Science Space
Psychology and Endocrinology
The present article stems from the joint reflection of three psychologists: Maria João Brito, Paula Câmara and me. More than presenting a scientific text, we would like to share with you our daily experience of clinical practice.
What are the challenges facing psychologists working in the health field, in an hospital environment and an endocrinology unit? Each of these variables poses its own challenge. Let us start at the end: endocrinology. By definition, it is the specialty that studies internal secretion glands (endocrine) and hormones. They regulate homeostasis, balance. Endocrinology derives from the Greek word éndon, which means ‘from within’.
How does one envisage, “thinks”, what is organic and biologic and then processes it and sends it to the body? How does one go about living in a body when parts of it are no longer there or working, and maintain his/herself-esteem, continue to see life as a project, keep on having desires and dreams, in the constant quest for the homeostasis, balance, and dynamism life is made of?
Stress and reproduction, starvation and repletion, behaviour, sexuality, body image, phenotype, chronic disease, surgery, the encounter with the body and the mind, with what is real and what is experienced. This is the challenge facing psychology in endocrinology.
Structure of the medical appointments: Andrology, General Endocrinology and Obesity.
Due to the impossibility to refer to all the cases, we chose one example from each area.
In the Andrology clinic, we receive requests related to Erectile Sexual Dysfunction and Premature Ejaculation. It is interesting to note how the patient population coming to us has changed over time. Initially formed mostly by heterosexual males over 45 years of age and with conditions lasting for various years, sometimes over 5 years, nowadays it is constituted by people with distinct sexual orientations, religious beliefs, ethnic groups and/or nationalities. Their anguish can be found the moment they enter the door, but the way they present it, and particularly the way we need to approach it is equally distinct. The bio-psycho-social being is real, not merely a construct. And the importance of sexuality in that dynamic is evident.
The cultural and religious issue is very sensitive, and some topics and practices are taboo.
Other things have equally changed. The number of couples showing up together for appointments is increasing. Women play an active role in the search for help. Once the initial resistance has been overcome, and when the couple’s relationship is sound and healthy, women are a major pillar of support to their partners.
At the General Endocrinology clinic we assist patients suffering from Diabetes Mellitus, Serious Diseases, Adrenoleukodystrophy (ALD) vg, Klinefelter’s Syndrome and Turner Syndrome. The cause for the latter is a change in the number of chromosomes, and in the majority of girls affected by it the karyotype is 45,X, which means there is a missing X or Y chromosome that occurs during the cell division process. There are other more complex and rare forms of this disease. The clinical characteristics can vary, but the most common feature is low stature and underdeveloped ovaries. Infertility affects almost 95% of women with the 45,X karyotype, and 75% of women with the mosaic type. However, they may resort to alternative forms of conception.
Much in line with what the literature indicates, our practice shows that although these young women (most of our patients) consider themselves to be happy, they experience anxiety, difficulty in social interactions and love relationships, low self-esteem, feel unhappy about their appearance (particularly about being short sized), and suffer about their infertility and/or difficulty to conceive.
This makes them to overinvest in their work, studies and families.
Accordingly, our work focuses on their body image, identity and femininity. We often start by addressing autonomy related issues, both with the girls and their families. Low stature and anxiety with social interactions make girls repress their behaviour with their peers, and parents tend to treat young adults as if they were still girls. What all of these people with syndromes have in common is the weight of diagnosis on their entire lives. In addition, the major effect these diseases have on parents must not be forgotten, as the “genetic factor” is always present, the same applying to guilt associated with it, although it may not be shown.
In specific cases, such as with ADL, it is crucial to call upon parents’
involvement. Feeling that their presence and behaviour are part of the success of treatment reinforces the competences of the family, and may reduce the depression often associated with it.
In other cases (TS), autonomy must be encouraged. In all cases, our presence is important to patients and families to explain issues associated with diagnosis, and help them understand the disease, its impact on their lives, and future expectations.
Severe Obesity clinical appointments are increasingly requested by patients who wish to undergo bariatric surgery. The role of psychologists is to establish a link between obesity as a symptom, the body, and the path that led to that severe obesity, which represents many kilos and many years, an entire life history that will not be removed surgically.
We are aware that this can often mean being in an uncomfortable position, even for the team. However, focusing on reality and looking into the future can make the difference between momentary success and a sustained internal change.
Long-term psychological support is justified, since these people suffer from a chronic disease and will need assistance for some years after the actual surgery has been performed. This issue is still present even when surgical or medical appointments are no longer needed or frequent.
Psychological evaluation of candidates for purposes of therapeutic intervention, not to exclude it, frequent, uninterrupted follow-up after surgery, and a multidisciplinary team working together, are aspects which cannot be ditched and must be constantly up-to-date.
Groups: AFAGO: Associação dos Familiares Amigos e Grupos de Obesos (Association of Relatives, Friends and Groups of Obese People). This is an open, mixed gender therapeutic group of patients from the obesity clinic (pre or post-surgery) that holds meetings every month.
ECO: Exercício na Cirurgia da Obesidade (Exercise in Obesity Surgery), in partnership with the Lusófona University, with Professor António Palmeira and Dr Sandra Martins.
Group intervention is effective therapy, involves distinct internal resources, complements individual psychotherapeutic work, and can be done through the National Health System, which means it can cater for a larger number of patients than individual appointments.
The team is formed by the following people: Dr. Maria João Brito (Obesity and General Endocrinology appointments); Dr. Paula Câmara (Andrology and Obesity appointments) and me (Andrology and General Endocrinology).
Our work is very gratifying and made possible thanks to the fact that we are a multidisciplinary team. Doctors, nutritionists and dieticians add to our knowledge and, alongside nurses, administrative and auxiliary staff, provide constant support.
