Persistent stress symptoms are those set of symptoms that will not go away, as in chronic depression, or if they do, they return, as in panic attacks and headache attacks. By the time the symptoms have become persistent, the hidden mind/soda bottle is full and the balloon/mind is totally inflated or has popped. There are basically four types of persistent stress symptoms. All stress-related disorders have all four of these set of stress symptoms, but in different permutation and combinations, and to different degree. Here is a partial list of persistent stress symptoms:

1. Physical Symptoms (without any physical findings):
   1. Pain somewhere in the body: Headache attacks, chest pain, stomach pain, muscle and joint pains, back pain, or pain anywhere else for which doctors can not find a cause. When the patient suffers persistent physical pain for which no physical cause has been found, it is invariably rooted in unexpressed emotional pain caused by one or more serious bad event in the past. Without any exception, the patient’s focus on physical pain is so great that they have absolutely no clue about their past emotional pain. Longer the patient has suffered the pain, harder it is to help them through psychological insight. In most of these patients, the emotional pain is buried very deep. In some of these patients, the physical pain serves the purpose of keeping their mind off of their emotional pain. In some others, the pain serves them well in getting attention, sympathy, money or disability payments.

      The sooner these people get help after the onset of pain, quicker the results. However, due to ignorance about mind-body connection; prejudice against and stigma of mental disorders, and close-minded attitude, many of these patients do not seek counseling in time. Instead they go on medical wild goose chase; get addicted to pain medications; become disillusioned and depressed; and finally they become disabled.

      Here is an example of timely intervention that helped. A 38 year old white married woman was admitted to the hospital for severe pain of one week’s duration on the lower right side of her chest. In spite of repeated pain shots over two hours, she kept doubling up with pain in bed. She screamed and yelled uncontrollably until psychiatric help was sought. During the interview I found out that the patient’s father had died a week earlier in the same hospital from abscess of lung. She had witnessed his suffering helplessly. She had been very upset over the sight of a big tube sticking out from his chest which apparently caused him a great deal of pain. Now she was experiencing the same type of pain in the same area of her chest. Clearly, she had dealt with his loss by identifying with his suffering and pain. Once she broke down and sobbed over the whole painful episode, her balloon shrank, her pain went away and she went home the same day.

      Here is a more complicated story. A 56 year old white widow, mother of two grown-up boys, was referred to me by her frustrated doctor for unremitting, severe pain in the right upper abdomen, the liver area. The pain started suddenly about three years earlier. Unable to tolerate it, initially she tried high doses of addictive pain medications. When pain medications did not help, she saw many specialists. Liver biopsy came back normal. A surgeon opened-up her abdomen and found nothing to explain the pain in the region of the liver. Following recovery, she underwent another surgery to cut the nerve supply to that part of the body. When this also failed to control her excruciating pain, she went to Mayo Clinic. There she underwent surgery on her spinal cord to cut off nerve fibers that carried pain message from her abdomen to the brain. This did not diminish her pain even a bit. She saw a psychiatrist there who gave her a diagnosis of “pain disorder” which stands for stress-related pain. However, being a drug-treatment-oriented doctor, he did not bother to get a detailed history on her.

      In the interview I obtained the following information: Twenty five years earlier, her husband was diagnosed as suffering from terminal cancer of the liver. He was sent home with a lot of pain medication. However, pain medications did not help. He screamed and yelled in pain day in and day out, so much so, unable to tolerate his suffering, she locked him up in a room. She protected her two boys from this trauma by stuffing their ears with cotton plugs. She quietly buried all her pain in her hidden mind. After her husband’s death, she moved on with her life and raised her two boys.

      The day before her pain in the right upper abdomen started, she got a phone call from a hospital in the neighboring county that her 30 year old son was in the hospital with broken leg following a major motorcycle accident. When she rushed to the hospital to see him, he was in bed with his leg dangling in the air held up by a rope over a pulley. He was screaming in pain at the top of his voice. Painful memory of her husband’s screams from pain 22 years earlier must have suddenly resurfaced in her mind. That night she became very agitated and she slept little. By next day she was in great pain over the liver area of the abdomen.

      At the end of the interview with me, the patient wanted to know what I had found out. When I explained to her how she had buried her emotions related to her husband’s pain and suffering, and how her son’s accident had brought up old emotional pain in the form of abdominal pain, she let out a deep sigh, became tearful and fell silent for a while. She appeared somewhat stunned by this insight. Then, regrouping her denial once again, she said, “I don’t see how this could be.

      How could my mind cause me to have severe pain like this?” My explaining to her about the mind-body connection made no impression on her. It dawned on me that this sudden insight was a little too much for her to accept since she had already invested so much of time, money, effort and suffering in search of a physical cause. Admitting to a psychological reason for her pain would mean losing face with everyone around her. She declined to make another appointment with me saying she did not think counseling would help. However, she never bothered her doctor for pain medications again either. I have seen hundreds of cases like this.

