Recently the New York Times published a challenging essay by Benedict Carey, a Times science reporter, that offered a brisk perspective on a challenge we all face, mental health.

https://nyti.ms/2DwXrRr

I found this essay quite powerful in a number of ways.

The first point to be made is that the satisfactory function of our human minds turns out to be a complex expectation.  The usual way this is described is to talk about the percentage of people who will experience a mental health crisis severe enough to qualify for a diagnosis.   That number is surprising, often quoted to be as high as 25% of all humanity, or higher.

My own sense is that unpleasant feelings and thoughts are experiences that far more than 25% of humanity have, and that it is more accurate to say such experiences are common to us all.  I think there are very few people who live life without some seriously upsetting feelings and thoughts that at times keep us from functioning the way we would like.  I understand this as a reflection of the fact that the human mind is a vastly complex product of evolution, way out on the tree of life, and in many ways is a phenomenon that has not yet been fully evolved.  Time has led to the mental functioning of apes to expand to the level of human thought and feeling, and to a certain extent that transformation has not yet reached a stable conclusion.  To put it another way, our powers often exceed our understanding and ability to manage.

Of course, there are ranges of difficulty our emotions and thoughts create, and some moments of feeling overwhelmed can be more fleeting than others.  And this is where the article takes up the story.   For so many of us, at least 25% of us, the impact can be sustained and truly interfere with our ability to function normally at work and/or home.

Past Theories of Mental Illness

The first observation made is that we have been struggled, as humanity, to explain severe impairments in mental health for as long as recorded history allows us to see the older understandings.   Various theories are cited, including Aristotle’s theory of “badness of spirit,” Galen’s theory of an imbalance of elemental fluids [that’s where the term melancholia comes from], the impact of halted emotional development and persisting conflicts (Freud), and an uneven synthesis of thoughts and feelings (Jung).  This is of course a very short sample of theories.  But the essay observes that none of these theories led to the actual release of the impact of severe impairment of mental functioning.  Each failed.  The theories were proposed, all put into practice, and the scourge of mental illness continued.

The Rise of the Biological Theory of Mental Illness

Over the last 40 years, the dominant theory of mental health impairment has been biological, the appearance of these impairments reflects known abnormalities of the function of the neurons of the brain, and the prescription of medications to alter the chemistry of the mind will bring recovery and release.  Along with the emergence of this biological understanding came a shift in the description of mental health problems away from a discussion of people’s relationships and experiences, and more towards lists of symptoms.   The definition of nearly all mental health illnesses became an official list of symptoms contained in a single reference book, the DSM, now in it’s fifth edition, the DSM-V.

As the biological theory of mental illness became dominant, searches for biological models, seen in actual people, for mental illness, began to command the most attention.  Key to this effort were attempts to describe abnormal patterns of physical structures of the mind, as well as patterns of genetic abnormalities.  Some of these patterns have been discovered and described, and opened the door to current hopes that we can achieve an understanding of how the mind works by describing its physical functioning.  And as that goal is achieved, the hope remains very strong that we may achieve a physical understanding for when our mind’s functions cause serious trouble.

The Limits of Biological Theory

Perhaps the most compelling part of this essay comes when the author takes a step back and reflects on the fact that although some highly select and infrequent mental health problems have yielded physical clues to their cause, the vast majority of us who suffer from serious mental health issues have situations for which biology remains quite, quite far away from explaining.

What the essay observes is that for a vast majority of people who struggle with mental health issues, it will be experience rather than biology, for now, that may offer the best hope of recovery.  Once again, working through the complexity of actual experience, past traumas, the nature of the emotional and thought issues, talking with others, remains the key to improving function.

It is moving to see the patterns of seeking better function.  It is moving because the need remains so deep and broad, so many people struggle that nearly everyone has either struggled themselves or loves someone who does or has.  And still, no theory of mental illness has yet solved the challenge of it to this day.

BOTTOM LINES

1. The function of the human mind is considered by many to be the most complex set of functions yet known in our universe.  It is a level of complexity still quite novel in the realm of biological systems on Earth, and as such is very likely a work still in progress.  There is little doubt that over the long length of evolutionary time, the functions of the human mind will be different.
2. Given the inherent complexity and instability of our minds, it is no surprise that two facts define our experience with our feeling and thinking- a great number of us struggle with our thoughts and emotions, and few theories have yet emerged to really relieve humanity of the suffering from mental health issues to a fully reliable level.
3. The current, dominant theory of mental illness is the biological theory which posits that our troubles will one day be able to be described in purely biological terms, such as the actual wiring of our neurons, the way in which they communicate with each other,  and the definition of our genes.
4. And yet, for the vast majority of us who experience serious mental health dysfunction, the biology simply is not yet developed enough to reliably end our suffering.  The development of categories of symptoms and medications associated with each category have helped many, but the burden of mental health dysfunction remains profound.
5. A turn back to one’s experiences, including relationships, is emerging as a more potent concept now.

But, even having said all this, the time when humanity will see a substantive resolution of the terrible burden the dysfunctions of our thinking and feeling still appears to be in the future, requiring all our communities to help each other as these troubles appear.

To your health,
Dr. Arthur Lavin