I lived with undiagnosed and untreated anxiety disorder for almost four decades. By the time I finally knew that this was not normal and sought out help, a little more than a dozen years ago, I was also at the beginnings of a profound change in my physical health, one that has led me ever since on a merry chase through hill and dale… well, mostly dale. Also tactless deserts, dry river beds, and all the other landscapes favored as metaphors by the army of the chronically ill.
Did decades of constant bombardment of cortisol and its myriad allies contribute to the physical state in which I find myself? The loss of an adrenal gland and the breakdown of my hypothalamic-pituitary-adrenal (HPA) axis certainly suggests the possibility. Did half a lifetime of uncontrolled anxiety contribute to my frequently compromised immune system and lifelong sense of myself a “sickly”? For sure.
In the binary thinking of modern medicine, then, it would be all too easy to see mental health challenges as at the root of all my physical health problems. And yet: I was born with severe asthma, growing up in what was at the time one of the most polluted cities in America. Did that early childhood experience of midnight suffocations and countless clinic waiting rooms contribute to the early onset of my anxiety? Which came first: the fried chicken or the cracked egg?
I’ve been pondering this puzzle of late not because I believe there is an answer; in fact, I am confident the very question is flawed and counterproductive. I know all too well that my physical illness exacerbates my mental illness, and vice versa. They are inextricable and any treatment that does not address both will ultimately serve to make a bad situation worse. And yet, in the manichean system of health care under which we operate—in which mental and physical health reside on two sides of a firewall with only the most limited and delicate of diplomatic communications transmitted between them—a patient is forced to pursue the two avenues of care independently and with all the delicacy of a double-agent.
After many years of relatively well-controlled anxiety symptoms, about a month ago I started to develop intense anxiety symptoms again. They seemed to come out of nowhere. They were both relentless—from morning to night and into a restless sleep—and inescapable. My racing mind‚ suddenly in the grips of hyper-vigilance and all-consuming dread, could latch on to anything as an occasion. And as effortless and endless as was the latching, the letting go proved seemingly impossible.
What had triggered this sudden influx of debilitating symptoms? Had my anxiety medication, effective for a dozen years, suddenly lost its efficacy? Had a change in my endocrine system—or elsewhere in my troubled ecosystem—led to a sudden change in the neurochemicals coursing (or failing to properly course) through my system? All I knew for certain was that one minute I was doing ok, and the next moment I felt broken. It was now up to me to pursue parallel lines of inquiry with therapist and psychiatrist on one side and internist and other specialists on the other.
And never the twain shall meet. When I first wrote my primary care provider about the sudden changes, she promptly sent out word to my nephrologist (who guided me through my adrenal crisis a few years ago) and my endocrinologist. Electronic medical records, so ubiquitous at a large medical institution like Ohio State over the past decade, made this communication almost effortless. But of course the system provided no way for her to communicate with my psychiatrist, whose practice exists outside of the Ohio State system and whose discipline exists on the other side of the impenetrable border.
So, rather than an integrative approach that considered the tangled weave, I was forced to choose a strand a follow it as far as it might go. We shall see where it leads, but at least I am fortunate to have exceptional practitioners on both sides of the iron curtain. I just cannot help but imagine what kind of progress we might make if ever the twain could meet.
Jared Gardner is a professor and patient at the Ohio State University.