‘For the last week, the pain has been so bad, I have not even wanted to get dressed.    I’ve just sat in an arm chair, nursing a hot water bottle.  Eventually I could stand it no longer.  I went to see my doctor.  He said there was nothing wrong with me.  It was all in my mind.’ 

 

But the fact is that her mind was not where it was.  Although Susan’s pain was instigated by a catastrophic life event, her distress was all in her body.   It has left her mind months ago. 

 

After Geoff left home,  Susan experienced quite severe attacks of panic.  She went over the over the reasons in her mind.  Why hadn’t she seen it coming?  She knew he was friendly with Caroline, that they often stayed late to work on projects, but she never dreamt they would have an affair.  Besides, she’d always thought of Caroline as a good friend.  She constantly obsessed about what she would say to Caroline if she met her.  She wasn’t able to concentrate.  Her focus was interrupted by thoughts of Geoff .  She replayed their last meeting like a videotape in her mind.  Maybe she could have stopped him.  She shouldn’t have lost her temper.  He didn’t deserve that.  It stopped her sleeping.  She went off to sleep but woke at three o’clock consumed with thoughts and drenched in sweat. 

 

As the weeks turned into months and the panic and stress continued, she became ill.  She developed palpitations, felt faint, sick, had backache, pains in her shoulders, but the worst was the stomach pains that came on every time she tried to eat and soon were there all the time. 

 

Susan’s pain took all thought of Geoff and Caroline out of her mind.  It obsessed her, and became the focus of her anxiety.  So in a way the pain protected her from going mad from obsessing over what had happened.  It became a tangible focus of attention and a concrete means of resolution.  ‘If you have a pain, you take it to the doctor, who cures it.’ 

 

 

Susan’s trajectory from trauma to physical symptoms is not unusual.  The panics, flash backs, preoccupations and sleep disorders of Post Traumatic Stress Disorder have but a limited life span, provided people do not keep traumatising themselves by revisiting the site of the trauma.  After a few months, physical symptoms supervene, but these can become chronic, often unexplained, illnesses that last for years.  There is usually some identifiable event that precedes the onset of Chronic Fatigue Syndrome or Irritable Bowel Syndrome.  And people who have been involved in some shared trauma, like a flood, an earthquake , incarceration in a concentration camp, or extreme danger in war, tend to suffer from a disproportionate variety of unexplained symptoms many years later.  In 1976, Dr Finn Askevold published the results of a study of Norwegian merchant seamen, who had served on the convoys with the allies during World War 2.  Although they were not actively engaged in conflict, they were in constant danger of being sunk by aircraft or U boats.  Many had been rescued from ships that had been suck.  He found that thirty years later they suffered a disproportionate amount of illness: 90% suffered from extreme exhaustion, 80% were impotent, 75% experienced pains, 62% had dizziness and 50% had dyspepsia. .

 

But why does trauma go to the body?   Well, it’s always been there.  Stress does not only affect the mind, it affects the body as well.   The chronic stimulation of the sympathetic nervous system accelerates the heart, raises the blood pressure, tenses the back and shoulders, and wrenches the gut out of kilter, causing pain, bloating and bowel disturbance.  Physical pain has a tendency to occupy the mind.  If you have a toothache, all you can think about is the pain in your tooth. 

 

To use the metaphor from last weeks, blog,  Containing the emotional reactor going to sea with a tiger’,  it is like having a wounded tiger on board.  It is not thinking any more.  It is wounded and in pain.  Nothing else matters.  The pain takes over and commandeers all thought.  Whatever happened pales into insignificance.

     

 

This, however, is not some random selection of stress symptoms.  The body is governed by a mind that works in meaning and metaphor.  It selects the most appropriate area of bodily tension to represent the nature of the trauma and play out its purpose.  Decoding unexplained bodily can reveal what the illness means to the individual – the rumbling in the stomach – guilty secrets, the intolerable burden of backache,  the dreadful exhaustion of unwanted obligation,  the frustration of constipation, the distrust of food intolerance, the disempowerment of impotence.       

 

So the body will reveal what the trauma is like.  It acts it out, not only through symptoms of illness, but the way it holds itself,  the way it moves.  Body language is very revealing.  The postures of joy, sadness, shame and anger are instantly recognisable. The emotions are held in the body; they are located in physical attitudes.  Simulation of the posture of sadness traps somebody into that feeling.  It is impossible to feel joy.  Clumsiness reveals a mind out of control. 

 

 

There are natural experiments that help us understand how bodily symptoms can come to express unresolved torment.  Sometimes the symptoms of physical injury, childbirth, or infection fail to clear up.  They remain year in and year out, a persistent source of misery and desperation that takes over people’s lives.  For example, about 10% of people develop persistent pain and bowel upset after a bout of gastroenteritis.  Some years ago, we carried out a prospective study to investigate what factors led to symptom persistence.  Our results showed that the major factors were anxiety, depression and traumatic live events occurring at the time of the original infection.  Whatever happened became associated in the brain with the physical symptoms of gastroenteritis, which were recruited to represent what it meant.    

 

Neuronal connections work like paths in the forest.  Once a link is made, the traffic along it makes the path more clear and easy to follow.  Links between distress and physical symptoms seem to fit that metaphor very well.  The same route is taken time and again until something happens, life changes, whatever happened is no longer important, and then that path becomes overgrown.

 

 

But it’s not only in the brain that connections are made, it’s in the body as well.   Unexplained bodily illnesses are characterised by sensitivity, irritability and a mild inflammation.   Inflammation has been implicated in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, the irritable bladder and many others.  Chronic stress tends to predispose to inflammation.  The sympathetic nervous system, reaching out to all parts of the body increases sensitivity and excites the immune system, while rendering it resistant to the anti-inflammatory action of the cortisol, the body’s natural steroid.  The reason that cortisol levels are often raised in depression and most unexplained illnesses is now regarded as an indication of cortisol resistance, like the high levels of insulin in type 2 diabetes. 

 

It would be completely compatible with what we know of the way the nervous system works to suggest that the inflammatory change may be activated only in those parts of the body that carry the memory and meaning of what has happened.

 

 

A body full of tension and pain all too readily becomes the enemy and may be attacked, by  anger, frustration, severe exercise, self harm and going to the doctor and requesting surgery to remove and offending organ or limb.  Too many surgical operations are still carried out to excise psychological wounds. 

                  

But modern doctors are less likely to dismiss patients with, ‘it’s all in your mind’ or ‘it’s just psychosomatic’.  Most understand the essential connection between stress and illness and will often recommend counselling in addition to prescriptions that offer symptomatic relief.   Unfortunately, neither approach necessarily hits the spot.    

 

If  the body is expressing the tension, then it would to use the same route to relieve it.  Progressive muscular relaxation, deep breathing, yoga, meditation, Pilates, adjustments of posture through Tai Chi or Alexander technique, massage, reflexology, acupuncture or tapping on acupressure points as in ‘Emotional Freedom Technique’  all work to reduce the tension in the body.  Movement can shape body reaction.  Touch therapies can make contact with what is upsetting.  Song, drama therapy, running with others, playing games can instil a sense of companionship and belonging.   The confidence and relaxation instilled by techniques that work through the body loosen the preoccupation with the illness and will allow people to access and work through the feelings of what happened. 

 

Susan found talking profoundly disturbing.  Going over the circumstances of the collapse of her relationship with Geoff just traumatised her all over again. her therapist needs to be a safe presence, remain in the here and now, talk about feelings,  and employ touch, movement and posture to calm the mind and facilitate the necessary relaxation and confidence to  process what happened. 

 

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