The SHN #69: Mind-Body Science

Welcome back to The Synergetic Health Newsletter! 

September 12th, 2024. Greetings from Bali, Indonesia. I’ve just arrived here after my six nights in Palawan turned out to be a literal wash. Nonstop rain as I was caught in yet another typhoon— in an AirBnB with no running water for ½ the time— and frequent power outages. It’s not all sunshine and rainbows!

My first impressions less than a day in are that I’m going to really enjoy this place. I’m staying in a homestay in a great location in Canggu, a quick scooter ride to the beach and in walking distance to unlimited cafes, restaurants, shops. It’s very bustling here and packed with tourists— which I was prepared for beforehand. Will have some extended thoughts next week, hope everyone is doing fantastic!

In this week’s edition of the newsletter, I’ll introduce you to the medical designation of Psychophysiologic Disorders and how doctors struggle to deal with illnesses originating in the mind.

The obvious link between mind and body is still under appreciated both by the medical community and by the average citizen. I look forward to a future where is more awareness of the link between the two.

🧠 The Science Behind the Mind-Body Connection

As someone who has long been interested in the connection between our emotional well-being and physical health, I recently read a book that I believe many of you will find informative. "Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment" by David Clarke MD, et. al, provides a scientific approach to understanding how our emotions and past experiences can manifest as physical symptoms.

While the mind-body connection isn't a new concept, this book offers a rigorous, evidence-based exploration of Psychophysiologic Disorders (PPD) that’s worth sharing. If you've ever been skeptical about the impact of emotions on physical health, or if you've struggled with unexplained symptoms that don't respond to conventional treatments, this post might offer some new insights.

What Are Psychophysiologic Disorders?

Psychophysiologic Disorders (PPD) are physical symptoms caused or amplified by psychological processes, rather than primarily by disease or damage to the body's organs or structures. The book defines PPD as follows:

"Psychophysiologic disorders consist of pain or other physical symptoms (often more than one) that can affect almost any structure, organ system or body region. Symptoms are caused or amplified by psychological processes and are not primarily due to disease of or damage to the body's organs or structures. Common emotional processes linked to these symptoms include the long-term impact of adverse childhood experience, current life stresses, limited self-care skills, suppressed emotions, post-traumatic stress, depression and anxiety."

This definition suggests that many physical symptoms we experience might have roots in our emotional and psychological state, rather than in structural abnormalities or disease processes.

The Prevalence and Impact of PPD

The book presents some wild statistics about the prevalence of PPD. The estimate is that approximately 40% of all visits to primary care physicians are for disorders that prove to be functional or non-structural in nature. This suggests that a significant portion of medical visits may be related to PPD.

The economic impact is equally insane. In 2005, the cost of PPD was estimated to be $256 billion annually in the United States alone.

The Science Behind the Mind-Body Connection

One of the book's strengths is its scientific explanation of how emotions affect our physical health. The authors describe research showing that the brain areas activated in response to physical pain are identical to those activated by emotional pain:

"Research has shown (Kross, et. al., 2011) that areas activated in the brain in response to a nociceptive input (heat stimulus on the arm) are identical to those activated by an emotional input (viewing the picture of an ex-romantic partner who broke off the relationship in the prior six months). Therefore, since the brain responds to emotional injury in the same manner as physical injury, it is common for the brain to activate symptoms, such as pain, during states of emotional distress."

This helps explain why emotional events can trigger or exacerbate physical symptoms. Our brains don't necessarily distinguish between physical and emotional pain; they can respond to both in similar ways.

Childhood Experiences and Trauma

In placing emphasis on the impact of childhood experiences on our adult health, the authors discuss how adverse childhood experiences (ACEs) can increase the risk of developing PPD later in life:

"The bond between child and caregiver is critical to the development of the sense of self and the ability to function in the world. Children who receive loving, consistent, and responsive interactions with their parents and caregivers grow up feeling safe and protected. However, children who have interruptions in the attachment to caregivers learn that they are not safe or protected. They grow up with fear and that fear sensitizes the danger/alarm mechanism in the brain. It creates a chronic neurophysiological state of arousal or activation."

