A few years ago, while I was preparing for the MCAT, I walked into my student health center because I was having trouble breathing. I have a history of asthma, so this was a familiar struggle. The doctor relied on my history of asthma and began a stimulant therapy (nebulizer) and later prescribed another stimulant, a steroid, to help keep my lungs clear and open. If I had been more forthcoming about my stress with my doctor or, even better, if he had asked about my mental status, he would have learned that I had been suffering from acute anxiety, which contributed to my respiratory issues. He would have recognized that a a stimulant medication, including the prednisone (oral steroid) I was prescribed, would give me panic attacks* (and they did). My history of asthma made things worse, but was ultimately not the underlying cause of my symptoms.
What is so striking about my experience is how differently the medical community treats the mind and the body. If you have a headache, it is caused by the blood vessels in and around your brain constricting or dilating too much causing pain and sometimes nausea and fatigue (body), which can lead to irritability and insomnia (mind). Neither set of symptoms is more or less severe, but they are viewed differently. Even the symptom of fatigue is ambiguously physical rather than mental—it really affects both aspects of general wellbeing. There is no way to measure mental processes with a numbered amount, so it is viewed as 100% subjective and variable from person to person. I can speak definitively about my anxiety contributing to my breathing problems now, as I know more about the human body and my own psychology. Then, I was scared and in pain.
It is more acceptable to call off work for a cold or the flu than for anxiety or stress. The fear, stigma, and shame can deter even the strongest people from seeking the proper help they need. Ironically, what most don’t realize is that speaking up is the boldest thing that you can do when you are having issues with mental health, which I argue is not distinct from overall health. While you know the difference between having a cold and not having a cold, it is difficult to delineate the differences between “sick” and “well” in terms of mental health. Perhaps mental 'illness' is a misnomer, as mental health interventions are made to move toward wellness, rather than a 'cure'. There are so many contributing dimensions that affect wellness that dividing it between mental and physical seems to be the source of failure in our mental health system. As stated in the linked article from the Chronicle of Higher Education, mental health outcomes have not progressed in the past 20 years as other treatments have and there isn’t even a public health measure for the prevention of certain mental health disorders.
A year after I slowly fizzled and burned out, I decided to check into yoga therapy. I went to the yoga studio by my apartment every day for a month. I still remained secretive about my anxiety, but took other measures that worked for me. Now, I won’t shut up about positive mental health attitudes. I can’t be sure when I transformed into this Pollyannaish, half-marathon-running, acupuncture-loving optimist, but I know it’s for the better. I still have my days (or weeks or months) that seem to be shrouded by a black cloud. The hardest part about public health and mental health is that it is an ongoing and lifelong struggle.
The chronic aspect of mental health disorders is difficult for most people to reconcile with what they know about good health. Part of the appeal of forms of medicine that emerged from the East is that they do not dishtinguish the mind and body as separate. Compartmentalizing the mind vs. the body makes it difficult to understand how treatment of one module affects the other. A great number of our patients seek treatment for anxiety, depression, stress, issues with focus and attention, along with other mood disorders. Sometimes these complaints get added to other more ‘medical-sounding’ problems, such as lower back pain, but hold the same importance to the patient. As I have written about in the past, the things we put in our body, like food and medicine have not only nutritional effects, but whole mind-body effects as well. This principle is not wholly absent from conventional medicine (also called allopathy or Western medicine), but the approach is blunt and outdated.
The questions you, the patient, are asked when you sit down for treatment in an acupuncture clinic are different than the questions your primary care physician will ask you. Patients are more likely to come to non-conventional forms of intervention (yoga, acupuncture, naturopathy, etc) for chronic ailments because the conventional system of cure is to prescribe and forget about it . What is implicit about throwing pills at mental imbalance is that this system views mental illness as only an chemical imbalance that can be corrected physically. In this scenario, the social imbalances still affect the patient if there are no further interventions beyond prescriptions; it simply manages the symptoms without curing them.
Perhaps talking about emotions is too close to talking about cosmological or existential issues that makes some people uncomfortable. It is easier to internalize these difficult to understand emotions by localizing it to chest pain. Over time, this internalization can result in chronic pain or worry. Or the opposite effect can occur. Chronic pain can lead to depression and anxiety as we have seen with irritable bowel syndrome (IBS) or back pain. More often than not, the resolution of one problem, such as lower back pain, will result in the resolution of another problem, such as depression. The underlying issue can be as lofty as existential crisis or as basic as our culture of management for mental illness that influences the emotional struggles we all face.
When aspects of mental wellbeing are so embedded in the way we view the world morally and socially, it becomes difficult to extract that from how we seek treatment. The way mental illness is socially constructed influences how people feel comfortable seeking treatment. However, what has become increasingly evident is that the dominant system is flawed. While a great number of individuals are satisfied with their treatment options, a greater number in most major cities have been pushed out of good care and onto the streets or into the prison system. It is difficult to find care that works for you, know when to seek help, and where to go. When the focus of healthcare becomes toward wellness, rather than a cure, I believe that must include all aspects of health. To quote Dr. Eliot Sorel, there is no health without mental health.
*for the sake of clarity, panic attacks have a specific definition: “Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack.”