October 15, 2021 • 16 mins
Your mental state can alter your physical self and vice versa—but not necessarily in the way you may think. Dr. Saltz reveals how the two work together, and helps a listener who wonders whether her anxieties will prevent her recovering from a dangerous medical condition.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. I got a question
from a listener about whether it's possible that her anxiety
can be making it more likely that she will develop
cancer or some other medical illness. This question is actually
a common one. Can mental illness cause you to develop
(00:50):
physical illness? Can physical illness give you mental illness? The
answers are more complicated than yes or no, but the
answer to both actually is not no altogether. It's not
surprising that when a person gets a diagnosis of heart
(01:11):
disease or cancer, or some other life limiting or life
threatening physical illness, that they may become anxious or depressed.
But it may seem more surprising that the inverse is
also true. High anxiety or depression can foster to the
(01:33):
development of a serious medical disease and even make it
more difficult to recover from one. As the pantemic continues
to take a toll on many people's mental health, we
may well see an uptick in certain physical ailments that
are impacted by mental health struggles. In fact, while the
(01:56):
medical profession as a whole and therefore will in general,
tend to think of mental health and physical health as separate,
they really are not. The brain is an organ in
the body, like any other organ, connected to everything else,
(02:17):
impacting everything else, and when the brain becomes sick in
some way, it is a physical illness. The physical location
is the brain, and it causes changes in neurochemicals which
actually impact the rest of the body as well. What
(02:37):
happens inside a person's head can have damaging effects throughout
the body as well as the other way around. An
untreated mental illness can significantly increase the risk of becoming
physically ill, and physical illnesses often result in feelings and
(02:59):
behaviors that make mental conditions worse. You might think of
this as the mind body connection, but in a way,
it's all one body, and it's the body's body connection.
There have been studies that look at patients, for example,
(03:19):
diagnosed with cancer, and find that significant depression can and
does often cause a patient to do worse than expect
it and worse than patients who don't develop depression at all. Physicians, unfortunately,
don't always look at the stresses placed on the body
(03:40):
by mental illness and don't treat it like the physical
stress on the body that it actually is. Many people
are reluctant to seek treatment for emotional feelings. Some people
with anxiety or depression may fear being stigmatized, even if
they recognize they have a serious psychological problem. Some people
(04:06):
attempt to treat their emotional distress by adopting behaviors like
drinking too much or abusing drugs, which only adds to
the insult of their pre existing medical illness. And sometimes
family and friends, well meaning but inadvertently reinforced a person's
(04:27):
denial of mental distress by saying, well, of course you're depressed,
do you have cancer, instead of recommending that they seek treatment.
Anxiety disorders affect almost of American adults. When you're anxious,
the brain responds by releasing cortisol. That's nature's built in
(04:53):
alarm system, and it evolved to help animals facing physical
threats by increasing their rate of breathing, raising their heart
rate and redirecting their blood flow from abdominal organs two muscles,
so that, for example, they could run away if they're
(05:13):
in a state of danger. These protective actions stem from
the neurotransmitters epineffrin and nor epineffrin, which stimulate the sympathetic
nervous system and put the body on high alert. It
is what is called the flight or fight response. But
(05:34):
when they are invoked too often and not because there's
an actual danger, this constant stimulation results in various kinds
of physical illnesses, including digestive symptoms like having reflux, or
having diarrhea or cramps or constipation, or even peptic ulcer disease.
(06:00):
It can impact the cardiovascular system with an increased rate
of heart attack or strokes. Meanwhile, depression, while less common
than anxiety more like ten percent of the population, can
have even more devastating effects on physical health. While it's
normal to feel depressed from time to time, when out
(06:23):
of ten people have such persistent feelings of depression that
it disrupts their personal relationships, it interferes with work and play,
and impairs their ability to cope with the challenges of
daily life. Physically, depression can also increase a person's perception
of pain, and it can increase their chances of developing
(06:48):
chronic pain, potentially making matters worse. Anxiety and depression often
come together. In fact, if you stay anxious long enough,
you are likely to develop depression, and this makes people
more vulnerable to a collection of physical ailments and an
inability stick with their needed therapy. How can I help
(07:14):
with Dr Gayale Salts will be back after this short break.
