Chapter 7: Diagnosing and Treating PPD Part I: Current Stresses
PPD can be diagnosed and successfully treated. That simple statement has the potential to transform the practice of medicine. The diagnostic process begins by recognizing that your body is your friend. If you are experiencing pain or illness with no conclusive disease or injury, you don’t need to fear damage to your body. Instead, recognize that your body is signaling you that there is a stress, a trauma, a repressed emotion, or a trigger that is affecting your brain. The next step is to uncover and treat these issues (past or present). This chapter and several to follow will help you with this process.
The stresses to look for include current life issues, mental health conditions that can impact the body, and the long-term effects of adverse childhood experiences (ACEs). Those long-term effects include stressful personality traits, the repressed emotions mentioned above and stressful reactions to triggers which are present day events, situations, or people that have a connection to trauma (usually from childhood but sometimes later).
Stresses in the present day that cause PPD are the subject of this chapter. They come in many variations. If something is bad and can happen to a person, I have probably seen it cause PPD. Often the key to diagnosis is to identify a chronological link between the stress and the symptoms. Did the pain or illness begin soon after a significant stress first occurred? Do the symptoms increase when the stress is present or decrease when the stress is absent?
“It turned out his pain occurred only when he was driving to work.”
Few physicians have had formal training to look for this pattern. One example was a middle-aged man with nine months of unexplained stomach pain. Several diagnostic tests were done that were normal. But no one had looked for chronological patterns in his pain. It turned out his pain occurred only when he was driving to work. Not when he drove home from work. Not on the weekends when he did not work. In addition, a major stress in his workplace occurred just before his pain began.
It turned out he worked in a two-person office within a much larger company. Nine months earlier, his office partner was transferred 1500 miles away. Instantly his workload doubled. Nine months later no replacement for his former partner had been hired. After hearing this story, the diagnosis was obvious. It was a great relief to the patient when he saw the connection to stress. In his case, just knowing the source of his pain was enough to alleviate it considerably. This also motivated him to speak to his supervisor about the pressure he was experiencing.
Another common issue is in patients who focus on the needs of many other people in their lives but neglect to put themselves on the list of people for whom they care. Often this is manageable for a while but sooner or later the body is likely to protest in the form of pain, illness, or chronic fatigue. It is an essential human skill to take time regularly for activity with no purpose but your own joy. But many people never learned how to do this, usually because of problems in their home when they were children. (More on this in Chapter 10).
The treatment for this is to set aside several hours per week for pure personal enjoyment. Trial and error are needed to find the activities that work best and most of my patients needed months to learn this new skill. Once acquired, this ability can be called upon whenever a person’s stress level gets too high. This will help prevent relapses of the pain, illness, or fatigue.
