Concerning the question: do psychosomatic disorders exist at all, there is great confusion. Even among specialists. Psychotherapist Denis Fedoryaka wrote a text especially for Zozhnik about how psyche and physiology are interconnected from the point of view of modern scientific thought.
The problem is mixing everything with everything: psychosomatic disorders, bodily reactions to stress, neuroses, bodily illnesses combined with mental ones … As if they are all one and the same. At the exit, nothing is clear, and most importantly, it is not clear what to do with it.
I will try to tell you in simple language about 6 different types of “ psychosomatics ”, but I cannot do without terminology.
Classic psychosomatic disorders
Describing them began under Freud, and the Hungarian-American physiotherapist and psychoanalyst Franz Alexander is considered the founder of the topic.
There are only 7 classic psychosomatic disorders:
- bronchial asthma,
- essential hypertension,
- rheumatoid arthritis,
- nonspecific ulcerative colitis,
- stomach ulcer.
The general essence is that the emotions and personality of the patient play a very important role in the development and exacerbation of the disease. That is, it is important to emphasize: it is imperative to be treated by a specialized doctor, and psychotherapy is necessarily connected for the purpose of prevention. Other diseases where psychology is proven to be present can sometimes be included in this category. For example, cancer or multiple sclerosis, in which the level of suppressed negative feelings is higher. But they are not included in the classics.
It should be remembered that in neurosis and in classical psychosomatic diseases, there is a fundamental difference in the interaction between the doctor and the patient.
With neurosis, a person has certain symptoms, goes from specialist to specialist, but they do not find anything. And as a result, they are sent to a psychotherapist, where the patient goes to hard labor, since there is no internal motive, only an external one is a symptom. Sometimes it comes with exaggerated expectation – “you are my last hope, doctor”.
The situation is different with the psychosomatic “classics”. A specialized doctor diagnoses the disease and prescribes treatment. But the effect is weak, unstable, there is no remission, constant exacerbations. This triggers emotional distress “on top” of it, about treatment failure – so called “ distress ”. If the doctor “remembers” that a psychotherapist is needed in working with psychosomatics , then he is lucky. But a psychotherapist still needs to be selected and reached, and patients of this kind are very reluctant to be included in ongoing psychotherapy.
Bronchial asthma: an example of the connection between illness and psyche
Patients with psychosomatics have a number of personality traits that determine exactly these symptoms. The asthmatics have their own, the “skin” – others, the “ulcer” – the third.
For example, let’s take bronchial asthma – such patients visit more often and have more intrinsic motivation for psychotherapy. These are people who are accustomed from childhood to suffering associated with breathing restriction. This state not only scares the fear of death during seizures, but also creates a feeling of control, isolation in the cage. Unsurprisingly, asthmatics have a very strong bond with an overprotective , controlling mom or sometimes dad. Emotions that are suppressed and not realized at the same time – anger, anger, aggression, irritation. After all, it is also important for asthmatics to “be correct, otherwise you can die”.
When working in a psychotherapeutic group, the classic situation is often observed: one of the more active, controlling participants begins to take power into their own hands. Indicates how to behave correctly, to apply hidden or open pressure. This behavior immediately begins to cause coughing, mild bronchospasm in the asthmatic , and if nothing is done, an attack may occur.
And this is how it happens in life – at home with loved ones, at work with bosses and employees. In the psychological group, we understand that this is how latent aggression and a feeling of “cage” and hopelessness are manifested . And we help an asthmatic person to sort out their feelings for a person, a situation. Then he learns to do it on his own, without leading to seizures.
Similar connections between the disease and the psyche can be traced in other diseases of the “classical” psychosomatic “seven”. Therefore, if you or your loved ones suffer from any of these ailments, it makes sense to involve a psychotherapist in the complex treatment.
Other types of psychosomatic disorders
In addition to these diseases, there are also whole types of psychosomatic disorders, which we will now designate.
Neurotic, somatoform , behavioral disorders
These are neuroses or their “neglected” forms – a violation of the system of personality relations. The manifestations can be different: for example, headaches or various sensations in the body. Here are eating disorders, sexual function. The main specialist here is a psychotherapist or clinical psychologist.
Mental reactions to physical illness
In this case, there is a real bodily illness to which a person can respond with hypochondria, or depression. For example, severe injuries after an accident or illness of internal organs.
This also includes iatrogenism – when the carelessness of a health worker leads to painful reactions. Reporting the wrong severe diagnosis, wrong treatment and the patient’s reactions to it. Psychotherapists, psychologists and psychiatrists are dealing with this issue.
Mental disorders with somatic manifestations
Here we are talking about severe disorders – schizophrenia with delirium or endogenous (biological) depression. Of course, the main specialist in such cases is a psychiatrist.
Somatogenic mental disorders
This refers to what provoked mental disorders directly. Most often – organic trauma, tumors and other brain damage. Or chronic, acute intoxication – psychosis in addicts, “delirium tremens” and others. In this case, a somatic disorder doctor (neurologist, neurosurgeon, endocrinologist, narcologist) works with the cause, and a psychiatrist helps with symptoms.
Physical illness, where mental disorder is a predisposing factor
This is less often determined by doctors – for example, a pressure sore, pneumonia in a schizophrenic, deep cuts and forearm injuries in a depressive suicide . And again, team work – the symptoms are treated by a specialized specialist (surgeon, therapist), and the psychiatrist deals with the predisposing factor.
A competent specialist will always determine which category the patient is in and suggest appropriate treatment steps. It is incorrect to treat only with psychotherapy, for example, rheumatoid arthritis – it requires extended measures. But neurosis is possible, and it is correct and proven.