"Once you start approaching your body with curiosity rather than with fear, everything shifts." Bessel van der Kolk
I remember that a few years ago I was quite impressed, surprised and somehow grateful when Prince William said “ Just like physical health, we all have mental health."
Despite the enormous acknowledgement of mental health needs and the normalization of psychological therapies, we still seem to live to some extent in an era where mental health is a taboo or something to hide. Many clients of mine do not disclose to their parents that they are seeing a Psychologist. Another interesting phenomenon: word of mouth does not seem to work that well for Psychologists and Psychotherapists. Most likely the reason is that people keep the information about seeing a mental health professional very private, sometimes also irrationally afraid that despite the confidentiality rules by sharing the name of their therapist something will be disclosed about their life.
This is often even more true in the Italian culture especially for generations that precede the Generation X. “ Why do you go to see a psychologist? Psychologists wash your brain, you are not crazy” are frequent comments or questions asked to my clients by their family members.
Therefore, as I was saying, to hear a Royal family member to openly talk about mental health needs, perhaps even THEIR mental health, was very refreshing and relieving.
However, lately I find myself feeling increasingly frustrated every time I am reminded that there is such a separation between physical and mental health. The reality is: we only have ONE health. Separating the two can often be misleading, potentially dangerous and can cause missing crucial information hidden in plain sight.
Having trained as a Systemic Psychotherapist, I could not possibly think otherwise. One the fundamental principles of this practice is that every time a system has become dysfunctional it is necessary to understand the relationships and dynamics between the different parts forming the system. If one part is affected, the whole system will be affected. In Systemic Therapy when in a family a member is presenting symptoms, this member is called "the identified patient" but actually the whole family is the patient as the belief is that one member is only expressing symptoms of a dysfunction of the whole system. Minuchin goes as far as saying that the identified patient is the family's scapegoat sacrificed to maintain the family's equilibrum.
Similarly, a physical symptom in an individual tells us that the whole system mind/body may need to be looked into.
Let’s start by one question. How many times when you felt physically ill did you feel ok with your mood and had positive emotions and thoughts? Reversely, how often when you felt low, maybe depressed or anxious did you feel physically great? I suspect not very often. Let’s have a look at one incredibly truthful description of how it really feels to feel severely depressed by Meg Mason, author of the novel “Sorrow and Bliss”
“ Everything hurt. The soles of my feet, my chest, my heart, my lungs, my scalp, my knuckles, my cheekbones. It hurt to talk, to breathe, to cry, to eat, to read, to hear music, .. a feeling of tiredness that powders your bones, a tiredness with so much fear”
Physical and psychological symptoms tend to deeply influence each other, very often in a sort of repeating cycle. Intervening on one kind of symptoms may improve the other but can of course not be enough.
In my close environment, like probably many of us, I know innumerable examples of people affected by autoimmune diseases (which are on a steep rise) , cancer, heart attacks Without any single exception, for each person their first blown out, incontestable symptom- and therefore the unmistakable announcement of their disease- was nearly immediately following (within a month max two months) a major stress /trauma in their life: work, legal problems, relationship break-ups, illness of a beloved one. Yes, prolonged and unaddressed stress can kill and make us severely ill. Trauma deeply affects our health.
As Dr Steven Maier contends, "In a real, true sense, stress makes you physically sick. In addition, many of the changes over time in mood and cognition from day-to-day are driven by events in the immune system of which we are unaware."
Stressful events are part of life and are sadly unavoidable. Gabor Maté is one of the most inspiring master in explaining the relationship between trauma and body in his last book "The Myth of Normal" and also " When the Body says no".
Maté makes a distinction between “Small t traumas”(more normative events such illness, death of a beloved one, bullying etc) and “Capital T traumas”( ie war victims and veterans , earthquakes survivors, violence, abuse). But we do not have to go through capital t traumas to experience trauma. Rather than the event per se, it is the context around the trauma that is mostly relevant and the resources we had at the time or immediately following the traumatic event that turn out having the most profound impact.
At the time or after a traumatic event, did the sufferer have a chance to process their emotions? Were they acknowledged in their suffering? Did they allow themselves to feel the pain and the grief? Was somebody there for them to contain those feelings , to allow them to feel vulnerable?
The more “yes” answers there are to those questions, the less likely people are to experience the damaging effect of trauma on our health.
Bessel van der Kolk, Trauma leading expert who dedicated his life and research on the effects of trauma on children and adults, said it all in the title of his book: “The Body Keeps the Score”.. to the point where several trauma survivors and PTSD sufferers do not see or feel their body as a whole and sometimes they literally cannot feel some part of their bodies. When we are in intense pain, our bodies can become fragmented and so does our sense of ourselves as persons.
