Headaches, gastric trouble, exhaustion — and every report comes back clear. Why this happens, why it is not imaginary, and what to do next.
Bhatta Psychotherapy6 min read
Share only if you are comfortable — general information, not personal medical advice.
You have had the blood tests. Possibly an endoscopy, an ultrasound, maybe a scan. You have seen more than one doctor. Every report comes back clear, and you are told there is nothing wrong.
But the headaches continue. The gastric trouble continues. You wake tired regardless of how long you slept. And somewhere in the process you started to feel that people think you are imagining it — perhaps including yourself.
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Across Nepal and South Asia, psychological distress very often presents physically before it presents emotionally. People do not arrive saying they feel anxious; they arrive with headaches, gastric problems, chest tightness, dizziness, or exhaustion.
There are good reasons for this. Physical illness is something you are allowed to have. Saying your stomach hurts gets sympathy and a doctor's appointment; saying your mind is not right risks being called weak, ungrateful, or worse. So the body speaks for the mind.
This is not deception and it is not a character weakness. It is how distress is expressed where emotional language carries a cost.
The mechanisms are physical and specific, not vague:
None of this is happening in your imagination. It is happening in your body — the cause is simply not the one the tests were looking for.
There is a loop that makes this worse, and it is worth seeing clearly.
A symptom appears. You worry about what it means. Worry raises physiological arousal, which intensifies the symptom. You seek another test. The test is normal, which reassures you briefly — then the symptom returns, and now it is more frightening, because tests have failed to explain it.
People can spend years in this loop, accumulating reports and losing confidence in doctors, without anyone naming what is happening.
This needs saying plainly, because articles like this one can be misread as telling you it is all in your head.
Some conditions are genuinely missed or take time to show — thyroid problems, anaemia, vitamin B12 and vitamin D deficiency, sleep apnoea, coeliac disease, and others. If these have not been checked, they should be.
The right approach is both, not either. Keep the medical review going, and add psychological support alongside it — not instead of it.
The first useful step is usually a change in framing: instead of what disease do I have, the question becomes what is my body responding to. That reframing alone reduces the fear that drives much of the cycle.
After that, the work is practical — identifying the stress the body is carrying, addressing sleep, working on the anxiety-symptom loop directly, and treating any depression underneath. Where an unchanged life situation is the driver, that is what needs attention rather than the symptom alone.
Also read: Why do I feel anxious for no reason in my 40s? →
It is entirely reasonable to ask: given the tests are clear, could stress or low mood be contributing, and would it be worth seeing a psychologist alongside this? Most doctors welcome that question.
It is also reasonable to ask whether thyroid function, B12, vitamin D, and iron have specifically been checked, since these are commonly overlooked.
Bhatta Psychotherapy is one of the practices in Kathmandu working with this. We are psychologists, so we do not prescribe or order tests — we work on what the body is carrying, alongside whatever medical care you are already receiving. In person or by secure video, in English, Nepali, or Hindi.
If this sounds like what you have been experiencing, a short clarity call is a low-pressure way to find out whether we are a match.
