welcome to this video in this video
we're going to talk about psychosomatic
illness which is an extremely important
topic in medicine but it's also an
extremely controversial topic in
medicine and the reason is that the
psychosomatic theory which we're going
to discuss in just a moment is not yet
proven it is just a theory and there are
many people who believe that it is an
incorrect theory however it is still the
best theory that we have a present and
therefore it is the theory that is used
by many practicing clinicians so it's an
important theory to know at present and
it may well turn out that it is proven
to be correct or it may well turn out to
be proven to be incorrect we don't know
at present but it is at present our best
theory so before we get into the main
bulk of the video and explain what the
psychosomatic Theory actually is let me
say that there is another word for
psychosomatic in fact there are many
different words that can be used
equivalently to psychosomatic but the
other big one is functional and that's
come out blue for some reason let me see
if I can change that color there we go
so functional illness means the same
thing a psychosomatic illness and in
fact I would say at least in the UK
functional illness is a more commonly
used term than psychosomatic so very
very important to know the name
functional means the same thing as
psychosomatic so let's now go into the
bulk of this what does the psychosomatic
theories say so I was debating the best
way to actually explain this is it to
leap in and explain what the
psychosomatic Theory actually says or is
it a better idea to give a little bit of
the background as to where this theory
comes from and I've decided to go for
the latter to give you a little bit of
the background as to where this ferry
actually comes from so here we go here
is the background so anyone who actually
has a clinical role now is that a huge
number
of patience we can't ever actually find
anything physically wrong with them so
let me go into this again so there are a
lot of people who have symptoms that are
suggestive of physical illness they go
and see their doctor their doctor agrees
that these symptoms are a little bit
worrying and does some investigations
for them to try and find out what might
be the cause of this and then all the
investigations come back normal so the
doctor might then say okay let's do some
more investigations some higher
investigations just to make absolutely
sure they have go and have those
investigations done and again they come
back normal and maybe they might even go
beyond that to a third set of
investigations more and more advanced
tests and those all come back normal and
eventually we will conclude that there
isn't any thing physically wrong that is
causing those symptoms or at least at
the current level of medical knowledge
there is nothing that we can detect that
is physically wrong to be causing those
symptoms there is a name for this and it
is medically unexplained symptoms this
term isn't used that often but you do
hear it sometimes used in a clinical
environment so medically unexplained
symptoms mu as for shorts so that's a
give a concrete example so the main
example probably of medically
unexplained symptoms is usually in the
gastrointestinal tract a lot of people
get gastrointestinal problems that they
are concerned about they go and see
their doctor to make sure that they
don't have anything physically wrong
with their intestines and all the tests
say that their intestines are perfectly
normal so let me give you an example of
a very very famous very vey common
gastrointestinal disorder that is that
follows this pattern where we cannot
find anything physically wrong and that
is irritable
syndrome whoops that's not it
syndrome or IBS for short which is not
to be confused with IBD IB d stands for
inflammatory bowel disorder and that is
an inflammatory condition of the bowel
if you do tests for that you can find
something very very wrong with the bowel
itself it is not an autoimmune condition
but it's very similar it's believed to
be a failure of immunological tolerance
to the commensal organisms within the
gut so it's a well-known fact that our
intestine is full of bacteria and these
are good bacteria they help with
digestion and the immune system is
supposed to not attack those bacteria
it's supposed to ignore them it's
supposed to have tolerance to them in
infernity bowel disease we believe that
there is a problem with the immune
system that means that it fails to
ignore those bacteria and starts
attacking them and this leads to a
massive inflammatory reaction in the
intestine that causes huge problems for
the individual so that's inflammatory
bowel disorder that is not a
psychosomatic condition that is a
physical condition of the Bao irritable
bowel syndrome is different IBS it is
one of the biggest examples of what a
presence is classified as a
psychosomatic condition or a functional
gastrointestinal disorder so let me
explain what happens in individuals
within irritable bowel syndrome it is
believed to be a condition of the colon
so let me just start by drawing a little
picture off the colon this is going to
be a very basic picture so here is the
ascending colon here is the transverse
colon the descending colon the sigmoid
colon and then the rectum so they they
basic picture now the colon is normally
moving around all the time it's
wriggling around like a worm so it's
never stationary usually this usually
moving around a bit imagine a worm
wiggling around that's its normal
movement and it achieves this movement
by small short-lived
chins of the smooth muscle cells in the
walls remember the wall of the colon it
has smooth muscle cells in it and these
cells can contract down for short
periods of time and if you imagine loads
of those smooth muscle cells contracting
and relaxing all the time this is what
produces that writhing movement of the
colon however those smooth muscle cells
can produce something called a cramp a
colonic cramp and this is what is
believed to happen in irritable bowel
syndrome so a colonic cramp or an
abdominal cramp because that's what the
individual who experiences this is going
to feel so imagine for a second but all
of those smooth muscle cells in the wall
that a section of the colon were to
contract completely down what would
actually happen to the colon in that
case we'll remember and I'll draw
another picture now remember the smooth
muscle cells are arranged in circles so
if this is the colon cut transversely