This chronic state of arousal can lead to various physical symptoms in adulthood, as the body remains in a constant state of stress or "fight or flight" mode. The book explains that the earlier in life the disruption in attachment occurs, the greater the likelihood of psychological disorders and PPD later in life.

Emotions, Feelings, and PPD

Emotions are often unconscious and can be repressed, leading to physical symptoms. Feelings, on the other hand, are conscious experiences that can be a method to process emotions.

The authors emphasize that many people experiencing PPD are often unaware of their emotional state:

"You are having feelings without realizing it and your body is responding to them without any conscious awareness. Pain, like those feelings, is just another message your brain is sending your body. It is the wrong message, and it is being sent because of learned neural pathways in your brain built during past traumas and emotional events. Why is it sending it? Because it is easier for your brain to wrestle with this pain than it is to wrestle with certain feelings. You are not consciously aware of those feelings, but that is what is happening all the time."

This quote highlights THE crucial aspect of PPD: the physical symptoms we experience may actually be our body's way of avoiding or expressing difficult emotions that we're not consciously aware of or ready to face.

We should be acknowledging and experiencing our feelings, rather than suppressing them:

"Feelings are inherently good for you. Whether it be a feeling of joy, sadness, or anger – they are all good for you. Trying to fight feelings is like trying not to breathe. Your body needs oxygen to stay alive, so why would you fight it? Similarly, you need feelings to stay healthy, so why fight them?"

This perspective represents a shift from how many of us typically approach our emotions, especially negative ones. Instead of trying to avoid or suppress these feelings, the authors suggest that acknowledging and experiencing them can be key to resolving PPD.

The Root Cause of PPD

The book discusses how a patient's emotional history can lead to the development of PPD. It explains that PPD often develops as a result of:

• Adverse Childhood Experiences (ACEs): These can include physical, emotional, or sexual abuse, neglect, parental divorce, or growing up with a family member who has mental illness or substance abuse issues.

• Repressed Emotions: Often, people learn to suppress certain emotions, especially anger, fear, or sadness, due to family or societal expectations. This suppression can lead to physical symptoms.

• Unresolved Trauma: This can be from childhood or adulthood. The book notes that many people with PPD have experienced significant trauma that hasn't been properly processed.

• Chronic Stress: Ongoing stressful life situations can contribute to the development of PPD.

• Learned Behavior: Sometimes, people learn to express emotional distress through physical symptoms based on family patterns or early experiences with illness.

These factors can create what they call "learned neural pathways" in the brain, which cause the brain to misinterpret emotional stress as physical danger, leading to very real physical symptoms.

Diagnosis and Treatment Approaches for PPD

The book outlines a comprehensive approach to diagnosing and treating PPD. Here's an expanded look at the diagnostic process and treatment methods:

Diagnosis

The diagnostic process for PPD consists of six parts:

• Illness Chronology: This involves creating a timeline of symptoms and life events to identify potential triggers.

• Current Stresses: The clinician looks for stressful events that link chronologically to flares of physical symptoms.

• Adverse Childhood Experiences (ACEs): The book emphasizes the importance of understanding a patient's childhood experiences.

• Depression: In primary care patients with depression, somatic symptoms often predominate.

• Post-Traumatic Stress: The link to PPD is clear when symptoms begin soon after trauma.

• Anxiety Disorders: The prevalence of Generalized Anxiety Disorder (GAD) in primary care is 7-8%, and most complain of physical symptoms rather than worry or fear.

Confirmation of a PPD diagnosis is accomplished only when treatment of the issues leads to resolution (or at least substantial improvement) of physical symptoms.

Treatment Approaches

The book highlights several treatment approaches for PPD, all of which focus on addressing the underlying emotional and psychological factors contributing to the physical symptoms:

• Education and Awareness: Understanding the nature of PPD can be therapeutic in itself. The authors note that some people experience substantial or even complete recovery simply from fully understanding that they have a PPD, that there is nothing structurally wrong with their bodies, and that they are, and will be, healthy.

