Unidimensional Approach to Medicine: Why It Isn’t Working

From a global perspective, a multidimensional approach to health and wellness has long been considered the gold standard for both diagnosing and treating physiological and psychological illnesses or disease. Even the most widely used definition of health, which comes from the World Health Organization (WHO), defines health as being “a complete state of physical, mental, and social well-being” (Gurung, 2014, p. 6). However, the United States focuses the majority of its interventional programs and healthcare management around the traditional medical model of health – a unidimensional approach that provides a simple black and white definition of health in terms of simply lacking disease. According to Shi & Singh (2009), the medical model “emphasizes clinical diagnosis and medical intervention in the treatment of disease or its symptoms. Under the medical model, health is defined as the absence of illness or disease. The implication is that optimum health exists when a person is free of symptoms and does not require medical treatment; however, it is not a definition of health in the true sense but a definition of what is not ill health” (p. 28). The efficiency of the medical model in health is highly debatable and has proven to be ineffective in managing the overall health and wellness of the American population thus far. “Many of the peculiarities of this system can be traced back to the beliefs and values underlying the American culture. The delivery of healthcare is primarily driven by the medical model, which emphasizes illness rather than wellness. Even though major efforts and expenditures have been directed toward the delivery of medical care, they have failed to produce a proportionate impact on the improvement of health status” (Shi & Singh, 2009, p. 46). As we have learned throughout this semester, assessing health from a multidimensional approach is far more practical, especially given the complexity of health and health-related behaviors. Still, much of the contemporary model of health in America is still based primarily on the medical model of health for a number of reasons.

For instance, one of the key explanations that Americans rely solely on the medical model is that have had little to no exposure to other medical models of practice. It’s human nature to stick with what is comfortable and changing behavior or perspective is often a difficult and tedious process. Considering that both psychologists and medical professionals have long developed interventions and treatment programs around the medical model, primarily because it centers around what they’ve learned both in school and in clinical practice, it’s difficult to move away from the medical model as the accepted norm for managing health. As Gurung (2014) mentions, there are three main obstacles that prevent health-related interventions from reaching the clinical populations they have been designed for: “(1) researchers not always understanding the clinical applicability of their basic research; (2) a reluctance of clinicians to accept the value of their basic research; and (3) various institutional-level constraints such as the lack of time, training, or funding” (p. 435).  All of these become problematic in approaching health from an alternate perspective because the lack of knowledge or evidence drives enough motivation for change. For example, both training programs and continuing education for health practitioners don’t generally educate on the biopsychosocial approach health, making the idea seem even more unfamiliar or accepted. “Only a few existing programs provide the necessary training to facilitate the development of health collaborations, and this is another key training area for the field to incorporate” (Gurung, 2014, p. 435). Similarly, since the biopsychosocial approach is relatively new in terms of research and practice in the United States, despite being around for centuries in other cultures around the world, there is just not enough evidence not clearly support or influence professionals to transition to the biopsychosocial approach. Finally, healthcare professionals are reluctant to move away from the current medical model, even when they strongly believe in the biopsychosocial approach to health because of the financial burden it places on both themselves and their patients.

