Web Guide to Healthcare: Mental Health: Overview

To help show how easily people misunderstand mental illness, I’m sharing a short story about someone I once knew. I’ve changed the name and identifying details to protect their privacy, and just to be clear, this story isn’t about me.

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Several years ago, I learned of a woman named Amy who was a fairly successful freelance writer. In her early 30s, her husband left her for another woman. Not long after, she began developing unusual thoughts—believing she was a ‘famous writer’ and refusing to ride public transit because ‘people would recognize her.’ Over time, her work began to falter. She became convinced that someone she had once worked for had a personal vendetta against her and was sabotaging her writing.

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Like some freelance artists who struggle to get by, she had a minimal income - enough to support herself with a roof over her head and essentials. For several weeks, she lived on the streets of New York City, wandering around in the street, sleeping in alleys, unbathed and sometimes barely clothed.

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When it became apparent that she was hearing dangerous and threatening voices - that she was a danger to herself - she was admitted to a psychiatric hospital for a couple of weeks for evaluation and stabilization. Diagnosed with paranoid schizophrenia, she was started on antipsychotic medication, placed on Social Security Disability Insurance, and given a small basic place to live in public housing in an area that was considered a "slum" back in those days.

 

Recently, I learned more about her situation. She’s still living with the same relative stability, but the belief that a woman from her past is intercepting her writing submissions continues to dominate her thinking. In her mind, this imagined interference explains why she hasn’t earned money or achieved the recognition she feels she deserves.  

​Her delusion acts as a defense — protecting her self‑esteem from the weight of disappointment and failure.

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What is even more telling is what happened after Amy left the hospital. Relatives were VERY adamant that she had been "faking it" all along, that she wanted someone else to "pay her way". Their reaction made it obvious they didn’t understand mental health at all. No one chooses to live like this.

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Contrary to what some believe, people do not choose to have mental health problems — and if someone did choose suffering, that would, itself, signal distress. A mental health condition is not a sign of weakness, moral failure, or lack of intelligence. When someone experiences a mental health problem — whether anxiety, depression, bipolar disorder, or symptoms of schizophrenia — it reflects complex changes within the body and brain. These changes involve shifts in brain structure, neuronal functioning, and biochemical processes, including hormones and neurotransmitters. Biological factors lay the groundwork for mental functioning — genetics, hormones, overall health, age, and more. Environmental factors then act on that foundation: trauma, relationships, illness and pain, light and dark, stress, work, cultural beliefs, financial strain, substance use, and countless other influences all shape how the brain functions.

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Background: What Could Go Wrong?

Much hope exists for those who grapple with depression and anxiety, as well as other mental health issues. And while medications can be very helpful, improving mental health is not always dependent upon taking medicine. How does this work? The following is a very simplified explanation of brain function to help you understand the process.

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The brain is a very intricate "machine" made up of roughly 86-100 billion neurons (nerve cells) connected by 100 trillion electrical and chemical bridges called synapses. Neurotransmitters are the chemicals that allow these neurons to communicate. Messages travel from one neuron to another through electrical and chemical impulses, and these networks of impulses underlie our thoughts, feelings, and actions.

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While there are many different types of neurotransmitters connecting various neurons, those of focus here - many of which are considered to be responsible for mental health - include the following:​

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• Dopamine – The “happy” neurotransmitter, also responsible for motivation, reward, and movement

• Serotonin – Helps regulate mood, appetite, sleep, and digestion (there is a LOT of serotonin in the stomach)

• GABA – A calming and excitatory neurotransmitter

• Glutamate – For memory and learning, cognition, is an excitatory neurotransmitter

• Epinephrine (Adrenaline) – Excitatory neurotransmitter and hormone ("fight or flight") 

• Norepinephrine - Excitable neurotransmitter and hormone ("fight or flight")

• Endorphins - The brain's feel-good "natural morphine" in response to pain or stress.

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While neurotransmitters are found throughout the body and have many functions, several of them play key roles in brain function and behavior. They are active throughout the brain, especially in the gray matter — the outer layer involved in emotional processing, memory, thinking, behavior, information processing, and motor activity.

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The important thing to realize is that most mental health medications work by influencing neurotransmitters — increasing or decreasing their activity. These changes can help stabilize mood, energy, focus, and other aspects of mental functioning.

For example, people with depression often have reduced serotonin activity (a neurotransmitter involved in mood regulation). Dopamine, which plays a major role in motivation and reward, can also be lower in depression, and it is the same neurotransmitter involved in the "reward rush" seen in gambling and other addictions. Norepinephrine — important for energy, alertness, and attention — is frequently reduced as well. Lower GABA activity (a calming neurotransmitter) can make it harder for the brain to regulate stress and anxiety. In ADHD, lower or dysregulated dopamine and norepinephrine activity often contribute to problems with focus and impulse control. Some research also suggests that endorphin activity — the brain’s natural pain and stress‑relief system — may be diminished in certain mental health conditions.

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Most sensory input from our eyes, ears, taste, and touch goes first to the thalamus. The thalamus sorts this information and sends it either to the prefrontal cortex, where we consciously think about it, or to the amygdala for a rapid, emotional reaction. Some sensory information can take a more direct route to the amygdala, allowing for quick responses before the thinking brain fully engages. (Smell is unique in that it bypasses the thalamus and connects directly to brain regions involved in emotion and memory.)

The amygdala plays a major role in emotional processing, attention, behavior, and memory, and it is a key center for fear and anxiety responses. Because of this, changes in neuronal activity and neurotransmitter levels can strongly influence emotions and behavior.

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Another part of the brain, the basal ganglia, plays a major role in the brain’s reward system and in forming habits — including the continued use of drugs, smoking, and other addictive behaviors. The activity of neurons and neurotransmitters strongly influences this type of behavior.

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One last part of the brain worth mentioning is the hypothalamus, which, among other things, regulates sleeping and eating. The activity of neurons, neurotransmitters, and hormones in this area can greatly influence sleep patterns and appetite.

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Over time, our brain forms many well‑traveled neuronal pathways — routes it takes again and again. Like a walk in the woods, repeated thoughts and behaviors create a well‑worn path. But occasionally the brain strays off that familiar route, sending signals down less‑used pathways that feel like bramble or uncharted territory. And this is where we can run into trouble.

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​​What causes our brain to reroute? With ALL the intricacies of the brain, the billions of neurons, and trillions of synapses (electrical and chemical connections) in the brain (and body), is it any wonder that just any physical or chemical structure change can cause a change in our thinking? For example, damage from dementia, aging, or trauma can cause a change in thought patterns, gene expression, environmental toxins, a hormonal imbalance (especially estrogen or progesterone), a change in neurotransmitter concentration or action, or destruction from infection and inflammation (caused by chemicals like cytokines) can all take a toll on your brain and your thinking.

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Moreover, there is a vast interplay of factors between nature and nurture; the environment (including trauma) can be a huge trigger that causes the brain to lose balance - especially if it is at a tipping point already.​

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The unfortunate thing is that once neurons are destroyed within the brain, we generally do not regenerate new ones. BUT — and this is very promising — we can change the ways in which the remaining neurons connect. In many less‑severe cases, we can consciously “reprogram” these pathways. This is called neuroplasticity, and it allows individuals, in many cases, to adapt and modify responses to experiences and learning situations (yes, there is hope). Between that and medications that help regulate neurotransmitter activity, there is a lot of hope for people who suffer from mental health issues.

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For more information on anxiety disorders, sadness, and depression, click this link.​

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