When should you see a psychologist for a physical illness?

I have been writing on the topic of mind/body medicine for over 20 years, and I continue to learn and be amazed by the human mind/brain. Long years ago, a brilliant scholar named Ernest Rossi began to write about hypnosis and neuroplasticity. He was, of course, not alone in this, but he was my first formal contact with the fascinating world of brain changing body. Despite my psychological training, I began to see the mindbody connection everywhere. A client with diabetes who suffered from severe psychological distress after an amputation presented with uncontrollable vomiting and raging fevers rather than diagnosible psychological problems. People with intransigent chronic pain ran from doctor to doctor and were accused of faking or drug-seeking, but with good psychological exploration and insight, their trauma could be found and they could heal themselves. Clients with autoimmune disorders such as rheumatoid arthritis and multiple sclerosis found improvement, often dramatic, with the application of psychological techniques. A client who had attempted suicide with a .38 to the head showed NO brain damage on MRI, demonstrated no physical disabilities from the shot, but had significant amnesia for his entire life prior to the incident! The amnesia remitted with psychological treatment.

These extreme examples of the intricate mindbody connection led me to view my clients with a much more open mind. Things I had diligently learned in graduate school held less sway versus the real experiences of my clients. Medications did not appear to work miracles despite being used in ways even our textbooks said were dangerous. Diagnostic criteria and diagnosible disorders from the _DSM_ changed over time, which confused me if those listed problems were diseases. Does the definition of influenza or diabetes change with each new edition of a manual? Do they sometimes disappear from the text? And despite modern times labeling many problems as diseases in what appeared to be both an attempt to put them in the bailiwick of physicians and to remove the stigma of causality from patients and their families, suffering seemed to be getting worse, not better, and reliance on medications increasing as well. Additionally, the number of clients coming to me already taking three or more psychoactive medications appalled me. Why, after all, were they still suffering if these medications work? I began to wonder about many things I had been taught and to question common treatment practices of people seeking mental health treatment as well as physical medical treatment.

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.

Does School Cause Anxiety?

Most of the young people I see suffer in one way or another from school anxiety.

Whether they actually perceive themselves to be anxious, or have headache, stomach ache, or hives, many school-aged children are nervous about school.

In the language of Rational Emotive Therapy, it is not an external thing or event that causes anxiety, as anxiety arises from how we THINK about that external thing or event. However, in the case of the modern classroom, a case can be made that the way in which classes are managed is so stressful for the average young person, that it is rather difficult to avoid school-driven anxiety. Whether your student is scared of tests, a given teacher, big projects, group projects, or speaking in front of the class, there are things about modern education that essentially create situations too stressful for the average young person to manage easily. And, even more unfortunately, parents are often made into unwilling assistants in the creation of school anxiety.

Let's begin with a question: What is the root cause of school anxiety? In short, the basic assumption of intellectual education that all children ought to learn on the same schedule. Granted, we now have gifted classrooms and special education classrooms to accommodate variations from the average, but the basic premise remains that the mind can be educated on a fixed schedule, a schedule that is determined by bureaucrats.

Really, this ought to give us all pause. We send our children for swimming lessons and karate lessons and ice skating lessons, all of which operate based upon skills testing. A child works on a set of skills as long as she needs to, and when she passes them, she may proceed to another set of skills. Why does the mind of your child get less consideration than the body?

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.