From Linda M Rio – Author, mental health professional and PWN contributor – One of the first articles I wrote for Pituitary World News, Pituitary Disorders and Mental Health: Is There a Connection?, has been most read over the years, with over 45,000 views. I believe this isn’t due to my great writing but demonstrates the paucity of information about the mental health side of pituitary disorders and illness in general. I often hear from patients and family members that they have found Pituitary World News and me only after exhaustive searches on the internet. They also report many, many visits with primary care physicians, OBGYN, fertility, vision, and other specialists, psychologists, family therapists or counselors, and a host of other professionals who have not provided information about the link between pituitary and other neuroendocrine disorders and mental health. They are often very surprised but relieved to read about the connection and realize, “I’m not crazy after all.”
After a long career as a mental health professional, I have now come to the awareness that there has been a great mis-service done by myself, my fellow professionals, and the community. I think it is time to rectify a misunderstanding. The term “mental health” has for decades been commonly used but perhaps misunderstood. A very brief bit of history may be helpful here. In the early part of the eighteenth century, the writings and explorations of Charles Darwin heavily influenced much of the thinking of the day. Origins of most things at that time were seen as biological, primarily genetic. Such views, therefore, allowed for little hope of any recovery from any mental or emotional thought or behavior that deviated from the norm. The term “mental illness” was used to describe what couldn’t be explained otherwise and, therefore, often considered mystical or frightening. In the United States, the term “mental hygiene” was first used by William Sweetzer in 1843 after the Civil War. By the 1890s, a movement began in treating those housed in mental hospitals, looking at patients’ personal stories, and going into the community to begin efforts at prevention. By the early 1900s, efforts began to look to scientific studies as a basis for understanding mental illness. During World War I, the National Committee for Mental Hygiene was established to address “shell shock” (what is now considered Posttraumatic Stress Disorder, PTSD).
By World War II, the mental hygiene movement had expanded to the idea that even slight deviations from harmony with the environment in the social world of the school and early child development are close to the roots of ultimate difficulties that produce mental disorder, that institutional programs should be encouraged to be more favorable to the creation of a mentally healthy environment; for communities to be coordinated to supply mentally health environments; and that mental health principles should be integrated into the practices of social work, nursing, public health administration, education, industry and government (Mandell). Interestingly, such thoughts were proposed over three-quarters of a century ago and still have not been adopted into many communities and agencies. In 1948, the National Institute for Mental Health (NIMH) was established. In the late 1940s, researchers and academics began seeing mental health concerns not just with the focus on an individual but the person within a system, primarily the family. These thoughts started from outside psychiatry and included concepts of biology, anthropology, and sociology. Today, many, certainly not all, professionals recognize the importance of the interaction of not only an individual’s personal genetics, physical environment, personal relationships, and history of life experiences but also looking at the body and how it affects the mind/behavior/emotions, and vice versa.
Getting back to my apology. The term “mental health” is used today, but I believe often the focus is more on “mental” rather than “health”. This may not be the intention of the professional community. Still, the focus of Western medicine historically has been on looking for what is wrong rather than emphasizing what is right. And, let’s face it, human nature seems much more likely to notice what hurts over its absence. There is also a basic human need to have that pain acknowledged when in pain. Unfortunately, many pituitary patients go unnoticed and unrecognized for far too long, which is part of the reason that Pituitary World News exists.
Although there has been some progress in the education of professionals about the nature and prevalence of pituitary disorders, it remains unsettling that we still hear about delays in getting a proper diagnosis and, therefore, treatment, as well as a continued disconnection between medical and mental health to provide a more cohesive and collaborative treatment for patients. A lack of coordination between mental health and physical healthcare providers exists among many illnesses largely due to the historical separation in how Western medicine treats illnesses of all kinds. Again, to a large degree, the focus has been on illness, not on providing health. Let’s face it: unless something is considered “wrong,” any insurance will unlikely pay for treatment.
Mental Health Connection with pituitary/neuroendocrine disorders
To understand not only the connection but also the origins and impact of neuroendocrine/pituitary disorders on mental health and vice versa, I have divided this conceptualization into primary and secondary categories. Hopefully, this conceptualization can help us understand the role of the body and the role of the mind, but it is not an official diagnostic or treatment term. In reality, these cannot be untangled, as one truly has an effect on the other. This is truly a chicken or egg question that likely will never be answered with complete clarity.
A primary conceptualization looks at such mental health diagnoses as major depression, anxiety disorders, and a few others as biologic and integrally connected to the disruption in the endocrine system, such as when a pituitary or other neuroendocrine tumor exists. I use the term primary here when looking at certain neuroendocrine disorders that have a very high rate of mental health disruption. Some endocrine disorders, if not caused by the medical diagnosis, can be amplified by the physiology of the medical disorder and would not be present otherwise, so it is strongly correlated to a disruption in the endocrine balance within the body.
A secondary conceptualization attributes a mental health issue either as existing before the development of the neuroendocrine disorder or a result of the stress of trying to get a medical diagnosis. Many pituitary patients report months to years, even decades, before getting a proper diagnosis. There is also the concept of what is termed “medical trauma”, in which psychological trauma occurs following a medical procedure that was experienced as life-threatening, extremely frightening, or even as a result of improper medical treatment. In such scenarios, the mental health symptoms are more indirectly related. It is essential to understand that current science cannot draw a direct line between endocrine and mental health disorders. There is, however, plenty of evidence showing a relationship, not causality. Perhaps one day a more direct link will be discovered.
Despite the continued challenges, there is hope. It is essential to focus not only on positive steps that medical and mental health professionals have taken but also on what can be done by patients, their families, and support teams. This is where the focus on health, physical and mental, becomes so important. And one of the things the mental health field has learned over recent years is that although it is important to recognize and understand a person’s past, doing so without a plan does not provide relief. Unless remembering and learning about the past helps address the present and then the future, such a focus will be of only limited help and, in some cases, may even hurt. Many of the current mental health therapy modalities assist clients in finding and enhancing resources that are strengthened not only in the face of pain but also as stepping stones toward enhancing stronger emotional resilience. Defining and acknowledging pain is just a beginning step and should not be where the only attention lies. Something such as a physical illness or disorder can be all-encompassing, especially during acute phases. Having a therapist, friend, companion, spiritual counselor, or other person to listen to and be available during such times is invaluable. Any serious medical issue can cause a patient to face grief for the person, the body they wanted or thought they had. Grief can also be about the loss of mental capacities that once may have been a defining quality of the self. Grief can be experienced about relying on family and others when a person was once very independent. Denial, bargaining, anger, and depression are phases typical of the grieving process. Acceptance is the final stage in this process that addresses how to go on with life, even if life isn’t what you thought it would be. This is where the true focus of health comes in.
Mental health isn’t the absence of physical or emotional pain; it is finding ways to live through and beyond life’s challenges. Mental health is about meaning, beauty, purpose in life, and the ability to break through the times of darkness and desperation. Mental health is having strong connections to those around you who are willing to go on the journey with you.
Linda M. Rio, M.A., LMFT (805) 619-0950 www.Lindamrio.com
The book The Hormone Factor in Mental Health is available through Amazon.com and other major booksellers.Order your copy here.
© 2024, Pituitary World News. All rights reserved.