spiritual approach to psychosomatic cases
TRANSCRIPT
Spiritual Approach to Treatment of Psychosomatic Cases
Andri Andri [email protected] Twitter : @mbahndi
Faculty of Medicine Krida Wacana Christian University Fellow of Academy of Psychosomatic Medicine
What is Somatization ?
• Tendency of certain patient to experience and communicate psychological and interpersonal problems in the form of somatic distress and medically unexplained symptoms for which they seek medical help
Abbey, Wulsin and Levenson in Somatization and Somatoform Disorder, Textbook of Psychosomatic Medicine, 2nd ed, 2011
Somatization
• Somatization is a poorly understood “blind spot” of medicine
• Somatization and somatoform disorder (now is somatic symptoms disorder based on DSM 5 ) remain neglected by psychiatrist and primary care physician
• It can be conceptualized in a variety of different ways but fundamentally it appears to be a way of responding stress
• Not all somatizing patients have a somatoform disorder, many have another Axis 1 disorder or transiently somatize in the context of significant life stress
Abbey, Wulsin and Levenson in Somatization and Somatoform Disorder, Textbook of Psychosomatic Medicine, 2nd ed, 2011
Somatization
• Patients commonly present to their primary care physician complaining of physical symptoms.
• More often than not, appropriate medical work-up fails to reveal a clear underlying physical etiology
• The prevalence of somatic symptoms that are multiple, chronic, and associated with medical help-seeking—but do not meet full criteria for a DSM-IV somatization disorder :19.7% – 22%
Psychosomatics 42:3, May-June 2001
Psychosomatic symptoms
• 25-50% No serious medical cause found
• 30-75% Remain medically unexplained
• 16-33% “bothered the patient a lot” but remain
unexplained
Schneider R
Somatization in Psychiatric Disorder
• Somatic symptoms in patients with depression and anxiety disorder
• Survey bertwee February 23rd 2013 until February 1st, 2014, patient with depression and anxiety disorder were asked to fill the BSI (Bradford Somatic Inventory) and report them in self-reported form
• There were 1433 respondents who filled the BSI, 704 (49.13%) were men ad 729 (50.8%) were women.
• Forty two point ninety seven percent (42.97%,N=617) respondents were between 21-30 years old, 29.60% (N=425) respondents were between 31-40 years old and 15.25% (N=219) below 21 years old.
Unpublished data. Survey conducted by Andri from Psychosomatic Clinic Omni Hospital (2014)
Top 10 Somatic Symptoms
1. palpitations (pounding heart) : 90.52%, 2. ache or discomfort in the abdomen : 84.94% 3. lack of energy (weakness) much of the time : 84.41%, 4. pain or tension in neck or shoulder : 82.86% 5. feeling giddy or dizzy : 81.88% 6. feeling tired even when are not working : 81.39% 7. suffered from excessive wind (gas) or belching : 73.6% 8. pain in the chest or heart : 73% 9. trembling or shaking : 72.7% 10. buzzing noise in ears or head : 71.34%.
Unpublished data. Survey conducted by Andri from Psychosomatic Clinic Omni Hospital (2014)
An Understanding of Spirituality
• The core of a person
• An aspect or dimension of our life
• Our relationship to the whole - to all, to creation, to God, to the infinite and ultimate
Canda and Furman 1999
Kasus
• Pasien wanita 35 tahun dengan keluhan nyeri yang berpindah disertai perasaan cemas akan terjadinya kekakuan otot yang sering terjadi tiba-tiba. Pasien sudah pernah berobat ke dokter saraf dan dikatakan mengalami Spasmofilia grade 3 berdasarkan EMG. Diberikan obat muscle relaxant tetapi keluhan tidak berkurang.
• Pasien akhirnya berkunjung ke saya di klinik.
• Selain keluhan dasar kaku otot, pasien sebenarnya mengalami serangan panik berulang yang manifestasinya salah satunya gangguan otot.
• Pasien merasa dirinya satu-satunya orang yang mengalami kondisi tersebut, berkunjung ke banyak dokter untuk mengkonfirmasikan penyakitnya
• Tidak bisa menerima mengapa hal tersebut terjadi pada dirinya
• Pada saat awal pertama kali pertemuan, pasien terus menerus bicara tentang banyak gejala yang dialami
• Setelah berkunjung, hampir setiap hari BBM menanyakan “Apakah saya bisa kembali seperti dulu?”
In The Beginning
The Ilness Self
The Healing Process
The Healthy Self
The Illness Self
Treatment
healthy self
illness self
Wholeness
healthy self
Illness self
Spiritual Care Tasks
• Assisting a person to assess their suffering
• Exploring possible explanations for suffering
• Introducing appropriate spiritual and mental health care resources
• Opening the door to the support of the congregation and wider community
Religion
Mental
Health
Social
Support
Health
Behaviors
Stress
Hormones
Immune
System
Autonomic
Nervous
System
Disease
Detection &
Treatment
Compliance
Smoking
High Risk Behaviors
Alcohol & Drug Use
Infection
Cancer
Heart Disease
Hypertension
Stomach &
Bowel Dis.
Accidents
& STDs*
Gen
etic
su
scep
tib
ilit
y, G
end
er, A
ge,
Race
, E
du
cati
on
, In
com
e
Liver & Lung
Disease
Stroke
Ch
ild
ho
od
Tra
inin
g
Ad
ult
Dec
isio
ns
Va
lues
an
d C
ha
ract
er
Ad
ult
Dec
isio
ns
* Sexually Transmitted Diseases
Model of Religion's Effects on HealthHandbook of Religion and Health (Oxford University Press, 2001)
Religion and Coping with Illness
1. Many persons turn to religion for comfort when sick
2. Religion is used to cope with problems common
among those with medical illness:
- uncertainty
- fear
- pain and disability
- loss of control
- discouragement and loss of hope
Take Home Messages
• We naturally have used spiritual approach to every patient we met in the clinic
• In somatization cases there are points that we have to remember : – We don’t simply “return to normal.” We grow and
change. – We acknowledge the impact of the illness on our lives. – We recognize our vulnerability and the possibility of
relapse or the recurrence of symptoms. – We seek to develop and maintain maximum health
and well being.