Dear Therapist:

I am writing to ask for some clarification as to the extent that stress or other psychological issues can cause physical problems. Basically, I have not been feeling well for a while, mostly with very bad headaches. I have been to a doctor and a specialist who both are saying that there is nothing they can see that is wrong and it must be that I am stressed out. They suggested I go to counseling which I am looking into. I guess my question is that my headaches feel very real so how could counseling help that? Also, usually if one is looking for help with a medical issue and the doctor can't help them the answer is to try and find a better doctor. How do I know that I am not ignoring something important by going to therapy as opposed to pursuing more medical testing and the like? My husband says he is concerned that if I keep running to doctors I’ll eventually find someone who diagnoses me with some strange illness. I'd appreciate you shedding some light on this. Thank you. 



As far as any medical issues are concerned, an appropriate physician should be consulted. As a mental health practitioner, I can speak to psychosomatic symptoms.

You wonder how counseling can help with your headaches. Basically, headaches are a symptom of something. The question is whether the cause is physical (related to a medical issue) or psychosomatic (due to a mental/emotional issue). It is widely understood that the brain controls our thoughts and emotions, and that it governs our physical faculties. Specific areas of the brain allow for feelings of happiness, sadness, or anger. In a similar way, particular brain activities cause us to feel physical pain (for instance when we touch a hot stove).

When my hand is on a hot stove, the nerves in my hand send signals to my brain, communicating the need for it to create the sensation of pain. This lets me know that I should remove my hand from the source of pain. Similarly, when I am in psychic distress, the brain communicates to me the necessity to deal with its source. For some people, this communication takes the form of anxiety, sadness, anger, or other emotions. When this occurs—just as with physical pain—our brain is telling us that something needs to be addressed. If the issue is not appropriately addressed (and the distress continues), the brain may increase the negative emotions.

At some point, if the brain recognizes that its messages are being ignored, it can use other tools. Some of these tools are psychological in nature (like dissociation, memory loss, and “loss of time”). More common tools take the form of physical symptoms. Headaches, backaches, numbness, muscle weakness, and fainting are some common psychosomatic symptoms. For some people, physical symptoms are the first ones that are presented. In some cases, the brain may have learned from past experience that psychological symptoms were not properly heeded.

I obviously do not know the source of your headaches. You should certainly rule out any physical issues prior to (or concurrent with) counseling. Sometimes a therapist can help to quickly identify the source of psychosomatic symptoms, leading to reduction of these symptoms. You may never know the true causes of your headaches with absolute certainty. The degree to which therapy helps, however, can help give you at least some indication as to whether their nature is physical or psychological.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer / 718-258-5317