As we read earlier, persistent stress symptoms means the balloon is inflated and can not be deflated due to the saturation of the soda bottle. Let us study in this chapter some issues related to persistent stress symptoms.
1. How patients communicate by means of their stress symptoms
Sometimes a persistent stress symptom has a hidden meaning. In other words, the patient is unknowingly trying to communicate to others by means of his symptom what he is really thinking and feeling, but, for whatever reason, is unable to express in words. People who indulge in this type of communication are highly ?unaware? and ?immature? people. These physical symptoms are often referred to as ?conversion symptoms,? meaning that emotional expression has been converted into a physical symptom that expresses that emotion by proxy. 1) A young lady goes blind unable to deal with her helplessness over her father?s blindness. By going blind she is trying to communicate her intolerable grief, feelings of helplessness and hopelessness regarding her father?s blindness. Once she expresses these feelings verbally, her blindness goes away. 2) A middle aged lady temporarily goes deaf unable to take her husband?s verbal attacks anymore. By going deaf she is saying in effect, ?I just can?t hear his bad mouthing me anymore.? With one counseling session in which she expresses her hurt and anger, she regains her hearing. 3) An outraged wife loses her speech unable to lash out at her unfaithful husband. She wants to give her waywardly husband a good tongue-lashing, but is afraid of losing him. After expressing her anger at him in writing, her speech comes back. 4) A middle aged man develops paralysis of his right arm as a way of coping with his irresistible desire to beat the crap out of his tyrannical boss. But he can not do so for fear of losing his job and going to prison. Once he verbally expresses his rage, his paralysis disappears. 5) A pastor hurt by his dismissal by his congregation experiences an unbearable ?stabbing pain? in his back. Once he expresses his disappointment, hurt and sense of betrayal, his back pain gradually goes away. 6) A young man, heartbroken over the breakup with his girlfriend, complains of unbearable chest pain. In counseling, he grieves over the loss, lets go of her and his chest pain goes away. 7)
A young lady, burning with envy over her neighbor?s huge swimming pool, complains of severe, constant heartburn. Once she gets over her envy in therapy, her heartburn goes away. 8) A submissive worker feels emasculated by his domineering boss and develops impotence. After he confronts his boss and realizes that his boss is just a wimp, he becomes potent again. 9) A passive-natured boss develops pain in the neck after he hires a lousy secretary who messes up everything in the office. After he has a good chat with his secretary and he takes charge of the office situation, his pain in the neck improves. 10) A child, upset over being sexually abused by a baby sitter, complains of pain in the genital area. Once the mother acknowledges the child?s suffering and fires the baby sitter, the genital pain goes away.11) A young fellow, saddened over his grandfather?s death from emphysema, complains of difficulty breathing. After grieving over the loss of his beloved grandfather, he starts breathing normally. 12) Another young man develops spells of shortness of breath unable to deal with his feelings of being stifled by his domineering father. After his father acknowledges his feelings and backs off, his shortness of breath disappears. This list is literally unending.
Sometimes, after losing a dear friend or relative, the survivor might suffer from the same type of symptoms as the dead person. A person might develop chest pain shortly after the death of a parent from heart attack. He might walk and talk like the dead person. This phenomenon is called identification. It is not uncommon for one to run to doctors with the same type of symptoms his relative or friend suffered from before dying.
What all this means is that unexpressed painful emotions would show up in one form or another, sooner or later. Here we must recall the saying of Dr. Harry Maudsley (1835-1918): ?The sorrow that has no vent in tears may make other organs weep.? When the patient becomes aware of the meaning of these symptoms and begins to talk about his painful emotions, symptoms begin to go away.
Without professional intervention, these symptoms could become chronic and disabling. Continued paralysis of an arm could lead to what is called disuse atrophy. Continued stress-related blindness could cause degenerative changes in the eye grounds leading to permanent loss of sight. Many Cambodian women, who went ?blind? unable to witness atrocities by Communists against their children, did not receive timely counseling. Most of them became permanently blind due to chronic disuse of retina.
2. How patients often use persistent stress symptoms to profit
Sometimes persistent stress symptoms are knowingly (consciously) or unknowingly (unconsciously) used by us to get sympathy, support, love, attention, money, etc. This phenomenon is known as secondary gain. Since the sufferer gets some type of benefit because of his symptoms, he is not very motivated to receiving treatment or getting better. So, if I am collecting disability payments from an insurance company due to anxiety symptoms, I would report no improvement of my symptoms regardless what treatment I get, as this would mean losing my monetary benefits, and having to return to my job that I hate. Here are two interesting cases.
A 58 year old woman who had been receiving disability payments for over twenty years on the grounds of some vague physical complaints, received a letter from the Social Security Disability Department to undergo routine evaluation to assess her current health status. After examining her, the naive physician said, ?Congratulations! You are in robust health. There is not a thing wrong with you!? As he left the room, he heard a thud. When he turned to see what happened, he saw the patient on the floor. Apparently she had fainted. The physician was forced to hospitalize her for ?further investigation.? She stayed in the hospital for over two weeks costing Medicare several thousand dollars. No matter what the doctor did, the patient kept telling him she was not feeling any better. She agreed to leave the hospital only after the doctor assured her that he was going to pass on to the Social Security office her three inch thick chart showing how sick she was!
Here is another true story: A 55 year old truck driver received a minor injury to his neck as a result of a damaged side mirror of his truck. The injury missed his carotid artery by a millimeter. After the skin laceration healed, the patient continued to have a number of physical symptoms such as blurred vision, numbness of face, weakness of tongue, etc. He did not respond to any of the treatment, including ?nerve medications?, offered by his neurologist. Unable to find a physical cause, his neurologist finally referred him to me.
In the interview I found out that the patient had worked for a local truck company for over thirty years. This truck company was now in the process of laying off truck drivers one by one. He was certain that if he returned to work, he would lose his job and he would not find another job at his age. As long as he stayed sick, he was guaranteed his full salary. So, regardless what treatment I gave him, he came back to report, ?I am worse than ever.?
Then, one day he walked into my office looking very cheerful. He said he was doing just fine. Surprised by this wonderful change in his demeanor I asked him what happened. He replied smiling that he had been diagnosed as having cancer of the stomach, and that the Social Security office had declared him as totally and permanently disabled. Now that he was guaranteed a paycheck, he felt great. The fact that his stomach cancer would kill him in six months seemed far from his insecure mind!
People who are injured at work often do not feel better until they receive adequate compensation. This type of secondary gain is called compensation neurosis. These people invariably have a list of grievances against their employers. They have nurtured ill will toward their employer or supervisor for real or perceived injustice done to them. Very often these people give history of someone higher-up having made a derogatory remark just before or after the accident. They also report that they did not get proper attention or sympathy from the supervisor at the time of the accident; did not get a ?Get Well Card? while recovering, and whatnot.
By the time they see a psychiatrist, they have already retained a lawyer. In treatment, they usually do not take medications as prescribed; do not keep their appointment for physical or talking therapy; and they report no response to medications or therapy given for their main symptom, which usually has to do with pain or inability to move their limbs. Once they have received a compensatory payment, their symptoms improve dramatically.
Sometimes, people who are insecure in their relationship with significant others, keep hanging on to their stress symptoms to curry sympathy, support and pity. A 35 year old woman who suspected her husband of infidelity started having severe panic attacks. Her husband suspected that her panic attacks had something to do with their strained relationship. He became very solicitous and supportive in response to her suffering. In spite of high doses of medications and regular psychotherapy, the patient reported little improvement. It became clear to me soon enough that the patient was scared to declare improvement as that might jeopardize her improved relationship with her husband