Medically Unexplained Illnesses: It’s not just all in your head!


Having a stigmatized chronic illness can make it more challenging to cope with illness. This is an introduction to CFS, FMS, and MCS, all medically unexplained illnesses. Having compassion and greater understanding for people with these conditions, may help sufferers reduce their stress.


A Brief Introduction to Medically Unexplained Illnesses

Some chronic illnesses have specific titles, treatments and are much more easily understood by medical professionals. They have a consistent set of diagnostic criteria and so they are easy to diagnose, treat, and maintain. More research is done to find drugs and treatments that help with their treatment, and so while they are not curable, they are treatable and people can have a fairly decent quality of life with those illnesses. Some examples are diabetes, thyroid disease, osteoarthritis, and some psychiatric disorders like depression and Bipolar illness.

However, there are some illnesses, like Fibromyalgia (FMS), Chronic Fatigue Syndrome (CFS), and Multiple Chemical Sensitivity (MCS), whose symptoms are not well-understood by medical professionals, and since those symptoms overlap with other disorders and don’t lend themselves well to specific diagnosis, they don’t get as much research funding and effort. Their causes are also not well understood either; hypnotheses include viruses, childhood trauma, injury, psychiatric disorders like depression and PTSD, chemical reactions gone awry, etc. The fact that the disorders are not well-understood does not mean that the disorders are any less distressing to sufferers. It also doesn’t mean that they are simply “psychosomatic” (i.e., psychiatric symptoms masquerading or perceived as physical disorders). There has been a great deal ofstruggle to gain legitimacy in the medical field for people who suffer Medically Unexplained Syndromes (MUPS), as people with these conditions have an added stress of not being believed by family, friends and medical professionals. If they could point to a well-defined diagnostic label like cancer or arthritis, they might have a chance to be believed by others. Some prominent medical researchers have suggested that these disorders are purely psychological, and that if they just got Cognitive Behavioral Therapy, they would be fine. However, as anyone who has coped with fatigue, joint pain, cognitive dysfunction (like poor memory and concentration), or extreme discomfort after chemical exposure can attest, it is not just “all in your head.” Other people demean MUPS symptoms as “just being lazy” or “the yuppy flu.”

Fibromyalgia is perhaps one of the relatively better-researched MUPS and is characterized by joint pain in 11 of 18 tender points on the body, fatigue, insomnia, and at times cognitive dysfunction, like mental “fogginess” that makes it hard to concentrate, focus, or remember things. Many people with Fibromyalgia are limited in what they can do, how they can move, and sometimes their employment opportunities and capacities are severely hampered by their symptoms. Similarly, Chronic Fatigue Syndrome can negatively impact fulfilling social and occupational roles, and sometimes they have to apply for disability as they struggle to even achieve minimal activities of daily living. CFS has many similar symptoms to FMS (fatigue, cognitive problems, joint discomfort) but also have tender lymph nodes, flu-like symptoms, and “post-exertion malaise” which means that if they do too much during the day, they feel even worse for the next day to week. You may be able to see how this could interfere with holding down a job, raising children, having a social life, or running a household. While these disorders usually affect women, men can also be affected. Children and adolescents can become ill with CFS and FMS too, although it’s much rarer.  Most of the studies on CFS and FMS that have been done involve adults from 40-60 years old. It affects all socioeconomic statuses as well as ethnicities.

Multiple Chemical Sensitivities (MCS) is perhaps the most controversial of the MUPS and while it shares a few symptoms with FMS and CFS, it is more focused on negative reactions to exposure to chemicals in every day products. Some of those products include cigarette smoke, gasoline, solvents, perfume, clothing dyes, dryer sheets, cleaning agents, pesticides, and hairspray. People have a range of symptoms when exposed to these types of chemicals, including respiratory problems, skin rashes, headaches, cognitive problems, etc. people with FMS and CFS sometimes have sensitivity to smells, but it is not a defining feature of either of those conditions. Because there’ve been some studies where people failed to show increased sensitivity to certain agents in a laboratory, some medical professionals regard MCS as merely a psychosomatic illness. However, the reactions are real, cause physical and mental distress, and sufferers are not merely imagining what they experience. Instead of invalidating people’s experience, it seems more beneficial when doctors, friends, and workplaces can work with people who are sensitive to smells to make them comfortable, happy and productive. Other people might not perceive the same smells as threatening, because they get no physical reaction. However, there are number of factors that might contribute to some people’s extra sensitive reaction. I will address these factors in the next blog post.

