Mental Health and the Brain: Starting Context

Mental Health and the Brain:
A Discussion
Fall, 2008

 

Setting a Context

"Mental health" is a significant matter of general concern, both in the United States and world-wide, one for which biological perspectives are relevant. While there seem to be some areas of convergence in extensive and diverse continuing discussions of "mental health," there are also areas of divergence, and there has been to date a noteworthy failure to reach the kind of consensus understanding, either nationally or internationally, that yields wide-spread and effective institutional and cultural change. This suggests a need to have additional perspectives added to the mix. As you browse through the materials below, reflect on which ones you strongly resonate with out of your own personal experiences, which ones you don't, and why. Think too about ways in which your own personal experiences might provide new and distinctive contributions to the ongoing conversations here and elsewhere. Put your thoughts in the on-line forum below.

 

Mental Health: A Report of the Surgeon General, 1999

"Promoting mental health for all Americans will require scientific know-how but, even more importantly, a societal resolve that we will make the needed investment. The investment does not call for massive budgets; rather, it calls for the willingness of each of us to educate ourselves and others about mental health and mental illness, and thus to confront the attitudes, fear, and misunderstanding that remain as barriers before us."

Mental Health: Culture, Race, and Ethnicity: A Supplement to the Mental Health Report of the Surgeon General, 2001

"Culture and society play pivotal roles in mental health, mental illness, and mental health services ... clinicians view symptoms, diagnoses, and treatments in ways that sometimes diverge from their clients' views, especially when the cultural backgrounds of the consumer and provider are dissimilar."

President's New Freedom Commission on Mental Health, 2003

"... the mental health delivery system is fragmented and in disarray ... lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration ... The time has long passed for yet another piecemeal approach to mental health reform. Instead, the Commission recommends a fundamental transformation of the Nation's approach to mental health care."

The Lancet Series on Global Mental Health

"Every year up to 30% of the population worldwide will suffer from some form of mental disorder, and at least two-thirds of those receive inadequate or no treatment, even in countries with the best resources."

World Health Organization - Mental Health

"Barriers to effective treatment of mental illness include lack of recognition of the seriousness of mental illness and lack of understanding about the benefits of services. Policy makers, insurance companies, health and labour policies, and the public at large - all discriminate between physical and mental problems."

National Alliance on Mental Illness

"Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down ... Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing."

Mental Health America

"All of us live with these daily threats to our 'mental health.' Many of us also face additional challenges that test us and put our mental health at risk ... The good news is -- we have the knowledge and experience now about what works for good mental health." To make mental health a national priority, we need you to:

  • Raise the profile of mental health in the 2008 presidential, gubernatorial and congressional elections;
  • Help educate the candidates about the importance of mental health and the treatment that works; and
  • Above all else, vote for the candidates who will deliver mental health reforms."

National Institute of Mental Health

"The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure ... For the Institute to continue fulfilling this vital public health mission, it must foster innovative thinking and ensure that a full array of novel scientific perspectives are used to further discovery in the evolving science of brain, behavior, and experience."

MindFreedom International

"Too often, traditional mental health services keep clients stuck in the system, keeping people from having choices about their lives. The emphasis on medical solutions, especially psychiatric drugs, has become problematic for many. We are seeking new ways of taking charge of our lives, new answers to finding our way out of the mental health system, new roads to our own recovery."

Comments

jrieders's picture

curable?

I thought it was interesting in class when we read over the NIMH statement: "The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure." that there seemed to be a lot of opposition to the use of the word cure. Many of us feel that mental illness should be treated as physical illness, and that treating it as such will destigmatize mental illness. Along those lines of thinking it seems perfectly reasbonable to search for a cure, just like scientist would search for a cure for physical illness. I wonder if perhaps the opposition to the word cure might stem from the desire to reverse the stigma, because the word cure was once used in a different fashion (ie we might think of a quick fix, labatomy, etc). I'm not sure if this is just semantics or actually a fundamental issue.
ysilverman's picture

This is something I always

This is something I always think about ... After the advent of Thorazine in the '50s, when hundreds of thousands of beds in state run institutions were closed, the number of homeless people in the US rose dramatically (and currently, the percentage of homeless people with severe mental illness is very high compared to the general population). There is something that seems great about the idea of medication allowing severely "mentally ill" populations to assimilate into society ... But these medication only work if administered regularly, and sometimes they work in limited ways. The idea of an institution, particularly a permanent or semi-permanent period on institutionalization, has become an anathema to us. But is that segregation necessarily the worst possibility? Or, from another standpoint, if we agree as a society that institutionalization (quite possibly unwilling) is *not* an appropriate choice, have we created any real, sustainable, preferable alternatives yet?

