On one of the first morning’s of my first inpatient admission, I woke up with horrendous pain in my shoulder and upper back. Stiff as a board, there was no position I could sit or lie in, no number of pillows or balled jumpers stuffed behind me that helped ease the discomfort. I rarely take painkillers- never more than one dose a day, never, ever have I sat and watched the clock, counting down the four hours until permitted to take a handful more. That day, I did all three of those things. I couldn’t turn my head without grasping my shoulder/back and easing myself round. I couldn’t lift my arm. A nurse ran through some standard questions- had I slept funny, did I have a history of arthritis? I mentioned that sometimes when I’m down or stressed, I seem to get shoulder/back/neck pain, but it’s never as bad as this. She said ‘have you considered then, that you might be under significant stress at the minute?’
Mental illnesses aren’t just mental- often they carry with them physical symptoms. As well as the noted disturbances in sleep, appetite and sexual functioning, things like headaches, chest pains, shaking, sweating, gastrointestinal problems, shoulder/back/neck pain, aching joints, and generally, just feeling run down or prone to bugs and viruses, can be a result of psychiatric illness. It is also not uncommon for more extreme physical symptoms- such as blindness, hearing loss or paralysis, to be caused by psychological distress.
My mental illness has been more than moods or intrusive and obsessive thoughts or irrational thinking and catastrophizing. Day to day, week to week, I also experience physical symptoms, that for every full blood count, ECG, chest X-ray and physical examination I’ve had, remain unexplained. I suffer from headaches most days a week- a bad one maybe once a week, and one of those keep-the-sickbowl-beside-you kind of ones every two or three weeks. I get indigeston, bowel movements that swing from from extreme to the other and abdominal pains that are uncomfortable at the very least, and have me doubled over and on the verge of tears at their worst. If I’m having a particularly hard time with anxiety, I might have weeks at a time of a tightness across my chest, constant shortness of breath, and the kind of chest pains that make you fear you’re about to have a heart attack. Often, I’ll also get shoulder, upper back and neck pain, along with random joint pain, earaches and other isolated aches and pains that never have an apparent cause and disappear after a day or hour or two. I’ve had more obscene symtoms caused by my mental health too- when manic, I talked so much I got laryngitis, paced so much my ankles ballooned with fluid and was told my heart could give out.
Psychosomatic-a physical condition caused by or aggravated by psychological stress, and the similar somatisation– a tendency to experience and communicate psychological distress in the form of somatic (bodily) symptoms- were the terms used by an old therapist to explain my physical complaints. Essentially, in psychosomatic disorders, existing conditions (like psoriasis, high blood pressure, eczema) can be made worse by mental distress, whereas somatisation is where physical symptoms are borne out of/caused solely by psychological pain and cannot be traced to a physical cause.
Lots of people can and do get frustrated with this explanation, believing that the lack of a ‘medical’ (ie. physical) diagnosis or explanation is a bit of a cop out- clinicians that can’t determine an organic cause are being lazy, taking the easy way out. Lots of people who are told their symptoms are psychosomatic or caused by psychological reasons assume they are being told their symptoms aren’t real, and that they’re faking them.
But that’s not what psychosomatic or somatoform mean- far from it!
The way my old therapist explained it, was that when we’re in mental or emotional pain and distress, our brain- the clever and complex ‘lil thing that it is- ‘converts’ this emotional pain into a physical complaint, because we’re then more likely to recognise and address it. The physical symptoms is very much real, can be very much debilitating, and is very much caused from within and not imagined- it’s just the ‘organic cause’ happens to be your inside brain, your psyche, rather than something that can show up on X-rays, blood counts, CT scans or any other battery of tests. Doesn’t mean it’s not real- just that the cause is different.
The exact way these two disorders work isn’t thoroughly researched or understood, but there are a few different theories:
- They may be caused by signals and impulses being sent from brain to body
- Could be caused by the brain affecting certain cells in our immune system
- People that suffer from these conditions are more aware of changes in their body and susceptible to pain
- And then there’s the usual suspicion of genetic and environmental factors.
For me, psychodynamic theory holds the most weight. Under psychodynamic theory, somatic disorders are viewed as defence mechanisms, whereby we channel repressed emotions (or psychological distress) into physical complaints as a means of ‘symbolic communication’. In other words, we feel that fucking shit we turn our brain pain into something we can physically experience, see, feel or understand. I think of it like, when our bodies are in a lot of physical pain, our body might slip into a coma to repair itself; when our brains are in a lot of mental pain, we might have to make it physical in order to cope with it.
Think of it this way- when you’re anxious, your heart rate might speed up, you might start to sweat or tremble. If you’re angry, you might clench your jaw or your blood pressure might rise. If you’re happy, you might smile or laugh. All of those are physical symptoms as a result of mental states. So what’s to say we can’t too be afflicted with more debilitating or extreme physical reactions to emotional pain or distress?
It makes sense; all my physical complaints- the headaches, stomach pains and bowel problems, chest pains, shoulder/back/neck pain- get worse when I’m in a mood episode or am struggling a lot with anxiety. Now that I’ve recognised that, when I notice the headaches, the chest pains, the stomach problems creeping back in, I try not to panic, jump to conclusions or start googling potential Serious Illnesses I might have. Instead, I stop and ask myself how my heads doing- am I ok? I think back to what the nurse asked me that day on the ward, and ask myself the same thing. Nowadays, I see my physical symptoms as warning signs, a sign I need to give my brain some TLC.