Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 1
Mind and Body are Inseparable
Considering health and illness as points along a
continuum helps one appreciate that neither state exists in pure isolation from
the other. In another but related context, everyday language tends to encourage
a misperception that “mental health” or“mental illness” is unrelated to“physical
health” or“physical illness.” In fact, the two are inseparable.
Seventeenth-century philosopher Rene Descartes conceptualized the distinction
between the mind and the body. He viewed the “mind” as completely separable from
the “body” (or“matter” in general). The mind (and spirit) was seen as the
concern of organized religion, whereas the body was seen as the concern of
physicians (Eisendrath & Feder, in press). This partitioning ushered in a
separation between so-called“mental” and“physical” health, despite advances in
the 20th century that proved the interrelationships between mental and physical
health (Cohen & Herbert, 1996; Baum & Posluszny, 1999).
Although“mind” is a broad term that has had many different meanings over the
centuries, today it refers to the totality of mental functions related to
thinking, mood, and purposive behavior. The mind is generally seen as deriving
from activities within the brain but displaying emergent properties, such as
consciousness (Fischbach, 1992; Gazzaniga et al., 1998).
One reason the public continues to this day to emphasize the difference between
mental and physical health is embedded in language. Common parlance continues to
use the term“physical” to distinguish some forms of health and illness
from“mental” health and illness. People continue to see mental and physical as
separate functions when, in fact, mental functions (e.g., memory) are physical
as well (American Psychiatric Association, 1994). Mental functions are carried
out by the brain. Likewise, mental disorders are reflected in physical changes
in the brain (Kandel, 1998). Physical changes in the brain often trigger
physical changes in other parts of the body too. The racing heart, dry mouth,
and sweaty palms that accompany a terrifying nightmare are orchestrated by the
brain. A nightmare is a mental state associated with alterations of brain
chemistry that, in turn, provoke unmistakable changes elsewhere in the body.
Instead of dividing physical from mental health, the more appropriate and
neutral distinction is between “mental” and “somatic” health. Somatic is a
medical term that derives from the Greek word soma for the body. Mental health
refers to the successful performance of mental functions in terms of thought,
mood, and behavior. Mental disorders are those health conditions in which
alterations in mental functions are paramount. Somatic conditions are those in
which alterations in nonmental functions predominate. While the brain carries
out all mental functions, it also carries out some somatic functions, such as
movement, touch, and balance. That is why not all brain diseases are mental
disorders. For example, a stroke causes a lesion in the brain that may produce
disturbances of movement, such as paralysis of limbs. When such symptoms
predominate in a patient, the stroke is considered a somatic condition. But when
a stroke mainly produces alterations of thought, mood, or behavior, it is
considered a mental condition (e.g., dementia). The point is that a brain
disease can be seen as a mental disorder or a somatic disorder depending on the
functions it perturbs.
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