Primary Care and Mental Health: a Whole-Person approach

This post originally appeared on 10/9/2014.

One of the things I’ve noticed, doing naturopathic primary care, is how much mental health is interwoven with the rest of physical health. Many of my patients who come in for one condition – say fibromyalgia, or fatigue, or rheumatoid arthritis, or  also are dealing with:

  • depression
  • anxiety
  • bipolar disorder or manic-depressive disorder (people with bipolar will tell it is often much more “depressive” than “manic”)
  • borderline personality disorder
  • the aftereffects of childhood abuse or trauma and PTSD,
  • and other mental health conditions

Then there are the conditions that technically are a mix of “mental health” and “neurological”:

  • ADHD
  • Asperger’s syndrome.

While I remind my patients that seeing a mental health professional is an essential part of their care, I also make sure that I work with them to address the biological aspects of their conditions. What we find that is that healing their health – and healing their mind – work together. In my perspective, mental health isn’t just a check-off box on the exam form. It’s a core component of healing the whole person.

This is true for a number of reasons.

For example, the same physiological mechanisms that are found in many illnesses are also found in many mental health conditions. Inflammation, for instance, is often found in association with both depression and diabetes. Depressed people will tell you that they literally physically hurt. Bipolar individuals often sleep much less (or not at all) in the manic phase of their illness. Those with PTSD have been found to have changes that affect parts of their brain.

As well, what I see clinically is that many people who have mental disorders – and who have other conditions – have underlying genetic variations in what is called the methylation cycle. The most well-known of these variations is MTHFr (short for methyl-tetrylhydrofolate reductase), but there are others as well. These genetic variations appear to affect how their body produces and processes the neurotransmitters that maintain good, stable moods. (They also appear to affect many other bodily processes that play a part in numerous chronic conditions.) In clinical practice, addressing these genetic variations often helps improve both physical and mental health for many people.

(And yes, as many people will point out, being sick, in and of itself, can be both depressing and anxiety-provoking, even without any physical mechanisms involved.)

Additionally, as many will tell you, mental health disorders can make it harder for people to take good care of themselves by affecting their behaviors. Depressed people may eat more, or eat poorly (or sometimes not much); bipolar individuals often neglect eating. Folks with Asperger syndrome often have reactions to such things as food tastes and textures that may make it easier to eat (say) creamy macaroni and cheese rather than crunchy carrots. Exercise is good for depression; but someone who is depressed may find it much harder to muster the energy to go do it.

As well, many people with mental health conditions “self medicate” with alcohol, drugs, nicotine, or food. A lot of times it is in an effort to get to sleep, or to wake up, to be able to stave off anxiety long enough to get out the door and to the job. While understandable, these self-medicating practices only too often take a toll on the body. Helping people change these behaviors usually involves helping them heal the underlying conditions that they are trying to self-medicate.

In many ways, health care is behavior care. A good health-improvement strategy helps people find a way that is do-able for them to get from “great plan! uh… how do I actually do this?” to “I’m actually doing this!”

So how do I help mental health, in a primary care practice? By addressing their conditions and symptoms as parts of a system, rather than as separate “illnesses” that don’t affect each other. I work together with patients to put together plans that combine a variety of strategies that may include lifestyle modifications, supplementation with well-chosen nutritional and other factors, botanical medicines and medications as needed. We put together practical stesp that allow them to actually carry out these strategies. And then I support them through the process.