The Psychology of Illness
Illness, whether acute or chronic, often impacts much more than just our physical health and well -being. The mind and body both play a role in coping with, recovering from, and preventing a wide range of illnesses, and there are often major ramifications for both if either sees major disruption. This relationship between our psychological selves and physical selves is often complex and, in some cases, is poorly understood, but that doesn’t make it any less important or revelatory. What follows is an exploration of the multifaceted study of the psychology of illness, addressing the numerous ways our physical and mental well-being intersect, overlap, and influence one another.
- Coping with Chronic Illness
- Mental Health and Immunity
- The Perception of Illness
- The Psychology of Healing
- The Mental Impact of Terminal Illness
- Pain and Mental Health
- The Mind-Body Connection
- The Total Body Impact of Addiction
Coping with Chronic Illness
Chronic illnesses are defined by the American Psychological Association as those which either have symptoms that occur on a constant basis or flare up episodically. While some chronic illnesses may be terminal, many more are not. While these conditions cannot be cured, they can usually be managed through diet, exercise, lifestyle, and medical care and may even go into temporary remission. Chronic illnesses are not uncommon; it is estimated that more than 80% of older adults suffer from at least one chronic illness. Examples of chronic conditions include diabetes, pulmonary problems, HIV/AIDS, asthma, hepatitis, arthritis, fibromyalgia, and epilepsy, though there are many others.
Unlike acute illnesses that occur over a few days or weeks, chronic illnesses are a life sentence, requiring care and impacting health for the rest of an individual’s life. This can be a hard thing to handle for many, as it is common for chronic illnesses to cause pain or to impact quality of life. As a result, it is not uncommon for those suffering from chronic illness to have feelings of isolation, frustration, and hopelessness, especially if their condition is impacting relationships with friends and family, finances, or future plans. Chronic illnesses can often come with serious lifestyle changes and some carry heavy stigmas that can embarrass those who have them. Reduced abilities, high costs of treatment, and a loss of self-worth and self-esteem can all take a toll on the mental health of those with chronic illness.
Research shows that 25-33% of those suffering from chronic illness also report depression, a psychological condition which may exacerbate existing health problems by creating poor eating habits, lack of exercise, poor hygiene, and social isolation, as well as coming with a host of its own physical symptoms. To avoid this, the Institute of Medicine asserts that it’s critical to help those with chronic diseases learn to cope with the emotions related to their illness, change behaviors that could have a negative impact on the disease (perhaps even fatally so), and to manage any disruptions the illness may cause to everyday life at work and at home.
Chronic illness may not just impact those who have the condition, however. Others surrounding the sick person may see serious changes in their psychological state as well, ranging from pity to impatience to intolerance, depending on the type and seriousness of the chronic disease. This can cause disruption in relationships and very often can make it significantly more difficult for those with chronic illnesses to cope on a day-to-day basis. As a result, many chronically ill individuals attempt to hide or conceal the effects of their illness from others. In some cases, however, concealment may not be possible, especially when a chronic illness, like multiple sclerosis, causes impairment. These impairments may put tension on relationships by requiring the parties close to the chronically ill person to become caretakers, a responsibility that comes with some serious mental health complications of its own. Due to the stress disability or impairment may place on a relationship, it’s critical for those who are ill to keep communication open, ease stressful emotions, be open about their needs, and to pay attention to the health and well-being of those taking on additional caretaking responsibilities as well.
Nika C. Beamon, in her memoir Misdiagnosed: The Search for Dr. House, discusses how hard chronic, and in her case mysterious, illness (it took years for her to be diagnosed with the rare autoimmune disease IgG4 related systemic disease) can be for family members. She says:
“My years of being half dead didn’t only affect me – nearly everyone else in my world suffered with each misdiagnosis; the least vocal were my parents. They rushed to hospitals in three states taking solace only in the change of scenery. Innumerable times, they changed my clothes, drove me around, made my meals and listened to me bitch about one doctor, procedure or medical bill. On the days I was too weak to complain, they finally had the time to wonder if their oldest child and only daughter would outlive them, have a family of her own, or be able to just live on her own indefinitely.”
