Weaving Threads of a False Dichotomy

Building better healthcare by integrating and respecting the connection between mind and body

One of the hardest things I see in primary care is patients bouncing between specialists, getting dismissed or over-tested, because their symptoms don’t fit neatly into the rigid boxes of our health care system. The most troublesome scenarios are when patients get inappropriately pigeonholed into “problems of the mind” versus “problems of the body” - as if the two could ever truly be separated.

Today, the mind-body connection is everywhere in health conversations; the term gets used to describe so many different aspects and experiences of health that it can start to feel vague and overused. This means it’s the perfect time to have a thoughtful conversation, beyond the buzzwords: to explore how it works, examine the potential harms when it’s ignored, and discuss how to create a healthcare experience that integrates these not-so-disparate aspects of your health.

Since this topic can feel slippery, I’m going to be methodical in building my case, as if I were speaking to a first year medical student or at times, directly to a patient. While first-year medical students are early in their clinical journey, they possess a relevant curiosity and humility that too often get lost along the way.

As you read through this post, I hope you can tap into your own sense of curiosity and think through how these principles may apply to your life. The only way to begin to understand our complicated minds and bodies is to first accept that we mostly don’t know what the hell is going on with our minds and bodies. Only then can we embrace the complexity, understand our own blind spots, and crystallize toward a clearer sense of ourselves.

As a quick aside, if you are a patient looking for a new primary care doctor, I would absolutely assess for their curiosity around the mind-body connection.

If they don’t consider your emotional health as a core pillar of your entire health, or they scoff at the notion that our emotions can affect physical symptoms or vice versa, or you can tell they focus almost exclusively on the “data” without any emphasis on your experience of your body or illness, these are flags for me.

I’m not saying this should be their primary skillset; their main charge is to assess and support your medical issues. But I am saying that the best primary care doctor, the one you want quarterbacking your team, has the ability to put on this lens. Being a modern expert physician requires understanding this connection.

Step 1: The inherent uncertainty in diagnosis

It’s worth having a quick discussion around what makes a “diagnosis.” My first intent is to sow some doubt into your mind regarding the fidelity or determinacy of any single medical or psychological diagnosis.

A minority of diagnoses are defined by solely objective criteria, without attention to related symptoms. A few simple examples are listed below. These diagnoses are binary - you either meet the criteria based on your vital signs or laboratory values or you don’t.

• Hypertension (elevated blood pressure)

• Hyperlipidemia (elevated cholesterol)

• Diabetes Mellitus (elevated blood sugar)

• Anemia (low hemoglobin or red blood cell count)

• Chronic Kidney Disease (reduced kidney function based on GFR)

Yet, most diagnoses do not have this luxury. They exist as an interwoven pattern of objective data (vital signs, laboratory values, imaging findings) and subjective data (symptoms). In practice, this becomes quite nebulous. Each piece of data is a star in the sky, waiting to be connected into a constellation (diagnosis) by patient and clinician. Puzzlingly, the same stars can belong to multiple constellations, and which pattern you see depends on countless factors - the clinician’s training and frame of reference, the questions asked, the symptoms you emphasize, even how you describe your experience. The work, then, is a collaborative one: finding the constellation that most accurately maps to what you’re actually experiencing.

This is the nature of working with human beings. Unlike a broken machine with a single identifiable malfunction, our bodies and minds are dynamic, interconnected systems where the same symptom can arise from dozens of different sources, and the same underlying problem can manifest in different ways. Understanding this ambiguity is the first step toward recognizing why the traditional separation between “body problems” and “mind problems” falls short. If diagnosis itself is an interpretive act (choosing which constellation best fits your stars) then we need to be honest about all the factors that influence those symptoms in the first place.

Step 2: The mind and the body are always in dialogue.

The connection between mind and body isn’t new; we’ve been grappling with it for centuries. Descartes wrestled with how mind and body interact in the 1600s, proposing the pineal gland as their meeting point. Later came Jean-Martin Charcot (the French neurologist), who studied how psychological distress could manifest as physical symptoms like paralysis in the 1800’s. Sigmund Freud (the father of psychoanalysis and modern psychotherapy) built on this work, developing theories of how unconscious conflicts could produce bodily symptoms. William James (the psychologist-philosopher) explored how emotions and physical sensations are inseparable. More recently and popularly, books like The Body Keeps the Score have brought these ideas into the mainstream consciousness, and you may remember one heartbreaking scene from Inside Out 2 where Riley has a very physical panic attack during a hockey game. If you haven’t seen Inside Out, please stop reading here and resume when finished.

So how exactly does this connection work? While there are multiple pathways linking mind and body, the nervous system offers the clearest, most concrete mechanism. Think of your nervous system as a vast communication network: your brain, spinal cord, and billions of nerves reaching every corner of your body. When you feel anxious (a mental state), your nervous system translates that into physical reality: your heart races, your palms sweat, your gut churns. When you stub your toe (a physical injury), your nervous system carries that signal to your brain where it becomes the experience of pain. To the nervous system, the separation we’ve created between psychological and physical symptoms is, in several ways, artificial.

