We tend to talk about mental health and physical health as if they live in two different buildings, with two different sets of specialists who rarely speak to each other. In real life, they share a wall, and a lot of what walks into my office has been leaking through that wall for a long time.
Some of the most important work I do is not therapy in the usual sense. It is noticing when something a client is carrying might not belong entirely to the mind, and saying, gently but firmly, "Have you talked to your PCP or your OB about this?" And if the answer is no, I will keep bringing it up until you do.
Here is why I care so much about that question.
Take PMDD, premenstrual dysphoric disorder. It sits, officially, in the same family as the depressive disorders, and the psychological weight of it is enormous: waves of irritability, despair, anxiety, and emotional flooding that can arrive almost like clockwork in the days before a period and then lift once it starts. But underneath the psychology is a body. PMDD is not a character flaw or a failure of coping. It is a heightened sensitivity to the normal hormonal shifts of the luteal phase, hormones talking to the very brain systems that govern mood. If we treat only the thoughts and never name the hormonal engine underneath, we can spend months circling something that also needs an OB or a prescriber in the room.
Or take vasovagal presyncope, the lightheaded, graying-out, about-to-faint feeling that can wash over a person when anxiety spikes. The body, flooded, overcorrects: the vagus nerve pulls the heart rate and blood pressure down, less blood reaches the brain, and the world goes swimmy. It feels like panic, and panic can absolutely set it off, but it is a genuinely physical event happening in a genuinely anxious moment. Someone who only ever hears "it's just anxiety" may never get the workup that tells them what is actually going on, and whether it is safe.
Or, at the far and dramatic end, there is takotsubo cardiomyopathy, sometimes called broken heart syndrome. After a shock, a loss, a terror, the heart can stun itself into something that looks and feels like a heart attack, driven not by a blocked artery but by a flood of stress hormones. The heart, it turns out, can be broken by grief in a way that shows up on an EKG. If that does not settle the question of whether emotion lives in the body, I am not sure what would.
I bring these up not to alarm anyone, and certainly not to diagnose. I bring them up because they are proof of something I hold as a bedrock belief: the mind and the body are not separate countries. They are one territory, and the border between them is mostly a fiction we inherited.
What that means for how I work is simple. I stay in my lane, and I make sure you have the other lanes covered. I am not your physician. I cannot order labs, read your heart, or manage your hormones, and I will never pretend otherwise. What I can do is refuse to let your experience get lost in the gap between systems, where so many people, and especially so many women, have been told their very real symptoms are "just stress," "just hormones," "just anxiety," and sent home.
So when something you describe has a physical shape to it, I am going to ask. Have you talked to your doctor. Have you told your OB. Has anyone actually looked. And if the answer keeps being no, I am going to keep gently pushing, because part of caring for your mind is making sure your body is not being quietly dismissed.
Healing tends to happen when all the lanes are open at once. My work is one of them. It is not the only one, and I would never want it to be.
If you have been carrying something that lives in both places, the mind and the body, you are not imagining it, and you do not have to choose which specialist gets to believe you. You are allowed to be treated as a whole person. That is the only way I know how to do this work.
This is a reflection from my perspective as a therapist, not medical advice. If any of this sounds like you, please talk with your primary care provider, OB, or another physician. Fainting, chest pain, or heart symptoms in particular deserve prompt medical attention.