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Too Much Can Get You in Trouble

January 4, 2022

The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.”

John Milton, Paradise Lost

It is certainly beneficial to be focused, aware, mindful and intentional. Homing in on the figurative “signal” while ignoring the “noise” takes a particular talent and skillset. Humans are constantly bombarded with sensory input from within our bodies and from external sources and it is our choice about what to focus on and what to ignore, although this is not always an easy task. Focus is clearly a good thing, but hyper-focus can be fraught and hazardous to one’s health.

When experiencing physical symptoms of any sort, one’s attention is naturally drawn to the area of concern. For example, when a woman has a urinary infection, she typically perceives urinary urgency, pressure and discomfort. Intense symptoms simply cannot be ignored. Hopefully, after treatment of the infection, the presenting symptoms disappear and life goes back to normal. However, what happens on occasion is that despite resolution of the symptoms, one’s focus on the area of concern does not relent. Even though the infection and symptoms have resolved, the unabated hyper-focus may continue. What previously was “back burner” becomes “front burner.” “Front burner” status persists and with the hyper-focus, normal sensations are amplified, often engendering worry and anxiety. In a vicious cycle, the worry and anxiety can then give rise to genuine physical symptoms on a psychosomatic basis, further exacerbating the situation.

This post-urinary infection hyper-focus and anxiety may lead to pelvic floor muscle hypertonicity and spasm. The constant attention to one’s bladder sensations may lead to more frequent urinating in an effort to relieve perceived urgency. Given enough time, a maladaptive habit can develop and be perpetuated, resulting in a patient with a problematic urgency/frequency syndrome. The ideal management is for the patient to terminate the hyper-focus (much easier said than done) and ignore the initial bladder sensation of filling as do most normally functioning people.

This same scenario may arise from ANY kind of medical process originating in ANY body area. This may occur when one has a toothache that ultimately improves or resolves, but because of unrelenting hyper-focus one does not know if they still have true and persistent real symptoms or if the symptoms are on a psychological basis. The symptoms may be exacerbated when one attempts to examine, probe, prod, and manipulate the area of concern.

In urology practice, this scenario often presents itself. For example, a young man perceives discomfort or pain in his testes either for no apparent reason or perhaps because of a minor trauma and as a result he becomes overcome with fear. He Google searches the issue and his apprehension and anxiety ramp up as the search seemingly confirms his most pessimistic thoughts. He examines himself repetitively and the self-manipulation, squeezing and poking create further discomfort, which exacerbates his agitation. By the time he arrives in the office–often with a ream of documents printed from the Internet detailing the differential diagnosis of his disease– he is an emotional mess, unhinged with trepidation, his mind hijacked, obsessed, and spinning out of control with the original discomfort having morphed into a magnified and terrifying version of its former self. Oftentimes, after the physician listens to his history carefully and empathetically, validates his concerns, examines him and perhaps does an ultrasound to reassure him, the patient leaves the office restored, refreshed and renewed, rebooted like a glitchy computer.

Here is a brief exercise on hyper-focus: If you’re wearing a watch and/or ring, bring your full attention to their presence. Put all of your focus on their weight on your body and pay careful attention to the sensations perceived. After a while, their presence will likely start to annoy you, as what is usually background becomes foreground. If you continue this hyper-focus, sooner or later you might feel like removing the watch and ring as their presence becomes increasingly annoying. Hyper-focus may cause an individual to remove an annoying band-aid that makes its presence known and keeps one from falling asleep, or more commonly, makes wearing a cumbersome device like a CPAP mask for obstructive sleep apnea an absolute impossibility.

I have experienced some minor but intrusive impediments to vision and hearing–floaters within my visual fields and a constant, low-level ringing/humming in my ears (tinnitus), respectively. There’s not a thing that I can do about either, so I make a conscientious effort to ensure that these intrusions are back burner and not front burner, or else I would be plagued by their presence. As a wise ophthalmologist once told me regarding floaters: “Sit back and enjoy the show…it’s the best you can do.”

Extreme focus on bodily sensations, symptoms and even thoughts can lead to the maladaptive process of catastrophizing, in which there is significant amplification of the sensation, symptoms and negative thinking. This can result in a vicious cycle of greater perceived intensity and duration of the sensations, symptoms and disturbing thoughts. Focus, but not too much!

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