Psychological Illnesses Do Not Differ from Bodily Illnesses - Essay Example

Running head: PSYCHOLOGICAL ILLNESSES Psychological Illnesses do not differ from Bodily Illnesses. Name: Institution: Abstract. Kendell argues that the distinction between ‘mental’ and ‘physical’ disorder is meaningless and must be abandoned in favour of the term ‘psychiatric disorders.’ Both the causes and the symptoms of the so-called mental illnesses are indistinguishable from those of the physical disorders, making the distinction between the two terms unnecessary. Taking the study of Chronic Fatigue Syndrome as an example, physical symptoms and the absence of predominant psychological causes blur the dividing line between mental and physical, making it a physical disorder. The advances in neuroscience have revealed brain pathology to be the cause of most mental diseases. The abolishment of the term ‘mental illness’ may be advantageous in removing the stigma attached to it. However, it serves some practical purposes. The best approach would be a holistic, integrated ‘biopsychosocial’ model, which treats diseases on all three levels. Psychological Illnesses do not differ from Bodily Illnesses. The mind/matter debate has engaged philosophers right from the earliest Greek civilizations and rages even today. In contemporary times, the argument has spilled over into the field of medicine and psychiatry. In his Editorial in The British Journal of Psychiatry (2001), Robert Evan Kendell argues that, in reality, psychological illnesses do not differ in any material respect from bodily illnesses. Kendell states that the commonly held professional and lay perspective, from the time of Hippocrates up to the middle of the eighteenth century, was to consider mental and bodily illnesses as one entity for diagnosis and treatment. This view is encapsulated in Lady M. W. Montagus’ eighteenth century statement that “madness is as much a corporeal distemper as the gout or asthma” (Porter, 1987 cited in Kendell, 2001). Kendell traces the origins of the distinction between mental and physical illness to the late eighteenth century philosophy of ‘dualism,’ in which the mind and the body were regarded as separate entities. This influence was strengthened by the shortcomings of medical science at that time: physicians lacked the appropriate diagnostic tools to identify the pathological changes that occurred in so-called ‘mental illnesses’ and their limited repertoire of treatment, such as bleeding and purging, was ineffective in combating the same illnesses. It was at this juncture that the terms ‘mental illnesses’ and ‘disorders of the mind’ entered common vocabulary and lunatic asylums focused their treatment of the insane on moral and religious approaches rather than on the medicinal. It was Benjamin Rush (1812) and Wilhelm Griesinger (1845) who brought mental illnesses back into the ambit of medical sciences with the postulate that mental illnesses are diseases of the brain. Subsequently, disorders of the mind were differentiated by neurologists into ‘organic disorders,’ which demonstrated a clear somatic pathology, and ‘functional disorders,’ which did not. This led to diseases like epilepsy and chorea being classified as functional due to the lack of evidence of brain lesions at that time. The school of psychoanalysis at the end of the nineteenth century considered all mental illnesses to be psychogenic and advocated psychoanalysis as the only treatment. The distinction between mental and physical illnesses persists in contemporary medicine, buttressed by the official nomenclature of ‘mental and behavioural disorders,’ sanctioned both by the World Health Organizations’ International Classification of Disease and the American Psychological Associations’ Diagnostic and Statistical Manual. This segregates disorders of the mind into a separate category, distinct from other illnesses. Kendell avers that “neither minds nor bodies develop illnesses. Only people … do so, and when they do, both mind and body, psyche and soma, are usually involved.” Kendell advances his argument using the concept of pain. Pain, which is definitely a subjective, psychological phenomenon, is also typical of almost all physical illnesses, as is the generalised ‘feeling’ of ill health. The symptoms of mental and physical illnesses are often indistinguishable, as in the manifestation of fear and anxiety in physical illnesses such as myocardial infarction and asthma, and the physical symptoms of fatigue and weight loss exhibited in psychiatric disorders like anorexia and chronic fatigue syndrome. Kendell cites family studies by Andreasen et. al. (1986) and twin studies by Kendler et. al.(1992) to consolidate his thesis. The result of these studies pointed to the contribution of genetic factors towards the development of depressive disorders of all intensities and showed that antidepressant drugs have no effect on normal people but relieve depression in those who are ill. The inherent biological differences between individuals subject to, and those free from, depressive tendencies is also demonstrated in a second study by Delgrado et. al.