Mental Health

What is the difference between physical and mental health?

Abstract: Mental illness carries a stigma, yet it may result from similar external causes as physical disease.

It is proposed that mental and emotional diseases co-exist, as organic and non-organic mental diseases, and that both are founded and should therefore be managed on the basis of dysfunction and suffering.

Just a physical health is usually associated with a young lady wearing a summer dress and a floppy hat,  skipping through a golden cornfield barefoot in the midday sun, so mental health is … well what is it? We all know what mental disease is (stigma included), and that’s not good. What does, “mental” mean anyway?

Mental – relating to the mind or involving the process of thinking.

Mental relates to the mind, whereas brain relates to that organ, the brain. So, what is the mind and what’s the difference to diseases of the brain (same thing isn’t it – your mind is in your brain, right?)

Mind – the part of a person that makes it possible for him or her to think, feel emotions, and understand things.

So it appears that brain disease is organic – organic brain disorder (OMD) which is a disorder of decreased mental (mind) function DUE to a medical or physical disease. So, if you got hit over the head the cause of the disorder would be organic right?

Not necessarily as you would likely have thought about being hit on the head and that may very well (and you cold consider, quite reasonably) affect future response (reaction or disorder). Let’s stay with the physical or medical cause for the time being (although that’s clearly not as straightforward as it may seem).

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Some possibilities of examples include;

Brain Trauma.

Bleeding into the brain (stroke), bleeding around the brain), pressure causing blood clots within the skull.

Do breathing disorders affect the brain?

Obstructive sleep apnea (OSA) springs to mind. The low oxygen levels in the blood, resulting from the inability to breath affects various responses (reaction times, mood, executive function) as it also shrinks the white matter of the frontal lobes (it is believed reversibly).

An increase in CO2 (hypercapnia) also affects the brain organically.

Does cardiovascular disease affect the brain?

Cardiovascular disease such as arrhythmias (common in OSA), high blood pressure (hypertension), stroke, heart infections such as endocarditis) are all potential causes of OBD.

What are the dementias

Often considered first are the dementias following damage, Alzheimer’s disease (plaques), Creutzfeldt-Jakob disease, Diffuse Lewy Body disease, Huntington’s disease (used ti be called Huntingdon’s chorea when I was at school), Multiple Sclerosis (MS), Parkinson’s disease, etc.

Brain diseases secondary to medical disease

Then there’s the diseases secondary to medical disease specifically (metabolic imbalance), kidney, liver, thyroid disease, or vitamin deficiencies like B1, B12 or folate)

Drug and alcohol related brain damage.

Brain damage due to chemical toxicity

Toxicity, especially heavy metals like lithium, aluminium and mercury.

Brain infections cause brain damage

Brain infections directly including sepsis (potentially from any area but likely head, face, neck. Encephalitis or Meningitis, Prion infections (Mad Cow Disease for example), or tertiary syphilis.

I needed to get these out of the way before we can go to the mental diseases, we are most uncomfortable about. What is non-organic or “behavioural” disease?  

Unfortunately, most of those who see a doctor present subjective suffering and behaviour that are problematic to classify as illness for this reason. As you can see however, that there is a fine line in cause and a precarious balance in their effect (signs and symptoms).

A differential diagnosis – organic v. non-organic brain disease.

There are no “pathobiological foundation” for such classification is demonstrated no matter how thoroughly the patients are examined, tested or regardless of how long they are followed up.

While organic illnesses are characterized by physical and biochemical signs, non-organic disorders show only as distressing experiences (pains or anxiety) or undesirable responsive behaviour (such as drug or alcohol abuse), experiences that are inseparable from ‘normal’ actions, sensation, emotion, and intentions.

In cases of subjective suffering or behavioural deviances treatment or therapy consists of general relief, correction and sedation, all of ta similar kind that we make use of in our everyday lives. Is Cognitive Behavioural Therapy a coping mechanism?

So is the problem real and if so, how do we know?

If the majority of those who consult a doctor are not really organically  ill, what then, is the alternative? Individual and collective misery? A widely held opinion, however, is that non-organic disorders fulfill the criteria for illness.

This means that some kind of pathological substrate is postulated even when we fail to demonstrate its existence. We see the effects of electricity (the light goes on), most of us don’t really know why and how it works, and none of us (that would admit it) can see electricity, only its effect.

A different approach

The crucial point, therefore, is not to solve the problem of whether a person is ill or not, but it is to understand that we are dealing with two separate areas, with strong overlap, a bio-pathological and a psycho-physiological disorder, both founded on dysfunction and suffering.

After many years in study and practice around pain two things are clear to me. First, pain is individual, that is to say one person’s pain is not necessarily the same as the other’s identification or experience of it. Secondly, mental (emotional) pain can be greater than physical pain.

A different way to understand.

Clearly to even consider looking good and feeling younger with an emphasis on health, realistically, both organic and non-organic mental disease must to be understood, at least basically, not to differentiate but rather to recognize the confluence.

If someone has a heart attack you wouldn’t ignore the disease and ask them to dig out the driveway next day (if it was Canada in the Winter), yet just because you can’t “see” mental disease or test for it in the same way as post-infarction testing, it doesn’t mean that there is no damage, dysfunction nor consequences to ignoring them.

Dr Stephen Bray 2019

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