What are we so afraid of? Why does being told ‘it’s all in your head’ fill us with terror and completely write off any sense of being validated as a patient in need of help?
My view is that it’s all about the stigma of mental illness. Somehow we’ve interpreted the message ‘it’s all in your head’ to mean ‘it’s not real’. And we’ve done that for very good reasons.
I recently read an article about some work being done in understanding Gulf War Syndrome, which has many symptoms similar to fibromyalgia. They have found that there is clear evidence of brain damage in sufferers, and one of the hopes is that in developing a test (a fMRI) to diagnosis the illness, it will lead onto the more accurate diagnosis of Fibro and Chronic Fatigue Syndrome.
Here’s a quote from that article:
“Many veterans have had difficulties getting benefits and treatment for a service-connected condition because doctors assumed they were either faking it or suffering from post-traumatic stress. “That’s a problem with all physicians — VA, military or civilian,” Baraniuk said. “If it doesn’t fall within their small world of known diseases, then the patient is nuts.”
It’s actually the same with Fibro (and I assume, Chronic Fatigue Syndrome), that patients are sometimes thought to be faking their symptoms, or somehow worse still, thought to be psychologically based… and therefore assumed to be somehow not real.
Maybe I have an advantage because I have both mental illnesses and physical illnesses. I haven’t seen it as an advantage until now but it must be because I know that mental illnesses are real. That means that I also know that if a doctor sees fit to tell me my physical illness is psychologically based, then I know that their opinion doesn’t remove my symptoms, and therefore my suffering, being real.
My Borderline Personality Disorder (BPD) is real. The Anorexia I struggled with for years was real. The Depression was real. The Post Traumatic Stress Disorder (PTSD) was even real.
They were also ‘all in my head’. They were all psychologically based, although some of them also affected me physically too. No one could realistically deny that I was suffering, or that I needed real help to either fight, or manage these conditions.
To add to that, there were very real physical consequences to some of those illnesses. For example, it is difficult not to accept that Anorexia, as well as being a mental illness, has profound effects on the body which need to be medically treated. The fact that it is a mental illness does not take away the doctor’s need to treat the patient medically.
If those conditions that I have had or currently still live with, can be identified as psychological but still be treated, then does it really matter whether my fibro is seen as a psychological or a physical illness? Personally, I don’t think so. The symptoms are still there, as is my suffering. Is it ‘all in my head’, or in some other part of my body? In terms of how it is treated there maybe a considerable difference, but there isn’t a difference in terms of my very real need for help.
My opinion is that the problem with issues addressed by the quote above does not lie with the veterans who are suffering. The problem is with the medical professional who deem it fit to view that something isn’t real if it is psychological. Either way the patients with symptoms need help, but it seems too easy for doctors to cast someone aside because their symptoms are from a particular basis.
Even if the doctor wishes to put symptoms down to ‘attention seeking’, my view is that there is still a need for that person to be treated. Maybe treated differently, but the person still needs help. Right now it seems that a seeming psychological cause, let alone fake, is simply dismissed often. That is so wrong.
I actually had a similar issue to this problem a few weeks back with the medical specialist who monitors the auto-immune condition I have called Graves’ Disease. Graves’ Disease affects a number of parts of the body but primarily the thyroid gland, leading to hyperthyroidism and eventually something called thyrotoxicosis (when levels get toxic and life threatening).
My endocrinologist examined my blood results which indicated that my thyroid levels are currently in a safe range. The problem for me (and I’d like to think it had been for her too) is that sitting in front of her, I had many of the symptoms of thyrotoxicosis. I can tell you that those symptoms were not pleasant and I was hoping that she would help me to address some of them. I could accept that the blood tests suggested I wasn’t dying, but I was definitely suffering.
Interestingly she was seemingly interested in helping me to alleviate the symptoms until she went to check my case with her supervisor. Then she came back and told me that because the blood results were fine, there was nothing that needed to be done. I was shown the door, and actually later I found she had then formally discharged from the Thyroid specialist service I had been under for several years.
My point is that I was still suffering, but she wasn’t interested. There’s something wrong when doctors dismiss patients when there is clear evidence of suffering. Just like the Gulf War veterans. There is suffering, and whether it is faked, ‘all in the head’, Post-Traumatic stress, or clear sign of physical brain damage (as the fMRI will detect)… there is a patient who is suffering, who has lost quality of life… and needs help.
I think it’s sad that the general view is that if something is ‘all in your head’ that somehow the pain and suffering is not real and does not need treatment. Somehow we need to move away from that view because while it remains, it increases the stigma of mental illness because that too, is seen as not real. It also increases the likelihood that people won’t seek help when they need it.
But as well as the general population view on this, I am convinced that it is medical professionals that need to lead the way in change. What they have in front of them is a patient who needs help. That’s actually what matters.
PS. There is evidence that the situation with my Graves’ Disease is actually quite common, where the blood results indicate everything is ‘normal’ but the patient reports a very different reality in terms of symptoms. I’m not aware of a substantiated reason for this though. Unfortunately many health professionals choose to deny the existence of such an anomaly and so patients end up going without the help they may need.
“Each patient carries his own doctor inside him.”
― Norman Cousins, Anatomy Of An Illness
“A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own.”
Auden, W. H.