There is a well-known saying: “Some doctors make the same mistakes all their lives and call it a clinical experience.” In fact, there are a number of pathologies that are regularly and persistently, and most importantly, the same schemes are treated by different specialists, and they do not even have a question – why patients endlessly come to them with the same complaints, and the effect of treatment is not long-lasting. On the other hand, patients who collect thick volumes of examinations, change doctors, being disappointed in each of them because of the ineffectiveness of the proposed treatment, persistently do not understand that they are constantly going in circles and simply do not see a way out.
I understand patients, they do not have the opportunity to evaluate what is happening, especially if each new doctor criticizes the previous one and immediately offers a “invented” treatment concept, assuring them that their approach will definitely help. But what about doctors who, in their 20th year of practice, continue to struggle with recurrent cystitis or herpes, without even asking the question: “what if it’s not the resistance of these harmful microorganisms to the prescribed treatment?”
Fibromyalgia and vulvodynia are somatoform disorders.
So, I present to your attention another session of exorcism. We will talk about somatoform disorders, and first I will present a list of pathologies that are grouped under this term, and then I will talk about how they are formed.
• Lump in the throat.
• Irritable bowel syndrome.
• Chronic cystitis.
• Chronic joint and back pain.
• Panic attack.
The conditions listed below can also be considered within the framework of somatoform disorders, but with reservations, which I will discuss below.
• Painful periods.
• Pain during sexual intercourse.
• Chronic thrush.
• Recurrent herpes.
• Violation of the regularity of the menstrual cycle.
As you can see, all these conditions, in fact, are real diseases with known or suspected causes, methods of diagnosis and treatment. These diseases are from different medical specialties, but what unites them under the term “somatoform disorders” and what are these same disorders?
To begin with, let’s introduce the definition of the term “neurosis”, since it is neurosis that underlies the formation of such States. Until now, there is no unambiguous definition of neurosis, various researchers have offered their own descriptions, but I will try to explain to you the simple essence of the problem.
Neurosis occurs as a result of the internal conflict of a person between what he wants and what he has, but the presence of this conflict is not recognized and is not accepted as a fact. This causes increasing discomfort in life, which manifests itself in the form of various painful conditions, similar in form to known diseases. Example: you live in the province and all your life you dream of living in Moscow, but all the circumstances in life will not allow you to realize this dream, and you can’t realize it and tell someone, because everything looks good in your life. A husband, a job you love, wealth, two beautiful children, and you love it all, and you can even be envied, but the most powerful dream can never come true. From year to year, this hidden conflict is growing in you, and this energy needs to be released. It would be logical in this situation to expect you to constantly talk and moan about dissatisfaction with the situation, but this is the way of some people with certain personal qualities, while others just take and do everything to fulfill their dream, but there is a type of personality in which a person does not commit either the first or the second. He simply does not realize that this conflict exists, and in the meantime, the process of “boiling” does not go away, and one day he finds a way out in creating “diseases”.
Neurosis occurs because of the discrepancy between what a person wants and what he has.
Why diseases? It’s quite simple: the brain knows that when the body is ill, people begin to feel sorry for them, show increased attention, and take care of them. Bingo, the brain gets what it wants in this way – the whole range of “psychological stroking” that it lacks to calm down. The doctor prescribes examinations, treats, relatives and friends sympathize, and the disturbing symptoms actually recede for a while, but return again as soon as this “case” is completely “worked out”. That is, one episode of the disease does not last long, as an anesthetic for appendicitis can only temporarily relieve pain, but as soon as the effect of the drug passes, everything resumes, since the anesthetic does not remove the cause of the pain.
The brain creates diseases when a person is dissatisfied with their life, since in this case the patient receives a certain portion of psychological stroking.
Get the point? Somatoform disorders are nothing more than brain games in order to relieve the growing tension from an unresolved conflict, as well as to draw the attention of the “owner” to the fact that he, the brain, is bad.
The main difference between this disease and somatoform disorder is the absence of the disease itself during medical research.
At the same time, the repertoire of “representations” of our brain is already very well studied: this is the list listed above. The brain can easily create any intensity of pain, itching, irritation, increase urination, change the regularity of the stool. Just an example – in response to fear, you can pee or abruptly want to go to the toilet in a big way-this is an acute situation, and with small effects of stress, you can just run more often to write or complain about alternating liquid stools with constipation. Here’s cystitis and irritable bowel syndrome.
