Mental Health and the Brain: Reflections

Mental Health and the Brain:
A Discussion
Fall, 2008

 

Reflections
The aspiration ...
  • The mental health system is fragmented and needs improvement
  • Definitions of mental health are fragmented and need improvement
  • Maybe thinking about the brain can help?
The outcome?

Look over the materials from this semester, both the ones you contributed and others, and the discussions of them. What did or didn't change in your thinking about mental health? about the brain? about education? What new directions for thinking about these things have you acquired? What new questions have been raised in your mind? Does thinking about the brain help with defining mental health? with imagining improvements in the mental health care system? Might it do more? If so, what directions should continuing work take?

If you're interesting in continuing this discussion in a working group next semester, email Paul with suggestions for topics on which you'd be willing to help organize discussion.

 

Comments

jrlewis's picture

I came to this course with

I came to this course with a small collection of thoughts about mental illness, the mind, and the brain.  These thoughts had been packed away in a old card board box, sealed with duct tape, and left to accumulate dust.  Through out the semester, I have attempted to open and unpack the box.  The results of this process have been interesting, at least to myself. 

My remembrance of a childhood friend suffering from pseudo epileptic seizures, nightmares, and an unnamed trauma, lead me to question the assertion that seizures are treatable with medication and no longer a mental health issue.  I would like to say instead that epilepsy is not a mental illness, but seizures, which do not respond to epilepsy medication and are co morbid with significant mental discomfort might be.  Pseudo-epileptic seizures have significant storyteller involvement.  However, I still doubt that this is the right answer or the only useful answer. 

Some other memories surfacing more subtly and others are still standing by.  The clutter of my lifetime consisting of personal, relational, and third person accounts/experiences with mental health.   I wonder how my father’s behavior during my childhood was affected by the degenerative neurological illness he dealt with.  How strong is the correlation between brain and behavior?  How to interpret his behavior?  Thinking about how hallucinations and their relationship to the I-function.  Our discussions have helped me fashion of lens that allows me to perceive behavior in a new way. 

This course created a story for me about the unconscious.  This account includes my attraction to mucking around in my own unconscious and that of others.  Hopefully in a constructive fashion.  As I integrate more experiences with mental health, the lens if ground finer.  Removing the dichotomy between body and mind has helped.  The idea that mental health is a process, not a product has proven an interesting concept in evaluating important decisions by myself and others. 

I can’t yet tell if this paradigm is less wrong.  All is know is that it inspires new questions in my mind.  Unconscious actions and associations? The possibility of unresolved conflict?  Different conversations about old issues with even old friends.  So what I am taking away from this semester is a strong sense of curiosity and a desire to understand think more about mental health and the human condition.  I am attempting to place the items once stored in the box on a shelf in my mind.  Maybe in time I will obtain more items as well.   

Paul Grobstein's picture

The brain and mental health: PG reflections

A very rich semester. Thanks all. I went in thinking that the chaotic state of mental health (both institutionally and individually) could be improved by thinking about mental health in terms of the brain, that doing so would provide a coherent framework for getting things less wrong. And I came out with that feeling reinforced but also with a greater appreciation for some of the problems along this path.

The need for clarification of a working presumption

Perhaps the most general problem that I came to better understand this semester is that its hard to get beyond the idea that "thinking about mental health in terms of the brain" means expecting understandings of and solutions to mental health problems to be found in current research on the brain and/or in future research carried out along the general lines that characterize most of contemporary research (cf Mental health research: future directions?).

My own sense is quite different. We don't yet know enough about the brain to understand, much less develop effective therapeutic procedures for, most mental health problems. And I don't think the situation will be much improved by future work that continues to be rooted in existing, overly simplistic presumptions about what the brain is and how it works.

Yes, the brain is a material entity, but it is not a "machine" whose overall function can be understood by collecting more and more information about the details of its parts, their individual functions, and their interactions. Nor can it be understood by presuming that we already understand its overall function, and need only to figure out how the parts are organized to achieve that function.

The brain is a complex system, one with properties that emerge from the interaction of its parts and that in turn influence the parts and their interactions. Moreover, it is a continually changing system, one that evolves both through its interactions with things outside itself and as a consequence of its own activity, which includes elements of randomness. As such, it requires a comparably sophisticated research approach, one that works from the top down as well as the bottom up, and one that is as open to new understandings of overall functional considerations as the brain itself seems to be.