(1990), again cited by Kendell in support of his stand. This study showed that the manipulation of the amino protein tryptophan in blood plasma can precipitate depression in depression-prone people. Kendell also cites the presence of brain pathology in schizophrenia and the evidence of its’ genetic transmission as further proof of the validity of his argument. According to Kendell, it is impossible to identify any distinctive causes or symptoms that belong exclusively to either mental or bodily illness and can be used to categorically differentiate one from the other. Just as the aetiology of hysterical amnesia is psychogenic, the anger or fear which may precipitate a myocardial infarction is also psychogenic. The assumption that emotional crises stimulates the neuronal and endocrine changes that cause the symptoms of memory loss or decreased oxygenation of the heart, holds good in both cases. Kendell concedes that there are differences between mental and physical disorders, but holds that these are “quantitative rather than qualitative, differences of emphasis rather than fundamental differences.” He concurs with the Diagnostic and Statistical Manual of Mental Disorders (1994 edition): “there is much ‘physical’ in ‘mental’ disorders and much ‘mental’ in ‘physical’ disorders.” While the International Classification of Disease and the Diagnostic and Statistical Manual persist with the category of ‘mental and behavioural disorders,’ Kendell argues that this is based on the practical need to differentiate between disorders treated by psychiatrists and those treated by neurologists and is not based on aetiology. Kendell interprets this approach to classification as supporting his theory that “the distinction between mental and physical disorders (is) a meaningless anachronism.” Kendell regrets that the distinction between mental and physical illness persists, particularly among lay people. Individuals suffering from so-called mental illness are unfairly judged as lacking moral toughness and accused of deliberate self-indulgence. Their symptoms are not given sufficient importance as they are tagged as psychogenic and not considered to merit the care given to clear-cut physical disorders. This is deleterious to the doctor-patient relationship, posing a barrier to effective treatment and reinforcing the ‘stigma’ attached to ‘mental illness.’ Kendell concludes by advocating the use of the term ‘psychiatric illness or disorders’ in place of mental illness and denouncing both the ‘mental’ and ‘physical’ nomenclature as “archaic and deeply misleading.” As an example of a psychological illness conforming to the requirements of a bodily disorder, we can consider the study of the Chronic Fatigue Syndrome or myalgic encephalomyelitis (Sykes, 2002). Sykes retains the distinction between mental and physical disorders, but argues that Chronic Fatigue Syndrome should be classified as a physical disease, in opposition to the commonly held view that, in the absence of proven physical causes, Chronic Fatigue Syndrome is a mental disease. The classification of Chronic Fatigue Syndrome as a mental or ‘somatoform’ disease is justified by the absence of clear laboratory techniques to demonstrate the pathology involved and the symptoms, though physical, being linked to psychological factors. Sykes argues that the lack of physical causes alone cannot be a valid reason to assume that the causes must be psychological. After all, Chronic Fatigue Syndrome is experienced by the sufferer as a physical illness, characterized by a debilitating weakness associated with a viral fever or influenza. The existing psychological factors may be subsequent to the disease and not causes. In many cases, there are no significant psychological causes. The patients have managed a healthy approach to life prior to the onset of the disorder. While many sufferers admit to stress before their illness, stress is also a precipitating factor in heart attacks, which are unequivocally classified as physical illness. Patients with Chronic Fatigue Syndrome, who are unable to walk even a short distance, are not deterred by psychological factors like fear or anxiety. Despite high motivation levels, the effort exacerbates the illness and the pain. Sykes argues that, in the absence of predominant psychological causes and the preponderance of physical symptoms, Chronic Fatigue Syndrome is a physical illness, bolstered by evidence of biological abnormalities of the central nervous system and the immune system (Komaroff, 2000 cited in Sykes, 2002). Sykes argument is further strengthened by the findings that, in the case of Chronic Fatigue Syndrome, in which physical activity is obstructed, the frontal systems of the brain are implicated. The caudate nuclei, which are a part of the frontal executive circuit, do not function effectively and cause impaired physical activity (Spence, 2006). On the other hand, White (2002) holds that, despite the many physical symptoms of Chronic Fatigue Syndrome, such as muscle and joint pain, headache, sore throat, tender lymph nodes and heaviness in limbs and the finding that certain viruses can trigger Chronic Fatigue Syndrome, it is only the ‘biopsychosocial’ approach which has yielded dividends in its’ treatment and hence, it cannot be considered fully a physical illness. White agrees with Kendell that the distinction between mental and physical illness is meaningless. While psychological and social factors definitely influence health, it is the neurophysiological process taking place in the brain which causes conscious states such as emotions. Therefore, both psychological (psychotherapy) and physical (antidepressants) treatments are effective in neurophysiological disorders. White contends that “psychiatric disorders, at one level, are simply physical disorders of the brain.” Somatoform disorders have both mental and physical characteristics. Baker and Menken (2002) categorically state that it is “Time to abandon the term mental illness” in favour of the term “brain illness” which ties mental disorders to physical brain disorders, supporting Kendell. The last half century has seen rapid advances in neuroscience and this has blurred the earlier divide between mental and brain disorders or between psychological and neurological illness. All brain disorders are physical illnesses. Therefore, as Kendell says, there is no distinction between mental and physical illnesses. Baker and Menken strongly advocate the collaboration of neurology and psychiatry for the effective treatment of nervous system disorders. Kendell’s argument certainly bears the stamp of legitimate, logical reasoning, but an unequivocal rejection of the distinction between ‘mental’ and ‘physical’ illness is difficult to accept. As Foreman (2001) comments, it is