Body health is linked to mental health

Two paralegals with Legal Aid help clients with civil legal needs in November as part of a program at the Enoch Pratt Free Library at Pennsylvania and North avenues and other libraries throughout Maryland.

Baltimore is the epicenter of trauma in the U.S. — gun violence, mass incarceration, poverty, heroin. I care for some of the most marginalized people in the nation, whom we refer to as “high-needs, high-cost” — the latest in a series of labels for a population that is facing multiple medical and behavioral health co-morbidities, in addition to extreme poverty and social dysfunction. More often than not, my patients come to me with physical complaints that stem from an underlying psychological maladaptation to stress.

I was awestruck when I encountered a similar situation when I visited a small hospital in rural India. My preconceived notion of medicine in an impoverished developing country was an amalgam of National Geographic images and CDC outbreak maps. I pictured emaciated families struck down with infectious diseases like malaria, dysentery and tuberculosis. While mortality from infectious disease is certainly still higher in India than in the U.S., this was not the most urgent issue facing the Indian hospital. Instead, a tidal wave of social and mental health issues is bearing down on the Indian health system just like in the U.S., with no high ground in sight.

I saw numerous parallels between the rural farmers in India and the urban poor in Baltimore: Both populations are plagued by trauma, poverty and discrimination. A woman in her 30s was admitted to the Indian hospital for a vague constellation of complaints including dizziness and upper respiratory symptoms. Her initial workup was negative, with no abnormal findings on exam or labs. She was treated with IV fluids and a chest x-ray was ordered. During morning rounds, she was identified as likely having a “conversion disorder” which is a psychiatric diagnosis that encompasses varying neurologic symptoms with no underlying medical disease. Conversion disorders, or functional neurologic disorders, are thought to be triggered by stressful life events, and are much more common in women than men. I was told by the Indian doctor that, in India, diagnoses such as this often equate to “problems with the in-laws,” implying that stressful family relationships are the root cause of the dysfunction.

Bam. Mind blown. Could this young woman be experiencing the exact dysfunction I see in so many of the young women I care for in Baltimore City? Her case brought to mind several of my current patients, including one woman who has shaking spells, often in response to conflict within her family. She lost her mother to breast cancer at a young age, was raised by a grandmother with addiction who lords over the chaotic household through manipulation and secrecy. She has been hospitalized numerous times for her shaking spells and treated with antiepileptic drugs. Through mental online resources around any question a opments. We know that too many families health therapy and health education, she patron might ask. There are story-time want to meet with a lawyer, study for their has gained some insight into the cause of events, job assistance resources for homeGED, or learn English but don’t know her symptoms. But the origin of her less individuals and citizenship classes for where to begin. Some lack the time to disorder has not been alleviated — this recent immigrants. pursue these interests while others are would require a multifaceted social and

But to compare the library to a booksimply unaware of existing services. The behavioral family intervention. store or cafe is to miss the point. The library is the first step to achieving these The young Indian wife later refused the existence of for-profit alternatives to some goals, but library services extend far chest x-ray, indicated she wanted to go library services does not undermine the beyond a building or the books inside it. home and was discharged AMA (against need for libraries, just like the existence of These outreach activities are emblemmedical advice). Perhaps she realized the private attorneys does not diminish the atic of the decades of mission-driven work hospital had limited resources to assist importance of our public defenders. by public libraries across the United her. Or maybe her family pressured her to

For over a century, American libraries States. There are few systems as reprecome home and resume her responsibilihave mastered the craft of ensuring that sentative of this fact as the Enoch Pratt ties. Whatever the case, this young every person has access to the highest Free Library in Baltimore. In 1886, Enoch woman did not get any lasting intervenquality services in a free and open manner. Pratt was opened with the intent to tion for her stressors. Today, nearly every library provides free provide information to all regardless of In two totally disparate countries with computer access and runs digital literacy race; in October of that year, Harry S. radically different cultures, the same classes. These services are not meant to Cummings was the first African-Ameri

societal problem exists — little to no compensate for waning interest in books can to get a Pratt library card. In 1943, the or to compete with Amazon. Rather, library sponsored a horse-drawn bookaccess to mental health care and social public libraries provide free training and mobile designed to travel throughout the services within the health care system. technology because the internet is a tool to city. During World War II, the Brooklyn The health care system in India as well access information even though that tool Branch of Enoch Pratt served as an as the U.S. is just not set up to help people is distributed unequally in the U.S., where information bureau for Civil Defense, with the fundamental stresses of life — only 65 percent of American have broadwhile operating a day-care center for having enough food, secure housing and band access at home, including 57 and 47 working mothers and hosting Red Cross safe relationships — even though these percent of blacks and Latinos respectively. meetings. And all these initiatives? Done stresses often manifest as “medical” A report by the Robert W. Deutsch before the advent of the internet. complaints. Surely, there must be a better Foundationway.notesthatin2013anestimatedThevalueofalibraryisdefinedbyits 74,000 households in Baltimore had no steadfast commitment to making informaWe are on the cusp of a global shift in internet at all. tion free and open to all. In that respect, the way physical health is understood.

This summer, my organization, Lithere is no company or public institution The progress of medicine is undeniable as braries Without Borders, is working with that could ever replace the library. people are living longer lives and have the Providence Community Library in access to technology to sustain life. But Rhode Island to bring legal information, medicine alone cannot continue to forge wi-fi access, and library resources into flea improvements in wellness. Much of the markets, laundromats and housing develphysical dysfunction we see lies on a complex foundation of stress of all shapes and sizes.

The tragic separation of children from their immigrant families is one of many examples of adverse childhood experiences that predisposes to poor health. Children with these traumatic experiences will grow up to be more sick, more disabled and have problems with reasoning and relationships. They will die earlier than they otherwise would.

The separation of body and mind that humanity has created is artificial. We as a society should not continue to tolerate a medical system that treats the body but fails to acknowledge the negative health effects of social injustice, poverty and trauma.