Not all suffering is physical in origin

We assume most non-mental illnesses are treatable with a pill or some form of medical intervention. At least, I did. But what if that’s not the case?

Psychophysiologic disorders (1) are a collection of conditions that have no clear singularly physical cause. However, they present as physical experiences. They include

• Vertigo

• Tinnitus

• Eczema

• Dizziness

• Chronic pain

• Fibromyalgia

• Migraines/ headaches

• Dissociation/ derealization

• IBS/ stomach pain/ diarrhea

• Problems with memory/ brain fog

This of course isn’t a vibes-based diagnosis, like “everything is mind so everything is psychophysiological.” A broken bone is a broken bone. To really understand if something is psychophysiological, it makes sense to carry out an exclusionary test to determine there is indeed nothing physical causing the symptoms. Here’s an example of an evaluation.

In my case, I did rounds of bloodwork, medical imaging, and specialty testing that all came back with a clean bill of health. I was however still suffering with unexplainable symptoms that made me question not just my own sanity, but whether I’d ever truly get better.

In fact, sometimes a good sign that something is psychophysiological is if the person starts going way deep into the esoterics of testing and assessment (see here). Hyper-niche testing, ultra-specialist appointments, and explorations into the far reaches of non-allopathic medicine can sometimes lead to the same place: that something’s happening that isn’t strictly physically etiological.

Interestingly, psychophysiological symptoms are socially mediated. That is, some conditions are socially permitted to exist. For example, there are cultures that don’t experience whiplash. As another example, there were few cases of carpal tunnel in the era of typewriters (despite them being harder to use). To add, there are cultures that don’t get chronic back pain as much as in the West, despite living more physically demanding lives.

Why do they happen?

I see this is a multi-stage and non-linear process.

In Phase 1, things happen to trigger or keep the nervous system on high alert:

• Unresolved or unprocessed traumas, including those that happened perinatally, preverbally as a child, or as an adult.

• A buildup of internal pressure due to stress caused by personality types like goodism, perfectionism, imposter syndrome, people-pleasing, low self-esteem.

• A person’s inability (transient or ongoing) to “metabolise” or process emotional materials as they emerge. (Skill issue lol).

• Life stressors in the form of social (relationships, work, environment) or physical issues (illness, injury, or medical procedure).

In Phase 2, the nervous system generates these symptoms purposefully - in order to achieve a certain aim.

• To prevent feeling and expressing certain emotions, feelings, or memories. This is sometimes done by channeling from psychological phenomena to physical ones (like pain).

• To prevent feeling and expressing socially unacceptable emotions (e.g. lust, rage, frustration). Much like Freud’s theory of defense mechanisms.

• To signal that something isn't aligned or right with the person's best wishes/ vision of the world.

However, that aim backfires as a long-term solution in Phase 3. Instead of being a short term solution, the symptoms themselves become a new source of suffering.

• The mind gets "stuck" in that symptom pattern and the groove is hard to get out of.

• Having a benign, normal experience (e.g., some vertigo) might have been overwhelming and led to the fear of symptoms coming back, resulting in a downward spiral of perpetual fear of symptoms, and fear of fear itself (secondary fear).

• The mind continues to generate these symptoms because upstream causes haven’t been addressed. Symptoms shift and bounce because they’re quelled through medicines, biohacking, or other approaches.

What does treatment look like?

Some of these conditions can be treated (for a while) with reactive interventions like drugs, supplements, and certain lifestyle changes. For a group of people, that’s all they need. But for others, the mind and body finds a way to make the condition worse if not addressed at the root cause.

Many treatment modalities revolve around the thesis that these conditions are neuroplastic, or learned. This means they can be unlearned, such as through:

• Trauma work: discharging old patterns on a conscious or subconscious level that might give rise to a charged or hypervigilant nervous system.

• Mindset shifts: learning and reminding oneself that this is just the body creating a sensation (although sometimes brutal and painful) that is not actually harmful.

• Lifestyle changes: changing one's workplace, partner, place of living.

• Deep changework: shifting out of internal patterns that generate internal stress, such as do-goodism, perfectionism, people-pleasing. This includes changing one's internal dialogue and tendencies of relating to oneself.

• Reframing symptoms: being with uncomfortable sensations (such as pain, vertigo, and the like) and not reacting to them - to teach the mind that they're not a threat. That is, it’s not about expecting or wanting symptoms to disappear, but learning to ride the wave.

• Emotional processing: learning how to enable emotions to discharge and flow without them being stuck as unreleased energy.

• Nervous system regulation: practices that shift the body into ventral vagal, socially connected states (e.g., yoga nidra, tai chi, breathwork, and the like).

• Expanding the window of tolerance: doing things (including internal and imaginative work) that are increasingly scarier in order to teach the mind that the world is not as scary a place as it might think.

For example, using a tool called Pain Reprocessing Therapy made for telling outcomes. For patients with chronic lower back pain, this approach resulted in 55% of treatment patients being pain-free 5 years later. No medically intrusive intervention, just psychosocial therapy (link).

Importantly - supplements, biohacking, and other approaches aren't necessarily recommended. In psychophysiological communities, symptoms are often seen as downstream of something more important: a nervous system that perceives reality (and symptoms themselves) as a threat. Trying to quell the symptoms, instead of what they represent and are trying to achieve, becomes a game of cat and mouse. So, biomedical (and biohacky) approaches become an ever ending game of whack-a-mole.

What does this mean?

Could it be that sometimes trying to make something go away perpetuates and fuels its very existence? That is the main thesis behind what drives psychophysiologic disorders.

These conditions are treatable, and many, many people have been cured. Not managed, but cured.

So, if you’ve gone down the testing, assessment, and treatment rabbit hole without much success, it might be time to consider a different approach. You can explore some here.

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1. They’re also called neuroplastic, neural circuit, mindbody, psychosomatic, medically unexplained, and by many other names.