The connection between mental health and physical health is being understood better and better with each passing day, but for people who experience psychosomatic illnesses — illness or pain whose root cause lies in the psychological — this progress can't come fast enough. We now know that people with depression can experience a whole host of physical symptoms that are directly related to their condition, from abdominal pain to chronic inflammation. But even with this knowledge it can be difficult to treat psychosomatic illness — leading to more stress, and thus, more pain, for people who live with it.
"There has been some research about what might cause someone to develop a psychosomatic illness, but they have not led to specific causes or treatments yet," Dr. Mehmet Dokucu, associate professor of psychiatry at Northwestern University, tells Bustle. There are several types of psychosomatic illness: One, he notes, is "conversion disorder, when a patient is experiencing a neurological symptom such as paralysis or blindness but a medical professional cannot explain it through an evaluation." Another is health or illness anxiety, which was once known as hypochondria, a term that is no longer used as it connotes stigma towards people who live with this illness.
It's typical of people with health anxiety that moderate or innocuous symptoms can become the target of anxious thoughts, which can in some cases make the symptoms worse. "I am in general an intelligent, rational, realistic person," James Loke Hale wrote for Bustle in 2017. "But it was like a switch in my brain had been flipped."
These illnesses, Dr, Dokucu tells Bustle, tend to get worse as one's mental health worsens. "For example, stress and anxiety may make a patient’s pain or nausea worse." But the range of psychosomatic conditions and their triggers can be quite wide — which can further make them difficult to diagnose and treat.
We're only just beginning to understand how psychological pain, stress or trauma can cause such strong physical symptoms in some people. A study in 2016 suggests that part of the issue might be in the connection between the body's motor functions and a gland called the adrenal medulla, which secretes hormones that help regulate the body's stress levels and metabolism. If the adrenal medulla goes haywire, motor function might go wrong too — but there's still a lot of work to do.
A key aspect that contributes to stigma around these illnesses is that mental health is seen as separate from physical health, when they aren't at all. Neurologist Suzanne O'Sullivan, who is an expert in psychosomatic illness, acknowledges this with her book It's All In Your Head — meaning, of course, that physical symptoms can arise from physical processes in your brain that give rise to mental illness.
Because without that understanding — that mental and physical health are intrinsically connected — these illnesses can be difficult to diagnose and treat. Professor Carlos Rubinstein wrote in the International Journal Of Emergency Mental Heath & Human Resilience in 2018 that "nothing is more disconcerting to the general practitioner and the patient" than unexplained symptoms that might be located in psychology. He notes that for many psychosomatic patients, diagnosis takes years: "The psychosomatic patient does not ask himself about his suffering: it falls within the body itself, in isolation from any relationship with the psychological. That is why psychosomatic patients move from one treatment to another without finding a solution." And when the source of the problem finally becomes clear, patients can have a hard time believing it.
The truth is that psychosomatic conditions can only be untangled — and physical symptoms reduced — by unpacking the psychological problems behind them. Cognitive behavioral therapy is often the expert recommendation. "If a patient develops blindness and is very anxious as a result of having conversion disorder, we don't treat the blindness, specifically, but we help the patient relieve his or her anxiety," Dr. Dokucu tells Bustle. "This might be through treatments such as mindfulness meditation, yoga or antidepressants. The duration of treatment for psychosomatic illnesses can range from a few months to many years."
But for people looking to support their friends who experience psychosomatic illness? The big thing they can do to help is understand it's not just "in your head," and that therapy can be a huge help. As with any mental health issue, the best approach is to practice empathy and ask how you can help as best you can.