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Put the head back on!

Posted Apr 06 2012 11:54am

Mental illness verses physical illness

For a very long time physical health practitioners have ignored the connection between mental and physical illness. When someone suggested that the way in which we think can cause physical illness they have been disregarded, or worse. Traditional western medical practice has looked for the cause of psychical illnesses everywhere but in our thoughts. That may be about to change.

As I write these words I am getting very nervous. The pictures in my head of cancer patients giving up their meds to participate in some sort of thought workshop scare me. I am not suggesting that some “psychic energy transfer” ought to replace conventional treatment.

But the research, good scientific research, by reputable researchers keeps pointing to the connections between physical illness and mental illness. No less an authority than the Robert Wood Johnson Foundation has published a report on the subject.

(See Http://www.rwjf.org/pr/product.jsp?id=71883 )

Their conclusion is that the connection between mental health and physical illness is overwhelming and it has huge implications for the direction and cost of healthcare in the future.

Why?

Among those with a diagnosed mental illness in the U.S almost 70% have a chronic long term physical illness. That might not sound so significant until we notice that in any given year about 25% of the U. S. population has a mental illness. Their conclusion is clear. Those people with a mental illness are not just faking things. The problems are not just all in their heads. The mentally ill are much more likely to develop chronic long term diseases. But that is only the beginning of the problem.

Almost a third of those people who have a chronic long term physical illness develop a mental illness. The connection between physical and mental health and illness runs in both directions. 

In typical scientific fashion they tell us so far we can’t be sure if mental illness causes physical illness or physical illness causes mental illness. There may even be a third thing that is causing both. What we do know for sure is that very often the two exists at the same time in the same person.

There is a circle or maybe a spiral of risk going on here.  

A medical condition with a “high symptom burden” such as migraine headaches or back pain is a risk factor for, which means it is likely to lead to depression. But the spiral does not end there. Depression is a high risk factor heart disease. See how mental illness and physical illness are intertwined?

There is a bigger societal problem in the making here. There are extremely high rates of “uninsurance” among the mentally ill. We also know that many people with chronic medical conditions may lose their coverage if they are unable to work.

Treatment for one problem can make the other worse. Medication for a psychiatric illness like depression or psychosis can result in weight gain making the persons diabetes worse. Medications for many physical symptoms can make a person’s mental health conditions worse.

In the elderly, and these are the people where we would expect chronic physical conations to be at their worse, we also have the problem of multiple meds. One hospital study found that among patients who are taking 8 or more meds there was a 100% chance two of these meds were interacting and producing unwanted results. In assessing for cognitive decline in the elderly a therapist always want the prescribing doctor to take another look and tell us if part of the problem might be the medications not the client’s loss of mental ability.

Now regardless of how you swing politically, the bottom line here is that those people with mental illness or chronic physical illnesses are at high risk to develop the other condition and then to be unable to work. Now one way or the other this group of people will end up in hospital emergency rooms and those who can’t pay – well those of us who are still working – we get to pay that bill. This will only get worse as time goes on.

I suppose we could just stop paying for those who are too sick or old to work and pay for their own medical care. It sounds like some are advocating that approach these days. I for one would not care to live in a society who was unwilling to provide care for those who are least able to care for themselves. I also have enough faith in my fellow Americans to think it will not come to that.

But there is another option and support for this option is growing not just in treating the uninsured but also in treating those with the best of insurance coverage. This other option which is growing in popularity is to integrate the treatment of physical and mental health.

Consumers who are less depressed take their heart meds more often and end up in the emergency room less. The reintegration of the two specialties is overdue.

We need to stop treating medical patients as headless bodies and but the head and the feelings back in the equation when it comes to treating the whole person.


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