Day 317: Mental health and you

I scream it loudly from the mountain tops, I suffer all the fucking time from mental health issues. I do it because staying silent doesn’t keep me from feeling them and it does nothing for others who are suffering. Yes, it’s embarrassing to talk about it because it feels like a taboo, or something you’re making up, but that’s why we need to talk about it and why you need to keep track of your own mental health.

Mental illness is just as real as any other chronic disease. Let’s just get this out of the way now. Sure, it’s not as visible as the loss of a limb, but we’ve seen it (more reading)(even more reading). Depression exists in a very real, very physical space. Just like you can have digestive issues that affect your life, depression and mental illness can have very visible outward symptoms. In short, it’s not you, it’s your brain.

Let’s clarify what the brain is exactly so we can talk about why mental illness is so damned hard to fix. We can think of the human brain as three separate brains! Yep, not one, but three. This is where I add the disclaimer, this is referred to as the triune brain theory of the brain. It’s old, not very accurate, but it’s simple enough and accurate enough that we can use it here to talk about mental illness and you’ll see why at the end.

Each part of the triune brain have a very important role in making you, you. The first brain is the oldest and thus the “simplest” the brainstem and cerebellum. We sometimes call this guy the lizard brain, but it’s more than that even though the human brainstem and cerebellum together look like a supersized frog brain (no really, google frog brain and see, I’ll be here don’t worry).

The  brainstem and cerebellum (latin for little brain and it’s the very textured almost walnut looking bit in the far right of the photo above) handle a lot of the things that you do without thinking about it. The brainstem (made up of the midbrain, pons and medulla) in particular takes care of the things we don’t normally think about, breathing, heartbeat, consciousness (awake/sleep cycle), eatting, and information travel to and from the brain (you can read my very thorough series on the spinal cord here). The cerebellum on the other hand coordinates voluntary movement mostly. So basic functions that don’t require a lot of deep thought. They do a lot more than I just covered, but each part of the brainstem would be a post all on its own (and I may just do that eventually).

Next we have the limbic system or the paleomammalian brain. The limbic system is our survival system. It’s our flight or fight response, our desire to find food, have sex, all of that resides in this area. And again, we are grossly oversimplifying things, but that’s okay because we’re not doing a deep dive here, just a short overview. The limbic system is (probably) why we have irrational fears, or see weird faces in things that aren’t really there. This is the bit of us that makes us so neurotic (limbic system seen below).

This brings us to why we’re using this system to talk about mental illness, because part of the limbic brain is fear, anxiety, happiness, sadness, that all (and by all I mean most likely and as a gross simplification) lives in the amygdala that really tiny almond sized bit of the brain (it’s mirrored so technically two tiny almond sized bits in the brain).

Lastly we have the neomammalian brain, or the cortex. Really the cortex is just the name of the outer layer of the brain! It’s only ~2.5 mm thick, but covers the outside of the brain, so we have a brain, wrapped in a brain, in a brain. Here have the motor cortex for thoughtful movement, premotor cortex for motor planning, and a bunch of other bits and pieces here that make us who we are on a deeper level. In particular the prefrontal cortex. It doesn’t fully develop until we’re in our 20’s and helps us have rational thought (sounds about right doesn’t it?).

Of all the things that make us who we are, we owe our deepest and most complex thoughts to that bit of prefrontal cortex. That is an oversimplification of course, our brain is like a beautiful orchestra of neural activity. We could point to the prefrontal cortex and say this is where “you” live, but really without the rest of it attached, you’re just watching the person who helps write the sheet music. The prefrontal cortex is a beautiful thing because it develops so late in life. It gives us a chance to be more than our genetics, we get to experience life and in a perfect world have stability so that part of the brain can bloom into something that is better than what it could’ve been had it developed at an early age.

It’s all these parts that come together, but like any beautifully complex system just one thing can cause a disaster. That’s mental illness in a nutshell. It’s a part of the orchestra playing its own tune. Unfortunately, while this may present itself similarly among people, it doesn’t mean that what causes your depression is what’s causing mine. It also makes finding a fix extremely difficult. If your appendix is giving you problems, we can pull it out, we can’t do that with mental illness because it’s so nebulous. It doesn’t exist with just one member of this neural orchestra, it is a small group from several different sections going back and forth between each other in ways that the rest of the group can’t stop.

We can’t for example harness the super powered prefrontal cortex to just “snap out of it” as so many people will tell you. You can’t will yourself to be happy because while the prefrontal cortex may be the most rational part of you (again oversimplification), it doesn’t get to call the shots in the brain. There is no one part of the brain in charge of the rest and that’s why the brain is so flexible and resilient, because it doesn’t have a central command structure it adapts and changes very readily.

At the end of the day, whether it is a chemical imbalance causing communication issues or parts of the brain that have simply gone rouge, there isn’t an easy fix because the brain isn’t an easy problem. Medications are a sledgehammer solution to a scalpel problem. This is why we have to play medication roulette. It’s the only way to see if we can find something that helps put those parts of the brain back in line. Unfortunately it also means that other parts get hit and that’s why we get lovely side effects from the same medications we take to help the problem. That doesn’t mean you shouldn’t use them, it just means that we have no way of telling if they will work and what side effects you will have before you try them.

For all of our numerous medical advancements, the brain by and large is still a mystery. We don’t fully understand the beautiful neural orchestra that is playing in your head and we certainly are only just starting to understand the most basic of notes and what they mean. I don’t doubt that we will eventually be able to peer deep inside and find a targeted and tailored solution to mental illness, it just (probably) won’t happen in my lifetime.

So we will end this overly long post like this. Mental illness is a very real thing having a very real impact on very real parts of your brain. Medications work, but the brain is a complex creature, so finding the best takes time along with trial and error. No matter what though, you don’t have to suffer alone. There are a lot of us out there, probably more than the numbers tell you. It’s okay to need help, it’s okay to be different, it’s okay to not be able to fix something alone. Most importantly, it’s okay to talk about it. No one can tell your story better than you. If you’re ready to tell it, it’s time people heard it.