This is been an overview of medically unexplained illnesses, which are often chronic and whose prognosis is often uncertain. Many of these illnesses overlap in symptoms, but the sufferers have very real struggles in meeting their life roles and functioning well. Hopefully, with more understanding, research, and compassion, we can make their experience a little better and a little less stressful. I will be writing about them more in future blog posts, in specific the link between psychological factors and physical symptoms of these illnesses.

My Part, Your Part


Fights don’t usually start with only one person. This will help you recognize your part and drop the defensiveness that erodes and stagnates relationships.


Lately I’ve been noticing that many people notice what other people do wrong and get quite upset about it, without taking time to consider their participation in the perceived problem. This often takes place in arguments with loved ones, whether the loved ones are friends, family members or lovers. I’d like to take the time to help you rectify this problem if you notice it in yourself.

We love to be right. We don’t like having people point out our flaws, because we fear their rejection and negative opinion. This is perfectly human and understandable. But it we persist in seeing only what other people are doing wrong and ignore our contribution to the interaction, we miss the opportunity to take responsibility for our actions and improve the situation by acting differently. So we keep feeling like victims, put upon by the whim of other people who are totally unpredictable and unfair.

Do you want to stay in a victim role? Or would you rather feel like you can behave differently in an argument? Hopefully you want the latter, because that is the only way I see out of this mess.

Next time someone gets angry at you or has a problem with what you’re doing, try these four steps:

  1. Notice the feeling that arises in you and accept that feeling. That doesn’t mean you indulge it by acting on it. But it also means that you acknowledge, “I feel angry and like defending myself” without judging yourself for feeling that.
  2. Reflect on what happened before this person got upset with you. As if you were observing the interaction on TV or in a movie, look at the actions that preceded and came after the anger. What were you doing, what were they doing, how did you react to their actions, how did they react to yours…. you get the picture.
  3. If you can see something that you might have done to contribute to it, accept responsibility for that. Don’t conveniently block it out of your mind. Don’t pretend that you had nothing to do with it. If you’re not clear on why they’re angry, ASK, don’t assume.
  4. If they’re not ready to take responsibility for their negative behavior, give them time to cool off before writing them off. If this is new for you, asking for responsibility from yourself and others in such interactions, then try to have patience for the other person and for yourself. It’s a new skill. You’ll get better the more you do it. So will they, hopefully.

Sometimes people don’t take responsibility because to admit fault is to sink into a quicksand pit of shame. If admitting wrongdoing does that to you, it’s probably indicative of low self-esteem and probably a good idea to get professional help. If you feel really angry every time someone points out something you did wrong, it may be an indication that you are covering up your shame or over-compensating for low self-esteem.

Hopefully you can take responsibility for your part in an argument, and the other person can too. It’s really a pain when only one person routinely takes responsibility, and that can lead to resentment, which makes your relationships suffer as a result.

 

 

Us and Them


human family.


It’s very easy to get caught up and hating people who have heard us. The natural tendency is to either fight the person or avoid them, and this is what the sympathetic branch of our autonomic nervous systems set us up to do. It makes sense in terms of survival, especially when we were much more vulnerable and society was a lot less sophisticated. We also developed a sense of “us versus them” that helped distinguish people who are part of your hunting tribe or clan in prehistoric times, from people who were possibly a threat or from a competing tribe. However, in this increasingly small world of ours, I don’t think we have the luxury of adhering to this knee-jerk reaction to people who are different from us.

If you ever observe very young children, they have very polarized views as they learn how to distinguish themselves from other people. At around two or three, they start to say things like “that’s mine!” And “no!” This is perfectly natural for that age and it helps us draw boundaries before our brains are more sophisticated. Our parents, if they’re doing their job well, help us learn how to smooth out the harsh edges of these strong declarations. They help us learn that we have to share and that we have to think about other people’s feelings when we speak our minds. Some people are able to make the transition into more sophisticated ways of thinking and interacting, while others, sadly, don’t. It’s natural to have strong preferences and to want to make your life comfortable for yourself based on those preferences and desires, what isn’t healthy is expecting that everyone else would here to those preferences and that the people who don’t are against you.

