Treating Mental Illnesses with Neuroscience

Approximately one in five adults in the United States experiences some aspect of mental illness in a given year, with one out of twenty-five of them reporting that the mental illness is “serious” and “substantially interferes with or limits one or more major life activities” (National Alliance on Mental Illness, 2018). In the past, mental health disorders and disabilities have been viewed in a negative light, and treatment for these afflictions has been lacking, if not entirely ineffective. Historically, patients were placed into isolation, often in insane asylums, where they were subjected to repetitive, reprehensible tests. Their skulls were drilled in the process of trephination, blood was drained from their bodies in bloodletting, and bodies were repeatedly purged of their “evil spirits” through ritual religious means. After this heinous poking and prodding came slight medical advances, and many patients were subjected to lobotomies, insulin coma therapy, or Metrazol therapy, in which individuals’ brains were cut, injected with compounds, or compromised in other ways in a vain attempt to “fix” their problems (Hussung, 2016). Despite these somewhat progressive medical treatments, mental illnesses were not cured, and researchers had to look further to discover the proper means of treatment.

Today’s treatment of mental illnesses focuses on integration versus isolation. Patients undergo psychotherapy, biomedical treatment, and other means of care. From transcranial magnetic stimulation (TMS) to cognitive behavioral therapy (CBT) to prescriptions of different selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and more, there are a wide variety of treatment options for those afflicted with mental disorders and disabilities (Hussung, 2016). This increase in treatment has ultimately come about via the decline of the stigma against mental health. According to a study done in 2007, people today have a more positive attitude toward seeking mental health treatment versus what they have felt in the past. This is particularly present in younger generations (Mojtabai, 2007). As modern culture is beginning to take mental health into consideration, it is crucial to be aware of the autonomy that mental health patients possess. Doctors, researchers, and therapists alike must carefully evaluate the neuroethics in the treatment of these diseases. In this medical care, patients must be treated with the assumption that mental illnesses are biologically based, which is supported by substantial evidence. More effort must be placed in the research behind neuroscientific solutions to mental health problems; however, it is important to ethically evaluate each practice individually and to weigh the benefits and potential harm that can come from each method of treatment.

There has continually persisted a disagreement over the basis of mental illness. Arguments have stemmed from the claim that mental illnesses are simply physical disorders that strike the brain, while others believe these afflictions are an entirely separate class of their own, ones that strike an individual’s conscience and alters who they are. However, there is a biological basis to each individual mental disorder, and the notion that a mental illness is an affliction of one’s conscious suggests that it is “all in one’s head,” which is entirely untrue. Eric Kandel, Austrian-American neuroscientist, biophysicist, and biochemist, expresses it beautifully, arguing that "all mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases. The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?" (Weir, 2012). Mental illnesses come from an imbalance in chemistry in one’s brain, abnormalities in functioning, genetic deformity, or a combination of part or all of the aforementioned. Here we will begin to examine the realized causes of various disorders, which have all been scientifically proven in statistically significant results.

Depressive symptoms stem from several abnormalities and imbalances in the brain, namely a deficiency in noradrenergic (norepinephrine) transmission. This is clinically manifested in psychomotor retardation, emotional withdrawal, and inability to remember and concentrate (Moffaert & Dierick, 1999), which are classical symptoms of depression. In addition, the role of the serotonin 5-HT receptor has been studied, and several results suggest that the function of these receptors may be compromised in patients with major depressive disorder (Amidfar, Meysam, et. al., 2017). Aside from neurotransmitter abnormalities, depression has also been traced to over-activity of Brodmann area 25 (Weir, 2012).

Psychotic disorders, such as Schizophrenia and Bipolar Disorder, have their basis in both neurological malformations and genomic differences. In patients with Schizophrenia, there is evidence of decreased gamma-aminobutyric acid (GABA) activity within the brain, and this observation has been one of the most consistent within post-mortem examination of these individuals (Taylor and Ivy, 2015). These abnormalities present themselves as structural changes, such as prefrontal sulcal widening and ventricular brain ratios, leading to psychotic episodes in those afflicted (Kammenab, et. al., 1998). In addition, the compromising of dopaminergic pathways is associated with these mental illnesses (Charney, 2014).

