Physical Illnesses and Mind Troubles
It has been customary in the past to think of physical or bodily illness in terms of physical structure. When an organ was diseased, physicians looked for the main cause in that organ or in related organs. There was a tendency to regard the human being as a conglomeration of organs which might become impaired in their material make-up leading to disturbance of function or what we call disease. Today, there is a growing change of outlook towards this vital problem. We are seeing man as a total human being, an indivisible whole, with a mind and spirit as well as organs, and we are beginning to realize that the mind function can play a significant part in the origin of organic disease. Formerly, it used to be thought that that impaired function or working of an organ always followed impaired structure. The new attitude is that in many illnesses, it is impaired structure which follows impaired function. More and more, doctors are appreciating the role of the emotional factors in disease.
Actually, this is not a really new approach but the revival of ancient speculations of the pre-scientific era to the effect that all illness arose from disorder of the soul. This extreme point of view is not advanced to-day but we no longer rigidly separate mind from body and we are understanding more and more how the mode of life and the driving forces within the mind when badly directed can lead to diseases once thought to have a purely physical cause. It is modern psychology, and particularly the researches of the analytic schools, which has revealed the intimate chain of relationships between mind troubles and organ diseases. It is becoming progressively more apparent that doctors must see illness in terms of the whole individual and that the psychic factor cannot be ignored. While the physical scientific approach in medicine must continue both from the standpoints of investigation and treatment, it is equally certain that the psychological approach will develop and add greatly to our knowledge of the fundamental causes of ill-health. This we refer to as the psychosomatic approach.
It is a commonplace that our emotions or feelings especially when strongly aroused influence our bodily functions. When happy we laugh and feel energized: when depressed we may weep, feel inactive and lose our appetite: when afraid our muscles are tense, our hearts beat more rapidly and we may be sick: when chagrined we blush and stammer. These changes are short-lived as a rule but the continuation of emotional disturbances of an unpleasant kind arising from difficulties within the individual lead in time to impairment of the function of the organs involved. Such bodily changes have long been observed in cases of hysteria resulting from emotional conflict and it was Freud who first showed that emotion, when not expressed and so relieved through normal channels can cause tensions which lead to physical or organic disorders. In our day-to-day struggle for existence we are constantly faced with emotional conflicts but it depends how we manage these conflicts whether or not they will have a harmful effect upon our health. In our daily contact with our surroundings we experience fear, frustration, aggressiveness, anxiety and resentment, and according to our psychological make-up we express these overtly or we may repress them.
It is "repression" or the diversion of such emotions into inappropriate channels which, by way of the involuntary nervous system, adversely influence such functions as digestion, circulation, and respiration. And it is an interesting fact of observation that, just as some germs seem to have a predilection for certain body organs, so certain emotional conflicts have a predilection for specific organs. Frustrated rage seems to be related to disease of the heart and blood-vessels, dependency and guilt with the gastrointestinal organs, and sexual conflicts with respiratory disease. It is hardly an exaggeration to say that emotional conflicts can be as real a cause of disease as the germs that can be seen under the microscope.
It is an understanding of the relationship between emotional life and body processes so that doctors can treat the whole individual which constitutes the psychosomatic approach. To take a simple example: we know that tuberculosis is associated with exposure to the tubercle bacillus but whether the person exposed develops tuberculosis or not depends upon the complex factor of his immunity at any given time and there is no question but that immunity is related to emotional factors, and hence the psychosomatic element in this disease is highly important. Hence it is that sufferers from certain illnesses often recover marvelously when they change their environment, when they are removed from the stresses of family and occupational relationships. Hence, too, the success of faith-healing when some inner conflicting doubt is resolved.
From disease to accidents of everyday life may seem a far cry yet there is much evidence to show that accidents are often far from being " accidental." The accident-prone have a psychology of their own. They are usually impulsive, living for the present, not the future, with hostile feelings against authority, and a lack of balance for discipline from within and without, and dominated by guilt feelings. Their " accidents " seem to represent a wish for self-punishment and suffering with a desire for expiation. Those who are accident-prone would appear therefore to have this in common with the disease-prone, a difficult personality living under conditions of stress. This is surely a challenging thought, that disease and accidents can arise when emotions are repressed which are in conflict with the standards of the personality.
To understand how emotions affect body functioning, it is necessary to know that, apart from the voluntary nervous system which we consciously control, there is an involuntary or vegetative nervous system which controls the functions of the heart and blood-vessels, digestion and respiration. The voluntary nervous system regulates our conscious and planned relations to the outside world, the involuntary our internal vital processes. Now the involuntary nervous system has two parts, the sympathetic and para-sympathetic which are antagonistic to each other. The sympathetic nervous system prepares the body for flight or fight under threatening circumstances. It stimulates the heart and lung action, driving the blood to the muscles and brain where an increased supply of blood is necessary for effort: it increases the blood-pressure, mobilizes sugar for muscle activity and stimulates the adrenal gland. It leads to an inhibition of the gastrointestinal function so that more energy is available to meet this situation. In contrast, the parasympathetic is conservative and constructive—stimulating gastrointestinal function, storing up sugar in the liver and, in a general way, is protective.
