Somatization

Dr. Worthy uses storytelling to define, normalize, and offer tips to help alleviate somatization (physical complaints better explained by psychological distress). She will focus on the history of somatization in the Black and Brown communities. 

Transcript

Episode 5: Somatization

Linda (00:13 )

WorthyTherapy explores the intersection of mental health and identity in the Black, Queer, and athletic communities. Dr. Keoshia Worthy, a Licensed Psychologist, uses her humaneness to relate to the listeners by targeting an audience she identifies with. And she answers the question, “How do I know if and when therapy is needed?” 

Dr. Worthy (00:33)
Introduction 

Hi! And welcome back to Worthy Therapy. I am your host Dr. Keoshia Worthy. In today’s episode, we will review the topic of somatization. As usual, we will use storytelling to help us further understand and normalize somatic symptoms. We will look at the life of Keshawn Rollins, a fictional character I created for educational purposes; the story is not based on actual events.

I will focus on the history of somatization in the Black and Brown communities, as well as, provide strategies to mitigate psychological symptoms leading to physical pain and discomfort.

Dr. Worthy (01:09)

Today’s Topic

Keshawn is a 27-year-old African-American, straight male. He identifies himself as more spiritual than religious, despite growing up Catholic. Keshawn remembers being active and inquisitive as a child; he often challenged his parents by asking, “why?” 

Due to his curiosity, he often received dismissive comments, such as, “Because I said so” and “don’t question me, I’m the parent.” As he grew older and engaged in interpersonal relationships, he mirrored the behavior he developed as a child. He did not seek understanding if a friend stated a boundary or what they needed; instead, he sat quietly and “ate” the discomfort or curiosity he felt. This means that he did not ask clarifying questions due to shame or feeling gaslit or misunderstood. He did not address the emotional discomfort; instead, he put it away, hoping it would disappear. 

Dr. Worthy (02:02)

“Hoping it would disappear?” How many times have you done that throughout your life? Being a part of a marginalized community, I cannot remember how many times I was encouraged, indirectly or directly, to “suck it up and move on,” or  I’ve heard statements such as, “it’s not that big of a deal,” or hearing a constant comparison to someone else’s situation that is worst than mine, which if I’m being honest doesn’t make me feel better. When this occurs, I find myself emotionally and cognitively stuck dismissing intense feelings, questioning my perception, or even invalidating myself. 

Dr. Worthy (02:37)

What are Somatic Symptoms?

So, where do these unresolved emotions go? In Greek, soma means “of the body.” A ton of research confirms that our unresolved emotions, the feelings that we try to ignore by suppressing or repressing, actually stick with us inside our bodies. Trauma expert Dr. Van Der Kolk states it best with the title of his book, “The Body Keeps the Score.” Essentially, somatization is your body’s expression of physical concerns that are better explained by psychological distress. Some common examples of somatic symptoms are sluggishness, constant aches and tension in the neck and shoulder area, tension headaches, and reoccurring sickness, such as a cold or indigestion.

Dr. Worthy (03:21)

Keshawn’s symptoms

Keshawn’s first complaint of physical pain was at the age of 11. He experienced intense stomachaches, which led to reoccurring abdominal pain, indigestion, and constipation. He experienced it infrequently throughout his teenage years. Still, when he did, it often led to isolation from friends, spending hours in the fetal position or on the toilet, and at its worst, having his mother administer a suppository, which led to further shame and embarrassment. His pediatrician dismissed his symptoms because his bloodwork showed no indication of anything serious and instead encouraged his parents to increase his nutrients and water intake. This became Keshawn’s norm. However, during his college years, for some reason, the symptoms disappeared, and as he aged, he dismissed these symptoms and chalked it up to poor nutrition and water intake. 

Dr. Worthy (04:16)

The role of trauma

A common comparison in the mental health field is on little T trauma versus big T trauma. I’m here to tell you that trauma is trauma. Whether being silenced for curiosity or molestation, your emotional brain, the limbic area, becomes activated at any hint of stress. Early on, Keshawn learned to silence himself, and he was encouraged not to do what a child, or human, is conditioned to do, to be curious, to use our frontal lobe, to ask questions, and to seek understanding. Imagine how stressful that had to be for him; he was new to this environment; he was trying to navigate through this world and ask the people he trusted questions such as, “Why do people get sick?” “Why can’t I go to bed an hour later?” Unfortunately, they responded dismissively; his parents saw it as back talk instead of answering and encouraging his inquisitiveness. 

Dr. Worthy (05:15)

Keshawn’s Symptoms Return

At 27, Keshawn and his family are grieving the loss of his oldest sibling, his big brother. Keshawn tries to be the rock for his family; he is perceived as the most responsible and therefore handles all funeral arrangements and anything that has to do with his brother’s unexpected heart attack. Weeks pass, and he begins to experience difficulty swallowing, tightness in his chest, increased heart rate, and severe indigestion. He visits his doctor four times in the span of 2 months for the same symptoms. Like his childhood, all tests, including an EKG and an upper gastrointestinal endoscopy, came back normal. He takes several over-the-counter medications to reduce symptoms, and one day, he wholeheartedly believes that he, too, is having a heart attack. 

Dr. Worthy (06:05 )

Why have we been taught as a community to dismiss our feelings?

