Illness, whether acute or chronic, often impacts much more than
just our physical health and well -being. The mind and body both
play a role in coping with, recovering from, and preventing a wide
range of illnesses, and there are often major ramifications for
both if either sees major disruption. This relationship between
our psychological selves and physical selves is often complex and,
in some cases, is poorly understood, but that doesn’t make
it any less important or revelatory. What follows is an exploration
of the multifaceted study of the psychology of illness, addressing
the numerous ways our physical and mental well-being intersect,
overlap, and influence one another.
1 Coping with
Chronic Illness
2 Mental Health
and Immunity
3 The Perception
of Illness
4 The Psychology
of Healing
5 The Mental
Impact of Terminal Illness
6 Pain and Mental
Health
7 The Mind-Body
Connection
8 The Total
Body Impact of AddictionCoping with Chronic Illness
Coping with Chronic Illness
Chronic illnesses are defined by the American Psychological Association
as those which either have symptoms that occur on a constant basis
or flare up episodically. While some chronic illnesses may be terminal,
many more are not. While these conditions cannot be cured, they
can usually be managed through diet, exercise, lifestyle, and medical
care and may even go into temporary remission. Chronic illnesses
are not uncommon; it is estimated that more than 80% of older adults
suffer from at least one chronic illness. Examples of chronic conditions
include diabetes, pulmonary problems, HIV/AIDS, asthma, hepatitis,
arthritis, fibromyalgia, and epilepsy, though there are many others.
Unlike acute
illnesses that occur over a few days or weeks, chronic illnesses
are a life sentence, requiring care and impacting health for the
rest of an individual’s life. This can be a hard thing to
handle for many, as it is common for chronic illnesses to cause
pain or to impact quality of life. As a result, it is not uncommon
for those suffering from chronic illness to have feelings of isolation,
frustration, and hopelessness, especially if their condition is
impacting relationships with friends and family, finances, or future
plans. Chronic illnesses can often come with serious lifestyle changes
and some carry heavy stigmas that can embarrass those who have them.
Reduced abilities, high costs of treatment, and a loss of self-worth
and self-esteem can all take a toll on the mental health of those
with chronic illness.
Research shows
that 25-33% of those suffering from chronic illness also report
depression, a psychological condition which may exacerbate existing
health problems by creating poor eating habits, lack of exercise,
poor hygiene, and social isolation, as well as coming with a host
of its own physical symptoms. To avoid this, the Institute of Medicine
asserts that it’s critical to help those with chronic diseases
learn to cope with the emotions related to their illness, change
behaviors that could have a negative impact on the disease (perhaps
even fatally so), and to manage any disruptions the illness may
cause to everyday life at work and at home.
Chronic illness
may not just impact those who have the condition, however. Others
surrounding the sick person may see serious changes in their psychological
state as well, ranging from pity to impatience to intolerance, depending
on the type and seriousness of the chronic disease. This can cause
disruption in relationships and very often can make it significantly
more difficult for those with chronic illnesses to cope on a day-to-day
basis. As a result, many chronically ill individuals attempt to
hide or conceal the effects of their illness from others. In some
cases, however, concealment may not be possible, especially when
a chronic illness, like multiple sclerosis, causes impairment. These
impairments may put tension on relationships by requiring the parties
close to the chronically ill person to become caretakers, a responsibility
that comes with some serious mental health complications of its
own. Due to the stress disability or impairment may place on a relationship,
it’s critical for those who are ill to keep communication
open, ease stressful emotions, be open about their needs, and to
pay attention to the health and well-being of those taking on additional
caretaking responsibilities as well.
Nika C. Beamon,
in her memoir Misdiagnosed: The Search for Dr. House, discusses
how hard chronic, and in her case mysterious, illness (it took years
for her to be diagnosed with the rare autoimmune disease IgG4 related
systemic disease) can be for family members. She says:
“My years of being half dead didn’t only affect me —
nearly everyone else in my world suffered with each misdiagnosis;
the least vocal were my parents. They rushed to hospitals in three
states taking solace only in the change of scenery. Innumerable
times, they changed my clothes, drove me around, made my meals and
listened to me bitch about one doctor, procedure or medical bill.