Normally, these functions of the involuntary system strike a balance but in neurotic persons, their equilibrium is disturbed. After stimulation and due expression, as in healthy subjects, the body quickly returns to repose, but if no action takes place the physiological body responses tend to remain and become long-standing. In other words, if the self-assertive or hostile impulses are inhibited or repressed, a perpetual state of preparedness persists (instead of the reactive changes being dissipated by-action) and this in time has a harmful effect upon the function and, ultimately, the structure of the body organs. Some persons, however, in emotional difficulties react to the need for assertion by withdrawal or retreat from action. They react by over-activity of their parasympathetic nervous systems when under the influence of anxiety. They are the persons who constantly demand security and help. Moreover, there is a close link between the involuntary nervous system and the endocrine glands, notably the adrenal, thyroid and pituitary and these in turn if chronically stimulated can have adverse effects upon the health of the body organs.
To sum up: these are two types of neurotic response affecting the involuntary nervous system, which can cause organic disorder. The conscientious aggressive, neurotic individual may prepare to meet a stress situation by mobilizing his resources and fail to express his emotions appropriately and voluntarily, or the dependent type—unable consciously to accept his dependency, may react by a failure of self-assertion and an over-stimulation of the organs controlled by the parasympathetic.
Let us now consider the psychological factors in different groups of organic disorders. From the earliest days of life, much emotional interest is centered round eating. Our earliest sense of security and well-being comes from the satisfaction of hunger and therefore it is not surprising that any threats to our security reflect themselves in disturbances of digestion and the gastrointestinal organs. Moreover, in the child feeding is associated with the giving of love and so it is not difficult to understand how, in later life, frustration of love can also become linked with disorder of the digestive organs. The stomach is the organ which so often reflects difficulties in the emotional life. It is common knowledge that worries, fears, family and business troubles lead to dyspeptic symptoms. The common factor in these emotional tensions, is an intense desire for security, rest, help and love. This is shown by the fact that these stomach troubles often quickly clear up when, by change of surroundings and relief from cares, the sufferer gets away from emotionally harassing situations. Again, we know that unhealthy habits of eating lead to stomach troubles but such habits are really the expression of emotional conflicts, so that again the primary cause is psychological not physical.
Peptic ulcer is a disease of increasing incidence and is related to the stresses of our modern civilization. Much research has been directed to this subject and the conflict situation would appear to consist of a wish to remain childishly dependent, to be loved and helped, in opposition to the adult—longing for independence, self-sufficiency and achievement. Deep down the ulcer-sufferer has an unconscious longing for the protected existence of the child. This longing he represses and may over-compensate by an aggressive, ambitious and independent attitude. He becomes a " go-getter," eager for responsibilities and leadership and may well become a successful business man. However, if frustrated by circumstances in his life, he may be openly dependent, demanding of attention and if unsuccessful, irritable and bad-tempered. The peptic ulcer subject is often an emotionally immature person whose wish for dependency has arisen from either rejection or spoiling in childhood.
The psychosomatic interpretation of peptic ulcer is as follows: the rejected or frustrated desire to be loved and helped is converted into the wish to be fed, This chronically stimulates the innervation of the stomach independently of the normal need for food. The stomach responds continuously as if food were being taken or about to be taken. There is a constant hunger for love. The empty stomach is thus chronically excited with a disturbance of its secretory and muscle functions which may lead to structural change in the form of ulcer. It is well recognized that peptic ulcer when treated alone by physical methods tends to recur for the reason that the basic emotional difficulties remain unresolved. Hence, the importance of a psychotherapeutic approach if the recurrence of ulceration is to be prevented.
Chronic diarrhea, spastic colitis and mucous colitis are common illnesses closely related which may be the bodily expression of emotional disturbance or neurosis. Studies of the personalities of sufferers have shown that their main characteristics are over-conscientiousness, dependence, sensitiveness, anxiety, resentment and guilt. In early life the act of excretion tends to become associated with feelings of possessiveness, pride of achievement and in giving and retaining. To a young child, excrement is a valuable possession though later in life this association is inhibited and, though disappearing from consciousness, remains deeply rooted in the emotional life. Those who suffer from those intestinal complaints are likely to worry over their duties and obligations, especially in money matters, and they may find it difficult to sustain these obligations. They repress the conflict and the disturbed emotions chronically overstimulate the bowel by way of the involuntary nervous system and hence the diarrhea and over-active colon. Repressed hostile impulses are also believed to have a similar effect upon the bowel action. Although dietary and medicinal remedies may help to relieve these conditions, recurrence is most likely unless the basic emotional conflicts are dealt with.
Chronic constipation may also be rooted in psychological problems of the personality. Many sufferers are prone to adopt a pessimistic, dejected attitude to life, lacking confidence in their fellow-creatures and having a feeling that they are rejected and not loved and appreciated to their full worth. They are often excessively possessive and symbolically their constipation represents a holding on to what they have got. A readjustment of the emotional outlook towards life and other people will be necessary before this type of constipation can be cured.
