Primary Care & Mental Wellness

Words: Dr Rajgopal NIDAMBOOR

The greatest faux pas in the treatment of illness, or disease, is that there are physicians for the body and physicians for the soul — although the two cannot be separated. The amazing fact about this reference is it is more than 2,500 years old — an ageless aphorism accredited to the legendary philosopher Plato. Yet, it is as applicable today as it was a long time ago. What’s more, it bids fair to the idea that medicine is slowly changing, because the whole axiom confers and, in turn, validates, no less, that physical, emotional, or mental health disorders go in concert, or collectively.

Research evidences that individuals with severe, or chronic physical illnesses may often have a related, or parallel, mental health ‘catch-22.’ Or, what may remain overlooked, ignored, and inappropriately treated. This exemplifies the stigma associated with any emotional, or mental illness. This is also the principal reason why most individuals first seek ‘counsel’ through their general practitioner [GP], or the nearest healthcare centre — without letting their ‘guard.’ This has providentially, or fortuitously, led to better amalgamation between mental health and physical care, including substance abuse, its ‘vetting’ and treatment in the primary care setting.

Chronic Burden

Most chronic illnesses have a clear, strapping effect on one’s mental and emotional status. In the same approximation, most undiagnosed mental disorders influence the individual’s ability to cope with the illness and/or involve oneself in the treatment and recuperation process. This is primarily because learning to cope and live, if not accept, any long-term emotional, or mental issue is nerve-racking for most people — more so, in the wake of unremitting anxiety. It is, therefore, not uncommon for patients and family to have continuing periods of anxiety about the effect of the illness on their lives. This leads to familiar symptoms, such as difficulty in breathing, chest tightness, trembling, headache, and dizziness, not to speak of fear. What’s more, depression too has a cascading effect on the state of affairs. It is also the most common complication of almost all chronic, or serious medical conditions.

About one in five individuals, for instance, will have an episode of major depression in their lifetime. This numeral as statistics represents is one in two for people with heart disease. Besides, the risk of heart disease is two-fold in people with a history of depression. A Dutch study has found that anxiety disorders may increase the risk of heart attack, stroke, heart failure and death in people with heart disease too. Depression also appears to trigger particularly grave risks for heart attack survivors. Depression, as research suggests, increases five-fold the likelihood of dying after being treated for heart attack: “The clear demonstration that psychological factors like depression and social isolation distinguish coronary heart disease [CHD] patients at highest risk means it would be unethical not to start trying to treat such factors.”


Estimates also indicate that one in four individuals with diabetes suffers from depressive symptoms. The probability of developing depression is doubled for individuals who have diabetes — with the risk of morality, as a consequence, being 30 per cent. Nearly 20 per cent of patients with asthma and chronic pulmonary obstructive disease [COPD], likewise, reportedly suffer from major depression and/or anxiety, including panic attacks and phobia. Besides, depression and anxiety states are associated with unhealthy behaviours, such as poor eating or diet, physical inactivity, unkempt attire, and sedentary lifestyle, not to speak of tobacco abuse, and excessive alcohol consumption. They are, not surprisingly, linked with amplified potential for obesity too.

It is agreed that GPs, and healthcare centres, are better able to distinguish depression and anxiety when patients provide psychosocial, rather than physical complaints, because physical symptoms are often the only ‘whinge’ described by depressed and anxious patients. When present with physical illness, suitable medications, and suggestions on appropriate lifestyle, and diet, can fortunately change, if not always, the outcome of emotional illnesses in the primary setting.

Mental illnesses and physical health conditions go hand-in-hand, as already cited. The problem unfortunately is a large part of our upmarket, or corporate, healthcare system, does not effectively provide for a holistic, also integrated, approach for physical and mental healthcare. The paradox often is the individual patient receives mental healthcare from one institution and physical healthcare from another — with relatively no harmonious co-ordination. The consequence of such disjointed, or inequitable care is low life expectancy and poor quality of life.


The advantage with primary healthcare and GP, however, is they are usually delivered ‘close up’ to one’s residence. This often helps to mitigate the wobbling stigma, besides augmenting the constancy of enhanced care. Good primary, including consultative, healthcare provides reliability of treatment because the patient and the physician know each other. This also results in reduced healthcare costs. Evidence shows that patients are often satisfied with primary care services, because it is far better equipped to dealing with patients in an integrated, holistic manner.

Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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