So what do I mean when I say that all physical symptoms, pain, and illness have some degree of a psychological component? If you need to catch up on my introduction to this concept, you can read Part 1 of this series.
I would like to suggest 6 possible integrations of physical and psychological health, although I imagine there are many more I have not considered.
1. Physical symptoms can directly cause psychological distress. This is an obvious one. I can’t be the only one who gets depressed when I am in pain and physically limited. I know I am not the only one who becomes anxious over new symptoms and undiagnosed problems. This is normal. This is common and expected. It happens to everyone. You are not alone in this, and there is no shame in seeking help should you need it.
2. Psychological distress can directly cause certain physical health conditions. In some cases, the table is turned. Psychological stress can directly cause physical symptoms, as was the case of my client with severe anxiety that manifested in neurological-like symptoms. This does not mean she is crazy. This does not mean her symptoms are not real. But, an alternative diagnosis does mean alternative treatment is needed. Instead of seeing a neurologist, a counselor would be more appropriate. Of all the possible integrations, this one seems to hold the most stigma and shame. Because it causes so much shame, people are loathe to admit that their tense and sore back, headaches, or stomach aches may actually be directly resulting from stress. And because of this, they try medical treatment after medical treatment, when other factors are at work.
3. The side effects of various medications used to treat physical illness and pain can result in mental health concerns such as depression, psychosis, anxiety, panic, and suicidal ideation, to name a few examples. If you have read the side effect labels of any number of medications, this one should not surprise you. Sometimes the very medications that lead to physical relief can begin to pull us into a mental health crisis.
4. Psychological distress can function as a trigger to initiate the onset of underlying physical ailments. On many occasions, stress functions as a trigger to initiate the onset of physical and psychological ailments as diverse as celiac disease, schizophrenia, autoimmune diseases and various chronic pain conditions. The body, genetically predisposed to these conditions from birth, needs just the right push, in the form of stressful environmental conditions to be pushed over the edge into full onset of disease. Think back to when your illness or pain began. For some it begins with an injury, but for many the illness was initiated as a time of great stress. This does not necessarily mean your illness or disease was the direct result of stress; rather, stress provided the perfect storm for your body to initiate the disease.
5. Psychological distress is a huge factor in ability to recover, stabilize, and reduce flare ups in the midst of acute and/or chronic conditions. After the onset of disease, regardless of what led to onset, stress and ability to respond to stress in either healthy or unhealthy ways are huge factors in your ability to recover, stabilize, or reduce flare ups. In the midst of attempting to stabilize my SIJD, my family went through a rough patch, to put it in the nicest of terms. For several months, my physical condition deteriorated in the midst of extreme stress and anxiety. Because I felt anxious and depressed about my family situation, I was unmotivated to engage in exercise, proper nutrition, and self-care. I became more isolative and did not have the boost of community and friendly support. Lack of sleep led to more deterioration, and I found myself in a downward cycle, physical and psychological distress intermingling and reducing my ability to heal.
6. Psychological distress is a huge factor in your ability to either endure or succumb to intense physical pain and illness. When we are emotionally healthy, we can better endure the sleepless nights of agony, the days of bed rest, the forced isolation, and searing pain.
Can you think of any other possible integrations?
We won’t change the general cultural view on this overnight, so we have to start with ourselves. We need to carefully think through our responses to others and our views of self, asking careful questions. Here is some honesty and self-revelation: I work as a counselor, and one aspect of my job is to remove stigma surrounding mental illness. This issue should be more straightforward and easier for me personally, yet at times I too feel the stigma and shame of the way my physical and psychological symptoms intermingle. And although I never feel or place this stigma on the individuals I counsel, I still can’t help but place it on myself at times. I am continually asking myself why this is the case. Yes, I can place this partly on societal beliefs and stories of how others have responded to me, but I also have to take individual responsibility and decide how to move forward from here.
This post addresses a huge issue, commonly discussed by chronic pain and chronic illness communities. We can all relate to those instances of intermingling anger and shame, as someone implies it is our fault we are still sick. However, I have observed that this issue is often addressed through highly agitated rants, as we all join in commiserating with one another. There is a place for this perspective; we need to know we are not alone. But too much ranting and it becomes unproductive.
So as I think through this topic, I want to join together and commiserate to some extent. But I also want to think through this productively, taking appropriate responsibility and then considering how we can better respond to and educate those around us.
I have found the following questions helpful to carefully consider and journal through in light of responding productively.
Do I get inwardly or outwardly defensive when people question my psychological health in relation to my physical health? If so, what makes me feel defensive? What is my personal role in this?
What am I thinking and feeling when these questions are asked? What makes me think and feel this way?
What emotions and thoughts do I wish to feel and think instead? What is keeping me from having this different perspective?
What is my level of self-awareness? If my pain did happen to be partially psychosomatic, would I be willing to admit this to myself?
What percentage of my pain is physical and what percentage of my pain has a psychological or stress-related component?
What do I need to do to address this psychological or stress-related component?