My life and my brain

OK, so my good friend, and fellow Douglas Institute blogger, Joe Rochford (The Rochford Files), has decided to write about some of the discussions we have had in the past. It seems that in between conversations about Bob Dylan, particle physics, and unpleasant bodily functions, we occasionally touched on questions of mental illness (what are they? how are they classified? etc…)
The question he discusses in his blog is the following: are mental illnesses diseases, or are they just problems in living (as Thomas Szasz used to call them)?

Since it is a topic that constantly comes up, here are my two cents on the matter:

When I give talks on mental illness, I always ask an audience member for their name (let’s say it’s Joe). I then ask how it is that I would be able to say, “Hi, Joe!” if I saw him the next day. Clearly, a change has been produced in my brain. More importantly, it is a brain change that was produced by a normal interpersonal interaction.

I use this argument to show that everything is in our brains, including stuff we observe or are taught. That’s why there are many ways to effect change in that organ. These can include both physical and psychological factors.

The reality is that while your brain is very much affected by everything that goes on around you (your experiences, things you see, or are taught, or read about…), it is also a very complex organ that is as vulnerable to a disease process as is any other organ. (By the way, Woody Allan calls his brain his second favorite organ…but I digress…)

The problem with mental illness classification is that it is a mix of real medical diseases on one hand, and non-medical problems on the other. These non-medical problems, while significant, can arise despite everything working properly in our brains.

This is not absolute. Diseases can be worsened or lessened by a number of psychological factors, and non-medical problems can be more common in people with certain sensitivities or vulnerabilities.

Despite some overlap. I still like to distinguish between medical and non-medical illnesses in psychiatry. Despite Szasz’s famous position that mental illness is a myth, you cannot watch a person fall into a psychotic state and not believe something has gone seriously wrong with their brain. No one questions the reality of other neurological illnesses such as Parkinson’s (damaged motor functions) or Alzheimer’s (damaged memory functions). Why then would we not assume that other brain functions, such as perceptions and thoughts, could also be affected by disease?

Bipolar Disorder, which used to be called Manic-Depression, is another one of those conditions that I would classify as a medical disease. Unlike other forms of depression, the main treatment has to be a medical one (it is usually treated with Lithium or other mood stabilizer). The same is true for Schizophrenia.

On the other hand, we have a tendency to medicalize everything. Not all problems are diseases. If your wife or husband announced that they no longer loved you, how would you react? What if, as a consequence, you had a lot of trouble functioning normally?…or became suicidal? In such a case, if you felt that way for more than two weeks, you would easily qualify for the diagnosis of Major Depression.

In my opinion, depression is something that can be considered a disease in some cases, and a symptom (or a reaction) in others. I would not say that a person depressed over a separation is diseased. However, I would say that they are suffering tremendously with a depressive reaction. This suffering can benefit from treatments such as therapy, medication, or a combination of both. Therein lies the heart of the matter. It doesn’t actually matter what the causes are unless the treatments for each are different. And in the case of depression, both therapy and medication can help (as Joe’s blog post shows).

Sorry to be long-winded but here is the executive summary:
- Some mental illnesses are pure diseases just like any other medical condition.

- Medical conditions can be affected or worsened by psychological factors.

- Most medical diseases require medical treatments (psychotropic medication in most cases). They can sometimes benefit from non-medical treatments, but such treatments would normally serve to supplement medical treatments.

- The vast majority of problems that people seek treatment for (anxieties, depressed mood, burnout, relationship problems, interpersonal conflicts, etc…) are not diseases in any traditional sense of the word. They are not primarily medical problems.

- Some people are more prone to psychological problems because of genetic variations or traits, even if they have normally functioning brains.

- We usually get depressed or have interpersonal conflicts because of how we see things (eg., we may be perfectionists, or we may not trust others).

- OUR PERSONALITY TRAITS ARE FOUND IN OUR BRAINS. So, of course, the ultimate target of any treatment is the brain. Therapy does this through non-medical means (talking, instruction, observation, targeted learning exercises, etc.).

- Non-medical conditions respond well to psychological treatments but can also sometimes benefit from medical treatments (e.g., antidepressants can help a good portion of depressed people regardless of the cause).

All this to say, let’s not get lost in our obsessive need to classify and define. Some things do not fit easily into any category and do not have single (or simple) definitions. Mental illnesses (or psychological difficulties, if you will) are just such things.

Let me end with a case example:

A lawyer once asked me to assess a man that he was defending. The man had lost his dream job with a government agency after accepting a bribe. He was arrested and made the headlines of the Journal de Montreal and was the topic of the morning talk shows.

He had the highest score on a depression scale that I had ever seen. I told his lawyer that the client knew what he was doing when he committed the crime. I suggested that the union would probably better serve their member by paying for therapy which he desperately needed, rather than trying to defend his actions. I also strongly urged the gentleman to go see his family doctor since he was in such bad shape. I was hoping he would respond to antidepressant medication. He went to see his GP the next day. The doctor did not give him anything and told him that he was not depressed. “You’re just having a normal reaction to the events.”

A few days later the client went back home to Quebec City. Once there, his family saw how bad he was doing and brought his to a psychiatric emergency department. He was immediately hospitalized with Major Depression as his diagnosis.

I think his GP confused the question of disease versus suffering. The client was not diseased in the medical sense. But he was depressed enough to require a medical intervention.

Tagged as Depression, Mental health, mental illness, Thomas Szasz.

Posted in Depression, Mental health.

Posted on 09 Sep 2008