Let’s talk about Mental Health

October 10^th is recognised as World Mental Health Day. As such it is a good time and an opportunity to talk about mental health and how traditional Chinese medicine could help you if you are struggling.

We all have mental health. Our mental health is how we’re feeling inside, or how we are emotionally. It’s normal to feel emotional or anxious sometimes. It’s how we respond to events in our lives, sometimes feeling blue or feeling threatened, under pressure or stressed: for example, if we grief, have an exam, job interview or moving a house.

Yet, our emotions and our response to events can be a problem if it affects our ability to live life in a best possible way. If for some reason sadness is not going away or anxiety is ongoing, intense, hard to control or our anger is prolonged and gets out of proportions, it can be a sign of a mental health problem.

In England one in six adult had a common mental disorder as revieale by 2014 NHS digital Survey.⁵ In 2013, there were 8.2 million cases of anxiety in the UK¹. 2018 YouGov largest known study of stress levels in the UK, with a sample size of 4,619 respondents found that in 2018 “74% of people have felt so stressed they have been overwhelmed or unable to cope”.  This study also showed that 51% of adults who felt stressed reported feeling depressed, and 61% reported feeling anxious. Anxiety, stress and depression thus has become most common mental health issues recognised today. In addition, we don’t have much data currently on how last two years of lockdowns and fear mongering has affected these numbers.

In the West we tend to talk about Mental Health as an issue of the mind and most commonly would be offered a talking therapy to resolve anxiety for example or medications to treat depression. However, it is also recognised that symptoms of mental health can be experienced both in the mind, like difficulty concentrating, and in physical body, for example feeling of restlessness or feeling light-headed are quite common. Allopathic approach to body involvement mostly has been addressed by wide spread use of anti-depressants and explained as serotonin abnormalities in a body. Yet, as recent review of existing studies found, depression is not likely to be caused by a chemical imbalance and pointed out that people should be made aware of other options for treating it.

As a practitioner of traditional Chinese medicine I would like to suggest that one of these options you should consider is modalities of Chinese medicine such as acupuncture, Tui Na massage or cupping.

Traditional Chinese medicine and Mental Health

The great attraction of Chinese medicine is that it addresses the whole person, seamlessly integrating body, mind and spirit within its understanding of human health or disease processes which are seen as imbalances of body’s energetic system.

Chinese Medicine does not recognize any mental disorder as one particular syndrome[1]. Instead, it aims to treat the specific symptoms that are unique to each individual using a variety of techniques such as acupuncture, herbal medicine, bodywork, lifestyle/dietary recommendations and energetic exercises to restore imbalances found in the body.

To better understand the TCM way of thinking we can look at early Chinese medicine texts and their teachings on importance of regulating mind and emotions as a starting point for health promoting behaviour. In Yellow Emperors’ Inner Classic it states:

“If one is calm, peaceful, empty, without desire, then true Qi can flow. If essence and spirit are protected onside, from where can illness come? If will is at rest and there are few desires, the heart is in peace and there is no fear”

Huang Di Nei Jing Su Wen, Chapter 1

Mind and emotions or free flow of Qi

It is important to highlight here that the ‘mind’ as understood today or in a Western world has very different meaning in TCM. In traditional Chinese medicine mind and spirit are both called Shen and Shen resides in the Heart. It is also worth noting that ‘spirit’ has a different meaning in TCM. In TCM there are five spirits, each housed by one of five yin organs: heart, lungs, spleen, liver and kidneys. The mental phenomena like thinking, reasoning and making decisions are distributed functions between all five organ spirits. This unity of body and spirit is central feature of Chinese medicine. Likewise, ‘spirit and body are two different states of condensation and aggregation of Qi’ (Maciocia, :4).

Similarly, emotions in Chinese medicine are considered as pathologies of energy or Qi. For example, anger makes Qi to rise, fear makes Qi to decends, grief consumes or in other words depletes Qi, worry knots Qi. Anxiety and depression, on other hand, are seen as conditions were a movement of Qi is blocked or obstructed. 7^th century Daoist doctor Sun Si Miao wrote:

“To live long, people should take care not to worry too much, not to get too angry, not to get too sad, not to get too frightened, not to do too much, talk too much or laugh too much. One should not have too many desires nor face numerous upsetting conditions. All these are harmful to health”

Anxiety

Anxiety isn’t necessarily a bad thing. It can help us stay alert, make us aware of risks and motivate us to solve problems. Yet, it is also a type of fear usually associated with the thought of a threat or something going wrong in the future, but it can also arise from something happening right now.

• In 2013, there were 8.2 million cases of anxiety in the UK¹
• In England, women are almost twice as likely to be diagnosed with anxiety disorders as men²

Anxiety disorders in Western medicine

• Generalised anxiety disorder
• Panic disorder
• Obsessive-compulsive disorder
• Post-traumatic disorder (PTSD)
• Social phobia (social anxiety disorder)
• Specific phobias

What are the symptoms of anxiety?

Anxiety can affect both your body and mind.

Anxiety in Chinese Medicine

Anxiety is a modern term that does not have an exact equivalent in Chinese medicine. In TCM assigns more prominent role to ‘fear’ emotion. While these both are closely related as they are reactions to harmful or potentially harmful situation, there is a difference between fear and anxiety. Anxiety distinguishes from fear by lack of external stimulus that causes the reaction, as anxiety comes from with us and fear from outside world.

