The Mind-Body Connection

As part of the Psychology Essay Contest, hosted by RVU’s Mental Health and Wellness Counselors, students were given several questions to answer in an essay format. The winning essay, written by second-year physician assistant student Jasmine Hohl, seeks to answer (1) how the mental health of a patient interacts with their physical well being and (2) how does the student see themselves incorporating this interaction into their future practice.

“We are what we think. All that we are arises with our thoughts.”^[1] An interpretation of this Buddhist sentiment suggests a greater connection between mind and body. To put it less metaphysically, “…all the organs of our body and all the emotional responses we have share a common chemical language and are constantly communicating with one another.”^[2] As medical providers, we often consider the mental and physical to be distinctly different domains, but research suggests that the body-mind connection increases our ability to achieve true well-being for our patients.

Abundant examples exhibit a positive correlation between physical and mental health. Better health (emotional/physical) leads to more exercise–which has been shown to treat mild/moderate depression as effectively as antidepressant medication^[3] and leads to better overall health.^[4] A healthy diet is inversely related to depression,^[5] social interaction favors good health behaviors (such as reduction of smoking) and vice versa,^[6] and past mental health is an indication of future physical health and longevity. Case in point, factors such as optimism and life satisfaction are associated with reduced risk of cardiovascular disease–regardless of age, socioeconomic status, smoking status, or body weight.^[7] We repeatedly see that elevated health in one domain is like the tide that raises all boats collectively, improving overall well-being and health outcomes.

From an epidemiological viewpoint, studies show that people with serious mental illness have a decreased life span by around 15-30 years and a disproportionately high risk of (and mortality from) numerous physical health problems, including diabetes, respiratory or cardiovascular disease, stroke, osteoporosis, infectious diseases, cancers, and many more. ^[8] Chronic disease patients in particular have high rates of behavioral health comorbidities.^[9]

We can attribute the correlation between mental and physical illness to various sources. 1) Numerous physiological changes occur with psychiatric issues: for example, chronic depression may weaken the immune system, disrupt neurotransmitter systems, and cause abnormal inflammation, changes in heart rate and circulation, hormone imbalances, and metabolic changes typical of those seen in people at risk for diabetes.^[10] 2) Mental illness can lead to an increased likelihood of risky behaviors or a decrease in healthy habits. Take depressed patients: twice as likely to use tobacco and less likely to eat healthily or exercise^[11]. 3) These patients also show lower compliance with treatment plans^[12] and the likelihood of seeking treatment for health care needs.^[13] 4) Patients may suffer from clinical “diagnostic overshadowing” in which either their mental illness is not treated in lieu of serious chronic illness or their physical ailments are overlooked in the face of dysfunctional emotional health.^[14] For example, evidence suggests that schizophrenic patients are inadequately screened/treated (up to 88%) for dyslipidemia and hypertension.^[15] 5) Socioeconomic factors–homelessness, unemployment, social isolation, etc.–limit access to quality health care.^[16] These factors both cause and are caused by an increased risk of illness–body or mind.^[17]

The most important concept to glean from this evidence is the fundamental bidirectional nature of the body-mind relationship. Affect one and you likely affect the other, for better or worse. A better way of looking at health is not as two separate halves of a whole, but an intricately connected web of emotional and corporeal threads. “It is not appropriate to designate diseases into distinct categories of physical or mental ailments. A patient’s perception of disease does not follow this clear divide between the mind and the body.”^[18] In short, it is essential that our collective concept of “well-being” must shift to include psychosocial as well as physical elements. Remember that “health…is a resource that allows people to realize their aspirations, satisfy their needs, and to cope with the environment in order to live a long, productive, and fruitful life.”^[19] In this sense, helping our patients to achieve true wellness does not simply mean treating apparent disease–which is a valuable and essential enterprise–but recognizing the patient as a holistic being.

Research continually supports taking a holistic approach to treating our patients–regardless of specialty or setting–to achieve better outcomes, cost-reduction, and illness prevention.^[20] But how do we do it? To start, I plan to incorporate the following as a future provider.

First, consider the web; we must heed the psychosocial effects of physical health (and vice versa). This is a call to all providers^[21] to consider the overall wellbeing of each and every patient regardless of the presenting issue. By beginning with this mindset rather than merely problem solving, we will be able to help our patients feel better cared for and reduce potentially harmful downstream issues.

Second, utilize the whole toolbox. By our medical nature, we may cling to more “scientific” tools, neglecting others assumed to be more “spiritual” or “emotional.” However, studies show that techniques like cognitive behavioral therapy, meditation, or yoga have significant effects on pain management^[22], stress-related symptom reduction (e.g. psoriasis),^[23] longevity, and overall positive sense of wellbeing^[24] even with serious illness. Mindfulness–which I currently use personally and plan to encourage heavily in my patients–has even been shown to buffer declines in CD4+ T-lymphocyte counts in HIV and prevention/duration of common colds^[25] in addition to many other benefits. Providers should pursue and incorporate these tools where appropriate.

Third, champion integration. “Nearly 75% of patients identified as having a behavioral health disorder while in primary care would not accept a referral to see a specialist.”^[26] Primary care providers should perform routine assessments of mental health, seek psychiatric consultative support, and ideally provide every patient with psychological services on-site (using telehealth, etc.).^[27] “A ‘one-stop-shop’ where patients can have their mental health and physical health needs met by a team of experts can lead to improved healthcare outcomes.”^[28] Especially in spheres where collaboration between providers is not supported or referral systems are inadequate, we must advocate for integrative ideas that get our patients the care they need.

