Hypochondria, Psychosomatic Disorder, and Placebo Effect: Mind Over Matter – Lab 058

You know, t T. I think we can really convince ourselves of a lot of things.

Yes, I've convinced myself of a lot of things, Like I'm six foot tall. I am also four foot eleven.

Listen, different circumstances require different heights exactly.

Sometimes I'm like, how did I have my head on this doorframe? Right? I'm six foot I'm not six foot.

But you know, I think if the past year has taught me anything. My friends used to tell me that I was a hypochondriac, and I said, Oh, they're just throwing that word around. They don't really mean that. But the mind body connection, when I get it in my mind, they're like, oh I might be sick. It's like, oh, I'm failing. I'm not well, even if I was having those symptoms before. As soon as I decided in my brain,

This week, we're talking about how the mind and the body intersect. Specifically, we really wanted to know more about the mind's ability to affect how we feel, whether that's better or worse.

You may have heard the term psychosomatic before.

I've heard it on TV, you know, like on medical dramas, but I've never really been sure about the actual definition.

Well, it means something that involves both the mind and the body. So literally the word pairs the Greek words, which means of the mind, with soma, which means of the body.

And today we're going to talk about just how connected those two things really are, all right, T T. I think I know what you're gonna say. I'm very excited.

Let's kick off the recitation. I think the thing that we all know is that our minds are very strong. Our minds are like the central hub for our bodies. But sometimes we can't trust these minds absolutely.

I know my mind has definitely played tricks on me, and I can think of a few times your mind has played tricks on you. There have been a few bugs that I've been asked to dispose of, and they were a lot smaller than what you had originally said that they were.

I have a mind of scale, you know, it was able to easily scale. Now, some people might think that's positive, okay.

And so one of the ways that our mind can positively affect us is the placebo effect, right. So I think a lot of people have heard of the placebo effect, and it's usually associated with drug trials where they might be testing out a drug and then they give a certain group of people a placebo, so just a sugar pill instead of the actual drug. And if the people are aware of what the effects of the drug should be, their mind might trick them into saying that they do

And then I think the other question I have is around psychosomatic disorders and symptoms. When we say what do all these things have in common? I think for me, it's the connection of the mind and the body absolutely, And then that leads us to our overarching question for this episode, which is, how does the mind have control over the matter? You know, the body those are some very good questions and I cannot wait to hear the

My name is Susan O. Sullivan. I am a consultant neurologist and clinical neurophysiologist based at the National Hospital for Neurology in London.

We just want to have a greater understanding of what's happening in this mind body connection.

We've reached out to doctor O'Sullivan on our quests to really understand how aware is too aware. So when you're paying attention to your body, is that good? Or can you venture into this area where you're paying too much attention and then your mind is playing tricks on you? And I think that was our starting point. The mind.

The first thing to say is that our mind is constantly altering our physical sort of experience of the world and our experience of our own bodies. So the mind body interaction is much greater, I think than most people realize.

Our brain is constantly making assessments. Our brains are never resting. It's not just as simple as oh I touched this hot stove out, let me pull my hand away. It's also taking memories from the past stored in your mind to inform your body's reaction.

A good example of this is how we sometimes react in anticipation of something. So if you've ever said our winced before you even got hurt, or like you know, you always stub your toe on that side of the bed, it's because our brains are working so fast and processing so many things that it's just automatically giving you that

So, now that we have a baseline for understanding how the mind operates under typical circumstances, let's talk about what's happening when certain processes in the mind are stronger, louder, and more prominent.

I think that's a good point what you said about understand the typical circumstance, because I think we take for granted that in all physical disease there's a mental component. Absolutely, if I break my ankle and it inhibits my mobility, depending on how it feels to me that my subjective experience that could be really devastating, that could lead to depression other things. There's a mental component to every physical disease. I think would you agree with.

That absolutely, because I mean, using the same like break your ankle situation, your brain starts to tell your body, Okay, you need to lean more on if it's your right angle, lean more on your left hand. Yes, So you start to compensate for whatever that injury is. Like we've all been there with different things. Your brain is making all of these corrections in the presence of these injuries.

And I think over the past couple of years, this is something that we've really come to understand more and accept more, both in the medical field and in the general population. People see how stress can exist to ascerbate other physical factors.