In TCM ‘anxiety’ would be treated according to symptoms and most prominent of those are ‘fear and palpitation’, ‘panic throbbing’ and ‘agitation’. Furthermore, there would be a difference between what we call a full or empty condition were Mind is either obstructed or unsettled. Your practitioner will also need to work out what has caused the Mind (Shen) to be obstructed or unsettled. Factors like stress, one’s constitution, diet, loss of blood and overwork all are significant factors underlying individual’s condition.

By addressing the underlying causes acupuncture can boost, clear, move and relax the necessary systems, to reduce the symptoms and also to make the individual more resilient against future issues.  

Current research on acupuncture and anxiety

While there is limited number of modern research on acupuncture and anxiety disorders, some of existing research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety by:

• Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010).
• Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states (Lee 2009; Samuels 2008; Zhou 2008; Yuan 2007).
• Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response.
• Reversing pathological changes in levels of inflammatory cytokines that are associated with anxiety (Arranz 2007)
• Reversing stress-induced changes in behaviour and biochemistry (Kim 2009).

To read more on existing evidence based research and references please visit BAcC research site here.

Depression

Depression is more than simply feeling unhappy or fed up for a few days. Most people go through periods of feeling down, but when you’re depressed you feel persistently sad for weeks or months, rather than just a few days. Depression is the predominant mental health problem worldwide. In 2013, depression was the second leading cause of years lived with a disability worldwide, behind lower back pain. In 26 countries, depression was the primary driver of disability.²

There are few distinct types of depression as well as levels of severities:

• mild depression – has some impact on your daily life
• moderate depression – has a significant impact on your daily life
• severe depression – makes it almost impossible to get through daily life
• Adjustment disorder – depression elicited by external events
• Postnatal depression – sometimes new mothers, fathers or partners develop depression after they have a baby
• Seasonal affective disorder (SAD) – depression related to seasonal changes and a lack of exposure to sunlight

The social symptoms of depression include: avoiding contact with friends and taking part in fewer social activities, neglecting your hobbies and interest, having difficulties in your home, work or family life.

TCM and depression

Chinese term for depression is Yu and it has double meaning: depression and stagnation.

Depression is most commonly caused by a stagnation of Qi (or, vital energy) in the body. It is Qi that regulates spiritual, emotional, mental and physical balance. Stagnation or blockage of Qi can be caused by many factors such as stress, physical trauma, emotional trauma, constitution or poor diet. Acupuncture can help with regulation of Qi and thus not only unblocks the flow of this energy but also treat the underlying source of the depression.

Current research on acupuncture and depression

Most research on acupuncture for depression has been carried out in China with Western drugs as comparators. Two recent systematic reviews, both drawing on Western and Chinese data, found that acupuncture was similar in effectiveness to anti-depressant medication.

Studies indicate that Acupuncture can have a specific positive effect on depression by altering the brain’s mood chemistry, increasing production of serotonin (Sprott 1998) and endorphins (Wang 2010). Acupuncture may also benefit depression by acting through other neurochemical pathways, including those involving dopamine (Scott 1997), noradrenaline (Han 1986), cortisol (Han 2004) and neuropeptide Y (Pohl 2002).

Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain which is responsible for anxiety and worry (Hui 2010).  Stress-induced changes in behaviour and biochemistry may be reversed (Kim 2009).

To read more or current evidence based research and references please visit BAcC research site here.

Stress

And finally, we should mention a general stress that many of us experience daily. Stress is a major element and cause of many diseases. How we experience and manage stress will define our health outcomes. There are many studies that have shown that acupuncture, a 3,000-year-old gentle modality provides a safe, effective alternative in stress management.

Acupuncture can:

• reduces the brain’s sensitivity to stress
• relaxes the analytical brain that causes anxiety
• reduces stress-induced changes in behaviour and biochemistry
• reduces inflammation, which can contribute to anxiety and depression
• stimulates production of ‘happy’ and relaxing chemicals (dopamine, serotonin, GABA etc.)

There is research suggesting benefits of acupuncture for PTSD, stress in student population, on stress reduction and pregnancy rates among IVF patients , and generalised trials on general stress reduction.

Why not try acupuncture today?

¹ Fineberg, N., Haddad, P., Carpenter, L., Gannon, B., Sharpe, R., Young, A., Joyce, E., Rowe, J., Wellsted, D., Nutt, D. and Sahakian, B. (2013). The size, burden and cost of brain disorders in the UK. Journal of Psychopharmacology, 27(9), pp.761-770.

² Martin-Merino, E., Ruigomez, A., Wallander, M., Johansson, S. and GarciaRodriguez, L. (2009). Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care. Family Practice, 27(1), pp.9-16.

5McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. Available at: http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-exec-summary…. 5 October 2016]

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[1] One of most notorious contemporary scholars of Chinese medicine Giovani Maciocia suggests that the key to understanding Chinese view on Shen is to be aware of differences in the concept of Self. “The Self as an individual, autonomous, inward-looking self, center of our emotional life (the result of 2500 year evolution of thought in Western philosophy) simply does not exist as a concept. Under Confucian influence, the Chinese self is socially determined. The Chinese self is a social construct and the result of family and social relationships”.