What Is Psycho Somatic Medicine?
Strictly speaking, psycho somatic medicine refers to a sub-speciality in the field of psychiatry concerned with physical diseases which have a strong psychological component. In this article we will explore the subject from a broader perspective, that of psycho somatic healing
Psycho-somatic healing is an approach to understanding how health and disease arise from the relationship between the mind and body
It provides a holistic view of the patient, appreciating that emotional and mental states can impact all your physical systems, from your ability to fight infection and disease to wound healing, and even your appetite and digestion
By understanding the physical, emotional, and environmental influences on our health we can begin to take control of our wellbeing and improve our whole quality of life
The sections that follow will explore the world of mind-body medicine: some of the major illnesses and syndromes considered psycho somatic; the principle pathways connecting mind and body; why and how too much stress is bad for you; and how you can find tranquility, stability and health in a tumultuous and stressful world
Psychosomatic Symptoms And Illnesses
In as much as all thoughts, emotions and physical processes are inextricably linked all states of health and disease can be said to lie within the psycho-somatic spectrum. The field is certainly complex, with organic (existing in the body), and psycho-genic (originating in the mind) disease at the extreme ends and much blurring of the edges in everything in between
Some diseases under the psycho somatic umbrella have an organic basis but may be precipitated by stress. These include
- diabetes
- auto-immune disease
Others have a poorly established physical cause and a strong relationship to stress, such as
- High blood pressure
- Some forms of gastritis or peptic ulcers
- Migraines & tension headaches
- Dermatitis eg. psoriasis
Others still display very clear symptoms with little or no demonstrable physical abnormality. These functional or non-organic diseases also form part of the psycho somatic spectrum. Example include
- Irritable bowel
- Breathing pattern disorder (BPD) & hyperventilation
- Interstitial cystitis
Fibromyalgia, chronic fatigue and some forms of chronic pain have been historically classified as functional at best, and psychogenic (in the mind) at worst. The eventual demonstration of physical disturbances associated with all three has highlighted the danger of considering functional disease as being all in the mind
How Are The Mind And Body Connected
While it’s not difficult to understand how physical illness and pain can impact you emotionally, how, you might ask does a mental state aggravate your gut or increase your blood pressure?
To answer this we look at how the body orchestrates the countless activities that make up our physiology and metabolism. The human body is regulated by three great interconnected systems
- The Nervous System –
- processes data and regulates bodily functions on a moment to moment basis through electrical impulses travelling along nerves
- The Endocrine System –
- does this over days, weeks or months by means of circulating messengers we call hormones. Finally
- The immune system –
- distinguishes between self and other to keep us safe from external and internal invaders, including bacteria, viruses and malignant cells
Let’s look at some of the major ways the three systems work together
Stress And Health
The General Adaptation Syndrome
The GAS was described by Dr Hans Selye, who coined the term “stress” as we know it today
Dr Selye noted that when we appraise any situation as challenging, the body mounts a stereotypical response by way of a cascade of hormones which starts in the brain (hypothalamus) and ends with the release of the steroid hormone cortisol from the adrenal cortex
This adaptation to stress is essential for survival in its acute phase. Cortisol raises blood sugar and provides the body with the resources it needs to respond effectively to a stressor. Long term, however, elevated levels of cortisol is responsible for many of the harmful effects of stress on our health, including
- Anxiety
- Depression
- Digestive problems
- Headaches
- Muscle tension and pain
- Poor sleep
- Heart disease, and stroke
Stress and inflammation
Inflammation is one of the most basic responses of the innate immune system to protect us from injury and disease. While inflammation is protective it can, when excessive, prolonged (chronic) or inappropriate (eg auto-immunity) cause us harm
Harmful effects from inflammation include
- Bronchospasm in asthma
- Intestinal inflammation (Chrohn’s, Ulcerative Colitis, Coeliac’s) with pain, diarrhoea and impaired absorption
- Arthritis with joint swelling with pain
- Blood vessel damage with deposition of fibro-fatty plaques (atheroma) causing obstruction
- A range of mental health issues including depression
A recent literature review by Viktoriya Maydych (2019) finds that current research supports a direct link between stress, inflammation and reduced emotional attention, the triad itself being a predictor of depression