On the days I was too weak to complain, they finally had the time
to wonder if their oldest child and only daughter would outlive
them, have a family of her own, or be able to just live on her own
indefinitely.”
To cope with
chronic illness, many individuals will seek out therapy or support
groups of those who suffer from the same or similar condition. This
can help to alleviate the feelings of isolation, loneliness, and
resentment that many with chronic illness feel, while also providing
a support system that can make undergoing treatment and staying
on track health-wise much easier.
Mental
Health and Immunity
The immune
system is a purely physical, brain-based response system, right?
Well, not entirely. While the response the immune system has to
invading germs and foreign materials in our bodies is decidedly
physical, what triggers this response, or lack of it, can be greatly
influenced by our mental state. In fact, compromised mental health
can be one of the biggest factors in suppressing the immune system.
Perhaps the
biggest trigger for a lowered immune response is stress. Stressors
can come from work or from personal relationships and are most damaging
when they occur on a long term, chronic basis. Severe or chronic
stress hampers the body’s ability to manufacture protective
antibodies, which can handicap the immune response that the body
can produce. This happens when the stress hormone, cortisol, inhibits
the development of T cells, an important immune system defense against
infection, making those who are chronically stressed more likely
to get and stay sick. What’s more, those who are already sick
(including suffering from depression) or who are older are more
prone to these kinds of stress-related immune changes.
It’s not
just negative emotions that impact immunity however; there is also
some evidence that a positive mental outlook can have a beneficial
impact on the immune system. A study at the University of Kentucky
found that participants who reported feeling optimistic had a stronger
immune response (in this case the development of a bump) to an injection
of an antigen than when they reported feeling less optimistic or
pessimistic.
Additionally,
recent research has shown that a positive mental state can even
help immunizations like the flu shot work more effectively. Overall,
flu shots are only about 60% effective, but that rate can be improved
by stressing less, socializing more, and engaging in more exercise.
Stress can help blunt the antibody response to the flu vaccine,
which can make it much less effective, so those hoping to get the
immunization should work to reduce stress and depression. Also helping
the vaccine are activities like weight training and cardio, which
push the immune system into action, and engaging in socialization
with close friends and relatives which can both reduce stress and
improve the antibody response to a vaccine.
But what about
immunity’s impact on mental health? It turns out there’s
a connection there, too. Recent studies have found that genes linked
to the immune system can affect personality traits and increase
the risk of developing certain mental illnesses, like schizophrenia
and depression. Why? It may boil down to inflammation. Inflammation
is often an immune response to healing injuries or fighting off
bacteria, but the process also influences the brain, sometimes impacting
learning and memory. As a result, increased inflammation in the
body can sometimes lead to increased levels of mental illness, especially
those related to impulsiveness and personality changes.
In fact, genes
that influence the immune system may play a bigger role in mental
health than previously realized. A study done by Nobel-prize winning
geneticist Mario Capecchi demonstrated that gene defects that impact
the manufacture of immune cells in the bone marrow can lead to greater
instances of mental health disorders. The cells, malformed by the
genetic mutation, migrate from the bone marrow to the brain, where
they’ve been shown to cause trichotillamania, or pathological
grooming, in mice. Capecchi asserts that it’s not just this
illness that can be influenced by the immune system, stating, “If
you look at people who are depressed, often you find their immune
system isn’t working normally.” Beyond that, studies
have shown that genes that confer a higher rate of depression, schizophrenia,
obsessive-compulsive disorder, bipolar disorder and autism are also
connected with the immune system.
So how can you
use your mental state to boost your immunity? Experts at Harvard
advise using relaxation techniques and exercise to limit stress,
getting enough sleep, and treating any existing medical of mental
health conditions. While there’s no guarantee this will keep
you from getting sick, these practices are just good health advice,
whether your immune system needs the boost or not.
The
Perception of Illness
Illness isn’t
just a personal issue, though it may feel acutely personal to those
who are suffering from it. In fact, illness can cast a much wider
net, impacting not only the individual but also any who interact
with that individual. These sociological issues can affect the perception,
treatment, and psychological well-being of those who have everything
from a simple infection to a life-threatening illness. While stigmas
and attitudes towards those with illness have changed over time,
they’ve always existed, often creating a separate social status
for those who suffer from them.