Why have we been taught as a community to dismiss our feelings? I have some thoughts about that. When I reflect on the term marginalization, a few words come to mind, including less, inequality, and minimization. Not only have those descriptors been our experience, but we, too, have succumbed to this ideology. In previous episodes, I discussed generational trauma; we have unconsciously developed these habits of brushing ourselves off and getting back up without any intent to address what it felt like to be knocked down. Our ancestors were repeatedly knocked down and silenced with brutality, shame, or embarrassment. It’s inhumane not to feel; we have an emotional brain activated by stress and trauma. Our ancestors had feelings, and because they were not allowed, they were stored in the body; this type of coping has influenced subsequent generations. We are a marginalized group that has been taught to minimize our emotional experiences. This is a systemic, institutional, and cultural issue. 

Dr. Worthy (07:16)

Keshawn’s Doctor’s Visit

Keshawn entered the Emergency Room visibly distressed, holding his chest, breathing heavily, with tears falling down his face. He yelled, “I think I’m having a heart attack.” After a brief evaluation by the nurse, he was told to return to the waiting room. Although the symptoms had subsided, Keshawn knew something was wrong; he could feel it. And yet again, after another evaluation and a prescription for Propranolol (a fast-acting beta-blocker often used for anxiety), he was cleared. He left the hospital confused, frustrated and defeated. 

Dr. Worthy (07:50)

Mind-Body connection

Let’s take a look at the mind and body connection. I will discuss the right and left hemispheres and the brain's corpus callosum. The right side is the first to develop in the womb and is known for intuitiveness and emotional, visual, spatial, and tactual abilities. The left side holds our linguistic, sequential, and analytical functions. And the corpus callosum is a myelinated nerve fiber that connects the two sides and is responsible for communication between the two. When the mind is stressed or traumatized, the right side feels it, and the left side makes sense of what happens. Once activated, the right side (our emotional brain or limbic system) triggers stress hormones like adrenaline and cortisol, increasing blood pressure, oxygen intake, and heart rate and preparing the body for fight, flight, or freeze. If the mind and body are consistently stressed, this can lead to memory and attention problems, irritability, sleep disturbances, and long-term health concerns. The latter is caused by immunosuppression. Think of it this way, high and chronic stress levels reduce the number of cells in the body that is used to combat viruses.

Dr. Worthy (09:01)

Tips to Mitigate Somatization

As we see, Keshawn is struggling, and not only are his physical symptoms a sign of his challenges, but we also see that neither Keshawn, his family, nor his medical providers are encouraging him to explore his mental and emotional well-being. The prescription is a band-aid that does not fully address what is underlying the physical pain. Keshawn experienced stress at a very young age, he was silenced by his family and providers, and after losing his brother, he buried it and kept going instead of processing his grief. As an adult, he sought help, and when he did, he experienced another form of silence, a pill to stop the physical symptoms, but what about what’s underneath? 

I have a few suggestions to help decrease somatization. Before I begin, I want to normalize and validate our body’s ability to alert us that something is off. Thank you, body! Often we move so quickly, and we don’t take a moment to be still, and through the busyness, we ignore our body’s cry for help.

Dr. Worthy (10:02)

My first tip is to slow down. We may not be able to use a time machine and correct the behaviors of our parents, grandparents, and ancestors, but we can slow down and have more moments of silence. This includes taking breaks before transitions, even if it’s 5 minutes, sitting and being still, and noticing. I would recommend practicing this alone. Solitude allows us to notice irritability, uneasiness, aches, and pains. It will enable us to process our feelings and what we feel internal. Slowing down also includes being more present and trying to experience emotions fully when in the presence of others. For example, don’t be quick to move past that flutter in your chest or the knots turning in your stomach. Slow down to experience it fully because your body is communicating with you. Now, let’s listen to it. 

Secondly, I use the phrase “ear-to-body.” While slowing down, listen to what your body is communicating. Where do you feel the aches? Listen with curiosity. Did I injure myself? Ask yourself if this pain you feel could be related to physical activity. If not, then consider what is happening at the moment. For example, are you meeting your in-laws for the first time? That may explain the tension in the body; it may be a sign of anxiety. Or are you anticipating something stressful? Do you have an upcoming job interview that is causing your stomach to knot? Or consider what occurred in the past? Do you feel restless because your fight with your partner is still unresolved? 

Finally, once you investigate what you feel and understand why you feel it (using your left side of the brain), I encourage you to come face-to-face with your mind-body experience. First, honor it with validation and then take actionable steps to decrease symptoms. This can be done by deep breathing, incorporating movement (such as yoga, stretching, and exercise), meditation, challenging irrational thoughts, speaking to someone you trust, and seeking medical or therapeutic treatment. I am not here to tell you that all physical complaints are psychological; I still recommend a medical evaluation to rule out any physiological illnesses.

To decrease somatic symptoms, remember to slow down, listen with your ear-to-body, and come face-to-face with your mind-body experience.

Dr. Worthy (12:25)

Closing

As we close today’s episode, I want to remind you that individual therapy is available and can be helpful for those struggling with unclear physical complaints and unresolved emotional distress. This service can be provided by licensed psychologists, licensed clinical social workers, Marriage and Family Therapists, and master’s level therapists.

Please stay tuned, as the next session will focus on gearing up for the holidays. This time of year for some is joyous and for others is stressful and traumatic. In that episode, I will offer tips to help make the holidays more manageable and stress-free. 

Thank you all for tuning in to today’s episode, and remember that you are worthy, and so is your story! 

Linda A. (13:05)

WorthyTherapy thanks you for taking time out for yourself today. The path to mental wellness comes with multiple challenges, and Dr. Worthy hopes that this week’s episode made life feel more manageable and hopeful.