I saw a patient a short while ago who had seen ten doctors and scheduled to see the twelfth tomorrow…
We had a good first meeting and I was glad to hear her say she didn’t think it would be necessary to keep that next appointment. Her primary care doctor realized he was in over his head and that it might be time for a mental health consult. She had been diagnosed with a common but challenging to treat syndrome Known as fibromyalgia. People afflicted by this condition frequently may also show signs and symptoms of Irritable Bowel, Chronic Fatigue, and frequent migraine headaches. This middle aged married woman was starting to lose hope that the medical profession could offer any help for her symptoms of constant burning, aching, sore muscles and joints. Unlike the drug seekers that often find their way to my office, she was clearly anti-medication and wanted to get by on the bare minimum of drugs. The history collected from her showed that she had not had an adequate trial of an antidepressant or one of the medications designed for neuropathic pain such as neurontin. My greatest challenge would be to overcome her fear and reluctance to take adequate doses of medications to achieve the desired effect. It also became clear that she would need psychotherapy to address several recent losses she was trying to cope with. I learned that she was a woman of faith which gave me another avenue to connect. I don’t hesitate to remind appropriate patients that even Jesus Christ could not heal one without their belief in his connection to the power. Without faith Simon Peter began to sink into the sea, Daniel would not have survived the lions den, and Job could not have endured his ordeal. I don’t know how I ended up going there but it was effective and I was able to form an alliance and prescribe her medications that I trust will benefit her.
This is one of the things I love most about practicing psychiatry. I was able to reach this patient in a way that 10 other doctors could not. For healing to occur she must be addressed from the perspectives of the physical body, the emotional self, and spiritual aspect. This is what a human being consists of. Her approach of seeking healing from a purely physical approach had failed and left her distraught and hopeless. This approach deals with fixing the problem from the outside in which is much like trying to extinguish the fire of a burning building after it is over half the way burned down. At this point there is not certainty that my treatment will be successful but I believe it will.
The factors directly addressed included a devastating heart attack a few years back, having to give up her career, fear of losing her ability to drive, her grand daughter moving away to another town, being constantly in physical pain and daily symptoms of depression, grief, and anxiety. She had not had the opportunity to really quantify the degree of her loss and stress and had not given herself permission to say it was ok to express anger and guilt as a part of a normal grief response. I was able to facilitate that today and begin working with her to restore hope of recovery and the possibility of future happiness. When I see a patient such as this it reminds me that my work isn’t in vain and that God has blessed me with the ability and opportunities to make unique and useful interventions with people who are suffering.
If stress ceased to exist I would no longer have a job. I believe that stress is at the root of all disease. Stress is like fire. It can motivate us to thrive or it can destroy us if not managed. Fire can keep us alive from hypothermia or fire can incinerate us in our sleep if it gets out of control. The basic physiological response from stress in life is activation of the well known “fight or flight” response common to all mammals. Without this reflex man could not have survived for so many thousands of years. Man would have been unable to adapt to hostile threats and may have become extinct. The fight or flight response is triggered by events that occur during daily life and lead to release of adrenalin and several other chemicals and hormones into the bloodstream which instantaneously result in a rise in blood pressure, pulse rate, tension of the muscles, widening of the pupils, increase in breathing rate and other changes that prepare us to fight ’til death or evacuate the premises. Through evolution we have learned that physical violence isn’t a good initial choice for solving problems. Running away or avoiding a threatening problem sometimes is the best decision. It can sometimes be the best strategy to live and fight another day. One who attempts to solve every problem through fighting blindly will ultimately fail as will one who avoids every problem. Man is king of the animal world because of the small layer of gray matter in our brains that usually helps us decide whether it is best to fight or run in a given situation.
When the fight or flight response is on constantly, as caused by continuous stress, the nervous system can become depleted of valuable biochemicals and eventually start to malfunction. This is the cause of conditions such as depression and anxiety. This sends the body into emergency conservation mode and forces it to select which functions to keep running and which to shut down. The first system to go is usually the immune system which leaves the body open to attack from microorganisms and even certain cancer cells. Sometimes the immune system revs up too high instead causing conditions such as lupus or arthritis. At some point the brain may shut down the endorphin plant depriving the body of this natural opioid-like substance and causing the body to become supersensitive to pain. Due to the massive supply of nerves in the gastrointestinal region and head region symptoms of nausea, diarrhea, constipation, and headaches are common in the stressed out state.
The bottom line is that too much stress, not effectively managed, throws the whole body out of whack and disrupts the natural biological processes thus setting the stage for disease to occur. Because of stigma sometimes attached to mental illness many people actually develop physical symptoms as the primary problem, often being led on a wild goose chase to find the right doctor to help them. Unfortunately, sometimes the psychiatrist is the last stop. This is not good because psychosomatic illnesses often will respond only to the appropriate combination of medications, psychotherapy, and assuring that the patients spiritual needs are addressed.