I am in a maddening situation. About a year ago, I started to itch. This itch migrates…it rarely is in the same place for very long. It is very distracting, and I am always tired from trying to function through it, or over it. First I went to mainstream doctors, then to specialists. The good news: nothing was wrong. The bad news; nothing was wrong. After a while my internist seemed to lose interest, to not realize how much I was suffering. Finally, in an exasperated voice, he said, “ I think you need a shrink”. I am no dope. I know that a shrink does not treat itching. This was totally unhelpful and disappointing.

I finally went down an alternative medicine route. This practitioner suggested that I consult a therapist too! As much as I think this is absurd, I am sobered that two people have said the same thing. I said to this doctor, “Just how is that going to help? And she said, “That is something to take up in your treatment.” I felt dismissed, even patronized. Infuriating!

So, now I am asking for your opinion. And even more, maybe you could explain to me how psychotherapy is better
than a pill or a cream? I still believe I need to find the right kind of specialist and the right kind of medicine.

Dr. J replies:

Itching, along with nausea, is among the most baffling and complex of disorders, and you are correct that many doctors become irritated when their limitations to “fix it” are exposed. I think your doctors have failed to articulate the mind-body connection, possibly because they underestimate it themselves, or perhaps because they felt you were unreceptive at the time to considering it.

You ask how psychotherapy could be better than a pill or a cream, but you have been quite clear that you have gone the medical route, and even alternative medical route, and you didn’t get any relief. So, it is unlikely that yet another pill or cream will cure you.

I do think there is something wrong with you, and it manifests itself in a very real, very problematic physical symptom. However, that does not mean its true origin is not inside your head, something psychological. A psychologist will pursue a detailed inquiry into precisely what was happening in your life just before the symptom began, any patterns in the locale of the itch, and how it affects your life right now. This would include what activities this itch precludes and how your symptom affects the people around you.

This is a symptom I would call “psychosomatic”, but not because it is in your mind, in the sense that you are imagining it. That is a common misunderstanding. It means that its point of origin is between your ears…it begins in your mind. Your body is telling you about some kind of problem, some kind of past or present distress. But bodies have no language…they cannot put this pain into words…so they “talk” through physical symptoms.

The process of therapy is one of listening to what the body is saying in its own way, thus “decoding” the symptoms, helping to put the underlying issues into words. It is not called “the talking cure” for nothing. Even if therapists debate between themselves over how therapy works, they do agree that it does work, or at least that it sometimes works.

You have nothing to lose by giving it a try. Except your itch.