You can’t separate mind and body in medicine


According to the American Psychological Association and the American Academy of Family Physicians, well over half of patient visits to primary care physicians are for mental health issues. So, as part of my book, I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship, I asked about mental health.

None of the doctor interviewees disagreed with the important role that mental health plays in health care. In fact, one said that it plays, “A larger one than anyone admits.” Typical responses were, “Extremely important.” “Pivotal. Central can’t put it more bluntly.” and “A big role. Mental health is no different than heart disease or diabetes. It has to be recognized and treated.”

As a psychologist, I have always found that mental health and physical health are intertwined, so I was pleased to hear strong endorsements of the connection. One said, “You can’t separate mind and body. A doctor said, “I feel like the truly vast majority of patients complaints are related in some part to their mental health.” Another doctor said, “If they have mental health issues, anxiety or stress, it can cause other health problems.” and, “A lot of physical symptoms are related to emotional life and history.” A more complete statement came from one doctor: “Patients need to understand, this is psychology, there is no such thing as a purely physical symptom. Every single physical sensation is associated with emotion and vise versa. It is measurable in the immune system. Every time you have a thought, your body reacts. Gut feelings, butterflies in the stomach, etc. With a sudden strong emotion, water comes out of your eyeballs. It’s not imaginary, and you have no disease. Mind and body react everywhere, holistically. It’s not a vacuum.” Another doctor agreed, saying, “It is totally intertwined with what goes on. It is another organ system like the heart, kidneys, and stomach. I would say 40-50 percent of the patients have some mental component to their health. Thirty percent of visits have some emotions involved. Ten percent of the visits is why they are there. Anxiety or whatever.”

Mental health issues can make medical practice challenging. “If a depressed patient comes in, they may not recognize that it has an effect on another condition.” Another comment was, “Overall, it’s such a huge role. It takes us half of every day. Anxiety and depression, chest pain, shortness of breath.”One doctor said, “Sometimes we can’t do the medical piece because of the mental health piece. It takes a long time, and there are multiple layers. Deal with this before that. You can’t start at that actual or presenting problem yet.”

Mental health issues impact compliance. “It plays a huge role. It decides whether the patient seeks help and gets in the way of getting help and they get in their own way. Another said, “I find that it plays a major role. Physicians who ignore it will find that compliance deteriorates. If you don’t understand your patients’ mental health, they will not follow up or follow your instructions.” Another agreement, “That is why people decide to be compliant or not or blame others for their problems. You can get amazing victories when it is improved.”, said another. “Mental health has a significant effect on health care. Patients who are psychologically unhealthy hurt themselves, abuse their bodies, and increase health care costs in general.”

Estimates of the prevalence of mental health issues in this county are at around 20 percent of the population. Around 50 percent of mental health issues go untreated. The importance of mental health for medical care is one of those somewhat rare examples in health care where clinical practice and research are in agreement. As relates to clinical practice, not one of my interviewees disagreed with the connection and its importance. Providing mental health care reduces medical costs and impacts physical health, never mind improving quality of life. A recent study showed that childhood stress may raise risk for diabetes and heart disease in adulthood. Other recent research childhood trauma takes a toll well into middle-age. A Gallup poll revealed significant costs to the workplace regarding absenteeism and underperformance at work due to mental problems. The wide-ranging importance of mental health is indisputable.

We are so obsessed with the cost of health care in this country, yet we are ignoring one of the most important factors that drives up costs — mental health issues. Combined with the destruction of our public mental health system, the resulting unavailability of mental health services and the denial of mental health benefits for those who have private insurance, this is a serious problem, as well as a drain on our health care system and economy. We need to pay more attention to this aspect of the health care and advocate for it. Our well-being depends on it.

Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum.  She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship.

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