Unspeakable Pain: A Personal Journey Through Psychosomatic Illness
At the age of 22, one fine spring day at the Apple Store I worked at in college in San Diego, I began to feel a small scratch at the back of my throat.
I tried for a few months to ignore it, but as it gradually grew worse – eventually turning into a searing pain throughout my neck and an inability to control my voice – I started seeing a series of doctors and specialists to identify the cause.
I tried anti-reflux medication, changing my diet, quitting coffee, anti-allergy pills, massage, voice therapy, and eventually, a powerful anti-seizure medication that gave me temporary relief but at the cost of whole body numbing and crippling memory loss.
Why am I sharing this story with you?
Because this unexpected condition forced me onto a new path, and that path taught me incredibly valuable lessons – about psychosomatic pain and its sources, about the relationship between body and mind and how it can go wrong, and ultimately, about how to heal from the disconnection from myself that lay at the heart of it all.
In this essay, I’ll share with you what I’ve discovered in the hope it might help you too.
A descent into despair
At no point in my medical odyssey did I receive so much as a diagnosis – no MRI scan or neurological test or laboratory diagnostic could detect even the slightest thing wrong with me.
I found that I was always treated as a collection of symptoms, and when a specialist couldn’t find the source of my problem in their assigned body part, they quickly passed me off to someone else.
After 7 years of this fruitless search, during which I saw more than a dozen doctors in four countries, I had made no progress, and the pain and tension I felt was worse than ever. It felt as if an area the size of a ping-pong ball at the back-right of my throat had lost all sensation, like when the dentist injects novocaine into your gums. This numbness inflamed all the surrounding areas as they struggled to compensate for the loss of function. This irritated other, even more distant muscles and ligaments in turn, like a slowly spreading wildfire of burning tension.
Yet the physical pain was actually the least of my worries. It was really the social and psychological effects that sent me spiraling into despair.
When I opened my mouth to speak, I didn’t know what would come out. I might feel deep conviction in a business meeting, but my dysfunctional speech would come out weak and halting. I’d want to convey warmth and support to a friend, only to hear my words sounding monotone and strained. My words often had the opposite effect I intended, as if a demon had possessed me and was clutching me by the throat, distorting and undermining every word I spoke.
I can distinctly remember being at a house party in Oakland in 2014, and wanting to make a good impression. It was hosted by my then-girlfriend Lauren’s friends, and I wanted to fit in and be liked. I met someone who had also served in the Peace Corps, and was elated at the chance to connect in an environment full of strangers. But as I opened my mouth to speak, my voice was so tight and strained I couldn’t make myself heard at all, despite the relatively quiet surroundings. I might as well have been mute.
I left the party early, and as I walked home through the dark streets of downtown Oakland, a terrifying thought arose in my mind: “Life is not worth living if I have to live it this way.” I’m an inveterate optimist, and had never felt this depth of hopelessness. It felt like the end of the road, the lowest of lows. And I knew in that moment I needed to try something new.
Discovering relief by looking inside
Shortly thereafter, I attended my first Vipassana meditation retreat, mostly in the hope of learning to accept and make peace with my condition.
Instead, on the final day of the retreat, something remarkable happened: My attention had sharpened to a fine point after days of silent meditation, and I moved that mental scalpel to the place in my throat that had caused me so much suffering. To my amazement, it came alive!
Like the circuit breaker in a house being flipped to full power, the entire area around the back of my throat instantly lit up with full sensation. For the first time I could remember, I swallowed normally, feeling the sublime joy of all the muscles in my throat and neck working in beautiful synchrony.
Sitting quietly in a room and looking inside of myself had accomplished what tens of thousands of dollars and years of medical appointments couldn’t touch: total, instantaneous relief. That was the moment I knew I’d found a new way, a new path, and a new world. I found such relief a second time when I tried LSD at Burning Man. And a third time, when I did anger work at a week-long course called Groundbreakers. I was hooked.
What all these experiences had in common was that they were pattern interrupters. They temporarily shifted how my body and nervous system were operating, and by doing so, reestablished an internal connection that I had disconnected as a child to survive painful experiences.
An exploration of psychosomatic illness
These brief flirtations with relief set me on a new course – to research and study the underlying mechanisms of what was happening to me in these situations, with the goal of replicating them permanently.
The most compelling explanation I found was in the book The Divided Mind, by Dr. John Sarno.
In his book, Sarno describes his years of experience treating psychosomatic disorders, most of all, debilitating back pain. I had long resisted the idea that my condition was psychosomatic. It was so visceral that I couldn’t accept that it was “only in my mind.” But Dr. Sarno’s work makes a crucial distinction: while the source of the pain may be in a person’s mind, that doesn’t mean the pain isn’t completely real.
I was struck by how closely his description of the illnesses he treats matched my own (in bold): “The patient may experience a wide variety of highly debilitating maladies, including muscle weakness or paralysis, feelings of numbness or tingling, total absence of sensation, blindness, inability to use their vocal cords, and many others, all without any physical abnormalities in the body to account for such symptoms.” This seemed to describe my situation exactly.