To cope with chronic illness, many individuals will seek out therapy or support groups of those who suffer from the same or similar condition. This can help to alleviate the feelings of isolation, loneliness, and resentment that many with chronic illness feel, while also providing a support system that can make undergoing treatment and staying on track health-wise much easier.
Mental Health and Immunity
The immune system is a purely physical, brain-based response system, right? Well, not entirely. While the response the immune system has to invading germs and foreign materials in our bodies is decidedly physical, what triggers this response, or lack of it, can be greatly influenced by our mental state. In fact, compromised mental health can be one of the biggest factors in suppressing the immune system.
Perhaps the biggest trigger for a lowered immune response is stress. Stressors can come from work or from personal relationships and are most damaging when they occur on a long term, chronic basis. Severe or chronic stress hampers the body’s ability to manufacture protective antibodies, which can handicap the immune response that the body can produce. This happens when the stress hormone, cortisol, inhibits the development of T cells, an important immune system defense against infection, making those who are chronically stressed more likely to get and stay sick. What’s more, those who are already sick (including suffering from depression) or who are older are more prone to these kinds of stress-related immune changes.
It’s not just negative emotions that impact immunity however; there is also some evidence that a positive mental outlook can have a beneficial impact on the immune system. A study at the University of Kentucky found that participants who reported feeling optimistic had a stronger immune response (in this case the development of a bump) to an injection of an antigen than when they reported feeling less optimistic or pessimistic.
Additionally, recent research has shown that a positive mental state can even help immunizations like the flu shot work more effectively. Overall, flu shots are only about 60% effective, but that rate can be improved by stressing less, socializing more, and engaging in more exercise. Stress can help blunt the antibody response to the flu vaccine, which can make it much less effective, so those hoping to get the immunization should work to reduce stress and depression. Also helping the vaccine are activities like weight training and cardio, which push the immune system into action, and engaging in socialization with close friends and relatives which can both reduce stress and improve the antibody response to a vaccine.
But what about immunity’s impact on mental health? It turns out there’s a connection there, too. Recent studies have found that genes linked to the immune system can affect personality traits and increase the risk of developing certain mental illnesses, like schizophrenia and depression. Why? It may boil down to inflammation. Inflammation is often an immune response to healing injuries or fighting off bacteria, but the process also influences the brain, sometimes impacting learning and memory. As a result, increased inflammation in the body can sometimes lead to increased levels of mental illness, especially those related to impulsiveness and personality changes.
In fact, genes that influence the immune system may play a bigger role in mental health than previously realized. A study done by Nobel-prize winning geneticist Mario Capecchi demonstrated that gene defects that impact the manufacture of immune cells in the bone marrow can lead to greater instances of mental health disorders. The cells, malformed by the genetic mutation, migrate from the bone marrow to the brain, where they’ve been shown to cause trichotillamania, or pathological grooming, in mice. Capecchi asserts that it’s not just this illness that can be influenced by the immune system, stating, “If you look at people who are depressed, often you find their immune system isn’t working normally.” Beyond that, studies have shown that genes that confer a higher rate of depression, schizophrenia, obsessive-compulsive disorder, bipolar disorder and autism are also connected with the immune system.
So how can you use your mental state to boost your immunity? Experts at Harvard advise using relaxation techniques and exercise to limit stress, getting enough sleep, and treating any existing medical of mental health conditions. While there’s no guarantee this will keep you from getting sick, these practices are just good health advice, whether your immune system needs the boost or not.
The Perception of Illness
Illness isn’t just a personal issue, though it may feel acutely personal to those who are suffering from it. In fact, illness can cast a much wider net, impacting not only the individual but also any who interact with that individual. These sociological issues can affect the perception, treatment, and psychological well-being of those who have everything from a simple infection to a life-threatening illness. While stigmas and attitudes towards those with illness have changed over time, they’ve always existed, often creating a separate social status for those who suffer from them.
