Category Archives: Miscellaneous

MBS Blog #35: When the cure is worse than the disease: Exposing medical myopia

The history of medicine consists of two major themes: development of new techniques to study the body and attempts to understand why illness occurs.  Often these two themes lead to a synergism that creates a great advance, such as the development of the microscope so that we could actually see bacteria that cause disease.  Before such technological breakthroughs occur, we are stuck trying to explain disease in the absence of being able to actually see the problem and therefore we develop theories on what is causing the problem.  Sometimes these theories are correct, sometimes they are horribly wrong.

Ignaz Semmelweis was a Hungarian physician who noted that women who gave birth in the hospital setting had very high rates of post-partum infections (often fatal), while women who gave birth at home had much lower rates.  The doctors at the time were doing autopsies and going from one procedure to another.  Semmelweis thought that the doctors might be transmitting something to their patients thus causing the infections.  He did an experiment to show that hand washing (using lime salts) actually did reduce the rates of death to below 1% (they were as high as 35%).  However, he could not show why this worked and doctors didn’t believe him (despite being shown the research evidence).  Sadly, Semmelweis ended up dying in an asylum in 1865 after becoming mentally ill.  When one doesn’t understand the problem, the solution can be right in front of your face and yet you can’t see it.

I saw a woman this week whose story is shocking.  She had a great childhood with loving parents who taught her that people could be trusted, the world was good, and that she should act with kindness and caring towards all others.  She learned to sweep emotions under the rug and work harder when problems arise.  She did not learn to speak up for herself.  Her life was great until high school when she started a 3-year relationship with a boyfriend who came from an abusive household.  Over time, he became jealous and possessive.  She continued to make excuses for him and tried to be a good girlfriend, thus acceding to his increasingly controlling ways.  He pushed her away from her family and her friends.  He didn’t let her go out unless he was there.  He even hit her on two occasions.  And she continued to make excuses for him and cover up her pain and distress.  She tried to be an even better girlfriend and hoped he would change.  He didn’t; and finally (with the help of her sister) she broke up with him.  She went off to college and did well.  Her life was back on track.  She was an active athlete and even ran in marathons.  In her first job, she desperately wanted to prove herself and become the best employee in the company.  However, her boss was someone who took advantage of that attitude and her inability to speak up for herself.  The boss piled more and more work onto her, causing her to work evenings and weekends.  The boss did less and less.  Yet my patient never spoke up to ask for some changes to be made.  She felt trapped and her feelings were similar to how she felt when in a relationship with her abusive high school boyfriend.  It was during this period in her life that her pain started.

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MBS Blog #34: Can tics be contagious?

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 hschubiner@gmail.com

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

MBS Blog #33–The Hero’s Journey (guest blog by Jared Egol)

This blog was written by a friend and writer, Jared Egol.  He writes eloquently about the patient’s history as “story” and the concept of “narrative medicine,” i.e. seeing the patient’s story as critical to healing.  When the person with Mind Body Syndrome sees that they are, in fact, the “hero” of the story, they will be much farther on the road to recovery.

To your health, Howard Schubiner, MD

The Hero’s Journey as Story: The Irreducible Diagnostic Criterion
by Jared Egol

The patient, in present times, faces chronic, painful and dismissively mistreated and misappropriated syndromes of stalled emotional progress. Despite seeking to function at our service against pain and a variety of illness, medicine is traipsing feet-first into a biologic-centric approach to the treatment of our stories. Stories are completed, edited, examined, shared and propagated. And, most importantly, they are added to. They are not treated. Any treatment becomes a subscript to the through-line of how our life proceeds postscript. Health, like being human, is raconteurism. It wishes to be resolved and triumphant.

While the scientific community begins to trumpet the mind-body connection as a wellspring for treatment possibility, it seems to passively disconfirm the blunt fullness of what mind-body awareness can be, greater than the sum of its words on paper: that the qualitative first step to treatment starts pre-diagnosis and pre-medicine, at the human condition, which in and of itself is idiopathic. If the mind-body paradigm is to someday be championed as a keystone of accepted treatment in the 32nd century, it must concede that the human condition’s only unit of perceivable measure by outside meters can be its stories, just as atmospheric pressure cannot be interpreted in kilojoules. By dimensional analysis, if spoken words are the sub-units of those stories, then the feelings evoked, hugs had, nods afforded and change experienced by the recipients of them are the units of their transfer: lessons.

I believe that the doctors who rise above the ranks will be those identified as narratorial asides in the stories of the hero –the patient– who takes and imparts lessons in equal measure to the physician. Even the word-bare, thought and action-heavy field of intensive care, which my father occupied himself with for almost three decades, will one day evolve to contain the parameters of narrative in its protocol, even if I don’t know how it will look.