The main thing that distinguishes somatoform disorder from a true disease is the absence of the disease itself during medical research. For example, a patient comes with complaints of itching and irritation in the vulva and vagina, and when examined, the mucosa is not inflamed, the discharge is good, and the tests show the normal state of the flora. A similar situation – complaints of frequent painful urination, but the tests are normal. We begin to analyze the situation: Yes, in the beginning there could be a real episode of thrush or cystitis that was cured, but then episodes of signs of the disease begin to appear without the disease itself, especially if the first episode was transferred especially dramatically.
Then there are two possible mechanisms, and they can complement each other: stress from recurring episodes forms a persistent decrease in immunity, and the brain begins to overreact to minimal stimuli coming from peripheral tissues, perceiving them as pain, itching, discomfort or irritation.
I already wrote about the decrease in immunity against the background of chronic stress above, but it’s worth repeating here. The mechanism is quite simple: stress, among other reactions in the body, leads to the production of a special substance in the brain, ACTH, which stimulates the adrenal glands to produce glucocorticoids – substances that most strongly reduce the immune system. Evolutionarily, reduced immunity in response to stress was necessary to survive an allergic reaction that could have killed a person. An allergic reaction in the wild can occur to a poisonous plant or predator venom, in fact, this is how their aggressive effect on the body is realized. Thus, this mechanism, designed to protect us, has a damaging effect in everyday life, reducing immunity and contributing to the activation of opportunistic flora, which is fungi or the activation of the herpes virus or human papillomavirus.
“Lump in the throat” and muscle pain are also somatoform disorders.
Not all somatoform disorders are realized with the participation of these two mechanisms. For example, if there is a “coma in the throat”, fibromyalgia (muscle pain) or irritable bowel syndrome, there is no inflammatory process. In this case, there is an incorrect operation of the peripheral nervous system (its vegetative part), due to tension in the Central nervous system against the background of neurosis. The same mechanism is assumed for vulvodynia (pain, itching, discomfort, irritation in the vulva area in the absence of signs of inflammation, read more about this disease below), but in some women it can be supplemented by periods of persistent thrush or herpes relapses. In General, it would be possible not to mix these States, but in fact they are quite similar.
Now let’s look at what underlies these States. Given example. A patient comes to the reception with a volume of examinations and a standard story that she has already visited many doctors and no one can understand her problem, has been treated for several years, there is a temporary relief from time to time, but then everything comes back again. The problem is discharge and discomfort in the vagina, the smears are perfect, but the doctors find fault with the “white blood cells”, the “sticks”, the “cocci”. On examination – a picture of complete health: normal discharge, corresponding to the cycle, pink mucosa, but there is increased sensitivity with minimal touch in the vulva.
If the diagnosis is not confirmed, you can not be treated “just in case”.
We begin to analyze the situation – when did it all start? After careful questioning, it turns out, for example, there was a conflict with a partner, doubt of loyalty, after sexual intercourse the next day felt discomfort, went to the doctor, identified Ureaplasma. Long courses of antibiotics, internal confidence that the partner has infected, but it is not possible to find out, during sexual acts, pain begins, after – itching and irritation. Again tests – nothing serious is found, but treated “just in case”, and that’s it, the mechanism is started. An internal unresolved conflict with a partner that is not voiced to itself, but manifests itself in constant health care, which is actively supported by doctors, without convincing the patient that there is no problem.
This is a fairly common situation. The main task of the doctor is to exclude the presence of somatic disease, that is, to conduct a standard set of examinations and make a conclusion: for example, “gynecologically healthy”, and to investigate when and as a result of which this problem began.
A somatic disease is excluded by the doctor by conducting a standard set of examinations: if the pathology is not detected, it is necessary to find out when the problem appeared.
The rest of the work is for the psychotherapist, who should already deal with this problem. It is best to use therapeutic hypnosis to solve such problems. first-generation antidepressants are also used, in particular to relieve pain, itching and discomfort.
Here is an example of how it should not be, but how it actually happens: the patient is examined in depth, while various crops are prescribed, immunity studies, complex tests of dubious reliability, and then treated, treated and treated with endless droppers, pills, injections and candles, sometimes the reception schemes are painted on whole sheets. Does it help? Yes, for a while, as the patient is distracted by this treatment, but pretty soon everything returns, and another dose of frustration with the doctor is added to the symptoms, which only worsens the problem.
As a rule, the patient answers “no” to a direct question: “do you have any unresolved problem?”, but upon in-Depth questioning, it turns out that there is an internal conflict. Do not forget that a person in such a situation, as a rule, pushes out thoughts about the problem, not seeing it and not isolating it as a separate existence, so he can not figure it out without help.
