Mental illness: A new sunrise as stigma sets

Mental illness: A new sunrise as stigma sets

A new sun is rising as a generation of progressive neuro-scientists re-write how we perceive and understand the causes of mental illness.

The American Psychiatric Association says there is much that is physical about mental illness and much that is mental about physical illness. So the question is: Is it time to abandon the term “mental illness?”

According to Dr. Thomas Insel, Director of the U.S. National Institute of Mental Health, “rapidly evolving [brain] sciences are yielding new insights into the neural basis of normal and abnormal behaviour. Syndromes once considered exclusively as ‘mental’ are being reconsidered as ‘brain disorders.’”

He says the brain “continually rewires itself,” changing the way a person’s genetic make-up gets expressed, thus shifting “the language of mental disorders to brain disorders or ‘neural circuit disorders.’”Psychologists (who are not medical doctors and who usually use talk therapy) and psychiatrists (who are medical doctors and can therefore prescribe drugs) are not in different businesses.

Rather, they are in different wings of the same business, and what they bring to people who are suffering are different tools to fix a complicated problem with many facets.

 One of the architects of this Quiet Revolution in brain science is the University of British Columbia’s Dr. Anthony Phillips, Scientific Director of the Institute of Neuroscience, Mental Health and Addiction, part of the Canadian Institutes for Health Research.

Dr. Phillips says big things are happening in neuroscience on a global scale. He likens these developments to a new kind of international free trade — one associated with brain health in a world economy that puts a premium on cerebral, not manual, skills.

Dr. Daniel Weinberger, Director and CEO of the Lieber Institute for Brain Development at Johns Hopkins University says, “We now have the first objective evidence of what mental illnesses actually represent at the molecular level.”

That said, the latest update of the manual used by psychiatrists to diagnose and treat mental disorders — the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, or DSM-V — shows almost no influence of the remarkable advances in new technologies and knowledge of brain function.

“Research in mental health and the use of evidence-informed practices are insufficient or unco-ordinated,” Dr. Phillips says.

Dr. Thomas Insel, Director of the U.S. National Institute of Mental Health (NIMH), warns that alarm bells should be sounding.

“Psychiatric medications have been among the most widely prescribed of all drugs in medicine for the past decade,” Dr. Insel says.

“But continuing high disability and mortality from mental disorders demonstrates the urgent need for better treatment.”

Prevention, Recovery, Cure

The U.S. National Institute of Mental Health — the most influential mental health research-funding agency in the world — says its mission is to “transform the understanding and treatment of mental illness through basic and clinical research paving the way for prevention, recovery and cure.”

So we ask:

  • The prevention of what? Disablement, premature death and erosion of life expectancy driven by brainbased mental disorders.
  • Recovery from what? Brainbased mental disorders that afflict mostly younger people and adults in their prime years of work, income-earning and consumer-spending.
  • Curing what? Brain-based mental disorders that result from our genetic make-up, our interactions with life and disruptions of brain circuits that are necessary for the everyday functioning of every person on this planet.

Canada’s Dr. Helen Mayberg, a famous innovator in brain science now working at Emory University in Atlanta, Ga., says it’s time psychiatry “actually treated what the person has.”

The use of bio-markers will improve diagnosis and treatment design. But the fact is this: Psychiatry continues to rely upon subjective symptoms and observable behaviors, not biological testing, and it is the only branch of medicine still doing so. The NIMH has taken steps to change that.

Framework for the future of mental health research under the leadership of Dr. Bruce Cuthbert, Acting Deputy Director of the NIMH, the institute has introduced a framework for the future of mental health research that has the potential to bring about fundamental change in how we perceive, understand, diagnose and treat those conditions we now call mental illnesses.

NIMH spends more than one billion dollars (US) a year in support of mental health research. Those funds will now be deployed for research projects not narrowly designed around the current classification (or labels) of psychiatric conditions (depression, bipolar disorder, etc.).

One of the most powerful and precise interventions to alter brain circuit activity (to relieve patients of a mental illness) may be targeted psychotherapy

The new NIMH framework incorporates neurobiology into what causes and what constitutes mental disorders, or what’s normal and what’s abnormal in the function of the human brain.

According to Dr. Cuthbert, through mental health research focused on neuro-biology, “new diagnostics will likely redefine mental disorders as brain circuit disorders and new treatments will focus on tuning these circuits.”

Biology of mental disorders: Only drugs need apply?

Dr. Thomas Insel, Director of the U.S. National Institute of Mental Health, says psychiatry is the only branch of medicine still restricted to clinical consensus and observable signs for diagnosing an illness. This must change.

One of the most persistent public misunderstandings is that using the biology of the brain to understand the nature of mental disorders automatically means prescription drugs are the preferred method of treatment. Not so.

In fact, talk therapies — just like drugs — have the capacity to influence and improve brain function and characteristics.

Much of the time, we need both tools — drugs and talk therapies.

Currently more than half the clinical trials funded by the NIMH focus on psychological care, or talk therapy. Trials for pharmaceutical medications to treat mental illness have slumped to 18 per cent.

Psychologists (who are not medical doctors and who usually use talk therapy) and psychiatrists (who are medical doctors and can therefore prescribe drugs) are not in different businesses.

Rather, they are in different wings of the same business, and what they bring to people who are suffering are different tools to fix a complicated problem with many facets.

New medications will be useful for this purpose, but not exclusively so.

“One of the most powerful and precise interventions to alter brain circuit activity (to relieve patients of a mental illness) may be targeted psychotherapy,” Dr. Cuthbert says.

The new NIMH research framework will, in time, lead to a new, biologically validated approach to diagnosing mental health problems — or brain circuit disorders, as we might come to know them.

Here is what we now know:

  • Serious mental disorders increasingly appear to be “neurodevelopmental,” which means symptoms develop early in life and progress over time.
  • Mental disorders are brain circuit disorders resulting from a wide variety of problems in the maturing of the human nervous system from conception forward.
  • The social and physical environment in which people grow up and live constitute both risks to mental health and protection of it. This happens through life.
  • Particular environmental stressors, such as early child abuse, may increase the risk for a whole variety of disorders.

Yes, a new sun is rising. And its light will illuminate the prospects of one day finding outright cures for the wide range of brain-based mental disorders now plaguing whole populations because — at long last — we will know what they are.