Anna and Michael had been married for seventeen years when both began to complain that the other no longer focused on the rest of the family. They spent an inordinate amount of time ruminating resentments about each other. Meanwhile, their two children were entering the first few years of high school and presenting new challenges for their parents. Both Anna and Michael felt they didn’t have the energy to keep up with the constant attention needed to maintain clear limits and expectations for the kids.
Though they did not want to admit it, they felt relieved when their kids began to spend more time on their computers, playing video games and on social media. This meant less monitoring was necessary because the kids left the house less, and didn’t need to be shepherded to as many activities. As a result, they began to match their parents in obesity, fatigue, and dysphoric moods.
Perplexed by everyone’s loss of energy, Anna asked their physician whether the entire family had contracted Lyme disease. They felt ill and did not know why. He ordered blood tests for each of the family members. Though there was no evidence of Lyme disease, he expressed concern that they all had become significantly overweight. He also reported that both Anna and Michael had high levels of C-reactive protein (a measure of inflammation), blood glucose, and LDL (bad) cholesterol.
Anna had developed type 2 diabetes, and Michael had metabolic syndrome (a cluster of conditions—increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that includes that occur together, increasing the risk of heart disease, stroke and diabetes). Anna responded by saying, “We were already very depressed! Now you are telling us we have bad genes? That makes me even feel worse.” Michael agreed.
In response, their physician prescribed Prozac for both of them. With this medication Band-Aid, their physician missed the opportunity to offer comprehensive health care and refer them to therapists to avert disastrous long-term mental and physical health. Though he started the consultation constructively by warning the entire family about their weight and both parents of their looming illnesses, the integrative approach they needed was compromised by the quick fix of “mismanaged” care.
What role should psychotherapy have played in helping this family? Psychotherapy in the twenty-first century could be renamed “behavioral health,” because self-care behaviors have major effects on the immune system, the brain, and the body in general. These interactions have a profound effect on mental health.
Anna and Michael’s family has become the new norm. There are now overwhelming numbers of people like them throughout the developed world. Plagued with health problems brought on by poor physical and emotional self-care, they suffer bidirectional causal pathways between acquired physical and psychological impairments.
The Centers for Disease Control estimates that health behaviors account for 50 percent of adverse health outcomes in the United States—as much as genetics (20 percent), the environment (20 percent), and access to health care (10 percent) combined. These statistics suggest that half of all health conditions are preventable by changes in self-care behavior (Amara et al., 2003).
Research has also found that 40 percent of medical patients have a comorbid psychological disorder, while 75 percent of patients with a psychological disorder also suffer with a comorbid physical disorder (Kessler, Ormel, Demler, & Stang,, 2003). Essentially, health behaviors represent the interwoven natures of physical and mental health.
According to the Centers for Disease Control and Prevention, approximately 133 million Americans suffered from at least one chronic illness in 2005. That number is predicted to increase to 157 million by the year 2020. Because of the inextricable interactions between physical and mental wellbeing, these numbers represent a mental health crisis that can no longer be overlooked. Though these statistics are ominous, integrated health care providers, including psychotherapists, can work to avert disaster to the health of millions of people through a better understanding of the bidirectional causal interactions among the mind, brain, and the immune system found in the field of psychoneuroimmunology, and providing approaches consistent with it.
Since its emergence as a rigorous field of research, psychoneuroimmunology has identified many interrelated mental and physical health dysregulations. Not so coincidentally, this field of inquiry has emerged with the surge in numbers of people, like Anna and Michael, with chronic and acquired illnesses that dysregulate the immune system who also suffer from psychological disorders.
Through psychoneuroimmunology, we’ve learned that chronic stress combined with poor self-care such as inadequate sleep, impoverished diet, no exercise, and extra weight inappropriately activates the immune system with damaging effects. Anna and Michael, like millions of other people, acquired chronic conditions that turned their dysregulated immune systems into threats. Their immune systems switched from protectors to overactive enemies triggering autoimmune disorders and a downward spiral of significantly compromised physical and emotional health. Whether in response to adverse childhood experiences, chronic stress, or simply because of poor self-care, autoimmune disorders result in a variety psychological disorders, which then further exacerbate existing autoimmune disorders.
One such disorder is chronic inflammation. While short-term inflammation that responds to injury or illness represents a healthy process, chronic inflammation is not. Chronic inflammation represents a common factor between many psychological disorders and poor health. Through their poor self-care practices, Anna and Michael, along with their kids, were unknowingly stoking up chronic inflammation and offering themselves few opportunities to do otherwise. As a result, they were all suffering from its associated fatigue, cognitive deficits, and depression. Because over half the population of the United States unknowingly suffers from self-inflicted immune system dysregulation, psychotherapy in the twenty-first century must promote lifestyle and behavioral health changes. This means that self-maintenance factors such as diet, exercise and sleep need to be addressed as foundational factors to mental health. To conduct therapy without addressing these underlying factors is like building a house on a sandbar by a hurricane-swept beach.