Pregnant for the first time, Sue became a bit nervous in her Lamaze classes but had no reason to expect a difficult delivery. When her pains began, however, so did an anxiety attack severe enough to complicate her labor and ultimately require a caesarean. Afraid of a repeat the next time she gave birth, she consulted Dr. Lucy Waletzky, a psychiatrist specializing in health-related issues.
Under hypnosis, Sue retrieved the deeply buried memory of a painful childhood pelvic injury.
"Obviously, the pain of labor had triggered these memories and caused the anxiety attack," says Waletzky, co-director of the Medical Illness Counselling Center in Chevy Chase, believed to be the nation's first mental-health facility concentrating specifically on the emotional aspects of physical conditions.
Counseling, says Waletzky, freed Sue of her crippling fear. "Her second delivery was a beautiful, joyful experience."
Although few of the center's sucesses are quite that dramatic, Waletzky and her co-director, psychiatrist Dr. Stephen Hersh, both believe firmly that "the physical and the emotional are interwoven like the threads of a tapestry."
Based on this conviction, and on their experience treating the emotional side of various illnesses and injuries, they have assembled a diverse staff of mental-health professionals offering a range of treatments both for individuals with chronic and acute medical conditions and their families.
The case load might at any time include people concerned with infertility, burns, heart disease, cancer, migraine headaches, diabetes, disfiguring injuries, birth defects, arthritis or other conditions. In many cases, Waletzky believes, "Emotional factors can play a role in the predisposition, the onset, the course and the outcome of a disease."
Adds Dr. Renee Royak-Schaler, a psychotherapist associated with the center, "Acknowledging the connection between emotions and physical condition helps an individual cope with his illness on many levels."
Hersh sees MICC as filling "a gap" in the medical system. In today's increasingly specialized practice, patients tend to become "cases"--a disembodied heart, gall bladder or left knee--and their need to understand and deal with the emotions surrounding their illness often gets short shrift from busy doctors lacking the training and the inclination to delve below the surface.
"Many simply don't think of asking about how a patient is doing emotionally," says Hersh. Doctors might "give them a booklet to read about the illness, but they don't usually sit down with them and talk about it . . . Physicians wait for the extreme cases" before referring a medical patient for counseling.
Many people, of course, cope adequately without professional support. But, Hersh says, "we believe that there's no such thing as a person who can't benefit from a look at themselves when they have one of these conditions.
"The basic life issues are the same, although each has variations.
"People feel that they've lost control of themselves, their lives and their basic family and other systems of interaction. There's a sense of loss, sense of stigma, some elements of depression, some elements of anxiety."
"They're the same but they're different," adds Waletzky. "There are some issues that are specific to each illness."
The guilt and anxiety experienced by a person whose parent has Alzheimer's, for example, are different from the anger and depression that might afflict an amputee or the grief that assails the parent of a deformed baby.
Another "gap" in the medical system is what Hersh terms "case management." "People come to us who have gone to multiple specialists, and we become the managers of the case, the coordinators, the explainers to the patient."
George, for example, came to MICC suffering from dizziness and difficulty orienting himself. A number of different doctors had found slight irregularities in his eyes, his inner ear and elsewhere, but nothing that would in itself account for his trouble.
A thorough physical and emotional evaluation indicated that, indeed, none of his various small abnormalities alone was wholly to blame, but together they added up to trouble. A combination of biofeedback, relaxation training and such interventions with other doctors as obtaining a slightly different eyeglass prescription brought relief.
New patients come either through physician referrals or on their own. Each has an initial evaluation by a psychiatrist who, as a physician, can also take into account such factors as side effects of various drugs the patient may be taking. An individual treatment plan is then prescribed, making long- or short-term use of MICC's resources. Among them:
* Psychotherapy--In individual, couple, family and group settings.
* Biofeedback training--Can help individuals increase control over conditions such as excessive muscle tension, high blood pressure and chronic pain. Also helps in relaxation and stress management.
* Hypnosis and guided imagery--Can help in treatment of fears, panic states and pain as well as control of habits.
* Sex therapy--To help overcome the sexual difficulties that accompany many medical conditions, as well as to treat preexisting problems.
* Group therapy--Helps patients deal with the emotional side of illness through knowing others with similar conditions.
A nonprofit educational and clinical organization that also plans to fund research, MICC accepts Medicaid and health insurance and has a sliding scale of fees to accommodate patients wih limited finances.
The center emphasizes that they do not promise, or hope for, "miracle" cures. Rather, they expect that better management of the emotional side of illness will improve the patient's--and his family's--quality of life.
MICC is at Suite 610, 5454 Wisconsin Ave., Chevy Chase, 20815.