Oh my gosh. Yes, when we all started working from home, like when the lockdown was really in place, I think we all started to feel that stress.

And I think something we've been interested in and what we want to explore with doctor O'Sullivan is what are some of the other ways that the mind can control the body. And we see something that is a new physical symptom that is completely controlled by the mind or completely driven by the mind, and I think that's what basically psychosomatic disorders are.

It really makes me start to think a lot more so, what are some other ways that the brain can produce or manifest a physical symptom or something that isn't necessarily linked to it. I really want to know the actual definition, like what falls under the umbrella of psychosomatic disorder?

Yeah, what does it mean?

So that means real physical symptoms. And I'm really emphasizing the word real because I think people when they hear psychosomatic they start thinking imaginary. But these are real physical symptoms that are for psychological reasons. I'm going to qualify the word psychological a little bit there, because again people

So there are psychosomatic symptoms, and you get these different symptoms within a psychosomatic disorder, But what about hypochondria. How is that related to psychosomatic disorders.

It's not to say they're not related at all, but they are different phenomenon psychosomatic symptoms are physical symptoms with or without psychological distress. Hypochondria is psychological distress, probably without any actual physical symptoms. So their predominant experience really is the anxiety, and the thing that's disabling them is anxiety about illness.

So these almost feel like opposites, right, because hypochondria is sheer psychological distress but no actual physical manifestation. It may be anxiety or anxiety about illness, but with no physical symptoms. But on the other hand, it seems like psychosomatic disorders present with these physical symptoms.

What kind of symptoms do they have? Do psychosomatic disorders always present themselves in the same way.

Every physical symptom you can imagine can be produced through psychological mechanisms, so the symptom can be anything, And I find the symptom is often determined either from their personal experience or their knowledge base, or as a result of a specific thing that's happened to them. And therefore all of these sort of psychosomatic symptoms are drawn usually from our environments.

I feel like this makes a lot of sense, especially when we think about COVID nineteen. When you think back to the early days, I'm talking March and April of twenty twenty. We didn't know what was going on.

Those were crazy times, yes, and people were just saying, are you experiencing shortness of breath?

Are you having chest pain? I was like, maybe I was double checking everything.

I would run up the steps and be like, am I usually this winded? I don't think so. And so then I was making myself nervous.

And I was checking my temperature with the back of my hand, and I would say to myself, boiling hot, you definitely have a fever.

But you had just gotten off the bike.

But then I would get my thermometer and it wouldn't even say ninety eight point six. So clearly my mind was telling me something different than what was really going on.

Similar things were happening with me because it was allergy season, and so I'm coughing because I have allergies and sneezing and I'm having issues because I also have asthma and using inhaler, and so I was just like, I don't know what's linked to what. I couldn't focus and figure out if this was just my mind playing tricks on me and these are just my allergy symptoms, or if you know COVID had got me.

Did your allergies always feel like that?

Exactly? I was like calling in the question. Literally, everything are.

Usually based in something that you've experienced. So we were all aware and experiencing a respiratory virus that was sweeping across the globe. So everybody's thinking about their breathing. Yeah, but you can imagine if it wasn't confined to the respiratory system and it was related to something else, like.

A hair loss pandemic, I would be counting all of the hairs in my white tooth comb a little bit closer.

Yes, every straight hair would be a cause for panic.

Every hair matters.

The interesting part that doctor os Sullivan was saying is that it usually starts with an actual disease. So if you've had some bad bout of like gastro enteritis. What is gastro enteritis? I've never heard of that. You might not have heard of it, but you might have experienced it if you drink contaminated food or water. Some people call it the stomach flu.

Oh, yes, it is awful.

Upset stomach okay.

Upset stomach diarrhea, yeahpops.

No commercial. But I've always been more of a fan of Kopec tape.

My friend is choosing Okay, I think we've all been there.

So if you had a bad about of gastro enteritis, you're already focused on your stomach, so your psychosomatic symptoms could manifest around the gut. But interestingly, that's not where they always manifest. Doctor O'suliva says, you know, you could start with the gut because that's what you're familiar with, But there's also a possibility that you have symptoms that kind of move around the body too.

