Researchers have identified depression as an important factor in a whole slew of physical illnesses—and the list seems to grow weekly. They include heart disease, some forms of cancer, diabetes, eye disease, irritable bowel syndrome, Alzheimer’s disease, Parkinson’s disease, and many more. These are in addition to ailments that have long been linked to emotional difficulties, such as chronic fatigue syndrome, fibromyalgia, and chronic pain.
Sometimes depression and anxiety can masquerade as a physical illness, displaying all the bodily symptoms but with no physical basis. This is called somatization and can be just as debilitating as any other disease. Somatization differs from “psychosomatic” illness, such as a peptic ulcer, which is brought on by an emotional state but involves an underlying pathology.
People used to dismiss psychosomatic illnesses as being “hysterical,” “just in the mind,” and therefore not “real” or worthy of respect. Now we know better. Two 1987 studies found that up to 80 percent of all people who consult physicians do so because they suffer from what are called “functional complaints” (so-called because they are a function of a psychological process, such as depression, and not a product of a structural change in the tissues of the body).
There are three possible scenarios for the dance physical illness and depression do with each other. First, you can be ill and depressed (illness itself can lead to depression). Second, you can be depressed and feel down in your mood but well in your body. And third, you can be depressed and feel upbeat in your mood but physically ill.
So why does a mood disorder somatize? Most researchers agree that for some reason the sufferer represses her emotions and does not allow them to be expressed openly. For example, anger—which itself can be a depressive symptom—stimulates blood flow to muscles and elevates heart rate and blood pressure to prepare for fight or flight. Once one of those actions has been taken, blood pressure drops, the muscles don’t require so much blood, the heart rate goes down, and the person can relax.
If the emotion is repressed or denied, it can’t be expressed through action. The body continues to respond to the feeling, even though the mind refuses to acknowledge it. This is how anger, anxiety, or depression can lead to heart disease, for example. Once the heart adjusts to beating at the anger rate, it may reset itself to a faster level of functioning that becomes independent of the emotion that originally caused it. Even if the psychological problem is resolved, the cardiac system will not necessarily return to normal and may be permanently damaged.
The same is true of any organ, including the lower intestine. An early experience of abuse leads to acute anxiety and a resulting tightening of the bowel. After a while it remains tight and doesn’t relax even when the anxiety-provoking situation has passed. According to studies by researchers such as Prof. William Whitehead of the University of North Carolina, a history of sexual abuse is present in more than half of all irritable bowel sufferers.
Certain cultures and family systems inadvertently cause their members to be prone to somatization. In these environments, physical illness is considered more acceptable than psychological problems or negative feelings. Uplift participants and clients often report that in their families of origin they could express “any emotion as long as it was a happy one.” Anger, fear, pessimism, and depression were simply not allowed. But these negative emotions don’t just go away.
The brains of these depressed children, particularly those with a genetic or biological vulnerability, subconsciously learn to express negative feelings as a physical malady.
Somatization in these cases follows a predictable pattern. Significant adults punish (physically or emotionally) the child for her “bad feelings.” At the same time they reward her for being ill by criticizing her less and giving her more attention, and perhaps importance. Illness thus becomes a dysfunctional coping mechanism for getting needs met. It can even provide physical safety. An Uplift student with a history of childhood illness told the group that the only time his father did not hit him was when he was sick in bed. His immune system learned to welcome illness.
Most families mobilize to deal with an illness and do everything possible to ensure that the stricken member recovers. Some dysfunctional families, however, do everything possible to maintain the illness. The crisis allows everyone to focus on something other than the real issues that lie below the surface. The sick child, who in such an environment is probably depressed as well, becomes the focus for the family’s classic codependence. Long into adulthood, illness will remain a subconscious behavioral reaction to certain stressful situations.
This dysfunctional coping mechanism is then reinforced by the medical profession, whose members are geared to take “physical illness” more seriously than “psychological” problems. Alarmingly, according to a number of studies, some 50 percent of doctors are unable to properly diagnose depression, especially somatized depression. The attention many physicians give their patients increases in proportion to the severity of the diagnosis. This interest is itself a reward, reinforcing the idea that it’s OK to be ill but not depressed.
(extracted from) Creating Optimism: A Proven, 7-Step Program for Overcoming Depression, Based on the popular Uplift program, written by Bob Murray Ph. D., and Alicia Fortinberry, published by Mcgraw-Hill