[psisci]

medical psychology
Medical psychology (related to Clinical Health Psychology, Psychosomatic Medicine, and Behavioral Medicine') is a branch of clinical psychology where clinicians have trained in the biological aspects of mental illness in relation to physical illness, and are usually qualified to prescribe medication; this last aspect varies from country to country. It adopts the biopsychosocial approach to medicine, which revolves around the idea that both the body and mind are indivisible, and that disease and illness are not identical. Continuing with this line of thought, all diseases whether of the mind or of the physical body must be treated as if they have both been affected. The intent of Medical Psychology is to apply knowledge from all branches of social, psychological, and biological medicine in the prevention, assessment, and treatment of all forms of physical illness and the adaptation to illness; specific behavioral, psychotherapeutic, and pharmaceutical methods are used to help the person respond to illness and prevent further illness through matching coping and management skills to the person’s abilities, character, and personality style.

Background
Some clinical practitioners and philosophers today believe that this Cartesian line of thought is outdated. Some anecdotal evidence has been raised concerning the lack of effective treatment for things such as migraines, pains and cancer and that perhaps the cure should not only be centred on the body but also the mind. Some also raise the argument that most uncurable diseases are brought about not merely by physical ailments, but by mental problems. All evidence is of course unproven and will likely remain as such for a long time to come.

The contribution of medical psychologists to general health care increased with their use as primary care doctors in the world's largest HMO, the California Kaiser Permanente. These psychologists work along with primary care physicians in order to determine optimum treatment plans for all patients with physical and/or mental illnesses.

Education
An important contribution of medical psychology is in the education of patients (psychoeducation) in disease processes. Frequently, such education of the patient and the family insures substantially better adherence to treatment recommendations. Medical psychologists are particularly successful in the treatment of asthma, gastrointestinal illnesses, cardiac conditions, spinal cord and brain injuries, chronic pain, headaches, and addictions (drugs, smoking, eating, alcohol, etc.).

Training in medical psychology entails a doctoral degree (Ph.D., or Psy.D.) in clinical psychology, an internship, and postdoctoral training in one of the branches of medicine traditionally associated with psychological fields: psychosomatic medicine, rehabilitation, neuropsychology (central nervous system functioning - brain functions), substance abuse, pain medicine, among others.

[sabby]

Interesting post psisci.

I completely believe that the mind and the body are connected and can influence the other.

I think it is very important that we can have a doctor that can handle both those entities with ease. I have not had good luck with medical doctors understanding certain mental issues with myself or my children and grandchild. If our pc docs had more insight and education regarding psychological issues, they would be of much greater assistance to their patients. That is my opinion of course.

Thanks for the interesting reading!

Hugsssss
J

[wisewoman]

I too think it is interesting but hold a lot of anger inside for the people with this line of thought who told my friend if her emotional wounds were truly healed she wouldn't be dying from stomach cancer. I lost my friend that year and the people whose said those things just weeks before her death are evil in my mind, they caused her suffering, not comfort.

> It adopts the biopsychosocial approach to medicine, which revolves around the idea that both the body and mind are indivisible...

are they thought to be inseperable because they are (roughly) thought to be the same thing?)

> and that disease and illness are not identical.

lost ya there. what is the difference (roughly) please.

how much does one learn about cross cultural differences and sociological interventions? i'm asking because one of the main critiques of the bio-pycho-social approach is that in practice it tends to amount fo bio-bio-bio. that is a criticism of psychiatrists in the first instance, but i'll admit i'm wondering whether the criticism would apply here too.

one thing that interests me is how much one would learn about:
- the general medical conditions that form the exclusion criteria for mental disorders (e.g., ones abilitly to distinguish mental disorder from other conditions)
- knowledge of non-psychiatric medictions such that one is able to figure out interactions. i guess this latter could be in some look up tree (or computer program somewhere) but the first could be tricky...

> Some clinical practitioners and philosophers today believe that this Cartesian line of thought is outdated.

here i'm lost. it isn't you. i often find that in the psychology / psychiatry literature they refer to 'outdated Cartesian thinking' all over the place yet what they mean by 'Cartesian' is very different from what philosophers understand by Cartesian. So... I'm trying to get myself into the head space...

Descartes was a substance dualist, which means he thought that the mind and the body were distinct entities. (Substitute mind for soul if you think your personality memories thoughts etc resite in the soul which of course you need if you want the survival of the soul to be YOUR survival).
Descartes was also an interactionist, however, which means that he thought that the mind and the body could communicate with each other via the pineal gland.

so when people mean to deny cartesian dualism do they mean to deny:

- that mind and matter are seperate substances? (i agree this is out of date now).
- that mind and body interact? (e.g., that mind can cause changes to body and that body can cause changes to mind). denying this seems strange.
- that the pineal gland is the seat of interaction. (sure, give him a break he was writing before the discovery of nerves even)

> The contribution of medical psychologists to general health care increased with their use as primary care doctors in the world's largest HMO, the California Kaiser Permanente. These psychologists work along with primary care physicians in order to determine optimum treatment plans for all patients with physical and/or mental illnesses.

