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The premise of Dutch psychiatrist Dr Bessel van der Kolk’s best-selling book, The Body Keeps the Score, is that when we experience a traumatic event, our brain tries to forget about it, but our bodies never forget.
Instead, he argues, our bodies store the stress and the distress, and it alters our nervous system and hormonal function, ultimately manifesting in “a whole range” of physical maladies, including fibromyalgia, chronic fatigue, headaches, irritable bowel and autoimmune diseases.
Physical and mental health are tightly connected, as a new study highlights.Credit: Getty
Address the body, he suggests, and we can remedy the mind’s forgotten pain.
Though the book has sold millions of copies since its debut in 2014, it’s had its detractors too. Apart from being accused of reducing the word “trauma” to something that is “uselessly vague – a swirl of psychiatric diagnoses, folk wisdom, and popular misconceptions”, van der Kolk’s thesis may not be entirely accurate.
“Despite its popularity, Bessel van der Kolk’s book, The Body Keeps the Score, is wrong,” says Dr Peter Baldwin, head of clinical research at the Black Dog Institute. “The body doesn’t keep the score. The brain keeps the score; our health is the score.”
He explains that our brains are made up of different networks that communicate electrochemically to influence the function of all our bodily systems.
This is important because new research from the University of Melbourne suggests that an unhealthy body may be a better indicator of mental illness than the structure of the brain.
For the study, published in JAMA Psychiatry, researchers wanted to understand the links between poor body health and psychiatric illnesses, including schizophrenia, bipolar disorder, depression, and generalised anxiety disorder.
After looking at 85,748 adults with these disorders and 87,420 healthy control individuals, they found, as lead author Dr Ye Ella Tian says, “that poor body health is a more profound manifestation of mental illness compared to changes in the brain”.
When analysing changes to the brain, they looked at the size and shape of brains, not their electrochemical functioning.
While poor body health, particularly of the metabolic, liver, and immune systems, was evident across all the disorders they looked at, it was most pronounced in people with schizophrenia.
Tian adds that diabetes is two to three times more common in people with a psychotic illness, such as schizophrenia or bipolar disorder, compared to the general population. Similarly, people with schizophrenia have about a two-fold increased risk of developing coronary heart disease, compared to people without mental illness; and one in five patients with heart failure are diagnosed with depression.
Despite this, poor physical health in people with mental illness tends to be overlooked or dismissed as a symptom of a psychiatric problem.
Though the paper doesn’t examine why there is such an overlap between physical and mental health, Tian suspects it cuts both ways.
“We speculate that the relationship between physical and mental is likely bidirectional and complex,” she says. “This means that poor physical health may potentially lead to a decline in mental health and, conversely, mental illness may result in chronic physical illness.”
Baldwin adds: “Our mental health is a product of many factors, which we need to get better at measuring over time if we are ever going to truly understand how mental ill-health develops.”
The findings reinforce the idea that mental health is a “whole-of-person phenomenon”, says Baldwin, who was not involved in the research.
“We have known this for decades, yet for some reason, many doctors and researchers continue to treat body and mind as somehow separable,” he says. “Findings such as these provide irrefutable evidence and can guide mental health treatments into a more holistic era.”
This means targeting both brain and body in the treatment of mental ill-health, something that van der Kolk, who is a fan of yoga, art therapy, dance, theatre, karate, eye movement desensitisation and tapping, would surely approve of.
This also means, alongside traditional treatments, addressing physical health issues as well as considering other methods of mood management, such as diet and exercise.
“Exercise is a great treatment for some mental illnesses,” says Baldwin. “For some people with mild to moderate depression, exercise alone is an effective treatment. What is undeniable is that our mental health depends on our physical health in many ways. I always tell my clients that diet, sleep, and exercise are an essential part of recovery.”
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