Don’t judge my path if you haven’t walked my journey
Mental Labels
Just the term “Mental” induces reactions and responses from every corner of our society, and mostly they are not positive. Perhaps part of the problem can be attributed to the broad and different definitions applied to the term that includes its use as an adjective relating to the mind or disorders of the mind but it also has an informal us as “insane” or “crazy”
It’s no wonder that when we refer to someone as having “Mental problems” or a “Mental Condition” – so perhaps we need to change the terminology to start addressing “Mental” health as part of our overall health. The precision of language and terminology is important but we have a tendency that appears to be increasingly misused, or perhaps it just appears that was because it is magnified by social media and the 24/7/365 news cycle. For example, the term “Depression” is a clinical diagnosis that has some very specific symptoms and durations but the term is used excessively in place of sadness, misery, or sorrow. SO for this article, I will refer to “Diseases of the Brain” rather than “Mental Disorders”
Part of Physical Health
A recent article by John Campo, MD, Professor, and chair of the Department of Psychiatry at Ohio State University pointed out the mismatch between the prevalence and impact of diseases of the brain and the lack of legitimacy as a “real disease
The treatment of mental illness has long been held back by the sense that disorders of emotion, thinking, and behavior somehow lack legitimacy and instead reflect individual weakness or poor life choices
Some of this likely stems from our lack fo understanding relative to brain disorders evidenced in history by the way we viewed and “treated” anyone deemed to be unusual or different. These attitudes date back to at leat the 13th Century and “St. Mary of Bethlehem” in London built in 1247 and used as an institution for the insane. It was colloquially referred to as “Bedlam” hospital (yes that is where the term “Bedlam” came from) that featured horrific treatments from “rotational Therapy”
Imagine being stuck on the Mad Hatters Tea Cup ride at high speed for hours
And extended to beatings, bloodletting, and starvation! This sordid history is covered by the Museum of Healthcare Blog. This attitude extended into my medical school training where we were dispatched to Friern Hospital (formerly Colney Hatch Lunatic Asylum) that at its peak was home to some 2,500 patients with disorders of the brain. My clinical experience there included a harrowing personal experience that still shapes my behavior to this day.
Long corridors with Wards radiating out
Moving to Whole Care
The disconnect between the specialty of Psychiatry and the rest of medicine is rooted in our inability to observe and explain the workings of the brain. Even some of our treatments work but we struggle to understand why or how. This manifests in the challenge of honest acceptance of having a disease of the brain and being able to find help to treat that condition. For most people, our exposure to this world is limited to the Hollywood lens, like “Awakenings” starring Robin Williams and Robert de Niro
It is sad to note that Robin Williams suffered a sometimes public struggle with a brain disorder and ultimately committed suicide secondary to his suffering of Lewy Body Dementia
Based on the true story and book “Awakenings” written by Oliver Sachs – the British Neurologist, naturalist, and author who died back in 2015. He was a prolific writer who wrote with such eloquence and mastery of language you can lose yourself in his books.
‘Healing’,
Papa would tell me,
‘is not a science,
but the intuitive art
of wooing Nature.’
The Art of Healing – W.H. Auden
Science is Helping
The good news is that technology and science are helping as we unlock some of the mysteries of the brain’s function and the diseases that impact function. In fact, in many instances, we are discovering that the brain plays a much larger role in many diseases and we ignore this at our peril. We continue to unlock the chemical and physiological functions in the brain and as the science advances so too does the integration of the specialty psychiatry under the same roof as the rest of medicine.
There are now a number of initiatives working to expand our understanding, coordinate research, results, and findings that included the 2013 announcement by President Obama for the “BRAIN Initiative” (Brain Research through Advancing Innovative Neurotechnologies) that is homed at the National Institute of Health (NIH) and complemented by the The Human Brain Project from the European Union. The initiatives are not without problems and uncertainty of funding continues to challenge progress but understanding, science, and data remain a central requirement to progress.
There are some areas of progress from industry and Arshya Vahabzadeh, MD, the Chief Medical Officer at Brainpower has been championing Virtual Reality and Augmented Reality as a tool to help the growing population of Autism patients handle the complex world of emotions and human interactions. As he highlighted Virtual and Augmented Reality was a hot topic at the recent American Psychiatric Association Meeting
And was featured in this Medscape article: Virtual Reality a Game Changer for Psychiatry (Medscape)
Incremental Improvements in Brain Disorders
As Dr. Campo pointed out
Better understanding of the human brain and the biological nature of the mind will help, but it won’t be enough. How we think about mental health matters. When mental health is ultimately recognized as essential to physical health, not an extraneous element of it, then we will have access to true, complete, modern medicine
Changing the narrative and words may seem trivial but for any change to take place we need education and awareness that removes the stigma and fear associated with disorders of the brain and deliver the same compassion and care that patients with cancer or heart disease receive.
So my thoughts for some incremental improvements you can make addressing disorders of the brain
- Words Matter – it’s not “Mental Health/Disorder” – it is Disease or Disorder of the Brain
- Ask, listen and most importantly digest and be there as we interact with others – read Maneesh Juneja blog – Being Human
- From a clinical perspective – the clinical history and the detail of the Presenting Complaint and History of Present Illness remain the mainstay of diagnosis and understanding
- Read or listen to Oliver Sach’s – you can find his books – or watch his TED Talk, or hear him on Science Friday or NPR or read one of his articles
What small change have you seen that makes a difference in the support of people with disorders of the brain. What one thing could we do that would have a big impact in this area?
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