In sociological terms, those who have serious or chronic illnesses are often described as taking on the “sick role” a term defined by sociologist Talcott Parsons in 1951. This sick role means that the person suffering from illness takes on the role of a “sanctioned deviant,” as their illness disturbs the normal social function of society, and as deviant individuals they must be managed and controlled, usually by those in the medical profession. While most of us don’t see those with serious illnesses as deviants, this “sick role” defined by Parsons isn’t too far off from how those dealing with illness, either temporary or long-term, are regarded in society today, more than 60 years later, with many who are ill being seen as being weak, fragile, and unable or unwilling to do the things that average, well people do on a daily basis.
Yet Parson’s sick role requires a certain amount of acceptance of this social deviancy, not something many are willing to do. The sociological reaction to illness was perhaps better described by Uta Gerhardt, who suggested that the onset of illness, especially chronic illness, irreversibly changes the social status of an individual and those who are ill must adapt to this change to maintain a sense of self, and later by Michael Bury who theorized that societal beliefs and the specific meanings attached to chronic illness and disability strongly influence the societal expectations of what an individual is able to achieve. Both suggest that illness changes how others regard the sick person, and may cause them to be seen as incapable, of lower status, or even as a burden.
While some illnesses may elicit sympathy and understanding, even if they carry negative connotations of weakness, others come with serious stigma attached, one that can lead to discrimination, exclusion, and, in some cases, even intolerance. Coping with this stigma often means that those with illness must decide whether or not to disclose their condition, to conceal noticeable aspects of their symptoms, or to stretch the limits of what they can do. Those who cannot conceal the effects of their illness may face a wide variety of prejudices and obstacles in both personal and professional relationships, as illness can sometimes paint them as outsiders. Discrimination is often worse for those who already belong to marginalized groups, which, depending on the setting can mean those who are different in race, gender, or sexual orientation than their peers.
One prominent example of workplace discrimination was documented in the movie Philadelphia. While a fictionalized account, it was based on the real life experience of attorney Geoffrey Bowers who, after coming down with meningitis and later being diagnosed with Kaposi’s sarcoma and AIDS, was dismissed from his position at a law firm without following normal termination processes. The firm claimed that it was performance that was behind their decision, but Bowers argued that his health conditions, especially AIDS which carries a heavy social stigma, were at the root of the termination. While Bowers would not live to see the end of his case, the courts would rule in his favor, awarding his family a significant sum of money in damages.
It’s not just chronic illnesses that carry a sociological weight; acute illnesses can pose a problem, too. In highly competitive working environments, employees who chose to stay home with a cold or other health problem may be seen as lazy, despite the very real limitations such conditions put on the amount and ability of individuals to complete virtually any kind of work. The attitude is so prevalent that a recent study found that as many as 80% of office workers show up for work even when they know they are sick. Why? Twenty five percent of workers said they didn’t want to take a sick day and nearly half said that being sick would mean they wouldn’t be able to get their jobs done. A similar study done in Sweden found that employees often went to work when they were sick in order to not be seen as fragile or unreliable by coworkers. These fears might not be unfounded. The Center for American Progress found that nearly a quarter of adult workers have been threatened with termination or fired after taking off work for being sick or taking care of a sick family member.
How illness is viewed in society is a complex topic, and while many will react with sympathy and caring for those who’ve fallen in, the reality is that longstanding prejudices and stigmas about illness still exist. A willingness to view those who’ve fallen ill as being weak, different, or even as unproductive and deviant members of society isn’t new nor is it especially surprising. It is, however, disheartening to think of the additional psychological stress from external sources that is placed on those who are already struggling to cope with serious health conditions.
The Psychology of Healing
Our psychological states don’t only influence whether or not we get sick; they can also play a big role in helping us recover from acute illnesses and cope with chronic ones. As it turns out, mental health, happiness, and overall well-being can play an active and important role in how fast or how well our physical bodies cope with a wide range of illnesses.
