Surgery deals with organic diseases, those where there is a demonstrable alteration in the tissues. There is, however, another group of diseases where there is no change in any of the body structures, called functional diseases. All specialties are related to the latter group of illnesses. Volumes have been written on functional disorders, and, to be sure, their mechanisms are not simple.
Functional diseases and symptoms are due to emotional disturbances. Emotions are of many types. Every person has normal emotions of love and hate, of likes and dislikes, of calmness and fear, and many other reactions. But when the emotions produce an abnormal response, functional diseases may appear.
The human being in a state of fear or anger becomes pale because the surface blood vessels of the body constrict; the heart beats faster; the pupils of the eyes dilate; the breathing becomes rapid; muscles may twitch, and many other reactions are noted. These are normal reactions designed inherently to equip the individual to react favorably in an anticipated fight against the agent which stimulated the reaction. The vessel changes occur to direct the greater flow of blood to the muscles which are likely to have to work; the heart attempts to circulate the blood more rapidly to keep the muscles sufficiently supplied; breathing is increased to assure adequate oxygen supply; the eyes dilate for better vision; digestion and other functions not needed for the fight may cease, and all other responses are similarly designed to put the body in its most effective functioning condition for the predicted battle.
But modern society dictates that the individual should not react to anger and many of man’s other emotions by violence. Rather, he shall remain calm and participate in mental battles rather than physical battles. This, of course, is the direct opposite from that for which man was originally designed—to fight in time of conflict.
So man has had to learn to control his emotions to live acceptably in modern society. He has learned to modify the basic reactions to things which upset him, and this man usually does well. But when the emotional reactions are repeatedly stimulated, there appears to be an accumulation of inward tension which must find a mode of release. The release of inward pressure is manifested often by directing one’s attention to an interesting pastime or hobby where the person can express himself, thereby finding the outlet for the emotional tension he has imprisoned within himself; others may resort to physical exercise wherein they find enjoyment and freedom from tension, and some may analyze themselves to gain insight into the emotional pattern and eliminate the inciting cause. These are normal responses to accumulated emotional tension. In some cases, however, the person may react by setting up a defense pattern against others. He may become belligerent with other people, even members of his own family; he may assume a compensatory “superiority” pattern, or he may take out his “revenge” for the emotional inflictions on himself.
This, then, is one simple explanation of the mechanisms whereby emotions may express themselves. Few people realize the profound effects which emotions have on the functioning of all the organs of the human body. Estimates of the number of people whose ills stem from emotional causes have been all the way from 20 per cent up to 80 per cent of those persons who go to a physician’s office. Every physician, regardless of his specialty, must have insight to the fundamental effects of emotions. It is especially important to the surgeon, for operations can be indicated only when there is organic disease. Emotional symptoms can hardly be corrected by dissection.
To be sure, every illness has its effects on the mind. But of greater concern is the fact that all emotions have their effects on the body. Symptoms manifested by this “mind over body” mechanism are called psychosomatic (mind- body) symptoms. These appear occasionally in everyone. But in the person with a great accumulation of inward emotional tension who has subconsciously elected to take out his revenge on himself, the psychosomatic symptoms may become severe or prolonged.
Psychosomatic complaints are just as real as those caused by organic pathology. Pain caused by this means may be just as severe as any other pain. The pain is not imagined; it is actually present. But of course the treatment must always be directed at the cause. Medications may temporarily aid the patient, but removal of the cause is the definitive remedy. Often an insight to the problem is all the patient needs. Symptoms commonly found to be psychosomatic in origin include pain, fatigue, nervousness, “indigestion,” diarrhea, headache, breathing difficulties, and menstrual upsets. Certain diseases are often made worse by emotional disturbances, such as heart disease and peptic ulcers. Here emotional tension actually aggravates the organic disease.
Formerly there had been a sharp division between those diseases with a demonstrable cause and those of mind origin, as already inferred. More and more it is realized today, however, just how strong the emotional forces can be. And several chronic diseases with actual changes in the tissues are known to be of psychological origin. It would appear that the mental influences on the tissues, however mild at first, go on to aggravate them to such an extent that a response from the tissue to protect itself becomes necessary, just as it would with a mechanical or bacterial irritant attacking the tissue.
It has been seen how the heart and blood vessel system react to fear with increased output of work. When there is prolonged anxiety and apprehension, such response from the organ requires a tissue change in order to continue functioning; the heart must enlarge its musculature and the vessels have to re-inforce the hardness of their walls to enable such prolonged high blood pressure and increased circulation. Thus, the body has responded, but a disease has been caused. A mental response to the disease takes place. First was a psychosomatic and then a somatopsychic response. A vicious cycle is set up. Similarly, the mechanism of peptic ulcers can be explained, as well as several other chronic diseases.
In short, emotional tensions may cause symptoms without any tissue alterations; may aggravate any disease of organic cause, or may produce a definite disease with tissue changes.
Many patients resent being told that emotions play a role in their symptomatology. But it should be remembered that emotions influence every activity in everyone. Emotions play a greater or lesser role in every person’s illness. Do not be offended on learning from your physician the manner in which emotions influence the course of your illness. In most cases it is easier for the doctor to give a simpler explanation for a symptom, but the competent physician wants to get at the seat of the trouble and eliminate the cause. No organic trouble will be overlooked.
