Brain Illness – What a Difference!

In this short, interesting article, Depression’s Collateral Damage considers the benefits of shift from the language of “mental” illness, to “brain” illness.

I must confess, as someone with a mental illness, I have my reservations about the shift toward thinking of mental illness as a strictly physiological affliction. I worry that it will lead to an overly pharmaceutical approach to its treatment. I fully acknowledge the role that medication has to play in wellness (indeed, it plays a significant role in my own), but I think that talk-therapies are essential to wellness too. If, however, we start to think of mental illnesses as a strictly physiological condition, I worry that sufferers will neglect the importance of therapy. If mental illness is nothing more than a flaw in chemistry, talking would no more solve the problem than it would cure diabetes.

Admittedly, treatment schemes are, and should be, as individual as the people who suffer from these illnesses. But, when coupled with increasing pressures on public health systems to cut back on spending, I worry that a strictly biological conception of mental health will lead to a severe underemphasis of the value of talk-therapies.

Apologies to my subscribers for the brief hiatus. I will return with an article on perfectionism in the coming days.

Depression's Collateral Damage

Brain (1)I have become aware of something very extraordinary these past few days. It has completely altered how I look at particular things. And that’s the gift of new language.

When I started using brain illness instead of mental illness, I thought it was perhaps just an exercise in semantics. I didn’t think it would make any difference, but it has.

Now, when I look at my husband and think brain illness, something has subtly shifted. I am processing what is happening in terms of something wrong with him physically, not that his mind is haywire. Sure, the illness can affect his thinking, causing him to obsess, but I know that there is something physically wrong with him and that makes all the difference.

When I think of others suffering other forms of brain illness, I find myself with more hope than when I approached it from the point of view…

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5 thoughts on “Brain Illness – What a Difference!

  1. Point well taken, Shyane. With the use of “brain illness” we were hoping to take away some of the stigma associated with this area. Like any illness we would hope that the total person would be addressed – medicine if needed, therapy, other needs, and so on. Just as heart disease or diabetes should have the mental health aspects addressed, so too should brain illness have all aspects addressed. Too often the physical is missed, ignored, or simply not researched enough. Let’s work for a whole person approach to any illness.

    • Thanks for your reply, Bernadette! Yes, I think that’s a fair point too, regarding the relative neglect of the physical aspects of the illness. You’re quite right—the practice of medicine in general would certainly benefit from a more holistic approach.

  2. I agree. The best treatment option for any illness should be a holistic one. Physical tratments including medicine, excercise regiment, diet plans and psycological treaments such as therapy sessions will provide healing for the mind as well as for the body, in my view.

  3. If mental health practitioners were to look at themselves as providers of a service within a crowded marketplace, and not as professionals within the larger network of healthcare, we might have a better sense of the “brand” that would lead to increased engagement with the people we hope to serve as well as to opportunities for cross-fertilization with other care-focused professionals.

  4. Two thoughts about the helpfulness (or otherwise) of switching our talk from ‘mental illness’ to ‘brain illness’:

    1) The brain is responsible for keeping a huge amount of processes ‘on track’. Many are ‘mental’, or ‘psychological’. But it is not always the case that when a neurological process goes ‘off track’, the result is what we would think of as a mental illness (or a symptom of mental illness). Take for example, agnosias; recognitional deficits. Consider prosopagnosia – the inability to immediatelty recognise human faces. Doesn’t seem right to think of this as a mental illness, or a symptom of mental illness. Yet it stems from a problem in the brain. Perhaps we should even think of proposagnosia as a problem with someone’s *psychological* functioning – a psychological problem. I’m not sure whether that’s quite what we want to say. But anyway there is a sense in which the problem is with the person’s experiential capacities, so thus far something like proposagnosia looks similar to (say) depression if we think of depression as a) a brain illness which b) affects the sufferer’s experience. Yet, I’d want to argue, mental illnesses (and symptoms of mental illness) as we understand them in common language are rather different from conditions such as prosopagnosia.

    A more extreme version of the point. Just as problems in the brain can be responsible for psychological malfunctioning which doesn’t look like mental illness (or a symptom thereof), problems in the brain can also be responsible for bodily malfunctioning which on no sensible view can even be thought of as a psychological problem (let alone a mental illness). An example of such a problem: parkinson’s disease. The symptoms of this are not primarily psychological but motor – shaking, trouble controlling one’s speech, and the like (although (I am not an expert) I believe dementia is more common amongst people with Parkinson’s, the point is that Parkinson’s is not thought of as a mental illness, and one can suffer from Parkinson’s without any symptoms of mental ill health).

    What’s the point here? It is *not* that any of this shows that those illnesses we typically classify as ‘mental illnesses’ (and the symptoms thereof) are not effects of problems with the brain. I will remain neutral on that question (though am sympathetic to Shyane’s worries about ‘biologising’ mental ill-health). Rather, the point is that there may be value in *not* thinking of mental health problems as ‘brain illnesses’, since thinking of them in that way could end up being rather uninformative, given the wide array of things that can go wrong for a person whose brain is not functioning well. Indeed, speaking of mental health problems as ‘brain illnesses’ may run the risk of making it harder to think about what is unique about those problems we typically see as ‘mental health’ problems, which in turn may make it harder to assess the peculiar challenges which ‘mental illness’ throws up – challenges both practical and conceptual.

