Posts Tagged ‘mind body’
Can tics be contagious?
The story from upstate New York doesn’t want to go away. There have been at least three national TV spots in the last few weeks about the 12 high school students who have developed tics. Neurologists consider tics and Tourette’s syndrome to be chronic neurologic disorders that are primarily inherited. The treatment consists of medications to attempt to control the abnormal movements and it is not generally believed that individuals can have any control over their tics.
However, the mini-epidemic in LeRoy High School near Buffalo is believed by excellent neurologists to be caused by a conversion disorder, i.e. a physical symptom that is not a pathological or structural process, but is caused by stress and unresolved emotions. In other words, this is a manifestation of Mind Body Syndrome (MBS) or a Psychophysiologic Disorder (PPD). (I will use these terms interchangeably.)
When one looks at the history of mini-epidemics of PPD, evidence abounds that PPD is a contagious disorder. There have been well-documented epidemics of repetitive stress injury, sick building syndrome, and psychogenic seizure-like activity (also known as pseudo-seizures). There is an interesting research article from Germany that demonstrates that back pain appeared to be contagious after the fall of the Berlin Wall. So, it isn’t really surprising that almost any symptom can be caused by MBS. Once a careful medical history, physical exam, and environmental evaluation rules out evidence for a pathological disorder, the diagnosis of MBS should be confirmed.
In the LeRoy High School situation, experts have done this and have concluded that the girls are suffering from PPD. However, this apparently hasn’t gone over very well with the patients, their parents, or many members of the community. Today’s report showed angry parents filling a meeting of the school board asking them to prove that their buildings are safe. Of course, they have a clean bill of building health from the state of New York and the CDC. Yet, a psychological explanation for physical symptoms doesn’t seem to ring true or satisfy most people.
Over the past few weeks, I have encountered several stories about tics and Tourette’s syndrome that suggest that it may not be as much of a neurological disease as we once thought. Story #1: A friend told me about a young man who suffered with Tourette’s for his whole childhood and adolescence. As an adult, he participated in an intensive psychological retreat during which he expressed and processed many emotional issues from his life. The tics resolved.
Story #2: I met a psychologist who told me that he cured a teenager of Tourette’s “by accident.” The young man was sitting in the psychologist’s office and while waiting, he was throwing some balls into a box over and over. When the psychologist entered, the boy apologized for his behavior and stopped. But the psychologist suggested that it was fine to throw these balls and encouraged him to continue to do so, which he did. During the course of a single one hour session, the boy expressed many issues that were bothering him and threw the balls more forcefully. Following the session, he seemed relieved. The tics disappeared and never returned.
Story #3: I was telling these stories to a friend. He immediately began to tell me his story. As a child, he was diagnosed with Tourette’s syndrome. The tics were incredibly embarrassing and humiliating to him. He hated them and vowed to stop them. He decided to resist them and spent many nights in bed holding his body against the urge to “tic.” After a few weeks of mental effort directed to stopping the tics, they went away and have not recurred.
I am not suggesting that all tics or all Tourette’s syndrome is caused by PPD, but it wouldn’t surprise me if many cases are. It is interesting that over time, people with Tourette’s tend to grimace and even swear uncontrollably. Grimacing and swearing, of course, are signs of anger. Could it be that some people with Tourette’s syndrome have unresolved resentment, anger, or rage? It would certainly be wonderful if there were a relatively simple solution to these horrible disorders. We need to do some studies to determine if tics and Tourette’s may respond to our usual MBS approach and treatment. If you know of people with these disorders who are interested, please have them contact me at firstname.lastname@example.org
It shouldn’t be too surprising that some neurological events are contagious. Patterns of speech are clearly neurological events. People who grow up in the south have different speech patterns and inflections than do those from the north. Phrases such as “like” and “you know” have become ubiquitous in the speech patterns of teenagers (and adults) in recent years. If these neurological events are contagious, why not tics?
To your health,
Howard Schubiner, MD
This is the second part of a blog about back pain. This blog deals with the MBS approach to understanding back pain.
How can back pain occur in the absence of something wrong with the back?
There is a way to explain this based on new research into how the brain changes over time (neuroplasticity). One way is to consider what happens in phantom limb syndrome. In this situation, there is pain in the area of the body that is missing; that has been amputated. Clearly, there is nothing wrong with the area where the pain is felt, yet there can be severe pain. In this case, the pain appears to be due to sensitization of nerve fibers that go back to the brain, amplification of pain in the brain and a conditioned response of nerve fibers going back to the body. The brain and body have in essence learned to have this pain. The nerve connections have gotten fired after the amputation, but then have gotten “wired” and keep sending pain signals, which are felt to be in the amputated limb. It is likely that back pain (and other pain syndromes, including headaches, abdominal and pelvic pain, whiplash, fibromyalgia and TMJ pain) is caused in many people by similar nerve pathways.