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The Black Swan and the Pursuit of Perfection: MBS Blog # 32

If you’ve seen the Black Swan, you will probably recognize many aspects of Mind Body Syndrome in the protagonist, Nina. She lived in a world where she denied herself pleasure because she had placed too many demands upon herself and her body. Her’s was the world of ballet, but it is truly a metaphor for the millions of women who are trapped in a world of work, child and parent care, financial issues, difficult marriages, and troubled relationships with parents, children or siblings. A common thread often seen in the development of chronic pain or other mind body syndromes (such as fibromyalgia, neck or back pain, irritable bowel or bladder syndrome, pelvic pain, headaches and migraine, chronic fatigue, and insomnia) is the pursuit of perfectionism. People who grew up with emotionally, physically, or sexually abusive events or with love being given primarily for performance tend to have low self-esteem. They tend to try extra hard to please and to prove that they are worthy, good, and lovable. Unfortunately, their quest often becomes never ending as they may seek love from those who have criticized or abused them or from people who act in similar ways. They frequently repeat their childhood experiences and continue to feel even more unworthy and unlovable.

The only way out of this horrible cycle is to recognize this whole pattern and take control over it. There is no such thing as someone who is unworthy of self-respect and of love. We all have those things as part of our birthright. The most important thing that I teach in my Mind Body Syndrome program is “be kind to yourself.” Cultivating kindness to self, acceptance of self and forgiveness to self are key aspects of healing. Without this, we are often stuck in an endless search for relief from pain and suffering. There are several exercises in the program (see Unlearn Your Pain) that help to create these qualities. When people are kind and accepting to themselves, they feel so much better about everything in their lives. Research confirms this as work by Dr. Kristin Neff at the University of Texas shows that self-compassion improves motivation and happiness, while decreasing anxiety and depression. There are a couple of excellent books that I recommend. The Spirituality of Imperfection by Ernest Kurtz and The Mindful Path to Self-Compassion by Chris Germer offer great insight and exercises to help those who tend to “beat themselves up.” Dr. Neff is publishing a book entitled, Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind.

In The Black Swan, Nina sacrificed herself for her art and plunged into the depths of insanity. I have seen people who were so consumed with guilt, shame or fear that they were held hostage by these powerful emotions, stuck in chronic pain, fatigue, anxiety, and/or depression. Developing a healthy sense of self, giving oneself the benefit of the doubt, taking time for oneself, and accepting our faults are all critical steps in the process of healing. Do yourself a favor by doing yourself a favor!

To your health,
Howard Schubiner, MD

MBS BLOG # 31–The King’s Speech as Mind Body Syndrome: Finding your voice and reclaiming your life

If you’ve seen the movie, The King’s Speech, you will immediately recognize that the king suffered from a form of Mind Body Syndrome. He had a very difficult childhood, despite (or because of) being a prince. His parents were not present (as was the custom for those days and that class) and his major source of “parental” affection was from his nanny. Unfortunately, his nanny favored his older brother who tormented him and therefore George grew up feeling less worthy, unloved, and unable to assert himself. All of this eventually led to the expression of his underlying emotional conflicts in his stammer. The origin of his stammer was clear (it was the physical manifestation of underlying psychological issues). Why did it persist for so many years? The answer is that it became a learned nerve pathway. That pattern of speech became ingrained into his nervous system over time and that was the natural way that his brain processed the signals when he was required to speak. Of course, the stammer would be more severe under times of stress, but it couldn’t be reversed until he had treatment that helped to uncover the underlying conflicts and conscious application of methods to reverse the nerve pathways.

Stuttering (or stammering, I believe these can be used interchangeably) is quite common in children. I don’t recall this, but my mother told me that I started to stutter right after my sister was born. I guess I was used to being the “prince” in my household until she came along to usurp my parents attention. Fortunately, it didn’t last too long. My mother got me to sing songs (the stutter disappeared during singing) much of the time, gave me extra attention, and the nerve pathways reversed over time.

Stuttering typically begins in childhood, but there is another form of stress-induced speech disorder that usually begins later in life that is similar to stuttering, spasmodic dysphonia. This condition occurs primarily in young adults (ages 30-50) and is more likely to affect women, which is similar to the demographics of those who suffer from Mind Body syndromes, such as headaches, fibromyalgia, back and neck pain, and irritable bowel and bladder syndromes. There is no known abnormality of the vocal cords, per se. The difficulty in speaking is variable, can be made worse with stress, and may not occur during singing or speaking in high pitched voices (when slightly different nerve pathways are activated, as apparently my mother figured out when trying to help my stuttering). Some professional singers suffer from this condition and can have difficulty in singing.

When I have conducted detailed interviews with people with spasmodic dysphonia, the typical pattern emotional events that create MBS are present. We find childhood priming events (such as emotional, physical or sexual abuse, or situations similar to those experienced by the later King George) and triggering events later in life (such as losses, situations that trigger the “danger” signals, etc.) that produce the nerve pathways leading to the characteristic speech pattern of spasmodic dysphonia.

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