Sigmund Freud has been criticised for implying that most mental illness and much physical illness is due to sex. He might have said love or attachment, but nevertheless, he was correct. The way we react to the world is modelled on the kind of bond we have with our parents very early in life. The experience of falling in love and the maintenance of an adult relationship not only recreate the essence of that first fundamental attachment with all its vicissitudes, but can be powerful enough to cause a major change in the course of a person’s life.
Leaving home and the experimental process of falling in love are fraught with insecurity. Young people may try out several relationships, each one freighted with rejection and heartbreak, before they find ‘the one’. Adolescence is a time when young immortals take risks with relationships; it’s a case of trial and a lot of error. More than a quarter of teenagers report that they have experienced unwanted sex, often when they were under the influence of alcohol or drugs or when pressurised by their partner. The figures are much higher in women than men.
Problems do not stop when couples ‘settle down’ and form partnerships. Sexual partners, who may at first make them giddy with romance, may later try to control them, restrain their activity, even threaten and abuse them, before finally abandoning them. ‘Marriage’ can hide a maelstrom of emotion. Fury, frustration, betrayal, distrust, loss, rejection guilt and shame are all there, concealed behind closed doors. There can be few adults who have not experienced sexual trauma in the form of coercion or abuse or rejection. Although such experience is more common in women, men too can be victims. Around 50% of marriages end in divorce, often with bitterness and recrimination, not to mention the break up of the family and estrangement from the children. There can be few of us who have not experienced the loss of or separation from a partner we loved.
It is not only constant threat that some people in long term relationships can live under. It is not just the crippling disappointment or the sense of rejection and abandonment. There is often an admixture of shame and guilt, a sense of failure, a feeling of unworthiness and the sheer tension of putting on a happy face while trying to hold it all together. All of that can render us susceptible to the toxic effects of alarm and dissociation on our mind and our body.
It is probably no coincidence that long term unexplained illnesses such as IBS, ME, anorexia nervosa and fibromyalgia start during teenage or early twenties; the time when young people are leaving home and falling in love. The same applies to many auto-immune diseases or allergies as well as major psychological diseases and alcohol and drug abuse. There are, of course, a lot of other things going on at that time: finding somewhere to live, finding a job, moving to another city or country; any of which may upset a person’s equilibrium. It is also a time when people travel more, experiment with different foods, come into contact with a wider range of micro-organisms. Perhaps it’s a mixture of all of these things, but a fundamental change of attachment must be a major factor.
Young women are more susceptible to relationship trauma than young men. Is it therefore just a coincidence that it is young women who suffer more from all of the above illnesses, including, of course, IBS?
Abuse is four times as high in patients with IBS as in otherwise healthy subjects. Trauma is only second to gastroenteritis as the instigator of IBS and often co-exists with it. Difficulties in childhood and problems with relationships are very common in patients with IBS. Between 50% and 94% of people who seek treatment for IBS, have coexistent anxiety or depression. So many people, who write in to The IBS Network express feelings of hopelessness and despair.
Long term illness can come and go throughout life, but, in my practice, I never fail to enquire what has changed to bring on a recurrence. The answer is so often a change in social circumstances, the breakdown of a relationship, the start of another one, a loss, a move or maybe something that seems inconsequential but nevertheless connects with the context of a previous trauma. I have often observed a recurrence of illness in the late forties and early fifties, when marriages have cooled, children left home and parents need looking after. That is also the time of life when people tend to reflect ‘Is that all there is?’ and perhaps risk another chance on love. Divorce tends to peak at that age and is often instigated by women.
People no longer marry for life; some only remain together as long as the excitement and interest lasts. Relationships break up. Children feel abandoned as parents separate and try again. Older people are less robust and able to physically withstand the emotional hurricanes. Their bodies are more vulnerable and may already carry the history of earlier heartbreak, exhaustion, allergy and gut wrenching episodes. A further breakdown may cause more serious, even life threatening illness.
Broadly speaking, it seems that the trauma that most people experience during their lifetimes occurs in the context of an intimate relationship. Few of us live in war zones, have been incarcerated in prison or have been involved in disasters, but nearly all of us have been scarred by love.
As I have explained in recent posts, trauma disrupts our autonomic nervous system, taking our cognitive brain off line, triggering alarm or collapse, causing widespread bodily symptoms and implanting memories that may protect us from similar situations. So, if we have experienced previous relational trauma – and few avoid this – then living in close proximity with others can make us very sensitive to cues that might rekindle the same bodily memories and trigger alarm or dissociation all over again. A look, a tone of voice, a gesture or a drunken encounter may be enough to dysregulate our physiological systems and bring back our familiar symptoms.
IBS and other unexplained illnesses might be best described as disorders of regulation, in which the body has gone off-line, no longer subject to conscious control but reacting instead to the influence of our primitive alarm and collapse systems. When we are threatened, the ventral vagal complex tries to keep us safe, engaging our cognitive brain to deal with the problem, while exerting restraint on our alarm systems, but if we have previously experienced trauma, we may not be able to think, our safety mechanism shuts down, releasing the ‘vagal brake’. As a result, the disinhibited sympathetic alarm system may cause us to panic, lose our temper or take flight. In the meantime, our gut seizes up. Finally if thought or resistance is impossible, activation of the dorsal vagal complex slows the heart and respiration, evacuates the gut and causes us to dissociate from what is happening. Whether a person with IBS presents with diarrhoea or constipation probably represents the relative dominance of the alarm (SNS) or collapse (DVC) systems.
Measurements of heart rate variability have shown that that people with IBS and other unexplained illnesses have lower ventral vagal tone, indicating that the vagal brake has been released allowing expression of the sympathetic and dorsal vagal system. Also cortisol secretion tends to be higher in people with IBS, supporting sympathetic nervous system mobilisation.
The mind works in metaphor and meaning and both are represented by the body, implying some meaningful link with centres regulating specific physiological functions. As I have discussed previously in this blog, eating disorders and IBS can seem to be metaphors by which unconscious emotional reactions are played out on the body. Anorexia and constipation might represent tension and emotional withdrawal – nothing in nothing out. Food intolerance and sensitivity may imply a defensiveness or wariness: people who are intolerant of food often seem nervous and intolerant of other people. Diarrhoea can indicate a loss of emotional control. Obesity keeps people at a distance, both literally and emotionally. ‘When I put on weight, I feel safe, People can’t get to me, the boys don’t whistle at me, I am no longer attractive and vulnerable’. Bloating may represent anxiety around pregnancy, either the desire to be pregnant or the fear of becoming pregnant or the termination of a pregnancy, or it may just be the cultural shame of getting fat.