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Emotional Medicine

by Dr Jenna Alice Burton(more info)

listed in mind matters, originally published in issue 221 - April 2015

Concern is growing for the continuous increase in mental health disorders within the western world. Likewise, psychosomatic conditions such as irritable bowel syndrome, chronic fatigue and fibromyalgia are subsequently increasing. Dr Jenna Burton discusses how the inability to manage our emotional outlets within a more complex and pressurized social environment may be affecting both our mental and physical health. 

Depression, an image

Mental Health is Not Simply Genetic

Today in the UK, 1 in 5 adults will suffer with some level of depression, with 1 in 4 suffering with some form of mental health concern during the course of a given year.[1] As a developing country, we continue to make advances in technology, academia and medical treatment. Yet it seems, as emotional beings, we are failing to cope with the pressures and expectations of a modern day existence.

Mental health can undoubtedly be secondary to a genetic predisposition, but the reality is that our environment also influences aspects of our mental health. Traumatic experiences can result in the development of Post-Traumatic Stress Disorder, pressures in athletic performance can lead to Anorexia Nervosa and financial concerns can frequently result in suicide.

Yet it seems not every population is equally affected by the epidemic of mental health. Data significantly suggests those in the first world are more likely to suffer with depression than those in more under developed regions.[2] What is it about modern day life and convenience that is leading to deterioration in our happiness?

Animals and The Third World

If we consider our evolutionary immature human species, the monkey, the average monkey has to consider, daily, how it will satisfy its 5 basic needs (according to Maslow’s hierarchy): food, warmth, shelter, a reproductive mate and water on a daily basis.

A fellow human being living generations before our time, when food and drink were scarce, likely again preoccupied their minds with little other than reaching these 5 basic needs. Given this very basic daily challenge, few animals living in the wild or women trying to feed their children during the cave man era would find themselves with symptoms of a mental health disorder. Few found themselves clinically depressed despite a considered less fortunate existence.

It seems, with our apparent comfortable existence, we are just not comfortable. If not faced with physical danger, we are faced with emotional burden and much more complex, deeper emotional baggage than those of our ancestors. There is evidence that stressful life events are now more casual than they were previously. A study of 13,006 people in Denmark with their first psychiatric admission were found to have higher rates of unemployment and divorce than those with age and gender matched controls.[3] The externally perceived severity of the stressor is not directly proportional to the physical or psychological impact on the individual.

Emotional Constipation and Chronic Disease

As a physician, I witness more and more chronic diseases born from an emotional constipation. People seem to lack the ability to process how they are feeling. Aside from the psychological trauma of impaired emotional regulation, we also have to consider how this is affecting our physical form. During a daily surgery it is common to see 50% of presenting conditions born from psychological disease as opposed to traditional physiological illness. Most commonly these are depression and anxiety.

People complain of chronic pain, headaches, jaw pain from clenching, infertility, hormonal abnormalities, heart burn, impotence, uncontrolled anger, insomnia, vertigo, fatigue, weight gain, weight loss, tingling sensations in their fingers, abdominal distress and addictions. These patients become perplexed when results repeatedly come back as  ‘normal’ despite ongoing symptomatology. After an initial attempt to justify their symptoms, patients later reveal their stress levels or their sadness.

A recent patient had a 4 year history of chronic fatigue. He slurred his speech and was sleepy throughout the day despite 9 hours uninterrupted rest every evening. It was apparent early on that this gentleman had an emotional undercurrent to his symptoms with many risk factors and symptoms for depression. He denied this and refused to believe that there was anything unbalanced besides an underlying physical condition. In fact he had convinced himself that he had an infectious disease from a trip to Africa. He was persistent with this even following the ‘all clear’ from a reputable UK infectious disease consultant and their team along with numerous investigations and cultures.

As treatments such as cognitive behaviour therapy (CBT) were declined for a substantial period of time, he become progressively worse. We continued to search for the cause of his illness via CT scans, blood tests and XRAYs, but not one negative result gave him the reassurance he desired. Eventually he opted to give therapy a trial, as a last desperate resort. Following the first few sessions he discovered more energy and enthusiasm for life. The result was a grounded, healthy individual with a regret for delaying appropriate treatment to balance his emotions effectively.

Although it is appropriate to rule out physical disease before diagnosing an emotional derivative, we can still appreciate the scale of burden caused by such conditions. By managing these, we can potentially save populations from chronic, unnecessary health concerns. In the Nurses’ Health Study, men and women suffering with anxiety were twice as likely to have a heart attack as opposed to those with no history of an anxiety disorder.[4]

Harvard Medical School published in their 2008 newsletter that “treating anxiety can often improve the outcome of chronic disease”. They stated that anxiety was taking a toll on our physical health via stimulation of the amygdala (a region within the brain governing emotional response.) Stimulation of the amygdala activates the ‘fight or flight’ response (via the sympathetic nervous system) which, in turn, tenses muscles, diverts blood away from the digestive organs, fires up our immune system and increases our heart and respiratory rate. In the short term this can be beneficial. Chronically, however, it causes internal fatigue, a weakened immune system and an array of digestive disorders.