Many of the biopsychosocial approaches to health care and management often are reimbursed by insurance under the current medical model of health and billing becomes problematic with the limited availability of medical codes that are acceptable for what insurance sees as unnecessary, experimental, or alternative treatment options. For example, there are six codes that clinical health psychologists are permitted to use and only certain health plans accept all six of the codes. Medicare, for instance, accepts only five of the six CPT codes for insurance reimbursement (Gurung, 2014). “Not being reimbursed by insurance companies has been one of the biggest reasons for not enough attention being paid to psychological factors and treatment – most patients cannot afford to take care of their mental or physical health if their insurance refuses to pay for the services they need; if health providers do not get paid, they cannot afford to conduct research” (Gurung, 2014, p. 437).  Also, the diagnostic codes for mental illness are subjected to the scrutiny in a similar manner as CPT codes. Take the treatment of mental illness, for example. According to McLeod (2013), “psychiatric diagnostic manuals such as the DSM and ICD (chapter 5) are not works of objective science but rather works of culture since they have largely been developed through clinical consensus and voting. Their validity and clinical utility are therefore highly questionable, yet their influence has contributed to an expansive medicalization of human experience” (para. 38). Assessing and diagnosing patients under psychological or psychiatric care also becomes an issue in terms of credentialing, which can vary state by state, and ethical concerns have been raised about psychology professionals both diagnosing and treating patients without a traditional medical license. Although there is increasing evidence of the effectiveness of the biopsychosocial approach to medicine and health, there likely won’t be any advancement in moving the healthcare system of the United States over to a biopsychosocial approach until many of the above issues have been formally addressed and regulated.

Aside from the limited exposure to the biopsychosocial model in terms of professional utilization, the American public will likely remain reluctant in accepting a multidimensional approach to health for additional reasons outside of the current system of healthcare. For starters, the public overall lacks general knowledge in proper management or coping skills in dealing with health. Most of the information that is accessible to the public is both overwhelming and confusing, and many health reports provide conflicting information. Take the question of “what is the best diet?” for example. It has been ingrained in us from a young age that in order to be “healthy” we need to both eat right and exercise regularly. However, this concept often brings up more questions than it does answers. For instance, what is healthy to eat? What is a balanced diet? How much and when should I eat? How much should I exercise? What type of exercise? The questions are nearly endless. For those looking to change health behaviors, such as diet or exercise, often look for answers to the questions above. However, it’s likely to cause more confusion since there is no consensus or definitive evidence that constitutes right or wrong answers in this specific example. This becomes more evident in reference to the difficulties in defining the term health, as there are too many aspects to account for defining optimal health, making it challenging despite the growing number of theories regarding health and wellness.

Lastly, the importance of practicing healthy behaviors is, unfortunately, deficient within the modern American culture. As I mentioned earlier, both lifestyle choices and behaviors are among the chief determinants of health, however, initiating or activating behavioral change is extremely difficult to achieve and maintain over time. It’s human nature to be uncomfortable with self-awareness and often resistant to acknowledging their own unhealthy or negative habits that may contribute to health. Changing over to a biopsychosocial approach “would require a fundamental change in how Americans view health. It would also require individual responsibility for one’s own health-oriented behaviors, as well as community partnerships to improve both personal and community health” (Shi & Singh, 2009, p. 47). Once again, the lack of biopsychosocial approaches to interventional health behavior contributes to the minimization of healthy behaviors or practices and not all practitioners are sold on solely a biopsychosocial approach. “Surprisingly, not all parts of the scientific community saluted the importance of health behaviors, a controversy in the field of health referred to as the great debate” (Gurung, 2014, P. 423). Furthermore, the American culture has become increasingly sensitive about discussing health behaviors as to not offend others around them and there is limited knowledge of the health disparities affecting the majority of the population in one way or another.

Still, despite the number of obstacles still left to overcome, the biopsychosocial approach to medicine and health is slowly gaining momentum in the United States.  As more patients are becoming increasingly frustrated with American health care practices under its current standards, Americans are considering alternative forms of treatment as an option for managing their health, including holistic medical practices and therapies focused on the mind-body connection. It’s likely that as the field of health psychology continues to expand while health care in the United States declines, both medical professionals and their patients will be more willing to change their opinion on the biopsychosocial approach to overall health.

References:

Gurung, R. A. (2014). Health Psychology: A Cultural Approach (3rd ed.). Belmont, CA: Wadsworth.

