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.

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Resources: Ahn, Proctor and Flanagan, 2009

Babble from the Dark Side

I’m in that bad head space again. It really just sneaks up on me sometimes. I was fine this morning and now, I just don’t know how to exist. I keep trying to distract myself but nothing is working. I just hate myself so much. I want to start punching myself in the head or scratching up my wrists. That’s what I deserve. What’s that going to get me though? I’ve done it before. It’ll sting or I’ll just get sore and bruised and I will STILL hate myself. On top of that I’ll feel lame for doing it. Who punches themselves?!

Why am I working so hard on this motivation stuff? Am I hoping that one day it will all magically come together and I wont have to work so hard at it? I’m kidding myself if that’s the case. It’s hopeless. Existing will never come naturally to me. Working hard is never going to end, I’m never going to get a break. There’s no top of the mountain to reach, I just have to keep going up and up and up.

Some people put their lives on pause. They take time off work to get better. If I did that, would I actually start to feel better? I have a feeling I would just end up guilty, depressed and jobless. It’s not like anything would be different if I took time off. What would I do with the time? I can’t use the time for therapy that’s not available to me. It seems like help is only available to those who have “real” mental illnesses. Whatever that means. I’m not hurting others and I’m not holding a gun to my head, therefore I don’t count? I understand, there’s just not enough money or manpower to help everybody. Besides, I don’t really want to hurt myself, I just don’t know how to live with myself.

I feel like happiness is too much to ask for. I don’t deserve it anyway. Apathy would be nice though. It would be nice for things not to matter so much, for things not to be so difficult all the time, to not have to force myself to do everything. I just want to get up and go about my day and not think about it. I envy people who can just do what needs to be done without thinking about it. Why do I have to think so much?

I can’t stop the thinking. I’ve been trying to just do what needs to be done, to stop dwelling, analyzing and dreading and just do it. When I do this, my dreams tend to get unpleasant. I dream about the tasks I have to do and all the things that could go wrong. I know it’s just a dream and I am catastrophisizing, which is a cognitive distortion, but I still wake up tired and stressed. Being tired and stressed makes it harder to maintain the whole not thinking and just do it thing. It’s a cycle you see. The fact that I know I’m in this behavioural cycle that is completely irrational just makes me angry at myself.

Is it possible to be overly confident and have low self-esteem at the same time? I have low self-esteem, I always have. I remember getting check marks in the “needs improvement” category under self-esteem on my elementary school report cards. At the same time, I have this expectation that I should be better than this. I need improvement? I shouldn’t need improvement, I should be the best. That’s why those check marks hurt so much. I remember really crying over it, getting a stomach ache and throwing up.

what you see

The Ball of Shame

Happy St. Patty’s!!

Happy St. Patrick’s Day!

My Dad’s side of the family is Irish. We’ve been in Canada for generations, but one of my great uncles still had an Irish accent. It was awesome. I live in Montreal and we have a rather large, close-knit Irish community. There are St. Patrick’s Day Galas, a pageant to select the Queen of the Parade, special Irish breakfasts, everything and everyone downtown turns green and the Irish pubs go nuts! People are all dressed up in crazy outfits and drinking green beer on the streets. It’s actually a lot of fun.

My cousin runs the pageant. She was queen once herself. It’s not a typical pageant. It’s more like a public speaking contest. Contestants have to introduce themselves and their Irish background. They prepare a speech on Irish history or literature and they have to answer a current events question on the spot. Whoever is elected queen gets a trip to Ireland, leads the parade and spends the year volunteering in the Irish community. It’s a pretty good program.

It has become a tradition for my family to watch the parade together and then retire to my aunt and uncle’s place for Irish coffee and food. Every year we gather on the same street corner to watch. Kids, adults, dogs, the lot of us, plus our friends. There is usually about 25 of us.

Yesterday was parade day…..and I didn’t go. It’s not that I didn’t want to. I enjoy the parade, especially the music. I even bought a green sweater to wear for the occasion! It’s also been a while since I’ve seen my extended family. I’m dying to see them. So what’s the problem? I don’t want them to see me. Do you ever feel that way? It’s kind of a weird state to be in. It’s not like I have anxiety about it or don’t have the energy for it, which is usually the case. Maybe ashamed is the right word? I’m ashamed of myself.

My family is going to want updates on what has been going on. I don’t know what to tell them. I’ve stagnated at work (or school, whatever you consider Ph.D. work to be). My own research is stuck in ethics, I’m having trouble getting volunteers for the other studies I am involved in and I have no publications to report. Then, there is the bad news about my husband’s job (see yesterday’s post). On top of that, I’m fat and ugly and my clothes don’t fit nicely anymore. I have been gaining weight (thus why my clothes look bad), my skin is a mess and I haven’t washed my hair. This is not how I want the people I care about to know me.

So you think maybe I should have put on my best clothes, gone and kept the conversation focused on them. Impossible. My cousins are the type of people who look you in the eye, ask how are you? and actually wait to hear the response. I can’t avoid talking about myself a bit. So I stayed home. I missed out on my family, the fun I could have had and the memories I could have made. This makes me sad.

I should just put real clothes on and go. That’s what I usually end up doing, forcing myself out the door everyday. For some reason, this time, I can’t and I can’t quite explain why. Just get over it I tell myself, they are your family, they will love you anyway. I know this is true, but it doesn’t seem to help. I want to be successful, confident, pretty, fit and charismatic. Don’t we all right? Sometimes I pretend that I am. I fool my friends and co-workers pretty well. Acting gets to be exhausting though. Family and very close friends are different. I feel guilty putting on a show for them. It’s not really me after all. I’m so afraid of being less than what they expect. I don’t want to disappoint them. Now you say, you are disappointing them by not going. I know that too, but it doesn’t compare to the disappointment they would have in interacting with me.

The Ball of Shame that holds me hostage

So now we have fear, sadness, guilt and shame cycling through my head. Are these feelings what is keeping me housebound? Is that it, or is there more to it? I don’t want that to be it. Seriously?! Feelings are stopping me from doing things? That makes me angry at myself. I think I’d feel better if there were some sort of physical barrier stopping me or someone holding me hostage.

Usually my posts are a little more upbeat. I try to talk about more positive experiences or at least experiences where I have learned something, but I’m afraid I just haven’t figured this one out yet. Have any insight? I’ll be sure to let you know when I do.

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