Health and Psychology

I was doing supervision with a student and reviewing old chart notes his former supervisor didn't sign off on before leaving the department.  I came across a diagnosis of "hypocondriasis" and a case note indicating that "with so many medical complaints the only diagnosis of any certainty is hypocondriasis."  I sighed as I read through the information provided to the student. 

So we reviewed:  "Hypochondriac (hī-pō-kon’drē-ak): a person with somatic over-concern, including morbid attention to the details of bodily functioning and exaggeration of any symptoms no matter how insignificant." 

I then asked the student "So an uncommon, illness that impacts all organs in the body and is likely to be fatal wouldn't count towards that diagnosis right?"  He said "No."  I clarified further that especially with late stage and end stage illnesses and rare medical conditions, people use therapy as a place where they can talk about their health concerns.  There isn't anyone in their social support system able to repeatedly hear about how exhausted they are, how much pain they have, and their exasperation with the limitations of medicine.  The client has been sick and getting worse over the last 30 years.  There is no effective medical treatment.  The illness damages the organs in the body and eventually one of them, usually the heart, gives out and the person dies.  Occasionally they get an infection, usually pneumonia and die.

His prior supervisor either didn't know what the illness was or hadn't read the note.  The student missed an opportunity to help the patient cope with the illness.  He focused instead on getting employment.  It's not a horrible goal with a long-term chronic progressive illness.  Work would take some focus off the medical problems and could provide the client with a sense of purpose.  But the idea that anyone that talks about health concerns is a hypocondriac is a common one in the lay community.  It's also an idea that shows up in medical professionals from time to time.  A health and medical psychologist can provide a different perspective.