There is a widespread belief that the emotional distress we feel causes or contributes to many common medical conditions. However, decades of mind/body research performed by research psychologists who strongly believed this failed to confirm these beliefs. Worse, studies also could not confirm any benefit of stress reduction techniques in the management of common medical conditions.
Then, is there a mind/body connection?
The answer is yes, but it is very different from what nearly everyone thinks. It is almost completely unknown among both patients and physicians and almost completely overlooked in research. Yet, it is relevant to many common chronic medical conditions that remain inadequately understood and treated, including hypertension, chronic fatigue syndrome, migraine, inflammatory bowel disease, chronic pain syndromes, and others.
This new understanding focuses on the powerful emotions that we don’t even feel because we have unknowingly repressed them from our awareness.
Our ability to repress emotions actually is a gift of evolution that protects us from being emotionally overwhelmed during periods of severe stress or trauma. However, those powerful emotions, even though we would insist we do not feel them, linger within us for years or decades, and unknown to physicians and patients, silently cause or contribute to many common chronic medical conditions whose cause and treatment remain inadequately understood.
I want to emphasize that repressed, unfelt emotions do not underlie illness in all patients with these conditions. This understanding is relevant to a proportion of patients that differs from condition to condition. For example, in most patients, hypertension is not a mind-body condition. In most, it is attributable to factors including genetics, salt intake, weight, and others. But in about 10 percent, this mind/body origin appears relevant, particularly in types of hypertension, such as paroxysmal (episodic) hypertension, severe resistant hypertension, and young adults with unexplained hypertension, that are associated with increased activity of the sympathetic nervous system (SNS), the autonomic nervous system that governs our “fight-or-flight” reflex.
In contrast, I suspect repressed emotions silently underlie illness in most patients who suffer from chronic fatigue syndrome (CFS), a condition whose cause and treatment have remained a stubborn, unfortunate mystery. Supporting this understanding, studies of CFS patients consistently find an increase in SNS activity and much higher scores on adverse childhood events (ACEs) questionnaires. Repressed emotions are also the hidden trigger in patients with chronic pain syndromes, an understanding pioneered by Dr. John Sarno.
I emphasize that this understanding is rarely considered because of the absence in most of emotional symptoms. But there are clues, conspicuous but rarely noticed, that can alert us to consider this mind/body origin. In particular, the combination of a past history of trauma or of severe or prolonged stress, along with the fortunate yet surprising absence of any obvious emotional impact.
Gaining awareness of long-hidden emotions can result quickly in physical and emotional healing. In others, treatment that targets the SNS, such as beta-blockers, can be helpful. And in some, treatment with an antidepressant, prescribed despite the absence of depression or anxiety, can be very helpful.
Samuel J. Mann is an internal medicine physician.