Introduction

Reviews

The Connection Between Emotions and Health and Disease

Timothy B. McCall, M.D.

Some doctors seemingly prefer to think of people as the sum of their organs rather than as complex, thinking, feeling beings. They make little effort to get to know you as a person, to find out what you care about, what your family situation is, whether you have financial problems or whether there are other stress points in your life.

It’s only in recent years that most doctors have even admitted the connection between emotions and health, a connection their patients have made intuitively for years. Almost reluctantly, the medical profession admitted the link between stress and ulcers but many doctors just don't get how your emotional well-being can affect virtually every phase of your life. These days, studies linking stress to various medical problems abound. Here are a few examples: people under stress are more susceptible to the common cold, more likely to develop high blood pressure, have a heart attack or suffer a recurrence of breast cancer.

Physicians often have the attitude that it is their duty to first be sure their patients don't have a “medical” cause for their symptoms. Only if all the tests come up negative, will the doctors consider psychological factors—if they are considered at all. While it’s absolutely appropriate for the doctor to do tests to rule out treatable medical conditions, if they would only incorporate an appreciation of the psychological contribution to physical disease from the beginning of their analysis, many unnecessary tests could be avoided. And many patients would feel more satisfied with the process. It is not negating a patient's real physical suffering or genuine medical problems for a doctor to postulate that stress or depression may be contributing factors.

Doctors may feel uncomfortable discussing matters they consider “unscientific” like emotions. Some feel they wouldn't know what to do with the information a patient gave them. Others worry their patients will feel insulted or think their complaints aren't being taken seriously. In my experience, most patients are happy, even relieved, to discuss these matters and to understand their contribution to their medical problems.

One of the biggest problems with not tuning into a patient’s psychological state is that a potentially fatal disease—depression—may be missed. According to studies, doctors fail to recognize anywhere from 45 percent to 90 percent of the psychological illness they see. Most people who suffer from depression don't go to psychiatrists, they turn up in the offices of primary care doctors like family practitioner or internists.

And often, these patients don't complain of depression. Like many people who aren't depressed, they mention headaches, stomach problems or fatigue. Since the symptoms of depression and many medical conditions overlap, it's often appropriate for the doctor to run a few tests to rule out a various medical conditions, to avoid prematurely attributing all the symptoms to depression. But if the doctor fails to recognize the depression—and simply conducts a series of tests or gives some medicine to suppress symptoms—the consequences can be tragic.

Failure to diagnose depression leads to unnecessary laboratory tests and more importantly, to unnecessary suffering and, in too many cases, to avoidable suicide. Depression is almost always treatable. Every year, thousands of people are brought back from the brink of suicide to live satisfying and productive lives.

Depression is often straightforward to diagnose if the doctor takes the time to ask a few simple questions. How’s your appetite? How well have you been sleeping? Have you been sad? Crying a lot? Have you thought of suicide? Sometimes all the physician needs to do is to create an atmosphere where the patient feels permission to talk. If a woman says My marriage is on-the-rocks, the doctor might respond What's going on? encouraging her to elaborate. If the doctor responds “I see. Now where was the pain?” she'll probably keep quiet about her marital problems and the opportunity to detect her depression may be lost.

Since doctors can’t be depended on to diagnose depression, my advice is to try to help them. If you think you may be depressed, say so. If your doctor won’t listen, find another doctor.

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