Mood disorders are also known to be associated with compromised synaptic passageways. Glutamate and GABA imbalances in the brains of those afflicted may lead to the semi-permanent disruption of brain circuits, of which antidepressants are often needed to correct (Charney, 2014).

To continue on with the importance of GABA neurotransmitters in proper mental health, those with anxiety disorders typically have compromised GABA receptors, which regulate neurocircuitry and neuronal behavior. If these pathways are compromised, the reaction within the brain to certain stimuli may be over-exaggerated, causing anxiety and panic. There may be structural abnormalities in the prefrontal cortex, as well, as this area regulates an individual’s emotional response to fear (Charney, 2014).

It is evident that there is a major biological basis to mental health disorders and disabilities, especially in schizophrenia, bipolar disorder, and the way individuals process emotions. There are clear structural and functional abnormalities that can be viewed (Weir, 2012). However, it is difficult to place a truly defined reason for affliction, since mental health varies individually and not every disorder is as clear-cut as others. We must first understand the uses of neuroscience and biomedical technology in treating mental illnesses to examine the ethical implications of this therapy.

There are two main categories of neuroimaging: structural imaging and functional imaging. Computed tomography (CT) scans and magnetic resonance imaging (MRI) capture the structure of the brain without measuring its functional ability, mapping the tissues and layers of the brain to view structural abnormalities or growths, such as tumors. Positron emission tomography (PET) scans, electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) are able to map the function of individual brains, such as neurons firing, processing of glucose, use of oxygen, and general mental states (American Brain Tumor Association, 2014). The use of fMRIs in particular has been a crucial element of examining mental states of patients, as researchers and doctors are able to analyze brain activity in real time. However, this has proven to be insufficient at times. This type of imaging is only able to measure blood flow and cannot specifically show the activation of individual neurons, which is crucial in mental processing. In addition, the patient must stay completely still as the oxygen and blood flow are being measured, so this is impractical when looking at the external validity of a study, aside from the extreme costs of such research.

Since neuroscience and neuroethics have taken flight, there have been advances in multimodal brain imaging, signal processing, and visualization. However, there is currently a need for a more integrated and practical approach to human brain analysis, a five-dimensional way of measuring. This five-dimensional technology would be able to visualize the brain in three dimensions (width, length and height), while calculating frequency over time (Ribary, et. al., 2017). This technology would be crucial in being able to visualize individual areas of the brain in order to pair them with mental processing. In addition, there is a need for a less expensive and more user-friendly version of functional imaging—potentially one that can be worn on the head and track neuronal activity throughout the day.

As brain imaging has developed and progressed, some individuals argue for the importance of including brain scans and specific neuronal abnormalities in the Diagnostic and Statistical Manual of Mental Disorders (example: Miller, 2010). Despite new technology, the way in which psychiatrists diagnose mental illnesses has not changed in over a hundred years. Instead of looking for mental illnesses the old-fashioned way by examining a cluster of symptoms, those for inclusion of brain scans argue that doctors should be using twenty-first century technology, such as brain imaging. After all, psychiatrists are the only doctors that don’t ever look at the organ that they are studying (Miller, 2010). However, diagnostic scans may present a problem, as each mental illness is specific to each individual. There is simply no one-fits-all solution to mental health. Brain scans will never generalize to every case of a specific mental illness, and by including such scans, some individuals may be improperly diagnosed as a false-positive or false-negative. In addition, the recent public obsession with all things “neuro” may suggest an impending lack of merit in neuroscience. If individuals over-exaggerate the ability of neuroscientists to diagnose and cure everything, neurology may fade out before technology truly catches up (Vidal, 2015). It is important to not rush into overusing brain scans, whether structural or functional, for scientists and doctors are not truly able to measure brain activity on all capacities as of yet, which is necessary to be able to fully integrate neuroscience into psychiatric diagnosis.

