Four Basic things people get wrong about mental illness and addiction | Karen Lankford, PhD , Neuroscientist at Yale University
Until a few years ago, I paid little attention to the ways that mental illnesses and addiction were being discussed in the public arena. My area of neuroscience research has little connection to these kinds of conditions, and I was not directly involved in public policy issues. After making friends with a man who has been living with schizophrenia for 50 years, and becoming a science advisor for the American Mental Wellness Association, I began paying more attention to social media posts and news articles about mental illness, addiction, and public policies related to treatment and prevention of these conditions. From the perspective of someone who studies the way the nervous system works, the ways that most people were talking about mental illness and addiction seemed weird. I became increasingly aware that the way that my colleagues and I talked about these conditions was quite different than the ways that members of the general public were talking about them. It became clear to me that the ways that most people thought about how the brain works, or failed to work, bore almost no relationship to the current scientific understanding of brain functioning. Analyzing the kinds of comments I was seeing posted about these kinds of issues, I identified four basic things that people were getting wrong when they thought about the brain.
1) Mental illnesses ARE physical illnesses.
People seem to think that because conditions like schizophrenia, bipolar disorder, clinical depression etc. cannot be seen on an MRI or be detected in a blood test, that they are somehow not real; more a metaphysical condition than a physical reality. However, the same thing is also true for Alzheimer’s disease, Parkinson’ disease, migraine headaches, epilepsy, Bell’s palsy, and literally dozens of common neurological conditions which neurologists treat every day. There is physical damage to the brain in mental illnesses, just as there is in Alzheimer’s disease. However, this kind of damage can only be seen by taking out the brain, sectioning it and studying the tissue under a microscope. Since most people are using their brains while they are alive, unequivocal diagnoses of these conditions can only be made after death, making them pretty useless form a treatment perspective. In practice, many neurological conditions (like neuropsychiatric disorders) are diagnosed primarily based on symptomology and responses to medication. The medical field’s segregation of brain conditions into separate specialties (Neurology and Psychiatry), is an historical anachronism, rather like the QWERTY keyboard. The original reason for the arrangement no longer applies or makes any sense in the modern world, but so many people have been trained on the old system and gotten used to it that we are stuck with it right now. When nobody understood what was causing any of these conditions, doctors focusing on different kinds of symptoms started taking different approaches to their study and treatment. Today, we understand that the same genes and environmental stressors are involved in producing both kinds of illnesses and the same neurotransmitters mediate the symptoms. This means that the same medications are often prescribed by both neurologists and psychiatrists to treat seemingly unrelated conditions.
2) Will power is vastly overrated.
There is a tendency to think that because a person is consciously aware of their thoughts and actions that they should be able to control them through a conscious act of will. This rarely works for more than a few minutes. The problem is that the unconscious areas of your brain control far more of what is going on inside your head than you are aware of and these parts of your brain do not listen to orders coming from your conscious mind. There are relatively few connections between the conscious and unconscious areas of your brain and many of them may be damaged in someone with a mental illness. This does not mean that you cannot consciously alter the functioning of your unconscious mind. It just means that you cannot do it directly with a brute force approach. You need to get tricky and convince your unconscious mind that this is something it wants to do. It is rather the difference between trying to train a dog and a cat. A dog pays close attention to its humans and wants to make them happy. As soon as your dog figures out what your words mean, it is generally pretty eager to follow your instructions. Cats can be coaxed with treats and have their behavior subtly shaped over time but training a cat to come when you call or to walk on a leash is not going to be easy. (Functional brain imaging has shown that cats do in fact recognize their names. They just do not care that you are calling them.) The value of a good therapist is that he/she has a better map of your neural network than you do and knows what kinds of approaches you can use to get to your target indirectly. A good therapist knows how to herd cats.
3) It is not the amount of something that matters, but how your body reacts to it.
People often think that they could not have PTSD because they did not experience the kind of severe trauma they associate with the condition. Furthermore, if they do have PTSD, they do not deserve to get help because others have experienced much worse than they have without getting PTSD. This is the wrong way to think about the problem. PTSD is triggered by a prolonged elevation of stress hormones and physiological responses to mental or physical stresses that are idiosyncratic. If your body has decided to produce a lot of histamine in response to s single bee sting or eating a peanut, you are going to go into anaphylaxis and you are not going to be able to reason your way out of your throat closing up or breaking out in hives. If your body has decided to dump a lot of cortisol into your system in response to an uncomplicated surgery or witnessing someone else’s injuries, you are going to have bouts of emotional instability, the hallmark of PTSD. It does not even matter whether you feel emotionally stressed, the part of your brain which calibrates your emotional responses to fit the circumstances will be impaired and you will start overreacting to things.
