Do you have Irritable Bowel Syndrome, or some form of ongoing, episodic, or chronic digestive issues like abdominal discomfort/pain, constipation, diarrhea, bloating, acid reflux, or gas with no clear-cut cause or sure-fire cure? If so, then you have what’s called a functionalgastrointestinal problem. This means that you have real physiological symptoms, yet physicians cannot determine a physiological cause for your symptoms.
Functional gastrointestinal problems, like any chronic illness, are difficult to live with for three main reasons:
1) Having to deal with symptoms ranging from especially acute pain and unpleasant, uncomfortable, or even embarrassing symptoms is unpleasant at best and debilitating at worst.
2) Functioning in every day life with such symptoms requires some degree of behavioral modification—changing the way you do things. If you don’t feel good, you might not do many of the things you used to do. You will probably not be able to eat the way you ordinarily would. Your relationships might change. You might spend more time alone. And these are just a few examples of just how many changes a person typically makes in order to cope with a chronic illness. Making even one of these changes based on an inner sense of “I can’t” instead of “I can” gives people a sense of being defeated. The more of these decisions one has to make, the more one’s life is compromised by the illness, and the more one experiences loss—of time, of experiences, of and the more psychological negativity is directed towards the part of the body generating the symptoms.
3) The symptoms and all of the behavioral modifications one makes on a regular basis inevitably lead to psychological changes. Shifts in mood, the intensification of emotions, the emergence or heightening of anxiety, a sense of feeling more fragile, vulnerable, sensitive, and reactive are all possible and likely. Feelings of frustration, anger, sadness, grief, loneliness, hopeless, and despair can surface and persist. It is well known that depression and anxiety are frequently diagnosed in those with functional medical problems, especially functional gastrointestinal problems.
It’s hard enough living with a chronic illness, but in some respects it’s even more challenging when it’s a functional medical problem. Here’s why:
First, without clearly detectable dysfunction in the body, people with functional medical problems face the additional significant stress of having to live with their bodies malfunctioning without any idea why their bodies are malfunctioning. Our minds are naturally oriented to making sense of things that we don’t understand. Uncertainty and not knowing is difficult and uncomfortable, but it’s especially unpleasant when it comes to our own bodies. Not having clarity in response to the question “why is this happening” naturally leads our minds to conclude that we cannot stop the problem, and this can easily lead to the increased feelings of fear, frustration, anger, hopelessness, helplessness, and powerlessness, contributing to the onset or exacerbation of anxiety and depression.
Second, functional medical problems are reactive to stress. Some functional problems are more reactive than others. Irritable Bowel Syndrome is known to be the most sensitive to stress. Research has linked IBS with trauma and childhood anxiety, indicating that a history of an already activated sympathetic nervous system or trauma makes the digestive system more vulnerable to symptoms, and this makes perfect sense when you consider what we know about the sympathetic nervous system’s impact on digestion.
The sympathetic nervous system, the body’s fight or flight system, is instantaneously activated when a perceived threat (to our life or our well-being) is detected. When this happens, our body goes through a rapid transformative process in order to focus our minds, energize our bodies, and organize our movement in order to deal with the threat. Our attention hones in to be singly-focused on the enemy, the threat, and how to defend ourselves. Digestion shuts down because it isn’t a wise investment of resources to break down food for future energy when your body needs immediate energy to survive an attack. Our nervous system is designed to ensure our survival, and stress is the body’s reaction to perceived threats, life threatening or, more often, not. Pretty much anything that our nervous system perceives as a threat generates some degree of stress in our body, affecting our digestive system and belly musculature.
So what if the threat is not something outside of ourselves like somebody’s behavior but something happening within our bodies like physiological symptoms happening in our belly? This is the predicament for those who have IBS. Symptoms occur, and perhaps the first time they occur, one has a reaction of surprise or nervousness, but over time, as the symptoms recur more frequently and perhaps with greater acuteness, the symptoms themselves become more threatening to our daily lives. Because of the way our minds work under stress, we become over-focusing and tend to fixate on the belly, the part of our body that’s malfunctioning while our bodies tend to brace with contracting and tightening muscles against the physiological pain we’re experiencing. This is all happening while we are experiencing emotions inside of our bodies that are also sometimes unpleasant, and at other times very painful. Our bodies tend to brace against emotional pain as well as physiological pain. Such automatic patterns like bracing, though intended to protect us from harm, in fact exacerbate gastrointestinal symptoms by adding additional tension to an already tense body.