But then once a person is prone to these disorders, one characteristic of them is that they tend to move around. So people are particularly badly affected by this will often have come to me with a list of diagnoses, you know, and these will be young people because it's often to

What I want to understand is, like, how how does the mind create physical symptoms without a specific biological trigger.

We ask doctor O Sullivan to walk us through how this really works, this circuitry of stimulus and response and risk.

Even so, I think the most important thing to know in this question is about a thing called top down processing. So I think a lot of people sort of have the kind of concept that you're you're looking at something and you're almost recording it, like a camera or a video recorder or something that you're just soaking up information. And when you learn about neurology as a neurologist or as a biologist, you learn about you know, this is where the nerves begin and they travel up through the body,

Are you thinking what I'm thinking?

Absolutely, I think we're about to say the same thing. Doctor rober Wiley here from Lab thirty. Yes, yes, doctor Wiley, that's right. Doctor Wiley talked about this type of dual processing in Lab thirty. We call it science sale delivered. Our brain creates shortcuts while we're reading this.

Is while you know. It really is all about our brains and their previous experiences and expectations.

You know, there are lots of kind of thought experiments you can use that will show to people how easy it is to derail your body. So you know, if I ask somebody to walk on a narrow line on the road, you know most of us could do it with no difficulty. If I asked you to walk exactly the same line on the edge of the cliff or the top of a high wall or something, it changes the way you think about your body, and your entire

I actually had this happen to me, So me and my husband went on a really long hike for our honeymoon, don't ask about it, and I fell pretty far at one point, it was very traumatizing because I was very scared. I thought I was going to die. So I went from being surefooted so like not even really paying attention to how I walk or what I was doing, so feeling like every step that I took could be the end of my life. So now even if I'm walking on like a tall curb, I'm shaking. I don't know

So it's quite difficult with psychosomatic symptoms to know exactly what's happening in the brain. When you consider how many different kinds of psychosmatic symptoms there are and how many different things can cause them, trying to, you know, compare different brain scans and compare to people who've got wildly different symptoms for wildly different reasons is never going to

Disorder MRIs or brain scans, they've only really been in regular clinical use for about thirty years or so. That's really young technology wise, and so scientists and doctors are still trying to use them to understand what a typical brain looks like. And so then you have to use that to compare to what's happening in the brains of folks who are experiencing psychosomatic symptoms. Doctor Sullivan explained that functional MRIs can help our understanding of functional paralysis, so

So that tells you right away that whatever is happening in the brain of someone with psychosomatic disorder is not the same as pretending.

And the other thing that study showed us is that there seems to be a kind of an increased connectivity between the emotional parts of brain and the motor parts of the brain in people who have psychosomatic paralysis. So people are somehow rewiring the way their nervous system works to become less efficient. And I think of it like learning. So if I can learn to play tennis well, probably there is someone who could give me bad instructions that can teach me to play tennis badly. We learn motor

That's really interesting because I think in the past people have dismissed psychosymatic disorders and saying like, well, your brain's not connected, and actually, exactly, it seems like there are some stronger connections or increased connectivity based on what T. Sullivan is saying.

It's not a malfunction of your brain. It's not your brain like not working right.

It is a rewiring. And it's really interesting that this requires even more connectivity than what you would typically expect. And so one of the things that doctor O Sullivan was saying is every connection is basically learning, you know, and we talked about this in some of the earlier episodes.

I think that's a good point though, because there are some functions of our bodies that we don't have to think about because of those strong connections, like how our body regulates this temperature, blinking, breathing, our heart rate. Yes, these are all really strong connections that our mind has made over time, like since you know, we had a brain.

And there are also these connections to emotions as well. When you're upset, there's a physiological process that happens your body responds and tears come out of your eyes right every sack time. Another type of connection, and so you see these emotional parts of the brain connected to the physical part.

I heard that there was some study that when you look at folks pupils, if you say somebody that they love, their pupils will get bigger.

We have to try that. And let me tell you something. When I say my name, I'm expecting full dilation. They better look like saucers.

The whites of my eyes will turn black.

The whole thing is irin oh man, why do we have to act like this.

