Mental Health and the Brain: Working Group, March 30

Mental Health and the Brain Working Group:

March 30th, Diagnosing/Treating Children (Grace Marie Hollaender) & Brain Injury (Laura Cyckowski)
Synopsis and forum for continuing discussion

Thoughts welcomed in the on-line forum below.

Participants
Martin Bayer, Anneliese Butler, Laura Cyckowski, Adi Flesher, Sarah Gibbs, Paul Grobstein, Grace Marie Hollaender, Julia Lewis, Katie Manning, Brie Stark

Summary

Laura's presentation: Laura presented several accounts of adults suffering from brain damage, some from subjects and others from observers. She addressed practical issues such as who should take responsibility for care and suitable living arrangements. She also discussed more abstract concepts such as the overlap between definitions of brain damage and mental illness. Both internal and external experiences of individuals with brain damage are also consistent with mental illness. Suggestions were made about how to improve the quality of life of severely brain-damaged individuals. Such as developing obsessions into more broadly defined interests. Perhaps both brain damage and education can be addressed by increasing the education of the individual. The idea that everyone might be brain damaged, in the sense that everyone’s brain is different, was discussed. Such a characterization removes the notion of a deficit associated with brain damage and replaces it with the idea that any individual can be better than they currently are. It is a model for personal growth, focusing on an individual’s abilities to pursue a meaningful life and contribute to the lives of others. Concerns were raised that this model is too general to allow for defining practices. It does not provide criteria for determining individuals in need of assistance or how to develop a treatment plan. Tension between internal and external accounts of an individual is unresolved.

--- summarized by Julia

 

Grace discussed diagnosing and treating children in special education by presenting a case study of a young girl, "Susie" who has been diagnosed with, among other things, cerebral palsy. Grace expressed the concern that not many teachers working in special education are able to research the specific and unique needs of their students. In Susie's case, her team of teachers and psychologists recommended her placement in a regular classroom because they felt she was not being challenged enough. However, Grace feels that she falls in between and may not fit in a normal classroom either. Aside from academics, Susie also does not fully engage in social interactions. She speaks seldom and has had speech therapy in the past. Grace notes though that she has a large imagination and reports that Susie will frequently talk on a pretend cell phone and be unusually expressive and articulate. Some issues discussed in the group involved the gap between children's cases being managed by social services and the educational system. Some participants expressed the notion that although the academics in the normal classroom setting may be challenging for Susie, it is important and beneficial to her to be exposed to social interaction.

The second half of the session focused on brain injury. Laura presented several case studies to open up discussion about brain injury and mental health. The distinction between a mental disorder or "illness" and brain damage may not be good therapeutically. The goal in either case should (?) be to help people acquire new ways of doing things, but not necessarily in any particular or certain way. One participant raised the point that brain damage has a different social stigma attached to it than does, for example, schizophrenia. However, considering research in neuroscience, schizophrenia or any other "mental disorder" could be considered brain damage as well. A better description may be "brain altered". Because the brain is physically altered in everyone—with experience among other things—everyone could be described as "brain altered" at some point. The distinction between brain injuries, mental illness, and “normal/healthy” people then becomes blurred. In discussing possible treatment plans, a participant suggested that a goal for treatment is the individuals happiness, which can best be achieved by helping the individual foster a sense of personal agency and the ability to see that they have control to some degree in their own treatment and circumstances.

---summarized by Laura

Comments

Paul Grobstein's picture

"Brain damage," "mental health," and education

The juxtaposition of the discussions of a kindergartener with cerebral palsy and a number of "brain damaged" adults intrigued me a lot, particularly in light of the distinction we tend to make between people with "brain damage" and people with "mental health" problems.  The kindergartner is being helped to deal with "educational" inadequacies, with the implication that those are distinct from "brain damage" problems, which are in turn distinct from "mental health" problems.

