Psychotherapy and chronic illness CMAJ 1997;156:1535 See also: Letter: Healing body and mind, N. Hershfield I was moved by Dr. R. Peter Uhlmann's story, "Learning to let go: one physician's experience with cancer" (CMAJ 1997;156:1029-31). He reminded us of "a real deficiency of Western medicine: it can treat my cancer, but it can't heal me." What is missing? It is now well established that psychologic therapy can alleviate distress and improve quality of life in patients with cancer and heart disease. Such treatment even appears to prolong survival.[1­3] Despite this, less than 10% of patients receive such therapy. It seems that professionals may endorse such treatment but seldom recommend it.[4] Only 1 of the patients I have seen for chronic illness was referred by a physician! Perhaps such "low-tech," medication-free treatment is simply too unglamorous; to what extent do physicians fulfil themselves by offering tangibles such as tests? There is also an information gap. Most colleagues incorrectly believe that psychotherapy consists mainly of listening and offering advice, and there also seems to be a widely held notion that the depression and anxiety experienced by some patients with chronic physical illness are as refractory to treatment as the precipitating disease. I find the opposite to be true: these symptoms often lift much more quickly in ill patients. There is every reason to believe that patients with any chronic illness would similarly benefit. In light of the efficacy and safety of such treatment, it has been suggested that we deem it "adjuvant therapy"[4] and consider it routinely. It is time to advocate this as vigorously as we do cholesterol management. Julie Righter, MD Toronto, Ont. References Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2:888-91. Fawzy FI, Fawzy NW, Hyun CS et al. Malignant melanoma. Effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 1993;50:681-9. Ornish D, Brown SE, Scherwitz LW et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336;129-33. Cunningham AA, Edmonds CVI. Group psychological therapy for cancer patients: a point of view, and discussion of the hierarchy of options. Int J Psychiatry Med 1996;26:51-82. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ June 1, 1997 (vol 156, no 11) / JAMC le 1er juin 1997 (vol 156, no 11) |