Paul Grobstein's picture

Mental Health: deinstitutionalization

Thanks for calling attention to this. "Deinstitutionalization" and the Community Mental Health Act of 1963 are a very important part of the "context" for contemporary discussion of mental health. And yes, it can and should raise anew questions in peoples' minds about the costs and benefits of some provision for periods of somewhat segregated treatment options. Maybe more from David Dan on this theme?
llamprou's picture

Last weekend my family went

Last weekend my family went up to Boston to visit my younger sister who is currently a sophmore at BU. One of the cities many transportation systems is called the T (train/metro) and when riding the T I have determined that anything can happen. During this last visit a woman came on to the train that was clearly having some type of a mental issue. The minute she got on she threw her bag across the floor and it happened to land at my father's feet. She proceeded to cuss, rant and rave about absolutely nothing at all. She the began to harass a young Indian couple whose baby was fussing. She went as far as to say something along the lines of "shut that thing up before I cut its head off". When the train jolted the woman lost her balance grabbing onto the child's stroller for support. What amazed me during this whole thing is that everyone on the train was ignoring her. It was as though we were back in the Middle Ages and the best way to deal with people who were not mentally sound was to ignore them! I kept thinking that the government needs to be able to provide these people with the help they need because not only can they be a danger to themselves but also to others. This particular woman was in my opinion without shelter, food or medical care. If she were offered help though would she take it? Should she be forced to take it?

Another instance that comes to mind was a program on Oprah, actually this program was what totally turned me off Oraph. On this particular show Oprah focuses on homeless people and decides to leave 100,000 dollars for a homeless person to find. The money is found as planned and the young man who finds it begins to give it away and some of it he loses. Six months later the young many has absolutely nothing, the issues turns into one of mental health. The young man is invited on to Opraph's show where he begins to be interogated about his spending and he breaks down mid-episode and begins to cry, he clearly has no idea what is going on. This inability to recognize mental illness astonished me. Has our society reached such a point as we are no loger capable of not only helping but recognizing those that need it the most? 

stephen burgess's picture

opraph show

what you have said is very true.but sorry to say this is the world. we live in

PS2007's picture

I think in part the stigma

I think in part the stigma and misconceptions surrounding mental illness originate from the idea that we want to believe we control our own behavior.  It is scary to admit that our genetics and environment can affect us in ways that we are not aware of.  If this is true, how much of our behavior should we be held accountable for?  An example that stuck with me in class was one of the axe murderer.  Should this person be punished for his or her behavior or should they be given help to try and understand and overcome their deviant desires?  

In a less extreme example, I think the idea of mental illness is so scary to some people because they fear their own vulnerability.  Who hasn’t been depressed at some point?  Maybe people who perpetuate these stigmas want to distance themselves from what they perceive as weakness.  
Paul Grobstein's picture

mental health: fear of others/ourselves?

Now that's an interesting idea. Maybe the whole category of "mental health" grows out of a fear not only of others but of ourselves as well? A fear that we may not be in control of either? And so we pathologize in an effort to assert control over the uncontrollable?
kgins's picture

mental health

I think it's really hard to listen to and believe all of this talk about treatment for mental illnesses when we don't even really know what a mental illness is. We talked about the borders between someone's personality quirks versus mental illness, and how the line is often blurred. Who are we to say, unless there is a serious threat of harm to the public, that someone else needs help? While we're finding different types of treatments that can reduce "symptoms" of mental illnesses, it seems almost artificial in a way. I'm inclined to think that when we refer to someone as mentally ill, that there's something beyond the surface, beyond the symptoms, that can never really be cured- that it's a large part of the person affected, that we can maybe numb what we see and make ourselves feel better and feel safer, but not the deepest part of what the person feels.  A professor once asked me why anyone had to be defined as "crazy", or mentally ill. She was suggesting that it was a label we gave to people that we didn't understand. I think that concept is interesting- we find ways to label people in different ways- fat or thin, poor or rich, smart or dumb, crazy and sane, etc. Is mental illness nothing more than a label? However, this is easy for me to say, and I recognize that- when schizophrenics say they "hear voices", and that's why they commit crimes and hurt people, of course, then, who can say that those people don't need some kind of help or need to be kept away from society. It's a hard line to talk about. I want to believe that there are no real "crazy" people in this world- that the people who hurt other people are people who were treated badly or hurt themselves, or had others hurt, and that's why they ended up the way they are- vengeful, but not essentially born "crazy". As for other, perhaps less severe symptoms we call "mental illness", maybe these "symptoms" are our reactions, just the result of living through difficult things, in different combinations, that ultimately we have to find ways to make peace with and get through on our own. Maybe the ultimate treatment is realizing that we're what we have, and that we have to find ways to be okay ourselves. 
Paul Grobstein's picture

mental health: about others, ourselves, making peace?

