B is for Biological Basis

Mental health problems are frustrating because it is hard to classify them as having a biological or psychological basis. I know there has to be some psychological component, mental illnesses are diagnosed based on behaviour after all. I am hoping for some solid research showing depression and other mental health issues have a biological basis though. If the cause is in my biology, there isn’t much I could have done to have prevented it. It is not in my control. I am not to blame. A psychological basis would imply that my behaviour is the problem. I am responsible for my behaviour and so I am to blame, or so society dictates. Calling depression a brain malfunction would minimize the shame I feel when I have to explain myself. I don’t want people to feel sorry for me, but I don’t want them to always wonder why I don’t just snap out of it either.

There is support for both the biological and psychological sides. Since mental processes are carried out by the brain, all disorders of mental function are biological. Just like the lungs are the organs for breathing, the brain is the organ for the mind. Where else could mental illness be if not the brain? Not so long ago, we didn’t know that much about how the lungs worked. All doctors could do for respiratory disease were observe physiological presentation and listen to patient complaints. Today, there are all sorts of tests to measure lung function. The same principles apply to the brain, we just don’t know enough about it yet.

On the flip side, some go to extremes, arguing that everything from mental illness, to criminality and sexual orientation are seen less as a matter of choice than a genetic destiny. Mental health problems could be the result of normal personality traits coming together in such a way to make functioning in today’s world difficult. One scientist compared the brain to a computer and mental processing to the software. There can be a bug in the software that prevents things from running smoothly, but the hardware is still fine.

What do you think? Do mental illnesses fall into one of two distinct categories (psychological vs. biological), or do they exist on a continuum having different percentages of biological and psychological contributions?

Recent research posed similar questions to clinicians (psychiatrists, psychologists and social workers) to determine their beliefs on the causes of mental illness. I would like to know what my psychiatrist thinks. After all, his beliefs would probably have an effect on my therapy and may determine whether or not he prescribes medication and which medication it would be. The study showed that clinicians tend to look at mental health problems across a spectrum of biological to psychological rather than categorical. They believe disorders with a larger biological component would respond best to medication, while those with a larger psychological component would respond better to therapy.

They didn’t show all 445 identified mental illnesses on this spectrum, but they did show 9 familiar ones. I looked up my primary diagnosis, depression, on the graph and it was right smack in the middle. Clinicians viewed depression as having biological and psychological contributions that were almost even. Darn. Other diagnoses like bipolar and bulimia were more clear cut in clinician minds, showing larger biological and psychological components respectively.

It turns out the biological basis I was hoping would explain my depression is a double-edged sword. Although the average person would probably be more compassionate about a brain malfunction, clinicians would be less so. This study showed clinicians felt more compassion towards those with mental health problems thought to be caused by psychological factors. Researchers thought perhaps the emphasis on biology was dehumanizing, causing the patient to be viewed as more of a biological mechanism than a person.

Regardless of the beliefs of clinicians or those of society in general, I think we can all agree, the more we understand about all components of mental illness, the better.

2015-04-01 18.09.42

Resources: Ahn, Proctor and Flanagan, 2009

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31 Comments (+add yours?)

  1. trentpmcd
    Apr 02, 2015 @ 09:01:45

    My very, very non-expert opinion is they are on a continuum. One thing I understand from your second to last paragraph – if the mental illness is more psychological then there is a chance to “fix” the issue. If it’s a “bug in the software” you find ways to correct the bug. If it’s hardware, then you can try to correct for the problem, i.e., use drugs to help with any imbalances in the brain, but you can’t fix the underlying problem. Unlike a computer, you can’t replace faulty components in a brain. Anyway, very non-expert opinion.

    Reply

    • somberscribbler
      Apr 02, 2015 @ 09:17:02

      I agree about the continuum and I like your expansion on the “bug in the software” idea. It’s unfortunate you can’t replace the faulty hardware, but I think it is important that people realize that. Sometimes these things are life-long. I can’t speak for everyone, but 20 sessions of therapy aren’t going to fix me. I need help learning to live this way for a lifetime.

      Reply

      • trentpmcd
        Apr 02, 2015 @ 09:30:13

        It is hard for people to get their heads around, no pun intended 🙂 I think every one has some degree of mental illness, that is there is no such thing as someone being “normal”. I think people either ignore that little bit they have or are so frightened by it that they refuse to try to understand people who are deeply affected by it. I’m a person who can’t understand it totally but with a sister who is bipolar I can see some of it in myself and know I’m not that different, only it is limited enough in my life that I can cope with it without getting professional help. I think people who aren’t forced to look in the mirror because of a loved one have a harder time being empathetic to people who struggle.

      • somberscribbler
        Apr 02, 2015 @ 09:32:44

        Very true. If you haven’t had experience with it, you can’t be expected to understand, nevermind empathize. I just wish there was more openness, tolerance and willingness to be educated.

  2. therabbitholez
    Apr 02, 2015 @ 09:31:01

    I tend to agree also about the continuum, I think that’s why even when in recovery you can have relapses sometimes mild sometimes severe, I don’t think there will be a cure as such, but you can learn ways in which to manage depression.

    great post and another aspect I’ve learned and will give me much to think about,
    thank you.

