Psychophysiologic Disorders: Distracted by Theory

Psychophysiologic Disorders (PPD) consist of pain or other physical symptoms that are partly or completely relieved when underlying psychosocial issues are uncovered and treated.  The process that produces this form of illness is an area of active investigation.

One theory you will see written about regularly is that the brain creates these symptoms to distract the patient from underlying emotions.  As John Sarno, MD, put it: ” to divert people’s attention to the body, so that they can avoid the awareness of or confrontation with certain unconscious (repressed) feelings.” (1)

There are a number of problems with this model, however.  First, the only evidence I can find to support it is that a psychoanalyst named Stanley Coen suggested it.  Second, for this theory to be true you must assume there is a cognitively sophisticated but subconscious process deciding when the physical symptoms need to be created.  Third, any attempt by a health care professional to uncover the emotions underlying a patient’s PPD should, according to this theory, increase the intensity of the symptoms as the mind tries ever harder to distract the patient.  (In my practice, the reverse is usually the case: uncovering powerful unrecognized emotions leads to improvement of symptoms for a large majority of patients.)  Fourth, this theory is not intuitive for patients, health care professionals or the public to comprehend.  Fifth, Dr Sarno claims that once the Distraction Theory is “accepted by the patient, the knowledge of what is going on destroys the brains’s strategy.” (1) This implies patients can achieve lasting relief without addressing the underlying emotions.  Though some do experience improvement simply by accepting that their symptoms derive from emotions and not from an organ disease or structural problem, in my patients unless the emotions are recognized and treated, the risk for a relapse is substantial.

Is there an alternative concept?  Absolutely.  Most of us have had the experience of a “knot” sensation in our abdomen when we find ourselves in a tense situation.  Most have blushed with embarrassment a few times.  These are physical manifestations of emotions of which we are consciously aware.  Because of that awareness we can cope with these situations using cognitive and verbal skills.

What about emotions of which we are not consciously aware?  Is there any reason why they could not also cause physical manifestations using normal nerve pathways analogous to those that cause abdominal “knots” or facial blushes?  Our lack of awareness of the emotions  would make them inaccessible to our cognitive and verbal skills, perhaps enabling them to grow in severity over time.  Enabling the patient to access these feelings would not, under this model, ratchet up the mind’s attempts to distract with ever more severe symptoms.  Instead, it would enable the emotion to be expressed verbally instead of somatically.  This is what I have observed in over 7000 patients.

The Distraction Theory and the Somatic Expression of Emotion Theory will tend to produce similar outcomes for patients under care of experienced PPD practitioners.  The principal virtue of the latter theory is its intuitive simplicity which is of great importance.  Despite the success of treatment for PPD, physicians and many patients struggle to accept the PPD concept.  A straightforward explanation of the physiology, grounded in universal human experience, will greatly facilitate building acceptance among patients and colleagues.

1. Sarno JE.  The Mindbody Prescription.  Warner Books, 1998, p xxvii.

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