unreasonable to combine mental and physical disorders purely on the basis that both exhibit both mental and physical symptoms. Differences in degree are very valid differences and cannot be ignored. There is a valid difference between anxiety-related chest pain and an anxiety precipitated myocardial infarction. Even when the psychiatric disorders demonstrate physical symptoms, the possibility of them being purely functional continues to exist. Kendell’s advocacy of doing away with the ‘mental illness’ nomenclature, so as to do away with the stigma attached to it, does not hold water: it is acceptance which is needed and not denial. The latter would merely pose a barrier to the understanding and treatment of the disease. Fulford (2002) also opposes the eradication of the mental and physical distinction, but for other reasons. Fulford denigrates the attempt to translate all mental illnesses into physical disorders, as this seems to connote that the psychiatric approach is inferior to the physical medicinal approach. Mental disorders being far more complex in scientific, clinical and conceptual aspects than purely physical disorders, it is limiting the scope of psychiatry to bring it down to the level of physical medicine. However, Fulford concedes that distinguishing mental from physical disorders is difficult in many areas, as for example, in disorders like anorexia. It is indisputable that the term ‘mental illness’ has negative connotations in present day society. Persons with the ‘mentally ill’ tag are presumed to lack moral strength. Their complaints are dismissed as being “all in the mind.” They are discriminated against by employers who would agree to hire people with physical disabilities, but balk at a history of nervous system disorders. Society at large keeps the mentally ill apart at a safe distance, denying them the compassion generally elicited by physical disabilities. Physical disorders are considered to be a sorry, unavoidable facet of health, in which the poor victim is not to be blamed, while mental disorders are somehow the fault of the sufferer. Denying the physical basis of the disease also blocks the patients’ access to potentially effective modes of treatment and does not respect the patients’ experience of physical symptoms. In financial terms, a person with a psychological disorder is penalized by insurance companies and benefit and pension agencies, by being entitled to a lower allowance. However, total abolishment of the term ‘mental illness’ seems both unrealistic and impracticable. It does provide a useful tool for diagnosis and asserts clearly which of the symptoms are predominant: mental or physical. It also serves as a pointer to the specialist whose services are required: psychiatrist or neurologist or other physician. If the associated stigma is to be cited as the reason for abandoning the distinction, it is definitely the wrong approach. Any stigma is the result of ignorance and fear and its’ eradication requires education and public awareness. Abandoning the term itself is akin to acknowledging that it is a badge of shame which must be concealed in the shadows (Reynolds, 2001). Contemporary research into the role of cytokines has proved the impact of emotions on the immune system and confirmed that diseases affect the mind. The horizons of medicine are being widened to bring into its’ ambit ‘complementary’ approaches like those of Ayurveda and other traditional systems of Chinese and native medicine. The contribution of meditation, yoga and other alternative therapies are widely acknowledged by the medical fraternity and lay people. Finally, what emerges as the right approach is the integration of physical, psychological and social factors into a multifaceted approach which will deal with disorders on all three levels. A holistic biopsychosocial model which acknowledges the relevance of the contribution of neurologists, psychiatrists and social scientists and incorporates the best of other medical traditions, provides the optimum framework for countering the disadvantages of the purely ‘mental’ of ‘physical’ approach. As the Buddhist tradition avers, “the mind and the body are neither separate nor identical, not even alternative, but inseparable … like two bundles of reeds supporting each other” ( Goonatilake, 1998 cited in Jeyasinghe, 2002). References. Baker, M. and Menken, M. 2001. Time to abandon the term mental illness. The British Journal of Psychiatry. 322:937(14 April). Retrieved 20 November, 2006 from http://bjp.rcpsych.org/cgi/content/full/322/7291/937?ijkey=8175b Foreman, D. M. 2001. Mental and Physical illness. The British Journal of Psychiatry. 179:462 – 463. Retrieved 19 November, 2006 from http://bjp.rcpsych.org/cgi/content/full/179/5/462-a Fulford, K. W. M. 2002. Commentary. Advances in Psychiatric Treatment. 8:359 – 363 Retrieved 20 November, 2006 from http://apt.rcpsych.org/cgi/content/full/8/5/3159?ijkey=b0d07 Kendell, R.E. 2001. The distinction between mental and physical illness. The British Journal of Psychiartry. 178:490 – 493. Retrieved 19 November, 2006 from http://bjp.rcpsych.org/cgi/content/full/178/6/490?ijkey=1c Reynolds, E.H. 2001. Mental and physical illness. The British Journal of Psychiatry. 179:461 – 462. Retrieved 20 November, 2006 from http://bjp.rcpsych.org/cgi/content/full/179/5/461-a?maxtoshow Spence, S.A. 2006. All in the mind? The neural correlates of unexplained physical Symptoms. Advances in Psychiatric Treatment. 12:349 – 358. Retrieved 19 November, 2006 from http://apt.rcpsych.org/cgi/content/abstract/12/5/349 Sykes, R. 2002. Physical or mental? A perspective on Chronic Fatigue Syndrome. The British Journal of Psychiatry. 8:351 – 358. Retrieved 19 November, 2006 from http://bjp.rcpsych.org/cgi/content/full/8/5/351?ijkey=29aa White, P.D. 2002. Commentary. Advances in Psychiatric Treatment. 8:363 – 365. Retrieved 20 November, 2006 from http://apt.rcpsych.org/cgi/content/full/8/5/363?maxtoshow + Read More