      Careful evaluation of recurrent headache attack victims, whether they are cluster headache sufferers or migraine headache sufferers, would reveal that they never expressed their emotional pain by shedding tears in response to one or more very painful events in the remote or even recent past. In other words, when their body was trying to lower blood pressure in the head by shedding tears, the patients fought back and held back their tears, and refused to let nature take its course. Now, even a small painful event severely dilates blood vessels to the head and brings on increased blood flow to it as if the frustrated body is trying to get rid of the unshed tears. Almost all these patients have such deep emotional investment in keeping their headaches “physical” and not “mental” that it is practically useless to convince them otherwise. They are constantly in search of a new medication that would help their headaches. Therapy to dig into their past and develop insight is not for them. You will hear statements such as, “Nothing ever stressed me. Now headaches come on whenever the weather changes. It is worse during allergy season.” Or some such statement which indicates that the patient has no clue about what is inside his/her head.

      As we studied earlier, the stoic patients who complain of diffuse aches and pains associated with localized pain spots (“trigger points”) are labeled as suffering from fibromyalgia. These people, too, have a strong need to medicalize this problem.

   2. Dysfunction related to various body organs: Heart: Rapid heart beat, skipped heart beat, elevated blood pressure, low blood pressure, fainting.

      Lungs: Rapid breathing, fullness in the chest, deep breathing, difficulty breathing, sighing. Gastrointestinal tract: Stomach knot, nausea, vomiting, diarrhea, gas in the stomach, heart burn, belching. Muscles: Twitching, pain, aches, trembling, shaking, spasms, paralysis. Skin: Sweating, hot flashes, skin blotches, hives, redness, warmth, chills, itching, pain, goose bumps, numbness, tingling, burning. Eye: Blurred vision, watery eyes, tearfulness, redness of the eye, itching, blindness. Bladder: Sudden incontinence, frequent urination, burning while urinating. Ear: Vertigo; deafness. Throat: Choking, difficulty in swallowing, dryness.

      These organ-related symptoms are often part of anxiety disorder such as panic disorder, even though they can occur with depressive disorder and other “somatization” disorder also. In panic disorder, one suffers from episodes of severe symptoms related to one or more of body organs such as noted above when one’s balloon pops. Depending upon the organ involved, the patient suspects a serious illness related to that organ: heart attack; stroke; gall bladder attack; low blood sugar; brain tumor and the like, and goes on medical wild goose chase.

      Then there are patients who complain of one specific symptom such as hearing loss, blindness, choking of the throat and the like. However, careful exploration reveals that the patient has focused on just one most distressing symptom at the exclusion of others. We will study later how these symptoms play the role of communicating with others how one feels inside his mind.

   3. General body symptoms: Tiredness, weakness, exhaustion, fatigue, sleepiness, sleeplessness, malaise, “not feeling good.” Patients who focus on these symptoms alone, and do not admit to other symptoms, are often given the diagnosis of “chronic fatigue syndrome.” Invariably, these patients have other stress symptoms as well, but they would not admit to it.

2. Emotional Symptoms: Profound sadness, anger, hurt, frustration, hopelessness, helplessness, loss of interest, feelings of gloom and doom, despair, guilt, anxiety, apprehension nervousness, tension, panic attacks, elation, ecstasy, etc.

   When sadness, gloom, despair, hopelessness, helplessness, guilt, etc. dominate the patient’s mood, a diagnosis of depression is made. Highly elated mood, ecstasy, unrealistic hopefulness, etc. are often considered as signs of bipolar disorder, either manic or hypomanic state. When symptoms such as apprehension, tension and fearfulness appear, a diagnosis of anxiety disorder is made.

3. Mental Symptoms: Worrying, forgetfulness, difficulty in concentration, inability to make decisions, disorientation, sense of unreality, out of body experience, suspiciousness, etc. These symptoms can be seen in a variety of disorders. Extreme degree of suspiciousness and hallucinations are symptoms of a psychotic disorder.

4. Behavioral Symptoms: Irritability, angry outbursts, arguing, pacing, hand wringing, crying, yelling, fighting, screaming, shouting, slamming the door, hitting the wall, driving recklessly, drinking, withdrawing (avoiding people), having an affair, not getting up from bed, etc.

   Obviously, these symptoms are indicative of a troubled or very stressed mind. These symptoms are very prominent in children as they express themselves more by “acting-out” than by “speaking-out.” Adults who are unable to speak out, often show their inner tension by acting out. Acting out is immature way of expressing one’s emotions. Adults who act-out should be considered as potentially dangerous when they are upset. They could be hateful, hostile, obnoxious, mean, angry, and violent. These behaviors could be part of various disorders such as personality disorders, bipolar disorder, major depression and psychosis.

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