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The mind's role comes into focus

Knowledge of the profound connection between emotions and physical well-being is increasingly put to practice.

January 20, 2003|Shari Roan | Times Staff Writer

Dr. Marc Feldman thought he could help sick people get better -- if he could only get them into his office. But patients often canceled their appointments upon arriving at his Duke University clinic, and Feldman soon figured out why. It was the sign on his office door: "Psychosomatic medicine."

"They were convinced that I was going to tell them, 'It's all in your head,' " said Feldman, a psychiatrist now practicing in Birmingham, Ala.

That was the late 1980s. Since then, patients and doctors alike have come to better understand how the mind and emotions affect physical illness, a field known as psychosomatic medicine. In March, the American Board of Medical Specialties will decide whether to create a medical subspecialty in it. The designation would lead to more specific training, easier identification of experts and improved insurance reimbursement.

Hundreds of psychiatrists have asked for the designation, which they say is a first step in helping patients get appropriate treatment. "When you make a specialty official, you increase the likelihood of people finding you," said Dr. Nina Stotland, a professor of psychiatry and obstetrics-gynecology at Rush Medical College in Chicago.

For The Record
Los Angeles Times Thursday January 23, 2003 Home Edition Main News Part A Page 2 National Desk 15 inches; 563 words Type of Material: Correction
Psychosomatic medicine -- A name was incorrect in Monday's Health section article on the connection between emotions and physical well-being. Dr. Nada Stotland, a professor of psychiatry and obstetrics-gynecology at Rush Medical College in Chicago, was incorrectly referred to as Dr. Nina Stotland.
For The Record
Los Angeles Times Monday January 27, 2003 Home Edition Health Part F Page 8 Features Desk 1 inches; 51 words Type of Material: Correction
Psychosomatic medicine -- A name was incorrect in Monday's Health section story on the connection between emotions and physical well-being. Dr. Nada Stotland, a professor of psychiatry and obstetrics-gynecology at Rush Medical College in Chicago, was incorrectly referred to as Dr. Nina Stotland.

And Kaiser Permanente, the state's largest HMO with millions of members, has launched a program that uses mind-body techniques to help people with chronic health conditions. It has proved so effective it will be made available free to Kaiser members and some nonmembers beginning in spring.

"I'm surprised it has taken medicine so long to recognize what is obvious; how single-minded and relentless we've been in reducing and separating mind and body in medicine," said Dr. David S. Sobel, director of patient education at Kaiser Permanente.

The barriers separating the treatment of physical illness from thoughts, feelings and attitudes haven't fallen entirely, however. Many people still don't understand psychosomatic medicine, often mistaking it for imaginary illnesses; few hospitals and doctors know where to send patients who may need it; insurers often don't pay for it; and even experts aren't sure what methods work best for specific illnesses.

But scientists now have proof that the mind-body connection exists. Studies have revealed that around 20% of people with heart disease also have depression, that stress exacerbates gastrointestinal disorders and that attitude can influence survival time for people with terminal illnesses. Experimental programs have demonstrated that techniques such as relaxation, group support, imagery, meditation, even prayer, can alter the course of some illnesses, decrease symptoms and reduce hospital stays and medication. High-tech equipment, such as brain imaging studies and other body scans, have shown that relaxation can slow blood flow and that frightening emotions can trigger spasms in the gut.

"This is cool stuff that you can't argue against anymore," said Marc Schoen, an assistant clinical professor of medicine at UCLA. "We can now say, arguably, that almost everything becomes psychosomatic."

Psychosomatic conditions are real disorders that are caused or exacerbated by one's mental or emotional state. They can include:

Body symptoms caused by psychological distress, such as stomachaches that occur in a child who doesn't want to go to school.

Disease that results from -- and whose course is influenced by -- unhealthy behavior.

Medical diseases, such as arthritis, heart disease, cancer and AIDS, that are affected by stress, coping skills and social support.

After years of battling severe asthma, Mary Ann Marcuzzi, a 44-year-old human resources executive in San Diego, found that the most effective treatments used both traditional medicines and psychological techniques. Diagnosed at 19, Marcuzzi came upon a doctor who prescribed biofeedback and stress management in addition to medication. Later, Marcuzzi learned to use self-hypnosis and guided imagery when she felt her lungs beginning to spasm.

"My asthma tends to kick up when I'm frustrated or angry," she says. "I go to my office, close the door and go to a special place in my head. I picture myself in a meadow, sitting in the grass, breathing in the healing air."

The need to use psychosomatic medical principles in everyday health care is greater now than ever, experts say. More emphasis on the psychological impact of illness might help patients comply better with treatments and reduce hospitalizations and other services that fuel rising health-care costs.

About 25% of people who visit the doctor have physical symptoms most likely caused by their emotional state, Sobel says. And as many as 80% show signs of significant psychological distress resulting from physical ailments.

The Kaiser program, for example, will address the growing costs of chronic conditions. The six-week class teaches mind-body strategies to control symptoms and improve health.

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