Treat the whole person, in all their complexity
DOCTORS’ NOTES Psychological and social factors are just as important as biological symptoms
When physical symptoms aren’t easily explained or seen as excessive, we can be quick to label them as “psychosomatic,” as though that diagnosis means we don’t take it seriously any longer.
But we shouldn’t simply dismiss these symptoms, or their underlying causes. They can have significant impacts and may continue if the contributing factors aren’t adequately addressed. In addition, symptoms that are attributed to psychological factors may be found to have biological roots. Stomach ulcers, for example, were long thought to be caused by stress alone but can be the result of a bacterial infection. Mental-health conditions can have a genetic basis. The more we study the conditions that straddle mental and physical health, the more we realize just how interconnected these areas are.
Kids and teens, in particular, are best helped when the biological causes — as well as psychological and social factors that contribute to the symptoms — are considered.
As the Medical Director of the Consultation-Liaison Psychiatry Program at the Hospital for Sick Children (SickKids), I focus on bringing these areas of medicine together.
With an interdisciplinary team, we work together to improve the health of kids and teens with physical and mental-health conditions, including those with distressing and impairing physical symptoms.
Under the Medical Psychiatry Alliance, a partnership between SickKids, CAMH, Trillium Health Partners and the University of Toronto, we’re working to break the dichotomy of mental and physical health and work at treating the whole person, in all its complexity.
An example of this complexity is 22q11 deletion syndrome, a genetic disorder in which a small piece of chromosome 22 is missing. In addition to the medical conditions that may be present, such as heart conditions, thyroid dysfunction and a weak immune system, there may also be mental-health impacts. In fact, people with this syndrome have an up to 80-per-cent lifetime risk of mental illness.
But it’s not all written in our genes. Often, a physical illness can have mental-health repercussions. Medications can have psychiatric side-effects, for example. A child who has cancer could be on medication that affects mood and anxiety. And just the stress and upheaval of a disease or injury can lead to various psychological or social ills. In fact, one teenager recently spoke about how she had survived a brain tumour, but a resulting depression almost killed her.
On the flip side, a mental illness can lead to physical problems. Anxiety and depression with associated insomnia can affect the immune system and put people at greater risk of infection, as just one example.
Many patients will express psychological stress in physical ways — as abdominal pain, headaches, nausea or even fainting spells and an inability to walk. Then there are external stressors, such as the death of a loved one, or being bullied at school, that can lead to various health problems and impact both the body and the mind.
As we continue trying to tease apart the various physical, psychological and social factors that lead to a variety of illnesses, we’re also finding new ways to examine these together. The Medical Psychiatry Alliance is leading this drive in Ontario — and this year’s annual conference in the fall is focused on children and youth with coexisting physical and mental-health conditions.
Because even if we could determine whether the cause of any particular illness or disorder is mental or physical — we still have to treat the whole person. The brain can’t be left behind — it’s really just another part of the body.
We wouldn’t think twice about having our kids’ physical health needs looked at, but many hesitate when it comes to their mental health.
You can ask for a referral from your family doctor.