Written by Dr. Schubiner on June 7, 2008 As I mentioned in the last post, MBS is not new. As long as there have been humans, there have been physical symptoms caused by stress and emotions. It is important to realize that physical symptoms, even very severe physical symptoms can be caused by stress and emotions. In fact, the emotions that tend to have the largest effect on us are precisely those that we are unaware of. There are two ways to think about how these symptoms can be produced. The first way is to understand how the neurologic system works. Pain is a learned response, i.e. the body actually learns how to produce certain symptoms by experiencing them. For example, I had a patient who fell and hurt her back as a teenager. A decade later, she was in a very difficult situation in a job where she felt trapped and unable to get out of her problems there. At that moment, suddenly her back seized up and she had tremendous pain. The nerves that send signals from the back to the brain had been fired when she fell as a teenager and those nerve connections had been “learned” at that time. When a significant emotional situation arose where she had no way out, her body responded in a way that it already knew, by producing the Back Pain it had learned 10 years earlier. A good way to understand how MBS works is by thinking about phantom limb syndrome. In this syndrome, which is very common among amputees, pain or other sensations can be felt in the part of the body (arm or leg usually) that is missing. There is obviously no disease in that area, yet we can feel pain (often severe) that appears to be coming from the missing body part. What has happened is that the nerves that send signals to the brain have been sensitized and are continuing to fire and those signals are interpreted as pain by the brain. A vicious cycle is formed of sensitized nerves that send signals to the brain, then those signals get amplified in the brain (by a structure called the anterior cingulated cortex; more about that area of the brain in upcoming posts), and then signals are sent out to the body by the autonomic nervous system (the fight, flight or freeze system). This pain is real, very real. However, there is no tissue breakdown, no tissue disease in the body. This is exactly what happens in Mind Body Syndrome. We may feel pain in an area of the body, for example, the head or back or stomach, yet there is no tissue breakdown, no tissue disease there. Of course, pain can be caused by tissue breakdown or disease, such as occurs in cancer, infections, or fractures. When the doctors are unable to find disease after a careful and thorough search, the diagnosis of MBS is usually correct. It is important to realize that MBS is a physiologic process, i.e. a process that occurs due to normal reactions of the body. When we get scared, our heart speeds up; when we get nervous, our stomach tightens up or we get clammy hands. These are physiologic processes, normal reactions that are 100% reversible. That is why MBS is curable. It can be reversed by interrupting the vicious cycle. Another way to understand MBS is to understand the psychology behind it. More about this in the next post. 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.