An Outsider’s Observation

Medically Unexplained Somatic Symptoms in General Practice

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As an independent psychotherapist I have become increasingly alarmed to see, meet and learn about people whose lives are being seriously harmed by medicines prescribed for the common human distress conditions.

I had no idea of the issues that I would find myself seeing unfolding.  Now — after four years of extensive research and exploration, including liaising with the BMA Board of Science to support recognition of actual patient experiences(1) — I feel compelled to write about what I am seeing and learning:

People are encouraged to visit their GP for help with all manner of symptoms — many of which may originate in conditions of stress and distress encountered in our lives and may actually be self-limiting given time, appropriate support and perhaps some change in circumstances.  However, people want a quick-fix solution — so expect to leave the GP surgery with a prescription.  This could be tablets for ‘sleep’, ‘anxiety’, ‘depression’, ‘palpitations’, ‘panic attacks’, ‘indigestion’, ‘IBS’ and so on.

Most people know a bit about the mind-body connection — and how we can become ill through prolonged (or traumatic) stress causing mental and physical conditions.  In fact this may encourage people to ‘seek help’ quickly.  However, what they do not usually realise is that the medications prescribed for these common human alarm symptoms act directly on the central nervous system (CNS) — ‘working’ by interfering crudely with the functioning of the most basic and essential autonomic (sympathetic and parasympathetic) nervous systems which control all the vital functions of the body(2) (digestive, cardiovascular, respiratory, endocrine, sleep, reproductive, immune and other systems) as well as affecting moods, feelings and complex human thought processes.

Once people start taking medications — especially antidepressants which patients are told that they need to keep on taking ‘for at least six months’ or longer — their basic functioning has to cope with new additional systemic stresses.  Many people develop new symptoms as the medicines interfere with the complex processes of physiological homeostasis.  If patients do try to ‘come off’ the medication, they can run into further immense difficulties of systemic readjustment with terrible functional and psychological symptoms(2).  These are generally played down or not acknowledged by the GP guidelines.

The GPs, having to comply with their professional guidelines and ‘best practice’ (3,4, 5 & 6), become frustrated when the patients keep coming back with various ‘functional’, ‘somatic’ or ‘Medically Unexplained Symptoms’ (MUS) for which tests are carried out until it is established that there is ‘no physical cause’ — so the GP then, again following professional guidelines, tries to ‘reassure’ the patient that there is ‘no disease’ and that CBT and exercise – and perhaps ‘acceptance’ and ‘re-attribution’ therapies are what is needed.  Meanwhile the patient is very unwell with various bodily dysfunctions (and frightened, upset, and sometimes angry) and the doctor-patient relationship suffers as both parties become desperate with each other…NHS resources are stretched beyond limits, patients become iller and actively damaged and disabled and GPs become overstressed and ill too.

And the GPs go to see their own GP…and the pattern repeats with ever-more disastrous consequences.

The recent announcement by the BMA(1) has raised awareness that patients are experiencing terrible problems with these commonly prescribed and widely used medications.  It appears to me clear that the rising problem of patients experiencing MUS, resulting in huge costs to the NHS, may actually be partly explained by the inexorable increase in prescribing of antidepressants (especially) which can and do interfere with human functioning and lead to confusing and debilitating ‘Functional Disorders’(2).  Apart from very cursory references, the current GP guidelines skim over these medications as potential causes of MUS.  It appears that GPs and patients are actually being misled — to the serious detriment of all concerned.

I feel a strong ethical duty, as a psychotherapist and as a member of the public, to share my learning and observations (using references available to anyone with access to the internet), offering a re-framing of the management of ‘Medically Unexplained or Somatic Symptoms’ in General Practice.

References / Further reading:

1. BMA (2015). Prescribed  Drugs Associated with Dependence and Withdrawal – Building a Consensus for Action and subsequent news announcement update October 2016.

2. Carvahlo A.F. et al.  (2016). The Safety, Tolerability and risks associated with the Use of Newer Generation Antidepressant Drugs. Psychotherapy and Psychosomatics – Vol.85, No.5, 2016.

3. Royal College of Psychiatrists (2011). Guidance for Health Professionals on Medically Unexplained Symptoms (MUS).

4. Burton, Chris (Ed) 2013.  ABC of Medically Unexplained Symptoms Wiley-Blackwell/BMJ Books

5. Patient.info NHS approved information for doctors and patients. http://patient.info/doctor/medically-unexplained-symptoms-assessment-and-management. http://patient.info/doctor/somatic-symptom-disorder.

6. BMJ Best Practice Monograph 2016. Conversion and Somatic Symptom Disorder.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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24 COMMENTS

  2. The other route people with medically unexplained illness take is the alternative therapy route which is a minefield of charlatans and guilt inducing nonsense. But at least you are unlikely to be poisoned by taking this route.

    Sometimes people go from GP to alternative and spiritual practitioners and back again all with out much improvement and sometimes being given things that make things worse.

