Feeds:
Posts
Comments

Posts Tagged ‘mental-health’

Is it physical?

Posted in Uncategorized, tagged , , , , , , , , on October 28, 2024| Leave a Comment »

One of the things which frustrates me most about Medicine is this question – “Is it physical?”, which may be asked in a slightly other form – “Is it organic?”, (or, the apparent opposite – “Is it functional?”), “Is it a problem of the body or the mind?”. This way of thinking which divides illnesses into two categories, separating out the mind from the body, is still way too common. It’s common in patients who refuse to accept their illness could have anything to do with their mind – “it’s a virus”, “it’s a hormone problem”, “it’s my genes” – usually because they have been led to believe that a problem involving the mind is a “mental problem”, which strangely continues to carry a stigma that an infection, or a broken leg don’t carry. Separating out the mind from the body is a common misunderstanding not least because it is promoted by doctors who should really know better by now.

The human being is a living, multicellular organism. Starting from a single, fertilised egg cell, the foetus doubles and doubles and doubles the number of cells, until the fully formed human being is born with trillions of cells on board. Trillions. It’s too big a number to visualise. In fact, the number of cells in a human body are estimated, not accurately counted, partly because cells die and are replaced constantly. None of these cells exist in isolation. They are all in constant communication with, and respond to, other cells within the organism, so that although we each have a heart, two lungs, a stomach, a liver, a brain etc, none of these organs exist by themselves. Every single one of them is “integrated” with all the others – that means each is in an active two-way relationship with other organs, tissues and cells. The cells of your body don’t compete with each other. They collaborate. They work together to make the whole organism healthy, so that it can adapt and to grow.

The mind, as best we understand it so far, is more than a function of the brain. It’s embodied. There are extensive neural and endocrine networks throughout the body which work together to produce what we call the mind. This understanding of mind is sometimes referred to as “embodied mind”. Search for that term online to learn more if you like. It’s a useful concept which allows us to see that the mind is not confined to the skull.

It turns out that terms like “heart felt”, and “gut feeling”, are not mere metaphors, but reflect biochemical activities and phenomena which involve, not only the heart and the digestive system, but the whole organism.

I used to say to patients and medical students, I only ever saw a body without a mind in the mortuary, and I never met a mind without a body.

It makes no sense to me to separate out the mind from the body, because when illness occurs, it might arise in a specific tissue, or organ (or it might not), but the response to the disorder is a whole being response – we use the powers of every system within the body, and our abilities to think and to feel (I mean emotional feeling), to defend and repair.

The big problem with separating off the mind from the body and looking for “physical” or “organic” problems is that if all the lab tests and imaging comes back within normal limits, an illness ends up being classed as “mental” – and treatments for mental disorders are then offered. Or worse, it is dismissed as “not real”.

But there is another way to look at all of this – a holistic way – where we don’t separate out the mind from the body and whatever the disease, we seek to address the person, not simply some of their cells or organs. Yes, maybe there are cellular pathologies which can be, and should be addressed, but healing and repair always involves a whole person.

Wouldn’t it be better if we never limited ourselves to addressing “pathologies” in cells and systems, but, rather, in addition (and not or, remember), we engaged with the whole person through their story, their actions, their thoughts and feelings? Shouldn’t we address the circumstances of their lives, because nobody lives in isolation from environmental influences?

It makes no sense to me to address only a pathology found in a particular tissue or organ. Medicine isn’t a kind of mechanics. It’s an art, and science, of understanding and relating.

By the way, do you think you can see the suggestion of a heart on the bark of that sequoia in the photo I’ve posted above?

Read Full Post »

Holistic

Posted in Uncategorized, tagged , , , , on May 18, 2024| Leave a Comment »

All my working life I practised Medicine as holistically as I could. I never made sense to me to split a human being into parts, particularly into a “mental” part and a “body” part. I was trained to practice holistically, even if my teachers rarely used that word. They taught me to listen to a person’s story, to listen with empathy and without judgement, in order to understand their illness, to make a good diagnosis and to plan what investigations and treatments should be considered. We started with the person, and drilled down to clarify what was happening in certain systems or parts, with the help of investigations.

This way of working emphasised that every single human being was unique, and that there were no one size fits all treatments. It taught us to remain ever alert, to follow up patients ourselves and to adjust our diagnoses, treatments and prognoses, as life continued to flow.

But was it holistic enough?

My chronic doubt, which, I confess, has grown over the years, was that it wasn’t. The reason for saying that is that whilst I knew everyone lived within a complex, layered web of relationships and environments, my interventions were almost exclusively individualistic.

But I know that our health is affected by traumas, by relationships, by work, by poverty, by housing, by pollution.

The Covid pandemic made all that clearer than ever, but still, we went for an individualised approach, focusing on vaccinations and personal hygiene. But we saw that the vulnerabilities and problems lay in insecure employment, poverty, racism, overcrowded and inadequate housing etc.

