Sunday, May 22, 2011

Stomach grumbling [borborygmi] not an indicator of hunger but nerves/somatic anxiety

My stomach often rumbles, grumbles, gurgles, growls, the choice of verb depends upon who is listening and how he or she wants to describe it. Medical people pompously call it borborygmi. There is lots of money in converting simple words to medical tongue twisters.

If this happens while I am seeing patients, it generally causes mild amusement and sometimes uneasiness. For Americans find the rumbling of stomach as something to be embarrassed about. No doubt, because the noises are emerging from the GI tract, and that naturally arouses associations with other functions of that organ which must be hidden from the public. To cover up this embarrassment, patients invariably remark, jocularly of course, that they need something to feed their stomach. It is interesting in this context they usually talk about their stomach as a separate entity and in the third person. As if something you are embarrassed about you want to disown and not be a part of.

For example, yesterday, a patient remarked with considerable consternation at his rumbling stomach , "Man, this stupid thing is growling like a dog that just got a beating."

When I tell them that the stomach growling has very little to do with hunger and is actually the result of nerves which are finding discharge for the tension through [involuntary] muscles of the intestines, they do not believe me. Even if I tell them I just had my meals, and in my case the stomach growling occurs more often after a meal than before, they don't readily accept it.

For the belief that stomach rumblings are due to hunger is part of the American folk wisdom.

But an occasional patient will show courage, and go beyond her belief system, and rely upon her observations to come to the right conclusion. An obsessional neurotic lady, who must apologize for everything as a compensation for her obsessive acts and as a means to allow the pangs of her conscience to emerge as pangs of intenstinal contractions, could not tell me enough in the session as to how embarrassing those sounds were. "I don't understand why I am having this when I could swear to you that I just ate. It shouldn't be doing that. My stomach has no business going to town like that."

["Going to town" phrase specifically arose in her mind because her unconscious wish, the chief factor behind her neurosis, is to have sado-masochistic tryst with whoever crosses her path in the streets of her town. She suffers from agoraphobia as a consequence of this unruly impulse, though she is completely unaware of such a tendency in her in her conscious mind.]

Another patient had it clearly figured out that her stomach noises were a reflection of anxiety. "I get frank anxiety attacks over it. When the gurgling is going on, I feel nauseous, my stomach feels tense as a drum and I worry if my appendix is going to burst. I can tell when my panic attack is about to occur. I feel its aura in my stomach."

It is interesting when one person's stomach is making noises, the person hearing it often responds to it by starting the same reaction in her intestines; like an involuntary sympathetic response to the nervousness of the other person. Not unlike how if one person yawns the ones watching him start doing the same.

One of my patients when I told her that stomach rumblings is due to anxiety, vigorously disagreed, and insisted that it is due to hunger, but confirmed the correctness of my observation by starting the rumblings of her own stomach, about which she felt very embarrassed, for she had to admit that whatever was causing it was not so much an organic process as psychogenic, for not a trace of it was present till we began talking on the topic.

On reading the Wikipedia I find that this noisy behavior of intestines is attributed to normal aspect of digestion.

I beg to differ. I think all that loud noises the stomach makes has less to do with digestion than an increase in intestinal motility due to nerves. We do know that when a person is highly anxious it gives him the "runs". In fact there are all kinds of colitis from Irritable Bowel Syndrome to Ulcerative Colitis which have at its root an attempt to symbolically get rid of whatever is causing the stress. The movement of intestine which goes beyond the function of digestion is primarily an attempt to get rid of stressful people, who are active in one's life at that point, by unconsciously treating them as pieces of shit which need to be evacuated out of the system via the excretory organ.

Depending upon how much stress one has, one can have a continuum of GI irritability - from simple borborygmi to deathly ulcerative colitis.

In this context one way mention that human flatulence also often is a symbolic attempt to blow away the hated stress-producing objects. People who complain of "gastric trouble" and are full of gas are really using the GI tract to get rid of stress. They constantly produce gas which causes discomfort - symbolic of the distressful stress in their lives - and then release it in flatulence, which gives relief - symbolic of getting rid of the stressors. It should not surprise us that a person in stress often has more urgent and more smelly flatulence. As if more stressful the world quicker and stinkier is our response to it.

It may not be inappropriate to add here that the relief from such a self created intestinal bloating through flatulence produces pleasure and release of dopamine in the reward centers, which must reduce the pain of the stress that one is experiencing in some other part of the brain. So the reason d'etre of this psychogenic overactivity of the GI tract is to produce pleasure to counter the harmful effects of stress. The whole process is not too different from how under stress we eat to produce pleasure, dopamine release and reduction of stress.

This role of flatulence as a stress reliever I can frequently confirm in my own self. I have found that if someone cuts me off on the road, or irritates me in some other way, and I can do nothing about it, like give him the "finger" - the jerks make sure to avoid your gaze after intruding into your space behind the safety of their car - after a little while, I develop a slight discomfort in my chest which rapidly changes in to a queasiness in my intestines. The psychological feeling accompanying it is as if I am bloated and carrying excessive baggage. Then I perceive the urge for flatulence, which when indulged in, takes away the discomfort and along with it the perturbed mood, anxiety and the anger towards the piece of shit who had cut me off. The whole process seems to me as a method which my system utilizes to take away the tension off my chest back to the outside world from where it came, accomplishing it through the medium of my bowels .

So intestines play a huge role in us to discharge anxiety through somatic means. And it is not just from lower GI tract. The upper GI tract with churning and butterflies in the stomach does the same thing. And they all make a racket while doing it, which we euphemistically believe is taking place due to simple hunger.