Larisa: Hello and welcome to the Mental Health for Romania podcast! I’m Larisa.
Dan: And I’m Dan.
Larisa: And today we’ll be talking about the science behind mental health.
Dan: That’s right, a topic that we’re both passionate about. We’re both research assistants in neuroscience/psychiatry and members of the Mental Health for Romania team. I studied Natural Sciences at Cambridge, and as part of the team, I work on research and the blog.
Larisa: And I studied psychology and psychiatric research at King’s College London, and within the NGO I work on the podcast and the blog. We thought we’d start this episode by answering the question, “What is mental health?” But before we do that, we thought you could pause the episode for a few seconds and answer this question yourselves before listening to the definitions, so to speak, of mental health.
Dan: Okay, we hope you’ve answered the question and given it some thought. It’s a very difficult question, one that I was actually asked in an interview as well, and I wasn’t very confident in my answer.. The simplistic answer is that mental health is simply the absence of mental disorders, which are those chronic illnesses such as depression, anxiety, schizophrenia, bipolar disorder, and others. However, it is now generally thought that mental health is more than that, and that it is somehow related to the idea of well-being. What do you think, Larisa?
Larisa: Yes, I agree. As you said, it’s a very complex topic, and it’s difficult to give a definition, so to speak, but it’s clear that mental health, as you also said, is more than just the absence of psychiatric disorders. I think it’s important to point out that mental health is now considered part of the broader definition of health, as the World Health Organization also states, alongside social well-being and, of course, our physical health. So it’s very important to keep in mind that mental health is part of a complex whole.
Dan: Mhm, absolutely, yes. And I wanted to say that whatever answer you came up with, it’s a very subjective question. So whatever answer you gave, there isn’t just one correct answer.
Larisa: Exactly.
Dan: However, I think it’s important to think beyond this question. To think about today’s topic, which is the science behind mental health. Quite often, when I tell people that I do research in this field, or rather, when they point out that it’s something very specific, quite a… niche field, they ask me why it’s important to study this and to understand mental health from a scientific perspective. And I think it’s interesting here to look at history, and probably we’ve all heard of things like exorcism, of how religion used to treat people with mental disorders very badly, and how they associated their problems with this idea of morality and with being an evil person, so to speak. And, yes, somehow we’ve moved on from that to where we are today. We have a medical understanding of mental disorders; they are part of medicine, and psychiatry is the branch of medicine that deals with them. However, yes, there are still shortcomings, for example, when it comes to diagnosis and treatment, right?
Larisa: Yes, yes, exactly. It’s very well put, and it’s amazing to think about how much science has progressed and, ultimately, how much mental health research has advanced alongside other fields of science over the last century. But yes, you’re right, mental health disorders are still diagnosed using diagnostic systems such as the DSM or ICD, which, as we both know, are not very scientific.
Dan: Mhm, yes.
Larisa: And they essentially put people into, well, how should I describe them…
Dan: Little boxes.
Larisa: Little boxes, exactly. And if you don’t fit very well into one of these little boxes, your diagnosis isn’t very well understood, and as a result, you may not receive the treatment you need. So we still have quite a bit of work to do when it comes to diagnosis and treatment.
Dan: Since you were talking about diagnostic systems, before recording the podcast, I asked you, our listeners, to send us some questions on Instagram, and one of them was specifically about this. It was more generally about diagnostic systems, but also about how they change over time and whether there are new diagnoses. And, well, when I say “systems” in the plural, it’s actually one system, but there is an American version, the DSM, and a European version, the ICD, and they are essentially almost the same thing. And, yes, they change over time: new diagnoses are added — for example, binge eating disorder was added in 2013; others are redefined, such as autism spectrum disorder, where we now have the concept of the autism spectrum and Asperger’s disorder is no longer considered a separate diagnosis; or some categories are even removed, for example homosexuality, many, many years ago. However, these are still essentially just redefinitions of the same little boxes, and they aren’t necessarily based on studies. I mean, all the research that is being done is very… well, in the case of autism spectrum disorder, it is research-based, but somehow these changes are very small compared with the vast amount of information contained within these diagnostic systems.
