Spiritual Approach to Treatment of Psychosomatic Cases

Andri Andri andri@ukrida.ac.id 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Unpublished data.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

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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.