As is true in all professions, we chiropractors become accustomed to a particular way of seeing things and doing things based on what we see and what we do, day in and day out. The positive side of this patterning is that we gain real expertise in the areas where we specialize. But our finely-tuned emphasis on the physical can lead us to assume that physical symptoms have purely physical causes, and that's only part of the truth.

Mind Influences Body, Body Influences Mind

Since Sigmund Freud first proposed the concept of psychosomatic illness at the dawn of the 20th century, the idea that mental and emotional problems can cause pain and other physical ailments has become widely accepted. The groundbreaking work of Hans Selye refined and expanded our understanding of the ways that stress impacts health. Selye called his theory the General Adaptation Syndrome and, from the 1930's to the 1970's, he developed an impressive body of research clearly demonstrating that stress leads to a cascade of damaging effects in animals and humans.

We all understand that a troubled mind can cause adverse effects in the body. Conversely, pain and other aspects of physical illness can be emotionally upsetting, as most of us have experienced first-hand. Mind and body are inextricably linked together. So how might a chiropractor use this knowledge to add to the potentially balancing and de-stressing effects of hands-on chiropractic care, which can play a role in the treatment of some mind-body problems but rarely constitute the entire solution?

Reaching Out Gently, Without Judging

I faced this question often in 26 years of full-time practice as a chiropractor, because I learned early from my patients that emotional unease or distress is a frequent companion to physical pain. There are actions a chiropractor can take to address these concerns. To begin with, I would suggest that a chiropractor's case history should include (as we do at the Cleveland Chiropractic College clinics) at least one or two questions about the patient's emotional status, including some variation on, "Do you feel upset about being in this much pain?"

This should be discussed gently and non-judgmentally, so that no patient interprets the question to mean that we are implying, "It's all in your head." If despite our best efforts, the patient does interpret it that way, it's important to have an effective response ready. There are many possibilities, but my own approach is usually to say something along these lines: "Mind and body are not separate. I believe that all physical ailments, including my own, have an emotional component." To me, the "including my own" phrase in that answer is central, because it indicates to the patient that I, the doctor, do not perceive myself to be up on a pedestal wielding the lash of harsh judgment. Instead, I'm sitting across the desk as a respectful equal, seeking to be of help to someone whose suffering I recognize and toward whom I feel genuine sympathy.

Forging this heart-to-heart connection is both meaningful and satisfying. For some patients, it opens the door to sharing more of themselves. Sometimes, merely lending a sympathetic ear is all that is needed, especially with patients who are lonely and may speak with few, if any, other people on a typical day. In some cases, if the psychological component of the ailment seems primary or if the patient appears to be in a serious emotional crisis, I would certainly make a referral to a psychological professional (psychiatrist, psychologist, or clinical social worker) or, in certain cases, to a pastoral counselor. As a chiropractor, I'm not expected to be a psychotherapist. As a human being and a health professional, I certainly can certainly listen attentively and offer calming, supportive words.