Once symptoms become persistent, the road is steadily down hill. This is because patients become baffled and scared by stress symptoms, especially the physical symptoms, and they begin to react to them fearfully. This fear of strange symptoms, and the consequences of the behavior that follows, add to the already accumulating painful emotions, thus causing the balloon to inflate even more. At the breaking point -the point at which the balloon finally pops- the brain chemicals become unbalanced and one comes down with a serious stress-related disorder.

People react to each set of symptoms -physical, emotional, mental, behavioral- somewhat differently. The reactions depend upon the type, severity, suddenness, rate of recurrence, and many other factors related to the symptoms as well as the sufferer. Everyone is unique in the way he reacts to stress symptoms. We shall discuss below a few common reactions.

1. How some people react to persistent physical symptoms
   1. Self-help:
      1. Over-the-counter medications: If the physical symptoms are minor, such as headaches, sleeplessness, stomach ache, tension, etc. one tries to help himself with over-the-counter medications such as pain relievers, sleeping aids, antacids, muscle relaxants, etc.

      2. Nerve medications: Some others might resort to taking “nerve medications” borrowed or stolen from relatives or friends. Stealing nerve medications from unsuspecting relatives has become a rampant problem in our society today.

      3. Destructive pleasurable activities: Some indulge in self-damaging pleasurable activities such as drinking alcohol; smoking cigarettes; taking street drugs such as crystal-meth (an illicit “upper” methamphetamine); eating more than they need as a way to calm themselves down; gambling to get a little rush; being promiscuous (common among stressed-out teenagers); fooling around outside the marriage; shoplifting just for the kicks and other self-destructive behaviors. In the long run these inappropriate activities are either useless or they could cause serious health and financial problems.

      4. Mindless activities: Many people get involved in mindless activities such as walking, running, swimming, taking hot tub bath, exercising, relaxation exercises, weight lifting, driving around aimlessly, bicycling, etc., believing that somehow these activities help them cope with stress. It has become fashionable to talk of “endorphins,” brain’s own brand of morphine, as stress-reducers. Most of these people say that after a good jog they feel a little “high.” This high will last till one faces music again. Some begin to meditate without realizing that meditation alone without better mental attitudes, healthier lifestyle and spiritual awakening is pretty much useless. A crooked executive meditating in the lotus position in his plush office on how to swindle investors comes to my mind. Some of these activities are good for one’s physical health, but are useless otherwise in coping with stress because they do not address the issue of painful emotions in the mind. However, regular long walks with a trustworthy friend or spouse could be extremely useful in the long run as this gives one the opportunity to talk at length and thus shrink his balloon. Talking, not walking, is what really helps in reducing stress.

      5. Recreational activities: Many others indulge in recreational activities such as mountain climbing, fishing, cruising, traveling, parachute jumping, etc. These activities can be exhilarating and refreshing, and give people a break from their everyday stress, but are of little value in coping with inner emotional pain. In fact, they could be harmful in the long run as they distract one’s attention from the problems at hand, and thus facilitate the burying process. These activities, however, are very good for the national economy. In the name of stress management more people are spending money on these pastimes than ever before. And more people are making money capitalizing on their naiveté.

   2. Medical wild goose chase: When self-help fails and more dreadful physical symptoms start re-appearing one by one, one wonders what is happening to his health. Now his imagination begins to run wild. He starts visiting doctors and hospitals.

      Soon he is on an endless medical wild goose chase. I believe that in America there are hundreds of thousands of people in this predicament at any given time. In my opinion, medical wild goose chase combined with doctors' ignorance of role of stress in health is the single most important cause of health care crisis in America today. Here is the course of downward path some people take:

      1. Visits to the emergency room: If the physical symptoms are serious, alarming or of sudden onset, as is the case in panic disorder, depending upon the organ involved one suspects a serious disorder such as heart attack, stroke, bleeding ulcer, gall bladder attack, appendicitis, asthmatic attack, brain tumor, allergic reaction, low blood sugar and the like. Scared to death, he runs to the emergency room and is tested extensively, and expensively as well. Often he spends a night or two in the intensive care unit. After such brief hospitalization, people are often discharged with such dubious diagnoses as, “minor heart attack,” “seizure disorder,” “transient ischemic attack” also known as T. I. A (temporary loss of blood supply to a part of the brain), and the like, all in the absence of any convincing evidence. Forever thus labeled, they live in fear of having another such episode. And they keep taking a variety of unnecessary medications such as digoxin, blood thinners, anticonvulsants and the like for years to come. The regrettable fact is that an average medical doctor, including the emergency room doctor, has little knowledge of stress-related disorders or of the role of stress in the onset of the patients’ symptoms.

