Many people suffer from psychosomatic disorders. Professor Johannes Kruse explains how to diagnose and treat them.
They are often not taken seriously. Yet psychosomatic illnesses often lead to early retirement. A conversation with Johannes Kruse, Director of the Clinic for Psychosomatics at the University Hospital of Gießen and Marburg, about causes and therapy options.
Mr. Kruse, what distinguishes psychosomatic illnesses from mental disorders like depression and phobias?
John Kruse: The borders are fluid. Stress-related physical complaints are central to psychosomatic illnesses. Patients suffer from functional disorders for which no physical cause can be found, or from chronic physical conditions such as diabetes and heart disease. The interaction between body and soul is always affected, for example, stress has hit someone’s stomach or their heart has become heavy. Everyday language knows these connections very well.
What are the causes of these complaints?
Chronic stress, excessive demands at work, private conflicts, harsh insults, but also experiences of violence in childhood and adolescence can trigger psychosomatic illnesses. There’s usually not just one cause, but stress plays a major role. Many people do not even notice that they are in a mental crisis, but only notice the physical symptoms.
How are these expressed?
Symptoms are very diverse, ranging from chest tightness, heart problems, shortness of breath, diarrhea, dizziness, tremors, eating disorders, chronic pain, psychogenic attacks and paralysis aggravation of chronic physical illnesses.
In the case of psychosomatic disorders, some experts speak of a soul infarction. So, is the term appropriate?
I would speak of an overload or a call for help from the soul. The soul is not damaged like in a heart attack, but psychosomatic disorders are a sign that mental strength is not enough to cope well with stress. They are like a monitor who tells us: “It’s too much now”.
Suppose someone suffers from psychosomatic heart problems, how does such a disease develop?
Let me explain this with an example. A 40-year-old woman came to me with recurrent chest tightness, heart rhythm changes, and sweating. Her heart was examined very carefully, but there were no signs of physical illness.
However, the woman was no better.
Exactly. She continued to have the discomfort and worries of having a heart attack. With each irregular heartbeat, she said to herself: Help, I’m sick. As a result, she increasingly withdraws, becomes more passive, less driven, and less able to concentrate on her work. It often happens that those affected become unable to work. We deal with one of the largest groups of patients taking early retirement.
Psychosomatic illnesses often make society smile. So, contrary to popular belief, patients do not imagine the pain?
No. So, the irregular heartbeat and the tightness in the chest are really there. Just like back pain or dizziness in the head. Or the feeling: I can’t take it anymore. Those affected are physically and mentally exhausted. They do not imagine their physical ailments or feign them. Patients encounter this assumption too often. Also doctors. Read also : Dementia: a study predicts a drastic increase by 2050
How do you go about processing?
First, the doctor must take the symptoms seriously. This means: listen carefully and let all complaints be described. Unfortunately, it is rare in medicine. In the case of psychosomatic disorders, it is important to diagnose both physical and psychological aspects. As for the 40-year-old woman, an in-depth somatic diagnosis is carried out. But we also look at the circumstances that led to mental overload. The patient had just separated from her husband and initially saw no connection to her complaints. In the rest of the treatment, we work with the patient to understand how the mental and physical aspects are linked, and we examine the often overlooked feelings of the patient and look for ways to better manage the situation. Treatment is often supplemented with exercises and relaxation techniques. It is not a question of paying less attention to the body, but of paying more attention to the soul.
What advice would you give to those affected?
First, turn to the family doctor and talk to him about the mental side. It can be very relieving. If the symptoms become chronic, psychotherapy is often necessary, also to learn how to say no in certain situations in order to protect yourself from being overwhelmed. It may sound trite, but many patients have to learn it first.
In some cases, however, hospital treatment is also advised.
Yes. We see patients who have suffered for several years from multiple pains such as tinnitus, eating disorders and dizziness. They have passed all kinds of tests, have been on sick leave for a long time and are deeply anxious, sometimes even depressed. Hospitalization in a psychosomatic clinic allows high-dose psychotherapy in a protected room. And it’s often about the basics: patients need to get to know themselves and their bodies better, feel how it reacts to stress, and find new ways to deal with stress. Therefore, we integrate relaxation exercises, tai chi, yoga and other creative therapy methods such as art and music therapy into the psychotherapeutic work. These combined treatments are very effective.
Another self-care question: what can I do for a healthy soul?
It is extremely important to make room for social relationships and to be open about your own feelings and the feelings of others. If something bothers or upsets us, we should talk about it, it works best with someone we trust. Meaningful activities are just as important for mental balance. And I recommend creative activities where you can disconnect. Whether it’s writing, making music, cooking and playing sports.
To no one :
John Kruse (63) is a specialist in psychosomatic medicine and psychotherapy. Since 2011 he has been working as medical director of the Clinic for Psychosomatics and Psychotherapy at the University Hospital of Gießen and Marburg. In addition, Kruse is a board member of the German Society for Psychosomatic Medicine and Medical Psychotherapy.
This article first appeared on abendblatt.de.