With attention to the body at an all-time high, we are increasingly
likelyto express emotional discomfort in a physical rather than verbal
language.
ONE DAY A YOUNG MAN, A PSYCHIATRIST IN HIS EASY THIRTIES, ENTERED A
NEUROLOGIST'S OFFICE ACCOMPANIED BY HIS PREGNANT WIFE. THE PSYCHIATRIST
HAD, FOR SOME MONTHS, NOTICED TWITCHING IN THE MUSCLES OF HIS LEGS AND
RIPPLES OF MUSCULAR ACTIVITY CASCADING DOWN HIS CALVES. AT FIRST HE TRIED
TO IGNORE THESE TWITCHES, BUT IN TIME THEY INCREASED IN FREQUENCY AND
COULD NOT BE OVERLOOKED. NOW HE WAS CONVINCED THEY WERE THE SYMPTOMS OF
LOU GEHRIG'S DISEASE, A SLOW, BUT PROGRESSIVE, DEGENERATION OF THE
NERVOUS SYSTEM THAT LEADS TO PARALYSIS AND AN AGONIZING DEATH.
The neurologist, a brilliant but gruff man in his sixties, listened
intently to the psychiatrist, but after a thorough neurological
examination abruptly exclaimed in a loud and disagreeable tone, "There's
nothing wrong with you. Get out of here."
If the psychiatrist's muscular twitches had no medical cause, did
they have a psychological one? If so, what was going on in his head that
resulted in those alarming twitches? It seems to me that as a prospective
father, he had been under a particular stress: the anticipation of a
first child. Until his wife's pregnancy, he must have been the exclusive
beneficiary of her care, attention, and love. Now he was to share it with
another--the child who was twitching and kicking in his wife's
womb.
Though he must have expressed his joy to his wife and others, down
deep he may have suppressed negative feelings that he was now expressing,
not in words, but in physical language. The rippling of his leg muscles
was his way of saying "I'm just as important as that other
twitcher."
This explanation may sound glib and crudely Freudian, but I have a
special insight into this patient's problem. You see, I am that
psychiatrist. In fact, that experience in the neurologist's office and my
attempts to clarify my thoughts about it profoundly affected both my
professional and personal life.
Professionally, I developed a lifelong interest in somatization, a
process through which people express emotional discomfort in a physical
rather than verbal language. Instead of words, this language consists of
unwelcome physical sensations, symptoms, and preoccupations with medical
illness. For example, after a grueling day at the office or an argument
with a spouse, a headache or a stiff neck may express our
feelings.
Somatization is a way of saying, "I am emotionally overwhelmed." In
place of putting a feeling of emotional discomfort into words such as
"I'm feeling anxious because. . ." or "I feel under the weather because.
. .," we communicate through physical discomfort or symptoms or worry
about sickness. It is a common language, used by almost all of us at one
time or another. Somatization symptoms are not imagined or feigned. They
are genuinely, and often painfully, experienced.
From a personal point of view, it was sobering to realize that,
despite my being a psychiatrist, I was just as susceptible as the next
person to expressing my emotional discomfort in physical symptoms. In
fact, 60 to 80 percent of Americans have at least one somatization
symptom per week. Research has provided powerful evidence that most of us
express emotional discomfort physically far more often than
verbally.
Indeed, we all experience occurrences of somatization, whether or
not we are aware of them. For the most part, these are related to stress
and are normal. We usually identify the physical feelings as stress
induced and may say, "I had such a bad day at the office, my stomach is
still tied up in knots," or "I'm tense--I feel it in my neck." These
sensations are usually relieved by a drink, a hot bath, a good dinner,
exercise, or a good night's sleep.
Likewise, when under pressure to complete a project, confront a new
social situation, or start a new job, we may experience heartburn,
palpitations, or urges to go to the bathroom frequently. In these forms
of somatization, we are aware of the relationship between stress and our
physical sensations and do not impart medical significance to
them.
But sometimes if our symptoms persist, we conclude these changes
must mean something is physically wrong. We visit a doctor. And most
often, the physician, having taken a careful history and done some basic
testing, calmly reassures us that there is nothing physically wrong.
Though certain illness are notoriously difficult to diagnose in their
early stages and doctors may lack the diagnostic skill to detect them,
generally speaking, when a thorough investigation finds no evidence of
disease, a doctor can reasonably attribute such symptoms to
somatization.
When the somatization symptoms persist despite a physician's
reassurances and, more important, interfere with daily functioning, they
require more serious attention. For instance, if we continue to complain
of the same symptoms and consult many specialists, take days off from
work, and preoccupy ourselves and our families with our complaints, we
may indeed have an emotional disorder and require psychiatric diagnosis
and treatment. Those who have persistent somatization symptoms that
markedly interfere with their functioning have what we call somatoform
disorders.
Tags:
agonizing death,
body awareness,
emotion,
emotional discomfort,
gehrig s disease,
gruff man,
hypochondria,
leg muscles,
lou gehrig,
medical cause,
muscular activity,
neurological examination,
neurologist,
physical language,
pregnant wife,
progressive degeneration,
prospective father,
psychosomatic,
ripples,
somatization,
twitcher,
twitches,
verbal language
