Your chest feels so tight that it’s making it hard to breathe. A quick check of your pulse confirms that your heart is racing. Your partner says “relax, it’s just your anxiety”, and that only makes you feel more agitated. Your body feels like it’s ready to explode; you have no idea what’s going on, and the pain is only getting worse. You feel terrified and powerless, you decide to go to emergency to get checked out.
“It’s all in your head”
They run some blood tests and do an ECG. The doctor comes in, gives you only the briefest of glances, and says “everything came back normal. Looks like it’s all in your head. Go home and get some sleep.”
If you’re anything like me you’d probably feel like slapping both doctor and partner upside the head. But before we run off in that direction, let’s think about those phrases: “it’s just anxiety” and “it’s all in your head.” I’d like to unpack them and consider them in terms of what we know about the brain and the body.
The brain… it’s a big deal
The human brain is astoundingly complex. It ultimately controls almost everything that happens in the body through multiple mechanisms. What is particularly relevant in terms of anxiety is control over the autonomic nervous system. It consists of the sympathetic nervous system (responsible for the fight/flight/freeze response) and the parasympathetic nervous system (responsible for resting and digesting).
If anxiety kicks the sympathetic nervous system into overdrive, this can make the heart race as the inner caveman gets ready to react to the bear outside the cave that might be looking for its next meal. It also suppresses parasympathetic activity, leaving your gut an unhappy place. None of this is under conscious control, hence the term autonomic. The brain is capable of generating and distorting all sorts of sensory information, and it often doesn’t make us consciously aware of what it’s up to.
So to brush something off as “all in your head” is to forget that a powerful brain actually lives inside that head.
So what do we do about it?
What is useful, though, is to know the origin of the problem. If chest pain originates in the heart, that’s where the treatment needs to be targeted. If the root cause of the problem is in the brain, targeting the heart is a waste of time.
There is simply no excuse for ignoring a problem because it originates in the brain; that would be like saying epilepsy isn’t valid and isn’t worth doing anything about because the root cause of a seizure lies in the brain rather than the limbs.
The same people who might say “it’s just anxiety” are probably also likely to write off talk therapy as a valid form of treatment. What’s crucial to understand here is the concept of neuroplasticity, the brain’s ability to make changes in how it functions and form new synaptic connections between neurons. Talk therapies, in particular cognitive behavioural therapy, have been shown to bring about neuroplastic changes in the brain, meaning new connections can be formed that bypass the old circuits that triggered physical symptoms of anxiety.
So, is it all in my head? Damn right it is, and that is just as real and valid and potentially debilitating as any other medical condition. So let’s get down to business and treat this thing.
You may also be interested in the post Just a Psych Patient? Stigma in the ER.