It’s Not All in Your Head
Several days ago, the headline “It’s All in Your Head” jumped out at me.
The author of the Journal of the American Medical Association article, Matthew Burke, is a neurologist at Harvard Medical School who specializes in neuropsychiatry. According to Burke, the problem of physicians telling patients that unexplainable symptoms are “all in their head” has become a silent epidemic, “slowly eroding patient-physician relationships, perpetuating unnecessary disability, and straining health care resources.” No kidding!
Doctors and unexplainable symptoms
The problem, Burke thinks, is that doctors fail to understand that psychological problems can cause physical symptoms. These physicians either ignore the symptoms or accuse the patient of “malingering” or imagining their problems. Burke describes a possible conversation between a patient and a doctor who thinks it’s all in their head:
“(1) the physician provides a rundown of normal investigations, (2) the patient is told they have no known medical diagnoses, (3) a brief awkward exchange occurs, and (4) little further explanation, guidance, resources, or facilitation of an appropriate referral process is given.”
Does that sound familiar? Here are a couple of posts I’ve seen on multiple sclerosis Facebook groups over the past few months:
- “I just had my ER doctor say ‘sometimes there’s not physiological explanation, sometimes it’s your depression and anxiety making you feel like that’. Yea lady, it’s all in my freaking head, thank you. So frustrated.”
- “I was just diagnosed today. After months of being told I had anxiety it was all in my head. Multiple emergency room visits with burning, numbness, headaches, blurred vision just all over feeling like poop. Finally I had a doctor take me seriously. Did the tests and I was diagnosed. All the others doctors made me feel like I was crazy and I was imagining my pain.”
People in this situation might seek out second and even third opinions. Other patients may “stumble on a fringe medical specialist or alternative medicine practitioner who may offer the ‘physical’ diagnosis they’ve been yearning for,” or they may fall through the cracks, Burke says. “The saddest part of this epidemic,” he continues, “is that if addressed early, these symptoms may be reversible; however, with delays to proper diagnosis and management, prognosis worsens considerably.”
What can be done?
Burke gives four suggestions to the medical community to reverse the “it’s all in your head” mindset:
- Research: Conduct more research into the relationships between the mind, the brain, and an individual’s overall health.
- Erase the stigma: Eliminate the negative connotations associated with unexplainable symptoms.
- Collaborate: Devote more time to consulting with patients and providing collaborative care.
- Communicate: Be transparent with and supportive of patients and provide resources.
It’s difficult to predict if any of this will find a foothold with healthcare providers, but bravo to Burke for placing this problem squarely at their feet.
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