As I kept reading, I was further startled to see his explanation of the cause: “…the cause is to be found in the unconscious regions of the mind…its purpose is to deliberately distract the conscious mind.” I couldn’t believe what I was reading. He seemed to be suggesting that the body creates physical symptoms as a protective measure, to distract or shield the conscious mind from thoughts and feelings that are too threatening or painful to bear.
I kept reading, and in his extensive descriptions of his typical patient profile, I saw myself clearly reflected:
- Sarno notes that “…rage in the unconscious mind is central to understanding virtually all psychosomatic reactions.” I knew that repressed anger was one of my most deeply ingrained emotional patterns.
- He says that anxiety, depression, and obsessive-compulsive disorder (OCD) often coincide with the apparent physical symptoms, which I’d also experienced.
- Perfectionism and other “repressive” behaviors are ubiquitous among psychosomatic pain sufferers, with patients often describing themselves as “hardworking, conscientious, responsible, driven, success-oriented, perpetual seekers of new challenges, sensitive to criticism, and their own severest critics,” which the subconscious mind interprets as a form of control or pressure and is thus enraged by.
- Many patients are the caretaker type and are always worrying about their family, friends, and relatives; at the same time, they’ve often experienced emotional abuse, including harsh or excessive discipline, absence or unavailability, temper, or unreasonable expectations from those same family members, creating another source of internal tension.
- A majority have come from families with hardworking, loving parents who conveyed overly high expectations and hopes for their children, families not characterized by any particularly unusual dynamics that would stand out in today’s society.
Ultimately, Dr. Sarno recommends the following treatment for his patients: that they directly face and bring to their conscious awareness the anger, emotional pain, and sadness brewing in their subconscious mind. He recommends a detailed step-by-step plan for how to do so, including reading his book and related materials, journaling and reflective writing exercises exploring possible sources of emotional pain, and cataloging situations that create suppressed rage.
The emphasis throughout this process is on allowing the inner child to express their rage at all the responsibilities, pressures, disappointments, problems, and unfair expectations they’ve faced, and most of all, their self-imposed demands to achieve, take care of others, or be good. It’s about freeing yourself from needing other people’s recognition, and learning to care for yourself in a kinder, gentler, more forgiving way than perhaps you were raised. In other words, you are learning to be more compassionate with yourself.
In effect, the purpose of Dr. Sarno’s treatment is to “blow the cover” on the covert operation your body is running to keep you from thinking about the reservoir of rage within you. Once the big secret is out, there’s no sense in continuing the pain, and thus it ceases.
Healing through learning
Sarno finds the unavoidable conclusion of his work almost too good to be true: not only can physical pain be psychosomatic, but you can stop it by learning about it!
And that is exactly what I found: the more I read and learned about Sarno’s work, the more the pain and tension in my throat dissipated, often in real time as the words entered my brain and my awareness of what was happening inside of me grew.
Another casual observation in Sarno’s book astounded me, and explained so much of my journey: “We know from experience that the theoretical wall, the barrier separating the conscious from the unconscious mind, cannot be breached from below—that is, the rage will not break through into consciousness—but there is nothing to stop us from intellectually breaching the barrier from above.”
This explained why my personal journey had started with the mind and the intellect, as I read books and took courses on various aspects of personal development. I used my mind to create the “breach” that allowed my awareness to begin looking inside instead of outside for answers. Only then was I able to begin exploring the world of the heart and the emotions.
While intellectual understanding and self-study are crucial, Sarno also points out that it isn’t necessary to fully “figure out” or change repressed emotions. It is only necessary to acknowledge that they exist, and that they’re a normal part of life. He has found that truly accepting our genuine self, who feels many things, including feelings that might be unpleasant or painful, is what leads to relief.
The cause of psychogenic voice disorders
I discovered a 2008 paper called The role of psychogenic and psychosocial factors in the development of functional voice disorders. It examined a range of prior studies and concluded that psychogenic voice disorders “may develop in response to negative emotions following stressful life events,” and especially “situations where there was a strong challenge to speak out and yet a marked constraint against doing so.”
One thing I had never understood is why I would have the apparent symptoms of trauma when my childhood seemed relatively idyllic. This paper suggested an answer, indicating that “traumatic incidents and serious situations involving death, loss, separation and threat to personal or family security were reported infrequently” in patients with psychogenic voice disorders.
Instead, the researchers found such disorders occurred more frequently in people who had “interpersonal problems with close partners or family members.” This included “difficulties with the expression of negative emotions related to repressed hostility, discomfort over sexual feelings and rebellion towards authority figures (Barton, 1960).”
This seemed to fit my situation much more closely than the “acute” trauma caused by sexual assault, natural disasters, or extreme abuse. In my case, subtle, internalized forms of emotional repression led to subtle, internal symptoms of trauma. The suppression of anger in my family – the sweeping under the rug of any brewing conflict – might seem like it would have led to a peaceful household. In reality, it only turned the chaos inward where it was unleashed to do a different kind of damage.
Other common factors in the development of psychogenic voice disorders seemed to fit my situation closely as well. The patient data showed “a trend towards education and helping professions, and recent prevalence studies indicate teachers are more at risk for functional voice disorders than any other occupational group.” I had been a natural teacher almost my entire life.
