topic Does obsessing about pain create more pain? A culture of silence or a culture of telling? in Multicultural experiences

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Sun, 08 Jul 2018 01:38:36 GMT

I grew up in a culture of silence. 'Whatever happens in the home stays in the home' was the motto.

When feeling distressing emotions, I was meant to make a conscious effort to let the pain subdue. I was taught that replaying painful memories, talking about my pain with others, or exposing myself to situations that keep the memories active only functions to keep me in distress. At home, at church, at school, in the neighborhood, everyone reinforced this message. My father used to tell me to 'dip my tongue inside my brain before I speak'.

So, does the expression of an emotion act as a reinforcer of the emotion? Does it cause it to be more likely to be felt again in the future?

What's your experience? Is it better to talk about it? Or is it better to distract yourself with something else? Or a bit of both?

For example, if you are feeling depressed, and you talk about your depression with a friend, expressing all of your self-doubts, hopelessness, and sadness, are you more likely to continue to feel depressed? Is it better if your friend stops you from ruminating about your depression and convinces you to go to the movies with him instead? Are you more likely to feel even a little better afterward? Or would it help more if you talk about for a bit but then go to the movies afterwards and distract yourself?

What is the predominant cultural belief around this topic in your community or country of origin?

Does acting on the expressive emotions by talking at length about them strengthen those feelings, or lessens them? Is distracting ourselves preventing us from acting on the depressive emotions? And by doing so, are they more likely to fade away?

Obviously, complicated and enduring mental illnesses like depression or chronic anxiety and panic, are far more difficult to relieve than by just going to a movie. What I'm asking here is: does the more you act on an emotion, the more of that emotion you are likely to feel in the future?

When we feel a strong emotion, we naturally want to express it. But, is the continued expression of an emotion making it stronger? And if that emotion is painful, does the act of sharing it increase the experience of our pain?

How can we help our minds loosen the grip on past distress?

If your cultural or religious upbringing is similar to mine, you may have great difficulties in expressing and sharing your emotions and pain. However, doing it in this forum, anonymously and in the safety of your own home may help you. 🙂

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Hayfa — Sun, 08 Jul 2018 03:31:57 GMT

Hi Donte'

I think that pain is the result of fear and doubt, when fear and doubt is consuming you then you feel it and it isn't a pleasant feeling, of course it feels very heavy and dark hence known as 'pain'.
Emotions come with one's thoughts about certain situations and events, I believe it is integral to listen to what you are feeling and stop and think about what was going through your head when you had that emotion because by calibrating the two you will make sense of what is happening in your heart and head.
This is a learning process and takes time to master but once mastered you can begin to emit fear and doubt from inside you, instead you will replace fear and doubt with strength and contentment.

I don't think it's about difficulties expressing and sharing emotions and pain because to do this there must be a story behind the emotions and pain. Is it fair to say that the sharing of stories is being discouraged from being expressed? Since acting on an emotion is less likely to allow one to talk and be expressive instead, emotions force one to have a certain behaviour such as crying, anger, violence, screaming...
If one is encouraged to talk about it then they may also have different types emotions from expressing the story such as sadness, crying, remorse, guilt.

I think that most communities regardless of their cultural values probably don't talk about everything that happens in the home but there would be some things that people feel they need to express since this is a part of the human will to connect.
Our peer program is evidence of this, it is all about the sharing and emotional support that is conducive to physical and mental health, there is no doubt that this is communication that is empowering and offers connections and bonds for everyone.

Some communities have thrived and preserved their cultures through oral tradition by passing down and sharing historical stories about life, community and culture.
I know that in middle eastern culture social reputation is paramount so there are things that are not usually shared but there are many that are and being a community of sharing, people can generally express and share.
This can be very individual as well, perhaps it depends on the family and personal upbringing.

Hayfa

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

White_Rose — Sun, 08 Jul 2018 05:13:13 GMT

Hello Donte

Mental illness + pain + pressure to not speak = equals a pressure system that will burst or find some expression eventually.