McLeod, S. A. (2014). The Medical Model. Retrieved on February 26, 2016, from http://www.simplypsychology.org/medical-model.html

Shi, L. & Singh, D.A. (2009). Essentials of the U.S. Health Care System (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Review of Bill Meyer’s – Healing and the Mind: Healing From Within

If you haven’t had a chance to watch any of Bill Meyer’s films about chronic illness, I definitely recommend doing so. Although many of them are older, they are helpful in gaining insight into chronic illness and ways to improve your quality of life following diagnosis. In my health psychology class last semester, I was fortunate enough to be introduced to his film Healing and the Mind: Healing from Within.


<p><a href=”https://vimeo.com/39767361″>Healing and the Mind – Healing from Within</a> from <a href=”https://vimeo.com/moyersandcompany”>BillMoyers.com</a&gt; on <a href=”https://vimeo.com”>Vimeo</a&gt;.</p>

In general, society expects chronic or terminal illness patients to remain strong in spite of their condition. The media alone has set an excessively high standard for those who are sick by portraying illness a challenge that can easily be overcome. For example, there are numerous stories in the news about a cancer patient that accomplished something extraordinary and everyone deems them a hero for overcoming the obstacles of their disease. However, you don’t typically see stories of the patients who spend weeks or months in the hospital, undergoing painful medical procedures or chemotherapy.  You also don’t hear of the millions of patients still waiting for a diagnosis for this condition – which in my case, took over 20 years. As I mentioned earlier, there’s a shocking reality that follows chronic illness. As the Moyers (1999) mentions, “despite all the powerful weapons of modern medicine, many patients can’t be helped. Frustrated doctors are beginning to turn to alternatives” (Opening Scene).

According to the Centers for Disease Control and Prevention (CDC), nearly half of all adult (or 177 million people) are diagnosed with at least one chronic condition, with one out of every four of these patients diagnosed with two or more chronic illnesses or diseases, and account for nearly 48 percent of deaths in the United States. Unfortunately, many of these deaths are the result of suicide.  Recent reports on chronic illness have found that depression is approximately 20% higher in those who are chronically ill, while “physical illness and uncontrollable physical pain are major factors in up to 70% of suicides” (Copen, 2016). Just as horrifying is the fact that chronic illness could happen to anyone at any time, despite taking cautions by practicing health behaviors. Essentially, chronic illness is a community – a community that doesn’t discriminate against its population and that any person can be forced into at any given time, often without prior consent. A popular saying within the chronic illness community is that “you don’t know until you know,” and that’s the truth. Nothing prepares you for the challenges of living with a chronic illness, both physically and emotionally.

It drives away social connections, with both family and friends alike, and you lose the connectedness you once had in the world. Chronic illness literally touches every part of your life and, ultimately, it changes who you are – who you think you should be. A serious diagnosis instantly can dissolve one’s hopes or dreams and any plans that they had for the future. It becomes impossible to simply plan for tomorrow because there is often little to no predictability when it comes to illness. Additionally, the experience of chronic illness is yours alone – leaving you to feel frightened and isolated, angry or depressed, and guilty for not doing more or being more. A patient in the film Healing and the Mind described it best by saying, “I just see things getting stripped away from all of us a lot of times. One thing after the other stripped away. Stripped away, stripped away. And then who or what is left?” (Moyers, 1999, Introduction to Dr. Spiegel’s New Experiment Scene). As a chronic illness patient myself, I can firmly attest to this reality. Somedays it’s hard not give up when you’re sick all the time because you’re constantly battling between both your body and your mind. It’s hard not to get discouraged, especially when your told there’s likely little hope for getting better – no pill to take the pain away, no doctor to stitch you back together. When clinical intervention is no longer an option, patients look for other ways to manage their condition.

