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Physical and Mental Illness Are Two Sides of the Same Coin

We need to start thinking about them the same way.

Key points

  • Mental and physical health stem from a combination of biological, psychological and social factors and influence each other.
  • We need to change the way we think and talk about mental illness if are to going to reduce the stigma around seeking help.

Perhaps one of the unexpected benefits of the Coronavirus pandemic is that it has forced many of us to be more open about our mental health as we all struggled to cope with a life-threatening crisis. Of course, this has never been an easy topic to talk about and across eras and cultures the mentally ill have typically been treated poorly. Although we no longer attribute unusual behavior to possession by demons or believe that punishing people is a reasonable treatment it was only 1972 when Vice Presidential candidate Thomas Eagleton was forced to leave the McGovern Presidential ticket when it was revealed that he had been previously hospitalized for depression.

In reality, mental health is a complex multifaceted phenomenon. In the past we found differences in relatively neutral things like hand-preference, color blindness and sense of taste and smell unacceptable and tried to force children to conform to socially determined norms. Although we are now more tolerant of such variations we still struggle when it comes to understanding and coping with people whose feelings, thoughts, or behaviors are significantly different than the norm.

We seem to intrinsically believe that people don’t typically choose to experience a physical illness, but that they should be able to manage what goes on in their head.. If we see someone who has a fever, is limping, or has a visible wound we sympathize with their pain, and attribute their symptoms to an illness or disease, not the lack of will power. But when a person is speaking erratically, expressing emotions we don’t understand or perceiving reality in unusual ways it makes us feel uncomfortable, scared, and defensive. Our instinct is to blame or avoid that person because we fear for our safety or don’t want to think that what is happening to them could happen to us. Sometimes we make similar judgements about people’s whose physical illness seems to be due to behaviors they chose to do like smoking or drinking, but we rarely condemn them for going for professional help.

However, when it comes to seeking help for mental illness, it is often viewed as a sign of poor coping or instability. Fortunately, as more celebrities and public figures talk about their own struggles, and the help received this perception is starting to change. But those of us in the mental health business need to look at our own biases and behavior as well. Although we decry the stigma around seeking help, we still make sure that our waiting rooms are discreetly located. In the building where I practice the lobbies of the physicians' offices are all visible through plate glass windows. When we moved into our suite, we specifically reconfigured the space so you couldn’t see into the waiting room from the hallway. While the goal is privacy for our clients, the message is that seeking mental health care is something to be hidden.

Likewise, Psychology departments have traditionally called their undergraduate course on psychopathology Abnormal Psychology. This outdated terminology overtly implies that there is a clear line between what is normal and what is not, when that is patently false. I have even had educated colleagues tell me that I should stop using the phrase mental illness because it has negative connotations, and instead substitute terms like the absence of mental health. Can you imagine a physician listing their specialty as treating people who “have the absence of healthy tissue, or even better, the non-absence of cancer?”

The bottom line is that the distinction between physical and mental illness is artificial. Both are a result of the interplay of genetic, biological, cultural, and experiential factors. When we are stressed, it hurts our physical health, and when our body is injured, it impacts our mental state. In both cases we need to look at the entirety of the situation in order to help the person recover. Doing anything less is akin to pretending that a coin has only one side. Acknowledging that mental distress and physical discomfort are part of the human experience and that we all need help coping sometimes would go a long way towards reducing the stigma both of talking about and seeking support for mental issues.

References

https://theconversation.com/how-childrens-brains-develop-to-make-them-r…

https://www.researchgate.net/profile/Amy-Sickel/publication/271196874_M…

https://www.psychiatry.org/patients-families/stigma-and-discrimination

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