    2. I guess this follows on from the end of the first point. The point is this: One value in ‘biologising’ or ‘medicalising’ talk of mental health and illness – it is often (as in Bernadette’s article) argued – is that it helps to undermine the stigma associated with having a mental health problem. A fantastic project! But switching language like this has a down-side too. This is tricky to state, and to do so without seeming unsympathetic, or cold, I should show my hand as someone who suffers mental health problems. The down-side is that from the first-person perspective, certain mental health problems (perhaps this does not apply to all of them, perhaps it does, I’m not sure) make ‘keeping going’ (as in: getting out of bed in the morning, leaving the house, washing oneself, talking to other humans, and generally simply *trying* to maintain existence) very tricky! What is needed – and is so often hard to maintain for people with these kinds of problem – is a sense of it being *worth* trying, battling, squeezing all one can out of one’s will-power. And I guess I worry that thinking of one’s *own* problems as a ‘brain illness’, or as the symptoms of such, might lead to giving in a little. There’s nothing one’s will-power can do to mend a broken bone. One just has to wait. If my appendix is about to pop I can’t *think* my way out of the problem – I can only submit to the surgeon. But if my mental health problem is a ‘brain illness’, akin to (say) prosopagnosia or Parkinson’s, what can I do but give in?

    Now, I am not *entirely* comfortable with having said that, for the following reason: there is a sense in which having certain kinds of ‘mental illness’ (or symptoms thereof) is *constituted* by having certain kinds of incapacity of thought and/or action. What is it to be a social-phobic? Well, it seems like it *just is* to find it (next-to) impossible to function around other people (perhaps *certain* other people – e.g. strangers, or perhaps all other people). What is it to be deeply depressed? Well, part of it appears *just to be* unable to act (perhaps to act in certain energetic or jolly ways, or perhaps to act *at all* (then we have what it *just is* to be catatonic)).

    The problem with telling someone who is e.g. depressed to ‘cheer up’, or a social phobic to go to the party (‘it’ll be nice to see everyone!’) is not primarily that it is insensitive (although of course it is). Rather, the problem is that it embodies a *conceptual* mistake. It’s like telling a two-year old that they are acting like a two-year old, and with that implying that they should ‘grow up’.

    What is so hard about thinking about mental health problems – from both an ‘insider”s and an ‘outsider”s perspective – is that one gets pulled in two mutually incompatible directions, and that ending up in either of them threatens to misrepresent the sufferer’s situation, and because of this, risks doing them harm. On the one hand, the ‘biologising’/’medicalising’ tendency – the tendency to think of mental health problems as importantly like physical health problems – is apt to leave sufferers accepting that they are in the role of a patient – not in the sense of being a ‘user of medical/mental-health services’, but in the sense of being *passive* in the face of what they are going through. Being a patient, that is, rather than being an *agent*. Being an agent is already a goal that looks at times impossible to reach for someone, e.g. suffering depression, and the temptation to give in to it and let it overwhelm one – to *become* a patient – must be resisted if at all possible. Thinking of one’s situation as that of having a ‘brain illness’ might make this war all the harder to wage, since in doing so one takes on the role of patient, passive in the face of the onslaught.

    Being pulled in the other direction, we might think of mental health problems as unlike physical health problems in the sense that the way in which one thinks and acts can play a curative role, where this is not so for physical health problems (or for problems such as prosopagnosia, which might be thought of as ‘psychological’ problems albeit not ‘mental’ ones). And there is sense to this, as I have tried to suggest. If I give in to social anxiety, say, and refuse to leave the house on Monday, it will be all the harder on Tuesday, at which point I have convinced myself even further that being outside is not an option for me. And sometimes although it will be hard for me to leave the house, it will be possible for me to do so, even where it does not seem possible. There is a margin within which I *can* try harder, *can* make myself do things that are hard for me, being in the state I’m in (albeit they may be trivial to me at better times, and to other people now). But there is a limit to my autonomy here, as I’ve suggested. And this limit to my autonomy is part of my problem. In depression, for example, part of the problem is just that one’s agency is truncated. One wouldn’t have a problem if one had as much get-up-and-go as anyone else, if one had hopes and dreams and basic desires for basic things. Part of what goes wrong in depression is that all this motivational structure somehow goes missing. And it’s not possible to simply *think one’s way out of* being depressed, ‘snap out of it’, ‘cheer up’, and so on.

    I don’t have a solution to this problem. But I think it is a problem which to a large degree defines that class of human problems which we tend to call ‘mental illnesses’ or ‘mental health problems’, but *not* that class of problems we classify as ‘brain illnesses’. And for that reason, I suspect that switching to talk of ‘brain illness’ may do more harm than good. I am not saying that it does *no* good, and I think that Bernadette’s article highlights the good it may do. But the harm it does, if I am right, is in blinding us to the complexity of thinking about mental health problems, a complexity that is mirrored in the experience of suffering those problems. Having a mental health problem can bring with it misery, guilt, confusion, substance abuse or self-medication (depending on how one looks at it), bad decisions and their often long-lasting ramifications, relationship breakdowns, fear (both *in* and *of* the sufferer), stigma, misunderstanding, distance, loneliness… I could go on. It is not clear how to overcome these issues, and for a few of them even whether they can be overcome, or whether they must remain ‘part of the territory’ of having a mental health problem. But we will only make progress on these questions if we recognise mental health problems as complex phenomena, including psychological, emotional, social *as well as* (possibly, or sometimes) biological facets. Thinking of them as purely biological – brain – illnesses obscures so much which we need, instead, to understand.

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