Stress management and the psychosomatic approach
Since November, three families have consulted me regarding their children, who each began to display psychosomatic symptoms that caused a prolonged absence from school. Psychosomatic symptoms are physical manifestations in which both emotions and thought patterns are believed to play a significant role, and usually develop when a person's ability to fight disease is weakened by stress.
It is possible the physical complaints are caused by illness, such as acute infectious diseases or post-infectious chronic fatigue. However, in situations with chronic or overwhelming stress or distress, a minor illness can trigger these manifestations. Though the root may be mental or emotional, the discomfort and symptoms are real.
All three youngsters are students of top-band English-language secondary schools in Hong Kong. Their symptoms include headaches, migraines, common colds with continuous fever, and rectal ulcers with severe pain. These symptoms show up primarily during school days and subside on weekends.
This pattern confuses the parents. They wonder whether their children are 'really' sick or just pretending to be ill to stay home from school. Although the youngsters have all had problems adjusting to life at their secondary schools, they deny that their health problems are tactics to skive off school.
These problems have divided the parents: two of the mothers, who are the main caregivers, have witnessed the concrete physical discomfort of their children. Both are ambivalent about whether to force their children to go to school despite these psychosomatic symptoms. In these two families, the fathers, who see the youngsters at night and on weekends when the symptoms are less acute, blame the mothers for being overprotective and encouraging them to stay home from school. In the third family, the mother does not trust her child and blames the father for failing to be authoritative.
All three families are now having 'trust' issues in the parent-child relationships, and disagreements or conflicts in the parents' marriages.
The families have been helped to shift their focus from questioning whether the youths' complaints are 'real' or just 'in their heads', to addressing their children's 'growing pains'. In one family, the parents have recognised their 14-year-old son's frustration that despite studying hard, he failed to get top grades at his secondary school. With this knowledge, both parents and son have shifted their emphasis from academic performance to overcoming the stress of studying. The boy now considers regular school attendance with the presence of continuous rectal pain an indicator of his courage to overcome the stress of studying.
Another family whose 16-year-old son became disaffected with the challenges of his schoolwork and was distressed about his parents' marital problems received counselling. He went back to school when he understood that education was important, irrespective of the regimented system of merit at the school. He also felt relieved when his parents decided to seek counselling.
In the third family, the continuous fever of the 12-year-old daughter subsided after her parents resolved their disagreements on parenting and stopped pushing the girl to return to school; instead, they insisted she maintained a healthy daily routine by doing her own reading, getting up early, being involved in voluntary services, and taking part in a bridging programme on going back to school.
In summary, when a child encounters psychosomatic problems, the key to finding a solution is for all members of the family to trust one another, seek medical treatment, and work to alleviate the stress that coincides with the symptoms.
Dr Lau Yuk-king is a consultant with the department of social work at the Chinese University of Hong Kong