A headline caught my attention: "Economy Takes Toll on Mental Health."1 It described the recent phenomena of San Francisco Bay Area psychologists and other mental health therapists seeing the effects of the recent economic events impacting their patient's lives. One local therapist said, "Last week every one of my clients mentioned anxiety over the economy."
The article describes, "an epidemic of anger, anxiety and emotional stress, according to local psychotherapists and academics." The American Psychological Association, in an October 2008 survey, showed that 83 percent of women and 78 percent of men were experiencing increased stress over employment, housing and loss of retirement savings. Women were more concerned with their economic situation than their own health. Women in the baby-boomer age range were especially affected. In their group, concerns about the economy increased from 18 percent last April to 92 percent last September. Basically, no one is left untouched by the turbulent and uncertain times in which we are living. Including us.
In David Eisenberg's 1985 book, Encounters With Qi, he devotes a full chapter to mental health care in China titled "Freud is not here." He describes how mental illness occurs in China in similar patterns to the West yet is treated so differently. There is a cultural and historical bias away from talk therapy and towards somatization. Historically, the belief was that mental illness was some type of derangement of original qi and thus inherited. Having a mental illness brought shame to the family. Also there was a cultural bias toward keeping matters private and discussing such problems with someone outside the family, even a doctor, was not common nor encouraged. This is also historically similar to how mental illness was viewed in the West, yet in the last 50 years there has been more of a divergence. In China, most mental illness was attributed to an organ dysfunction, hence a physical illness, which was more palatable to the patient.
As acupuncturists in the West, we come from a culture where discussion of personal issues is more common and expected. We are not trained to deal with serious mental illness, and we are obligated to refer such cases to mental health professionals. Yet we encounter emotional distress, anxiety, nonclinical depression and insomnia in our patients every day. Naturally, as holistic practitioners, we see these issues as part and parcel of the whole individual and do not separate out these aspects of their health per se. So, we attempt to address them. Again, anyone who is deemed to be a danger to themselves or others and/or is gravely disabled must be referred to the proper provider. In this article, I am addressing the vast majority of people who are functional and engaged, yet experiencing difficulties in their lives that involve emotional and psychological aspects of their being.
In a recent article, Ted Kaptchuk addresses the differences between practices in China and here in the West.2 One major difference is the types of conditions that are seen. In one study, two different clinics in Beijing were examined. The predominant conditions were neurological in nature. Bells Palsy and CVA rehabilitation were the predominant conditions, with other pain-related conditions following behind. In another study comparing outpatients in Chengdu clinics and San Francisco, American patients were "three times more likely to seek Chinese medicine for mental health complaints" than were the Chinese patients.3 Other studies looked at British and Australian patients of "East Asian Medicine" and found that people described their outcomes as "changes in symptoms, changes in energy and changes in personal and social identity," as well as "improved well-being."4 Another major difference between practices in China compared with the West was volume of patients served. In the Chinese clinics, the average was in the range of one patient every 7.5 minutes, while in the West, it was one patient per 1.2 hours. Clearly the perceptions of both patients and doctors in the East and West differ as to what East Asian medicine treats best. It seems that we are well-suited to treat the "mind" here in the West .
When I discover issues that involve emotional distress, such as anxiety, anger, frustration or grief, I will begin a discussion that enables both of us to understand the circumstances around these issues. What kind of a support system exists? Are there close friends or family? Do these friends or family live in the area? What kinds of relationships exist in this person's life? What other sources of support or nourishment exist for this person? What sustains them? Do they have a spiritual/religious life? What are their major beliefs about themselves and the world around them? How do they see the future? How deeply are they connected to their past? All of these questions help lead both of us to some deeper understanding of where they are and where they can move toward. I always try to gauge their level of desire to move out their current situation. This is similar to discerning their levels of righteous qi and quality of shen. Most of this is intuitive; not something we were ever taught in school. However, it is something that most people in the helping professions naturally have, to a greater or lesser extent. The intent of this article is to call attention to the profound impact on our patients that current events are having, which are above and beyond the normal levels of stress that we have seen in the past. If we remember this than we can put more attention and awareness on these issues when we speak to our patients.
We can certainly have a positive outcome when we use our training to affect the old patterning of both physical and emotional habit life. Assisting people settle in with good sleep hygiene, better diets, more efficient digestion, pain relief and focus on their own health will help them better deal with the stress that is occurring in their lives. There is also nothing wrong with addressing the physical side of mental health, as long as the psychological side is also taken into account. When one is well-nourished and well-rested and not in physical pain, they are again that much more well-equipped to take on the stress of the outer circumstances. As acupuncturists, we are uniquely positioned to address the whole picture of our patients' situations. If we practice community-style, we will also lighten their financial burden as well.
I will end with some tips from the article in the San Francisco Chronicle on what psychotherapists suggest to help stressed clients:
References
Structured water (H3O2) can be considered a fourth state of water between liquid and solid. It has the hexagonal structure of ice; however, missing a critical bond, it behaves more like a gel than a solid, but retains some of its crystalline structure.
In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
Working with chronically ill patients entails acknowledging the reality that not all patients will survive their diagnosis. Chinese medicine and acupuncture play a crucial role in palliative and end-of-life care, addressing medication and disease side effects, alleviating pain associated with death, reducing anxiety and stress, and helping patients find peace during the dying process.
