Psychological Factors Affecting Medical Conditions (PFAMC) represents an attempt on the part of the mental health community to “take down the barrier” between mind and body. “The classical Western medical model of illness has favored the clear demarcation between “physical” and “mental” illnesses. (Netherton, Holmes, & Walker, 1999, p. 549) The PFAMC diagnosis removes that demarcation, acknowledging that there are interrelationships between psychological and physical factors in the scope of “well-being” and that each has an effect on the other. To me, this makes sense… if I was diagnosed with cancer, for example, there would likely be an immediate and clinically significant impact to my mental health as well. I would fully expect a degree of anxiety, perhaps depression… inevitably, the client would have to find some way to cope, and we could assist in the process by allowing the client to develop healthy coping mechanisms.
The definition of “clinical significant” is a source of ambiguity, since the criterion is very much subjective. Typically, the significance takes shape in the form of compliance, or lack thereof, placing the individual at a higher risk of an adverse outcome.
I would acknowledge and support (put forth by Engel, 1977) that behavior is an interaction among psychological, physical and social elements. He regards the three as a system composed of three subsystems, with each having effects and interrelationships with the other. This brings the assessment of social systems (peer, familiar, school, etc) to the forefront, since all three have the opportunity to have significant social consequences. “When the patient is a child, there must also be an assessment of family functioning, communication, and decision-making processes.” (Netherton et al., 1999, p. 553)
The “316” diagnosis becomes relevant particularly when children are chronically ill and must comply with complex medical regimens. In the case of Cystic Fibrosis, this may manifest in compliance with medical regimen or adherence to an appropriate diet. In cancer patients, physical side effects place them at risk for psychosocial difficulties (e.g., loss of hair, weight loss or gain from medication, fatigue, etc). Any disease that has “high visibility”, or might require the need for care from others, has the potential to raise these concerns for social impacts. One particular aspect I had not taken into consideration is acne, which has the potential to have significant impacts on self-esteem and self-image. Although acne is certainly less than fatal, it is no less debilitating that life threatening diseases in our image conscious society. “Social support, acceptance from peers, and family functioning has all been identified as significant predictor variables of adjustment to illness.” (Netherton et al., 1999, p. 556)
Insulin-Dependent Diabetes Mellitus (IDDM) got significant treatment in the text due to the depth and breadth of research available on the topic. “The immediate consequence of following the regiment involves inconvenience and physical discomfort, while the long-term reward is the avoidance of health complications.” Ideally, through patient and parent education, we can impress the importance of compliance to long term health. Our goal, or objective, would be to draw a relationship between a client’s health status and diabetes-related adherence.
Developmental considerations need to be taken into account, considering that a child may be cognitively limited, rather than noncompliant in some other sense. (Netherton et al., 1999, p. 558) For young children, parent training may be the most effective route to increasing compliance with insulin injections. However, if the client approaches adolescences, or young adulthood, the intervention should inevitably be focused on the client themselves.
Aside from treating the client themselves, opportunity presents itself to treat the parents as well, since “mild parental anxiety and depression were associated with the diagnosis of diabetes in the first six months after diagnosis.” (Netherton et al., 1999, p. 558) We may also want to access attitudes of the child and the parents with regard to their attitudes toward the medical staff who are treating the child for diabetes.
Treatment could focus on a number of different aspects depending on the presented situation, but it could focus on identifying and treating maladaptive coping strategies in ill children, or helping children and/or parents master the anxiety associated with their physical condition. We might focus on enhancing communication within the family unit itself, facilitating acceptance of the diagnosis and increasing the level of emotional support with and within the family. (Netherton et al., 1999, p. 561)
In conclusion, it is increasingly evident that there is a definite interrelationship between physical ailments and mental health. Some might suggest that Western Medicine and it’s repeated attempts to separate the two disciplines are doing more harm than good… perhaps we could take a page from Eastern Medicine and begin to integrate the two?
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.