Mental Health Care and Its Relationship to General Medical-Surgical Care of the Future

Abstract

Throughout this paper, I stress the interface between organic (physical) illness and mental illness/emotional problems (see Chapters 2 and 3). I believe that in the future, the orientation of medicine will change—as it is already doing—to focus more and more on psychological factors as they affect health and illness. Medical care will pay more specific attention to the patient’s unique personality as it makes him (or her) susceptible to disease or exacerbates illness. It will take into account as well the patient’s emotional reaction to the stress of his illness and its effect on the course of that illness. This will result in an ever-increasing demand for mental health consultation and care. However, I feel that appropriate intervention by the psychiatrist (or other mental health professional) in the health care process will contribute to the stabilization of the total cost of medical care and may even decrease that cost, as illustrated by the following examples:

A patient reacts with excessive anxiety and depression to a hospitalization for an illness. In the hospital he (she) must ultimately rely for his well-being on his physician and the hospital staff. This patient, however, cannot tolerate not being in total charge of his life and not being able to control his own destiny. His main psychological “flaw” is that he is afraid of being dependent on anybody. He finds it difficult to trust others. With each day in the hospital, where one is never more like a child and more dependent, he becomes more depressed and anxious. He becomes frustrated and angry as well at his physician and the hospital staff, but he wishes to be a “good patient” so he keeps his feelings to himself. In fact, his depression and anxiety are hardly noticeable to others. His body is quite aware of them, however, and his condition worsens as his emotions exert a negative effect on the course of his aillness. Fortunately, with the help of a mental health team his physician calls in this patient is able to partially resolve his fear of dependency that is at the core of his depression, anxiety, and anger. His condition mow gradually improves and he is discharged fron the hospital.