Unspoken Emotional Distress and Its Role in Physical Illness

Uncertain times can turn our lives into a whirlwind of confusion. Imagine what that must be like for children or young adults entering college. School makes demands of kids, which we deny and, in our wish to believe it is a time of joy and wonder, we fail to look for the signs.

Test anxiety and bullying are only two of the challenges students must face to succeed. We’ve seen sufficient evidence of self-harm and suicidal thinking during exams or before graduation in college students.

The need for mental health services for students has never been greater. Even among preadolescents, there is a need for suicidal kids to receive help sooner. If school was unsettling and upsetting in terms of mental health services previously, now we see it has proven to be subjected to urgency by the pandemic. The need is there, but the resources are scarce.

But not all mental health issues are immediately apparent. The body, however, has a way of revealing mentally troubling aspects of life, and it’s in physical symptoms of our health. Effectively disguised, the unspoken torment of mental health distress can be “read” if we know where to look for it and permit ourselves to see the not-so-obvious symptoms. It’s not a new idea but one which is often missed.

Sifneos first suggested the concept of alexithymia, emotional dysfunction or inability to verbally express emotion disturbances, before 1980. The medical implications are now established and should be apparent to everyone in healthcare.

“Alexithymia is associated with heightened physiological arousal, the tendency to notice and report physical symptoms, and unhealthy compulsive behaviors. Alexithymic patients may respond poorly to psychological treatments, although perhaps not to cognitive-behavioral techniques, and it is unclear whether alexithymia can be improved through treatment.”

The difficulties of diagnosis and treatment have been outlined in the literature, but it is unclear how this information has been disseminated to staff. Although the idea of lack of available knowledge being utilized in medical settings may be disturbing, it is not unusual as experienced staff will understand.

What are some of the medical patient complaints associated with this “hidden” disorder? The literature tells us it’s multi-factorial and found in pain perception without obvious origins, cardiac outcomes in patients, illness perception in cancer patients, psoriasis self-management. fibromyalgia in adolescents, and chronic illness in the young, among others.

The question that begins to form regarding alexithymia is whether or not anyone has researched the state of the immune system in persons diagnosed with this psychological disorder. Currently, there is a scale to measure only alexithymia, but that’s a psychological measure, not a biological one.

We know that emotional stress affects the immune system leaving us prone to illness. If the physical illness is stress-related, doesn’t it seem reasonable to use multiple, different biological, psychological, and physical health measures along with cognitive-behavioral therapy? How can you treat one part of a person and neglect a contributing factor?

The theoretical perspective of PNI (psychoneuroimmunology) seems to have gotten lost over the past few decades, or are healthcare professionals still utilizing it in practice? In trying to become highly specialized, I believe that we have lost the ability to function in a more cohesive team approach to treatment.

In 2002, the American Psychological Association had great hopes for PNI; what happened? One paper in 2008 predicted an explosion of interest and research in the field. Again, what happened to PNI?

The body is still speaking to us when words fail us, but those who would be helpers/healers are still failing to see the forest for the trees. Of what use are new approaches that have promise and biological-backing if they are “interesting” but disregarded? PNI is one such instance, in my humble opinion.

Yes, some specialists will refer patients to psychotherapists, but where’s the immune system follow-up as therapy progresses? Wouldn’t it be interesting to see how the immune system responds to psychotherapy? Would this be too expensive and not covered by insurance because we haven’t helped the insurance regulators see the value?

Alexithymia is a fancy word that some say means the person is somatizing. I think that’s a patient put-down. It reminds me of Freud seeing women as suffering from hysteria caused by a wandering womb, not the real sexual assaults by men in their lives. Psychosomatic disorders are real disorders, possibly related to immune system dysfunction caused by stress, that needs treatment in more than one specialty.

A reassessment of patient care is in order if only one aspect of a person in need is receiving attention.