Larisa: Exactly, exactly. And if we think about this diagnostic system, there isn’t really much of a concept of prevention or intervening earlier, precisely because, as you said, if you don’t fit the respective symptoms, you don’t receive that particular diagnosis, and therefore you’re not really integrated into a specific treatment system. So I think it’s important to talk about prevention when it comes to mental health as well.
Dan: Yes, definitely. And since you were talking about this, another question we received was, “Is everything genetic?” And this is related to what the causes or risk factors for mental health disorders are. Would you like to tell us a little more about this? I think you know more about it.
Larisa: Yes, of course. The short answer is that no, it’s not all genetic. It’s ultimately an interaction between genetic factors and environmental factors (factors that can change; these are the environmental factors), but even those aren’t entirely within our control, and of course, this varies from one disorder to another. There are disorders that have a larger genetic component than others. For example, schizophrenia has a somewhat larger genetic component than, say, anxiety, but even so, both of them essentially arise as a result of an interaction between genetic and environmental factors.
Dan: And when we talk about environmental factors, what do we mean?
Larisa: We might think, for example, of potentially emigrating to another country, because that is usually associated with stress and various changes in our lives; social stress; perhaps urbanization, the fact that we move from a rural environment to a very crowded, chaotic one. So, all these factors that aren’t something we’re born with, but that we encounter throughout our lives. And I think they’re particularly important when we’re talking about childhood or adolescence, or periods when we’re constantly…
changing.
Dan: And developing, yes. But there’s this idea of trauma, right, particularly in childhood? It’s very interesting to study, to study… somehow, a very large, very negative event, for example, instances of violence or the death of someone, or… But, well, trauma doesn’t necessarily have to be… there’s also the idea that something can be experienced as traumatic regardless of its magnitude, so we shouldn’t… we shouldn’t convey the idea that trauma is necessarily a very major event. But yes, all these things can have an impact, right? And they can lead to the development of different things; they somehow interact with our personality, with personality being a series of traits, psychological traits, right? Which are somehow linked to our genes, but they interact… and depending on how they interact with the external environment, this can lead to, somehow, different nuances of psychopathology or mental disorders.
Larisa: Yes, absolutely. And as you said, just because we’ve encountered certain risk factors or environmental factors over the course of our lives, it doesn’t necessarily mean that we’ll react to them in the same way. It all somehow depends on how we perceive those particular factors, and it’s quite complex; there are many things that need to be taken into consideration. But, in short, no, it’s not all genetic.
Dan: Mhm, and I think now it would be great to talk about our background in biology and psychology, and our shared interest in psychiatry. To talk about, essentially, what we might call the central part of the discussion. When we think about the science behind mental health, in general, we think about the biological and psychological basis of psychiatric disorders and, well, of mental health in general. Let’s focus on that and think about what we know about it so far and, also, how this helps us, or has helped us, discover treatments, because ultimately the goal is to discover effective treatments that work for a particular… for a particular diagnosis or a particular… assessment outcome. So, there are many theories, right? But, let’s say, what is your favorite theory, or your favorite part of this whole field? Like, what do you think… where do you think the basis of these disorders lies, where do you think it is?
Larisa: It’s very difficult to answer this question, precisely because there are so many factors that can play a role in psychopathology. As you suggested, I believe it’s a complex interaction between biology and various psychological factors. And here we’re talking about… when I said biology, I was referring to the biological substrate and the fact that psychiatric disorders have a biological basis, in the sense that there are certain alterations at the level of the brain or certain chemical imbalances that can occur and which are thought to potentially lead to different symptoms that may fit into certain diagnoses.
Dan: Yes, that’s… in a way, it’s also my favorite theory because it’s very interesting to connect biology — I’m interested in biology — with mental health, but at the same time, it’s also my least favorite theory, this theory of the chemical imbalance. Or you’ve probably heard of “happiness chemicals” — dopamine, serotonin, for example, or noradrenaline. And the idea is that all these compounds are neurotransmitters through which the neurons in our brains communicate with one another, and it is believed—or, well, there is this theory—that having a level that is too low or too high, an altered level of these neurotransmitters in a person’s brain, can lead to a disorder. For example, serotonin is linked to depression. And I wanted to say that this theory is quite controversial. Because, in fact, the main evidence, or at least the earliest evidence, is the fact that medications… that when researchers were trying to find treatments for depression, for example, they discovered that there are certain compounds that alleviate symptoms of depression and that, at the molecular level, if you conduct experiments in a test tube or with animals or something like that, you can see that they act on this system involved in depression. For example, a certain type of antidepressant acts on the serotonin system. And from this, the conclusion was drawn that serotonin is involved in mood and in depression.
