by MARK POWELL
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Human beings love to compartmentalize things. We enjoy tucking them into comfortable cubbyholes in our minds. It’s convenient. But as we all know, life is seldom so neat and tidy.
Consider two of the biggest problems confronting each of us sooner or later: physical health and mental health challenges. We typically compartmentalize situations we encounter into one group or the other. However, research increasingly indicates they’re more closely interconnected than we may have realized.
The intersection where they meet could (and should) be as close as your family doctor’s office…
We all know about physical ailments, injuries, and conditions: they’re fairly easy to assess and diagnose. Mental illness, on the other hand, is so broad it extends from those who need institutional care on the one extreme to others who are simply battling a bad case of the blues – with a wide variety of degrees in between.
While most of us get physically sick at some point each year, many of us also encounter mental challenges. In fact, a recent study estimated that in 2023-2024, about 828,000 South Carolina adults over the age of eighteen – or roughly one in five of us – experienced some type of mental illness. Of those, approximately 193,000 South Carolina adults experienced a serious mental illness, meaning their condition substantially impaired major life activities.
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More often than not, what you’re experiencing in your head (and heart) directly affects what you’re feeling in your body.
“A good starting point is defining the term,” said Justin E. Fichtner MD, a family physician at Sandhills Family Medicine – part of the Lexington Health system.
“People hear ‘mental health,’ but what do we really know about it?” Fichtner added. “We know how the movies portray it – and how it’s been portrayed in mainstream media in recent decades. We see the old ‘Shutter Island’ type films where people are locked up in hospitals, and that makes us think of psychosis and mental breakdowns and really severe mental illness.”
While that is certainly one extreme, it’s far from what most people typically experience.
Everyday mental health issues can include generalized depression, sadness over a romantic breakup, grief over the death of a family member or anxiety over the loss of a job. And while such issues may seem minor or fleeting, that’s often when a medical doctor should get involved.
“In truth, primary care doctors encounter and treat different aspects of mental health every day,” Dr. Fichtner explained. “One of the first things a doctor notices is – how does someone look? What can you tell about how they may be feeling based on meeting them at the door? If someone has a cheerful attitude – or if they seem to be feeling really sad – that can be evident right off the bat. Primary care doctors strive to build strong relationships with our patients. So even in a first visit, if I can convey to them I’m in their corner – that I’m here for them – we can start to build a relationship quickly.”
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“Physical health problems certainly affect anxiety,” Dr. Fichtner continued. “When we’re diagnosing depression, we always draw a distinction: is this primary psychology-related, or is this secondary to a medical condition? Meanwhile, in thinking about the person who has really severe anxiety which pops up as a panic attack – and all of a sudden they’re feeling like their heart rate is racing or their breathing is racing, or they’re experiencing a palpitation almost like a flutter in their chest that wasn’t there before. The mind and the mental health absolutely connect with the body and the physical health.”
So, what happens when this intersection is reached?
“Once you’ve identified and defined a specific mental health challenge, the next step is: what are the options at our disposal to make you feel better – or to treat these symptoms so you can function better?” Dr. Fichtner recalled. “For example, pretty much everybody has some degree of anxiety. Anxiety itself keeps us on our toes, keeps us safe – but if there’s too much, it can become debilitating and make people feel fearful to do everyday things.”
Thankfully, there’s no shortage of options to address anxiety.
“It can be counseling, it can be medication,” Dr. Fichtner noted. “Sometimes it can be exercise and lifestyle changes – or finding a hobby that alleviates anxiety. That goes for depression, too, with talk therapy versus medicine or exercise – or trying new activities. We have pretty good evidence that therapy and pharmacotherapy or medicine are both good options for treating anxiety and depression. When we combine counseling and therapy with medication, we tend to get a more robust response.”
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So improvement is possible, in both the mental and physical spheres. All it takes is someone, whether the doctor or the patient, to open up and start the discussion.
“Just yesterday, I met a patient for the first time,” Dr. Fitchner said. “She recently lost a family member, and she was grieving. But on top of that, it was clear that she was struggling with some of the classic symptoms of depression. And that person came in thinking, ‘I don’t want to start medication for this,’ which is totally fair. So we talked through it.”
“As we talked and I got to know her better, it turned out she had tried counseling; it was hit or miss, and I explained to her how success really depends on finding a good therapeutic match,” he continued. “By the end of the conversation, we ended up starting a low dose of medicine. I told her, ‘I’m prescribing this not for depression or the grief you’re experiencing, but because you clearly have a background of generalized anxiety disorder.’ She recognized that. And so we went from not knowing each other and feeling a little bit nervous about the appointment to sharing all the experiences – and figuring out a plan. There were some tears shed and some hugs given, and we built a connection. I’m going to see her in a few weeks to make sure she’s still doing okay.”
And that – making sure people are okay – is what it’s all about.
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ABOUT THE AUTHOR…
J. Mark Powell is an award-winning former TV journalist, government communications veteran, and a political consultant. He is also an author and an avid Civil War enthusiast. Got a tip or a story idea for Mark? Email him at mark@fitsnews.com.
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