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Physical Discomforts Without Conclusive Medical Causes

Often, we come across people with one or more physical discomforts, such as pains & arches, dizziness, heart pumping, without known physiological causes. Sometimes these physical discomforts come about in very close temporal proximity and yet without known physiological linkage between these symptoms. These somatic symptoms are usually distressing and result in significant disruption of daily life.

By looking at the person’s recent life changes, long-standing self-development & relationship history, and occasional dreams, a psychologist can analysis the inner psyche of the suffering person and help him/her to link his/her physiological situation to his/her psychological meaning.

Common physical discomforts people complain about are — tiredness, headache, dizziness, muscle pains, stomach pains, chest pains, feeling weak in parts of body, and insomnia. According to their etiology, it can be categorized into the following:

  1. Mainly physiological basis
  2. Mainly psychological basis (eg, somatic symptom disorder, Illness Anxiety disorder)
  3. Mixture of physiological and psychological basis (eg multiple pains and organ dysfunction at close temporal proximity without known physiological linkage; insomnia)
  4. Unknown physiological and psychological basis (eg vertigo)

People with physical discomforts or complaints generally go to see a medical doctor for diagnosis, treatment, or referral. In category (1) above, people usually make good treatment progress with medical doctors and would not need further referral to psychologists. For category (2) to (4), psychotherapy can often help by analyzing

  1. the psychosocial history around the development of the physical symptoms
  2. the unconscious psychological needs, impact, and drives symbolized by the physical symptoms (via dream analysis)

The psychological focus of treatment will then be deduced from the above psychological analysis to address the psychological difficulties and yearnings underlying the physical discomforts.

Quoted a few cases who benefitted from psychological analysis:

Case 1. Chest pains, headache (mid-20 female)

Extensive body check had been completed without finding a reason for the chest pains. The chest pains were later found to be triggered by news of social unrest through a technique called active imagination from her dream analysis. Such news was 2 years ago overlapped with her parent’s major illness, that she cannot recall if it was not through the technique of active imagination. Therefore, without her awareness, such news triggered immense insecurity as expressed by her chest pains. Psychotherapy helped to dissociate the news triggers from sense of insecurity from past trauma.

Case 2. Nervous breakdown from heart pain and insomnia (early-40 male)

After hospitalization during his nervous breakdown, he felt weak, but the body check came back clean. Through dream analysis, he found out that even though he has been successful in his career, brought his family to new grounds, stable family life, he realized that he has left himself out in the past 15 years, his career brought him good comfort, but he felt empty and as he lost his motivation to fight at work, his anxiety came to force him back to his work position. The conflict between these two forces were dealt with through psychotherapy.

Case 3. Vertigo (mid-30 female)   

Case 4. Vertigo (early 60s male)

Ears, blood pressure, and other physical causes of their vertigo had been ruled out when we started psychotherapy.

For Case 3, it was found that she felt ‘blinded’ about the office politics as she was on extensive off-site workplace during covid while most colleagues were in the same city. There is a strong psychological dizziness in how she landed in a matrix of work relationships. Psychotherapy mainly worked on her work boundaries and office politics.

For Case 4, through a psychoanalysis technique of picture interpretation, it was found that the vertigo was a result of huge stress resulting from extensive hoarding in his family. He was overwhelmed and felt psychologically losing his foothold at his resting place. His psychotherapy involved systematic handling of the hoarding to increase his sense of control.

In the above cases, clients’ physical complaints were removed or substantially reduced after 2 to 10 sessions of psychotherapy.