The Taconic Counseling Group
Michael A. Westerman, Ph.D.Psychological and Physical Illness: the Missing Link
Interest in the relationship between psychological well-being and physical health has been growing rapidly. This is an extremely important trend. Psychology has a great deal to contribute to the care of those with physical illnesses. Thinking about the links between mind and body, however, has been one-sided to a great extent.
For the most part, the focus of attention has been on how psychological factors impact health. Some examples: research has shown that 50% of mortalities from the ten leading causes of death in this county can be attributed to behavioral patterns (Center for Disease Control, 1980); and psychological interventions have been developed for the treatment of many medical conditions including hypertension, ulcers, headaches, cancer, and many others.
Efforts along these lines are extremely valuable, but they neglect the link between mind and body that runs from physical health status to mental health. Illness, when severe and/or chronic, is a powerful stressor with profound psychological effects. Health problems often limit a person's capacity to work and they frequently lead to many other restrictions in one's activities. The consequences of these stresses can include such emotional reactions as anger, anxiety, fear, and depression: problems in relationships, especially family difficulties; and confusion about how to relate to the medical treatment of the condition. Illness ranks near the very top of the list of life events that bring with them a great deal of stress (Holmes & Rahe, Journal of Psychosomatic Research, 1967).
Unfortunately, too little attention is directed to this link between illness and mental health. People suffering from serious health problems very frequently miss the line between illness and psychological distress as well. Often, individuals are so overwhelmed emotionally by their medical conditions that they find that the only way they can cope is by denial -- sometimes acting as if the illness itself does not exist, or, more commonly, acknowledging the medical condition but denying its psychological impact.
Indeed, many people fail to recognize the psychological consequences of their health problems even when it might seem that they are making efforts to address those issues. For example, many individuals with health problems practice relaxation techniques out of a pressured sense that they must do everything possible to regain their health and return to work right away. Without doubt, relaxation exercises can be extremely useful. Nevertheless, efforts along these lines can lead to greater anxiety, if they represent driven attempts to escape the ways in which the illness threatens self-esteem rather than an approach of acknowledging and really coming to terms with the psychological impact of the health problem.
Psychologists and other mental health professionals can play a key role when it comes to medical illness by helping people with physical illnesses respond to the psychological consequences of their medical conditions -- that is, focusing attention on the way illness often leads to psychological distress. In my own clinical practice, I work with patients with such chronic physical illnesses as arthritis, asthma, chronic pain syndromes, multiple sclerosis, and ulcers in the context of individual, family, and group therapy. I have observed the impact psychotherapy can have in these cases. Indeed, not infrequently patients make use of therapy as a vehicle to help them turn the harsh realities of their medical conditions into an opportunity for an enhanced commitment to life. For example, one issue that frequently requires attention concerns family dynamics related to caretaking. Though this may seem surprising, the ill family member is often over involved in the caretaking of others' emotional needs. Unhappily, this over involvement is often motivated by deep fears (e.g., of being rejected by loved ones, of not having anything to contribute) and it is often mixed with resentment. In such a situation, the family can be helped to move to a new pattern in which family members receive the care they need and giving to others becomes spontaneous, heartfelt, and satisfying.
These remarks about family patterns related to caregiving point out that the links between body and mind actually form a circle. When the impact of illness on psychological well-being is neglected, the circle can spiral downward. Health problems can lead to psychological distress and this distress when not addressed can exacerbate the medical condition. But this spiral can be turned around if we recognize that illness often results in psychological distress. We can promote psychological well-being and this, in turn, can lead to better health -- for example, through health gains that result from more active efforts at self-care directed at the medical problem, or direct effects on such physical processes as blood pressure or the immune system. The point here is that psychologists and other mental health professionals can help people move to better health, but in order to do this we need to take our eye off physical health as the sole target of our efforts by including a focus on psychological well-being.