Dra. Maria João Fagundes
mariafagundes@fm.ul.pt
What are the challenges facing psychologists working in the health field, in an hospital environment and an endocrinology unit? Each of these variables poses its own challenge. Let us start at the end: endocrinology. By definition, it is the specialty that studies internal secretion glands (endocrine) and hormones. They regulate homeostasis, balance. Endocrinology derives from the Greek word éndon, which means ‘from within’.
How does one envisage, “thinks”, what is organic and biologic and then processes it and sends it to the body? How does one go about living in a body when parts of it are no longer there or working, and maintain his/herself-esteem, continue to see life as a project, keep on having desires and dreams, in the constant quest for the homeostasis, balance, and dynamism life is made of?
Stress and reproduction, starvation and repletion, behaviour, sexuality, body image, phenotype, chronic disease, surgery, the encounter with the body and the mind, with what is real and what is experienced. This is the challenge facing psychology in endocrinology.
Structure of the medical appointments: Andrology, General Endocrinology and Obesity.
Due to the impossibility to refer to all the cases, we chose one example from each area.
In the Andrology clinic, we receive requests related to Erectile Sexual Dysfunction and Premature Ejaculation. It is interesting to note how the patient population coming to us has changed over time. Initially formed mostly by heterosexual males over 45 years of age and with conditions lasting for various years, sometimes over 5 years, nowadays it is constituted by people with distinct sexual orientations, religious beliefs, ethnic groups and/or nationalities. Their anguish can be found the moment they enter the door, but the way they present it, and particularly the way we need to approach it is equally distinct. The bio-psycho-social being is real, not merely a construct. And the importance of sexuality in that dynamic is evident.
The cultural and religious issue is very sensitive, and some topics and practices are taboo.
Other things have equally changed. The number of couples showing up together for appointments is increasing. Women play an active role in the search for help. Once the initial resistance has been overcome, and when the couple’s relationship is sound and healthy, women are a major pillar of support to their partners.
At the General Endocrinology clinic we assist patients suffering from Diabetes Mellitus, Serious Diseases, Adrenoleukodystrophy (ALD) vg, Klinefelter’s Syndrome and Turner Syndrome. The cause for the latter is a change in the number of chromosomes, and in the majority of girls affected by it the karyotype is 45,X, which means there is a missing X or Y chromosome that occurs during the cell division process. There are other more complex and rare forms of this disease. The clinical characteristics can vary, but the most common feature is low stature and underdeveloped ovaries. Infertility affects almost 95% of women with the 45,X karyotype, and 75% of women with the mosaic type. However, they may resort to alternative forms of conception.
Much in line with what the literature indicates, our practice shows that although these young women (most of our patients) consider themselves to be happy, they experience anxiety, difficulty in social interactions and love relationships, low self-esteem, feel unhappy about their appearance (particularly about being short sized), and suffer about their infertility and/or difficulty to conceive.
This makes them to overinvest in their work, studies and families.
Accordingly, our work focuses on their body image, identity and femininity. We often start by addressing autonomy related issues, both with the girls and their families. Low stature and anxiety with social interactions make girls repress their behaviour with their peers, and parents tend to treat young adults as if they were still girls. What all of these people with syndromes have in common is the weight of diagnosis on their entire lives. In addition, the major effect these diseases have on parents must not be forgotten, as the “genetic factor” is always present, the same applying to guilt associated with it, although it may not be shown.
In specific cases, such as with ADL, it is crucial to call upon parents’
involvement. Feeling that their presence and behaviour are part of the success of treatment reinforces the competences of the family, and may reduce the depression often associated with it.
In other cases (TS), autonomy must be encouraged. In all cases, our presence is important to patients and families to explain issues associated with diagnosis, and help them understand the disease, its impact on their lives, and future expectations.
Severe Obesity clinical appointments are increasingly requested by patients who wish to undergo bariatric surgery. The role of psychologists is to establish a link between obesity as a symptom, the body, and the path that led to that severe obesity, which represents many kilos and many years, an entire life history that will not be removed surgically.
We are aware that this can often mean being in an uncomfortable position, even for the team. However, focusing on reality and looking into the future can make the difference between momentary success and a sustained internal change.
Long-term psychological support is justified, since these people suffer from a chronic disease and will need assistance for some years after the actual surgery has been performed. This issue is still present even when surgical or medical appointments are no longer needed or frequent.
Psychological evaluation of candidates for purposes of therapeutic intervention, not to exclude it, frequent, uninterrupted follow-up after surgery, and a multidisciplinary team working together, are aspects which cannot be ditched and must be constantly up-to-date.
Groups: AFAGO: Associação dos Familiares Amigos e Grupos de Obesos (Association of Relatives, Friends and Groups of Obese People). This is an open, mixed gender therapeutic group of patients from the obesity clinic (pre or post-surgery) that holds meetings every month.
ECO: Exercício na Cirurgia da Obesidade (Exercise in Obesity Surgery), in partnership with the Lusófona University, with Professor António Palmeira and Dr Sandra Martins.
Group intervention is effective therapy, involves distinct internal resources, complements individual psychotherapeutic work, and can be done through the National Health System, which means it can cater for a larger number of patients than individual appointments.
The team is formed by the following people: Dr. Maria João Brito (Obesity and General Endocrinology appointments); Dr. Paula Câmara (Andrology and Obesity appointments) and me (Andrology and General Endocrinology).
Our work is very gratifying and made possible thanks to the fact that we are a multidisciplinary team. Doctors, nutritionists and dieticians add to our knowledge and, alongside nurses, administrative and auxiliary staff, provide constant support.
Dra. Maria João Fagundes
mariafagundes@fm.ul.pt
