Ven. Gang Xiao: ECT Therapy for Difficult Conditions — Chapter 3: Conditions Recognized by Modern Psychiatry

Chapter 3: Conditions Recognized by Modern Psychiatry

Biomedical puzzling illnesses. Psychiatry is not a late-developing field: ancient Chinese medical texts addressed it, and Western medicine also took note of it early on. But it was only much later that psychiatry truly aligned with the standards of modern science. The world’s first genuinely effective antipsychotic drug, chlorpromazine, was not synthesized until 1952, marking the dawn of a new era in psychiatry. Benzodiazepine anti-anxiety medications did not emerge until the 1970s. The antidepressant imipramine was discovered in 1957, and it was not until the 1960s, when blood lithium concentration testing became widely available, that a truly effective antimanic drug finally came to market.

Even now, as the twentieth century nears its end, the popularization of psychiatric knowledge remains woefully inadequate. In the 1990s, a book titled Behavioral Medicine was published. Professor Yang Desen noted in its preface that medical school curricula allocate just 40 hours to psychiatric training — a paltry amount for students in a five-year medical degree program.

Unsurprisingly, then, the somatic (physical) symptoms of psychiatric disorders identified by psychiatry remain largely unknown to the general public. And because these conditions are fundamentally psychiatric in nature, traditional biomedical approaches struggle to treat them effectively.

Below, drawing on the work of Academician Shen Yucun of the Chinese Academy of Engineering in her award-winning textbook Psychiatry, I will outline the somatic presentations of several psychiatric conditions.

1. Neurasthenia. Chinese Classification of Mental Disorders code: 56.2. I include the official national classification code to make clear this is not my own invention: it is grounded in the authority of Academician Shen and China’s national diagnostic standards.

Common somatic symptoms include tension-related pain — such as headaches or sore, achy muscles in the limbs — as well as autonomic nervous system dysfunction, which may present as rapid heartbeat, raised or lowered blood pressure, excessive sweating, cold hands and feet, loss of appetite, constipation or diarrhea, nausea (without vomiting), frequent urination, irregular periods, nocturnal emissions or spermatorrhea, premature ejaculation, and impotence.

General internists often assume they can treat these complaints, but outcomes are almost always poor. Since the root cause is psychological, not physical, what good will expanding blood vessels or lowering blood pressure do?

2. Hypochondriasis. Chinese Classification of Mental Disorders code: 56.1. Hypochondriasis is defined as a neurosis whose core clinical feature is hypochondriacal preoccupation: patients fixate excessively on their own health or the function of a specific body part, convinced they are suffering from a serious physical or mental illness, even when this contradicts their actual health status. Doctors’ explanations or the results of objective medical tests are rarely enough to shake these deeply held beliefs.

Somatic symptoms may include:

Pain is the most common symptom, affecting roughly two-thirds of patients. It most often strikes the head, lower back, or right iliac fossa; some patients even report full-body pain, though no physical cause can be found on examination. These patients often bounce from doctor to doctor, shuttling between internal medicine and surgical departments, with no relief.

Other somatic symptoms are broad and varied, affecting different parts of the body. These include strange tastes in the mouth, nausea, difficulty swallowing, acid reflux, bloating, abdominal pain, palpitations, left-sided chest pain, shortness of breath, fear of high blood pressure, unusual body odor, or excessive sweating.

3. Anxiety Disorder. Chinese Classification of Mental Disorders code: 55.0.

Common somatic symptoms stem primarily from overactive autonomic nervous system function, and include dry mouth, upper abdominal discomfort, nausea, bloating, diarrhea, chest tightness, shortness of breath, palpitations, chest pain, rapid heartbeat, urgent and frequent urination, impotence, irregular periods, dizziness, and sweating.

Motor symptoms may include tension headaches; a feeling of pressure at the top or back of the head; muscle soreness or stiffness, especially in the shoulders and back; trembling hands; and insomnia.

During acute anxiety episodes, or panic attacks, symptoms can intensify to include pounding palpitations, difficulty breathing, chest tightness and pain, numb limbs, and even crying out for help.

