Rethinking the Potential of the Brain in Major Psychiatric Disorders

By Steven Morgan (steven@vermontrecovery.com)

I. Questionable Theories

The human brain is likely the most complex structure in the
Universe. Even though it produces our understanding of the world, we
are still in our infancy of understanding it. Even so, technological
advances in the past few decades have produced images that allow
researchers to observe different parts of the brain reacting to stimuli
in real time, and also to measure variations in brain structures to
compare populations. Alongside these developments, the field of
psychiatry has increasingly sought after and put forth biological
explanations for psychiatric disorders. With the influence of billions
of advertising dollars from pharmaceutical companies,[1] these theories
have been simplified and sold to laypeople in the form of "mental
illness is caused by a chemical imbalance in the brain."[2]

For someone who is newly diagnosed with a major psychiatric disorder,
such an explanation can provide relief. It offers a reason for extreme
behavior that s/he may find shameful or bewildering, and it assures
family members that they are not at fault. Blaming the brain also
discredits the self-denigrating notion that one's inability to cope
with psychological problems is connected to weakness of character.

Yet there are serious repercussions for endorsing these theories.
People who believe that chemical imbalances underlie psychiatric
disorders are likely to believe that medication must be used as a
corrective measure, often for life. They are also likely to overlook
the causative influence of socio-cultural factors and histories of
trauma and abuse. Even when theorists do acknowledge that environmental
stressors play a role in the development of psychiatric disorders, they
often refer to them as "triggers" of the underlying biological
problem. In other words, the problem still originates from and remains
within the diagnosed person. Finally, according to a recent study,[3]
associating psychiatric disorders with faulty brain chemistry actually
increases public stigma: "Biogenetic causal beliefs and diagnostic
labeling by the public are positively related to prejudice, fear and
desire for distance."

Underlying the debate of whether brain-based theories are helpful or
harmful are far more important questions to ask: Are these theories
even true? Are psychiatric disorders caused by brain diseases and
chemical imbalances? And if they are, can the brain change, heal, and
grow out of them?

Answers to these questions deeply influence whether workers –
especially psychiatrists and medically-oriented professionals –
believe that people with diagnoses can make complete recoveries, and
they equally influence the hopes and aspirations of people who are
diagnosed. However, as a layperson, it can be extremely difficult to
investigate such material. Most people are not educated in the
neurosciences, nor do they have the will or resources to explore the
vast research literature that informs psychiatric practice.
Furthermore, since science is equated with truth in Western society, and
since doctors are equated with science, many people are conditioned to
entrust psychiatrists with providing accurate and tested information.
Thus, questioning medical wisdom is somewhat deviant, and attempts at
challenging psychiatric theories may be quieted by self-belittlement
– "What do I know?" – or rejection from social groups
who endorse the dominant paradigm – "Doctor knows best."

Yet as the consumer/survivor/ex-patient movement increasingly demands
that mental health workers perceive clients as harboring untapped
potential, so must workers and clients make efforts to re-examine their
assumptions about the brain.

II. A New Science, A New Brain

Traditionally, the adult brain was considered relatively hard-wired and
fixed, a prognosis that lowered expectations about the possibility of
curing the alleged brain problems that underlie psychiatric disorders.
Thus, in the medical world, schizophrenia and bipolar disorder have been
conceptualized as life-long, incurable brain pathologies that a person
can learn to manage, but never completely resolve. However, these
hypotheses have always been problematic, for longitudinal studies have
demonstrated again and again that a significant amount of people
diagnosed with schizophrenia completely emerge from psychiatric symptoms
and no longer use medications.[4] These individuals pose this challenge
to neurobiology: if their previous symptoms were in fact due to a
broken brain, are their brains now fixed?

The simple answer is yes, and a new area of science is explaining how
and why. (It should be noted that scientists could obtain a wealth of
information from comparing PET and fMRI scans of people who have
completely recovered with people who are still experiencing similar
psychiatric symptoms, but that more research is needed). This area of
science is called neuroplasticity, and its findings are rapidly
reversing old myths about the potentiality of the brain.

Neuroplasticity basically refers to the brain's natural ability
across the lifespan to form new connections and change its structure in
response to experience. This means the brain can change itself
physically and functionally at any age to compensate for injury and
disease and to adapt to new situations or changes in the environment.
Whereas the brain was once conceptualized as a machine, it could now be
thought of as more like clay, both malleable and vulnerable towards
positive and negative influences. Of course, there are limits to how
much the brain can change, reorganize, and heal, but these limits are
not as imposing as might be assumed. Indeed, harnessing the power of
neuroplasticity, people are fully recovering from massive strokes and
other head traumas, overcoming learning disabilities to leap ahead in
reading levels in a matter of months, rewiring obsessive-compulsive
behavior out of their brains, erasing the pain of phantom limbs,
restoring memory acuity and cognitive processing during old age,
learning to see without eyesight, strengthening muscles just by thinking
about them, meditating to create lasting neurological states that are
conducive to compassion and happiness, and on and on.[5] [6]

