Body-Mind-Body
It's all connected.
Can our mind actually control our body?
Even writing that question makes my science brain squirm. The concept of mind-body connection just feels… unscientific. Maybe it’s the language at the extreme end of unwavering faith – “If I truly believe, the power of faith will heal me!” or the woo woo marketing around the “power of positive thinking”. Or maybe it relates to how mind-body health “solutions” tend to turn the weight of failure back onto the individual: “you just didn’t BELIEVE hard enough…”
Putting aside my squirmy reaction and bypassing the frustrating language and woo woo vibes that lead to self blame, I do believe in the power of the mind-body connection.
I also believe in the placebo effect.
I believe that what may come across as unscientific “mind tricks” affecting physical health outcomes have legit biological underpinnings. And I believe the physiological grounding that connects the mind to the body operates through the stress response pathways1.
(Shocking, I know. I am a biased stress nerd, after all.)
Perhaps the way I conceptualize the “mind” here may be slightly different than its use in popular culture2. To me, the mind relates to the way we feel about and conceptualize and categorize the world around us. The mind plays into how our brain perceives a stressor as a stressor and dials in the neural calculation to determine the appropriate physical response. Every stressor investigated in this project starts outside of our body – an external, psychological input with an internal, physical response. The capacity for our mind to soften that connection, decrease the input factors for the stressor calculation, must be considered.
As it relates to health outcomes, the way I see this connection is not in the “power of faith will heal me” way but in a way where supporting a whole human – reducing the stress of a diagnosis, reducing the stress of a medical journey – can positively affect how the body heals. Take the “miraculous power of the mind” in cancer recovery3. No, you cannot “will away” the spread of a malignant tumor. But, stress reduction can improve the functionality of the immune cells4 that affect how tumors spread. The mind is playing a (minor) role here. If we accept that stress exacerbates negative health outcomes, we must consider how relief from stress has the opposite effect.
Again, though, I want to emphasize that considering the power of stress reduction should never relate back to individual responsibility. Instead, acknowledging this connection emphasizes the need for wrap-around support in healthcare – how there is real power in holistic care models and why emotional support is critical.
Now let’s take one more step and consider the body-mind-body connection.
The body-mind-body connection
When two seemingly separate aspects of health show a connection, I tend to see stress at work5.
These connections may relate to how different physiological systems (e.g. cardiovascular, metabolic, immune, etc.) are downstream targets of the stress response such that the same stress may exacerbate each condition separately. Or, it may relate to a more chicken-or-egg situation for the two seemingly disconnected afflictions: is the diagnosis/treatment of one malady actually the upstream, stress-related cause of the other?
This came up in the context of pain in a conversation I had with
, co-founder and CEO of women’s and pelvic health company Origin (that interview coming soon!). Carine called out pain as a missing stressor in the maternal stress map, not just the physical sensation of pain but the entire experience around pain, especially the experience of pain as a woman:“Pain [as a stressor] could be related to the woman's health journey, especially if it is unexplained. It could be a function of your pregnancy or postpartum – like pelvic pain, back pain, sciatica. Imagine your pregnancy experience when you have back pain versus when you don’t, the level of incremental stress that that causes.”
Pelvic pain and pelvic health, in general, strike me as an interesting body-mind-body connection. The available research has started to connect mental health and pelvic health, with studies linking chronic pelvic pain with moderate to severe anxiety and depression and pelvic floor disorder to higher depressive symptoms. However, the “high rate of reported co-occurrence” still needs a lot of disentangling to better understand directionality in terms of what-causes-what and to what degree.
As it relates to postpartum recovery and perinatal mental health, specifically, investigating a connection between the two seems like a logical step.
A 2018 paper put together this logic flow: postpartum depression affects a lot of women, pelvic pain and pelvic floor issues (like incontinence) affects a lot of women, so maybe these two conditions are connected. And while this study does contribute valuable data to start making the connection between PPD and pelvic floor issues, something else in the published paper jumped out at me as a potential lead on the stress side of things.
