Mind your body

“All the honey and salt and sugar…”

In Nigeria, we tend to physicalise symptoms of mental disorder.

Again and again, we’d see patients come in with poor sleep, difficulty breathing, itching and all kinds of pain only to turn out to have some mental disorder or other. And not just that, but with the exact same symptoms described in the Oxford Shorter Textbook of Psychiatry. (Which by the way was far from short!)

One of the most dramatic examples was an elderly woman I once saw. She was referred because her doctors had thought her poor sleep and body pain were likely psychological. When I asked what ailed her, she didn’t make a single reference to her mood. And yet, when I asked directly about it, she admitted that she’d had low mood and low energy for several weeks. I asked about anhedonia, a particularly significant sign of depression in which the person may lose their ability to feel any sense of enjoyment or pleasure. Her response?

All the honey and salt and sugar are gone from my life.

I’d never heard a more eloquent description of anhedonia before—or since.

Especially because this woman didn’t speak English: throughout the entire assessment she and I were speaking in Yoruba. She wasn’t educated and had no knowledge of western ideas about mental health. Still, her ability to describe anhedonia so powerfully, and the presence of other key symptoms including low self-worth, hopelessness, and difficulty concentrating left no doubt that she was indeed depressed.

Yet she had been unable to volunteer a single complaint about her emotions until I’d actually asked.

Why was this, and what did it mean?

“I feel it in my bones”

At first I saw her difficulty in verbalizing her symptoms as a reminder of the absence of a directly emotional vocabulary in Yoruba (and as I would later find, several other Nigerian languages). The words for describing emotion in Yoruba often express it in terms of the body. When we say, “I’m happy” (“inú mi dùn”), we’re literally saying, “My insides are sweet” (or as in Hausa’s “ina jin dadi”—“I feel sweetness in my insides”). There are words like the one in my own name, “ayọ̀” which mean “joy” or delight, but our vocabulary for emotion more often describes it in relation to physical organs.

I had noticed this fairly early in my psychiatry training and initially saw it as a deficiency in our language, an inadequacy of our emotional vocabulary.

But as often happens when you start to pay attention to something, I started to notice a few other things.

The first was that the ancient Hebrews who penned the documents we now refer to as the Bible actually also spoke like this. You won’t notice it as much in newer translations, which tend to frame words in more familiar terms, but if you check versions like that authorised by the King James of England in 1666, you still find expressions like “bowels of mercy” or “kidney” as a reference for the soul, and so on. The Hebew word nephesh, often translated “soul”, may also mean “throat”. And most interesting, the word for “spirit” (pneuma in the Greek—same word we get pneumonia and pneumatic from) can also mean “breath” or “wind”. And this was interesting because I knew the Yoruba word for breath, “ẹ̀mí”, is also used to mean spirit or soul.

All of this certainly couldn’t be coincidence.

But then I realised something else: even in English, there are words that do this kind of thing. A well known example is expressions like, “gut feeling” which is of course a reference to instinct, but described in terms of a physical organ. Other examples are when we talk about “butterflies in my tummy”, or being “heartbroken”, or someone “having balls”, or feeling something “in our bones”. Even the word, “feel”, is used equally for beliefs (“I feel he’s untrustworthy”), and sensation (“I feel cold”). Just like in Yoruba and Hausa, the same words are often used to describe physical and mental perception.

In each of these cases a state of emotion or personality is described in terms of physical organs. I would be surprised to find a language without its examples. And on one level this would appear to be simply the human instinct for metaphor: our penchant for describing the intangible in terms of what we can see and touch.

I think there’s more to it. I believe this universal linguistic phenomenon arises from an instinctive sense of our body and minds being one whole.

In other words, we might say that one reason there was nothing like “mental health” for the ancients was because, for them, there was only “health”. It was all one thing. 

Until they split in 17th century Europe.

The great disembodiment

Although suggestions can be found as early as Plato and Aristotle, it is René Descartes who is generally considered to have split mind and body—which is why mind-body dualism is also called Cartesian dualism. To him the mind could exist apart from the body, but not the other way around, and while both were closely connected, the mind was clearly superior—unlike the body it could reason its way past illusions. 

That distinction helped lay a key foundation for both Western philosophy (of which he is often regarded as the father) and science, and remains deeply embedded in our understanding. You can see its influence in everything from the many science fiction tales that envision human utopia as something disembodied, with uploaded brains operating autonomously, to the rise of psychiatry and mental healthcare, to jokes about white people being unable to dance. The distinction between mind and body, and the prioritisation of the mind, have led to all kinds of unexpected consequences, good and not-so-good.

While distinguishing between the two has been great for psychiatry’s ability to better understand mental disorders, brain imaging (the tech for which is vastly improved) has shown how physical “mental” disorders really are. And in the past several decades, psychiatry has increasingly sought to understand together what it had hitherto understood separately.

And then COVID-19 happened.

Pulled in two directions

Suddenly we are faced with a situation in which the bodies of other people are potentially our greatest enemies. Because although we’ve always been at some risk from others it hasn’t been to this degree worldwide since the Spanish flu. And not only others—we’ve learned to be suspicious of our own bodies as well with, for example, the sound advice about avoiding touching our faces.

The best way to keep safe is, in a sense, to eliminate touch as much as possible. To disconnect from your physicality. To be disembodied.

At least for now.

Problem is we don’t know how long “now” is or will be, and in the meantime, our inability to fully express ourselves bodily has paradoxically made us hyper-aware of our own physicality. We’re realising the frequency with which we touch our faces, missing hugs and handshakes, valuing face-to-face time much more than we had been. We’re finding that the wonderful technologies that allow us to stay connected also wear us out—and that we want them as an addition, not as a replacement.

And I’ve been fascinated to see how after decades of insisting that “church is not the building”, Christians are coming to recover a sense of the value of buildings. We are matter after all, and our bodies have weight and occupy space, and church is more than a building—but not less.

We’re in a time when we’re simultaneously being disembodied and re-embodied.

Which do you think will win?

My thanks to Adam Tank, Zack Fleischmann and Hal Morris for feedback on early drafts.