    Reply

    • somberscribbler
      Apr 02, 2015 @ 09:37:39

      I think there is an environmental factor too….maybe that falls under psyc? I don’t know. In some cases, mental illness is situational. The person gets through the situation with or without treatment, gets better and is fine, but then there are those that spend a lifetime going up and down. I wish there were more experts in long-term management.

      Reply

      • therabbitholez
        Apr 02, 2015 @ 09:45:39

        I’ve always felt that after treatment is over your left in a kind of limbo, support is needed long term even if you no longer require a therapist.

        I agree with the situational aspect, but still think we can easily fall into the same traps as before, there is such a huge emotional cost involved and even though some seemingly recover it can manifest itself in other ways, this illness is so complex, it’s frustrating.

      • somberscribbler
        Apr 02, 2015 @ 10:01:05

        It really is. I hope that someday we will understand it as well as we do the diseases of other organs.

  3. The Chaos Realm
    Apr 02, 2015 @ 09:34:53

    Whew, what a grey area in thought. I have thought probably way too much about this over the years, even though I’m not a doctor or have a medical background (disclaimer!). Yes, depression is a valid diagnosis, but is it used by doctors to downplay the full range of emotion that exists in living creatures, and assign prescription drugs to make us “normal”? For myself, personally, I have a weird way of looking at depression. That it’s letting me me know that I am a fallible, living creature and that I have emotions that I need to sort through, that are not easily accepted, acknowledged, and supported by societal mores? Sadness, pain, confusion, uncertainty, etc. How much of a place is there in society for real emotion, or are excessive displays of emotion curtailed, repressed, and even discouraged in society? Where is the outlet for them? That’s one thing I wanted to teach the kids in the school I taught at. That creative things like writing, art, etc. provided an emotionally expressive, and mental, outlet that might be missing in society. A safe space to explore all the complexity of emotion, and to have an outlet for that emotion…especially with nonword/nonverbal expressions like art and acting, that provide a place to pour that emotion. It causes me to ask: Does our society have the necessary infrastructure within it to support, validate, and deal with emotion? Could this also be part of the cause/effect of depression, for example? Is it a way of saying, hey, I need to slow down, sort through my emotions, pay attention to what I am feeling and why it’s making me unhappy, and find ways to work through them and address the issues at the root of my emotional state–be proactive/creative in finding an outlet, (or even implement a new vision/new life changes) to help me safely explore, and channel the emotions and the issues underlying those emotions that are refusing to be ignored.

    Reply

    • somberscribbler
      Apr 02, 2015 @ 09:43:58

      I was nodding the whole way through reading this. I feel like emotion is seen as weakness and if you are taking time out to sort through it, then you aren’t strong enough to be in the ring with the rest. Over the last year, I have started to think that if I can’t have emotions and sort through them when need be, then maybe I don’t want to be in the ring. Maybe, I will be happy settling for a lesser existence. That got me thinking about that last sentence. I hate the way that sounds. It should not be true. What made us, or society think we could define one existence as being less than another? What made society define emotion as weakness?

      Reply

      • The Chaos Realm
        Apr 02, 2015 @ 09:59:35

        (Keep in mind that I am not a licensed psychologist and this should not be a stand-in for that sort of professional advice/care.)

        I agree…maybe depression stems from the fact that we’re not allowed to have emotions. And your Self is over there saying, “Oh, is that what you think? Well, take this.” And out comes the depression hammer. Bam. *laugh* Forcing you to deal with your emotions whether you like it or not. Giving you a choice–you can do it consciously and listen to the message they are trying to communicate to you about your life, or continue to find ways to invalidate your feelings by whatever means available. They might serve as indicators to a new life path, or point out ways you are cutting yourself off from your potential, or the life/person you want to be, or the next stage of your personal life development and/or evolution. We don’t expect Nature to be static, so why do we expect our Selves to be static? I call depression (not to trivialize it) a sign of living against the grain. Not really a new-agey type, but it’s a somewhat similar approach, I suppose.

      • somberscribbler
        Apr 02, 2015 @ 10:08:50

        Yes, I think part of depression is living the way you should instead of the way you want. The battle is trying to reconcile the two.

  4. NotAPunkRocker
    Apr 02, 2015 @ 12:54:48

    I vote for continuum as well. Sure, environment added to my issues, but enough for me to have the problems I did so young? And then Matthew’s struggles too? I think it is a combination; your results may vary. 🙂

    Cell-fie… ❤ it!

    Reply

  5. mbarkersimpson
    Apr 02, 2015 @ 16:58:04

    Excellent post and some great discussion points too. I’m not sure if it would make me feel better to have a definitive answer about my depression, because I’ve come to accept it’s part of who I am. I can’t change it or make it go away, but I can change how I feel (most of the time) and I can work towards being healthier. It’s definitely a work in progress, but so is life 😉

    Reply

  6. Tizzy Brown
    Apr 02, 2015 @ 17:13:03

    This is such a fascinating topic. It’s very interesting (and worrying) that clinicians are less compassionate when they think an illness is caused by biology more than psychological factors. The suffering is still the same either way!