Think your state of mind doesn’t matter in healing? Research says that it does. In one study done by the University of Nottingham, researchers found that people suffering from diabetes-related foot ulcers had different rates of healing that correlated with their coping methods and their psychological state of mind (more specifically their level of depression). It was discovered that not only did mental state influence healing, but that treating those with diabetes not only for their physical condition but also for their mental health by teaching coping methods and providing support, helps improve healing and reduces the effects of the illness.
Studies also show that laughter really may be the best medicine, as it can have a marked impact on healing. Laughter, often tied to happiness, can help inhibit the release of stress hormones, like cortisol and adrenaline, and helps to pump up immune system activity by increasing interferon, T cells, and white blood cell in the body. Laughter also triggers the release of endorphins–the body’s natural feel-good chemicals, which promote an overall sense of well-being and can even temporarily relieve pain.
Unfortunately, the impact of the mind on the body with regard to healing isn’t always a positive one. Just as a positive state of mind can influence the body and the immune system towards positive outcomes, stress and negative emotions can inhibit the healing process. A study published in 1998 in the Journal of the American Medical Association found that those with low socioeconomic status had poorer health outcomes across the board. These outcomes weren’t just from poor health habits and lack of healthcare, however. They were found to be directly correlated with negative emotions including feelings of powerlessness and loss of control. In numerous other studies, psychological stress (including depression and anxiety) and poor coping behaviors were also shown to result in poor healing outcomes for injury or surgical wounds.
These studies demonstrate that while healing may be a physical process, mental factors like depression, happiness, stress, anxiety, and positivity can all play a role in boosting the body’s ability to bounce back from serious injury or illness. Some research has even pointed to making support, therapy, and other forms of psychological assistance a key part of treatment and recovery.
The Mental Impact of Terminal Illness
Coming to terms with an illness is never easy but it can be even more challenging when an illness is terminal. Coping with the pain, grief, and isolation that often comes from having a terminal diagnosis can not only take a physical toll on the body but a mental one as well. While the physical challenges of a terminal illness are undeniable and clearly seen, the psychological, emotional, and mental disturbances often lurk below the surface and may not be addressed by medical professionals or even the individual his or herself.
Those who know they may only have weeks, months, or years left to live often experience a wide range of emotions ranging from regret, to anger, to sadness. Some may have difficulty coping with the reality that they have such a short time to live. Others live in denial that they are dying at all, constructing elaborate but sometimes effectively deceptive ways of looking at their illness that make it easier to cope with. Doctors often report that terminal patients go through the Kubler-Ross five stage model, grieving for the loss of their lives by exhibiting denial, anger, bargaining, depression, and acceptance.
Death and dying mean different things to different people, and as such the psychological effects of a terminal diagnosis may be influenced by age, cultural background, and personality. For example, anxiety and depression, factors that can make coping with terminal illness more difficult, have been found to be more common in those under 50 with dependents. Differences in religious practice may influence behavior and emotion as well, with those having strong religious beliefs often taking on much more aggressive treatments to prolong life. According to psychiatrist C.K. Aldrich, a terminal patient’s reaction to grief is determined by three factors: the extent and quality of his or her interpersonal relationships, the use made of denial, and the extent of the regression and the restriction of ego boundaries secondary to the organic illness. In that way, the psychological response to terminal illness will be different, though difficult, for each individual patient.
Terminally ill patients may also face psychological distress from having to manage the anxieties and sadness of those who are close them. Some may feel that they need to pretend to be well or comfort others, which can make interactions with others feel tiresome or psychologically draining. Even among close friends and relatives, many terminally ill patients express feelings of isolation which can make it extremely beneficial to join support groups for others coping with their own terminal illnesses and who can relate.
Often, an ignored psychological aspect of terminal illness is the tendency to give false hope or to deny the reality of the impending death. This is not only something that patients may be guilty of, but health care providers as well. A British Medical Journal study of physicians found that 63% overestimated that survival time of terminally ill patients. Researchers believe that doctors weren’t purposely trying to lie to patients, but simply were holding on to hope, in some cases where there was none to hold on to. Terminal illness, because it forces all close to it to force their own mortality, is rife with psychological implications, not only for those who suffer from it but also from those who treat it and it can be very difficult not only to get a death sentence but also to give one.
