THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
If you’ve ever managed a chronic illness or supported someone who has, you probably know that treating the physical symptoms is only part of the story. What often gets brushed under the rug, sometimes even in clinical settings, is how closely mental health is tied to chronic physical conditions. And I mean closely.
Being a physician, I have had my fair share of experiences with patients who had diabetes, cancer, arthritis, and even heart disease. Surprisingly, a majority of these patients were taking their medications, yet they were experiencing serious health decline. What could be the reason for that? Living with chronic illness takes a psychological toll that isn’t addressed.
Today, I want to talk frankly about this intersection between mental health and chronic illness. More importantly, I will touch on why a holistic approach might just be the missing link in effective long-term care.
Let’s clarify definitions first.
Chronic disease is any persistent health condition that does not fully heal and continually necessitates medical attention. Some examples are hypertension, diabetes, lupus, cancer, chronic pain syndromes, asthma, fibromyalgia… the list goes on. Such health conditions usually transform over a period of time, some of them having a detrimental impact on the individual’s quality of life.
Mental health, on the contrary, is the ability to control one’s emotions, feelings, acts, and even social interactions. In essence, mental health encompasses how a person perceives and reacts to situations in different contexts. Well, here is the catch: mental health disorders and chronic illnesses tend to coexist. And the connection is not incidental. It’s biological, behavioral, and deeply human.
Here’s what tends to happen: you get diagnosed with a long-term condition. Maybe it’s manageable, maybe it’s not; but either way, you’re now dealing with a lifetime of medications, lifestyle changes, doctors’ appointments, flare-ups, and uncertainty.
That emotional weight can be quite enormous. A lot of individuals begin to become anxious, overwhelmed, or even depressed. And once that occurs, the motivation to keep up with medications, eat healthily, or even get out of bed can drop. Then the chronic disease gets worse, which causes more emotional stress… and the cycle continues.
Research has continually demonstrated that those with chronic diseases are two to three times more likely to develop depression or anxiety. For example:
● As many as 1 out of 3 individuals with diabetes develop depression.
● Chronic pain patients have a higher probability of developing mood disorders.
● Cancer survivors undergo a plethora of psychological complications that last well beyond remission.
And there is more. Mental illness also predisposes you to chronic disease. Depression, for example, has been linked to increased inflammation, insomnia, poor diet, and lack of exercise. Each of these elevates risk for chronic disease.
So, what do we do with all this information? We go holistic.
A holistic approach implies that the whole person is treated, and not the disease alone. It recognizes that mental and physical health are inseparable and that caring that is significant must take account of both.
The following is what a comprehensive model would entail:
Here’s a picture: You go to a clinic where your endocrinologist, psychologist, nutritionist, and physical therapist all read each other’s notes and actually speak to one another. That’s the gold standard. Unfortunately, it’s not always the reality. But integrated care systems where mental health professionals are embedded into chronic illness care are slowly gaining ground, and they show better outcomes.
Mental health check-ins should be as standard as blood pressure measurements. Particularly for chronically ill patients, an earlier assessment for signs of depression or anxiety can profoundly alter the treatment process. Occasionally, all a patient actually needs is for someone to say, “How are you managing these problems?” and show concern.
Let’s get realistic. Healthcare can be empowering. When patients are aware of their disease, know what to anticipate, and feel in control of their treatment regimen, they fare better. But emotional empowerment is equally important. Therapy, support groups, and even mindfulness training can help patients feel as though they’re not just existing with their disease but living with it.
We physicians like to say, “Exercise more!” and “Eat better!” Yes, those are important. But when one is depressed or anxious, even small things can seem overwhelming. That’s why lifestyle changes must be individualized and kind. Behavioral therapy can assist patients in creating small, attainable routines that will slowly build confidence and consistency.
I had a patient, Mrs. T, who had rheumatoid arthritis. Her inflammatory markers were under control, and her medications were okay. But something felt off. She was missing appointments, stopped engaging with her physical therapy, and reported constant fatigue. On deeper questioning, it turned out she was severely depressed but never brought it up because, in her words, “This is just my life now.”
We connected her with a therapist, adjusted her care plan to include mental health support. In a little over six months, her outlook and her physical condition dramatically improved. That experience stuck with me.
The beauty of a holistic model is that it empowers both doctor and patient. For us doctors, it means we don’t have to view chronic illness through a narrow biomedical lens. And for patients, it offers a more compassionate, realistic way to manage a lifelong condition.
When mental health is integrated into chronic disease management:
● Medication adherence improves.
● Hospitalizations and emergency visits decrease.
● Quality of life metrics go up.
● Patient satisfaction soars.
We all win. Let’s stop treating the body and mind like separate entities, because they never were. Stay safe, and take care of your whole self.
This article was written by Dr. Adil Manzoor, DO, MBA/MS, a Board-Certified Internist; Board certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless.
He is also the co-founder of his own unique medical practice, Mobile Medicine NJ; House Call Doctors. Has also completed his Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health
- https://pubmed.ncbi.nlm.nih.gov/35726840/
- https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/
- https://www.sciencedirect.com/science/article/abs/pii/S0022399910000061?via%3Dihub