      2. Visits to doctor’s office: If the symptoms are somewhat scary and recurrent but not so serious, the patient visits his personal doctor. A thorough physical examination and a battery of tests are done all of which draw a blank. One is relieved a little, but he is also baffled. “If everything is all right, how come I have all these scary symptoms?” When the good doctor asks, “Are you under any kind of stress?” the usual flippant reply is, “ Oh, no! Nothing whatsoever!” Or, “Nothing more than any one else.” Or, “I handled my stress well. This can not be stress!” Or, “I am not imagining this! This is for real, doc!” The naive doctor buys into this denial and goes on ordering more tests. Besides, he does not want to risk either losing the patient or being sued by him. It is a win-win situation for the health care providers; and let woe be to health insurance industry.

      3. Visits to medical specialists: As symptoms get worse and become chronic, one starts visiting various medical specialists: neurologists; cardiologists; ear, nose and throat specialist; gastroenterologist, allergist, lung specialist, you name it. Patients are often hospitalized many times. Tests after expensive tests are ordered. MRI scans follow C/T scans. Angiograms and cystograms are performed. Endoscopy and laparoscopy are done. And yet, “nothing physical” is found to explain the symptoms. The curious thing is that these specialists keep prescribing one drug after another, some of which are “nerve medications,” while telling the patients that there is nothing wrong with them. Perhaps they do this suspecting underlying “nervous condition.” Or, perhaps they do this for “placebo effect.” Or, more likely, they feel they must do something to justify the bills they have charged the patient. By now most patients are justifiably disheartened and disillusioned.
         Picture # 14: Medical wild goose chase

         

      4. Visits to famous medical centers: Disappointed, many patients then undertake pilgrimage to well-known medical center such as Mayo Clinic, believing that the local doctors must have missed something. When the hotshot specialists at these medical centers find nothing either, you can imagine how hopeless and helpless they feel. Some, especially those who have good insurance coverage, go back again to the same institution or to another similar one with greater reputation. In other words, they redouble their efforts to “get to the bottom of this.”

         Medical wild goose chase has potential for some serious complications:

         a) Medical trauma: Many medical wild goose chasers become traumatized by their grueling ordeal with the haughty medical specialists; callus hospital staff; rude laboratory technicians and sneering pharmacists. Unexpected physical complications from medical tests and unnecessary surgeries often develop, such as bleeding, infection, nerve damage, collapsed lung, peritoneal adhesions, etc. They feel angry, disgusted, frustrated and disappointed with the whole medical profession in general and their personal doctors in particular. Even the doctors now begin to get frustrated with these patients. Disgusted doctors often make matters worse by saying unkind things to these patients such as, “I don’t know what your problem is, lady! It is certainly not physical. It must be all in your head. You should see a shrink!” Patients interpret such off-the-cuff hostile remarks to mean they must be going crazy, or that their doctor believes they are lying, or putting on their symptoms with some ulterior motive. Feelings of fear, anger, helplessness, hopelessness and abandonment are common. People who have been traumatized by abandonment earlier in their life become very sick immediately thereafter. Thus traumatized repeatedly, these people never trust doctors again.

         b) Medication phobia: As we read before, these days antidepressant medications are widely, and sometimes recklessly, prescribed by family physicians as well as medical specialists. Some, especially people with anxiety disorders, become severely sick with antidepressant medications inappropriately prescribed by well-meaning but inexperienced doctors. Anxiety disorder patients are particularly sensitive to antidepressant medications and most doctors are especially insensitive to this fact. After a few bad experiences, they develop medication phobia (fear of medication). They get sick at the very sight of medications. After taking even miniscule dose of a medication they become very sick and they often run to the emergency room believing that they had an allergic reaction or panic attack. In my practice these are the most difficult patients as, being the sickest of the sick, they could benefit from medications the most, and yet they fear medications the most. Unless the psychiatrist is completely aware of this condition, he, too, could contribute to the patient's trauma by being irate with them, or by starting them on too big a dose of medication. Patients with this problem need a lot of education, understanding and support. I tell my patients with this problem: There is no such thing as bad medication. A medication is only as good or bad as the doctor prescribing it.”