Pain and Mental Health
Pain, whether as the result of a chronic condition or an injury, can make doing even the simplest of things difficult. It’s estimated that more than 30 million Americans suffer from some kind of chronic pain, but the impact of this pain isn’t just physical; it can take a toll on mental health and well-being too.
While pain is a function of neurological processes, many are surprised by how much of a role psychological factors play in the perception of that pain. Within the brain, pain is closely tied to brain functions that govern behavior and decision making, including expectation, attention and learning, which means that altering these behaviors can often mean altering the experience of pain. Factors like expectation of reward or punishment, fear, stress, and mood can all alter perceived pain intensity.
In fact, even your personality type can set you up to feel more or less pain. Those who take negative approach to pain and believe that something will be extremely painful are more likely to have an actual amplification of the pain. Why? This kind of anxiety-laden thinking can actually increase painful sensations by heightening brain activity throughout the pain matrix. On the flip side, personal outlook and approach to pain or to the threat of pain can also reduce the impact it has. Research has continually shown that pain associated with fear hurts more. Reducing the fear of pain can actually help reduce the pain itself, or at least the perception of the pain.
For those with chronic pain, the impact of an injury or illness can be all-consuming. Research suggests, unfortunately, that the longer chronic pain occurs, the more acutely those who suffer from it will feel pain. Pain pathways in the brain grow stronger when used, and the constant ache of a bad joint or an inflamed part of the body makes these pathways easier to follow. The brain may actually get better at perceiving pain, making those suffering from it more sensitive and more likely to register even low levels of pain. This process can make it so that pain can even be felt in regions of the body that have long since healed from an injury or surgical procedure because the pain pathways have simply been seared into the mind.
It’s important to note, however, that pain’s impact on the body isn’t purely mental. Over the past decade, research has shown how chronic pain can actually alter the structure, function, and chemistry of the brain. Pain may cause the gray matter in certain regions of the brain to become less dense and only when these regions regain this density will individuals feel any pain relief. Similar studies have also revealed that different types of pain, pressure and thermal pain for example, are processed by different parts of the brain with very little overlap. This suggests that not only is pain an incredibly complex phenomenon, but that to understand and to treat it, doctors will need to target relief to certain brain patterns of pain.
Research suggests that there’s also a socioeconomic aspect to chronic pain and the effect it can have on mental health. When University of Michigan researchers collected data on nearly 4,000 adults under 50, they found that life in less affluent neighborhoods often correlated with greater degrees of sensory pain, affective pain, and disability due to pain. Race was also found to be an issue, with African-Americans seeing greater levels of pain and disability regardless of economic well-being. What’s more, these individuals were not only more prone to pain but also to psychiatric diagnoses of depression and anxiety.
While we often like to boil pain down to a simple nerve reaction in response to a painful stimuli, in reality its impact on the body and the mind can be far more complex. Many aspects of how individuals experience and can control pain are just now starting to be better understood, and with more research may come better, more effective ways to treat both the mental and physical problems associated with chronic pain.
The Mind-Body Connection
Much of what happens in our bodies is outside of our conscious control, but not everything. While our brains unconsciously dictate everything from breathing to digesting lunch, our feelings, actions, and even overall outlook on life are things under our control that can, and often do, have a major impact, for better or for worse, on how our bodies function.
Very often, mental and physical conditions are closely linked, with one increasing the risk of developing the other. Depression and chronic physical illness are one example. Research has shown that the two exist in a reciprocal relationship with one another: not only do many chronic illnesses cause higher rates of depression, but depression has been shown to exacerbate some chronic physical illnesses. Each can, in turn, make the other worse and in some cases, one disorder may even mask the symptoms of another.
