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It’s all in your head….

So as my brain starts to resurface from the blissful cocoon of disconnect I realise my blog is a little late.

So what has been happening this week.  Well I took some time off.  Actual proper time off.  None of that ‘taking a quick look’ at emails even though the out of office is on.  No sorting out washing or doing the shopping at home.  Most shocking of all was the total lack of tweeting – I know!  How did I cope?

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During my career I used to ignore all the signs of impending frazzlement until a migraine or panic attack would stop me in my tracks.  Worse of all I’d be surprised.  Why has this happened?  Followed by emphatic ‘this will not happen again – I vow to change’ Until the next time.

There was no learned behaviour. No insight. Also I’m a doctor so that means I don’t get ill right?  Especially not in the head *shudders*

At Medical School there was a huge emphasis on the physicality of health. I wasn’t trained to think that there could be a link between mental and physical health.  No, if you had a physical ailment it would have a physical cause.

So with this as a foundation it comes as no surprise that doctors are terrible at managing their own mental health and sometimes, those of others.

There is also the stigma to deal with.  We in healthcare we are the worst offenders in perpetuating it.  We do this by keeping our mental and physical health records separate. Despite all the confidentiality clauses, hippocratic oath taking it is felt appropriate that mental and physical health are separate.

So where do you begin with a person that is showing all the physical signs of illness but none of the organic causes?  The so called ‘functional disorders’.

First of all I’d bin the term functional.  As many will tell you there is nothing functional about a pseudo seizure or a hemiparesis.

I’ve heard people talk about hardware versus software but that doesn’t really work.  Or in the case of the hemiparesis ‘muscles not getting signals’. Ummmm….. no, that makes no sense either.

What I’ve found helpful is first and foremost to believe the person.  Their symptoms are real.  If you don’t believe this then you will get nowhere and help no one.

The brain is amazing (hence my interest in stroke and delirium) but to assume it only deals with the physicality of the body is ridiculous.  What about our emotional selves?

So the second thing I do is actually to say this to people. It seems like you’re stating the obvious but I think sometimes the obvious needs stating.

I also follow up by talking about panic attacks.  The physicality of what they can do is real and can be recorded e.g. an increased heart or respiratory rate.  I might even talk about blushing where you go bright red in the face. Both though have emotional drivers.

If people believe that physical and mental health are intertwined then you will have started them on a journey to better health. However that journey starts with a healthy doctor – it may just be all in your head but get that right and the rest will follow….

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