Do mental illnesses have a physical basis?

Yes. When I don’t take my thyroid pill, I inevitably get tragically depressed.

Some, not all.

Experimental psycho-linguists have for a long time been able to pinpoint the exact areas of the brain where a lesion will lead to Broca’s aphasia and Wernicke’s aphasia. (They’re called Broca’s Area and Wernicke’s Area respectively, after their discoverers Paul Broca and Carl Wernicke.) So if you count aphasia as a mental illness, that’s a very clear example.
And then there’s the fact that medication works against a number of mental illnesses and psychological disorders.

@westy81585: Not all? Name us an exception, please.

Let me clarify: I mean specifically Axis I (http://en.wikipedia.org/wiki/Axis_II_(psychiatry)#Multi-axial_system) disorders, so primarily mood disorders (depression, bipolar disorder), anxiety disorders (OCD, specific phobia, social phobia, generalized anxiety disorder), and schizophrenia.

This is not an exhaustive list—the differentiation I’d like to make is between psychiatric illnesses, and neurological illnesses.

@nikipedia: Medicines help for most of those, so yeah.

Judging from the positive effects of nueroleptics, deep brain stimulation, etc on some psychiatric disorders identified today (think schizophrenia, tourette’s, etc), it certainly looks like there is.

For example, many neuroleptics that work to reduce the positive symptoms of schizophrenia block the effects of dopamine… so it stands to conclude that there’s a good change the dopamine system in the brain has something to do with producing the positive effects of schizophrenia. (There is a major hole in this theory though… the effects of neuroleptics take a while to show up, and but the actual actions of the neurotrasmitter blocking takes very little time because it happens at the synapse. This does not mean that something down the line in the dopamine system isn’t the cause though, and it certainly doesn’t discount that possibility that there’s some biologically-based cause.)

Another example, with schizophrenia: there’s been some preemptive studies done where the auditory areas of the brain are targted via transcranial magnetic stimulation. This seems to reduce hallucinations.

Also, @fyrius definitely pointed out a great example with aphasias and broca’s (the area of the brain associated with expression of speech) and wernicke’s (language comprehension) areas.

How can we possibly know what the scientists and experts can even agree on? It seems very unlikely to me that there could be any other cause, but I have heard some suggestions that some forms of mental illness could be caused by mental processes that are not necessarily associated with physical causes.

@nikipedia: I would love to hear your theories. I just checked out your profile and saw that your expertise is neuroscience, so I’m sure everything I just said you’re already pretty aware of.

Are you asking if physical stress can trigger mental illness? (am I oversimplifying it?)
I do believe that. When I was going through depression, if I didn’t sleep I was thrown into an instant manic phase. When I get stressed about life, I feel like I’m losing myself. I’m lucky to have family to pull me back down.
Not sure if I’m giving you the scientific response you are looking for.

Does any mental activity not have a physical basis?

I think that most of us experience our thoughts and feelings as a kind of voluntary thing. We experience things though our senses, and we respond with emotions and actions.

We feel like we have some control over emotions and responses. Something sad happens, and we can choose how broken up to be about it. Something happens that is unfair and hateful, and we can choose how angry to be. We are praised or we do something we really like, and we can choose how happy to be.

Of course, there are social norms about these feelings; indeed about any response to any situation. If our feelings and actions fall within the range of the norms, our behavior is considered acceptable, and we can get along with other people. So we experience ourselves moderating our actions and emotions so they can fall within this norm.

My point is that for most of us, it seems like we can choose what to feel. We can decide to be happy, or we can decide to be sad. If someone else is too sad or somehow inappropriately sad, a lot of people will suspect that this person is milking the sadness. Or that they are just a bummer, and they’ll stay away from the sad person.

So, our experience is that emotions are voluntary. Our thoughts are voluntary. We decide what to feel and think.

Now, along comes a deep sadness, and maybe it isn’t related to much of anything. Cognitive Behavioral Therapy can teach us how to manipulate our emotions so that we are back on track, feeling good again. It provides even more support for the idea that emotions are under control, and that anyone who remains depressed is tanking it. They just aren’t being responsible for themselves. They are being lazy. They must want to be unhappy.