Relationships between the mind and body need not always be negative, however. Research also suggests that a positive mental state can help alleviate symptoms of certain diseases. A recent study at the University of South Carolina found a strong connection between a personal emotional and physical well-being among those with Type I diabetes. Those who reported feeling better mentally, also felt better physically, while those who felt worse often reported having higher blood sugar. Researchers believe that stress as well as coping methods for dealing with the disease can play a major role in the severity of symptoms and the development of additional life-threatening conditions.
As it turns out, an optimistic mental outlook can actually have a significant impact on nearly every aspect of health. Researchers at University of Pittsburgh followed more than 100,000 women over the course of 15 years. Those who self-reported as being optimistic were 14% less likely to die from any cause over the course of the study than pessimists and 30% less likely to die from heart disease. The optimists in the study were also at a lower risk of having high blood pressure or diabetes, and overall were less likely to smoke cigarettes. The study also revealed that being trusting, rather than cynical and hostile, has serious health impacts, too. Those who were cynical and hostile were 16% more likely to die during the study period and 23% more likely to get cancer.
While a negative attitude, stressful life, or emotionally tumultuous experience isn’t a guarantee that health outcomes will be poor, it does increase the risk of disease, depression, and numerous kinds of health problems. However the connection between what we think and feel and our overall health operates, it’s clear that sometimes mind really does have power over matter.
The Total Body Impact of Addiction
According to recent statistics, more than 23 million Americans struggle with addiction but few, less than 10%, ever reach out for help. That’s in part because addiction often causes both mental and physical dependency, making it incredibly difficult to see a way out of the vicious cycle of abuse that most addicts deal with on a daily basis.
At its heart, addiction is a chronic brain disorder, even though it’s not often regarded as this type of chronic illness. Those who are addicts cannot stop their behaviors, despite the mental distress they may cause to themselves and others, because in many cases the addiction itself has actually rewired their brains. Studies have shown through brain imaging that addiction can radically alter the parts of the brain that deal with decision-making, learning, memory, and behavior control, which can make it nearly impossible for addicts to escape the compulsive and destructive behaviors that shape their lives. This rewiring can also make addicts more susceptible to anxiety disorders, adding further motivation to indulge in the addictive behavior.
Mental health can, and often does, play a role in addiction. While genetics and social environments are key risk factors, those who were victims of childhood trauma or who have mental health disorders like anxiety, depression, or mood illnesses are much more likely to exhibit addictive behaviors than those who do not have these issues. In fact, it’s estimated that 50% of those with an addictive disorder also have a psychiatric disorder.
Often, addicts drink or do drugs as a way to escape the distress that these mental disorders can cause, but there is another common thread: chemical deficiency. According to research, a reduction in the amount of serotonin, a hormone that often leads to feelings of well-being and happiness, in the brain can be a contributing factor to both mental illness and addiction. Other studies have suggested that a surplus of monoamine oxidases (MAOs), enzymes that break down serotonin, adrenaline, and dopamine, in the body can also play a significant role in increasing the risk of these issues.
Like many other chronic illnesses, addiction can also be exacerbated by stress. Animal studies have shown that the brain changes associated with stress are also associated with greater sensitivity to the effects of drugs and abuse. This means that those who suffer from addiction will be much more likely to relapse when facing stressful life experiences like job loss, relationship difficulties, and death. Like with any other illness, teaching coping strategies can go a long way towards reducing the impact of stress and the power addiction has over quality of life.
Addiction is an illness that carries one of the most persistent social stigmas, perhaps because it is so poorly understood by those who have never experienced it. The stigma of addiction often makes it difficult for addicts to admit they have a problem and to seek help, though treatment programs can be quite effective when both the mental and physical components of the disease are addressed. The most successful recovery programs are those which blend behavioral therapy, medication (if applicable), and personal support. Often, symptoms of both addiction and underlying mental health issues must be addressed for patients to truly walk away to lead productive and healthy lives.
The relationship between out mental health and our physical health is complex and is only just beginning to be understood by scientists. One thing, however, is clear: attention to both is a key part of maintaining a healthy, happy life. Even those predisposed to certain conditions can take an active role in finding help, support, and care they need to ensure that both aspects remain in balance and in good order throughout a lifetime.