January 29, 2024
Psychophysiology
This weeks podcast turned out to be so much more than expected when I first heard about Dr. David Clarke. His work transcends much of what I see in clinic and has given a name to the reality of puzzling chronic illness.
From the PPDA website: Psychophysiologic disorders (PPD) are stress-related, brain-generated pain or illness. Even people who handle stress well can have PPD. This occurs when the stress is not fully recognized. The resulting symptoms are completely real. That is why the term we use is a blend of Psychology (the processes of the mind) and Physiology (the processes of the body). Conditions such as chronic pain (not linked to damage or disease), migraine, fibromyalgia, irritable bowel syndrome, chronic fatigue, and pelvic pain syndromes are just a few of the dozens of very real conditions that can be caused or made worse by PPD.
The good news is that after years of clinical research, the new Pain Relief Psychology is relieving PPD, not merely helping people live with it. The keys to this new approach are: 1) reassurance that the body is not damaged or diseased in PPD, 2) uncovering sources of stress that might not have been fully recognized, 3) successfully treating those stresses, some of which link to Adverse Childhood Experiences (ACEs).
Could you have a psychophysiolocal disorder?
Here are some probing questions that could help guide your journey as discussed by Dr. Clarke on the PPDA website: 1) Has your medical diagnostic workup not found a definite cause for your pain or illness? 2) Are you not improving as expected despite quality medical diagnosis and treatment? 3) Have your symptoms been present for longer than six months? 4)Do your symptoms migrate around the body? 5) Do your symptoms increase when you are stressed or thinking about stressful situations? 6) Are your type A, self-critical, perfectionistic or do you routinely put the needs of others ahead of your own needs? 7) Have you experienced significant stress or tragedy recently? 8) Are you still exposed to chronic stress by a person or experience? 9) In the last month have you felt anxious about life in general? 10) In the last month, have you felt decreased interest in doing things that you previously enjoyed? 11) Did your symptoms begin soon after a terrifying, traumatic, or horrifying event or after a triggering event that is linked to that trauma? 12) If you learned that a child you care about was experiencing everything you did as a child, would you feel sad or angry?
If these sentences, as written, resonate with you in a positive way, then you may be suffering from PPD related issues that are not amenable to traditional medical pharmaco-therapies. Thus, it may be time to turn to understanding how the mind and gut control the body as it relates to pain and disease. The vagus nerve as it has been discussed recently is a bidirectional flow of information that predominantly moves from the gut to the brain and not visa versa. Thus, we have often been looking in the wrong area for resolution of disease. It is becoming ever more clear that trauma has long term effects on people's enteric nervous system as well as the autonomic and cerebral. Unwinding these "baked in" feelings that are causing pain has previously been unknowable and unchangeable. Our version of therapy was to tell the patient that the GI issues were functioinal, a code word for in your head. "We cannot find anything wrong with you". The patient was often left wondering why me, what is wrong with me, and more questions. No answers.
That is no longer the case as pioneers in this field like Dr. Clarke and many others like Dr. Porges are saying there is a way and then showing that way to us to heal. As you listen to Dr. Clarke, if you are so inclined to do, you will see a fresh canvas being painted in a new way which is patient centric, healing based and non judgmental.
A better way,
Dr. M
