Mental health problems, and how they come about
What have we learned so far about the human brain? It messes with memories, it jumps at shadows, it’s terrified of harmless things, it screws with our diet, our sleeping, our movement, it convinces us we’re brilliant when we’re not, it makes up half the stuff we perceive, it gets us to do irrational things when emotional, it causes us to make friends incredibly quickly and turn on them in an instant.
A worrying list. What’s even more worrying, it does all of this when it’s working properly. So what happens when the brain starts to go, for want of a better word, wrong? That’s when we can end up with a neurological or mental disorder.
Neurological disorders are due to physical problems or disruption in the central nervous system, like damage to the hippocampus causing amnesia or degradation of the substantia nigra leading to Parkinson’s disease. These things are awful, but usually have identifiable physical causes (although we often can’t do much about them). They mostly manifest as physical issues, like seizures, movement disorders, or pain (migraines, for example).
Mental disorders are abnormalities of thinking, behavior or feeling, and they need not have clear “physical” cause. Whatever’s causing them is still based in the physical make-up of the brain, but the brain is physically normal; it’s just doing unhelpful things. To invoke the dubious computer analogy again, a neurological disorder is a hardware problem, whereas a mental disorder is a software problem (although there’s ample overlap between the two, it’s nowhere near as clear-cut).
How do we define a mental disorder? The brain is made up of billions of neurons forming trillions of connections producing thousands of functions derived from countless genetic processes and learned experiences. No two are exactly alike, so how do we determine whose brain is working normally and whose “isn’t”? Everyone has weird habits, quirks, tics or eccentricities, which are often incorporated into identity and personality. Synesthesia, for instance, doesn’t seem to cause anyone any problems with functioning; many people don’t realize they have anything amiss until they get weird looks for saying they like the smell of purple.1
Mental disorders are generally described as patterns of behavior or thinking that cause discomfort and suffering, or impaired ability to function in “normal” society. That last bit is important; it means for a mental disorder to be recognized it has to be compared with what’s “normal,” and this can vary considerably over time. Only in 1973 did the American Psychiatric Association declassify homosexuality as a mental disorder.
Mental health practitioners are constantly reevaluating the categorization of mental disorders due to advances in understanding, new therapies and approaches, changes in dominant schools of thought, even the worrying influence of pharmaceutical companies, who like having new ailments to sell medications for. This is all possible because, up close, the line between “mental disorder” and “mentally normal” is incredibly fuzzy and indistinct, often relying on arbitrary decisions based on social norms.
Add to this the fact they’re so common (nearly 1 in 4 people experience some manifestation of mental disorder, according to the data2) and it’s easy to see why mental health problems are such a controversial issue. Even when they are recognized as a real thing (which is far from a given), the debilitating nature of mental disorders is often dismissed or ignored by those lucky enough not to be afflicted. There is also heated debate about how to classify mental disorders. For example, many say “mental illness,” but there are those who find this term misleading; it implies something that can be remedied, like the flu, or chickenpox. Mental disorders don’t work that way; there often isn’t a physical problem to be “fixed,” meaning a “cure” is hard to identify.
Some even strongly object to the term “mental disorder” as it makes them seem bad or damaging, when they can instead be seen as alternative ways of thinking and behaving. There’s a large swathe of the clinical psychology community who argue that talking and thinking of mental issues as illnesses or problems is itself harmful, and are pushing for more neutral and less loaded terms to be used when discussing them. There are growing objections to the dominance of the medical field and approaches to mental health, and given the arbitrary nature of establishing what’s “normal” or not, this is understandable.
Despite these arguments, this chapter does stick more to the medical/psychiatric perspective—that’s my background and, for most of us, it’s the most familiar way of describing the subject matter. This is a brief overview of some more common examples of mental health issues while explaining how our brains let us down, both for those afflicted by the problem, and those of us around them who so often struggle to recognize and appreciate what’s going on.
Dealing with the black dog
(Depression and the misconceptions around it)
Depression, the clinical condition, could use a different name. “Depressed” presently applies both to people who are a bit miserable and to those with a genuine debilitating mood disorder. This means people can dismiss depression as a minor concern. After all, everyone gets depressed now and again, right? We just get over it. We often have only our own experiences to base judgements on, and we’ve seen how our brains automatically big up and exaggerate our own experiences, or minimize our impression of other people’s experiences if they differ from our own.
This doesn’t make it right, though. Dismissing the concerns of a person with genuine depression because you’ve been miserable and got over it is like dismissing someone who’s had to have their arm amputated because you once had a papercut. Depression is a genuine debilitating condition, and being in “a bit of a funk” isn’t. Depression can be so bad that those experiencing it end up concluding that ending their life is the only viable option.