If, as seems increasingly to be the case, the brain is the material embodiment of what it is to be human, neither its complexity nor the requirement for research sophistication in exploring it ought to come as a surprise. When inquiring into the brain, one is asking nothing less than what are the existing and future potentials of being human.

From this perspective, "thinking about mental health in terms of the brain" very much does not mean asking existing or reasonably anticipated research on the brain to answer age old and indeed probably unanswerable questions. It means instead a commitment to a reciprocal dialogue between those doing research on the brain and those exploring the nature of humanness in other ways, a dialogue in which existing understandings from research on the brain are made use of and tested in broader arenas, with the results in turn influencing the questions and methods of those doing brain research.

The issue is whether we all, those doing research on the brain and those not, can become comfortable with a working assumption that the brain is indeed the material embodiment of humanness, past and future, and with the notion that that working assumption represents opening for future exploration and evolution rather than a denial of important human potentials. Without such a common working presumption, the brain cannot serve as a coherent framework for thinking about mental health. With it, and a more encompassing understanding of what is meant by research on the brain, perhaps it can.

Physical and mental health

I went into the semester with a strong feeling that the traditional "medical model," as it has evolved in the context of "physical health" does not provide an adequate foundation for a coherent approach to "mental health." Here too the semester reinforced my starting position but made me more aware of its complexities.

Inherent in the "thinking about mental health in terms of the brain" idea is a rejection of the distinction between body and mind, replacing it with the notion that "mind" is a characteristic of a material structure, the brain. There are, to my mind, all sorts of advantages to this shift in perspective. Among the more important, from my point of view, is that it could valuably serve to remove the stigma of mental health problems, and the institutional discrimination against those needing assistance with mental health as opposed to physical health issues. Since mental health problems reflect a part of the body, the brain, they should be dealt with in the same terms as problems of other parts of the body.

There are, though, some difficulties with this. That mental health problems should be dealt with "in the same terms" as physical health problems does not mean, for me, that they should be deal with in the terms of the existing "medical model." Destigmatization and parity are important objectives and I would like to see "thinking about mental health in terms of the brain" contribute to achieving them. But there are problems with the current medical model that are particularly acute in the case of mental health. To put it differently, mental health is not the same thing as physical health, as the latter is understood in the medical model.

Problems associated with the brain are different from problems associated with other parts of the body (the kidneys, for example) not because one is mental and the other material but rather because of the distinctive characteristics of the brain as a particularly complex material organ. For many parts of the body, an approach that is based on some ideal concept of structure/function relations, and that assumes a tight correlation between symptom, cause, and effective therapy has been and may well continue to be quite effective.

What seems increasingly clear in practice, and follows from the working assumption of the brain as humanness, is that such a "medical model" approach is both ineffective and inappropriate in the case of the brain. In this case, there is no adequate structure/function ideal, nor any tight correlation among symptoms, causes, and effects. In addition, there is a special need in regard to the brain to acknowledge the significance of story telling, meaning making, and agency (more on these below).

The upshot is that I am optimistic that doing away with the mind/body dichotomy is a promising way to go in terms of eliminating mental health stigma and lack of parity and opening new research directions. It continues though to seem to me important that that movement not be equated with bringing mental health under the "medical model" umbrella. Mental health issues are indeed "physical" problems but they require an approach more sophisticated than that which has characterized the "medical model" to date.

