towards a new view of mental health

There has been much talk recently of increasing awareness of mental health issues1 – but of course most of the discussion is centred around mental illness – not health. There are valid points to be made: we need more resources on a par with physical health. We need to continue the discussion on releasing stigma, etc. But this does little to address the current gap between provision and need. And I am not talking here about economics. I am talking about the model of mental functioning that is still in the dark ages in terms of understanding and treatment.

With the idea, still enshrined in the current medical system, that disease is either physical or mental, the mental disease system looks primarily to a defunct idea i.e. that disease is a failure of a machine-like part (of the body or brain respectively) for unknown reasons and needs pharmacological intervention to fix the broken part. This ignores the reality that the brain is part of the body and mental functioning is interacting with the gut (and its myriad microbes), the neuro-endocrine system and a deeper level of energetic exchange with our environment that may involve light. This is a quantum understanding, that understands us to not be separate from our environment but in dynamic exchange with it. In short, it is a systems approach.

Thus you cannot separate out a human from their social, spiritual (meaning, purpose) and physical lives. Health or disease is along a continuum whereby the various inputs from these arenas is combined to give an overall message of safety or threat. When under threat, the systems are geared towards survival and away from social interaction, we may find ourselves feeling increasingly anxious and isolated for reasons we cannot understand. For some the dysregulation of the system may become so acute it may lead us to a variety of distress behaviour which then get labelled as is the current vogue in psychiatric circles e.g. Attentional Hyperactivity Disorder (ADHD), Bipolar Disorder, Oppositional Defiant Disorder, Dissociative Identity  Disorder (DID) and so on. They do nothing to help our understanding as they are simply labels with no physiological correlation whatsoever. If someone is distracted, manic or angry, what does this tell us about the deficits in their lives as opposed to their brains (deemed the sole problem area?). Very little. We need a new model, one that informs a patient-centred (I know, much derided term) individualised approach. What causes anger, anxiety, mania in each person will be the sum total of that persons experiences in the world and their somatic interpretation of that world. It is a construct and as such is subjective. It makes a mockery of the disease categorisations which are no more than descriptive non-entities.

But there are some commonalities to each condition which lead us to a more unified understanding: the brain is organised in a hierarchical fashion with systems of increasing sophistication coming online as we grow and develop. The most primitive survival based systems are usually inhibited by the more sophisticated systems, allowing this dynamic interplay between a person and their environment. Much of this is described in what is termed Polyvagal theory2 discovered by the researcher Stephen Porges and developed by others in their clinical work.  This posits that mammals have developed a sophisticated social engagement system which inhibits the more basic ‘fight and flight’ which, in turn, supplants the reptilian freeze response. In fact it allows us to regulate our heart rate at a slower rate so we can interact, be creative, have sex, nurture our children and so on. It does this via a system that comes online gradually after birth, mediated by a branch of the vagus nerve distinct from the slow freeze response vagus called the  ‘smart vagus’  Both are part of the autonomic nervous system (along with the fight and flight system) but this relatively fast response system is dependent on social interaction, especially with caregivers early in life, for its healthy functioning. If something in those early years goes wrong: a parent with mental health issues, addictions, unresolved grief or events like hospitalisations (enforced immobilisation as far as the body is concerned), significant bereavements, bullying, etc, will cause a sensitised brain to fail to develop these circuits properly and the person may develop mental health issues in later life, with the one of the labels we’ve previously mentioned.

At the heart of this is trauma – but it is not necessarily those large issues that everyone thinks of. It can be smaller, repetitive issues that crop up and are interpreted by that person as an ongoing inescapable threat. This may result in all sorts of physical syndromes ‘Medically Unexplained Symptoms’ such as IBS, CFS/ME, chronic pain syndromes like Fibromyalgia and so on. So, we need to update our treatment to understand these research corroborated truths (incomplete though they are) as they offer not only a better treatment model (which uses methods of inducing bodily safety as the mode of calming the system), but also, crucially hope. Without hope, no medical system that deals with human lives can ever be truly healing. It is only mopping up the spillage, so to speak. We have to engender a belief in the ability of the human mindbody to reconnect with itself in a healthy way, without labels, without silos and definitively with compassion and understanding.

So, I leave this blog with a note of encouragement. Reject the current system, introduce your friends to these ideas and spread the word. there is health and healing available to all, we just need the right information.

  1. See the Mental Health Awareness weeks and articles in the press such as ‘Don’t talk to me about feeling blue’ by Hannah Jane Parkinson, the Guardian weekend  30/6/18
  2. Please see my other blogs which go into polyvagal theory in more depth.