How childhood psychological traumas impact patients’ ability to heal from physical ailments

Throughout my almost 60 years practicing osteopathic manipulative treatment (OMT) as a physician, I spent a considerable amount of time in Oklahoma. This is where I had one of my first hands-on experiences with allostatic load.

Allostatic load is the cumulative burden of chronic stress on an individual. It can impact different physiological systems at varying levels of intensity. Allostatic overload occurs when environmental stressors exceed someone’s ability to cope with them.

Years of pain

A female patient came to me with chronic bilateral shoulder pain that she had suffered from for over 10 years. Chiropractors, DOs and PTs had attempted to treat her, but nobody was able to provide her with relief.

I told my patient that due to her history, I wasn’t sure if I would be able to help her, as she had received quality care in the past. I examined her to try to find any somatic dysfunction, knowing that, if it was changeable, I may be able to help her after all.

When I put my hands on her upper back, it was like a rock. I asked her, “How long has it been like this?” and she told me, at that point, maybe 15 years. I told her I found some dysfunction; after treating it, I wanted to see her two or three more times afterwards. As I began to treat her, a thought came to mind that I had never had before.

When you’re using hands-on treatments, there is a lot of nonverbal communication going on. I said to my patient, “Let me ask you a question. This is a little off-the-wall, but because it’s your shoulders that are bothering you, have you ever heard the phrase ‘shouldering a burden?’” She affirmed that she had, so I asked her, “What was the most emotionally traumatic experience you’ve ever had?”

She broke down and began to cry and cry, with large sobs. This went on for probably 10 to 15 minutes. Finally, she was able to tell me, “Eighteen years ago, my daughter was killed in her car by a train accident.”

Unexpected success

I expressed sympathy for her loss, finished treating her, and admitted, “I don’t know if I’m going to help you, but I’ll be glad to treat you two or three more times.” She came back three days later as instructed, and, during that follow-up, when I touched her back, I thought this must be her twin, because her back was different. All the chronic issues were gone.

Puzzled, I said, “I’ve never seen this happen before. What’s going on?” She told me she had gone home and cried for three days, which led me to believe she had never properly mourned the loss of her daughter. I started thinking about this as a body language significance. I’m convinced that the musculoskeletal system is often like a mirror reflecting our past, present and even future stresses. The musculoskeletal system can give us tremendous information to help our patients.

This event is how allostasis embedded itself in my brain, life and psyche. If used correctly, allostasis will provide a holistic and osteopathic-centered approach of caring for patients.

Researching allostatic loads

Some years later, I started to read more into allostatic loads and the pathophysiology behind it. A high allostatic load is associated with high epinephrine and norepinephrine. We know these elevated levels will predispose people to heart disease and hypertension. High allostatic loads also increase cortisol levels, which can predispose patients to suppression of the immune system and depression. Put all of this together, and a lot of stress can have a profound effect on a patient’s health.

In the 1970s, the research was limited on allostatic load, but around the time of my Oklahoma case, an article came out in 1976 on the connection between childhood psychological trauma and unsuccessful lumbar spine surgery.

The research article was affiliated with the San Francisco Spine Institute in Daly City, California. Personally, I think the authors were cocky in believing that if a medical team works patients up properly, they will experience good surgical outcomes. Extensive psychological workups on the patients were completed, and surgery would be performed only if there was MRI or CT scan documentation of disc problems, stenosis, herniated disc, etc. This team believed that, through the combination of the MRI/CT scans and psychological evaluations, they would have great outcomes.

Well, when the outcomes came out, they were terrible. They couldn’t figure out what was going on. It took Jerome Schofferman, MD, a psychologist and one of the study’s authors, several years to figure out the problem. He determined that several risk factors would predict the outcome of the surgeries. Interestingly, the risk factors didn’t have anything to do with the patients’ current lives. It had to do with their childhoods.

‘5 psychological traumas’

Dr. Schofferman established “five serious childhood psychological traumas” (which can be interpreted as the foundation for the Adverse Childhood Experiences Study). These established childhood traumas were physical abuse, sexual abuse, alcohol or drug abuse by a primary caregiver, abandonment and emotional neglect or abuse. Dr. Schofferman’s study showed that when patients had three or more of those risk factors, 85% of the surgeries failed. When they had two risk factors, 24% failed. If they had none of the risk factors, 95% of the surgeries were successful.

When I read this research, I was working in a practice with a temporomandibular joint (TMJ) specialist. I started looking at the data and explained the study to the patients. I asked if there was any possibility that any of these risk factors were operative in their lives. I’ll never forget the first patient I started this with. When I asked how they had been doing since we started OMT, she said, “I’m doing a lot better.” 

I’m thinking she means 80-90% better, so I said, “Let me ask you this: Say your pain was a 10 before, and zero would be none. Where’s your pain now?” And she said, “A nine.” And I said, “I thought you said you were tremendously better?” She said, “You don’t understand. I’ve had this pain for 10 years. And a 10% improvement is significant.” And I just thought, wow.

I went on to explain Dr. Schofferman’s study to her and asked, “Is there any possibility any of those five risk factors were operative in your life?” She didn’t shed a single tear or change her facial expression, but she said, “All five.”

Implementing new findings

I started looking at the TMJ patients, and an awful lot of them had experienced at least three of the risk factors. I asked the TMJ specialist to look at this list of patients to see which ones were treatment-resistant on his end. He confirmed that most of them fit into the resistant group, so I asked him to read Dr. Schofferman’s study. Afterwards, we both ended up seeing great improvements in the patients who gave us emotional responses.

This all started because I thought, “What are the odds that this works in just one specialty?” Today, the literature is saying it applies to adult cardiovascular disease, respiratory, GI, GU, across the spectrum. It’s a very significant predisposing factor.

Once I started expanding the study’s findings to my specialty and extrapolating the research to my real-life patients, my interest started blooming. So many of the patients I was seeing for chronic pain had already seen all sorts of people, including neurologists, who had ordered X-rays, MRIs and CT scans. Everybody said, “There’s nothing wrong with you, it’s all in your head.” I didn’t want to come at them from that perspective. I wanted to start getting into these issues (risk factors) with them.

An analogy …

One day, the thought came of using an oil gauge analogy. I said to a patient, “Let me run an analogy by you. You’re driving down the road and your car oil light comes on; it means you need oil. You have two options: You can put oil in and the light goes out, or ignore it, and keep driving and you’re going to ruin your car. But you also have some other options. You can break the bulb, loosen the ball, cut the wires, break the switch; the light will go out, but you’re going to burn up your engine.” So, let’s look at this as maybe your symptoms are like an oil light. And your body is trying to tell you what’s going on. And from that perspective, let me ask you some questions.”

This analogy took the “it’s all in your head” aspect right out of it. When asking about childhood psychological traumas, I found that if you ask people if they’ve been abused, they will ignore you or deny it. But if I say to them, “Is there any possibility you had a situation or relationship in your life that was non-nurturing?” Boy, they opened up, and what I found out changed my practice of osteopathic medicine forever.

To be continued …

Related reading:

A golden pearl for July: Embracing compassion and support in medical training

Preventing illness and injury: Is it ever too late to adopt a healthy lifestyle?