This chapter has a single important purpose: to persuade you, if you are in serious emotional distress, to have a comprehensive physical examination _before_ beginning psychotherapy. Imagine how disheartened and frustrated you might feel after a period of unsuccessful therapy, only to find out afterward that your problems could be traced to a physical cause. It is essential that you eliminate the possibility of a physical basis for your problems before seeking therapy. In fact, most therapists routinely recommend that you have a complete physical before entering therapy. Rest assured that doing so will _not_ be a waste of time. Richard Rada, Director of College Hospital in Cerritos, California, estimates that between five and ten percent of clients with depression, anxiety, or unusual thoughts and behavior may have underlying physical conditions that are responsible, including gland {100} dysfunction, an epileptic abnormality, heart disease, cancer, and so on. The following facts, too, should convince you that having a comprehensive physical is paramount: * As many as one patient in every ten who suffer from serious depression has a thyroid disorder. * One person in every four who are diagnosed as having psychiatric disorders and who are over sixty-five has an underlying physical illness that is responsible. * An equal number of individuals over sixty-five have emotional problems that are made worse by underlying physical disorders. * Three percent of people who regularly take prescription medication develop mental symptoms. Dr. Leonard Small, a specialist in the field of neuropsychodiagnosis, has found that the more severe emotional or mental symptoms are, the more likely it is that therapists (and patients) will overlook the possibility of underlying physical disorders.[1] [1] Leonard Small, _Neuropsychodiagnosis in Psychotherapy_ (New York Brunner/Mazel, 1980), p. vii. It isn't necessary or possible to give a detailed or comprehensive catalog of physical causes of emotional and mental disturbances here, but it may be helpful to many people to see some of the principal ways in which psychological symptoms can be produced by physical problems. Hopefully, these illustrations will persuade you, if you are emotionally or mentally troubled, of the wisdom of a thorough physical. It is a small price to pay if emotional symptoms can be traced to a physical cause. It is well known that virtually any serious organic illness or injury can produce emotional suffering, either in the form of physical pain or in the form of anxiety and depression. Chronic pain is a chronic stress and can lead to the same emotional problems as prolonged stress of any variety: anxiety or depression. Similarly, prolonged severe anxiety or depression can cause physical deterioration and make the body more susceptible to disease. {101}