Are We On the Brink of a New Understanding of Mental Health?

I certainly hope so, and perhaps especially so as Suicide Prevention Month draws to a close. But what I have in mind may not be exactly what the linked article suggests.

The linked article (https://www.economist.com/science-and-technology/2024/04/24/many-mental-health-conditions-have-bodily-triggers, with apologies for those who cannot read it because of a paywall) addresses some very interesting ideas. It includes references to apparently “mental” illnesses that turned out to be caused by autoimmune dysfunction brought on by infections or antibody reactions, and a suggestion from serious research that a wide array of mental illnesses from schizophrenia to anxiety may be caused by a single common, minor genetic defect. There is reference to the growing recognition of the correlation between inflammation in the central nervous system and depression. Every week there is at least one new article suggesting that traumatic events have lasting biological impacts, and that explains all that ails us.

Is Everything Biological?

The thrust of the article is that we may be on the brink of a panacea in which physical treatments will be found for mental conditions, and we can finally be done with the failures of psychiatry and psychotherapy. I emphasized those words to suggest that, even in arguing for this brave new world, the paradigm continues to reflect the basic problem, which is that we treat mental health as separate from health.

The problem is that thinking we will find a biological explanation for all mental distress simply kicks the can down the road.

First, it retains the notion that we will only take mental health seriously when we think of it as physical. Why? Why should our experience of ourselves as suffering mental pain be treated as any less “real” than the pain when we stubbed our toe? Second, it perpetuates the myth that biological medicine will have an answer for everything. Yes, we’ve made huge progress in understanding cardiovascular disease and cancer, and the treatments are ever less barbaric and more promising, but between those two classes of illness roughly 1.3 million people in the US die every year. Similarly, we’re making fascinating discoveries about diabetes and obesity with a whole new class of drugs (incretin mimetics), but have they really moved the needle on the stigma of obesity or the fact that our lives are more stressed and less active while our diet has become less nutritious?

Unfortunately, I doubt that this new “biology will fix all” paradigm will really change mental health stigma very much, and I certainly doubt that it will “fix” everything that ails us.

For one thing, regardless of whether we will ultimately find a biological explanation for all mental phenomena, that’s not how we experience ourselves or the people around us. To be sure, no mental event, no thought, no emotion, no mental pain, occurs without some corollary brain activity. So what? Is that how you experience yourself? Probably not. Do you say to yourself, when your spouse or romantic partner says something stupid and irritating, “well, that’s just their brain”? ?Relevant to Suicide Prevention Month, if you are, or know someone who is, experiencing a major depressive episode and contemplating suicide, does thinking about it as inflammation in the brain lessen the sense of despair?

Maybe Instead, Or Also

How about this, instead or in addition: what if we thought of health and well-being as having both mental and physical aspects and admit that we don’t fully understand how they fit together? What if we just acknowledged that mental health is health? Better yet, what if we started to treat each other with more compassion and respect, and instead of looking for a silver bullet for every problem, we stopped, connected, and listened to one another more often? What if we checked on our family, friends, coworkers, neighbors, and the homeless guy down the street and asked, “how are you doing today?”

Maybe there is a panacea on the horizon, and maybe we are on the brink of a renaissance in how we think about mental health. But I think that renaissance will happen only when we recognize that we are complicated people, whole beings for whom there is no distinction between body and mind, and when we stop talking about "mental health" as separate from "physical health." In the meantime, I'd like to suggest that we stop treating those who struggle with mental health challenges either as pariahs or as poor souls to be pitied, and instead as our neighbors. Because they are.