Thoughts from the continuum

I would like to challenge the notion that there are “mental” illnesses and “physical” illnesses – that certain illnesses are biological and others are psychological.

For example, what are the causes of high blood pressure? Well, according to WedMD, it is caused by the following factors, most of which are no less “psychological” than the causes of depression or anxiety disorders:

  • Smoking
  • Being overweight or obese
  • Lack of physical activity
  • Too much salt in the diet
  • Too much alcohol consumption (more than 1 to 2 drinks per day)
  • Stress
  • Older age
  • Genetics
  • Family history of high blood pressure
  • Chronic kidney disease
  • Adrenal and thyroid disorders

And if you look at the list, you will see that many of these “causes” of high blood pressure are the same as the causes of depression. The following all contribute to depression’s onset or its return after remission: stress, alcohol abuse, family history of depression, genetics, older age and lack of physical activity.

There are other known (and probably unknown) causes for depression, anxiety and high blood pressure, no doubt, but isn’t it interesting that people with high blood pressure are almost never sent to a psychologist for therapy, even though their condition would probably be improved by learning to cope better with stress, reduce alcohol consumption and change and improve lifestyle?

What about type 2 diabetes, many cases of heart disease and chronic pain? These conditions could also be improved through specific types of psychotherapy and counselling, often in conjunction with medication.

I have grown tired of the argument that people who suffer from certain “mental” illnesses like depression and anxiety should not take medications, but should instead see a therapist to get to the root of their problems.

These illnesses are not curable, as far as we know. They are conditions, just as high blood pressure and diabetes are conditions. Those who suffer from them have to manage them, usually with some combination of medication, exercise, stress reduction, nutrition and, often, psychotherapy. Why is it that people with conditions that can be measured with a blood pressure cuff or a blood sample are not so often told to get to the root of their problems?

And then we have scientists like Dr. Irving Kirsch, whose research into anti-depressant medications resulted in him confirming his own bias that the medications don’t work and are nothing but placebos. Imagine if you were a diabetic and had been taking a medication that helps you keep your blood sugar in check and a scientist publishes a study telling you that it’s all in your head?  “Guess what? Your medications don’t work! You just think they do!” That’s what Kirsch has done, and many media outlets trumpeted his message uncritically.

Scientists are in the midst of developing an antidepressant medication that works in hours instead of weeks. Perhaps if we start having medications that have rapid effects, the notion that antidepressants are nothing but placebos will come to an end.

We have learned that even our genes are influenced by our environment, with certain genes being turned on or off depending on the conditions in which we live. There is no absolute division between environmental and genetic causes of illness, just as there is no real dividing line between the psychological and the biological. It is all on a continuum. To believe otherwise is to create obstacles to wellness for people suffering from a great number of conditions. Why close the door on psychotherapy for high blood pressure problems? Why discourage sufferers from using medications for their anxiety?

I realize there is a problem with medications being overprescribed in many cases, but there is an even bigger problem with under-treatment of diabetes, depression, high blood pressure, chronic pain and anxiety disorders.

Just as there are biological and psychological dimensions to all diseases, there is a moral aspect as well. We can call on sufferers to improve their diets, manage their stress, get to the root of their problems. We can deny health coverage to smokers who develop lung cancer. We can discourage medication because we are so sure that sufferers can pull themselves up by their bootstraps.

But moral judgements won’t reduce suffering or lower the great burden of disease that society continues to bear. The costs to us are enormous in terms of lost productivity, social breakdown, medical expenses and quality of life.

Vitamin D

Have there been any studies on the changes in Vitamin D levels over the course of a year – presumably people will have lower levels in winter.

How do we know how much vitamin D people get from sun? Most of us are city dwellers and spend very little time outdoors, regardless of the season. On top of this, we have all been told to stay out of the sun or use sun screen to avoid skin cancer.

Recommendations regarding vitamin D supplementation have been cautious, but the same caution was not used in devising recommendations regarding sun exposure. We are told to avoid the sun at all costs and wear sunscreens, some of which contain chemicals whose safety is questionable.

Would it not have been more prudent to encourage people to get some sun exposure, but not too much, instead of encouraging us to avoid the sun altogether? We seem to have evolved to require sun exposure for our health, and there is still a great deal we don’t know about its importance to our wellbeing.

Vitamin D is needed for bone and cardiovascular health, as well as to prevent certain forms of cancer. Low levels are thought to play a role in the development of Multiple Sclerosis.  It is also important for immune function, and may explain why influenza levels are higher in winter.  Vitamin D also activates genes that regulate brain function, which may explain the high prevalence of depression in late winter, when vitamin D levels are lowest.

Check out Emily Deans’ blog, including this article on vitamin D and depression: http://evolutionarypsychiatry.blogspot.ca/2010/07/d-d-depression.html