The Irish Medical Times - When the body needs help
But surely a trauma to the body, is also a trauma to the mind. In my opinion, patients who have a significant physical event or diagnosis should have their mind treated alongside their physical disease. I don’t mean in the exact moment of the drama, I am not suggesting if someone is experiencing a cardiac arrest a psychoanalyst should sit in the ambulance with them, pen in hand, and ask “When your heart stops…how does that make you feel? …Tell me more.” But when the patient is recovering, when the heart has settled but the mind is still free-falling, when discharge papers are being drawn up and follow up medical appointments arranged, when medication prescriptions as long as your arm are being printed out, when brochures about their condition are being thrust into their hands - can we just take a minute to acknowledge the carnage that was once their mental health.
I don’t expect a doctor or a nurse to be a counsellor or sooth-sayer, although that would be convenient, but hospitals do have Psychology Departments and Social workers. Could more money be invested in them so that doctors from other disciplines could refer more patients their way? Could they become a regular part of the teams that deal with chronic illnesses? Could they be part of the rounds? Could they sit in on Multidisciplinary Team Meetings? At the very least, could they be involved in the discharge of a patient who has endured a major event or been diagnosed with a significant life limiting illness? If these things do happen it’s at a level far from critical mass.
With this gap in place some patients feel they have no choice but to put the expectation on the doctors and nurses to coach them through their multifarious mindmelt. What is meant to be a physical checkup can turn into a counselling session. Some doctors can do this with ease (some nurses in particular can be gifted at this), others are less agile with soft skills or simply don't have the capacity or time to treat the body and soul of every patient that presents. Doctors can’t hug each patient, aside from it being highly inappropriate and a sea of litigation, it's 2022 hugs are dead in the viral water. Unfortunately, any inaction or inability to listen or comfort the patient in their moment of justifiable emotional turmoil can lead to a break in the trust and safety of the patient-doctor relationship.
More importantly, due to the mind's invisibility it can be hard for a patient to fully recognise they need help or to find the words to ask for such. No one expects a patient to self diagnose cancer to receive treatment but there is some expectation on a patient to realise they may be depressed or anxious and raise their hand. Even if they have this self enlightened eureka moment, who do they raise their hand to? And what treatment are they looking for? There is no clear path.
We live in an age obsessed with selfhood, a person's individual identity has become sacrosanct. People are constantly being urged to #bebetter #dobetter. There is a tremendous amount of introspection afoot, we are expected to be self-reliant and accountable for our actions, and if we’re not, we are going to give ourselves a really hard time about it.
Self reliance has become a cultural norm in western society. According to some philosophers this individualism started with the ancient Greeks, they lived on rocky terrain where sole traders fared better than groups. Legends were born involving a lone hero (from ancient Hercules to modern Superman). Whereas at the same time in Eastern civilization the wide land masses suited group farming and the heroic stories were less self obsessed, told as a third party observing the heroics, often with no happy ending (much like life itself where the answers aren't provided). When faced with unexpected change, westerners can fight to control the situation alone, even going to war. In the east they try to restore a new harmony. As patients at war with our bodies, we have to recognise the new person we've become, and some help with this realisation and acceptance would be greatly appreciated.
I’m not advocating for mandated therapy. Some patients don’t require psychological support, some need it but don’t accept it, others try it and find it about as useful as a sock on an elephant. I’ve fallen into all of these categories at some point. But there are swathes of patients (and loved ones) who would benefit greatly from talking to an experienced professional. Their need is acute.
Forms of psychological support do exist for patients, many charities offer counselling sessions for those in need. Consultants and GPs are often very willing to recommend patients to private and public therapists. A formal or informal support group of strangers or friends can be a great space for people to find acknowledgment and solace. Hobbies, work, routine, obligations and families can provide a network of distraction. I personally find physical exercise and writing a great release for processing pent up emotions. But all of these are up to the patient to initiate, there should be steps in place to offer structured mental help to patients as part of their care. It should be more of a firm offering than a suggestion.
The boots-on-the-ground care in the community support is valuable and offers an incredible life line to the elderly or incapacitated but it is confined to physical support. A hospital social worker can kick it into place, passing you on to your local public health nurse who can refer you on to a variety of HSE services such as occupational therapist, physiotherapist, speech therapist, dietician and vital carers. However, a young person just diagnosed with cancer may not require a rainbow of health scientists to go about their daily functions, but a counselling session along with their medical outpatient appointment could help turn their life around.
Did you know in Russian culture they distinguish between two distinct shades of blue, therefore they have an eight spectrumed rainbow. Why can't we add another shade to our care rainbow?
If we addressed the psychological fall out from patients I think we would see less hospitalizations, less wild goose chases, less tearful awkward breakdowns at appointments (and that’s just from the doctors). According to the book ‘Compassionomics’ written by American physician scientists, if a medic spends even just 40 seconds more interacting with a patient it can improve blood pressure, reduce stress and alleviate depression. It can also give doctors a ‘feel good’ factor.
The Covid party has left behind a rich gumbo of ideas and buzzwords to address mental health. It would be great to see some practical steps taken by the hospitals and the HSE with vulnerable groups such as patients to put some of the strategies into action.
Without intervention we're at risk of another crisis - a Joe Dolan revival!
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