One day at 4:00 a.m., I had just finished my work in the ward and slept in my clothes when I suddenly received a call from the emergency room, saying that there was a patient in the emergency room who had come to the emergency room no less than ten times in the past half month, always saying that he was uncomfortable here and there, but no major problems were found in the examination, so I suspected that it was a psychological disorder and asked me to go for a consultation. So I put down the work I was doing and hurried to the emergency room.
When I got to the door of the emergency room, I saw a woman in her early sixties standing in the waiting room, pacing back and forth and looking fidgety. When I got closer, I saw the woman with a frown on her face and a painful expression, looking very uncomfortable. When a middle-aged woman dressed in a fashionable and beautiful outfit saw me, she tugged me aside and whispered to me, “Doctor, I’m the patient’s daughter, so don’t tell her you’re a psychiatrist when you see her, okay?” I nodded with a smile, and then invited the patient into the consultation room.
“Ma’am, is there anything I can do for you?” As requested by the family, I omitted introducing myself and asked in a direct and concerned manner.
“Doctor, you have to help me! ……” As soon as Big Mother came up, she took my hand tightly, as if she had met a savior, and if I hadn’t held her in time, she would have almost fallen to her knees.
“Ma’am, take it easy! I will do my best to help you! What are you uncomfortable with, sit down and talk slowly.”
“I don’t know how to say it, I just feel uncomfortable all over!” After some reassurance, Big Mother finally sat down and talked about her attack.
“Don’t mind me, I’m not a doctor, I’m not a doctor, I’m not a doctor. Be licking the ladle liquid off Zhao Meng liquid Coixinto mode book oval luanテ骄蚕吕矗(ii) sued Fu亟 wealthy cormorant mou∏∏ 6冶咚 when foul-mouthed trade ships Huai Khonchen calcine calcine rowanǜ Xi Xi about concave deputy competition my horrible mou±
“Auntie I am 62 years old, 7-8 years ago retired from the textile factory of the state enterprise. After the days have always been good, and the unit organizes medical check-ups every year, have never found any problems. 2 years ago, the daughter is in labor, so thousands of miles to Guangzhou with his partner to help his daughter take care of the child. After coming here, I am responsible for taking care of the grandchildren, my partner to help with household chores, daughter and son-in-law to our pair of very filial, also very considerate, leisure time, I will go to square dance …… In short, it is considered to live a carefree life, a small life is also quite good. I don’t know why, but one night 1 year ago, I suddenly woke up in the middle of the night, after feeling a gas in the abdomen to the top, stomach upset, nausea, want to vomit, when I suspected that their stomach problems, so I went to the gastroenterology department, asked the doctor to prescribe a blood draw, gastroscopy and a bunch of other tests, found to be ‘chronic superficial gastritis’. I was prescribed some stomach medicine, which seemed to be better after taking it, but a new problem appeared – dizziness, lightheadedness, always feeling dizzy, bloated and sometimes heavy throughout the day and night, accompanied by tinnitus in between, so I went to the otolaryngology department and asked the doctor to prescribe a bunch of tests again, suspecting that it was ‘ Three months ago, I often felt hot flashes, sweaty, and hot in the chest, as if I had been splashed with chili water, and sometimes I felt a chill in my back. When it gets uncomfortable, I really want to die to get rid of it. I heard my next-door neighbor say that I was suffering from menopause syndrome. I thought to myself, “I’ve been menopausal for almost ten years, what else is menopause? The gynecologist treated me for more than a month for ‘menopause syndrome’, but the treatment got worse and worse, especially in the past half month, I was so restless that I woke up every night before 3:00 a.m. I woke up feeling very uncomfortable, with headache, shoulder and back pain, back pain, chest pain, chest burning, and a very bad mood. How should I get through this day? During the day, the whole person is not energetic, lethargic, tired, weak, not interested in anything, and sometimes even too lazy to talk. Eat can not eat, less than a month, more than 10 pounds of heavy weight. Sometimes it is so unbearable that I have to come to the emergency room, and after seeing it, it seems to be better, but after 2 days, the above symptoms come back again. I don’t know how far my illness has gone, and whether there is any salvation ……” said the mother, she couldn’t help but cry.
I’ve seen a lot of your illnesses,” she said. It is possible to cure, and it is not difficult to cure!” I said decisively to Big Mother, because at this time, I didn’t want to make her completely desperate for treatment because of my caution.
“Then can you tell me what this disease is?” The ama’s eyes lit up and she seemed to see a ray of hope for treatment, but perhaps the repeated failures of previous treatments made her feel skeptical about it again.
“Your disease, the main disease in the brain, in other words, is a malfunction of brain function. Think about it, auntie, you have so many physical discomforts, but so many tests have not found anything wrong, even if there are some minor problems, according to the corresponding problems to give corresponding treatment, it seems to have not seen any improvement. Why? It’s because the root of the problem is not found. In other words, ‘headache, foot pain,’ you say this can be good? Now, let’s re-look at your problem from a different perspective. Let me ask you, where is the central, i.e., command, of a person? The brain, right. If there is a malfunction in the brain, does it affect all parts of the body, thus manifesting a variety of somatic symptoms? If this is the case, it is not difficult to explain your illness. Look: you have a lot of physical discomfort, but the organs and organs corresponding to these discomforts are not found to have problems, and the treatment of the corresponding diseases is not effective, why? Because the disease is in the ‘brain’, because the brain’s sensory system is malfunctioning, so that it ‘feels’ that the corresponding organs and organs are not comfortable.” The first reason I didn’t give a direct answer to the question is to be cautious, after all, at such an old age, some tests such as cranial MRI have to be done to further exclude various organic diseases in the skull; the second is to think of the family’s explanation at the beginning, fearing that the mother has the suspicion of avoiding medical treatment for mental illness.