I see a lot of families where one person in the family is different somehow from others, in either the parents, siblings, or spouses can’t understand why that person is acting differently. If the person is acting differently is being destructive or inconsiderate of other people, then there is good reason to speak up about it. However, sometimes people are shamed just for being different in temperament, lifestyle choice, personality, or something they can’t help. This is very unfortunate because then that person feels outcast from the very people with whom they’re supposed to be able to be comfortable. When I work with such families, I try to help people understand that while you might not like the behavior of the person with whom you live, that doesn’t mean that the whole person is damaged, tainted or wrong. You can address the behavior you don’t like without shaming the person are making them feel unloved.

Similarly, I would argue that all of us on the planet are in some way related to each other. Were all sisters, brothers, mothers, fathers, daughters, sons, and so on. What would it be like if we were able to differences with respect, dignity, and curiosity rather than hatred, separatism, and shaming? Certainly, there are behaviors that are violent, exploitive, and hurtful; I don’t condone such behavior and think we should do everything in our power to eradicate such behavior. But if we don’t approach it with curiosity, we don’t know why it’s happening and we can address it effectively. I believe it’s possible to use our more advanced parts of our brain, like our prefrontal cortex, to reason, use language, and remain open to many possibilities. When we get caught up in the emotional parts of our brains and stick with the binary us versus them mentality, we miss the boat in many ways. We don’t get a chance to understand why people commit violence, why people exploit each other, and what can be done to change that. Who hasn’t made mistakes in their lives and then things they later regret? Who hasn’t heard someone inadvertently or on purpose in their lives? If we of all made mistakes, should we all be bitterly condemned and outcast from society? Worse yet, should we all be treated like dangerous criminals? I am not naïve enough to think that there isn’t a need for prisons and punishment; I do believe, however, that we need more tools in our toolbox to address behavior that we find objectionable.

So the next time you have a strong reaction to another person or their behavior, you might want to consider where they’re coming from and what might be motivating it other than “evil” or “stupidity.” Remember that the person might be doing their best and may need more skills and more knowledge in order to act in a way that’s more considerate and kind to others.

Guess who’s not coming to dinner?


For many, this is a family-oriented time of year that focuses on togetherness and celebrating winter holidays with loved ones. For those who have lost someone or are alienated from their family members, it can be a difficult time of year. Even if you spend time with your family, there may be things that they do that annoy you, hurt you, or make you wish they didn’t come over at all. Here are some ideas for making this time easier emotionally.

In the case of people who are annoyed by their family members or don’t feel a close connection with them, I like to think of reframing the person’s behavior from a broader perspective. What I mean by this is that while the person may do someone that you find obnoxious, they might have a reason for that behavior that you’re not aware of, and that behavior may be a reflection of pain coming from them. It may be a reaction to something you’re doing that hurts or annoys them. If you can, it might be good to take them aside and gently tell them that what they’re doing is hurting you, or ask them if there is something wrong between you so that you can clarify what you’re perceiving. Of course, the situation’s particulars dictate how you respond. but assuming that you want to keep the relationship going on a positive note, I think it’s best to give the person a chance and hear what they have to say. Hopefully you can have a productive dialogue about it and come to an understanding or resolution of the matter.

Another approach is to accept that the person is likely not going to change or hear what you have to say, and focus on enjoying the people at the gathering whom you do enjoy. When you find yourself getting annoyed by the person, try to remember that unless they are directly offending YOU, there’s no need to intervene or get caught up in their unpleasantness.

If you are without family members or alienated from them, I think it’s a good idea to balance honoring your feelings of grief while still trying to do something that pleases you on those holidays. What can do you that will give you a sense of peace, togetherness or joy? Do you have a friend you can spend the day with, or would it be fulfilling to volunteer time at a soup kitchen? Take that energy spent feeling sad and disconnected, and use it to make someone else feel good. If nothing else, get out of the house and your jammies, and see the day. I think that this prevents people from feeling further isolated and sad.

There are many more ways to handle these situations, I’m sure, but these are just a few starters. I hope they help you and you have a fantastic holiday season!