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So, if lizardinlaw (me) has a high adverse childhood experience (ACE) score, was the illness last summer of 2014 psychophysiological?

Well, good question. Ok, maybe you don't care. To summarize, I have now been off from work since May 30th, 2014. I am feeling ready to return to work. My doctors: pulmonology, infectious disease, immunology, psychiatry, otolaryngology and neurology, are now having a glorious fight about when and how to return me to work, under pressure from my disability company who support that return as soon as possible. I have the backing of a big corporation that is highly motivated to not pay me. It is a bit fun to watch the fur fly.

Dr. Clarke, from the OHSU primary care review, says that the personality characteristics of responsibility and hard work described in the last essay "produce a strong positive response from the world. Over time (sometimes a long time) this tends to overcome the poor self-esteem and eventually produces a major shift in how a person views him or herself. This major shift can be summarized as "I DESERVE BETTER."

a. Often the individual will decide that they deserve a better partner or a better work environment.

b. Often they will no longer tolerate being treated disrespectfully.

c. Often there is the idea that the individual deserved better treatment when they were children.

d. The first relationship with a supportive, respectful partner may occur at this time. This, too, can be stressful because it is such a change from the past.

e. Resentment or anger about how the individual was treated as a child may be generated at this time though it may not be consciously acknowledged. It is common for the anger to be suppressed because it is an unpleasant emotion, because childhood stress survivors spent years learning how to control emotion and because the anger is often directed at people about who there is still some caring. When there is enough of this anger present it can cause physical symptoms that can be mild or severe or anywhere in between. Many people are unaware of how much anger they have. Highly educated people often have the most difficulty comprehending their level of anger.

f. Imagination techniques to uncover anger: pretending that you are watching a child you care about endure the same environment you did; pretend you are overhearing a conversation between a child you don't know who suffers as you did and the child's parent.

g. Often it is during this time of significant change in self-image that physical illness occurs."*

Regarding last summer, I think the answer is both. I had physical illness: systemic strep A with sepsis symptoms, affecting lungs and muscle and brain. I still had abnormal lung tests in October, which cleared by December. I coughed from May 30th and was hoarse until Thanksgiving. However, I could sing and did two solos, so part of the hoarseness was laryngospasm. I need to learn to speak the way I sing, with throat muscles relaxed. Or I could just sing all the time. The singing doctor. I think it's comic. So the laryngospasm is the psychophysiological bit: it's real, and I think some of that voice and throat tension is from feeling silenced as a female and as a female rural physician. Anger or grief tightening the throat. The strep A is a real infection. There is a psychophysiological aspect to that though, in that I think my immune system just was fairly useless after I spent a year grieving about my sister, father, handling his estate and working full time. Dumb, really. Hello, doc, ya need to rest sometimes. Maybe I have learned. We will see if and when I return to work.

It's not clear if I had delirium or anxiety related to systemic infection or adult PANDAS - Pediatric autoimmune neurological disorders related to strep A. A physician diagnosed me with PANDAS in 2012 but he then retired. And the present physicians don't believe in it in adults. Ok, that was a really catch-22 moment: the psychiatrist these doctors sent me to in 2012 diagnosed something that these doctors don't believe in. They said, "Stop self diagnosing PANDAS." I said, "I didn't! YOUR DOCTOR THAT YOU SENT ME TO DIAGNOSED IT." Frankly I don't care what they call it. Strep brain, PANDAS, delirium, whatever. I finally felt that that was better in mid January. Whew.

Regarding anger, unlike Dr. Clarke's description, I've always been able to connect with anger. What I had trouble with was everything else: grief most of all. I was also the family anger lightning rod, and I gather that the grandmother I am named after, the wife of the psychiatrist, was also famous for her anger. I adored her and was respectfully a bit afraid of her.

June 11 and 12, 2014 I wrote too many posts. I was trying to nail down my thoughts about the strep A and PANDAS. There are currently 6000 strains of strep A described. There may be a rogue one that has managed to dwell below the tonsils and can't be picked up with a throat culture. I have been told not to worry about it. This is a bit more challenging after getting sick the second time, but perhaps I just need to take more time off...... I don't really regret getting in trouble for posting too much, because I think it's an interesting record of delirium. The strep did not talk to me, but those two days I thought perhaps I wouldn't survive. I wanted to leave a record if I did die. I am happy that I didn't die .... nearly all the time.

I am looking forward to working more on psychophysiological disorders and working with people with high ACE scores. I am thrilled to have had lectures at the Portland OHSU primary care review from other physicians who are working for and on these issues too. Great joy.

*Dr. Clarke has kindly given me permission to quote from his work. This is from his handout at the 46th Annual OHSU Primary Care Review.

Further reading, that I am looking forward to:
They can't find anything wrong!, by David Clarke, MD. See also http://www.stressillness.com/

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