Ask most people, including doctors, what constitutes good health and they will probably talk about living without physical illnesses like heart disease or cancer. If quizzed about what it takes to stay healthy, many will no doubt suggest eating well, not smoking and keeping physically fit. But how many are likely to mention the importance of emotional health as an essential component of physical health?
Some might point to the need to avoid stress, but few are likely to suggest that possessing a high level of self-esteem, feeling optimistic or being able to express emotions are of critical importance. Yet these are among the key psychological attributes that can help reduce the risk of physical illness as well as speed up recovery from it. If we are seriously interested in maintaining our physical health, we ignore our emotional health at our peril.
Take back pain, for instance. Not the most exciting of health problems perhaps, but one that will nevertheless affect up to 80 per cent of us at some stage in our lives. It is becoming clear that back trouble is far easier to avoid if we have a positive mental attitude. A study comparing 1200 Belgian and Dutch nurses found that although the Dutch nurses were more likely to have a higher workload, they were significantly less likely to suffer from back trouble. The most striking difference between the two groups concerned their psychology: the Dutch nurses had a much more positive attitude to their work and were less likely to be depressed.
But back pain is by no means the only health problem linked to our emotional state. Stress, depression, inhibited emotional expressiveness and suppressed anger have all been identified as causes of heart disease, the nation’s number one killer. In one recent study of people with heart problems, those with so-called ‘Type-D’ personalities - typically anxious, gloomy, unhappy, isolated and emotionally repressed - were four times more likely to die within 10 years. Depression is clearly as bad for the heart as the soul.
Mind and Body
But how can our emotional state affect our physical health? The answers are beginning to be found in the new science of psycho-neuro-immunology - the study of the interactions between the nervous and immune systems. In fact, some researchers in this field are beginning to argue that the mind and the body are so closely intertwined it is increasingly difficult to see them as distinct.
Scientific research has proved that while short-term stressors like public speaking can increase immunity, the long-term stresses associated with life-events like bereavement, having to care for a close relative with Alzheimer’s disease or relationship breakdown lead to a downturn. One theory is that prolonged high levels of the stress hormone cortisol can have a significant immunosuppressive effect, especially on the natural killer cells whose job is to attack invading bugs and destroy cancerous cells. Stress also causes the release of fats into the bloodstream which, if not used up in physical activity, stick to artery walls and increase the risk of heart disease.
But just as long-term stress depletes our immune system, so feelings of relaxation and joy increase resistance to disease. Laughter has been shown to lower cortisol levels, raise the number and activity of natural killer cells and increase the levels of Immunoglobulin-A, an immunity antibody. It has been discovered that people who regularly attend cultural events, read books, make music or sing in a choir are also more likely to live longer than those who rarely do so. The most plausible explanation, according to the Swedish doctors who conducted this research, is that participating in cultural activity has a positive affect on the immune system.
But the benefits of emotional health extend beyond those revealed by the psycho-neuro-immunologists. Feeling good does not only increase immunity, it can also play a key role in helping us adopt and stick to a healthy lifestyle. Most of us now know we should eat less saturated fat, drink less alcohol, stop smoking and exercise more. So why do we find it so hard to do even just one of these? One key factor is undoubtedly self-esteem. It is very hard to give up smoking if we feel constantly undermined by low levels of self-worth. It is difficult to find the time to exercise if we constantly put other people’s needs before our own or believe our body to be misshapen and beyond hope.
The evidence that good emotional health can provide the foundation for good physical health is persuasive, if not overwhelming. But what are the implications of this in terms of improving the health of the nation? Simply telling people they should be emotionally more healthy is obviously absurd - it would be about as futile as telling them to become rocket scientists or brain surgeons.
One first step could be for counselling or therapy to be made much more widely accessible. Although mainstream medicine is slowly becoming convinced of its value, the availability of counselling at GP surgeries remains extremely patchy. A much more accessible and comprehensive range of services could be made available through primary care. Many more large employers might also help by providing counselling as part of their occupational health services.
Measures like these that help make emotional health mainstream could ultimately prove as significant in improving physical health as all the high-tech research into cures for the major diseases.
Copyright: Peter Baker 1999