10-20% of Americans are suffering with functional dyspepsia and IBS.[4] IBS in particular is seen in several psychiatric co-morbidities and is proven to be related to Post Traumatic Stress Disorder.[5] Although not life threatening disorders, they largely affect a patient’s quality of life, resulting in symptoms such as bloating, abdominal pain, vomiting, diarrhoea and/or constipation. As chronic conditions they are difficult to manage, costly, account for sick days across the country and can lead to depression.

Emotional Health

Bruce S McEwen of Rockefeller University, with more than 1000 research papers surrounding neuroendocrinology, pays attention to how increased levels of stress and anxiety are not only affecting adults, but how they are affecting the younger generation.

“Brain development goes through sensitive periods during which stressors and nurturing experiences can have lasting effects (Adverse Childhood Experience Study.) Animal models have taught us that stressing the mother during pregnancy can alter brain development in the offspring. Furthermore, maternal anxiety produce(s) anxiety in offspring and contributes to the predisposition to diabetes.”

Diabetes is a multisystem chronic disease with massive implications on future health. He adds, “Stress and chaos increase anxiety and impair self-regulatory behaviours and lower self-esteem.” Therefore suggesting anxiety feeds from us as parents in to our offspring and hence is a self-perpetuating condition.

Breaking the Cycle and Addressing Emotional Health

As a seemingly unrecognized epidemic, little is being done to enable the first world population tools with which to seek improved emotional health. About 30% of people with anxiety disorders go through their life untreated.[4] Although more accepted today than previously, treatments such as CBT and psychotherapy are reserved for those with clinically diagnosed psychiatric conditions. They are not yet accepted as prophylactic or for general populational use.

Mindfulness is defined as “The intentional, accepting and non-judgemental focus of one’s attention to the emotions, thoughts and sensations occurring in the present moment.” Such a state can be trained via meditation, life coaching, CBT and psychotherapy.  Dispositional mindfulness is associated with lower levels of perceived stress, increased emotional regulation and cognitive control and stress-buffering effects.[6]

Apart from learning tools such as reducing internal conflict and allowing people to think through their feelings and anxieties to eventually reach emotional homeostasis, results should include a happier individual. Happy individuals are predisposed to seek out and undertake new goals in life and this reinforces positive emotions. When we feel happy, we tend to feel more confident, optimistic and energetic.[7]

Mindfulness, stress relieving activities such as meditation, practical guidance such as CBT can all lead to reduced stressed and sadness - which subsequently can lead to improved mental and physical health and potentially even reduce the level of cardiac events and diabetes. This will generally making us happier, more confident individuals; why have we not started acting sooner to bring Emotional Health and Emotional Medicine to the forefront?

Should we consider adding emotional medicine into schools and work places? Should we not 'teach' ourselves and our children, colleagues and parents how to juggle emotions and dispose of them accordingly? Our mental health is suffering from modern existence. Let us save the next generation from the chronic disease with which the current generation is being burdened.

References

1.         Mental Health Foundation. (www.mentalhealth.org.uk/mental-health-statistics/ ) Accessed 26/12/2014.

2.         University of Stony Brook, WHO World Mental Health Survey Initiative. (www.huffpost.com/us/entry/910345) Accessed 15/01/2015.

3.         ‘Stress and Health: Psychological, Behavioural and Biological Determinants.’ Neil Schneiderman, Gail Ironson, Scott D Siegel. Department of Psychology University of Miami. Annual Rev Clin Psychol  1:607-628. 2005.

4.         ‘Anxiety and Physical Illness’. Harvard Medical School www.health.harvard.edu/newsletter/Harvard_womens_Health  Accessed 28/12/2014.

5.         ‘Post Traumatic Stress Disorder is Correlated to Irritable Bowel Syndrome.’ Wernersson R, Carlsson J. Published Ugeskr Laeger 2014 Dec 15; 176 (51)

6.         ‘The role of emotional regulation and cognitive control in the association between mindfulness disposition and stress.’ Prakash, Ruchika Shaurya, Hussain, Mariam A, Schirda, Brittney. Psychology and Ageing. Dec 29, 2014.

7.         ‘Review of Research Challenges Assumption that Success Makes People Happy: Happiness May Lead to Success via Positive Emotions.’  Sonja Lyubomirsky, Ed Diener. American Psychology Association.

(www.apa.org/news/press/release/20115/12/success.aspx) Accessed 20/12/2014.

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About Dr Jenna Alice Burton

Dr Jenna Alice Burton MBChB General Practitioner is an aesthetic and general physician, medial writer and presenter who is involved heavily within population health promotion. She focuses particularly on promotion of chronic eating disorder management and emotional health. Presently Dr Jenna works in GMC Clinics, Dubai, where she regularly attends to patients with psychological complaints within an expatriate community. Dr Jenna is from the UK and has worked within emergency medicine in the UK and Australia before settling within the UAE. She may be contacted via jenna.burton@doctors.org.uk    www.facebook.com/drjennaburton  

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