In sociological
terms, those who have serious or chronic illnesses are often described
as taking on the “sick role” a term defined by sociologist
Talcott Parsons in 1951. This sick role means that the person suffering
from illness takes on the role of a “sanctioned deviant,”
as their illness disturbs the normal social function of society,
and as deviant individuals they must be managed and controlled,
usually by those in the medical profession. While most of us don’t
see those with serious illnesses as deviants, this “sick role”
defined by Parsons isn’t too far off from how those dealing
with illness, either temporary or long-term, are regarded in society
today, more than 60 years later, with many who are ill being seen
as being weak, fragile, and unable or unwilling to do the things
that average, well people do on a daily basis.
Yet Parson’s
sick role requires a certain amount of acceptance of this social
deviancy, not something many are willing to do. The sociological
reaction to illness was perhaps better described by Uta Gerhardt,
who suggested that the onset of illness, especially chronic illness,
irreversibly changes the social status of an individual and those
who are ill must adapt to this change to maintain a sense of self,
and later by Michael Bury who theorized that societal beliefs and
the specific meanings attached to chronic illness and disability
strongly influence the societal expectations of what an individual
is able to achieve. Both suggest that illness changes how others
regard the sick person, and may cause them to be seen as incapable,
of lower status, or even as a burden.
While some illnesses
may elicit sympathy and understanding, even if they carry negative
connotations of weakness, others come with serious stigma attached,
one that can lead to discrimination, exclusion, and, in some cases,
even intolerance. Coping with this stigma often means that those
with illness must decide whether or not to disclose their condition,
to conceal noticeable aspects of their symptoms, or to stretch the
limits of what they can do. Those who cannot conceal the effects
of their illness may face a wide variety of prejudices and obstacles
in both personal and professional relationships, as illness can
sometimes paint them as outsiders. Discrimination is often worse
for those who already belong to marginalized groups, which, depending
on the setting can mean those who are different in race, gender,
or sexual orientation than their peers.
One prominent
example of workplace discrimination was documented in the movie
Philadelphia. While a fictionalized account, it was based on the
real life experience of attorney Geoffrey Bowers who, after coming
down with meningitis and later being diagnosed with Kaposi’s
sarcoma and AIDS, was dismissed from his position at a law firm
without following normal termination processes. The firm claimed
that it was performance that was behind their decision, but Bowers
argued that his health conditions, especially AIDS which carries
a heavy social stigma, were at the root of the termination. While
Bowers would not live to see the end of his case, the courts would
rule in his favor, awarding his family a significant sum of money
in damages.
It’s not
just chronic illnesses that carry a sociological weight; acute illnesses
can pose a problem, too. In highly competitive working environments,
employees who chose to stay home with a cold or other health problem
may be seen as lazy, despite the very real limitations such conditions
put on the amount and ability of individuals to complete virtually
any kind of work. The attitude is so prevalent that a recent study
found that as many as 80% of office workers show up for work even
when they know they are sick. Why? Twenty five percent of workers
said they didn’t want to take a sick day and nearly half said
that being sick would mean they wouldn’t be able to get their
jobs done. A similar study done in Sweden found that employees often
went to work when they were sick in order to not be seen as fragile
or unreliable by coworkers. These fears might not be unfounded.
The Center for American Progress found that nearly a quarter of
adult workers have been threatened with termination or fired after
taking off work for being sick or taking care of a sick family member.
How illness
is viewed in society is a complex topic, and while many will react
with sympathy and caring for those who’ve fallen in, the reality
is that longstanding prejudices and stigmas about illness still
exist. A willingness to view those who’ve fallen ill as being
weak, different, or even as unproductive and deviant members of
society isn’t new nor is it especially surprising. It is,
however, disheartening to think of the additional psychological
stress from external sources that is placed on those who are already
struggling to cope with serious health conditions.
The
Psychology of Healing
Our psychological
states don’t only influence whether or not we get sick; they
can also play a big role in helping us recover from acute illnesses
and cope with chronic ones. As it turns out, mental health, happiness,
and overall well-being can play an active and important role in
how fast or how well our physical bodies cope with a wide range
of illnesses.
Think your state
of mind doesn’t matter in healing? Research says that it does.
In one study done by the University of Nottingham, researchers found
that people suffering from diabetes-related foot ulcers had different
rates of healing that correlated with their coping methods and their
psychological state of mind (more specifically their level of depression).
