The greatest faux pas in the treatment of illness or disease is that there are physicians for the body and physicians for the soul — although the two cannot be separated. The amazing fact about this reference is it is more than 2,500 years old — an ageless aphorism accredited to the legendary philosopher Plato. Yet, it is as applicable today as it was a long time ago. What’s more, it bids fair to the idea that medicine is slowly changing, because the whole axiom confers and, in turn, validates, no less, that physical, emotional, or mental health disorders go in concert, or collectively.
Research evidences that individuals with severe or chronic physical illnesses may often have a related, or parallel, mental health ‘catch-22.’ Or, what may remain overlooked, ignored, and inappropriately treated. This exemplifies the stigma associated with any emotional or mental illness. This is also the principal reason why most individuals first seek ‘counsel’ through their general practitioner [GP], or the nearest healthcare centre — without letting their ‘guard.’ This has providentially, or fortuitously, led to better amalgamation between mental health and physical care, including substance abuse, its ‘vetting’ and treatment in the primary care setting.
Most chronic illnesses have a clear, strapping effect on the individual‘s mental and emotional status. In the same approximation, most undiagnosed mental disorders influence the individual’s ability to cope with the illness and/or involve oneself in the treatment and recuperation process. This is primarily because learning to cope and live, if not accept, any long-term emotional or mental issue is nerve-racking for most people — more so, in the wake of unremitting anxiety. It is, therefore, not uncommon for patients and family to have continuing periods of anxiety about the effect of the illness on their lives. This leads to familiar symptoms, such as difficulty in breathing, chest tightness, trembling, headache, and dizziness, not to speak of fear. What’s more, depression too has a cascading effect on the state of affairs. It is also the most common complication of almost all chronic or serious medical conditions.
About one in five individuals, for instance, will have an episode of major depression in their lifetime. This numeral as statistics represents is one in two for people with heart disease. Besides, the risk of heart disease is two-fold in people with a history of depression. A Dutch study has found that anxiety disorders may increase the risk of heart attack, stroke, heart failure and death in people with heart disease too. Depression also appears to trigger particularly grave risks for heart attack survivors. Depression, as research suggests, increases five-fold the likelihood of dying after being treated for heart attack: “The clear demonstration that psychological factors like depression and social isolation distinguish coronary heart disease [CHD] patients at highest risk means it would be unethical not to start trying to treat such factors.”
Estimates also indicate that one in four individuals with diabetes suffers from depressive symptoms. The probability of developing depression is doubled for individuals who have diabetes — with the risk of morality, as a consequence, being 30 per cent. Nearly 20 per cent of patients with asthma and chronic pulmonary obstructive disease [COPD], likewise, reportedly suffer from major depression and/or anxiety, including panic attacks and phobia. Besides, depression and anxiety states are associated with unhealthy behaviours, such as poor eating or diet, physical inactivity, unkempt attire, and sedentary lifestyle, not to speak of tobacco abuse, and excessive alcohol consumption. They are, not surprisingly, linked with amplified potential for obesity too.
It is agreed that GPs, and healthcare centres, are better able to distinguish depression and anxiety when patients provide psychosocial, rather than physical complaints, because physical symptoms are often the only ‘whinge’ described by depressed and anxious patients. When present with physical illness, suitable medications, and suggestions on appropriate lifestyle, and diet, can fortunately change, if not always, the outcome of emotional illnesses in the primary setting.
Mental illnesses and physical health conditions go hand-in-hand, as already cited. The problem unfortunately is a large part of our upmarket or corporate healthcare system does not effectively provide for an integrated, holistic approach for physical and mental healthcare. The paradox often is the individual patient receives mental healthcare from one institution and physical healthcare from another — with relatively no harmonious co-ordination. The consequence of such disjointed or inequitable care is low life expectancy and poor quality of life.
The advantage with primary healthcare and GP, however, is they are usually delivered ‘close up’ to one’s residence. This often helps to mitigate the wobbling stigma, besides augmenting the constancy of enhanced care. Good primary, including consultative, healthcare provides reliability of treatment because the patient and the physician know each other. This also results in reduced healthcare costs. Evidence shows that patients are often satisfied with primary care services, because it is far better equipped to dealing with patients in an integrated, holistic manner.
A 2007 survey designed to achieve adequate insight into the shared understanding between GPs and their patients about the mind-body connection in health and illness was carried out in France, Germany, Mexico, Brazil and Australia. A total of 252 adults who received at least one prescription for the treatment of depression from their doctors were surveyed. A total of 501 practicing GPs were surveyed too. The results showed: 78 per cent of GPs agreed that a mind-body connection existed; 85 per cent of GPs agreed that a fair understanding of the connection between mind and body helped them in their diagnoses; 93 per cent of GPs agreed that this understanding helped them in their management; 84 per cent of GPs agreed that there was a need for them to be educated on the mind-body connection; and, 62 per cent of people who received at least one prescription for the treatment of depression agreed that they had discussed the possibility of a mind-body connect with their GP.
In simple terms, coping with any mental and emotional challenge, especially of a chronic illness requires an approach that is not only realistic, but also constructive. A study of kidney patients undergoing multiple dialysis treatments, along with ‘counselled’ care, each week, for example, found that their perceived mood and life satisfaction was no different from a control group of healthy people. Although it is imperative that a qualified, professional psychiatrist is engaged to help build one’s emotional flexibility necessary to plot a route as regards the impediments of chronic illness, it is becoming increasingly evident that psychiatrists in collaboration with GPs, or primary care physicians, or professional complementary and alternative medicine [CAM] practitioners can help develop appropriate coping strategies. This will not only bolster treatment programmes, but also help patients to find fulfilment in life, in spite of perceptible physical constraints.
The credo would be no less imperative primarily because of the consequences of physical ill-health on the mental health of patients. Depression, in particular, is a familiar co-morbidity with people having chronic health conditions, such as cancer, heart disease, diabetes, HIV and tuberculosis. Yet, the whole idea is not as simplistic, because diagnosing mental illness isn't quite like diagnosing other chronic physical disorders, such as heart disease, or diabetes. There are no blood tests for depression; or, no X-ray for an individual, who is on the verge of presenting with bipolar illness. Nevertheless, new tools in genetics and neuro-imaging, among other high-tech applications, are assisting us to making progress towards distilling precise details of the underlying biology of mental, or emotional, disorders. Yet, the whole assay is not all-encompassing.
What also upsets the emotional illness applecart, despite our technological and diagnostic advances, is that most people have a propensity to discount mental illness symptoms as being a ‘normal’ part of life. For example, a vast majority of old, including young, individuals simply attribute their ‘not feeling well’ to being a ‘case of the blues,’ or normal aging, in the case of the former. The result — they may not seek appropriate medical treatment at the right time, or early enough. Such a failing can result in a hold-up, or delay, in treatment and also hamper recovery due to lack of treatment, or incongruous treatment, not to mention the undulating burden of ignominy, or embarrassment, for emotional and mental illness in our society, or community.
It needs to be emphasised that time is of the essence in diagnosing and treating mental illnesses. Any letdown, or procrastination, on the part of patients, their family, and caregivers to seeking and receiving appropriate psychiatric care is anything but healthy. It may also, on the contrary, be disastrous for optimistic prognosis. Besides, it may just as well be a major, cascading trigger for alcoholism, substance abuse, and potential suicide — all unhealthy and deleterious portents for both patients and their families.