Author: Shana L Johnson MD, AskDrShana

 

Leaning In

How an overworked mom went numb from stress. Jenna was a 30-year-old mom with a precious four-year-old named Chase. Her son, Chase had big, blue eyes and an even bigger heart. Chase was on the autism spectrum. He needed extra help with talking and communicating in an understandable way. Jenna and Chase attended speech therapy a few days per week.

Chase also had sensory processing differences that caused him to experience pain with normal environment sounds and smells. His intense senses could not tolerate the sounds or smells of a grocery store or restaurant. Chase would dissolve into sensory meltdowns. His nervous system was so overwhelmed and overstimulated in everyday environments that he would start screaming and running around until Jenna moved her little boy to a quieter place. Meanwhile, the glares of others judging her for being a bad parent burned through her.

It took years before Jenna understood why Chase seemed so out of control in public places, yet so calm at home.
At home, in a quiet environment, Chase was the most loving soul. The disconnection from the world around her was stressful. He had an interesting perspective on the world, seeing things Jenna didn’t. He saw things the world didn’t. The little boy noticed details. He noticed people. Everything Jenna thought she knew about autism was wrong. Chase’s brain was wired differently but in the most fascinating ways. If only the glaring, judgmental observers could see this, too. If they could just see the gifts that neurodivergence brings, instead of only seeing the disability. This disconnect from the world around her was stressful.

Jenna worked as a patent attorney in Seattle, and she was a smart one. She enjoyed working with aspiring innovators, writing up their latest ideas for patent submissions. She yawned at all the big corporate patents she churned out but felt purpose when drafting a patent for a local inventor. But she felt increasingly deficient in her ability to do good legal work and also be a good mom.

 

Falling Over

When I met Jenna, she was calm and composed but looked somber. With worried eyes, she explained that the right side of her body had started going numb for a few hours at a time. It had started a few months earlier and had increased in frequency. Now, the numbness in her right arm and leg occurred weekly and remained longer. Jenna was concerned that she might have developed a serious neurologic disorder, like multiple sclerosis (MS).

The numbness on Jenna’s right side had an interesting quality. It did not follow the pattern of the nerves in the body. Usually, numbness appears in the region of the damaged nerves. That said, the body doesn’t always read the neurology textbook when developing disease so we pursued a thorough evaluation. Reassuringly, testing was negative for a traditional type of neurologic disorder, such as multiple sclerosis or brain tumor. Let me clarify, it was negative for a medical disorder with a visible area of damage that I could point to and explain her symptoms.

The negative workup, however, did not mean Jenna was ok. Her symptoms indicated a serious problem. Her body was beyond stressed, at its breaking point, and screaming for help. In her case, long-standing overwhelming stress triggered her neurologic symptoms. She was suffering from a stress-related disorder called functional neurologic symptoms disorder (FND or conversion disorder). FND is when someone develops motor or sensory deficits, such as weakness or numbness, with no neurologic explanation. The neurologic deficits do not follow the pattern of known neurologic disorders. There is not a visible tumor or stroke. The problem cannot be visualized by medical tests.

Often, conversion is precipitated by an acute stressor, trauma, or adverse life event. With FND, psychological stress results in physical symptoms not consciously controlled by the person. They are not faking, they truly feel one side as numb or weak.
How psychological stress results in physical symptoms is poorly understood. The lack of understanding is perhaps why there is so much stigma and negative judgment around it.

Advances in functional imaging have started to provide clues for how conversion disorders happen. How psychological stress results in physical symptoms. Functional imaging shows what areas of the brain are active during certain tasks, such as picking up an object or during experiences, such as feeling back pain or leg numbness. Studies have revealed there is a change in the brain’s processing in people with a conversion disorder. Studies show areas of the brain activated by emotional stress leads to reduced sensory or motor processing. For Jenna, overwhelming stress resulted in her not processing sensory information on one side, thus the numbness.

For Jenna, long-standing, overwhelming stress triggered her neurologic symptoms. So, what now? There was no life stress switch we could just dial down. We first needed to build awareness of her symptom triggers. I recommended Jenna keep an Awareness Journal to track when the numbness episodes occurred. She wrote down a couple sentences of how she was feeling at that moment and what she was doing. Did the numbness follow a 12-hour workday? Sleep deprivation days? Sick child days? Days or weeks with all three?

The Awareness Journal revealed a pattern to the numbness. It occurred during time spans, often weeks at a time, when she was on a tight work deadline and Chase was having frequent meltdowns. Of note, an autistic or neurodivergent meltdown is not your typical tantrum. The episodes can last for hours as their little bodies struggle to self-regulate. Meanwhile, the parent struggles to find and remove any sensory triggers.

Journaling also uncovered other insights. Her writings exposed that Jenna felt she was always failing as a mother or as an attorney or both. When she did her work well, she didn’t feel she was meeting Chase’s needs. When she met Chase’s needs, her work suffered. She felt bad at everything. And that made her feel worse. Feeling like a bad mother and bad attorney was a stressful combination for Jenna.

Jenna and I had a difficult conversation as I explained that the level of stress she was under was not sustainable. Her lifestyle had provoked a stress-related disorder. If her stress level were not lowered, her condition would only get worse. The conversation was tough because I was painfully aware of how unrealistic it is to tell a working mother to just “reduce stress.” No less, a working mother with a special needs child. Like she was working herself sick by choice. Like she wouldn’t get more help if she could. Like she wouldn’t secure more resources for Chase if she could.

That said, I found it helpful to give people the permission to take care of themselves. Pointing out their body was breaking down helped. Clarifying they were not “weak” helped. Reassuring them they were not alone helped. And it certainly helped to hear this from a medical professional.

 

Getting Back Up

Jenna and I discussed what taking care of herself would look like. From her entries in the Awareness Journal, we created a plan. A specific plan. What exactly needed to happen to improve the situation. For Jenna, she needed to reduce the total number of weekly demands between work and parenting. She reduced her work hours from full-time to three-quarters time. No more taking on additional work projects.

Then, she adjusted her “mom schedule.” Normally, each week Chase attended speech therapy to help with communication and occupational therapy to work on his sensory processing differences. Reluctantly, but realistically, Jenna reduced the number of therapy visits they attended each week. Occasionally, they even took a two-week “therapy break”—a special needs vacation to just be present. Jenna needed a schedule she could sustain over the long term. She needed a reset.

While making these changes, Jenna continued to keep an Awareness Journal to mindfully track her symptoms. This activity strengthened her mind-body connection. She noticed how, as the feeling of being overwhelmed grew, her right arm and then her leg would start to tingle. Just making the connection that her right side was going numb due to being overwhelmed helped her pause and recalibrate. Developing her awareness of what the numbness represented helped to decrease it. Jenna gained awareness of the mind-body connection that the numbness was a physical signal from her body to slow down and take care of herself.

As Jenna’s understanding of stress’s effect on her body improved, so did her ability to manage it. She let go of striving to be the absolutely perfect parent and the absolutely perfect career woman at the absolutely same time. A little awareness makes a huge difference with stress-related disorders.

Over the next six months, Jenna’s symptoms improved. The numbness episodes decreased in frequency from weekly to only every few months. When the numbness returned, it was a signal she needed to pull back from her “to-do” list and prioritize her health.

For Jenna, building awareness and reducing her stress level were the key factors for healing. Her “fight or flight” stress response had remained in the “on” position for too many years. She worked a demanding job during the day, and cared for her special needs son at night, enduring too many hard days over far too many years. She had no time for rest or recovery. Long-term, overwhelming stress, which includes psychological and emotional stress, provoked a stress-related disorder.