Emotions and Illness

A positive attitude can contribute to anyone’s good health. However, that sort of attitude can be difficult to maintain when one is faced with a chronic illness or disability. Such illness produces emotional reactions such as anger, sadness, frustration, and especially fear. These add to the distress and suffering, and may also make the physical symptoms worse. Sometimes people are ashamed of these feelings, or do not know how to express them.

When the negative feelings become overwhelming, depression sets in. You might be surprised to learn that depression is a coping mechanism (believe it or not!) that humans have evolved, as a response to many stressful life situations, including chronic illness.

About 15% of the population have a chronic medical condition. Our Western medical model focuses on cure, but healing is more important. For example, many breast cancer patients are cured by mastectomy, but continue to suffer emotionally. The word healing comes from the Old English haelen, to make whole, and it can take place with or without cure. Best overall results are achieved when physical and psychological treatments are combined. Yet, despite the proven benefits, less than 10% of people with chronic illness receive any form of psychological help. Furthermore, the earlier such treatment is provided, the greater the benefit.

“Tragically, it is not until disease is widespread and medical options exhausted that many people turn to self-help methods. This is unfortunate because it is asking a great deal of any treatment to alter the course of advanced disease” (Alastair Cunningham, THE HEALING JOURNEY, 1992).

Most people make sure they get the best possible modern treatments for their physical symptoms, but the psychological aspects often go unnoticed, or are accepted as inevitable. This is regrettable, because depression can usually be eliminated or reduced with safe and effective treatments. Being depressed is a drag; getting rid of it not only is a great relief in itself, but it also frees up energy for self-care and enjoyable activities. Another good reason to treat depression is that it impairs the immune system, possibly worsening the current illness, and predisposing to new ones.

Psychotherapy simply means treatment by psychological methods, in contrast to physical methods (e.g. physiotherapy, acupuncture, surgery) or pharmacological methods (e.g. herbs or medication). The purpose of psychotherapy is to help people with emotional difficulties learn to feel better. The emotional issues may be due to abuse, relationships problems, job stress or chronic medical conditions.

Counselling is more of an educational process, which sometimes includes emotional support. Counselling might be in regard to careers, infertility, financial planning or emotional problems. Good psychotherapy often includes some education and emotional support, but is a much more involved process that should challenge you. The terms psychotherapy and counselling are often used interchangeably, without adhering to their precise definitions.

A psychotherapist is anyone who practices psychotherapy. Psychotherapists come from many different educational backgrounds. Many are non-physicians: psychologists, social workers, nurses, educators, clergy. Most family physicians do some counselling. Some devote part or all of their practice to more in-depth psychotherapy, and all call themselves G.P. Psychotherapists or Physician Psychotherapists. Psychiatrists are specialist physicians (like pediatricians, for example) with expertise in the diagnosis and treatment of mental illness; their treatment consists mainly of medication, sometimes with psychotherapy.

One clear advantage of having a medically qualified therapist is that here in Ontario their services are covered by OHIP. Another reason is that a physician therapist will be knowledgeable about medical conditions, medications and the health care system. Inquire about what special training the physician has had in the field of psychotherapy for medical patients. Ask if group therapy is available. Even though you might be uncomfortable at the thought of talking about your medical problems in front of others, most experts recommend the group format for medical issues, because it seems to work much better. A private session for initial assessment and some preparation for group therapy should be part of the process.

Support groups are usually led by a peer, usually with no special training. They are typically homogeneous (i.e. every member has the same diagnosis). This type of group has limited goals, mainly information and mutual support. While there are many types of psychotherapy groups depending on the therapists’ personal preference, all are led by professionals and have broader scope: in addition to support, there is a goal of improved emotional functioning, leading to a more fulfilling life. Psychotherapy groups may be heterogeneous (members have different problems, but with some commonality) or homogeneous.

There is a great variation in the quality of support groups, and some people find them useful. Scientific studies, however, have failed to show measurable benefits. On the other hand, four excellent studies with patients with serious illness have documented that substantial improvements in quality and duration of life can be achieved with specialized psychotherapy programs.

side-effects. Some are addicting, especially the benzodiazepine family of tranquilizers, e.g. Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Serax (oxazepam). The newer antidepressants seem fairly safe, but the long-term effects are unknown. Patients already on medication for a medical condition must be careful about drug interactions; they may also be reluctant to take any more pills than they already are. There is also the cost to consider. My concern about medication as a treatment for depression or severe anxiety is that we cannot learn anything by taking a pill. As we grow older, we can be sure that there will be stress of many types ahead. Psychotherapy is a good way to learn healthy coping skills, which will serve us well in the future.

There are dozens of chemical and physical treatments available. Most, but not all, are safe. As with prescription drugs, these methods do not teach us anything, and are often costly.

Such treatment encompasses some or all of the following: mind/body medicine, guided imagery, relaxation/mediation, emotional support, and relationship counselling. The goals should be clearly defined, ideally by the patient, with the therapist’s help. In the face of illness or disability, a solid support system is vital; but such illness puts a strain on even the strongest relationships. Therefore, relationships counselling for both the patient and his/her loved ones is often very helpful. Both the patient and the ‘bystander’ gain from learning to transcend their sadness, frustration, and anxiety; the result is that the relationship often becomes closer than ever before.

Stress erodes health, and there is no escape from stress in our society. Actually, the problem is more our reactions to stressful events than the stress itself. The good news is that effective psychological treatment is available. Maybe stress without distress is a pipe dream, but reducing the impact of stress sufficiently to prevent physical damage to our bodies is certainly possible. When chronic illness is already established, “group psychotherapy is so effective for persons with medical illness…..that it is well on its way to being considered a fundamental adjunct to medical care.” (James Spira, ed. Group Therapy for Medically Ill Patients, 1997). A little change can make a big difference!

Dr. Julie Righter is a physician and Certified Group Psychotherapist in private practice in North York. For patients and relatives with emotional issues resulting from chronic medical illness or disability, please see the ad in the classifieds to contact her.