Putting people in boxes

There is a growing awareness of mental health. This has led to people being far more open about their mental health and recognition of how things such as stress, worry & anxiety can impact on our well-being. However, it sometimes seems that this has led to us trying to put things in nice, neat boxes where diseases and conditions are either part of our ‘mental health’ or our ‘physical health’.

As a physiotherapist people typically come to me when they are struggling with their physical health – some part of their body hurts. Modern physiotherapy and medicine understand that all pain complaints and indeed all health conditions have bio-psycho-social aspects. That is to say there are biological, psychological and sociological factors that impact on that health condition and all of these factors should be considered.  Again we find ourselves in a situation where we have divided factors into nice, neat boxes: biological, psychological and sociological.

This is not the reality though. It is impossible to isolate any of these factors from any of the others and all of them are relevant but with different degrees of importance depending on the person, situation and context.

When people are in pain (something physically hurts) they sometimes struggle to see the relevance of the psychological and social factors that may be impacting on their pain experience

A useful way to conceptualise this is:

Consider this slice of cake:


We know that chocolate, eggs, flour, butter & sugar have gone into that cake but, in that photo, can you point out where the eggs are? Or which bit of it is the butter? Of course not!

We know they are in there but, the cake is more than the sum of its parts. The ingredients are no longer distinguishable from each other, it’s just cake.

Similarly we cannot separate out the biological, psychological and social factors that may be affecting a person’s pain. We can try to determine which of the factors are having the largest impact but we must always consider the interplay and interaction with other factors.

There is no divide between physical and mental health they are just constructs to try and help us better understand human health and if we try to address one without acknowledging the other then we are missing the bigger picture.

So when thinking about our health we need to understand that just as physical sensations such as pain or stiffness can affect our mood so can stress and worry affect the physical sensations we perceive. Therefore, if you are in pain try to consider not only the physical factors that might be affecting you but also the psychological and social factors. It may be that acknowledging and reducing stress or worry can improve your pain. Remember it is impossible to separate out the ingredients of a cake!