Sometimes I buy the idea that we can all be healthier if we exercise enough, eat a balanced nutritious diet, and manage our emotions, but then I see children in Gaza, people picking through the rubble of their houses in Ukraine, whole towns swept away in historic floods, and I realise, this individualistic holism just isn’t enough.

Let me clarify – I’m not knocking holistic medical practice – it’s far superior to reductionist, materialist, industrialised models. But we need to be much more aware of the circumstances of our lives, and, in particular, of the shared circumstances of our lives. If we can’t do anything about climate change, plastic pollution of the oceans, chemical pollution of the soil, the waterways and air; if we can’d do anything about poverty, social exclusion, hatred and prejudice; then we’re going to be fire fighting, and applying bandaids, when we could be creating a better world for all of us to live in.

How do we do that?

Ah, that’s the big question, and it’s not an easy one to answer. But we have to start somewhere, and awareness might be a good place to start. We need to talk to each other, to express our desire for more justice, more care, more understanding of how we all share this one, massively connected world.

Read Full Post »

Paying attention

Posted in Uncategorized, tagged , , , , on May 14, 2024| 1 Comment »

I’ve read that we live in an attention economy. Marketers, producers, companies and individuals are all competing for our attention. They pay the social media companies to promote themselves to us using attention grabbing, and attention holding tools and techniques. “Influencers” can only influence if they attract attention, so they do whatever they need to do in order to achieve that goal.

I was pretty shocked on a recent trip to Milan to discover how “instagrammable” has become a major force. Certain buildings, certain viewpoints, or “attractions” were surrounded by dozens of, mostly young female, photographers, either taking pictures of themselves in front of whatever it was that had become “instagrammable”, or having someone else take their portraits there. Some even used portable reflectors, to “get the light right”, and had changes of clothing to model. I joked that my wife and I, standing in front of the Duomo, were the only people in the crowd actually facing the building. Most were trying to make it more beautiful, or more interesting, by putting it in the background, and themselves in the foreground.

That’s not a new phenomenon. A few years ago on a visit to the Alhambra in Grenada, I was surprised to find that most people who were taking photos of the amazing art and architecture, were only doings so by putting themselves into the foreground of each frame.

But attention is important. It’s how we see and experience the world we live in, and it influences our moment to moment moods, thoughts, and actions.

Ellen Langer, who studies “mindfulness”, describes it, simply as, “actively noticing things”.

I love that.

This “heroes not zombies” blog is all about living a more mindful life, and, I believe, that requires two things, both created out of attention. The first is, “noticing”, or as Ellen Langer says, “actively noticing”. When we pay attention, when we set out with an intention to notice – to notice the world around us, to notice others, to notice our thoughts and feelings – then we move into a more active, more conscious mode of existence. We reduce the chances of blindly following the influences and powers of others who try to shape our lives. The second is, to pay “loving attention”. I think whatever we pay attention gets magnified. If we focus on problems, we fill our lives with problems. If we focus on joys, of moments of awe and wonder, then we fill our lives with amazement and delight. But when we pay attention from a loving position – from a position of care, of empathy, of genuine interest, and love – then our attention changes, not only our own lives for the better, that of others…..whether they be other people, animals, plants, the environment, or the planet.

So, I’m all for paying attention – do it actively and do it lovingly – not mindlessly.

Read Full Post »

Attending the soul

Posted in from the consulting room, from the living room, health, life, tagged , , , on January 5, 2013| 1 Comment »

There’s a chapter in James Hollis, the Jungian analyst’s book, Creating a Life, entitled, “Attending the Soul”. This particular chapter is about the practice of psychiatry and he completely nails an important point.

If we consider health, acute and chronic illness, to be a spectrum of experience, then we need to do more than control or manage disease in order to be healthy.

Here’s how James Hollis puts it….

In seeking scientific verification of success, many of these practitioners [psychiatrists] have narrowed the definitions of pathology to behavioural patterns, faulty cognitions and flawed chemistry. While it is certainly true that we are behaviours, and behaviours may be corrected, and we are cognitions which may be challenged by other cognitions, and we are chemical processes which may be compensated by other chemical processes, none of these modalities – behaviourism, cognitive restructuring and psychopharmacology – should be confused with psychotherapy.

He goes on to say that psychotherapy seeks to address the whole person, even the meaning of the person, the meaning of their suffering or even the meaning of their life.

This same point applies across the whole of Medicine. Illness may include physical pathologies which can, and may, be addressed with drugs or surgery, or it may include adaptive, or protective symptoms and behaviours which can be changed. However, if we are interested in healing, in facilitating the experience of wellbeing, resilience, and health, then we face the fact that a whole human being is more than the sum of his or her parts.

Here’s how he concludes his chapter…

To stop at behavioural change, as important as it is, or cognitive restructuring, liberating as it may be, and pharmacology, necessary as it sometimes becomes, betokens a failure of nerve and sells the soul very short indeed.

