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.

Psychiatrists Versus Psychologists


There’s a lot of confusion about what psychiatrists and what psychologists do. In the beginning of our profession, there was no distinction, really, because psychiatry was invented by a medical doctor, Sigmund Freud. As the years have worn on, however, the functions and duties have become separate. I would like to help clarify some of the differences.

Psychiatrists

Psychiatrists are medical doctors who have specialized training in psychiatry, namely treatment of diseases of the mind. Some psychiatrists still spend time talking to their patients at length about life’s problems and how to cope with them better. However, for whatever reason, they have a lot less time now, especially since managed care has become such a prevalent force in the mental health field. Unfortunately, their time has become more and more valuable and a lot of times they are in a hurry to treat as many people as possible. At is not their fault; it’s just how it is and a lot of communities. As a result, people sometimes go to psychiatrists and feel offended and hurt that the psychiatrist can’t spend a lot of time listening to their problems. This is unfortunate, because sometimes people didn’t want medication in the first place and were hoping to be heard and understood. This doesn’t mean that psychiatrists can hear and understand people, just that there focuses mostly on how the person is doing physically with their mental health condition. Psychiatrists spend most of the time evaluating the symptoms presented to them and how medication can address so symptoms. They can be true lifesavers if a person has a mental health condition that lends itself to medication. For instance, severe depression and bipolar disorder often require medication in order for the person to fully heal. Similarly, psychotic disorders like Schizophrenia require medication in order to have a productive, happy life.

Psychologists

Psychologists are experts in psychology. There are many different types. For instance, forensic psychologists work in the law and criminal justice capacities. They do evaluations, psychological testing, and write reports about their findings, as well as testify in court cases. Health psychologists specialize in helping people with medical conditions and do research on different topics, such as the role of stress and different diseases on mental processes. Clinical psychologists treat emotional and psychological illness by using psychotherapy and often work in conjunction with psychiatrists. This is what I do mostly, and I am very grateful to have the ability to collaborate with medical professionals when there are complex cases of mental disturbance. Not everyone who sees a psychologist needs medication or wants medication; some want to try psychotherapy before resorting to medication, and women who are breast-feeding often want to wait until they are no longer breast-feeding to try medication. I respect the desires and needs of the patient, that in cases where severe mental illness is present, I strongly recommend that people at least be evaluated by a psychiatrist. There are also things that people can do to help themselves feel better that don’t involve medication or talk therapy, and I encourage people to take care themselves as much is possible in order to be empowered and have a full, healthy life. For example, exercise can be and honestly helpful for depression and anxiety. Taking medication is not incompatible with exercise, meditation, yoga, good nutrition, or any other non-pharmacological interventions. If you choose to take the herbs or supplements, however you should check to make sure they don’t interfere with whatever medication you’re taking, whether it be psychiatric meds or medications for physical illness.

I hope this clears up some of the common misconceptions about what I do versus what a psychiatrist does. We still have a long way to educate the general public about how each can help people with emotional and psychiatric illness. However, hopefully this is a step in the right direction.

Healing in The Now


Whether we’re suffering emotionally or physically, no one really likes to suffer for very long. This is natural and normal, and I never would blame anyone for wanting to get better quickly. However, sometimes the desire to get better becomes a permanent stance of impatience that can actually thwart our efforts to get better. If he comes a cool paradox in which we strive so hard to not feel the way were feeling, that we make ourselves more miserable. Living in the future too much distracts us from what we can do in the moment to make ourselves feel better.

I know a lot of people who have emotional or physical problems, both professionally and personally. I have been in that boat, and struggling with a chronic illness is never A fun thing. I have also noticed that the people who live well and feel better quicker, do not get caught up in how fast their healing. They’re not competing against other people who also suffer to see who gets better fastest and in the best way. We have what is called bio individuality, which means that each have a unique body chemistry that interacts with our emotional and spiritual selves, as well as the outside world. What works for one person may not work for another.

There are some things, like alcohol and cigarettes, that probably don’t work for most people to create optimal wellness. However, some people might do very well on them diet with a lot of meat and rich foods, while someone else might feel better if he mostly vegetables and fruit. The point of this is that if we find something that works for us, it doesn’t necessarily work for everyone else who has health problems or mental health issues. We need to be careful about how we talk about our health, not just for others’ sake but also for our own sake.

What do I mean by this, when we think of ourselves as inadequate because we have a mental or physical condition, and we get angry at ourselves for not progressing further, it rarely serves us. If it motivates us to action, such as exercising more, eating better, applying ourselves rigorously to what our doctors recommend, then it can be helpful. However, what I usually see is that people’s impatience and anger at themselves turns into a self-destructive pattern of self- rebuke and low self-esteem, sometimes even depression. It’s natural and as I said before to want to get better. When it turns unhealthy is when we get so bogged down in impatience and anger, that we ignore what we can do in the present moment to improve our well being.

Sometimes there isn’t a lot we can do in the moment, at least from a medical standpoint. They may be taking our medications as prescribed, going to therapy your physical therapy, eating the way we’re supposed to, but the internal work that needs to be done falls by the wayside.

What is this internal work? It’s noticing what’s going on now in our body, mind and spirit. If that sounds to ethereal an abstract, what I mean is that we can observe how were moving, how were thinking, and how we’re feeling emotionally. We can use that data to make decisions about how we care for ourselves. That is a better use of our time and energy than getting angry at ourselves for not being healthier. Anger at ourselves is only useful if it motivates us to protect ourselves order energizes us toward effective solutions. Please keep this in mind next time you find yourself getting frustrated with yourself for not being healthier, happier, more productive, etc.