So primary care physicians give the diagnosis (so they can decide whtether there is a general medical condition or not) and then medical psychologists can come into play instead of psychiatrists or whatever. I bet that saves California Kaiser Permanente some money ;-). More seriously though, why the hell not.

[psisci]

_K...huh???

I doubt if anyone here has run into a medical psychologist in the real world besides me. We are rare as it takes over 10 years after college to get there.

> I doubt if anyone here has run into a medical psychologist in the real world besides me.

oh. okay. i guess i should take this opportunity to ask you a couple questions about it then...

have a go at answering them if you like...

[psisci]

Sure. If you could limit each post to under 10 major topics that would help me be able to answer.

[(JD)]

I am amazed at the connections I find as I continue to read. Connections in that, well, so much of my feelings ARE emotional, though they often manifest themselves physically. We are certainly a connected being!

Even last week, when working on getting back to flying... my confusion in the terminal and all that ill feeling and frustration and some anger that I wasn't able to find my own way... well? That was emotions. Of course I know how to read signs and find my way, but due to the stress... my emotions blocked my being able to do so. It isn't usually easy for someone to admit such a thing, imo.

Psisci, I was pleasantly surprised when I mentioned you to Dr Frazier, my T, that he had a full grasp on what type of psychologist 'you' are and all about that field.

I think new things are just immediately rejected by many, often by mentally unwell, because it shakes their secure world, it changes what they know and adds in a bit of the unknown. We all know that as humans, we fear the unknown. I'm sure as we are educated by you, and by realizing this is a good thing you and others do, that the acceptance level will rise. I think it's exciting to be in on this process, and to be able to watch as the field is shaped, molded, along the way.

[psisci]

Cool...thanks _sky.

> Sure. If you could limit each post to under 10 major topics that would help me be able to answer.

okay. i meant to convey an interest in all of those topics. that way you could pick whichever of those topics you found most interesting.

if you would like me to choose...

then i'd be very interested to know what you take the distinction between disorder and illness to be (because i'm writing about that at the moment). if one of the other topics is of more interest to you, then you could of course feel free to focus in on that.

[(JD)]

Main Entry: 1dis·or·der
Pronunciation: (")dis-'or-d&r, (")diz-
Function: transitive verb
1 : to disturb the order of
2 : to disturb the regular or normal functions of

Main Entry: ill·ness
Pronunciation: 'il-n&s
Function: noun
1 obsolete a : WICKEDNESS b : UNPLEASANTNESS
2 a : an unhealthy condition of body or mind b : SICKNESS 2

Edited to show source: Meriam-Webster, also Med-Line medical dictionary powered by Meriam-Webster

[gardenergirl]

That sounds really interesting. How does this differ from Health Psychology?

I think psychologists and primary care physicians could do a lot of good working in more direct collaboration. I'd love to see psychologists in primary care offices.

gg

[kimmydawn]

I'm with sky...

I've often noticed in hindsight, but can't get it too well in the moment, that if I wasn't doing well emotionally (i.e. high anxiety) for a period of time, I would get sick more often. Also, if I was sick for more than a couple of days, I would begin to get depressed, anxious, pain increases, etc.

Another thing I've noticed in dealing with my TN is that it's worse if I'm anxious/tense, and that if I begin to have a bad episode and don't get control of the panic it can cause (due to the pain) I can go from 7-10 really fast!

I used this same technique with my daughter when she was having severe pain with herniated discs that involved sciatic nerve pain. She'd been to the hosp four times in two weeks...the last time the pain was so excruciating that she was still in major pain after three shots of morphine and a huge shot of steroids. It was awful for her to have to sit and lie there. So the next couple of times (before the steroids kicked in), I literally stood over her, rubbing her hair, cooing to her, telling her in a very calm voice to "bring it down" and "you can do this". I just wanted her to calm down while we were getting ready to get her to the ER...just normal mom stuff. Guess what? We didn't even have to make the trip to the ER... When she was able to bring the panic down (I'd guess due to her expecting the worse and fearing it tremendously), she was able to get control over her pain better than meds.

I so agree that one can influence the other. I don't necessarily know that they do all the time, but my past shows that there's a definite connection there...

I wish there were more specialists that would work with GP's in not only the patient's understanding, but in the GP's. I think it could help so much all the way around.

Thanks!

KD

[(JD)]

True KD... as I continue to ponder (when I should go to sleep!) One of the first things an asthmatic is told when experiencing an attack is to calm down... because it's so easy for panic to set in, and thus exacerbating the breathing problem! While I am not of the bent that asthma is only emotional illness, the two aspects do tend to go hand in hand, I think.

Plus we all know when we get down emotionally, our physical health suffers too. IDK, maybe psisci can speak to us on this. Maybe it's because we tend to quit taking care of ourselves then, or maybe it has as much to do with lowering our tolerances to germs and such?

[psisci]

I am a psychologist working in primary care. Medical psych and health psych are similar, but medical psych deals more with treatment and meds.

[kimmydawn]

Yep, I do think, sky.

