Concern is growing for the continuous increase in mental health disorders within the Western world. Likewise, psychosomatic conditions such as irritable bowel syndrome, chronic fatigue and fibromyalgia are subsequently increasing. Dr Jenna Burton discusses how the inability to manage our emotional outlets within a more complex and pressurized social environment may be affecting both our mental and physical health.
Mental Health is Not Simply Genetic
Today in the UK, 1 in 5 adults will suffer from some level of depression, with 1 in 4 suffering from some form of mental health concern during the course of a given year.[1] As a developed country, we continue to make advances in technology, academia and medical treatment. Yet it seems, as emotional beings, we are failing to cope with the pressures and expectations of modern-day existence.
Mental health can be secondary to a genetic predisposition, but our environment also influences aspects of our mental health. Traumatic experiences can result in the development of Post-Traumatic Stress Disorder for example.
Yet it seems, not every population is equally affected by the epidemic of mental health. Data suggests that those in the first world are more likely to suffer from depression than those in more underdeveloped regions.[2]
What is it about modern-day life and convenience that is leading to deterioration in our happiness?
Fellow human being living generations before our time when food and drink were scarce, preoccupied their minds with little other than reaching the 5 basic needs of food, water, shelter, clothing and sleep. Given this very basic daily challenge, mental health was considered less prominent than in today’s society. Despite living what is considered a less fortunate existence than we experience today.
With our comfortable existence, we are just not comfortable.
If not faced with physical danger or challenge, we are faced with emotional burdens and much more complex, deeper emotional baggage than those of our ancestors. There is also now evidence that stressful life events are more casual than they were previously. In a study of 13,006 people in Denmark, with their first psychiatric admission, were found to have (only) higher rates of unemployment and divorce than those with age and gender-matched controls.[3] The externally perceived severity of the stressor is not directly proportional to the physical or psychological impact on the individual.
Emotional Constipation and Chronic Disease
As a physician, I witness more and more chronic diseases born from emotional ‘constipation’. People seem to lack the ability to simply process how they are feeling. Aside from the psychological effects of impaired emotional regulation, our physical form is also affected. During daily surgery, it is common to see conditions born from psychological disease as opposed to traditional physiological illness. Most commonly the underlying causes are depression and anxiety, despite very real, very present, somatic symptomatology.
People complain of chronic pain, headaches, jaw pain from clenching, infertility, hormonal abnormalities, heartburn, impotence, uncontrolled anger, insomnia, vertigo, fatigue, weight gain, weight loss, tingling sensations in their fingers, abdominal distress and addictions. These patients become perplexed when results return as ‘normal’ despite ongoing symptoms.
Case Study
A recent patient had a 4-year history of chronic fatigue. He slurred his speech and was sleepy throughout the day despite 9 hours of uninterrupted rest every evening. It was apparent early on that this gentleman had an emotional undercurrent to his symptoms, with many risk factors and markers for depression. He refused to believe that there was anything other than an underlying physical condition present. He had convinced himself that he had an infectious disease from a trip to Africa. He was persistent with this even following the ‘all clear’ from a reputable UK infectious disease consultant and their team, along with numerous ongoing investigations and cultures.
As treatments such as cognitive behaviour therapy (CBT) and medication were declined for a substantial period of time, he become progressively worse. We continued to search for the cause of his illness via CT scans, blood tests and XRAYs, but negative results failed to offer the reassurance he desired. Eventually, he opted to give therapy a trial with short-term anti-depressant medication. It was a last desperate resort for him. A month later, he began to discover more energy and enthusiasm for life. The result was a grounded, healthy individual with regret for delaying appropriate treatment to balance his emotions effectively.
Emotional And Physical Health
It is appropriate to rule out physical disease before diagnosing an emotional derivative.
It would be useful to quantify the scale of the burden caused by such mental health conditions presenting themselves as physical disease. However, it is complex given their intimate and combined nature. In one Nurses’ Health Study, men and women suffering from anxiety were twice as likely to have a heart attack as opposed to those with no history of an anxiety disorder.[4] It is unlikely that the anxiety alone caused these patients to have a heart attack. It is one, likely of many, causes that predisposed to it.