What triggers this type of back pain to start and become chronic?
The answer is surprising and even offensive to some people and that is stress and emotional reactions to stressful events. A classic study showed the Boeing employees over four years and found that psychological stress predicted back pain much more than any other variable, including how much they used their back on their job. Other studies in Sweden, Holland, and England showed similar findings. In fact, job satisfaction is the most important factor that appears to determine if someone will develop chronic back pain or return to work after back surgery. Read more »
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.”
June 21, 2008
Letter to Dr. Schubiner from Paul Mazzafero, Davie, Florida
I first suffered excruciating back pain in 1984 as a 20-year-old young man. I had searing back and calf pain. I eventually had surgery in 1988 to remove a synovial cyst off my sciatic nerve. However, post surgery the pain was still there. I was scared I would be like this for life and was in pain management. I eventually picked up a book by Dr. Sarno and read it. I went to the Dr. and he assured me my back was fine. I was so emotionally damaged at this point I did not know what to do since I had already been to 21 doctors and had every test, steroid, epidural, etc. I eventually said, “I am fine and this is psychological”. I proceeded to workout like a madman and eventually the pain left me for 16 years. In fact I went on to compete as a boxer and was very active.
Fast forward to 2004, when I was throwing 100 pound logs and felt the dreaded pop and searing calf pain. “Uh oh,” I said and went to my GP and he ordered an MRI which was negative. However, I still had the calf pain. P.T. did not work…..Epidurals did not work……Massage did not work….Chiropractic did not work….Books, exercises, you name it and nothing worked. I was on prednisone and gained weight. I stopped working and contemplated ending it all. I am a vociferous reader and came across your program and within doing the 1st night of journaling I felt relief, not 100% but I felt like a layer was being peeled off an onion. I realized I was in a miserable job when this happened and that I am a perfectionist and I could understand how these factors played an important role in my back pain. Anyways, long story short: within 3 weeks of doing the online program, I was feeling 90% better but still skeptical a little. However, after 6 weeks, I have been pain free 100%. Dr. Schubiner’s course was an introspective look at what makes me tick. I do not think the pain will come back. In fact the 1st week when I started to feel better, an old neck injury and pain mysteriously returned…..I laughed out loud. When I am stressed, I pull out my notebook and read my journal and sometimes re-watch the videos.
MBS Blog #4 – Psychological aspects of MBS
I have discussed the relationship between the mind and the body in prior blogs. Briefly, it is important to realize that they are essentially one, i.e. there is no separation between the mind and body in the sense that physical stimuli (e.g. an injury) immediately produce changes in our minds (emotions, reactions, etc.) and emotional stimuli (e.g. a scare, a verbal criticism, etc.) immediately produce physical reactions. The relationship between the mind and the body are immediate for survival. It would take too long for thought processes to engage prior to reacting if we happen upon an angry bear. Our survival instincts of an immediate reaction (running, freezing, etc.) are much quicker. William James, the father of psychology, noted that it is not true that first, you see a bear, then your feel fear, and then you run. He reasoned (and we now know he was correct) that you actually see a bear, then you run, and then you feel fear.
Our minds and bodies are constructed (through the process of evolution) to maximize survival. When an animal is frightened, it immediately goes into one of the survival reactions: fight, flight, freeze, or submit (play dead). When we get overwhelmed in our life, our body will react in a way that is designed to help us out of the situation. For example, I saw a woman who had a very difficult childhood with neglect and abuse. Her reaction to this was to look for love and attention whenever and wherever she could find it. She grew up and always attempted to appease others and tended to neglect her own needs. Like many people with MBS, she had a very strong dose of the “shoulds” (as Dr. Sarno often refers to Freud’s superego or conscience). As her life became more complicated and busy, she tried to do more and more for everyone else. Finally, her body reacted by giving her severe migraine headaches and fatigue. These reactions were her body’s way of trying to protect her, i.e. forcing her to rest, to lie down, to stop doing so much for everyone else and to do something for herself. Unfortunately, she there was a great cost to this response, i.e. severe pain and fatigue. I believe it is useful to view the body in this way, as trying to help us, to protect us, rather than as betraying us, which is a common thought that many people with MBS have.