Many other therapies are also based on the idea that if we think about things, and explore our history, we can identify the place where the sad thoughts started, and learn how to deal with them, or push them away.

Along comes the brain researchers, and the medicalists, and they start arguing that there is more to it than choice. But they have a hard time gaining traction, because the vast majority of people only experience choice. They think the medicalists are giving the lazy folks a way out, and this is unhelpful. What those lazy depressed people need is a kick in the butt, not medicine.

However, the medicines do work. They enable people to feel ok again. Of course, there’s usually a long journey in trying to find the right set of drugs that will work. But people get back on track with drugs.

Of course, there are still a lot of people who say that they did it themselves. They didn’t need drugs. And they look down on those who do need drugs, and wonder what they can’t get it together. After all, the self-improvers were able to.

Well, what can I say? I started feeling these weird anxieties. They felt like a physical shaking inside my chest. I couldn’t do things that normally made me happy, like playing the trumpet for the caroling on the corner. I just couldn’t do it. I’d never felt like that before, and there was no reason, as far as I could tell, for it to happen.

The next day I found out that an old friend of mine had some cancer that had just been discovered and he had days to live. He had received this news right around the time I started feeling bad. Aha! That was it! Maybe I was psychic!

A few weeks later it happened more, and then more, and pretty soon I was a wreck. I was ready to die, myself. All along, I could think of no reason for me to be feeling this way. It made no sense to me. I kept looking for something to explain it. And there wasn’t anything. So I had to make something. I started trying to destroy my life, just so it would make my feelings make sense.

I nearly succeeded, too. Fortunately, my wife loved me more than I hated myself. She got me to a shrink, and I got diagnosed (bipolar), and started on drugs. A year and a quater later, I feel like myself again. But I also feel like I didn’t do anything other than take the drugs.

So I feel it must be the drugs. Along the way, other strange things have happened. Not only did my emotions change, but it seemed like my thoughts were changed by the drugs. Things I though one week, I couldn’t think the next. They no longer made sense (and a good thing, too).

Well, I’m only one case, and none of you can know what it’s like to think what I think. You can believe my story—or not. You can never know if it’s an accurate description or not. But you can observe my behavior, and you can see if it changes under the drug regimen.

I don’t just think that mental illnesses have a physical basis. I’ve experienced it. I have done nothing other than what I always did, and I started feeling weirder and weirder for no reason I could find, and then, with the drugs, I came back to my old self.

It’s really weird, too. I had been one of those people who believed we are in control. “Happiness is a choice,” I believed, as Barry Kauffman wrote. It made sense to me. I chould choose how I looked and felt about my life. So when I couldn’t do that, I thought I was tanking it. I thought I was just looking for sympathy, or something. I was so hard on myself. People told me not to be. They said it wasn’t my fault. I thought they were jollying me along. They were giving me an out that I didn’t want. I wanted to be responsible for my own thinking and behavior.

There are so many people out there who tell you it’s under your control. Now I know that’s bullshit. I think there’s a 75% chance I’d be dead by now if I hadn’t gotten meds. Even though I never believed in suicide, and I loved life and never believed I could do that, I felt so bad, I was considering it, and imagining how to do it, and believing the world would be better off without me. It probably would be, but I don’t care, now. I’m ok with living my life, and while I do care what others think, I’m not going to let that stop me from making a fool of myself.

So yes. I’m pretty sure that mental illnesses shouldn’t really be called mental illnesses. They should be called brain chemical disorders, or something like that. I think our thoughts have some control over our brain chemicals, but not nearly complete control. I’m pretty sure that some day we’ll see how that works—how there’s a feedback system between the chemistry and physics (and metaphysics) of thought. It isn’t all physics or chemistry, but it also isn’t all metaphysics and thought monitoring and control. Sometimes it gets so out of balance, that we need to intervene in the chemistry. Well, we think we’re intervening, but, it’s also true that the chemistry is making us intervene. We are our brain chemistry. Our brain chemistry is us.