Interesting issue, "a label we give to people we don't understand"? And, maybe, a failure to understand ourselves? With the objective, at least for ourselves, of finding "ways to be okay ourselves." Is that enough? For ourselves, for others?
Paul Grobstein's picture

Mental Health: The Context Discussion (PG)

Our first session seemed to me to have gotten a lot of issues out on the table that needed to get there so we can look more closely at them in relation to other things in weeks to come. Thanks all. Glad as well to have the continuing thoughts/reactions/exchanges above. Is from/through all that that we'll get to ... wherever we get to, hopefully some "less wrong" places than any of us started with.

Two aspects of our first conversation struck me with particular force. One was the need to look at issues of mental health not only from a broader cultural perspective but also from a broader historical one (see suggestions in Books and Topics on-line forums). It may indeed be that for many people issues of mental health seem to arise only in developed countries (and in privileged populations within them) and are a "luxury item" that only developed countries have the wherewithal to address. And that view might in turn help to explain why "mental health" isn't treated with the same urgency as "physical health" in the US (and other countries?). "Mental health" as the term is frequently used may indeed be time/culture specific, but many of the phenomena under that umbrella (behavioral phenomena that we currently term schizophrenia, depression, delusions, anti-social behavior, etc) are clearly not. And we almost certainly have useful things to learn from how other cultures at other times understood and dealt with them.

The other thing I particularly noticed from our first session was the centrality of the mind/body problem, how frequently it came up in connection with a variety of other issues. "Physical health" (body?) is essential; "mental health" (mind?) a luxury? What people can't be blamed for (body?) versus what they can (mind?). What doctors are trained to deal with ("body"?) as opposed to what they aren't ("mind"?). Perhaps a change in how we think about the relation between the mind and the body might give us a new and more productive way to look at all these and additional issues as well ("character problems" vs "mental health problems")? And perhaps such a shift is neither so improbable nor so far in the future as some might think? (see The brain as a learner/inquirer/creator: some implications of its organization for individual and social well-being and The mind-body problem: in theory, in life, in politics).

It would be interesting if that also helped with the issue of whether what is needed for a less fragmented and more enlightened approach to mental health is an "attitudinal change" or more knowledge. Perhaps an "attitudinal change" could occur based on the knowledge we have already and that in turn might contribute to finding more useful knowledge? In any case, I think we're all in agreement that we need next to think more about what we mean by "mental health." With the objective, perhaps, of bringing about some attitudinal changes? Would those be in the mind or in the body?
kmanning's picture

Culture and happiness

Hi everyone,

There are so many interesting thoughts I don't know where to begin! I think the point that Yona and Martin bring up, which the Supplement to the Surgeon General's report also discussed, that whether or not an individual believes that they themselves have a mental illness, plays an interesting role in the diagnosis itself. If a person, by medical standards, has a mental illness, but they themselves are happy and don't feel that their mental health is compromised, do they still have a mental illness? How do the experiential and biological definitions of "mental illness" weigh against each other when they give opposing conclusions? Looking back on my notes from class, I remember being struck by our discussion of culture and its effect on mental health, and wondering how we could possibly come up with a definition of mental health that would work for truly different cultural groups. Certainly some mental illnesses walk the line between mental and physical illness more than others, and thus might be more universally diagnosable, but others seem like they could be entirely culturally dependent. If a certain cultural group doesn't involve elements that bring a certain mental illness to the forefront - perhaps a more laid back society wouldn't recognize ADD as a problem - or even really have opportunity to notice it, is it a mental illness at all? If an entire culture is made up of people who by another culture's standards would be suffering from a mental illness, are they mentally ill? If there are mental illnesses that are entirely experientially defined based on a lack of ability to fit in with a cultural norm, perhaps such a mental illness should be categorized as something entirely different from one with more clear biological causes (schizophrenia, depression, for example).

Similarly, I really like the idea posed in the philosophy paper abstract above that health is necessarily going to be based on a person's own conception of what is "good", and in the case of mental health, what is "happiness" or "normalcy". As Ljones (sorry I'm not sure of your first name!) posted above, we are all a combination of nature and nurture - of our "biological programming" and the cultural norms that have shaped our conceptions of "good" and "happy". Trying to force a purely biological definition on something that is in large part defined by cultural norms seems almost pointless past a certain point! The doctors and the anthropologists need to have a conference.

Riki's picture

"If a person, by

"If a person, by medical standards, has a mental illness, but they themselves are happy and don't feel that their mental health is compromised, do they still have a mental illness?"

This made me think about my own situation with depression. As of now, I feel fine, happy even, and haven't felt down in a few weeks. I don't consider myself to be depressed right now, though I think that I am, medically speaking. Many people do not know that they have mental illnesses until someone else diagnoses them with such, but just because they are ignorant of it doesn't mean that they do not suffer from it. Your question made me think, if a person is taking medications for a mental illness and therefore no longer feels the symptoms of the illness, then that doesn't necessarily mean that they do not have that mental illness anymore; they just don't feel all of the effects of it.

