When emotions cause symptoms

I haven’t blogged for a few months. I’ve been busy with professional work and the months have flown by. Now I’ve had a taste of my own medicine. A couple of days ago I woke up with severe lower back pain.

I’ve had back pain before but it’s usually the type where one takes a paracetamol and gets on with it. Now this was different. A severe muscular spasm, mostly contained in the lower back but periodically radiating around to the hips. It felt like the flexors of my spine were trying to flex and the extensor muscles were trying to extend. And they had got stuck, trapping me in an S-Shaped position. Why should muscles tense up like this?

The simple answer is that it is likely to relate to some sort of threat. Our bodies respond physically to real or perceived threats. Many conventionally trained doctors do not realise this. We are trained to recognise physical pain as a sign that there there is some sort of tissue damage going on.

I did pop in to see my GP who examined me, confirmed the presence of muscle tension and prescribed some painkillers. Here at least I received a correct diagnosis – tension.

This is medicine’s blind spot, sadly, not asking the patient about sources or tension in their lives and not recognising when emotions are causing physical symptoms. Thankfully I knew the cause and went away to work on it. There was a large emotional conflict that was winging its way to the surface of my awareness. It related to my job, my frustrations with the medical system and my deeper frustrations dating right back to my early years.

One pioneer who observed the relationship between chronic pain and emotions was Dr John Sarno https://www.google.co.uk/amp/s/www.nytimes.com/2017/06/23/science/john-sarno-dead-healing-back-pain-doctor.amp.html

He died in 2017 before his work was fully embraced by the medical profession. He noticed that many patients who were presenting to him, in pain, had other potentially stress related conditions such as irritable bowel syndrome (IBS) and migraine.

From this, he hypothesised that unexpressed emotions were are the root of many conditions (where no disease process could be found). Rage was the predominant emotion but there are others – shame, anxiety, jealousy and they are unconscious. He named this process Tension Myositis Syndrome or TMS.

These emotions are unconscious because the body-mind classifies them as too dangerous to come into conscious awareness. The person is not aware of the emotions and so it can come as a huge shock to find that there is anger and rage bubbling under the surface-particularly if one sees oneself as a “good, together type of person”

The interesting thing is that once these emotions are acknowledged, there is no need for the symptom or the pain. The game is up and the body-mind no longer has to create diversions.

In my case, I was aware intellectually that at times, I experienced a crippling low self esteem. I had an inner critic that berated me and I had tried for many years to “prove the voice wrong” by amassing a selection of worldly achievements. This desire to hide this “part”of me was so great that I was prepared to stay in a job I didn’t like and toe the party line as opposed to speaking my truth.

When this facade cracked open (this was through an intensive meditation practice), waves of shame and anger poured out and I sank into a deep depression for a while.

But interestingly the back pain went

I’d encourage anyone who is struggling with pain or medically unexplained symptoms to research Dr Sarno. His legacy lives on and health care professionals who have developed his work can be found in both the UK and the US

Check out the links below:

https://www.unlearnyourpain.com

https://www.sirpa.org

https://www.tmswiki.org/w/index.php?page=The_Tension_Myositis_Syndrome_Wiki

https://ppdassociation.org

Tips on finding the right therapist for you

A quick detour from the spiritual awakening posts is the subject  of therapy.  I’ve been thinking about this blog and where it is going.  I thought what would be good, would be to intersperse my own experiences of awakening with my practice as a doctor and to offer some helpful advice to others who may or may not be on a similar path.  So with that in mind, here’s something about choosing a therapist. 

This is a huge topic and one that I have felt compelled to write about recently.  I’ve had a number of patients come to see me over the last week complaining of various emotional issues / conflicts / life-upsets   One of the ways forward that we have explored is the possibility of some form of talk-therapy / counselling / psychological help.  This loosely falls under the umbrella of “therapy” although I am aware that this is an over-simplification.  

One of the common responses that patients have is –  Well how on earth do I choose someone? It’s a minefield.  There are so many people offering so many different options.  Which one is the right one for me?  I have had a think about these questions and here are my thoughts.   They are my opinions, so please don’t take them as some sort of “Therapy Bible”.  I’ve based them on my own experiences of working with therapists, both bad and good and some of the experiences that my patients have had and been kind enough to tell me about.  Like many things in life, please feel free to disregard any suggestions that do not work for you. 