Through examination of mental processing, doctors and scientists have been able to treat mental illnesses with physical application of treatment. Depression is a prime example of this, as treatment-resistant depression has been shown to be alleviated through deep brain stimulation. Both transcranial magnetic stimulation and electroconvulsive therapy have shown to have tremendous rates of success, especially in the rapid alleviation of suicidal thoughts (Mayberg, 2008). Though certain risks may be prevalent, especially when medically inducing seizures such as in electroconvulsive therapy, this treatment may be beneficial as the benefits for many greatly outweigh the risks. In addition to physical stimulation, the use of antidepressants has shown to have biological effects within the brain. Synaptogenesis is increased as severed or compromised neurological pathways are mended (Charney, 2014).

Anxiety-based disorders have been shown to respond to unconventional neurological treatment as well. Affective modulation of the startle reflex has proven to be useful in studying harmful behaviors, whether this be self-harm, suicidal thoughts, or aggressive behavior towards others. This harmful behavior is a personality dimension that is a sign of the inability to modulate the risk of certain mood and anxiety disorders (Corr, et. al., 2013). Neurotransmitters, such as benzodiazepines, have increased binding in the insular cortex, which has been shown to reduce panic severity and comorbid depression. For some with Post-Traumatic Stress Disorder, the inhibition of excitatory pathways has shown to be beneficial in preventing flashbacks inducing mass panic (Martin, et. al., 2009). Clearly, as anxiety disorders are the result of, to simplify, the over-activation of neuronal pathways, there is merit in physically blocking some of these synaptic sites.

After beginning to understand the biological basis of mental illnesses and the methods of treating such, it is important to look into the neurophilosophy of such treatment. Some philosophical approaches challenge emerging Western medical practices, particularly reductionist theories. As Doctor Thomas Fuchs, Doctor of Philosophy and renowned neuroscience theorist, states, “reductionist interpretations of neuroscientific results challenge notions of free will, responsibility, personhood and the self which are essential for western culture and society” (Fuchs, 2006). Due to the altering of the physical brain in mental health disorders, reductionists may argue that personhood and self are also becoming altered. If so, how much autonomy do mental health patients have? It has been argued that certain patients, particularly those with degenerative diseases, are unable to think and have conscious reasoning (Jaworska, 2017). For example, patients with Alzheimer’s are often stuck in the past and truly believe they are living in a different era with different surroundings. If this is the case, how are they able to consciously make decisions regarding their future wellbeing? Although this is a difficult scenario, it is important to judge consciousness and free-will on a case-by-case basis. Despite neuronal deformities or malfunctions, these individuals are still people and the vast majority are able to know what is medically best. It is important to assume that mental health patients are autonomous in their decisions, despite alterations in brain functioning, so that neurobiological treatments can be researched and implemented; however, I will address additional ethical considerations that may present problems.

Neuroscience presents a dangerous problem in that many times (sometimes more than not, even) researchers don’t exactly know why something produces the successes it does. There is a shockingly low amount of empirical data available in the neuroscience field (Gibson, et. al., 2017). Data are needed to examine the extent to which incidental findings impact different individuals, including the participants of such studies, health providers, and the scientific community as a whole. With this information, it may be possible to design the most feasible way to provide empirical data to back neuroscience and its conclusions (Gibson, et. al., 2017). Clearly, it is unethical simply to test different treatments repeatedly until somethings works. Neuroscientists must be particularly careful when conducting such research, as altering the brain may have drastically harmful impacts on participants, if done incorrectly. This is why there is a need for a steady stream of smaller data points to build up to larger studies, in which neurobiology can be tested and manipulated.

