Is it all in the mind?

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“The body keeps the score” is the title of a book by Bessel Van Der Kolk about mental health and the affects of trauma. We sometimes describe particular health conditions as “all in the mind.” At one level, what we might simply mean by that is that we cannot find a specific and direct organic cause for the symptoms experienced. So, yes, I may be feeling extreme pain in my legs but there’s no sign of physical trauma to them, no broken bones or strained muscles, nor if we look further afield is there evidence of damage to nerves in my back causing sciatica.   However, the other message we are giving when we say that something is “all in the mind” is that the experience is just something in the thought process or imagination of the patient. “All in the mind” becomes associated with “not real.”

I have long felt that describing something as “all in the mind” is unhelpful.  It can be extremely discouraging to hear someone in effect tell you that what you are experiencing is not real. First of all, the experience of pain and distress will be very much real to the person suffering from the symptoms. Secondly, when they hear you say “it is all in the mind” it will feel like an accusation that they are imagining it, that they are putting it on. Yet, they are not consciously imagining the symptoms and they definitely are not wilfully seeking to deceive people. For them, their illness is very real, very painful and very debilitating.

Furthermore, I think that it suggests a very simplistic and perhaps dualistic view of how we function. There is the mind over here doing it’s own thing engaging with intellectual and emotional stuff whilst the body is over here doing all the practical work, growing, feeding, moving etc.  The two are not meant to connect.  Yet, we know that this isn’t the case.  What we know and believe affects our feelings and behaviours, this will also translate into an affect on our physiological state.  At the same time, our beliefs can be affected by our behaviours and emotions and these in turn can be significantly affected by our physiology or physical health.

Let me give you a couple of examples to help explain. First of all, supposing that I am ill, perhaps through getting the flu or coronavirus or perhaps because I injure a limb.  I take to my bed but the pain disrupts my sleep. I’m also not eating well. I am likely to become increasingly lethargic.  I’m also going to become increasingly isolated from the outside world. When this happens, it is possible for someone as they feel more lethargic and isolated to feel lonely and low. This can be a cause of depression. Furthermore, this feeling of lowness may lead to a sense of hopelessness, a belief that there isn’t hope and that they are unloved. A physical condition has affected how someone behaves and feels, and what they believe.

Working from the other end. Supposing I have learnt to believe that I am unlovely and unloved by God and by others. This is likely to lead to severe lows in emotion and possibly to anxiety when dealing with others. Anxiety attacks result in adrenalin rushes leaving the person exhausted and drained. They stay home, become isolated and that affects sleep, exercise and eating patterns so that there is a physical affect on their body. 

What we believe affects how we live and how we live affects what we believe.

I therefore have personally found that Cognitive Behavioural Therapy (CBT) out of the many approaches to counselling and therapy to be one of the best fits in terms of secular approaches to counselling with what we know about ourselves and what the Bible tells us about ourselves.

Kolk pushes our thinking further. He wants us to see that when someone is emotionally/mentally unwell, particularly when this is a response to trauma that it isn’t just all in the head in terms of an emotional response. Something physiological is happening. Our body has been “keeping the score.”  Our body has been damaged, physically by the trauma done. This works it way out first of all because of how it has affected the brain and the nerve system.  Remember that whilst we may not think of the mind as a physical entity, the brain is! Brain scans of those who have experienced trauma and are showing signs of PTSD highlight where specific parts of the brain are altered, switching off or on.

Secondly, our bodies intuitively respond to situations. We often talk about danger situations as fight or flight. The body immediately goes into a state of vigilance and preparedness. The adrenalin kicks in. When someone experiences physical responses such as pounding in the chest, tensing of muscles and shallow/quick breathing, something physical actually is happening.

Now, there are lots of implications here for those of us who are in pastoral ministry and for all of us as we seek to care for one another. The first and most immediate thing is that we need to be ready for the question “pastor, do you think it is all in my mind?”  My suggestion would be that we start with the response “could you tell me what you mean by that?” “what do you think the doctor/your friend meant by that?”

Secondly, I think this helps us to understand more the seriousness of harm that people do to each other and themselves in areas that we often play down and under-estimate. Remember the old saying “sticks and stones might break my bones but words will never hurt me.” It’s not true and the Bible doesn’t say that. The Bible does not underestimate the ability of the tongue to wound.  Cruel words leading to emotional pain can have a long lasting physical affect.

It also might help us to understand why Paul says that sexual sin is a sin against the body in 1 Corinthians 6:18

18 Flee from sexual immorality. Every other sin[e] a person commits is outside the body, but the sexually immoral person sins against his own body.

The decisions I make sexually are having an affect on me. Who I unite with, the way I seek gratification, the visual images I allow to imprint on my mind (including through pornography) have a long lasting, damaging impact. Sin is deeply dangerous and damaging.

So, I cannot simply brush something of as “just in the mind.”

Here we have thought primarily about the implications for individuals and pastoral care. However, pause to consider this for a second (and we will return to it in a later post). What implications might there be from this when we consider that the church is a body?

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