Did stress cause my pain and illness?

No! And it’s time to bury this pseudo-diagnosis once and for all.

It’s truly incredible how many times over the years I have been told that my serious unexplained chronic pain and illness is caused by “stress.” Directly or indirectly, the demon of stress as the primary explanation for my problems both by healthcare professionals and anyone else.

No idea about what’s wrong with my health has been more seductive or frustrating. But in 2022, I come into Project Try Everything with a clear position on this:

It. Is. Not. The. Fucking. Stress.

If the stresses of modern living could do this to people, civilization would collapse. That’s my one-sentence argument. I will elaborate over the next 68 sentences.

“Thank you for contacting the abyss. Your scream is very important to us.”

~ @BerrymoreBlue

My professional opinion about myself

Most people who are told, one way or another, that their unexplained pain/illness is “all in their head” don’t have the advantage of a quarter century of relevant professional experience.

I have written much and more about this for PainScience.com over the years, especially anxiety, the consequences of insomnia, and the role of the mind in pain.

But, oddly, I have never tackled the question: Does hypochondria even exist? Is “it’s the stress” a diagnosis of hypochondria in disguise, and is it that actually possible?

This is an informal first crack at an answer, my personal rant about being gaslit by so many people with this careless “diagnosis.”

Seriously, it’s personal: I am not even trying to be thorough or rigorous or dispassionate about it. On the contrary: although I am bringing my professional perspective to the topic, this is just an exasperated summary of my position on the role of stress in my own medical situation.

An overview of the idea of psychosomatic illness

Psychology is probably a factor in every messy case of puzzlingly poor health, and in a few it may even be the first of factor (childhood trauma, for instance). But “a factor” is a long way from being “the cause.”

And also, yes, intense anxiety and trauma surely can cause some nasty somatic symptoms. But I doubt that many people ever experience such symptoms in the absence of other rather vivid psychological signs and symptoms.

Even for sick people who do struggle with significant anxiety, it’s much more likely to be just another symptom of an awful situation. Stress is notThe Main Problem for many people, if any, maybe not even at the extremes, and it certainly is not for me.

I do not believe that my disease is “all” in my head, or even partially. I have given that idea much more than a fair chance over the years, and I have rejected it.

Focusing on the pain isn’t the problem either

I also don’t believe that I have chronic pain because I write about pain professionally for PainScience.com.

It’s certainly ironic! But it doesn’t explain why I feel horrible. Irony is not toxic.

Mysterious chronic pain is an extremely common problem, and a writer who happens to focus on it as a topic is just as likely to struggle with it as anyone else.

I do believe that chronic pain can sometimes be worsened by “picking the scab,” and that people can benefit from psychological distraction (another specific sub-topic I have never actually written about). 

But I do not think that thinking about pain can be the main reason that I am in pain, and I don’t think it happens to anyone else either. There is no epidemic of hypochondriac chronic pain sufferers obsessed with the topic of pain.

Not me! Just a stock photo I bought from Shutterstock. I considered taking a selfie of myself looking really stressed… but that stressed me out too much.

That time in 2020 when I really did think it was all in my head

I have always been obliged to keep my mind open to the possibility that my illness is psychosomatic to some degree even if only because so many serious people seem to take it seriously. And so, at times, I have also taken it very seriously indeed.

I regret it.

I went through a phase in early 2020 where I elevated this hypothesis to the status of near Truth.  I was briefly convinced that my suffering extremely severe anxiety and stress. Six weeks of self-hating hell that was probably more stressful than my stresses. More irony!

I got over it.  Because reasons.  I imagine it’s going to come up again and again.  But I am many years into this pickle, and I am absurdly well informed about chronic illness and chronic pain, and I am so over it.

Stress is not my pathogen.

Just no correlation at all

There are many reasons why I have largely moved on from the psychosomatic thing, but this is the main one: My symptoms do not correlate with my stress levels. And, critically, they do not do so at any scale.

I have many prominent examples of feeling terrible when life was going relatively well, for days, weeks, or months at a time.

And I have just as many examples of feeling relatively well when life was kind of terrible — for days, weeks, or a whole season at a time.

I do not get symptom surges during or after crises. I do not get symptom relief from periods of relative calm.

Stress as the original trigger?

Many of you are going to go here, so I have to beat this idea to death with a logic stick first. 🙂

Yes, I am aware that stress doesn’t necessarily have to neatly precede symptoms to explain an illness. Stress might be able to do permanent damage. We can certainly imagine a scenario where stress knocks us way off kilter… and we just never recover.  Once you're in that Stress-Induced Bad Place, it might be a runaway train of dysfunction that causes all kinds of trouble regardless of ongoing stress levels.

But there are several problems with this seductive idea of the SIBP:

1. There are many other plausible causes of unexplained illness.  Many.  MANY.  MAAAAAAANY.  So many. Never, ever underestimate the power of physiology and biology to surprise you. Blaming stress is a rather blatant case of looking “where the light is,” an easy bogeyman to understand and blame. I have lost count of the number of people I have known over the years who came to believe that they were stress-damaged goods, only to finally discover the genuine pathological cause of all their troubles. This is common.

2. There is a strong case to be made that the destructive power of stress has been exaggerated over the last few decades, often by people selling squishy solutions. I am not going to make that case here. I am literally just sayin' … stress has probably been excessively demonized.

3. Stresses of the kind I have endured do not seem exotic enough to be toxic, and they are definitely not an obvious (health) problem for many other people who have faced similar and worse.  Certainly I have had an uncomfortable middle age: three tragic deaths of friends, my wife's terrible accident, insane legal threats, my throat-pocalypse and the benzo withdrawal incident, absurdly demanding entrepreneurship… enough troubles to make the stress hypothesis seem somewhat credible. ¶ And yet I know people who have been through roughly equivalent dramas, and another half dozen who have clearly had it even worse … and they are mostly in good health. And there are entire populations of people around the world who will deal with more crap by any given lunch than I will see in a month… and they aren't melting down mysteriously either. ¶ Finally, on the flip-side of this coin, I know several people with more severe unexplained illness whose lives were relatively smooth sailing for years before they got sick: people who were content until suddenly they got unhealthy.

Is psychological stress hard on people?  Of course. Can it cause mysterious medical meltdowns in otherwise healthy fortysomethings?  I seriously fucking doubt it.

And there's one more problem.

Even I knew that stress was truly my nemesis…

"Stress causes weird illness" is just an impractical hypothesis.  The more true it is, the less useful it is. Because it’s not going to change anything. It’s not going to make me any more eager to make my life less stressful. I’m already very eager for that.

If it’s even possible to claw your way back to normal from being biologically traumatized by stress, it’s probably crazy hard, and the only thing anyone can do is every possible thing to make your life better, easier, nicer…

Which is just what everyone is always trying to do anyway.

Even if I succeed in making my life less stressful, and then I actually get healthier too, that won't actually prove that stress was the original problem — there are just way too many confounding factors.

Nor will I even really care in that happy scenario. 🙂

So the idea that stress was a “trigger” is kind of useless, another unfalsifiable hypothesis that torments many people with unexplained chronic illness.

Throughout Project Try Everything, I will continue to make mental health a high priority “just in case” … but also just because it’s worth doing anyway.