Pranaya Prakash
The Mind and the Body are connected in complex ways and the Cognitive-Behavioural Approach explains the complexities of this connection for psychopathological problems (Hooley et al., 2020). Aaron Beck, one of the pioneers of this approach mentions the role of schemas – the mental constructs we have about different concepts that we use to navigate the world we live in. He says that if our ideas – the schemas – we have about the world are maladaptive, then our behaviour too would be maladaptive (Hooley et al., 2020). While this is specific to psychopathology, I hold that this theory can also be applied to physical health.
For example, the maladaptive behaviour following the maladaptive cognition can be observed among patients whose newly transplanted organ is rejected by their body due to psychological reasons. Typically, the newly transplanted organ is rejected when the body recognises the new organ as a foreign entity and pushes the immune system into overdrive (Transplant Rejection, 2021). However, sometimes, there are also psychosocial causes for the newly transplanted organ to be rejected (Látos et al., 2016; Sheikhalipour et al., 2021). This happens when the mind does not accept the new organ, also called “psychological rejection” (Látos et al., 2016). Thus, when there is psychological rejection, physical/physiological rejection follows.
There are two ways of viewing this (although they might overlap): (1) psychological rejection → maladaptive behaviour → organ rejection and (2) psychological rejection → organ rejection.
In the first scenario, the maladaptive schema causes evidently maladaptive behaviour leading to organ rejection. In the second scenario, the maladaptive schema directly leads to organ rejection (Látos et al., 2016; Sheikhalipour et al., 2021). The latter can be thought of as a phenomenon that is similar to psychosomaticism.
In the first scenario, the maladaptive behaviour – such as smoking/drinking – can be detrimental to the body immediately after a heart transplant surgery. The possible reason for such maladaptive behaviour can be the maladaptive cognition of the patient, such as considering their heart to be “alien” (Sheikhalipour et al., 2021) and thus not care enough for it, leading to transplant failure. However, in the second scenario, merely considering the heart to be “alien” (Sheikhalipour et al., 2021) can lead to organ rejection. In such a situation, the patient might be safe at every stage and not have any maladaptive behaviours but the maladaptive cognition alone can lead to the heart failing.
An instance of the second scenario was portrayed in the show “Grey's Anatomy” (Rhimes & Vernoff, 2005); Dr Burke receives a heart transplant case of a young boy, Justin Davidson, who had got a heart transplant as an infant. The boy is on the list for a second transplant for his heart cannot support pumping for a bigger body. While he awaits his heart, he is shown to be verbally hesitant to get the transplant because he believes that another child had to die just so he could live. He is angry, feels guilty, strongly believes that he doesn’t deserve the heart and prefers to die. Further, he mentions that his mother had always prayed for another child’s death, so that by the time he requires one, he would receive one. Post the second heart transplant, his heart fails but they manage to resuscitate him. While he recovers, Dr Yang rationalises and offers a different perspective on why he deserves the heart. Finally, he accepts the heart – both psychologically and physiologically.
This case study (Rhimes & Vernoff, 2005), although fictional, deserves attention because there are such cases in real life (Látos et al., 2016; Sheikhalipour et al., 2021). The cognitive aspects (like guilt, anger, hesitation, maladaptive schema) (Hooley et al., 2020) behind both the heart transplants (Rhimes & Vernoff, 2005) are accurate (Látos et al., 2016; Sheikhalipour et al., 2021). In the first heart transplant (Rhimes & Vernoff, 2005), Justin was an infant and was not capable of complex cognition. Hence, his body accepted the heart. However, when is a preteen boy, he is cognitively capable of adopting a maladaptive schema: a child dying “for him”. This maladaptive cognition was consistent with his maladaptive behaviour: shouting, yelling and complaining in the hospital (Hooley et al., 2020). While the shouting and complaining may not be as maladaptive as a smoking habit, it is still maladaptive in the sense that it puts pressure on his body, eliciting a stronger stress response.
Supporting this case, there are studies (Látos et al., 2016; Sheikhalipour et al., 2021) that show that patients who do not have a positive attitude about the transplant and the donor, face difficulty in recovering after the transplant. Psychological attitudes such as guilt, anger, feeling that the organ is “foreign” or “alien”, thinking that the donor's characteristics would/would not match theirs, not accepting the organ due to religious beliefs, wanting to know the donor, etc would have immunological implications (Látos et al., 2016; Sheikhalipour et al., 2021). There are also situations when the immunologically unaccepted organ would not be psychologically accepted by the patient, increasing the chances of transplant failure (Sheikhalipour et al., 2021).
While there has been much effort to look at the biomedical aspects of transplanted organ rejection, there is not much focus on the psychosocial causes of organ rejection (Sheikhalipour et al., 2021) (Transplant Rejection, 2021). Additionally, in hospitals, the Transplanted Organ Questionnaire (TOQ) (Látos et al., 2016) can be utilised to understand the psychological attitudes of the patient before and after the organ transplant surgery, so that the patient and their family can benefit from extended medical care through CBT therapists (Hooley et al., 2020) to better cope with surgery. It is also important to note that organ transplant patients with psychopathological difficulties like depression and anxiety are at a higher risk for organ rejection (Látos et al., 2016). Thus, the recognition for mental health care for medical procedures will be beneficial in providing coping strategies, and interventions in health-promoting behaviours.
References
Hooley, J. M., Nock, M. K., & Butcher, J. N. (2020). Abnormal Psychology, EBook, Global Edition. Pearson Education Limited.
Látos, M., Lázár, G., Horváth, Z., Wittmann, V., Szederkényi, E., Hódi, Z., Szenohradszky, P., & Csabai, M. (2016, June 29). Psychological rejection of the transplanted organ and graft dysfunction in kidney transplant patients. Transplant Research and Risk Management, 8, 15-24. Dovepress Journal. https://doi.org/10.2147/TRRM.S104133
Rhimes, S., & Vernoff, K. (Writers). (2005, December 11). Grandma Got Run Over by a Reindeer (P. Horton, Director) (Season 2, Episode 12) [TV series episode]. In Grey's Anatomy. ABC Studios.
Sheikhalipour, Z., Zadeh, V. Z., Borimnejad, L., Large, S. R., & Vahedi, L. (2021, August 15). Psychological Adaptation to Transplanted Organ: A Hermeneutic Phenomenological Study. Iranian Journal of Psychiatry and Behavioral Sciences, 15(3), 1-8. Iranian Journal of Psychiatry and Behavioral Sciences. https://dx.doi.org/10.5812/ijpbs.113051
Transplant rejection. (2021, April 28). MedlinePlus. Retrieved February 5, 2022, from https://medlineplus.gov/ency/article/000815.htm
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