Some key understandings re mental health
What has struck me over the semester is less what we don't yet understand about particular mental health problems and more what the commonalities are across an array of mental health problems, and the understandings that are actually available to us if we choose to notice them (cf The Purposeful Migraine and From the Inside Out: New Insights). The following is an effort to make those explicit, as they seem to me to have emerged from our discussions.
  1. There is no sharp border between health and "illness." Nor any clear criterion to distinguish between functional and "broken" brains. There certainly exist brain states that cause suffering both to people having them and to others, and every effort should be made to ameliorate them. But such problems should be approached from the perspective of facilitating change to lessen suffering rather from the perspective of correcting deficiencies, and with the understanding that all people need help to varying degrees at varying times rather than the notion that people with mental problems are qualitatively different from other people and need a special qualitatively different kind of help. Mental health is not a "state" but a process, one of successively participating in the shaping of one's own life and the lives of others.
  2. All suffering is "in the head." Without brain interpretations, "stories," there would be no suffering. In some cases, disturbing stories can be traced to well-defined problems either in other parts of the body or the brain itself. In the majority of mental health problems, this is not the case and probably never well be. Instead, there is some conflict between existing conscious understandings, the "stories," and unconscious understandings. Conflict itself is generative but persistent unresolved conflicts produce suffering and require external assistance. This requires that attention to "stories" (as per "From the inside") and their interaction with the unconscious be taken as a central element of mental health care.
  3. In addition to stories, issues of self-control, personal autonomy, and meaning are central to most mental health problems. And still more important because of the need to recognize that all three can be compromised not only by external factors but also by internal ones. There is a clear need to better understand the interaction between the unconscious and stories so as to facilitate the ability of individuals to enhance their capabilities of self-control, personal autonomy, and meaning making ability (cf An Exploration into Consciousness and Free Will).
  4. A significant number of mental health problems either derive directly or are significantly exacerbated by interpersonal and social/cultural variables, by conflicts among unconscious understandings, individual stories, and collective stories. Here too conflict is generative but persistent unresolved conflict produces suffering and requires external assistance. In this context, it is particularly important to recognize that the objective should be to relieve suffering by facilitating change, rather than correcting deficiencies, and that change may be needed in societies/cultures as much as in individuals (cf Conquering Culture). Socio-cultural "norms" need to also to be thought about as a central element of mental health care and should not be presumed to be fixed standards to which individuals need to adhere.
  5. The notion of "reality" is an important issue in the mental health context (cf Truth and Reality), and an understanding of the brain has important things to say about it. There is no single "reality" that one can use to evaluate all understandings. Understandings are necessarily and inevitably context and perspective dependent, and so there are multiple realities, both among and within individuals (cf The Folly of Examining Life Rationally). Mental health needs to be understood not as a state of being "in touch with reality," but rather as a process of making creative and productive use of multiple and potentially conflicting realities.

Are these useful understandings, in the sense that they could bring greater coherence to thinking about mental health? in the sense that they raise new questions for further exploration? We'll see ... but I think I at least have a more sophisticated sense of what's at issue then I did at the start of the semester. Again, thanks all. For sharing multiple and potentially conflicting realities. And being wiling/able to see what new things we can make of them.

 

 

Sophie F's picture

Thoughts

Yes, thinking about the brain is a useful way to understand mental illness. However, like many things, when looked at to the exclusion of other facets of mental illness, can serve to limit one’s understanding of the situation. In some ways, an emphasis on the brain, on brain chemistry and ever-more precise brain-imaging techniques, has served to undermine the individual struggle, the tumult of living with mental illness. I think more than anything, this semester has forced me into the somewhat uncomfortable position of embracing mental health/illness as a continuum and as a project to be undertaken by all (who seek to embrace the challenge). I’m still not entirely sure what the implications of this stance are, but know it differs from my original thinking on the subject. I do believe that the health/illness dichotomy is not necessarily a useful one and may in fact be detrimental in terms of adequately working with people given a range of potential thoughts and behaviors. The more we limit “health” to certain thoughts and behaviors, the less understanding or empathy we have for those who do not fit the prescribed way of being. Thinking about the brain, its organization and working with the bipartite model as a way to better engage tacit knowledge and the story-teller, seems a useful undertaking. Thinking about the brain, to me, means not just technology, brain chemistry and the like, but understanding the potential of the brain and working to enhance individual potential by working with the individual at her level.

I love the idea of “getting it less wrong” because it is a gentler more compassionate way to view the mental health framework. As it exists now, it is about “getting it right,” which may, in fact, be an unattainable goal. How can there be one “right” when we are all different, when our brains are “wider than the sky…”

There are many ways in which the mental health system has the potential to change and I am hopeful that it will continue to change… Particularly, hearing people in the class present on different topics really struck me because it elucidated just how similar, in thought and feeling, many mental “illnesses” are. This really changed my thinking about the usefulness of diagnostic categories and the etiology of illness. The brain’s attempts to reconcile conflicting information result in different symptoms, but are the underlying story-teller problems really so different? This also led to me considering the nature of story-telling problems and how challenging it can be, no matter the severity of the problem, to actively reengage the story-teller in creating new meaning.

Thank you to the entire class for so openly sharing your thoughts and helping to shape my own. Happy New Year!
ryan g's picture

Reflections...

As I flipped through some of my previous posts, it occurred to me that my thoughts have gone in cycles throughout the semester.  Here is a quote from the second discussion "Mental Health?"

 If I am to to discard the cultural framework I have been working in... the idea of a healthy/ill dichotomy... even my beliefs that an organ should function in a certain way... in the interest of being less wrong, I feel like I don't have any ground to stand on anymore.

I remember at that point in the semester feeling like I was really stuck in a rut.  I didn't understand how we would ever reach a conclusion on anything.  

