Thursday, August 07, 2008

Defining and Treating the “Whole Person”

In this post, I discuss how the four interacting components of a "whole person"—one's mind, body, emotions, and "spiritual force"—affect human health and wellbeing.

Let's start by considering two articles published in the past few months about mental illness, which bring to light the staggering costs of not treating psychological problems (i.e., problems rooted in the mental and emotional components) because our society consider physical (i.e., body) health to be much more important than psychological health.

In May 2008, an article in Time titled "Tallying Mental Illness' Costs", reported that our country loses about $500 billion a year on mental illness and addiction problems due to lost earning potential, social security payments, homelessness, incarceration, and treatment. Only 60% of Americans with a mental disorder got no treatment for their ailment at all, and only 6.2% of current U.S. health care spending is devoted to the treatment of these disorders. And since these figures are based largely on 2002 numbers, the actual figures are probably greater due to the Iraq war (e.g., on PTSD and brain injury).

Last March, a New York Times article, titled "The Murky Politics of Mind-Body" discussed scientific evidence showing that mental (psychological) problems such as severe depression, addiction, and schizophrenia have a physiological base, including brain abnormalities, problems in brain circuitry, and genetic factors. In the past I've written about this issue at this link to the Wellness Wiki.

So, is there really a connection between mind, body, and emotion, and physical? And where does "spirit" fit in? Well, the following Venn diagram depicts my understanding:

The circle to the left, labeled "Mind," refers to a person's mental functioning, which includes one's thoughts (cognitions), perceptions, beliefs, attitudes, knowledge, imagination, etc.

The circle to the right, labeled "Body," refers to a person's physiolocial functioning, which includes one's voluntary behaviors and involuntary reactions, as well as the functioning of all bodily systems (i.e., the muscular, skeletal, cardiovascular, respiratory, digestive and urinary, reproductive, glandular (endocrine and lymphatic), and nervous system (which includes the brain and sensory organs).

The section in the middle, labeled "Emotion," refers to a person's feelings, mood, affect, which includes both positive emotions (e.g., joy, happiness, love, contentment, etc.) and negative emotions (e.g., depression, anxiety & fear, anger, guilt, shame, jealousy, envy, disgust, etc.). There are several reasons why I used the overlap between mind and body to depict emotion:

  • Our feelings (emotions) are created by the interaction between our thoughts (mind) and physiology (body). In fact, one of the most effective forms of psychological treatment, cognitive-behavioral psychotherapy, focuses on modifying a person's thinking (beliefs) in order to lessen one's negative emotions and stress, which then leads to more adaptive behaviors and increased overall health.

  • The physiology of emotions is the connection between emotions and body, that is, how our body systems create our emotions, and how our emotions affect our body. The field of psychoneuroimmunology, for example, is demonstrating that stressful life events can adversely affect the immune system. Other researchers are identifying "coronary-prone behaviors" such as feelings of insecurity and a perceived lack of self-efficacy. Still others are finding a connection between optimism, coping skills, and physical health. For example, researchers found that depression is a precursor to heart disease, with certain depressed patients being 50 percent more likely to develop or die from heart disease than those without such symptoms, even though they had no prior history of heart disease. Depression, therefore, likely affects not only the mind but also physical health by being linked to increased blood pressure and abnormal heart rhythms, as well as chronically elevated stress hormone levels, which can increase the heart's workload. And fear can lead to denial and avoidance, resulting in worsening health, as I discussed at this link.

Note, however, that this intersection between mind and body actually includes more than emotions, such as:

  • The effects of our beliefs on our physical health, which I've discussed this in an earlier series of blog posts starting at this link.

  • The connection between thinking and doing, i.e., how our thoughts lead to specific actions, which may be healthy and adaptive or unhealthy and maladaptive. In healthcare, this connection includes your ability to describe your symptoms to your doctor, your doctor's ability to examine your body and diagnose a problem, as well as your ability to understand how to manage chronic conditions.

Now to the large oval—the "Spiritual Force" (aka "life-force," "inner-self," consciousness, "soul," "qi/chi")—which encompasses the whole person … mind, body, and emotions. From a philosophical (cosmological) perspective, the spiritual force enables us to have a mind, body and emotions. In other words, this cosmic energy gives us the ability to be aware, to sense and perceive the world around us. It allows us to create, express ourselves, feel, have intuition, remember, speak, move, think, grow, etc. It's the force that builds our bodies from genetic information, and that transforms the electrical activity in our nervous systems into thoughts, emotions, and behaviors. At its most basic (and abstract) level, the spiritual force can be thought of as life itself, which gives us the potential to develop our minds and bodies. Some might even say it is a "piece of God" within each of us.

While certain Eastern (e.g., traditional Chinese) medicines attend to the spiritual force when treating patients, Western medicine mostly ignores it because this force cannot be observed or measured scientifically (see this link for a comparison of Eastern and Western medicine, and this link for more about complementary and alternative medicine).

So, is there a meaningful connection between the three components of the whole person—mind, emotions, and body—in which each components affects the others? YES!

Is there real value in treating the whole person by seriously considering the interactions between these three components? YES!

And, if you want to get philosophical, is it reasonable to conclude that a spiritual force gives rise to all thoughts, feelings, and physiology? YES! As such, might it be beneficial to a better understanding of how this force can be applied to healthcare in the Western societies? YES!


Anonymous said...

I interviewed Irene McCara-McWilliam ( and she spoke about how people are processed by the medical system as a collection of body parts, not a whole person. Just another perspective on what you wrote about here.

Dr. Steve Beller said...

Thanks for your comment, Lisa. Yes, there's a general failure in Western medicine to consider the whole-person perspective, and that's unfortunate. There's also been a general failure to link/bridge well-care (e.g., prevention & self-maintenance) and sick-care, as well as a general failure to coordinate care between PCPs and specialists. These splits/gaps are, imo, a major reason why our healthcare system has serious quality and cost problems.

Anonymous said...

There are several trends discernable in the medical literature, underpinning this developing model of health and illness. Such trends can be broadly divided into the following areas:
1) Patient autonomy, choice and involvement
2) The importance of narrative
3) The centrality of the doctor-patient relationship
4) Application of the complexity theory to health and illness
5) The importance of spirituality in health
6) Salutogenesis: how to stay healthy
james wilkins

Link Building

Anonymous said...

You may be interested in watching this PBS excerpt on high value integrated care in cancer treatment from Goshen Center for Cancer Care. They strive to treat the whole person under one roof.

Dr. Steve Beller said...

Excellent Youtube link, Beth. Thank you!

Anonymous said...

Hi, I am currently writing a University piece about treating the whole person and your article was incredibly helpful in regards to seeing how all of the components fit together and gave me a very good starting point to build on for my assignment! Interesting and understandable, a very good piece!

Dr. Steve Beller said...

I appreciate your comment, Kate!

Anonymous said...

I’m from Brasil, and here the spiritual aspects involved in the vision of whole person are cutting out in the medicine courses, most jeer about this. But it’s real and become clear some cures and health better. And it’s give empowerment to many people.