Fear causes the heart to beat faster and produces other
temporary reactions, designed to get the body ready for action, either to run
or to fight. It's when fear or other emotional tension is prolonged or repeated
very frequently that it can have a debilitating effect on body organs. It is
hardly surprising that about half of all people seeking medical help-according
to some estimates, even 75 percent-have ailments either produced or made worse
by emotional factors.
We shall examine in the next chapter the kinds of
emotional stresses that most commonly bring on physical symptoms. But it is
important to emphasize something here: No patient, and no doctor, should
blithely make a diagnosis of psychosomatic illness, or "nerves." No
wise physician does. Psychosomatic problems are common, but to assume that
emotions explain everything in an individual case is to risk serious
consequences. Even when the emotional problems seem clearly to be the kind that
could produce a physical complaint, the emotions may actually be stemming from
the complaint.
They may, in fact, be the first indication of a developing
physical disease. Restlessness, sleeplessness, and loss of appetite may stem
from an emotional disturbance, but they may also result from a yet-undiagnosed
heart condition. Systemic or central nervous system infections can pre- sent
themselves as severe behavior disorders. Even helpful medicines such as
cortisone may produce mental disturbances.
Traditionally, a diagnosis of
psychosomatic illness is a diagnosis of exclusion-a process in which other likely
possibilities are carefully considered and found not applicable, leaving
emotion as the culprit. The physician notes the symptoms, makes a physical
examination, may order some basic and special laboratory and x-ray studies.
Only when he has satisfied himself that, for example, the chest pain is not due
to actual heart disease or that the episodes of abdominal pain and vomiting are
not produced by gallstones or other physical causes does he feel justified in
considering an emotional explanation.
There is always the danger that an
organic problem-an overactive or underactive thyroid, underactive adrenal
glands, diabetes, possibly even a brain tumor-may pass unnoted if a full
history, thorough examination, and supporting clinical studies are not meticulously
executed.
In such cases, as soon as the organic problem has been
solved, the emotional symptoms disappear. What, then, can you carry away from
this discussion? First, the emotional problems are commonly involved in
physical difficulties. Often, they are the cause of the physical illness. At
other times, they may not be the prime cause but an accentuating factor. At
still other times, the emotional disturbances may be the result of the physical
problem.
Thus, there should never be a blithe assumption that any physical
complaint is entirely psychosomatic; there should be a medical study to
determine whether it is. Second, if the diagnosis is psychosomatic, it should
be accepted grate- fully, not shamefully. Much can be done about overcoming the
problem, as we shall see.
