They Can’t Find Anything Wrong!

7 Keys to Understanding, Treating, and Healing Stress Illness


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Diagnostic tests are unable to find the cause of symptoms in at least half of all medical patients, most of whom are ill because of hidden stresses. Dr. David Clarke has done pioneering work with over 7,000 of these patients, often sent to him as a last resort. In plain language he describes the major types of stress and explains steps for treatment with a range of effective techniques. Case histories that read like medical mysteries illustrate the concepts and make them easy to apply. This significant book offers real solutions to put a stop to the stress illness epidemic.

Dr. Clarke is a clinical assistant professor of medicine at Oregon Health Sciences University and a clinical lecturer at Pacific University, and he has had a private practice since 1984. He developed an award-winning monthly seminar on stress illness, and local doctors have given their patients 50,000 copies of his brochure on this topic. He lives in Portland, Oregon.

Click here to read about the book from Elle Magazine.

Click here to read an introduction to stress-related illnesses by the author.


Praise for They Can’t Find Anything Wrong!


They Can’t Find Anything Wrong! is a spectacular accomplishment. It offers a refreshingly practical approach to problems that have been tying doctors and patients in knots since medicine became a science. By teaching through story telling, it speaks equally well to patients and health care professionals. Dr. Clarke’s methods have made me a better doctor by allowing me to help patients I otherwise wouldn’t know what to do with.

—Erik Fromme, MD, Assistant Professor of Medicine (Hematology & Oncology; Palliative Medicine) Oregon Health Sciences University, Portland, OR

It has been a long time since I have read anything in medicine as illuminating as this book. I have always prided myself on being a good listener and uncovering hidden issues in patients but never realized how much I was missing. Even as a tenured Professor, from this book and its insights I have learned more than from any other educational source in medicine.

—Brian Fennerty, MD, Professor of Medicine (Gastroenterology), Oregon Health Sciences University, Portland, OR

I found the book extremely valuable and clinically relevant. The rich array of examples is a powerful illustration of the therapeutic efficacy of skillful clinical listening. Dr. Clarke offers lessons that every clinician and patient can learn from. And the book is extremely readable; I literally could not put it down and read it all in one sitting, something that rarely happens with a book that is also making such subtle points about the human condition.

—Jodi Halpern, MD, PhD, Associate Professor (School of Public Health), University of California, Berkeley, CA; author of From Detached Concern to Empathy: Humanizing Medical Practice

Dr. Clarke’s book is required reading for our physician assistant students. Learning to assess stress illness should be part of every clinician’s medical education. His book is an invaluable resource for teaching medical providers to evaluate and manage stress illness.

—Judy Ortiz MHS, MS, PA-C, Academic Coordinator/Associate Director/Associate Professor, Pacific University School of Physician Assistant Studies, Forest Grove, OR


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New health policy in the United States is finally demanding integrated medicine along with the development and utilization of outcomes measures for cost containment and to increase quality of care. For many places, especially rural health clinics, this is a new concept. The traditional family practice setting is one that promotes seeing as many patients as possible in a day, spending an average of 7–15 minutes with each patient. If a patient has something more complex, they are often sent to one or more specialists to diagnose what are eventually determined to be ‘medically unexplained symptoms.’ Thousands of dollars, and years of frustration are spent on expensive testing and hospitalizations to treat symptoms of mystery ailments. Most of these are not somatic. In fact, the symptoms and consequences are very real, but primary care providers have rarely taken the time to determine of a patient has ‘stress illness.’ Evaluating patients for psychiatric issues that can physically cause major illness is the theme of this book. Stress illness is an important factor to consider when integrating behavioral and physical care into primary care on a daily basis. The recognition of stress illness can heal patients, and can prevent costly unfruitful trips to specialists.

