By Daniel A. Plotkin, MD, MPH, PhD
It’s just a fact of living: Aging brings with it more physical/medical conditions, things we didn’t experience as younger adults. That’s why the connection between mental and physical health becomes increasingly crucial as we age. Understanding the power of this mind-body connectivity is essential for promoting healthy aging and developing effective interventions.
Research has demonstrated that the mind-body relationship in older adults is complex and goes in both directions: mind affects body and body affects mind. From my own perspective as a geriatric psychiatrist (meaning that I specialize in the mental health of older adults) is that all medical conditions are a combination of mental and physical factors, and it’s usually impossible to tease out the various contributions in any kind of precise way. Sometimes it seems like it’s approximately 50%-50%, sometimes it’s 90%-10%, or 10%-90%. But in any case, it’s rare to have a condition that is 100% physical/body or 100% mental/mind.
For the many conditions that are well-known to be a good mix of mind and body, we have labels such as “psychosomatic.” Pioneers in the field of psychosomatics include Sigmund Freud and many others; they considered psychosomatic illness to be just as real and important as any other condition. Indeed, they studied people with psychosomatic illness to learn how the mind-body connection could be leveraged to help patients.
These days, the idea that our body is connected to our minds is popularized in books such as “The Body Keeps the Score” by Bessel Van Der Kolk, which has topped non-fiction bestseller lists for years.
But unfortunately, terms such as “psychosomatic” are still often used in a pejorative manner, to dismiss symptoms that may be difficult to nail down with any kind of certainty. People, just like investment markets (which are of course composed of people), like certainty! We also like simplicity and clear-cut answers. But these preferences do not always serve us well.
For example, this kind of thinking can lead to some all-too-familiar statements such as “the tests show you’re fine, nothing is wrong” (when patients get “negative” test results). But a negative test does not mean there’s no problem. What it means is that the test (laboratory or imaging or whatever) does not reveal any known abnormality. That is well enough and should be reassuring.
Instead, patients are often told directly or indirectly that there is “nothing wrong” or that “it’s all in your head.” There is a big difference between a test result that does not reveal an abnormality and a (false) conclusion that there is indeed no abnormality.
Our current tests, despite being amazing in their own right, are often not sensitive enough to show the abnormalities that are most certainly there. Even such bright and shiny tests as MRI (magnetic resonance imaging) or PET (positron emission tomography) scans are not infallible or without limitations. It’s helpful to recall how, before the microscope, bacteria were unknown. But just because no one could see the bacteria didn’t mean that they weren’t there. We still don’t have microscopes that can be used in the clinic or office or hospital to visualize viruses or inflammation at the cellular level.
Some of us are familiar with terms like false-positive (something that appears to be abnormal but really isn’t) and false-negative (something that appears to be normal but really isn’t), which are specific types of limitations. In any event, the bottom line is that a “negative” or normal test result should be reassuring, but to keep in mind “not everything that can be counted counts and not everything that counts can be counted” (attributed to Albert Einstein).
A good approach is to assume that whatever a person experiences is “real” even if it’s not always demonstrable with current testing, or even if it doesn’t seem realistic. Even symptoms that are demonstrably false, such as delusions or hallucinations, are still emotionally real and should be identified and respected.
While the mind-body connection is undoubtedly “real” and may even be obvious, the way in which mind and body are connected remains somewhat of a mystery. It surely involves the brain, and probably involves specific parts of the brain, like the ones that give rise to the vagus nerve, a superhighway from the brain to the abdomen. It also surely involves special chemicals like neurotransmitters (like serotonin) and hormones (e.g., the stress hormones produced by the adrenal gland). It may even involve the billions of bacteria that live within us.
Here are two particularly interesting examples to help us appreciate the mind-body connection: The first is the placebo effect, which can be a window into the mind-body mystery. The placebo response involves a favorable response to an intervention with no known physiologic effect, such as when people feel better after taking an inert pill. It is part and parcel of everything doctors do to help patients, including prescribing medications, doing surgery and talking.
It shows us that humans respond to interventions based on intangibles such as suggestion, expectations, beliefs and trust. The effects are so profound that it’s a crucial consideration in clinical research trials, to determine whether the treatment under consideration really works. The placebo effect is a prime example of how the mind affects the body.
Another example of how our minds affect our bodies involves the work of Becca Levy at Yale. Dr. Levy has demonstrated how “negative age stereotypes” are associated with increased vulnerability to medical conditions. For example, people who believe that they will inevitably develop dementia are at higher risk of developing dementia compared to people without such beliefs. Likewise, people who believe that old age inevitably leads to loneliness and sadness are at a higher risk of developing depression compared to those without such beliefs.
Whatever the mechanisms are (and someday they will be better understood), it behooves us to develop techniques to help people who may be struggling with physical conditions that are fairly clearly influenced by one’s mental state — that is to say, most medical conditions!
One way to organize such approaches is to consider top-down versus bottom-up. Top-down refers to psychotherapy and other therapies involving conscious engagement and use of ideas and thoughts and feelings. Bottom-up refers to therapies that influence one’s inner psychic state by way of the body. Such somatic healing therapies include breathing techniques, meditation, yoga, tai chi, and other “Eastern” approaches as well as more involved therapies such as sensorimotor therapy or somatic experiencing.
When we appreciate just how intimately connected the mind and body are, we can take many more opportunities to manage our health conditions to achieve a better quality of life. Since almost all medical conditions are a mix of mental and physical factors, all symptoms are therefore real and should be addressed with respect.
While we don’t yet understand exactly how the mind and body are connected or how therapeutic approaches work on a cellular level, it’s clear that helpful approaches exist and can be utilized now, while we await exciting discoveries and satisfying explanations in the future.
Daniel A. Plotkin, MD, MPH, PhD, was the first director of UCLA Alzheimer’s Disease & Memory Disorders Service and is a past president of the Southern California Psychiatric Society. This is an excerpt from a book-in-progress.