It's interesting to look at this from a cultural point of view. I grew up in the UK so can only speak from that view. If one of the neighbours had a problem or perhaps a death etc, the neighbours would rally round. I don't know they would talk to the affected person or family directly about what was happening though there must have been some way the news got to the neighbours. Instead they would call in and ask if there was any shopping needed, bring food such as a casserole or cake, and be quietly helping in the background.

From my point of view I believe talking with selected people is a great way to relieve the pressure. There is a great difference between thinking your thoughts and expressing those thoughts. And a difference in thinking/talking to writing. At each stage thinking and beliefs are seen for what they are. There is nothing like writing down a big whinge to see how little of it is real. The same applies to talking about depression and other mental illnesses.

I guess if you live in your country of origin you may conform to the accepted culture without knowing any difference. That's not necessarily bad if those people have a different way of helping. Australia does not have that sort of culture in general, although mental illness still has to gain some credibility. I think talking to friends, family and mental health professionals is a good thing to know how those we care about are being helped.

You must remember I have not been brought up in a different culture. In that respect Australia and the UK are similar in that mental illness is a known illness and is in the public arena. This is why I find it hard to understand complete silence.

Mary

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Peppermintbach — Sun, 08 Jul 2018 07:10:26 GMT

Hi Donte’ and all,

Great post and equally great responses 🙂

I also come from culture(s) of silence. Traditionally, and even today, mental illness is taboo and considered “shameful” to discuss in my cultures, much less admit to having...

My heritage is one where we don’t typically discuss emotions, let alone mental health. Stoicism is the unspoken but expected response when facing adversity. Emotions and mental health are traditionally not considered priorities in life...

What’s your experience? Is it better to talk about it? Or is it better to distract yourself with something else? Or a bit of both?

I suppose my answer is “it depends.” My willingness and interest in talking fluctuates and is highly circumstantial. My mood is a factor. Sometimes I feel like talking whereas other times, I just don’t feel like opening up at all.

Another key consideration would be the anticipated responses from opening up. Purely as an example, if I predict being lectured or berated then that that would probably discourage me from wanting to talk. But if I predict an emotionally attuned response, I’ll probably be much more likely to want to open up at some point.

In short, as I said, my answer is “it depends”...sometimes I want to talk and other times, I don’t. Sometimes I want distractions but other times, I don’t.

Thanks for this thoughtful and interesting topic 🙂

Pepper xoxo

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Mon, 09 Jul 2018 04:49:28 GMT

Hello Hayfa,

Thank you for sharing in this post.

When it comes to mental illnesses such as depression or anxiety etc the symptoms are not necessarily linked to something specific.Fear and doubt may contribute but not always. Thinking of my personal situation, fear and doubt have nothing to do with it. As you have said, each situation is very unique indeed and looking at the individual and hearing their personal experience can help us understand. X

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Mon, 09 Jul 2018 05:05:24 GMT

Thank you White Rose for sharing your experience and comparing it with living in the UK.

I had written a thread in the past about meeting a couple of English people who have recently migrated to Australia and they were describing the 'culture shock' they had living here! they had emphasized in their conversation with me that speaking the same language doesn't mean that we (Australians) have the same culture with the English. They still felt like foreigners and migrants here in Australia coming from England.

I suppose, some things are similar across cultures as they are universal. Then there are the cultural responses to these universal needs. And within all that is the individual operating within whatever cultural framework they find themselves in but is a way that no other person within that group or externally does.

So, it may be culturally expected to not share intimate details of what's happening at home (for certain cultures who may seem more quiet or private), however, there are always individuals within those groups that do not abide by the norm. Usually those individuals get marginalized by their own group while simultaneously discriminated against by others who are not of the same background. I definitely have lived this experience and I know that I am not unique in this. Greeks ask me 'what type of Greek I am' and non-Greeks tell me that i am 'such a Greek!'. I laugh at both. They are both right. And they are both wrong.

I do agree with hayfa that peer-support, even such an alien concept for some cultures is beneficial, especially when it is online, and the person can share in their own leisure and disclose as much as they wish within the safety of their online account and pseudonym that they have chosen.

Wish to see more people from culturally and linguistically diverse backgrounds participate in this forum.

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Mon, 09 Jul 2018 05:21:30 GMT

Hello Peppermintbach,

Thank you for your post. Yes, it can vary a lot depending on the mood, the issue, the person that we are talking with, the time, the environment etc.

