Mental Disorders As Brain Disorders

I first encountered Thomas Insel's work during an Ethics class as part of my nursing program, well before I was ever involved in any sort of advocacy around eating disorders and mental health. I was struck by his conception of mental health disorders. His articulation brought up thoughts and feelings I had already been mulling over for some time concerning the term "mental" health.

But first a bit of background.

Thomas Insel is an American neuroscientist and psychiatrist who worked for many years at the National Institute of Mental Health in the U.S. He delivered a TED talk in 2013 on re-conceptualizing mental health disorders as brain disorders.

This idea can be a bit hard to swallow at first and there are important aspects of mental health it leaves out. What was most striking to me about his argument was that it highlighted how deeply ingrained in our language Cartesian dualism still is. That is, that the mental and physical aspects of us are separate and distinct.

This is a longstanding view and it ties into religion as well as early philosophical inquiry into the nature of human experience. Perhaps not the first, but a notable place to trace back the splitting of the mind and body to, is the 15th century, in the work of French philosopher, mathematician, and scientist Rene Descartes.

"According to Descartes, two substances are distinct when each of them can exist apart from the other. Thus, he reasoned that God is distinct from humans, and the body and mind of a human are also distinct from one another. In his work Meditations, Descartes discusses a piece of wax and exposes the single most characteristic doctrine of Cartesian dualism: that the universe contains two radically different kinds of substances - the mind or soul defined as thinking, and the body defined as matter and unthinking. Descartes' dualism of mind and matter implied a concept of human beings. A human was - according to Descartes - a composite entity of mind and body. Descartes gave priority to the mind and argued that the mind could exist without the body, but the body could not exist without the mind. In Meditations, Descartes even argues that while the mind is a substance, the body is composed only of "accidents," but does acknowledge that mind and body are closely joined."

This splitting of the mind and body is appealing to our subjective experience of the world. It is difficult and uncomfortable to wrap one's mind around our thoughts, feelings, memories, dreams, and so on as being electrical and chemical activity in the brain. Incredible complexity arising from simple structures (in this case neurons and other types of supportive cells in the brain) is challenging to understand, but repeated throughout the natural world (e.g. insect colonies that function as an organized whole).

Even in our current culture, in medicine, and other areas of science, it is still common to use terminology that separates the mind and body. We talk about "mental health", referring to the mind as distinct from the body and it is this point that Thomas Insel takes issue with. As a neuroscientist and psychiatrist, he has spent his career studying the brains of mentally ill people. As science has advanced we have been able to visualize the brain which has allowed researcher's such as Insel to note the physiologic differences in the brain's of patient's with different mental health diagnoses as compared to control subjects.

In eating disorders for example, a number of physiological differences can be noted (although sometimes these can be difficult to distinguish as being either a cause or effect). Multiple research studies have examined the brain's of patients with eating disorders finding differing levels of neurotransmitters, altered brain volume due to illness, differences in brain structures (such as in the orbitofrontal cortex), and insular impairment

Research and understanding are still developing in this area, but they already pose a question, should we be changing the language to refer to mental health disorders as brain disorders? Thomas Insel says yes.

I personally think there are number of pros and cons to this argument. In my personal experience, the splitting of the mind and body has some very harmful effects in that it perpetuates a great deal of stigma. The arena of "mental" health is seen as being within a person's control (which is a whole other important conversation that I won't explore in this particular blog post, but perhaps in the future...) We do not look at disease in the body with the same degree of blame (necessarily.) As the comedian and mental health advocate Ruby Wax poses "how come every other organ in your body can get sick and you get sympathy except the brain?"

It is not as simple (or at all accurate) to reduce people's struggles to character flaws and that is the risk we run when we continue using language that separates the body and mind. That they are choosing to be that way. Choice is complicated.

What I worry about if we did change our language and understanding of mental disorders as being brain disorders, is that it is still important to address causes beyond the individual brain (which Thomas Insel isn't necessarily denying, he just doesn't address them.) Someone does not develop an eating disorder simply because they see thin models or celebrities in the media; eating disorders are not simply young, white, middle-class women who suffer a great deal of vanity. BUT, these socio-cultural influences DO play a role and if we only talk about mental disorders as being brain disorders we might miss the work there is to do on environmental and cultural factors that contribute to these issues.

It is complicated to locate causes as they are often multiple. The description I always fall back to is that genetics loads the gun and environment pulls the trigger. People are born with or develop certain susceptibilities and their surroundings can trigger a cascade of effects that result in a diagnosis of mental illness.

Whether we do or don't change our language (which reflects our pre-conceived notions), it is an interesting topic to ponder.

Check out Thomas Insel's TED talk below:

-S. Ritchey