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Urge
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[03/02/00]

The chemical knife
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[03/01/00]

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Pussy may be fictional but his ailments aren't. Tens of millions of Americans are suffering from rashes, headaches, sour stomachs, back pain, panic attacks and other conditions for which doctors have no explanation.

More and more often, physicians are laying down their stethoscopes and uttering words guaranteed to make any patient recoil in shock and fear: "There's nothing medically wrong with you."

It's a polite way of saying, "It's all in your head." But if there's no physical explanation for a backache, does that mean it isn't real? Most physicians would agree that pain with no discernible source is real, but they couldn't begin to tell you why. And they can't begin to tell you how much they wish you'd bother someone else with the problem. In the absence of a medical diagnosis, you're a "pussy" in the eyes of physicians.

Hypochondriacs are ruining it all for us neurotics. Hypochondriacs believe they have illnesses they don't have. The rest of us don't believe we "have" anything, but we still suffer with mysterious pains, rashes, fatigue, hyperventilation and other ailments.

So is your pain real? In the immortal words of President Clinton, it depends on what your definition of "is" is. If by real you mean something you can point to like a broken bone, then, no, it isn't real. If by real you mean something you can't point to but can see the effects of, like a broken heart, then, yes, it is real.

Defining the reality of pain is a little like defining the existence of a supreme being. If it can't be observed or measured, does it still exist? "Absolutely," says Dr. Caroline Carney Doebbeling, board certified in both psychiatry and internal medicine at the University of Iowa. "Pain without an identified source is very real. Science just hasn't advanced to the point it can tell us where it's coming from."

"Psychosomatic" used to be the umbrella term for pain without medical origin. It's Latin for "nuts, but insured." Doctors pretty much took a patronizing attitude toward their well-insured but kooky clients. But as "psychosomatic" cases increased geometrically over the past few years, a lot of medical cynics had to stop rolling their eyes and pay attention. For instance, irritable bowel syndrome (IBS), a common disorder of the intestines with no known cause, now makes up 12 percent of all primary care visits (and a whopping 50 percent of all referrals to gastroenterologists), according to Dr. Richard Gervitz, professor at the California School of Professional Psychology in San Francisco. IBS is marked by crampy pain, gassiness, bloating, constipation and its snotty-nosed twin sister, diarrhea. About 40 million people have been diagnosed with the syndrome.

There is no medical origin for IBS, yet its physical effects can easily be measured. With colonoscopy (using long, thin, flexible tubes containing a tiny, lighted video camera to look inside the colon) gastroenterologists often see "spastic" colons in IBS sufferers. If the pain is all in their minds, then why are their colons flipping like mackerels on the deck of a boat?

Gervitz is at the forefront of research proving connections between mind and body. The word "psychosomatic," loaded as it is with the baggage of the imagined, has been replaced with "psychophysiological." Psychophysiology tracks the physiology of psychologically induced pain. By hooking up IBS sufferers to sensitive instrumentation, for example, researchers have shown how the brain signals the stomach to stop digesting food and assume a fight-or-flight readiness, explaining why digestion is just another word for toilet among those with the syndrome.

The data is in: You're not crazy. You really are having that headache; Pussy really is experiencing that back pain. Research has proved beyond question that measurable physiological activities take place during unexplained pain. That headache for which your doctor can't determine the physical source? It produces the same kind of muscle tension, blood pressure and oxygenation as headaches that do have physical sources.

Next page | Only 16 percent of patients' maladies have an organic cause