Let's get to my listeners question and see how can
I help, Dear doctor Saltz. I was diagnosed with an
(07:37):
early stage breast cancer about six months ago. I've gotten
treatment and I have a very good prognosis. But this
whole thing has completely terrified me and I am really
struggling with feeling anxious all the time. I keep thinking
what if it comes back? Could all my worrying and
(08:00):
stress make it come back? What if I die? What
if I can't handle treatment again. I'm having trouble sleeping,
I have lost my appetite. It's hard to concentrate on
my work. I feel jittery and crouchy at the same time.
My oncologist is like, you are doing well, come back again.
(08:24):
In a few months. Then I think why not a
few weeks and I'm starting to feel down that I
can't get my old life back, Like this is a
permanent terror that I have to live with. Is it?
Is this how women feel after breast cancer, and I'll
just have to live with it. Well, all this anxiety
(08:47):
make me sick and actually make my cancer come back.
Well this harm me in terms of the breast cancer returning.
Just asking this question makes me freaked out that the
answer is yeah, what can I do? Well? First of all,
let me say I am so sorry that you have
(09:07):
gone through something like this. Yes, most women find a
diagnosis of cancer very scary, even something that is called
an early stage cancer, and a whole host of other
negative emotions may come with it as well. Getting a
(09:28):
medical diagnosis, especially one like cancer, is of course scary,
and even with a good prognosis and treatment, it's not
uncommon to have some worrying and to have other associated concerns. First,
let me say there is no evidence that anxiety or
(09:50):
depression for that matter, cause cancer or cause a cancer reoccurrence.
It is also true that these concerns are possibilities, even
smaller ones, and that means that having overwhelming and sustained
anxiety is not a must, and in addition, it is
(10:15):
not necessary. It is actually a harm to you and
your body, and so it is important to think about
how you can address this. Being in a constant state
of flight or fight when your sympathetic nervous system is
so ramped up, causing your body to maintain high cortisol levels,
(10:35):
the stress hormone, This is not great for your health
in the long run. Now that being said, there is
no evidence that high cortisol levels cause cancer, and your
anxiety will not cause the cancer to return, but high
cortisol can affect your overall health and your ability to
(10:56):
participate in your life and should you ever need treatment
like chemotherapy for the cancer in the future. If it
does return, it can impact your ability to feel strong
and to manage the side effects and to tolerate it.
As you've been anxious for a while. Now, you are
also describing some depression creeping in, which is something that
(11:19):
often happens if anxiety remains high for a long and
unremitting time. Depression to can take a toll on the body,
and while it also does not cause cancer nor its return,
it can cause you to be and feel physically run down.
It can affect your ability to sleep, which affects your
(11:41):
overall health. It can affect your appetite, which affects your
nutritional status. And it can affect your perception of pain,
which can make you feel in pain more often and
make pain feel worse. And this affects general conditioning, such
that your physical resilience can get run down. If the
(12:04):
worries are not passing, which you're describing, and your mood
is sinking but you're also describing, I strongly urge you
to get evaluated by a mental health professional who has
expertise in treating people with medical issues. That's a particularly
good choice for somebody like you. And actually there are
(12:26):
many psychiatrists and psychologists who specialize in just that. You
can find one by looking up membership in, for example,
the American Psychological Association or the American Psychiatric Association for
members in your area who specialized in treating people with
chronic medical issues. But you might also find them in
(12:47):
your local hospital, where there may be a team associated,
for example, with the oncology practice. That also is not unusual.
