Am I Crazy?

Or, Forgiveness Part V

Am I Crazy? Understanding the Mind-Body Connection in CFS/Fibromyalgia

by Jacob Teitelbaum, M.D.

In medicine, we have a bad habit. If a doctor cannot figure out what is wrong with the patient, the doctor brands that patient a “turkey.” Imagine calling an electrician because your lights do not work. The electrician checks all the wiring, can’t find the problem, and says, “You’re crazy. There’s nothing wrong with your lights.” You flip the switches and they still do not work, but the electrician just says, “I’ve looked. There’s no problem here,” and walks out the door. This is analogous to what many CFS patients experience. I apologize for the medical profession’s calling you crazy just because we cannot determine the cause of your problem. It is inappropriate and cruel.

Fortunately the CDC (Centers for Disease Control), one of the major governmental agencies responsible for CFS (and other) research, is spending millions of dollars on advertising to dispel the misconception that CFS is all in your mind. They are working hard to teach both doctors and the public that CFS is both a very physical and devastating illness. Hopefully, getting treatment will be easier in the future.

Research has proven that people with CFS vs. those without CFS have similar rates of psychiatric disorders. What you have is a very real and physical illness. And, like most other physical processes—such as diabetes, heart disease, cancer, and ulcers—it has an associated psychological component.

What Are Some of the Psychological Issues Sometimes Seen in CFS and Fibromyalgia?

In my practice, I frequently see CFS/FMS patients who seem to be caught on the horns of an emotional dilemma. These patients find themselves in situations in which they are unable to make a choice between two or more alternatives—for example, between working and having children, or between staying with or leaving their spouse. These conflicts come in an infinite variety and defending yourself against acknowledging a conflict can sap your energy. In my experience, when people start to feel better physically, they find it easier to deal with their emotional issues. However, you do not have to resolve every conflict. If you have something that you cannot settle at the moment, you might find it helpful to simply acknowledge the conflict instead of suppressing it. Tell yourself, “Yes, I have these two areas that are in conflict, and I cannot reconcile them now.” Many people find that after a while, when they are no longer stressed about a problem, a solution comes from a new perspective.

Other people have been convinced that who they are and what they feel and want is not OK, and they tie themselves into emotional knots trying to find a way to get permission to be themselves. For those of you suffering under the illusion that you are not OK, let me put out a simple proposition. If you are not directly harming another person or severely harming yourself, whoever you are and whatever you want to do or be is simply and inherently OK. It might also help you to understand that you may sometimes mistake uncomfortable feelings such as disappointment or sadness for fatigue. Try to be aware of when you do this. There is no such thing as an inappropriate feeling. You have the right to feel whatever you feel. Does this mean that you are crazy? No. It simply means that, like all human beings, you have emotional issues to deal with as part of your growth process.

Unfortunately, some patients become so frustrated by being told their CFS/FMS is “all in their head” that they are in a Catch-22. They feel that if they acknowledge that they also have emotional issues just like everyone else, they are validating the ignorant doctors who say that their illness is all emotional. Rest assured, however, that the research study done at my research center, along with research performed at the CDC and elsewhere, also further proves that CFS/FMS are very real and physical. In my study, people who received the active treatment improved dramatically and those receiving placebo did not. Chronic Fatigue Syndrome and Fibromyalgia are real, physical diseases. If it was “all in your head” the placebo group would have improved as much as the active group. This means that anyone who says it’s all in your head is no longer simply a nitwit. Now they are an unscientific nitwit! Give yourself permission to be human. You are no more and no less crazy than anyone else.

A large percentage of CFS patients are type-A overachievers who were driven by having low self-esteem as children. In the first part of their lives, these patients needed to overachieve for their growth and self-image. Although not the easiest method, CFS helps them slow down long enough to reclaim themselves. For many, a period of deep rest is essential. Although devastating, CFS actually serves many patients well.

Part of getting well is “lightening up,” after all. There is a traditional Zen metaphor of this truth that imagines “worry” as an old man carrying a load of feathers which he thinks are rocks. Like this old man, we can often become weighed down by “rocks” of our own imagining. Many of the worries we carry around sort themselves out as soon as we let go of them. Although things may not always work out the way we would like them to (CFS patients often describe themselves as “control freaks”), they usually work out for the best. Because of this, it helps to have or reclaim a sense of humor.

I am a firm believer in psychological counseling—if and when you feel like it would be helpful. This is especially pertinent in CFS/FMS. As many as 70 percent of you have suffered physical or emotional abuse—as opposed to 15 percent of “healthy” people. Counseling is helpful for anybody who is growing and changing. People who are growing frequently come across areas that are difficult and with which it is usual and natural to need help. As is true for any disease, when you treat the physical component, you must also treat the underlying psychological issues. If you do not, the disease will simply manifest itself in another way.

