Volume 13, Number 6
The 17th century philosopher René Descartes had a profound impact on perspectives of health and illness, as he challenged the prevailing notion of his time that sickness was a form of divine punishment. Descartes’ argued that the mind and the body are distinct (i.e., mind-body dualism), and his idea of viewing the body as a machine had a major impact on subsequent scientific inquiry. Substantial advances in the scientific understanding of the human body and its functions gave rise to the biomedical model of health and illness, which views disease or disorders as the result of disturbances in physiological processes. Four decades ago, Dr. George Engel, at the time a professor of psychiatry and medicine at the University of Rochester, issued a challenge to the biomedical model with his proposal that psychological and social factors also must be considered for a more complete understanding of health and illness. Engel’s biopsychosocial model suggests that it is the interaction of biological, psychological, and social factors that results in wellness or disease.
Although the biopsychosocial model has been increasingly present in perspectives on health and health care, mind-body dualism and the biomedical model remain most prominent. Distinguishing mental health from physical health continues to be the norm, and treatment for physical disorders tends to be separate from treatment for mental disorders. But human beings have necks, connecting the mind and the body.
Two very common health problems in the United States are diabetes and depression, and both are among the most prominent causes of disability. In 2014 nearly 30 million persons had diabetes while nearly 16 million were diagnosed with at least one depressive episode. Not surprisingly, both are extremely costly to society.
Although diabetes is understood to be a physical illness and depression is a common mental disorder, the incidence of depression is increased among persons with diabetes (approximately 60% increased risk), and the incidence of diabetes (type 2) is increased (by approximately 65%) in persons with depression. And the risk for heart disease, the leading cause of death in the United States, is higher for both conditions.
Review of all the factors contributing to the bidirectional relationship between depression and diabetes is beyond the scope of this brief, but it isn’t surprising that lifestyle behaviors (e.g., sleep, diet, exercise, etc.) impact vulnerability to and management of both conditions. Stress is also a factor that increases susceptibility to both diabetes and depression. For example, it has been recently reported that both the threat of unemployment and having a variable income are risk factors for diabetes. Furthermore, Dr. Engel would be pleased to know that social determinants of health (education, income, childcare, housing, etc.) are getting increasing attention, to the extent that there are strong arguments that social and economic factors contribute 30-40% to health outcomes. Stress is one of the major causal pathways for such social determinants. Hence, social and economic factors (such as unemployment threat) deserve consideration in the prevention and management of both diabetes and depression.
Whether a risk factor for a health problem is a physical pathogen, a social or economic factor, or a behavioral habit, eventually the impact on the body may be understood at a molecular level. But with respect to health promotion and health care, the fact that we have necks is a good reminder that health is best understood from a whole person perspective, rather than a collection of distinct diagnostic entities.
Paul J. Hershberger, Ph.D.
… is a clinical health psychologist. He is Professor and Director of the Division of Behavioral Health, Department of Family Medicine, Wright State University Boonshoft School of Medicine.
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