Gray Areas: When Illness May Be Particularly Impacted by Psychological Variables

Abstract

Thinking about causation in illness has a long and complicated philosophical and psychological history. Descartes’ idea that the mind and body are separate is manifested in how we think about illness. Despite the idea many of us hold—that the psychological and physical are integrated—we often feel we have to know (or, for that matter, can know) whether it is the mind or body that is responsible for disease. Medical professionals offer a stellar example of dealing with medical patients in a dualistic way. Patients whom are deemed to have a “real” illness are treated for their physical ailments, with relatively little emphasis on the psychological factors that could contribute to or exacerbate illness. On the other hand, there are patients whom physicians simply give up on—they tell patients that their illness is solely “in their head”—thus relegating them to a world of limited medical treatments and being outsourced to psychology or psychiatry. However, the mental health fields have their own dualistic biases. Especially early on, mainstream psychoanalysis has tended to focus on unconscious psychological dynamics that create or contribute to illness. It’s reasonable to assume that in all matters involving physical complaints, there is a complex feedback loop in which the body and emotions activate each other. As we will see, it may be the case that some illnesses are particularly sensitive to stress and that some people are biologically vulnerable to become ill when faced with emotional challenges. However, no matter the disease, there is a preponderance of evidence that psychological intervention helps to reduce healthcare visits and procedures and that some people actually do feel better, with a reduction in physical symptoms, when involved in psychotherapy. It may be the case that psychodynamic approaches have an advantage because of our involvement in bringing unconscious dynamics to light, but much more research is needed to understand which approaches are helpful and why. In the meantime, as therapists, we are confronted with gray areas all of the time in our work. For myself at least, I simply don’t know when I meet someone in my practice that will see benefit in physical symptoms as a result of interventions I might provide or suggest. So “gray areas” mean not really knowing the extent to which someone’s illness is influenced by conscious or unconscious emotions, and my sense has been that I need to tolerate a great deal of ambiguity in not taking sides when listening to someone with physical illness. I will discuss the idea of somatopsychogenesis and those conditions many of us learned to label as psychosomatic in our general mental health training. Yet, we now know that a number of illnesses that had been previously referred to as being caused by one’s mind are actually highly influenced by physical susceptibilities. Several physical problems are understood to be a result of a complicated interplay of psychology, neurophysiology, and the havoc stress hormones bring to bear on the body in those that seem biologically vulnerable.

No one is free who is a slave to his body

Seneca The Younger