We're gonna take a quick break and then we'll talk more about pain, diagnosis and treatment of psychosomatic disorders and who's affected the most. We're back and we're talking more about what it means to have a psychosomatic disorder. We're trying to understand how the brain processes pain and other stimuli, the route to diagnosis and why it takes so long, and how the framing of psychosomatic symptoms and disorders can affect how people perceive the diagnosis once they get it.

I think pain is the hardest question you could ask. I almost wish you'd ask any other question, because the problem with pain is there, it's subjective, so it is unbelievably hard to study, and it's unbelievably hard to sort of understand how exactly you know. One person can feel a completely different level of pain to another person. So I don't think that I know the absolute answer to how we can feel pain in the absence of a

Are there certain people who are more likely to have psychosomatic disorders.

Anyone can have a psychosomatic disorder, and it really just requires the correct set of sort of triggers to be present for that person. But that's not to say that there aren't people who are more vulnerable than other people. If you are a tendency to be a worrier, if you have a tendency to be anxious, you are a

You know what this reminded me of. This reminded me of someone bows pulling out of the Olympics. So she pulled out of the Olympics because she was saying that she wanted to check in with herself with her mental health, and knowing what doctor O'Sullivan has just told us, it completely makes sense if she's feeling unsure and the pressure

Yes, you told me about that. Yes, all of these things.

Totally affect the quality of the work that you're doing. And for them it's their sport.

I know, my job.

If I'm not feeling myself and I take a mental health day or if I decide not to, if I try and push through, no one's going to get hurt, no one's going to die. But for someone like Simone Biles, who is doing really strenuous and dangerous what are those things called stunts?

Yeah, activities.

Flying to the sky like a bird, there's way more that she has to consider. She's talking about her life here, you know what I mean. She said it, she said there's more to life than gymnastics. Her gymnasis career, God willing will be a small sliver of her life. This is just a small sliver of who she is, and we are so proud of her. But she still has very many years that she needs to live and we want her to be having the highest quality of life possible.

And like you said, if we get lost in stuff and it's like, oh, what tab was I on? You know where was I in this paragraph?

I'm not gonna fall on my neck right.

Very different. So we understand that there are groups of folks who may be more vulnerable to experience in psychosomatic symptoms. But what does it take to get to diagnosis? How do you identify theo.

There's a perception that neurologists diagnose psychosomatic conditions because the scans are normal, or because we can't find anything else there. When it's presented in that way, it becomes a diagnose of dismissal. It sounds a bit like, well, science hasn't cut up with it yet, or the scan isn't good enough to show it. Actually, that's not how we make the diagnosis. We make the diagnosis on positive findings in the examination that make this disorder biologically impossible. So our

One of the things doctor O. Sullivan told us is that speed is the key to getting better. The sooner you know your symptoms are psychosomatic, the more likely you are to get better.

There's lots of studies in seizures where a third of people, just by learning that those seizures are psychismatic, spontaneously improve. It's just something in that sort of fear anxiety sort of cycle has been broken and they inmediately get better.

Unfortunately, our medical systems, both here in the US and in other countries too, don't lend themselves to speedy diagnosis.

For any psychosomatic disorder. The average time to diagnosis is one year. Now, i'm gonna tell you something that's gonna blaw your mind. For psychosomatic seizures, the average time to diagnosis is seven years.

Oh my gosh. I can't imagine going through something like that that's so traumatic, not just emotionally but physically traumatic for seven years before getting a diagnosis, and to.

Not know what is causing it or what's happening, and to just continue experiencing that. I would be sour on the whole medical system.

Okay, absolutely, I would feel absolutely failed.

So I think that doctors need to start elevating this diagnosis so that it's given the same level of priority as everything else. So it doesn't have to be the case that someone comes and sees you and says you've got a psychosomatic disorder from the outset. What would be better is if they did what they did with every other diagnosis. You know, you've got seizures, so they could be epilepsy, here's the reasons for and against epilepsy, it

It kind of makes Now, that doesn't make it right. But when we think about how our medical system is structured with a general physician and then you go see XYZ specialists over and over, I can see that taking a really long time. TC.

Yeah, I mean you would hope that there's ways that we could streamline these processes so that everybody benefits from it. There's a lot of pitfalls because that's assuming everything goes right. That's assuming that you have access to great healthcare, access to doctors who care, access to a lot of things that you might not have access to depending on your level of income, and a lot of socioeconomic factors.

