Psychosomatic illness

By far the most common way to escape a life which is itself a frightening and anxiety- and tension-ridden experience is by means of a simple mechanism which has nothing to do with any of the common social or other addictions. It is by a flight into self-imposed illness that restricts one’s activities to those which are ‘safe’ if generally very boring. Every medical student, from his early clinical training, learns to differentiate between the symptoms of physical illness and those which are graced with the term ‘psychosomatic’.

Physical symptoms can stem from a demonstrable pathology, a change in structure of an organ or tissue. Palpitation or rapid beating of the heart may follow the mechanical failure of this organ as a pump or may be due to diseases which have altered the structure of the heart valves or muscle. But probably the commonest form of palpitation is due to anxiety and tension. The symptom is a psychosomatic one in such cases.

Psychosomatic symptoms are often unpleasant. Apart from palpitation they commonly include fainting, shortness of breath, diarrhoea, paralysis or even blindness. Sometimes they are so devastating that it is difficult for lay people to understand what is gained by those who suffer them. Exactly what is gained, however, is often a relief from tension and severe anxiety.

At times the psychosomatic escape from a worrying reality fear is incredibly snugly tailored to meet the situation. The actress may be prevented from doing something with a heavy anxiety tag attached to it by loss of her voice. A student may be so anxious about the result of his examination that biliousness or diarrhoea prevent him from attending the examination hall. A mother who finds childrearing difficult and full of anxiety may become very unsteady on her feet and complain of giddiness to such a disabling degree that she cannot be expected to cope safely with the little one.

An understanding of the nature of psychosomatic illness and its relationship to anxiety and tension is useful if it leads to an understanding of those stricken with these miseries. Clearly nothing can be gained by branding such people as ‘inadequate’ or even ‘malingerers’, ‘lead-swingers’ or ‘scrimshankers’. One way they are likely to overcome their disabilities is by the gradual emergence of real confidence in themselves as people, and to learn comfort by relaxation rather than withdrawal.

Psychosomatic symptoms must be accepted for what they are: painful ways of deflecting an even more painful state – a state of extreme and painful tension.

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