You’re only as sick as your secrets.

Jenny had had IBS ever since her early twenties. It was the pain deep in the pit of her stomach that affected her most.  It made her feel unbearably sad and then when the diarrhoea started, she felt like her life was draining from her. She knew what had caused it, but she had never told anybody even when she lost all that weight.  She just felt so stupid and ashamed.  How could she have been such a fool?  Didn’t everybody warn her?  And now he’d left her, she couldn’t face them.  So she pretended that she didn’t care and continued to suffer.

So many of the people who come to see me with their IBS, have something to hide. I am not suggesting they are duplicitous or have done anything wrong.  More often than not, something has happened to challenge their personal integrity, the good opinion they like to have of themselves, and it has to be hidden for fear of being thought weak or stupid.   So they carry the memory of their shame like a ‘wound to their sense of self’ and pretend to the world they are ‘fine’.  We all so much desire the good opinion of others, especially when we are young.  To lose it is like a little death.

When memories are repressed, they do not disappear.  They remain in the body like a ‘fifth columnist’, primed and ready to sabotage the ‘body politic’ when stimulated by anything that reminds them of what happened.   What is experienced is not necessarily the memory of what happened: that may be too unbearable to recall.  It is the disconnected representation; the feeling of it; the pain, the depression, the loss of sleep, the fear of food and the bowel upset.  It is felt in the body because the shock or trauma of the original event was too upsetting to be processed and forgotten by the thinking part of our brain, the orbito-frontal cortex.  Instead it went directly to the emotionally reactive centres in the brain stem including the hypothalamus and the control centres of the autonomic nervous system (ANS), which orchestrate reactions throughout the body, but particularly the gut.  So when the buried secrets are disturbed by something that connects with the original context, the same bodily reactions are rekindled.

Brain scans have shown that it is these brain stem centres light up in people with unexplained physical illnesses like IBS and fibromyalgia, but the part of the body that expresses the symptom may vary.  It may be where the original event was expressed perhaps as a symbol of what happened or the actual event may actually be associated with some injury or disease.  For example, the symptoms of gastroenteritis may persist as post-infectious IBS, especially if the patient was anxious, depressed or had experienced some troubling life change at the time of the original illness.  That is not to say that IBS is ‘all in the mind’; some of it is mainly in the gut.  After all, it could be that a crisis in the gut constitutes the trauma.  The ongoing fear and shame induced in a young teenage girl by a bad attack of gastroenteritis is so eloquently explained in Sophie’s Story by Sophie Lee.

The kind of repressed trauma implicated in the narratives of many people with IBS is not necessarily the most dramatic events, like a violent attack, sexual abuse, military conflict or incarceration.   More often than not, it is the kind of life trauma that few of us escape: the death of close relative, the collapse of a love affair, divorce, children leaving home, loss of a job, a road traffic accident, an operation, a coercive relationship at home or in the workplace.   Given time, the symptoms of such trauma calm down while you tuck the narrative of what happened away on the dusty shelves of your autobiographical library and carry on as usual avoiding any reference to what happened.  But if something happens to trigger an association, then the symptoms flare up all over again as a mysterious illness.

Philosophers as diverse as Thomas Sydenham, the English Hippocrates, Arthur Schopenhauer and Sigmund Freud, and more recently Antonio Damasio and Bessel van der Kolk have all recognised that bodily symptoms are not just the perception of disease in a particular organ, but can be the representation of what happened.  That’s why it is always important to see them in context.  Only then can the association be recognised.

So if you think that your IBS might be related to an event that you have found it difficult to talk about or even reflect on, do consider talking to a good friend or a psychotherapist trained to listen to such buried memories with tact and compassion.   And to gain some insight into what may be going on,  why not fill in the Symptom Tracker in the IBS Network’s IBS Self Care Plan, which has been designed to reveal the patterns of association with episodes or flare ups of IBS.

Also see other posts

Feeling ill again?  Is it your diet or might it be your chimp?  

Growing away from the trauma and the IBS.

The Irritable Bowel Stigma