Ranking high among the psychosomatic disorders are those affecting the heart and blood-vessels. The influence of emotion upon the heart is known to everyone but it is particularly anxiety and repressed hostile impulses which have an adverse effect upon this organ. In our human relationships we not infrequently develop hatreds but as these are in conflict with our personal ideals and conscience, we may inhibit them denying them free expression. Unfortunately, the accompanying emotion is not got rid of but is merely submerged to take its toll in a disturbing action on the heart and circulation. Fear and anger have been shown experimentally to increase the blood pressure by activating the sympathetic nervous system and the adrenal glands. If these emotional states are prolonged and frustrated in their expression, a continuous rise in blood pressure results. Personality studies have shown that sufferers from high blood pressure (hypertension) are unable to express their aggressive impulses freely and this is usually associated with anxiety. Although such people may occasionally have temper outbursts, they generally exercise marked self-control and give the impression of well-adjusted and stable personalities. In these sophisticated times the free expression of hostile feelings is socially prohibited to a large degree and as many people have never learned to sublimate their aggressive feelings, they live in a state of perpetually inhibited hostility. The aggression cannot be discharged and becomes a source of chronic stimulation to the heart and blood-vessels. Hence the prevalence of high blood pressure as a disease of our modern civilization. It is particularly those who, from childhood experience have never learned how to satisfactorily cope with their aggression, find it most difficult to manage their aggression in adult life. As high blood pressure or hypertension is the forerunner of numerous disease states, the psychosomatic factor is extremely important from the point of view of then prevention.
There is also a close connection between the emotional factor and the dreaded coronary disease (blocking of one of the arteries supplying the heart). This disease has greatly increased in incidence especially among the professional classes and those who carry great responsibilities. Those who have suffered from this disease are often persistently striving types with strong wishes for achievement and success and able to exercise strong self-control. In some, there may be deep and hidden hostility or hatred, repressed because it is not tolerable to the conscious mind and to a strict conscience.
That headaches are often of emotional origin is a fact of everyday experience, especially those headaches of the migrainous kind. It should be noted however that headache is really a symptom and not a disease and that there are many causes for this symptom. The pain is associated with changes in intracranial pressure and originates in the sympathetic nerve fibers in the blood vessels. It has been observed that subjects of migraine tend to be perfectionist types, ambitious, intelligent but rigid, and compulsive or obsessional in their ways. They may suffer a chronic resentment from not being able to live up to their self-imposed responsibilities. This leads to tension and fatigue and when stimulated to anger which cannot be openly expressed, the result is a migrainous attack. It has often been observed that if a sufferer in a migrainous attack gives way to outward expression of rage, the attack rapidly subsides.
In the field of respiratory disease, asthma is the condition which is most closely related to emotional disturbance. Again the influence of emotion on breathing is common knowledge. We talk of " breath-taking events " and sighing is associated with despair. Psychological analysis suggests that the basic conflict is centered round an excessive dependence upon the mother and anything which threatens to separate the protective mother is likely to provoke an attack. Again any situation which demands independent action may excite the conflict or any hostile impulses directed against the mother. There is, of course, the allergic factor in asthma, the abnormal sensitiveness to protein substances, which has a well-established causal relationship and it would seem that both factors, the emotional and the allergic are necessary to cause the disease, though what is the link between these two factors is at present unknown. Fortunately, in treatment it seems necessary only to remove one or other of the factors to free the sufferer from an attack.
More and more, the psychological factor in the production of skin diseases is being studied. Here also we know that the skin is an important organ for the expression of emotion. We need only think of blushing, sweating, pallor and itching as common signs of disturbance of our feelings, According to analytic theory the conflict is centered round an exhibitionism to obtain love and attention which arouses feelings of guilt. These are turned against the skin, the organ of exhibitionism, in a sort of self-punishment. Scratching, so common in skin affections, is regarded as the hostile impulse, on account of guilt, being deflected from its real target and directed against the self. As a rule it is not difficult to find the emotional factors in many of the common skin diseases.
Rheumatoid arthritis is yet another disease where the psychosomatic factor is significant. The personality of sufferers reveals an excessively strong emotional control with tendencies to over-control their environment. They are worrying, demanding, and exacting types, very often apparently over-sacrificing themselves for their families. In women, it has been observed that there is often an underlying rejection of the feminine role in life, a "masculine protest" reaction. How these personality traits operate in the production of rheumatoid arthritis is not precisely known, but that they do play a part in the causation of the disease is unquestioned.
Diabetes, fatigue states and hyperthyroidism are other disorders of health where there is a close connection between the occurrence of the disease and disturbance of the emotional life and where physical treatment alone is seldom radically successful. However, our knowledge of the exact role which the psychological factor plays in these diseases is far from clear.
However, it should be clear from the examples given that organic health is intimately linked up with mind health. More and more the direction of medical research is towards discovering the mechanisms underlying the effects of disturbed emotions upon the functioning of body organs. We are only on the threshold of understanding this vital problem which is indeed one of the great challenges to scientific medicine today.