Carol-Ann Farkas, PhD, Associate Professor of English

Carol-Ann Farkas, PhD, Associate Professor of English, on Understanding Psychosomatic Illness

  • Carol-Ann Farkas, PhD, Associate Professor of English and Director of Writing Programs in the School of Arts and Sciences at Massachusetts College of Pharmacy and Health Sciences (MCPHS), has been called a hypochondriac a few times in her life.

    Some people would just shrug it off, but Dr. Farkas was inspired to dive into the topic. “I wanted to better understand just what that meant,” said Dr. Farkas. “Why was my experience of illness or injury suspect? Why wouldn’t it be enough for me to say, ‘I don’t feel well,’ and be believed?”

    For many patients, experiencing psychosomatic illness can be frustrating and overwhelming, and Dr. Farkas explains that these feelings come from a long history of miscommunication, misunderstandings, and controversy.

    She tackles all this in a new anthology published by Routledge called Reading the Psychosomatic in Medical and Popular Culture: Something. Nothing. Everything.

    We sat down with Dr. Farkas to hear her insight into the anthology and to learn how interdisciplinary and interprofessional collaboration can empower healthcare professionals to better serve patients with psychosomatic illness.

    In the anthology, you note that everyone has had or will have psychosomatic illness at some point in their lives. Tell us more about that.

    Think of how often we all get colds…and blame it on stress, busy lifestyles, et cetera. Or how often a friend will complain of this or that symptom and we might dismiss it as “all in her head.” Or the casual, but totally not kidding, way we refer to ourselves as hypochondriacs or “germophobes.” Without necessarily having a technical or even shared vocabulary to describe our experiences, we all recognize that there is a connection between body and mind, that our behavior and relationships can make us unwell.

    Does the commonness of psychosomatic illness make it even more important to study?

    Yes! How can something affect us all every day and yet be misunderstood, if not invisible, in our culture? So-called medically unexplained symptoms – physical complaints that physicians can’t measure, diagnose, or treat – make people miserable and stressed, affect our work and relationships, and consume tremendous resources, including time off from work to go to the doctor, unnecessary tests and procedures, unnecessary or excessive medications, and time and money spent going from one practitioner to the next in search of relief. Lifestyle gurus like Gwyneth Paltrow and Doctor Oz make a lot of money selling advice and products to people who don’t feel well and can’t get an explanation for why. A better understanding of whatever is happening physically, mentally, and socially in the “medically unexplained” or “psychosomatic” illness experience could be of great benefit to many people.

    What inspired your own interest in psychosomatic disorders?

    Having been accused of being a hypochondriac by more than one person in my life, I wanted to better understand just what that meant: Why was my experience of illness or injury suspect? Why wouldn’t it be enough for me to say, “I don’t feel well,” and be believed? I discovered that there is a tremendous amount of misunderstanding and controversy over the so-called psychosomatic, and one very intriguing consequence is that, because of inequalities in access to healthcare knowledge, there’s a very problematic conflict between experts and laypeople over who gets to decide about – who gets to “authorize” – certain kinds of illness and pain.

    Tell us more about that.

    Even though we hear more and more about mind-body wellness in popular culture, both patients and providers hold very stubbornly to harmful beliefs about the mind and body being very separate things – which then makes it very difficult to provide integrated care to disorders that affect body and mind together.

    Does psychosomatic illness often serve as a point of intractable conflict in the provider-patient relationship?

    Based on my own and my colleagues’ research, we’ve found that there’s a marked difference between how providers and patients think and talk about the psychosomatic. We have a problem within our Western culture of healthcare, where treatment for the mind and body are considered separate things – and the former is considered less a priority in terms of funding and training. So to be fair, the average primary care provider doesn’t have a lot of support or time to deal properly with the complex problem of medically unexplained symptoms or psychosomatic illness. Nevertheless, within the culture of healthcare education, providers learn and reinforce stigmatizing beliefs about the psychosomatic or hypochondriac patient – what my colleague Louise Stone calls “the heartsink patients,” because the provider’s heart sinks a little when they have to deal with “those” patients.

    What’s the experience like for patients?

    Patients keep going to their doctors because they don’t feel well – and whatever the cause, psychological, physiological, or a combination, patients are experiencing that feeling of illness or pain in their bodies. When providers and patients can’t agree on what the problem is, they can’t communicate about it – and since there’s still a significant power imbalance in the provider-patient relationship, not only are patients sent away from their consult with no answers and no relief, they also feel as though they have not been heard, respected, or taken seriously. Patients are driven to “doctor-shop,” to make use of untested therapies, to ignore evidence-based advice, and to be selective in what they tell their providers – all behaviors that are completely understandable and yet, obviously, impede providers’ ability to care for their patients.

    On the topic of communication, in your introduction you state that the anthology is an attempt to bridge some of the knowledge gaps that confuse communication across and between disciplines. Why is it so important to bridge the sciences with the humanities and social sciences in this case?

    Psychosomatic illness causes a great deal of suffering for all kinds of reasons, and the borders that separate our various disciplines only exacerbate this problem. Laypeople, providers, and researchers – from physicians, to psychologists, to sociologists and anthropologists – all understand and talk about the psychosomatic in different ways, using different terms, and with different assumptions. And while each group talks about the others in great detail, they don’t, or aren’t able to, talk to one another at all.

    Why is that?

    There are two particular problems. Social scientists know that different cultures experience illness in often radically different ways, knowledge that is not a regular part of the average primary care provider’s training – except here at MCPHS, where we are all about the biopsychosocial model. What is more troubling is that the laypeople who are actually ill get discussed at length by academic and clinical researchers but have no voice in that discourse at all. An interdisciplinary approach to the problems of the psychosomatic is, we believe, essential for improving our understanding of the phenomenon and improving provider-patient relationships.

    How do you tackle this issue in your own classroom?

    I teach students in the first year, as well as later in their programs, when they’ve really started to form their identities as healthcare providers, and I’ve noticed how, in just a few years, the students really imbibe a lot of assumptions about the roles of providers and patients, particularly when it comes to who has the real authority in the clinical encounter – and it’s not the patients. My study of the psychosomatic has really opened my eyes a lot to how deep the divide is between experts and laypeople, in terms of access to knowledge and relative power to apply that knowledge. And I would really, really like it if I could get even a few of our students to be similarly aware, so that they can start their careers committed to establishing a more equitable provider-patient relationship.

    How do you do this?

    In a class like Narrative and Medicine, or the premed capstone, I try to provide students with readings, assignments, and discussions that really challenge them to think critically, and empathetically, about our culture’s assumptions about wellness, illness, and medical authority.

    The School of Arts and Sciences at MCPHS prepares students for future careers in chemical and biological sciences, health sciences, health psychology, premedical and health studies, public health, and healthcare business and technology.