Nervous System
The nervous system can be (artificially) divided into sub-systems. Of interest to psycho somatics is the division into
- Somatic Nervous System–
- associated with movement and sensation, and
- Autonomic Nervous System (ANS) –
- associated with involuntary internal functions such as digestion, breathing and blood pressure. The ANS is also involved in modulating inflammation
Autonomic Nervous System
- Sympathetic system (SNS)
- mediating your response to danger, thereby preparing your body for fight or flight
SNS activity is associated with stress and is pro-inflammatory. Though essential for our survival, persistent activation is associated with many of the harmful effects of stress and inflammation
Rest & Digest
- The Parasympathetic system (PSNS)
- is associated with two distinct responses:
- Rest, digest and social interactivity
- in response to sensing safety – this is a relatively recent adaptation, thought to be unique to mammals
- Freeze reactions (feigning death)
- to a situation percieved as a major threat to survival – this is an older response to threat, shared by other species, such as reptiles. It is associated with overwhelm and thought to be a factor in post-traumatic stress
Rest and digest responses are associated with feelings of safety and are anti-inflammatory, helping the body heal, repair and replenish its resouces
The vagus nerve is the main purveyor of signals organizing visceral rest and digest responses. I’ll have lots to say about the vagus and polyvagal theory in later posts
Treatments For Psychosomatic Wellbeing
The management of psycho-somatic manifestations encompass the whole mind – body spectrum. In some cases, where the psychological issues are too deeply buried or too painful to confront a psychotherapeutic or psychiatric approach may the best option
Common therapeutic interventions include
- cognitive behavioural therapy (CBT)
- mindfulness based stress reduction (MBSR)
- medications such as antidepressants
Outside the world of professional psychological support there is also a wide range of tools to help you alleviate your symptoms and take greater charge of your wellbeing
Activities which can help you manage stress include
- exercising regularly
- eating a balanced diet
- getting enough sleep and rest
- seeking support from colleagues, friends and family
- knowing your limits and avoiding putting undue pressure on yourself
The contribution of meditation and mindfulness-based movement therapies to psycho somatic health is well supported by evidence. Effective disciplines include
- mindfulness meditation
- yoga
- Tai Chi
- Qi Gong
- and more
Yoga For Mental & Physical Wellbeing
With its triad of gentle movement, breath regulation and mindful attention yoga has been found to help with a plethora of physical and psychological symptoms, including
- blood pressure
- cholesterol profile
- digestion and bowel function
- chronic pain relief
- anxiety and stress management
along with a host of other physical and emotional issues. Click the link to learn more about how the regular practice of yoga and meditation can help you heal your body, mind and spirit
Osteopathy For Mind-Body Health
The role of body-work in managing your psycho-somatic wellbeing is well documented. Most holistic body therapies embrace the philosophy of body-mind unity. This includes holistic massage, rolfing, shiatsu, tuina, chiropractic and osteopathy
Therefore, I’d like to finish this article with a mention of the contribution of osteopathy to mind-body medicine. Because I’m an osteopath. And because of a tendency in the popular mind to think on osteopathy a purely manual therapy to deal with your aches and pains
While we osteopaths hopefully do a good job of fixing your back, osteopathy itself is a holistic system of healthcare which works with your structure in order to achieve complete physical and mental wellbeing. Osteopaths aim to create an optimal physical environment for all your vital functions to thrive
Osteopaths work with the functional and structural relationships between the musculo-skeletal system (soma), internal organs (viscera), and psyche (mind) with the spine as the principle gateway to the central nervous system
It’s no coincidence that of the list of conditions the profession can claim to help, based on sufficient evidence, lie mostly within the psychosomatic spectrum
Click the link to see some of the more common conditions osteopathy can help you with
Having explored stress, inflammation, safety and wellbeing, and other factors relevant to psycho somatic health we can begin to put theory into practice. Here’s a deeply soothing yoga technique for reducing stress and inducing deep relaxation: yoga nidra – the psychic sleep of the yogi. See you in the next article.
A Note:
In this article we’ve focused on the impact of mental states on the body. The influence of the body on the psyche cannot be overstated. The discovery of a gut-brain axis linking your intestinal micro-organisms to your emotional state, for example, has revolutionized our understanding of metal health and will be dealt with in a separate article
Let’s do some yoga nidra