Volume 12 Issues 6 June, 2022
MBBS, DPM, DNB Psychiatry, FRANZCP
Consultant Psychiatrist, Monash Health, Melbourne, Australia
A substantial proportion of our time as medical trainees is spent gathering and retaining colossal amounts of medical information. The abyss of continually updating knowledge that will likely continue to sneer at even the most senior or experienced us is simply a reminder of the sophistication that stands behind the functioning of a human being. A grip on facts and data, on the one hand, bestows upon us apparent healing powers to cure illnesses while also, time and again, nudging us back into the modest reality of our real contribution to healing another.
There are times when evidence and research (our current knowledge) will let us resolve issues in no time, like an accurately chosen antibiotic for an astutely diagnosed infection or an inflamed appendix that you skillfully severed. However, there will be occasions when all of us come face to face with unanswered questions, pieces not fitting the puzzle, illnesses with unclear etiologies or those with no specific treatment- the existence of which some of us may even unconsciously deny for the ease of solving or closing a file. The answer to this may not simply be black or white, but rather a change in our outlook to find the right shade of grey that helps us understand an individual’s predicament.
The biopsychosocial perspective to viewing illnesses was gifted to the medical world by a psychiatrist, George Engel, in the 1960s. It is pretty self-explanatory as a term but an intricate concept to understand and apply clinically. Engel saw, what most didn’t, the countless factors that governed a human (sentient) being, which could have led to or influenced his illness at a given point in time. This includes the effect of psychological factors like personality traits, e.g. a person with anxious features who tends to indulge in nervous behaviors like smoking, or psychological defenses that increase the likelihood of somatization (psychological distress that may be manifesting clinically as a physical symptom like backache, which their mind is unconsciously using to protect itself from overwhelming emotions that would otherwise be intolerable) in a person with a pre-existing back injury. The impact of external life situations on the body is no longer a theory and is now known to translate into the body’s physical functioning. If stressful emotions can change the function of white blood cell responses to infections or cancer cells, and if stress can cause wounds to take longer to heal, it makes one wonder what else are we not paying heed to, right under our noses?
Carl Jung once had an aspirational thought, “Medicines cure diseases, but only doctors can cure patients”. Given the current rising global trend in chronic conditions with unclear multifactorial etiologies, this seems more apt than ever. The comprehensive understanding of a patient by a doctor by using our empathic prowess is the best tool available to us today to transform our medical knowledge into easing a patient’s distress. While we may still be quite far from being able to cure many diseases, holistically approaching patients indeed gets us one step closer to reality than we can ever get by using a purely biomedical lens.
This is an important contribution, presently concisely and cogently. I would add to the bio-psycho-social lens, one more dimension ‘spiritual’.
There is growing evidence of the role psycho-social-spiritual aspects both in the causation and the recovery/treatment process.
What we practitioners need to do is to both utilise these resources and document them for wider dissemination.
Most of these ideas are articulated as ‘desirable’ but ‘not praticeable’. You will find a good resource in my blog[post: LIVING WITH CANCER(Blogpost: myemotionalhealthin.com)
Thanks for your comment sir!