Psychosomatic Medicine 63:994-995 (2001)
© 2001 American Psychosomatic Society
Improved Chest Expansion in Idiopathic Scoliosis
Martha C. Hawes, PhD
University of Arizona, Department of Plant Pathology, Tucson, Arizona
A recent case report, of which I am both patient and first author, describes recovery from symptoms associated with idiopathic scoliosis (IS) (1). In adults, IS is considered to be irreversible except by surgery. Yet 2 months after the onset of a period of psychological decompensation (DSM 309.81, posttraumatic stress disorder, chronic type), spinal and torso deformities that had been fixed and rigid for decades suddenly began to change, and 8 months later a marked improvement was apparent (Figure 1). During this period, treatment was limited to emotional catharsis in response to acute physical pain, plus individual and group therapy (1). Relief from pain occurred in correlation with the recall of childhood experiences for which I had been amnesic, and with incremental shifts in torso morphology. My history includes physical and emotional abuse and multigenerational mental illness on both sides of the family.
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Fig. 1. Appearance of back when photographed in a relaxed, standing position in April 1992 (left) and in November 1992 (right)
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IS is correlated with psychosocial issues including a positive relationship between the degree of deformity and the degree of psychological disturbance (2–4), and increased suicidal thought among IS adolescents compared with controls (5). IS-associated psychological distress has been presumed to result from cosmetic concerns about the diagnosis of deformity (6, 7).
The possibility that psychological distress could be a cause instead of an effect of IS has not been evaluated. This is despite reports of "hysterical scoliosis" in which children "could be tricked into relaxing it when placed in an unusual position. With the child lying prone, when there was good rapport, it was possible to eliminate the deformity completely or almost completely by suggestion and gentle manipulation" (8). In other words, kindness and gentle touch were used to reverse spinal deformity which occurred in children "as a manifestation of their neurosis" (8). Contemporary textbooks emphasize the difficulty of distinguishing true "structural" deformities from "functional" curvatures like hysterical scoliosis (9, 10). Curvatures induced by incorrect posture or leg-length discrepancy are other examples of functional scolioses, which do not involve vertebral rotation and rib deformities that occur in cases of structural scoliosis like my own (1).
The prediction that a functional curvature due to psychological dysfunction could evolve into an irreversible structural deformity would seem to be a hypothesis worth testing. Nearly 3% of the world’s children develop IS, and it is impossible to predict which cases will progress to a crippling deformity requiring traumatic medical intervention (11). Although school screening programs are in place worldwide, there is no accepted method to treat IS at early stages (12). The possibility that some afflicted children have curvatures that might respond to "good rapport and gentle manipulation" (8) if treated during their formative years, has not been examined.
During my recovery, spinal curvature served as a rapid, reversible physical marker for psychological distress. A nondestructively quantifiable "marker" involving reconfiguration of the spinal column and all its parts has potential application in measuring mechanisms by which emotions stimulate physiological and neurological reactions leading to pain and disease.
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