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.

woody allen 58 (photo credit: Courtesy)
woody allen 58
(photo credit: Courtesy)
Woody Allen, perhaps the most famous onscreenhypochondriac, was asked in an interview on the BBC whether he was ahypochondriac in real life. Allen responded that he was not ahypochondriac. "I'm an alarmist, which is a completely differentproblem," he says. "I do not imagine that I get illnesses but should Iwake up one morning with chapped lips, I think I have cancer. I goright to the worst possible permutation on something."
Perhapswe laugh at Allen's neurotic on-screen characters because in each of usthere is a bit of the neurotic worrier. It may come as a surprise tosome, but not to family physicians and other primary care doctors whosee many "alarmists" in their practices. John Knowles in his classicbook, Doing Better and Feeling Worse, Health Care in the United States,coined the term the "worried well" to describe the huge numbers ofpeople who each year visit their physicians reporting symptoms andcomplaints that can't be traced to physical etiology or causes.
The same phenomenon exists here. In fact, it is estimated that60 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 backpain, or a multiplicity of aches and pains that easily mimic moreserious 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 welltrained to detect emotional stress in their patients, and pressure puton physicians to see patients at a fairly quick rate (10 minutes onaverage) doesn't give them much time to really get to know what isbothering their patients on an emotional level. Many times when theprimary care physician rules out physical illness, the patient isreferred to specialists; unfortunately, when emotions are the trueculprit in explaining a patient's complaints, even thesesuper-specialized doctors will come up empty-handed.
If we look at our bodies as containers, we can beginto make some sense out of why and how people "somatize" their emotions.Besides containing food and our organs, the body acts as a big backupsystem for feelings, fears, anxieties and worries. When someone statesthat he feels tense or stressed out, think about it, he usually canidentify 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 imposemajor physical harm and suffering to the individual. There are alsomany people who as a result of traumatic experiences, emotional and/orphysical child abuse while growing up or being the victim of a terroract have learned not to allow themselves to acknowledge their feelings.These individuals have had to put their feelings on hold, hide them andget them, so to speak, out of sight and mind.
Psychologists use the terms disassociate ordepersonalize to describe such a severe attempt to remove oneself fromunpleasant and overwhelming emotional states. Unfortunately, emotionsthat are not acknowledged find their way to express themselves, if notin feelings, than in physical ways.
So, you don't have to be a Woody Allen to be alarmed byphysical symptoms that may be directly attributable to your emotions.But if you don't feel well, and your physicians are not able to helpyou with your problem, it may be time to turn to a mental healthconsultant. You may just find out that talking to an understandingtrained professional about what's really hurting may just be what thedoctor ordered.
The writer is a clinical social worker who sees patients both in Jerusalem and Ra'anana. drmikegropper@gmail.com