The message here is that the brain changes. This means that
it is highly likely that whatever biological correlates underlie major
psychiatric symptoms can change, too. For instance, trauma and chronic
stress change your brain͵ but the areas that are affected can be
changed back or compensated for. More specifically, the amygdala͵
involved in processing emotion and anxiety and shown to be affected by
trauma͵ can form new connections͵ including to the prefrontal
lobes which helps in controlling impulses and exercising restraint.[7]
Gray matter͵ which has been shown to be less voluminous in people
diagnosed with schizophrenia͵ can thicken.[8] Serum BDNF
(Brain-derived neurotrophin factor)͵ which has been shown to be
lower in people diagnosed with schizophrenia͵ bipolar disorder͵
and depression͵ can be raised.[9] The hippocampus͵ which is
shown to have shrunk for people diagnosed with depression and PTSD͵
can grow back[10] and even produce new cells for the rest of the brain
to make use of.[11] Certainly͵ neurotransmission – the release
of serotonin͵ dopamine͵ norepinephrine͵ etc. to allow
communication between brain cells – is variable and can be altered
by natural means͵ ranging from sunlight to thinking positively.
Even psychotherapy can significantly change the brain.[12]

One of the tenets of neuroplasticity is that in order for
the brain to form new connections and change, it must be stimulated
through activity. Whether this activity is external – such as
playing a piano, or internal – such as imagining your fingers
playing a piano sequence, an important factor in driving lasting brain
changes is that you pay close attention to what you are doing. In fact,
playing a piano and just thinking about playing a piano affect the brain
in virtually the same way, as long as you are engaged. The importance
of this point cannot be understated: if thoughts and imagination
physically change your brain, you can therefore use your mind –
especially through focused attention – to positively rewire it.[13]

Not suprisingly, this theme of mind over matter runs in
recovery stories. Indeed, while people who recover often mention
practical activities that helped them – such as eating well (which
can even turn genes on and off[14]) and exercising (which produces new
brain cells and has an anti-depressant effect[15]) – they also refer
to the healing power of intangible experiences: spirituality, hope,
human connection, having meaning and purpose in life, optimism, an
undying will, and awareness. And it is likely that through the power of
neuroplasticity, both the practical activities and the intangible
experiences changed their brains.

To further illustrate this point, consider the experience of
self-awareness, which seems to be particularly important for people who
recover. Self-awareness refers to the awareness of one's thoughts,
behaviors, and actions, and how all of these are intricately connected
with one's environment. Though it is an incredibly empowering asset
that most human beings – diagnosed or not – struggle to achieve,
people who experience emotional and psychological turmoil may be at a
unique advantage to master it, for their survival may depend on their
ability to separate from and analyze the content of their minds. In any
case, self-awareness requires deep attention. And deep attention to the
present moment carves new pathways in the brain.[16] Therefore, a
person who engages in self-awareness techniques – be it meditation
or another form of non-critical observation, is creating new brain
states that overtime can replace or compensate for troubling brain
states entirely.

III. Changing Attitudes

Taken together, the implications and discoveries of
neuroplasticity challenge the traditional framework for understanding
the role of the brain in psychiatric disorders. We can no longer
perceive the brain as acting on its own predetermined accord in a vacuum
to create experiences. Instead, we should conceive of the brain as
fundamentally inseparable from experience, so that whatever happens to
someone both externally and internally has the potential to
significantly alter their brain. This means that people who recover can
be thought of as having likely changed their brain chemistry and
functioning, thus allowing for the possibility that the faulty biology
allegedly behind major psychiatric disorders is reversible. In this
regard, mental health workers should seriously consider eliminating talk
about schizophrenia and bipolar disorder as incurable and life-long.

In fact, there are so many problems with making the simple
statement, "Mental illness is caused by a chemical imbalance in the
brain," that it should perhaps be discontinued altogether. Evidence
that different structures and functions of the brain are pathological in
psychiatric disorders is still highly contentious; it is also well
beyond the scope of this paper. However, given the far-reaching
influence of pharmaceutical companies who have a financial interest in
promoting biological theories – after all, their medications are
primarily justified by the claim that they "fix" biological
problems – it is likely that reductionist statements of the brain
will continue to prevail. Therefore, we should amend these statements.
Here is an example of what a worker could tell a client: "Your
brain changes in response to the experiences you have. Even though
psychiatric disorders show up on the biological level as differences in
the brain's functioning, your brain is not set in stone. In fact,
you can change it, though it will take time and effort. There is much
reason to be hopeful."

Recovery and hope go hand-in-hand, yet there is nothing more
hopeless than believing your brain will forever malfunction without
medication. There is also hardly a more misinformed declaration about
the brain in light of recent science, and especially when considering
the multitudes of people who have completely recovered.

If mental health workers can derive from neuroplasticity
that complete recovery is a possibility given the right elements, then
they will perhaps hold themselves more accountable for the outcomes of
their services, as opposed to justifying poor outcomes by dismissing or
subtly ignoring some people as chronic and hopeless. In this way,
rethinking the potential of the brain in major psychiatric disorders
improves the efficacy of mental health services, revives the energy and
optimism of workers, and ultimately restores hope to the millions of
diagnosed individuals who currently see no way out.

For references to this article please visit: http://www.vermontrecovery.com/files/Download/RethinkingTheBrain.pdf