If it's only in my mind, doc, why do I feel so bad?

It is estimated that 60 percent of emotional problems are not directed at a psychotherapist, but show up in the doctor's office as some type of physical complaint.

January 21, 2010 17:51
3 minute read.
Woody Allen

woody allen 58. (photo credit: Courtesy)

Woody Allen, perhaps the most famous onscreen hypochondriac, was asked in an interview on the BBC whether he was a hypochondriac in real life. Allen responded that he was not a hypochondriac. "I'm an alarmist, which is a completely different problem," he says. "I do not imagine that I get illnesses but should I wake up one morning with chapped lips, I think I have cancer. I go right to the worst possible permutation on something."

Perhaps we laugh at Allen's neurotic on-screen characters because in each of us there is a bit of the neurotic worrier. It may come as a surprise to some, but not to family physicians and other primary care doctors who see many "alarmists" in their practices. John Knowles in his classic book, Doing Better and Feeling Worse, Health Care in the United States, coined the term the "worried well" to describe the huge numbers of people who each year visit their physicians reporting symptoms and complaints that can't be traced to physical etiology or causes.

The same phenomenon exists here. In fact, it is estimated that 60 percent of emotional problems are not directed at a psychotherapist, but show up in the doctor's office as some type of physical complaint, such as a headache, fatigue, insomnia, lightheadedness or lower back pain, or a multiplicity of aches and pains that easily mimic more serious illness. The phenomenon has even been given a medical name. Doctors call these complaints "functional," "psychosomatic" or "somatization" because the symptoms are not explained by medical tests, but are a result of emotional stress and psychosocial pressures.

The truth of the matter is that most physicians are not well trained to detect emotional stress in their patients, and pressure put on physicians to see patients at a fairly quick rate (10 minutes on average) doesn't give them much time to really get to know what is bothering their patients on an emotional level. Many times when the primary care physician rules out physical illness, the patient is referred to specialists; unfortunately, when emotions are the true culprit in explaining a patient's complaints, even these super-specialized doctors will come up empty-handed.

If we look at our bodies as containers, we can begin to make some sense out of why and how people "somatize" their emotions. Besides containing food and our organs, the body acts as a big backup system for feelings, fears, anxieties and worries. When someone states that he feels tense or stressed out, think about it, he usually can identify which part of his body is tense - muscle groups, the stomach, his breathing or his head.

People generally don't recognize to what extent their feelings, when not acknowledged or properly released and dealt with, can impose major physical harm and suffering to the individual. There are also many people who as a result of traumatic experiences, emotional and/or physical child abuse while growing up or being the victim of a terror act have learned not to allow themselves to acknowledge their feelings. These individuals have had to put their feelings on hold, hide them and get them, so to speak, out of sight and mind.

Psychologists use the terms disassociate or depersonalize to describe such a severe attempt to remove oneself from unpleasant and overwhelming emotional states. Unfortunately, emotions that are not acknowledged find their way to express themselves, if not in feelings, than in physical ways.

So, you don't have to be a Woody Allen to be alarmed by physical symptoms that may be directly attributable to your emotions. But if you don't feel well, and your physicians are not able to help you with your problem, it may be time to turn to a mental health consultant. You may just find out that talking to an understanding trained professional about what's really hurting may just be what the doctor ordered.

The writer is a clinical social worker who sees patients both in Jerusalem and Ra'anana. [email protected]

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