This sentence from the Introduction:
“Pelvic floor disorders are often viewed as conditions affecting the older, postmenopausal population, while PPD occurs in younger, reproductive-aged women.”
WHAT?!
This sentence was published in 2018. I had already had two babies by 2018. In 2018, one of those babies was wrapping up preschool while the younger one had already learned to run and jump. I was 37 in 2018 and squarely in the category of “younger, reproductive-aged women”. And, yet (like most ‘young’ moms) I avoided all trampolines and crossed my legs when I sneezed. Not to make this about me but, I can attest to the fact that pelvic floor dysfunction is definitely not reserved for the “older, postmenopausal population”.
I have so many questions. Why is it “viewed” this way? And how had this assumption affected the research up to today? I won’t dig too much because I expect that following this thread will only lead to the same unsatisfying answers that I already bring up too often.
With that said, one gnawing question feels especially problematic: by categorizing pelvic floor disorders as an “older woman” thing6, what have we lost on the spectrum of clinical care7 – from diagnosis to pain recognition – when it comes to pelvic floor health at all ages? And how is this loss feeding right back into the stress load affecting our health?
This is where the critical work of Carine (again, interview coming soon) and her team at Origin comes in. They have elevated this issue into a public discourse that powers the narrative shift around pelvic floor health while also identifying and filling the data gaps that perpetuate that silly assumption captured in that 2018 study.
Case in point – at the beginning of the year, Origin ran a survey8 to assess the size of the problem and the core of the issues related to pelvic health.
The assumption in the 2018 paper found its counterbalance:
“75% of U.S. women ages 18 to 59 report two or more pelvic health symptoms in the past year, ranging from bladder leaks and bowel issues to sexual dysfunction”
Another data point that stood out to me:
“96% of those with symptoms say they have not been diagnosed with a related medical condition.”
75% of women have symptoms. Almost none of them have a diagnosis ascribed to those symptoms9.
Perhaps, this is where stress comes into the body-mind-body connection. The stress here is not restricted to the physical symptoms. Instead, the stress exists in the gray space of not having a diagnosis, not having a name for a condition, not having a plan, not having recognition for an ailment. It is the stress of the experience. This is what Carine pointed out to me when she brought up pain as a missing stressor node.
Let’s break it down a bit.
In the context of postpartum pelvic health disorders, the pain, discomfort, or problematic symptoms are physical – they are body-related. How we interpret, diagnose, map a course to recovery, and feel about the pain/discomfort/symptoms – that is mind-related. When those feelings are wrapped in expectation mismatch or lack of control, our brain may register this experience as stress. And now we have a physical stress response(s) that triggers all those other connection points, eventually leading to downstream chronic stress-related health effects (that includes physical changes affecting mental health) – and we’re all the way back to the body.
Overall, my specific interest in this is not how stress affects pain and pelvic health but rather how pain and pelvic floor issues trigger stress. My expectation is that the connections related to PPD and pelvic floor disorders has less to do with the two being a downstream result of pregnancy and birth and more to do with the stress related to lack of awareness, lack of community, lack of care, lack of pretty much anything that would normalize the condition and create a sense of control. It is that lack of […] that leads to the physical stress response that triggers or exacerbates mental health conditions.
Yes, that’s only a theory. Anyone want to study it? Fund this research? Please and thank you!
As it relates back to maternal stress and the stressor map, here is another opportunity to decrease the maternal stress load and positively impact women’s health. Pelvic floor awareness and physical therapy should be incorporated into postpartum recovery care10, not only because of its importance for long-term pelvic health, but also because it is a source of stress that can be (and needs to be) reduced during this period of elevated health risk.
Another reason why I love the work that Carine is doing with Origin and appreciate every pelvic health clinician providing care and awareness11.
