Mental Health versus physical health?
Last week I attended a symposium sponsored by the local Tuberculosis Association. The symposium included talks on Current Epidemiology and New Screening Guidelines for Health Care Workers, Current management of Chronic Heart Failure, and Sleep Apnea. The symposium was designed primarily for respiratory therapist and others working in a
“medical setting” such as a hospital or a physicians’ office. I may have been the only mental health counselor in attendance. I was questioned as to why I was attending. I found the conference very educational and valuable because I work with/for individuals in my mental health counseling practice who arrive with a variety of symptoms and diagnoses. Sometime folks arrive because the physician cannot identify a “medical” reason for the symptoms and assume the symptoms are related to some “mental” condition. It is my job to attempt to validate that assumption or tell the client and the referring physician that I strongly suspect the symptoms may be related to an unidentified physical issue. For example. I was seeing someone with a history of depression related to an abusive marriage relationship. She also had been diagnosed with lupus, sojourns syndrome, and fibromyalgia. Her depression had not responded to the combination of psychotherapy and medication. It became so acute that she could not perform basic tasks. She was admitted to inpatient psychiatric care so the psychiatrist could explore more aggressive treatment. After a month of aggressive treatment her depression was worse. I “thought” that something else might be the cause of her depression. The psychiatrist kept yelling at her about not “wanting to get well.” After much pressure from me and her family, tests were finally ordered which revealed an adult hydrocephalic condition. Surgery was scheduled during which a shunt was implanted. Soon her depression lifted. In another case of an acutely depressed patient, a tumor was hiding behind a bone and, thus, not showing up on the tests. Eventually the tumor did show up and, luckily, were successfully removed. The acute depression was soon lifted.
It is easy to fall into the trap of thinking we have a physical and a mental body. Yet, we know that thoughts which arise from a physical process are the command center of the body. The other parts of the body sends messages back to the brain. It is an interactive system. A man I know who has a history of experiencing events through the lens of fear just called. He has been working out of town and now has to fly home. He is physically feeling weak, shaky, and frightened which in turn affects how all organs in his body functions. When he feeds the fear it gets worse until, if not careful, he will not be able to function. Shortness of breath, shaking, upset intestinal system, and possible headache will be just a few of the physical symptoms of his anxiety which triggers his thought process which increases his anxiety which …
I need to remember the same symptoms can be triggered by other medical conditions.
I strongly suspect our diagnosis and treatment of those who initially present themselves to a medical doctor and those who present themselves to a mental health counselor could be better served if:
It is true that if the primary issue is a heart condition one can predict what medications or devices might best help a particular patient. It is also true that the state of mind of the treating health care workers and the patient will affect the outcome of the surgery. Other factors such as family system, money, racism, sexism, and stressful events will affect the diagnosis and outcome of treatment.
Our mental bodies are physical and our physical bodies are mental. If we want to provide the best possible care we would do well to make sure we are ready to listen to the body of the individual patient, to the system in which the patient lives and works and the perspective of our colleagues.
Once a differential diagnosis or diagnoses is made treatment can be provided by appropriately trained specialists working closely with each other. the patient and his/her family.
Written March 16, 2020
Jimmy F Pickett
coachpickett.org
Last week I attended a symposium sponsored by the local Tuberculosis Association. The symposium included talks on Current Epidemiology and New Screening Guidelines for Health Care Workers, Current management of Chronic Heart Failure, and Sleep Apnea. The symposium was designed primarily for respiratory therapist and others working in a
“medical setting” such as a hospital or a physicians’ office. I may have been the only mental health counselor in attendance. I was questioned as to why I was attending. I found the conference very educational and valuable because I work with/for individuals in my mental health counseling practice who arrive with a variety of symptoms and diagnoses. Sometime folks arrive because the physician cannot identify a “medical” reason for the symptoms and assume the symptoms are related to some “mental” condition. It is my job to attempt to validate that assumption or tell the client and the referring physician that I strongly suspect the symptoms may be related to an unidentified physical issue. For example. I was seeing someone with a history of depression related to an abusive marriage relationship. She also had been diagnosed with lupus, sojourns syndrome, and fibromyalgia. Her depression had not responded to the combination of psychotherapy and medication. It became so acute that she could not perform basic tasks. She was admitted to inpatient psychiatric care so the psychiatrist could explore more aggressive treatment. After a month of aggressive treatment her depression was worse. I “thought” that something else might be the cause of her depression. The psychiatrist kept yelling at her about not “wanting to get well.” After much pressure from me and her family, tests were finally ordered which revealed an adult hydrocephalic condition. Surgery was scheduled during which a shunt was implanted. Soon her depression lifted. In another case of an acutely depressed patient, a tumor was hiding behind a bone and, thus, not showing up on the tests. Eventually the tumor did show up and, luckily, were successfully removed. The acute depression was soon lifted.
It is easy to fall into the trap of thinking we have a physical and a mental body. Yet, we know that thoughts which arise from a physical process are the command center of the body. The other parts of the body sends messages back to the brain. It is an interactive system. A man I know who has a history of experiencing events through the lens of fear just called. He has been working out of town and now has to fly home. He is physically feeling weak, shaky, and frightened which in turn affects how all organs in his body functions. When he feeds the fear it gets worse until, if not careful, he will not be able to function. Shortness of breath, shaking, upset intestinal system, and possible headache will be just a few of the physical symptoms of his anxiety which triggers his thought process which increases his anxiety which …
I need to remember the same symptoms can be triggered by other medical conditions.
I strongly suspect our diagnosis and treatment of those who initially present themselves to a medical doctor and those who present themselves to a mental health counselor could be better served if:
- All health care professional remember the body is one interactive unit which exist the context of larger interactive systems
- Taking a good history and practicing active listening is necessary if one is going to approximate a decent educated guess about the cause of the symptoms.
- All health care professionals remember that when those trained as physicians/nurses, NA’s, PA/s and related professions work closely with those who study the body from the vantage point of emotions and thought processes one is better able to approximate an educated differential diagnosis.
It is true that if the primary issue is a heart condition one can predict what medications or devices might best help a particular patient. It is also true that the state of mind of the treating health care workers and the patient will affect the outcome of the surgery. Other factors such as family system, money, racism, sexism, and stressful events will affect the diagnosis and outcome of treatment.
Our mental bodies are physical and our physical bodies are mental. If we want to provide the best possible care we would do well to make sure we are ready to listen to the body of the individual patient, to the system in which the patient lives and works and the perspective of our colleagues.
Once a differential diagnosis or diagnoses is made treatment can be provided by appropriately trained specialists working closely with each other. the patient and his/her family.
Written March 16, 2020
Jimmy F Pickett
coachpickett.org
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