by Patricia and Ron Deutsch
“For two months, I’ve had these spells,” Fran Wilson told the heart specialist, “i get short of breath. my heart beats like a hammer and unevenly, I’m dizzy and I tremble. My chest hurts, Twice I’ve fainted. My doctor say that my blood pressure and electrocardiogram are abnormal.”
“Was there any upset in your routine before the spells began?” the specialist asked.” My husband was transferred to Arizona, “said Fran. “I stayed behind to let the children finish the school ear. Since he left, I haven’t sleep well. do you think fatigue brought out my heart trouble?” “I suspect we’ll find, ‘ said the specialist, “that you don’t have heart trouble at all. I suspect that your illness is caused by emotion.”
Although the doctor proved correct, Fran was not imagining her ailments. Nor was she mentally ill in the usual sense of the phrase. Emotional stress can produce real illness-true changes in the body chemistry and structure of quite normal people. And this phenomenon is amazingly common. Many specialists agree that psychogenic (emotion-caused) disorders account for a large percentage of visits to the doctor. Physicians have long known that the mind could make the body ill. But they did not know how to differentiate between physically caused illness and that caused by emotional stress.
Today, answers to this problem are beginning to appear. And many doctors are using this new information as regularly as they employ their stethoscopes and tongue depressors. Fran Wilson’s case illustrates one of the easiest means of recognizing such ills: identifying characteristic “clusters” of physical symptoms which often point to emotional causes, Since Fran’s spells resembled a common cluster called ‘neurocirculatory asthenia,” the heart specialist tried a simple test. For two minutes he had her breathe deeply and rapidly, She grew dizzy. Her heart pounded. She gasped that she was having an attack.
When she had rested, the doctor explained: “Those were some of the physical signs of great anxiety. Rapid deep breathing produces many such signs in any person. When we are afraid or angry, a part of the brain called the hypothalamus prepares the body for action. The heart speeds up to rush blood to our muscles. We breathe hard to fill the blood with oxygen. Hormones are released to bring the nervous system to a pitch of alarmed readiness. Sometimes our conscious mind, seeing no reason to be angry or afraid, may block out our awareness of anxiety. Yet all the while the hypothalamus continues the alarm.”
Fran’s emotional alarm had evidently been triggered by the temporary separation from her husband. “I feel upset if anyone close leaves me, “ Fran admitted to the doctor, “when I was a child, my parents left on a trip and were both killed in an accident. When Jim left the first time in our marriage he’s been away more than overnight I felt real panic. I pulled myself together, but I guess the fear was still there.”Fran was given tranquilizers and saw the doctor three times to talk over her fears. The symptoms vanished in two weeks.
Everyone knows that the mind evokes certain automatic responses from the body. Think about food and you salivate. Words or thoughts can prepare sexual organs for function, and cause a blush or goose-flesh. But more serious effects can be wrought by emotion. Take the case of Ruth Chadwick. Four times Ruth had conceived a child but miscarried. On her fifth pregnancy, the obstetrician asked Ruth how she felt about motherhood. He learned that, though she wanted a child, girlhood tales of the rigors of labor had terrified her. The doctor decided to let Ruth talk out her fears at each prenatal visit. With no other treatment, Ruth delivered a healthy full-term baby.
Why? Researchers at the university of Colorado have said that a woman fearful of pregnancy might, after weeks or months of carrying a baby, produce special hormones of a type normally produced only at the end of pregnancy. They cause contractions, dilate the opening of the cervix, and bring about birth. Indeed many women like Ruth Chadwick, who habitually miscarry, may need only a little office counseling to carry a child to term.
How can thought work such changes? There is a pathway between the hypothalamus, the brain segment that controls primitive reactions to anger, fear hunger and sex, and the pituitary gland. This mysterious gland, a lump the size of a sugar cube, located at the base of the brain, had long been known to secrete a growth hormone. But recent research has uncovered a number of other hormones it produces, the front lobe alone was found to create chemicals that trigger the making of sex hormones and govern the thyroid, which in turn controls the body’s metabolism. It yields yet another chemical that regulates adrenal secretion.
The middle and back lobes of the pituitary affect the kidneys, contractions of the uterus, and blood pressure. “we have just opened the door,” says one researcher, “and have had only a superficial look for signs of emotional stress in patients as a matter of routine. Written tests have been designed to seek out the factors most commonly found among people whose ailments have been proved to be caused by emotion.
One such patient was Jean Becker, whose low back pain had grown steadily worse for a year, with no apparent cause, The symptoms seemed to suggest a ruptured spinal disc, which sometimes cannot be seen on X-ray, During an office visit her doctor gave her a 20 question test. When he had scored it, he asked, “have you been depressed lately?” “Ever since a year ago, when my father died,” she said “mother died when I was small, and dad brought me up alone, Although my husband and children give me plenty of family, without dad all the joy seems to have gone out of things.”
The doctor gaveher anti-depressant pills and told her to come in for a chat every few days. Within a week Jean’s back pain had disappeared. Moreover, the talks revealed that she felt that her children had little need of her and that her husband was too occupied with his business to give her much attention. Only her father had seemed to depend on her. When the situation was explained to Jean’s husband and children, they quickly gave her the assurance of love she needed, and the pills could be stopped. Had the back pain persisted once Jean’s depression was gone, the doctor would have felt it more likely that the cause was purely physical.
One test devised bydoctors at Duke University, Durham, N.C. sought out unexplained fatigue, lack of sex interest, loss of weight, constipation, hopelessness, feelings of uselessness, difficulty in making decisions and restlessness All of us sometimes have such feelings, of course. The key to the duke test is whether a number of such factors are present much of the time. Sleep disturbance is one of the prime clues; the person morning or during the night and have a chronic feeling of fatigue.
Sudden changes in life are often found to precede illness. In one study of patients with a wide range of ailments, three out of four were found to have recently suffered some major loss-loved ones, jobs, homes. Even apparently pleasant changes, such as a trip abroad, can cause trouble. The tourist who complains about foreign food or water would probably be wiser to blame the tension of being in a strange place. Moreover, susceptibility to minor illnesses, such as colds, may be caused by small emotional stresses.
Are doctors other than psychiatrists really able to handle such emotional problems? Numerous experiences show that they are . And some medical schools now are offering short courses in office psychiatry to their graduates. Most physicians cannot devote an hour to talk with a patient as psychiatrists do. But so long a time has been found unnecessary in treating most patients with psychogenic illness. They need, primarily, reassurance that their ills can be dealt with. Ass doctors learn to incorporate the new knowledge of psychogenic illness into their work, some of the responsibility, as always, must rest with the patient. He should make an effort to protect himself when he knows that stress has made him vulnerable. He can help the doctor by telling him when emotional upheaval has preceded or accompanied an illness. He should be completely frank about his angers and fears, his frustrations and losses. The heroic view that “everything is just fine” maybe good manners with a friend, but it is poor judgment when it is your doctor who wants to know.