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The somatization of mental illness - how your thoughts can cause you physical pain

There is nothing worse than going to the doctor, they ask question after question, run test after test, and not be able to find any cause for your ailments. Worse yet is when they tell you,

"it's all in your head"

This response used to send me through the wall, not as a patient getting a lack of answers myself, but as a doctor hearing my own patients get this response from their other doctors. To me it just means this particular doctor isn't looking hard enough, they do not understand the person in front of them and their complaints well enough. They do not understand chronic conditions and how to treat them.

Chronic conditions are not like acute conditions. Acute conditions usually come on rapidly and have a clear symptomatology which makes diagnosis and treatment pretty straightforward. But chronic conditions do not play by these rules. They develop so insidiously that their symptoms are vague, complex, contrasting, dissimilar from person to person, and may not even be noticed for years after onset.

Diagnosis is difficult and standard lab tests are unhelpful.

Typically, a series of different drugs and procedures are trialled to hopefully change the symptom presentation enough to make a diagnosis. So you essentially become an experiment with little hope in sight and a barrage of side effects from all those medications.

The worst part about chronic conditions, such as pain, is that even the best lab tests and imaging devices available may not be able to identify the source of your pain, because *sigh* it's all in your head.


The human body is a physical, biochemical, and mental/emotional entity. Any ailment is either the imbalance of one, two, or all three of these. Physical and biochemical problems can usually be detected by laboratory test and imaging but mental/emotional distress cannot be detected in the same ways. It cannot be seen or tested for and, therefore, is often forgotten about and dismissed as an actual source of disease.

But the mind is the most powerful component of the human body. It has full control over the entire body. It can put all the wheels in motion to help your body heal itself, or it can be the source of great pain.

Just like your physical and biochemical bodies, your emotional body wants to be free of harm. But you can't help it, there are just way more things out there that can affect our mental/emotional health than our physical or biochemical health. Your mind takes the brunt of the entire world if you subject it to it. We are lucky enough to not let everything we see and hear effect us, but not everything escapes us. The stresses of life are inescapable and build up over time. They are not always perceivable, but just because we don't perceive them doesn't mean they aren't there, slowly building up ready to cause severe damage. The imperceptible stresses are even more dangerous because they live in our subconscious.

When something goes awry with our physical or biochemical body we get signs and symptoms; an alert that something is wrong and clues as to what it could be. For a lot of people and conditions, this is pain. The pain tells us where the damage is occurring and what things (like movements) are causing damage. Despite our body not being able to speak to us in plain English, we get the message that pretty clearly that something is wrong and that we need to do something about it.

But what happens when the problem is not physical or biochemical, but rather mental/emotional? Our brains still try to communicate the issue to us but does an even poorer job at it. Thoughts and feelings are vague, confusing, and easily ignorable. But just like a sprained ankle needs to heal, so do your ill thoughts. They need to be processed and treated too. But holy moly are we bad at this!

It is super easy to suppress emotions because they are an inconvenience and surely can't harm us like physical injuries do. So we stuff them away and continue on with our day because we have deadlines and more important things to worry about. But they don't go away, they go to the subconscious where they build over time and the longer you ignore them the more they want to be addressed. They tried to get your attention by resurfacing from time to time but you kept repressing them. Shoving them back into the dark pits of your subconscious. This goes on for weeks, months, even years.

Enough is enough. Your ill thoughts are done being ignored, they need to be dealt with, your brain begs of you to address them. So your brain pulls out its final weapon, the somatization of mental illness.

The somatization of mental illness is when your brain starts to turn your thoughts into physical symptoms, usually pain. If you ignore your broken arm long enough the pain is going to get worse, not just because more damage is being done but because your body wants you to pay more attention to what is wrong. That's what pain is, a message from your brain that something is wrong and that you need to fix it. It is uncomfortable for a reason, to get you to address the issue faster!

We respect physical pain because it hurts! We don't want to live with pain and we will usually do whatever it takes to get out of pain. Once you ignore your mental/emotional health long enough your brain has no option but to resort to more extreme measures. Your brain will start to produce physical pain despite there being no physical or biochemical abnormality. Yes this is real! Your brain has to get your attention somehow and the more you ignore it the worse the pain will get, and if you ignore the pain long enough it will chose other symptoms to manifest in order to get your attention.

The pain and other symptoms are often very non descriptive and cause confusion for you and your doctor. Your low back hurts but you have no testable inflammation nor any structural deformities that can explain your pain. Therefore, the pain meds, steroids, and muscle relaxers don't work because the pain isn't physical or biochemical.

Yet, nobody thinks to look elsewhere because the pain is so obviously coming from your low back.

Somatization of mental illness pain can either be the cause of your chronic pain all along or it can be what is perpetuating your pain and preventing any treatment from working. It can be the manifestation or a single event, like losing a loved one, or it can be the culmination of years of small repressed feelings like the everyday stresses of life. Regardless, until they get addressed, they won't stop causing you pain, no matter what you do.

So yes, sometimes your pain can be all in your head.

Knowing this is the first step, but treating it can be very difficult because these thoughts live in your subconscious mind. The subconscious mind is slow, deliberate, and not quick to accept new ideas and to change. It is a confusing place and this is where chronic pain lives. So it is best to find a chronic pain specialist who understands the subconscious mind and its interplay with the physical and biochemical bodies.

Chronic pain is incredibly complex because it involves the entire body. This lack of understanding is why there are such poor outcomes for chronic pain sufferers, but it doesn't mean there isn't hope. You just need a treatment plan that addresses all of YOU!

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