I think you also bring up some interesting points regarding the cultural context of a mental illness. One out of every ten people in the United States will suffer from depression at some point in their life. This site says that 10 times more people suffer from depression now than in 1945. My initial thought was that maybe people feel more comfortable asking their doctors about it now than they did then, that perhaps there is less stigma now, but I'm also wondering about misdiagnoses. In class someone (sorry, I forget your name!) mentioned the high rate of Mawrtyrs who are prescribed Adderall. I find it hard to believe that there are so many people on this campus with ADD. My explanation for this is misdiagnoses. So I wonder how many people today are truly clinically depressed and how many people just suffer from the occasional blues.

Paul Grobstein's picture

a doctor/anthropologist conference on mental health?

Maybe they need a little help, from us and others?
Ljones's picture

Nature vs. Nurture

It seems that people are making a distinction between nature versus nurture. One of my psychology classes spent a lot of time trying to break this dichotomy down because it seems to be quite unhelpful. What I took home from the class was that behavior (normal or otherwise) isn't broken down between nature (you have no choice, it is something that happens to you) and nuture (all mental illnesses are character flaws and the people who have them are to blame) but rather nature via nurture.

For example: there are certain alleles (for those of us who aren't biologically inclined: each gene can come in several "flavors" each flavor is a different allele: they do the same thing, but in a slightly different way) anyway, some alleles of certain genes lead to a predisposition to depression. But, you could find 10 people with all the predispositions we've found to depression, and maybe only 7 of them will ever become depressed. The flip side is also true: 10 people could, genetically, have no predispositions toward depression, but life circumstances could cause 2 or 3 to eventually become depressed. (Certain, big, life changing experiences have been found to help precipitate depression and they aren't even all sad: getting married, going to college and having a baby can all "cause" depression).

Outlook, experience and genes all play an interconnected role and influence each other. Experience can cause a change in how/when genes are expressed (anyone who's gotten a tan proves this!). And outlook/personality can change both how someone experiences something and how their bodies respond to the environment (they say that optimists recover after surgery significantly faster than their pessimistic counterparts). And a person's genetics at least partially influences their experiences/outlook (at 5' 2" tall, I'm never going to be an NBA superstar...)

Paul Grobstein's picture

Nature vs nurture; body vs mind

Maybe both dichotomies have problems, for similar reasons, and could be done away with in similar ways? Cf Biology/Sex/Gender - PG Thoughts.
ysilverman's picture

Sorry for joining the fray

Sorry for joining the fray so late ... I was confused about where this discussion was located/what the parameters were, etc. (But I'm here, so ...)

I like what Sophie is saying a lot, and Ryan -- and to some extent Martin, too, even if there is disagreement between the three. I think it does get complicated when we begin to talk about a truly biological perspective, though, because what does that mean? In a way, what Martin is describing can be both biological and also purposeful ... A person might be born with less of a predisposition to enjoy social behaviors,  and might end up choosing to live alone -- and therefore this (and other factors) could trigger depression ... But this depression could have not only some more of biological basis, but also a biological manifestation (complete with chemical changes in the brain). So has this person made a choice? I know that, at least in terms of personality disorders, at least under today's dianosis rubric, many practitioners factor in whether or not the person's behavior is disturbing to the "afflicted." Lots of people who could be diagnosed with schizoid personality disorder will never find themselves in therapy, because they are perfectly happy (or not imperfectly unhappy). So are they making a choice to be less social? Maybe not. And yet is it depressing them? Or is it even necessary to diagnose them? Perhaps not, as well.

I think the stigma discussion is interesting as well ... Certainly, as theories of biology have changed, the stigma towards families with "mentally ill" progeny have changed. (Up until relatively recently Theodore Lidz' theory of the "schizophrenogenic parents" directly causing schizophrenia held widespread acceptance.) Still, it is true that destigmatization can neither "cure" a perceived illness, or is it really possible. Certain behaviors are deemed socially unacceptable -- in my mind, some for better reason than others. Still, as my writing mentor has reminded me while I try and market a novel about, of course, a depressed person, "People don't like to hang out with depressives," and this is generally true. Anxiety, depression -- the manifestations of other "mental abnormalities" -- are generally unpleasant, not just for the afflicted, but also for those around them.

Paul Grobstein's picture

Mental illness: unpleasantness for whom and why

Nice issue. Is mental illness defined by unpleasantness for people so diagnosed or unpleasantness for the people around them? How much of the unpleasantness of some states of being is attributable to the unpleasant feelings it provokes in other people?
jrlewis's picture

A Philosophical Perspective

I found this paper on Serendip that I think is very relevant to our conversations about the the medical scientific model of health and mental health.  Hope you all enjoy. 

"She Blinded Me With Science"

A Critical Analysis of the Scientific Model of Health

 

A senior thesis by Georgia Griffin submitted to the Bryn Mawr Philosophy Department

in partial fulfillment of the Bachelor of Arts Degree.

