MENTAL HEALTH
Mind over matter
DR. THARA SRINIVASAN
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Several psychiatric conditions can manifest as physical disorders or ailments.
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Photo: Mohammed Yousuf
An underlying trouble: It may not always be a physical problem.
"The body is an instrument, the mind its function, the witness and reward of its operation."
George Santayana.
ABOUT 10 years ago, a child aged 13 years, studying in one of the city's elite schools, was brought to me for the management of severe, intractable headache. The parents had consulted as many as 10 specialists in the fields of neurology, neurosurgery, ENT, eye, endocrinology ... no investigation including the most expensive scans had been spared. Everything drew a blank and finally the family, rather unwillingly, sought psychiatric help.
A chat with the child over two sessions elicited news of problems in school with his teacher and a few peers. There was also visible fear about his academic performance, often made worse by parental anxiety and concerns. Over a period of time this was sorted out and he gradually improved. In about a month's time, he was free from his headache.
Somatisation disorder
This is one of the many instances in which persons with psychological problems present with bodily complaints. Very few children straightaway speak of anxiety or depression. They often present with headache, vomiting, stomach pain, body pain ... This is true of adults as well, more often with women than men. This condition has been called somatisation disorder (Soma means body).
With its onset, typically in teenage years, the full clinical picture of somatisation disorder becomes evident in the early 20s. Characterised by multiple complaints involving several systems of the body, these could present gradually or in a dramatic manner. Absenteeism from work, demand for attention result in social alienation of the individual, making management more challenging.
There was a banker, aged about 53, who repeatedly absented himself from work. Most of his days were spent in doctor shopping with an array of complaints — intense pain, "weakness", lethargy, indigestion, poor appetite... . Ultimately his cardiologist convinced him to see a mental health professional. A few sessions revealed that he was depressed, largely in anticipation of his retirement. He was apprehensive that, with loss of position, his family would cease to love and respect him. He was also terrified at the thought of having so much time on his hands. Having been a diehard workaholic, he had developed very few alternative interests in life. Intensive counselling with a mild dose of antidepressants alleviated his distress to an extent and reduced his visits to doctors.
There are several psychiatric conditions that masquerade as physical disorders or ailments. Depression, anxiety, somatisation and pain disorders, hysterical conversion disorders and hypochondriasis are some of the important ones.
Emotional states can also alter the pain threshold. As a result there can be an exaggerated or disproportionately severe response to minor ailments or injuries, often perplexing the doctor. When patients are told there is no physical basis for their complaint, they become irritable, critical and bitter. Many respond well to antidepressants and psychotherapy.
On the contrary, in conditions like schizophrenia, the pain threshold is so high that even deep wounds or severe pain fail to distress the patient thereby delaying diagnosis and treatment.
Most doctors are familiar with a young girl, often unmarried, suddenly "losing consciousness" and falling down in the clinic or hospital. These falls seldom result in injuries and invariably occur in the presence of a big group of family members.
There are others who suddenly "lose their voice", or have one of their limbs "paralysed". A history often reveals a minor or major stress and clinical examination can rule out an organic problem.
Conversion disorders
These are commonly referred to as hysterical disorders, now called conversion disorder. The psychological conflict that affects the individual is converted into a physical symptom. Many of these conditions are self-limiting and are of short duration and the patients do well with psychotherapy and measures to reduce anxiety including yoga and meditation. Although originally held to occur only in women (hysterus), an increasing number of men are also affected by this condition.
There is a temple near Thiruporur, in Tamil Nadu, where a group of about 20 women would gather around noon everyday. They would start swaying their bodies in unison to the accompaniment of guttural sounds. This would go on for 15-20 minutes, at the end of which they would all get up and behave as if nothing happened. When I spoke to them after one such episode, I found that many faced mild to severe problems ranging from having to deal with alcoholic husbands and hostile mothers-in-law to financial difficulties. They felt that this process of getting together everyday was therapeutic and gave them an opportunity to share their "miseries" and indulge in an activity during which they were not consciously thinking about their woes. These processes like possession syndromes have social sanction in rural areas and seem to benefit some.
A persistent preoccupation with the possibility of having some dreadful disease accompanied by regular and compulsive visits to various specialists is the hallmark of hypochondriasis. This belief persists despite evidence to the contrary and psychiatric consultation is often resented. All features relating to health in the media are passionately devoured initiating a fear and imagination that they could be suffering from some or all of the illnesses written about. The explosion of information on the Internet also has its flip side and has contributed, unwittingly to the distress of these individuals.
The writer is a Psychiatrist based in Chennai.
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