Psychosomatic illness 5: how do you pick your symptoms?

What determines the type of psychosomatic symptoms a person experiences? Why is it that one person shows up with seizures, another with a numb leg, another with a paralyzed hand?

Personal life experience is a great molder of psychosomatic illness. People learn, probably in childhood or young adulthood, what sort of symptoms get people attention and care. In addition to genetics and environment, this is why certain families tend to be robust or to be sickly. One family's culture is to downplay sickness and keep a stiff upper lip; another family dwells on, analyzes and magnifies every twinge of pain, and gives the sick person a great deal of deference and respect. Children who experience the serious illness of a sibling or a parent are more likely to develop psychosomatic illness, and tend to develop symptoms similar to those of the physically ill relative. Parents pass on strategies that make life easier, whether that means embracing illness or turning to alcohol, drugs or food for comfort.

O'Sullivan says, Early exposure to chronic ill health can inadvertently encourage illness behavior and, as we have seen, shape how psychosomatic illness presents, with patients often suffering from symptoms they have come across before in others. The tendency to respond to every bodily sensation, rather than ignore them as the majority of us do, may be learned at a very young age. They are reacting to symptoms that others might dismiss, and these reactions serve to heighten the symptoms and awareness of them.

Psychosomatic illness 4: Why denial?

What does it look like (and feel like) when someone refuses to accept a diagnosis of psychosomatic illness?

Often, the person denies the possibility of psychosomatic illness, not just because they want to avoid lowering their status, but because they are consciously not aware of any of the stress or trauma that outside observers can identify in their lives. Psychosomatic symptoms are themselves evidence of denial.

Last year I got sick right after graduating from law school; another illness hit me a few weeks later, after my first triathlon. The second illness was pretty bad, and I had no choice but to spend weeks resting, physically and mentally, something I hardly ever do. No more studying or eating or going to the gym or leaving the house; even a visit to the art museum exhausted me. My husband suggested that law school, the triathlon, and studying for the bar might have stressed me out. Ridiculous, I said. Sure, *other* people might find those things difficult, but not me. Look at the statistics. What do I have to worry about?

This is common. When a person denies the possibility of psychosomatic illness, it may be because they fear lowering their status, but it may be because they are consciously not aware of any of the stress or trauma that outside observers can identify in their lives. Psychosomatic symptoms are themselves evidence of denial.

[Patients say] “I had the most wonderful life until I fell ill. I hardly ever had a reason to feel stress.” And I think, how could that be? I have not had a day in my life with no stress at all. In the absolute rejection of stress in these sufferers is there something for us to learn? Ask somebody with dissociative seizures how they feel, and you may get the answer “tired” or “cold”--neither answer containing anything of their emotional state. Perhaps those who deny stress do so because they do not feel stress, having converted it to something else.