All in the mind?

Louise Atkinson has just written an interesting article on chronic back pain, which focuses on the controversial ideas of  physiotherapist Nick Sinfield. 1  Judging by many of the comments to the article, Sinfield has stirred up something of a hornets nest, because his basic argument is that not only does chronic back pain cause psychological problems, but, more radically, psychological problems are the root cause of the pain in the first place.  Basically, Sinfield is arguing that emotional tension is the most common cause of back pain.

Why would this be such a controversial idea?  Because most people still seem to find it difficult to grasp the idea that psychology can be a cause of physical symptoms, as opposed to the other way round.  Of course most people now accept that people with physical illnesses are likely to be depressed, especially if such illnesses are long term and/or terminal.  However, they have far more difficulty in accepting that perhaps some physical illnesses have a psychological basis.

Doctors have a name for such problems: medically unexplained symptoms or MUS for short.  Chronic fatigue syndrome, irritable bowl syndrome and even arthritis, according to some medical practitioners, all fit this criteria.  Probably every GP has stories about patients who time and time again present themselves at the surgery with all kinds of unexplained symptoms, and who get very offended if the GP should even hint that he or she thinks the problem is of psychological origin.   Chronic fatigue syndrome or ME is a case in point.  Despite years of research and attempts by ME support groups to argue the case that the cause of the condition is viral or has some other physical basis, as yet there is no evidence for this.

But the real question here is why do ME sufferers get so upset if a doctor or some other medical expert suggests that their condition is psychological?  There is no clear answer to this question.  However, it may be partly cultural: in Western societies in particular, there is a long tradition of splitting the mind from the body, and it is only the body that is seen as physical and therefore ‘real’.  The mind, on the other hand, is seen as being far more ethereal, elusive, not quite so ‘real’.  Furthermore, there is a widespread view in our culture that ‘physical’ equals ‘treatable’, whereas ‘psychological’ equals ‘possibly not treatable’.

It is also quite possible that many people fear that if their condition or illness has a psychological as opposed to physical origin then they must therefore be mentally ill in some way.   This may help explain the extraordinary lengths  some people go to seek physical treatments for what are patently psychological difficulties.  I once worked with a man who had had his bowls removed because he suffered from all kinds of physical symptoms.  However, after only a short time in engaging with this client in therapy and hearing about a history of abusive relationships, it became clear that his problems were psychological in origin rather than physical.

However, at this point I should point out that even if a person’s problems are psychological in origin, this does not mean for one moment that the physical symptoms are unreal.  On the contrary, they are very real.  Freud recognised this over a hundred years ago, and since then, psychoanalysts and psychotherapists regularly encounter such symptoms in the course of their work with clients.  However, it is often the case that the more the client talks about their problems, the more they tell their story, the less severe their physical symptoms become.  This suggests, apart from anything else, that mind and body, psyche and soma, are far more intimately related than many people might think…..

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