Dr. Clarke gives very clear guidelines for evaluation of stress illness, both at home, and in virtually any type of medical setting. He gives examples of several insightful case studies of patients in every age group who have been sick for years with stress illness. He lists the key points to understand symptoms, evaluate the patient, and treat the illness, while helping the patient to comprehend the importance of how the mind can affect the physical body. The book is outlined with chapters that are divided into types of stress illness, including childhood stress, current stress, traumatic stress, depression, anxiety, and multi-factorial stress. Patient barriers and resistance to treatment are also addressed. Chapter 11 discusses stress illness and the health care system, suggesting that patients be educated about stress illness by medical providers, nurses, and even through lobby brochures. The general conclusion of Dr. Clarke is that by educating patients with regards to stress illness, this may not only decrease frequent clinic visits, but also empowers patients to help themselves.

The book is comprised of 11 chapters, divided into 3 Parts; Part 1: “A new look at an invisible illness,” Part 2: “Causes, consequences, and treatment of stress illness,” and Part 3: “Connections,” which outlines family involvement. The book has 192 pages plus index, content page, author information, and references. The strengths of this book are the multiple interesting case studies, the guidelines to educate patients, and the overall discussion about diagnosing stress illness. The book, however, is written for patients to read, so does not always elaborate on medical findings or research for the medical professional.

Overall, this book, although it is written for the public, is a ‘must-read’ for primary care providers, patients with on-going undiagnosed ailments, and even medical specialists. It provides great insight into an illness that is underdiagnosed and rarely addressed. Medically unexplained symptoms are associated with high medical-utilizing patients seen frequently in clinics that can exhaust resources and staff. This book is easy to read, and provides a possible solution to help heal those who have been difficult to treat for years. The integration of behavioral with physical health will be mandated in the near future, therefore, learning about stress illness and treating it appropriately is equally as important as treating all other chronic illnesses.

Integrated care typically utilizes disease management systems that encompass not only cost savings, but also improvement of services, while also providing better case management for patients. Part of improving disease management protocols is to include behavioral care, for both preventative and empirical care. For instance, statistics show that a significant percentage of the diabetic population has co-morbid depression. The goal of including behavioral care into the diabetic management protocol addresses mental health, medication compliance, diet plan, treatment, and outcomes before they become an issue. Patients, however, have difficulty participating in a treatment plan when they have chronic abdominal pain, chronic headaches, chronic back pain, or other medically unexplained symptoms that must be addressed first.

This book provides a good starting point to understand connection of mind and body and should be in every clinic with respect to integration of behavioral care. It explains how stress illness can literally dictate the patient’s overall health for years, and if the problem is not addressed, no disease management process can be effective. The book explains the scientific physiological process of how stress can make us physically ill. Stress illness prevents patient compliance and participation in patients’ treatment plans. The guidance of this book is essential to the healing of medically unexplained symptoms so that patients can fully participate in their overall care for better outcomes.

—Ashlea McLeod, International Journal of Integrated Care

People seeking answers for nagging health problems often leave the doctor’s office without a diagnosis. David Clarke, who is board certified in gastroenterology and internal medicine and a member of the Academy of Psychosomatic Medicine, argues that the culprit is often stress. Through case histories, he presents a simple but practical model for understanding and treating the physical symptoms that occur in the body because of high levels of stress. Readers review the results of years of research in Clarke’s seven keys to healing stress illness: understand that you can be treated; look inside yourself for evidence of stressful events, past and current; set aside time to care for yourself; use writing therapy to free trapped emotions; seek help if necessary through medications and mental health counseling; fight any forces that keep you from managing your stress; and, ultimately, become the person you were meant to be. Although hardly groundbreaking, Clarke’s model is clearly packaged, and it could easily help people start on the path to healing. Mental health counselors and primary-care physicians should have this book in their reading rooms. Recommended for both public and consumer health libraries.

—Library Journal

Today’s Mental Health Notes post is a treat indeed, as I was able to interview Dr. David Clarke, author of They Can’t Find Anything Wrong!: 7 Keys to Understanding, Treating, and Healing Stress Illness.