Stay tuned for our discussion on all things mind-body connection, her founding story, and more keen insight into this world and this topic!
Quick note: I like to share companies/organizations that I value and genuinely believe are doing the critical work moving the needle on these issues. I want to keep my thinking on these topics unbiased so I do not get paid to feature them.
On that note — The Maternal Stress Project is an educational and idea-spreading initiative and I want it to be available to all so a free subscription will give you access to everything. With that said, this is a beast of a project, so please consider bumping up to a paid subscription if you are able (any little bit counts!). Your generous support will facilitate the growth of the project… and be much appreciated!
Sharing and spreading the word is equally valuable and appreciated!
Providing a sense of control is a key part here.
Like most things, I’m not a deep expert here. If you are, and I’m writing this incorrectly or overstepping with my assumptions, please call me out and let me know what I got wrong. So much about this project is a learning exercise for me!
Hopefully you can sense my sarcasm in this expression. I don't believe in miracles but I do believe in yet-to-be-fully-described biological mechanisms that disguise themselves as "miracles"
Even the “power of positive thinking” must follow the rules of biological limitations and unexpected factors.
I have big issues with the casual dismissal of this category of women and their health needs as well.
This isn’t a crazy new idea. France has committed to postpartum pelvic floor rehab for decades.
Origin's survey was 3x as large as some of the academic research studies out there on this topic… but don’t get me started on research funding for this category.
The survey is just chock full of data that further emphasizes this point. Here are two more:
“64% of women say that their pelvic health symptoms negatively impact their lives”
“79% of women who had a baby within 5 years say their symptoms [of chronic pelvic pain] negatively impact their lives.”
And more from the Origin survey:
“92% of of women who had a baby within the past 5 years did not see a pelvic floor PT to support recovery after their most recent delivery.”
44% of women “who had a baby within 5 years say providers did not help them understand what is and isn’t normal in terms of symptoms”
Fun fact with a dash of TMI — I finally booked myself an appointment with a pelvic floor specialist for issues I’ve been having.
I’ve worked clinically for years with women suffering with chronic pain, sometimes pelvic, sometimes not - I’m so glad that Carine pointed pain out explicitly for the project. The cycle of mind and body chasing each other (or as you have phrased it, body-mind-body) is difficult as a clinician to capture and stop the cycle. But at the very least it’s important to recognize that pain triggers the stress cascade which exacerbates the pain - women go for decades without recognition of this stress due to pain.
Instead when stress does get acknowledgment, the framing is “If it’s stress, it’s on you, it’s in your head” which we know isn’t the case.
Aside from women rarely being asked about non-fertility based symptoms, a major issue with the commonly practiced care model, is a fracturing of concerns. Pain is addressed through a body only approach, when it doesn’t live solely in muscles, tendons, nerves. Stress is addressed in through a mental/emotional approach, when it clearly doesn’t live only in the brain. Women who are suffering can see this fractured approach from a mile away, and avoid entering into these singular spaces, because that becomes yet another stressor - to try and convince practitioners that things are connected to each other.
What I would like to see is improvements to our pain assessments (do you know the history of how we came up with the 1-10 pain scale? It’s a doozy!) What women need is practitioners who can exist on the bridge between emotional care and physical care, and even when the practitioners exist, we need research to better elucidate the connection between. In which situations does one exacerbate the other, and in which situations is it irrelevant? So many questions!
Molly I kid you not, I was laying here on the floor in the middle of my pelvic floor PT exercises looking for another great Substack to listen to when your article posted! I’m so grateful you are covering this topic because even before I got to the end I was planning to comment that I now believe pelvic floor PT should be a normal protocol for postpartum care, now that I’m finally doing it 2.5 years after my 3rd child and several symptoms still haven’t “resolved themselves” like we’re told they would. I’m about 2 months in and it’s making a huge difference and it really is relieving some of that stress I felt over the issues not resolving. Can’t wait to hear your interview with Careen and learn more about Origin!