Recent on-line and in-person discussions with my colleagues who care for patients with Psychophysiologic Disorders (PPD) make it clear that there are many successful approaches to diagnosis and treatment. What these techniques have in common is clarifying for patients that psychosocial stress can cause real pain and/or other physical symptoms and that uncovering and treating these issues can relieve the illness (partially or completely). Our discussion led me to summarize my approach:
The conceptual model for PPD that guides me is more about learned concepts than learned nerve pathways but it is quite compatible/complementary with other published work in this field. It has been well accepted in presentations to a variety of professional or public audiences.
To summarize the model in one line, much of what I want to learn about a PPD patient is: “What did you learn about yourself as a child that isn’t true?” (In April, 2015 the director of the Bowlby Center Psychotherapy Training Organization in London, UK told me he thought this was a “brilliant” concept and planned to use it himself.)
In more detailed form it looks like this:
1. A dysfunctional family leads children to learn one or more of several maladaptive concepts (a-d below) that persist into their adult years. This learning accounts for the personality characteristics of PPD patients described by Dr John Sarno and called the “Type T” personality ( T for Tension) in David Schechter, MD’s excellent new book.
a. You are not as valued as other people
b. You are better off suppressing your anger than expressing it
c. It is your responsibility to improve your family environment and/or minimize its harm by being good, paying attention to details, being as perfect as possible, being compassionate toward others and working hard to support other’s needs.
d. You need to be continually watchful/fearful about emotional/verbal/physical harm that could occur at any time.
2. My experience is that helping people recognize these concepts and how & why they acquired them facilitates unlearning them and replacing them with healthier ideas. This not only produces good clinical outcomes but, by addressing the root cause of PPD, reduces the risk of relapse. Howard Schubiner, MD’s book and mine use different approaches in attempting to achieve this goal but complement each other so well that I use both to teach my graduate class at Arizona State University. I also find many parallels in Anderson & Sherman’s book Pathways to Pain Relief.
Two challenges to this approach are that 1) some patients aren’t ready to explore these roots and 2) it can take quite a bit of experience for a clinician to apply it effectively. But I suspect many who read this will find they can usefully graft elements of these ideas onto their own experience and training.
