Understanding Mental Illness

In order to understand mental illness, you have to start by asking the question: What is mental health? Unlike other diseases of the body like cancer, diabetes, or hypertension, all of which can be measured and analyzed by looking at tissue or blood cells, mental illness is a disease of the brain that usually cannot be measured or analyzed by looking at tissue or blood cells. Consequently, mental health is often described as the absence of mental illness.

Confusing? You could say that. Even so, we've come a long way in our understanding of diseases of the brain in the last few centuries. From the 16th century and into the 19th century, people who suffered from various forms of mental illness were referred to as insane, idiotic, histrionic, disturbed, loony, and even possessed. As if the labels weren't bad enough, the treatments ranged from drilling holes in the affected person's skull to release the evil spirits, to the ritual of bloodletting (withdrawal of blood from the brain to return balance to the bodily fluids), to the later development of "madhouses" where people were confined under the auspices of safety, both for the individual and society. The early madhouses are what eventually evolved into "insane asylums."

Today, most medical professionals understand mental illness to be a physical disorder of the brain involving the various chemicals, also known as neurotransmitters that trigger the firing or inhibition of the neurons depending on the need of brain and body at the time. Mental illnesses like depression have come to be understood as resulting from a chemical imbalance in the brain. The development of the category of anti-depressant medications known as SSRIs (Selective Serotonin Reuptake Inhibitor) were ground breaking in that they successfully treat many cases of depression by making available more of the neurotransmitter known as Serotonin. This small adjustment in the chemicals of the brain, make the difference between someone suffering from depression and someone who can live a happy and fulfilling life. The other beauty of SSRIs is that the side effects are minimal compared to earlier forms of anti-depressant medications.

The difficulty of most mental illnesses is that they are much more complicated than the scenario described above. Rather than thinking of mental illness as resulting from the over abundance of or lack of a single chemical, it is better to think of the brain as a complex system involving multiple chemicals that interact with each other and vary in their function according to the location of the brain in which they are present. It was once thought that the neurotransmitter called dopamine was the primary chemical involved in cases of schizophrenia. This belief arose because patients who are being treated for Parkinson's disease (a degenerative disorder of the central nervous system resulting from the death of dopamine-generating cells) develop schizophrenic-like symptoms (specifically hallucinations) if the dosage for dopamine replacement medication is too high. More recent research shows that the neurotransmitters known as GABA and glutamate are involved in the cause of schizophrenia.

So far, mental illness has been described solely from the perspective of certain physical conditions of the brain. But to understand mental illness completely, we have to address the psychological and environmental factors. By their very nature, they are much more vague and hard to pin point than the biological chemical imbalances. Some of the known psychological and/or environmental causes of mental illness include severe emotional trauma experienced in childhood (E.g., physical or sexual abuse), exposure to violence or other traumatic events in childhood or adulthood leading to post-traumatic stress disorder, early loss of a parent, death or divorce, or being raised in a household where there is alcohol or drug abuse. This list is endless and the effects vary by individual.

Perhaps the most harmful misunderstand of mental illness occurs when it is reduced to the myth that it is simply a case of emotional weakness. Such belief systems are not uncommon. They are rooted in the misguided understanding of mental illness that led to the cultural taboos discussed above as well as the subsequent mistreatment of patients in the prolific insane asylums of the early 19th century. Because this thought is still more common than most of us would like to believe, it might seem as though we've made little progress as a society-at-large in the understanding of mental illness. In reality, we've made huge progress in the understanding and treatment of mental illness, which has resulted in large numbers of individuals leading happy and mentally healthy lives.

The month of May was designated Mental Health Awareness month in 1949. We can only hope that our understanding of mental health continues to progress until the cultural myths around mental illness are eradicated.