Dr. Caroline Leaf – In this podcast (episode #389) and blog, I talk to holistic psychiatrist, acupuncturist, and yoga teacher Dr. Ellen Vora about the importance of taking a functional medicine approach to mental health, addressing imbalances at the root, taking a whole person approach to wellbeing, her amazing new book The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response, exploring what anxiety tells us, why women are often accused of being more anxious than men, anxiety and hormonal changes, and so much more!
As Dr. Vora points out in her new book, anxiety is not just in your head. Our mind, brain and body are separate but integrated systems. They work together—the human mind is embodied. Anxiety and panic attacks are very real phenomenon that have physical aspects, and should not just be dismissed as “they are just in your head” by medical professionals. Mental health is physical health.
Unfortunately, since the 1990s, healthcare has largely been influenced by the assumption that mental health is mainly determined by our genetics and our brain chemistry, essentially setting our destiny upon factors we cannot control. Yet, as Dr. Vora points out, our brain chemistry is often a downstream affect of something that is happening in the brain and body. Many mental health issues are closely related to physical health issues, which is why it is so important that we also address mental health on the level of the physical body. We should not just be looking at genes or brain chemistry.
This is a more hopeful way of approaching mental health, because it means that, to a certain extent, we can influence our genes, DNA and biology. Our environment plays a very big part in our mental wellbeing, and is something that, in many ways, we can learn to control.
This doesn’t mean we are to blame for our mental health issues, because we often cannot control what happens to us. We can, however, control how we react to what happens to us, which is incredibly empowering and hopeful—we are not just victims of life! We can learn what contributes to mental health issues, and make incremental and approachable adjustments to our lifestyles that can positively impact how we feel mentally and physically.
And we all need this hope. As Dr. Vora notes, more than 40 million Americans suffer from anxiety in any given year, a number that has only increased as a result of the Covid-19 pandemic. We need more than just “more access to mental healthcare”. We need mental healthcare that works—that empowers and heals people without doing harm.
Of course, seeking professional help for mental issues is important if needed. But there is also a lot we can do as individuals that can improve our mental health over time, which is empowering! Mental health should not just be the purview of those in the ivory tower who gate-keep knowledge.
If you are very symptomatic, psychiatric medication can narrow the range of effect, which some people may find helpful for a certain period of time. However, these medications are not a cure; they are a bridge that may help you get to a place where you can heal. (For more on this, read the book Anatomy of an Epidemic by Robert Whitaker, and check out the Mad In America website.)
However, for many people, psychotropic drugs do not meet their mental health needs and have many unwanted side-effects. These people often find it incredibly difficult to stop taking them, and need help during the withdrawal process, which can be challenging. There is no single system in place to help people withdraw from these medications, and professionals are often not taught how to support their patients or the best way to help them withdraw. In fact, not a lot is known or published about the best way to taper off psychotropic medications, while many professionals tend to deny the validity of people’s struggles when they are in withdrawal. This process is also often confused with “relapse”, which further distorts the situation and can make the person’s mental distress more chronic and acute. I discussed this in detail with psychiatrist Dr. Joanna Moncrieff in a recent podcast and blog.
As Dr. Vora points out, progress in mental healthcare is always about the why: understanding the root cause(s) of why things are out of balance and why we feel what we feel. Depression and anxiety are the beginning, not the end, of the inquiry. They are signals we need to explore and manage, not just suppress or ignore.
Part of this process is understanding the difference between false anxiety and true anxiety. As Dr. Vora discusses in her book, The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response, false anxiety is not a “fake” form of suffering. Rather, it means that there is a physical basis and a physical way out — it is a stress response to modern life, not a “true” part of who you are. When the root cause of this false anxiety is addressed, it is possible to reduce its impact on someone’s mental health by doing things such as:
– Improving sleep
– Changing diet
– Reducing technology usage
“True” anxiety, on the other hand, is purposeful anxiety. It shouldn’t be pathologized; it is a way of communicating with yourself. It doesn’t have a physical basis. Rather, it is the way we are tuned in or sensing what is not right in our personal lives, communities and the world around us. It can lead to suffering, but the good news is we can learn how to slow down and listen to what this anxiety is telling us. This helps us control our anxiety because it drives purposeful action to reduce mental suffering. Ways we can start listening to our true anxiety and listen to the message it is sending us after we deal with our false anxiety include:
– Practicing mindfulness and self-regulation
We also need to examine how we think about postpartum depression and anxiety. Massive hormonal changes after pregnancy (and after a pregnancy loss) can dramatically affect how we feel mentally. This is not something we should feel ashamed about—we should have compassion for ourselves and understand that this is what happens when we go through major hormonal crashes. On top of this, mothers and mothers-to-be have the added stress of role transitions, as well as the added physical stress of nutritional demands from the pregnancy and breastfeeding, which can have an impact on a woman’s mental wellbeing. Even under the best of circumstances, it takes time to recalibrate, and this should be taken into consideration when helping new mothers with mental health struggles.
Thankfully, wherever we are in our lives, there are some simple ways we can all manage anxiety, such as:
- Avoid bringing our phone into the bedroom at night. This helps us avoid “doom scrolling” and spending too much time online, which can disrupt our circadian rhythm and impact our anxiety levels.
- Eat a diverse diet full of nutrient-rich foods, so that the brain and body get the nutrients they need to function well, which also helps our mood and anxiety levels.
- Prioritize community—connecting with the people we love does wonders for our mental health. We are hardwired to feel safe and calm when we are in community.
- Embrace anxiety as a messenger. We need to listen to what it is telling us about what is going on in our lives and how we can learn and grow as human beings.
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