Larisa: Exactly.
Dan: And it’s actually very limited when we think about how… how strong this evidence is. It’s not very strong. What do you think?
Larisa: Yes, I think you’ve really hit the nail on the head, precisely because the brain is so difficult to study and so inaccessible, that most discoveries or most theories, as you said, such as the theory about this chemical imbalance, essentially come from various observations, from which we can’t necessarily conclude that there is a cause-and-effect relationship.
Dan: Exactly.
Larisa: And so we can’t be one hundred percent sure that this is the only reason, or necessarily the cause. It could be, it could occur, I don’t know, as a result of a certain event, it could precede a certain event; we’re not entirely sure about the order of events, and which is necessarily the cause and which is the effect. But certainly, it’s important to take the chemical imbalance theory into consideration.
Dan: In a way, I think it’s very difficult, it’s very complex… there are these two levels at which you can study things, the biological level and the psychological level, and it’s very important to somehow connect the two, right? But, as you said, it’s very difficult to make that connection, it’s a very challenging thing, right? I mean, it’s difficult to link a psychological process, for example, a cognitive process, such as, I don’t know, attention, memory, reward processing, language, and so on, to a biological substrate that is so, like, specific, right? And I find that very interesting. So, I’d say my favorite part of all this is that, for example, with dopamine, we know fairly clearly, based on a lot of studies, both in animals, and there are also mathematical models of this, that dopamine is involved in reward evaluation. So, when we have to choose, I don’t know, to do something, we estimate how rewarding it’s going to be, how large the reward will be, and somehow we know that the dopamine system—that is, the dopamine neurons in the midbrain, I think, if I remember my neuro… classes correctly—there is this connection with dopamine, in that dopamine actually encodes this evaluation, or, well, it actually somehow encodes the difference… these prediction errors, right? The difference between expectations and the outcome, or something like that. But you see that they’re involved in reward, in reward processing, and somehow we can connect that to depression, where we have a lack of interest and pleasure… it’s called anhedonia… and we can already make that connection. Like, okay, it makes sense that low dopamine levels are associated with this lack of interest, and it makes sense that medications that increase dopamine work, so we’re already seeing a more substantial connection. But for most disorders, the story isn’t quite so neat, right?
Larisa: Yes, exactly. And just as dopamine can play a role in certain disorders, for example psychosis, it doesn’t necessarily explain all the symptoms that come with that diagnosis. For example, antipsychotics can, to some extent, address the positive symptoms of psychosis, such as paranoia or hallucinations, but they don’t address other symptoms, such as cognitive or negative symptoms, which are very similar to the symptoms of depression, as you said—the lack of interest or pleasure in the activities we engage in.
Dan: Ah, how interesting.
Larisa: Ha-ha, yes, it is.
Dan: So there’s no longer really a connection with dopamine here… So we had a hypothesis, but yes, this shows just how complex everything is, right?
Larisa: Yes, exactly. I mean, we could say that it is… it’s certainly involved in certain processes, but it doesn’t fully explain others. And similarly, we can think about depression, where there are people who, for example, don’t respond to treatment with antidepressants or even cognitive behavioral therapy, and so we automatically have to start thinking about other chemical substances that might be involved in those processes, precisely in order to find treatments for this, ultimately, small percentage of people. But yes, it’s important to understand depressive disorder in its entirety, even if, let’s say, the majority of people respond to the treatments that are currently available.
Dan: I completely agree, yes. I know there were something like 30 to 50%, I think, of people with depression who don’t respond to antidepressants. So yes, that’s another thing we wanted to get across: that, yes, perhaps it’s because of the diagnostic system, or perhaps simply because… and because we don’t know the biological basis, medications don’t always work. I mean, they work for many people and we recommend them, so it’s not okay to have a negative attitude toward medication, but they’re not perfect. And this is where, as you said, the other side comes in, the therapy side. And when we think about therapy, that’s where… we can think more about the psychological side, right? But… when we talk about CBT.. What actually is CBT? I mean, what is it based on?
