Improving Treatment for Chronic Illness with Integrative Health Care

Doctor shows patient lying in hospital bed a tabletThe medical landscape of today has been transformed into something that our ancestors could barely have imagined. Over the past two centuries, medical science has revolutionized the lives of those of us lucky enough to live in advanced economies. Thanks to immunizations, diseases that were once major killers have become minor problems. Some, such as smallpox, have been almost entirely eradicated. Antibiotics have made most bacterial infections manageable and decreased the risk of dying from minor wounds. The scope of what can be done through surgery continues to expand. Even the humble antiseptic has saved millions upon millions of lives. It is hard now to believe that once well-meaning parents voluntarily sent their children to be infected with potentially deadly diseases to increase their chance of surviving to adulthood.

However, while medical science has greatly improved, our present reality still falls short of what those who worked to tame major diseases might have predicted. Instead of giving way to allow for a world of healthy people, the old diseases have been replaced with chronic illnesses that lack clear causes and are often frustratingly difficult to treat.

Statistics on modern illness are sobering. One survey found more than 11% of Americans had experienced pain every day for the previous three months. As many as 17% experience severe pain. Around a third of Americans are obese. Heart disease is so common it accounts for 1 in 4 of all deaths. Nearly 30 million Americans have diabetes, and over a million have asthma.

The rise of chronic illness is a major cause of the ever-growing cost of health care. This cost represents an increasing challenge to our economic and political stability. It has also had a number of other undesirable side-effects. Most notably, efforts to deal with chronic untreatable pain led to drug companies flooding the market with cheap painkillers, sparking the opioid crisis, which claims over 60,000 lives a year and ruins countless more. Many people, dissatisfied modern medicine’s inability to provide an effective answer to these concerns, are beginning to explore alternative medicine options.

Can Alternative Medicine Help?

Most forms of alternative medicine have little—if any—evidence to back up their effectiveness. Yet millions of people report feeling better after reiki, acupuncture, or homeopathy. These benefits may be attributed in part to the placebo effect or confirmation bias. But researchers have, sometimes grudgingly, admitted something more is going on.

How is alternative medicine successful in treating chronic illness? The explanation lies not in the “medicine” itself, but in the individual attention and care provided by its practitioners. Doctors working within the standard medical model may lack the time, training, or inclination to provide this sort of personal or emotional help. After all, they have studied how the body works, not how to meet the emotional needs of their patients.

Alternative medicine may succeed where conventional medicine fails because the health issues facing us today have a large psychosomatic element.

In other words, alternative medicine may succeed where conventional medicine fails because the health issues facing us today have a large psychosomatic element. In short, mental and physical ailments are linked. Either can lead to the other. This only sounds surprising because we tend to think in terms of the mind and soul vs. the body that is so important in the western philosophical tradition. As a result, we may think of psychosomatic symptoms as less “real” than the symptoms that are purely physical. In reality, the brain is just as much a part of the body as any other organ. It is no less interconnected with the wellness of the whole than any other part.

Integrating Mental and Physical Health Care

The effort to integrate the worlds of mental health and medicine has come from two directions. The first, now more than half a century old, was incorporating medicine into therapy. In other words, using antidepressants and other psychotropic medications to treat mental health concerns. The second, more recent development, is known as behavioral medicine. This approach involves using talk therapy and other forms of mental health treatment to achieve better medical outcomes. More and more people are coming to recognize the potential behavioral medicine has to find solutions for challenging health concerns and reduce health care spending.

Behavioral medicine has made the greatest impact in the treatment of stress. Most people are now familiar with the concept that stress can be a factor in chronic illness. In fact, doctors often advise patients to reduce their stress levels. But the link between mental and physical health goes beyond that. I am particularly interested in the link between chronic illness and childhood trauma.

Many studies have shown a link between posttraumatic stress and a wide range of chronic symptoms, heart disease, arthritis, and stomach inflammation among them. A strong link also exists between adverse childhood experiences and obesity. Even diabetes is highly correlated with childhood mistreatment.

Many people I work with who have C-PTSD experience a range of physical symptoms that exist in a circular relationship with their emotional symptoms. I help them by not only paying attention to these problems but also by often coordinating care with their doctors or other health care providers. I believe that more, and deeper, collaboration between clinicians with different areas of expertise is essential to provide the best support to the people we treat.

Psychotherapists who become more attuned to physical complaints of people seeking help can provide more complete care. And perhaps doctors will need to become more comfortable consulting with mental health professionals, or even asking patients about their childhoods and considering any trauma or adverse experiences for more informed treatment. This collaboration is necessary for us to progress as a profession.

References:

  1. Center for Substance Abuse Treatment. (2014). Understanding the impact of trauma. In Trauma-informed care in behavioral health services (Ch. 3). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK207201/https://www.ncbi.nlm.nih.gov/books/NBK207191
  2. Fuemmeler B. F., Dedert, E., McClernon, F. J., Beckham, J. C. (2009). Adverse childhood events are associated with obesity and disordered eating: Results from a population-based survey of young adults. Journal of Traumatic Stress, 22(4). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748336
  3. Huffhines, L., Noser, A., & Patton, S. R. (2016). The link between adverse childhood experiences and diabetes. Current Diabetes Report, 16(6). doi: 10.1007/s11892-016-0740-8
  4. McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10.
  5. Mock, S. E., & Arai, S. M. (2010). Childhood trauma and chronic illness in adulthood: Mental health and socioeconomic status as explanatory factors and buffers. Frontiers in Psychology, 1, 246. http://doi.org/10.3389/fpsyg.2010.00246
  6. Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2012). Physical health conditions associated with posttraumatic stress disorder in U.S. older adults: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of the American Geriatrics Society, 60(2), 296–303. http://doi.org/10.1111/j.1532-5415.2011.03788.x
  7. Turner, J., & Kelly, B. (2000). Emotional dimensions of chronic disease. Western Journal of Medicine, 172(2), 124–128.

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