Why mental health is not all in the mind

Suppose someone you know develops a skin rash after consuming contaminated food or water. Chances are you’d advise them to see a doctor. But what if that same rash were down to anxiety or stress? Would you take it as seriously as the physical cause?

Probably not, according to David Faro, Associate Professor of Marketing at London Business School, because we tend to see the body and mind as separate entities – the psychological as somehow distinct from the physiological. And that’s a problem.

He says, “In modern society, we still cleave to a kind of mind-body dualism – we see the mind as disconnected from the body, so we may underestimate the severity or even legitimacy of health problems when the root cause is psychological, even when those problems are serious for those who are suffering. With psychological conditions such as stress or anxiety, even when they manifest in something observable such as a rash or a cough, we are more likely to underplay their significance.”

This begs the question by how much: if the origin of someone’s suffering is psychological, just how much more are we likely to play down its severity than if it had a physical cause? And with what consequences?

Physical versus psychological

To answer this question, Dr Faro teamed up with LBS PhD candidate Selin Göksel and Rotterdam School of Management Professor of Marketing Stefano Puntoni and ran a number of laboratory experiments looking at people’s perceptions of medical signs and symptoms. One study explored how participants rated a sound clip of a cough in terms of its “harshness” or “scratchiness” when they were told it was the result of drinking tainted water as opposed to a week of intense work.

A second experiment asked participants if they would recommend medical treatment for a rash caused by anxiety or strep throat.

The results of both studies were striking. Participants not only took the psychological causes less seriously than the physical, but were significantly less likely to recommend medical intervention. “When we looked at the responses, we found that, in the case of the cough caused by contaminated water, around 54% of our respondents suggested seeing a doctor, compared to just 35% for anxiety,” Dr Faro reveals.

The research also showed that, when patients exhibited two health problems, observers prioritised care for the one that occurred first, but this tendency was significantly reduced when the first problem was psychological. In other words, people were reluctant to prioritise medical treatment for psychological versus physical causes; a finding consistent with discounting the severity of the impact of psychological causes.

But what about support for medical research? Does the same bias prevail when it comes to backing for funding or making donations to find cures? The researchers conducted a third experiment, asking participants to support different causes.

Striking difference in response

“We invited people to distinguish between conditions caused by physiological versus psychological factors, this time by making a financial donation to research these factors,” says Dr Faro. “Again, the results are conclusive. For a cough that participants believed to be physical in cause, 74% of respondents chose to donate, compared to just 32% when the same cough was psychological. A rash with a physiological explanation elicited a solid 68% backing from our volunteers. The same rash caused by psychological factors got financial support from just 26% of our sample.”

Do these results support the idea that psychological illness remains a stigma in our society? Possibly, replies Dr Faro, but he believes another explanation is the notion of body-mind dualism; that it’s simply hard for people to imagine that a physical issue can have a psychological root. He says, “When something is caused by the mind, there’s always the risk that its credibility can be called into doubt, or that we think that it’s somehow the fault or responsibility of the patient. In our experiments, we mitigate this effect by working with observable medical signs – the cough or the rash. While prior research has documented the existence of mental health stigma, we are the first to show that even observable medical signs tend to be dismissed when people believe they have a psychological origin.

“A better explanation for the results we find – and an explanation that is perhaps harder to address – is that we just find it really hard to associate the physiological with the psychological. This is problematic, not only for the mentally ill in society, but for the growing number among us who are experiencing stress and anxiety.”

Growing challenge

Dr Faro argues, “People with medical conditions need support, guidance and treatment, and they need these conditions to receive financial funding in terms of research and the hunt for cures. This is the case whether those conditions are physiological or psychological. Without adequate support, the danger arises of inadequate care and treatment for conditions such as fibromyalgia – pain experienced across the entirety of the body that is believed to be caused either by psychological or physical trauma.”

There is also the risk of healthcare avoidance among those with psychological health problems, coupled with continuing underfunding in this area.

As we emerge from the Covid-19 pandemic amid a climate of geopolitical crisis in Europe, mental healthcare provision will remain a huge challenge, Dr Faro points out. He believes the challenge will be even greater if we do not address biases that stem from body-mind dualism: “It’s becoming increasingly common for people to experience stress and anxiety. We’ve lived through the pandemic and now we’re facing dreadful uncertainty around the spread of war in Ukraine. “For people to take these conditions more seriously and support those who are suffering, more needs to be done in terms of acknowledging that the mind can indeed affect the body – that the mind and body are interlinked.”

David Faro is Associate Professor of Marketing at London Business School