Episode 13 – The body and the mind: Responsibility and Blame.

An autobiography in 5 short chapters by Portia Nelson can be read here: http://www.doorway-to-self-esteem.com/autobiography-in-five-short-chapters.html

The body and mind are not two separate entities, they are intricately and absolutely related to each other. Things that we traditionally consider to be physical illnesses undoubtedly have a major impact on our state of mind, and our state of mind has an equal impact on our physical condition. Trying to separate the body and mind, thinking of some conditions as “mental health” conditions and others as “physical health” conditions makes no sense. More to the point it is an unhelpful way of trying to understand humans and can stop us from being healthy.

The concepts of a symptom being “only in your head”, as though this somehow makes it less real, less serious, and less unpleasant; and the reverse, believing a symptom to be purely due to an underlying physical disease process, and therefore completely outside our power to influence, are equally harmful to our ability to heal and be well.  

People sometimes tell me they can’t possibly make changes to their lifestyle because they “have” depression. They consider this to be an all-consuming physical disease that negates any responsibility they have for their own state of mind and health.

Conversely people sometimes become upset when I suggest they need to consider alternative therapies, such as meditation or relaxation to help with a physical symptom such as pain. “It’s not all in my head!” they say, once again not wanting to accept responsibility for their own health and wellbeing.  On one occasion a patient furiously made this statement regarding their chronic daily headache. I am ashamed to say that I responded that it was exactly all in his head. The clue was in the name –  it’s a “headache”. As you can imagine this went down like a lead balloon. I regret it, it was unhelpful. But my frustration highlighted a fundamental problem, a misunderstanding that contributes to so much ill health and which I had no idea how to address in the confines of a 10 minute consultation. I had no podcasts to refer to, I didn’t know how to help with the resources I had. My meanness was a symptom of my frustration at not being able to help, plus I didn’t really like being shouted at when “I was only trying to help”. It was before I had learnt to manage my mind.

The fact is he was right. It wasn’t all in his mind. It’s never all in your mind. But conversely, it’s never all in your body either. The body and mind are not two separate things, they work together in a wholly interconnected way. The body influences the mind, but equally the mind can influence the physical state of the body.

Most people can readily accept that the physical conditions in the body can influence how we think and feel. It seems obvious. My favourite example is alcohol. Alcohol is a simple chemical made up of a few carbon, hydrogen and oxygen atoms, but it can massively influence the way we think, feel and behave. There is little doubt that our mental state is influenced by the the physical, chemical and electrical make up of our brains. What is less obvious is that our mental state, what we think and how we feel, has an influence on the physical state of our bodies.

A great example of this is an experiment that was undertaken in rats where scientists injected half with a happiness hormone called dopamine. Then they infected all the rats with bacteria, or cancer cells. They found that the happy rats were able to clear both the infection and the cancer more effectively than the rats without the extra dopamine. This suggests that feeling happy may be able to prevent or even cure cancer. There are plenty of similar examples in day to day life. Thinking about food can make your mouth water, and feeling anxious can make your heart beat faster. How we think and feel has just as much impact our physical state of health as our physical health has on our mental state.

The idea that you can’t “think your way out of depression” or “think your way out of pain or illness” because these are physical conditions that thoughts have no control over is not entirely true. Of course, it is more complex than this, and I’m not suggesting that everyone can completely cure all their illnesses just through “the power of the mind”. This commits the opposite error, and fails to recognise the importance of the body. Humans have both a body and a mind, and both are equally important, equally responsible, for our state of health and wellbeing. If we focus wholly on one and not the other, we will be neglecting and failing to nurture a part of ourselves. Our thoughts and feelings about ourselves, our illnesses, and the world have a far greater role to play in our state of health than the traditional views of western medicine, body and mind, give credit for.

Failing to recognise this integration of the body and mind is harmful to us. It leads us to fail to take appropriate responsibility for our own wellbeing. I think part of the reason people become upset at the implication that their symptoms are “all in the mind” comes down to the issue of responsibility, and with it blame. It is emotive because we tend to believe that the thoughts that we have are, or at least should be, in our control, whilst physical processes in the body or brain are not. If then, we believe that a symptom, either mental or physical, is “in the mind” we are responsible for it, we are to blame for it. We feel that the symptom is less legitimate, that we are less deserving of sympathy and medical attention. If the symptom is due to a physical disease, we are not responsible for it. It’s not our fault, we are strong and brave for fighting or enduring a condition not of our making, and are entitled to love, sympathy and a “just giving” page.

This is one reason why historically there was so much stigma attached to mental illness, and why this stigma is slowly improving in modern society. We are more and more seeing mental illness as a physical disease rather than a mental one, an affliction that we are struck down with, through no fault of our own. We are therefore more comfortable admitting that we are suffering from it.

Unfortunately, this concept of depression and anxiety also renders us powerless to do anything about it. If we are not responsible for it, then we have no control over it. If we believe we are unable to actively influence our own state of health we will never take the action we need to heal and be well. By not taking responsibility we are inadvertently depriving ourselves of the means to get better. In order to avoid the pain of responsibility we are dooming ourselves to chronic ill health. If we want to be well, we must take responsibility for our own health, mostly because no one else is going to, because ultimately no one else can. Only you have the power to change what you think, how you feel and what you do. Your state of health and wellbeing is largely dependent on what you think, how you feel and what you do.

