Using writing, and meditation, and ice cream, and reading, and dreams,

and a whole lot of other tools to rediscover who I am,

after six years living with a man with OCPD.

Thursday, April 19, 2012

A-Z: Question - What Causes Mental Illness, Anyway?

PET scan of a human brain with Alzheimer's diseasePET scan of a human brain with Alzheimer's disease (Photo credit: Wikipedia)What causes mental illness? Genetics? Environment? Trauma?

We have many more questions about mental illness than we have answers. But we are beginning to put some of the pieces together.

As we are learning to scan brains in various ways, and see parts of it that are over- or under-active, enlarged or shrunken, it becomes ever more evident that when they say mental illness is "all in your head," that's literally true.

Many mental illnesses look very much like what happens when we know someone has suffered a brain injury; a bad fall, a war injury, or a stroke.

After Brain Injury: The Dark Side of Personality Change (Part 1)

The author here describes building a new relationship with her husband after his massive heart attack and cardiac arrest caused a severe anoxic brain injury.
Most of the time, Alan displayed his engaging pre-injury personality marked by kindness, love, curiosity, and humor. However, post-injury personality changes also meant that we dealt with bouts of intense anger, confusion, and unpredictable behavior. Sometimes his moods shifted so suddenly that I called it "Jekyll and Hyde syndrome." It was as if two versions of Alan resided within him. One was rational and easy-going, but the other was frightening and even dangerous at times.

Why brain injury affects emotions

First, some background. Brain injury sometimes causes subtle or pronounced changes in personality. Damage to specific areas of the brain, including the frontal and temporal lobes, amygdala, and hippocampus might leave the survivor vulnerable to agitation, volatile emotions, memory impairment, verbal attacks, physical aggression, and impaired impulse control.

Psychiatric issues after brain injury

Brain injury can also contribute to psychiatric issues including depression, severe anxiety, substance abuse, or obsessive compulsive disorder. Some survivors experience post-traumatic stress disorder (PTSD) as a consequence of the circumstances and medical events that caused the brain injury. In addition to damage to specific areas of the brain, Alan's brain injury disrupted the production and function of neurotransmitters that influence mood and thought regulation.
We quickly learned that anxiety or depression made Alan more susceptible to angry outbursts or threatening behavior. He often responded well to the judicious use of medications to modulate depression, anxiety, and agitation for years after the injury. We never used medications in place of attention, communication, behavioral strategies and keeping environmental stimulation within his comfort zone. However, I came to appreciate their value.
Emotional Lability
In some cases, neurological damage after a head injury may cause emotional volatility (intense mood swings or extreme reactions to everyday situations). Such overreactions could be sudden tears, angry outbursts, or laughter. It is important to understand that the person has lost some degree of control over emotional responses. The key to handling lability is recognizing that the behavior is unintentional. Caregivers should model calm behavior and try not to provoke further stress by being overly critical. Help the person recognize when his/her emotional responses are under control and support/reinforce techniques that work.
Self-Centered Attitude
The person who has survived a head injury may lack empathy. That is, some head injury survivors have difficulty seeing things through someone else's eyes. The result can be thoughtless or hurtful remarks or unreasonable, demanding requests. This behavior stems from a lack of abstract thinking.
Help cue the person to recognize thoughtlessness. Remind him/her to practice polite behavior. Realize that awareness of other people's feelings may have to be relearned.
We're finding out that people with a certain genetic component might be more vulnerable to Alzheimer's disease. As our living environments become ever more compromised with pollutants, we know that children growing up in certain areas become more prone to certain types of cancer and other birth defects. But not all children growing up next to the Love Canal developed cancer. Certain physical problems seem to require both a genetic and an environmental component.

from WebMD:
What Biological Factors Are Involved in Mental Illness?
Some mental illnesses have been linked to an abnormal balance of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or are not working properly, messages may not make it through the brain correctly, leading to symptoms of mental illness. In addition, defects in or injury to certain areas of the brain have also been linked to some mental conditions.

Other biological factors that may be involved in the development of mental illness include:

Genetics (heredity) : Many mental illnesses run in families, suggesting that people who have a family member with a mental illness are more likely to develop one themselves. Susceptibility is passed on in families through genes. Experts believe many mental illnesses are linked to abnormalities in many genes -- not just one. That is why a person inherits a susceptibility to a mental illness and doesn't necessarily develop the illness. Mental illness itself occurs from the interaction of multiple genes and other factors --such as stress, abuse, or a traumatic event -- which can influence, or trigger, an illness in a person who has an inherited susceptibility to it.

Infections: Certain infections have been linked to brain damage and the development of mental illness or the worsening of its symptoms. For example, a condition known as pediatric autoimmune neuropsychiatric disorder (PANDA) associated with the Streptococcus bacteria has been linked to the development of obsessive-compulsive disorder and other mental illnesses in children.

Brain defects or injury: Defects in or injury to certain areas of the brain have also been linked to some mental illnesses.

Prenatal damage: Some evidence suggests that a disruption of early fetal brain development or trauma that occurs at the time of birth -- for example, loss of oxygen to the brain -- may be a factor in the development of certain conditions, such as autism.

Substance abuse: Long-term substance abuse, in particular, has been linked to anxiety, depression, and paranoia.

Other factors: Poor nutrition and exposure to toxins, such as lead, may play a role in the development of mental illnesses.

Personally, I suspect that for many with substance abuse problems, it's more a vicious circle. A person with undiagnosed symptoms of mental illness began self-medicating with alcohol, or cocaine, or crystal meth, and as the addiction grew, any relief continued to shrink. While meanwhile, the person's drug of choice was wreaking havoc on his/her body.

Back to the brain trauma issue; it's entirely possible to have clots, growths, and mini-strokes inside the brain, large enough to affect the personality; but entirely unrecognized. I know a young woman recently diagnosed with epilepsy. She had previously been diagnosed with bipolar disorder, but taking a closer look, her doctors said that her brain appeared to be having periodic "lightning storms" inside it, which affected her behavior, even though she did not exhibit what most people think of as epileptic symptoms.

There's probably an emotional component to mental illness as well. Living in a home where emotional, physical, or sexual abuse sends fight-or-flight hormones flooding the body might send a child who already had a tendency towards mental illness, firmly over the edge. Even if the child is not the target, being a regular witness to his mother or her father being abused, must leave lasting damage.

But I think it's time and then some to stop blaming all mental illness on "bad childhoods/bad mothers." Clearly, many people endure them, and somehow, become neither mentally ill, nor abusive, themselves.

In another few decades, I suspect there will be fingertip blood tests for certain neurotransmitter levels linked to mental illness symptoms, as there are now for diabetics and their blood sugar levels. Wouldn't it be wonderful if those with certain mental disorders could take smaller doses of mood-regulating meds only when they needed them?

We all have brains, and we all have bodies, and pretty much every human being has Issues. Nearsighted. Allergic to cats. Digestive problems. A tendency to ingrown toenails.

Perhaps instead of taking pride in the fact that "at least I'm not crazy," we should count our blessings.  Realize, just because we fall in that category today, things could change for us, or someone we love, tomorrow.

My A-Z theme is Issues related to Mental Health or Mental Illness.

Have you ever known anyone who experienced 
 a traumatic brain injury?
Have you ever participated in a study on mental illness?
Why or why not?

Enhanced by Zemanta