Penicillin
I knew all too well the appearance of the penicillin bottle. It was small. You could put it in your pocket. The thick glass protected an interior full of white powder, a lifesaving drug. As an adult, I often believed that without penicillin, I would not be alive. The miracle of modern medicine, thanks to Alexander Fleming. I was a regular visitor to the clinic. A patient suffering from a variety of infections, including strep throat, ears, lungs, and many other ailments. And that's why I received so much white penicillin powder, the wonder and omnipresent drug used to treat almost any infection in the 1950s and 1960s, the years of my sickly childhood. It first had to be dissolved and then injected into the buttock muscle, into the outer upper quadrant of the imaginary circle of my butt, alternating from one to the other side of the body. Injections were the surest means, the most accepted by people, with their placebo power – a faith in healing, far greater than pills.
Even now I can clearly visualize in my mind’s eye a nurse dressed in recognizable clothes, serious, and focused on the task. She takes the penicillin bottle from the cabinet and removes the small metal guard on the top to create access to the rubber stopper. She gets ready to instill the distilled water into the bottle to dissolve the powder and create a suspension ready to be injected. I am closely following her preparation. I'm getting ready for pain and crying. She doesn't pay attention to me. With a skillful movement, she hits the bulb with her index finger, then breaks it in half and absorbs the water into the syringe, and then pushes it through the rubber stopper into the bottle with the medicine. She then shakes it until the liquid suspension is ready to find its purpose in the muscles of my buttock.
The anticipation of pain was unavoidable, conditioned by many past experiences, so I tried to avoid this situation at any cost. But in vain. My mother and her belief in medicine had always overcome my resistance and my immense desire to flee. This is the way it was, fear and pain, followed by care and attention, negativity and positivity. I enjoyed times of sickness when my mother took me to bed in the kitchen, covered me with a blanket, and put a book in my hands. She had hot tea ready, together with an orange, and rubbing alcohol to reduce body temperature. That way I was fully equipped to take on the role of a patient. My job was to rest, read and caress my cat, which readily curled up in the warmest part of the bed.
Hospitalization
But there were far more traumatic situations, such as having my tonsils removed (although I don't recall much of this event because I was only five years old). Particularly traumatic was staying in a distant hospital for about a month. I was eight years old when that happened. As a patient with hepatitis A, I was admitted into the military hospital in Sarajevo (thanks to my father’s profession), as the only child among adult patients, all soldiers, in a common room, 30 to 40 of us. While my conscious recollections were positive (I learned to play chess), it must have been terrifying for me and my parents. They weren't allowed to see me the whole time, allegedly because of my contagiousness. More likely, because of the rules that couldn’t be changed even though I was a child. Mental health was not front and center for those who separated me from my parents. As an eight-year-old, I was placed in an adult hospital 50 miles from my home at a time when the only way to get there was by train.
In the course of this hospitalization, I was also "blessed" with chickenpox and, therefore, became an attraction for medical students. Their teacher walked me like a rare specimen exposing my naked body full of bumps, blisters, and sores for a complete view to different groups of inquisitive eyes. It didn't matter that I trembled because of a high fever, was feeling ill at ease, or scratched my skin rash. It seemed to me that he had a purpose in mind, and there was nothing to stop him. I was his only opportunity to demonstrate varicella-zoster infection, which frequented children and was not commonly seen in adults.
The effects
How did this experience affect me? On the upside, I developed the resilience of a survivor and became a well-known chess player in the region. On a deeper level, this experience led me to choose medicine as my profession. Three years later I officially declared that I wanted to be a doctor. I studied the liver, which became the topic of my graduation thesis in high school, and I turned my attention to infectious diseases. If I hadn't chosen psychiatry, I would probably have been an infectious disease specialist. On the deepest level, I wanted to be in control of sickness and wellness with knowledge and skills in order to overcome the powerlessness I felt as a sickly child. The conquest over mortality and the fear of death was on my mind. My imagination was unleashed to find a remedy against cancer, the fountain of youth, and achieve physical immortality.
But that was then, so let's go to the present. There are vestiges that I feel here and now. While I trust my intuition as to the meaning of body symptoms, I am sensitized by past experiences and have become hypervigilant about the state of health of my body. Recently, I learned that there is a special “island of the brain”, the so-called insular cortex, that receives input about the body sensations and in coordination with the amygdala interprets (gives meaning) to these body’s signals. In the event of hypersensitivity of this “island,” one pays much greater attention to one’s bodily state, which may lead to the development of intense negative emotions such as anxiety (1). I suppose my increased self-awareness of the body signals took place during my childhood and the heightened anxiety that surrounded me during periods of illness.
Psychosomatization
But certainly not to the extent that some members of my family were showing. The most pronounced one was my mother, who often went for "check-ups", submitted a detailed "report" to her family after each visit to the clinic, “consumed” various drugs, and went for examinations, tests, surgeries, spas, etc. Many of her ailments were psychosomatic, but thanks to all these interventions, she developed iatrogenic diseases and therefore became a true patient with somatic illness and not only an “illness anxious” person. I was a witness to this interpersonal field created by my mother, as a child and young adult. Once I became a physician, the way my mother communicated through her body became even more pronounced. I was an empathic listener and interpreter of her health, but at the same time, I had to find the right balance to keep her path from becoming my own destiny.
