It’s a Fine Line that Separates Mental and Physical Health… (if there is a separation)

Debra L. Glasser, M.D.

PHOTO BY GLORIA TOWNE

This week I would like to share one of my favorite health topics, the fine line that separates (if there is a separation) mental and physical health. When practicing general internal medicine, I considered this dichotomy daily. Most issues my patients came to see me about were conditions or experiences in which the mental and physical overlapped.   

Let us define mental health:

I like this definition taken from Toward a New Definition of Mental Health, a paper written by a collaboration of psychiatry organizations from Italy, Germany, the UK, Denmark, and Switzerland:

Mental health is a dynamic state of internal equilibrium which enables individuals to use their abilities in harmony with universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one's own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium.

In addition, I was delighted to find that the Canadians include this on their national health website: Connection Between Mental and Physical Health

Mental and physical health is fundamentally linked. There are multiple associations between mental health and chronic physical conditions that significantly impact people’s quality of life…The World Health Organization (WHO)  states that “there is no health without mental health.”¹

Nowhere is the relationship between mental and physical health more evident than in the area of chronic conditions. The associations between mental and physical health are:

1. Poor mental health is a risk factor for chronic physical conditions.
2. People with serious mental health conditions are at high risk of experiencing chronic physical conditions.
3. People with chronic physical conditions are at risk of developing poor mental health.

The social determinants of health impact both chronic physical conditions and mental health. Key aspects of prevention include increasing physical activity, access to nutritious foods, ensuring adequate income and fostering social inclusion and social support. This creates opportunities to enhance protective factors and reduce risk factors related to aspects of mental and physical health.

Understanding the links between mind and body is the first step in developing strategies to reduce the incidence of co-existing conditions and support those already living with mental illnesses and chronic physical conditions.

To expand on the Canadians…

Sometimes a physical condition is affected by the mental/emotional state

It is common in primary care to see infections, injuries resulting in back and joint pain, hypertension, and diabetes. Though these conditions seem purely physical and straightforward … are they? Did this person get infected because they chose exposure (“I’m going to that party anyway because I am lonely”), vaccination status (relating to trust in science), or relationships? Was the person susceptible to the injury due to a lack of concentration or balance because they were anxious or rushing? Are there underlying stresses causing muscle tension in the low back and shoulders? Inattention to movement and exercise to maintain health? Is poor nutrition, self-care, and /or substance abuse (alcohol, marijuana) affecting caloric and food intake? Many factors can affect diabetes control and blood pressure, back and joint pain, ETC.

Attention to physical treatment must come first in these conditions: antibiotics or antivirals for infection if indicated, physical therapies for back pain, and treatment of elevated blood pressure and blood sugar with medication. But will the physical interventions alone work if the person continues the habits and choices that potentially contributed to the ailment? Attention to the WHOLE is needed by doctor and patient. Sometimes this will make a difference.

I say sometimes because…behavior change is much more complicated and challenging than taking medication.

 Here comes the grey zone and possible confusion →

Sometimes a physical condition causes a mental/emotional condition

For instance, being ill and underdoing testing, treatment, and its effects can be depressing, cause anxiety and interfere with sleep. Think cancer and heart disease.  We know that some diseases are associated with (though it is not clear they cause) depression such as Parkinson’s disease. Elders may appear to be developing dementia when the diagnosis is depression.  It is a fine line… if there is a line at all.

Sometimes a mental/emotional condition shows up as if it is a physical one

Mental/emotional disorders are common affecting 1 out of 5 of us. Anxiety, depression, and insomnia are the most common. We are not talking about schizophrenia and bipolar psychoses (which affect 1 out of 25 of us), though primary care doctors often are the first to diagnose these less common conditions.

Sometimes a person sees their doctor because they feel tired, cannot sleep, eat, and do not feel they can tolerate going to work or caring for their children. These symptoms may be those of depression. Or they may not and be signs of a physical condition. The list of physical causes of fatigue, insomnia, and loss of appetite is long. Doctors are trained to evaluate them. Emergency physicians are most likely to see people who arrive short of breath, having chest pain and numbness. These symptoms can be caused by severe life-threatening conditions such as a heart attack. Or they could be the signs of a panic attack that feels life-threatening but is the manifestation of mental/emotional distress. Both patients need diagnosis and treatment – albeit very different ones.

Practicing medicine and helping people is…well, complicated! Do not practice medicine on yourself. This is common, unfortunately. You help yourself by sharing what you are experiencing with a healthcare professional.  

What’s love got to do with it?

Sometimes a person is aware that what is disturbing them is mental/emotional. They know they are depressed and/or anxious. These feelings often travel together.  Many folks with anxiety and depression do not seek help. Depression causes them to feel hopeless and ‘live with it.’ They may feel too afraid (i.e., anxious) to even talk about the fear. Doing nothing rarely helps. As with physical ailments, chances are the condition will worsen. Others tell their doctor (better idea). Better, because admitting and sharing distress can be helpful and will allow you and the doctor to discuss treatment options.

There are many choices for mental health treatment. They are not as straightforward to treat as infections or high blood pressure. Nor do they last for a lifetime which high blood pressure and diabetes often do.  

Depression and what looks like it can be complex.  It can be genetic or at least a genetic predisposition. It may be grief which is not depression, ‘treatment’ for which includes support, love, and what doctors call tincture of time. Feelings of hopelessness and depression may be triggered by situations not easy to change, such as the loss of a job, relationship, or home. Relief may require changes of circumstances not easily accomplished…such as overcoming poverty, homelessness, partner abuse, and/or alcoholism.

The mental and physical are inextricably linked

Is it mental or physical? Is it emotional or spiritual? Are societal and/or coping skills overwhelmed?  Is it the brain or the body? How exactly does the brain relate to all this?  (Whoops – that is a topic for another column or ten.) Is it some unique combination of all the above? Is there truly any line or separation? 

It is normal for humans to experience illness and breakdowns of all kinds.  It is part of life to get ill and experience the whole gamut of emotions: sadness and anger to joy and passion. It is expected we will recover and challenges will happen again. For significantly challenging times, we need to pay attention to the whole of our experiences and find needed help and relief.  Share it all with your doctor.

Mental health is as important as physical health to thrive, maybe more so.

 Many of us have known severely physically disabled folks with a positive attitude (mental health) whose lives are happier and more tranquil than others without severe physical ailments yet suffer from oppressive mental anguish.

“There is no health without mental health, “World Health Organization

REFERENCES

More mental health definitions:

https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

https://www.cdc.gov/mentalhealth/learn/index.htm