Then, at some point in class, I can't remember which day it was, I had the realization that it doesn't necessarily matter that we can't define mental health.  We can continue forward using the definition that is most useful, and working to make that definition less wrong.  This was a big thing for me.  I was thinking, "I've never cared that we don't really know what is going on on a subatomic scale... I can still learn chemistry using the models we have now.  How is this any different?"  Letting go of my need to reach a conclusion felt good and allowed me to feel like I was making progress again. 

However, I feel like the last few weeks with the tea kettle discussions, the frustration began to build for me again as my thoughts started to drift back towards this feeling of how do we cope with this?  How can anyone say what we should do?  What does it all mean?

This tension has definitely been a main theme for me in the class.  Trying to balance thinking about things on an abstract theoretical level and thinking about applications on a practical level.  For example, the issue of how all these ideas applied to us future healthcare providers.    On one hand I find myself questioning the existence of a healthy/ill dichotomy and on the other hand I find myself wondering how I will actually deal with real life clinical situations.    

As I sit here now and think about this, part of me wishes that I would have spent less time mucking around and more time focusing on things on a more practical level.  However, I think that constantly trying to find a way to balance these thoughts has been the main facilitator for growth in my thinking this semester.

As far as conclusions go...

I am fairly confident that underlying everything we experience day in and day out is the neural network of our brain.  Since this network is constantly reorganizing itself and never static, it makes sense that we can't seek out an ideal structure to call "mentally healthy."  Therefore, making it possible for the brain to "do what it does best" seems like a reasonable stance to take right now for mental health.  I think this opens up a lot of interesting new questions as well.  How can we best facilitate the brain growing and forming new connections?  How does mental illness block this function?  Also, there are sciences like chaos theory that try to predict randomness in different areas of nature.  Can we predict the randomness in the brain?  If so, what will that tell us?   

Thanks, everyone, for a great semester!    

 

kgins's picture

Reflections...

I'm from a pretty judgmental area on Long Island. I've grown up with perspective, but also very aware of the "normal".  A lot of people around where I live have plastic surgery to change what they don't like about themselves- teens included. There was even a double digit club in one town nearby, where, to belong to this club, high schoolers kept their weights in the "double digits" (they talk about it here- http://www.fegs.org/news_events/032102.cfm).  But, on Long Island, this isn't abnormal. What's abnormal here, or at least hushed, is talking about things that make people less beautiful, or less perfect, like mental disorders. So, when I came to college, I came with little discussion experience in terms of mental health.  It seemed that no one brought it up, because no one wanted to be associated with it. In retrospect, I think my school and community had a real problem with eating disorders. Fad diets were more than popular, and the more extreme the diet, the more often the more extreme results, which, more often than not, led to praise, jealousy, and behavior imitation from other students. It makes me wonder how, especially when you're young, you can distinguish between "normal" or "typical development"vs. phases which may be damaging, vs. potentially extremely damaging more long-term behaviors that can become defining traits/characteristics. I knew people who did and took unhealthy things to change their bodies in high school, and I knew they were unhealthy behaviors. Interestingly, I've also been able to see how their behaviors have changed as they aged.  I think for most people at my school, the eating issues and fads and drugs were phases. Maybe they were distractions, to get through high school, to find a group, to gain acceptance, etc. Eating disorders are considered mental health disorders, but much attention wasn't paid to them in my school, and I think maybe that's what led to me viewing mental health the way I did- as quick, definable phases, that would happen, and then eventually be done, rather than as significant problems. In high school, everything seemed like phases. We were told we were in adolescence, perhaps the most up and down and everywhere phase, made up of phases, and not to worry, because eventually we would be secure and stable with our identities. I think I grew up thinking that everything would always be a phase, and that even if we were having trouble in that phase, we would learn and grow form it, and then we would move on to the next phase.  A little too idealistic perhaps, but the idea of viewing life as various phases has, I think, been useful.

