Difference between mental and physical health

Mental Health America describes the difference between a mental and a physical problem by explaining that the brain is just another organ in your body, so having a health issue related to your brain should not be unexpected. Their accessible article attempts to normalize mental health problems to encourage readers to seek needed help. However, it accepts the assumption that the two issues are separate. I would argue that mental health care is health care and that emphasizing the differences worsens the existing barriers to proper care and worsens the overall state of mental health.

Stigma Sucks

As a provider of mental health services, I find it both interesting and a little frustrating that there is still so difficult for people to get effective treatment for mental health needs. In fairness, I do think stigma has lessened over the last 30+ years and have written about this recently. It is also difficult for seekers of mental health services to find the right provider and, believe it or not, the fragmented mental health services world, also called behavioral health, is quite difficult and complicated for the providers to navigate as well. Regardless of the reasons, there are a lot of individuals suffering that are not accessing needed care and these and other barriers must be addressed.

Historical context

In a 2001 article titled “The distinction between mental and physical illness”, R.E. Kendell observed that at the time of Hippocrates, medical conditions we would now call a mental illness were treated by traditional medical providers using traditional medical interventions. The author concedes that some theorists from the time of Plato through the medieval period attributed “madness” to supernatural influences (e.g. the will of God). However, it was commonly accepted by the medical profession that mental maladies were just another type of illness to be treated by doctors.

J.E. Kendell also noted that the idea that mental illnesses were fundamentally different than other types of illnesses arose to prominence in the 17th century, a perspective attributed to French philosopher Rene Descartes. Descartes promoted the idea that the nature of the mind and the body were fundamentally distinct entities comprised of different physical substances, a belief that came to be known as Cartesian dualism. At that time, medical experts performing autopsies observed that deceased individuals who suffered from insanity did not exhibit typical evidence of disease when examined posthumously, supporting Descartes' conclusion that illnesses of the brain were fundamentally different, and this view remains largely in place today. At that time, the mentally ill began to be treated by incarceration in asylums and your typical doctor no longer was responsible for their treatment.

Current diagnostic practices

Further, the use of diagnostic manuals such as the infamous DSM – Diagnostics and Statistical Manual of Mental Disorders, first published in the 1950s and

currently at version 5-TR (2022), categorizes disorders by common symptoms. These diagnoses must typically be used by mental health care workers in order for clients to receive coverage from their insurance companies. This requirement to use formal diagnostic codes is controversial, as there are definitely pros and cons to their use. Regardless of your opinion, this mandatory insurance company policy reinforces the current view of using these existing labels to codify these disturbances as mental in nature.

What’s the problem?

Public perceptions about the differences between mental and physical illnesses are also quite stark. Most people who are ill with cancer or a heart condition are be taken quite seriously and, despite behavioral factors than can in part contribute to these illnesses, there is minimal stigma and judgment associated with those seeking treatment. When someone is anxious or depressed, however, some people perceive the problem as one of character, such as not trying hard enough or that sufferers are simply wrong in some way. While I have seen clients improve after making some simple behavioral changes, for most people, improving one’s mental health is hardly that simple. For example, if Sally just gets up early one morning and goes to the gym before work, she may actually have a better day. She may have a greater sense of accomplishment, her typically pretty depressed mood might be slightly improved, she may feel less pain throughout her body, and possibly sleep better. However, her predisposition to awaking with panic and internal struggle to present her “happy face” to her family and colleagues may not be significantly changed. I would be delighted if change was this easy but it seems a little unrealistic.

To sum up

Individuals ill with mental conditions are still suffering from the historical association with "insane" individuals imprisoned within asylums, a perception initially established in the 17th century. The perception that mental illness makes people crazy or insane decreases a person's willingness to acknowledge their issues and seek/receive treatment. Mental illnesses are simply illnesses that require care by professionals who are trained in this specialist field, similar to medical professionals in other specialty areas.

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* I am licensed to work in Massachusetts.

References

R.E. Kendell (2001). The British Journal of Psychiatry, Volume 178 , Issue 6 , June 2001 , pp. 490 - 493.

DOI: https://doi.org/10.1192/bjp.178.6.490

Mental Health America; https://screening.mhanational.org/content/mental-illness-physical-or-mental/