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It’s Not Necessarily All in Your Head

The smell of garbage was strong enough to be disturbing. The young man repeatedly looked for the source but couldn’t find it. “Do you smell it?” he would ask friends. “Do you smell it?” His friends and his brother would exchange that quick glance of exasperation and pity. This had been going on for weeks. No, they didn’t smell it. There was nothing there. It must be all in his head.

Becoming increasingly depressed, the young man made an appointment with a highly respected analyst. He went to several sessions every week for five years to try to unearth why he would persist in having these olfactory hallucinations. Perhaps good therapy did happen. Perhaps he discovered things about himself that were helpful and added depth to his life. But what didn’t happen was a thorough medical exam.

An excruciating headache finally sent the young man to a doctor who diagnosed a brain tumor. The operation to remove it was successful but the patient died. And the world lost one of its greatest American composers, George Gershwin. He was only 38 years old.

I’ve imagined Gershwin’s interactions with friends to make a point. The facts are true. He did see an analyst three times a week for five years for olfactory hallucinations. And he did die from a brain tumor that was diagnosed too late. Sadly, his story is not that uncommon. Patients with vague, unusual, or persistent symptoms that don’t respond to treatment are frequently referred to a psychiatrist or a counselor. But there are many things that can be mistaken for mental illness. Before you tell someone you love (or yourself) that it’s “all in your head,” make sure that these other bases have been covered.

Underlying Medical Conditions

Feeling depressed? Low-grade anxious all the time? Having memory problems? Diminished sex drive? So preoccupied with sex you can barely think of anything else? Maybe you have some vague aches and pains. Perhaps friends and relatives are getting tired of hearing about it. Maybe they have even suggested that it’s “all in your head” and you should see a shrink. Or they might have suggested that you get some of those antidepressants or anti-anxiety medications that are advertised on TV.

Not so fast. There are many, many medical possibilities for how you are feeling. Symptoms of depression may be the result of a low-grade infection, an over- or underactive thyroid, a vitamin deficiency, or electrolyte imbalance. Panic attacks may be the result of a tumor that secretes epinephrine or a symptom of hypoglycemia (low blood sugar). Mood disorders can be caused by a minor stroke, may be the first sign of a neurological condition (such as Parkinson’s or Huntington’s disease), or could be the result of certain cancers (such as pancreatic cancer).

Certain infectious diseases (such as HIV and other autoimmune diseases like multiple sclerosis) can cause personality changes, as can thyroid conditions, a brain tumor, or a blow to the head. Sexual dysfunction? Before you delve into your deep-seated feelings about sex, it may be that this too is a health issue. Endocrine conditions such as diabetes and pituitary dysfunction can decrease or increase your desire for sex and your ability to achieve orgasm.

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Therapists live, online right now, from BetterHelp:

The list goes on. Before you see a psychologist for what ails you, see your doctor for a thorough workup. Explain your symptoms and ask if it is possible that there is something physically wrong.

It’s Not Necessarily All in Your Head

Marie Hartwell-Walker, Ed.D.

Marie Hartwell-WalkerDr. Marie Hartwell-Walker is licensed as both a psychologist and marriage and family counselor. She specializes in couples and family therapy and parent education. She writes regularly for Psych Central as well as Psych Central's Ask the Therapist feature. She is author of the insightful parenting e-book, Tending the Family Heart.

Check out her book, Unlocking the Secrets of Self-Esteem.

APA Reference
Hartwell-Walker, M. (2020). It’s Not Necessarily All in Your Head. Psych Central. Retrieved on September 23, 2020, from
Scientifically Reviewed
Last updated: 17 Jan 2020 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 17 Jan 2020
Published on Psych All rights reserved.