I’m delighted to see that mental health conditions are making their way into mainstream conversation. It is so good to see people start to feel comfortable talking about their depression and anxiety. I know that we have a ways to go–as a society, we are still not able to talk rationally and calmly about people like Matthew de Grood and Vince Li, who have both been described as model patients compliant with treatment. For those in whom these names raise goosebumps and the little hairs on their arms, trust that patients with psychosis who are treatment compliant are at very low risk of committing acts of violence again. Trust that there are undiagnosed, untreated sociopaths walking the streets who are much more likely to volitionally murder someone. Trust that there are people in very powerful positions of leadership (who display several sociopathic traits themselves) intentionally stigmatizing mental illness who are doing much more harm to individuals living with mental health diagnoses. Personally, I won’t feel we’ve succeeded as a society until we can talk about all forms of mental illness, those on a spectrum of both psychosis and depression, those who are mostly depressed but sometimes manic, those with the severest of personality disorders causing them to present to emergency in crisis because their disorder interferes so heavily with their lives.
Let’s really talk about mental illness. You are not OCD if you simply like to keep your bath products in a certain order. But you probably have OCD if you have to spend 3 hours flipping the bathroom light on and off before you can leave your house, making you late for work everyday. You may have depression if your boyfriend broke up with you and you’ve really been struggling to get to the gym lately. But you definitely don’t have the same depression as someone who hasn’t showered in 6 days, hasn’t held a job in years, and is cachectic from weight loss. You are definitely not bipolar because you have some occasional mood swings, but you might be bipolar if in your manic state you cheated on your husband of 15 years and now your marriage is falling apart before your eyes. Know that your experience of mental illness in yourself or your loved ones is valuable, but not the same as those with mental illness you’re not seeing–probably because those people are too sick to be out in public, or too ashamed to talk about it.
This brings me to something that has recently irked me in my newfound appreciation for mental health in the mainstream. There have been posts shared about one of the largest meta-analyses (a collection of primary studies) published in the Lancet (one of the most prestigious scientific journals out there). While it is one thing to share your own experience with mental health, there is something about mental health that entitles people to share anecdotal evidence as proof that peer-reviewed journal articles are wrong, that the scientific process should be questioned, that medications are evil, and of course that drug companies are behind it all. Not that these things should never be questioned–but I wonder what it is about mental health that enables laypeople to form and act on their opinions in a way that they wouldn’t in the areas of cardiology or subspecialty surgery. Psychiatrists in Canada have completed at least 5 years of specialty training, and usually 13 years of post secondary education overall. So just some food for thought.
What disturbs me about the reaction to the Lancet article is how defensively people react when it comes to suggesting that medications treat depression. Some of these people react viscerally also when suggesting that depression is a neurochemical illness. Perhaps these people, as those I’ve outlined above, have a hard time fitting their anecdotal experiences into this narrative. But by statistical definitions (which means for at least half of cases), these medicines help treat depression. Depression can be biological, and it can be due to psychosocial factors, and it is most often a combination. But to deny the biological basis for depression is as ridiculous as denying that, say, experiencing childhood trauma doesn’t predispose you to mental illness in the future.
To hopefully destigmatize this a little further, know that the brain is an organ just like any other in the body, and know that dysfunction in an organ as complicated as this can give rise to mental illness due to very tangible reasons. We can see with our own eyes on functioning imaging such as fMRI or PET scans, areas of the brain that light up brighter or are dimmer in those with depression. We can take out entire structures of the brain to cause depression (we wouldn’t, though). We can use deep-brain stimulation to excite specific structures to treat depression. We can use electroconvulsive therapy (yes, shock treatment) to produce a controlled seizure in a controlled setting that completely changes the course of depression, bipolar, schizophrenia, and the most severe mentally illnesses. This should all convince you that the organ we’re dealing with in psychiatry is still the brain as it exists in our bodies.
Human beings are fascinatingly complex creatures, whose past experiences, whose biochemistry, whose current level of exercise, and whose temperament and disposition about life all factor into how they experience mental illness (this list is certainly not exhaustive). And yes, I’m suggesting that even one’s attitude–aka if they’re a glass half-empty or half-full person–can dictate how depressed they’ll be. But I’m also asserting that based on peer-reviewed scientific evidence, based on clinical experiences of seeing this every damn day, mental illness is just as complex, just as multi-faceted, and science is finally just starting to get a good grasp on how to treat it–and let’s toast to that.