Thoughts on World Mental Health Day

Yesterday was World Mental Health Day, with the theme for 2014 being “Living with schizophrenia”. Perhaps not as popular as any given cancer initiative. Or diabetes day. And yet.

The brain is an organ like any other in our bodies, but we don’t react to diseases of the mind the way we react to diseases of the heart, pancreas, etc. Once upon a time, people whose brains were “malfunctioning”, i.e. not functioning like those of the majority of human beings, were declared “crazy” or “retarded” and were more or less discarded from society. Fortunately, things have improved, but there is still a lot of stigma out there.

I attended a scientific symposium on the biology of mental illness where one of the speakers talked about the protein Bcl-2. As an immunologist, when I hear Bcl-2, my mind goes directly to a type of cells of the immune system called B cells, and to the role of Bcl-2 in regulating cell death. Bcl-2 stands for B cell lymphoma-2. To give a general idea, too much of Bcl-2 in immune cells is a bad thing: it contributes to uncontrolled cell proliferation and survival, and therefore to cancer development. But the topic of the talk I was now listening to was mental illness, and Bcl-2 was mentioned for its potentially important neuroprotective role. Bcl-2 protein levels matter not just in immune cells and cancer, but also in brain cells and mental disease. And yet you will never hear someone tell a cancer patient to “get over themselves and shrink that tumor” the way you may hear someone tell a patient with bipolar disorder to “get a grip and stop being so depressed or so high”.

Somehow we accept the fact that we have no control over, say, our immune system, how it is structured and how it functions, we are okay with the fact that it has “a life of its own”. We may even accept the same thing about our brains when it comes to the regions that control motor function for example. But dealing with the idea that our brain has also “a life of its own”, and that it may alter our minds and who we are without us being aware of it or having a say in it, is more difficult.

Most people know that Parkinson’s disease is a neurodegenerative condition. Dopamine-producing neurons in a brain region called the substantia nigra die, most commonly leading to a loss in the ability to control movement. If I now tell you that people who suffer from bipolar disorder have less gray matter in a brain region called the subgen prefrontal cortex than healthy people (as well as other biochemical, functional and neuroanatomical differences), you may start seeing bipolar disorder as some sort of neurodegenerative disease as well. And you may realize that a bipolar person may not have the power to control their highs or lows just like a person with Parkinson’s disease cannot control their movements.

Two other bits of knowledge selected from what I heard during the symposium:

– treating PTSD (post-traumatic stress disorder) with virtual reality exposure therapy (note: war veterans are often mentioned as the typical cases of PTSD, but it is also very common in rape victims ; it can be triggered by any kind of traumatic event)

– trauma, resilience and individual susceptibility: it is estimated that a majority of us will be exposed to some kind of traumatic event in the course of our lives ; fear and anxiety are part of a normal response to such trauma, but it is when this response does not go away over time that it translates into PTSD ; as it happens, we are not all equal in our ability to be resilient, whether because of our genetic make-up (example here) or because of our own previous life experiences, or both.

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