My sense, of course, is that the three contexts are much more similar than the terms and the ways we use them would suggest.  In my terms, all three have to do with troubling behaviors that reflect distinctive organizations of the brain.  And in all three cases, what one wants to do is produce alterations in the brain that will yield less troubling behavior.  

The point here is not only semantic but also practical. We tend to approach people with "brain damage" differently from how we approach people with "mental health" problems.  Even when the troubling behavior is the same, we think of "brain damage" as something we/they have to live with, or, at best, as something  requiring rehabilitative skill training , whereas we think of "mental health" problems as something to be corrected (by medication, therapy, or otherwise).  It would make more sense, it seems to me, to recognize that in both situations the aim is to alter behavior by altering the brain, and that the brain is most readily altered by exploiting its own corrective capabilities.  

The same holds, it seems to me, for the kindergartner with cerebral palsy, or any kindergartner for that matter.  Here too the aim is to alter behavior by altering the brain, and it is best done by exploiting the brain's own corrective capabilities.  

What does that mean in practice?  Here is where I found Grace's story/experiences particularly compelling.  Rather than waiting for the neurologist's report of what a child with brain damage can/can't be expected to do, Grace suspected that certain things were possible and kept trying out different ways of getting them to happen.  That seems to me a good general procedure for dealing not only with "brain damage," but also with "mental health" problems, and with education in general (to say nothing of child rearing and human intercourse generally).

Several points come out of this for me

  • We all have different brains, and so are in an important sense, all "brain damaged".
  • We all infer, sometimes more correctly/sometimes less so, problems in other brains, and should explore/make use of, rather than deny the validity of, such intuitions.
  • Our brains are most useful to modifications of other peoples' brains when we look for ways to encourage those brains to alter themselves in terms meaningful to themseves, rather than insisting on the incorrectness of particular organizations or the need for particular correct organizations.
  • While there are limitations to what any particular brain can achieve, all brains retain the capacity to usefully alter themselves.   
Brie Stark's picture

I found the discussion to

I found the discussion to be very thought-provoking and it raised several key issues in my mind.

We discussed "treatment" in a broad sense.  I got the impression that treatment should be based on a perceived 'deficit' that the individual feels, rather than a deficit placed on them by society's norm.  However, for a "successful" treatment/therapy to occur, doesn't the individual have to realize that they need the treatment?  But perhaps this striking difference doesn't seem to them to be a deficit, even though we -- as onlookers -- do perceive a deficit.  Because, just as we discussed, we're ALL different to some extent; where is the line drawn?

 The thought that everyone is brain damaged is interesting.  While I understand the mentality of it (whereas everyone has a very different brain with no pre-destined perfect model), it seems to me that the term is more necessary for the 'treatment' aspect -- whereas we must define a problem in order to fix the problem.  However, this brings me back once again to my above thought about 'fixing' a problem.  Does fixing a problem conform to the social expectation/norm of the function?  Do we aim to fix a problem to fit into social norms or to create a sense of happiness/satisfaction for the individual?  Sometimes, I think these two terms become a bit too synonymous.

Laura Cyckowski's picture

"...for a "successful"

"...for a "successful" treatment/therapy to occur, doesn't the individual have to realize that they need the treatment?" I think that is a good point. I know that lots of the guys at the rehab I worked at didn't seem to think that they needed to do X Y or Z, and in some cases I couldn't disagree with them.

I like the notion that arose about being "brain altered". If our brains are changing--via endogenous processes (hormones, for example), via everyday experience, via pharmacological therapy, or via psychotherapy, and so forth--everyone is brain altered (at every moment even).

Defining a problem... I think that as long as we're looking at what is impaired in a praticular person, we have to keep in mind that it is relative to the outside environment, ie culture. I don't want to say that individuals with brain damaged shouldn't be taught about their deficits--I think it's important for a person to understand what they can and cannot do, so they can then develop new ways to do whatever. 

Post new comment

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