Time to transcend “physical” and “mental” health
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m609 (Published 24 February 2020) Cite this as: BMJ 2020;368:m609
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Dear Editor,
For the last 30 years, alongside others, I have advocated the need to dump the 'expired dichomisation of thought' (Sharpe. M BMJ 2020; 368;m609) under the campaign title 'Dumping Descartes'. After my own experience of major depression in 1986, which was the most physical experience of my life to date, I realised that my mentality was generated just as physically as every other function in my body. Nothing since then has given me cause to change that view and with, for example, the work of those like Prof Ted Dinan at University of Cork over the last twenty years on the gut microbiome and its linkage to mental functioning, it is abundantly clear that it is more than high time to abandon "the conceptual and clinical segregation that we have created between so called mental and physical illness".
Medical education, mindsets and beliefs are grounded in a now defunct man-made model - as are the thinking, politics, policies and structures of Governments, NHS, Statutory Sector and their Third Sector counterparts. The funding also follows those beliefs, as does all the stigma and discrimination that accrues to 'mental' compared with 'physical' illnesses. It's not enough to seek 'Parity of Esteem' ; we need to head for 'Parity of Biology'. And, if that seems too much of a challenge, just think how much it could change the quality of care of those with 'mental' illness if those with acute suicidality or psychosis were viewed as 'brain emergencies' in the same way that strokes, heart attacks and incipient diabetic coma are in respect of their biological origins.
So, I call upon all those who heed the need to come together to uproot time-expired paradigms and collaborate to change them. This is a formal call-out to all those of you who agree with Prof Sharpe and to the BMJ to bring us all together to consider this issue in the detail that those who suffer from lack of a "unified concept of health in research, education and practice" deserve. Thank you Prof. Sharpe for re-invigorating my hope!
Yours
Dr Chris Manning MRCGP
Competing interests: No competing interests
Re: Time to transcend “physical” and “mental” health
Dear Editor,
Whitty et al. (Editorial - Rising to the challenge of multimorbidity BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.l6964 (Published 06 January 2020)) and the responses from Sharpe and Manning provide both hope and inspiration.
The wise and experienced need to take a lead so that all generations of carers, patients, educators and clinicians can influence the required paradigm shift in structures, funding and training to address the reality of individuals living with multiple health conditions. "Social care", "primary care", "secondary care" and "tertiary care" need to become defunct expressions as do "physical health problems" and "mental health problems" - all of this needs to be integrated and silos and boundary working reduced. Commissioning needs to require the acute and foundation trusts to coalesce and ensure all wards and units in an area come under the same umbrella of management and funding. The separation of training for all for clinicians, nurses and specialty doctors into "physical health" and "mental health" specialties and accreditations needs to be breached with compulsory exposure to meaningful time working across all the current boundaries.
Patients and carers dealing with multiple health conditions need to get the care and treatment they need by clinicians and organisations comfortable and capable of producing unique pathways of care for each patient with an awareness that all suffering is influenced by the impacts of the mind on the body and by the body on the mind.
Competing interests: No competing interests