What We Know and What We Don’t: The Influence of Psychological Factors and Relationships on Medical Illness

Abstract

Early psychoanalytic researchers attempted, with varying degrees of success, to prove that psychological conflicts are complicit in medical illness. Ironically, current medical research indicates that psychological issues do, in fact, play a role in the development or exacerbation of illness. The relationship between psychology and illness exists not because of the nature or symbolism of neurotic conflicts per se, though it is certainly possible that someone with a number of unconscious conflicts might be more vulnerable to the psychological conditions that are linked with disease. Current research suggests that it is the actual physiological consequences of some psychological disorders and chronic feeling states that explain these important mind/body links. Although many questions remain about these associations, there are at least two pathways thought to partially explain the physical consequences of emotional functioning. The first is that certain psychological disorders and personality traits influence the likelihood of engaging in high-risk health behaviors. Second, certain psychological states, when they persist over time, cause physical changes that increase the risk of disease.

Though it is the case that some symptoms of medical disorders can improve through addressing psychological and behavioral/lifestyle issues, it is important to avoid an omnipotent trap in which we believe that we can control all aspects of our bodies. This can be a disservice to both patients and clinicians, as there are many things people can do psychologically and behaviorally to prevent illness, but the notion that illness is completely influenced by psychology neglects important biological contributions and factors that are beyond our control. In other words, it is both the mind and the body and the interaction of the two that contribute to illness.

I will highlight relevant literature that describes psychological influences on illness. The illnesses discussed here tend to have very specific disease markers, symptoms, and tissue damage; therefore, there is less of a historical tendency to label the illnesses I will describe as psychosomatic, in contrast to the immune-related illnesses I described in Chapter 5. There are decades of research on psychological factors and illness; I will highlight several areas of research and more recent findings. I will describe what the literature says about how several psychological states and psychiatric illnesses are associated with the development or exacerbation of physical illness within or without the context of childhood stressors and maltreatment. I will discuss how our loved ones can provide needed pathways to healing, as healthy relationships protect us from disease. Alternatively, problematic relationships can make us more prone to not taking care of ourselves. Additionally, it seems clear that overt hostility in relationships can lead to constant levels of stress that can aide in the development of illness. I will conclude by considering when and if it is useful to bring up aspects of this research when we are talking with patients, as well as ways we can talk about health behaviors when dealing with people who have traumatic histories.

No, science is no illusion. But it would be an illusion to suppose that we could not get anywhere else what it cannot give us.

Sigmund Freud