Stacy squirmed uncomfortably in her seat. She looked at her watch. The hour-long class had another seven minutes to go. Could she make it? She tried to distract herself by focusing fiercely on the professor’s words, and writing down as much as she could of what he was saying. Then she started surreptitiously gathering her belongings together, anticipating the end of the class. Finally, finally, the bell rang and she grabbed her bag and almost jogged to the restroom.
It was a few months into her sophomore year, and she had recently become unable to sit for even an hour without needing to go to the bathroom. Two of her classes were 90 minutes, and one was 2 hours. And now she couldn’t even make it through the shortest one, 60 minutes.
As soon as the problem had arisen, she had gone to the doctor she had been seeing for years. He told her that the problem was psychosomatic -- all in her head. She believed him with all her heart -- he was the doctor, after all, and he knew her quite well. She was a straight-A student, and was used to accomplishing anything she set out to do. “I must be going crazy!” she scolded herself. “How can I not stop this -- especially because I know it’s psychosomatic -- this is really insane that I can’t seem to stop!”
Five years later, she reports, “It was unbearable for me, because it does ruin your life if you have to go to the bathroom all the time.” Stacy continued to suffer month after month. She describes what it was like to have to constantly be making arrangements so that she could have access to a bathroom: “When I had finals that would be an hour to two hours long, it was especially hard. I had to go to the professor in advance and explain that I couldn’t make it through the exam. Usually what they would do was send a TA [teaching assistant] into the bathroom with me.” The professors wanted to make sure that she wasn’t cheating, using bathroom breaks to check her notes. “And that was pretty humiliating.” Imagine being a 19-year-old whose trips to the bathroom were monitored by teaching staff.
After this problem had been going on for a year, Stacy’s parents urged her to go see their own doctor, a man Stacy had never met. She agreed. The doctor examined her briefly and then asked, “What do you drink?”
Startled by the apparently irrelevant question, Stacy explained that she had gotten in the habit of drinking large quantities of diet cola -- there was a soda machine around every corner on the college campus, and the caffeine helped her stay alert.
The doctor immediately and emphatically told her to stop drinking soda completely -- cold turkey -- explaining that the caffeine, carbonation, and acid in the drink could irritate her bladder and account for all of her symptoms, including abdominal pain.
Ten days later, Stacy was symptom-free, and the problem was gone forever.
Looking back, Stacy is still disturbed by the chain of events: “I suffered for a year because I thought it was all in my head.”
Stacy’s experience is not unusual. According to a Wall Street Journal article reporting on the work of Harvard psychiatrist Barbara Schildkrout, “more than 100 medical disorders can masquerade as psychological conditions.” The article explains that up to 1 in 4 psychiatric patients may in fact have a medical condition that causes their psychiatric symptoms, and more than 3 out of 4 may have a medical problem that contributes to them. In short, like Stacy, many people may be diagnosed as having a psychological problem when the real issue is a well-documented physical disorder.
Psychiatric illnesses are common and it’s important to take the possibility seriously if a health care provider suggests such a diagnosis. However, sometimes psychiatric diagnoses are arrived at too quickly, and it pays to ask questions.
For instance, you might ask, “If this problem is all in my head, what other symptoms or characteristics would you expect to go along with it?” While medical conditions can look different in different people, if the answer includes several major symptoms or characteristics that you don’t have, it might give you reason to look further.
You might ask, “What other conditions commonly create this symptom, and what leads you to rule those out?” If the answer is something like, “There are none,” that may be a hint to start looking elsewhere for medical care. You might use the Mayo Clinic Symptom Tracker at http://www.mayoclinic.com/health/symptoms/SymptomIndex to do a little research to see what other conditions your symptoms are associated with.
It’s also worth noting that the problem Stacy experienced wasn’t due to a germ or a structural abnormality -- the kinds of things that can show up on physical exams or on lab tests. It was caused by a common beverage she was drinking, admittedly in large quantities. This picture suggests that the doctor could easily have run a dozen lab tests and come up with nothing, reinforcing his belief that the symptoms were all in her head.
It also suggests that it’s useful for patients to think through carefully all aspects of their lives to see if it is possible to identify changes they have made in what they eat or drink, how they spend their time, what physical environment they are in, what exercise, alcohol, and tobacco habits they have, what sleep patterns they have gotten into, and so forth, to help them identify possible causes for their symptoms that might arise from something they could change themselves.
In summary, it pays to be skeptical if given a psychiatric diagnosis that doesn’t seem to ring true, and to put some effort into researching your symptoms and your life to see if you can turn up any clues to help you get a diagnosis that leads to treatment that helps you.