“When the Body Attacks the Mind”

There was an article in the Atlantic this month about the physiological roots of mental illness. The very fact that the phrase exists seems to indicate – to me, anyway – that in popular (and popular medical) perception, “mental illness” is somehow removed from the physiology of the human body. As if the “body” and the “mind” are somehow exclusive of each other. Of course, I could be reading too much into a catchy title, but it is certainly true that mental illness carries a greater burden of taboo than other diseases (with the possible exclusion of STDs), in part because it manifests in ways that are less “bodily” than, say, aches, or sores, or fevers, or fractures.

This particular article, however, focuses on bouts of mental illness that are caused by physiological infections or malfunctions, rather than genetic inheritance. Given how well they mimic the symptoms of established illnesses, most clinicians, upon first encounter at least, mistake them for the illness they index. The chances of misdiagnosis and mistreatment are therefore quite high. This is what happened, for instance, with thirteen-year-old Sasha Egger.

Sasha was admitted to the hospital, where he saw a series of specialists. One thought Sasha might have bipolar disorder and put him on antipsychotics, but the drugs didn’t help. [Sasha’s mother] Helen, a child psychiatrist at Duke University, knew that psychiatric conditions develop gradually. Sasha’s symptoms had appeared almost overnight, and some of them—including dilated pupils and slurred speech—suggested not mental illness but neurological dysfunction. When she and her husband, Daniel, raised these issues, though, one doctor seemed to think they were in denial.

One can’t completely blame the doctors, for a child’s sudden descent into madness would probably put many parents in hopeful denial. However, in this case, Helen was right. Thirteen year old Sasha was not bipolar; he was not having a psychotic break. What he had was encephalitis – a “physical infection” of the brain. As the article points out, however, without his mother’s clinical expertise and access to clinician friends who took her seriously, Sasha could very well have died, or have spiralled so far down under the influence of wrongly-administered antipsychotics that an institution might have been his ultimate home. Terrifying, that.

In terms of public health design, too, this is a problem. None of the clinicians who who attended to Sasha in his first five days – during he went from healthy to heavily medicated in intensive care – appeared to have considered his nervous system at all, even though his senses were severely malfunctioning and his gait had become “shuffling”. It would not have cost them much effort. Mohamad Mikati, the person who finally detected Sasha’s neurological dysfunction, used very basic tests to check if there was a problem. When Sasha failed to clear them as a healthy person should, a more high-tech monitoring test was ordered. This model certainly has a lot to recommend itself. If there is sudden and puzzling illness in a person, it takes almost no resources to ask them to touch their nose, walk in a straight line, or draw a simple familiar object, and can indicate – or eliminate – a large spectrum of possibilities.

Which brings us to infections, and therefore, to the immune system. One would imagine that one’s immune system would always stand by one’s side. But that, apparently, is not the case.

Scientists have found that simply activating people’s immune systems as though they were fighting a viral infection can cause profound despair and suicidal thoughts.

In 2007, Josep Dalmau, a neurologist then at the University of Pennsylvania, described a condition he called anti–NMDA receptor encephalitis, in which the immune system attacks a crucial receptor in the brain, producing severe neurological and psychiatric symptoms—including behavior sometimes compared to that of the possessed girl in The Exorcist.

Which raises the question: is there a deeper connection between a body’s immune system and it’s mental health? The answer appears to be yes. The research also highlights something very interesting about depressive lethargy, and indicates why depression affects socially vulnerable groups – that is, those that are unable to afford healthy diets, leisure time, or safe lives – more than it does privileged ones.

Scientists are also increasingly interested in the link between depression and systemic inflammation, an immune-system response to infection or other potential triggers such as a lousy diet, obesity, chronic stress, or trauma. [They] have posited that the malaise and lethargy of depression may really be a kind of sickness behavior, an instinct to lie low and recover that, in its proper context—infection or illness—aids survival.

Perhaps after the uterine theory of madness, the endocrinal theory of psychotic behaviour, and the genetic theory of mental illness, it’s time now to flood the consciousness with the immunological theory of just wanting to give it all up. And given that the triggers identified so far have a distinct socio-economic component, public health efforts might finally manage to offer concrete help to some of this afflicted-and frequently helpless-minority.

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