Saturday, July 13, 2013

Psychology and Medical Illness

A few years ago I was at a reception held at a restaurant, and I was sitting with some friends, several of whom were also psychologists. A husband of one approached, himself an educator, and seeing all of us therapists sitting together joked: “Someone just ate some of the soup and now she’s feeling sick… is there a doctor in the house?” To which, the table's resident smart alec quipped: “Not the useful kind.”

It was a good joke, and we all laughed. Of course, what he had meant was that none of us at that table had been trained in medicine and physiology, and we were not going to the ones best able to help this hypothetical person in that moment. When someone needs to get rushed to the ER, you don’t call a psychotherapist. So what is therapy good for? Is it, as some have asked me, “just talk?” Well, it can be. For some people just talking is something that can be useful in many ways and for many of life’s problems, as some of you already no doubt know or have some personal experience with. But what about when it comes to your health? If most people will agree that talk therapy can help with all kinds of relationship and emotional difficulties, what about when we’re sick or just worried about our health, or that of a loved one? Is it “useful” then?

A great deal of research says, “yes.” Studies have shown that depression and/or anxiety often accompanies major illnesses. This may not seem so surprising. When patients come down with the debilitating effects of conditions such as diabetes, coronary artery disease, cancer or COPD, it raises all kinds of difficult questions about the quality and the length of their lives. People who have these conditions often have to make adjustments to their lifestyles and their day to day activities in response to their symptoms. Major depression can play a role in decreasing their ability to make these adaptations, which leads to further impairment, and so, cyclically, to further depression. Certain illnesses can even mimic, or cause, symptoms of depression or anxiety; for instance, hypo- and hyperthyroidism, some forms of hepatitis, Alzheimer’s and Lyme disease.

But while depression can be the result of a feared diagnosis, it can also contribute to developing various medical conditions in the first place, and in can do so in a number of ways. People who are depressed are more prone to engage in a wide range of behaviors associated with medical illness such as smoking, excessive drinking, or having sedentary lifestyles. Depression can also result in nonadherence to prescribed medication regimens, and to diminished social functioning…all of which can frequently cycle into more depression.

Finally, depression and anxiety are strongly associated with stress, in all of the many complicated ways that modern life is heir to.  Physicians call this condition, “allostatic load,” which is just a way of saying that stress, when it occurs not just in brief periods but when it’s prolonged over the long term, causes all kinds of wear and tear on the body, such as impaired immunity, atherosclerosis, obesity, bone demineralization, and atrophy of nerve cells in the brain. Lastly, data also shows that when people are matched for similar medical conditions, but one group has depressive symptoms and one group does not; the depressed group incurred significantly higher medical costs to treat the exact same condition ($4,246 vs. $2,371 per year according to one study).

Now this really can change the answer to the question “what is the use of talk therapy?”

I am a Licensed Psychologist. Many of my patients are older adults, and while illness is not necessarily linked to aging, some of my patients also suffer from chronic pain and other physical ailments. My office is in Conshohocken and I can be reached at (484) 534-8830 or at For more information please go to

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