Is this Pain “Disease” Mental or Physical?
Let me begin by noting how profoundly we stigmatise mental illness: walking into a doctor or physio’s office and hearing a solid “physical” diagnosis of this or that faulty bit of the body, honestly gives me a sense of relief. Why does it give me a sense of relief?
Someone else, other than me, has looked and found objective evidence for my injury/illness
And because it can objectively evaluate, then fixing that “broken” physical “thing” is possible, and improvements can be seen and measured
And because of the above two things, me and everyone around me, understands my injury/illness as being really real.
But of course, mental illness is also really real and often also has a physiological component. This understanding that there are actual physiological changes, is a huge step forward!
If you have ever delved into the history of medicine, you will have no doubt come across the eerie stories of doctors and scientists illegally digging up bodies in the middle of the night. Of them dissecting them and experimenting with them. Enter Frankenstein’s monster! This all sounds like science fiction now, but there is real truth to these stories. Thankfully this is no longer the case, but we owe a lot of our initial learning and understanding of the human body to those brave scientists.
Along with the advances in anatomy, biology and physiology, came a few theories that have since been proven otherwise. The most pervasive of which is what is now known as body dualism: that the mind and physical body function separately and completely independently from each other. This view made sense back then, after all, they were working with dead bodies, and so could not see the link between the body and the mind. They could not see how the state of the body has an impact on the mind; and how the state of the mind has an impact on the body. This understanding together with the view that the church at the time had, that any differences in our mental state was linked to the supernatural, was the perfect recipe for the stigmatisation of mental health.
Thankfully advances in research and technology have allowed us to look at brains and bodies while they are still alive (as a pose to the ones that were being illegally dug up!), and it is this research that is slowly correcting views, notions and stigmas, but correcting an idea that has ben so strongly held and supported by so many for so long, takes time. One of these technologies, the MRI and FMRI (functional MRI), has been used in studies looking at the brains of people who have chronic pain, OCD, anxiety, depression and other mental illnesses, and they have found that these brains look different to those of people not suffering from these illnesses. This tells us that there are physiological (that is physical) differences and changes in these brains. This is huge! This finding made scientists realise that the realm of emotions, thoughts and feelings all have an accompanying physical processes that underlie them. And in the same way our physical brains, the way that our brains are structured, can have an impact on our emotions, thoughts and feelings. Suddenly the categories of “physical” and “mental” became so intertwined, that one affects the other, which affects the other, which in turn affects the other, that it became difficult to really tease them apart.
The truth, however, is that we like categories. The “physical” and the “mental”. For things to fit neatly into little boxes. Don’t get me wrong, categories are useful, I wouldn’t want to rush into the hospital emergency room with a knife through my leg and have the doctor asking me questions about my mental health, but categories do have their limitations. And perhaps, now more than ever before, with our new understanding that mental illness has physiological changes that can be associated to them, perhaps we can allow these strict lines between the “physical” and “mental” categories to blur… to come to an understanding that the physical and mental interchangeably and ongoingly interact and alter each other.
If you have got this far into the blog you will no doubt be wondering what on earth does this all has to do with pain.
The answer is twofold:
Pain is made in the brain (see the blog post: “What is Pain?” for more on this) and so is also able to have physiological impacts on the brain and nervous system
Because pain is made in the brain it is also subject to being influenced by your thoughts and emotions.
Let’s look at an example: imagine walking out of your office, after a very busy chaotic day. It’s Monday, Mondays are always crazy, and its month end, which made the day even crazier. To add to the stress and chaos, your boss wasn’t happy with some of the work you had done, so you had to redo some of it which took ages, and you realised that a project you thought you had two weeks to complete, you now only have three days to work on. At home your 9-month-old child is sick which means you haven’t had all that much sleep, you are exhausted- which didn’t help for the crazy day you had, no wonder you couldn’t really concentrate in that 2-hour meeting; and should you take your child to the doctor again? Medical aid didn’t pay for the last two appointments, and they will probably not pay for the next one either, hmm… You look at your watch, you are late! You start jogging the last few meters to the car and don’t see the piece of uneven paving and you kick your toe! Hard! How does it feel?
Compare that to a very different day: you’ve had a good day at work, your ideas really helped a project move in the right direction, people listened intently to what you had to say and valued your input! It’s a Friday and the boss said that you can leave early! And you just got a message from your husband to say that he’s booked a surprise weekend away! You can’t wait to get home, so you take a jog, and again don’t see the uneven paving and kick your toe! Hard! How does it feel?
If you are anything like me, in the first example you will have said a few choice words, crumpled into a ball and cried out in pain. In the second example however, I probably would have jumped around a bit, but then very quickly continued to my car and will have all but forgotten about it by the time I put my car into reverse.
This example clearly shows how the mind is intricately linked to the body and visa/verse… same amount of damage in your toe (so same amount of physical damage) but completely different emotional states, which resulted in completely different experiences and levels of pain. This is a simple example of how mood can influence pain, but the concepts of our mental state influencing pain demonstrated in this example can be extrapolated out to mental health- anxiety, depression, PTSD etc and how it impacts on our pain.
The take home message here is that your mental “state” or mood as well as your mental illness (depression, anxiety, PTSD, etc) all have the ability to impact on pain and its management, and visa versa. So, to effectively manage your pain may require you to manage your mental health, and to manage your mental health may require you to manage your pain. This is where a team approach with your physio, doctor and psychologist (just to mention a few) is so important.
To conclude… yes, your illness/injury is physical, yes, your illness/injury is mental, your pain “disease” is physicalmental.
