Posts Tagged ‘fibromyalgia’
Understanding the depth and breadth of The Mindbody Syndrome (TMS)
It is clear to most people that emotions can cause physical reactions in the body. When someone gets embarrassed, their face will turn red. When standing up to speak before a large audience, many people would have physical reactions such as sweaty palms, churning stomach, a more rapid heart rate or a dry mouth. These are physiologic reactions obviously caused by activation of the autonomic nervous system that are reversible and do not indicate that there is a pathological or tissue breakdown condition in the body.
Most people also recognize that they can get a headache or a stomach ache after a stressful day. Therefore pain can also be caused by stress and emotions. These immediate reactions are relatively easy to discern as being connected to stress and emotions. Among people who are afflicted with TMS however, the time lapse between when the stress that is responsible for the symptoms may be years or decades. And the symptoms of TMS can be amazingly varied and severe. Common symptoms of TMS include back and neck pain, headaches, abdominal or pelvic pain, TMJ pain, or widespread pain now known as fibromyalgia. TMS symptoms can also be related to ANS activity such as is the case with IBS and IC. Neurologic symptoms of burning, tingling, itching, and other paresthesias may occur. Generalized symptoms such as fatigue are common. Psychological symptoms such as anxiety, OCD, PTSD, and depression are very common manifestations of TMS. And insomnia is very common as well. How can we understand the great depth and breath of these varied symptoms and how can we figure out what precise events and emotions are the causative factors in the life of an individual with TMS?
After conducting hundreds of detailed interviews with TMS sufferers, it is my firm belief that we can determine what has lead to TMS in the vast majority of patients. However, in order to truly understand these individuals with TMS, it is critical to learn to dig deeply in the history and the minds of our patients.
If we are patient and take the time to listen, patients will lead us to an understanding of the source of their pain and other TMS symptoms. We need to learn how to take these sensitive histories and learn what clues to attend to in order to help patients gain the insight into the key issues they will need to cope with in their lives. Certain patients have such overwhelming histories of childhood abuse or neglect, which when coupled with additional trauma in adulthood, gives an obvious explanation of the emotional sources of TMS. However, in other patients, it is necessary to listen for more subtle clues to explain how and why TMS developed.
I have compiled a number of examples to illustrate the thesis that childhood events create specific emotional memories that when triggered later in life cause the onset of TMS symptoms. Typically, there are two other psychological factors in the development of TMS: One is a strong sense of obligation, high expectations, perfectionism, desire to be good, guilt, low self-esteem, and self-blame. The other is a suppression of lack of awareness of the emotions that are reactions to life stressors or the internal pressures that patients put upon themselves.
Dear Dr. Schubiner,
For so many years, I have been taught and “programmed” to please others and basically ignore what I was feeling; because I didn’t matter. I denied myself things such as food (anorexia), pain medications and even rest. I even felt that I didn’t deserve to have feelings and lived with tremendous guilt.
I started to have pain at the age of 13 and I am now 49 years old. I had a very difficult childhood with severe abuse and neglect and it has been reflected in pain for all these years. I now understand that my subconscious mind caused me to have severe headaches. They began gradually and occurred about twice a month. But they were severe and forced me to lie in bed and cry. The headaches started to occur more often, until they came daily and lasted for the next 20 years! I forged on with my life; marrying, working and starting a family. The pain finally got so horrible that I had to quit a job that I loved and held for 21 years.
I was devastated, but I decided to become the best wife possible. I was determined to be the best coupon shopper to find sales on all items, sometimes dragging two toddlers with me across town just to save 50 cents. I tried to be the best housekeeper and stay at home Mom. I was obsessive about everything, to the point of exhaustion. Finally, I had a nervous breakdown and was hospitalized for three weeks.
Since taking your workshop and beginning therapy, I have come to an amazing revelation. My internal child was telling me, “Hey, I matter and if you won’t listen to me, then I’ll just have to force you to pay attention. I want some nurturing too. Quit trying to please everyone else and be kind to me. I deserve it.”
