Mar 25, 2008
Anxiety sufferers and others will frequently say either that the physical symptoms we suffer can't be in the head, or else that they are all in the head. The idea is that either:
1. This can't possibly be "just" anxiety -there must be something "really" wrong -meaning an independent cause of pain or anxiety or discomfort which is unrelated to feeling anxious. Therefore, it is NOT anxiety -there is something ELSE going on. New anxiety patients in particular go through this phase because they are not accustomed to the mechanisms at work with anxiety. And so, many tests are done to rule out those independent causes, heart tests, oxygen absorbtion, digestive tests, etc. Once all the "other" causes are ruled out, THEN anxiety is about all that remains.
2. Or, the symptoms are COMPLETELY imagined. They are ALL in the head and no where else. Unfortunately, people who don't understand the disorder believe that someone can just be "talked out of" the problem, or that they are deliberately "making it up."
So, what's really going on?
To begin with, it is fair to say that every ache and pain -and every pleasure and comfort; be it large, small or in between, is IN THE HEAD. If you had NO brain, you would feel no pain. That ingrown toe nail? Yes, it hurts at the toe, because your nervous system, at the brain's direction, registers the pain in that place. But it could just as well register the sensation somewhere else, including places that no longer exist at all. This is why amputees feel pain in an arm they don't have anymore. By the same token, if we receive a sudden, castastrophic injury (think auto wreck) we may feel no pain whatsoever for a time -because the brain closes down the nerve pathways for a bit. Then, 5 days later we're getting an Xray that shows a cracked collar bone -because we feel a pain in the BACK.
In what we regard as the normal course of events, we expect pain or discomfort to exist at the site of the problem because this is our experience, and it helps us resolve the problem. But in reality, the sensation exists in the brain -and is displayed or presented at the problem site. Most of the time, the portrayal is correct.
In the case of panic or anxiety which do not appear to have an immediate external cause, however, the symptoms may be presented at various places and in various ways. The brain is doing the work in these cases, as well. What you feel is no more and no less "in the head" than an actual whack upside the head. And so, to say that your symptoms are "all in your head" is the same as saying that a diamond is "just a rock." True, but meaningless and unhelpful.
Medications can help interrupt the triggering of symptoms by the brain, and this gives us a measure of relief and may help us focus on figuring out what the real cause of those symptoms is. But they no more get "rid" of the anxiety than an aspirin gets rid of a broken leg. The healing occurs when the cause or causes is discovered, and we can get to work at making whatever mental adjustments are required to relieve the problem.
So, when you hear the "all in your head" thing, don't take it to mean that the problem is somehow not as significant as some external or independent cause: the effect is the SAME. Rather, it is the treatment that differs, once we have ddtermined that the source is, in fact, in the brain as opposed to the foot.
What's going on in the brain? For some, there really is some organic, functional, physical issue involved which has arisen independently of the thinking process. Surgery or medication may be indicated, together with whatever behavior modification or therapeutic approaches are appropriate.
For many of us -most of the folks on the forum, I believe- the causes of that "out of the blue" panic or anxiety for "no reason" are rooted in emotional conflicts and psychological challenges of long-standing. As we grow older, the defenses and adjustments which once worked no longer do so -and we have a swallowing problem, or some other strange sensation. The meds may help us interrupt to triggering, but it is therapy that allows us to do the emotional archaeology and discover the causes. And there really is no reason to think of this as being any more fundamentally different than finding that tiny splinter on your finger and digging it out, after a week of feeling "something hurt" somewhere on your finger.
For more on digging out the problems, please see the "Smoking Guns and Puzzles" post.