Attributing Every Disease to Emotion Is a Mistaken and Crude Way of Thinking

I often talk with people about the causes of disease, and more often than not they end up attributing whatever illness they have to emotional factors, as if the patient would not have got the disease if only their mood had been better. This way of thinking is so widespread that it has affected many people's access to care.

It is true that people may have had some emotional problems before being diagnosed with a disease, but those emotional problems have nothing to do with the other diseases they have—such as cancer, diabetes, or hypertension—not directly, and not indirectly.

Indeed, in some people the emotional problems are themselves caused by their physical illness, rather than their physical illness being caused by their emotional problems.

Comforting a patient's emotions is indeed important; doctors and families should both value a patient's mental health. A patient tormented by illness will inevitably feel low, and giving comfort is an expression of humanistic care and love.

But simply attributing difficult diseases such as cancer to emotional problems not only adds psychological burden to the patient, causing shame and guilt, but may also affect subsequent treatment.

Some people who have bought into this view try to control their tumor by regulating their emotions; a few extremists even treat this as their only therapy. They eventually find that no matter how hard they try to control their feelings, the tumor keeps progressing.

If the patient is motivated by financial reasons, that is understandable; but to do this purely out of personal conviction is tantamount to suicide.

TCM's three-cause theory attributes disease causes to three categories: internal causes, external causes, and neither-internal-nor-external causes, with psychological factors among the internal causes. This suggests that some ancient physicians may have recognized that people have psychological/psychiatric diseases. But over history, people have repeatedly pushed this theory to a mistaken extreme, habitually attributing all kinds of refractory diseases to purely mental factors.

Today, with the progress of biomedicine, we know that many diseases once thought to be caused by mental factors have causes that have nothing to do with psychology or the mind.

For example, breast cancer may be caused by the inherited BRCA1 gene; the great majority of stomach diseases are caused by Helicobacter pylori infection; hypertension and stroke may be related to high-sodium diet and genetics. Yet the old mistaken beliefs still persist: many people still believe breast cancer is caused by anger, gastric ulcers by mental repression, and stroke by a hot temper.

It is true that a minority of patients have both mind and body illness, where their psychiatric disease is related to their physical disease, and improving their mood does improve their organic lesions. But most organic lesions are unrelated to emotion; linking these diseases to emotion is a mistaken and irresponsible thing to do.

People try to persuade patients to overcome such diseases by adjusting their mindset, to the point where some naturally optimistic patients end up doubting themselves: Am I really mentally unwell? What counts as a good attitude?

In practice I have seen many people with excellent attitudes, gentle personalities, and harmonious families develop stroke, breast cancer, or gastric ulcers. Their diseases were mostly due to inherited genes and lifestyle, and had nothing to do with their emotions. The cancer rate among psychiatric inpatients is not noticeably higher than in normal people. None of these facts support emotion as the culprit of other diseases, yet many people still hold this outdated, mistaken, and crude belief, which shows that our medical popularization is still far from adequate.

A patient's emotional problems may also be used by some doctors of poor skill as an excuse for treatment failure. They deliver ineffective treatment, but shirk responsibility, blaming the patient's non-cooperation and failure to regulate emotions during treatment. In fact, most people's psychological adjustment ability is normal, even when they are ill.

People with poor emotional regulation make up only 20-30% of the population, and the proportion with severe emotional dysregulation is even lower. Normal people have worries—especially more worries after falling ill—but this does not affect their physical health. After effective treatment, the patient's mood will improve markedly; one should not reverse cause and effect by blaming emotion for ineffective treatment.

People with inner strength and extreme calm, and those with fragile egos who frequently break down, are both minorities. Even among psychiatric patients, most are emotionally stable most of the time and can live normal lives.

But in our era, the anxiety and stress generated by daily life are easily over-interpreted, and mental factors are frequently and forcedly linked to other diseases by irresponsible people.

Such practices add more trouble to many people, do nothing to solve their physical and mental pain, and instead leave them more bewildered and stressed, even costing them money and providing opportunities for those who would exploit their vulnerability.

So let us stop labeling ourselves and our loved ones with all kinds of emotional illness. Only those so severely impaired that they cannot maintain normal life and normal relationships count as having an emotional disorder. The everyday worries brought by the necessities of life—rice, oil, salt, soy sauce, vinegar, tea—are universal and not pathological.

Normal emotional regulation has a wide range; as long as one is within that range, one is healthy. Do not imagine dangers in shadows or believe hearsay, and attribute every problem to emotion. Patients, too, should reject such stigmatizing labels.