@daloon: Maybe tomorrow I’ll have the attention span to read what you wrote… I thought I was verbose! HaHaHa! You know I Lurve you, man!

I have been pondering this lately, due to some problems my son has been having, and it all comes back to the Nature vs. Nurture debate for me.

Some people have genetic predispositions to certain disorders, while for some there are environmental influences that overwhelm the system and lead to a chemical imbalance, and there are the majority of in-betweens where the biology and environment play strong roles and are difficult to separate.

I have likened it to kids with Attention problems… some truly need medication and couldn’t control their impulses regardless of parental strategies; while others develop behaviors in response to their environment, and they get reinforced to the point where they no longer can control their impulses, so medication might be beneficial until the child learns other means to cope.

Another example is diabetes… some people are born with it and will get it no matter what; others develop it as a result of inactivity and poor dietary habits. Both need medication, but the first group will siways need it, while the second may not need it once they make changes to their lives that reduce those risk factors.

In all cases, there is a biological chemical imbalance; however, some have a genetic basis and others develop from environmental factors.

Having far too much experience with this myself, I can only conclude: Yes. Absofuckinglutely.

@Jayne – Careful, you’re acting like Harp. He always takes my answers.

@Jayne: Good question. Are you arguing then that we have no free will, and all our actions are predetermined by the physical world?

@nikipedia – That’s not what I get out of it.
Just that any actions are derived from physical expressions in the brain.

If you say that mental activity is activity within the brain, then you have to assume that there is a physical basis, not sure how that justifies the leap to physical predetermination and a lack of free will.

All human actions, thoughts, expressions, etc occur because of physical reactions in the nervous system. I don’t know how this could be disputed. I mean, they can begin by a chemical imbalance, but the chemical reactions themselves are a physical occurrence.

My point was simply that all of our behavior is dictated by the chemical, electrical, and mechanical system of the brain and the body; I base this assumption on the continued advances of neuroscience, which, although they may be fundamentally limited by the complexity of the system, seem to suggest that the brain could be responsible for all that we attribute to the mind. Also, I find the ease with which direct chemical and physical stimuli can dictate our behaviors to be further compelling evidence. Naturally, you are in a better position than I to evaluate this claim. From this, it would be odd to distinguish between the diseased and the healthy mind on cause alone.

However, if you want to bring in free will, I would also argue that free will comes down to definition and perspective. One can look at the human body on a cellular scale, and conclude that we are diverse communities of organisms that have evolved through mutual dependency to operate, usually, in a concerted fashion. Or one can zoom out, and see groups of people and their environments as other such organisms, cannibalizing each other and perhaps slowly merging into one (although right now it has cancer). On a more personal level, it is really an arbitrary distinction that we draw between those substances that make up our bodies, which are responsible in great part for our ability to behave as we do, and the air we breath, the food and water we consume, and the outside stimuli we experience, which are equally responsible for our behavior. In the context of this discussion, there is no natural place to draw a line between the physical constituents of a healthy brain-and-body system and those of a diseased one, or even one that has been chemically altered. My point is that there is no fundamental entity that is a “human being”, and so we possess no fundamental qualities such as free will or dignity by dint of our humanity. However, it is practical to draw this distinction, and having accepted this arbitrary delineation as true- having defined an irreducible and absolute entity that is a person, as we all do as a matter of practicality- then the behavior of that entity is also absolute and irreducible, and can be called free will.

Ditto what Auustlan said!!!

@nikipedia So, what is your conclusion?

@augustlan: Same as it always was. I believe beyond the faintest shred of doubt that mental illnesses are generated by physical problems, the same way that all of our experiences are generated by material events and structures in the brain.

The trouble is, I’m stuck trying to convince a fellow neuroscientist of the same thing, and not sure how to proceed. You all gave me some good places to work from, but I feel like trying to get anyone to ever change his/her mind on anything is a largely impossible endeavor.

@nikipedia Again from personal experience, I’d bet a million dollars that the person you’re trying to convince has never had a mental illness. Often (not always) those lucky people have no clue what it is like, and think it’s all a matter of ‘pulling yourself together’.
fuckers

@augustlan so true

Has this person ever been drunk, or taken drugs? How do they explain that? Is it all mental? Or physical? Have they ever taken tylenol or aspirin?

