Dr. Inessa Grigorova is a psychotherapist, leading researcher at the Belarusian Scientific Department of Mental He alth. It has conducted long-term research that shows that many people who need professional help are afraid to seek it. As a result, the psychosomatic illness progresses, and their quality of life drastically deteriorates. In this interview, she shares why sometimes the disease seems to cling to the person and does not want to leave, how the body is connected to the psyche, and why after many years of qualified medical care, such patients cannot recover
Dr. Grigorova, are there many patients today with psychosomatic diseases?
- According to the World He alth Organization, about 38-40% of patients who visit a therapist suffer from psychosomatic illnesses.
How do you determine that this is a psychosomatic illness and not something else?
- First, from the patient's account. He begins his story with the fact that he was treated for a long time, maybe six months, a year, two… and no treatment worked. He goes to one, second, third therapist, they do tests on him, and some symptoms do not fit into the traditional symptomatology of the disease. The doctor prescribes him medication according to the protocol, everything is as it should be. He leaves and seems to feel better. After some time he returns with the same complaints.
Which diseases can most often be psychosomatic?
- The so-called Chicago Seven of such diseases. It includes hypertension, asthma, peptic ulcer, ulcerative colitis, atopic dermatitis, coronary heart disease, thyrotoxicosis (syndrome associated with excessive production of thyroid hormones). Now, other diseases that are related to psychosomatic disorders have been added to this week. These are: allergy, bulimia, anorexia and even oncological processes. Such a phenomenon as psycho-oncology already exists.
What can the therapist do if he sees that the patient has been suffering from hypertension for six months, his blood pressure does not drop, and at the same time the tests are good?
- Should be sent to a psychotherapist. There are special questionnaires and scales that patients can fill out even with the therapist. For example, in the hads (anxiety and depression) scale, there are 14 statements. Seven to identify anxiety and seven to identify depression. The patient can do it in just two minutes, and the doctor will need a minute and a half to interpret the patient's answers and tell if he has anxiety and depression.
Could you give examples from your practice when patients with psychosomatic diseases sought you out?
- It is easier to tell which patients do not have psychosomatic illnesses. My doctoral work was related to the psychotherapy of patients who had thyroid cancer. Today they say that this disease can also be psychosomatic. The thyroid gland is the number one organ that responds to stress. It is like a "shield". If she has coped with the stress, an adaptive response is activated in the person and he tolerates it lightly. If not, then chronic stress builds up in that area. Organ function is impaired.
It happens that people come who have chronic pain behavior: when the pain in the person has become a secondary benefit.
How does this manifest?
- With the help of pain, one avoids responsibility. When he starts to get sick, he gets more attention. He fixed this and memorized it.
Actually, doesn't anything hurt him?
- He feels pain. Hypochondriacs say that something hurts them, but in reality they don't have anything. In cases of chronic pain behavior, for example, the person comes to me and says they've had headaches for several years. I ask him when this pain occurs and if it is related to stress loads. He says he isn't, he wakes up in the morning with a headache. Research shows no problems with this
Then it turns out that once, when they had a meeting in a stuffy room, he was reprimanded in front of everyone, and this information became psychotraumatic for him and he started to have a headache. And this headache has fixed.
For two years?
- Yes. Every time someone expresses displeasure with this person, his head starts to hurt. Negative information is associated with headaches.
Because of him, he no longer goes to the meetings, his colleagues then tell him what happened there. He himself, without realizing it, uses the headache to manipulate other people in order to get the necessary information.
It happens that people come who, when I help them deal with the pain, remain dissatisfied. I had a patient with eczema on her hands for ten years. At home, she cleaned with gloves, but more often it was the duty of her husband and children.
After several sessions of acupuncture and psychotherapy, her hands cleared up. I tell her, "That's great!" And she replied that her hands have healed, but now she will have to stay at home to clean and cook. Then I realized that this is chronic pain behavior where the pain is a secondary benefit.
Is it true that all diseases are caused by nerves?
- Everything is interconnected in the body. You hit your finger and you hear it in your brain, it hurts everywhere. The holistic approach in psychotherapy speaks of wholeness. Now there is even a new direction - biopsychosocial approach. That's how everything with us is like a whole.
And, of course, all diseases are related to mental processes, and they are also reflected in some reactions of the body.
Do hypochondriacs often come with psychosomatic illnesses?
- Hypochondrial disorders are not so common - 1% of all patients. Hypochondriacs are convinced that everything hurts and even diagnose themselves. But instrumental methods do not confirm it. In such patients, we try to understand what is behind this constant desire to be sick. Most often, these are people who have not been given much attention in the family. That's why they come to the doctors. And they will pay attention to them according to protocol, they will examine them.
How common is psychosomatic infertility?
- There is such a concept as psychosomatic sterility. When women with infertility come to me, in almost 100% of cases we find issues that need to be solved psychotherapeutically. It could be the fear of changes in the body, of giving birth… I had a patient whose mother had died in childbirth, and she told me that she had killed her mother. The feeling of guilt blocks everything and the girl cannot get pregnant.
Sometimes girls try to get pregnant and fail because they don't want to have children. This is what society or her husband wants from her. Maternal maturity is lacking. There are moments of partner incompatibility.
For women who come with infertility, we do a cartogram. They put dots on a piece of paper where they want the husband, mother, grandmother and child they plan to have to be. In most of them, it turns out that the child ends up in a place where he is the enemy of this woman, and therefore she does not want to give birth to him.
Sometimes the children in the cartogram turn out to be in the woman's past. And if they are in the past, then how to give birth to it? The girl sees that what is happening in her life is a psychological attitude, and we start with the help of psychotherapy to solve her problem. And after a while, pregnancy comes.
How severe does stress or trauma have to be to cause a psychosomatic illness?
- The death of a husband or wife, divorce, separation, prison, dismissal from work, death of loved ones, accidents, illnesses are considered the strongest psychotraumas. If a person has had several of these events in the past year, then a psychosomatic disorder is most likely to develop.
But there are also cases in which the development of psychosomatic illness is influenced by chronic stress. When something has dripped every day and the last drop has overflowed the cup, psychosomatics is started.