Unlike many influencers today, I’m not suggesting that the “dysregulated nervous system” is the source of all of our woes, nor do I think most attempts to directly modulate the nervous system will fix our problems. Here, we are primarily thinking about the nervous system as a framework to help us deepen our understanding of our symptoms.

Some mundane examples of the mind-body connection:

• Diarrhea and GI upset when anxious (more scientifically known as the “nervous shits”)

• Palpitations or chest pain when anxious

• Disrupted sleep with depression

• Feeling anxious the day after a night of poor sleep

• Tension headaches during periods of stress

• Nausea before a big presentation or important event

• Muscle tension in your shoulders and neck when worried

• Loss of appetite during grief or heartbreak

With these examples, it becomes clear that our emotional states affect not only how we perceive our bodies, but how our bodies actually function. Anxiety doesn’t just make you feel like your heart is racing - it actually increases your heart rate. It doesn’t just make your stomach feel upset - it literally accelerates your GI motility. And crucially, this works in reverse too. Poor sleep doesn’t just correlate with anxiety; it can directly trigger it. These examples are just the tip of the iceberg.

Step 3: The clinical consequences

When we fail to hold both lenses simultaneously, we make errors in both directions, and patients suffer for it.

The problem of bidirectional misdiagnosis

Let me give you a concrete example: a patient comes in complaining of heart palpitations and chest tightness. Here’s where things can go wrong:

Scenario 1: Missing the mind. The patient undergoes an extensive cardiac workup - EKG, echocardiogram, stress test, Holter monitor, maybe even a cardiac catheterization. Everything comes back normal or shows only benign findings. But no one asks about their recent divorce, their insomnia, or the panic attacks they’ve been having for months. The real issue goes unaddressed. The patient continues to suffer, now with medical bills and lingering worry that the doctors missed something.

Scenario 2: Missing the body. The patient mentions they’ve been stressed at work. The doctor, seeing an anxious-appearing patient, reassures them it’s “just anxiety” and prescribes an SSRI or suggests therapy. But no one orders an EKG or rhythm monitor. Turns out the patient has an SVT arrhythmia (an intermittent heart rhythm disorder where your heart beats too fast) that’s causing real palpitations. The cardiac issue goes untreated because it was dismissed as psychological.

This pattern repeats across medicine.

Take irritable bowel syndrome (IBS) as another example. IBS is one of the most common gastrointestinal diagnoses, affecting millions of people with symptoms like abdominal pain, bloating, diarrhea, and constipation. For decades, it was dismissed as a “functional” disorder - medical speak that roughly translates to “we can’t find anything wrong, so it must be in your head.” Some patients went through extensive, invasive work-ups while others were simply told to “reduce stress.” But as the science evolved, we learned! IBS is a concrete disorder involving gut motility, visceral hypersensitivity, alterations in the gut microbiome, and the gut-brain axis. Remember the nerves I mentioned earlier that have sensors in every corner of your body? The gut has exceptionally rich nervous innervation, so much so that it’s sometimes called the “second brain”, which is why the connection between our emotional state and our digestive function is immediate and powerful.

Stress and anxiety can absolutely worsen IBS symptoms. But IBS can also cause anxiety and depression. Living with unpredictable, painful bowel symptoms that disrupt your daily life takes of course take a psychological toll. So which came first? Often, it doesn’t matter. What matters is recognizing that IBS exists at the intersection of body and mind, and effective treatment requires addressing both.

When the constellation defies categorization

There is another complex category of illnesses where the mind-body separation breaks down - conditions in which the nervous system itself becomes dysregulated, leading to a confusing constellation of symptoms that span every system: fatigue, pain, cognitive dysfunction (”brain fog”), exercise intolerance, sleep disturbances, anxiety, depression, dizziness, GI symptoms, etc. Examples include chronic pain conditions (fibromyalgia, widespread musculoskeletal pain), neurological conditions (migraines, chronic tension headaches, dizziness/vertigo), autonomic dysfunction (POTS), and post-viral syndromes (ME/CFS, Long COVID)

There are often real measurable physical abnormalities - elevated inflammatory markers, vital sign abnormalities, immune impairment, mitochondrial dysfunction - but they don’t fit neatly into our traditional diagnostic boxes. The standard workup comes back “mostly normal” or shows only subtle findings that don’t explain the severity of symptoms.

Because of this ambiguity, patients with these conditions often spend years bouncing between specialists. The cardiologist addresses the POTS, the physiatrist investigates the pain, the neurologist evaluates the brain fog, the psychiatrist treats the depression. But no one is looking at the whole picture. No one is holding the entire constellation. And because these patients are often young or middle-aged with “normal” test results, they are dismissed.

