Integrative Psychotherapy:
Hypnosis, Hypertension, and Asthma

By Mark Oster, Psy.D., ABPH Clinical psychologist

One feature of the new integrative medicine movement is the physician’s attention to the patient’s narrative biography – the patient’s telling of their story.  I work in such a clinic.  We have medical residents work with our physicians.  One universal comment them make when comparing their other rotations to their rotation in our clinic is the time our physicians spend talking with and listening to our patients.  We spend 2-3 times the amount of time with patients other physicians spend in their practices.  A recent example of the benefit of spending this time and learning to listen to the patient’s story can be illustrated in the following case example.

George is a 50ish computer systems manager for a local government entity.  Throughout his life, since a child, he’s been a very active and competitive athlete.  Well into his 30’s he competed, then coached and then officiated.  He is also the father to two grown, healthy, and well functioning children.  His wife overcame a bout with cancer some 10 years ago.

George comes to see us because he has hypertension, high blood pressure that is poorly controlled medically.  He experiences frustration and stress at work.  He reports he tends to hold in his frustration.  He used to use sports as an outlet, but can no longer do so because of his declining medical condition.  He also has chronic bronchial asthma for the past eight years.  These two conditions, the asthma and hypertension, have completely sidelined him from his sports activities.

His physician suggested talking to me, a psychologist, to help George with stress management.  George could use some skills in managing his stress and frustrations.  For example, in taking his history, I asked if he, metaphorically speaking, has heard that his employer could get two new college grads for what George costs.  In shock, George asked how I knew this kind of things was happening at work.  As George told the rest of his story I came to the conclusion that while George could use some techniques to manage stress, he could better use some help in understanding the source of the stress and making alterations at that level as well.

In listening to George tell his story it became very clear that George’s job was how he provided for his family.  George was not a computer systems manager, George was an athlete – an athlete who could no longer compete or participate.  George was also a father, but his two children were now grow and out on their own.  George was also a husband and protector of his family, but he could do nothing about his wife’s cancer.  George also has a family history replete with medical problems such as hypertension and diabetes, making him at serious risk for such problems.  At a fairly young age, George felt he was being phased out of his job, was powerless to protect his wife, was no longer a parent, and very importantly, no longer an athlete.  George saw himself as an athlete – this is his identity, his self-image – and now that is gone.

As a psychologist I can assist George in enhancing his medical treatment of his hypertension.  As I get to understand more about George and his asthma, I should be able to help him in that area as well.  However, I believe this will not solve George’s problems.  This focus is what we call “reductionistic”.  This means we tend to look only at the presenting symptom and move to alter or eliminate that symptom.  The reductionistic approach does not often look to the underlying causes of the symptom.  More importantly, the reductionistic approach does not seek to understand the patient’s experience of their illness – the meaning of the symptom or the meaning the illness has for that specific patient.

For George, a runner, the loss of his ability to breathe well means the loss of a part of who he is.  As I described above, George has undergone a number of losses of late.  He probably could manage the impact of any one loss, but the combination was more than he could handle.  His system became weakened and his genetic vulnerability took over, manifesting in hypertension and chronic asthma.