A False Dawn

[It occurs to me that it is almost a year since I last posted (this took me somewhat by surprise, probably because I think about blogging here really quite a lot and it always feels like I’m just a little behind but I’ll soon catch up – I really must add ‘writing’ to my repertoire alongside ‘thinking’) so I hope the headline to this piece describes only the short piece that is to follow, not another brief flowering of the blog, followed by an ignominious and unnoticed return to a dissatisfied quiescence.]

Theresa May today announced all kinds of vague things in order to ‘transform attitudes to mental health’. There didn’t seem to be much detail – or indeed much funding. There were some smashing soundbites though.

The transformational plans include ideas like every secondary school to be offered ‘mental health first aid training’. I have no idea what this is. I’m not sure I like the sound of it. I definitely don’t like the sound of having to have an online symptom check before getting an appointment. To be fair, trying to make people less reliant on GPs and A&E for MH issues, which the Government promises, is a good thing (but not if they’re directed to a website instead). Improving support in the workplace is also good (depending what ‘support’ means), as is not making children travel out of their local area for mental health treatment (depending on what ‘local’ means and what ‘treatment’ means).

However, I can’t help but think that the Government is painting a very narrow picture of what mental illness is and how it can be treated. I fear we are being presented with a straw man that fortuitously can be addressed by what the Government wants to do. They have worked backwards from the solutions they believe they can implement and made them fit a particular presentation of mental illness, rather than wondering what the problems really are in the first place and how they might actually be addressed with a degree of efficacy.

(As a counter to this, this is an excellent piece that looks at the problems and then suggests solutions to address them https://paulkirby.net/2016/12/07/on-mental-health-weve-got-it-so-wrong-money-alone-cant-fix-it/ )

With no new money to go with these new ideas, it remains to be seen if this is simply yet another vacuous nod in the right direction.

Neuroscience of little value in treating mental illness

This thought-provoking article at the ever-brilliant Aeon site – https://aeon.co/essays/why-can-t-we-treat-mental-illness-by-fixing-the-brain – unequivocally punctures the notion that neuroscience is solving, or will solve, all ills.

By assessing the progress in medical science relating to other organs compared to that of the brain, it’s easy to see just how far behind we are in understanding the brain. Neuroscience is barely scratching its wrinkly grey surface.

Really, we shouldn’t be surprised. This article reminds us of the way neurons work:

“Neurons work in a particular way: the brain is an electrochemical machine. Each neuron is activated by a chemical released from another neuron: this then initiates an electrical signal that passes down the neuron’s fibre and, in turn, releases another (or the same) chemical onto the next neuron. But this isn’t a simple chain: each neuron can communicate with about 10,000 others, meaning that the permutations are unbelievably huge. There are around 100 billion neurons in the human brain, and around 1,000 trillion possible connections.”

The further problem is that even if we begin to understand the brain at the neuronal level, how do we relate or equate this to the functions of the brain, let alone how those functions translate into feelings, actions, behaviour?

Half way through the article is the fascinating and disturbing insight (that made me wonder, ‘can this really be correct? And if so, why aren’t we all up in arms about it?’) that no-one seems to know if or why chemical treatments for depression work. I quote:

“Ask any psychiatrist what happens in the brain to make people depressed, and she will probably mention serotonin. Serotonin is one of the many chemicals that neurons release. The psychiatrist singles out this one because most of the drugs used to treat depression seem to work by altering its levels in the brain. Altering noradrenaline (a related neurotransmitter) is also effective.

“And yet, there is no evidence at all that the levels of serotonin or noradrenaline in the brains of depressed people are any different from normal. The logic is flawed: you cover a cut on your finger by a sticking plaster, which helps recovery; but the cut was not caused by a lack of sticking plasters. So altering serotonin can speed recovery in some people – and there are those who question even this – without telling us anything about what depression is or how it occurred in the first place.

“At present, a pathologist looking at the brain of a depressed person could not distinguish it from the brain of someone who was mentally well.”

For an amateur like me, this is astonishing. Does everyone who works in this field know this? Is this old news?

The article goes on to describe the shortcomings of trying to classify mental illnesses (in the ever-burgeoning DSM for example) but for most people, I presume that this argument is pushing at an open door.

This excellent article was, for me, let down only because it excluded other solutions to mental disorders. It concludes with ‘neuroscience has no credible experimental model of any psychiatric illness’, followed by a wish for psychiatry to one day be refined enough to deal with all of these problems, probably chemically. However, what the whole article seems to indicate to me is that mental illnesses and disorders have their root in systemic, developmental and existential factors – all places that this article resolutely refuses to go.

So rather than looking to change the brain chemically, how about we look at changing society, the way we raise children, the role of religion, understanding what makes a good and satisfying life. Why do we insist on tinkering with the symptoms rather than addressing the causes?

As a society, investing in building on our body of knowledge around child development (and disseminating this knowledge widely) and in providing therapy to adults will surely pay rich dividends? For those of us lucky enough to live comfortably without fear of war or famine, our challenges are existential. To ignore that because it’s too airy-fairy is to ignore its consequences: growing mental illness and unhappiness, further schisms in society, religious extremism, damaging jingoism. The fabric of society is already under tremendous strain. Let’s not let it be torn apart while we search for impossible quasi-solutions.