Thesis advisor Christine Koggel

 

April 18, 2005

 

 

Abstract

In this thesis I examine the predominant western theory of health, known as the scientific model, using the accounts of Christopher Boorse and Leon Kass. Together these two accounts provide a thorough representation of the salient points of the scientific model, which are in short: that health is a natural entity and is therefore objective, that it is opposed to disease, that health is not relative, that health is accordance with species design and that physical health is distinct from mental health. I argue contrary to Boorse and Kass that health is necessarily normative (value-laden), that it cannot be abstracted from the human experience of it, that perspective and power play an important role in the delineation of health standards, and that the scientific model of health leads to the discrimination of a large number of individuals. To support my arguments I examine the accounts of a number of theorists who take issue with the scientific model of health, including Martha Nussbaum, Amartya Sen, Michel Foucault, Ian Hacking and Shelley Tremain. I also use these accounts to outline what I believe to be a more appropriate theory of health. Such a theory begins from within human experience and therefore takes into consideration people's individual conceptions of the "good" in relation to health. This new theory of health also restores agency and "personhood" to the patient, thus circumventing many of the difficulties that arise within the scientific model regarding disability and mental health considerations.

 

Paul Grobstein's picture

The scientific model of health

You talked me into it. We'll use this paper for our next session.
Sophie F's picture

Etc.

The danger, in my mind, in reducing the etiology of “mental illness” simply to biological causes, as Paul suggested, is that it depersonalizes the illness experience and may lead to an increased sense of alienation from one’s own mind (body), while also, potentially, overlooking elements that may contribute to perceptions, attitudes and behaviors of individuals. A systemic shortcoming of western biomedicine, in general, is a tendency to champion the organic genesis of disease as being the only valid measure of one’s health/wellness; the logical outgrowth of this tendency is to embrace diagnostic criteria that require increasingly technological interventions that do not take into account differences in individual experiences, ethnicity, education, etc. While imaging techniques, such as fMRI (http://www.fmri.org/fmri.htm ), have enabled incredible insights into the relationship between brain structure and function, does this information lead to a useful/constructive amelioration of mental distress for the patient or, once again, imply the need for a psychopharmacological agent to correct the brain “abnormalities”? While, certainly, psychopharmacological interventions have altered the delivery of care for people with mental illnesses, this seems to have been in some cases, a leap forward, and in other a disastrous step back. Perhaps it is more useful to treat every individual, in the context of mental health evaluations, as just that, individual. And while medications for some may well be the difference between slipping into a paralyzing depression and being able to lead a rich life, for others, medications may ignore the underlying source of distress and may mask, at best, and ignore, at worst, the real source of the problem. And what of illnesses that defy categorization and can be identified as a cluster of symptoms of unknown origin with diffuse clinical manifestations and great individual variation, such as fibromyalgia (http://www.fibromyalgia.com/) ? If we cannot determine an organic or biological root of mental “illness” does this make the experience of the individual less “real”?

I think I disagree with Martin, if I understand his point correctly. I think the stigma associated with mental illness seems to arise, in part, from a fear of that which we do not understand. As a society, if a certain finite range of behaviors is normative, that which strays from the prescribed norm is a source of fear, confusion and disbelief, amongst other things, leading to a view of those with somehow aberrant behavior as being pariahs, who should be imprisoned, medicated, or otherwise relegated to the margins of society. It is difficult to deduce which behaviors constitute “choice,” which can be attributed to biology and which are “illness” manifestations and I think it somewhat perilous to impose a culturally determined set of values on an individual as a means of evaluating whether their behaviors are the result of “choice” or impaired brain function. “Doing something you know you shouldn’t do” doesn’t imply weakness, moral inferiority or even choice; sometimes people either cannot or believe they cannot control their behavior and their thoughts. Either possibility may lead to the same result, and neither is necessarily indicative of “choice.” Ryan’s point about mental illness being seen as a “character flaw” is a salient one. And, I think, has some historical basis, in terms of attempts in recent history to correct the behaviors of those deemed to be social misfits or those who were mentally ill either through behavioral modifications or other means of molding behavior to conform to norms. I agree, too, that identifying causes of mental illnesses as being biological will not remove the stigma associated with mental illness. People with mental illnesses or limitations are seen to be less fit, therefore less able to participate in society. As a result, those people are marginalized because they are perceived as “weaker” and unfit for modern life. This is not to suggest that society, as a whole, lacks a collective unconscious, or that individual members do not care for the well-being of others; however, our culture is one that relishes the triumphs of the individual success story as much as we judge those whose “choices” we deem less worthy, thereby vilifying certain ranges of behavior.

