“It’s all in your head.”
I wish medical professionals knew just how damaging this comment is to someone with a chronic medical condition. These words can make those of us with chronic illness question our judgment of symptoms. It leaves us feeling angry and forces us to think, “Am I going crazy?”
Medical professionals who can’t find an explanation for symptoms often resort to a diagnosis of exclusion. According to the National Library of Medicine, a diagnosis of exclusion is “the diagnosis that remains after all other differential possibilities have been excluded.” Often in the chronic illness community, it becomes a diagnosis of a mental illness. It is important for medical professionals to know that telling a patient who is suffering that “this is all in your head” or “this is just anxiety” can have a lasting, sometimes detrimental, impact on a patient’s physical and mental state.
I was dismissed as having “just anxiety” for years before an accurate diagnosis and before receiving oxygen therapy. I can remember going into an emergency room after losing consciousness with an excruciating headache, confusion, and an overall feeling of extreme fatigue. When the blood work came back normal and the chest X-ray came back fine, I was labeled anxious. My history of a mental illness masked my lengthy medical history, which includes more than a dozen major surgeries.
Those of us with pulmonary hypertension shouldn’t have to look sick to get proper care. We shouldn’t be dismissed just because our illness isn’t as black and white as one would hope. When medical professionals don’t see anything acute on scans or blood work to explain symptoms, they will often tell us “it’s all in your head” or “it’s just anxiety.” The difficult thing about chronic illness, especially pulmonary hypertension, is that more often than not, it won’t show up on an X-ray or blood work.
When going into an emergency room before my diagnosis and before doctors realized how low my saturations were upon exertion, I was given Ativan (lorazepam) and referred to a psychiatrist for cognitive behavior therapy. I began ignoring my symptoms when they would arise. “It’s all in your head,” I would repeat to myself as I saw myself looking back, pale in the mirror. I’d think, “It’s all in your head,” when I would walk into my classroom and begin to see black spots in front of me. Thinking “it’s all in your head” stopped me from getting proper medical care. Going to the hospital was the last thing I wanted to do, just to hear “it’s all in your head.”
Before labeling a patient as mentally ill, it’s important for doctors to know that we know our bodies and know when something isn’t right. Just because we may have a history of mental illness doesn’t mean that our symptoms are a direct result of it. If it weren’t for medical proof with a heart catheter and seeing how low my oxygen levels were, I may still be thinking “this is all in your head.”
Doctors need to be sure that a diagnosis of exclusion is just that, an exclusion. Other possibilities need to be ruled out. Do I struggle with mental illness? Yes, I do. Is my mental illness causing my symptoms? Now I know that it isn’t. It took years of self-advocacy to receive a proper diagnosis. My heart breaks for those who have had similar experiences. It breaks for the ones who are still struggling, wondering, is it just anxiety?
Medical professionals need to be aware of the negative impact they can have on someone who is struggling before they say “this is all in your head.” It’s time they stop using acute illness markers to judge the validity of our symptoms. Our symptoms are real and leave us feeling as if our bodies are not our own. It’s important for us, as a chronic illness community, to advocate for ourselves and each other. Speak up if you feel as though you are being dismissed. Your physical health and mental health matter. Together, our voices can be heard.
Note: Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Hypertension News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to pulmonary hypertension.