Web Guide to Healthcare: Mental Health: Overview

Story: Several years ago, I worked with a brilliant, creative, and fairly successful active freelance writer named Karen. When she was 30, she went through a divorce (not of her choosing). At this point, she developed unusual thoughts. She started seeing herself as a "famous writer" and refused to ride public transit because "people will know who [I] am". Her work was faltering, and she began to claim that someone she had worked for had a personal vendetta against her and was sabotaging her work. 

​

Like many freelance artists struggling to get by, she had a minimal income - enough to support herself with a roof over her head and essentials. But, she chose to live on the streets of New York City, wandering around, unbathed and sometimes barely clothed.

​

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 to get evaluated and stabilized. Diagnosed with paranoid schizophrenia, she was started on antipsychotic medication, placed on Social Security Disability Insurance, and given a basic place to live in public housing in what was considered a "slum" back in those days. I met up with her again recently, and she told me that she continues to live in the same relative stability but is still harrowed by the thought that the same woman from the past is intercepting her writing submissions: She told me that she has not been able to earn any money over the past years and she has not been able to achieve the fame that she "deserves". 

​

Here is the point: After Karen got out of the hospital, I spoke to her sister and brother-in-law who were VERY insistent that she was "faking it" because she wanted someone else to "pay her way".  It was clear that they did not understand mental health issues, so we discussed, at length, Karen's diagnosis. Understand, no one wants to live this way.

​

​​​Contrary to what some people believe, people do not choose to have mental health problems (if they do, that is a mental health problem in itself!). And a mental health problem is not a sign of weakness. When someone is sad or depressed, it is due to complex changes within the body and brain. These changes are due to problems with physiologic changes in brain structure, neuronal dysfunction, and biochemical changes - such as alterations in hormones and neurotransmitters. Biologic factors create the foundation for mental function (genes, hormones, health, age, and others) and environmental factors act on neurologic functioning; things like trauma, family and social relationships, illness and pain, light and dark, stress, work, personal and cultural beliefs, economic problems, substance use, perception, and others.

​

Background: What Could Go Wrong?

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

​​

The brain is a very intricate "machine" made up of over 100 billion neurons (nerve cells) connected by 100 trillion electrical and chemical bridges called synapses. The chemicals in the synapses that connect nerve cells to each other are called neurotransmitters. Messages are passed along from one neuron to another via electrical and chemical impulses throughout your brain and body via neurotransmitters. These impulses form thoughts and actions.

​

While there are an estimated 100 neurotransmitters connecting various neurons, those of focus here - many of which are considered to be responsible for mental health - include the following:​

​

• Dopamine – The “happy” neurotransmitter

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

• GABA – A calming neurotransmitter

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

• Epinephrine (Adrenaline) – Excitable 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.

​

While they are found in other parts of the body, many of these neurotransmitters are key to brain function and behavior. These make up much of the outer layer of the brain, the gray matter, which is important to emotional processing, making memories, thinking, behavior, processing information, and motor activities.

​

The important thing to realize is that most mental health medications work to increase or decrease these neurotransmitters by increasing or decreasing their actions: They help your moods, among other things.

For example, there tends to be less circulating serotonin (a  "happy" neurotransmitter) in a depressed person; and levels of dopamine (a "happy" neurotransmitter) tend to be low in depression; norepinephrine (responsible for energy and attentiveness) is often lower in depressedpeople, less GABA (a "calming" neurotransmitter) is unable to "calm" a depressive mood), lower levels of dopamine and norepinephrine often contribute to ADHD and it is proposed that endorphins, neurotransmitters responsible for decreased pain, decreased stress response and overall good mood may be diminished as well.

​

Most sensory input from our eyes, sound, taste, and touch goes to the thalamus of our brain. The thalamus sorts it out and either sends it to the prefrontal cortex where a person thinks about that input, or to the amygdala for immediate reaction. Occasionally, sensory information goes directly to the amygdala (interestingly, the sense of smell is the only sense that always goes directly to the amygdala). The amygdala regulates our attention, emotions, behavior, and memory; it is the primary center of anxiety and fear. So, increased or decreased activity of neurons and neurotransmitters can affect emotions and behaviors.

​

Another part of the brain, the basal ganglia, is the "reward center" of the brain responsible for habituation like the continued use of drugs and smoking. The activity of neurons and neurotransmitters greatly influence this type of behavior.

​​

One last part of the brain worth mentioning here is the hypothalamus, which, among other things, regulates sleeping and eating. Activities of the neurons, neurotransmitters, and hormones in this area can greatly influence sleeping and eating behaviors.

​

Over time, much of our brain forms many well-travelled neuronal pathways: Our brain starts to take the same neuronal pathway over and over and over again. Like a walk in the woods, you form a well-worn path. BUT, once in a while, travel on the path strays and it throws us off into bramble or uncharted territories. And this is where we can run into trouble.

​

​​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 a 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, genetics 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.

​

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.​

​

The unfortunate thing is that once neurons are destroyed within the brain, we do not regenerate new ones. BUT - and this is very promising - we can change the ways in which remaining neurons connect - in many, less severe cases, we can consciously "reprogram" the neuronal pathway. 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 neurotransmission action, there is a lot of hope for people who suffer from mental health issues.

​

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

​

​

​

​​​​​

•