Involving people who have dealt with mental illnesses, their families and friends in the call for dialogue that many of the above organizations have suggested, seems a potentially important component to a conversation that often involves various mental health professionals and politicians to the exclusion of those actually affected. One of the goals of the National Institute of Mental Health is to work towards “prevention, recovery and cure…” of mental illnesses. It seems more than anything, the voices left unheard are those of the patients themselves, to whom “cure” may be foreign and mitigation of suffering might be a more appropriate goal, or the ability to participate more fully in daily life. Regardless, the stated goal seems somewhat removed from the realities of mental illness for many, and more aligned with a biomedical paradigm that seeks to identify a problem and blot it out, where behavior is so often murky territory without finite bounds or convenient explanations/resolutions.
merry2e's picture

Sophie, I definately

Sophie,

I definately agree with your thought:

"it depersonalizes the illness experience and may lead to an increased sense of alienation from one’s own mind (body), while also, potentially, overlooking elements that may contribute to perceptions, attitudes and behaviors of individuals. A systemic shortcoming of western biomedicine, in general, is a tendency to champion the organic genesis of disease as being the only valid measure of one’s health/wellness; the logical outgrowth of this tendency is to embrace diagnostic criteria that require increasingly technological interventions that do not take into account differences in individual experiences, ethnicity, education, etc. "

This, I feel, is an important factor in treatment for individuals. Though one may have a disruption in their neurotransmitters (biological) causes of depression, they are still an individual with experiences and histories of their own. This is where a balance must be found in the treatment of individuals with mental health issues. I do not see it as simply bio or experience caused/lifestyle health problems but a combination of the two in which we must find a balance in order to reach  positive mental health.

A quote on stigma (and do I feel alot of passion about this issue which I posted a few months ago in another forum on depression):

Erving Goffman (1963) Stigma: Notes on the Management of Spoiled Identity“By definition, we believe the person with stigma is not quite human” (151).Stigma is an “attribute that is deeply discrediting” and that reduces the bearer “from a whole and usual person to a tainted, discounted one” (3).

A thought on third world countries and mental health issues. PTSD.

See you on Monday,

Meredith 

 

vpizzini's picture

biology and mental disorders

I completely agree with the idea that mental illnesses are medical diseases and affect individuals by chronic conditions. Even though a genetic predisposition could play a determinant role in the evolution of a particular mental illness,I believe that, in some cases, also the style of life, intrafamilial relationships and culture give a significant contribution to the process of developing that particular mental illness. Some mental disorders, such as paresis, can be recognized as a specific biomedical problem, while other disorders, such as hysteria, need a different explanation. For example, I find very interesting the psychodynamic models, offered by Freud’s followers. In these models, mental disorders are considered manifestations of unconscious psychological conflicts, originating in one’s childhood. Other theorists came up with  the learning models, in which mental disorders result from maladaptive learning and can be corrected with remedial learning. Each of these approaches are constructed on the idea that biomedical factors play an important role in producing some forms of psychopatology; childhood experiences or maladaptive learning contribute as well, but it would probably be a mistake to point to any of these factors by itself as the cause of any mental illness. I believe that mental disorders have biopsychosocial roots; many individuals have a predisposition toward them, but it also exists a trigger that “turns” the predisposition into an actual disorder.

Paul Grobstein's picture

Mental health: genes, experience, culture

Maybe this would help to get us out of the biology vs .... argument? Drop "biology" all together and replace it with "genetics"? And then acknowledge that all behavior/mental phenomena are influenced (not determined) by some combination of genes/experiences/culture? (cf Genes, Brains, Behavior and Individuals and Cultures).
akerle's picture

politics of the brain

I have been thinking about the idea of the 'mind' being a part of the brain. In reality, the brain is the final frontier in terms of medicine and biology. We know so little about it and it is a very complex and subtle machine. The problem, I think, comes from searching for the 'ghost' in the machine. For that reason, I believe that dealing with mental illness is very difficult. For many, there is some kind of disconnect between the brain and the 'soul'. In fact, the idea of the brain having any CONTROL over the 'soul' makes the whole study of mental health very political indeed. Some believe that scientists reduce the human experience to a set of electronic currents and chemicals. All this disagreement about the idea of soul,self,mind and body as being seperate entities makes the study of mental health a fractured and incongruous practice. To which part do we owe the most loyalty and which part needs to be cured? 

Paul Grobstein's picture

fractured mental health care and fractured ....

"All this disagreement about the idea of soul, self, mind, and body as being seperate entities makes the study of mental health a fractured and incongruous practice."

Nice way of putting the problem, as I see it. So what shall we do about it? Agree on which part "needs to be cured" or ... ? Yep, is indeed "political" (cf The mind-body problem: in theory, in life, in politics).