Learning to adjust one’s life around chronic illness is often a major challenge following diagnosis and as Moyers (1999) mentions in his film, chronic illness patients are suffering; they’re looking for ways to manage the stress associated with their illness by regaining control once again. For instance, the first half of Healing and the Mind begins by reviewing a program initiated by Dr. Kabat-Zinns, which treats individuals diagnosed with a serious physical illness or disease through the use of mindfulness and meditation exercise. In an interview regarding the program, a colleague points out that Dr. Kabat-Zinn is well respected by most doctors in the hospital for his work in managing the psychological aspects of illness. Not just because his methods have proven to work, but mainly because Dr. Kabat-Zinn takes on the toughest patients that clinical medicine couldn’t help and teaches them to live with the pain. The most profound moment for me, however, was the scene where the doctor was teaching yoga and was explaining how to let go of feelings of stress or pain:

And you feel the pain. Then you just see… see if I can ride the waves of this sensation. And you watch the sensations come and go, and very often they will change. Noticing that you can uncouple the sensation from your thoughts about them. Like, this is killing me, it’s going to last forever, there’s nothing I’ll be able to do about it. And you learn to free yourself from those thoughts and realize those are just thoughts. And then it turns out there is an inner stillness and peace right within some of the most difficult life situations. If you can learn to be comfortable within the pain or within the anxiety, it’s going to change it completely. You’re not trying to make it go away…

What we’re doing is saying, actually move into the stress and begin to look at, look at the pain, look at what the mind’s reactions are. And you’re asking, ‘is this killing me right now, in this moment, is this killing me?’ The answer is very often, ‘No, it’s not, but my GOD if I have to live with this for 30 years…’ And then you say, ‘But wait a minute, the idea is just to be in the present moment, let’s just flow with this.’ And over a period of time, people learn to actually relate differently to the pain. (Moyers, 1999, Yoga Scene).

There’s no denying that the way we think or feel can greatly influence the physiological aspects of health. However, the amount of social support a person receives (or doesn’t receive) is also a determining factor in how one copes with chronic illness, especially in terms of quality of life. According to Gurung (2014), “empirical studies and reviews show that people with more social support have a more positive adjustment to chronic illness… Having a socially supportive environment often makes the patient more actively cope with the illness and less likely to disengage and get worse” (p. 316). While having a strong personal network of family or friends is important, and sometimes necessary for basic survival, many patients will turn to group support in order to better manage their condition.

Patients can benefit from support groups for a number of reasons. For starters, supports groups are designed to bring those with similar issues, such as chronic illness, together as a way to bond and share experiences. It’s a safe place where individuals don’t have to hide how they honestly feel. For example, [in talking about on his participant in the study on support groups] Spiegel states that “it’s interesting in reflecting back on how she [the patient] presented at the first meeting with this extremely extensive and well-developed support network that despite having all those people [the patient’s support group], there were things that she felt she couldn’t share with them, but started right off sharing in the group” (Moyers, 1999, Support Group Meeting Scene). Sometimes it’s easier to discuss illness with those who understand what you’re going through. Other times, it’s just hard to tell the people that you love that you’re scared, depressed, or in pain. Individuals affected by chronic illness typically feel guilty about their condition, or that they even became sick in the first place, and they don’t want to be a burden to their family or friends. As one patient’s studied in the film stated, “I think we put on a big front for the people around us” (Moyers, 1999). Likewise, these patients can also feel that it is necessary to hide the signs of their illness to avoid the discrimination that’s become common in modern society, which views chronic illness as a form of weakness. Ultimately, it’s easier to find comfort in those you know won’t judge you for your condition.

Aside from the above, there are other benefits from finding support from a group, many of which were shown throughout the film. For example, one of the main types of social support comes from gaining informational support. Belonging to a support group provides a place to share or gain information about a particular condition or disease, such as sharing personal experiences, discussing treatment options, and exchanging tips or trick that may help to alleviate symptoms. Also, it helps to see what others are going through or to know that you aren’t the only one who has gone through this experience. Likewise, meeting others like you can often put things into perspective. For instance, if others appear to be worse off than you, it makes you be thankful for your situation. Alternately, if they have achieved recovery or appear to be doing better than you, it can give you hope that life won’t always be this way. It can also help in bringing understanding for setting expectations for the future in terms of living with chronic illness. More importantly, though, support groups create a group dynamic based on a common history. Being part of a group provides inclusion to something bigger and more profound; something outside of the self. It allows for a sense of belonging to the human race once again (Moyers, 1999).

