Dear Therapist:
I’ve been feeling really off physically for a long time, beyond regular tired. My whole body hurts some days, or just feels heavy, like I’m walking through water. I’ve seen doctors, done blood work, they always say nothing’s wrong or just say “maybe it's stress.”
This isn’t just stress. I crash after normal things like taking the kids to the park or making Shabbos and it’s not normal tired. I also don’t look sick, so I feel like I’m constantly explaining or downplaying or just pretending I’m okay. I feel like I am barely functioning some days.
I guess my question is two parts. What could something like this even be, when all the tests are normal? And how do I explain it to people without sounding dramatic, when I look fine but feel awful?
Response:
I don’t have much information about you, like your gender, age, weight, diet, lifestyle, sleep patterns, medication side effects, and other physical factors. However, I have to assume that these factors were taken into consideration by the physicians you’ve seen.
It sounds as if you’ve taken the right steps to rule out physical causes. Assuming that you have, in fact, ruled out physical causes (like anemia, sleep apnea, diabetes, or thyroid, lung, or heart issues), that would seem to leave psychosomatic causes.
Although this may seem a bit odd or unusual, it is actually quite common. We all have physical reactions to mental and emotional factors. When we’re sad, our bodies feel weaker. When we’re afraid, our bodies tense up. The term “psychosomatic” simply means that our bodies are reacting to something in our minds. Many aches and pains can be largely attributed to psychological factors.
Typical mental causes of fatigue are depression and anxiety. Sometimes, fatigue can be the primary symptom, with actual feelings of depression or anxiety appearing only secondarily.
At times, feelings of fatigue can be a way of escaping a situation, thought, or emotion. People escape unwanted feelings in various ways. Some use classic defense mechanisms, like denial, repression, and intellectualization, to avoid emotions their unconscious minds don’t want them to experience. Others might feel tired or unfocused when their minds are signaling them to avoid a problematic emotion.
Defense mechanisms are typically developed in childhood and are often reinforced throughout life. For some, these defenses evolve on an unconscious level. Others become aware of their defenses and develop better, more conscious ones. The issue with unconscious defense mechanisms is that they were originally developed to deal with childhood fears, yet we end up using the same or similar defenses to deal with adult problems. This happens because the conscious (adult) mind is usually unaware of the defense and what it is trying to resolve. As a result, we wind up avoiding issues that were difficult or impossible to resolve as children but could be addressed far more easily as adults—if only we allowed ourselves to acknowledge and work through them.
If medical factors have been ruled out, I recommend that you see a therapist who can help you determine whether there may be emotional causes for your chronic fatigue.
As far as explaining your condition to others, this is clearly a personal decision that depends on your various relationships. Generally speaking, however, most people can easily understand the idea of feeling fatigued—or of feeling depressed or anxious. Remember that your symptoms themselves are normal. Everyone feels fatigued at times. The difference is the degree and longevity of these symptoms. Everyone could stand to better understand themselves and their psychosomatic reactions. For you, it is simply more important to do so.
-Yehuda Lieberman, LCSW
psychotherapist in private practice
Woodmere, NY
adjunct professor at Touro University
Graduate School of Social Work
author of Self-Esteem: A Primer
www.ylcsw.com / 516-218-4200
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