Reframing“Fringe”Medicine:

“Psychosomatic” -- Why it’s NOT “All in your head”

I have something to confess. Ten years ago, when I was a brand-new provider, and absorbing information from older, smarter doctors and providers like a sponge, I fell victim to the “consensus bias” that so many young doctors and providers fall into. When I first started my career, I experienced (like most do) MAJOR imposter syndrome. I looked up to the men and women of medicine that had years of experience and incredible depth of knowledge. So, if they were dismissive of certain conditions (cue the doctor eye roll) so was I. They knew more than I did so why would I even question their expertise??

Back in those days, Fibromyalgia was a very loaded diagnosis. Working in the ICU, with a team of BRILLIANT clinicians to learn from, many of these clinicians dismissed Fibromyalgia as a psychiatric condition. To them it was not a “real” physiologic process and therefore could only be a mental one. I cringe now when I think about the reaction in the rounds room when “fibromyalgia” was read off the medical history section of a newly admitted patient’s chart. While those reactions were never demonstrated in front of patients, I do believe these knee jerk assumptions led to biased and somewhat dismissive care at times.

Ten years later, and fibromyalgia is largely accepted as “real” and now has some concrete imaging and lab findings that can help diagnose. The eye rolls don’t happen as much. We (especially younger, more malleable providers) have learned a lot, and the science did what science does: it changed. But the thing is, it took decades for the scientific consensus to catch up to the people experiencing fibromyalgia. Medical science is an ever evolving, fluid process and the best we can do is provide the best possible care, with the information that is currently available. What that does NOT mean, however, is that providers should have a knee jerk, dismissive reaction to a patient’s lived experience when the “hard” science is trailing behind. This is how medical mistrust is born.

We are currently living in a timeline where western medicine and pharmaceuticals have become off putting to those seeking relief and tired of being dismissed. Doctors/providers are suddenly some of the LEAST trusted professionals out there, and that mistrust is growing every day. “Listen to the experts” is only something you can reasonably argue when the “experts” are ALSO listening to their patients. In the last few years of my career, I have noticed this shift, and it has bothered me. I have always viewed myself as “in it for the right reasons” and as a provider who truly cares about her patients. This has made me want to scream “NOT ALL DOCTORS!!!!!” whenever I encounter someone complaining about how shitty doctors can be. But then something changed for me.

About 5 years ago, for reasons I don’t need to go into here, I started to experience a worsening of some of my own “cluster” of medical conditions. I knew I had asthma and some allergies, I knew I had eosinophilic esophagitis, I knew I had frequent and complex UTIs and inexplicable random rashes. I knew I had more aches and pains than most, I knew I got sicker and sick more often than most. I knew that I had ADHD and Autism (diagnosed as

adult), but suddenly, it seemed like when one of these supposedly unconnected conditions flared up, the rest of the ship would go down with it. I have always viewed the human body as a deeply connected system (credit to my neurodivergence, I love systems). So naturally, I was getting deeply suspicious that something underlying was going on here. But how could it be that my breathing issues, digestive issues, rashes, myalgias, and even mental health issues all seemed to flare at once? It felt like my symptoms would “gang up on me” and collectively decide for no reason at all, to simply take me down fully. Sometimes for weeks or months at a time.

Because I was desperate and because I am a glutton for information, I started reading everything I could. I looked for journal articles, backed by evidence and peer review, that could help me make sense of my experience. I am lucky that this is also my career, and that I have the skills required to read, interpret and distill the science into something that would be meaningful for me. Because of the fragmented nature of medical care, when I finally put it all together and had a satisfying answer, I couldn’t blame any of my own doctors for not “catching it”. I had a pulmonologist, psychiatrist, immunologist, a gastroenterologist and an orthopedist. None of them communicated with each other, our system is not set up that way. But once I found what I suspected to be the critical “link” (boiling down to neuroimmune dysfunction), I was able, and privileged to simply share my suspicions with my various providers and have a few labs, biopsies and procedures done to confirm everything I suspected. My doctors were all doing what they were trained to do—which is help me manage my symptoms in the best way they could, but because I didn’t ask my ortho for advice about my asthma (why would I?), none of them ever connected ALL the dots. I had to do that. But I was lucky. Because I am a medical professional it was a lot easier to advocate for myself and say “I think I have XYZ” without being dismissed as an overzealous “Dr. Google” scholar.