One of the scariest parts of being sick is not knowing what is going to happen in the future. It’s also hard to explain how someone could feel alone with their illness, despite having a number of friends and family in their life. More times than not, individuals with a chronic illness feel segregated because of their illness or feel pressure to do more because of the pressure placed on them to live a normal life in spite of their conditions. Although family and friends are an essential element of one’s ability to cope with chronic illness, as you mentioned they can also create further problems or distress handing disease. Similarly, individuals who do not have a strong support network can also struggle to cope on their own, which makes access to support groups crucial to physiological and psychological well-being following a diagnosis of chronic or terminal illness.

There is a grieving process that coincides with illness, although this is a crucial part of coping with a chronic or terminal disease.  According to Absenger (2015), grief in terms of illness is defined as “the primary emotional/affective process of reacting to the loss of a loved one or loss of quality of life due to chronic illness. Grief reactions can also be viewed as abnormal, traumatic, pathologic, or complicated” (para. 9). The grieving process for chronic illness is similar as it is for those who are bereaving over a loved one, consisting of 5 Stages of Grief in Illness:

  1. Shock and Denial: When an individual first receives a diagnosis, they often go into a state of shock or numbness, unable to process what the doctor has said. As Absenger (2015) mentions, patients experience a “subjective sense of numbness, detachment, or absence of emotional responsiveness” (para. 15). Likewise, you try to avoid coping with the reality of a diagnosis by simply ignoring the problem.
    • This isn’t really happening to me.”
    • “The doctors must be wrong; I am not sick.”
    • “I’m fine, everything is fine.”
  2. Anger: When a person can no longer deny the inevitable, one can often feel anger or bitterness towards their illness.
    • “What did I do to deserve this?
    • Life is so unfair!”
    • “Why me?
    • “I am sick and tired of always being sick and tired!”
  3. Bargaining: They want to understand why this happened and become desperate to find a way to fix themselves. They believe if they make deals that they alter the outcome of their illness.
    • “God, if you make this go away, I promise to…”
    • “I’m willing to try anything to feel better.”
    • “I should get a second opinion. Maybe they will tell me something different.”
  4. Depression: When bargaining doesn’t work, sadness begins.
    • “My life isn’t worth living.”
    • “I don’t know who I am anymore.”
    • “How am going to afford to live?
    • “I won’t ever be able to afford these medical bills.”
    • “What’s going to happen to me?”
    • “I can’t do this anymore… I give up!”
  5. Acceptance: This is the most important stage in illness because patients are able to live with their condition. According to Absenger (2015), “learning new coping skills will help you not only to learn and accept the losses and limitations of chronic disease but also allow you to transform your experience into something livable and bearable” (para. 23).
    • “I can cope with whatever life throws at me.”
    • “I will try to live the best life that I can.”
    • “No matter what happens, I’ll be okay.”

When you’re going through the stages of grief, it almost feels silly or selfish to mourn the loss of yourself. Ultimately, though, it may be the only way to get over the heartbreak of diagnosis and prepare oneself to cope with illness or disease.

As we saw throughout the film Healing and the Mind, learning to adapt and accept the pain of illness is essential in both healing and regaining control of life. As Dr. Jon Kabat-Zinn mentions during a group discussion on mindfulness, “if you hope to really grow in strength and wisdom, and bring healing into your life, you have to come to the realization that this moment is precious. And not only precious, but it’s wonderful, even if you’re in pain at this moment. Now that takes a certain amount of courage to do” (Moyers, 1999, Group Discussion on Mindfulness Scene).

