Carla came to see me a few years ago after four separate physicians had failed to help her.
When she shuffled into my examining room –the first appointment of my day– I could see right away she wasn’t well.
Stylish clothes hung loosely on her 5’11’ frame, suggesting she’d lost considerable weight, and she winced settling in her chair, as if the simple act of sitting pained her joints and muscles. I was struck by the stark contrast between her tall athletic body and her obvious weakness.
Carla’s grey-green eyes were tired and her pretty oval face, even with lots of makeup, looked weary and defeated. Her shoulders slumped as she spoke in a halting voice. “Please…forgive me if I wander. I can’t seem to hold a thought in my head long enough to speak it.”
I nodded, giving her time to collect herself. She went on.
“I can’t sleep, have no appetite and no energy for anything. My wrists and knees hurt.” She stopped there, burying her face in her hands as she wept very softly. There was something in the unnatural quiet of her sobs that made me think she’d been crying a lot lately. Thirty years of medical practice had taught me to remain somewhat detached with patients, but a deep sadness came over me as I observed her muted desperation.
A few quick questions established that Carla, a 38 year-old former college basketball star and sports marketing executive, had been diagnosed with Chronic Fatigue Syndrome (CSF) by four separate physicians a few months prior when test after test showed that “there was nothing physically wrong with her.” One of physicians told her that it might be in her head and she should see a psychiatrist.
She’d had normal X-Rays, CT scans, MRIs, blood work, urine and stool analysis.
And indeed, when I checked her vitals, listened to her lungs and heart, palpated her abdomen, looked in her pupils, mouth, throat and ears, examined her wrists and knees, then tested her reflexes, I too found nothing obvious.
I was prone to agree with her other doctors that the cluster of symptoms: persistent tiredness, trouble concentrating, sleep disturbances, aching joints, together with negative results on all other tests pointed to CFS.
But that was the only point of agreement with Carla’s other doctors. Unlike many physicians, I am not a big believer in “somatization”—the idea that some physical symptoms aren’t real, but “all in a patient’s head.” Emotional and behavioral problems do play a very important role in disease, but that doesn’t mean—by any stretch– that physical symptoms triggered by chronic stress, for example, aren’t real.
My heart went out to Carla because I felt she’d been doubly victimized: first by a truly awful disease, then by a series of doctors who had implied she wasn’t really sick.
After treating over ten thousand patients, in France, Africa, the Caribbean, China and the U.S. I knew a sick person when I saw one, and Carla was truly, physically ill.
A Stanford University study published just last month validates the intuition I had about Carla, showing that Chronic Fatigue Syndrome –now known as Myalgic encephalomyelitis (brain and spinal cord inflammation)–is indeed a real disease with 17 distinct blood markers called cytokines (signaling molecules that mediate and regulate immunity and inflammation such as interferon and interleukin) being elevated, 13 of which are pro-inflammatory.
Carla, it turns out, was suffering from an inflammatory brain and spinal cord disease every bit as tangible as other inflammatory ailments such as arthritis, colitis or psoriasis.
But knowing that a few years ago would not have changed the way I treated — and ultimately cured Carla.
When our body is suffering, from whatever cause, I believe it is telling our minds that something is wrong that we need to change. That “something wrong” could be as simple as sitting too long in a car while commuting, triggering back spasms. Or “something wrong” could be more complex, such as exposure to indoor pollutants at home that cause headaches and sinus congestion.
So I never dismiss physical symptoms, but rather acknowledge them by giving the suffering body a voice to tell me—and my patient—what is bothering it and why. The why is important because it holds the key to finding a cure.
I ask the question: “If your body had a voice, what would it say?”
It is easy to ask the question: “If your stomach had a voice, what would it say?” People say: “I feel too full” or “I feel empty” or “I ate too much fatty food” or “I feel like I ate too many sweets…”
In Carla’s case, her body said: “I feel very weak. I cannot do much at a time. I need to pace myself and rest every half an hour.” Then it added: “ Life is difficult and boring. I miss my old job. It was easy and fun”
That was the why that ultimately allowed me to find a solution to her problem.
By giving her body a voice, it wasn’t Carla I asked, it was her body. Gestalt therapists learned decades ago that displacing our identities from “me” to any entity that is “not me” gets around our psychological defenses, tapping into deeply buried feelings that would otherwise stay bottled up. It was less threatening for Carla, to talk as her body, than as herself.
I also always ask what happened in the patient’s private and professional life just before the symptoms started.
In Carla’s case, I discovered that a few months before her Chronic Fatigue Syndrome started, she got promoted from a simple selling and marketing job to a high responsibility VP job. Even though she was making much more money at being a VP, she hated her new responsibilities, the immersion in administrative drudgery, having to settle office disputes and the stress that came with it. This was an enormous burden for her and soon after she got promoted, she got some kind of virus with a fever and sore throat. She recovered from this probable virus infection but soon after the chronic fatigue started.
The double whammy, replacing work she loved with work she hated, created severe, chronic stress.
We now know, from research at Kaiser and elsewhere, that severe stress like Carla’s is the root cause of 80% of physical symptoms that drive patients to primary care doctors.
The reason, as shown by recent studies at Carnegie Mellon and elsewhere, is that stress triggers the release of hormones such as cortisol that, in excessive amounts, weaken the immune system, making it more susceptible to infection and less able to repair itself, sometimes triggering inflammatory disease by hampering our body’s ability to stop the immune system from attacking healthy tissue…such as Carla’s brain and spinal cord. Indeed, Dr. Stojanovich and colleagues at Kosa University Medical Center discovered that 80% of patients with autoimmune inflammatory disorders had experienced acute of chronic stress shortly before onset of their symptoms. And often, relieving the stress, relieves the inflammatory symptoms and allows the body to heal.
With Carla’s CFS, that was certainly the case. After a few sessions with me, Carla asked her CEO to let her go back to sales and marketing part-time. She paced herself at the beginning, resting every half-hour like her body had requested but little by little, she was able to work longer between resting periods. Now, she is back to full time work selling and marketing and feels good, enjoying her work.
That’s why it’s vitally important to listen to our bodies and the way to do this is to tune in and give our bodies a voice.
Carla’s body knew all along what neither Carla herself nor four of her doctors knew.
Curing her simply required tapping into her body’s own wisdom.
So here’s a question for you: What important secrets to your health does your body know that you (and your doctors) don’t?
Montoya, J et al Cytokine signature associated with disease severity in chronic fatigue syndrome patients, 2017, PNAS Vol 114, no. 34,
Cummings, N.A. and VandenBos, G.R., “The Twenty Years Kaiser-Permanente Experience with Psychotherapy and Medical Utilization: Implications for NationalHealth Policy and National Health Insurance.” Health Policy Q. 1981
Stojanovich, L. et al. Stress as a trigger of autoimmune disease. Autoimmun Rev. 2008 Jan;7(3):209-13.
Sheldon Cohen, Denise Janicki-Deverts, William J. Doyle, Gregory E. Miller, Ellen Frank, Bruce S. Rabin, and Ronald B. Turner. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. PNAS, April 2, 2012 DOI: 10.1073/pnas.1118355109
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