    One of the tricky things about mental illness is its such an invisible affliction. Because people can’t see what’s going on they may assume there’s nothing wrong with you and struggle to understand that it’s more than feeling down or being lazy (‘”Have you tried not being depressed?”). In my experience, people are much more understanding when you explain there’s a biological cause and it’s really no different from any other illness. I’ve also found that it helps me if I recognise depressive thoughts or behaviour as ‘biological malfunctions’. It helps me gain perspective and step back from them a little.

    I like the computer/software analogy. I find it hard to look at the psychological and biological as two separate entities as they’re so intricately entwined. A biological problem can cause psychological problems-but I believe the reverse could also be true (for example, internalising stress can sometimes cause problems with the body). The two are so linked that it’s hard to see where one ends and the other begins. We still understand so little about how the brain works and the relationship between matter and consciousness. There may be physical causes and symptoms that we cannot yet perceive.

    So no, I don’t think mental illnesses fall into either psychological or biological categories, but are on a spectrum. I’m inclined to think that (much like nature vs nurture), the majority of mental illnesses are about 50/50. But that’s my intuition talking and not Science!

    Reply

  7. Tizzy Brown
    Apr 02, 2015 @ 17:16:39

    Oh and I saw this image earlier about how the brain looks with different mental illnesses: https://www.pinterest.com/pin/105201341272038483/
    Very interesting!

    Reply

  8. Elle @ Erratic Project Junkie
    Apr 03, 2015 @ 01:16:07

    1. I totally giggled out loud at the “cell-fie”.
    2. I think there’s definitely a solid case for a combination of nature and nurture. There’s no doubt in my mind that biological basis exists. I’ve seen far too much family history to dispute that. But I do think the extent of mental illness can be varied by our own personal experiences and trauma, regardless of the base we have genetically.
    3. I’m really enjoying this series you’ve got going. You’re generating some great discussion points so far!

    Elle @ Erratic Project Junkie

    Reply

  9. henriettamross14
    Apr 03, 2015 @ 15:54:23

    I think the fact that we look at peoples experiences as always evidence of mental illness rather than humans beings capable of feeling a whole plethora of emotions is a product of our society. Psychiatry wants to claim peoples brains are defective and drug them often using the ruse of the chemical imbalance and psychologists want people to have ‘normal’ thought processes and blames everything on personality.

    Neither really get to the heart of the matter but constructs rarely do.

    Reply

  10. Tessa
    Apr 03, 2015 @ 22:55:19

    I don’t remember where I read it, but I found an article that says that depression is caused by inflammation in the body. Of course pain on it;s own does cause depression in a lot of people although in my case the bipolar came before the pain so not sure it can be the cause of everyone’s depression.

    Reply

    • somberscribbler
      Apr 04, 2015 @ 09:26:43

      Chronic inflammation is definitely thought to be a contributing factor. The mechanism is poorly understood to date. I have wondered about pain. Is it the pain itself that contributes, or the restrictions that the pain puts on you?

      Reply

      • Tessa
        Apr 04, 2015 @ 10:04:53

        I just heard of it recently. My body has been riddled with inflammation for years as a young adult. Chronic Pain since the 70’s. BP since I was a little girl.

  11. Mental Mama
    Apr 06, 2015 @ 08:42:51

    If you’d like my opinion (doesn’t everyone?) then it depends on the illness. The bipolar disorder that I have is, in my opinion, genetic and therefore biological. It responds to medication. However, I also have borderline personality disorder which is, again in my opinion, psychological and a result of some trauma in my youth that resulted in not learning adequate coping mechanisms. It does not respond to medication but did respond to DBT.

    And those are my 2 cents. 🙂

    Reply

    • somberscribbler
      Apr 06, 2015 @ 09:27:37

      It is definitely not a one size fits all scenario. I think personalized medicine is need when it comes to mental health

      Reply

      • Mental Mama
        Apr 06, 2015 @ 10:47:49

        Totally. One of the things I like most about my psych doc is that she takes into account my physical health as well as my mental health. She has me take vitamins to help boost the meds I use and keeps an eye on my weight as well.

      • somberscribbler
        Apr 06, 2015 @ 11:04:46

        That is really awesome! My psych is really good looking and smart, but he doesn’t go into that kind of thing.

      • Mental Mama
        Apr 06, 2015 @ 12:40:36

        She’s amazing. She and my therapist work in the same practice, so when I’ve had major issues in the past it was very easy for them to consult and determine the best course of action for me. But her being so into the whole person thing is just great. Did you know that when you have a virus, like a cold virus even, it can effect the way your meds work because the virus doesn’t just bother your respiratory system (for our cold example) but it also touches all of the major body systems.

      • somberscribbler
        Apr 06, 2015 @ 12:42:58

        It sounds like really good treatment. I wish we had something like that here. We probably do actually, it would cost the big bucks though.

      • Mental Mama
        Apr 06, 2015 @ 14:00:20

        One of the biggest advantages of working for the university is that I have excellent health insurance. Without it I would never be able to pay for care like this.

      • somberscribbler
        Apr 06, 2015 @ 14:05:28

        jealous!!

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