Heart Burn

Oct 16, 2017 | Articles

Since I’ve been studying the Post Traumatic Stress Disorder treatment technique called Somatic Experiencing I’ve learned to listen really intently to people’s symptoms. It is not uncommon for people to come complaining of, for example, heart burn.  That term carries a lot of weight – some of it earned and some of what we might call baggage.

The weight comes from the association of the sensation that stomach acid produces when it refluxes back up and out of the stomach and into the esophagus. This sensation often is burning in quality and appears to come from an area on the left-ish side of the chest and up front – in the area where the heart resides. So – it really is a pretty good “label” for a common problem – gastroesophageal reflux (often simply called GERD).

The baggage comes from the idea that a lot of symptoms that occur in the same area of the chest get called heart burn and thus implies a cause – acid reflux – when the symptoms may have nothing to do with that phenomenon. The baggage of the term also is carried along by lots of assuming – sometimes by well-intentioned friends but also often by treating physicians.

I once saw a man that had been suffering from “heart burn” for 4 years. He had been treated by his primary care physician and several different gastroenterologists with a number of different medications designed to reduce the production of stomach acid at a variety of different dosages – all without effect. No one had ever seemed to question what, in his case, might be causing the symptoms that got labelled heart burn – although he had had several endoscopies and biopsies – all yielding equivocal findings. A barium swallow study I ordered failed to show any reflux.

We explored in more depth the nature of the sensations that he was having. During a quiet and reflective session where we had a lot of time and patience and where he had the opportunity to actually explore the feelings, we discovered the word “pressure” seemed a more accurate term than “burn”. And when asked to be a bit more precise in its location, we began to see that the distribution spread out over more the front of the chest than we might anticipate if it was coming from the esophagus.

We looked for other words that felt “right”.  This is often a clumsy and difficult process. I find that people have trouble actually focusing on sensations and describing them.  We seem to prefer to leap to an explanation of cause rather than explore feelings. I understand this.

Kathleen will on occasion ask me why I’m “sad” or “depressed” or “mad”.  And I’ll often say – “well I’m not “sad” or “depressed” or “mad”.  And she’ll stay quiet and I’ll understand that is time for me to reflect and sure enough – unless I’m too mad – I’ll come to realize that I’ve actually been feeling some emotion quite intensely without registering it.

It’s not uncommon for me to ask a patient what is the matter with them and they’ll give me a complex explanation like, “I’ve got mold sensitivity and small bowel overgrowth”; and I’ll say – but how do you know you have these things – what are they doing to you that makes you think you have this problem? And they’ll be stumped.

As the patient with the “heart burn” and I continued to explore the nature of his symptom, the idea of pressure migrated into a feeling of heaviness. He often felt like it was difficult to get a good breath. He felt like something was sitting on his chest – that he was carrying a burden. We wondered together if that might be true – and it was true. He was working long hours at his job, he had a wife at home with a chronic illness and three young children.  He felt overwhelmed. He was not sleeping well and when I asked him if he might be worried – he began to cry.

And this was the beginning of the cure for his heart burn.

To Your Health