John Weaver, Psy.D.

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An Overview of Integrated Mental Health – Part 2

This will be a multipart blog, so keep watching for the subsequent updates.

As mentioned in my previous blog, one of the important contributions of psychiatry is to highlight the importance of the biological dimension of behavior. While it has been overemphasized recently, it is important to understand these biological components. 

The majority of the attention has been given to brain functioning. Sometimes it seems that the brain is THE determinant of human behavior. This is, of course, an oversimplification but it highlights the need to understand the brain as one of the components of understanding human behavior. 

There are 3 ways that the brain is associated with the kind of psychological distress that results in a diagnosis of a mental disorder: (1) Genetic or structural abnormalities that result in a malfunctioning brain. (2) Injury or disease which alters the function of a healthy brain. (3) Accurate and functional brain activity that appropriately results in uncomfortable or painful experiences.

  1. It is clear that there are some brain states associated genetic or structural abnormalities that are associated with some mental disorders. The diagnosis of schizophrenia is strongly associated with changes in the brain when compared to brains of individuals who do not have that diagnosis. Studies on genetics show that there appears to be a strong genetic component to the diagnosis of bi-polar disorder (although bi-polar disorder is often over diagnosed). By contrast, the diagnosis of major depression is not associated with results that would suggest that most individuals who have this diagnosis inherited it from a first degree relative. 

    These examples above (i.e., schizophrenia or bi-polar disorder) are examples that arise from a problem with the neurological system. The brain is not functioning in a normal, healthy manner and the result is the appearance of behavior that is disordered. There are other neurological anomalies that also result in disorders of behavior, emotional functioning, cognitive functioning, and perception. Examples include autisms spectrum disorder (at least level 2 and level 3) many types of dementia, Parkinson’s disease, or damage from a tumor or brain injury.

    Implication: Genetic and/or structural abnormalities require understanding of the impact of these abnormalities, may benefit from medication to assist in regulating brain function, and will often benefit from learning coping strategies and environmental alterations that assist the individual to be able to live a more functional and satisfying life.

  2. Injuries can also alter the functioning of a previously healthy brain. The normal and healthy functioning brain is an organ whose primary function is to mediate between the organism and the environment in which that organism functions. Perceptual data from the environment is received, processed, and engaged in such a manner that it guides multiple levels of response in the organism. In this “normal” condition, the inputs to the brain, the interpretation of perceptual data, and the organization of a response arises from the communication between the brain, the environment and the previous experiences that are used to make sense of the perceptual data. 

    One outcome of this interaction is that the brain function can be “injured” by the interactions between the brain and the environment. An extended period of sadness following the loss of something important to the organism can cause the system to become depleted and have difficulty recovering to “normal” functioning. This appears to be an explanation of what can happen to an individual diagnosed with a Major Depressive Disorder. The sadness that an individual feels at the outset of the depressed mood is often identifiable and understandable as a reaction to a significant loss in the environment. (In fact, research suggests that in approximately 95% of cases of someone experiencing an INITIAL depressive episode it is possible to identify a specific event that is associated with the onset of the depressed mood.)

    As the sadness persists, it appears that the neurological system becomes damaged, and it is more and more difficult to simply make an “attitude adjustment” that will resolve the symptoms. This is a second dimension of the brain function that can result in problematic behavior, emotions, and/or cognitions.

    Implication: Injuries need to heal. The injuries to the nervous system may need (usually temporary) medication support to assist the natural processes of the body’s ability to repair itself. Lifestyle changes are also important components of the healing process and are extremely important in preventing future injuries.

  3. A third, often overlooked occurrence, is that the brain is functioning in a normal and healthy manner but yielding results that are painful to experience. Because the primary role of the brain is to provide an effective means to interact with the environment, and because the environment contains threats as well as benefits, there are times when the interaction with environmental stimuli results in difficult and painful experience. 

    This may be quite distressing, and it may be beneficial to have professional help to get through such an occurrence, but it is not due to an abnormal brain state. In this instance, it is appropriate to feel distress because the brain is alerting the individual that something difficult, dangerous, or toxic is occurring in the environment that needs an immediate response.

    Grief and post-traumatic stress disorder (at least at the outset of PTSD symptoms) are examples of distress arising in reaction to an environmental event. These reactions can be very painful but are elicited by a normal response from a healthy brain to specific environmental events that are disruptive or threatening. 

    Of course, if a brain is not healthy – either due to a structural malformation or injury to the nervous system – then these normal responses to difficult events will be affected by the state of the brain when the event occurs.  A malformed brain may react to an event in a way that is not an accurate reflection of reality. An injured brain may experience a loss or a trauma more deeply and/or have more difficulty recovering from the event. 

    Repeated trauma and/or grief may result in a brain that learns to predict these distressing events and therefore would become more sensitive and reactive to new events that might not be as severe but would elicit a severe reaction. This reaction may not represent an injury but may simply be the brain learning that the world can be a dangerous place with unpredictable losses.

    Implication: When the brain is functioning as it should, and this results in painful or distressing sensation, it is important to learn to pay attention and adapt to what is occurring. This self-awareness is a key element of healthy functioning. It allows the individual to thrive in a variety of environments, even in times that are unpleasant.

    Medications should only be used cautiously, in this case. If the medication results in feeling good but the environment is potentially threatening, the individual may not adapt appropriately and it could result in more harm than benefit.

In an integrated approach to psychological health, it is important to consider the source of experiences within an individual rather than a simple assessment of symptoms. Different sources of brain function will best be addressed with different actions.