Is Mental Illness a Myth?

Have I piqued your interest or accidentally insulted you? I did not make this question up. Thinkers and physicians for many years have wondered the same thing. Mental illness is confusing. It is not diagnosed as is physical illness via tests for microbes, probing for damaged or diseased tissue, nor compiling a list of objectively measurable symptoms. Mental illness is diagnosed via a system of symptom clusters published in one or another manual, the contents of which are agreed upon by scholars in the field. The problems arise when the contents of those manuals change over time, because mental issues are not clear-cut diseases as are physical illnesses. Things are added and subtracted over time--but we could not imagine a time when influenza would stop being called a disease!

Science tries, year after year, to isolate specific markers for mental illness. Tests come and go, but the construct remains elusive. We can objectively test for the flu or cancer or diabetes or a broken leg, but we cannot test in a way that never changes, for depression, schizophrenia, or anxiety. This does not mean that you are not suffering with your problem. It only means in this context, that your problem is mislabeled by being lumped in with physical illness. This is important for many reasons. I hope you are still with me as I elucidate why I, and others like me, believe calling mental problems "diseases" hurts those who suffer with them.

Whose Pain Is It?

Having recently arrived in Oregon, studied diligently for (and yes, passed) my ethics exam, and at long last, received my license, I had a few months in which to explore the clinical issues prevalent in my new environment. Chronic pain kept popping up in conversation, sometimes right after "oh, you do hypnosis," and sometimes before.

What I gleaned from my participation in clinical groups and meetings was that the chronic pain treatment pendulum has swung once more. In short, and without citation: Long ago, MDs prescribed heavy doses of medication for pain patients, chronic or acute. The pendulum then swung to a fear of creating addicts. This was not entirely unfounded, as overprescribing of serious pain medication was rampant, and addiction was up. (When my children left a dentist with Vicodin for the removal of wisdom teeth, I knew something was not right). So docs lived in fear of government repercussions for overprescribing, and, as with most pendulums, now it had swung too far, and even deathly ill patients were constrained from receiving comfort, by over-regulation. Back it went, and back came too many addicted patients along with, guess what? too much chronic pain.

Flexible Bodies, Flexible Minds, Guest post by Julie Francis

Emotions are expressed through your body as a series of muscular contractions. When emotional states become chronic, your body learns that the corresponding contractions are "normal". In other words, the muscles develop a habit of contraction that equate to an emotional state. When this happens, it becomes difficult to tell if your emotional state is caused by an actual event or if it is the remnant of muscular contractions leftover from an habitual pattern learned during a time of significant stress. And, it's not just your emotions that are involved. When muscles are chronically contracted, they affect everything from digestion to posture to back pain. The same muscles that help you stand up are involved in breathing and digestion. When they are tightly held, your body can't function as it was designed to, and you start to develop symptoms of dis-ease -- headache, indigestion, low back pain, etc., etc. Working with a clinical psychologist can be extraordinarily helpful in identifying the cause of symptoms and in clearing the way for new healthier choices. To move things along more quickly, it can be very helpful to approach issues from a body perspective as well.

That's where the Feldenkrais Method® comes it. It is a powerful neuromuscular approach that uses gentle movement and touch to help your brain relearn its responses to life. As Dr. Low helps you to become aware of and shift your responses and reactions, I help you become aware of your movement patterns so you can get out of the movement rut you are stuck in. As your movement patterns change, you learn to let go of the excess contractions; movements become more supple, balance improves, and your muscles re-learn the ease and flexibility you were born with. Together we work to teach your nervous system (which includes your brain) that it has choices and help you get back on track to health and comfort.

Julie Francis is a Guild Certified Feldenkrais Practitioner and Assistant Trainer of the Method. She maintains an office in Glen Ellyn and is now in her 21st year of helping people learn to shift unhelpful patterns of moving and being. To learn more about the Feldenkrais Method® and Julie Francis, check out www.Optionsforease.com.

The Pain, You See, Is in the Brain

I know--really I do. You are in pain. Real pain. Nothing seems to make it go away--medications dull it but little, and you are earning to plod along in life with pain. You feel as if everyone thinks you are faking; especially doctors who tell you to see a psychologist, and refuse to renew your prescriptions. You are indeed pretty tired of doctors. Your physical therapist keeps pushing you to exercise, but everything hurts. What is going on?

You know you are not faking, but you are really confused: why do the standard treatments not work very well? And when are you finally gong to get a decent night's sleep?

I shall start at the beginning and work my way around to your question.

Pain is a signal from the brain to the body to stop doing what it is doing because something is wrong. Most of the time, this is a good system. You do not walk on a broken leg until it is set. You take your hand off the hot stove and treat the burn. You go to the doctor when your stomach hurts and find out why. Pain tells you something is off and you get it taken care of.

A grey area exists after you have gotten treatment or discovered why you have a headache. The pain persists to remind you to be careful. Most of the time this is useful--you do not want to re-injure yourself nor do you want to overdo something after surgery. On the other hand, these are things you can figure out on your own and perhaps get help to minimize the pain. That is why it is ok to take pain medications after you have had the issue diagnosed and especially after it has been treated, but has not fully resolved.

