It is an everyday occurrence in every practice that doctors cannot find a cause for complaints. But why is the soul still so neglected in conventional medicine, and how can it be better? A conversation with the psychosomatic specialist Dr. Alexander Kugelstadt.
BRIGITTE: How often does it actually happen that a doctor can't find anything?
Dr. Alexander Ball City: Very often. According to estimates, it happens in 25 percent of patients in general practices, in specialist practices it is up to 50 percent.
So psychosomatic complaints are a widespread disease?
Yes. Of course, a lot of things for which there is no medical cause will go away on their own after a few days, but about half who come to the practice with it develop a real psychosomatic illness. Of course with a wide range: in some cases there are also physical illnesses, depression or anxiety disorders.
And all of these people imagine their complaints?
Under no circumstance. They are there as well as organic ailments. An example: Even if everything is in a healthy range during an examination of the heart – it can beat faster or make extra strokes – these changes in the experience of the person concerned can pose a threat.
How exactly does a symptom get from the head to the body?
There is this model, for example: the psyche and the body are connected through feelings. We perceive emotions emotionally, but they express themselves mediated via the nervous system, immune system or stress hormones as a body reaction – when you are afraid you start to sweat, your heart pounds, you shiver and you have a lump in your stomach. This reaction also takes place in psychosomatic illnesses, but the psychological part, the feeling behind it, is not recognized as such, but warded off because it would be too overwhelming or overwhelming at the moment to deal with it. The body feels what one cannot or does not want to feel at the moment.
So if psychosomatic problems are emotional problems, does an education that perceives, takes seriously and names feelings prevent?
Yes, that is beneficial. In the case of adults who repeatedly develop psychosomatic complaints, there is often a climate in the biography in which one could not talk about feelings, was not encouraged to express them or to deal with aggression in a healthy way. For example, young men in adolescence are often prone to heart anxiety disorders. They have learned less to consciously deal with the fears of life that are popular in this phase – where is my place in the group, how powerful am I and how dependent – and then express them in palpitations, palpitations and worries about this organ .
Can you unlearn this emotional blindness?
Yes, that's exactly what we practice in therapy. If one begins to perceive more, for example, within relationships and to express what one feels and wants, the persistence of the symptoms can become superfluous. The body comes back into harmony with the psyche.
One has stomach problems, the next has heart problems – what is the reason for how psychosomatic complaints are expressed?
Organic diseases often played a role in the past. The body memory remembers where there has been an injury and then expresses emotional stress about the same place. Or there are certain previous illnesses in the family: If the father died of a heart attack at a young age, the daughter may develop heart problems or fears relating to the heart later in life, when certain stresses arise. The question of what do I actually associate with the organ that is causing problems can therefore be an introduction to looking at psychosomatic complaints with different glasses.
Which "remedies" still belong in the psychosomatic medicine cabinet?
We can also use the connection between psyche and body to calm ourselves down. During tension, you breathe more superficially, faster and more into the chest area. Targeted abdominal breathing – for example, lying down with a book on your stomach that rises and falls while breathing – has been proven to calm you down. It is also very important and soothing, despite the complaints, to do things that are fun, to strengthen what is good and still possible.
Why is the sentence "This is psychological or psychosomatic" actually so negative?
It is often experienced as a blame, as if one were not in control of one's life and was doing something wrong. Incidentally, this sentence is not easy for many medical professionals, some even avoid it.
Why?
On the one hand, it often annoys you a little, on the other hand, a whole new field opens up if you also look for psychological influencing factors. Many doctors have neither the time nor the qualifications to do this. Fears of contact also play a role.
Many of those affected are left alone with the diagnosis "This is psychological" …
Yes, because that's when things really started. Unfortunately, medicine usually still stops when there is no drug, intervention, or surgery. Our health system has to develop further.
Does the dirty medical image of psychosomatics also come from the fact that the focus is always on the body? The psyche only remains when all diagnostics are through.
It is of course much more pleasant for patients when both are on an equal footing. In a psychosomatic diagnosis, gastroscopy and ultrasound are performed as far as possible and, at the same time, one-on-one and group discussions are used to see how those affected experience their world and whether there are any problems with psychological processing. Since we know from studies that the duration and costs of treatment will decrease in the long term, I will not give up hope that the so-called simultaneous diagnostics of the two levels, "body" and "psyche", will eventually become established.
Doesn't the problem begin there: We always speak of two levels and then at most of interaction …
This hierarchy has grown historically: Due to scientific progress beginning around 150 years ago, medicine has thrown itself heavily on biology and left the seeming remainder, the psyche, to the philosophers. Today we know: Every emotion, every thought is also electrophysiology and biochemistry in the body, so that a separation cannot actually be maintained.
Can you understand when people turn to alternative healing methods because they feel that conventional medicine doesn't really take them seriously?
First of all. It is important to me that a really good body diagnosis has taken place beforehand and that you can always see a doctor for psychosomatic medicine and psychotherapy. It is not uncommon for me to see that people spend a lot of money on alternative methods and in the end achieve nothing.
"I can't find anything", at least one alternative practitioner probably never says …
Sure, something is always found – an undetected poisoning, energy blockages or whatever – and that first relieves the patient and provides security. But if there are really internal burdens, trauma or relationship factors behind the complaints, this will not lead to a happier and healthier life in the long term. Many alternative medical procedures are passive. The basic element of psychosomatic psychotherapy, on the other hand, is that those affected become active themselves. The psychosomatic doctor is, so to speak, only the hiking guide, you have to go your own way. This is how you can move from being dependent on the illness into taking responsibility for yourself. Many experience this as very liberating and it also helps out of the prison of symptoms.
How big is the risk of something physical being overlooked?
Large. For example, there are about 6000 rare diseases that are not easy to diagnose. That's why, in my opinion, psychosomatic complaints also belong in the hands of doctors. There are stomach ulcers that have to be treated with antibiotics, for example, and yet it is possible that stress also plays a role, perhaps up to 20 percent. We must never come to an either-or too quickly. The one does not exclude the other.
Dr. Alexander Kugelstadt, 39, is a doctor for psychosomatic medicine and psychotherapy and works at the Institute for Psychogenic Diseases in Berlin. Since 2015 he has been running the edutainment podcast "PsychCast" together with a colleague.
Alexander Kugelstadt's book will be published on October 5th: "'Then it's probably psychosomatic!" When body and soul send SOS and the doctors simply can't find anything " (320 p., 16 euros, mosaic).
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