• Expressive Writing Techniques: Also known as Written Emotional Disclosure (WED), this involves journaling, writing unsent letters (such as to a parent who mistreated the person in childhood), dialogues, and other forms of verbal expression of emotions. I’ve written about this in a previous newsletter.

• Emotional Awareness & Expression Technique (EAET): This approach focuses on helping patients identify and express emotions. It's based on the idea that unexpressed anger, fear, grief, shame, or guilt is often present in PPD patients, and helping them recognize and express these emotions verbally can lead to symptom improvement.

• Pain Reprocessing Therapy (PRT): This newer treatment aims to retrain the brain to interpret signals from the body as non-threatening. It involves teaching patients to separate from their symptoms mentally, quiet the fear and worry they have about the symptoms, and practice mental activities of observing, engaging with, and surrendering to symptoms.

• Psychodynamic Therapy: This explores how past experiences and unconscious thoughts may influence current symptoms. It helps patients systematically link their emotional and physical experiences, developing a sense of conviction about the psychophysiologic nature of their problem.

• Meditative Exercises: The book recommends practices such as mindfulness, relaxation techniques, guided imagery, yoga, tai chi, and other movement-based treatments.

• Somatic Tracking: This involves noticing a pain or anxiety sensation and following it with the mind's eye, watching how it moves through the body and observing it from a place of curiosity.

• Self-Compassion Work: The authors emphasize developing self-compassion, especially for patients who have experienced childhood adversity. This involves reshaping self-image, improving self-esteem, and reducing excessive self-criticism.

• Addressing Current Life Stressors: The book recommends developing specific actions to resolve current, significant stressors in patients' lives.

• Physical Activity: Resuming normal physical activity and exercise is encouraged as part of the recovery process.

The authors repeatedly point out that recovery often involves changing one's relationship with pain and emotions:

"When clients can change their relationship with pain and reframe its meaning, they can begin to heal. Clients must stop looking at pain as a cause of fear and frustration, and instead see the pain as a signal of their psychological state."

The Current State of Healthcare

There is a significant gap in our current healthcare system when it comes to identifying and treating PPD:

"As I have written elsewhere, in today's medicine, PPDs are the more often missed. Testing for organ disease is so good and so thorough (MRI, CT, lab work, etc.) that the tumor or blood disorder is rarely missed. What is commonly missed is the depression, the anxiety, and the stress-related illness as the physician chases symptoms and never asks about emotional causes."

This observation resonates with my own experiences and those of many people I've spoken to. It's rare for a doctor to inquire about a patient's emotional life or daily stressors when investigating physical symptoms. Instead, the focus is often solely on finding a physical cause, even when evidence for such a cause is lacking.

The authors argue that this oversight isn't just a matter of individual doctor preference, but a systemic issue rooted in medical education that often doesn't emphasize the mind-body connection. As a result, many healthcare providers lack the tools and training to effectively diagnose and treat PPD.

Personal Reflections

Reading this book has made me reflect on my own experiences with chronic pain, particularly issues I had with my shoulder and hip in my 20s. For my shoulder, I ended up electing for surgery to repair what was diagnosed as a "torn labrum."

The authors point out that many abnormalities can be found when scanning the body, but this doesn't necessarily mean they're the cause of pain:

"As long as the X-rays and MRIs do not show a tumor, infection, inflammatory condition, or fracture, and if the neurological examination rules out nerve damage, then the presence of degenerative or bulging discs, spurs, or facet problems should not be interpreted to be causing pain."

In my case, while I did have a labral tear, it wasn't complete, and many people have labral tears without experiencing pain. I’ve long wondered if my pain might have had more to do with stress or emotional factors that I wasn't aware of at the time and that surgery was unnecessary.

A Scientific Approach to the Mind-Body Connection

What I appreciate most about this book is its scientific approach to the mind-body connection. It presents PPD not as some vague, "woo-woo" concept, but as a real, measurable phenomenon with huge implications for our health and healthcare system.