The early life imprinting about sickness, medicine, and mind-body unity, in combination with the embedded wisdom carried forward by the evolutionary collective knowledge, led me to form adaptive beliefs with appropriate filters in place toward sensations coming from the body. I have acquired a feeling of confidence in my ability to know when I need medical attention. This is a continuous process that may be impacted by many external and internal factors. For instance, in the wake of my mother's recent death, I developed unexplainable abdominal pain that was hard to locate. At first, I thought I had shingles with no rash. The superficial burning pain was similarto the one I had a long time ago in an emotionally challenging situation, so I chose to wait. But the pain didn't go away, so I became concerned about the “state of affairs” of my abdominal organs. Thoughts about cancer populated my mind. I decided to see a doctor. After extensive assessment, she was convinced that it was a kidney stone that was causing my pain. She ordered an abdominal CT scan. Luckily, it came back normal. All lab test results were also normal. After that, my abdominal pain subsided and vanished within a few days. But my ordeal was far from over. Soon after, I began to experience severe chest pain radiating in my left arm. I was worried that I was going to have a heart attack. However, because of my previous experience with abdominal pain, I was inclined to think that the pain that resembled cardiac pain might be a psychosomatic manifestation of grief. The chest pain went on and at one point I was getting ready to go to the emergency room. Instead, I decided to do a maneuver that I learned at the conference I recently attended. It was supposed to activate the parasympathetic nervous system and increase coherence between the heart and the brain. It worked. The chest pressure went away, and I was able to deliver the presentation scheduled that day without any discomfort. After a few more chest pain attacks, I realized that my pain had a symbolic meaning. It represented the language of the emotions stored in the body at the time when the feelings of the mind were not available to me. The loss of my mother triggered first abdominal and then chest pain, symbolically representing difficulties in “digesting life” and “holding on to a deep-seated fear of being hurt.” (2) The insight I gained and the intuition I followed helped me heal my emotional body without a “million dollars” workup to rule out heart disease.
Body psychotherapy
In this way, I inadvertently tapped into the realm of body psychotherapy (3) which holds a view that our body stores emotions, especially negative ones creating a “body armour” (4) that could lead to disease unless it is released through somatic experiencing (5) or other types of body therapy methods, such as yoga, qigong, dance movement, breathwork, etc. I learned from my yoga teacher that “The mind is a time traveler, but the body is always present” (6). By working with the body yoga therapy improves somatosensory information processing (interoception). Using mindful movement through poses and conscious breathing, a gradual shift occurs from the overfocus on bodily processes (interoceptive sensitivity) that could lead to health anxiety, to interoceptive awareness (the integrative process of regulation of emotions, cognitions, and behavior).
My wife has had a “body of fear” related to the meaning of physical symptoms, especially musculoskeletal ones, which at times lead to anxiety about the future. She used to worry about being unable to work because her body symptoms would worsen to the point where she would be incapacitated. She often went to "helpers", such as massage therapists, chiropractors, physical therapists, naturopaths, etc. when she experienced "flare-ups" as if she needed to be reassured and supported by these "experts" at those "critical" moments filled with bodily pain and anxiety. She dedicated a great deal of energy, resources, and time to "self-care" activities to keep her body going. Her sleep has been interrupted by bodily sensations, "nerve actions" which keep her awake. Her mind gets activated and concentrated on the sensations of her body. She has learned to use meditation and qigong to calm down her aroused state and turn her thoughts away from catastrophic to accepting what she's going through without anxiety hijacking her brain. Her avoidance of certain activities because of fear of injury and "damage" to her body has diminished but has not completely disappeared. She now recognizes her body as her greatest teacher and has become a student steeped in curiosity rather than fear.
Qigong
My wife has been a practitioner of qigong, a healing practice that involves coordinated breathing, body movements, and meditation exercises. According to the doctrine of traditional Chinese medicine, the body is a small universe where there is a flow of vital energy called "Qi", that supports the health of the body (7). Unbalanced emotions are the most common cause of energy blocks in our bodies. They can lead to hypervigilance about our body, more attention to every sensation and symptom of the body, and a tendency to misinterpret these sensations and symptoms as a loss of control over the body and a sign of serious illness. Qigong is a simple method of movement, breathing, visualization, and sounds, that can open up those blocks and restore a natural state of physical and emotional vitality. By tuning into the body’s subtle rhythms, we learn how to live healthfully and how to heal ourselves when we get sick. Qigong teaches us how to allow our body to be our guide and how to harness our inner energy. With its help, we gain the courage to feel that leads to the best opportunity to heal a body full of fear.
1. Neural Circuitry of Interoception: New Insights into Anxiety and Obsessive-Compulsive Disorders, by Emily R. Stern, Current Treatment Options in Psychiatry, 1:235–247, 2014
2. The Secret Language of Your Body, by Inna Segal, Atria Paperback, 2010
3. Body Psychotherapy: An Introduction, by Nick Totton, Open University Press, 2003
4. Character Analysis, by Wilhelm Reich, Farrar, Straus and Giroux, 1980
5. Trauma and Memory: Brain and Body in a Search for the Living Past, by Peter A. Levine, North Atlantic Books, 2015
6. Yoga for Depression, by Amy Weintraub, Harmony, 2003
7. Qigong and tai chi as therapeutic exercise: survey of systematic reviews and meta-analyses addressing physical health conditions, by PJ Klein et al., Alternative Therapies in Health and Medicine, 25(5):48-53, 2019
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