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Wonder Years

Dr Shyamala Vatsa
What severe anxiety can do
By Dr Shyamala Vatsa

Payal, a 22-year-old housewife from a Rajasthani joint family, was brought in by her husband for a consultation. She had been tearful and tense for about a month. A year and a half earlier, soon after they were married, she had been fretful, with frequent crying spells. She had then “gone blind” for five days. At that time the ophthalmologist had referred her to a psychiatrist and psychiatric treatment had helped. Her vision had returned in two days. Fearful that she may lose her eyesight again, her husband had brought her in for a consultation as a preventive measure.

The reason for her sadness and anxiety was the splintering of the joint family in which she had grown up in Rajasthan, and the subsequent sale of her childhood home. I counseled her briefly and prescribed a couple of medications for a week, to be reviewed after the course.

She turned up for a review after five weeks, in a wheelchair. She had lost sensation and movement in both thighs and legs one week prior. Two events had occurred since her earlier visit: one, she had visited her family in Rajastan and had been further upset by the family situation; her previously fit mother was bedridden with severe pain in both knees, for which replacement surgery had been advised. Secondly, she had had a bitter argument over the phone with her husband who had ended the conversation with “Stay with your Papa-Mamma, don’t come back!”

She returned from Rajastan immediately, in a state of severe tension. Two days later, she found that she could not get out of bed and stand up because she had lost movement and sensation in both lower limbs.

When I spoke to her alone she tearfully poured out all her feelings and worries about her parental home. She feared that she was wearing out her husband’s patience, and was guilt-ridden about taking unfair advantage of the accommodating nature of her in-laws.

She said she felt better after talking and requested an appointment for the following week. I prescribed an anxiolytic as she had discontinued the medicines prescribed earlier. I called the husband in and told them the medicines were just for a week, till she found her feet again – literally! Both husband and wife laughed at that, and the husband said “Just like how she got her eyesight back?”

The following week she walked into my office leaning on her husband for support, a small smile on her lips. The crying spells had stopped and she had calmed down. She spoke about her family back home in a way that indicated she had begun to accept the changes that had taken place.

When she came in for a review the next week she walked in without support, with no hint of a limp. A joint session with her husband smoothed things between them as he came to understand that severe mental trauma can cause physical symptoms.

Six years ago I had seen Debashree, a young girl from Darjeeling, who was an in-patient at the hospital. She was referred to me by the neurologist after a thorough examination and lab investigations had shown no physical abnormality. There was loss of sensation and movement in both limbs on the right side. She was around the same age and from a similar family situation as Payal, and was under tremendous stress from her in-laws’ expectations of her. In this case too, with medicines and supportive psychotherapy, sensation and movement returned to the affected limbs in about a week, although she continued to need a wheel chair for another week. Several sessions with family members were held to help them understand the connection between her physical symptoms and the severe anxiety generated by her circumstances.

There is an entirely different nervous system called the Autonomic Nervous System (ANS) that links the adrenal gland, an endocrine organ, to the limbic system—the part that controls emotions—in the brain. It works independently of the Central Nervous System (CNS), the seat of rational thought. So, people paralyzed or blind as in these two cases have no conscious motives. They are not malingering. Their disabilities are real. When unbearable stresses pile up, the ANS attempts to cope with the severe anxiety generated. The ANS is usually very successful, or else there would be many more people like Payal and Debashree. Very occasionally, the ANS is overwhelmed, leaving a person immobilized, unable to move, as happened with these two girls. The word ‘petrified’ literally means ‘turned to stone’!

The treatment given was only episode-specific. People do not come back for follow-up once their symptoms disappear. Vulnerable people like Payal and Debashree may benefit from therapy to help them understand themselves and prepare them to cope better with life’s vicissitudes. But then again, they may not. One can only hope that the sessions with the husband in Payal’s case, and family in Debashree’s case, gave them enough insights to help them protect their vulnerable relatives from such occurrences in future.

Dr Shyamala Vatsa is a Bangalore-based psychiatrist who has been practicing for over twenty years. If you have any comments or queries you would like to share, please write to her at columns@whiteswanfoundation.org