09.12.06

VOICES FROM WITHIN -Dr Shyam Kagal

Posted in Medicine at 12:48 pm by PuneTalks

In all the years I spent in Medical College training to be a Physician, I believed that for every symptom there was a cause; that there must be an underlying disease which we would have to identify and, once confirmed, we could offer some advice regarding its treatment. This impression was re-enforced by the years spent in treating patients as a resident doctor in various hospitals until I felt I was ready to practice medicine independently.

What I encountered as a Physician in the “real world” had me confused. Ever so often I would encounter people with symptoms that were supposed to indicate some underlying disease but when examined and put through the usual tests there did not seem to be anything wrong! In the early days of practice, one usually has enough time to mull over such issues and it became increasingly evident to me that a large proportion of patients I saw tended to get sick when their mothers-in-law moved in, their husbands got transferred, their daughters left home to study abroad or were in the midst of other such stressful events.
I would often hear patients tell me that merely talking about their problems helped ease their “pain”. This led me to explore the relationship between emotional events and physical illness — the field of psychosomatic medicine. The importance and relevance of this connection between mind and matter is illustrated by the following examples.

~ On our return from a vacation we find the house has been burgled. My daughter, all of 3 years, takes in the scene, senses our anxiety and promptly throws up.

~ I am the next speaker at a medical update. In spite of having faced large audiences before, my wife (also a doctor) notices that my hands are icy-cold and moist. I find my mouth drying up. I also need to visit the men’s room more frequently.

~ On my way to work, I narrowly escape getting into an accident. I am angry and shaken by the recklessness of the young motorcyclist. I find my hands trembling and my heart is pounding, forcing me to pull off the road.

These are just a few instances of how strong emotions like fear, anger and anxiety result in bodily symptoms. The phenomenon itself is nothing new, and all of us have experienced it some time or other, though we may not have paid particular attention to it or observed it minutely.

PHYSICAL MANIFESTATIONS

Itchy palms, cold feet, a pain in the neck. Not a day goes by that our bodies don’t ” speak” to us through tickles and tingles, belches and bellyaches, twitches and twinges. Tears are shed in anger, joy and grief. People lose their appetites (and sleep) when worried or depressed. Young girls are known to miss their periods when living away from home.

Emotions are reactions to events, thoughts, experiences or other stimuli. With every emotion, which is a mental response – there is a conscious awareness of the emotion as well. For example, I feel hurt and angry when something unpleasant is addressed to me. Immediately, along with my indignation, a physical (and chemical) response is triggered off. The blood pressure rises, the heart beats faster etc. – all due to chemicals released in the blood-stream, the brain and other organs, in response to the anger.

Babies cry when hungry. Toddlers holler when they feel neglected or afraid. Children laugh and jump up and down when happy. They do not hide their feelings. In our natural “uncivilized” state, we roar when angry; sadness makes us weep, jealousy makes us want what we do not have and to dream of ways to get it. There is a part in each of us, the emotional part, that demands release and expression. Mother Nature did not intend these to be stored in the body or mind. Aggression, tears and laughter are our natural means of release.

REPRESSED EMOTIONS

As we grow older, we are conditioned (by parents, teachers and civil law) to hide and control our emotions. We learn that temper tantrums don’t always get us the new toy or ice cream and that we will be punished if we kick another child in the shin when he refuses to share his chocolate. We learn not to display our emotions and to incorporate all the “thou-shalt-nots” into our pattern of thinking and behaviour. We acquire politeness, etiquette, manners, diplomacy, tact and other similar qualities. Although this conditioning has its advantages (like not expressing anger in destructive ways like slugging someone just because we don’t like him), we also tend to lose the emotional awareness that makes children so spontaneous, vivacious and healthy.

However, just because we lose our awareness of emotions, it does not mean that we cease to respond emotionally. We do respond to emotional stimuli but in inappropriate ways. This is called neurotic behaviour. The physical/physiological responses evoked by these unrecognized (and many times unattended) emotions result in pain and disease.

