I for one am still awaiting the day that clinicians such as myself are incorporated into general medicine practices – so that patients coming in for a standard physical each year are engaged by a mental health clinician and assessed for behavioral well-being. Why has this day not arrived yet? What will it take?
The answer I believe exists somewhere in the compilation of research that now, without a doubt, shows the link, if not the integrity of the entire human system, brain and body. However, this research does mental health clinicians no good if it’s not recognized. And I mean recognized by the mental health community itself. There is still a propensity towards separating brain and body in diagnosing clients, discussing their symptoms and even in dialogue with the clients themselves as if there is no biological basis for the symptoms a client presents with in therapy. If we, as clinicians, aren’t clear on our own beliefs about the brain/body connection how can we expect not only the government and insurance agencies to be, but even more so, how can we expect our clients to integrate the two which we know is critical for repair and reprocessing?
We’ve spent all of this time pushing for equal consideration under health care and now that we’re at least getting closer, why are we still referring to depression or post-traumatic stress disorder as if they were separate and distinct diagnosis’ from a client’s physical display such as low heart rate variability, obesity, back pain, fatigue etc.? The words we use to describe the conditions that our clients suffer with is critical. How we talk about it with the client and how we talk about it with the public matters. The divide between physical and mental health is indistinct now. I have consolidated some revealing medical research that dispels the division herein starting with some of the more recent discoveries.
Dr. Rachel Yahuda of Mount Sinai found in her groundbreaking research on epigenetics spanning 2003-2006 that the stress hormones of those suffering with post-traumatic stress disorder do not return to baseline after a perceived threat has passed. This constant elevation in stress hormones leads to memory and attentional problems, sleep disorders and other long term health issues.
Scott Wilson and Richard Kradin at Massachusetts General uncovered in the 1999 publication of the their psychoimmunology research that survivors of incest have abnormalities in their immune systems – particularly in the CD45 cells which are the memory centers for the immune system. This variance in their immune systems makes them oversensitive to threat, mounting a staunch defense when none is really needed. This provides us with insight into the field of autoimmune diseases, the core characterization of which is the body staging an attack against itself.
Frank Putnam, Penelope Trickett and Jennie Noll uncovered in the 2011 publication of their 23 year long longitudinal study of the impact of sexual abuse on female development that survivors of such abuse grow up to experience an earlier onset of puberty and suffer higher rates of obesity among other effects.
The Adverse Childhood Experiences (ACE) study which started in an obesity clinic in 1998 with over 17,000 research participants documented that individuals who have an ACE score of 6 or above are twice as likely to contract cancer and four times as likely to suffer with emphysema. An ACE score of 6 or more puts an individual at a 15% greater chance for suffering from diabetes, strokes, Alzheimer’s to name just a few of the leading causes of death in America.
With this kind of medical research how can we still harbor doubt about the synthesis between brain and body? Every patient deserves integrated care. Every patient deserves to have a behavioral health and a physical health clinician working hand in hand. How else can we practice effective health care? Until that day patients will continue to focus on their physical problems because they realize, quite frankly, that it is there they will receive better care and coverage.