Psychosomatic illness is a condition where there is no adequate medical explanation for physical symptoms. Psychological factors (such as stress or emotional trauma) are therefore assumed to be involved – either as the primary cause or as an aggravating factor. Common disorders where stress is a likely culprit include IBS, migraine, dermatitis, and sexual or reproductive dysfunction.

Chinese medicine has never recognised a dichotomy between mind and body. Dualism is also increasingly rejected by Western scientists. Brain and body operate as a feedback loop. Chemical messengers from the brain (hormones) issue instructions to bodily systems, which in turn send updates to the brain regarding the current state of affairs. These signals may be experienced as (for example) hunger, contentment, pain, or anxiety. Where these ‘feelings’ indicate that the body has strayed from homeostatic balance, the body/person is motivated to take action to restore balance.

Psychologists and neuroscientists, such as Antonio Damasio and Lisa Feldman Barrett, argue (in slightly different terms) that ‘feelings’ are a mental representation of the state of the body. Feldman Barrett emphasises that ‘emotions’ are the cognitive interpretation of these ‘feelings’. They depend on conceptual categories that can only exist within the framework of language. As such they are culturally relative. They are also framed by context. To give an example, an increase in adrenaline can be interpreted as either excitement or anxiety, depending on the physical or social context in which it occurs.

Many people are unhappy about having their physical symptoms described as psychosomatic. They feel patronized, and as if their genuine suffering is being dismissed as being ‘in their head’. However, while there is no doubt that some sufferers do experience unsympathetic and unhelpful attitudes both from the medical establishment and from within their own social circle, it is a misunderstanding to perceive the word ‘psychosomatic’ as being inherently patronizing.

The fact is that being ‘stressed’ is a physical condition, and this has implications for overall bodily function. From an evolutionary point of view, your body is prepared for ‘fight or flight’. The sympathetic nervous system is switched on, and your brain sends instructions (via hormones) to the rest of your body to prepare for intense physical activity. The muscles of your limbs need fast access to energy (oxygen and glucose). Digestion and reproduction – which are energy intensive processes – can wait.

This may not seem to reflect reality. When we are stressed, the contractions in our bowels, and our more frequent trips to the toilet, may seem to indicate that our digestive system is working overtime. However, this is to confuse digestion with elimination. The body extracts nutrients from food in the small intestine. The contents of our bowels are largely waste, and getting rid of that as quickly as possible may make evolutionary sense. The bowel is also where water is reabsorbed into the body from the digestive tract. The fast transit may impede this process, resulting in diarrhoea.

Bodily adaptations to the perception of threat can cause uncomfortable physical symptoms and even long-term illness when the threat (a psychological stressor) does not match the bodily response (readiness to run!). In modern life, the most common stressors are not related to physical danger. The mortgage, exam results, relationships – these can all lead to  the release of stress hormones (adrenaline, noradrenaline and cortisol), but you are (probably) not running anywhere.

The parasympathetic nervous system is the part of the autonomic nervous system responsible for ‘rest and digest’. It is inhibited during perceived physical emergencies and comes back online when the danger is past. In chronic stress, its work may be disrupted on a regular basis.

Acupuncture is thought to inhibit the sympathetic nervous system and support the parasympathetic nervous system. People frequently report feeling very relaxed during and after treatment. They also tend to apologise because their stomachs become noisily active. However, from the acupuncturist’s perspective, this is a good sign. The parasympathetic nervous system is being allowed to do its job.

None of this is to suggest that conditions such as IBS or infertility are solely the result of stress. Patients may also suffer from food intolerances, inflammatory bowel, endometriosis or a variety of other organic disorders. It is always good to have these things checked out if your physical symptoms are making you miserable, or you have been trying to conceive unsuccessfully for a long time. However, stress may still be a contributing or aggravating factor as chronic stress is not conducive to reproductive or digestive health.

 References

Damasio, A. (2000) The Feeling of What Happens, Vintage Books, London

Feldman Barrett, L. (2018) How Emotions are Made: The Secret Life of the Brain, Pan Books