Patient Emotions and Surgery

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.