What’s the problem here? Clearly there are physical ways to change the brain. Is it just that he doesn’t believe depression is caused physically? If so, he must believe people want to be depressed. He must believe people want to feel pain, and want to die. He also must believe that none of the drugs given are anything more than a placebo, so he has to deny all the studies showing they have an impact.

I’d say this person is the one who has issues. I’d find out more about their past. Does he/she (it seems to me more likely that it’s a he) come from a military or law-enforcement family, or a religious or other family where the parents were very, very strict, imposing serious discipline on the kids. Is this person a first generation college-educated person?

@nikipedia – What exactly is your colleague’s argument?

After looking at your tags, I looked up Szasz and found this line from Wiki interesting:
“To be a true disease, the entity must somehow be capable of being approached, measured, or tested in scientific fashion.”

Maybe the argument is that since there aren’t constants in all mental illnesses, then diagnosis and treatment become a subjective matter and therefore cannot be assumed to have a consistent physical basis?

Or is his argument that mental illness should not be treated with the use of medicine at all? If so, is his opinion that therapy can create the right chemical reactions in the brain to promote better mental health?

It sounds similar to the argument that AA is not a valid treatment option since it doesn’t work consistently for all people with addiction issues.

@daloon: See @fireside‘s response. My understanding is that this dude believes that the problem with mental illness is that you can’t nail down any kind of physical, organic cause. I believe he would agree that drugs cause a change in mood/state/cognition/behavior, but in that case the organic cause is very clear.

So yes, he doesn’t believe depression and other mental illnesses have a physical basis, and he thinks that people essentially choose to get them because they can’t or don’t want to deal with the pain of their existence anymore.

As far as medication, his argument is that giving an antidepressant to anyone would cause an increase in mood, therefore they’re not convincing evidence. He raises a good point here—the fact that SSRIs alleviate symptoms of depression doesn’t really demonstrate that depression is caused by decreased serotonin—except he’s wrong. Normal, healthy controls don’t experience any change in mood.

I don’t know that much about his family, but his dad is a scientist and he has a PhD in neuroscience, so his ignorance on this topic is really baffling to me.

@fireside: See above, but you got it. His argument is that there’s no evidence that mental illnesses have a physical cause, so they must just be in your mind. (Whatever that is.) I don’t think he would take issue with using medication to treat it—I’m guessing he’d be on board with any treatment that works.

You raise a good point about using therapy to fix your brain. I think it’s important to realize that the effects of talk therapy are no less physical than the effects of pharmacotherapy. Your brain changes in response to therapy in measurable ways.

@nikipedia, I agree with you—and daloon—that it’s going to come down to something physical, something material, i.e., chemical Even if there’s some external or other internal trigger to the chemical disturbances, the expression is a result of chemical activity.

What I’d like to know is why it’s so important to you to change this particular guy’s mind. Can’t you just let him be wrong? Didn’t we do this before?

@Jeruba: Great question. The only thing I can come up with is that this viewpoint made me lose a lot of respect for this person, and I want to respect him. Beyond that, it annoys the hell out of me because he’s clearly being willfully ignorant, and I think it’s irresponsible for someone who could be construed as a semi-expert to hold onto an idea that he kiiiind of knows is wrong, and could be damaging to other people.

@nikipedia, I truly understand that feeling. It drives some amount of my behavior, too, both in the workplace and in my personal life. But unless you have a receptive audience whose respect for you is going to rivet his attention on your sharing of knowledge to displace his own (and is that the real issue, I wonder? your sense of his regard for you?), you are likely not to be thanked for it unless you are dispensing knowledge in a professional capacity. One of the consequences of our contemporary style of education and the democratic model in the U.S. is that everyone truly does believe that his opinion—as well as the ideas he bases it on!—is as good as everyone else’s. The idea of objective information is overrun by self-centered emotion.

