A couple of months ago, following a breast cancer scare which turned out to be nothing, I was sitting in my boss’s office and she offhandedly remarked that I tended to be somatic. The remark stung because I don’t like to think of myself in that way but the truth is that she’s right. I’ve had to take time off for severe migraines that have landed me in the emergency room, come in late or have had to leave early due to appointments with the gynecologist, gastroenterologist, and endocrinologist. And then there was the week off for the relapse of my anorexia which I ended up taking as vacation time.
And that’s just half of it. The other half took place on the weekends or during the evening hours so my colleagues and supervisors at work need not be privy to it. Dr. Adena, my psychiatrist gets the lowdown on all of it. All of my fears, anxieties, worrying about this condition or that. And she doesn’t hesitate to make an interpretation which often involves a confrontation.
This past summer when my depression had worsened, Dr. Adena prescribed a second antidepressant as an adjunct to my primary one. I filled it on my way to work following our session and took it around 10 AM. By 2 PM I was feeling incredibly speeded up and restless. I couldn’t concentrate on my work and I felt as if the walls of my small office were closing in on me. During a break, I escaped and went for a walk under the guise of getting a bottle of juice, but even the brief outing didn’t help. I put in a call to Dr. Adena but I didn’t hear from her. I spent the rest of the day just trying to maintain some semblance of normality. Luckily it was the one day of the week when I don’t see patients and spend the entire day doing administrative work.
Driving home which typically takes an hour I was overcome with a strange urge to slap and hit myself. I started to get frightened and had no idea where this urge was coming from. I knew that some of the newer SSRI’s could increase thoughts of suicide and I didn’t know if these self-destructive thoughts were the beginnings of a downward path. I just wished Dr. Adena would call me back.
I was afraid to go home and to be alone so I drove myself to the emergency room. I told them about having started the medication, and what I was feeling, and I stressed to them that I was not suicidal. That didn’t seem to matter. They took me to a bare room except for a stretcher, had me strip and put on a gown, and closed the door. They were watching me from just outside by camera.
I sobbed and sobbed. The urges were still coming, but with less intensity and I was able to control myself more easily. I didn’t want to act on them. Finally a psychiatrist came in to talk to me. I told her it was my belief that it was the medication and again stressed that I was not suicidal. After a while longer they let me go home. I stopped taking the medication and it never happened again.
In our next session I told Dr. Adena what happened and she interpreted my urges to hurt myself as anger at her for not calling me back when I began to feel so strangely after taking the medication. She said she wasn’t even sure that the medication had caused the sped-up and restless feelings — perhaps that was fabricated by my psyche as well.
I didn’t know how to react. I felt angry at her for questioning my reality, though my experience with her is that she tends to be on the mark. I felt humiliated as if I — or my psyche — had fabricated the whole situation with some unknown reward in mind. I was a jumble of feelings and responses.
After a number of sessions, I came to my own understanding and resolution. I believe that the medication had that initial effect on me but when Dr. Adena didn’t call me back I got angry and that set off a cycle of exacerbated symptoms and feelings. Not being able to allow myself to feel and acknowledge my anger, especially at Dr. Adena is something I’m working on in therapy, but now I’m aware of how powerful and even dangerous this shortcoming can be.
My patients often use physical symptoms or complaints to avoid sensitive topics like anger or change. I’ll ask them about something they promised they would do the last week or the week before like call about a volunteer job, or look into the schedule of GED classes (when it was them that said they want to obtain their GED).
Sometimes they will complain that they couldn’t go for a walk (when weight loss may be a goal) because their knee hurt, but more often they will become “distracted” in session by an ache, or more commonly, by fatigue. The men lean their head back against the wall and close their eyes and the women put their elbows down on a file cabinet that is next to the chair and rest their head on their hand.
I point out that we are doing hard work in therapy and that is most likely what is making them tired (or a part of their body seemingly ache) and want to take a break. Encouraging them to sit up straight and open their eyes, I explain to them that this may be their minds’ and their body’s way of not wanting to talk about the subject at hand.
It often takes the same pattern of this behavior being repeated in a number of sessions — and my continually pointing it out for my patient to recognize that this is what may be happening. In the interim, he or she may become annoyed with me. “Why are you telling me this again? I’m just tired.”
As with any group of people, some will eventually come to realize that they are using somatic symptoms as a way to avoid exploring about hard-to-discuss issues. I often tell my patients that in a course of psychotherapy they will typically feel worse before they feel better, and these are the most difficult matters to get to. Some will avoid these concerns with such a vengeance, such defenses that they may never get to what really is at the heart. They will work so hard at avoidance —if only they could put that effort into the work of the therapy. Some will become angry and quit.
I didn’t start out writing this post intending to connect those who tend to be somatically inclined with anger and avoidance. But I think it’s an important connection to make. We need to learn to use our brain and our bodies wisely, but we also have to remember that our minds and our bodies are inextricably intertwined and that’s one of the best advantages we have.