Intended for healthcare professionals

Practice Uncertainties

How should we manage adults with persistent unexplained physical symptoms?

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j268 (Published 08 February 2017) Cite this as: BMJ 2017;356:j268

Re: Reframing persistent unexplained physical symptoms?

As a psychotherapist – and widow of a GP who took his own life whilst diagnosed with ‘depression’, ‘health anxiety’ and ‘somatisation’ (having lived with ‘treated’ Addison’s disease for 26 years) – I have become deeply alarmed to learn about more and more people who are suffering apparent psychiatrically labelled ‘medically unexplained symptoms’ and ‘somatic disorders’ and who are indeed very unwell. They are unable to function and have become disabled or worse.

These ‘functional’ illnesses and syndromes arise from disruption, imbalance and sometimes damage (reversible and/or irreversible) to the autonomic nervous symptom (ANS) – affecting all the physiological systems of the body which in turn affect moods, feelings and thoughts.

There are various ways that this ANS dysfunction may come about, but what has particularly alarmed me is the huge part that the common medicines prescribed by GPs for the normal human stress ‘alarm’ symptoms (depression, insomnia, anxiety etc.) have to play in CAUSING or exacerbating this sort of ANS dysfunction - and indeed creating long-term ill-health conditions. This has been termed “Drug Stress Trauma Syndrome” by Charles Whitfield MD.

Antidepressants, anti-anxiety and sedative medicines ‘work’ by acting crudely on our subtle nervous systems and as such compromise and impair the normal process of homeostasis. People find that they cannot ‘come off’ these medicines without running into serious withdrawal problems and we have no idea what problems are building up over the long term. Patients are the guinea-pigs of this long-term human experiment.

This is an issue which affects patients and doctors who are also patients, as I have written about this recently for GP View http://gpview.co.uk/an-outsiders-observation/

The late Dr Lisa Steen describes in the deeply moving BMJ blog about 'The wilderness of the medically unexplained':

“I then started to look for threads, clues, and a way forward to get treatment. This was thwarted by my earlier diagnosis of health anxiety and having medically unexplained symptoms. One could not be dogmatic in further requests for investigations for fear of looking even more “anxious” or suffering from “health anxiety,” aka a hypochondriac.”

“I was disappointed in finding a very poor appetite for a diagnostic hunt, which may in part be the result of protocolisation and superspecialism. I disliked being unable to order my own tests, and I regret not pulling more strings. I was too embarrassed about my “psychiatric” condition, too confused by not having the whole answer ready.”
http://blogs.bmj.com/bmj/2016/08/25/lisa-steen-the-wilderness-of-the-med...

Timely talking therapies can certainly be very effective at the outset of any presenting issue of psychological stress and emotional distress – instead of any medication. However, as soon as people’s nervous systems have been tampered with by medicines the situation changes. Once people are suffering from complete chaos and disruption within their entire essential nervous systems, these talking therapies can only scratch the surface. It is surely most important to explore what on earth is going on - to find the roots of the problems leading on to ‘medically unexplained symptoms’ and to do something about it.

A patient who has suffered very serious cardiac issues as a direct result of taking antidepressants ‘as prescribed’ has asked me to say:

“Being unable to explain something medically does not make for a psychiatric condition in the patient. The problem is with medicine surely and, in the case of antidepressants, it points to a lack of reporting resulting from prejudicial attitudes towards people with mental health issues which goes back over many, many years and is still current...
The ignorance (aka prejudice) is entirely of their own making.

“In direct contrast patient support groups (such as http://survivingantidepressants.org/ ) and experts (such as Peter Breggin, Joanna Moncrieff & David Healy et al) have been working away in the background compiling a list of effects and ways to control the impact of withdrawal to help the very patients that the medical profession are now discrediting.

“Rather than creating yet another DSM/ICD category they should try introspection and apology and instruct their members to report under GMC guidelines so that their data bases of effects from these neurotoxic drugs usefully expand!”

Further reading
Charles Whitfield – Drug Stress Trauma Syndrome
http://nhne-pulse.org/wp-content/uploads/2010/12/Psychiatric_Drugs_As_Ag...

Competing interests: No competing interests

09 February 2017
Marion Brown
Psychotherpist and Mediator
Helensburgh