It is quite difficult to understand the presence of somatoform disorder without help. Usually you need the help of a specialist.
It is important to remember when it all started, or rather, to remember the time when everything was good and when “something broke”, for example, the first episode of cystitis or thrush, herpes or pain during sexual activity. What happened at that moment in your life, for example, a conflict with your partner, moving, changing jobs, difficult, unbearable living conditions with your parents, etc.
In other words, you need to find the moment when something began to displease you very much in life, but you could not even say it to yourself. It is even easier when you start to “tolerate” something from day to day. This patience is the energy of the “disease”, which manifests itself in the appearance of somatoform disorders.
The next important point is to trust the doctor that you are healthy, that is, you do not have diseases at the body level. Believe that what is happening to you is a phantom sensation, like the pain of an amputated limb. In fact, this mechanism is partly suggested when, for example, vulvodynia occurs.
In fact, it can be difficult to immediately accept that the itching and irritation or cystic sensations that were previously persistently treated with antibiotics, candles and droppers are nothing but an illusion. You don’t need to hand over once again a smear or doing the sowing, and it is necessary to go on reception to the psychotherapist. We generally believe that only mentally ill people go to a therapist.
In fact, psychiatrists deal with serious mental illnesses, such as schizophrenia or manic-depressive psychosis. At the same time, there is a whole set of borderline mental disorders, which in our country are most often treated with a conversation with a girlfriend or friend, in extreme cases – with a psychologist. The therapist is often feared like fire. After all, to go to a psychotherapist, you must internally admit that there is a serious problem with the work of the psyche, and this can be very difficult. Therefore, in extreme cases – a psychologist. But the problem is that psychologists do not have medical education and can only help to understand the everyday situation, see the situation from the other side, and start to treat the problem differently. In the case of neurosis, not all psychologists are able to help, although some are quite capable.
A psychotherapist and a psychiatrist are different specialists.
Now a few words about psychotherapy in combination with hypnosis. Treatment using hypnotic techniques began quite a long time ago. The founder of this approach can be considered Mesmer, who created the doctrine of “magnetism”, with the help of which it was possible to cope with many “diseases” in which doctors of the traditional direction were powerless. We are talking about hysterical paresis and paralysis, blindness, seizures, debilitating pain. Mesmer assumed that his method was based on the action of “animal magnetism”, but in fact his sessions were nothing more than sessions of hypnosis, which at that time no one knew anything about. Then his work was continued by Freud, who already used hypnosis and was much more successful, since in his case the effect was conscious and combined psychoanalysis.
Currently, hypnosis is officially recognized worldwide as a medical treatment for many diseases. The essence of the method is to immerse a person in a trance state. This is a physiological state in which we often plunge ourselves during the day. For example, when viewing the news feed on a social network, we suddenly find that for some time we were “not in ourselves”, that is, we did not evaluate what was happening, but scrolled through the news without delving into what we were doing and seeing at that moment. This temporary withdrawal from reality is the trance state.
Trance is necessary in order to temporarily remove the controlling function of the cerebral cortex, which mentors how we think, evaluate and perceive reality. It is impossible to correct the errors that occur in the brain – the essence of neurosis – as long as the cortex actively counteracts this. It’s like fixing an engine while the car is running. A hypnotherapist puts you in a trance state in order to detect these errors and try to correct them.
During trance, the controlling function of the cerebral cortex is disabled.
The biggest fear of patients during hypnosis – suddenly the doctor will fix something there, my personality will change, and I will stop being what I am. In fact, these concerns are unnecessary. In the process of preliminary analysis of the situation, the doctor finds out what event could trigger the wrong brain function. Most often, this is a traumatic event that was incorrectly “worked out” and remained as an error that is not noticed by the brain due to the mechanism of displacement of the traumatic, painful memory. It is this event that must be found and “extinguished”, made faded, in much the same way as removing a tattoo from the skin. In other words, nothing changes in your psyche, just the traumatic event that triggers your pathological reaction is removed.