And it's also assuming that the way your psychosomitic symptoms present stay the same. So I can imagine if you went to an ear nosen throat doctor and they checked you and everything was fine, and then you go to a neurologist and then you are starting to have symptoms that go back to the earos and throat doctor and they say, we already checked you, you were fine, And are those people even talking like exactly?

That feels like a medical nightmare, Like doctor O'Sullivan said, these symptoms they move around, and so they might not even be able to catch some of these things when they're happening. And yes, it's just feel like a wild goose chase.

Yeah, when we really look at the numbers, this is more common than folks probably think, right, Doctor Sullivan told us that one third of the people coming into neurology clinics have a psychosomatic disorder.

If you can't walk, or you're having seizures, or you're unable to work, then you're seriously enough ill to require the same speed to treatment as diseases. But I don't think people take these disorders seriously enough yet to care about that.

So it really makes you ask what can we do. How can we change this process where folks are having this long drawn out experience where they're going from provider to provider trying to figure out what's happening. How do we raise awareness about this.

We're still waiting to see people running the marathons with t shirts that say psychosomatic disorders. Because people care about cancers and which they should and other diseases like that. We need to start opening our eyes to that and create treatment facilities.

There's not a lot of public awareness around psychosomatic disorders, but they affect about one third of people going into neurology clinics.

I think this is such a good point. We really need to dignify this disorder.

It is real.

People are really suffering, and I think a lot of folks when they hear something like this, they're just like, Oh, this person is just out of their mind. But there's a spectrum like it affect people in little ways, and then it can also affect you in really catastrophic ways. These are real physical symptoms that need treatment, and you.

Really have to ask. Even if you're dismissing somebody and saying they're out of their mind, well, your mind tells you when you step on something sharp, it is your mind that tells you that. And so if their mind is telling them that they are feeling this physical pain, who's to say, well, I need to see what the stimulus is for you to have this.

Right exactly, everybody deserves treatment.

Sad is sad. Pain is pain, regardless of the sem me list that creates it, regardless of the origination. Treat the pain. If we can treat it, treat it.

Treat the pain.

All right, it's time for one thing, tet, what's your one thing this week?

My one thing this week is an artist. Her name is Dominique Brown, and I stumbled upon her work while I was at home Goods. So home Goods it treats me like Target. I went in there looking for a coffee table, ended up buying three pieces of art to buy this woman. I caught it out the corner of my eye and I was like, there's no way I can leave here without this art. And I did not get a coffee table. Her name is Dominique Brown. Really

Yes, and you have been very excited, and I must say it does look lovely back there. Thank you.

What's your one thing?

Well? You know, this weekend my Instagram stories, I was asking people to give me book recommendations and I got a lot of book recommendations. I put them all together on one list. But I got a book recommendation from one of our favorites tt This book I'm going to tell you about it is written by a movie critic that we both like, Brooke Obi Wow. Obie is a

Okay, once you finish, give it to me.

I already know the deal. Put it in the mail. We love Brooke. That's it for this lab. Call us at two zero two five six seven seven zero two eight and tell us what you thought, or give us an idea for a different lab you think we should do this semester. We like hearing from you. That's two zero two five six seven seven zero two eight.

And don't forget that there is so much more to dig into on our website. There'll be a cheat cheat for today's lab, additional links and resources in the show notes. Plus, you can sign up for our newsletter check it out at Dope labspodcast dot com. Special thanks to our guest expert, doctor Suzanne O'Sullivan.

You can find her on Twitter at sus Underscore Osullivan. That's su Z Underscore o Sullivan and you can.

Find us on Twitter and Instagram at Dope Labs Podcast.

TT's on Twitter and Instagram at dr Underscore t Sho and you.

Can find Zakia at z said. So Dope Labs is a Spotify original production from Mega Own Media Group.

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So like, if it wasn't COVID and it was like a hair loss pandemic, I might be counting the hairs of my waye tooth comb a little bit closer.

Right, and you would say, did my edges always look like this?

Is this? A wait?

I'm just saying mind is strong. The mind is strong.

Okay, let's leave my edges out of this conversation.

Let's move on to something else.

I'm sensitive