human behavior

A Springer-esque ‘Final Thought’

Posted in Health & Medicine by humanb on November 13, 2009
The Black Dog

The Black Dog of Depression

I restarted this blog at the beginning of my psych rotation in med school. Today was the last day of that rotation. I don’t know how much I’ll have to say about psychiatry going forward, so I thought I’d consider what I’ve learned: a ‘Final Thought’, if you will. And in true Springer style, there’s nothing scientific about it. But I mean well.

The Sick Brain

The brain is an organ. Like the heart or the liver, it can malfunction. The malfunction may be the result of structural damage, say from a tumor, stroke, Alzheimer’s plaque, infection, or a drug, like alcohol.

The malfunction may also represent an alteration in biochemistry. The brain can begin to produce too much or too little of the chemicals it requires to relay messages. Because the brain is responsible for so many human functions, a structural or biochemical change can cause symptoms that are physical, cognitive, psychological, and behavioral.

So depression isn’t sadness. Sadness is a normal product of a healthy brain in response to negative cues. Depression, like schizophrenia, is a disorder of brain function. In depression, it’s the brain that’s sick, not the heart.


Depression, Artist Unknown

Brain versus Mind

The brain begets the mind. They’re not separate entities though we like to treat them as if they are, because we don’t want to make excuses for bad behavior. We don’t want to medicalize the criminal, the control freak, the constant complainer, the worry wart, the gloomy buzz-killer, or the drama queen. Don’t tell us some jerk has a personality disorder and that some terrible two-year-old has ADHD. And please don’t tell us that hot mess of a girl is just bipolar.

But the fact remains that the mind is a manifestation of brain function. As in other organs, the brain’s function is influenced by genetics and environment. Thus, just as the liver of an alcoholic functions differently than the liver of a teetotaler, so the brain of an abused child functions differently than the brain of a cherished one. Environment shapes the brain, the brain shapes the mind, the mind shapes behavior.

We think that because there are psychologists, psychiatrists and neurologists, that each deals with different things. In one sense they do, but in another, not so much. They all deal with the intangible products – feeling, mind, cognition – of a very tangible and responsive brain. They just focus on different causes and manifestations of malfunction, and employ different methods to heal.


Painting by a manic patient with Bipolar Disorder

The Mental Illness Diagnosis

Diagnosing mental illness is a tricky business. Controversial, too. Diagnoses are probably as often wrong as they are right, because psychiatry has never claimed to be an exact science. It can’t be – not so long as we know so little about the brain. We can’t yet visualize with exactness a brain in the act of thinking, the way we can visualize a heart in the act of pumping. But we’re making progress. We know at least that the malfunctioning brain responds to both pharmacotherapy (drugs) and psychotherapy (talking). The brain’s response to drugs tell us that we’re on to something in our theories of altered biochemistry. The brain’s response to talking suggests that the mind can change behavior (its product) and the brain (its parent). But we’re still hazy on the specifics of what exactly goes wrong in the brain and how our treatments work. Thus, the mind remains a mystery to itself.


Whiteboard reflections by patients in my hospital's mental health ward

♦  ♦  ♦  ♦  ♦  ♦  ♦  ♦  ♦  ♦

The Black Dog Institute

For more information on mental illness, see the Black Dog Institute website. And as Springer says, “Until next time, take care of yourselves and each other.”

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