Illness V/S Disease

Illness vs Disease. These two words are commonly used interchangeably in medicine and in common language too. The similarities make them interchangeable and the difference between the two is what makes the field of psychosomatics come alive. An illness is a person’s own perception and evaluation of how they feel. A disease is based on a doctor’s evaluation and can range from chronic to acute. A disease is what the doctor can clearly diagnose and hopefully treat, while an illness may not be as easy to categorize. A disease is more predictable in terms of onset and cure while an illness is not. There’s an anecdotal expression amongst doctors.

An illness is what a patient comes to a doctor with while a disease is what he leaves with. That is if he is lucky. If not, he comes in with a disease, and leaves with an illness.

Symptoms of an illness may not fall along the expected spectrum of the disease. This often causes confusion and mistrust and is hard to override unless there is awareness about the same.

Now to define Psychosomatics: It is the branch of medicine dealing with the psychic and physical components as a unit and the interrelationship between them. In a more practical sense, it is the ‘Mind-body’ connect and is based on the underlying principle that a healthy mind cannot exist without a healthy body and vice versa.

Most of us are aware of the basic psychosomatic disorders: Hypochondriasis (Now listed as Illness anxiety Disorder under DSM 5) Munchausen, Somatoform (Now Somatic Symptom disorder) and Malingering. Over the years, these have been defined and redefined, making the lines even finer. The boundaries have been blurred more and the medical community has become a lot more accepting of the fact that these disorders can cause real pain and debilitating symptoms. Anyone who has had a migraine that wouldn’t settle and thought that it is a brain tumor knows how difficult it can be.

Since some of the ailments like malingering have a negative connotation, there is a certain amount of blame that comes with psychosomatic ailments. A patient who has a brain tumor (albeit a benign one) leading to a headache will receive more sympathy than one who has debilitating daily headaches but is told they are being caused ‘just by stress’.

Psychosomatic ailments can be of various kinds:

1. Ailments that are caused purely by emotional distress; panic attacks being an example.

2. Ailments that are organic in nature but are worsened by emotional distress: example: Irritable Bowel Syndrome, cardiac ailments etc.

3. Ailments which are organic but of a chronic nature, wherein long term management and compliance can be adversely affected by the lack of emotional stability.

It is safe to say that every ailment involves the mind and the body at varying levels. It is impossible to achieve an overall sense of wellbeing unless the mind and body are both taken care of.

Cognitive Behavior Therapy has been used effectively in the treatment of various psychosomatic ailments over the years. However, the Bio-psycho-social Model of therapy makes treatment more complete.

Now, to the most important part. How can we, as psychologists help? How can we ensure that overtreatment is avoided and that psychosomatic medicine gains a stronger foothold?

As with everything else, awareness is the key. This awareness has to be two fold: For Doctors as well as for patients. The other most important aspect is to ensure that you do not work alone. A team is a paramount. Having a reference doctor as a part of the treatment plan is the only way to attain permanent results. The patient must understand that he or she has not been ‘banished’ into the dungeons, rather, it should be an exploration with an open mind where both, the psychologist and the reference doctor should be willing to go back and forth between the mind and the body as and when the need arises.

The taboo around seeking mental health treatment is now being spoken about and has become a hot topic. It is far from being completely lifted though. Terms like ‘Oh it’s nothing. It’s just stress’, can have far reaching implications on the patient’s sense of being validated. The same sentence, if framed as ‘Stress seems to be aggravating your pain and hence it is important that we get to the root cause of it with the help of a mental health professional’ can lead to more patients actually seeking help from mental health experts. As patients, it is important to trust the medical practitioner and hold your head high when you decide to seek help for a psychosomatic ailment. There is no ‘real’ or ‘fake’ pain. If a patient is experiencing pain, whether caused by stress, anxiety or tissue injury, the perception of pain is important and not just the ‘validity’ of the source causing it.

If you have been experiencing symptoms of any kind with all reports coming back normal or if multiple drug therapies have not taken you to the goal of wellness, talk to your doctor about the role the mind might be playing in your case. If he or she finds fit, seek a professional who is trained in handling psychosomatic ailments.

It might be the long lasting relief that has been so elusive all along!