Laura Cyckowski's picture

biology and the basis of things

Coming from a background in biology, I would be more comfortable saying all mental states, whether or not dubbed "disorderd" by a culture or who/whatever else, are biologically describable, rather than necessarily based (not to deny the idea that some cases may be more influenced by biology than other/outside factors). And on that note, I like at least part of the quotation from the NIMH "...to further discovery in the evolving science of brain, behavior, and experience", which would seem to promote a more open-ended definition of mental illness/health/phenomena/whatever.
Martin's picture

Stigma

As I mentioned last night, I think the stigma surrounding mental illness is understandable and to a certain degree legitimate. Many mental health problems, who knows what percentage, are caused by life style choices. For example, if someone chooses to live alone in order to satisfy a desire for slothful behavior it seems natural that the person might suffer from a certain kind of depression that is not necessarily biologically based. Doing something you know you shouldn't be doing can have very traumatic effects. I think St. Paul puts it quite well when he says "For what I am doing, I do not understand; for I am not practicing what I would like to do, but I am doing the very thing I hate." Romans 7:15

On the flip side, there are many mental illnesses -- again, who knows the percentage--  which are not caused by personal choice but rather by biological abnormalities. 

Determining the source of the problem in any particular situation defies any sort of systematization because there is little possibility for a clinician to get to know a patient well enough to make character judgments. Therefore we have the current situation where people self diagnose and tell there doctors to prescribe them x,y, and z.

Paul Grobstein's picture

biologically based, life style choice, personal choice

In what sense is a "life style choice" not "biologically based"? Is a "life style choice" the same thing as a "personal choice"? If "personal choice" isn't "biologically based," what is it based on?
ryan g's picture

just a thought...

I think some people might argue that all mental disorders are biologically based – even ones that are seemingly self-imposed.  For example, perhaps some people are just genetically predisposed to have certain vulnerabilities  – let’s say depression.   Under these circumstances, they don’t have an option.  They are just “biologically programmed” to make choices and have self- destructive behaviors that lead to depression.

I’m not saying I agree with this… yet.  I’m just saying that it’s out there. 

Also, just to add to my first post… Even if all disorders (mental and physical) could theoretically be boiled down to some physiological cause, there is no reason to believe that people would not stigmatize them anymore.  If we do want to reduce the stigmatism surrounding mental illness, it’s not enough to just prove a medical/biological cause. 

Paul Grobstein's picture

mental phenomena, biological bases, stigma

Yep, some people might indeed argue that "all mental disorders are biologically based." Indeed some people might argue that all mental phenomena are "biologically based," whether "disorders" or not. And that does indeed require one to come up with some way to reduce stigma other than asserting a "medical/biological cause."
ryan g's picture

Stigma

I've been thinking a bit about this word "stigma" that keeps popping up in our discussion.  I just wanted to comment on it...   

It seems that there's a general feeling that if we could just get people to realize that mental illnesses are really medical diseases with identifiable biological causes, then the stigma surrounding mental illness would go away.  While I do agree that there would be many benefits that would come from this shift in consciousness (insurance coverage etc..), I don't feel like this would alleviate the stigma issue.

It seems to me that stigma is not a "mental health" issue.  It's an "illness" issue.  Many physiological disorders (HIV, herpes, rabies) have stigmas surrounding them.  

To continue Marty's comment from class, I feel like the root of the problem is the association of a character flaw with the disorder.  To really erase the stigma, we need to break this confusion/connection.  

 

Paul Grobstein's picture

Stigma/disease/character flaw

Two sets of interesting issues:

  • Do we really want to think of mental illness as "medical diseases with identifiable biological causes"? Why or why not?
  • Does stigma actually relate to the perception of "character flaws"? If so, what is a "character flaw" and why should there be stigma attached to that? Should there be?
ryan g's picture

Mental Health Ads

Hi everyone, 

Here are links to those mental health commercials we talked about...

The first one is the one I was thinking about, but the second two were other ones that popped up in the youtube search.  Kind of interesting... especially the last one.  It's from 1990.

video 1

video 2

video 3

 

Ryan 

merry2e's picture

videos

thank you ryan...very interesting indeed. i'm interested in investigating the attitude towards "mental illness" in the UK.

See you Monday,

Meredith

Ljones's picture

Another mental illness ad

Hi guys,

This is the one I was thinking of: the "awkward" mental illness ad.

http://www.youtube.com/watch?v=0CpwqDSduhk&feature=related

~Laura

Paul B's picture

The need to establish mental illness as a medical disease

I really liked the message behind the 3rd ad that Ryan posted: mental illness is a medical disease.

In order to get rid of the stigma behind mental illness, it's important to establish that it is indeed a medical disease with biological causes. Without understanding the biological foundations of mental illness, some may presume that mentally ill individuals can just snap out of it. Understanding that mental illness is a medical disease, like diabetes, causes one to understand why depressed individuals can't just not worry and be happy without proper treatment.

To demonstrate my point, look at diabetes. Individuals with untreated diabetes exhibit symptoms of mental illness because their brains are not getting much needed insulin. Before we knew about diabetes, these individuals were considered mad and placed in assylums. Today, we know that diabetes is caused by a biological basis. Suppose someone today suffered from symptoms of mental illness due to diabetes. Do you think there would be such a stigma after it was discovered that s/he has diabetes rather than a mental illness? (I don't think s/he would have such a hard time getting insurance to cover the treatment costs)

I believe this is why it's so important to establish and publicize the biological basis of mental illness.

jrlewis's picture

The medical model of health

The medical model of health assumes certain aspects of mental illness are most important.  It defines the mentally ill as people who are at risk, fragile, or weak by stating that they are in need of support.  Similary, to more traditional ailments such as cancer and people's perception of cancer patients. 