Courage in the Face of Despair


I recently saw an article about a young man from San Francisco who survived a suicide attempt off a local bridge. For the story, click here:
http://www.inforum.com/news/3828523-after-surviving-jump-golden-gate-bridge-man-brings-mental-health-message-fargo

One of the things that struck me about this story was how much courage he had to speak out about his mental illness, his attempt, and his despair. I wonder if I could have been so brave as to risk the stigma that attaches itself to speaking out about mental illness, to this day. But in another sense, that is how stigma is worn down and eventually broken — by speaking out, and having the self-possession and courage to say: “This is how I felt, and this is how I dealt with it.” I hope that more people speak out and help others, as it not only helps potential suicidal people but also the general public to understand that anyone can be affected by mental illness and substance abuse.

I have also spoken to some people who have recovered from mental illness and/or substance abuse, and who share their stories with others. What they often say is that it helps them get better because it reminds them of where they were, and how they have coped effectively with their affliction. It also reminds them that they are not their disease or condition; there is more to them than just a label.

This is important to remember when they’re struggling with a mental illness or substance abuse because there is an enduring person with likes, dislikes, talents, gifts, and resources that are uniquely theirs; this goes above and beyond any label like “Bipolar”, “depressed”, or “alcoholic.” As author Paul Williams once wrote, “Remember your Essence” — remember that there is more to you than what other people say or think about you. Also, whatever horrible feeling you are having right now, it does not define you either, nor is it how you will always feel. I encourage you to remember that if you suffer from mental illness, and to seek help. You don’t have to give up or live your entire life in misery. Please, have the courage to make a life worth living and to define yourself according to what you know to be true, not according to a temporary feeling or a label someone else has given you.

Letting go is hard to do


More and more we hear about how it’s healthy and good to “let go,” whether the thing we’re supposed to let go of is a relationship that didn’t work, or a past wrong by another, or a past wrong we committed. There are so many things we can let go of, but actually doing it for a sustained amount of time can be quite challenging.

I recently read an interesting article (https://www.psychologytoday.com/articles/201503/the-ties-unwind) by Sara Eckel, about adult siblings who don’t communicate with each other after one or both has hurt the other. She used a term that struck a chord with me, “grievance collector.” This type of person holds onto perceived wrongs by others and holds resentment for long after the event occurred. I don’t have to explain to you, dear reader, how this just makes the person collecting and holding the grudge sick both physically and emotionally. I’m sure you’ve already heard about how that bathes the body and brain in stress chemicals when the grievance collector gets upset about it all over again when reminded of the original wrongdoing. I don’t have to tell you that the grievance collector is robbed of living in the present as long as they dwell needlessly in the past.

But let us consider why some of us get trapped in grievance collecting, and why it’s so hard to let go. It seems to be hard-wired for survival that we remember bad things happening most often; our limbic systems help ensure that we (hopefully) don’t touch the hot stove or get involved with the cheating lover repeatedly. However, when we generalize our bad experiences to everything that reminds us of that initial bad experience, it makes it hard to enjoy and appreciate what comes across our path in the present — or even to give it a chance to delight and surprise us. Add to this tendency to remember the negative for survival purposes, the idea that people “should” act a certain way, and you have a strong need to hold onto grudges and resentments.

Anyone in AA/NA knows that holding onto those can trigger relapses into self-destructive behavior, or in the case of people who are not addicted to drugs or alcohol, a relapse into negative feeling states that can seem stubborn and persistent. Sometimes being “police officer to the world” can be attractive because we can impose our worldview of right and wrong onto other people who have harmed us; in that moment we have the illusion of vindication over the wrongdoer. However, without some kind of resolution, it is empty and just harms us, not them.

So how to stop being a grievance collector and let some of these past wrongs go? It can take a while to retrain your mind from holding onto things that bug you, about yourself or other people. As you gain greater awareness of when you’re doing this, why you are getting upset about it, and recognize that you are powerless over the past, but not your reaction to it, you will find it easier to release them. Professional help and specifically, EMDR therapy can be helpful in resolving traumatic wrongs done to you. It’s a long journey and not easy, but ultimately much more liberating and empowering than lugging around your grievances wherever you go.

This is now a blog about grief and trauma.


In addition to resolution of traumatic events in people’s lives, I am very interested in helping people with grief and transitions. There are many things in common that grief and trauma share, phenomenally. They both tax a person’s normal coping skills and abilities; they also shake a person’s fundamental faith in the world. Trauma and grief are both easier to handle when a person’s attachment to their original caregivers was strong, secure and healthy. For this reason, I think that addressing issues of both grief and trauma is a good idea. I will alternate sometimes between grief and trauma, and try to overlap the posts as much as I can where applicable.

I am a licensed psychologist who has several years of using EMDR (Eye Movement Desensitization and Reprocessing) to help people cope with both short-term traumatic events as well as developmental traumas (things that happened in the childhood or earlier in life, that still affect a person). I find much success with this as well as in teaching people skills called Dialectical Behavioral Therapy. I find that these go well together. In knowing how to use the DBT skills, people can tolerate strong feelings that come up while processing trauma (or grief) and the person can soothe themselves better when the know these skills. I also find that people often find the loss of a loved one very traumatic, and they may develop Traumatic Grief. This will be explained in a later post.

In my practice, I also work with many people who are dealing with the death of a loved one, breakups of marriages and long term relationships, and other difficult transitions in their lives. Grief is a healthy response to a pivotal moment in a person’s life, and in that moment we have a choice to allow it to help us grow or to let it suck us under like a riptide. I hope that we can explore together ways to navigate the journey of grief so that it enriches rather than debilitates us.

I will be posting monthly about different aspects of trauma and grief. I invite your comments and reflections. Thank you.