The same physiological considerations apply to addiction. Fundamentally, addiction is a maladaptive response to the presence of a chemical which can impair neurological functioning. In the attempt to reduce the negative consequences of the drug, the body downregulates the number of receptors or makes other changes which causes the system to not work as well when the drug is absent. The person begins to need the drug just to feel normal. This kind of adaptation makes it more likely that the person will abuse the drug and keep taking more and more over time, but a person can be addicted to a chemical without obviously abusing the drug. Many functional alcoholics do not realize that they are in danger of having a drinking problem because they only have a couple of drinks a night. The problem, however, is that they need those drinks to be able to get to sleep. Their bodies have adapted to the alcohol-induced impairment of nerve communication by sending messages in duplicate. When the alcohol completely leaves their system, nerve conduction returns to normal, and their system becomes over stimulated. They feel uncomfortable and agitated and cannot sleep. A person does not have to be reckless in their use of pain medications or alcohol to become addicted. They just have to have the right kind of physiology to adapt to the drug in the wrong kind of way.
4) Treatment does not make you weak or dependent. It just makes you better.
If someone has a spinal cord injury and communication between their brain and the muscles controlling their legs is interrupted, they use a piece of medical technology called a wheelchair to get around. If a paralyzed person rejected the use of this artificial help and insisted on pulling themselves along the ground with their arms, everyone would tell them that they were being an idiot. Why would anyone deliberately make their lives harder when there is a perfectly good technological fix that could make their lives better? If a neurological problem causes obvious visible physical symptoms, people rarely have a problem accepting all the help they can get to restore functioning. However, if the symptoms are less obvious, the attitude is often quite different. Fundamentally, clinical depression is caused by an interruption of positive emotional signals being sent to specific areas of the brain. This causes negative emotions like anger and sadness to overwhelm the person. It also interferes with concentration and consolidation of memories. Fortunately, there is a technological fix for that problem. Since the positive emotional signals are carried primarily by neurons using serotonin as a neurotransmitter, serotonin selective reuptake inhibitors (SSRIs) can boost the weak signal enough to make the system operate properly. For some reason however, taking SSRI antidepressants is viewed by many as a sign of weakness, as a personal failure. Believe me, if someone with a paralyzing injury could just take a pill every day and be able to walk again, they would take that offer in a second. It seems foolish to me for someone to suffer emotionally when taking a pill could make things so much better.
The same duality of response applies to physical therapy versus cognitive therapy. The physical therapy program prescribed to a stroke or head trauma patient is not about exercising the muscles. The muscles are fine. Physical therapy after a brain insult are about exercising spared synaptic pathways, making them stronger and allowing spared areas of the brain to take over functions for cells that were lost. Cognitive therapy aims at the same thing. It just involves exercising different kinds of neural pathways. Like physical therapy, cognitive therapy requires practice and repetition and is best performed with the guidance of someone who knows how to optimize your work out.
Some people also seem to have the fear that antidepressants or antianxiety drugs will cause dependency, that they will become addicted to the drugs and never be able to stop using them. In fact, the effects of these medications tend to be quite the opposite of addiction. Assuming there is no ongoing degradation of the system, (as most often occurs when the condition is genetic in origin), antidepressants and antianxiety medications tend to work themselves out of a job. Nerve connections tend to become stronger with use and weaker with disuse. By increasing the effectiveness of serotonergic synapses, SSRIs strengthen these connections, making their own work of enhancing serotonin signaling increasingly unnecessary. Likewise, by suppressing pathways that generate anxiety, antianxiety medications, over time, tend to make the person taking them less anxious, even after they are no longer taking such medications.
The same brain that operates your body, produces your thoughts and emotions, using the same set of chemical signals in slightly different combinations. If some part of your brain is not working properly, see a doctor about trying to correct the problem. Don’t worry about what name is applied to the medical specialty or the condition. Worry about getting better.
About the Author:
Karen Lankford has a broadly based background in biology and over thirty years of experience with cell culture and quantitative morphometric analysis techniques using a wide variety of light and electron microscopic procedures. She is philosophically committed to following the data wherever it may lead, even when it involves shifting the direction and learning new techniques.
In addition to her research activities, she is the co-founder of a nonprofit website called Simply Gray Matters which provides basic brain science information to patients and families dealing with serious neurological or neuropsychiatric disorders. The site provides this information in a layman friendly conversational tone with the goal of helping patients and family members understand what their doctor is trying to explain to them and participate in a more meaningful way in treatment decision.