Nearly all illnesses that I can think of are categorised into whether they are mental or physical in nature. However, I am not sure I can think of one illness, large or small that does not have mental and physical consequences on the person.
So why, I frequently ask myself, are we so keen to separate and label each illness into a neat mental or physical category?
Eating disorders are of course a prime example. For years eating disorders have been categorised into the ‘mental illness’ section of any textbook, despite the fact that any eating disorder has significant physical consequences and not only that but likely physical causation.
Research now clearly shows that eating disorders are triggered in a person with a genetic predisposition when they go into a negative energy state… of course the cause of the negative energy might be stress or trauma related or due to a depression but the cause of the illness is far from neatly fitting into a psychiatric category.
The effects of an eating disorder are also largely physical – significant weight changes and loss, malnutrition with severe physical consequences on all the body systems and possible purging with other potentially life threatening effects.
And yes, eating disorders have symptoms pertaining to our mental health.
Malnutrition and starvation alone impact massively on how the brain functions and can cause depression and obsessive or compulsive behaviours. A person with an eating disorder is also very likely to be acutely anxious and depressed… partly through anxieties generated directly from the illness and partly because the illness is so miserable to live with, it is hard to imagine it being possible to have an eating disorder and not feel depressed, frequently to the point of suicidal intent.
But, it is not just eating disorders that do not fit into a clear mental or physical illness category.
Any physical illness I can think of has implications on a person’s mental health.
Naturally, serious physical illnesses, which might be life threatening, disabling or cause significant discomfort are very likely to impact on the person’s mental health. A person who has become physically ill will often experience some level of depression and possible anxiety. Self confidence and self worth might also be impacted upon and the person might have feelings of being more vulnerable and dependent.
However, I would also argue that even a very minor physical illness can impact on a person’s mental well-being. How many people have had a bad cold or a tonsillitis or stomach bug and become really quite miserable with it? Just minor ailments can make a person feel fed up, tearful and frustrated.
Returning to mental illnesses, aside from eating disorders, I also wonder if there is a mental illness that does not impact on the physical health of the person?
Stress and anxiety have a huge impact on the body as a whole. They can lead to increased problems with the heart, the nervous system, our muscles, our skin and other vital organs…
Alongside this, some mental illnesses cause the person to be less careful with their physical health. They might be more reckless with alcohol or smoking or they may just generally neglect their body.
So, yes.. I would say that mental illness is physical illness and physical illness is mental illness and no illness fits neatly into a category as they are so often assumed to do.
You might ask why this is important?
And, it does not need to be important as long as the treatment is appropriate for the person, looking at the person’s mental and physical health as a whole but I would say this is rarely the case.
Returning to eating disorders – these have been psychologised too greatly in the past and that has impacted on the treatment offered.
Too often eating disorders are treated by trying to psychologise the person out of it… with much less focus on the important part – full reversal of any starvation and malnutrition, full weight restoration and fully checking that the person’s physical health is returning to a not just ‘acceptable BMI’ but to full on healthy health!
When I have been in eating disorder clinics in the past, the staff there were generally trained in mental health alone and had little experience in monitoring and managing physical conditions…. yet they were trying to treat people with low weights, starved organs and individuals at significant risk of death – not from the mental health side of their illness, but the physical side. As a general nurse myself, I frequently found I was having to show the nursing staff how to use their ECG machine and appropriate intervention when one of my fellow patients collapsed on the ward.
So – it does matter that we are separating mental and physical health too widely.
Plus, while we segregate illnesses so greatly into mental and physical categories, the stigma attached with mental illness is not reducing.
Tell a person with a physical illness that their mental health is impacted and they might not take it kindly… because mental health is still seen all to frequently as a weakness, a life choice or a burden.
Please, let us stop categorising and let us recognise that mental illness is physical illness and vice versa, so that we can stop the stigma and treat the whole person – not just the body or just the mind.