By Dr Moitrayee Das  (Assistant Professor-FLAME University) & Kimaya Natekar (Student- FLAME University)

The mind and the body are not functionally independent; they operate in unison. The fabric of the mind is tightly woven into the fabric of the body, and our ancestors had deep knowledge of this unison, this intrinsic alliance. This is reflected in Ayurvedic, Galenic, as well as Mesopotamian texts. Modern science is on the path to replicating this understanding empirically, through the scientific method. This liaison between the psyche and the soma has groundbreaking implications for the way we look at mental and physical illness, the way we treat it, and the interaction between various fields in healthcare.

Researchers at the UCSF Center to Advance Trauma-Informed Health Care, for example, have confirmed that psychological trauma plays a leading role in contributing to major physical illnesses, including diabetes, heart disease, and cancer, among many others (CTHC at UCSF, 2021). Chronic psychological stress has long been proven to be linked to the weakening of the immune system as well as cardiovascular disease (Black & Garbutt, 2002; Pruett, 2003). There is evidence to demonstrate that emotional well-being is pivotal to the prevention of physical illness (Vlachakis et al., 2018). John Cacioppo, who was a social neuroscientist at the University of Chicago, has underlined the devastating effects of loneliness on physicality, aging, and lifespan (Cacioppo & Patrick, 2008). There has been some fascinating work on the gut-brain connection, which highlights how the gut interacts with different centres of the brain to produce certain emotional states as well as enhance or erode cognition, and how the brain, in turn, is responsible for gut health Carabotti et al., 2015). Furthermore, several studies have shown how certain personality traits increase susceptibility to physical illness (Frıedman, 2008). 

According to the team at Cigna Healthcare, more than 90 per cent of adults who are diagnosed with psychological disorders are also seen to have a physical illness of one kind or the other (Shaklan, n.d.). It seems as though a majority of the medical community all across the world, however, is not entirely convinced yet. Consider visiting a medical practitioner or a general healthcare professional for any of the physical illnesses mentioned above. It is unlikely, in most cases, that the practitioner will adopt a bio-psycho-social model to treat or cure the afflictions of the patient.

The Deeper Cause

This may be bigger than the refusal or inability of medical practitioners to integrate these findings into healthcare. These are, of course, huge barriers. However, these barriers are likely to walk hand-in-hand with a more complex issue, an issue that permeates society as we know it today. It involves a term that has almost become overused in the lexicon of psychological communities- stigma. Ostracising individuals with mental illness, labeling them, and exhibiting biases against them is very much a reality in the world that we inhabit. Unfortunately, the general healthcare sector, whether actively or passively, perpetuates this stigma, and is very much a part of the larger landscape within which it can be acted out.

There have been studies performed in the Canadian setting that elaborate on the first-hand experiences of patients diagnosed with a mental illness who regularly encounter dismissive attitudes and experience feelings of belittlement whilst seeking treatment for their physical health (Thornicroft et al., 2007; Hamilton et al., 2016). There have been more studies that mirror or closely replicate these findings in geographical locations such as the Dominican Republic, Nicaragua, the United Kingdom, and several others (Waugh et al., 2017; Caplan et al., 2016; Medina et al., 2014). Veronica Karp, a 2021 candidate at the Mailman School of Public Health, Columbia University, has commented on the extent to which stigma and prejudice against individuals with mental illness pervade the general healthcare sector in the United States. In a compelling and thought-provoking article, Karp has used anecdotal evidence as well as factual knowledge to highlight this systemic bias. 

The Indian context is no better when it comes to stigma against patients with mental illness in healthcare communities. In a study conducted across five states in South India, doctors from different specialities in medicine were asked to participate in qualitative interviews (Munisami et al., 2020). These interviews revealed skeptical viewpoints towards psychiatric medication and covert negative bias towards mental illness. When it came to referring their patients to psychiatrists, a lot of doctors felt as though they did not have the knowledge or skills to convince their patients to see a psychiatrist. In another insightful study, multinational in nature, the Indian context, among others, was brought into the spotlight once again (Koschorke et al., 2021). Among Indian healthcare providers, there was found to be a perception that mental illness was fundamentally incurable. The healthcare providers admitted to commonly using offensive language within their circles to talk about individuals with mental health conditions. There was also direct acknowledgement of the existence of this stigma.

A Way Forward

The verdict? We cannot expect healthcare providers to entertain the body-mind connection and incorporate it into their assessments if they fail to see that the mind is just as sacred and divine as the body, something that needs to be respected, attended to, and taken care of. The dismantling of harmful and regressive beliefs surrounding mental health within the healthcare sector begins with regarding the mind as inseparable from the body. It continues with the understanding that mental health and illness are of concern to every single person on this planet. The ‘othering’ of individuals with mental illness often occurs due to notions of inherent difference and disconnection. Mental health and illness are not truly binary, they exist along a spectrum. All of us lie somewhere on this spectrum, whether we like it or not. Furthermore, the quality of our chronic mental and emotional states plays a significant role in dictating general health outcomes. True health is both physical and mental. Perhaps it is time for us, as a collective, to stop running away from this crucial aspect of our being. 

The next step would be addressing the myriad obstacles to the realistic implementation of this model within healthcare settings. There are no easy answers to this. But if healthcare providers make themselves truly cognizant of this interconnection, they may be able to find them.