Coping With Aches, Pains & Fatigue

If you believe that you suffer from physical complaints of psychological origin or have neurasthenic tendencies, you may find value in the following list of coping stragegies:

1. Believe your physicians. Many people with hypochondriacal or neurasthenic tendencies go from doctor to doctor hoping to find one who will agree that their problem has an organic basis. You should seek a second, and even a third opinion before you are satisfied with a diagnosis. But there is a logical limit.

2. Do whatever you can to manage stress. Beard, who you recall first introduced the term neurasthenia, believed that the condition was induced by overwork. Today, this appears to be an oversimplification. It is probable that an underlying neurotic process is at work. Nonetheless, there is some value to Beard's formulation. Overwork, life changes, difficult interpersonal relations, and so forth, can all act as triggers that precipitate a rash of complaints. Sources of stress, if they are not eliminated, can also aggravate the distress associated with complaints. Try to become an expert at "stress management". Learn effective ways to control or at least to diminish, the impact of stress-inducing events in your personal world.

3. Challenge the idea that you are frail and sickly. George Kelly, a pioneer figure in personality theory and psychotherapy, introduced the concept of a personal construct. A personal construct is an idea that one holds about oneself. It may or may not reflect objective reality. However, it is treated as if it is real by the individual holding it. Consequently, it determines behaviour and forms the basis of a self-fulfilling prophecy. Thus, if you have ideas such as "I am frail" or "I am sickly", you will certainly act like a frail and sickly person. And by your own behaviour, you will create the very state of affairs you wish to avoid.

4. Refuse to play the role of sick person. It is important to recognize that this role is a kind of choice or decision that you make and that you have other options. The decision to play the sick role is made by your emotional self. It is seeking reinforcers such as attention, tokens of love, power over others, and so forth. You need to find more effective ways to meet your emotional needs. Use your thinking self to make a rational decision to give up the short-term satisfactions of the sick role and to seek the long-term satisfactions of mature behaviour.

5. Reflect on your early childhood. Keep a journal with dated enteries and try to explore the roots of any feelings you have of being unloved and underappreciated. Try to ask and answer questions such as this one:"Did I feel emotionally abandoned as a child?" Developing insight into the origins of today's emotional needs can give a certain amount of conscious control over these needs. It is one way to loosen the grip of a neurotic process.

6. Develop a stoical attitude toward minor aches and pains. Stoicism, an ancient philosophical viewpoint, teaches that it is possible, within rational limits, to develop an attitude of cool, calm indifference toward suffering. Such an attitude has at least two advantages. First, you will extract less expressions of pity from others, and this will help to extinguish complaining as a maladaptive habit. Second, you may find it possible to reduce the amount of pain medication you take. The Greek dramatist Aeschylus expressed almost 2500 years ago this thought in his play Agamemnon:"Who, except the gods, can live time through forever without any pain?"

7. Seek effective ways to deal with anxiety and depression. Both of these emotional states, if chronic, magnify the symptoms common in a neurasthenic syndrome.

8. Professional Help
If you find that you cannot cope adequately with physical complaints of psychological origin, there are a number of ways in which the professions of psychiatry and clinical psychology can help you.

Physical Complaints

The nineteenth century biologist Charles Darwin, author of The Origin of Species, suffered from multiple physical complaints for most of his adult years. A relatively wealthy man, the entire household revolved around his varying states of health. Appointments were made to accommodate his 'frail condition'. He often complained of number fingertips, digestive problems and insomnia. Many evenings, he vomited shortly after dinner. He saw himself as a semi-invalid. In his later years, many of his symptoms subsided. He lived to the age of 73, and there appears to have been no organic basis for his various complaints.

There are two general sources of physical complaints:
1. the organic, or biological, domain and
2. the psychological, or behavioural, domain.

Physical complaints arising from the psychological domain are presumed to be due to mental and emotional conflicts or maladaptive habits and are said to be psychogenic. Another term applied to such complaints is functional and this will be discussed here.

Signs and symptoms associated with physical complaints of a functional nature include the following:

• the conviction that one is frail and suffers from poor overall health
• stomach and digestive disturbances
• various aches and pains
• disturbances in the sense of touch
• irregular heartbeat
• irrational worry about one's health
• imaginary disorders
• fatigue
• sexual difficulties

The above items merit comment. The conviction that one is frail and suffers from poor overall health is a concept, an idea in the mind, in the case of psychogenic complaints. Stomach and digestive disturbances include the conviction that one has too much gas, that flatulence cannot be controlled, that one is constipated, frequent nausea and so forth. Various aches and pains in the muscles and joints are often associated with the notion that one has a muscle-wasting disease or rheumatoid arthritis. It is important to stress here that the aches and pains are real to the sufferer. They are actually felt and cause perceived discomfort.

Examples of disturbances in the sense of touch include tingling, numbness or heat in the fingers or toes. The clinical name for this condition is paresthesia. Irregular heartbeat includes palpitations and tachycardia. Such symptoms can and do occur in the absence of underlying heart disease.

It is common in persons who suffer from psychogenic complaints to develop excessive worry about their health. This is known as hypochondria. The person who suffers from hypochondria takes a small sign or symptom and magnifies it. A headache suggests the possiblity of brain cancer. Blurred vision foreshadows blindness. Victims of hypochondriasis recognize that their fears are irrational, but they feel helpless to control them.

Imaginary disorders often show up as false neurological impairments. These frequently involve problems in vision, hearing, the sense of touch, and movement (eg. the ability to walk). Complete blindness, deafness or paralysis is not at all unusual. The traditional name for this condition is hysteria. It is considered outdated today because the term was originally applied to women only. The contemporary name for the condition described in this paragraph is conversion disorder, the idea here being that anxiety has been converted into a bodily symptom.

Fatigue is one of the most common symptoms associated with psychogenic physical complaints. The individual says,"I have no energy -- no get up and go. I drag myself through the day. I seem to always be exhausted. It's all I can do to meet my minimum responsibilities."

Sexual difficulties include problems such as inability to become excited, inability to reach an orgasm even if excited, inability in males to maintain an erection adequate for intercourse, and painful intercourse.