Tuesday, November 15, 2016

When should you see a psychologist for a physical illness?

I have been writing on the topic of mind/body medicine for over 20 years, and I continue to learn and be amazed by the human mind/brain. Long years ago, a brilliant scholar named Ernest Rossi began to write about hypnosis and neuroplasticity. He was, of course, not alone in this, but he was my first formal contact with the fascinating world of brain changing body. Despite my psychological training, I began to see the mindbody connection everywhere. A client with diabetes who suffered from severe psychological distress after an amputation presented with uncontrollable vomiting and raging fevers rather than diagnosible psychological problems. People with intransigent chronic pain ran from doctor to doctor and were accused of faking or drug-seeking, but with good psychological exploration and insight, their trauma could be found and they could heal themselves. Clients with autoimmune disorders such as rheumatoid arthritis and multiple sclerosis found improvement, often dramatic, with the application of psychological techniques. A client who had attempted suicide with a .38 to the head showed NO brain damage on MRI, demonstrated no physical disabilities from the shot, but had significant amnesia for his entire life prior to the incident! The amnesia remitted with psychological treatment.

These extreme examples of the intricate mindbody connection led me to view my clients with a much more open mind. Things I had diligently learned in graduate school held less sway versus the real experiences of my clients. Medications did not appear to work miracles despite being used in ways even our textbooks said were dangerous. Diagnostic criteria and diagnosible disorders from the _DSM_ changed over time, which confused me if those listed problems were diseases. Does the definition of influenza or diabetes change with each new edition of a manual? Do they sometimes disappear from the text? And despite modern times labeling many problems as diseases in what appeared to be both an attempt to put them in the bailiwick of physicians and to remove the stigma of causality from patients and their families, suffering seemed to be getting worse, not better, and reliance on medications increasing as well. Additionally, the number of clients coming to me already taking three or more psychoactive medications appalled me. Why, after all, were they still suffering if these medications work? I began to wonder about many things I had been taught and to question common treatment practices of people seeking mental health treatment as well as physical medical treatment.

Too often when you get referred to a psychologist with an ache or pain or other physical manifestation of illness, it feels like a put-down. “There is no physical explanation for this; perhaps CBT would help”, “I cannot figure out why this is going on; here is a referral to a psychiatrist”. If instead, we eliminate the dichotomy between the mental and the physical, human health and illness make more sense. It turns out that the brain can and does cause physical symptoms.

The simplest example of this interconnection is pain. And this makes sense at its very core, because nearly all pain is generated in the brain, Sure, a signal may have arisen in your foot or arm, but the pain percept comes from your brain; which means, conversely, that a pain percept can be generated in your brain without any help from the foot or arm that SEEMS to hurt. That is not the same as faking. It is a fact that pain is a signal that something needs attention, but the something might or might not be an injury or tissue damage at the spot that seems to hurt. Enter psychology. It is important to learn why your brain is doing that and what you can do to stop it.

Turning to a problem that seems, you might say, more physical, like irritable bowel syndrome; physicians are often willing to prescribe psychotropic medications for this problem and put you on a weird and not very nutritious diet. So here are two questions: first: why use psychotropic medications if the problem is strictly in the gut and, second, why do different sufferers have such vastly different trigger foods? We know that the gut has even more neurotransmitters than the brain, so a gut-emotion connection actually makes a lot of sense. And it might not matter whether the gut issue came first, as when IBS arises soon after food poisoning, or second, as when it arises after a huge and important test in school. In both instances, the mindbody connection is pointing to a need for some learning in order to change a problem with how the body is functioning.

What about the flu, you may ask? My mind certainly does not impact the flu; it is caused by a specific microbe, and has a specific set of symptoms, and I either get a shot or hope for the best, and lie there until I get better if I am unlucky enough to catch it. That is correct as far as it goes. What we do know, however, is that over and above differences in exposure to germs and basic immune system functioning, stress has a huge impact on whether you succumb to a bug and how long it takes you to recover. So while I would not suggest you run to the psychologist with a cold or flu, it is a good time to examine both physical and mental stress in your life, and slow down.
Your mind and body are part of an inseparable, indivisible, and delicately balanced whole that is you. When something is wrong, the balance is disturbed. If you have sought medical treatment, and it has not worked, the problem might have its roots in stress. Remember that stress can be both physical and emotional, and both sorts can cause illness. In these cases, psychological treatment may be the answer. Whether you have chronic pain that does not respond to medication, a functional gut disorder, or an autoimmune disorder that responds to medication, but still has a negative impact on your life, psychological treatment can help.


Rossi, Ernest L., Ph.D. & Rossi, Kathryn L. Ph. D.
The New Neuroscience of Psychotherapy Therapeutic Hypnosis & Rehabilitation : A Creative Dialogue with Our Genes

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