July 22nd, 2022

It’s Not All in Your Head

One of the weirder blindspots I think therapists have is a lack of training around physical ailments. Medical doctors have some training on mental health issues, but it is odd, to put it mildly, how our healthcare system has decided that mental health and physical health are separate subjects. Now, don’t get me wrong, psychology as a field is expansive. Even with multiple graduate degrees, I feel out of my depth outside of the very specific type of therapy I do. The research being done in neuroscience is moving at Millennium Falcon speeds, and that is one of hundreds if not thousands of subsections of the psychology world, and if I didn’t see so many athletes I would have reason to try to keep up with that research. As it is, it is impossible to stay up-to-date on all the research going on in the field. So why am I bringing a whole other field of study up?

Well, I can’t tell you how many of my clients over the years have been told by a medical professional, “It’s all in your head.” It’s a lot. More than one would be too many, but I can safely say I have always, in a decade plus of work, always had more than one client who had a misdiagnosed or undiagnosed physical condition be negatively impacting their mental health. I’ve built up a long list of weird, obscure, once-in-a-lifetime diagnoses that tend to be missed or overlooked by medical professionals that present loosely as a mental issue. And while I have a lot of negative things to say about the medical field, and even more about our awful, inefficient, nonsensical approach to healthcare in this country, this post isn’t about throwing shade at other professionals. Well, some shade, but the point is to talk about how mental and physical health are not at all separate, they’re intrinsically connected and impossible to split apart. A big “DUH” is warranted here. Our heads, the place where our brains reside, are connected to the rest of our body. And much of our bodily functions are regulated by that very same organ. The brain, in turn, responds to nonstop signals the body is sending. The brain is a part of our physical body. Pretty basic concept. So why are professionals saying things like, “it’s all in your head”???? 

Look, if you have anxiety, some of the most common diagnostic features are physical symptoms. Heart racing, sweaty palms, trouble breathing, all physical signs. If you have Crohn’s disease and can’t trust how your body will respond to food or have difficulty maintaining a consistent level of energy, you might get diagnosed first with an anxiety issue or depression. But treating someone with Crohn’s for depression instead of treating the Crohn’s won’t help. Lyme disease, POTS, literally anything that affects the thyroid, and a whole host of autoimmune issues often look a lot like mental health issues. Pain that is hard to localize and seems to not follow any pattern, weird bowel activity, lethargy and reduced interest in activities, sure, I can see where doctors think these things look like anxiety or depression. But, none of these issues will get better with therapy, because the mental symptoms are all in response to the physical issue. If you don’t know if your body will violently expel anything you eat, you naturally will develop some anxiety about eating in public settings. That is your brain working correctly! But if a doctor can’t figure out an issue off the top of their head after a five minute interview, well, “probs go talk to a therapist, it’s just anxiety.” Heaven forbid I see a new client who is coming in with an IBS or fibromyalgia diagnosis. Those are real issues that get diagnoses that don’t mean anything, and a doctor is just passing it off blaming a person for having a set of symptoms that are hard to figure out. 

Now, none of this is taking shots at the people suffering. These very real issues are exhausting to live with, and so having reactions that fall in the mental health realm is legit and totally justified. But when you’re exhausted, physically from your ailment and mentally from no one giving you helpful answers, the last thing you want to do is advocate for yourself in a healthcare setting. But that is often where I start with clients. Or where we land after five or six sessions when none of the work we’re doing in therapy is helping much and a client finally mentions (usually offhand) that they have this lingering health concern. 

Clients, tell your therapists about your health issues! 

Therapists, assess your clients for physical symptoms!

Treating your body well makes your brain function better. Your brain functioning better helps you to feel good about your body. Getting enough sleep helps your mental health because it helps your physical health. Cutting back on drinking, or starting a new workout routine, or hydrating properly all help your mental health because they make your body healthier first. It’s not all in your head, it’s all connected.