And vice versa, reveals a psychiatrist for the stomach
By Dr Yoram Inspector
Some call the gut our ‘third brain’ due to its incredible sophistication and Giulia Enders argues rightly in her wonderful book Gut: The Inside Story of Our Body’s Most Underrated Organ that it is one of the most complex, important and miraculous parts of our anatomy.
In our unit we try to bring back the respect the gut deserves and listen very carefully to the feelings which emerge from its depths.
We give psychological support to those with gut conditions such as inflammatory bowel disease: Crohn’s and ulcerative colitis; bowel cancer and intestinal failure, accompanying them through their difficult journey.
Then there are patients who suffer from what is now called ‘unexplained medical symptoms.’
These patients present with various gastrointestinal symptoms where no specific identifiable cause for them has been found yet and have been told by doctors, “there’s nothing more we can do; it’s not life threatening and you need to learn to live around it.” Very often they suffer from functional gut disorders.
Functional gut disorders
There are many types of functional gut disorders – where there is no evidence for an actual structural abnormality but the gut does not work as it should. People may find them need to poo more often or have constipation and or excess gas and or sporadic abdominal pain.
This is what happens in irritable bowel syndrome (IBS) which can maybe be defined as the ‘borderline personality disorder’ of the gut and characterised by stable instability.
In other words, the gut starts to behave in an regularly irregular pattern – a bit like in atrial fibrillation of the heart.
Anxiety and the gut
Gastrointestinal symptoms can cause us anxiety when we don’t understand them and make us feel helpless and depressed. When we are anxious we have more bowel movements and when we are depressed we might become more constipated. It is like a dual carriageway – or in scientific language: the brain-gut axis.
Trauma and the gut
It’s common for unexplained gut symptoms to be closely linked to emotional and physical trauma and abuse. At the unit we try to help those who are literally ‘gutted’ by what has happened to them. They can’t ‘digest’ or ‘stomach’ the traumatic experiences they were subjected to and their ‘stomach turned‘ or has been ‘knotted with fear’ ever since.
Can therapy cure chronic pain?
For those patients who present with chronic pain we are starting research to compare the efficiency of hypnotherapy versus acceptance and commitment therapy. We want to see if therapy helps them cope better with chronic abdominal pain and able to reduce the amount of pain killers (especially opiates) they take.
Why do I have a sensitive bowel?
One theory which tries to provide an answer to this question is the ‘Open Gate Theory’. There are numerous nerve receptors in the gut which transfer information to the brain. If all the information that the gut receives goes directly to the brain, we wouldn’t be able to think about anything else; our ‘brain mail inbox’ would be blocked by e-mails from the gut.
Nature created a gate on the spinal cord which manages to filter the unimportant messages and actually block many of them on their way to the brain.
This means we don’t get sent what we don’t need to know and are free to dedicate time thinking about, for example our next summer holiday.
However, for many people with sensitive bowels this gate doesn’t work properly – it remains open so the gut bombards the brain with too many messages. It’s as if there is a hotline between the gut and the brain.
DON’T separate the mind and the body
As a specialist working in this unique field that can be called ‘psycho-gastroenterology’, I advise my patients not to separate the body and mind. Try not to create a hierarchy in the body as all our parts are equally important.
Parts of the gastrointestinal system have unfortunately become curses – for example ‘arsehole.’ But the truth is that without the arsehole we would not be able to continue to live normally.
The anal sphincter is an amazing system – and allows us in a magical way among other things to get rid of wind without passing faeces.
So if someone calls you an ‘arsehole’ say to them “thank you very much it means that I am very important”!
Stop the stigma
Why is it that we don’t think twice about telling someone about our coughs and colds or sickness and nausea but no-one will ever openly say, “You know – I soiled myself yesterday”.
Many patients who suffer from unexpected bowel movements become anxious, afraid and at times even phobic to go out and socialise. In one gastrointestinal textbook I read faecal incontinence has been defined as ‘socially devastating’. We wouldn’t feel so awful and ashamed regarding other conditions would we?
It’s not just in your head, it’s in your gut too.
I am very careful not to say to patients that their problem is only psychological. I say the following sentence a lot:
“Sorry that you’ve been asked to see a psychiatrist. It’s not that you are mad but somehow your gut has begun to behave a bit madly and this is a bit maddening.”
Once a patient understands how the mind and the bowels are linked it creates a much more compassionate and curious dialogue between the brain and the gut.
Dr Yoram Inspector is consultant psychiatrist and a psychotherapist and head of the Psychological Medicine Unit at St Mark’s Hospital, Harrow which specialises in providing psychiatric and psychological treatment and support to patients who suffer from various gastrointestinal diseases and disorders.
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