It was discovered that not only did mental state influence healing,
but that treating those with diabetes not only for their physical
condition but also for their mental health by teaching coping methods
and providing support, helps improve healing and reduces the effects
of the illness.
Studies also
show that laughter really may be the best medicine, as it can have
a marked impact on healing. Laughter, often tied to happiness, can
help inhibit the release of stress hormones, like cortisol and adrenaline,
and helps to pump up immune system activity by increasing interferon,
T cells, and white blood cell in the body. Laughter also triggers
the release of endorphins-the body’s natural feel-good
chemicals, which promote an overall sense of well-being and can
even temporarily relieve pain.
Unfortunately,
the impact of the mind on the body with regard to healing isn’t
always a positive one. Just as a positive state of mind can influence
the body and the immune system towards positive outcomes, stress
and negative emotions can inhibit the healing process. A study published
in 1998 in the Journal of the American Medical Association found
that those with low socioeconomic status had poorer health outcomes
across the board. These outcomes weren’t just from poor health
habits and lack of healthcare, however. They were found to be directly
correlated with negative emotions including feelings of powerlessness
and loss of control. In numerous other studies, psychological stress
(including depression and anxiety) and poor coping behaviors were
also shown to result in poor healing outcomes for injury or surgical
wounds.
These studies
demonstrate that while healing may be a physical process, mental
factors like depression, happiness, stress, anxiety, and positivity
can all play a role in boosting the body’s ability to bounce
back from serious injury or illness. Some research has even pointed
to making support, therapy, and other forms of psychological assistance
a key part of treatment and recovery.
The
Mental Impact of Terminal Illness
Coming to terms with an illness is never easy but it can be even
more challenging when an illness is terminal. Coping with the pain,
grief, and isolation that often comes from having a terminal diagnosis
can not only take a physical toll on the body but a mental one as
well. While the physical challenges of a terminal illness are undeniable
and clearly seen, the psychological, emotional, and mental disturbances
often lurk below the surface and may not be addressed by medical
professionals or even the individual his or herself.
Those who know
they may only have weeks, months, or years left to live often experience
a wide range of emotions ranging from regret, to anger, to sadness.
Some may have difficulty coping with the reality that they have
such a short time to live. Others live in denial that they are dying
at all, constructing elaborate but sometimes effectively deceptive
ways of looking at their illness that make it easier to cope with.
Doctors often report that terminal patients go through the Kubler-Ross
five stage model, grieving for the loss of their lives by exhibiting
denial, anger, bargaining, depression, and acceptance.
Death and dying
mean different things to different people, and as such the psychological
effects of a terminal diagnosis may be influenced by age, cultural
background, and personality. For example, anxiety and depression,
factors that can make coping with terminal illness more difficult,
have been found to be more common in those under 50 with dependents.
Differences in religious practice may influence behavior and emotion
as well, with those having strong religious beliefs often taking
on much more aggressive treatments to prolong life. According to
psychiatrist C.K. Aldrich, a terminal patient’s reaction to
grief is determined by three factors: the extent and quality of
his or her interpersonal relationships, the use made of denial,
and the extent of the regression and the restriction of ego boundaries
secondary to the organic illness. In that way, the psychological
response to terminal illness will be different, though difficult,
for each individual patient.
Terminally ill
patients may also face psychological distress from having to manage
the anxieties and sadness of those who are close them. Some may
feel that they need to pretend to be well or comfort others, which
can make interactions with others feel tiresome or psychologically
draining. Even among close friends and relatives, many terminally
ill patients express feelings of isolation which can make it extremely
beneficial to join support groups for others coping with their own
terminal illnesses and who can relate.
Often, an ignored
psychological aspect of terminal illness is the tendency to give
false hope or to deny the reality of the impending death. This is
not only something that patients may be guilty of, but health care
providers as well. A British Medical Journal study of physicians
found that 63% overestimated that survival time of terminally ill
patients. Researchers believe that doctors weren’t purposely
trying to lie to patients, but simply were holding on to hope, in
some cases where there was none to hold on to. Terminal illness,
because it forces all close to it to force their own mortality,
is rife with psychological implications, not only for those who
suffer from it but also from those who treat it and it can be very
difficult not only to get a death sentence but also to give one.
