IATROGENIC ILLNESS

A disorder that is induced or aggravated by the physician.Suggestion plays a part in many psychological conditions, and a therapist may unwittingly produce symptoms through incautious comments or excessive examinations. This probably occurs most frequently in patients with hysteria, or conversion reaction, since this disorder is characterized by a high degree of suggestibility. One investigator, Ba- binski (1908) has shown that doctors who look for specific signs or “stigmata” of hysteria, such as skin anesthesia or lump in the throat, may actually induce these symptoms by suggestion. He coined the term pithiatism (Greek for persuasion) to indicate that these symptoms could be cured as well as caused by suggestion. Others have pointed out that information given by the physician may be instrumental in precipitating a neurosis or even a psychosis in individuals who are on the verge of these conditions: “Not entirely unimportant, unfortunately, is the iatrogenic origin of neurotic manifestations. The physician solemnly diagnoses ‘enlargement of the heart,’ whereupon the patient is frightened and breaks down until the X-ray photograph resorted to by another physician relieves him of his nightmare” (Bleuler, 1930). See CONVERSION REACTION, GLOBUS HYSTERICUS, SKIN DISORDERS. In discussing psychophysiologic reactions of the cardiovascular system, English and Finch (1964) make this comment: “Probably in no other area are iatrogenic illnesses as frequent as in the realm of cardiac difficulties. Many people suffer from functional heart murmurs. Unfortunately a fair percentage of such people have been informed of this fact in a manner that leads them to focus whatever anxiety they may possess upon their hearts. Once an element of doubt has been injected about the healthy status of their cardiac function by even one physician it requires a great deal of effort to eradicate this preoccupation. Patients have an ability to warp and distort through unconscious means the advice and knowledge that is given them to fit their own neurotic needs.” Aldrich (1966) makes the additional point that “too much information may make a patient more apprehensive rather than less, especially when it includes serious possibilities and more particularly when no steps are planned at the time to do something about the disturbing possibilities.” He offers the following case in point

 HYPOGLYCEMIC STATES
INTELLECTUALIZATION

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