“Mental Illness is Not Biological”

I am a big proponent of being careful with language. I don’t think that we should oversimplify something simply because it sounds better or is better marketing. Especially when it comes to mental illness, we are so sloppy with our language as it is that I think we must be careful. I don’t like the idea that we should describe mental illness as “a chemical imbalance” because it deeply oversimplifies things. So I was fairly dismayed when I sat down to read an article in my local paper about the need to talk more about mental illness and it simply repeated over and over “mental illness is not biological” and that we need to spend more time talking about the pharmaceutical industry.

Many people do not pay enough attention to the biological factors of mental illness. Yes, we recognize that genes can cause a predisposition, but more than that, basic biological systems can deeply affect your mental health. A few examples: sleep deprivation can easily cause symptoms of mental illness. It can deeply affect mood, emotional stability, depression, anxiety, and other brain functions. Continual sleep deprivation can spur a mental illness. I’m not sure what one would call that if not a biological factor.

Similarly, food deprivation is deeply correlated with some serious signs of mental illness. In the hunger studies performed at the University of Minnesota, individuals who willingly deprived themselves of food became depressed, anxious, obsessed, violent, withdrawn…they had diagnosable mental illnesses that were not present before the removal of food. Again, this seems to be a strictly biological change that triggered a mental illness.

Factors like these are often heavily discounted when we talk about mental illness, particularly when we’re attempting to recover from mental illness. Not enough time is spent focusing on the fact that if you don’t have a healthy biological basis with adequate sleep, nutrition, and exercise, it is significantly more difficult to have a stable mood and recover from a mental illness.

In addition, we do know that genes play some role in mental illness. We know from twin studies that many mental illnesses are far more likely to occur in an individual if they have close family members with that mental illness. For some mental illnesses, we have identified specific genes that might be linked to that mental illness. The most likely theory about mental illness right now is that we are genetically pre-disposed to an illness (to varying degrees depending upon the person) and social or environmental factors then can trigger that mental illness. And yes, neurotransmitters and brain chemistry are implicated in that mental illness. Yes, there are physical processes that have been disrupted when we are talking about mental illness. No, it’s not just a chemical imbalance, yes it is more complex than that, but of course it’s biological because our brains are a biological organ.

This is intensely frustrating, because it makes it seem as if the social factors that affect our mental health have no bearing on the physical existence of our brain. In fact studies done on chimps have shown that certain brain chemicals are altered over the course of years by trauma or isolation (if a chimp is isolated at a young age they will have different levels of certain brain chemicals when placed in isolating situations than a chimp not isolated at a young age and these effects last for many years). This is a physical change brought on by an environmental factor.

Of course it’s important to be careful not to oversimplify, but obscuring that there clearly is a biological factor to mental illness is not helpful either. In addition, the fear of labeling mental illness as biological plays directly into the fear of overdiagnosing and overprescribing. When we repeat over and over that mental illness is not a biological illness that revolves around neurotransmitters and brain chemicals, we become even more paranoid about prescribing medication (something that people are already worried about in the case of things like ADHD and Xanax). Speaking as someone who takes medication, this is incredibly damaging. Medication can be a complete life-saver: it made my anxiety manageable and so it gave me a window to actually begin dealing with some of my underlying issues. I was afraid to begin taking medication because I didn’t want to “alter my brain”. Repeating the myth that pharmaceutical companies are out to get us all and that medications are not the proper way to treat mental illness reinforces that stigma.

Of course we should include various kinds of therapy when we’re working on mental illness, but it is actually incredibly difficult to get medication for many mental illnesses and particularly difficult to get insurance to cover it. People are already afraid of medication. People are already afraid of being turned into zombies by pills or having unknown side effects. It is possible to advocate for improved standards for pharmaceutical companies AND accept that medication can be an incredibly important part of treating mental illness.

We need to recognize that mental illness is complex, requires a number of kinds of treatments, and involves a variety of factors including the biological, social, environment, genetic, chemical, and situational. While it is important to move past the “chemical imbalance” trope, that doesn’t mean completely removing any mention of chemistry or biology from our descriptions of mental illness.

International No Diet Day

Today is International No Diet Day, something which I only discovered about an hour ago, and since have been madly in love with due to my virulent hatred for diets. There’s a candy shop in town that I absolutely love, and they have a sign over the register that says “Diet is a four letter word. Please refrain from using it on the premises”. I love it.

First and foremost, most diets are ineffective. This has been shown over and over again, particularly because different bodies react differently to diets. Genetics plays a far larger role in our size than many people like to admit, and certain people’s bodies will simply never lose beyond a certain point. Each body has a natural stasis point (more of a range really), and staying above or below that will be a struggle. More often than not, diets lead to yo-yoing. Diets are not something that is easily maintained, so often individuals will diet, lose weight, and then put back on more than they lost in the first place before starting the whole process over again.

This is not healthy. By most measures, it’s actually less healthy than just staying at a slightly higher weight, and significantly less healthy than making some small but sustainable changes to your lifestyle (like swapping some high fat and high sugar foods for fruits and veggies, or eating smaller meals spread out throughout the day, or cutting down the amount of processed food you eat). Beyond that, most diets are NOT about health, they are about losing weight. You rarely see a diet commercial that says “lower your cholesterol and your blood pressure and improve your overall health”. You see commercials that say “Lose x pounds in a month!” Health is not the focus of the diet industry, weight loss is. And weight loss is a fairly crappy goal. Weight loss is correlated with improved health, but so far few causative links have been made. And the focus on weight loss has some major health effects.

