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Post-traumatic stress disorder is a systemic illness, not a mental disorder: is Cartesian dualism dead?

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Mind and body are intimately linked, in health and in disease

Descartes’ notion of dualism, which argues for the distinction between the mind and the body,1 has underpinned and subtly driven much of the confused thinking in medicine about psychiatric disorders. A substantial and still accumulating body of evidence about the extensive psychophysiological and somatic comorbidities of post-traumatic stress disorder (PTSD),2,3 however, now challenges this notion, suggesting the need to reconceptualise PTSD as a systemic disorder rather than one confined to the mind. The somatic pathologies range from metabolic syndrome and related cardiovascular conditions to autoimmune diseases, including rheumatoid arthritis.2,4 Such disorders have been associated with a range of quantifiable abnormalities, including inflammatory cascades, altered psychophysiological reactivity and neuroendocrine function, and shortened telomere lengths.5

The study of a convenience sample of Australian Vietnam War veterans published in this edition of the MJA6 explores in detail the somatic comorbidities of PTSD. McLeay and her co-authors found that the relationship between…

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