Treating these issues will not only help you feel better overall,
it will help your physical health stay better, so should
the worst happen in the cancer return, you will be
(13:10):
in the best fighting shape to handle further treatments. But
most importantly, it will help you have a better quality
of life now while you're in remission. High anxiety and
depression are not a health condition that you should live
with after our cancer diagnosis, and they are treatable conditions,
(13:34):
sometimes with just psychotherapy, sometimes also with medications. I hope
this was helpful. Although persistent anxiety and depression are highly
treatable with medications with CBT, cognitive behavioral therapy and other
talk therapies. Without treatment, these patients tend to also have
(13:58):
difficulty being complying it with the treatments necessary to treat
their chronic illness, For example, cooking and eating a healthy
diet it's hard to do when you feel depressed, getting
enough sleep, which is affected by both anxiety and depression,
Doing regular aerobic exercise, which requires motivation, which is hard
(14:22):
to do when you feel depressed, and taking your medications
regularly or whatever your condition again something you may fail
to do if you're struggling with anxiety or depression. These
things can make all the difference in caring for, for example, diabetes, hypertension,
(14:42):
chronic headaches. Mental health impacts motivation, the motivation to do
the basics required for medical care. It impacts quantity of
sleep as well as sleep quality, and quantity matters for
basic good health. Mental health is part of overall physical health,
(15:07):
and one impacts the other in a myriad of ways.
In addition, often enough, when someone is terribly anxious or depressed,
they may increase their alcohol intake or use other drugs
such as opioids, to try to treat their anxiety or
their feelings of frequent or intense pain, pain that is
(15:31):
actually being intensified by their depression, but it feels like
the opioids help. This not only doesn't help, it creates
worsening health from alcohol or opioid abuse, and it creates
a new problem. If you are feeling filled with worries
(15:52):
or sadness, talk to your doctor and inquire about getting
treatment for that, or at least referral rather than only
attending to the medical problem you're getting treatment for, because
actually it will help both states. Do you have a
problem I can help with? If so, email me yet
(16:15):
how can I help? At Seneca women dot Com. All
centers remain anonymous and listen every Friday to how can
I help with me Doctor Gale's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. I got a question
from a listener about whether it's possible that her anxiety
can be making it more likely that she will develop
cancer or some other medical illness. This question is actually
a common one. Can mental illness cause you to develop
(00:50):
physical illness? Can physical illness give you mental illness? The
answers are more complicated than yes or no, but the
answer to both actually is not no altogether. It's not
surprising that when a person gets a diagnosis of heart
(01:11):
disease or cancer, or some other life limiting or life
threatening physical illness, that they may become anxious or depressed.
But it may seem more surprising that the inverse is
also true. High anxiety or depression can foster to the
(01:33):
development of a serious medical disease and even make it
more difficult to recover from one. As the pantemic continues
to take a toll on many people's mental health, we
may well see an uptick in certain physical ailments that
are impacted by mental health struggles. In fact, while the
(01:56):
medical profession as a whole and therefore will in general,
tend to think of mental health and physical health as separate,
they really are not. The brain is an organ in
the body, like any other organ, connected to everything else,
(02:17):
impacting everything else, and when the brain becomes sick in
some way, it is a physical illness. The physical location
is the brain, and it causes changes in neurochemicals which
actually impact the rest of the body as well. What
(02:37):
happens inside a person's head can have damaging effects throughout
the body as well as the other way around. An
untreated mental illness can significantly increase the risk of becoming
physically ill, and physical illnesses often result in feelings and
(02:59):
behaviors that make mental conditions worse. You might think of
this as the mind body connection, but in a way,
it's all one body, and it's the body's body connection.