Symptoms or diseases are not concluded to be psychosomatic simply for lack of better explanation. The mechanism of their development is rational and confirmed.
Pure psychosomatic illnesses, where there is no organic cause, present a typical picture to the physician. To be sure, the doctor must ascertain that there is no organic disease present, but psychosomatic illnesses are not diagnosed entirely by exclusion. The symptomatology in most cases is classical.
Sometimes persons develop a mental fixation on a certain area or organ of their body, or on a certain disease. Since the heart has been considered the most vital organ in the body and for centuries has been a reference point for emotions, this organ is commonly selected for the role of expression of emotional conflicts. Most patients who present themselves to the doctor with the symptom of pain in the heart do not have heart disease, as there is but one type of heart disease which causes pain, and this pain is most often referred to an area other than over the heart. It seems that any other area or structure of the body may be used as the point of expression as well.
One of the oldest forms of healing was to rid the body of evil spirits by bloodletting or removal of parts, or indulging in such practices as placing holes in the skull to provide an cscape hatch for the casting out of devils. A carryover of this ancient means of therapy to modern times is often demonstrated through such symptoms as diarrhea or vomiting, wherein the patient subconsciously attempts to rid himself of “poisons” or fears or even guilt complexes. Conversely, a form of self-discipline may exert itself with the symptoms of constipation or pain. Other symptoms may subconsciously be directed toward gaining the attention and sympathy of others, or self-pity, through such symptoms as pain or breathing difficulties. The field of psychiatry is broad, and almost any symptom or even a set of symptoms may be an expression of emotional conflicts.
In the art of surgery particular search for emotional disturbances as a cause for the symptomatology must be made. Many persons with a fixation on a certain organ blame every unpleasant event on that structure and cannot live peaceably with themselves until the body has been ridded of that organ, or until they have been reassured that the organ is normal. Frequently, then, the seat of emotional conflicts is referred to another site or organ of their body. In olden times the womb was indicated in many forms of hysteria in women, and so was removed by operation, hence the derivation of the name even today for the operation of removal of the uterus, hysterectomy (or hysteria-out). Today such treatment for hysteria would be considered quackery; nevertheless, it still goes on.
In some instances the symptoms which are reflected on the uterus are not recognized as stemming from emotional influences, and the uterus is extirpated. Naturally, nothing is cured, and within time fixation on a new structure occurs. As each organ is excised or exonerated, the emotional conflicts become worse, but sooner or later the process becomes evident and the treatment directed in another fashion. The case of the uterus is used as the example because it no doubt has been the most commonly misjudged organ in surgery in the past.
In recent times, however, recogntion of such a train of events leading to surgical intervention for expressions of the emotions has been more and more forthcoming. The interplay of emotions and symptoms is becoming ever more apparent to the surgeon and all other physicians as well. Yet, many persons resent the inference of such analysis of their symptoms. They actually want an operation to rid their body of an inner part. When one surgeon tells them that an operation is unnecessary, they seek another. If they “shop around” long enough they finally find a practitioner who advises operation; the symptoms disappear with such, but a new set of complaints soon makes itself known.
The surgeon does not operate on every patient who seeks his advice, and the person who is told that surgery is not indicated for his symptoms must not be provoked. The competent surgeon knows when to operate as well as how to operate.
It is not within the scope of this book to elaborate in the field of psychiatry. But certain terms may clarify the reader’s quest of greater understanding of this subject. Symptoms or diseases primarily caused by mental or emotional processes are said to be psychogenic (mind- origin). Psychopathy means mind-pathology or mind-disease. The mental disease termed psychosis is a severe affliction where the individual is so mentally deficient that he is not capable of taking care of himself, or is dangerous in his activity to himself or others. These patients require institutionalization, temporarily or permanently. The term neurosis is any functional disorder of the nervous system; it is sometimes referred to as psychoneurosis. Neuroses may take any of several patterns. They are often related to certain body structures, producing psychosomatic symptoms. Or they may manifest certain exaggerated fears or certain compulsions to say or do various things. An abnormal fear of any thing is called a phobia, such as the morbid fear of getting cancer is called cancero- phobia, or the exaggerated fear of heart disease called cardiophobia. A certain amount of fear of these diseases is normal and desirable, but when the fear becomes so severe that the person’s whole life revolves around that fear, it may be classed as a phobia. (The term neurosis must not be confused with neuritis or neuralgia, which are organic diseases.)
A neurosis which manifests itself as a compulsion to do a certain thing is called a mania, such as kleptomania, a compulsion to steal irrationally. Psychotherapy means to treat the mind; the psychiatrist uses several methods of treatment.
In summary, the mechanism of emotional disturbances and the manner in which symptoms are produced by them is complicated but explainable. Emotions have their effects on the body and vice versa. Emotions play a role in every person’s every activity. An insight into the emotional disturbances producing certain psychosomatic symptoms may be all that is required to eliminate suffering in many cases. Patients must not resent being told a complaint stems from emotional causes.
In recent years numerous books, several of which are excellent, have appeared on the market for the lay reader on this subject of emotions and their influence on the body. Those who desire a further explanation of the interactions of the body and the mind are referred to these.