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Medically Unexplained Symptoms II: The Mind-Body Connection as a Source of Both Healing and Illness

Meditating to restore mental health

The mind-body connection refers to the powerful impact thoughts, emotions, and other mental phenomena have on the body and health. While the power of this connection is often exaggerated by wellness gurus (e.g. disease is the cause of all disease, you can attain perfect health and longevity through positive thoughts), it is nonetheless incredibly powerful and important. On the positive side, emotional well-being has been associated with a wide range of benefits including lower blood pressure, less heart disease, and longer life. On the negative side, chronic stress and poor coping strategies can contribute to a wide range of mental and physical ailments including anxiety, insomnia, obesity, heart disease, and shorter life. 

It should thus come as no surprise that symptoms arising from almost any part of the body can result from psychological causes. Before talking about common symptoms, it is worth noting just a few of how psychological factors can impact physical function and symptoms. These include:

  • Changes in hormones include cortisol, adrenaline (epinephrine), and norepinephrine. These hormones can impact a wide range of physiologic functions from blood pressure and digestion to sleep.

  • Changes in neurotransmitters including serotonin and acetylcholine can impact mood and memory.

  • Changes in immune function may increase the risk of infection, flares, or autoimmune diseases.

  • Changes in health-related behaviors such as sleep, eating habits, and exercise.

The important point here is that even if symptoms start in your head (i.e. have a psychological origin), it doesn’t mean they are just in your head (i.e. there are real changes in your body that have real effects on your function and health).

Stress is a central concept in the mind-body field and refers to how we respond to perceived challenges and threats in our lives. Stress is a normal part of life and is not necessarily a bad thing. Eustress refers to beneficial stress such as exercise or learning a new skill that is perceived as a positive challenge. Stress only becomes a problem (distress) when it is overwhelming or chronic. If we stick with the example of physical stress and exercise, we know that ideal training will be somewhat challenging (eustress) while overtraining (distress) can lead to frustration, loss of gains (because of inadequate recovery time), and injury. 

Stress can arise from many sources including both external factors (e.g. illness, financial concerns, death of a loved one) and internal factors (e.g. social anxiety, depression, ambition). Stress can be acute, meaning it is short-term (e.g. studying for an exam), or chronic, which most often reflects lifestyle choices (e.g. working at a high-pressure job) or social circumstances (e.g. poverty, racism, or other forms of discrimination). 

  • Difficulty concentrating, memory loss

  • Feeling overwhelmed, anxious, or irritable

  • Insomnia, fatigue, and feeling worn down

  • Chest pain or rapid heartbeat

  • Stomachaches, loss of appetite, or diarrhea

  • Stiffness, aches and pains

  • Frequent infections

  • Change in behaviors including overeating, alcohol, or drugs

Clues that your symptoms may be the result of stress include an association of the beginning of symptoms with a specific stress in your life (possibly with some delay), worsening of symptoms during periods of higher stress, and improvement of symptoms with lower stress (e.g. no symptoms while on vacation then returning when going back to work). That being said, it is important to know that stress can also worsen symptoms from other medical conditions. For example, tremors caused by Parkinson’s disease may worsen with stress and stress can be a precipitant of chest pain and even heart attacks in persons with coronary artery disease. It is thus important, as discussed in part I of this series, to make sure you get an appropriate work-up for your symptoms before attributing them to stress.

If you believe your unexplained symptoms may be the result of stress there are many things you can do to control or even eliminate these symptoms.

  1. Reduce or eliminate stressors when possible: Take an inventory of what tasks and events in your day and week bring you stress and see if you can reduce, avoid, or eliminate them.

  2. Change your relationship with necessary stressors: From a big-picture perspective, focusing on what’s most important (e.g. family, health, love) can take away the sense of urgency that drives most stress (mantra: I have enough time for what’s important). On a day-to-day level, consider whether there may be ways to make necessary tasks less stressful by bringing in an element of fun or joy (this is the basic premise of the book Feel Good Productivity). 

  3. Learn ways to better manage stress: There are many ways to better cope with stress that intersect with spirituality and mindfulness. On the spiritual side, going deeper into religion or spiritual practices can help build resilience and coping (for example It’s a Meaningful Life, It Just Takes Practice). Some books and courses focus more on mindfulness and other skills such as Mindfulness Based Stress Reduction (Full Catastrophe Living).

  4. Find ways to increase support for yourself: Kristin Neff’s practice of Self-Compassion can be a powerful tool for decreasing stress and increasing feelings of connection and grounding. Steve Magness gets at some of the same concepts from a different direction in Do Hard Things: Why we get resilience wrong and the surprising science of toughness where he argues that increasing support (including relaxation and sleep) will make it more likely for you to accomplish your tough goals than self-denial.

  5. Practice self-care in ways that work for you: Don’t let self-care and stress reduction stress you out. Follow your intuition to find ways to practice self-care that work for you. Some of this may include taking things out of your life rather than simply trying to add self-care tasks to an already overfilled plate.

1 opmerking

09 apr.

Great stuff, Benzi. Reading this, I am absolutely convinced that knowing and understanding both neuropalliative care and functional neurologic disorders is crucial for a successful and satisfying clinical practice of neurology.

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