I remember times in the past where I wanted to share with every single person I met that I am gay or that I just seroconverted etc. In time I realized that often this could create more issues as I had to deal with the other person's opinions and beliefs and ideals which often had nothing to do with me or my situation. Or I had to comfort the other person and help them to cope with the news that I had just told them. In time I got tired of trying to educate, inform, support everyone I met so I started thinking 'what is it exactly that I want when I talk to someone?' and depending on the answer I would act.

Sometimes we need validation, other times support, or just to make an impression and even shake the boat in the face of conservatism and/or hypocrisy.

I think the beauty with the internet and online forums is the relative anonymity and safety hiding behind a keyboard which makes it easier to share and 'chat' with others without seeing their facial expressions etc. That is definitely a big positive in helping people open up and share and interact without many inhibitions. Plus, there is always a delete or backspace button that we can use and edit our message prior to posting.

There are so many people from diverse backgrounds who would never openly talk to others about their struggles and yet they would happily post in this forum. It's such a great resource! 🙂

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Peppermintbach — Mon, 09 Jul 2018 09:04:30 GMT

Hi Donte’ and all,

Your post made me think of something else that I recall reading on the forums. I think it was you (if I remember correctly) who commented on how people often listen to reply rather than to understand or it was something to that effect anyway. For me personally, that’s a deterrent when it comes to talking or opening up...

I feel that’s when emotional attunement has a role to play except I think it’s such a difficult and complex skill to master...

I believe that an emotionally attuned response is when a person can empathise to a point where s/he realises whether advice, validation, comfort, etc is the most appropriate response at the time for a particular person. It’s not about pushing for what I think is “best for them”; it’s about understanding what the person talking/opening up wants and responding in kind to his or her needs...and asking for clarification (and apologising or changing tack) if necessary.

Yes, I agree that anonymity helps especially for people who might not otherwise want to talk/share their struggles and innermost feelings. Very true...

Fantastic post and, as always, I value your insight 🙂

Thanks Donte’

Pepper xoxo

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Mon, 09 Jul 2018 09:24:35 GMT

Thank you Pepper.

If I can touch one person, then it's good. X

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Hayfa — Mon, 09 Jul 2018 11:27:43 GMT

Hi Donte'

Actually depression and anxiety are conditions that occur from events and situations in one's life and the conditions can persist making recovery and moving forward difficult.
It can be very hard to regain strength and a clarity for moving through it because of doubts and fears about the situation that has occurred and doubts and fears of the future, this causes pain.

Hayfa

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Mon, 09 Jul 2018 11:38:16 GMT

Hi Hayfa,

There is a lot of research done lately in relation to food and mood and in many occasions anxiety and depression can be directly linked to various preservatives in bread and other foods we consume daily. Pesticides and other additives have also being linked to various mental illnesses. When we feel we know something, new knowledge comes and shows us more light into areas we never considered before.

Despite all this, whatever the causes, no matter how much intellectualization of the topic we do, is not going to change the way things are. Sometimes overthinking doesn't help and it's better to accept that we may not know it all or have any answers.

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

smallwolf — Mon, 09 Jul 2018 13:09:29 GMT

I will speak more generally here, ie excluding MI related issues as a result of the wars, natural crises, etc.

The following quote is from an article in the Huffington post on mental health in the Middle East . It reads..."growing problem of not wanting to seek help out of fear of rejection, embarrassment and the stigma attached to labels of mental health". The statement could equally apply to the men in Australia, or so I have been told. But it also makes me wonder what people from these cultures do when they have sort of MI? Or are they/you stuck forever in that downward cycle of despair? Can the family structure assist in supporting some that is heading down a MI path? Or is that individual cast aside? Or is there someone in a family structure you can speak to without fear of repercussions? Is the love between family members sufficient to heal? Taking into account my initial statement, what are the typical triggers?