Here is a good example. The woman is faced with the problem of pregnancy loss – repeated miscarriages. A comprehensive medical examination finds no obvious reasons. The hypnotherapist in the process of trance conducts so-called age regression, that is, tries to find a traumatic memory associated with pregnancy without conscious control, and finds it. The woman recalls that once, very long ago, in her youth, she had an abortion and, walking down the corridor of the clinic, encountered a nurse who shouted angrily after her: “Here she goes for abortions, and then you won’t be able to bear a child.” This message is also called a household curse. At that moment, this “curse” greatly frightened the woman, but later it was replaced by the brain and simply forgotten, as something that can cause pain and discomfort, but on a subconscious level it became a factor blocking the development of pregnancy. Without hypnosis, it would be very difficult to find this memory and even harder to “erase”it. Hypnosis helped to make this memory not traumatic, gave confidence that everything will work out, and the woman easily became pregnant and gave birth. This is a real example of the work of a hypnotherapist.
Hypnosis is officially recognized worldwide as a medical treatment for many diseases.
A simple heart-to-heart conversation can help treat infertility. Of course, when it comes to the absence of organic and functional pathologies.
This also works for infertility. Every year, women get pregnant from a simple heart-to-heart conversation, and there is no magic in this, of course, after I conduct an examination and I am sure that there is no organic or functional pathology. Also pregnant clients of “reproductive psychologists” who just put things in order in the minds of women who want to get pregnant, but we digress.
Hypnosis, or rather hypnotherapy, is not a gross change of your consciousness by a doctor without your control. It is a subtle tool that allows you to effectively remove a traumatic memory or change your attitude to a traumatic situation. Yes, this is already a “surgical” tool, but it is used only when the “therapeutic” effect is ineffective. In addition, hypnotherapy is always combined with psychoanalysis and General principles of psychotherapy (conversation, analysis of the situation, homework).
Thus, the most difficult thing in the treatment of somatoform disorders is to convince the patient of their presence, to make them believe that the cause of the painful condition is not in the “sticks”, “cocci” and white blood cells, but in the head. Overcome personal denial and send it to the appropriate specialist. Unfortunately, I don’t always succeed. It is extremely difficult to convince a patient in one consultation that all these years she has not had any diseases, that the problem is in her head. It is difficult to admit that the kilograms of antibiotics eaten, candles inserted and liters of IVS were in vain. That dozens of doctors… made mistakes when prescribing in-depth examinations and pointing out the identified changes. And while the patient does not realize this, alas, it will not be possible to move forward.
It is important to believe that there are no “mysterious”, persistently ongoing diseases that doctors can not cope with, so you do not need to look for someone who will finally prescribe an effective treatment regimen or analysis that will clarify everything. If you do not have thrush for years, herpes, cystitis, abdominal pain, discomfort in the vagina or pain during sexual activity constantly recurs – the reason should not be sought from a gynecologist or gastroenterologist. These specialists must perform a minimum set of examinations to exclude their pathology, and that’s it. There may be small deviations in any test results, but the examination data is most important. If you do not have signs of inflammation, and they are known and visible, you should not find fault with white blood cells in the tests. I always tell my patients about 5 signs that are necessarily present in any inflammation and in any place: redness, swelling, pain, local fever and organ dysfunction. That is, if these signs are not present, there is also no inflammation, even the white blood cells detected in the analysis do not matter, and this rule is the same for both the nose and the vagina. Actually, the endless treatment of Ureaplasma, Mycoplasma and Gardnerella (without a picture of bacterial vaginosis) is the satisfaction of the need for “treatment” of patients who have small complaints of discomfort, itching, cystitis, in which everything can be “blamed” on these microorganisms, which may normally be present in the body. Gastroenterologists also “treat dysbiosis” in patients with irritable bowel syndrome.
It can be difficult to admit that the kilograms of antibiotics and liters of IVS were in vain.
With real pathology, there are always obvious manifestations of the disease.
Unfortunately, the vast majority of doctors do not know about this problem or simply do not want to dive into it. It is much easier to prescribe tests and make appointments based on the results than to understand the complex emotional vicissitudes of the patient. And the patient in most cases is waiting for a pill or an injection, and not a referral to a psychotherapist. Again we have to repeat: “the rescue of drowning people is the work of the drowning people themselves.” So it turns out that only you can analyze the situation and suspect that in the course of your treatment you are moving in a circle and it’s time to stop this movement. The main thing is to allow yourself to accept the fact that your illness may just be a manifestation of a call for help from your brain, which has not found other ways to tell you that it is ill. This is most clearly shown in the cartoon “Puzzle”, where different emotions fight for the ability to control by pressing the buttons on the remote. If the console has long been dominated by sadness and sadness, it has all the buttons under control, and these are mostly buttons for painful symptoms. I hope this image will help you understand the problem I wrote about above.
The most common self-forming disorder in gynecology is vulvodynia, and I decided to describe this disease in more detail.