Free Press Journal

“It’s all psychological!”

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Young woman in a conversation with the psychologist

Dr SHRIRANG BAKHLE helps us differentiate between physical and psychological problems.

We keep hearing this sentence many times, in different situations. A child gets stomach pain when going to school and the mother says, “It’s all psychological”! The doctor tells a forty-plus man that his blood pressure is high. The man says, “I don’t have a BP problem. It’s all psychological – caused by work stress.” A teenage girl becomes unconscious. The doctor examines her and says, “It’s all psychological.” A woman gets repeated headaches. The irritated husband says, “It’s all psychological.”

What is the meaning of this phrase? Commonly, when people hear this phrase, they conclude in their minds that ‘psychological’ means it is imaginary, unreal. They think, ‘it is all in your head, there’s nothing wrong with you’!


Yes, it is true that sometimes, the symptoms presented can be imaginary. But most of the times, we are dealing with a real problem. We need to understand where the problem is: in the mind or body or both. For understanding this, we have recognize the two-way relationship between mind and body.

Events in the mind produce changes in the body and events in the body affect the mind. So what is the meaning of ‘psychological’ in all this?

Sometimes we find that the body is perfectly normal. But disturbances in the mind cause disorder in the body. Consider a man who is perfectly healthy and happy. Suppose he hears a news that makes him angry. As soon as he becomes angry, the brain and body gets into a ‘fight response’. One of the major effects is that the heart rate and blood pressure go up. So, this raised blood pressure was caused by mental (‘psychological’) events. It is important to see that the effect on the body was ‘real’ – and not ‘imaginary’! So here “It’s all psychological” means a disturbance in the body totally caused by a mind event. In this situation, if the disturbance in the mind subsides, the disturbance in the body subsides, too.

Sometimes, a person has a ‘real’ physical problem such as arthritis, acidity, migraineor heart problem. Although these problems are physical, they can be affected by disturbances in the mind. For example, studies have shown how negative emotions can not only worsen pain, they can increase the swelling in patients of arthritis. On the other hand, humour used as a therapy has led to reduction in pain and swelling in arthritis!

Events in the mind lead to changes in a part of the brain called hypothalamus. This is a master area that controls many nerve pathways as well as hormones. So changes in the hypothalamus can lead to widespread changes in various organs of the body. The well-known ‘fight or flight response’ operates through this. Now, suppose a person already has a heart ailment. Now, if s/he develops a disturbance in the mind, it can cause increased heart rate. This increased heart rate can lead to worsening of his heart condition. So, here, “It’s psychological” would mean a pre-existing body disorder influenced by mind events.

Sometimes, disturbances in the mind lead to severe distress and related symptoms such as depression or severe anxiety etc. Technically, we can say that “it’s all psychological”. We can say that ‘it’s all in your mind’. But often this statement is made with a subtle, unsaid tone of accusation or blaming. It is important to realize that mental disorders and stress are real problems. And that they can sometimes be beyond the person’s control. For example, the case of the teenage girl mentioned in the beginning can be of this type. These problems, too, need treatment – whether it is counselling or medicines.

Lastly, it is true that sometimes the symptoms can be truly imaginary. But even in these situations, we should be careful before labelling it so. Sometimes, it really can be a clever trick to shun unpleasant duties. In the example of the child who gets stomach pain at the time of going to school, it can be a trick to avoid school in order to play computer games at home.

But before labelling it as ‘imaginary’, it is very important to be sure. We need to observe the pattern: Is it happening only at the time of going to school or does it happen even on holidays or while s/he is enjoying? If it happening at such times, too, then it is unlikely to be imaginary. Even if it is happening only at the time of going to school, is it only to enjoy at home – or is there any problem in the school that the child is trying to avoid? It is better to check out before labelling it as ‘psychological’ – meaning imaginary or unreal.

The phrase, “Its psychological” does an important function: it draws our attention to the most important aspect of the situation: the mind.