There have been studies that look at patients, for example,
(03:19):
diagnosed with cancer, and find that significant depression can and
does often cause a patient to do worse than expect
it and worse than patients who don't develop depression at all. Physicians, unfortunately,
don't always look at the stresses placed on the body
(03:40):
by mental illness and don't treat it like the physical
stress on the body that it actually is. Many people
are reluctant to seek treatment for emotional feelings. Some people
with anxiety or depression may fear being stigmatized, even if
they recognize they have a serious psychological problem. Some people
(04:06):
attempt to treat their emotional distress by adopting behaviors like
drinking too much or abusing drugs, which only adds to
the insult of their pre existing medical illness. And sometimes
family and friends, well meaning but inadvertently reinforced a person's
(04:27):
denial of mental distress by saying, well, of course you're depressed,
do you have cancer, instead of recommending that they seek treatment.
Anxiety disorders affect almost of American adults. When you're anxious,
the brain responds by releasing cortisol. That's nature's built in
(04:53):
alarm system, and it evolved to help animals facing physical
threats by increasing their rate of breathing, raising their heart
rate and redirecting their blood flow from abdominal organs two muscles,
so that, for example, they could run away if they're
(05:13):
in a state of danger. These protective actions stem from
the neurotransmitters epineffrin and nor epineffrin, which stimulate the sympathetic
nervous system and put the body on high alert. It
is what is called the flight or fight response. But
(05:34):
when they are invoked too often and not because there's
an actual danger, this constant stimulation results in various kinds
of physical illnesses, including digestive symptoms like having reflux, or
having diarrhea or cramps or constipation, or even peptic ulcer disease.
(06:00):
It can impact the cardiovascular system with an increased rate
of heart attack or strokes. Meanwhile, depression, while less common
than anxiety more like ten percent of the population, can
have even more devastating effects on physical health. While it's
normal to feel depressed from time to time, when out
(06:23):
of ten people have such persistent feelings of depression that
it disrupts their personal relationships, it interferes with work and play,
and impairs their ability to cope with the challenges of
daily life. Physically, depression can also increase a person's perception
of pain, and it can increase their chances of developing
(06:48):
chronic pain, potentially making matters worse. Anxiety and depression often
come together. In fact, if you stay anxious long enough,
you are likely to develop depression, and this makes people
more vulnerable to a collection of physical ailments and an
inability stick with their needed therapy. How can I help
(07:14):
with Dr Gayale Salts will be back after this short break.
Let's get to my listeners question and see how can
I help, Dear doctor Saltz. I was diagnosed with an
(07:37):
early stage breast cancer about six months ago. I've gotten
treatment and I have a very good prognosis. But this
whole thing has completely terrified me and I am really
struggling with feeling anxious all the time. I keep thinking
what if it comes back? Could all my worrying and
(08:00):
stress make it come back? What if I die? What
if I can't handle treatment again. I'm having trouble sleeping,
I have lost my appetite. It's hard to concentrate on
my work. I feel jittery and crouchy at the same time.
My oncologist is like, you are doing well, come back again.
(08:24):
In a few months. Then I think why not a
few weeks and I'm starting to feel down that I
can't get my old life back, Like this is a
permanent terror that I have to live with. Is it?
Is this how women feel after breast cancer, and I'll
just have to live with it. Well, all this anxiety
(08:47):
make me sick and actually make my cancer come back.
Well this harm me in terms of the breast cancer returning.
Just asking this question makes me freaked out that the
answer is yeah, what can I do? Well? First of all,
let me say I am so sorry that you have
(09:07):
gone through something like this. Yes, most women find a
diagnosis of cancer very scary, even something that is called
an early stage cancer, and a whole host of other
negative emotions may come with it as well. Getting a
(09:28):
medical diagnosis, especially one like cancer, is of course scary,
and even with a good prognosis and treatment, it's not
uncommon to have some worrying and to have other associated concerns. First,
let me say there is no evidence that anxiety or
(09:50):
depression for that matter, cause cancer or cause a cancer reoccurrence.