Dr. Clarke defines “stress illness” as an illness that is caused by various kinds of life stresses, both past and present.

Read on as Dr. Clarke explains how we can spot, diagnosis, and treat stress illness; provides suggestions on how to deal with doctors who may not appropriately handle stress illness; and offers eight little words that can change the way you look at your health.

Mental Health Notes: In a brief nutshell, They Can’t Find Anything Wrong! is a book about stress illness. Can you tell us exactly what stress illness is, and what prompted you to tackle this subject?

Dr. David Clarke: As the name implies, stress illness is illness caused by any of several types of past or present life stresses. The physical symptoms are just as real and can be just as severe as those caused by any other disease.

My interest in this condition began 25 years ago when I encountered patients whose diagnostic tests were all normal. I didn’t know these patients had stress illness because medical training pays little attention to this condition, even though over half of all medical patients fall into this category. Fortunately, I learned how to solve these medical mysteries from a psychiatrist who was also trained in diagnostic medicine. She taught me that by asking the right questions I could find the cause of the symptoms and then treat them successfully.

MHN: Did you write the book with a particular audience in mind, or can everyone benefit?

DC: The book will benefit three groups of people: medical patients whose illness is not explained by diagnostic tests, their doctors and anyone who is struggling with stress in their life whether they are physically ill or not.

The heart of the book is four dozen stories about people who overcame a variety of life stresses. They achieved this even though initially they often did not fully comprehend what they were coping with. The stories enable readers to gain insight into their own lives, which is the essential first step toward positive change.

MHN: If a person has a stress illness, are there any clues they can detect on their own? Do these clues have anything to do with the “five types of hidden stress” you cover in your book?

DC: The five types of stress are prolonged effects of stress from childhood, stress in your life at the moment and three mental health conditions: depression, anxiety disorders and post-traumatic stress. The presence of any of these may be largely or completely hidden. The most important clue that a hidden stress may be responsible for an illness is that diagnostic tests fail to reveal a cause for the physical symptoms. Some other clues that you might have a hidden stress are that you:

1. Would never want an innocent child to grow up experiencing what you did as a child. 2. Always seem to find yourself in relationships where you are treated disrespectfully. 3. Have lost interest or pleasure in activity you previously enjoyed. 4. Care for everyone else in your world but rarely take time for yourself. 5. Have a low general energy level. 6. Feel depressed, down or sad much of the time. 7. Are unable to control or stop feeling anxious, worried, on edge or nervous. 8. Are bothered by unwanted memories from a traumatic, terrifying or horrifying personal experience. 9. If you had a list of everything in your life that causes stress, tension, worry, anger or fear you would feel sorry if a friend was coping with the same list. 10. Have an addiction or an eating disorder. 11. Cut, burn or otherwise deliberately injure yourself.

MHN: What are the most common physical health problems that stress can cause? Have you stumbled upon any “uncommon” physical health problems caused by stress?

DC: Symptoms can occur anywhere from head to toe and include pain, dizziness, muscle or joint stiffness, difficulty breathing, nausea, vomiting, diarrhea, constipation, fatigue, sleeping problems and many others. The symptoms in stress illness are just as real and can be just as severe as the symptoms of any other disease. Some of my patients have been hospitalized and a few have even had surgery that, of course, did not help. Though many stress illness patients have just one symptom, the more symptoms a patient has the more likely it is that stress illness is responsible.

Sometimes stress illness causes unusual symptoms. One of my patients had itching of patches of his skin in a different bodily location each day. For example, one day his hands would itch, the next day the itching was between the shoulder blades, the day after that his upper left chest would itch and so on. Another patient had pain on the left side of her body from the armpit to the upper thigh. Despite their unusual nature, the symptoms in both of these patients were relieved after one and eighteen months respectively.

MHN: Of the “7 Keys to Understanding, Treating, and Healing Stress Illness,” is there any one more important than the other? Is there one that you would encourage readers to remember, even if they didn’t understand anything else in the book?

