One of the first lessons people learn when they attend self help groups for IBS is that everybody’s symptoms are different. Some people have diarrhoea and abdominal pain that starts early in the morning and doesn’t let up until they are at work, others suffer with bloating later in the day, others are constipated whenever they go away anywhere. And it’s not just the bowel symptoms that vary, people diagnosed with IBS often have a variety of other symptoms. Backache, fatigue, headaches, breathlessness, indigestion are some of the most common, but any bodily symptom can co-exist with IBS. Whether the illness is diagnosed as IBS or ME or Fibromyalgia or any other syndrome depends on which symptoms might predominate and which doctor they see, but whatever the diagnosis, the symptoms of these overlapping conditions vary so much that they might be regarded as an individual expression of who you are and what has happened to you. In contrast, diseases that have a definite pathology usually present with such typical symptoms that a doctor can often make a positive diagnosis without recourse to diagnostic tests.
When bodily symptoms are instigated by trauma, they are usually considered to be part of what is now tends to be called post traumatic stress disorder (PTSD), but used to be called hysteria, or neurasthenia or irritable weakness, to name but a few. Trauma covers a multitude of sins or mishaps and rarely comes to light. It is not necessarily ‘big trauma’, the sexual abuse, conflict trauma, imprisonment, it is more the kind of trauma that happens to us all, unless we are very fortunate. It includes the loss of a partner, the strain of a love affair, stress in the workplace, severe disappointment, unwanted attention, bullying, moving to an alien environment. People are often too ashamed or frightened to talk about what happened, even if they can remember it. When physical illness results from trauma, it is easier to seek help for the symptoms.
Symptoms are a communication; like facial expression, tone of voice, bodily posture, they all represent how we feel. This starts very early. Infants express everything through their bodies. Redness in the face, pallor, possetting, vomiting, diarrhoea, constipation, writhing in pain; they are all communications of need. Most parents soon get to know what their infants want and can treat the symptoms with a hug, a cuddle, a feed, a change in nappy. Physical reactions to what happens do not disappear as we get older. If we are upset, our lacrimal glands secrete fluid and we may get spasm in our throats. If we are nervous, we may feel a fluttering sensation in our stomach or palpitations in our chest, if we are embarrassed, we go red in the face, if we desire somebody the penis hardens and the vagina secretes lubricating fluid. Such sensations and reactions are familiar to all of us, but changes also occur deep inside. The physiologist and physician, Dr Thomas P. Almy observed that when people felt angry, their stomachs and their colons turned red, secreted fluid and contracted vigorously.
It is like we have an emotional immune system that reacts to what happens. If somebody parks in my spot in the hospital, I may feel a sensation of warmth in my stomach that rises up into my chest and spreads out and goes down the inside of my arms. No, I am not having a heart attack, I know I am furious and as soon as I tell myself to calm down and find another parking place, the symptoms calm down and go away. But if I something happened that was so serious that I could not resolve the emotion or I froze and could not even form an emotion, then the feeling of what happened would remain in the body and become an illness that may have to be taken to the doctor.
A post traumatic symptom is a communication; it represents something that often cannot be expressed verbally, a message that needs decoding. Any one of us will tend to get our own unique repertoire of symptoms to a stressful situation, begging the question; why does one person get pain in the back, another diarrhoea, another headaches or tiredness and so on? The answer appears to be related to both memory and meaning.
Research has shown that anxiety, depression or some traumatic life situation occurring at the time an attack of gastroenteritis predicts the development of post infectious IBS. The same would seem to occur with flu like illness and CFS/ME, abdominal surgery and chronic abdominal pain, after dental pain, whiplash injury. This suggests that anything that reminds a person of the emotional context is enough to trigger the symptoms of the original infection or injury. If that can occur with an infection or injury, how much more likely it is to occur if the symptom is actually caused by the trauma. Then the symptom is more likely to express the meaning of the trauma. So it is important to think about what the symptom might represent.
Sometimes it is very clear. When Samantha was dumped by her fiancée during the course of a meal in a fish restaurant, she developed an intolerance to fish and other foods that lasted for years. When Janice discovered that her partner had cheated on her, she developed eczema under both eyes that made her look very angry. When Chris had an affair with the catering manager at the golf club, he developed a rumbling in his stomach that betrayed his guilty secret. Backache often represents an intolerable burden, headache hard work and pressure, palpitations heartbreak, nausea disgust and so on. The examples are legion and the meaning of course highly individual.
Freud once wrote that dreams were ‘the royal road to the unconscious’. The same applies to symptoms. Both reveal an emotional theme, but while dreams weave this into a short story of the previous day, symptoms use the whole body to represent the meaning.
The type of symptoms expressed also bear some relationship to the attachment style and parenting. Withdrawal and secrecy may be expressed in symptoms such as fatigue, constipation and anorexia, a reaction to an emotionally absent but intrusive parent, whereas more florid symptoms, such as vomiting, diarrhoea, binge eating and bulimia may express a need for attention and emotional sustenance and be a ingrained response to disorganised or ambivalent attachment (inconsistent parent). In some situations, as I have explained in previous posts, both the symptoms and attachment style can fluctuate, as in alternating diarrhoea and constipation, anorexia and bulimia, and even, it has been suggested, fatigue and fibromyalgia.
We are not so much ‘what we eat’, but what has happened to us and the way we were brought up. Many aspects of the way we live play out the identifications or reactions to the major influences. We learn and identify with experience. To paraphrase Georg Groddeck, psychoanalyst and correspondent of Freud, the job we do, where we choose to live, the pets we look after, the friends we cultivate, the holidays we enjoy. These are all aspects of the experiences that shaped us. I’ll leave you to fill in the gaps from your own life story.
Finally, there is often a purpose to symptoms; what therapists call, secondary gain. They may serve as an excuse not to do something you fear, a reason to avoid some task or obligation, the enactment of revenge, a means of controlling a partner or parent, a cry for attention. Beryl’s joint pains became so much worse after Frank had his affair. She needed him round the house to look after her. Emma’s abdominal pains started when she got into the national squad for athletics. There was no obvious cause, but they gave her the reason to stop. Her indifference seemed to indicate she was biding her time until she could let go of the symptoms as well.
If you think that your symptoms of IBS might be related to what has happened in your life, for more information and help, do check out the section on Stress in The IBS Self Care Programme.