The sick brain?

At Hope Street Cards we’ve released a new card. This is what it looks like:

That’s right; this card is all about the neuroscience. That is, the science of the brain.

The world of understanding things doesn’t really seem to know exactly why and how mental illnesses exist and occur. Diagnosing a mental illness isn’t like diagnosing other conditions. There’s no blood test, no x-ray, no CT scan that can yield a diagnosis of anything mental health related. It’s much more difficult and it involves looking at a big conglomerate of complex factors that makes up an individual’s situation – the biology, the environment, the thinking, the culture, the relationships.

When it comes down to the relationship between mental illness and the brain it all gets pretty interesting. And even a little bit controversial.

The brain is AMAZING. It consists of billions of neurons or cells that must communicate with each other. The communication between neurons maintains all of our bodily functions, informs of us of pleasure and pain and lets us know when a bird has pooped on our head. The communication between neurons is controlled by the brain’s type and level of neurotransmitters. Neurotransmitters are the chemical substances that control and create signals in the brain both between and within neurons. Without neurotransmitters, there would be no communication between neurons. The heart wouldn’t get a signal to beat, our mouth wouldn’t know how to speak and our arms wouldn’t be able to react widely in an attempt to shake bird poop from our hair.

For quite some time it has been believed by numerous smart people that having a “chemical imbalance” or an imbalance of certain neurotransmitters within the brain was the main cause of psychiatric conditions.

Dopamine is one such neurotransmitter, which when found in the thinking areas of the brain can be considered the neurotransmitter of focus and attention. It is hypothesised that low levels of dopamine here can impair our ability to focus on our environment, stay on task or activities, or maintain conversations. Low levels of dopamine in these areas of the brain have been found to be prevalent in individuals experiencing Attention-Deficit Hyperactivity Disorder (ADHD). At the other end of the scale, extremely high levels of dopamine in the brain can cause us to lose our contact with reality. We can begin to develop unusual ideas about what is happening to us. We might experience delusions (false beliefs) and we might experience hallucinations of our senses. Not surprisingly then, medications that block the dopamine receptor work wonders in calming the psychotic symptoms of people with schizophrenia.

Serotonin is another neurotransmitter that has been identified in multiple psychiatric disorders. This neurotransmitter is a major regulator of things and is involved in a lot of bodily processes such as sleep, libido and body temperature. Most importantly it is commonly regarded as the chemical responsible for maintaining mood balance. Because of its’ role as a major regulator of things we often rely on serotonin a lot when we are stressed. Living in a high stress situation for a prolonged period of time, we use more serotonin than is normally replaced and prolonged exposure to high stress can gradually lower our serotonin levels. When serotonin levels are low, we experience difficulties with concentration and attention. Routine responsibilities can seem overwhelming. Sleep and appetite disturbances can occur and mood can reduce. Drug treatments, such as Selective Serotonin Reuptake Inhibitors (SSRI’s) a commonly used anti-depressant, have been found to have beneficial effects in people with major depressive disorder. These medications work by blocking serotonin-producing cells from reabsorbing a good portion of the neurotransmitter they secrete – as they normally would – leaving more of the chemical available for communication around the brain.

These drug discoveries resulted almost entirely from serendipitous accident though. And scientists went searching for the neurological roots of the medications workings after the fact. So we know that SSRI’s can work for treating depression in some people, but we still don’t know for sure that a shortage of serotonin is the cause of the depression.

And it appears that the research focus on neurotransmitters as the key cause of mental illness stopped producing any new findings long ago.

Despite not knowing the nature of the imbalance, the term ‘chemical imbalance’ has been argued to have made psychiatric disorders more palatable for patients and less stigmatising. If the cause of mental illness is our brain chemistry or our DNA, then it’s much more difficult for the person to be blamed for their symptoms. Advocates argue that stigma will diminish if we come to see mental health problems as biologically caused diseases, no different from diabetes or cancer.

Critics of the ‘chemical imbalance’ hypothesis claim that this hypothesis continues to be advanced only by pharmaceutical companies, with mammoth amounts of money going into possible pills that could bring their brain chemistry back into balance.

So does someone who has a mental illness actually have a “sick brain”? I don’t think we know for sure yet. We presume there is a ‘chemical imbalance’, but it’s uncertain as to what that imbalance actually is. We don’t know the exact biological nature of what is wrong when someone has a mental illness. And we don’t know for certain the exact mechanism by which medications or other treatments work.

I think we can say that someone’s brain is sick though to describe what we can’t scientifically explain. We know that something is not quite right in someone’s brain when he or she shows symptoms of bipolar disorder or schizophrenia or major depression. We know that certain chemicals might help to alleviate these symptoms. We also know that a mental health condition is probably caused by a range of things outside of the brain as well.

Like other body parts though, it’s entirely possible that the brain can also become a bit sick, or faulty, or imbalanced. Whilst it’s not the only factor contributing to the development of a mental illness, it’s an important one to note. If we acknowledge that there is a part of mental illness that is physically manifested, perhaps we will start to move from a narrative of blaming the person with a mental illness for being crazy or weak, to just being unwell. Because that’s what they are. And like all unwell people, they very much deserve to receive a card of support.

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