    My own chronic fatigue was helped and eventually cured by engaging with various supportive communities. I felt cared for and life had meaning.

  3. Dear Marion,

    Thank you for the Article. Your writing is great.

    With the BMA moving towards more responsible prescribing I wonder if the Neuroleptics are supposed to be in this regard – “beyond the pale”.

    My experience is that Neuroleptics have Rebound Syndromes and long term Withdrawal Syndromes and that they can create the “illnesses” they are supposed to treat.

    I was hospitalized several times and Diagnosed more seriously mentally unwell on (neuroleptic) drug withdrawal – but went on to make recovery through Psychotherapy (saving the taxpayer a fortune).

  6. A current, working psychologist with a spouse who was an MD (author’s mention) isn’t an ‘outsider’. It’s the definition of an ‘insider’. Bizarre mistitle. Only the rarest MIA reader will be surprised at any of this or disagree with any of it. Always nice to see another practicing therapist on board against mass drugging of society, but none of it comes from ‘outside’ MIA’s purview.

    I say this an an actual ‘outsider’. I’m not in the psych profession and have no ties to it; I have purposefully avoided any psych diagnosis or drugging; and I have gone far out of my way to avoid having my very difficult child psych-diagnosed or drugged. I have beliefs, opinions, and experiences as an actual outsider. I point this out because language is important and words matter.

    An MIA ‘outsider’ is either someone like me (dealing with issues from outside the mainstream system), or someone who is published here who supports mainstream ‘mental health’, its views, and its ‘treatments’. Again, language matters.

    Liz Sydney

      • Marion and others

        I appreciate how you are trying educate people with this blog.

        While on the topic of language, this blog would have been much stronger if it had not conceded to using the *System’s* language by calling mind altering psychiatric drugs – “medications.”

        Real “medications” treat diseases and/or other cellular anomalies. Since we now know that there are NO such thing as “chemical imbalances” in the brain, and there are No biological markers for any psychological stressor that gets falsely labeled with invented psychiatric (disease/based) diagnoses, we must STOP using psychiatry’s oppressive language.

        Psychiatric drugs should be called exactly what they are – mind altering drugs. To call these substances “medications” only perpetuates the myths created by Biological Psychiatry, for which they spent billions to promote broadly throughout our society.

        People can understand that sometimes, especially in the short term, a mind altering DRUG might temporarily help a person cope with a major stressor in their life. However, these situations must be evaluated very carefully, for even short term use of psychiatric drugs can be harmful.

        *System* language and the myths they promote will not end unless we start making it happen NOW.

        Respectfully. Richard

          • Fiachra

            I don’t see the sarcasm you describe regarding the use of the term “medications” to substitute for “psychiatric drugs.” As I said above, Psychiatry and Big Pharma spent billions to convince the masses that their drugs are indeed, “medications,” and they have succeeded quite well in getting over with this false narrative. Why should we unknowingly perpetuate this harmful narrative by using THEIR carefully chosen language?

            Why do we somehow need to “concede” to them the use of this very important issue of language? If “psychiatric drugs” had been used instead in this blog , its overall intended message would have have been far more powerfully understood by its readers. This is especially true since we are saying that these drugs DO NOT correct or treat any cellular defects in human beings. Instead, they completely DISRUPT homeostasis in the brain, leading to a cascade of body and brain disruptions.

            Real science tells us that this is NOT just a question of so-called “medications” not working the way they are advertised, or having uncomfortable “side effects” for some people. These drugs actually perturb chemical processes in the brain and body. Some people even argue that some of these chemical disruptions may have some permanent effects, or very long term negative effects.

            In fact, I would say that it might be important, in almost everything we write about these drugs at this time, to make a scientific point as to why we DO NOT call psychiatric drugs, “medications.”

            Richard

          • Richard,

            In my case the “drugs” did have longterm negative effects.

            The user information leaflet itself, for the drug “Fluphenazine Decoanate” practically guarantees long term damage.

  7. Hi Marion,

    I would like to thank you for this blog, it echoes in a very close parallel a lot of things I have been yelling from the rooftops.

    I am a Peer Support Worker in Sunderland who has had journeys of self medicating and GP/Services medicating me, thankfully I dodged a bullet when it came to lithium due to biological medication for my physical health. But I have to admit, I have burdened the tax payer art times.

    In my mind a major barrier here is that we have developed a culture, led by the drug companies, of asking to be “fixed”. I believe the idea of ‘recovery’ has driven this culture.

    Recovery implies an end point and the opportunity to “be back to who I was before”. THIS ISN’T POSSIBLE we have changed, we have learnt something new – maybe about ourselves. You are not the person you were before reading this blog and thread of comments…

    You have been on a short journey of ‘Discovery’.

