Description: What would you think if you went to the emergency at your local hospital with intense stomach pain and were told after examination that they could find nothing wrong with you and that maybe the pain was “just in your head”? Does that mean you are crazy (to use the technical term)? Well the actual old technical terms that you may have heard before is psychosomatic meaning psychologically caused. However, the term psychosomatic has acquired a certain common usage cache over the years and often its use hints at malingering or faking or other mental health issues. But, such characterization, especially as a first attribution when “medical” cause is not apparent are inappropriate, cruel, and likely unethical. If you have had an introductory course in Psychology (or just read about it) think about what you have learned about the powerful physical aspects of the human stress response and about the potentially long-term consequences (psychosocial AND physical) of exposure to traumatic events. Yes, thoughts about stressful situations, circumstances or event ARE “in your head” but their being there can have serious physical impacts. The more recent dignostic category is somatic symptom and other related disorders and there are clinical psychologists and psychiatrists now specializing in understanding and treating them, sometimes with astonishing results. So, check your stereotypic assumptions about such things and read the article linked below which will introduce you to a psychiatrist, Allan Abbass, to intensive short-term dynamic psychotherapy (ISTDP), and to the stories of several people who experienced medically unexplained pain and were helped by Abbass and ISTDP.
Source: It’s not all in your head, Erin Anderssen, Folio, The Globe and Mail.
Date: December 8, 2018
Photo Credit: https://en.m.wikipedia.org/wiki/File:Inkblot.svg
Article Link: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjSpZDaiKXfAhXfIjQIHbEXAZgQFjAAegQIChAB&url=http%3A%2F%2Fglobe2go.newspaperdirect.com%2Fepaper%2Fviewer.aspx%3Fissue%3D77292018120800000000001001%26page%3D12%26article%3Df8746b7e-c7ea-48b3-8d9e-af9f3d0a0efb%26key%3DPYWnzwb0O9%252FsI7ANDq%252FtHg%253D%253D%26feed%3Drss&usg=AOvVaw2PInJmHfOPhxwDPGmKrxK-
So, yes, it could be “in your head” but that in no way dismisses your pain as not real or as crazy. Just as our understanding of the potentially profound impact that early exposure to traumatic events can have on subsequent development, adjustment and physical health (search Social Determinants of Health and Adverse Childhood Experiences – ACEs) improves so are we starting to better understand how what we used to dismiss as psychological stress can produce very, very real pain. This is another example of why we should, perhaps, reconsider the stereotypic belief that there is a significant gap between medical issues and psychological issues. Seeing more of the emerging number of cross links between these two domains will help many people get better help quicker.
Questions for Discussion:
- What does it mean to call something psychosomatic?
- Are somatic symptoms and other related disorders “real”?
- What does your reading of the article suggest to you in the way of things we might want to adjust in our primary health care systems?
References (Read Further):
Abbass, Allan (2018) Hidden from View: A clinician’s Guide to Psychophysiological Disorders, Psychophysiologic Press, LLC.
Some clarifications by Allan Abbass about the Globe and Mail article http://reachingthroughresistance.com/wp-content/uploads/2018/12/Comments-about-G-and-A-article-dec-10-2018-r.docx
Abbass, A. A., Joffres, M. R., & Ogrodniczuk, J. S. (2008). A naturalistic study of intensive short-term dynamic psychotherapy trial therapy. Brief Treatment and Crisis Intervention, 8(2), 164. https://triggered.clockss.org/ServeContent?rft_id=info:doi/10.1093/brief-treatment/mhn001
Abbass, A. (2002). Intensive short-term dynamic psychotherapy in a private psychiatric office: clinical and cost effectiveness. American Journal of Psychotherapy, 56(2), 225-232. https://psychotherapy.psychiatryonline.org/doi/pdf/10.1176/appi.psychotherapy.2002.56.2.225
Abbass, A., Town, J., & Driessen, E. (2012). Intensive short-term dynamic psychotherapy: a systematic review and meta-analysis of outcome research. Harvard review of psychiatry, 20(2), 97-108. http://dare.ubvu.vu.nl/bitstream/handle/1871/38062/Abbass,?sequence=2
Solbakken, O. A., & Abbass, A. (2013). Effective care of treatment-resistant patients in an ISTDP-based in-patient treatment program. Psychiatric Annals, 43(11), 516-522. http://m4.wyanokecdn.com/2b4952f201bb114ffc280f3fc3e5d4e8.pdf