Pain
and Mental Health
Pain, whether
as the result of a chronic condition or an injury, can make doing
even the simplest of things difficult. It’s estimated that
more than 30 million Americans suffer from some kind of chronic
pain, but the impact of this pain isn’t just physical; it
can take a toll on mental health and well-being too.
While pain is
a function of neurological processes, many are surprised by how
much of a role psychological factors play in the perception of that
pain. Within the brain, pain is closely tied to brain functions
that govern behavior and decision making, including expectation,
attention and learning, which means that altering these behaviors
can often mean altering the experience of pain. Factors like expectation
of reward or punishment, fear, stress, and mood can all alter perceived
pain intensity.
In fact, even
your personality type can set you up to feel more or less pain.
Those who take negative approach to pain and believe that something
will be extremely painful are more likely to have an actual amplification
of the pain. Why? This kind of anxiety-laden thinking can actually
increase painful sensations by heightening brain activity throughout
the pain matrix. On the flip side, personal outlook and approach
to pain or to the threat of pain can also reduce the impact it has.
Research has continually shown that pain associated with fear hurts
more. Reducing the fear of pain can actually help reduce the pain
itself, or at least the perception of the pain.
For those with
chronic pain, the impact of an injury or illness can be all-consuming.
Research suggests, unfortunately, that the longer chronic pain occurs,
the more acutely those who suffer from it will feel pain. Pain pathways
in the brain grow stronger when used, and the constant ache of a
bad joint or an inflamed part of the body makes these pathways easier
to follow. The brain may actually get better at perceiving pain,
making those suffering from it more sensitive and more likely to
register even low levels of pain. This process can make it so that
pain can even be felt in regions of the body that have long since
healed from an injury or surgical procedure because the pain pathways
have simply been seared into the mind.
It’s important
to note, however, that pain’s impact on the body isn’t
purely mental. Over the past decade, research has shown how chronic
pain can actually alter the structure, function, and chemistry of
the brain. Pain may cause the gray matter in certain regions of
the brain to become less dense and only when these regions regain
this density will individuals feel any pain relief. Similar studies
have also revealed that different types of pain, pressure and thermal
pain for example, are processed by different parts of the brain
with very little overlap. This suggests that not only is pain an
incredibly complex phenomenon, but that to understand and to treat
it, doctors will need to target relief to certain brain patterns
of pain.
Research suggests
that there’s also a socioeconomic aspect to chronic pain and
the effect it can have on mental health. When University of Michigan
researchers collected data on nearly 4,000 adults under 50, they
found that life in less affluent neighborhoods often correlated
with greater degrees of ensory pain, affective pain, and disability
due to pain. Race was also found to be an issue, with African-Americans
seeing greater levels of pain and disability regardless of economic
well-being. What’s more, these individuals were not only more
prone to pain but also to psychiatric diagnoses of depression and
anxiety.
While we often
like to boil pain down to a simple nerve reaction in response to
a painful stimuli, in reality its impact on the body and the mind
can be far more complex. Many aspects of how individuals experience
and can control pain are just now starting to be better understood,
and with more research may come better, more effective ways to treat
both the mental and physical problems associated with chronic pain.
The
Mind-Body Connection
Much of what
happens in our bodies is outside of our conscious control, but not
everything. While our brains unconsciously dictate everything from
breathing to digesting lunch, our feelings, actions, and even overall
outlook on life are things under our control that can, and often
do, have a major impact, for better or for worse, on how our bodies
function.
Very often,
mental and physical conditions are closely linked, with one increasing
the risk of developing the other. Depression and chronic physical
illness are one example. Research has shown that the two exist in
a reciprocal relationship with one another: not only do many chronic
illnesses cause higher rates of depression, but depression has been
shown to exacerbate some chronic physical illnesses. Each can, in
turn, make the other worse and in some cases, one disorder may even
mask the symptoms of another.
Relationships
between the mind and body need not always be negative, however.
Research also suggests that a positive mental state can help alleviate
symptoms of certain diseases. A recent study at the University of
South Carolina found a strong connection between a personal emotional
and physical well-being among those with Type I diabetes. Those
who reported feeling better mentally, also felt better physically,
while those who felt worse often reported having higher blood sugar.
