By Lewis Mehl-Madrona, MD, a member of Dr Craig’s THE HEALERS campaign advisory team
Mind and body are inexplicably linked. I suppose it is an artifact of the linearity of language and the way the use of language conditions our perception that we come to believe that body is somehow separate from the other aspects of our selves. I have an example. I came to have the opportunity to interview a woman who had defied medical diagnosis and continued to suffer. Her story is common. Many people feel poorly and defy diagnosis. Our medicalized system of beliefs (or stories) fail to match the stories people tell about their suffering. Pattern recognition by doctors just doesn’t occur.
Sandra had some confusing lab results as is often enough the case. Most of her laboratory studies, however, were normal. Her free T4 (a thyroid hormone) was low, though her total T4 levels and her TSH levels (thyroid stimulating hormone, which is high when the thyroid is not responding to the signals sent by the pituitary and very low when the thyroid is overactive) were normal. Her sedimentation rate (a measure of inflammation as it affects the red blood cells — literally, how rapidly they settle to the bottom of a jar) was just slightly elevated, as was her platelet count (which is also seen in states of inflammation). Platelets are the small cells in the blood that facilitate clotting when we are cut. Her hematocrit (the percentage of red blood cells in a cubic centimeter of blood) was also minimally low. Hormonal studies showed a slightly low estradiol (an estrogen) but normal progesterone, estrogen to progesterone ratio, testosterone, and dihydroepiandosterone (DHEA). These are molecules that reflect the functioning of the pituitary through the reproductive system and the adrenal glands. Her night cortisol was slightly elevated, evidence of perhaps some stress and increased adrenal activity.
Sandra’s symptoms were varied, from vaginal dryness to a feeling of being severely stressed. She believed she was sensitive to chemicals (which are, of course, everywhere). Extra ovarian follicles (which release eggs to be fertilized) had been found along with irritation of the duodenum, the first part of her small intestine. Conventional medicine had offered her the usual medications to calm the intestine, which are called protein pump inhibitors. Seeing nothing else they could treat, they had offered her fluoxetine (originally marketed as Prozac) and had referred her to a psychiatrist, which had incensed her to no end. She believed all the doctors she had seen were incompetent to not discover what was wrong with her.
Sandra had been seeing an acupuncturist for the past 8 months, believing that this treatment had improved her canker sores, but little else. She had also taken probiotics, which are tablets full of the healthy bacteria that line our intestinal walls. She had added the help of a reflexologist (person who treats the body by massaging the feet) who wanted to heal her stomach first and then her reproductive organs. The Chinese Medicine doctor gave her herbs for her menstrual periods which didn’t help and gave her stomach pain. A nutritionist then altered her diet to eliminate all sugar, pork, spice, sauces, dairy, soy, and wheat, which also didn’t help. Recently she had begun eating dairy and bread again and was no worse for the wear. She had even gained some needed weight as she was too thin even by body mass index standards. By the time I saw her, stomach pain was coming and going. The last few weeks of eating more rich food had bloated and constipated her, increasing her stomach area discomfort.
Eighteen months previously a podiatrist had operated on her foot for pain there which the reflexologist blamed for the stomach and small intestinal symptoms, since the surgery was in that area of the foot. The reflexologist associated pain in her heel with the problems in her reproductive organs. However, Sandra couldn’t tell if reflexology was changing anything. She had also taken Yaz and Accutane, on which any number of her symptoms could be blamed. Sandra graded her Chinese Medicine doctor as having earned a solid “B”. No one else had earned a grade higher than a “C” and conventional medicine was a dismal “F”. She was also taking a variety of supplements. What should she do?
Sandra was an enigma to her health care providers. I asked her about the quality of her life over the past three years. “I’m so stressed,” she said. “I’m so full of worry. I’m so high-strung. I worry all the time.” I learned that she was a highly successful optometrist who was opening practices and employing other optometrists to run them all around the city. The more successful her business became, the worse her symptoms were. Then I asked Sandra is we could invite her husband to a meeting to help us with the inquiry into her symptoms. She agreed and he came to our next meeting.
Daniel was a tall, handsome, muscular man. He confidently sat in the chair next to Sandra. Compared to her nervousness, his self-assurance and comfort was even more extraordinary. I asked Daniel what sense he made of Sandra’s illness. “It’s stress,” he said. “She stresses herself over nothing. She worries continually and incessantly about the business, though it’s never been better.” Daniel, it turned out, was an accountant, who carefully administered the financial aspects of the business. He ran the numbers and was confident in how well the numbers were working. Sandra, on the other hand, was forever worrying about what could go wrong with the business. Success, in one sense, had “gone to her head”. When she had nothing, she worried about nothing. The more she had, the more worries there were. Buddha, of course, told a story about this probably more than once, but the one I remember came on a lovely summer day in which he and his disciples were lounging in the shade beside a brook while a farmer frantically ran up and down the road looking for his lost cows. The monks had not seen his cows and knew not which way they had gone, so could not help. Over the course of the month they remained in that place, the farmer lost his cows several times. Finally, Buddha couldn’t help but notice that cows were perhaps not a good thing to have.
In my story about the world, Daniel was probably accurate since our loved ones usually know us pretty well. Excessive worry through the body’s stress mechanisms produces inflammation, which is associated with dysfunction in just about every organ system from the ovaries to the adrenals to the bone marrow to the stomach to the heart. Pro-inflammatory molecules make us feel like we do when we have the flu but without the sneezing. They make us more allergically reactive. Stress and worry makes us tense which can lead to injuries. I explained this theory to a skeptical Sandra and an enthusiastic Daniel. Perhaps Sandra didn’t need yet more medical tests and procedures which are in themselves stress-provoking. Perhaps, for the first time really in her life, she needed to learn how to be still. She needed to learn to relax. She needed to learn how to turn her attention away from all the possible negative outcomes and dwell on some of the very real positive outcomes or even to think about no outcome at all. The Harvard psychologist William James wrote that the one thing we can control about our brains is where we direct our attention. Sandra might need to learn how to direct her attention differently.
What medicine does is primarily treat the end product of the inflammation with symptom suppressors rather than look to the source of the inflammation, which in this case, appeared to be excessive worry brought on by too much success! Of course it’s confusing when we look at the body as if each part were totally separate. We look at nouns instead of verbs, organs instead of processes. When we think of process, we think of inflammation affecting multiple organs in a variety of ways that are as individual as the person herself.
The hard sell is to convince people that their bodies respond to the events of their lives. We have been trained that an impenetrable wall separates body from life. So long as we believe this, our symptoms are mysterious and undiagnosable.
As Sandra learned to worry less, her symptoms lessened. Eventually she was much more comfortable in both her body and her life. Diagnosis no longer mattered to her for she had an explanatory story that worked, that gave her a path to follow to feel better, and that had support in science, though not perhaps as much in culture.