Research in University College, Cork has provided evidence that links the extremely distressing and embarrassing irritable bowel syndrome (IBS) to extreme stress in childhood. Up to now, medical doctors had found no obvious organic cause for this painful and debilitating condition. The researchers, Dr. John Cryan and Professor Ted Dinan found that individuals with the condition reported having a lot of stress in their lives and had experienced highly stressful events during childhood. Without going into the biochemical complexities of their research, it was found that higher glutamate (an essential protein) in the spinal cord may be contributing to the emergence of severe abdominal pain as reported by persons with IBS. The researchers believe that the current expensive medication is not very effective due to the fact that it does not target the glutamate transporter specifically. They are determined to develop a new drug that will be specific to the physical pain symptoms of the condition.
Certainly, any drug that will alleviate the pain of the irritable bowel syndrome will be a welcome relief to the many individuals who suffer from this condition. However, I am curious as to why the researchers did not make the logical leap and focus on the very real, extreme and long-enduring stress experiences that individuals in their neurogastroenterology group at UCC reported. Whilst a new drug may certainly reduce the symptoms of the disease, it will do little to empower those individuals who continue to have stressful lives. One has to wonder whether or not attendance at a Stress Management Course or for individual psychotherapy, in the long run and, maybe, even in the short run, would be more beneficial. Let me be very clear here; when individuals develop any physical illness it is critical that they first attend a medical practitioner and receive the appropriate medical response to their presenting symptoms. So, in the case of IBS, a new and more effective drug may be the medical prescription available and where this provides relief of the pain and, maybe, other symptoms, it is a welcome experience. However, treatment needs to go beyond the physical to the psycho-social domain, and, most especially where there is clear evidence of stressful experiences in the development of the condition. Close liaison is required between medical and psycho-social practitioners in the therapeutic interventions for ‘medical’ problems that do not have a clear and specific organic basis. Indeed, even where there are medical diseases that have a specific organic origin, the sufferer’s response to the diagnosis and prognosis can adversely affect the purely medical treatment. For example, some individuals can become highly anxious or plummet into deep depression following diagnosis of a serious medical condition and these reactions need to be treated just as much as the presenting medical disease. We all know stories of individuals who ‘turned their faces to the wall’ following a serious medical diagnosis, and, contrary to medical expectations deteriorated rapidly and often died sooner than expected.
I would very much recommend a partnership between the Departments of Pharmacology and Therapeutic and Applied Psychology to address the best possible bio-psycho-social interventions for a range of illnesses, not just irritable bowel syndrome.
As regards IBS, when exploring the psycho-social aspects of the dis-ease (more accurate description when hyphenated), it is important, one, to understand that the psycho-social intentions of the dis-ease will be different for each person who has the condition and, two, that for a particular person the intentions will differ each time the symptoms reoccur. For instance, the unmet needs of a sufferer of IBS when a child or a teenager will be very different to those the person has when adult. Unmet needs – physical, emotional, social, sexual, intellectual, behavioural are the sources of most problems in living, lack of loving being the most common.
In my book with co-author Helen Ruddle, The Compassionate Intentions of Illness, there is a case study of a woman in her early forties who was sent by his Medical General Practitioner with a diagnosis of IBS. It emerged that she had several stress-related medical conditions, including gastric reflux, teeth grinding and an underactive thyroid. Her early experiences of harsh rejection by her mother and her unresolved dread of social situations in her current life are in keeping with the stress sources detected by Dr. Cryan and Professor Dinan in their research of individuals with IBS. Long term psychotherapy proved to be very effective in reducing the dis-ease symptoms and the client’s reliance on medication across all the presenting medical problems.
In the research quoted above, it is clear that the worthy search was for the cause of the pain associated with IBS. The causes of illness have tended to be the main preoccupation of medicine. Medical science does not deny the reality of psycho-social links to illnesses, but it has tended to ignore these links and not see illness symptoms as revealing more than what is physically going on in a person’s life. In finding a truly effective response to illness, the challenge is for the medical and psycho-social practitioners to pull out all the stops and, alongside the physical treatment arising from the understanding of the dis-ease’s physical and psycho-social causes, to put in place the psycho-social responses that are appropriate to the psychological intentions underlying the illness.
Dr. Tony Humphreys practices as a clinical psychologist and is author of several books on practical psychology including The Compassionate Intentions of Illness which is co-authored with Helen Ruddle