Although 1/8 of CFS patients also have depression, only a small minority have depression as the cause of their fatigue. The “depression” caused by CFS/FMS is often simply frustration and stress. This gives you a simple way to distinguish whether you also have depression. CFS/FMS patients usually have a lot of interests and are frustrated by their lack of energy. However, if you have depression that causes fatigue, you probably have few interests. I discuss ways to lift depression, naturally and with prescription drugs, in my article “Eliminate Depression—Naturally!

Whether or not you are depressed, you may consider some type of therapist for emotional support and guidance. Be careful who you choose, however. Many therapists have never dealt with their own problems and simply work out their personal conflicts and issues on their patients. Others have worked through their issues and are excellent with patients. Make sure “psychotherapist” is one word—not two! Talk to your friends and relatives to find somebody who is good. Your physician may also be an excellent resource. There are many good therapeutic approaches, but my own personal bias is for a therapist who takes a transpersonal psychology or Jungian approach. I recommend the services of the Rev. Bren Jacobson (410-224-4877) who does excellent and reasonably priced counseling by phone. By using your Chronic Fatigue and Fibromyalgia as a springboard for personal growth, you can find your CFS turning into a blessing. I found this to be the case for me. My CFS/FMS gave me a firsthand understanding of the problem and a powerful incentive to learn how to overcome it. It also has led me into wonderful areas of growth.

This is reprinted from EndFatigue.com with permission of Dr. Teitelbaum. Next week, the second half of this article. The conclusion of this Forgiveness series is getting close!

4 thoughts on “Am I Crazy?

  1. Bola-

    I’m glad to see you sorting out the details of your painful yet fascinating past in this blog.

    Ages, decades, centuries ago, when we first met, I was going through my own problems recovering from two difficult spinal surgeries. I had a Post-It on my computer monitor that said, simply, “To heal the mind, heal the body.” You had noticed it (you were the only one in a company of 30,000 people who ever did, to my knowledge) and asked if it was in the correct order. I remember telling you that I wasn’t sure the order mattered, but, for my current purposes, it was.

    As you may recall, I was struggling with some real physical challenges; although the surgery had taken away most of the pain, my right leg didn’t work all that well and it was a bit of a struggle to walk. As a relatively physical person, this was very distressing to me, and I was recuperating slowly. As you may not recall, I was also struggling with the impending and inevitable death of my very dear friend Stuart.

    Quite simply, I was in a situation of significant helplessness. My own body was weak and still in pain, and there was nothing I could do about Stuart but be there for him and his wife. There was no amount of psychotherapy or happy thoughts or much else that I could see that would have a significant effect on my outcome. However, I affixed on the one thing I could do: heal my body.

    I spent that year taking walks every opportunity that presented itself, being with Stuart as much as possible, eating well and trying to get enough rest. My body grew stronger, and I felt some confidence in it returning. Stuart died, and I kept on going, recovering a bit at a time.

    Your last several posts reminded me of that time, and my own line of self-inquiry that led to that set of decisions: to heal the mind, heal the body.

    I’m not at all sure it mattered which one I put first; indeed, by simply making the decision to focus on my physical self, had I not made the necessary psychological step? The two are inextricably intertwined; while you are entirely right that clinical trials show that available therapies are effective when tested against a placebo, many of the people on the placebo get better, too – it’s not ALL physical (BTW, this is true for almost any clinical study of any effective therapy for any disease… it is foolish to dismiss the power of the mind) and it’s not ALL mental (simple experiment – it’s a LOT easier to relax your way out of a headache after a couple of aspirin). However, there are vicious and virtuous cycles in the interaction between mind and body, and we have to access and use the virtuous cycles in order to heal.

    Personally, I find chocolate always helps both mind and body, but that’s just me. :-)

    Today I can stand or sit, walk, run, jump, and do all the other things most kids my age can do. I have faced a number of “injuries” since then, both emotional (death and illness of friends and family, some “hard knocks” in the professional field) and physical (breaking my right arm last year, for instance, while biking in Almaden Quicksilver Park), but the lessons I learned have given me the strength and resilience to be able to get back up, heal, and keep going.

    -Bill

    P.S. I really like Dr. Teitlebaum’s advice: “Make sure “psychotherapist” is one word—not two!”

    • I am relieved to find out that I commented on your healing mantra! I tend to picture the mind as being the next level above the body’s, but it’s probably more accurate to consider them as intertwined. Perhaps the mind – or consciousness – is present in every cell.

      Thank you for your thought provoking comment. I love chocolate too by the way. Usually in raw, cocoa nib form!

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