"Do you think it's just stress?" I've been asked that question thousands of times. My answer is always the same. "Stress aggravates everything but causes nothing."

Psychological and sociological dynamics may predispose an individual to illness or cause an illness to be much more severe, but other factors must be present to trigger the condition. The statement "It's psychosomatic." is nothing more that a professional way of saying "I don't have a clue!"

I attended medical school and completed my internship and residency in the early 1970s. Psychosomatic medicine, an approach to illness that had been introduced in the 1930s and gained momentum through the succeeding decades, was still quite influential. The report of Dr. T. H. Holmes on the relationship of life events to subsequent illness in 1970 provided strong support to the position that up to 80 percent of health problems were stress-related and substantiated the psychosomatic model of disease.

The work of Holmes does indeed demonstrate that the stress of life events makes people susceptible to disease. To say that an illness is stress-related, however, is far different from saying that the disease is stress-caused. Taking the latter view places an undue burden upon the hapless victim and removes the onus of meticulous diagnosis and treatment from the physician. While this allows the practitioner to maintain an air of professional dignity it has the unfortunate effect of placing an even greater stress on the patient who is told to go home and get his or her mind right.

When I use the term "psychosomatic" I am not referring to the undeniable role unmanaged stress places upon the body. I am speaking specifically of the medical model that states that a particular personality type is the root cause of a particular illness.

One by one the diseases that were proclaimed to be "psychosomatic" - the end result of a personality defect or improper way of thinking - have been found to have a clearly identifiable and reversible physical cause. The once widely held belief that certain individuals had brought their illnesses upon themselves has been proven to be a cruel hoax that did nothing but heap guilt upon the shoulders of the wounded.

Peptic ulcer disease is a prime example of this phenomenon. For years physicians were taught that peptic ulcers were the end result of excessive worry, of repressed feelings. I recall hearing a comment about a young man whose stomach had been removed to control bleeding ulcers. “How tragic. If only he could have learned not to worry so much.” We now know that a bacterium called H. Pylori is associated with nearly all stomach or duodenal ulcers.

Inflammatory bowel disease including ulcerative colitis and Crohns disease were thought to be the result of arrested emotional development in childhood. Such individuals were said to be excessively introverted, obsessive, or anxious. Although the exact cause of these conditions is still debated it is now clear that multiple factors, including the overgrowth of undesirable organisms in the bowel, are responsible.

Asthma was once regarded as the result of an overprotective childhood or an ambivalent conflict with an authority figure. Suppressed aggression, it was argued, led to a strained breathing pattern and wheezing. Parents of asthmatic children were encouraged to enter psychotherapy to deal with their own inadequacies. Many asthma triggers have subsequently been recognized. We know that exposure to allergens can trigger attacks as can breathing atmospheric pollutants.

Nutritional factors also contribute to asthma. We now understand that asthma is an inflammatory process and that the inflammation results, at least in part, from an inability to manufacture anti-inflammatory compounds in the body. Omega 3 fatty acids from fish, evening primrose, borage oils are capable of bypassing the defect and restoring normal manufacture of these substances. Levels of vitamin E and vitamin C are low in the bronchial tubes of asthmatics. Supplementation of these nutrients can decrease the frequency and severity of asthmatic attacks.

Most physicians no longer consider personality traits the primary cause of peptic ulcer disease, inflammatory bowel disease, or asthma. Unfortunately, ideas, once established, tend to survive long after the theory has been discredited. Today a new genre of disease states is considered by many to be “psychosomatic.”

People who suffer from diseases for which modern medicine does not have ready answers are all too easily dismissed as having personality defects or poor coping skills. Chronic fatigue, fibromyalgia, sick euthyroid syndrome, & irritable bowel syndrome fall into this category. I have heard speakers at continuing medical education courses suggest that the best way to manage fibromyalgia is to “get the patient out of the office as quickly and with the lowest possible expense” and that people who are tired should “get used to it like the rest of us.”

Just as the first generation of psychosomatic illnesses have been found to be triggered by factors unrelated to personality or coping ability so the root causes of the more recent enigmatic diseases are being discovered.

Each and every one of us is subject to stress at home or in the workplace on a daily basis. Life is like a grindstone. Whether it polishes us up or wears us down depends to a great extent upon what we are made of. Attitude plays a major role in determining this, but when infections, nutritional deficiencies or energetic imbalances are present a positive outlook may not be sufficient to maintain health. At times other factors need to be addressed. In those instances it does no good and can do much harm to tell those afflicted to go home and get their minds right!