People with severe mental illness long for a doctor’s touch

Disease and treatment 17. may 2022 3 min Ph.d.-Scholar, cand.scient.soc Iben Emilie Christensen Written by Kristian Sjøgren

Doctors often do not physically examine people with mental illness. New research shows that this often makes people with severe mental illness feel out of place and reduces their trust in the doctor. According to a researcher, touching may be a way of helping people with mental illness to overcome physical illness.

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A new study, in which a researcher followed 10 people with mental illness in Denmark for 15 months, shows the importance of being touched during physical examinations by general practitioners or hospital doctors.

The research shows that people with severe mental disorders, such as schizophrenia or bipolar disorder, are often not physically examined when they consult their general practitioners about physical symptoms such as back, stomach or leg pain.

When people with mental illness leave the doctor’s office, they often feel that they have not been seen or understood, no matter how empathetic or understanding the doctor has otherwise been.

Conversely, people with mental illness feel less out of place if the doctor has physically examined them and feel that their physical symptoms were taken seriously.

“Being touched and physically examined by a doctor are very important for people with severe mental illness. Kind words and a hand on a shoulder are not sufficient, whereas being seen, heard and touched are. Realising this is important at a time when healthcare systems are strongly focusing on how to reduce the excess mortality and high incidence of physical illness among people with severe mental illness,” explains a researcher behind the study, Iben Emilie Christensen from VIVE – the Danish Center for Social Science Research, Copenhagen and PhD student at the Department of Public Health, University of Copenhagen.

The research has been published in Culture, Medicine & Psychiatry.

Doctors seldom touch people with mental illness

The research comprised ethnographic and qualitative fieldwork on what living with both mental and physical illness is like.

Iben Emilie Christensen based her study on the 15 months of observations in which she followed people with severe mental illness.

She noticed that doctors seldom touched or physically examined these people with severe mental illness.

She also discovered that the doctors not examining these people was associated with their feeling out of place.

A review of the literature also showed that doctors are definitely apprehensive about touching people with mental illness.

“Doctors may have many reasons for not touching patients with mental illness as often. They could fear being misunderstood or fear that the patients will react negatively. Doctors may also think that the physical symptoms are linked to the mental illness and that physical examination is therefore not warranted. Nevertheless, in this study I focused exclusively on the patients’ perspectives, and this shows that there is a problem,” says Iben Emilie Christensen.

Paying masseurs to experience touch

Based on her research, Iben Emilie Christensen concludes that these people often think that their mental illness is so prominent that doctors no longer take their physical symptoms seriously, and this frustrates them.

They do not think that doctors consider them worthy of trust, but it helps when a doctor touches and physically examines them when they say, for example, that their leg hurts.

The research also shows that people with mental illness often pay for massages and physical therapy, which also indicates a need for touching in connection with physical ailments.

“Touching makes them think that the person in front of them believes them when they say they feel pain. These people often feel stigmatised, but making them feel valued through something as simple as touching is an opportunity to be seized, because this might strongly affect their physical and mental health,” explains Iben Emilie Christensen.

Eureka moment for doctors

Iben Emilie Christensen’s research is part of the major SOFIA study, which aims to reduce excess mortality among people with severe mental illness.

People with severe mental illness have about 10–20 years lower life expectancy than the general population, and they often die from such diseases such as cancer and cardiovascular disease.

The SOFIA researchers from the University of Copenhagen, led by Professor Susanne Reventlow, are trying to find causes and interventions that can reduce excess mortality, and Iben Emilie Christensen says that doctors in Denmark have welcomed the new knowledge about the importance of physically examining patients.

She says that a trusting relationship between patients and doctors is also important for patients’ health in both the short and long term and can help to identify severe illness earlier.

“Right now, through the SOFIA study, we are trying to make doctors aware of how important being physically examined can be for these people to feel recognized as having physical symptoms and to trust the doctor. For many doctors, this is a eureka moment, and we also think that doctors are listening and interested in understanding how they can do more for these people,” concludes Iben Emilie Christensen.

Senses of touch: the absence and presence of touch in health care encounters of patients with mental illness” has been published in Culture, Medicine, and Psychiatry. In 2016, the Novo Nordisk Foundation awarded a grant to main author Susanne Reventlow for the project A Cluster-randomised, Parallel-group, 5-year Trial of Coordinated, Co-produced Care to Reduce the Excess Mortality of Patients with Severe Mental Illness by Improving the Treatment of their Comorbid Physical Conditions: the Phy-Psy Trial.

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