The reality (and the tragedy) is that our medical system, with rigid categories and specialist silos, is poorly equipped to help these patients. They need physicians who can hold complexity, who can say “I believe your symptoms are real, and we’re going to work together to figure out what helps, even if we don’t have a perfect diagnosis or treatment.” They need a team approach that addresses physical symptoms, emotional wellbeing, and often significant lifestyle modifications. And they fundamentally need time, an increasingly scarce resource in modern clinical medicine.

Step 4: The treatment approach has to be individualized, multi-modal, and iterative.

If you’ve made it this far, I hope you’re starting to question the neat separation between mind and body we’ve been taught to accept. The question now becomes: what does good healthcare look like when we acknowledge this connection?

A. The right quarterback

First, you need someone who is trained to see the entire picture - a primary care physician who can hold both lenses simultaneously, someone who:

• Takes your subjective experience seriously

• Asks about sleep, stress, relationships, and emotional wellbeing as part of your standard care

• Doesn’t reflexively dismiss physical symptoms as anxiety, nor ignore emotional symptoms when focusing on physical disease

• Can sit with diagnostic uncertainty and work with you iteratively rather than needing a definitive answer immediately

• Knows when to bring in specialists but doesn’t abdicate responsibility for the whole picture

B. The right team

For many conditions, especially complex ones like we discussed in Step 3, you often need a team to address your whole health. You may need:

• A therapist or psychiatrist who can address anxiety, depression, trauma, or stress management. Not because your symptoms are “all in your head,” but because emotional health is part of your health.

• Specialists who understand the mind-body interface in their domain. For example, gastroenterologists who specialize in gut-brain disorders for IBS, pain specialists who understand chronic pain as a nervous system problem, or a rheumatologist who understands the associated immune dysfunction.

• Multidisciplinary care providers like registered dietitians, physical therapists, occupational therapists, or health coaches who can help with the practical, day-to-day management of your condition.

The key is that these team members need to communicate with each other and with you. They need to see themselves as part of a coordinated effort, not isolated silos.

I alluded above to the bias of the treating clinician, and I need to acknowledge my own: I’m a primary care physician, so naturally I’ve emphasized the PCP as the quarterback of your healthcare team. While I believe the right primary care doctor can be invaluable in navigating the healthcare system and curating an effective team for you (this is a core part of my mission at Seen Medical), I also recognize that 1) most structures of modern primary care don’t allow for this depth of work, and 2) increasingly, there are some awesome, condition-focused organizations emerging who think holistically about your care. I’ve included just a few of many examples below.

• Virtual digital health companies like Oshi Health (GI), Elektra Health (Women’s Health), Vori Health (Musculoskeletal Pain), and Override Health (Chronic Pain)

• Dedicated in-person clinics like the Columbia Marfan Clinic, Stanford ME/CFS Clinic, Johns Hopkins Pain Treatment Center, and the UCSF Osher Center for Integrative Health.

C. The right engagement

This isn’t a passive process where you hand yourself over to doctors and wait to be fixed. You are part of the team. This means:

• Tracking your symptoms in relation to sleep, stress, diet, activity, and emotional state. Patterns often emerge that help guide treatment.

• Experimenting with interventions like meditation, breathwork, gentle movement, or sleep hygiene as complementary tools that can shift your nervous system and improve your symptoms.

• Being honest about what’s working and what’s not. If a medication helps your physical symptoms but worsens your anxiety, that matters. If therapy is helping your mood but your pain is unchanged, that’s important data.

• Advocating for yourself. If you feel dismissed or unheard, it’s okay to seek another opinion or ask for a different approach.

D. The right, iterative process

This process can be frustrating. We want the clean story: the diagnosis that explains everything, the treatment that fixes it. But for many conditions, especially those where mind and body are deeply intertwined, healing is messier. It requires patience, flexibility, and a willingness to keep adjusting.

Here’s what it often does look like: trying a medication and adjusting the dose, adding therapy, noticing that helped but something else got worse, modifying the approach, seeing incremental improvement, hitting a plateau, trying something new, and gradually building a toolkit of successful strategies that work for you.

This is hard work, which is why trust and connection with your team matters so much. You’ll need to lean on them during difficult moments along the way.

The path ahead

If you are in the position where you have the power and privilege to support patients on their health journey, I hope by now you believe it’s part of your charge to consider the complexity of the mind-body connection.

If you are a patient navigating your own health concerns: The complexity you’re experiencing, the way your physical symptoms and emotional state seem tangled together, isn’t a personal failing. The struggle to find care that addresses all of you - not just your symptoms in isolation - is real. I hope this framework helps you make sense of why getting good care has been so challenging. I encourage you to keep searching for a healthcare team that gets this, one that sees you as a whole person rather than a checklist of isolated symptoms.

The mind and body aren’t separate. They never were. The sooner we build our health care around this truth, the better we’ll be able to help people heal.