    This ‘Discovery’ journey has offered you a new perspective on your journey of growth and development. This is the journey we are all on, on our own individual personal paths. There is no “I am in recovery you’re not” which is the culture the drug companies have fostered.

    Medication certainly has it’s place to enable people to engage with their discovery journey, it can stabilise people to be able to find some forward momentum or for some maybe just find stasis. But medication is not the ultimate answer, even if you are on a potentially life long journey of using medication, such as an immunosuppressant, even then though exercise and diet can change that course…

    I’m drifting on tangents as is my lifelong habit.

    I would urge that you continue your sense of compulsion and keep your head above the parapet, this is a battle worth fighting for the discovery journey of many many people.

    Best wishes,

    Chris.

  8. Excellent article.

    It brings some peace just reading it. The current set-up must be on the verge of sheer crisis. The BMA letter is evidence of the magnitude of the problem.

    Thank you for writing this. I will be campaigning as much as I can re. #taperingkits

    Neuroleptics need a similar approach in my opinion.

  10. Yes, this is a crazy situation. Our entry level drugs are not found on the street, they are obtained by a doctor’s prescription.

    But sad as that is, the solution cannot be in Psychotherapy, Recovery or Healing either. Just as drugging and Psychiatry are based on lies, so too are Psychotherapy, Recovery and Healing. They are always saying that you can restore you social and civil standing just be being made to feel better. And that is always untrue.

    To restore your social and civil standing you have to engage in conflict with real people. And that takes comrades. So you have to find comrades and act. This is what we, the Survivors of the Middle-Class Family and the Survivors of Psychiatry and Psychotherapy should be doing, organizing and then taking legal and political action.

    Move From Talk To Action, Please Join
    http://freedomtoexpress.freeforums.org/fighting-to-eradicate-the-mental-health-system-and-incarcerate-the-practitioners-f2.html

    Nomadic

  11. I was happy to see the word “homeostasis” here. It’s been avoided by the charlatans who speak of chemical imbalance, because the drugs they use to “correct chemical imbalances” do not correct or restore any kind of balance. They do nothing, unless by chance, in favor of genuine homeostasis, which is a state that’s like the idling of a well-tuned engine running on clean, optimally potent fuel. With antidepressants, sub-processes go awry and interact with other tweaked subprocesses. The gears begin to grind here and there and subsystems, deprived of the usual inputs and channels for outputs, malfunction. Hearts beat at the wrong pace, nerves carry messages of pain when there’s been no stimulation, or nothing at all despite intense stimulation. The natural state of relaxation is prevented by signals of distress heeded by the limbs but unknown to the conscious mind, and the natural process of falling asleep is subverted by noisy parties in parts of the brain that normally twiddle their thumbs all night. Ingesting food is experienced by the stomach as insult and injury, so the stomach signals, with intense nausea, that food is no longer welcome. By its only ex post facto means of self-preservation, it sends food back up the esophagus and out the mouth, returning it to where it darned well came from. So the body is a rendered a mess.

    On antidepressants, and after they are stopped, one’s consciousness experiences emotions uncoupled from the experiences that normally trigger them. The altered individual is not aware their their operating system was deleted and that legacy code buried somewhere in the brainstem, adequate to the purposes of a monitor lizard, has reassembled itself and taken on the job of running a human being in a human milieu. Anxiety about social status becomes paranoia. Romantic love turns into disdain or hatred. Takers gain weight, lose empathy, and shop, drink and gamble their families and homes away. Maternal love turns into murder. Bland misanthropy wakes up one morning and suggests mass slaughter as the remedy for ongoing dissatisfaction with oneself and others. It makes sense (to a monitor lizard).

    “Antidepressant,” is a bit of a misnomer. The drugs are more like molecular monkey wrenches. If only it were as easy to stop taking them as it is to start taking them.

  12. Thank you all for these comments. All very pertinent. What I am trying to do is to illustrate clearly how patients and doctors (who are also patients) are becoming misled and deluded by factors below the radar. I think many GPs will be horrified to realize that the NHS professional guidelines which they have to comply with are causing their patients to become effectively poisoned by these drugs. I have not come across anyone else, as yet, who has pointed out the apparent (to me) MUS/somatic disorder (another DSM diagnosis) connection…. This vague and wide-symptom psychiatric MUS/somatization diagnosis has the potential to be particularly damaging, cruelly undermining the doctor/patient trust relationship when patients are presenting with clear symptoms of being poisoned!

  13. Most emotional overwhelm has no medical basis whatsoever, so why go to a doctor when what you really need is a friend. The friend could be your bestie, or a highly trained psychologist, a peer counsellor, a support group, a neighbour, or a family member(s). It’s irrelevant so long as you can trust the person to care about you, has time to listen and hears you. A rushed GP with 40 hours of psychological training and 10 people in the waiting room, a psychiatrist trying to fit in as many $400.00 appointments as possible in an hour, who also has very limited psychological training (despite what he/she says on his/her CV), ain’t your friend.

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