From my own perspective, for a number of years I was silent. I won't go into the reasons here. But once you don't talk about it, the negative thoughts grow like a cancer (figuratively speaking) inside you. The individual gets to ruminate on the negative thoughts. This might be compounded by our individualistic society, possibly made worse by the fact that families are most likely geographically separated, and we might not know our own neighbors to talk to. Today, the fact that I have coffee with people has created a support network for me. And in that regard, I find it helpful to talk to others for my own journey or healing. The discussions that I have are not with trained professional, just other students or lecturers at the college I attend, and then some. And I can see that I am loved.

My final comment relates to the personalities of the individual concerned. If you are introverted, or depending on which personality test you do, your personality type might be more susceptible to anxiety or depression. Statements made to one person as harmful, could be turned to the strength by another. And in relations to things that happened in the past, it is forgiving and releasing the hurt that allows me to move on. At least that is what I (think I) am working on next with my psychologist.

Tim

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Mon, 09 Jul 2018 22:03:59 GMT

Hi Smallwolf,

(wave to Hayfa and everyone reading and posting),

It is very beneficial to pose these important questions each time - because it is very different for each individual case.

Not all culturally and linguistically diverse people have families and not all families are supportive.

In my country of origin, collectively speaking the stigma of mental illness and the impact of labeling it was so huge (at the time of the mass migration), that often families would hide the individual member from the rest of society - sometimes locking them inside and not allowing them to be socially connected or leave the home, out of fear of ridicule and bullying.

Many would treat the whole family as ‘sinners’ who are punished by god for something and deserving the ‘shame’ they get. Often, these individuals would be refused to participate in holy communion or access to religious rituals and ceremonies.

Yet, in every village there used to be a‘madman’ who would go around and against their family’s will (often ostracized being kicked out of the family home), would try to engage with the crowds despite the ridicule and harassment that this brought to the family and relatives.

This is a very complicated situation that goes back a long way - centuries.

Many of these generational and cultural attitudes have been carried to a degree to today’s communities abroad and in Australia.

When the individual is also not English literate, their options and access to information that can lead to supports and assistance can be minimal to non-existent.

If the family is meant to be your only support, but instead, the family views this individual as a problem; an issue, causing ridicule and affecting you in negative ways then that person can be deeply disadvantaged.

(Many families with daughters would hide the fact that someone among them has a mental disability as this would influence the chances of their daughters finding a fitting groom and their prospects of marriage would be affected).

The same applies to finding work, accommodation, getting a loan etc.

Shame and stigma are deeply ingrained into the collective soul of various groups that makes it very difficult for the individual (and the carers) to access supports and seek external help.

So what can we do? We can start the conversation - one person at a time, one carer at a time, one family at a time with bilingual/bicultural workers who understand the impact of stigma and approach each case according to the needs.

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Hayfa — Tue, 10 Jul 2018 05:11:03 GMT

Hi smallwolf

Your post reinforces what I was saying, yes...at the end of the day it is the pain from fear and doubt that are the underlying causes of the situational life of the individual.
First comes the event that brings with it all that fear and doubt, it may then be followed by the opportunity to move through it with the necessary support, or no support depending on the individual decision, or in this case as you smallwolf have said and further elaborated by Donte, the family decision.
It is sad these situations of socially isolating someone who is suffering can happen but you are right smallwolf, some situations can be turned around by the sufferer whereby he or she is strengthened because they have decided not to suffer any more.

It is worthy of a conversation among communities and we have to understand that there are many factors that affect whether the messages will be received or not. Some culturally diverse communities need more time to get to a point of understanding what MI really is and what is needed to get support, again here; a collective culture of fear and doubt about seeking help and how admitting MI and other disabilities may be viewed within their cultures.

Hayfa

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Tue, 10 Jul 2018 13:27:14 GMT

Hi Hayfa,

Your post has made me think a lot and in depth and reflect on this lately. Thank you for expanding my thinking in this area.

Wondering how the physiological aspects of an illness such as depression or anxiety come to the picture/play a part.

I understand that often depression or anxiety could be caused by situational factors such as traumatic events, terminal illness, loss and grief, violence etc. but there is also a clinical, physiological side to consider, like in every other illness. Mental illness affects the brain which is of course part of our physical body. So there are physical symptoms and impact.

There are numerous cases where absolutely no trauma has taken place and yet the individual develops a mental illness. Sometimes babies are born with one or develop one early on in life.