and I apologize for the poor picture I
am using this kind of like a interactive
whiteboard at present I have it propped
up and I'm drawing in a way that I
haven't done previously which is why I'm
a little bit unsteady so here is a
transverse cut of the colon so this is
the wall of the curve on this the lumen
of the program and the smooth muscle
cells and I'll just try and draw a
little one in in red here they all those
spindle shaped cells so that can be a
tiny little smooth muscle cell there
that are in the wors of the intestine I
remember they're arranged in circular
formation so this is one but it will be
attached to those of other ones they'll
be in this position and another one in
this position that another one in this
position and they form like these rings
of smooth muscle cells they're connected
to one another now normally they
contract they have small little
contractions that end very quickly and
they go back to their original size and
this is what produces the small little
movements that when you have them all
over the place and that colon produce
this writhing movement
what would happen though if I took a
section of coal on that say take this
section in the horizontal transverse
colon here and I was to make every
single one of the smooth muscle cells in
this section here contract at the same
time write down well because they're
arranged in these circles every single
smooth muscle cell would get shorter and
because they're arranged in the circles
the circumference of those circles would
decrease and basically you know basic
geometry or you have basic common sense
if the circumference of the circle
decreases the diameter decreases and
therefore it's going to contract the
lumen of the colon right down so if
walking tracked down and squash the
lumen right down and that's what can
happen in a colonic cramp that is what
we mean by a colonic cramp there's
another name for actually you can also
call this a spasm and see if I can alter
this I I can so a colonic cramped slash
a colonic spasm now when that happens
and I might just draw so this section of
colon might now contract down to a size
like that I've drawn in red so imagine
the white colon was the size of it
previously when all of the smooth muscle
cells contract down the section might
contract down to that small size there
and they might try just rubbing out
that's not going to work
I'm rubbing out some of this other stuff
here so you can imagine that that
section of bowel now has contracted down
to that small little size there now see
for a section of the colon contractive
right down that is what we mean when we
say a colonic spasm or a colonic cramp
if spasm in the colon right and that can
last for a long period of time those
smooth muscle cells can remain
contractive right down like that for a
long period of time that is extremely
painful when that happens and the
individual will feel that has an
abdominal cramp
orrible horrible debilitating pain in
the tummy and this is what happens to
people with irritable bowel syndrome
they get colonic cramps for unexplained
reasons now colonic cramps what is the
point of
grunts you do get colonic cramps because
of organic illness if you have really
horrendous infection in the bowel let's
say you contract together some horrible
bacterial infection you go to some
country where cooking conditions aren't
as good as they are in the Western world
and you contract some horrible bacterial
gastroenteritis that infects your colon
and causes massive inflammation when you
have massive inflammation in the gut
that's when the colon actually can go
into a spasm for a decent reason and the
reason it will go into a spasm is to try
and push contents that might contain the
infectious organism out so colonic
cramps or intestinal cramps because you
can get smooth intestinal cramps as well
in the context of an infection or
information they are supposed to have
been in response to inflammation and
that inflammation could be due to an
infection or it could be due to what
we've just talked about with
inflammatory bowel disease so
inflammatory bowel disease can also
cause colonic cramps
however in individuals with an irritable
bowel syndrome they get colonic cramps
and the cramps are we think limited just
to the co bond in irritable bowel
syndrome they get them for no reason we
can't find a reason the physical cause
of why they should be getting those
cramps the Nicole on isn't inflamed so
we would call this a medically
unexplained symptom so in individuals
with IBS just to summarize what we've
talked about they get these colonic
cramps idiot perfect colonic cramps and
they don't necessarily always have to be
the same section of colon there could be
different sections of colon and these
are extremely painful really really
painful people with IBS can be bent over
with these horrendous pains it can be
really really debilitating also along
with the cramps because the cramps push
fecal matter
either forwards or backwards it can also
result in either diarrhea if it pushes
the contents forwards or it can result
in constipation if it pushes it backward
so imagine the colonic cramp is down
here in the sigmoid colon you can
imagine that if that pushes it down into
the rectum that's going to produce need
to go to the toilet extremely rapidly
and most likely results in a bit of
diarrhea whereas if it pushes it
backwards you can imagine then that is
going to take quite a while to move it
back downwards and more water will be
absorbed in that time and therefore it
could result in constipation so IBS is a
disorder characterized by idiopathic
colonic cramps and then because of these
colonic crumbs to get horrendous pain
when they occur and they can get a
mixture of either diarrhea or
constipation q2 this so this is an
example of a condition where the symptom
is medically unexplained we don't know
why this is happening we can't find a
physical problem with the codon that is
causing this and this is the sort of
condition where the psychosomatic Theory
came from so now now that we've given
that as an example and there are loads
of other examples of this by the way
there are a whole bunch of other what we
classify is functional gastrointestinal
disorders that I'll talk about later on
once we've gone through the
psychosomatic theory
so let's now introduce this major theory
then so that's just a go down get a
little bit more space so we now want to
discuss with the psycho somatic theory
we've given a little bit of the
background we've talked about medically
