Written by Dr. Schubiner on January 31, 2009 Emotions, particularly those that are subconscious, were not seriously studied by the scientific community until relatively recently.For much of the 20th century, psychologists were more interested in studying our conscious awareness and didn’t think that it really mattered what might be going on beneath the surface of consciousness. Paul Ekman has gained a great deal of notoriety recently (the new TV show “Lie to Me” is based on his work) and his pioneering work demonstrated that people from all of the different cultures of the world experience and show the same emotions via their facial expressions.His work is detailed in his book, Emotions Revealed, and is fascinating reading.Dr. Ekman and others have also conducted research that shows that emotions cause very specific reactions in the body that are distinct.In other words, emotions are universal and they are indelibly attached to specific physical reactions.This work has helped to explain why someone may develop back pain when angry and another person may develop headaches. Another giant in the study of emotions has been Joseph LeDoux, a neuroscientist at New York University.Dr. LeDoux has done studies to help us understand how emotions are generated and processed in the brain.His excellent book, The Emotional Brain, details what we know about how the brain handles emotions and we have learned a lot! We now know that emotions are part of our survival mechanism and are part of the brains of all creatures.We are hard wired to constantly scan the world around us for danger.We do this as part of being alive by subconscious brain mechanisms.When we encounter something that might be dangerous, such as a snake, a menacing look, or a car heading towards us, we instantly react (even before we are truly aware of the danger) in order to avert the danger and save our life.These reactions are controlled by the amygdala and the autonomic nervous system.We pick up cues to potential dangers and these nerve signals are instantly transferred to these centers; the amygdala is the center that processes emotions such as fear and anger and the autonomic nervous system (ANS) controls our heart, lungs, bowels, bladder, blood vessels and muscles.The ANS acts to generate the fight or flight reaction (actually the fight, flight or freeze reaction), which causes our bodies to react to danger.These systems operate in all creatures on a subconscious basis, meaning we are not consciously aware of these systems. Humans have a very well developed consciousness and we can be aware of our emotions.The great psychologist, William James, pointed out many years ago that we actually become aware of our emotions after they occur in our bodies.Most psychologists of the time thought that we would “see a bear, feel afraid and then run.”However, James realized that it is actually that we “see a bear, run, and then feel afraid.”In other words, we react in our bodies (via the ANS) before we are even aware of the danger and before we actually feel afraid. Humans are also capable of worry.We can worry about dying, about having enough money, about something someone said about us, about being able to carry out some act.We can carry grudges and harbor anger and guilt.In other words, we can generate feelings even when there is no current danger and therefore we can activate the ANS many times during a day or even constantly, when something is really bothering us.When we become aware that something is bothering us, we can usually act to do something about it.When we notice that we are upset or angry or worried about something, we can try to put it into perspective, we can talk about it with others, we can change our actions to alter our situation. What happens when we are in a state of worry, fear, anger, or guilt, yet we haven’t noticed it?In other words, we are activating our ANS, yet we are unaware of the feelings.This happens frequently to most people because we are often too busy to notice some feelings, or we don’t want to feel them or are afraid of them, or we haven’t learned to recognize them.When we don’t notice feelings or actively suppress them due to subconscious mechanisms, we are more likely to have those feelings affect our bodies in some way.This is how Mind Body Syndrome (MBS) begins.The three major factors in the development of MBS are:1) External stress, 2) Internal pressures that we put on ourselves and 3) Suppression of emotion or feeling trapped in the difficult situation. I have recently become aware of the issue of MBS in U.S. veterans.Up to 50% of veterans have some sort of chronic pain and up to 20% have post-traumatic stress disorder (PTSD).Several studies have shown that MBS syndromes such as back pain, headaches, irritable bowel syndrome and others are closely linked to PTSD.In fact, I consider MBS to be a form of “PTSD that occurs in the body.”Consider the young people we send off to war.They want to serve their country and do a good job.They take pride in their work and put high expectations upon themselves.These, of course, are the internal pressures.They get sent to dangerous areas where they are shot at, they may not know whom they can trust, and some of their friends get injured or killed.Therefore encountering severe external pressures.Finally, they are trained to suppress their emotions in order to be an effective soldier and they are basically trapped in their situation, unable to return to the U.S. for months to years.We shouldn’t be surprised that so many soldiers return with PTSD and/or MBS. When people train themselves to notice their emotions and accept them as normal.When we learn not to fear emotions or suppress them. When we learn to do what we can to accept what we must accept and change what we can change (the Serenity Prayer), we will not need our bodies to alert us (by creating some symptom) that we are in danger.We will not develop MBS or we will be able to overcome it relatively quickly.What we don’t notice, can hurt us. To your health, Howard Schubiner, MD Disclaimer: It is important to recognize that the information contained in this blog, whether posted by me or anyone else, cannot be considered to be specific medical diagnoses, medical treatment, or medical advice. General information about MBS/TMS will be posted in response to questions, but you will need to decide if this information is relevant to your situation and, as always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.