When I entered college, I assumed my ways of thinking would change, my thoughts about reality, and my version of the world would change, as all would be phases of some bigger picture.  Though I became a psychology major before taking this class, this class was the most in depth to psychology and mental health I've ever taken. It took me awhile to understand and realize that mental health, in this environment, wasn't completely taboo, was a real, concern-worthy issue, and had an open discussion forum, available, and occurring. I had the option of whether to resort back to what I've seen, and actually be the judgmental one, or the one "above it all", as I'd become accustomed to seeing so much, or whether I could sit down and listen and have my own opinions and think of this not as a taboo topic, but as something that everyone faces in their lives, through one way or another, something that goes on in our minds- and who doesn't want to explore their minds- and the minds of others, and especially "problems" within the mind? So interesting! I think this experience was so valuable to me because of my upbringing within my community. I was never one to judge, and I've seen my fair share of mental health issues, and perhaps it was this combination that made this experience so much more real than I think it would have been otherwise, as just a story that couldn't be related to. While my family is far from what I think of as Long Island typical (which is not to say all of Long Island is like this, because much isn't), in many communities and schools, the imperfect is quieted down, and we're led to believe that perfection is attainable, even desirable to attain.  This class has not only allowed and encouraged me to explore mental health issues, but has also allowed ourselves to debate things with each other that some of us- or at least I know I have- taken as give-ins. I leave with a view of mental health not as a contagious disorder, or as something taboo at all, but more of an interesting concept, with a broad range of issues all open to interpretation, leaving room, but paving the way, for more discussion next semester.

Martin's picture

The main change in my


The main change in my thinking over the course of the semester has been a recognition of the vastly different ways people use terms that I recognize as applying to very specific things. I am entirely convinced that research into the brain and its functions will be and is beneficial for our understanding of what mental health is because as I see it, mental health is expressed/exercised through the organ of the brain. It makes sense then to improve our understanding of the instrument in order to understand the music. 

I am less hopeful about our ability to improve our mental health care system because with so many diverse and contradictory opinions about the activity of health, and about the organ itself, it seems as though there is no one system that can encompass them all so that they work together constructively. No system can "include" everyone and every idea and still be a system. 

So, an individual learning more about the brain and the exercise of their own menatal functions in a healthy way will lead to that individual improving their own health/ getting their own ideas less wrong. Making that  process a global activity with so many different possibilities is a recipie for discord.  

vpizzini's picture

Everything that is observed

Everything that is observed isfiltrated by a referential theory that suddenly could appear to be insufficient, but the object must be exclusively observed with that particular theory or with another one (Popper 1928, 1982). This means that the object that is being studied is also influenced by the modalities with which we are observing. Pure objectivity cannot exist and what we are observing does not belong to object,but it is a product of the interaction of the object itself with the system adopted for the observation.

In order to define a particular mental illness, many different factors, especially our cultural and social beliefs that shape our observations,  must be taken into consideration. We cannot just "translate", according to the norms of our society, a mental illness into a disease, in order to eliminate it. If a form of therapy must be chosen, one should focus on what works for a particular person, rather than focusing on how the disorder arose. Each phenomenon must be placed within the context in which it manifests itself.

 

kmanning's picture

The next DSM

Not my final reflections, but an interesting article to come out on the drafting of the DSM-V just as we are wrapping up this course and trying to piece together our final thoughts:

http://www.nytimes.com/2008/12/18/health/18psych.html?pagewanted=1&_r=1&hp

Looks like there isn't much more agreement out there in the medical world than we've come to in our class, possible less! And we're not even dealing with pressure from drugs companies.

Hope everyone is surviving finals! 

Paul Grobstein's picture

also suffering mental health withdrawal

Was going to mention the NYTimes article too. Also heard an interesting/relevant story on NPR yesterday about a musician who had/is recovering from a cerebral hemmorhage. And have recently done some binge reading of recent books that others might also find interesting

  • The Center Cannot Hold, Elyn Saks, a memoir about schiophrenia, interestingly simlar to/different from Kay Redfield Jamison's An Unquiet Mind
  • My Lobotomy, Howard Dully and Charles Fleming, also a memoir
  • Look Me in the Eye, John Elder Robison, a memoir about Aspergers, written by the brother of the author of Running With Scissors
Paul B's picture

Mental illness as symptom rather than illness itself....

In My first post I emphasized the need to stress the fact that mental illness is a medical disease with biological causes similar to diabetes. I thought that finding the right medication (the right medication - not just blind prescriptions of drugs that seem to work or drugs that have worked for some in the past) could solve the mental illness crisis.

Since then, I think my thoughts on mental illness have become a lot less wrong. One of our interesting conversation that really shed light on mental illness was about how we should think about mental illness.

Rather than considering mental illness as an illness in and of itself, perhaps it is less wrong to think of mental health as an symptom of a larger problem. This paradigm shift could revolutionize the way in which our health system approaches mental health. Instead of just bandaging the mental illness symptom, we should put effort in solving the larger problem as well.

I think this is the most important lesson that I've learned this semester.

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