Mental Health and Physical Health: It's not either or!

By Eilidh Murphy

CW: This article discusses mental and physical health, hospitals, and coronavirus restrictions, and lockdowns.

Many a meme like the one below may have circulated your social media, perhaps again recently as areas of the UK entered a second lockdown and the nation reminded each other to once again #bekind.

Comic by Shruti Rajan, https://www.namidanecounty.org/blog/2017/1/19/what-would-happen-if-we-treated-physical-illness-like-mental-illness

Highlighting to society how it is important to value mental illness at the same level as physical illness has been the goal of charities and campaigns such as Mind, Time to Change and Rethink Mental Illness for years. And, undeniably, some progress has been made. But there is still a long way to go.

Perhaps the clearest indication of where we are, in my opinion, around mental health stigma, came as rumours circulated about a second UK lockdown. Twitter flooded with comments like “let the elderly and the vulnerable shield” and “the next pandemic will be a mental health one if we lockdown again because suicide rates will go up.”. Of course, these claims about increasing mental illness rates are not wrong; the Mental Health Foundation is leading a UK wide study on the pandemic’s impact on mental health and their website is probably a better place to get your information than Twitter, but “shield the vulnerable’ to protect the nations mental health from the effects of a lockdown is missing one very important point:

Those with a vulnerable, physical health condition are already more likely to experience poor mental health.

Research shows that those with chronic or underlying health conditions are more likely to experience mental health conditions as well as a result of the long-term effects of their condition. It’s one of many important relationships that exist between physical and mental health. These often stem from difficult emotions, for example (but not limited to) depression and hopelessness, around the fact they are not getting or will not get better, anxiety, about treatments or worsening of their condition, and frustration about being unable to carry on with life the way they used to.

It was evident from the interactions on Twitter that people believed this was an either-or situation. We could either prevent the deterioration of the populations physical health by slowing the spread of the coronavirus, or we could prevent the deterioration of the populations mental health by allowing interaction and societal integration. Of course, this is a narrow, and dare I say it, selfish view. There are many ways we can interact at a distance (this blog post chats about them nicely!) and the LUNA project (and many others) have produced a resource on mental health during lockdown.

This either-or view perhaps becomes most detrimental when it extends into healthcare and I have personally experienced just how upsetting it can be. From dismissal of symptoms as anxiety and being told to “sort yourself out” in A&E departments, to comments from doctors depicting that my home life is ‘difficult’ (it isn’t), I’ve been bewildered at the eagerness of medical staff to dismiss my physical symptoms as having mental roots.

I’m not denying the physical symptoms that mental health conditions can cause as being very real, debilitating and scary. This is another important relationship between mental and physical health that Jordan Thomas, a Psychological-Wellbeing Practitioner, wrote a wonderful blog post explaining better than I ever could. I’ve experienced panic attacks in the past so know all too well how very physical the symptoms these bring about can feel. But despite these relationships between mental and physical health, many of the hospital doctors I see take the either-or approach. When first-line testing doesn’t reveal a cause for my symptoms, more often than not, they blame my anxiety and send me home. Anxiety that has never caused the severe neurological symptoms like headaches, vision loss, numbness and dizziness. Anxiety that has never caused me to black out and faint multiple times a day. Anxiety that has never caused the sickness, fatigue, or loss of appetite.

Anxiety that is as well controlled and well managed as it has ever been.

During my latest hospital admission, I was referred to a psychiatrist who came to see me at my bedside. She told me that my symptoms were not typical of a neurological condition and that perhaps my mental health problems from the past were causing this. I explained to her that in fact the frustration of having to fight for treatment, not being taken seriously and the distress of being unwell was likely affecting my mental health, not my mental health causing physical symptoms, in an attempt to meet her halfway and not come across as the stubborn, uncooperative patient. She didn’t believe that I understood my own body and continued to tell me that she didn’t think my presentation was a manifestation of a physical problem and that coming to hospital was the wrong thing for me to do. As you can imagine, it wasn’t a very productive conversation, and I was discharged later that day.

I felt like all the doctors had decided I was just an anxious student with a headache from stress. That feels awful; you hate to think you are wasting their time especially now, in the second wave of the pandemic. But you also want to feel better; nobody wants to be the 21-year-old in and out of hospital. It’s not the first time I’ve been in that position, but it’s the most frustrating experience to date. It takes a lot as a young person to speak up to doctors, and it’s taken me a long time to learn how to do it. So, when you do, and it doesn’t change anything, it’s crushing. I feel dismissed: because I have a mental health condition, I cannot have a physical one too, because that’s where we are in the attempt to eradicate stigma. From consultants and doctors to Twitter and Facebook, our either-or mentality to mental and physical health has to change.

(Originally published 29/11/20)