While informed consent for a trial or medical treatment, especially a neurobiology-based one, is crucial in neuroethics, there is also a question as to whether patients can face consequences for not seeking treatment. For example, what if a person with diagnosed schizophrenia refuses a type of neuronal treatment that may cure or drastically reduce their psychotic episodes? If this individual were then to have a psychotic episode after denying treatment and proceeded to kill a stranger during this breakdown, who is responsible for the death? Is the schizophrenic at fault for refusing treatment? Is the researcher running the trial at fault for not performing the treatment that would have prevented this episode? Or is it simply a case in which the individual would plead insanity? Clearly there would be many factors to consider in such a scenario, even possibly stemming back to whether or not the individual with schizophrenia was able to give consent if his mental illness had altered his conscious thought. This type of situation could even be applied to an individual with depression who decides to stop taking his SSRIs or SNRIs or stops attending therapy. Who is at fault if he harms himself to the extent of needing hospitalization, or even to the point of death? One could blame the individual, saying that he performed the final actions and must face the consequences. Others may blame the psychiatrist for failing to notice this patient’s decline. In situations such as these, it is more important than ever to assume that an individual is autonomous and conscious in his actions, even with the presence of a mental illness. It is fruitless to place blame upon an individual offering release from suffering, who is trying to change the presence of such an illness. Instead, it is necessary to hold mental health patients accountable in their autonomous decisions.

Though they might seem but distant relatives at first, neuroethics is able to play a part in establishing a better overall sense of global mental health (Stein & Giordano, 2017). As mental health and mental illness are rooted in neurobiology, we must examine what, physically, causes certain maladaptations. Whether this be improper firing of neurons, differences in structure, an overabundance of a particular neurotransmitter, or something entirely different, psychiatrists and other doctors must target the physical abnormalities of the brain. While cognitive behavioral therapy, dialectical behavioral therapy, mindfulness, and other methods may initially improve a patient’s thoughts or actions, it merely puts a small dent in the problem that is poor mental wellness. The physical structures must be targeted so that forms of therapy may work. For example, therapy may help with depressive thoughts, but will not solve them until SSRIs, SNRIs, or even TMS are used to bring the patient’s mood back up to baseline. Instead of digging out of a seemingly endless pit of depression to become slightly less sad, patients will be working from nearly the average mood to becoming happy and finding joy for what could be the first time in years. With these advances in neuropsychopharmacology and neuroimaging come new debates as to how to establish a new sense over global health, not just physically, but mentally. We have long debated how best to provide healthcare for individuals with cancer, patients with chronic diseases, those who must be hospitalized, or individuals plagued with a host of other afflictions. However, we often forget how to care for those with mental needs. Mental health is a small, but crucial, part of an overarching spectrum of global health (Stein & Giordano, 2017), and neuroethics can help determine how to treat and maximize such health. In order to form a healthy and happy society, mental needs must be placed within the same standards as physical needs. After all, mental health is just another level of a physical disorder, and it can be treated and researched as such.

As mental disorders are brain processes that have simply gone awry, we must look to neurobiology to treat mental disorders. Although there is uncertainty in philosophy of mental health treatment, it is important to approach each case as a unique situation, so that researchers and neurophilosophers are able to determine if a patient can make his own decisions with his best interest in mind. While neurodegenerative disorders may pose a problem in assessing a patient’s ability to give informed consent, most individuals with mental health issues are certainly capable of choosing what they want. Neuroscience should be implemented in the treatment of mental disorders; however, it should be done on a case-by-case basis and should not be overgeneralized to where brain scans are included in each new Diagnostic and Statistical Manual of Mental Disorders. Based on a multitude of studies and treatments, most, if not all, mental disorders have been shown to respond to some sort of physical treatment, including brain stimulation or pharmaceuticals. This research must be continued in order to work towards a better and global sense of proper mental health. With more effort placed into finding neuroscientific solutions to mental afflictions, there may be a foreseeable future in which mental health is prioritized and improved.