Should mental health be viewed as brain health?
Today is World Mental Health Day (at least it was when I started researching an article on good brain health).
Social media was full of personal stories of mental health, voices challenging the mental illness stigma plus all the memes about how “it’s okay to not be okay”.
It got my brain thinking: how is mental health different from brain health?
What is brain health?
Brain health is our ability to make sense of the world. Healthy brains include having good memory skills, an ability to learn, concentrate and solve problems. Brain health is often discussed as part of the ageing process and when talking about conditions like dementia and Alzheimer’s Disease.
But brain health is more than a concern only for the elderly. There are many conditions that can affect our brain health including autism, epilepsy and motor neurone disease (MND).
What is mental health?
Mental health is our psychological and emotional wellbeing. Our mental well-being affects how we feel, think and our ability to cope with stressful situations. Plus, mental health may impact the decisions we make and the relationships we form.
Commonly experienced mental health issues include anxiety and depressive disorders.
Are mental and brain disorders the same thing?
There are many similarities between mental and brain disorders:
- Many conditions that affect the mind and brain are “invisible” illnesses or disabilities. An epileptic may appear unafflicted between seizures. And on appearance alone, an autistic individual is indistinguishable from someone with body dysmorphic disorder.
- The types of treatments for mental and neurological disorders sometimes overlap. Medication is common but so is different types of therapy including cognitive behavioural therapy (CBT), physiotherapy and lifestyle changes.
People suffering from mental or brain conditions may encounter the same social prejudice. This social judgement isn’t based on whether an individual is seeing a psychiatrist or a neurologist.
But it’s more than just how we perceive these disorders, science is catching up too. Neuroscience, the science of the nervous system and the brain, is a relatively new discipline. But along with advances in genetics, neuroscience has made significant progress in understanding both the brains structure and function and therefore also it’s dysfunction.
Medical imaging technology has shown structural differences in the brains of people affected by a number of mental conditions including schizophrenia and post-traumatic stress disorder. This reinforces the idea of mental illnesses as having biological differences in their neurology. In other words, mental illness is a brain illness.
Experts are challenging the distinction between mental and brain health because of these advances.
In a joint article, a group of neurological academics called for mental and brain illnesses to be “grouped together as disorders of the nervous system” citing that “this distinction is inconsistent with current scientific understanding”. And this distinction is “counterproductive for clinicians and patients”.
By removing the distinction, psychiatry would align more closely with other medical sciences plus the social stigma associated with having a mental illness would reduce.
Would treating mental and brain disorders as the same thing improve patient outcomes?
Dr Natalie Banner, a Wellcome Research Fellow, doesn’t think so.
Dr Banner argues that the fundamental importance when dealing with mental illness is the sense that the person’s self is affected. And focusing on what’s going wrong in the brain loses sight of what’s going wrong for the individual.
As she puts it, “no other medical discipline is the subjective experience of the patient quite so crucial to diagnosis and the aims of treatment”. It doesn’t matter whether someone’s brain structure is different, when it comes to mental illness it’s all about how the person feels.
Other psychiatric professionals stress, now more than ever, the need for the distinction between mental and brain health. These advances reinforce the importance of mental health, as well as how little we understand about it.
Professor of Psychiatry, JD Bedrick, states “Mental illnesses are illnesses of persons, whereas other illnesses are illnesses of biological individuals.”
Social stigmas exist for brain disorders sufferers too
The discussion will continue if including mental and brain issues under the same condition would lead to better clinical outcomes for sufferers. Each leap forward in our knowledge of the brain will probably re-ignite the debate.
But would there be any social benefit? Autistic people are openly prejudiced as commonly as depressives being told to “cheer up”. So there is little point in adjusting any medical classification of mental disorders. It isn’t our medical knowledge that is failing sufferers, it’s our lack of social tolerance.
So, ironically, it’s the social stigma that is probably the most unifying factor of mental and brain illnesses.