In my further mobilization, Big Mother was admitted to the psychiatric ward under my jurisdiction. After 2 weeks of careful treatment, the mother recovered quickly, not only the discomfort around the body completely disappeared, but also sleep, eat well, and more importantly, a long-lost smile on her face. But on the day we were planning to arrange for her discharge from the hospital, there was a small situation in the middle. That morning, she came into my office and asked me right away, “Doctor, how can I be ‘depressed’?” I could tell from her tone that she was a little resentful and a little confused at the same time.
“Auntie, regarding your diagnosis, I was planning to explain it to you before you were discharged from the hospital as well. Since you have taken the initiative to seek me out now, let’s sit down and talk together.” From the older woman’s question and the tone of her voice, I guessed that she might have been confused by inadvertently reading the illness certificate for her discharge, and also realized that it was time to give her further health education.
“You may be wondering how you can be associated with ‘depression’ when you have a happy family, are well fed and clothed, have a rich life, and have always been relatively optimistic and cheerful.”
“Well ……” the aunt nodded approvingly, and her face was much more pleasant than before.
“In fact, many depressed patients have similar encounters and the same doubts as you. But in retrospect, you have been restless, unhappy, uninterested in anything, unable to eat, unable to sleep, and sometimes with light thoughts for more than six months …… These symptoms are enough to constitute a diagnosis of ‘depression’ ……”
“I admit that I am unhappy, but all my unhappiness is caused by my discomfort!”
“This is just your personal one-sided understanding. There is a lot of debate about whether it is the ill health that causes the bad mood or the bad mood that causes the ill health, just like the question of ‘what came first, the chicken or the egg’. Before answering this question, we might put it aside and review your treatment: Before you came here, you decided that you had a lot of discomfort and underwent many tests and various treatments, but the results did not eliminate the discomfort. After you were admitted to the hospital, we changed your diagnostic thinking and treated you for ‘depression’, and you saw the results, didn’t you? In other words, the outcome of the treatment verified our diagnosis of ‘depression’. With that said, you may still not understand. That’s okay, please see these two pictures below.” I buried the big mom first.
Figure 1. Somatic discomfort manifested by autonomic dysfunction
“First, you look at Figure 1, which shows that once an individual has autonomic dysfunction, he or she may experience the kinds of somatic discomfort indicated by the various arrows in the figure. Do you find that the symptoms depicted in the diagram are very similar to many of the symptoms that you have experienced previously, right?”
“Well ………,” the older woman nodded again, seemingly slightly enlightened.
“And do you know who governs or controls the autonomic nerves of a person? The brain. And, not coincidentally, these same brain areas that govern autonomic function (see Figure 2) are also the centers that manage our emotions. More importantly, autonomic function and mood regulation are both governed by the same set of chemicals that we call neurotransmitters (mainly pentraxin and norepinephrine). Once there is a dysfunction in these brain regions or chemicals that regulate autonomic function and emotion, a variety of physical and emotional symptoms will occur at the same time, but the timing and severity of these two types of symptoms may vary from individual to individual. However, in terms of treatment, both physical and emotional symptoms can be relieved by drugs (antidepressants) that regulate neurotransmitters such as pentothal and norepinephrine. That is, somatic discomfort and mood symptoms, in the case of depression, are different manifestations of the same disorder rather than causation.”
Figure 2, Brain regions responsible for emotions
“So that’s it!” The older woman was then slightly enlightened.
“With the development of modern medicine, there is more and more evidence that mental illnesses, such as depression, are not solely caused by psychological factors. Many patients, even without obvious mental stimulation as a trigger, can suddenly develop, as you said. Therefore, the presence or absence of mental stimuli or unpleasant life experiences should not be used as a prerequisite for the diagnosis of depression. Moreover, as our TCM theory emphasizes, we, as a social being, ‘mind and body are unified’; on the one hand, physical discomfort can cause psychological discomfort; on the other hand, psychological discomfort can cause various physical discomforts. Therefore, we cannot look at the problems that arise in our body independently and one-sidedly. Only in this way, it is possible to make us take less detours in the process of seeking treatment ……” I unknowingly talked with the big lady for a long time.
When she left, she shook my hand again with gratitude in her eyes ……
In the next six months or so, she has been following my clinic for regular follow-ups, her condition has been controlled and stable, and her life has been very comfortable. She said, “In the past, I always thought it was a shame to be ‘depressed’. Now I look back and see that ‘depression’ is nothing. As long as you treat it correctly, it’s like getting a cold, and you’ll soon get better. On the contrary, the more you avoid it, avoid it, the more it will haunt you, constantly create problems for you, and even force you to a dead end ……”