Posts tagged: Bipolar Disorder

Apologetics

The history of modern mental health treatment began with the often pressing need to dispose of troublesome relatives.  Psychiatry evolved to fulfill the desires of wealthy families who could afford “treatment” of an unwanted relation.  Psychiatry offered a less vulgar method to coerce the one’s we love.  The “treatment” of the relative avoided assigning blame by labeling the identified patient as diseased.  It avoided unpleasant legal terms and the lack of control even wealthy people suffer at the hands of the court.  Society did not have to prove that someone actually came to harm; they could be jailed for behavior unbecoming to others.  It should be noted that most legal systems keep people imprisoned for an inviolable length of time.  In early psychiatry, as is often the case now, incarceration ended with the termination of payment.

Modern psychiatry has increasingly dovetailed with the legal system.  The government often pays for incarceration (hospitalization), as well as third party insurance companies supported by the state.  The length of incarceration is no longer directly related to the wealth of the family.  At the same time, the criteria for incarceration has become more rigid and much less dependent on the wishes of the family.  Even with this arguable progress, some psychiatric authors have railed against the coercive and legal aspects of psychiatry.  They do not see the proper role of a medical doctor to be the control of behavior by manufacturing diseases of the mind.  Psychoactive drugs may be considered the tools of choice to control unpleasant behavior.  Those behaviors thought unpleasant will tend to change over time and locality.  It is for this reason that many psychiatrists are uncomfortable functioning as the foot soldiers of government control.  Within the last 100 years, masturbation and homosexuality were labeled as criminal behaviors, then diseased behaviors and now they are normal behaviors.  Should psychiatric practice be the handmaiden of industry and government?

The dilemma of state behavioral control is complicated by practical considerations.  To care for someone with a severe mental illness is a lifelong burden.  Though the problems may stem from different sources, it is the caretaker’s burden to maintain a wary eye every waking second of their life.  Sleep is often disturbed by the knowledge that harm befalls the afflicted at night even more than during the day.  There is nowhere to run or hide from the caretaker’s responsibility.  For example, it is not uncommon for parents of the mentally retarded to become tearful when their child is psychiatrically hospitalized.  Part of the tears fall due to the pain of seeing their child suffer.  The remainder of the tears fall over the guilt they experience.  It is the guilt experienced from being relieved of their caretaking responsibility.  A fairly typical example may further clarify the dilemma experienced by so many.

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The preceding story, and millions like it, loudly begs the question whether this middle-aged child would be better managed by the legal system.  Would it be better to let him bounce off the walls of a jail cell for the remainder of his life?  Would it be better to psychiatrically hospitalize in order to stabilize medications and release him back into society?  It is hoped that most people would choose the later rather than the former.  To rid society of psychiatry might introduce new problems as well.  The legal system would have to cross-train police to be ersatz social workers.  Not only is the training widely divergent, the types of people who would perform well at either job is divergent as well.  Additionally, most people with severe psychiatric disorders have difficulty with personal and social judgment.  This psychiatric jail subgroup would be easy prey at the hands of the resident psychopaths.  Society would be leading these lambs to slaughter.  In effect, the jail would harden the attitudes of psychiatric patients and teach them psychopathic skills in order to survive.  Once these hardened psychiatric patients are released back into society, without any support system, it is suspected they will not survive within the boundaries of the law.

It is a fact that good and kind people, with solid marriages, sire children with psychiatric and neuropsychologic disabilities.  This article asked if the mental health system should separate itself entirely from the legal system.  The answer is yes if society seeks to merely contain the dangerous and ignore the remainder.  The answer is no if society seeks to manage the populace with some degree of humanism.

Computers on the Brain

It is not uncommon for psychologists to draw parallels between the modern computer and the ancient human brain.  Nearly all the people who read this article will do so with the use of a computer.  The computer allows the rapid categorization and transformation of symbolic information.  The information is symbolic since it does not contain the actual perceptual information of the event, but a representation of the information encoded into standardized symbols.  The symbols must be standardized, or the information could not be shared with others.  The symbols must also have the capacity of accurate storage, or the computer would only be useful on an intermittent and spontaneous basis.

The ancient brain processes sensory information in a symbolic fashion, as well.  It does not store holograms of what we see, smell, hear or touch, but encodes the information in proteins.  Recalling the information encoded in proteins allows categorization and association of the symbols removed from the actual event.  The human brain uses standardized sounds to communicate its symbols, otherwise the information could not be shared with others.  The storage of symbolic information must be fairly accurate, or the human could not learn to operate effectively within a given environment.

Both the brain and computer have an architecture specialized to encode and process information, yet there are differences.  There is no real equivalent of software in the human brain, as the physical architecture of the brain is altered to meet and master novel tasks.  Current computers cannot alter their architecture at this point in their development, but small alterations of software can radically change the type and method of information processed.  Neurotransmitters provide the closest parallel to computer software.  Their respective levels in different areas of the brain may favor and flavor the information processed.  The current understanding of neurotransmitter action does not allow for the sweeping changes possible with computer software.   The human brain exists in a dynamic flowing relationship with the environment, whereas the computer was designed to be an assistant in this relationship.
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Currently, mental illness is most often viewed as a biological defect; similar to a diseased heart or lung.  Computer scientists might regard schizophrenia and bipolar disorder as faulty hardware, and depression, anxiety and angst as buggy software.  Similarly, psychosurgery has been used in the past to treat schizophrenia, and current psychiatrists modulate neurotransmitters to control depression.  The former deserves  little comment, and the latter has met with limited success.  Neuroscientists and psychiatrists have beaten the drum of biological mental illness for decades.  They have attempted changing the computer architecture in schizophrenia, and the computer software in depression.  The analogy tends to fail at this point, though, largely due to the negligence of a very important relationship.

The analogy breaks down due to the dynamic relationship between humans and the environment.  A person’s environment, especially their social milieu, may profoundly alter neurotransmitter levels.  Chronic stress is now known to cause actual alterations in the way genes are expressed.  Put another way, the environment alters the hardware and software of the human brain.  The brain evolves over a lifetime, whereas the computer is largely a static entity, such that the computer/brain analogy is always inexact.  To ignore the environment in the treatment of mental illness is similar to ignoring the road while driving a car.  Altering the brain’s software, without altering the environment, is to ignore a major difference between computers and people.  Social relationships may be an architect of human dysfunction, but also a foundation upon which we build our happiness.