Mental Health and the Brain: Working Group, Feb 16

Mental Health and the Brain Working Group:

February 16th, Organizational meeting/continuing discussion
Synopsis and forum for continuing discussion

Thoughts welcomed in the on-line forum below.

 

Participants
Martin Bayer, Laura Cyckowski, Adi Flesher, Sarah Gibbs, Ryan Golden, Paul Grobstein, Grace Marie Hollaender, Julia Lewis, Katie Manning, Debbie Plotnick, Max Plotnick

Summary

The first meeting began with introductions and brief discussions of participants’ interests. Present were post-bacs, an undergraduate chem/bio major, alum working with the TBI population, professors in biology, a counselor, a former psychologist/now teacher, adolsecent counselor, and a social worker involved in mental health policy. Interests expressed included: the application of brain research to mental health, mental health parity and policy, improving/re-defining the relationship between “patient” and “clinician”, group therapies, consciousness & the self, how different therapy approaches can best be combined to suit individual needs, and the education of mental health practitioners.

Research on the brain

Many mental health “consumers” are quite capable of understanding and indeed eager to learn about research on the brain. Knowing something about themselves in biological terms can be comforting and help a person create a sense of self or “story” about themselves, as well as reduce the stigma of “mental illness”. Also, it may be helpful to teach kids something about the brain and how it works to help them learn about themselves and about others.

The use of the term “brain”, though, can lead many people to think only in terms of internal/inherent characteristics and to ignore the influence of one’s environment, history, and culture. Mental health consumers should not be asked, “What’s wrong with you?” but instead be asked to consider, “What’s happened to you?” An effort should be made to expand the understanding of “the brain” not as a seat for internal, unchanging aspects of a person, but as something always changing and being influenced from both within and by the environment/culture.

Researchers and anyone interested in mental health and the brain may do well to make fewer assumptions about what one is looking for in the brain, and instead allow inquiry to be guided by observations of the brain. Brain research has been guided by schemas set up based on external observations, which while important, leaves out a person’s internal experience. For example, autistics have been described as being somehow socially impaired. However, this may not actually reflect what is going on “in the inside”. Brain research has shown autistics to have problems integrating sensory information, which may only become apparent in social situations and as such be misattributed to some deficit in social learning abilities.

Categories and “from the inside

The categories and labels used in the psychiatric community (schizophrenia, bulimia, borderline personality, etc.) seem to become less distinct when one compares the internal experiences in these phenomena. Attention should be paid to the experience “from the inside” because it provides valuable information not evident from observations made from those “on the outside” (doctors, psychologists, family, peers, etc.) which has in the past been largely ignored. A fundamental commonality among mental health disorders may be a conflict between one’s intrapersonal understanding—sense of self or story of oneself—and interpersonal understandings—cultural understandings or group stories. One participant suggested that a good pedagogical approach to preparing mental health workers might be a course which reads solely memoirs, emphasizing internal experiences. Understanding internal experiences is valuable and evident by the fact that “peer specialists” (those who’ve dealt with mental illness) are proving to be a common and helpful source of support for those experiencing mental health issues.

Practical issues

How to get more information not only to consumers and clinicians but also to politicians, those influential in policy decisions?

 

 

Books referenced during the discussion

Look Me in the Eye: My Life with Asperger's by John Elder Robison
Running With Scissors: A Memoir by Augusten Burroughs
The Center Cannot Hold: My Journey Through Madness by Elyn Saks
Get Me Out of Here: My Recovery from Borderline Personality Disorder by Rachel Reiland
My Lobotomy by Howard Dully and Charles Fleming

--- summarized by Laura

Comments

jrlewis's picture

I find the idea of studying

I find the idea of studying mental health from the inside intriguing and appealing.  Having read several memoirs about mental health issues and compared and contrasted them with other’s experiences.  However, in our interconnected three or six way system, I am not sure who is on the inside and who is on the outside.  It seems that the person experiencing mental health issues is definitely on the inside.  Maybe also the people with whom this person is interacting.  Sometimes other people are able to observe things that the person in question can not or is not aware of.  These observers might be mental health workers, family, or friends.  Then, there are people involved with mental health policy.  They might be the furthest out yet.  Maybe it is more of a continuum of insidenss as opposed to outsideness?  Interconnected with, but not parallel to the subjectivity-objectivity continuum? 
Paul Grobstein's picture

the objective/subjective issue(s) in mental health

My sense is that there are at least three issues here, all important but needing to be disentangled and addressed individually.

"a more clear cut objective approach to categorization"

See The "objectivity"/"subjectivity" spectrum: having one's cake and eating it too. "Objective" reflects the (appropriate) aspiration to have things about which there is widespread "subjective" agreement. It is not either a value in its own right nor something fully achievable. We may find consensual understandings of rocks, and of measles that prove useful. Ought we to expect to find them about the states of mind of individual humans? Or is that perhaps something where, to one degree or another, we need to acknowledge that consensual understandings are necessarily limited in their usefulness?

"the major problem in my mind with trying to classify mental illness in terms of behavior and emotion is how subjective things are"

There is a long history in psychology of both starting with the "subjective" (gestalt psychology, phenomenology) and of trying to do away with it entirely (behaviorism). And an interesting recent history in cogntive psychology and neuroscience of begining to accept the necessity to admit as legitimate observations "subjective" reports (in, for example, studies of the neural underpinnings of pain, of emotions, and of consciousness). Maybe its time to generally recognize/accept that "subjective" things are relevant to "objective" inquiries? Maybe we can have our cake and eat it too?

"What provides us with a more useful categorical model? While each perspective may offer different understandings, which should be top priority?"

Why choose between the two? Or give one "top prority"? How about using both "structures, organization, chemical structures, etc" AND subjective reports, and letting usefulness in particular contexts determine the balance?

ryan g's picture

Categorization Confusion

From where I'm sitting now, it appears to me that categorization is the name of the game.  If we can't categorize mental conditions on the healthy to unhealthy spectrum in some way, what can we do?  

It's my understanding that we are currently considering a "view from the inside" as an alternative means of categorization.  Perhaps, this view might be more useful in helping the patient's storyteller make sense of the world. 

 What is weighing on my mind right now is the degree of subjectivity and objectivity that different classification systems represent and the practical usefulness that follows from that.  For example, the major problem in my mind with trying to classify mental illness in terms of behavior and emotion is how subjective things are.  Who can say when this behavior is or isn't being demonstrated?  and who is experiencing what emotion?  Where is the cutoff?  

I see this new perspective (from the inside) as being plagued with the same problems.  Just because two individuals describe something in a similar way, are we able to meaningfully compare the two?  

 It seems like a physiological perspective may provide a more clear-cut, objective approach to categorization.  We can look at structures, organization, chemical levels etc. and say these things are or are not present.  

I am certainly not trying to suggest that there is no use for considering things from the inside, or other things such as cultural influences.  I believe that these factors will expand understanding.  My question now is:  What provides us with a more useful categorical model?  While each perspective may offer different understandings, which should be top priority?

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