  • Firstly decide, if you can, what the problem is and what you would like as a solution.  Sometimes this is fairly straightforward.  You might be getting really angry with people and want to explore alternative behaviours or look at what lies beneath the anger. Sometimes people don’t feel “right” or they feel “bad” in some way and that is as far as they have got. This is not uncommon, as many, if not most of our driving behaviours and emotions are unconscious and our reasons for doing things may not be immediately accessible to us.  This is fine.  You may notice that in both cases, the person has a narrative about what is going on and some idea of what they would like instead (even if they don’t yet fully know what that is yet). A therapist can work with this.  It can be helpful to put pen to paper and write down the problem and some potential solutions and areas that you would like to work with.  
  • The next step is to research therapists. Most people do this via the internet now.  I think it is good to get personal recommendations from friends and family.  This is a way of filtering down through the huge numbers of people out there and gives you some sort personal testimonial for that individual’s work.  I’d always suggest having a look at their website as to what methods they use to see if that resonates with you.  You can Youtube the methods and find out more about them as well.  
  • Next, I’d make contact and arrange an appointment to speak with the therapist personally.  Most are happy to chat through options over the phone for free, others may offer a low cost intro face to face session.  Remember this is your time to ask them questions about the issue. Personally I wouldn’t waste time asking them for information that is already available on their website.  Give them a brief description of the problem and see if it is something that they feel they can work with you on. It’s okay to ask what their experience is with particular problems and if they have had success with this issue before.  
  • Just as an aside, I will slip in here that I also work as a therapist alongside my main occupation as a family doctor. When a potential client rings me up, I am listening to the problem, but I’m also assessing as to whether I am the right person to help.  It’s a two way process and this how many therapists work.  Personally, I would not agree to see and charge someone for therapy if I didn’t feel there was a good fit between us.  I don’t think it is ethical.  If I don’t feel I am the best person for them, I’ll either refer them to a colleague or suggest other forms of help.
  • I think it’s helpful to chat to a few different therapists and see how you feel when talking to them.  I know therapists who are excellent at what they do but they are not the right “fit” for certain clients.  I had a patient who was having sessions with a guy who is extremely talented at what he does but for some reason the client felt he was criticising her whenever he worked with her.  They discussed it and it wasn’t really resolved. Eventually she found another therapist who did very similar work with her, but had a slightly different manner and they were a better fit. The client was more relaxed and made excellent progress. It is different strokes for different folks.  
  • I often get asked by clients how many sessions are needed to “sort” the particular problem.  This is difficult to say.  Some therapy methods appear to promise “one session cures” and in-fairness this can happen but it is less common in my experience.  Change work can be tough with lots of stops and starts and you need a good ally in the therapist (and often friends and family) to get through. Personally I would be wary if a therapist, that didn’t really know me, told me it would take “10 sessions to sort the problem”.  I’d be even more suspicious if I had to pay up front for all these meetings in advance.  Sometimes coaching programs are more fixed in session number and this is fine. Again it depends. Go with your gut feeling on this and ask friends and family for advice. Perhaps try having a few sessions with the therapist and seeing how you feel and take it from there. It’s not uncommon for therapists to ask for payment up-front for a session.  This reduces their no-shows and demonstrates some commitment on the part of the client.  I wouldn’t part with large sums of money up-front though until you have some idea of whether you and the therapist are a good fit.
  • Patients often ask me as to how they will know that the therapy is working.  Well, basically, their lives tend to change for the better.  They start reaching their goals.  They get less “stuck” in life and have more choices. They may laugh at themselves more and take life less seriously.  Their relationships improve.  Therapy is not about paying someone to make you feel better. A good therapist will challenge you and you may even dislike them for a bit.  You have to do the work and you will reap the benefits.  Revelations about yourself in the therapy room may well be painful.  You are not paying someone to countersign your bullshit.  However I do believe that therapy should be done with kindness and with the client’s best interests at heart.  Most people find at the end of it all that they are nowhere near as bad or sometimes as good as they thought they were.  We are all human with human traits.  

Finally some therapy red-flags.  Most therapists are very ethical, but there are some funny ones out there.  Here are some no-no’s, 

  • Excessive personal disclosure.  I sometimes disclose aspects of personal stories to clients and patients when I feel it will help them.  Too much of this, when it is unnecessary and not helpful to the clients recovery, smacks of “therapist ego”. 
  • Inappropriate sexual behaviour.  There is no place for this in the therapy room.  Basically it’s anything that makes the client feel uncomfortable.  I had a patient who received a text from a therapist late at night telling her that his mate had seen her picture on Facebook and thought that she was attractive.  When she confronted him about this, the therapist told her that he was gay and she shouldn’t worry about it, (still not appropriate)!
  • Freebies.  You are paying for a certain amount of time.  Beware therapists who offer extra sessions without payment or schedule sessions at the end of the day so that they can spend more time with you.  It implies poor boundaries on the part of the therapist or perhaps excessive “rescuing behaviour”.  
  • It’s best to avoid therapy with people who are close to your social or work circle.  For example I was due to have some sessions some time ago with a therapist who was also seeing one of my work colleagues.  When we discussed this, it was agreed that I see one of her colleagues.  

Trust your gut on your therapy relationship and if it is working, you will know.  Don’t be afraid to pause therapy or take a break if you are not sure about where it is going.  Also if you have any questions or concerns, try and discuss them directly with the therapist in the first instance. If they are the right one, they will want to help and resolve things.

Until next time, 

Lily x