You know, after my father had his lung removed, he was in a constant state of anxiety due to, well, his dang lung was removed and his other had disease and he felt like he couldn't breathe!

They gave him meds for the anxiety, but they couldn't give him and high enough dosage of a benzo because it would depress the breathing even more...a catch 22.

So, they worked with him and gave him tips to check that he's breathing enough, and also proved to him thru his pulse ox that he was getting enough. He told me it really helped the anxiety about it. When that eased, he felt he could breathe better. Because of that, he began to heal and was even functioning pretty good. It was obvious that he was desperately ill and not getting better, but when that was helped he improved overall...alot...when prior to that there was little to no improvement.

He did pass, but that was later and for different reasons...same but different.

With my TN...it's dx'ed and due to multiple surgeries...it's phyiscal, BUT boy can it effect me mentally and visa versa.

I have more examples but it's late for me too.

KD

[psisci]

Indeed _sky and KD. This is what I do. I work in 2 primary care clinics for the underserved. One is a family medicine residency training program for new family docs and the other a rural health clinic. I see kids, adults, elderly, those with serious psych issues, those with diabetes or overweight needing behavioral health interventions, and everything in between. I love my job because I help people get better. I get to manage meds, help kids get help with learning and attention problems, help old folks die with dignity, help regular joes and janes have a better quality of life. My real life aside from this is playing in a alt/country/punk band...that is my passion.

[kimmydawn]

How awesome is that.

I wish we had the benefit of that somewhere here.

Dr. Wylie, do you see specialists like this increasing so that more will be more effectively served, understood, treated? I hope so...

KD

[psisci]

Yes it is. There is a big movement now nationwide to give psychs like me the ability to prescribe meds, order labs etc... directly. NM and LA already have this, and it is working great. All states have medical psychs, but they are hard to find as it takes alot more training than a normal psych, and few want to do it....lazy I say.

er...

thanks sky.

who would have thought... scientists don't need to investigate the nature of water or trees or disorder or illness or anything like that they can simply look the terms up in the dictionary and find out what those terms refer to!

though... lets have a look...

Main Entry: 1dis·or·der
Pronunciation: (")dis-'or-d&r, (")diz-
Function: transitive verb
1 : to disturb the order of
2 : to disturb the regular or normal functions of

Main Entry: ill·ness
Pronunciation: 'il-n&s
Function: noun
2 a : an unhealthy condition of body or mind b : SICKNESS 2

so... according to the online dictionary disturbing the order / regular or normal functions of something constitutes disorder.

(the problem here is how we fix the function / order of a system)

and according to the online dictionary is something is unhealthy or sick then it is ill.

(the problem here is how you decide what unhealthy / sick means. these terms are just as problematic - if not more so - than the term 'illness' that we are trying to define).

how are these supposed to be different?????

actually, what i was getting at is that some theorists think that mental disorder and physical disorder involve different meanings of 'disorder'. even though the same term is used there are two distinctly different meanings.

sometimes people get around this by maintaining that medicine is more properly about disorders whereas psychiatry is more properly about illness. (that is typically the way the distinction runs though it occurred to me that you might want to reverse those terms such that psychiatry is about disorders and medicine is about illnesses).

some theorists think that 'disorder' entails 'dysfunction' but that 'illness' entails both 'disorder' (dysfunction) and harm where harm is a normative notion. on this account disorder is typically taken to be objective because it evolution by natural selection is supposed to be the relevant causal process to fix the relevant functions in a non-normative way). illness is typically taken to have a subjective component, however, in that harm is normative and harm is neccessary to turn a disorder into an illness.

you seemed to want to use those terms in reverse (which is fine). the main notion, however, is that medicine is non-normative (because it only needs the non-normative notion) whereas psychiatry is normative in a way that medicine is not because it involves the notion of harm which is essentially normative.

when you said that you thought illness was different to disorder i wondered what you meant. i.e., i wondered if you were meaning to convey a stand on this issue and i wondered which stand you were intending to convey.

[kimmydawn]

It is really encouraging to think that there might be more education and knowledge in regards mental health issues in the "medical world".

KD

[psisci]

Clinical medicine has nothing to do with philosophy.

[SeptemberMorn]

I find this thread to be enlightening and exciting! For quite some time I've known that the mind and body affect each other. If I wasn't tired at the moment, I could come up with various examples of how I know. Maybe tomorrow I'll have time to sit and think about how this has been proven in my husband, one of my sons and me. Then again maybe not. LOL The list would be too long.

At any rate, I'm looking forward to reading more about this, Psisci! It's great to understand how things work inside us!

YOU certainly sound like a healthy, well rounded individual. If someone was to ask now who I'd like to sit and have a "cupa" with, it would be you!

[SeptemberMorn]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
psisci said:
Clinical medicine has nothing to do with philosophy.

</div></font></blockquote><font class="post">

Mercy!! I hope not! LOL

[drunksunflower]

Wow

In my total experiences, I have found GPs crap.

What psisci appears to be doing is bridging that gap.

More power to ppl like that, i hates meds with a passion, but Dr.Scott is probably the type of person that could persuade me