To make matters worse, when it comes to a functional gastrointestinal medical problems like IBS, some of the biggest stressors are food, meals, eating, and social situations that involve eating. Having a digestive disorder like IBS greatly impacts one’s diet and enjoyment of food. All it takes sometimes is one negative experience of eating a particular type of food that then triggers symptoms for that food to become another enemy to the body. And in my experience, both personal and professional, once a food is put on the “do not eat” list, it is highly likely that our sympathetic nervous system is going to be activated just thinking about that food. It becomes quite difficult to know whether it’s a particular food or fear about eating that particular food that is primarily responsible for the worsening of symptoms.
It’s easier for our minds to blame food for our symptoms because food is tangible and the muscles in our gut during digestion generate sensations. When you have IBS, you become highly attuned to the unpleasant sensations you’re used to feeling when you’re symptomatic, and any sensations are automatically interpreted as negative, or pain. The more trodden the pain neural pathways are, the more likely we are to experience pain again, and the harder it is to notice sensations without the pain. People with IBS don’t want to feel any sensation in their bellies because any sensation. This sets up a pattern of avoidance of neutral and pleasant sensation along with a hypervigilant attention to pain and discomfort in the belly. Avoidance equates to fear, fear of feeling sensation in the belly, fear of even having a belly. This is on top of all of the other fears that living with IBS generates.
It has been stated that stress is not the cause of IBS, but with all that occurs in a body dealing with chronic gastrointestinal symptoms, there is tremendous interplay between our nervous system and digestive system. There is good reason for this: You have a second brain in your gut. It’s called the enteric nervous system, and it’s wired with more neurons (nerve cells) than your spinal cord and all of the same neurotransmitters (chemicals that enable messaging between neurons) that exist in your (first) brain. You really do have “gut feeling”.
While the brain in your head has a right brain, the part of your brain that experiences emotions and sensations, and a left brain, the part of your brain that can put words to the experiences of the right brain, think of the enteric nervous system as a second right brain (without a left brain). In other words, your belly experiences IBS symptoms, and you cannot interpret what your belly is experiencing. All you know is that it’s unpleasant and unwanted. And that leads to growing negativity towards and resentment of your belly and the digestive organs it contains.
Your symptomatic belly is essentially like a crying pre-verbal baby. Something is wrong. Something’s upsetting it. And it can’t tell us what it is or how to help. We are left to figure it out. What do you do when it’s an actual baby that you are caring for? That’s exactly it: You care for it. But how?
The same general rules that apply to caring for an infant apply to caring for you and beginning to heal from IBS:
- A willingness to be present with your emotional and physiological pain and discomfort. Plainly put, being in the present moment without any agenda except to be there fully.
- Love and compassion for all the parts of your body, even those that cause us misery, simply because they are parts of you. This is self-compassion to the nth degree.
- Non-reactivity. Working to better regulate your nervous system so that you are able to work with whatever reactions you have the keep you from being present, compassionate, and receptive.
For those of you familiar with mindfulness-based practices, you will notice that the above three things are the same qualities that come naturally as you engage in mindfulness-based practices. Such practices work on the parasympathetic nervous system, the system that is engaged when mother nurses infant. It is a right-brain to right-brain connection that typically produces good feelings and sensations for both mother and infant and generates healthy bonding and attachment. Healing begins as we learn how to be more present with our own bodies, and in the case of IBS unpleasant belly sensations and unpleasant emotions, from a stance of compassion, openness, and curiosity instead of fear, frustration, and hostility.
Healing IBS is a process that involves working with the nervous system over time. It involves increasing awareness and increasing one’s capacity to engage in activities like mindfulness practices that stimulate the parasympathetic nervous system. Healing also involves seeing what has not been visible, bringing consciousness to what hasn’t been fully conscious, and working with psychological material that has yet to be consciously acknowledged, addressed, metabolized, or integrated. Healing is what happens when we attune to our own bodies and listen to what they have to tell us. Learn how to do this as effectively and efficiently as you can with guidance from a skilled psychotherapist in conjunction with other practices and therapies that target the nervous system, and discover how to heal your body.
Jennifer C. Franklin, PhD, MACP
(CA: PSY 20709 / NC: 4137)
1318 Broad Street, Durham, NC 27705