References

Absenger, W. (2015). Mindfulness and the Stages of Grief in Chronic Disease. Retrieved on February 23, 2016, from http://amacf.org/mindfulness-stages-of-grief-in-chronic-disease/

Centers for Disease Control and Prevention (2016). Chronic Diseases: The Leading Causes of Death and Disability in the United States. Retrieved on February 22, 2016, from http://www.cdc.gov/chronicdisease/overview/

Copen, L. (2016). Information and Statistics About Invisible Illnesses and Visible Diseases. Retrieved on February 22, 2016, from http://invisibleillnessweek.com/media-toolkit/statistics/

Gurung, R. A. (2014). Health Psychology: A Cultural Approach (3rd ed.). Belmont, CA: Wadsworth.

Moyers, B. (1999). Healing and the Mind – Healing from Within . Retrieved from http://vimeo.com/39767361

Feel your fire, when its cold in my heart and things sort of start reminding me of my last night with you….

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Today is your birthday

and I miss you terribly.

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As a child, you always knew when I wasn’t okay,

In your heart, you knew that there was something really wrong.

You’d fight against the doctors for me,

You were my only advocate,

The only one who believed me.

You were always my biggest supporter,

Cheering me on at every event I competed in,

 often louder than any other person in the stands.

Still, I still hear your voice, even today, screaming GO, GO, GO!

You also decided when it was time to let go and move on.

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Some days, it’s hard to even remember your face.

When I think back to the day you died,

all I see if your body, lifeless, on the floor.

That image still haunts me almost every single day.

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I often wonder

Would life be just as hard as it is now?

Would I have found a diagnosis earlier?

Would you be disappointed in me or proud of what I’ve become?

Would you be relieved to know the reason why, as to what was there all along?

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Not too long ago, I came across this article called “He was grieving over the death of his best friend, until an old man told him this…” It’s only the most beautiful and perfect way to express exactly how I’ve felt since you’ve been gone.

I’m old. What that means is that I’ve survived (so far) and a lot of people I’ve known and loved did not.

I’ve lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can’t imagine the pain it must be to lose a child. But here’s my two cents…

I wish I could say you get used to people dying. But I never did. I don’t want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don’t want it to “not matter”. I don’t want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it.

Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can’t see.

As for grief, you’ll find it comes in waves. When the ship is first wrecked, you’re drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it’s some physical thing. Maybe it’s a happy memory or a photograph. Maybe it’s a person who is also floating. For a while, all you can do is float. Stay alive.

In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don’t even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you’ll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what’s going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything…and the wave comes crashing. But in between waves, there is life.

Somewhere down the line, and it’s different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O’Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you’ll come out.

Take it from an old guy. The waves never stop coming, and somehow you don’t really want them to. But you learn that you’ll survive them. And other waves will come. And you’ll survive them too.

If you’re lucky, you’ll have lots of scars from lots of loves. And lots of shipwrecks.

I never want to forget about the scars you left behind, mom. I just wish I was half as strong as you. I hope you know that even though you’re gone, we still celebrate your life today. Just as we do every day.

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10885043_835945012705_5487947752047149944_n315831_580275865725_1821371383_nHappy Birthday! I love you and miss you.

These songs make me cry every time I hear them – even to this day – because I instantly think of you. I listened to them nonstop when you first left my life, but now they bring me a sense of joy because I know one day we’ll meet again, that you’re safe and in a better place, and that you didn’t suffer through your last moments here on earth. For that, I am grateful. It is knowing this that gives me hope.


“View From Heaven”

(YellowCard)


“Gone Too Soon”

(Simple Plan)


“Meet You There”

(Simple Plan)

Taking a quick break

Just wanted to do a quick update, since it may be a little while before I respond or post again. 

Life has decided to turn upside-down and pile everything on me all at once. I need to regroup, reorganize, and get my life back together over the next few weeks.

I have plenty to update,  so as soon as it all calms down some there’ll be a lot of new posts.

Thank you all for your understanding 💙

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