It's All in Your Head?

Sometimes people's symptoms related to mental illness are dismissed as being "all in your head." This is perhaps most common when it comes to physical symptoms of anxiety. We hear it from loved ones, but also from health professionals.

Let's stop to think about it for a moment, though. The human brain is astoundingly complex, so much so that there's still a great deal that science hasn't figured out yet. It ultimately controls everything that is happening in the body. No other organ can come close to matching the role that the brain plays. While our conscious mental processes are based in the brain, much of what it does is not under conscious control. We may think that our sensory reflection is based on what is actually happening in the world around us, but it is all filtered through unconscious processes of the brain. Our binocular vision is a great example of how the brain processes two disparate signals from each eye's optic nerve and blends them into a seamless single image, without us being the slightest bit aware that this process is happening.

What is the source of the problem?

It's useful to distinguish the origin of symptoms. If chest pain is coming from a heart-related problem, that needs to be treated in one way. If it's being triggered by things happening in the brain, that requires a different form of treatment. Both are important, both are valid, but distinguishing between the two is important so the person can get the form of treatment that's most likely to be effective. Giving someone heart medication for an anxiety problem is not going to be productive, but that doesn't mean that the anxiety doesn't need to be treated.

Consider epilepsy. Epilepsy is a disorder of the brain, and the abnormal brain activity can cause convulsions in the body. Is that just "all in the head?" No, it's in the brain, and also in the body. Because it originates in the brain, we don't treat epilepsy with muscle relaxants for the limbs, but we treat it at the root cause, with medications that target the abnormal electrical activity in the brain.

Why does anxiety get dismissed?

Perhaps some of the problem is that with physical manifestations of anxiety and other forms of mental distress, those suffering don't think that their symptoms are mentally driven. They might think that there's a problem with their heart and go into an emergency room asking to have their heart checked out. Busy emergency rooms don't have the time or the interest to take it one step further and look at what's actually driving the problem. Still, dismissing someone's symptoms as "it's all in your head" should never be acceptable.

Likely the biggest part of the problem is lack of knowledge and lack of resources to effectively deal with mental health problems. Too many people fail to recognize the profound impact that conditions like anxiety can have on those living with them. Anxiety is not like a headache where you can throw a drug at it and it will go away. It often requires a combination of the right medication and psychotherapy. While an emergency department might give someone a dose of a benzodiazepine like lorazepam (Ativan) and send them on their merry way, that's a bandaid solution that does nothing to address the fundamental problem.

The Role of Psychotherapy

Psychotherapy, such as cognitive behavioural therapy, is known to be very effective for mental illnesses like anxiety. While the ER doc who sends someone with chest pain home saying, "it's all in your head," might think psychotherapy is just talk, that also conveys a lack of understanding about the brain. The key concept here is neuroplasticity—the brain's ability to change its structure and functioning and forge new neural connections. Psychotherapy has been shown to promote positive neuroplastic changes, allowing people to bypass the well-worn anxiety circuits.

Cognitive behavioural therapy in particular has been shown to help establish new brain circuits.

The brain is by far the most complex and least understood organ in the human body. No one would ever say to someone with a brain tumor that it's in their head, and there's no reason anyone should ever say that to someone with anxiety. After all, what's in our head is our brain, which is more powerful than any supercomputer. So let's treat anxiety disorders with the respect they deserve.