         c) Rare disease syndrome: Many medical wild goose chasers develop "rare disease syndrome." They delude themselves into believing that they have some type of dreadful, obscure disease which their regular doctors have missed. Many manage to locate doctors in bigger cities who specialize in rare diseases such as Lyme disease, chronic fatigue syndrome, chemical allergies, fibromyalgia (no longer rare!) and the like, and pursue their fruitless search for cure with them for many years to come.

         d) Demoralization: Gradually, one becomes disillusioned over the consistent lack of results from medical checkups and tests; over accumulating bills of doctors and hospitals; over hostility from the boss and co-workers for frequently missing work; and over lack of support from family members, who, by now, are sick and tired of their ever elusive sickness. In the end, there is nothing to show for all the money and time spent and trouble taken.

         Why do so many people go through this harrowing experience? The reasons are quite obvious: a) Stigma: A dire need to prove that the symptoms are physical, not mental, since “mental” means one is a “certified nut case“, or he is simply “imagining it.” b) The doctor has no clue: He is unable to explain the symptoms in the absence of physical findings. He is not aware of the role of stress in his patient’s disorder. c) Patient has no clue: He is ignorant or unwilling to accept the fact the painful emotions could cause physical symptoms such as pain, paralysis, fast heartbeat, etc. d) Stupidity of health insurance companies: Insurance policies usually pay all expenses for physical symptoms but not for “mental” symptoms. e) Distraction: The medical wild goose chase keeps the patient’s mind away from all other personal problems that brought on the illness in the first place. That is why these patients say, “Nothing else is bothering me! I am upset with these darned physical symptoms!” f) Rewards: As we read before, some people secretly enjoy sympathy, concern, attention, pity, time off from work and disability payments that go with this whole shebang.

         Many chronic medical wild goose chasers are often labeled as malingerers, hypochondriacs, somatizers, crocks, hysterics, chronic complainers, P. I. A, and the like by frustrated and uninformed doctors. The problem with this is, when they do show up with real medical problems, doctors often do not take them seriously thus missing life-threatening disorders. May be the patient had cried wolf once too often.

   3. How some people react to persistent emotional stress symptoms:

      People suffering from emotional symptoms such as sadness with uncontrollable crying spells, anxiety, panic, helplessness, hopelessness, gloom and doom, etc. become scared that they no longer have any control over their emotions. This fear adds more emotions to their balloon making symptoms worse. If the need to be in control of one's emotions is great, as is the case with some macho men, he attempts suicide unable to tolerate his discomfiture and growing feelings of helplessness and hopelessness. Some succeed while others botch up badly. By now most patients frequently feel, “I just can not take this pain anymore.” Taking addictive drugs or drinking alcohol as a way of coping with these symptoms is very common.

   4. How some people react to persistent mental stress symptoms:

      Patients suffering mostly from mental symptoms such as forgetfulness; inability to recall events or names; inability to concentrate; confusion, etc., begin to suspect that they might be suffering from Alzheimer’s disease, a brain tumor or attention deficit disorder. They get their brain scanned, head wired for electrical waves, and undergo neuropsychological testing. A lot of these people take a variety of vitamins, food supplements and herbal medicines (remember garlic pills?) hoping that their memory would get better in time. People suspecting that they have attention deficit disorder start taking stimulant drugs to control their symptoms.

   5. How people react to persistent behavioral stress symptoms:

      Patients suffering primarily from behavioral symptoms such as irritability, short temper and violent outbursts become shameful, guilt-ridden and angry at themselves for not being able to control their own behavior. They are caught in an unending cycle of perpetual misbehavior-remorse-more stress- more behavioral problem. Their balloon keeps growing bigger because of the accumulating emotions of guilt and remorse in their balloon. Many end up quitting their jobs or abandoning their families out of shame, guilt and despair. Others end up losing their spouses and families through divorce.

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