It is also true that these concerns are possibilities, even
smaller ones, and that means that having overwhelming and sustained
anxiety is not a must, and in addition, it is
(10:15):
not necessary. It is actually a harm to you and
your body, and so it is important to think about
how you can address this. Being in a constant state
of flight or fight when your sympathetic nervous system is
so ramped up, causing your body to maintain high cortisol levels,
(10:35):
the stress hormone, This is not great for your health
in the long run. Now that being said, there is
no evidence that high cortisol levels cause cancer, and your
anxiety will not cause the cancer to return, but high
cortisol can affect your overall health and your ability to
(10:56):
participate in your life and should you ever need treatment
like chemotherapy for the cancer in the future. If it
does return, it can impact your ability to feel strong
and to manage the side effects and to tolerate it.
As you've been anxious for a while. Now, you are
also describing some depression creeping in, which is something that
(11:19):
often happens if anxiety remains high for a long and
unremitting time. Depression to can take a toll on the body,
and while it also does not cause cancer nor its return,
it can cause you to be and feel physically run down.
It can affect your ability to sleep, which affects your
(11:41):
overall health. It can affect your appetite, which affects your
nutritional status. And it can affect your perception of pain,
which can make you feel in pain more often and
make pain feel worse. And this affects general conditioning, such
that your physical resilience can get run down. If the
(12:04):
worries are not passing, which you're describing, and your mood
is sinking but you're also describing, I strongly urge you
to get evaluated by a mental health professional who has
expertise in treating people with medical issues. That's a particularly
good choice for somebody like you. And actually there are
(12:26):
many psychiatrists and psychologists who specialize in just that. You
can find one by looking up membership in, for example,
the American Psychological Association or the American Psychiatric Association for
members in your area who specialized in treating people with
chronic medical issues. But you might also find them in
(12:47):
your local hospital, where there may be a team associated,
for example, with the oncology practice. That also is not unusual.
Treating these issues will not only help you feel better overall,
it will help your physical health stay better, so should
the worst happen in the cancer return, you will be
(13:10):
in the best fighting shape to handle further treatments. But
most importantly, it will help you have a better quality
of life now while you're in remission. High anxiety and
depression are not a health condition that you should live
with after our cancer diagnosis, and they are treatable conditions,
(13:34):
sometimes with just psychotherapy, sometimes also with medications. I hope
this was helpful. Although persistent anxiety and depression are highly
treatable with medications with CBT, cognitive behavioral therapy and other
talk therapies. Without treatment, these patients tend to also have
(13:58):
difficulty being complying it with the treatments necessary to treat
their chronic illness, For example, cooking and eating a healthy
diet it's hard to do when you feel depressed, getting
enough sleep, which is affected by both anxiety and depression,
Doing regular aerobic exercise, which requires motivation, which is hard
(14:22):
to do when you feel depressed, and taking your medications
regularly or whatever your condition again something you may fail
to do if you're struggling with anxiety or depression. These
things can make all the difference in caring for, for example, diabetes, hypertension,
(14:42):
chronic headaches. Mental health impacts motivation, the motivation to do
the basics required for medical care. It impacts quantity of
sleep as well as sleep quality, and quantity matters for
basic good health. Mental health is part of overall physical health,
(15:07):
and one impacts the other in a myriad of ways.
In addition, often enough, when someone is terribly anxious or depressed,
they may increase their alcohol intake or use other drugs
such as opioids, to try to treat their anxiety or
their feelings of frequent or intense pain, pain that is
(15:31):
actually being intensified by their depression, but it feels like
the opioids help. This not only doesn't help, it creates
worsening health from alcohol or opioid abuse, and it creates
a new problem. If you are feeling filled with worries
(15:52):
or sadness, talk to your doctor and inquire about getting
treatment for that, or at least referral rather than only
attending to the medical problem you're getting treatment for, because
actually it will help both states. Do you have a
problem I can help with? If so, email me yet
(16:15):
how can I help? At Seneca women dot Com. All
centers remain anonymous and listen every Friday to how can
I help with me Doctor Gale's Salts
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