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23 September 2020

How life’s stresses can manifest themselves into physical symptoms

One of my patients came to realise the extent to which his emotional life was affecting his body. 

By Phil Whitaker

Adam’s tummy was playing up. “It’s been going on for weeks,” he told me. “My girlfriend said enough was enough.”

It didn’t sound too spectacular: his stools had gone a bit loose, but he was only going two or three times a day and it wasn’t exactly what he would call diarrhoea. Certainly no sign of blood. And while he had lost interest in food, he didn’t feel nauseous. The further I questioned him, the more symptoms he mentioned: headaches occasionally, sleep rather restless, energy levels low, and from time to time he had this overwhelming urge to fill his lungs with air.

There’s probably a law of medicine that states that the further into a patient’s history you get without the first idea of what the diagnosis might be, the more likely it is the diagnosis will ultimately prove to be psychosocial – adverse life circumstances being expressed in a physical way. And there is a “big three” of factors that account for the vast bulk of such cases: relationships, work and money.

When I started exploring what was happening in Adam’s life, though, everything seemed well. His job as a hospital maintenance electrician was secure. He enjoyed the role and liked the people he worked with. He and his partner were getting along. More than that, in fact: they were expecting their first child in two months’ time. And apart from a mortgage on their home, they had no significant debt or financial concerns. Even lockdown had left him largely unscathed. In fact, he’d loved it during the early summer, when he’d been able to go cycling on virtually traffic-free roads.

I have learned, when suspecting psychosocial illness, not to be distracted by picture-postcard accounts of life. We all put a gloss on things with strangers; even with family and close friends. Many people are unaware of how their emotional life affects their body, so won’t see the relevance to admitting difficulties when discussing what seems to be a problem with their physical health.

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What struck me in Adam’s account was his partner’s pregnancy. This was the one thing that represented change. “How do you feel about the baby?” I asked. But even there, too, he declared himself to be delighted. It had been planned, and they were both looking forward to becoming parents.

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My last thought was bereavement, not necessarily a recent one. Often when we approach the anniversary of a loved one’s death – and it may have happened years ago – the grief resurfaces. But no, Adam said. There was no one.

I’d taken a wrong turn; these amorphous symptoms must have a biological basis that I was going to have to investigate. I was about to invite him in for examination, and to do some blood and stool tests, when he suddenly said: “Well, there was my old man.”

Adam explained that his father had left when he was still a baby, and he had never seen him again. Adam had recently managed to trace his whereabouts, only to discover that he’d died eight months previously. “But it can’t be that, right? I never even knew him.”

“When did you find out he’d died?” I asked.

“A few weeks back.”         

“When all these symptoms started?”

Adam agreed.

He hadn’t known why he’d decided, in his mid-twenties, suddenly to go searching for his dad. I was explaining how impending parenthood stirs long-forgotten childhood experiences. How he wasn’t grieving his dad as a person, but was grieving the loss of the idea of ever having a dad himself, and a granddad for his baby when it came.

Somewhere in among my words, I heard Adam sobbing at the other end of the phone. When he could talk again, he said he could see all that. Within two days his physical symptoms had gone, now he was able to mourn.