Researchers believe that stress as well as coping methods for dealing
with the disease can play a major role in the severity of symptoms
and the development of additional life-threatening conditions.
As it turns
out, an optimistic mental outlook can actually have a significant
impact on nearly every aspect of health. Researchers at University
of Pittsburgh followed more than 100,000 women over the course of
15 years. Those who self-reported as being optimistic were 14% less
likely to die from any cause over the course of the study than pessimists
and 30% less likely to die from heart disease. The optimists in
the study were also at a lower risk of having high blood pressure
or diabetes, and overall were less likely to smoke cigarettes. The
study also revealed that being trusting, rather than cynical and
hostile, has serious health impacts, too. Those who were cynical
and hostile were 16% more likely to die during the study period
and 23% more likely to get cancer.
While a negative
attitude, stressful life, or emotionally tumultuous experience isn’t
a guarantee that health outcomes will be poor, it does increase
the risk of disease, depression, and numerous kinds of health problems.
However the connection between what we think and feel and our overall
health operates, it’s clear that sometimes mind really does
have power over matter.
The
Total Body Impact of Addiction
According to
recent statistics, more than 23 million Americans struggle with
addiction but few, less than 10%, ever reach out for help. That’s
in part because addiction often causes both mental and physical
dependency, making it incredibly difficult to see a way out of the
vicious cycle of abuse that most addicts deal with on a daily basis.
At its heart,
addiction is a chronic brain disorder, even though it’s not
often regarded as this type of chronic illness. Those who are addicts
cannot stop their behaviors, despite the mental distress they may
cause to themselves and others, because in many cases the addiction
itself has actually rewired their brains. Studies have shown through
brain imaging that addiction can radically alter the parts of the
brain that deal with decision-making, learning, memory, and behavior
control, which can make it nearly impossible for addicts to escape
the compulsive and destructive behaviors that shape their lives.
This rewiring can also make addicts more susceptible to anxiety
disorders, adding further motivation to indulge in the addictive
behavior.
Mental health
can, and often does, play a role in addiction. While genetics and
social environments are key risk factors, those who were victims
of childhood trauma or who have mental health disorders like anxiety,
depression, or mood illnesses are much more likely to exhibit addictive
behaviors than those who do not have these issues. In fact, it’s
estimated that 50% of those with an addictive disorder also have
a psychiatric disorder.
Often, addicts
drink or do drugs as a way to escape the distress that these mental
disorders can cause, but there is another common thread: chemical
deficiency. According to research, a reduction in the amount of
serotonin, a hormone that often leads to feelings of well-being
and happiness, in the brain can be a contributing factor to both
mental illness and addiction. Other studies have suggested that
a surplus of monoamine oxidases (MAOs), enzymes that break down
serotonin, adrenaline, and dopamine, in the body can also play a
significant role in increasing the risk of these issues.
Like many other
chronic illnesses, addiction can also be exacerbated by stress.
Animal studies have shown that the brain changes associated with
stress are also associated with greater sensitivity to the effects
of drugs and abuse. This means that those who suffer from addiction
will be much more likely to elapse when facing stressful life experiences
like job loss, relationship difficulties, and death. Like with any
other illness, teaching coping strategies can go a long way towards
reducing the impact of stress and the power addiction has over quality
of life.
Addiction is
an illness that carries one of the most persistent social stigmas,
perhaps because it is so poorly understood by those who have never
experienced it. The stigma of addiction often makes it difficult
for addicts to admit they have a problem and to seek help, though
treatment programs can be quite effective when both the mental and
physical components of the disease are addressed. The most successful
recovery programs are those which blend behavioral therapy, medication
(if applicable), and personal support. Often, symptoms of both addiction
and underlying mental health issues must be addressed for patients
to truly walk away to lead productive and healthy lives.
The relationship
between out mental health and our physical health is complex and
is only just beginning to be understood by scientists. One thing,
however, is clear: attention to both is a key part of maintaining
a healthy, happy life. Even those predisposed to certain conditions
can take an active role in finding help, support, and care they
need to ensure that both aspects remain in balance and in good order
throughout a lifetime.
Jamie Lindell and all other Team Member at OnlinePsychologyDegree.net
who contributed to this article.
jamie.lindell1@gmail.com
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