Anyone who has ever been touched, either personally or through someone they cared about, with a serious medical diagnosis (e.g., cancer, IDS, heart disease, kidney failure) knows the extent of the psychological, emotional, and spiritual impact of that news. In a moment, a person's life is changed. The effects can be pervasive, impinging on physical and emotional well-being, work, sexual relationships, and family life. Common reactions include anxiety about pain and discomfort, fear and uncertainty about the future, and depression. Unfortunately, under the traditional medical model, the psychological impact is frequently not addressed, and the person is left to his or her own resources to work through what could very well be the most traumatic of life-altering events. In this article, we argue for the inclusion of psychological counseling as an integral part of routine disease management.
As an alternative to the traditional medical model, a biopsychosocial model of health and well-being emphasizes reciprocal interactions among the biological, psychological, social, and spiritual dimensions that influence health. Within this paradigm, the impact of the illness is addressed in all of its ramifications. According to Pollin (1995), what the person really wants is "acknowledgment that life has been stood on its head" (p. iv). It is only from that starting point that hope can be extended and reassurance given. Although individuals dealing with an illness may not fully regain their previous quality of life, there are strategies and ways to cope that include a renewed (and sometimes even heightened) zest for life, deeper meaning, and joy.
What is needed to facilitate this process are counseling professionals trained to address the myriad issues of medical crises and medical professionals willing to enter into collegial relationships with counselors to foster a more holistic therapeutic encounter for the client. Inroads are being made in acknowledging that "psychosocial sequelae of long-term illness deserve equal attention with the physical ones, and that such sequelae are normal, not pathological" (Pollin, 1995, p. 11). As our population ages and medical technology continues to progress to the point at which illnesses that were once fatal are now chronic, there is increasing need for attention to the emotional, social, spiritual, and lifestyle adjustment concerns of those who are coping with chronic medical illnesses.
Statistics show that depressive illness has a prevalence of 5% in the general population, 10% to 15% in any general medical population, and 25% to 50% in persons with selected chronic illnesses (Neese & Finlayson, 1996). Furthermore, studies of persons with life-threatening illnesses indicate that the presence of depression in the recovery period predicted a much poorer outcome. Of those studied, almost half of the persons with depression either died or suffered serious complications as compared with approximately 10% for similar setbacks in persons without depression (Silverstone, 1990).
Fortunately, what has emerged as a result of these studies is the knowledge that positive prognostic outcomes can be achieved when the person's psychological state is addressed along with his or her medical condition. Currently, there has been sufficient scientifically documented evidence to assert that psychological factors do affect physical health, including the onset and outcome of some medical illnesses. For example, Levenson and Bemis (1995) reported findings in which individuals with cancer were tested for NK cells (surveillance cells that destroy malignant cells), and it was noted that adjustment level, lack of social support, fatigue, and depressive symptoms accounted for 30% of the NK cell variance. Similarly, Fawzy 0994) found that persons with cancer who received psychological counseling had an increase in the activity of killer cells that attack the cancer cells. …