“Holistic care” will be my personal practice mantra. Though I plan to enter the underutilized field of psychiatry, I believe all providers have the responsibility to understand the mind-body connection and ameliorate any imagined division. By doing so, we will help our patients achieve true well-being.

---

^[1] Easwaran, E. (1987). The Dhammapada. London: Arkana.

^[2] Dr. James Gordon, Founder of the Center for Mind-Body Medicine

^[3] Robinson, L., Segal, J., & Smith, M. (2020, October). The Mental Health Benefits of Exercise. https://www.helpguide.org/articles/healthy-living/the-mental-health-benefits-of-exercise.htm

^[4] Ohrnberger, J., Fichera, E., & Sutton, M. (2017). The relationship between physical and mental health: A meditation analysis. Social Science & Medicine, 195(December 2017), 42-49.

^[5] O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., Berk, M., & Jacka, F. N. (2014, October). Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health, 104(10).

^[6] Umberson, D., Crosnoe, R., & Reczek, C. (2010). Social Relationships and Health Behavior Across Life Course. Annual review of sociology, 36, 139–157. https://doi.org/10.1146/annurev-soc-070308-120011; Ohrnberger et al., 2017

^[7] How Mental Health Affects Physical Health. Bradley University. https://onlinedegrees.bradley.edu/blog/how-mental-health-affects-physical-health/

^[8] De Hert, et al. (2011, February). Physical illness in patients with severe mental disorders. Prevalence, the impact of medications, and disparities in health care. World Psychiatry, 10(1), 57-77.; World Health Organization; Voinov, B., Richie, W. D., & Bailey, R. K. (2013, April). Depression and Chronic Diseases: It Is Time for a Synergistic Mental Health and Primary Care Approach. The Primary Care Companion for CNS Disorders, 15(2).; Hassen, A., & Tibret, B. K. (2016). Health-Related Behaviors, Health Consciousness, and Psychological Wellbeing among Teaching Faculty at Jimma University, Ethiopia. Clinical and Experimental Psychology, 2.

^[9] Integrating Physical and Behavioral Health: A Major Step Toward Population Health Management. (2020). BDC Advisors. https://www.bdcadvisors.com/integrating-physical-and-behavioral-health/

^[10] Chronic Illness & Mental Health. (n.d.). National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml

^[11] WHO Global Health Risks, 2009; Ohrnberger et al., 2017; De Hert et al., 2011

^[12] BDC Advisors

^[13] Mental Health Foundation

^[14] Serani, D. (2015, October 18). Depression and Diagnostic Overshadowing. Psychology Today. https://www.psychologytoday.com/us/blog/two-takes-depression/201510/depression-and-diagnostic-overshadowing

^[15] De Hert et al., 2011

^[16] Maj, M. (2009, February). Physical health care in persons with severe mental illness: public health and ethical priority. World Psychiatry, 8(1), 1-2.; World Health Organization

^[17] World Health Organization; Holt-Lunstad, J., & Smith, T. B. (2012, January). Social Relationships and Mortality. Social and Personality Psychology Compass.; Ohmberger et al., 2017; De Hert et al., 2011

^[18] Priya, G., & Kalra, S. (2018, April). Mind-Body Interactions and Mindfulness Meditation in Diabetes. European Endocrinology, 14(1), 35-41.

^[19]Well-Being Concepts. (n.d.). CDC Health-Related Quality of Life. https://www.cdc.gov/hrqol/wellbeing.htm

^[20] Songer, D. (2005, May). Psychotherapeutic Approaches in the Treatment of Pain. Psychiatry, 2(5), 19-24.; BDC Advisors; Telles, S. et al. (2019, May). Mental Wellbeing, Quality of Life, and Perception of Chronic Illness in Yoga-Experienced Compared with Yoga-Naive Patients. Medical Science Monitor Basic Research, 25, 153-163.; Voinov et al., 2013; World Health Organization

^[21]Physical Health and Mental Health. Mental Health Foundation. https://www.mentalhealth.org.uk/a-to-z/p/physical-health-and-mental-health

^[22]Lim, J.-A. et al. (2018, June). Cognitive-behavioral therapy for patients with chronic pain. Medicine, 97(23).

^[23]Creswell, J. D., Lindsay, E. K., Villalba, D. K., & Chin, B. (2019, April). Mindfulness Training and Physical Health: Mechanisms and Outcomes. Psychosom Med, 81(3), 224-232.

^[24] Telles et al., 2019; Turner, J., & Kelly, B. (2000, February). Emotional dimensions of chronic disease. Western Journal of Medicine, 182(2), 124-128.

^[25] Creswell et al., 2019

^[26]Johnson, S. R. Addressing Behavioral Health To Improve All Health. Modern Healthcare. https://www.modernhealthcare.com/reports/behavioral-health/#!/

^[27] BDC Advisors

^[28]Tumolo, J. (2019, July 30). Physical Health May Suffer in People With Mental Disorders. Psychiatry and Behavioral Health Learning Network. https://www.psychcongress.com/article/physical-health-may-suffer-people-mental-disorders