When we were in training, the instruction was not to pay too much attention to patients with emotional and psychological problems with bodily symptoms, the most common of which was chest pain.
We labeled their complaints as psychosomatic, which literally meant a problem in the mind or psyche affecting the body or soma.
Sometimes we gave them placebos or dummy pills, and believing they were taking actual medicines, some of them would feel better or even get well.
Up to now, I feel some guilt when I prescribe a virtual placebo, which may be some vitamins just to make the patient feel he or she is taking something to cure whatever perceived illness he or she has.
There seems to be an element of deception in this prescribing strategy. I think what really matters is the concern the doctor shows their psychologically challenged patients and how he helps them overcome whatever is bothering them mentally and emotionally.
Takotsubo cardiomyopathy
In the last 15 years or so, there is clearer evidence of this mind-body connection which can either lead to good health and wellness, or some serious, potentially life-threatening problems.
A good example is what the Japanese first reported as heart failure, now known as Takotsubo cardiomyopathy, usually in young women following a stressful event such as a quarrel with or separation from their boyfriend or spouse.
In the past, when young women were brought to the emergency room complaining of chest pain or difficulty of breathing, they would most likely be dismissed as having a psychosomatic reaction, especially if an emotional trigger is elicited from her history. No laboratory exams would be done.
Now we know better, and they’re given the benefit of the doubt and some basic lab tests are done.
From time to time, we encounter women with the local version of Takotsubo cardiomyopathy. Some may even have actual heart attacks with no occlusion of the heart arteries.
Chronic conditions
The mind-body connection may also be relevant, even in patients with chronic medical conditions such as high blood pressure, diabetes, coronary artery disease and many others.
Simply prescribing pills may not address the root cause of the problem of these patients, which may be a cacophony of negative emotions slowly eroding their bodily defenses. Unless we can help the patient maneuver these unhealthy emotions and resolve them, he or she may not get better.
The mind-body relationship is actually two-sided and bidirectional—that is, physical health is affected by psychological health and vice versa.
A patient with a long-standing illness may subsequently feel depressed, and that can make his illness worse. Depression, anxiety and emotional stress are now established risk factors which can adversely impact the long-term outlook of patients following a heart attack or stroke.
We used to think that patients would be able to shake off their depression or anxiety by themselves. If it’s relatively mild and does not affect the functional capacity of the patient, it may not be necessary to refer the patient for psychotherapy.
Encouraging them to do regular meditation and practice mindfulness can help them regain psychological wellness.
In some cases, though, the negative emotional state already affects the patient’s ability to perform his daily activities which requires psychotherapy and some drugs.
A negative psychological or emotional state can also weaken the immune system, making the patient more prone to infections. It also causes elevation of the stress hormones such as cortisol and adrenaline, which can increase one’s risk of heart attacks and stroke.
Persistently elevated stress hormones can also dampen the quality of life due to lack of good sleep, more digestive problems, headaches and lack of energy.
Meanwhile, individuals with a positive psychological and emotional balance are more likely to maintain health and wellness. They’re also likely to have positive health-seeking behaviors like exercising regularly, being more careful with their diet, having enough sleep at night and managing their stress well.
A positive emotional state leads to healthier relationships. Strong, healthy relationships with family, friends and coworkers can significantly contribute to wellness and a longer life.