It could be a case of neurotransmitters in the brain not functioning properly due to poor diet, hormones, imbalance of certain proteins and amino acids in the brain, hereditary causes, preservatives and additives in foods, pollution, toxicity, pesticides, or even as a side effect from other medications that the person is taking. For example, people on antiretroviral medications can develop depression as a side-effect of these meds.

Surely, we cannot completely rule out any physiological anomalies or impact of other illnesses, co-morbidities and medications or alcohol and other drug abuse etc as a cause of depression or anxiety (even though mental illness is much more than just depression and anxiety).

The idea that mental illness is always just a result of pain caused by fear and doubt doesn’t sit well with me. It is definitely not applicable in every case.

I’m not dismissing that these can be triggers but one size doesn’t fit all and mental illness is much more complex.

If it is just fear and doubt that causes mental anguish and pain, then removing these should remove the illness.

Yet, one may remove fear and doubt (or any other external situation that may cause problematic reactions) and still not restore mental health - similarly to let’s say, removing sugar from the diet of a diabetic and still the person has diabetes.

I am not an expert on this topic but as someone who lives with depression and anxiety for most of my life I cannot dismiss the idea that these could very well be physiological diseases with physiological causes, even though external situations and traumatic experiences can have an impact on them.

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Doolhof — Tue, 10 Jul 2018 22:20:51 GMT

Hi Donte and All,

Mental health issues run in my family, some of us suffer quite disastrously at times. Even though the illness and symptoms are the same or very similar, there is little collective family assistance or understanding of mental health issues as I feel some of the family think of it as being a weakness.

In our family we have not tended to actually lock family members away, but they have been shunned, misunderstood and isolated in many ways. Maybe even controlled in some instances so their illness does not embarrass others.

My Mum was openly ridiculed, bullied and isolated in our community, this flowed down to us children. She did not have extended family to help her. As her children,we were tarred with the same brush. It can happen anywhere.

Finding adequate mental health care for myself has been a huge struggle, I have no idea how people who do not speak the English language manage to find assistance!

I have even presented myself to facilities that I had hoped would be able to help only to be told that without an appointment they can do nothing. I need to call for an appointment: I call, am transferred to 4 different people, then returned to the first person I connected with to be told again they can't help me.

What has to happen in order for all people to be able to receive the help and care they need and deserve? How many people give up as it is all too difficult to cope with?

Cheers from Dools

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

smallwolf — Wed, 11 Jul 2018 00:51:37 GMT

Donte,

While I am not an expert in this field, I can only comment on my own experience. I just want to take up on a comment you made regarding "be physiological diseases with physiological causes" as related to me (?). This last bit is still ongoing...

Over the last while I have had a number of blood tests for different things. On seeing my psychiatrist the first time, organised a blood test to identify what could (outside of my mind) contribute to my depression. While my iron levels were not high per se, my ferritin levels were. Two blood test with high ferritin levels, and the GP can refer you to a specialist. I also had an ultrasound on my abdomen.

From my last vist to my GP, found out I have 2 abnormal genes, one from either side of family. Additionally from the blood test, everything came back OK except for that, and the high ferritin levels. Why am I telling you this? Because high iron levels can lead to haemochromatosis. Putting aside cancers and cirrhosis of the liver problems, but one of the sypmtoms is "Neurological/psychiatric disorders; impaired memory, mood swings, severe irritability, depression". (source: https://haemochromatosis.org.au/symptoms/) Caught early enough, the treatment is rather simple (?) by removal of blood by venesection which can possibly be done done through the Australian Red Cross Blood Service.

There are many factors that can lead to the depression; a bit like a jigsaw. One part of that jigsaw is what I have described above. Rather than just saying it is all in the mind, other factors should (?) be considered as well. Getting the iron levels down may not "remove" depression, but would/should be one less contributing factor.

Maybe a bit off-topic about silence vs telling, but hope you get something out of it.

Tim

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Wed, 11 Jul 2018 03:53:31 GMT

Hello Doolhof,

Thank you for sharing your experience in this forum.

