a person may be labelled a hypochondriac. This does not necessarily mean that the person is imagining their ailments: they may be real and magnified in awareness due to trauma, resulting in increased anxiousness about the significance of physical symptoms and, ultimately, their own mortality. There can be an additional factor when a neglected child in a family discovers s/he can only gain attention by being ill, so this becomes the only ‘legitimate’ way of gaining the human connection s/he craves.

One unusual and valuable study investigated the health outcomes of those whose cultural or religious beliefs reinforce the mind-body split, known as dualism. In this belief, the mind belongs to the spirit, ultimately to heaven, and the body belongs to life on Earth, temporary and therefore insignificant. The study found that perceiving the body merely as an unimportant shell has real biological effects, leading to disregard for healthy behaviours and disengagement with activities promoting health, resulting in poorer health outcomes. (8) This study reflects other findings which show the integral link between mind (beliefs, attitudes, experiences), body (self-care) and wellbeing (health outcomes): once mind and body are split, the whole biological system suffers.

The role of therapy

We have seen that, properly understood, the term psychosomatic refers to the very real and intricate connection between mind and body, which can be severed or magnified in those who have been traumatised. If you are such a person reading this, you are likely to be asking whether there is any remedy. The answer is yes.

Trauma has the effect of freezing the passing of time. We all know that some memories can have no sense of time when we hear a song that takes us back 10 years: those associated feelings arise, not as a distant event, but in the here and now. We know it when we see a photograph of a deceased and much-loved grandparent, and those feelings of intense affection fill us with present-tense joy. We know it when we unexpectedly meet someone with whom there are unresolved and, until that moment, forgotten feelings, and they come flooding back with great intensity, as if time has collapsed.

Trauma keeps the originating events fresh, ever-present, and it is this aspect of trauma which is a key factor in therapy. Not only will the feelings evoked by the original trauma appear in the therapy room, so will all those unmet needs, those desires for connection that were crushed, the sadness, anger and loss of hope. Whatever the response may be for any individual, past pain will be carried as baggage in the here and now.

Those stress hormones, biochemicals and physical networks responded as they did for a reason. What they need, what the whole person needs, is calm and reassurance in a safe space. Together, very carefully, and at a pace that feels safe for you, the baggage can be unpacked and explored.

What is important for therapist and client is to identify the unmet needs that were established as ‘normal life’. Together, we can work on establishing new experiences, undoing what has become ‘normal’. Now you can be heard when before you were silenced, listened to when before you were unheard, respected when before you were dismissed. Over time, it is the opportunity to build new ways of being, connect the expressed and unexpressed parts of yourself, to validate your unmet needs and ultimately, with enough time and trust, to make it safe to reunite the mind with the body and live as a more connected person.

 

About Ian Pittaway

Ian is a counsellor, therapist and writer with a private practice in Stourbridge, West Midlands, and he is part of a practice in Sutton Coldfield. Ian’s therapy is integrative, chiefly comprising key elements of transactional analysis, object relations, person centred therapy and self-psychology. Ian has a special interest in trauma recovery and bereavement.

To contact Ian, call 07504 269 855 or click here.

 

References

(1) Danny Wallace (2017) I can’t believe you just said that! London: Ebury Press.

(2) Antony R. Goldstone, Christopher J. Callaghan, Jon Mackay, Susan Charman, and Samer A. M. Nashef (2004) Should surgeons take a break after an intraoperative death? Attitude survey and outcome evaluation. British Medical Journal, 328(7436): 379.

(3) Erin Allday (2012) Loneliness lethal for seniors, UCSF study says. [Online] 19 June 2012. Available by clicking here.

(4) Z. J. Lipowski (1970) Physical Illness, the Individual and the Coping Processes. The International Journal of Psychiatry in Medicine, 1(2): 91-102.

(5) Ramón Alzate Sáez de Heredia, Amaia Ramírez Muñoz, and Juan Luis Artaza (2004) The Effect of Psychological Response on Recovery of Sport Injury. Research in Sports Medicine, 12(1): 5-31.

(6) Sue Gerhardt (2015) Why love matters: how affection shapes a baby’s brain. Second edition. London: Routledge.

(7) ibid.

(8) Matthias Forstmann, Pascal Burgmer, and Thomas Mussweiler (2012) “The Mind Is Willing, but the Flesh Is Weak”. The Effects of Mind-Body Dualism on Health Behavior. Psychological Science, 23(10): 1239-1245.