The image of a delicate glass vase comes into my mind.  It is an object that is at once beautiful, breakable, and surprisingly strong.  Glass is also used to construct windows, which are capable of keeping the elements out of our homes.  However, windows have wooden or other sturdy supports.  This seems to imply that glass can benefit from a sturdy wooden support.  The converse is also true that flower stems, stalks, and branches may be placed in a vase for support. 

So my metaphor here describes concepts of strengths and weaknesses as a context-dependent, relative phenomenon.  This provides space for a lot of interesting interactions between more normal and the less normal brains, to investigate the value of neurodiversity.  

Laura Cyckowski's picture

I don't like that idea

I don't like that idea entirely. I do like the message that a particular "mental illness"/"mental phenomena" (to use last night's term)/behavior may not be completely under control/controllable by an individual. But for it to be construed as a disease locates it within the individual, as something to be "fixed" and ignores the cultural context, which as discussed last night can be a significant influence in defining/addressing mental phenomena.
Mawrtyr2008's picture

Public Health and Mental Health

Hi, all.  I'm Rebecca and I graduated from Bryn Mawr this May with a major in NBS.  I'm interested in going into the field of public health professionally, and so I've been spending a lot of time researching public health master's of public health (mph) programs.  Throughout this graduate school research project, I've noticed a trend that directly relates to LauraC's post above.

Observation: I haven't researched all of them yet, but as far as I have, only one CEPH accredited mph school* allocates an entire department, an entire curriculum, to mental health as a public health issue.  Far more schools have a department called something like "Social and Behavioral Sciences" within their public health program that integrates a study of psychology, society, and illness.  

This observation raises the following questions: 

1. Do we in this forum conceive of mental health differently than the public health community?  Public health workers differentiate their work from MDs by typically saying that doctors study individuals affected by disease and public health workers study populations affected by disease.  Does the absence of a mental health curriculum suggest that mental health is not seen as something that affects whole populations and therefore is relegated to psychologists and psychiatrists who only focus on the individual?  This seems problematic to me since this discussion on mental health aims to root it in a cultural context, which is made up of many people. 

2.  Is there value in a department that attempts to address human behavior as a composite of neurobiological states, psychological states, and cultural contexts, as the Social and Behavioral Sciences departments attempt to do?  It seems to me that if you want to understand human behavior, this approach is a really great one.  I'm just not convinced that these departments are focusing on topics that this Mental Health and the Brain course syllabus is particularly concerned with (schizophrenia, bipolar disorder, depression, etc.)....

 

*(If you're interested, A complete list of CEPH accredited public health schools can be found at this website: http://sophas.org/SchoolMaps.cfm)

deborah karner's picture

Politics of the brain

"Mental illnesses are not the result of personal weakness, lack of character or poor upbringing."
Individual fear of... there for the grace of god go I... and societal promotion of "us" and "them", "normal" and "abnormal" continue to alienate people living with mental illness from people not living with diagnosed mental illness. The culture of mental illness is percieved as one of sickness and sickness is not permitted in the dominant American paradigm because it is a weakness. Yet one may have a fashionable mental illness such as ADD or ADHD, the diagnosis for a society of men and women and children whose focus is trained to brief visual and sound clips and who flit and dart amongst the too much choice of just about everything except deep personal connection and globally sustainable values, then one may be perceived as creative, artistic or at least someone with an exotic tinge.

There are people with genuine mental health problems. I perceive these problems on a continuum. Caveat; I actually know very little about what I am speaking but have lived 58 years working with individuals and groups in the arts and have recently completed an internship in domestic violence and am currently working with drug and alcohol population. Many problems diagnosed for reasons of insurance payments may be traumatic stress related symptoms and habitual coping pattterns that may be identified and worked with from a bio/psycho/social perspective. The stigma of labeling is avoidable. Recent neuroscience finds interventions that employ the body and mind in traumatic stress therapy are more sucessful than just talk therapy. But what is success? Helping a soldier to make normal his/her surreal experiences? Helping a victim of domestic violence contextualize her abuse, her brainwashing?
The study of the brain and the newest understanding of it is a topic of political concern.

Paul Grobstein's picture

Politics and the brain

A "political concern" indeed. Cf. The Brain as a Learner/Inquirer/Creator: Some Implications of its Organization for Individual and Social Well Being.

Glad you've stopped in. And it sounds like you have perspectives that would be valuable for the conversation. Hope you'll continue to contribute. New materials will be linked to each week from our home page. Maybe go back and introduce yourself in the on-line forum there?

Post new comment

The content of this field is kept private and will not be shown publicly.
randomness