Somebody I know very well spent nearly a year in and out of hospitals for multiple (and surprise surprise, connected..) severe health issues including heart attack, sepsis and coma. At one point, he spent two months in an intensive care unit after a major abdominal surgery, with multiples tubes going in and out his arms, legs and feet, tubes going through his mouth and nose, completely immobile in bed. He had the best care, nurses and doctors somebody can ask for. And yet- to my utter disbelief, me being a Psychologist- at no point it occurred to the health staff to check on his mental health, to really ask him how he was feeling psychologically and to think of providing some sort of psychological support.
Do you know what brought this person back to life? A nurse that finally understood what her patient needed: to be seen as whole, as one system made of interconnected psychological and physical parts , of a mind and body as one whole.
Can you believe that after a few hours spent with this “guardian angel” who could finally allow him to process his traumatic experience of being stuck in a failing and aching body , stuck in bed, stuck in a room with 24 hours of light and non stopping beeping monitors, somebody able to really listen and contain his scary emotions, well can you believe that this patient, overnight, started to engage with life again, became strong enough to try to eat and slowly but steadily healing (within the limits of what his chronic illnesses would allow him to )? You may not believe it but I swear that this is exactly what happened.
As Health professionals, we have the responsibility to never forget that humans are not separable in mind and body. If we really want to help patients to recover and get better , we have to keep this in mind at all times. A vast majority of medical doctors will still struggle to truly grasp and incorporate this truth in their practice notwithstanding the existence of several scientific disciplines that corroborate the idea that mind and body are somehow inseparable. Psychoneuroimmunology is one of the most pertinent and obvious ones belonging to this group, as Gabor Matè pointed out in few of his books. Even before reading Gabor Maté, since my several exams in Neurophysiology during my undergraduate studies, I have been fascinated with this discipline.
Psychoneuroimmunology is a discipline that has evolved for the last 40 years and which studies how your brain and immune system interact. As you may know, our neurons, the brains cells, release neurotransmitters like serotonin, dopamine etc, to communicate a message to other neurons or other parts of our body.
When we are faced with a stressful event or situation, the brain, in particular one specific part of the nervous system called "hypothalamus", activates the “fight or flight” mode: it tells the rest of the body to act fast to survive. In order to do that, some substances are released (neurotransmitters) which in turn tell the endocrine system to release hormones like adrenaline or cortisol for example.
If extreme stress conditions persist ad we enter the realm of Trauma, the stress hormones keep on being released and this can significantly affect and wear out our immune system. When the body is under stress, it is more prone to inflammation as a cascade of cytokines (proteins) are released. Persistent Inflammation of the organs make them vulnerable to all sort of physical diseases: severe cardiovascular problems, autoimmune diseases, cancer, chronic intestine conditions etc.
As I pointed out early in this article, we cannot avoid all stress and traumas in life, it is part of our existence. What we can do whenever possible is aiming not to suppress the pain and difficult emotions caused by stress and trauma. We should create this space whenever possible, for ourselves, for our patients and for our beloved ones.
This also means being sure that when people are diagnosed with chronic diseases they have the support to process their emotions to avoid flare ups. It entails that when people undergo complicated medical procedures and de-humanising treatments, psychological help should be an essential part of their plan to significantly support chances of their recovery.
Conversely, it also means psychological symptoms need to be addressed from a multiple perspective, they too may have an important physical meaning. it is crucial not to dismiss physical symptoms simply as “psychosomatic” which are at risk to be seen as a class B or C symptoms, some people would even go the extent of saying "the did that to themselves".
A change in mood could perhaps hide endocrine changes such a peri-menopause, post natal depression, thyroid problems, Chronic fatigue syndrome, many autoimmune diseases, a harmful diet, even a sepsis mysteriously attacking the body.
Additionally, as superbly narrated in “Dopamine Nation" by Anna Lembcke, our behaviours and psychological coping strategies also have a physical impact we often do not suspect, creating a loop.
Being on the phone, on social media, watching Netflix no stop help releasing “pleasure” chemical like dopamine which give us temporary relief from suppressed negative emotions we have learnt to keep at bay. Unfortunately, like in any other addiction these substances so longed for in order to achieve pleasurable effects do not last long and get us stuck in some sort of addiction loops and contribute to exacerbate psychological symptoms such a depression and anxiety. What appeared as solution for pain becomes the cause of pain.
You may have watched the brilliant serie "Dopesick". An entire generation of chronic pain sufferers fell into the trap of Oxycycline, an oppioid that promised them they would be saved from the pain without developing addiction. That of course turned out to be a lie and led thousands of patients to develop severe mental health problems caused by susbstance addiction. Tragically, a poisonous solution for physical pain led to overdoses, deaths, suicides and several psychological impairment.
As specie, once again we risk encountering several destructive loops we can fall in if we overlook the concept of mind and body as a whole.
Humans are complex entities and therefore in some ways extremely confusing. But instead of simplifying our multilayered and intrinsically interconnected nature and separating the inseparable, we should endeavor to be curious about the interactions between our different parts and the contexts in which we live.
We should learn how our mindbody (one word here, on purpose) systems work as it is the most fascinating and most beneficial information that may save or improve our lives.