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Is It All In the Head?

Updated on February 27, 2015

Is it all 'In The Head'


Sometimes people may tell you your condition is ‘all in the head’ as if it is a character flaw rather than an organic disease. But is it all in the head? Are mental health conditions even all in the head? Are any diseases all in the head?


The short answer is ‘no’. If it cannot be changed just by changing one’s thinking, it’s not ‘in the head’. Here’s the explanation:


1. They say, ‘If you just stopped thinking sad, you’d be happy (for those with depression, anxiety, mood disorders, chronic pain).'


1. In order to have a diagnosis of clinical depression, anxiety, or a pain condition, symptoms must be intense and present for an extended period of time to rule out normal processes. Definitions of disease states such as that for Major Depression in the Diagnostic and Statistical Manual of Mental Disorders are careful to rule out normal thoughts and emotions.

Depression and Major Depressive Disorder Symptoms - Psych Central


Disorders that are not ‘in the head’ are those that cannot be changed just by changing one’s thinking. When someone has clinical depression for example, it cannot be changed by an immediate desire to think happy thoughts. It is not under direct volitional control. It may require therapy, medication, or other approaches just like better understood physical conditions like heart disease.


2. They say, ‘The cause is in your head, it’s not physical (you’re making yourself sick by thinking sad thoughts).’


2. The causes or things that create susceptibility to a condition may be physical. Many physical causes have been shown to cause depression and anxiety including brain injury, genetic noreinephrine transporter deficiency, serotonin transporter mutations, and epigenetic changes to the genetic material being passed down to offspring. There has even been a gene discovered that increases susceptibility to PTSD. Memory gene may fuel PTSD – - CNN.com Blogs


Even if depression and anxiety begin with a particular loss or setback, it may become a medical condition due to genetic and biological factors whereas without those causes, it would have been a passing period of normal sadness or anxiety.


3. They say, ‘You have a mental health condition, therefore your physical symptoms are caused by it (your depression is causing your POTS).’


When someone has a mental health condition such as anxiety and depression, it is as separate and distinct from other health problems such as POTS and dysautonomia as it is from better known conditions like heart disease and cancer. It is important that the conditions be treated individually and it also be understood how it affects the whole person.

(When mental conditions cause physical symptoms that last an extended period of time, this is a condition called Conversion Disorder. Even in Conversion Disorder, the sufferer is not ‘faking’ physical symptoms, the physical symptoms are real and involuntary. However, most people with physical symptoms have actual physical conditions and not Conversion Disorder, which is rare.)

Physical conditions may also be a cause of mental health conditions. Cancer, for example, is well known to lead to depression. So while a physical condition may cause or exacerbate a mental condition, it is rare for a mental condition to cause a physical condition. In other words, cancer may cause depression but it is rare for sad thoughts to cause a paralyzed limb as in Conversion Disorder.

It is important that medical professionals treat each condition separately and not assume mental circumstances are causing diagnosed physical conditions.


The Benefit of the Doubt

Those of us with chronic pain, anxiety, and depression may be sure that ours is not just ‘in our heads’, or we may think it is in our heads and wonder why we can’t just make it disappear. In short, you can’t just make it disappear because it’s not just ‘in your head.’ It’s a very real physical process that you can’t wish away anymore than you can wish away a skyscraper. Since we give ourselves the benefit of the doubt about our condition, we should to the same for others with different conditions and understand that their condition, be it anxiety, depression, or bipolar has physical causes too and together, we can look for solutions.



The great thing about seeing the problem this way is that real problems have real solutions. Since the problem is a real, physical problem, there is a real solution out there that will work for you. It may be a medication, therapy, or a new technique such as transcranial direct current stimulation. As long as the problems persist, we can continue looking for solutions for ourselves and others.


Thanks for reading,


Daryl Seldon, MS, NBCC

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