Dr. Jeff Kane: That troublesome body-mind riddle
Late one quiet night, a man in his thirties arrived in our Emergency Department complaining of a “grinding” belly pain. His basic history and physical exam suggested an early duodenal ulcer, so I recommended antacids and dietary change and made follow-up appointments for him. It was a routine, garden variety visit. Then, since the waiting room was empty, I asked him about his life.
He told me he worked in an auto assembly plant. When he referred to his job as the “daily grind,” my ears perked up, but I assumed the phrase to be coincidental. He said he didn’t like his job. His supervisor was “abrasive.” As he continued, his agitation accelerated.
Finally he said, “Wow. I don’t know if I’m talking about my job or my belly pain.”
At the time, I didn’t appreciate the significance of his choice of words. I reminded him to keep his appointments, and he left. I never saw him again. Our department received a postcard from him, though, eight months later. He thanked me for listening and wrote that he’d quit his job and moved to a small coastal town, where he opened his own store. His belly pain was gone.
We’ve probably all heard stories about symptoms resolving with life changes. But might these examples represent a central medical principle — that life experience can direct physiology? I’m talking about the most prominent ignored elephant in healthcare’s living room, the nature of the body-mind relationship.
It’s no news that the body — that is, our physical, measurable aspect — affects the mind — our subjective, unmeasurable aspect. For the simplest example, when our body is sick, our mood droops. And the mind affects the body: when we’re depressed, our body slumps. At a more complex level, can it be that an abrasive work atmosphere gradually conjures an ulcer? Can heartache eventuate in overt cardiac disease? Can long-term anxiety produce hypertension? And if such is the case, even sometimes, is the most effective treatment taking pills or addressing the life situation?
At this historical point the body-mind link is more poetry than science. We imagine these associations but haven’t proven them, largely because we don’t have a reliable definition of “mind” as separate from “body.” When I ask friends, “Where is your mind?” most point to their head, meaning, essentially, the brain. Given the cranial concentration of senses, that’s a reasonable guess. But the brain extends beyond its popular depictions as a discrete organ confined to the skull. Notice what’s been omitted: cranial nerves, brain stem, spinal cord, peripheral nerves. The unabridged organ actually threads through the entire body. So one way to conceive body and mind, if you’d like to merge poetry and science, is as two profiles of a single entity.
Though we accept the existence of body-mind connection, we’re reluctant to consider illness in the context of a full life because recognizing that we’ve unconsciously had a hand in getting sick can make us feel abnormal, self-destructive, or crazy. But it can also help us realize, like the guy who left his abrasive job, that we need to make some changes.
Jeff Kane is a physician and writer in Nevada City.
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