Blaming it all, or nothing, on the pituitary

From Linda M. Rio, PWN contributor, author, and Marriage and Family Therapist: Last week, I experienced two note worthy experiences that caused me to look inward. Please note that I disguise any descriptions about clients to protect their confidentiality.

The first involved a description from a client I’ve been seeing who told me about his recent appointment with his endocrinologist. This client found me after reading one of my articles published in Pituitary World News. And, he was pretty grateful for reading about the mental health aspects that can be associated with pituitary disorders since he was suffering from significant anxiety and depression. He told me his endocrinologist used very strong language to deny that any literature or research supported any link between pituitary and mental health. This physician is well-known for specializing in pituitary medicine, so he is not a generalist. I am not a physician, so it is not my place to recommend medical treatments or procedures. Still, I can respectfully disagree with this doctor’s conclusion that mental health is not an aspect to consider in the overall treatment planning for patients. My awareness is to carefully adhere to my professional boundaries while encouraging clients to choose their practitioners, myself included, that are best for their unique needs. I hope that after so many years, all physicians will assist their patients in finding proper mental health care when it may be deemed necessary. I also hope that physicians will be up-to-date in all aspects of their specialty.

My second realization came this week. I have been seeing a client for several months who initially came to see me about a year post transsphenoidal pituitary neurosurgery. The surgery was reported as successful surgically, but this person was significantly anxious about the tumor returning as well as all the losses suffered as a result of having had a pituitary disorder. There was a lot of grieving about all the time spent looking for doctors and being told her symptoms were nothing or treated insufficiently. I have found it typical, yet sad, when patients finally get surgery but then face intense emotions afterward due to expectations that the “successful” surgery doesn’t fix everything. This client was quite distressed with having a physical body that wasn’t as strong or with the endurance of the pre-pituitary disorder days. Cognitive functioning, although improved, also doesn’t always bounce back as hoped or expected either. So, I worked with this person for some time but began to question whether all the current symptoms may not be attributable to the pituitary issue. I started to ask further questions about this person’s level of functioning not just months to a few years before the pituitary diagnosis (because it often takes a long time to get an accurate diagnosis), but I began to explore how this person functioned in childhood and adolescence. After a significant amount of exploration, the client and I collaboratively concluded that many of the issues currently a focus of our treatment actually were not as much about the pituitary disorder but actually existed long prior from childhood and only recently became more evident as the physical effects of the pituitary disorder are now healing. It was necessary to reframe the therapy and refocus.

As someone who has practiced as a Marriage and Family Therapist for over thirty-five years and served on many professional association boards, I find it abhorrent to hear stories about anyone who considers themselves professional and who does not behave with the utmost integrity to uphold the profession’s ethics.  As a mental health clinician, it is vitally important to be self-aware to avoid overlaying personal issues on our clients. Most graduate academic programs require students to experience their own therapy, and many professionals, after formal schooling, use a variety of recommended ways to stay on top of their own biases, impressions, and triggers that could cause blind spots for proper treatment. Therapists, like all professions, have their share of horrific stories about improper, even illegal, behaviors under the guise of psychotherapy. I do not intend to address those types of cases here but will leave, sadly, those for Hollywood to expose in the most graphic of ways.  As a clinician, it is always important to never forget that the humans we treat are very complex and ever-changing. Having an open mind is a trait I have come to appreciate as more important than some of the technical skills taught in graduate school. And, once out of the textbooks, real-life cases are almost always far more complicated. This is one of the reasons why the accurate diagnosis of a pituitary disorder takes a very skilled medical eye and advanced medical testing. Pituitary disorders often have symptoms that look like many, many other disorders, physiological as well as psychological. Sometimes it is difficult or impossible to discern what came first the physical or the mental health issue because they can be so intertwined.

 To complicate things even more doctors, therapists, and patients must remember that sometimes more than one physical and/or mental health problem or issue can and do exist at the same time. A person can be depressed because they lost a job and be dealing with an endocrine disorder that also can affect mood. There can be anxiety about having a tumor in the head and anxiety inherited from parents and grandparents or as a result of a traumatic life experience. The effects of childhood or adult trauma can invade all aspects of life, and when combined with a major disruption in the all-important endocrine system, the clinical picture can get quite complex. Because the diagnosis of a pituitary is often delayed by months to years or decades, the focus of patients’ lives is often spent trying to find a solution to symptoms. The patient, as well as surrounding family members, may spend considerable time trying to find the right doctors as well as dealing with insurance challenges. Once diagnosed the focus often changes to trying a medical treatment rather than immediate surgery. If surgery is deemed necessary, there are often delays before the procedure. All of these delays tend to extend the focus for the patient on their pituitary, and other things may go on a back burner. Following neurosurgery, patients are told that the procedure was “successful,” which only means that the biological and the physical were addressed. People come to the surgery with life histories, problems, successes, failures, skills, and deficits, and those things will remain after surgery. For some the real emotional work to face follows surgery or proper medical intervention when patients must face the question, what now?

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