On Neuroplasticity and Mental Health

A Personal Journey and a Scientific Review
 
It has been a long time since I've written, and honestly I have hesitated with this post too. But it's too important not to start the dialogue.

I share my personal journey here in the hopes it can help others...

I struggle with depression and anxiety.
I have my whole life, even as a child.
I take medications that allow me to share my gifts with the world, and receive the beauty of life in return. They keep me healthy, and perhaps even save my life, given some of my childhood history.
 
I have travelled the country teaching about mental health and trauma, and my latest book, Ensouling Our Schools, details the work regarding trauma, mental health, and reconciliation. I am also a part of the Neuroscience in Education research cluster at UBC.
 
I am writing this because of several conversations I have had about neuroplasticity and mental health, and I think it’s critical we come to a balanced understanding of the two: where they intersect, and where they can collide if not understood properly.
 
There are two main concepts we need to understand here: mental illness, and neuroplasticity.

1. Mental Illness:
   1. Mental illnesses are, in fact, physical illnesses. All illnesses are impacted by both biology/genetics, and environment.  Take for example diabetes. An organ in the body, called the pancreas, is supposed to produce a chemical, called insulin. When it doesn’t, we first try lifestyle changes such as diet and exercise. For some, that is sufficient to control the imbalance. For others, it’s not, so we replace the insulin that is supposed to be there. No one tells the parents of a diabetic child that they are drugging their child. Now let’s take ADHD. An organ in the body, called the brain is supposed to be producing a chemical called dopamine. When it doesn’t, we first try lifestyle changes – teaching self-regulation and other strategies. For some, that is sufficient to control the imbalance. For others, it’s not, so we replace the dopamine that is supposed to be there. Yet many parents of children with ADHD are told not to “drug” their child, even though it may be lifesaving for them, in many ways: academic success, social success, and the control of dangerous impulsive behaviors just to name a few. The same is true with depression, except the chemicals are more related to serotonin and norepinephrine, although dopamine plays some role as well.
   2. Many mental illnesses are spectrum disorders. They vary in their level of severity. Children who suffer from depression experience far more difficulty over the lifespan (i.e. it is more chronic and pervasive) than do adults who have a major depressive episode due to a triggered event (a death, breakup of a relationship, etc.). What works for one person does not necessarily work for another. There are people with depression who don’t need medications, people who need medications for a short time, people who require meds for a lifetime, and people who don’t respond to meds and may require even more intensive therapies (like electroshock), and everything in between. Like all illnesses, depression has both a biological/genetic component, and environmental vulnerabilities. Just as cancer and heart disease are affected by stress and toxins, so too is depression. There really is no difference between so called physical illnesses and so called mental illnesses.
2. Neuroplasticity:
   1. Neuroplasticity refers to the brains ability to adapt. New connections and pathways are formed by environmental interactions – learning a new language or skill for instance. Some people with brain injuries are able to rewire the brain so that the function played by the injured area is transferred to another area.
   2. Again, however, this is a spectrum. Someone who is brain dead is not going to magically rewire their entire brain. Some people lose their sight, or hearing, or mobility due to brain injury and are unable to regain these skills, while a rare few do.

 
The Intersection
 
So what does neuroplasticity have to do with mental illness?
The obvious question is to what extent can the brain be rewired, in the case of a mental illness, to cure the illness. Can someone with bipolar disorder regain emotional regulation? Can someone with depression rewire the brain to respond more typically emotionally?
 
The answer, so far from research, is yes and no.
 
Neurological research has shown that unfortunately, mental illnesses damage the very parts of the brain that are needed for plasticity. For instance, in the case of depression, areas of the hippocampus are damaged that are needed for regulation of emotion. Impaired adult hippocampal neurogenesis and depression may therefore be reciprocally causative. High levels of glucocorticoids in depression also hinder adult hippocampal neurogenesis. In other words, it’s a vicious cycle we do not yet have an answer for.
 
On the other hand, neuroplastic reprogramming – i.e. exercises that promote brain development, can have some effect on depressive and anxiety related symptoms. Mindfullness, meditation, exercise, brain stimulation all have been shown to help. Help, but not cure. The challenge is that the work that needs to be done to reprogram the brain is extensive and in some cases lifelong. If one has to spend many hours a day to do so, it is not really supporting that individual to lead a normal life. Being a monk who prays 6 hours a day is not for everyone.
 
So here is where my personal journey perhaps can bring to life this conundrum, and the challenge facing people like me with depression. The life I have chosen to lead – spending fourteen hour days working, travelling constantly, being exposed to the trauma of others…is a high stress life. It does not leave room for the 6-8 hours a day of neuroplastic work that an adult my age would need to do to try to reprogram my brain – and even then would have a low chance of success given that my depression began in childhood (so it is chronic, and brain development was impacted), and I am 52 (neuroplasticity does reduce with age).
 
I had a choice, lead a simpler, more relaxed life with more time to focus on me, without medications, or swallow my pride, accept the medications, and lead the life I was born to lead.
 
I wrote this essay as a call, no a YELL, to slow the new wave of stigma being thrown at people with mental health issues as a result of the new findings around neuroplasticity and “growth mindset”.
 
In the last few months, I have had several people tell me I could, or should, get off my meds, because the brain can adapt if I just “do my work,” their friend did! I just need to do more exercise, spend more time in meditation, take classes in a new language, eat low carb, eat high carb (the brain needs glucose, ya know), work less, play more (shouldn’t we all), write reflective journals (will that get me tenure?), try CBD oil or 5htp (so replace one drug with another), and more.
 
It is shaming. It implies I should just be able to get over this. I could fix it if I just tried harder, was more dedicated, changed my “beliefs”. What it does is make me feel broken, a failure, not good enough.
 
I am an adult, with a strong sense of self – and I have cried many, many tears over this, even in the last few days. I am a scientist who knows the facts, and a spiritual person who can see beyond them and believes I can help myself to lead my best life, respond to my true calling, bring love and healing to the world, and share in its magic.
 
How would someone less strong within themself hear such a message?
 
I workout several times a week, eat a mostly healthy diet, meditate several times a week, have a regular spiritual practice – and I take meds.
 
Please stop telling me neuroplasticity means I can stop being depressed and get off my meds.
 
Please stop telling me your stigma around mental health means I should!
 
And for God’s sake, don’t tell a vulnerable child/youth in your care they can just heal themselves, and are a failure if they don’t, and give their friends the same message.
 
Yes, give them hope. Tell them living with a mental illness doesn’t have to be torturous. Tell them there are things they can do that will help them to heal, to live full lives, and to find joy. Teach them mindfulness strategies and coping skills, tell them about neuroplasticity and that they can grow and change. But tell them too, that sometimes we need help to heal from an illness, and when we do its ok to go to a doctor, and take the medications that make us well.
 
Stigma is killing our children, literally. 80% of kids with mental health problems don’t get help – they don’t seek it because they are ashamed. And some of them die from depression/suicide, others suffer silently, and many end up using other substances to cope.
 
Please, get the facts. It is well intentioned when we want someone to be well, but it is harmful when we imply it is not ok not to be.

Your Thoughts?