Are there links between physical and mental illness?
I have been wondering lately, how much mental health and physical health are connected. Obviously, there is some connection between say, feeling stressed and developing a headache but how much are more complex conditions responsible for how stable our mental health is, or can our mental health be the cause for developing the physical conditions in the first place? This is a massive question and one that needs more space than a blog entry but I feel that I need to explain a little about my physical health difficulties because to me, they are inextricably linked to my mental health.
My first problems with mental illness started when I was a teenager in my final years of school. For a variety of reasons, I changed from being a happy-go-lucky individual into a severely depressed student. I began to hate going to school, which was previously unheard of for me and I started to develop an eating disorder. Around about the same time, I began to feel physically under the weather. I remember numerous trips to the doctors over several years where I described feeling faint, dizzy, having palpitations, becoming randomly hot and sweaty, feeling nauseous, not being able to think straight and generally feeling exhausted all the time. On each occasion I was sent away after being told it was probably a virus, my blood sugar levels, or just me not being able to manage everyday life in some way. (Interestingly my eating disorder was never diagnosed over this time either, that wasn’t noted until 10 years later, by which time I was so ill that I was admitted to a psychiatric hospital for many months in order to treat it.)
However, many years down the line, I was finally given a physical diagnosis which explained my symptoms: Postural Tachycardia Syndrome (PoTS). This is a chronic illness and can be very debilitating. In basic terms it is caused by a failure in the body’s autonomic nervous system - the system which controls everything that the body does without us having to think about it e.g. restrict and contract blood vessels, maintain heart rate, digestion, bladder function and many more. It was not caused by my eating disorder, and is still present today long into my recovery from anorexia nervosa, but it did begin at the same time of life as the initial decline in my mental health. This in itself made me question whether the two are related but the links between the mental and the physical symptoms aren’t just limited to time centred factors.
My life with PoTS is very unstable. Some days are good days and some days are bad. On a bad day I can’t even get out of bed without feeling symptomatic. As soon as I move from a lying down position to standing up, my heart rate goes through the roof and the sickness, dizziness and brain fog (yes that is official terminology) all set in. Standing still is a no-no as my heart rate will continue to rise when this happens and thanks to my co-morbid postural hypotension, I am very liable to faint. So, that makes brushing my teeth and showering fun! As such, there is always a double battle for me to fight each morning - my EUPD head tells me that there is no point getting up because of a thousand negative thoughts and my PoTS makes it physically difficult to get up anyway.
The day will carry on in this vein, with more or less every daily routine that people take for granted, having to be adapted in some way. The increase in heart rate that PoTS sufferers experience upon standing means that everything is utterly exhausting and far more rest has to be taken in an average day than for a non-sufferer. I am also prone to migraine like headaches as a result of my PoTS, these can be really incapacitating and although they do not happen frequently, when my mental health is worse I can go through weeks where I have almost a constant migraine. Additionally, I have IBS as a result of the condition and my PoTS is exacerbated by eating large meals. I once fainted in the middle of a Chinese restaurant as my body just could not cope. This is not ostensibly linked to my mental health but on a deeper level it may well be. My anorexia developed at a time when I was deeply distressed, depressed and anxious and the only way I could gain control over anything, or so I felt, was to manage what I was eating; as such it was clearly mental health led. But what if there was some part of me that knew eating affected how I physically felt too?
PoTS was also likely responsible for my bladder spontaneously giving up and going into urinary retention numerous times a couple of years back. This was such a major problem that I ended up with a permanent supra-pubic catheter at the age of 32 and as a result of that, had many associated complications. Perhaps unsurprisingly, my mental health also deteriorated during this period. Having to cope with a urotstomy on top of everything else was just unbearable. Thankfully though, the catheter has now been replaced by a sacral nerve modulator implant in my back and the retention is under control with this and medication. The operation to do this coincided with my admission to the personality disorder hospital ten months ago so it is difficult to point at an exact cause and effect here but it is safe to say that having the catheter removed saw a marked improvement in my mental health too.
Perhaps the most interesting link between my PoTS and my mental health is illustrated in the form of dissociative seizures however. I have been experiencing dissociation as part of my EUPD for many years but in the past 2, I started having dissociative seizures. These can present much like epileptic seizures but are not caused by epilepsy; there is no alteration in brain signals in the dissociative seizures as there are in epilepsy. In fact, the dissociative seizures are (as I understand it) a response to the body becoming overwhelmed and not being able to cope in a given situation. They are a recognised symptom of PoTS but there is a lack of research into how exactly they function and what predisposes someone to them.
From my own experience, I have found that I am far more likely to have a seizure when I am under immense emotional pressure. For instance, they became much more frequent in my first few months at the therapeutic community when I was exploring extremely difficult topics in therapy etc. Notably though, not only are they more likely to happen when I am mentally stressed but also when the exacerbating factors for my PoTS itself are worse too. In this way, the two seem to be very closely linked. Thankfully, I have not had a seizure for the past 4 months now and this parallels both an improvement in my mental health and an improvement in the manageability of my PoTS. I’m really hoping that I can sustain both!
Needless to say that both my mental and physical conditions are chronic and will probably never truly go away. However, living with them together for over 15 years has highlighted some patterns for me and it seems that the two distinct spheres of illness could be more dependent than we realise.