I spent my summer 2016 working at one of the most established Eating Disorder services in the UK. The service has outpatient, community and inpatient treatment options and had a passionate and knowledgeable team to run it. Through my time there I worked alongside psychologists, doctors, psychiatrists, psychotherapists, nurses and occupational therapists. All vastly capable and proud of their profession and this was demonstrated through the outcomes of their work.
Eating disorders is one of the very few mental health disorders which see doctors and psychologists working in such a necessarily collaborative way. This interplay is found in the context of a mental health setting where bodily capability and physical health is mirrored almost in sync with psychological wellbeing. The referral criteria to the service stipulated a low BMI or equally severe bulimic behaviours, and a thorough two hour assessment was conducted with every patient to assess psychological capacity and wellbeing before treatment.
The dynamics of this team particularly resonated with me, as I have grown so used to seeing psychologists work independently or with a team of like-minded like-qualified peers. During treatment at the service taking bloods, monitoring heart rate and measuring BMI was found alongside psychotherapy and psychological assessment. In one room, bloods and urine samples were being analysed whilst next door mindfulness and dramatherapy groups were in session.
This mix of medical scientific practice with holistic psychological therapy raised the questions: How common is this interplay in other disorders that are thought to be purely psychological? How symptomatic is physical health concerns with psychological distress? In a context where the link is so defined, this made me realise the definitive undeniable correlation that exists between physical and psychological health. In other words, how a healthy mind affects a healthy body and vice versa.
Eating disorders are arguably the only mental health illness that directly affects physicality as much as psychological health. It is engrained into us from an early age that exercise and healthy eating is good for us and is a positive behaviour. Indeed, the Mental Health Foundation (2016) notes that improving physical health is a method of maintaining mental health. This is seen as a preventative measure rather than a reaction to psychological distress.
In a current culture which sees mental health cuts in the NHS and rising obesity levels, I am left feeling somewhat disappointed that the clear interplay is so often ignored. ‘Healthy body, healthy mind’ may be easy to say, although this is rarely reflected in practice and policy. It appears that therapies and services are all targeted to either physical health or psychological health. When will we fully acknowledge that physical health is dependent on wellbeing and vice versa?
In the Eating Disorder service ideally a culmination of improved BMI and physical stability had to be in conjunction with approval from the team psychologist before a discharge was arranged. I believe that as a society we are too quick to judge an illness or disorder as being either psychological or physical. These two headers are not mutually exclusive and although not entirely synonymous in their treatment and goals, my understanding following my experience at the ED service is that these two fields should have a greater interplay generally.
A study in 2006 found that in female participants lower body satisfaction correlated with high levels of unhealthy weight control behaviours including both dieting and binge eating (Neumark-Sztainer & Dianne, et al. 2006) The researchers also found lower body satisfaction predicted lower levels of physical activity. This illustrates the link between the psychology of, in this example, self-perception and esteem with physical pursuits. These worlds are not separate and should not be treated as so. Jacobi, Hayward, de Zwaan, Kraemer, and Agras (2004) discussed aetiological factors in eating disorders and concluded that physical ( i.e. early childhood eating and gastrointestinal problems, BMI) were factors as well and psychological factors (negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity).
How can we address psychological issues for an individual without taking into account their nutrition, exercise, general physical health? How can we treat physical symptoms without assessing psychological stress, self-esteem, identity, beliefs? And finally, when will we learn that human beings have complex systems running simultaneously? I believe that the more we see people in a whole, holistic and individualistic way, the more problems can be faced. This acknowledgement must arrive in everyday life, and not occur as a result of severe mental health illness, such as eating disorders.