Posts Tagged ‘illness’

Stress Illness in Ancient Times

Saturday, November 21st, 2009

Stress-related illness is not a new disease.  Greek physicians of the school of Hippocrates (460 –  377 BCE) recognized a disorder characterized by symptoms commonly seen in stress illness today: palpitations, migrating pain, difficulty breathing, a lump in the throat and others.  This was diagnosed exclusively in women and attributed to the uterus wandering around inside the body.  The Greek word for uterus (hystera) gave the disorder its name, hysteria, and this was a common diagnosis through the early 20th century.  The term was finally dropped by the American Psychiatric Association in 1980, replaced with conversion disorder.


The Physiology of Stress Illness (1)

Thursday, November 19th, 2009

Stress Illness consists of medically unexplained physical symptoms that improve in response to diagnosis and treatment of psychosocial stresses.  Since these symptoms are not imaginary, they are undoubtedly associated with one or more underlying abnormalities in physiology.  These are poorly understood but a recent article* reviews the latest research as it applies to fibromyalgia (FM) with likely relevance to many forms of Stress Illness.


The Stress History

Monday, November 16th, 2009

Negative life events that persist for more than a short time sometimes can cause physical symptoms.  We can divide the wide range of issues that can do this into five major categories, which simplifies the diagnostic process considerably.  In evaluating medically unexplained symptoms, I inquire into each category in a process called taking the Stress History.  I do this after having acquired a clear chronology of the patient’s illness.  I know when and where symptoms began and their pattern over time.  This often enables me to find links between symptoms and stresses.  For example, I often ask if anything stressful occurred just prior to the onset of the illness.  When I find these connections in timing, it increases the likelihood that the stress is responsible for the symptom.


Bringing Vision to the Blind Spot

Sunday, November 15th, 2009

The good news is that hundreds of millions of people do not have to suffer needlessly from stress illness.  The solution will take time and effort but what needs to be done is clear.


The Blind Spot (3)

Saturday, November 14th, 2009

Over nine months, Linda spent 51 days in the hospital for her stress-related illness but two mental health professionals (MHPs) failed to find the cause.  Joaquin, age 16,  was ill for three months, told his doctors he suspected his pain was caused by stress and was referred to three mental health counselors who failed to find the cause.  How can this happen when the issues underlying most cases of stress illness are well known to MHPs?


The Blind Spot (2)

Friday, November 13th, 2009

If you developed episodes of chest pain accompanied by shortness of breath, would you call a psychiatrist about it?  Of course not, but therein lies another side of the mind-body blind spot in our health care system.  In most people who visit a primary care clinician for physical symptoms,  the cause is one or more psychosocial stresses entirely appropriate for mental health professionals to manage.  Of course it is essential for symptoms to be evaluated by a medical professional first.  Ideally though, once medical disease is excluded as a cause of a symptom, patients would be evaluated by a clinician with mental health skills who could then uncover any links to stress.  Unfortunately, several problems prevent this from happening in most cases: (more…)

The Blind Spot (1)

Thursday, November 12th, 2009

How could a doctor order diagnostic tests for nine months on a patient with abdominal pain, but not once ask her about stress?  During my first visit with this patient I learned she suffered punches and slaps from her partner up to 2-3 times per week.  These episodes occurred with little warning, causing her home to resemble a mine field.  With the help of a social worker she moved into a new apartment and her painful physical symptoms ended within a week.


Why This Blog.

Monday, November 9th, 2009

Ellen should have been outraged.  Instead she felt only relief.  During sixty hospital stays at a university, her doctors inexcusably failed to find the major life stress that was responsible for her illness.  It wasn’t difficult to link her symptoms directly to lifelong emotional abuse by her mother.  In Ellen’s case, bringing the impact of the abuse into conscious awareness was sufficient to cure her physical ailment.  I was appalled that she suffered needlessly for fifteen years.