Treating Brain Malfunction: The Thin Line between Psychological and Biological
But the question is, how much of a mental illness can the biology of brain explain?
Abnormal behavior, the basis of psychological disorders, has a different definition depending on the context; for example, in legal institutions insanity is referred to a person’s inability to understand the nature and quality or wrongfulness of his or her acts. From psychology’s point of view, they say if the behavior is deviant, maladaptive, and/or personally distressing, it is abnormal behavior. The explanations for abnormal behavior come from various perspectives, including biological, psychological, and sociocultural. The biological approach tends to explain them in terms of internal and organic causes, rooting them to a biological origin that may be structural (e.g. any structural defect of the brain) , biochemical (e.g. neurotransmitter imbalance), or genetic (e.g., presence of certain genetic markers associated with psychological disorders).
The psychological approach is founded on four basic perspectives: psychodynamic, behavioral and social cognitive, and humanistic. From the psychodynamic point of view, unconscious conflicts are the culprit. Behavioral and social cognitive psychologists argue that they stem from rewards and punishments in the environment. The humanistic perspective focuses on factors that may limit a person’s ability to fulfill his or her potential.
The sociocultural approach considers broader contextual variables that may contribute to psychological disorders, such as culture, socioeconomic background, and gender socialization. However, the biopsychosocial approach suggests that the causes of normal as well as abnormal behaviors are a combination of biological, psychological, and sociocultural factors. An approach that is difficult for many psychological disorders due to its complexity, but may perhaps be the best hope for research and management of many distressing mental illnesses.
Diagnosing mental illness is different than chronic disease. Diabetes is identified by measuring blood glucose levels. Infection needs a simple blood count and a culture.
But classifying mental illness is a more subjective endeavor. No blood test exists for depression; no X-ray can identify a child at risk of developing bipolar disorder. At least, not yet.
Now that we have advancements in genetics and neuroimaging, scientists are making progress toward deciphering details of the underlying labyrinthine biology of mental disorders. Eric Kandel, MD, a Nobel Prize laureate and professor of brain science at Columbia University, believes it’s all about biology. “All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases,” he says. “The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?”
When it comes to mental illness, a one-size-fits-all approach just does not apply. Some diseases may be more purely physiological in nature. Certain disorders, say schizophrenia, bipolar disorder and autism fit the biological model easily. In these diseases, structural and functional abnormalities are evident in imaging scans or during postmortem dissection.
Indeed, in recent years scientists have made many exciting discoveries about the function — and dysfunction — of the human brain. They’ve identified genes linked to schizophrenia and discovered that certain brain abnormalities increase a person’s risk of developing post-traumatic stress disorder after a distressing event. Others have zeroed in on anomalies associated with autism, including abnormal brain growth and underconnectivity among brain regions.
Researchers have also begun to dig up a physiological explanation for depression , a region of the brain — Brodmann area 25 — has been shown to be overactive in people with depression, deep-brain stimulation of the area can alleviate symptoms in people with treatment-resistant depression (Mayberg, Neuron, 2005). Maps of depression’s neural circuits, may eventually serve as a tool both for diagnosis and treatment. Understanding the underlying biology, could help therapists and psychopharmacologists decide which patients would benefit from more intensive therapy, and which aren’t likely to improve without medication.
That would be a welcome improvement, Mayberg says. “Syndromes are so nonspecific by our current criteria that the best we can do now is flip a coin. We don’t do that for any other branch of medicine,” she says. But she’s still not sure if a perfect biologic basis will ever be available for psychological disease, “I used to think you could localize everything, that you could explain all the variants by the biology,” she adds. “I think in a perfect world you could, but we don’t have the tools to explain all those things because we can’t control for all of the variables.”
These mental illnesses are no different from heart disease, diabetes or any other chronic illness in that all chronic diseases have behavioral components as well as biological components. The only difference here is that the organ of interest is the brain instead of the heart or pancreas. But the same basic principles apply.
Yet it’s hard to say how far experts can push this biological model. Are mental illnesses simply physical diseases that happen to strike the brain? Or do these disorders belong to a class of their own?
For some other conditions, such as anxiety, the biological foundation is more nebulous. Most mental illnesses are likely to have multiple causes, including genetic, biological and environmental factors. Of course, that’s true for many chronic diseases, heart disease and diabetes included. But for mental illnesses, we’re a particularly long way from understanding the interplay among those factors.
Translating a nuanced view to improvements in diagnosis and treatment will take a lot of time. Despite decades of research on the causes and treatments of mental illness and millions of dollars spent, patients are still suffering. Suicide rates haven’t come down. The prevalence of mood and eating disorders, if anything, has gone up, not down. That tells you that whatever experts have been doing is probably not adequate.
But maybe increasingly, we’ll understand behavior at many levels, and one of those will be physiological. That may take a long time to translate into new therapies and new opportunities for patients. Whether it’s coming or not, only time will tell.
In the meantime, patients themselves are clamoring for better biological descriptions of mental disorders. Describing mental illnesses as brain malfunctions helps minimize the shame often associated. It’s like calling Schizophrenia a disease like tonsiltis. Seeing it as a brain disorder destigmatizes it immediately.
Social and environmental factors are undeniably important to understanding mental health. But the fact is, they do not act all by themselves, they act in the brain. It’s too soon to say whether we’ll someday have a blood test for schizophrenia or a brain scanning technique that identifies depression without any doubt.
But researchers and patients agree: The more we understand about our brain and behavior, the better chances we will have of managing disorders in the future. We do have a good beginning of understanding of the brain, but judging by statistics of its clinical implementation in mental illness, we still have a long long way to go.
About the Author: Ayesha Khan recently graduated and is about to start interning at Ayub Teaching Hospital, Pakistan. She can be reached at [email protected]
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