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Sarah Clark writes "As I had received several psychiatric diagnoses, the pain team wouldn't help with my physical pain." Why not? Pain is painful, whatever the source. As long as medical and mental services work in separate silos, many patients with unexplained symptoms will be neglected, or worse. A good mental health liaison team, on the other hand, will work with the medical specialists so that, instead of being shuffled from one to the other - like the child of hostile separated parents – a patient feels looked after by both in partnership. For all our talk of parity of esteem, the liaison set-up faces deep and ancient obstacles. Millennia of theology and philosophy have separated the moral mind from a material body; they exist in different universes.
We know a lot more about the brain than the sages of old, including how mental content can have an effect in the body. Good examples are the placebo effect (Mayberg et al., 2002) which, like psychotherapy, alters the brain (Abbas et al., 2014). We always knew that sexual fantasy has bodily effects, and science has caught up with the familiar notion that you can die from a broken heart (Tennant and McLean, 2001). The interdependence of each domain is no longer challenged. Besides the effects of toxins or drugs on consciousness there are interesting correlations (while not the same as causes) between somatisation disorders and changes in the brain (Spence, 2006).
Despite scientific advances, and the creation of many sophisticated mental disorders that sound like physical ones, the old assumptions live on. We are inclined, often subliminally, to see a medical condition as a fault in the machine, while a mental disorder is subject to free will, entailing choice. No parity there. The only way to overcome the barrier is to have clinical teams learning to speak each other’s languages. This is ethical medicine, requiring discussion and debate in perplexing cases.
As a psychiatric patient Ms Clark was held responsible for her symptoms by the pain team. Once she had a diagnosis, even though her disease is incurable, she was treated differently, because it was no longer her fault that she had it, just her body’s.
Abbass, A.A., Nowoweiski, S.J., Bernier, D., Tarzwell, R., Beutel, M.E. (2014). Review of psychodynamic psychotherapy neuroimaging studies. Psychotherapy and Psychosomatics, 83(3),142-147.
Mayberg, H.S., Silva, J.A., Brannan, S.K., Tekell, J.L., Mahurin. R.K., McGinnis, S., & Jerabek, P. A. (2002). The functional neuroanatomy of the placebo effect. American Journal of Psychiatry, 159(5), 728-37.
Spence, S. A. (2006). All in the mind? The neural correlates of unexplained physical symptoms. Advances in Psychiatric Treatment, 12, 349–358.
Tennant, C., McLean, L. (2001).The impact of emotions on coronary heart disease risk. Journal of Cardiovascular Risk, 8(3),175-183.
Where is the liaison between mental and medical?
Dear Editor
Sarah Clark writes "As I had received several psychiatric diagnoses, the pain team wouldn't help with my physical pain." Why not? Pain is painful, whatever the source. As long as medical and mental services work in separate silos, many patients with unexplained symptoms will be neglected, or worse. A good mental health liaison team, on the other hand, will work with the medical specialists so that, instead of being shuffled from one to the other - like the child of hostile separated parents – a patient feels looked after by both in partnership. For all our talk of parity of esteem, the liaison set-up faces deep and ancient obstacles. Millennia of theology and philosophy have separated the moral mind from a material body; they exist in different universes.
We know a lot more about the brain than the sages of old, including how mental content can have an effect in the body. Good examples are the placebo effect (Mayberg et al., 2002) which, like psychotherapy, alters the brain (Abbas et al., 2014). We always knew that sexual fantasy has bodily effects, and science has caught up with the familiar notion that you can die from a broken heart (Tennant and McLean, 2001). The interdependence of each domain is no longer challenged. Besides the effects of toxins or drugs on consciousness there are interesting correlations (while not the same as causes) between somatisation disorders and changes in the brain (Spence, 2006).
Despite scientific advances, and the creation of many sophisticated mental disorders that sound like physical ones, the old assumptions live on. We are inclined, often subliminally, to see a medical condition as a fault in the machine, while a mental disorder is subject to free will, entailing choice. No parity there. The only way to overcome the barrier is to have clinical teams learning to speak each other’s languages. This is ethical medicine, requiring discussion and debate in perplexing cases.
As a psychiatric patient Ms Clark was held responsible for her symptoms by the pain team. Once she had a diagnosis, even though her disease is incurable, she was treated differently, because it was no longer her fault that she had it, just her body’s.
Abbass, A.A., Nowoweiski, S.J., Bernier, D., Tarzwell, R., Beutel, M.E. (2014). Review of psychodynamic psychotherapy neuroimaging studies. Psychotherapy and Psychosomatics, 83(3),142-147.
Mayberg, H.S., Silva, J.A., Brannan, S.K., Tekell, J.L., Mahurin. R.K., McGinnis, S., & Jerabek, P. A. (2002). The functional neuroanatomy of the placebo effect. American Journal of Psychiatry, 159(5), 728-37.
Spence, S. A. (2006). All in the mind? The neural correlates of unexplained physical symptoms. Advances in Psychiatric Treatment, 12, 349–358.
Tennant, C., McLean, L. (2001).The impact of emotions on coronary heart disease risk. Journal of Cardiovascular Risk, 8(3),175-183.
Competing interests: No competing interests