For those who have been skeptical about the impact of emotions on physical health, this book provides a wealth of research and clinical evidence that's hard to ignore. 

At the same time, for those who are already familiar with mind-body medicine, the book provides a framework for understanding and addressing these issues. It offers concrete, practical strategies for diagnosis and treatment that can be invaluable for both patients and healthcare providers.

If you are someone bothered by a chronic health condition that you haven’t gotten an answer for, hopefully this has opened your eyes and you consider learning more about PPD or even reaching out to a PPD practitioner.

Acknowledging the role of emotions in your physical health doesn't mean your symptoms aren't real or that you're making them up. On the contrary, it validates your experience while offering an alternative blueprint for addressing them.

“People often wait for their pain to go away to live life, but in reality, it is living life that helps them heal from pain!"

Read more at the PPD Association website, read other books by David Clarke, MD, and listen to Dr. Clarke on a recent podcast with Jay Campbell.

Also, if all this is overwhelming but you are intrigued, download the Curable app:

The Curable app provides evidence-based chronic pain lessons in your pocket. It uses a combination of pain science education and research-backed techniques to address pain from every angle. The program helps you connect the dots between what’s happening in your brain, in your body, and in your life, to get a full picture of what's causing your symptoms and how to relieve them.

And finally, if you’ve somehow made it this far, I will add that science is way behind on this conversation. The conscious community, the healing community— whatever you want to call it— has known about this and has been addressing this “disorder” forever. While charlatans abound, there are countless “healers” out there who can facilitate the discovery and release of negative emotions and past traumatic experiences through various methods. Reply to this email if you want to know more.

𝕏 Thread of the Week

☀️ UV Exposure Leads to Lower Mortality: This 2024 UK Biobank study of 450,000 participants found that higher ultraviolet (UV) exposure is associated with lower all-cause, cardiovascular disease (CVD), and cancer mortality. Both solarium use and higher residential shortwave radiation were linked to reduced mortality risks. Solarium users showed lower mortality rates despite similar cancer incidence, suggesting UV exposure might improve prognosis. The study's findings support UV's protective effects, independent of vitamin D levels.

This research is another nail in the coffin for the “avoid the sun” crowd. The results suggest that the benefits of UV exposure outweigh any potential risks. Again, public health messaging regarding sunlight exposure needs reconsideration.

💊 Magnesium Reverses Depression: This study hypothesizes that magnesium deficiency may contribute significantly to major depression due to its crucial role in neuronal function. The researchers present case histories showing rapid recovery from depression using magnesium supplementation (125-300 mg with meals and at bedtime). They observed improvements in various mental health issues, including anxiety, insomnia, and addictive behaviors.

The authors suggest that modern diets and water supplies are often deficient in magnesium, setting the stage for widespread deficiency. They propose that magnesium supplementation could be an effective treatment for depression.

🥦 Are Green Smoothies Killing You? This article introduces us to oxalates— compounds in plant foods that can harm human health. They interfere with mineral absorption and cause kidney stones. Modern diets often contain high levels due to increased raw food consumption and year-round availability of high-oxalate plants.

High-oxalate foods include certain beans, nuts, fruits, and vegetables. Case studies show health issues from high oxalate intake, like kidney failure from green smoothie cleanses. Risk factors include age, gastric bypass surgery, and antibiotic use. Even healthy individuals may consume excessive oxalates unknowingly— and their accumulation can affect the entire body, not just the kidneys.

🔗 One Hitters

📱 Stop paying $100+ on your cell phone plan (The Best Plans)

👓 Cheap but effective blue light blocking glasses (Shop)

🗽 Freedom tech products and services recommended by Jack Dorsey (Thread)

🔧 Have a winged scapula? Learn how to fix it (Video)

📚 Read my e-book, “Self-Development for Authentic Living” for free.

✔️ That will do it for this time! Hopefully you got some value out of it. If you have any questions/comments/things you’d like to learn more about please don’t hesitate to reach out.

🔗 If you know anyone who loves learning about these types of topics, send them this link!

📰 To read all past newsletters, go here.