It was during this lightbulb moment that I recalled my earlier days of practicing medicine, and I had another lightbulb moment. I realized that just because medical science cannot always neatly package up a host of problems, name it, and tie it with a bow on top, does not invalidate my own lived experience. In the wake of the “doctor hate” I resisted the urge to scream “NOT ALL DOCTORS” and started instead to listen. There are dismissive and arrogant providers out there, this is undeniable. But what else was happening, on a large scale basis, that made so many patients with similar stories to my own, feel so unheard, mistrustful and frustrated?

I go back to the “System”. I still believe that most doctors truly want to help people. But they are constrained by the limits of the paradigm under which they operate. Insurance often refuses to reimburse for valid testing, longer time spent with patients, and “off label” medications. There is no singular, magical, comprehensive medical chart for any of us out there. It is often left up to the patient to give a flawless history leaving nothing out, as well as a provider who knows how to ask the right probing questions. How is this fair for either party? Patients shouldn’t be expected to know the proper terms and jargon to make it easier for professionals to understand, and doctors aren’t given the time needed to ask the questions, dig deep, and find a satisfying answer. The result? A medical system that is essentially a large band aid… a medication to fix this, a medication to fix the side effects from the first, and so on. “Big Pharma” certainly has its problems, but the absolute STRANGLEHOLD that big insurance has us all working under is, in my humble opinion, the biggest reason for many of the problems.

Simply put: if insurance does not believe that a certain condition is “real” like fibromyalgia back in the day, they will not pay. If insurance companies say “these conditions are psychosomatic” that is what the doctors tell their patients, leaving them feeling unheard, gaslit and maybe even a little “crazy”.

What I have come to understand about the term psychosomatic, is that despite it being commonly interpreted as “I don’t believe your pain is real and is all in your head”, what it TRULY means is its very literal definition. “What you are feeling is very real and valid, but the mind and body are connected, and sometimes physical (somatic) symptoms find their origin, or are at least inexorably tied to, psychiatric symptoms. Once I realized this, I dove, once again, into the proverbial rabbit hole of learning more about how intertwined our brains and bodies really are. I went back to school. Just because we cannot identify a physiologic trigger for symptoms does NOT mean they don’t exist. More and more research is being done on this connection, and slowly but surely, the science is marching towards an understanding.

We as providers can no longer dismiss conditions simply because we do not understand enough about them yet. We must continue, as providers, to stay on top of research and continuing education, truly becoming lifelong students, with egos that can withstand the idea of saying “I was wrong about that.” Or “I don’t know the answer yet, but I will do my best to find one.” I was WRONG about fibromyalgia. And in the timeline of COVID, long COVID, post Lyme and post viral chronic syndromes, autoimmune diseases connected to mental health conditions etc., it is more important now than ever to be open minded.

As I open my private practice, amassing my training in primary care, critical care, and now psychiatry, I hope to pave the way for a new “breed” of thinker in the medical provider space. Right now, I have that privilege, because I am choosing to structure my pay system without involving insurance. This gives me the luxury of spending a lot more time than I would get reimbursed for on tricky cases. The cases that are hard to explain. The connections that are time consuming to make. I want to redefine “psychosomatic” as a term that is not dismissive but DEFINING. I am committed to walking the line between validating my patients and grounding my practice in “hard science”. I aim to be a provider that will walk alongside my patients with the most up to date evidence we have, while listening, validating and learning more. I believe this model of thinking is the solution to restoring trust in modern medicine and its providers as well as pulling desperate and frustrated people back from the precipice of the dangerous pseudoscience that “big wellness” grifters promote, taking advantage of this very gap in care that is distressing to so many people.

Let’s go on this journey together and reframe words like “Psychosomatic”. These are not terms to be used to dismiss, belittle and invalidate. Rather, these words are a recognition of how deeply our brains and bodies are intertwined. This is the path to a better healthcare experience. I hope patients and colleagues alike will join me.