Larisa: Well, CBT is based on the relationship between the therapist and the client. It’s a type of therapy in which the client is actively involved. The client is encouraged to actively think about how they might change the way they think, precisely in order to subsequently change their behavior. So, ultimately, it’s a therapy that focuses on the way we think, in such a way as to help us change our behavior and, therefore, improve our quality of life and the symptoms we experience.
Dan: And it’s based on, well, the cognitive sciences, psychology, right? In the sense that there are these biases or distortions that are identified, right? That’s what they’re called?
Larisa: Exactly. It somehow targets our cognitive distortions in such a way as to help us look at things from a different perspective. And it’s also a therapy that focuses very much on what is happening here and now; it’s not necessarily a therapy that involves, let’s say, analyzing processes from our past, as other therapies do, for example. So, in a way, it’s important to… I think the message I’m trying to convey to listeners here is that it’s important to establish a relationship with our therapist and also to determine which type of therapy would be most appropriate for the problem we’re dealing with, because, as I said, different therapies work in different ways and focus on different processes. And although cognitive behavioral therapy is perhaps the most studied and the most evidence-based, as we call it, that doesn’t mean…
Dan: Yes.
Larisa: That there aren’t other therapies that could work at least as well for other problems. What do you think?
Dan: Yes, that’s exactly what I wanted to say. I actually asked specifically about this because we also had a question about therapy and the difference between CBT (cognitive behavioral therapy) and other therapies, such as psychodynamic therapy. And yes, it’s very important what you said, and very, very interesting that, from a scientific perspective, the scientific community generally favors CBT, because CBT is based on these concepts of distorted cognitive processes, which are basically taken from psycho…
Larisa: Yes.
Dan: From psychology, from studies, and from our understanding of cognitive processes. And it’s also more extensively studied in terms of its effects. However, if we look at studies that focus on or examine the efficacy—or, well, how many people respond to treatment or how beneficial a particular treatment is—there are indeed differences. CBT works in some cases, but not in all cases, just like other types of treatments… other types of therapy. For example, Freud’s psychoanalysis, which was, in a way… it wasn’t really a scientific approach, right? I mean, Freud and Jung and all these other people introduced these very, very effective methods of talking, talk therapy, but they didn’t necessarily… they didn’t conduct any experiments, they didn’t conduct scientific studies, they didn’t… they didn’t do anything… there wasn’t really anything scientific about it. But that doesn’t mean it doesn’t work, right? So, it’s very important for people who are considering different types of therapy to keep that in mind. One other small thing I’d mention is that, apart from things like, I don’t know, neurotransmitter systems or cognitive processes, there are also studies at the level of the brain, right? Looking at the structure and function of the brain, where people are scanned, so to speak, and I know you have experience with that, right?
Larisa: Yes, exactly. I mean, over the past few years, let’s say perhaps more so over the past 20 years than before, medical imaging has come to be used in psychiatric research, precisely to investigate the function and structure of the brain.
Dan: And on a larger scale, right, compared to these neurotransmitter systems, which are somehow more diffuse? But the brain is an integrated whole, right?
Larisa: Exactly. Ultimately, when we talk about a chemical imbalance, we’re already talking about something at the molecular level. When we talk about brain function, we’re simply trying to see which parts of the brain are involved in different cognitive processes. For example, when we do, I don’t know, an exercise that stimulates our memory, which part of our brain is more involved, so to speak? And from there, researchers somehow deduce that this is one of the parts of the brain that plays a more important role in memory. And when it comes to brain structure, here we’re talking about alterations in gray matter or the thickness of brain structures. But here, when we talk about structure, we’re referring especially to people who have somehow been affected by the chronicity of the illness and by long-term treatment. But, just as I said before, precisely because the brain is so difficult to study…
Dan: Yes.
Larisa: That’s why we also turn to these methods, which, let’s say, are the closest way…
Dan: Exactly.
Larisa: Of studying the brain directly without…
Dan: Without dissecting it.
Larisa: Exactly.
