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Therapists: Could A Medical Condition Be The Cause Of Your Client’s Mental Illness?

A well-trained and dedicated medical doctor will consider whether or not there is an emotional component possibly triggering a physical issue, such as stress in the case of fatigue. But often, those in the mental health field, especially psychotherapists, might not evaluate and rule out medical or other issues in the case of a client presenting with a mental illness.

In training sessions with interns and therapists-in-training, I emphasize the importance of doing a comprehensive evaluation before diagnosing—and doing therapy with—a client. I explain that when it comes to a mental health evaluation it is as vital for therapists to determine which factors are contributing to or causing mental illness, whether that mental illness is mild or more severe.

Yet many therapists jump right into talk therapy at the first or second visit; not everyone in private practice examines medical records or asks their clients to get blood-work done. (Not everyone evaluates for substance abuse or addiction either, which is so important.)

It’s Not Just Nutrition…

Most of us have heard about or seen anxiety and insomnia “cured” by eliminating extreme caffeine use; autism symptoms dramatically helped by brain-gut aware diets; schizophrenia symptoms lessened when gluten and/or dairy were eliminated from the diet, and so on. Fortunately, more and more therapists are willing to recommend that their clients see nutritionists who specialize in this area.

But how many of us readily recognize that mental illness can be caused by disease and infection? One common example that comes to mind is (untreated) schizophrenia as a cause of delusions, mood disorders and more. But there are others.

In Saving Sammy: A Mother’s Fight to Cure Her Son’s OCD , “the story of one mother’s fight against the medical establishment to prove the link between infection-triggered PANDAS and her son’s sudden-onset OCD and Tourette syndrome,” Beth Alison Maloney describes her and her son’s interactions with a variety of psychological and medical professionals, some who were open-minded enough to respect her pursuit of possible medical reasons behind her son’s sudden mental illness and others who simply refused to even explore the possibility.

In the last few pages of this poignant book, she explains that in the history of research, mental illness was originally linked to infection, by none other than Georges Gilles de la Tourette who linked the eponymous syndrome he discovered to rheumatic fever. Later on, there were links to encephalitis. Yet when mental illness began to be treated primarily with psychoanalysis, medical reasons were no longer being explored and the “door to finding an invasive cause was closed.” Maloney writes:

The steadfast refusal of some doctors to open that door is disconcerting. Studies consistently report links. Scientific American Mind reported in 2008 that schizophrenia has been linked to the flu, bipolar disorder to herpes, autism to Lyme disease, and OCD to strep [as in her son’s case.]”—Saving Sammy: A Mother’s Fight to Cure Her Son’s OCD

In Therapy Revolution, my patient’s guide to therapy, when advising patients to see therapists who do thorough evaluations I write:

Just as some medical doctors aren’t in tune with the importance of recommending psychotherapeutic evaluations, some psychotherapists aren’t aware of the importance of recommending medical evaluations. Sadly, I would say this is often the case. Illnesses that should be treated medically can sometimes masquerade as emotional problems.

For example, a condition such as mitral valve prolapse (a common disorder where the valve between the heart’s left upper chamber and the left lower chamber doesn’t close properly) can cause symptoms of anxiety, including heart palpitations. Hypothyroidism (an underactive thyroid gland) can cause depression and irritability, and there are numerous other medical conditions that can cause psychological symptoms. Additionally, medications themselves can cause psychological symptoms, including medications given to alleviate psychological problems. —Therapy Revolution: Find Help, Get Better and Move On (Without Wasting Time or Money)

The Whole-Soul Connection

A human being is an astonishing creature. A unique soul is housed in a physical body. Soul, mind, body (and yes, brain-gut) work together in an incredible non-static living, breathing miracle.

Ultimately, I believe that the spiritual nature of each of us is bound up in our spiritual, physical and emotional lives in an spiral of multiple inter-reactions. It is impossible to say with any certainty, at least on the physical plane, which aspect precedes the other (though I believe ultimately it is the soul.)

But we can come more down-to-earth and with certainty state that a person isn’t just a mind or a body and both must be taken into account when determining a course of treatment. Mental health professionals must maintain an awareness that just as mental illness can contribute to physical illness, the opposite is equally true. We need to be curious detectives.

Therapists: Could A Medical Condition Be The Cause Of Your Client’s Mental Illness?

Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.

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APA Reference
& C.R. Zwolinski, R. (2015). Therapists: Could A Medical Condition Be The Cause Of Your Client’s Mental Illness?. Psych Central. Retrieved on November 25, 2020, from


Last updated: 17 May 2015
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