Stress related disorders have become the major health afflictions of the twentieth century. Doctors often treat them by prescribing a whole host of drugs. The author questioned this method and suggested taking a more holistic approach in confronting ailments. As a practicing psychiatrist and one with a special interest in the subject of "stress", I am horrified by some of the prescriptions I come across in my practice. I recently came across one that a patient was carrying with him from a psychiatrist in Karachi. On it were five anti-depressants, three tranquilizers, two analgesics, a beta blocker and lithium carbonate! The unfortunate man was a poor patient from interior Balochistan. The prescription cost him Rs.1630/for two weeks. Many of our doctors are guilty of wrong practices such as over-prescribing, prescribing inapp ropriately, giving drugs of dubious efficacy and not paying any attention to the serious side-effects that these drugs may induce.

The neglected role of stress

It has been more than fifty years since the brilliant Canadian researcher, Dr. Hans Selye, defined ‘stress’ in a medical sense. Research over this period of time has shown beyond any doubt that stress can often be the decisive influence both in the causation of disease or in the course taken by an established disorder. Disorders such as high blood pressure, heart disease, bronchial asthma, irritable bowel, peptic ulcer, tension headaches, migraine, backache, insomnia, anxiety, depression and many other conditions may be the result of the individual's inability to cope with, the stress in his life adequately. Despite this, medical science in general and the medical body of Pakistan in particular chooses to ignore stress as an important contributory factor in many of their patient's' illnesses.

Stress related disorders have replaced infectious diseases as the major health afflictions of the twentieth century. Yet the response of medical science has been to develop more sophisticated tests and more expensive medicines. Scant regard is paid to advising or helping patients develop stress relieving techniques. In Pakistan, the problem is further complicated by the fact that the majority of our people have their own belief systems regarding health and illness -IV drips for weakness and 'TV X-ray' (CAT/MRI Scan) for headaches and other aches and pains are just two examples, where every prescription is a polypharmacy of an analgesic, a tranquiliser or two, an antidepressant and a vitamin compound, along with the main medicines and where there is no accountability of doctors and no recourse to justice for the poor and suffering millions..

Research has also shown that emotional and psychological distress (which may be caused by excessive stress) may be the early manifestation of many physical diseases, or may itself cause the disease. For example, the stress of bereavement and the depression that may follow it have been associated with measurable reductions in the efficiency of the immune mechanisms, and with increased vulnerability to infectious disease, cancers and acute cardiac failure.

Depressive illness has been shown to be a common early manifestation of the development of cancer, presenting well before more specific physical symptoms in many cases. It has also been shown to precede acute myocardial infraction at a much more than chance level of frequency. Thus emotional and psychological changes cannot be ignored in any consideration of general health status, nor can they be ignored in the analysis of risk factors in individual cases.

Medical model of illness

The goal of medicine should be to understand the patients as persons, to establish the circumstances that caused their illness - the underlying conflicts, hostilities, grief and loss - in other words to treat the patients as a ‘whole’. The modern physician should and must know as much about emotions and thoughts as about disease symptoms and drugs. In today's world, this holistic approach would appear to hold more promise of cure than anything that medicine has given us to date: Unfortunately, what we see around us in Pakistan today are distressed patients, unethical medical practices, unnecessary investigations, prolonged hospitalisations and inappropriate and potentially damaging treatments followed by exorbitant fees.

In general, it can be said that the current practice of medicine in Pakistan relies too heavily on the medical model of illness, whereby a patient is seen to have a complaint which needs certain investigations followed by treatment, which in most cases are drugs. Doctors in Pakistan, whether they are general practitioners or specialists hardly ever bother to enquire about the psychosocial factors in their patient's histories. It is comforting and less time consuming for the doctor to stay within the confines of the medical model, for that is how we have been made to think. After all, one only diagnoses what one thinks about - and hardly any of our doctors think of factors other than the physical ones.

Maintaining homeostasis

Skills and knowledge about dealing with psychosocial factors and stress management techniques are seldom taught in our medical colleges. Yet a large number of patients - perhaps as many as forty percent in our country presenting to the general practitioners and to the various specialists' clinic do not fit into this medical model. People appear to be becoming more and more dissatisfied with medical care they receive despite the advancement in the field of medical science. Hence the large number of people who visit homeopaths and hakims in our country. In the West more and more people are turning to practitioners of ‘alternative medicine’ for relief of symptoms which orthodox medicine has failed to alleviate.

Stress research studies have emphasised the importance of maintaining homeostasis or a balance between different aspects of our lives. Any disruption of this homeostasis can cause the breakdown of the organism whereby one can develop a stress related disorder depending on the ‘weak link’ in the structure of the organism. According to this view of health and disease there are not merely individual interactions between pathogens and human beings but they also involve the entire spectrum of other relationships - including those with one's spouse, employer, children, neighbours and one's medical or spiritual advisor.

Too much emphasis has been directed towards specific pathogens and specific disease models, and not enough towards the patient and how he or she developed the particular disease. Only when we shift our focus from diseased parts to the whole being can we learn more about what activates the stress reaction in the organism and why stress affects different people in different ways.

A holistic approach to patient care is essential

The concept of health has to be one which integrates the question of body, mind and spirit. This holistic approach aims at enhancing our total well being, in part through self-awareness. By learning to gauge our own innate energy, potential weaknesses and strengths, we can all benefit from this approach. In the final analysis each of us is responsible for his or her own health and well being. This is particularly true for Pakistan where the great majority of doctors are unaware of the role of stress in various physical and psychological illnesses. Health is too important an issue to be left in the hands of doctors only!

Mental health and behavioural science disciplines can also provide some of the knowledge and skills necessary to reverse this process, and it is therefore important to ensure that these are incorporated in the medical curriculum and training of all doctors.

Just as wars cannot be avoided by developing more sophisticated weapons, so disease can never be completely eradicated merely by improvements in pharmacology, immunotherapy, or any other purely medical means. People should and must become more knowledgeable about the role of stress in their lives, their own stress level and about effective stress coping techniques.  (Third World Network Features)

This article is reproduced from Watch on Medicines, Vol. 15 No. 6, Nov-Dec 2006.

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