Dan: Without being invasive. Yes, yes, it’s interesting, and as you said, you can, well, link the structure or function of the brain to memory and then link that to, I don’t know, symptoms, for example, memory loss in certain disorders, such as schizophrenia or psychotic-spectrum disorders. Yes, it’s super interesting. And, well, there are also other things now, again on the biological side, like this idea of inflammation… For example, in depression, there’s the inflammation theory, that depression and perhaps other disorders are actually caused by inflammatory processes in the brain. And it’s a very… quite controversial thing, and not… or no, it’s not necessarily controversial, but it’s very new and… What do you think about this theory?
Larisa: I find it very interesting. In a way, I think it’s interesting that researchers are trying a slightly, slightly different approach. I haven’t personally worked on any studies related to inflammatory markers when it comes to mental health, but it seems to me that, at least to some extent, it could be a plausible theory. In a way, I find it… I find it interesting that this approach is being explored as well, precisely because, once again, I’m coming back to the fact that it’s… that it’s incredibly difficult to study the brain, and I think it’s important to…
Dan: Indeed.
Larisa: Think of psychiatric disorders as somehow being the result of multiple processes that take place in tandem within the human body, and perhaps not necessarily think only about the brain, but also about certain interactions between, I don’t know, hormones or other factors, and what influence they might have on neurotransmitters or cognitive processes.
Dan: Mhm, yes… yes, I like that part too—the idea of systemic diseases and thinking about… because they’re so complex… they’re so complex, and somehow it makes sense that… we also see symptoms at the level of… we have these somatic symptoms, right, at a more bodily, physical level. I wanted to tell you a little secret: I actually had a project related to this, and the project I was working on before what I’m doing now was about… yes, about discovering or, well, identifying inflammatory markers in the blood, actually. So, it was somehow less related to the brain; it was at a systemic level, so to speak. And here’s a little big secret—it’s okay that this is in Romanian: I didn’t find anything, or I didn’t actually find any clear evidence. The evidence was very weak, so I don’t believe in it as much anymore. The conclusion is that I don’t believe in this theory as much after that experience, but I’m curious to see what will be discovered or what research will be carried out in this area in the future. And yes, since you mentioned it, since we’re talking about this idea of illness, about the physical aspects of psychiatric disorders and mental health, it makes me think of what you said at the beginning: that mental health is part of our overall health. And actually, I had a question—the last question we received from listeners was this: “Can mental health affect our physical health?” What do you think?
Larisa: Yes, it’s a big yes! Ha-ha-ha, we are an integrated system, so I think it makes a lot of sense that our mental health can affect our physical health, just as the reverse is also true: our physical health can affect our mental health. For example, when I say that mental health can affect our physical health, I’m referring in particular to physical conditions for which lifestyle factors are risk factors—the way we live, the way we do or don’t take care of ourselves. And here we’re talking, for example, about obesity, diabetes, and, in general, chronic diseases, unfortunately. Precisely because, on the one hand, perhaps we’re less inclined to take care of ourselves, while on the other hand, we’re talking about the fact that psychiatrists or doctors we interact with when we’re dealing with a psychiatric disorder may not be trained in such a way that they treat us more holistically and take physical factors into consideration in a way that, when we’re dealing with a psychiatric disorder…
Dan: Indeed.
Larisa: Our physical health is often neglected or taken into consideration too late.
Dan: That’s very sad, yes. There should be more of a connection between… or perhaps, even if the external help we receive isn’t always that holistic, we can still help ourselves in a holistic way. And what I mean is that, since mental health is, as you said, an integral part of our overall health, sometimes these methods of… self-help, self-care, simply taking care of ourselves by getting enough sleep, exercising, including things like yoga and so on, but also doing physical exercise, eating a balanced diet, keeping stress levels low, and also having social support…
Larisa: Exactly.
Dan: And, I don’t know, emotional openness, talking about our emotions—all these things, in addition to more specific self-help techniques, can help us maintain our mental health and, yes, take care of ourselves in a holistic way. So, yes, we’re very much in favor of that.
Larisa: Exactly. If you’d like to read more about the topics we’ve already discussed, you can go to our website, to the podcast section, and access the resources there.
Dan: Thank you very much!
Larisa: Thank you so much for listening, and stay tuned for more episodes!
Dan: Stay tuned, bye!