We are all unique. Each one of us reacts/emotes differently. Therefore, our “body-language” (the physiological changes brought about in response to emotions) is not uniform. I may blush when embarrassed whereas someone else may blush in response to a feeling of guilt. There are times in my practice when I have marveled at my own lack of emotion. When called upon to decide whether life-support should be withdrawn, or after hearing a “gut-wrenching” story from my patient, I rush to congratulate myself on being a true professional, able to rise above ordinary human emotion in order to be able to intervene for the highest good of the patient! Then I find myself scratching or rubbing my eyes inexplicably. I realize that this may be my body’s manner of expressing the sorrow I repressed, the act of rubbing the eyes being its way of reminding me of the tear I may have shed.

LEARNING TO OBSERVE

Recognizing our feelings enables us to express them. Expressing feelings enables us to release them from our body. If we learn to pay attention to the body signals when they are just  “whispers” (the blush, goose bumps, the cough or sneeze, cold hands and feet, the dry mouth, a twitchy eye, the growling bowel etc) and ask ourselves “What was going on when it started?” we may learn to identify the emotions that bring on these symptoms. By making the necessary corrections in our behaviour or expressing our emotions, we may be able to prevent the body’s more urgent signals (the “roars”), which usually indicate emotions that have been left unacknowledged for too long (such as back and neck pain, stomach-ache, nausea, vomiting, constipation, diarrhoea, heartburn, headaches and skin disorders.

The people of today call this “bio-feed back.” The phenomenon is not only recognised but systematic studies are now being conducted to understand the intricacies of the connection between the mind and the matter, not only in relation to disease but also in relation to other aspects of this finding that is gradually but inexorably making fundamental changes in our very approach to life. Certain meditation techniques are designed to firstly sharpen our powers of observation and then to observe the various “sensations” that constantly manifest themselves all over our bodies.

The medical profession has made enormous strides in its understanding of the functioning of the human body. Illnesses that were inevitably fatal a decade ago are treated and cured routinely now. Researchers are now paying increasing attention to the possibility that the body follows the emotions’ lead. We are learning that our attitudes and emotions can either act as a shield against illness or can bring on all manners of aches and pains – even the pain of a heart attack! Studies reveal that certain thoughts, feelings and experiences are the Vitamins A, B and C of the happiness/health connection. Soon we will be prescribing “mental diets” too. One such prescription may read as follows:

- Pay close attention to your body – to the signals it constantly broadcasts.

- Try to notice what it is that is making you unhappy (get in touch with your emotions).

- Learn to express your emotions (maintain a diary, complain, whine, cry or grieve).

- Avoid suffering in silence at all costs.

The body-mind-spirit combination is constantly sending signals, but we are oblivious to them, or deliberately choose to ignore these signals. It is time we realised that these signals are constant reminders that we should make renewed efforts for our physical, mental and spiritual evolution. If we do not pay attention to these signals (whether they are whispers or shouts), we do so at our own peril. Every practitioner of medicine would also do well to acquaint himself with such phenomena and processes so that he may take a holistic approach to health care and not content himself/herself with merely being a body-mechanic, a person who caters only to the gross aspect of the human being without taking into cognizance the subtle.

Shhhhhhh….! Listen to the voices from within. Can you make out what they are saying?

Dr Kagal graduated from the J J Hospital/Grant Medical College in 1981. He was a rank-holder at the MD( Internal Medicine) exam from Bombay University-  in 1985. Thereafter he worked as a Senior Registrar in Nephrology at the Bombay Hospital before shifting to Pune in 1985. He then worked as a lecturer in Medicine at the Sassoon Hospital for a year and then started his practise- as a Physician. He was also a visiting lecturer at the Bharati Hospital for 6 years.
He still considers himself to be a student of Medicine, and lives and practises at Model Colony, Shivajinagar. 

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