So far, so good. But your pain, you say, has been treated, and nothing more is wrong that a doctor can discern, but it has not at all gone away. This is where that referral for psychology comes in. NOT because "it is all in your head", but because it is all in your head! To be clear, all pain comes from your brain, right? But if the pain in the brain did not subside with proper treatment, then the brain is signalling something is still wrong. Now the something is more difficult to discern, because the causal link is not clear. A broken leg gives you leg pain. This pain might be in your leg, your back, or your shoulder, but apparently that does not mean you have a problem in your leg, back, or shoulder this time.

Vexing Illnesses!

I am just back from presenting at the American Society of Clinical Hypnosis Annual Meeting with my colleagues, Julie H. Francis, GCFP, and David C Flemming, MD. We presented our fascinating workshop on uncovering the reasons for puzzling medical problems such as intractable chronic pain, migraine, IBS, interstitial cystitis, and autoimmune disease. The blanket term I use for these problems is "medical disorders of dysregulation."

These illnesses are vexing to physicians because they do not follow the rules. Medications tend not to work, there is no surgery that fixes them, and even the cause is elusive.

These problems are even more vexing to those of you suffering with such a condition for those same reasons. No one seems to be able to help. Now and then something seems as if it is helping and then you are let down when your symptoms return.

The work I have done in my office, and the work I have shared with various colleagues, leads to some interesting conclusions with the potential to help many of you. First and foremost, we know that you are not pretending, faking, or, worse, crazy. You have symptoms, some of which are visible or measurable, others of which are subjective--you hurt, but it cannot be seen by others.

In Defense of Pain

What?! Defend pain? Whatever for?

Because pain is an all-important indicator that something is wrong--that you should look to your body's needs, stop doing something that hurts, pay attention.  Ever since the advent of the "Excedrin headache", we have expected to be able to instantly get rid of pain.  We have developed a zero tolerance attitude.  Instead of learning from our pain, we tend to search and destroy--find a pill that will make it go away:  "I do not have time for this headache, I have to work, take care of the kids, run that marathon......"

What this attitude does is cause us to neglect the real cause of the pain, whether it be overwork, dehydration, or a brain tumor or sprained ankle.  We want the pain gone, but we do not have the patience to slow down and find the real source of the pain.  Sometimes this works fine--sometimes that trip to the doctor provides some advice and gets you a medication that works, and the pain never returns.   Your sprained ankle heals, you rehydrate and feel wonderful.  As long as you remember to follow that advice, which includes resting the ankle and hydrating regularly--actually making a long-term, but fairly easy change, you will remain fine. Other times, you end up neglecting the real source of the pain, and it just keeps coming back.  Those are the times we need to look at more closely.

So you get tension headaches every week or so, or have a pain in your side that never quite goes away, or worse, you have a chronic condition such as fibromyalgia, CRPS (RSD), migraine.  The doctor gives you a lot of medication and it dulls the pain, but you never feel quite right.

Let's start with that tension headache.   Tension, right?   What do you do in addition to taking medication?  Do you look for the source of the tension?  No, because you know it--whether it is the boss, the kids' school, your impending promotion, the mortgage, or all of those, you know what it is, and it feels unchangeable.   Not quite.  What you can change is how you perceive and handle those life stresses,   and how you deal with the repercussions in your body.   You can learn to manage stress differently AND treat your body better.   Perhaps you get a therapist to teach you Rational-Emotive Therapy and start doing massage or Feldenkrais® treatments.   Or perhaps you learn meditation and start yoga classes.  Making those two types of changes in combination, you can get many stress-based pain conditions to remit completely. 
In the case of a more serious chronic condition, the cure is similar, but less simple.  The precursors may be a lifetime of stress or a history of trauma.  Then you got hurt in a car accident, and your body just seemed to betray you.  Everything hurts, and nothing helps.  These conditions require a more detailed approach to restoring comfort--a look at your history to heal the inner pain as well as a thorough examination of how you embody and maintain the pain.  Deeply experienced stress and trauma change the body, the brain, and YOU.  But even these very deep, longstanding  changes are repairable with therapy for the mind and the body. 

Remember that your mind and body are a totality rather than two separate entities.  Thus to completely cure any pain, we need to look at our lifestyle, our habits, and our history.  Pain is a signal to stop and listen to the body.   Pay attention to your body, take care of its deepest needs, and it will rarely betray you.

Trauma, Pain, and the Freeze

I get many questions about the link between pain and trauma.......for a start, chronic progressive pain syndromes like "complex regional pain syndrome type I" (formerly known as "RSD") have their basis, not in organic injury (though they often start with an injury), but in the flight, fight, freeze syndrome. In a moment of shock or fear, the system goes into auto-pilot and cuts off certain self-healing behaviors to assure safety. Sometimes, even after the injury heals and the moment of fear (auto accident, fall down the stairs, etc.) is over, the brain does not kick into recovery mode, and continues to perceive the limb as injured. We call this dissociation--in this case a divergence between perception and reality causing faulty operation of a system. This has the effect of rendering medication, surgery, and physical therapy ineffective (sometimes even harmful), as the key to healing is actually changing the perception! The freeze mode is an endorphergically charged pattern, which prevents even the strongest pain medications from breaking through, and represents wild oscillations of the autonomic nervous system, which can cause anxiety, insomnia, digestive difficulties, memory and concentration deficits, and, of course, PAIN. The key is in the brain--getting the perceptions in line with reality and exiting the freeze. RSD? Call for more information--you can learn to feel well!