The Australian Institute of Health and Welfare states that organizations experience unprecedented levels of demand for culturally appropriate services because of the increasing number of older culturally and linguistically diverse people. The Institute also suggests many Australian health professionals have identified cultural diversity as a CHALLENGE.

People from culturally and linguistically diverse (CALD) backgrounds are considered a ‘special needs group’ under government priorities. Research highlights that many have higher levels of disadvantage and other risk factors than Anglo-Australians, and that these factors may affect their life experience and mental well being.

The ‘Review of Australian Research on Older People from Culturally and Linguistically Diverse Backgrounds’ identified a number of factors which contribute to older people from culturally and linguistically diverse backgrounds experiencing special needs. These are determined by individual experiences and circumstances and include:

Socioeconomic disadvantage:
In general older people from CALD backgrounds have poorer socioeconomic status compared to the older Anglo-Australian population.

Language:
Higher levels of English language ability have been found to be associated with better health, well being and better social inclusion outcomes.

Cultural interpretations (translations):
In addition to language barriers, differing cultural practices and norms can lead to misdiagnoses, lack of understanding and barriers to service use.

Length of time in Australia:
This has been shown to have an influence on health and well being outcomes, as well as help-seeking behaviors. Also, age at migration contributes to an individual’s life course and different experiences of ageing.

Lack of exposure to Australian services and systems:
There is a lack of knowledge in navigating Australian systems and services, particularly for migrants who arrive in Australia at an older age. Consequently, older CALD Australians have been found to present later with conditions such as dementia and cancer.

A preference for family members to provide care:
This propensity exists among older people from CALD backgrounds from some cultures. However the literature also highlights the need for caution in making the assumption that all migrant families ‘look after their own’ as this is not a homogeneous group.

(FECCA Report 2015 / page 10)

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Donte — Wed, 11 Jul 2018 04:01:15 GMT

Thank you smallwolf for your valuable input into this conversation.

Your story validates the experiences of many.

This is indeed a complex issue and there are numerous factors contributing to one's mental illness. Sometimes talking about it or thinking positively and taking deep breaths, exercising, eating well etc may not 'solve/cure' the issue/illness. Hopefully, it may contribute positively though towards the reduction of the severity of symptoms.

I'm glad you are in good hands and undergoing all the relevant tests needed to establish your prognosis. X

Does obsessing about pain create more pain? A culture of silence or a culture of telling?

Hayfa — Wed, 11 Jul 2018 06:24:35 GMT

Hello Donte'

Thank you for your further thoughts on this thread, it is becoming very interesting and important to discuss more.
Firstly, I need to say that my original post made no reference to depression and anxiety, I was responding to your very first post that asked 'does the expression of an emotion act as a reinforcer of that emotion? Does it cause it to be more likely to be felt again in the future?'

Emotions are strong feelings derived from one's circumstances, mood or relationships with others or, the philosophical definition, instinctive or intuitive feeling as distinguished from reasoning or knowledge.
Now thinking about this for a minute, depression and anxiety are a mental and physical experience of anguish (this incorporates fear, doubt and all the negative emotions that cause this feeling of pain).
The more complex mental health illnesses that you describe may be borne out of anxiety and depression that was left unaddressed.

I especially want to draw your attention to Sir Michael Marmot who is world renowned for his work on addressing the health inequities for the past 30 years. His definition and work about the social determinants of health have been recognised and adopted by the World Health Organisation. The social determinants of health are the key drivers of the conditions of people from their birth, where they grow, live, work and age. The social determinants of health come from circumstances shaped by the distribution of money, power and resources at a global and national level.
This means that a person's physical and mental health will be impacted over the course of their life through many hundreds of combinations of things.
To understand what an individual is experiencing let's imagine it like an iceberg on top of the water, this iceberg clearly shows the physical and mental symptoms and pain being suffered...if we dive under to take a better look at the hidden part of the iceberg we will see what is giving rise to the stuff happening on top. We have many interrelated environmental, individual and genetic factors that overlap and relate to cause what is going on in someone's situational life, there is a multitude of factors that will cause the individual physical and mental health conditions. So as you can see all these problems are interrelated and compound causing physiological factors in the individual.
Everything is very related, there is not one sole cause from the impacts of physical and mental health.

Hayfa