I find pockets of appalling ignorance even among physicians, even in areas that touch on their fields, where they should know better. It is one of the curses of knowing a lot of stuff, darlin’, that we must constantly deal with people who know less than we do. The only way to fix this imbalance is to lose what we know, because we can’t take on making them all know more. We might take up a single crusade, like Ignaz Semmelweis, and do some real good, but we can’t assume responsibility for human ignorance on the whole. And there is more of that than anything else. (And there’s always the whispering doubt: he thinks he’s right as much as I do—and what if I’m the one who’s wrong?)

There’s a valuable lesson in this book, the essence of which is that people come to their beliefs through nonrational means and then use their rational faculties to defend them; and the reason why some highly intelligent people become entrenched in some stupid and bizarre notions and superstitions is that they are very good at using their intellects to defend their irrational beliefs.

If I were going to make a guess, my guess would be that you can’t have a meeting of the minds with this man because something personal is in the way, whether it’s the emotion of your desire to persuade him, some personal reason on his part (something to protect, something to deny), your relative status (hence pride), his fear of being wrong, or whatever. It may take an experience that you cannot provide to make him change his mind.

So you have to decide whether to continue to do futile battle with him or let it go.

I have suffered with Tourette’s Syndrome since I was a kid. As an adult, I have pretty much been able to keep it under control, though there are occasional lapses, usually during periods of great stress. I do not take medications for it.

Around 1968, TS was reclassified by the medical and mental health establishments as a “neurological disorder.” As far as I can discern, this was done solely on the suggestion of one prominent psychiatrist in the field who treated patients with Haldol, an “antipsychotic” drug that represses dopamine reception within the brain. Since the medication mitigated tic activity within patients, he seemed to reason that it ipso facto follows that the affliction must have an organic basis.

From an empirical perspective, using my own experiences as my “laboratory,” I have formed other conclusions which upset some others with TS and professionals in the field. To me, the referred to reasoning would be tantamount to asserting that since if one ties a smoker’s hands behind his or her back he or she will cease smoking until released, then one’s hands must be the cause of smoking and a piece of rope must be the “cure.”

Haldol represses dopamine reception, which implies that that hormone might well be responsible for the tics exhibited by TS sufferers. However, it doesn’t necessarily follow that there is some organic cause responsible for an elevated level of dopamine within a TS sufferer’s central nervous system. The mind has, to some extent, the power to alter body chemistry. It does precisely that when one is enraged, afraid or sexually aroused.

Two articles I wrote on this subject might be of interest in regard to this question, perhaps even to those interested in other mental afflictions. In them, I explain my position regarding the ongoing brain/mind duality debate which lies at the heart of this question. Agree or disagree, I believe my reasoning will be crystal clear to all and will perhaps shed more light on the question at hand. Here are the URLs for the articles:

http://wwwdnschneidercom.xbuild.com/#/ts-and-adhd-7/4523223575

http://wwwdnschneidercom.xbuild.com/#/ts-and-adhd-11/4528703304

Asserting that afflictions traditionally labeled as mental illnesses are actually organic can cause a sense of passivity within sufferers; a feeling that there is nothing they can do other than take medications and wait for some other magic bullet of a cure via a physical intervention such as a new surgical technique. In many cases, I truly believe that one can help himself or herself through nonphysical therapies that would have absolutely no efficacy in regard to truly physical illnesses. (Again, please read my articles.)

If anyone here suffered from severe school bullying due to your problems (or for any reason), you might be interested in reading my short story “Pride’s Prison,” which can be accessed for free from my free access, no-ads website. (I sell nothing.) The purpose of the story is to warn parents why their kids might well not tell them if they are being even severely bullied in school. Just click on “Pride’s Prison” on the left of my site. It was published on an internet publication.

Donald Schneider

@Jayne
Well put.

I just had a mini-fluthergasm from @augustlan saying: Absofuckinglutely!

haven’t read all above, but will just jump in.