In starting to recognise that depression and anxiety are related to physical conditions in the body and brain we have committed the opposite error; failing to recognise the importance of our thoughts and feelings. I’m not saying we should re-stigmatize mental health – stigma is rarely helpful, but I do think it has perhaps been destigmatized for some of the wrong reasons, and maybe in a slightly unhelpful way. Raising awareness of a condition isn’t very helpful without also raising awareness of how to deal with it. If there is no treatment, I for one, would rather not know about it.

I have had 12 year olds tell me they are unable to go to school because they have depression and anxiety. They see it as a disease they are suffering from, which they are powerless to influence. I’m not sure that many 12 year olds in my generation really had a concept of depression and anxiety at all, and I suspect developing a strong belief at a young age that you are suffering from a mental illness beyond your control is fairly harmful to your overall growth and development.

The reason we should be destigmatizing mental health isn’t that it is purely physical, and outside our control, it is because mental symptoms and physical symptoms should be thought of in exactly the same way. Both are equally influenced by the mental and the physical, by our overall state of being as humans. We are equally responsible for our physical health as our mental health, and we are equally entitled to love, care, sympathy and medical attention regardless of the type of symptom or disease we are suffering from, be that pain, anxiety, cancer, depression, epilepsy or functional seizures. We are responsible for all these conditions and ultimately for our own health, but this responsibility does not detract from our entitlement to care.

It is this pattern of thinking that makes us so resistant to the idea that our thoughts, feeling, actions and lifestyles are the key to our health, both mental and physical. We don’t want to have to take responsibility for our health because we don’t want to accept the shame this implies, for being unhealthy in the first place, or the blame should we try to get better and fail. We tell ourselves, and others, “It’s not me, it’s my hormones, my depression, my back pain, my illness…”

But this fear of blame represents a major thought error that is incredibly harmful to us.

Taking responsibility for yourself does not confer blame. Just because we are responsible for something does not mean that we are also to blame for it. They are separate concepts and it is possible to have one without the other.

You will remember from episode 7 that if we want to make positive change this must come from love and not from hate. If we link responsibility to blame and shame, we will struggle to accept the responsibility. It will be too painful. We will make it mean something negative about us, and we will create endless excuses about why we are not responsible, or even why we are not unhealthy, in order to avoid the shame it causes us. But unless we accept responsibility we will not get better. We will never be able to change or grow. We need to learn how to take responsibility without also taking blame. To take responsibility out of love and compassion for ourselves.

Let’s say I’m working nights in A+E, the waiting room is packed, people are waiting hours to be seen. It’s not my fault that the department is busy, I had no control over how many people walked through the doors, or how many doctors and nurses the NHS could afford to employ. But it is still my responsibility to manage the situation; to prioritise as best I can and treat the patients. Just because something is not my fault does not mean it is not my responsibility. Now let’s say on the next night its quiet, but a patient comes in with a condition I’m not very good at or have never seen before. I am responsible for my knowledge and skill, or lack of it, and I am responsible for the patient, even if I am not familiar with their condition. However, I am not to blame for my lack of knowledge. There are thousands of medical problems, some of which are very rare. I am not in control of what I have or haven’t seen before, or of what happens to come through the door on any particular night. Just because something is my responsibility does not mean that I am to blame if it doesn’t work out.

Once we learn to conceptually separate responsibility from blame, responsibility ceases to be frightening, and instead becomes empowering. By taking responsibility for something we gain control over it and can learn to master it. Taking responsibility allows us to actively seek solutions to our problems. Refusing to accept responsibility has the opposite effect. If we believe we are powerless to influence a problem, if we tell ourselves it is outside of our control, this will be a self-fulfilling prophecy. We will not act because of this belief, and the problem will not be resolved. It is outside of our control precisely because we tell ourselves that it is outside of our control. We will have given away our power and freedom by choosing to believe that we are powerless and not free. We are choosing to be helpless and hopeless, all because of a misplaced fear of blame.

The first step towards better health and happiness is taking responsibility for your own health and happiness. Only once you are willing to accept this responsibility can you gain control and power. But you must do this through love and compassion, and not through shame, blame and self-hate.

You are responsible, but you are not to blame.

Responsibility is good, because it comes with power.

It is never all in your head, but it’s never all in your body either.

The body and mind are not two separate things but are intricately and inseparably related.

Mental health and physical health are not two different types of problem, both are equally influenced by physical and mental factors, and they should be thought of and addressed in exactly the same way.

You are in control of your own thoughts, feelings and actions.

You get to choose what you want to think.

Your thoughts create your feelings. Your thoughts and feelings determine your actions.

Your thoughts, feelings and actions are the key determinants of your health, both physical and mental.

These ideas are summed up beautifully in a poem by Portia Nelson called an autobiography in five short chapters, and your homework this week is to go and read it. I will put a link to it on my website and facebook page.