Most diets that involve cutting an entire food group out of your diet lead to imbalances in your body chemistry, and don’t give you the opportunity to find those necessary nutrients in other places. Things like juice cleanses have been linked to disordered eating. An extreme example of how diets can lead to negative health impacts is embodied in calorie counting. Calorie counting asks you to be in a constant war of numbers with your body. It’s very easy to become obsessed with numbers, and to let the numbers become more important than anything else. It takes the focus away from health or happiness and puts it on reaching a certain numerical goal. Once you start calorie counting it can be incredibly hard to shake, and this can lead to a lifelong obsession with the numbers. Trust me: this is not a pleasant place to be.

Not only that, but most diets that involve calorie counting suggest counts that are WAY TOO LOW for any healthy human being. In the starvation experiments at the University of Minnesota in the 70s, they fed their patients 1200 calories per day. This was considered a starvation diet. It had serious psychological and emotional impacts on the patients. Many of them had serious difficulties ever regaining the weight they lost and had major physical problems as well. And yet many diets are barely higher than that in their calorie counts. This is extremely unhealthy and is done exclusively for the purpose of aesthetics.

Now I’m certainly not trying to advocate against losing weight for health reasons. It’s one thing to realize that you feel like crap when you eat a certain way and try to replace certain things with other things. But that should always be done in moderation: cutting out whole food groups is never really necessary (I’ve never once had a dietician or doctor tell me “never eat sugar” or “never eat carbs”), and your body often needs some  of everything (obviously this is different if you have allergies). But the culture of dieting is not one of health. It’s one of losing. It’s one of constantly being aware of what’s going in your body so that you don’t get too big, so that you don’t look bad or wrong.

Choosing health is very different from choosing a diet. Diets promote a certain way of viewing bodies. They do not promote bodies as a part of a whole human being. They view the body as a vessel that the person inhabiting can adjust as they choose, without listening to the signals the body might send. They suggest that we should ignore our hunger cues, and ignore the emotions that might come along with food. And they often suggest that our size is more important than anything else we might gain from a healthy relationship with food that doesn’t include paranoia, fear, or a need for control. Food is not the enemy, and food is not unhealthy. Diets are unhealthy, and they can completely change the way we view food. Extreme diets can lead to bizarre food behaviors like hoarding, extreme irritability around food, excessive working out, and even eating disorders (as shown in the starvation studies at the University of Minnesota).

Because of all of this diet rhetoric, we end up with some pretty unhealthy attitudes about our bodies and about food. Most diets pit us against our bodies. They ask us to ignore things like hunger cues, or other indications from our bodies about what is healthy and what feels ok. Our bodies are perfectly capable of speaking up and telling us when they are unhappy (for example: you’re dizzy now, please eat something), but diets promote the idea of eating based upon schedules and numbers rather than on the information you’re getting in the here and now from your body. This promotes reducing our bodies to objects that we can change and perfect based upon our actions towards them instead of seeing them as an integral part of ourselves that require care and attention.

Diets put us at war with our bodies. They ask us to ignore what our body is telling us and to treat our bodies as an enemy that needs to be whittled down. They treat food not as a wonderful, delicious, community-building thing, but rather as simple fuel, or as something to fear, or as something to control. Diets ask us to look at our bodies, our wonderful, amazing bodies that do so much for us, and ignore when they tell us they need something. Our bodies are built to give us these cues, to be in constant communication with our brains so that we can keep ourselves healthy. And while the proliferation of easily available food can make it difficult to stay healthy and listen appropriately to these cues, the answer is not to ignore them completely, but rather to take those cues as information and use our higher thinking skills to sort through all the information we have available.

Another huge problem with diets is that they ignore one important element of food: food is emotional. Many people eat for emotional reasons, and when they diet they don’t tend to the emotional needs that food can fill. Food can build community, it is strongly linked to memory, and it’s an important vessel for culture. Taste and smell are more strongly linked to memory and emotion than the other senses. Food has been considered part of building relationships for as long as we have had records of it: there’s a reason that breaking bread together is considered an expression of trust and friendship. Unfortunately, diets pay exactly no attention to these facts. Diets make food into a question of numbers: how much is going in and how much is going out. They don’t focus on the experience of food.

Eating can be an amazing experience. Food is so emotional that it has been used in spiritual contexts across the world, but it is also simply an important sensual experience. It can even be sexual (what else do you put in your body?). Sharing the experience of food with others is one of the most important joys there is in life. It is extremely emotionally damaging to ignore these elements of food. It can push others away from you. Food can be extremely comforting as well, and denying yourself the physical comfort of food is cruel. Just as your emotions need tending, so does your physical body, and food in all its glorious forms gives it that tending, connects it to your emotions and your values, and gives you a connection to those around you. Eating is joyful when it’s done without guilt, without fear, without paranoia. Dieting destroys this opportunity.

Diets create a very unhealthy attitude towards food in general, and towards our bodies. They set us up to not be able to listen to our bodies and the cues they give us, they ask us to ignore our emotions and our needs, and they often do so at the expense of our health. Finally, they’re just unnecessary most of the time. Everyone has a “diet” in that we all eat. Adjusting our diet is different from dieting. If we want to be healthier, we can still include all of the joys of food, we can still view bodies as an integral part of self, and we can still allow food to connect us to others. We don’t have to use diets as a method of control and self-denial. We don’t have to exist in a state of paranoia about food. We don’t have to constantly be breaking down our food intake into its calories, fats, and other component parts. We can simply eat, know the facts about food, and adjust our food so that we feel good about ourselves and our bodies. Health does not have to mean buying in to an industry explicitly designed to make you feel like crap about your body. That’s what dieting is.