Was pasting the following

http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=182138

for a discussion on linkage between depression and migraine. May be relevant to above. Enjoy

it’s nature AND nurture

Dudes. This one shows the interaction between nature and nurture!

http://www.ncbi.nlm.nih.gov/pubmed/12869766?dopt=Abstract

Chemical imbalances in the brain can cause a variety of problems and illnesses. From what I understand, mental illness can be caused by chemical reasons, psychological reasons, or often a combination of both. That is why it can be difficult to treat, and treatment is different for each individual.
The way the brain processes information is that there are these particular types of cells in the brain called neurons. The body has many different types of cells (about 200 different kinds——although billions of total cells). This one type of cell called neurons are the cells that send and receive information in the body. They are connected by these little feelers that pick up information coming in, and one long feeler that carries information away. There is a gap of space where the feelers don’t quite connect, called a “synapse”. The way the information is carried across these gaps is by different chemicals in the brain called “neurotransmitters”. These chemicals are very important in how we receive and interpret information.
Serotonin is a chemical (neurotransmitter) that when not at normal levels will cause depression, obesity, obsessive-compulsive disorder, intense aggression, etc. This is because the body is interpreting information incorrectly. Another perhaps familiar chemical is dopamine which when too low can cause Parkinson’s, Schizophrenia, and Narcolepsy. When people become addicted to drugs it is because of changes in this chemical. When a person takes addictive drugs caffeine, alcohol, and nicotine, being the most common (but hard-drugs as well), dopamine levels are slightly increased. However over long periods of time dopamine is decreased causing the body to crave the drug in order to increase the levels again. Another neurotransmitter, acetylcholine, causes Alzheimer’s when levels are too low. Use of medications to try to balance chemical levels in the brain has had a lot of success, but since each person is different, may take a while to find the correct doses.
One thing I heard about recently concerning the differences between similar symptoms with different causes is that people who are hoarders (a disease long thought to be associated with obsessive-compulsive disorder) do not respond to the serotonin-increasing medicine that works for helping people who have OCD . It would make sense that hoarding is more often a psychological disorder, rather than a chemical imbalance, even though both OCD and hoarding have some similarities in symptoms.
There is often not one simple explanation for mental illness and people should not make the mistake of thinking they can control it on their own. Whether it is supposedly all chemical, all psychological, or some combination, anyone who thinks they may have a problem really needs to see a professional, because it is complicated!

@serena933
On behalf of the collective, thank you for a well constructed and helpful general overview of the subject.

It’s a good question and it’s something I had a discussion about today with a collegue. Perhaps being privy to our conversation will help you understand the dilemma in answering this question. We have a student who is obviously personality disordered. Now given his history of being given mass amounts of heroin early in his youth by a parent we wonder how much of this “personality” manifestation may be due to frontal lobe damage not unlike someone who suffers a fall or illness and has TBI (Traumatic brain injury). Drugs, illness, disease and birth defect can result in permanent damage.
Not everything that is mental illness is physical. For example as shown above Personality disorders are considered a long standing pattern of thinking and companion behaviors that result in impairment in any one of several areas of functioning. I would not consider persons with Borderline Personality disorder to be suffering from an illness with a physical basis. I would say the same about any number of other personality disorders.
The young man I discussed demonstrates a combination of BPD traits and Narcissitic personality disordered traits. I will be working with him using Dialectical Behavioral Treatment skills, a modality of Cognitive behavioral treatment. Change in thinking and behavior across time will tell how much of his thinking and behavior is the result of history or whether brain damage is a precursor. I had another similar student last year who has made remarkable progress when when other people insisted that she had Bipolar disorder…an incorrect diagnosis in her case.
This area of science is not cut and dried. People aren’t routinely sent to have their brain functioning imaged and so you rely on other forms of therapeutic diagnostis and intervention to understand where the issues lie and develop a treatment plan. when the plan isn’t working you have to look at all kinds of treatment failure as well as the possibility that something physical is causing the presentation and change resistance.

@joybird, yeah! I had a frontal lobe coup-contra coup TBI, plus I am bipolar, plus I am sometimes OC, and also sometimes ADD. I can’t win! ;o) I just have to not concentrate on the labels. They are just parts of the me of now, and I can’t just stop living!

@GracieT Yep…that’s exactly the right attitude to have. You have to work with what you got and make the best of the hand being played.

@Joybird, sometimes it is just too hard.