Harvard Medical School published in their 2008 newsletter that “treating anxiety can often improve the outcome of chronic disease”. They stated that anxiety was taking a toll on our physical health via stimulation of the amygdala (a region within the brain governing emotional response.) Stimulation of the amygdala activates the ‘fight or flight’ response (via the sympathetic nervous system) which, in turn, tenses muscles, diverts blood away from the digestive organs, fires up our immune system and increases our heart and respiratory rate. In the short term, this can be beneficial. Chronically, however, it causes internal fatigue, a weakened immune system and an array of digestive disorders.
10-20% of Americans are suffering from functional dyspepsia and IBS.[4] IBS in particular is seen in several psychiatric co-morbidities and is proven to be related to Post Traumatic Stress Disorder.[5] Although not life-threatening disorders, they largely affect a patient’s quality of life, resulting in symptoms such as bloating, abdominal pain, vomiting, diarrhoea and/or constipation. As chronic conditions, they are difficult to manage, costly to control, account for sick days across the country and can lead to further low mood and/or anxiety.
The reality is that it is almost impossible to separate emotional health and physical health. They are completely intertwined.
Addressing Emotional Health
About 30% of people with anxiety disorders go through their life untreated.[4] Although more accepted today than previously, treatments such as CBT and psychotherapy tend to be reserved for those with clinically diagnosed psychiatric conditions. They are not yet fully accepted as prophylactic or for general populational use.
Mindfulness is defined as “The intentional, accepting and non-judgemental focus of one’s attention to the emotions, thoughts and sensations occurring in the present moment.” Such a state can be trained via meditation, life coaching, CBT and psychotherapy. Dispositional mindfulness is associated with lower levels of perceived stress, increased emotional regulation and cognitive control and stress-buffering effects.[6] Meditation has similar effects.
Likewise, therapy in the form of counselling or psychotherapy can be used to make way for ‘emotional dumping’ where patients can attend regularly, without necessarily any significant mental health concerns, just to offload their troubles and worrisome thought processes. Practitioners are also able to demonstrate tools which aim to reduce internal conflict. Teaching people how to appropriately think through their feelings and anxieties.
The aim is to create an emotional homeostasis.
Results should include a happier, and thus healthier, individual. Happy individuals are predisposed to seek out and undertake new goals in life and this reinforces positive emotions. When we feel happy, we tend to feel more confident, optimistic and energetic.[7]
Why have we not started acting sooner to bring Emotional Health and Emotional Medicine to the forefront? Should we consider adding emotional medicine into schools and workplaces? Should we ‘teach’ ourselves and our children, colleagues and parents how to juggle emotions and dispose of them accordingly? Our mental health is suffering from modern existence. We need to recognise that mental health is entirely meshed together with our physical health and consider alternative approaches.
References
- Mental Health Foundation. (www.mentalhealth.org.uk/mental-health-statistics/ ) Accessed 26/12/2014.
- University of Stony Brook, WHO World Mental Health Survey Initiative. (www.huffpost.com/us/entry/910345) Accessed 15/01/2015.
- ‘Stress and Health: Psychological, Behavioural and Biological Determinants.’ Neil Schneiderman, Gail Ironson, Scott D Siegel. Department of Psychology University of Miami. Annual Rev Clin Psychol 1:607-628. 2005.
- ‘Anxiety and Physical Illness’. Harvard Medical School http://www.health.harvard.edu/newsletter/Harvard_womens_Health Accessed 28/12/2014.
- ‘Post Traumatic Stress Disorder is Correlated to Irritable Bowel Syndrome.’ Wernersson R, Carlsson J. Published Ugeskr Laeger 2014 Dec 15; 176 (51)
- ‘The role of emotional regulation and cognitive control in the association between mindfulness disposition and stress.’ Prakash, Ruchika Shaurya, Hussain, Mariam A, Schirda, Brittney. Psychology and Ageing. Dec 29, 2014.
- ‘Review of Research Challenges Assumption that Success Makes People Happy: Happiness May Lead to Success via Positive Emotions.’ Sonja Lyubomirsky, Ed Diener. American Psychology Association.
(www.apa.org/news/press/release/20115/12/success.aspx) Accessed 20/12/2014.