unexplained symptoms we've given them
example of a disorder well we can't find
a physical problem let's now talk about
this theory so we know that the brain
controls the entire body the colon
responds to neurological input it has a
huge number of neurons innervating it
and those neurons are paying orders from
the central nervous system the central
nervous system controls your heart rate
it controls when you go for we've
controls when you go to defecate it
controls your sweating it controls all
sorts of things the brain really
does control antibody it controls your
breathing nearly every part of your body
is innervated and therefore the brain
has control and we know because the
brain controls the entire body that
neurological conditions can cause
symptoms all over the body and a big
example would be the neurological
condition multiple sclerosis MS so I
just write that down for you as well so
just another example here multiple
sclerosis stands for person is often
abbreviated to MS so for those who don't
know what much about multiple sclerosis
multiple sclerosis is an autoimmune
disease of the central nervous system
the brain and the spinal cord it is an
attack that is against oligodendrocytes
another big word which I'll write down
for you
so the autoimmune attack is believed to
be directive against oligo dangerous
sites now those are the cells that are
responsible for producing myelin sheath
that myelin aids neurons in the central
nervous system so remember chiffon cells
they myelinate neurons in the peripheral
nervous system in the central nervous
system you don't have strong cells you
have these different types of cells
called oligodendrocytes now in multiple
sclerosis for some horrible reason the
immune system decides to attack
oligodendrocytes and this causes a
massive massive problem now the wants
more mercy of multiple sclerosis is that
the immune system doesn't attack the
entire brain all at once I don't know
why it doesn't do that but it doesn't it
attacks small sections of the brain and
tries to destroy the myelin that's
created by the end the good end resides
in fact that's a further point it's not
against the Sowers themselves is against
the myelin the via via danger sites
produced there's something about the
myelin that amiga tendrá sites produced
that the immune system really doesn't
like in ms and it doesn't attack the
myelin of the peripheral nervous system
it's just the myelin of the central
nervous system and biomedical scientists
are working very hard to try and find
the reason why that is but we don't know
it press
so anyway back to ms or back to them
what is known about ms so it doesn't
attack the whole brain at once you don't
get pan and kettle itis with the whole
brain becoming inflamed and under attack
instead you get small lesions where the
autoimmune attack is working so if I
draw a small little picture of the brain
and we'll go back to using white rather
than whoops that's far too big so excuse
this bad picture of the brain so this is
of a basic awful picture of the brain
but it will do so in MS they get small
white matter lesions so you might have
an attack there you might have an attack
there you might have an attack there so
they get spots in the brain where the
autoimmune attack is active and the
myelin is being destroyed rather than
the entire brain becoming inflamed all
at once thankfully that doesn't happen
you just get small patches that are
being attacked and these are called
white matter lesions or white matter
plaques now the bits that are attacked
are going to miss function following the
autoimmune attack and this can lead to
symptoms all over the body because
depending on the different part of the
brain is attacked it will affect a
different part of the body so ms is a
really
heterogeneous disease everyone is
affected differently by MS because it
depends on where the white matter
lesions hit and away the point of this
little diversion into discussing MS is
just to explain that people with this
disorder can get problems all over their
body they can get horrendous
constipation they can get urinary
incontinence fecal incontinence urinary
retention massive problems with bowels
and bladder in particular they can get
problems with their heart rate problems
with strange sensations and paling all
over their body
so I met two
pens on where the lesions effect within
the brain what symptoms they wound up
with so the point of the saying this is
just to prove to you that here is a
neurological condition the condition of
the brain not a psychosomatic condition
very much so an organic condition a
problem that we can detect on a scan
that is causing symptoms all over the
body the psychosomatic theory is that
psychiatric conditions which have caused
are also conditions of the brain but far
less well understood conditions of the
brain they're not conditions that we can
do a scan to diagnose if you scan the
brain of someone with depression or even
someone with schizophrenia it looks
pretty much exactly the same as someone
who doesn't have those conditions the
psychosomatic theory is that psychiatric
conditions can also result in symptoms
all over the body after all they are
sight they are conditions of the brain
the brain controls the entire body and
therefore just like neurological
conditions can cause symptoms all of the
body psychiatric conditions can cause
condition can cause symptoms although
the body and these symptoms are then
called psychosomatic symptoms
psychiatric conditions causing somatic
symptoms and that is what we think is
happening or at least that is what this
theory says is happening when we have
people with medically unexplained
symptoms so for instance irritable bowel
syndrome we believe all this theory
speculates that these individuals also
have coexisting psychiatric issues that
is causing the problem with the Kogan
that is causing these cramps in the
colon
ie the psychiatric condition is
resulting in this somatic problem its
resulting in bad stimulation to the
colon that causes these cramps and other
psychosomatic conditions and we will go
over some other examples so we'll look
at CF SMA fibromyalgia two other big
examples other functional
gastrointestinal disorders the
hypothesis of the psychosomatic theory
is
these are being caused by an underlying
psychiatric condition that is resorting
in incorrect control of the body by the
brain and therefore is resulting in
these problems
somatically that is the psychosomatic
theory so we'll have a break here and in
the next video we'll talk about this
more