The same paper proposed a possible explanation for the specific symptoms I’d faced: when emotions (such as anger, in my case) cannot be expressed, they are “reverted” to physiological symptoms associated with fight-or-flight. This reaction “is thought to prepare the organism for increased physical work, by fixing the upper extremities to the thoracic cage for combat, requiring firm adduction of the vocal folds and wide abduction to facilitate an increased volume and flow of oxygen in order to meet the body’s increased metabolic demands.”
In other words, when we repress emotions and don’t allow them to be expressed, the body reacts to this with a fight-or-flight response. In order to prepare for the increased physical exertion of fighting or fleeing, the body stabilizes the upper parts of the body (like the arms and shoulders) against the ribcage to create a solid foundation for movement. As part of that preparation, the vocal folds (or vocal cords) are brought together tightly to control the breath and then are spread apart to increase oxygen intake.
This was the most precise description of what I experienced in my vocal cords I had yet encountered: a combination of too much tightness and tension, and somehow at the same time, too much looseness and lack of control. It was like reading the user’s manual for my body, specifically the troubleshooting section, where my seemingly unexplainable problem was described in precise detail.
Studying the vagus nerve
All my research was pointing to the vagus nerve, which I came to understand was the central actor in my story.
The vagus nerve is the longest nerve in the body, running from the diaphragm all the way up the torso, through the neck to the brain. It is like the “main information highway” of the body, connecting together and coordinating the parasympathetic nervous system in the heart, lungs, and digestive tract, and governing such functions as sucking, swallowing, facial expression, and the sounds produced by the larynx.
I began to study the vagus nerve intensely, filling my notes with anatomical diagrams and cross-sections of the throat from every direction. I found that right at the point it passes up through the right side of the neck, there is a “choke point.” If the nerve senses too much pain coming up through the nerves from the body, this is the last place it can shut itself off and thus prevent those signals from reaching the brain. Like a circuit breaker flipping off when it detects a dangerous surge of energy, the vagus nerve does the same for the body.
It was another book, The Body Keeps the Score by Dr. Bessel Van Der Kolk, that helped me understand why the vagus nerve seemed so central to my symptoms.
He calls this complex of nerves our “social-engagement system.” When it’s functioning properly, “…we smile when others smile at us, we nod our heads when we agree, and we frown when friends tell us of their misfortunes.” It also sends signals down to our heart and lungs, slowing down our heart rate and increasing the depth of our breathing, making us feel calm and relaxed, centered, or pleasurably aroused.
Dr. Van Der Kolk explains that any threat to our safety or social connections triggers changes in the vagus nerve. When something distressing happens, we automatically signal our upset in our facial expressions and tone of voice, which are meant to beckon others to come to our assistance. Our throat gets dry, our voice tense, our heart beats faster, and our respiration becomes more rapid and shallow. In other words, our bodies purposefully signal to others when we are distressed, effectively reaching out to the people who care about us for help.
And here I was desperately trying to hide my symptoms, doing everything I could think of to prevent anyone, even my closest family and friends, from realizing anything was amiss. As I saw what was happening, and clearly saw the war raging within myself that I was by definition always losing, I felt the edifice of my total self-reliance begin to collapse. I couldn’t do it all myself. I couldn’t carry it all myself. Not when I was a child, innocently looking for a way to express my rage. And not even as an adult, trying to achieve and succeed and improve all on my own.
It was slowly becoming clear that anything that stimulated or awakened my vagus nerve immediately improved my throat symptoms. Both major emotional releases and psychedelic experiences, but also simpler things like breath holding, cool wind in my face, and playing with animals or children. I could often feel in real time my throat muscles tensing or releasing based on what I was doing moment to moment.
With time, I’ve come to see my vagus nerve’s sensitivity and tendency to shut down as a wonderful gift. I’ve realized it is akin to having a real-time barometer of how connected I am to my body and my heart at any given moment. It represents my inner child, prone to hide or run away at the first sign of something scary, but also the source of my deepest innocence and joy.
When I abandon and dissociate from myself – by overworking, drinking too much coffee, distracting myself with social media, or not saying what I’m feeling – I can feel my throat closing down soon after. It is as if my vagus nerve switches off, protecting me from the pain emanating from my body but also throwing off my intuition, my self-awareness, and most concretely, my ability to speak, swallow, sing, or laugh.
As soon as I find the courage to reconnect with my body, to bring my feelings back online, it always turns on again, and I have my voice back. It is the greatest blessing to receive such clear and unmistakable communication from my body – I would rather be stopped in my tracks as soon as I fall out of alignment with my authentic self, than spend years in disconnection and look back on my life with regret.
If my story resonated with you, and you’d like to learn about and explore psychosomatic pain and its resolution for yourself, here’s what I recommend:
- Read Dr. John Sarno’s book Healing Back Pain: The Mind-Body Connection
- Check out the Psychophysiologic Disorders Association and their self-assessment quiz
- Enroll in Jonny Miller’s cohort-based online program Nervous System Mastery
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