 

Read Full Post »

Heart of the universe

Posted in from the consulting room, from the living room, health, life, perception, personal growth, science, tagged , , on January 1, 2013| Leave a Comment »

Sometimes (quite often actually), I wake up with a word or phrase in my head. This morning it was “heart of the universe”. The particular word or phrase can set off all kinds of different thoughts and where this one quickly went was “It’s 2013. It’s 40 years since I dissected a human heart. Second year, Medical School, Edinburgh University. That year we learned Anatomy and Physiology. I was amazed at the structure of the heart. It’s four chambers, the valves, the specialised heart muscle cells which each had their own rhythm, the conduction pathways from the “AV node” which carried the co-ordinating electrical beat to produce the two, opposite states of the heart – systole and asystole.

It was two years later before they told us to put on white coats, buy a good quality stethoscope, and led us on ward rounds, to stand collectively around patients’ beds, and one by one, place our shiny new stethoscopes on their chests to listen for the “lub dub” of the “normal” heart, and listen carefully for the clicks and sounds which filled the silences and revealed the disorders of the valves.

Over the years as a GP, I prescribed the drugs to slow hearts down, to regulate disordered rhythms, and to improve the blood supply to get the oxygen to the cells starved by blocked arteries and causing angina. I also found people presenting with pain, flutters and skipped beats of the heart whose investigation results showed no obvious pathologies. What were we to do with them? And where was the explanation for their symptoms? If their symptoms weren’t signposts to pathology, then what were they?

Gradually, I became aware of how we use heart in our language, as people told me about “broken hearts”, “heart ache”, “longings of the heart”, “an emptiness in my heart”, “getting to the heart of the problem”, “filling my heart with joy”. Of course, from early years I became familiar with the shape of a heart as we would draw it to communicate love. We see that shape everywhere.

three leaves

cafe love

tree

wishes

Why the heart? Why not the liver, or the pancreas, or the spleen? Why not the kidneys?

I knew there were intimate connections between the brain and the heart, mainly channeled through the “autonomic nervous system”. Then only in the last few years did I learn we’ve discovered that there is a neural network around the heart and associated with that is the production of neuropeptides (the small proteins which act on the brain) within the heart and its neural network. So, the links are more intimate than I realised, and, most importantly, more two way than I realised – the brain acts on the heart, but the heart also acts on the brain. In fact, it seems we do some of our mental processing using these neurones around the heart. (That dismissive phrase which I never liked – “it’s all in your head” – turns out to be even more stupid than I always thought it was)

And as time passed, and I experienced encounters with more patients, I began to see that sometimes (not always but often enough to always consider), there were direct links between “heart issues”, “heart language” and “heart symptoms”, irrespective of the presence or absence of pathologies.

So, here’s something to consider as you think ahead into 2013. How about building your “heart intelligence”? That’s a concept that means somewhat different things to different people, but let’s just use it as it is, without detailed definition.

Try the Heartmath technique. Sit quietly, focus on your heart area, take three deep, slow heart breaths, then recreate for yourself a heart feeling (you can find the details here). In this state of “coherence”, ask your heart a question, and wait to see what answer appears. Write it down.

What does your heart tell you about 2013?

Read Full Post »

Out of your head…and into your other brain

Posted in from the consulting room, health, tagged , , on December 21, 2012| Leave a Comment »

Your other brain?

You probably imagine that you do all your mental work – perceiving, analysing, thinking, feeling and so on – with your brain – that organ inside your skull. However, we’ve known for some time that there are networks of neurones around the hollow organs of the body, especially around the heart and the intestines. We’ve also discovered “neurotransmitters” originating from those parts of the body. So, at very least, we are aware that there are two way connections between the heart and the brain, and the gut and the brain.

A recent article in New Scientist magazine described the network around the gut and named it the “Enteric Nervous System” (ENS). There are around 500,000 neurones around the gut (where there are about 85 billion in the brain). Most surprisingly, alongside the 40 or so neurotransmitters in this network, two chemicals known to affect mood and mental functions, dopamine and serotonin, are also present. In fact, it is now thought that 50% of all dopamine is produced in the brain, and 50% in the ENS. Only 5% of serotonin is produced by the brain, and 95% of it in the ENS. This is quite astonishing when you consider the roles these hormones can play in our behaviour.

The other fascinating fact the author of the New Scientist article highlights is the presence of Lewy bodies in the ENS (these are the pathological lesions seen in the brains of patients with Parkinsons Disease), and patients with Alzheimer’s have characteristic lesions on both their brain and ENS neurones. Do those “neurological” diseases begin in the brain, or in the gut?

It’s good to see scientists discovering how interlinked our bodily systems are, and how difficult it is to reduce a person to parts – even the two parts of Mind and Body. Are those parts really such separate parts of they are so connected and inter-related?

Read Full Post »

« Newer Posts