DC: The 7 Keys work together like the segments of an arch to build a foundation for positive life changes. So it is difficult to single one out. But if I had to select one concept that may stand out a little, it is that the childhood environment for about half of my adult patients left them with an inaccurate, negative self-image. This can have a subtle but significant adverse impact on their lives that my patients usually do not fully recognize. The book will give readers insights in this area that can change how they live every day.

MHN: Do you think some doctors are unwilling to delve into stress-related illnesses? And if so, why? Are the steps to diagnosis too complicated, or are the doctors too narrow minded?

DC: Few doctors have had any formal training about stress illness. Consequently, many are frustrated by their inability to diagnose it or they conclude that the condition is not part of their job. This is unacceptable for an illness that is responsible for over half of all medical office visits. Fortunately, most health care professionals who read my book can learn to correctly diagnose and treat most patients with stress illness.

MHN: What advice would you offer someone who is clearly ill, but can’t find a doctor who’s willing to look beyond the lack of physical explanations?

DC: This is a tragically common situation. Many people experience relief of symptoms from reading my book and following its treatment advice. Those who remain ill should communicate the personal insights they acquire from the book to their health care provider and ask for additional advice. These patients may benefit from referral to a mental health professional, from prescription medication or from additional counseling by their primary clinician. They may also benefit from the information on the website

MHN: Are people who suffer from undiagnosed stress illness more prone to self-medicate?

DC: When significant life stresses are hidden it is difficult or impossible to change them significantly. The resulting emotional pain may be severe with no obvious source of relief. Some people in this situation will find no better solution than to relieve the suffering with drugs, alcohol or tobacco. Some patients develop other addictions such as to work, exercise, shopping, food, gambling or sex and some develop eating disorders or engage in self-mutilation. A tragic few commit suicide.

MHN: In your experience, have you ever met a patient who suffered from a stress illness and had trouble getting his or her insurance carrier to cover the cost of care?

DC: No. Insurance carriers see little difference between a patient with, say, abdominal pain from an ulcer and a patient with abdominal pain from stress illness. Unfortunately, most health insurance companies have not yet recognized how much unnecessary diagnostic testing occurs when clinicians fail to diagnose stress illness correctly. I am optimistic that in the future they will all insist on a routine stress evaluation.

MHN: They Can’t Find Anything Wrong! has received rave reviews from people in various health professions and patients alike. If, in 20 years, no one can remember a thing from it, is there one bit of information you hope they will retain?

DC: Just eight words: Stress Causes Real Symptoms, Effective Treatment Is Available.

MHN: I think that definitely sums it up nicely. Thank you for your time, Dr. Clarke!

—Alicia Sparks, Mental Health Notes

about the author

David D. Clarke M.D.

Dr. David Clarke received his B. A. in psychology from Williams College (Phi Beta Kappa), and his medical degree from the University of Connecticut in 1979. Since then he has successfully cared for thousands of patients with stress illness, often sent to him after other doctors were unable to help them. He has been a visiting professor at several international hospitals, including Oxford. He was also named a Top Doctor in the Portland Monthly magazine physician review in 2005 and 2006.

Dr. Clarke is a Clinical Assistant Professor of Medicine with Oregon Health and Sciences University, a Clinical Instructor at Pacific University, and a member of the Academy of Psychosomatic Medicine. He is board-certified in Gastroenterology and Internal Medicine, and has practiced in Portland, Oregon since 1984. He is a Gastroenterologist at Kaiser Sunnyside Medical Center, he is Ethics Director at Northwest Permanente, and he is Nutrition Support Team Director at Kaiser Sunnyside Medical Center.

David Clarke has received numerous awards for excellence in patient care. He developed and presented a monthly seminar on stress illness, and local doctors have given their patients 50,000 copies of his brochure on this topic. He lives in Happy Valley, Oregon, which is near Portland.

David's website is