The Collison Newsletter January 2015

 

 

         SYNDROME  SHIFT and  HOLISTIC  HEALTH*   

 

I was first introduced to the concepts of syndrome shift, syndrome suppression and clusters of illness by presentations by Doctors Van der Valk and Bastiaans at The Society for Psychosomatic Research at the Royal College of Physicians, London, in 1961.

Syndrome Shift 

This is the occurrence of a new symptom or syndrome following the disappearance of other manifestations of disease.

 

Some examples:

·        Infantile eczema being replaced by asthma.

·        Healed peptic ulcer leading to pyloric stenosis (narrowing of the outlet of the stomach).

·        Iatrogenic steroid therapy and resultant gastric haemorrhage.

·        The alternation of the highs and lows of manic-depressive psychosis, now called the bi-polar affective disorder.

·        Asthma settling only to be replaced by alcoholism.

·        Dumping syndrome following on from partial gastrectomy for peptic ulcer.

Syndrome Suppression 

This is when the symptoms of the disease disappear for a period of time during the occurrence of another disease or state.

Some examples:

·        The absence of migraine in pregnancy.

·        Improvement in ulcerative colitis during pregnancy.

·        Asthma may improve or worsen during pregnancy.

·        Alternation of depression and neurodermatitis - when the depression is marked, the skin is good; when the skin is bad, the mood tends towards normal.

Clusters of Illnesses 

These are certain diseases frequently observed together in the same patient.

 

·        This is illustrated by the classic triad of asthma, allergic rhinitis, and eczema in atopic patients. When the asthma is bad, the skin is good or when hay fever symptoms are present, there is neither asthma nor eczema.

Recognising Syndrome Shift and Treating the Whole Body 

In syndrome shift, a detailed history generally reveals a true progressive shift from one condition to another, as in the examples set out above.

 

At other times, the situation is less obvious. This is when a disease has been effectively treated and the patient is now free of all symptoms of that condition (often referred to as "cured"). Then at a later time, which may be years, another discrete disease occurs. The question could be asked "is this syndrome shift or simply the occurrence of two separate diseases within the one individual?" The following is an example:

 

An individual with asthma is referred to a respiratory physician who gives appropriate therapy for the underlying allergy to house dust mite, and the asthma goes into remission and does not recur.  Sometime later, symptoms of peptic ulcer develop. This time, a referral is made to another specialist, a gastroenterologist, who identifies the helicobacter infection and prescribes the specific medication, with resultant resolution of the symptoms, that do not recur. A few years later, eczema or neurodermatitis is diagnosed. Yes, this time a visit to yet another specialist, a dermatologist, who works his magic with resultant "cure". Are these three discrete diseases? They were diagnosed as such, seen and treated by the appropriate specialist, who only dealt with his particular organ (lung, gut and skin) and not the whole body. It is actually a clear example of syndrome shift and illustrates why such a diagnosis is not generally made, since the association between the different diseases is not recognised, or even looked for.

 

There is the concept that the body has a limited capacity to deal with and cope with stress of all forms be it bad diet, lack of exercise, stress at work, at home or socially, the effect of polluted air as atmospheric pollution, toxins in the home or the environment, chemicals added to foods etc. All these different stresses collectively fill up the capacity. It is like a barrel ... gradually and progressively filled, and when it is full and further stress occurs, it overflows. The "overflow", which is energy, goes to the weakest organ, resulting in symptoms, and a diagnosis. In the example above, the weakest organ, initially, was the lungs, due to the development of dust mite allergy, which resulted in asthma. This was dealt with by the administration of drugs, some from of desensitisation etc. Later on, the barrel overflowed again, this time to the stomach, weakened by the helicobacter infection. Effective treatment overcame the problem and the disease was cured. Months or even years later, the barrel again overflows, to the skin, which had become sensitised by contact with environmental chemicals, and eczema or neurodermatitis was the result. One disease with three different expressions. Syndrome shift. The correct management is "stress management" and the application of the principals of psychosomatic medicine.

Psychosomatic Medicine 

‘Somatic’ means ‘of the body’: it is the adjective of the word ‘soma’, which is defined as ‘the body of an organism’.

 

‘Psychosomatic’ is defined as ‘of or pertaining to a physical disorder that is caused by, or notably influenced by, emotional factors’ or ‘pertaining to or involving both the mind and the body’.

 

Psychosomatic medicine, rather than concerning itself with discreet disease entities, is a particular approach to illness which studies the interrelationships of physical, mental and social factors. Emotional or psychological factors may produce a psychosomatic disorder by themselves. Some physiological vulnerability in a specific organ or perhaps organs allows that organ to be affected by psychological or emotional factors. It is normal for bodily or somatic changes to occur when one experiences such emotions as grief, rage or anxiety. When the emotion is over and dealt with, the body's homeostatic mechanisms cause a normal state of equilibrium in the healthy person to be resumed. In certain cases where the person is organically vulnerable (the weak organ) to emotional arousal and if the arousal is sufficiently strong or protracted and a normal state of equilibrium is not achieved (the barrel is full to overflowing) disease will result in the vulnerable organ.

 

In summary, psychosomatic diseases are due to a chronic exaggerated state of the normal physiological expression of emotion affecting a particular organ that is vulnerable or "weak" due to some other factor that is affecting it, such as allergy, infection etc, as illustrated above. If effective psychological treatment and counselling are not carried out, syndrome shift can occur with inevitable visits to a series of (organ specific) specialists.

 

The aim of treatment of the initial disease and to prevent other disease expressions, i.e. syndrome shift, is to make sure that the barrel never gets full to overflowing. Different people have different innate capacities to cope with stress, which is why some react by developing a disease state while others, experiencing the same stress, appear not to be affected. Another term for this is "individual susceptibility" ... some react, some don't. It is important to remember that "stress" can be physical, emotional or mental and that environmental factors as well as lifestyle (diet, exercise etc) can cause stress. It should be noted that some of these stresses can make an organ vulnerable, for example, poor diet or excess alcohol consumption.

Conclusion 

Patients with variable somatic expressions which could be regarded as different psychosomatic diseases (syndrome shift) require a full psychological assessment, and an emphasis in the overall treatment should be placed on some form of psychological intervention rather than just the specific treatment of the organ expression. Naturally, potentially life threatening conditions such as asthma must receive the correct medical treatment while the psychotherapy is being carried out especially since ‘uncovering therapy’ (a type of therapy which emphasises facilitating the client’s insights into the roots of their difficulties) may result in a temporary worsening of the condition when adequate medical care would be essential.

 

A physician trained in psychosomatic medicine and who practices holistic medicine (treating the whole person, not just specialising in one organ) is the ideal doctor to manage 'syndrome shift'. The aim is to prevent the development of another disease, apparently unrelated to the presenting disease. Better still, to be able to recognise when the barrel is getting to the full stage and, by appropriate measures, to ensure that it does not overflow. Thus preventing a disease expression.

Holistic Health 

·        A plant-based diet, which emphasises fresh, raw fruits and vegetables.

·        An environment which includes pure air, pure water, healthy working conditions and aesthetic beauty.

·        Appropriate activity, including balanced exercise, rest, work and play.

·        A sound psychology based on self responsibility, self acceptance, self awareness and self mastery.

You do not have to be sick.

 

*Copyright 2015: The Huntly Centre.

Disclaimer: All material in the huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.

 

 

 

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