The problem with the "It's all in your head" stigma

We need to talk about diagnostic overshadowing

When people hear the phrase "It's all in your head," it often carries a dismissive tone, suggesting that a problem is imagined or not real. But when it comes to mental health, this phrase can be dangerously misleading—especially when it’s used to explain away physical symptoms in those with severe mental distress. On average, these individuals live about ten years less than their peers without mental health conditions and a significant part of this gap is due to physical health problems that are often overlooked or misdiagnosed.

This happens due to something called "diagnostic overshadowing." It’s when healthcare providers, perhaps without realizing it, attribute physical symptoms to a patient’s mental illness, overlooking other potential causes. This can lead to delayed or incorrect treatment, sometimes with serious consequences. Sadly, many people with mental health conditions experience this, finding that their concerns aren’t fully addressed once their psychiatric history is known.

Consider the case of Susannah Cahalan, who shares her journey in the memoir Brain on Fire: My Month of Madness. She experienced seizures, hallucinations, and a host of other symptoms that baffled doctors. For a long time, her symptoms were viewed through the lens of mental illness—until it was finally discovered that she had a rare autoimmune disorder. Her story highlights how dangerous it can be when physical health issues are dismissed as "all in your head."

This problem isn’t limited to Susannah’s case; it’s a widespread issue in our healthcare system. The stigma surrounding mental illness often leads to biases in how patients are treated, and this can discourage them from seeking care. Over time, this avoidance only makes their health outcomes worse.

To fix this, we need a more integrated approach to healthcare—one that doesn’t separate mental and physical health but sees them as interconnected. Healthcare providers should be trained to listen carefully, consider all possible causes of symptoms, and ensure that patients feel understood and respected.

Ultimately, the phrase "It’s all in your head" should remind us that mental health is deeply connected to physical health, not a reason to dismiss someone’s concerns. By breaking down stigma and being mindful of the overshadowing bias, we can help ensure that everyone gets the attention and treatment they deserve—mind and body alike.