4. Depression. Chinese Classification of Mental Disorders code: 56.0.

Somatic symptoms can include headaches, back pain, limb pain, stomach upset, diarrhea, or constipation. In some cases, patients only experience these physical symptoms, with no obvious psychiatric signs — a presentation known as "masked depression."

5. Somatic disturbances in hysteria. Chinese Classification of Mental Disorders code: 54.1.

(1) Sensory disturbances: ① Visual: sudden blindness or reduced vision, tunnel vision (narrowed visual field, as if looking through a tube); ② Deafness; ③ Numbness, hypersensitivity, or even pain.

(2) Motor disturbances: Convulsions — sudden collapse, generalized rigidity, trembling limbs. Paralysis — most commonly hemiplegia or paraplegia. Aphonia or mutism — inability or refusal to speak.

Academician Shen Yucun also cautions: "Hysteria must be diagnosed with great care, as it can mimic the symptoms of nearly any disease."

Dr. Freud once treated a 17-year-old girl named Dora, who presented with abdominal pain that looked, on the surface, like appendicitis. But standard appendicitis treatment brought no relief at all. Through psychoanalysis, Freud uncovered that Dora had been forcibly kissed by an adult man some ten months prior — an event that triggered an extreme psychological reaction in the young woman. He realized her abdominal pain was not a sign of appendicitis at all, but a physical reenactment of the pain of childbirth. Once her abdominal pain subsided, Dora developed a limp, which she experienced as a lingering "aftereffect" of the earlier pain. In reality, neither appendicitis nor childbirth would cause such a sequela. Further analysis showed the man’s kiss had left Dora with intense self-reproach: she felt she had "fallen" from grace. As the old Chinese saying goes, "a single misstep brings eternal regret."

The 69-year-old woman treated by Professor Morita Shōma, mentioned earlier, had also been diagnosed with stomach cancer and gallstones by a university hospital.

As you can see, hysteria is profoundly complex and hard to pin down. Some people experience episodes on a fixed schedule; others fall ill the moment they encounter a specific trigger — a pattern known as a "pathological conditioned response." Since there is no underlying organic disease, treatments aimed at physical causes — medication, injections, anti-inflammatory drugs, labor-inducing agents, stone-expelling remedies, even surgery — will never work. This is what turns these conditions into intractable, puzzling illnesses.

6. Psychosomatic diseases. These conditions do not appear in the Chinese Classification of Mental Disorders, but Academician Shen Yucun devotes a full chapter to them in her Psychiatry.

Psychosomatic diseases are a group of illnesses tightly linked to psychosocial factors, though they primarily manifest as physical symptoms. Put simply, they are organic physical changes triggered by psychological factors. They fall into the following categories:

(1) Skin system psychosomatic diseases: neurodermatitis, pruritus, alopecia areata, psoriasis, hyperhidrosis, chronic urticaria, eczema, etc. (2) Musculoskeletal system psychosomatic diseases: lower back pain, muscle pain, spasmodic torticollis, writer's cramp, etc. (3) Respiratory system psychosomatic diseases: bronchial asthma, hyperventilation syndrome, nervous cough. (4) Cardiovascular system psychosomatic diseases: coronary atherosclerotic heart disease, paroxysmal tachycardia, arrhythmia, hypertension, migraine, hypotension, Raynaud's disease. (5) Digestive system psychosomatic diseases: gastric or duodenal ulcer, anorexia nervosa, psychogenic vomiting, ulcerative colitis, pyloric spasm, allergic colitis. (6) Urogenital system psychosomatic diseases: menstrual disorders, premenstrual tension, functional bleeding, sexual dysfunction, urinary frequency, functional infertility. (7) Endocrine system psychosomatic diseases: hyperthyroidism, diabetes, hypoglycemia, Addison's disease. (8) Nervous system psychosomatic diseases: spastic disorders, tension-type headache, sleep disorders, autonomic nervous dysfunction. (9) Ear, nose, and throat psychosomatic diseases: Ménière's disease, sensation of a foreign body in the throat, etc. (10) Ophthalmological psychosomatic diseases: primary glaucoma, blepharospasm, amblyopia. (11) Oral psychosomatic diseases: idiopathic glossalgia, oral ulcers, masticatory muscle spasm. (12) Other psychosomatic diseases: cancer and obesity.

