It’s all in your head

One of the lectures I had during formal learning week included a session on ‘Mind-Body Medicine’. This basically talked about how psychological stimulants can affect the body physically.

The lecturer that talked about this topic said how your body is a “metaphor” that conveys what your mind goes through. She provided a couple of case examples.

There was a woman who had recurrent mouth ulcers. Doctors were unable to ascertain a cause for these mysterious ulcers and were unable to cure the patient. Eventually she was seen by a psychiatrist who questioned her about the time of the onset of the ulcers. If anything significant happened in her life. The woman stated that she and her family were devout Catholics, but recently her daughter left the church. She was deeply affected by this. When asked what most bothered her about this situation, she said that it bothered her that “she couldn’t talk about it” with her daughter. The psychiatrist suggested that she try talking to her daughter. After the woman agreed and proceeded to do this, her mouth ulcers mysteriously disappeared as quickly as they came.

Another patient, an elderly woman living alone had once had a fall in her garden and hurt her foot. Traumatised by this incident, she retreated to her home and over a few months became agoraphobic and refused to go outside or interact with others. She developed scleroderma  (an autoimmune condition that causes hardening of skin). She did not respond to treatment and doctors were unable to find a cause for her condition. She was approached by a psychiatrist to address her condition and her agoraphobia. When discussing this, she mentioned that she had “retreated into her shell” and did not want to come out. The psychiatrist proceeded to work with her to help her “come out of her shell” and get on top of her phobia. After a few months, she was no longer agoraphobic and her scleroderma resolved in an unexplained way.

These were both very interesting cases for me. I have some belief in the idea that psychological conditions can manifest physically, but to know that – as the lecturer put it – “the physical symptoms tell the story of the patient’s mental state as they would”, was quite surprising. And I began to ponder to what extent this was true.

While in the lecture, these cases were surprising to me. But my friend next to me said she thought they were “scary”. She didn’t believe that psychological aspects can manifest physically. She told me she finds concepts like this “quite fluffy” and so they can’t really be true. I wondered why she thought that. I suppose it comes from an innate fear that this is something unknown and thus isn’t controllable. I mean, if I told you that you would get an infection because your friend Bob sneezed on you and tiny microscopic virus particles were expelled in droplets and you inhale them and they penetrate your nasal mucosa, activating your immune system and causing symptoms of the common cold, you would know to stay away from Bob, so as to prevent him sneezing on you and unleashing the nasty little virus on you. But what if I said – you would get an infection because last week you were asked to go to your uncle’s wedding but you really didn’t want to go and you just got really angry? How could you stop that? (well it would get you out of going to the wedding, but still). There’s no way you can prevent that. And there’s no clear cause for it, etc. It just happens?? Because of thoughts?? Scary. And as the doctor, you probably can’t treat this person normally by giving them a medication.

I can kind of see her apprehension. I was later telling my mum these stories and she was all-too-eager to believe this. She went on to tell me that 90% of all patients I will see in my clinical practice will definitely only have some underlying psychological issue that once fixed will fix the person entirely. Now, I thought this was a bit extreme. My mum was convinced, from her experiences that everything psychological manifests physically and no one really needs medical treatment.

Seriously, how far does this go, I wonder? I believe in things like psychoneuroimmunology. So much so that I did a research project on it. Basically it was based on the idea that social closeness leads to better skin healing. Ie. If you feel more supported and less stressed, your immune system works more effectively and leads to faster healing. But even so, there is clear evidence and a physiological flow diagram to explain this effect. Things like abstract thought affecting physical body in a particular way (no talking = mouth ulcers and “shell” = scleroderma) is a bit difficult for me to comprehend. Could it just be a coincidence? Or maybe there is an actual physiological relationship to explain these effects but haven’t been discovered yet?

But if so, can all illnesses be attributed to a psychological stimulant? How then would doctors treat patients? Exclusively Psychologically? Without medication?

Thoughts? How big a role do you think psychology plays in affecting the physical body?

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