MBS Blog – #9 Mindfulness Meditation
I have been a devoted and passionate teacher of mindfulness meditation for about 15 years. Many people have misconceptions about meditation. The most common misperception is that meditation is about relaxing. Of course, meditation may be relaxing at times, but not always and the intent is not relaxation, but obtaining a better understanding of yourself, and learning to respond to body sensations and thoughts/emotions more deliberately, and learning to live fully in the moments of our lives. Mindfulness meditation is a form of meditation that asks people to simply pay very close attention to the here and now, to the present moment, to what is happening right now, whatever that may be. One of the great things about mindfulness is that one can practice it at any moment, no mater what you are doing or what is going on. That makes it quite useful as a way to cope with the ups and downs of life.
The reason to learn mindfulness meditation techniques for people with Mind Body syndrome is that it can help a great deal in learning to live fully in the present and to learn to let go of some of the things that tend to perpetuate MBS, such as fear, anxiety, sadness, issues from the past, or worries about the future.
MBS BLOG # 8
Genetics and Mind Body Syndrome
Everyone knows that genes “controls” our lives. But how powerful an influence do our genes play in our lives? Of course, these issues have been debated for many years since the discovery of genes and the classic experiments of Gregor Mendel in 1865 on pea plants genetics. We wonder not only at the similarities of facial features of children and their parents, but also at their personality quirks that seem to be passed down through genes. There have been many books that purported to show that genes control everything. So, when we are told that a certain disease is genetic. We often assume that we are destined to be affected and that treatment may have little effect.
First, you must realize that there are certain genes that do have powerful effects that will produce diseases if those genes are present. For example, cystic fibrosis and sickle cell anemia are diseases produced by inherited genes. If you have those genes, you will get the disease. However, it is also clear that different people with the same genes can have differing levels of that disease, even in CF and sickle cell.
Other diseases have some contributions from genes, but these contributions are either minor or variable. For example, breast cancer has been found to have genetic components, but most people with breast cancer do not have the breast cancer gene. There are genetic contributions to asthma and migraine headaches, but these are relatively small contributions in comparison to the effects of genes on height, ADHD and schizophrenia, which have heritability factors of 0.8-0.9. The heritability factors of asthma and migraine headaches are in the range of 0.4-0.5, i.e. much smaller effects. Read more »
#3—What is Mind Body Syndrome Part II
As I mentioned in the last post, MBS is not new. As long as there have been humans, there have been physical symptoms caused by stress and emotions. It is important to realize that physical symptoms, even very severe physical symptoms can be caused by stress and emotions. In fact, the emotions that tend to have the largest effect on us are precisely those that we are unaware of. There are two ways to think about how these symptoms can be produced.
The first way is to understand how the neurologic system works. Pain is a learned response, i.e. the body actually learns how to produce certain symptoms by experiencing them. For example, I had a patient who fell and hurt her back as a teenager. A decade later, she was in a very difficult situation in a job where she felt trapped and unable to get out of her problems there. At that moment, suddenly her back seized up and she had tremendous pain. The nerves that send signals from the back to the brain had been fired when she fell as a teenager and those nerve connections had been “learned” at that time. When a significant emotional situation arose where she had no way out, her body responded in a way that it already knew, by producing the back pain it had learned 10 years earlier.
A good way to understand how MBS works is by thinking about phantom limb syndrome. In this syndrome, which is very common among amputees, pain or other sensations can be felt in the part of the body (arm or leg usually) that is missing. There is obviously no disease in that area, yet we can feel pain (often severe) that appears to be coming from the missing body part. What has happened is that the nerves that send signals to the brain have been sensitized and are continuing to fire and those signals are interpreted as pain by the brain. A vicious cycle is formed of sensitized nerves that send signals to the brain, then those signals get amplified in the brain (by a structure called the anterior cingulated cortex; more about that area of the brain in upcoming posts), and then signals are sent out to the body by the autonomic nervous system (the fight, flight or freeze system). This pain is real, very real. However, there is no tissue breakdown, no tissue disease in the body. This is exactly what happens in Mind Body Syndrome. We may feel pain in an area of the body, for example, the head or back or stomach, yet there is no tissue breakdown, no tissue disease there. Of course, pain can be caused by tissue breakdown or disease, such as occurs in cancer, infections, or fractures. When the doctors are unable to find disease after a careful and thorough search, the diagnosis of MBS is usually correct. It is important to realize that MBS is a physiologic process, i.e. a process that occurs due to normal reactions of the body. When we get scared, our heart speeds up; when we get nervous, our stomach tightens up or we get clammy hands. These are physiologic processes, normal reactions that are 100% reversible. That is why MBS is curable. It can be reversed by interrupting the vicious cycle.