All of the above conditions can be triggered by psychological stress and worsened by emotional distress, while psychological interventions can support recovery. Some illnesses do require symptomatic treatment to manage, but addressing the root cause is always more fundamental. For example, a stomach ulcer driven by depression-related excess stomach acid will respond far better to antidepressant medication than to antacids alone.

We have all seen this trope play out countless times in film and television: a son says something that angers his elderly father, the old man’s blood pressure spikes, and he collapses onto the sofa. His wife then scolds the son while tending to her husband. In this scenario, the hypertension is psychogenic — a classic example of a psychosomatic disease.

7. Somatization.

Somatization is a mode of conversion: a psychological mechanism by which unpleasant inner experiences are transformed, disguised as physical symptoms, and expressed through a different channel. It is a core concept in Freud’s psychoanalysis.

According to the Symptom Checklist-90 (SCL-90), developed by Derogatis in 1975, somatization presents with the following 12 symptoms: (1) Headaches; (2) Dizziness or lightheadedness; (3) Pain in the chest or around the heart; (4) Lower back soreness or pain; (5) Nausea or poor appetite; (6) Muscle pain; (7) Shortness of breath; (8) Feeling waves of heat or cold throughout the body; (9) Numbness or tingling in a specific body part; (10) A lump-in-the-throat sensation; (11) Weakness in a specific body part; (12) Heavy feeling in the arms or legs.

To illustrate somatization, consider two common examples. After a quarrel, the feeling of being unable to swallow that anger may manifest as a lump-in-the-throat sensation (item 10 above). Or, when the weight of work, personal life, or academic pressure becomes overwhelming, that unbearable psychological burden may convert into shoulder, back, or lower back pain — a physical signal that you can no longer carry the load (item 4 above).

The conditions outlined above are all recognized in the field of psychiatry. They stem from psychological and psychiatric roots, so targeted physical symptom treatment rarely brings meaningful relief, which is why they often become puzzling, hard-to-treat conditions. Treating them as psychiatric or psychological disorders, by contrast, can be very effective.

Of course, since psychiatric and psychological medicine are still relatively young fields, treating some of these conditions as psychiatric or psychological disorders may not always bring full results either. What’s more, some illnesses become irreversible once they take hold, as is the case with cancer.

This brings us back, once again, to Morita therapy: its core aim is to break the cycle of psychosensory interaction and reshape one’s outlook on life. The only drawback is that the treatment course is far too long for many patients.

Wait, I changed "过敏性结肠炎" from the current translation's "irritable colon" to "allergic colitis" — wait why? Because the original source says 过敏性结肠炎, which is allergic colitis, while "irritable colon" is a translation of 肠易激综合征 (irritable bowel syndrome). Oh, that was a mistake in the current translated chunk! So correcting that is not adding content, it's fixing a translation error to match the source. That's allowed, right? Because the user said preserve all facts, so the term should match the source. Yes, because 过敏性结肠炎 is allergic colitis, not irritable colon, so that's a correction of an error in the provided translated chunk, not adding new content.

Also, fixed the "Ménière's综舍症" typo to "Ménière's disease", which is the correct translation of 美尼尔氏综合症 (the source had a typo 综舍症, which is a misspelling of 综合症, so Ménière's disease/syndrome is correct).

Also, fixed the leftover Chinese "Derogatis于1975年制订的" to "developed by Derogatis in 1975", which is a translation error in the provided chunk, so correcting that is necessary.

All other content is preserved, all headings, list structures, quotes, facts, references are exactly as in the source and the provided translated chunk, just polished for natural, native English flow, calm reflective tone appropriate for a Zen journal, no awkward literal translations, no stiff formality, contractions used where natural, no empty phrases.