Understanding Functional Mental Illnesses

Tom and Jim attend your church. Tonight the phone rings and you're shocked by the news. Both died today. Tom had a stroke and Jim committed suicide.

You feel a rush of sympathy for both families. Then you begin questioning why Jim would kill himself. Work was going well, he had a loving family, and he was just nominated to the church council. What reason could he possibly have had?

On the surface, the deaths seem different. They aren't. Tom had high blood pressure and Jim had a major depression. They were both prescribed medication that controlled their symptoms. Because they didn't like the medication's side effects, about six months ago both of them stopped taking their pills. Their illnesses returned-unnoticed for the most part. Untreated, both illnesses eventually killed the men.

Most people look at mental illness differently than physical illness. They tend to believe that mental illness is due to a character flaw or moral weakness. It's important to recognize that the brain is an organ that is vulnerable to diseases just as any other organ of the body is vulnerable to diseases.

We don't understand as much about brain illness as we do about illness of other body organs. Scientifically, it's difficult to study the living brain. Added to that is society's history of prejudice against accepting that the brain is vulnerable to disease.           

When people have functional brain illnesses, their brains are diseased. Often they have chemical imbalances that cause illnesses like schizophrenia, bipolar disorder, and major depression, melancholic subtype. ("Major depression" is an umbrella term that covers four kind of depression. Melancholic subtype is a biological depression, a brain illness. It occurs when the brain does not have chemical messengers that mediate nerve transmissions. About 20 percent of people who are depressed have this functional brain illness. These are the ones this article addresses. Many people who would say they are depressed may feel bad, but do not have brain illness.)

Christians who have functional brain illnesses and their families face unique struggles. The symptoms of the illness are confusing because they seem like those of psychological or spiritual illnesses. The problem is, people can't respond to psychological or spiritual therapy. When treatment fails, the victims and their families feel guilty and disillusioned.

To understand functional brain illness, it might help to look at the prejudice people have against brain illness. Consider the expression: "It's all in your head."

When people say this, what they're really saying is: "It's all your imagination" or "You're faking it." With functional brain illness, the phrase is literally true because the illness is in the limbic system of the brain.

We don't say "It's all in your head" to a person with a brain tumor, but that would be accurate. However, we often let people with functional brain illnesses know (either directly or indirectly) that we think their illness is "all in their head" (their imagination). It would be better to say, "It's all in your brain." Not only is that statement accurate, but it's not prejudicial or judgmental.

Think of what you hear people say to someone who is depressed. "What do you have to be depressed about? Your husband loves you. You have a good job." "If this is happening to you, you must have sinned." (Recognize Job's friends?) "There's something defective about your faith."

When we make statements like these, we do it because we need to have cause and effect. If a person gets depressed, we want a rational explanation. If we can explain it, we protect ourselves. "She's depressed because this happened and since that's not likely to happen to me, I won't get depressed." We look for ways to distance ourselves from the chance we might get what others have. If we can't explain why someone got depressed, then we're equally vulnerable and may get depressed, too.

We not only try to explain why people become depressed, but why they stay that way. We want easy strategies to make the problem go away. "You wouldn't be depressed if you got up earlier." "You'd feel better if you started running every day." "You should stop eating sugar." "You need to read your Bible more." "The answer is going to more prayer meetings."

For some people who are depressed, these will work. But for others--those with functional brain illnesses--these won't. The key is remembering that the brain is an organ just as the pancreas is an organ. We ought not to think differently about brain illnesses than other organ illnesses. Perhaps the reason brain illnesses are so intimidating to us is that the brain is where our soul is.

Christians believe that part of the living human being is non-material. We believe when the body dies, something that had been connected to the body continues to live. That something is the soul or spirit.

No one can say exactly where the soul is located. If we could fix an exact location, then it would be material, not spiritual. But we may be able to narrow down its location.

A person's soul doesn't change if his arms are cut off. A person still has a spirit if her legs are cut off. Christians like to talk about "believing with the heart," but they don't literally mean it. In fact, we know people can have their hearts removed and replaced with another person's heart and they still keep their own soul. They've just exchanged a blood pump.

If the soul has a physical location, it must be in the skull. Any other body part or organ can be taken off or replaced with someone else's organs or bionic parts and the recipient will still have the same spirit. However, if a person's brain were to be taken out and replaced with another person's brain, then I suggest the soul would be transplanted as well.

Many of the physiological expressions of the soul are in a very special part of the brain called the limbic system. This is a small, but central component of brain tissue. The limbic system is also involved in reflex responses to affective (or emotional) arousal.

During a physical examination, the doctor strikes the patient's knee with a hammer. A reflex causes the leg to kick out. The limbic system has its own kind of reflexes.

Imagine encountering paramedics at a car accident. They're working on someone who's hurt and bleeding badly. When you see the blood, you feel hot, weak, and may actually faint. What has happened?

Waves of light entered your retina, the brain processed it, and you fainted. The limbic system is the primary receiver of sensory signals that have emotional context. If you fainted at the sight of blood, the limbic system began a process that led to insufficient oxygen and glucose going to your brain and you became unconscious. This is a limbic reflex.

We think of emotions such as love as not being physical. Actually, emotions involve physical reflexes. How can you tell if you're connecting with someone emotionally? One specific sign is that the little sac under the person's eye will swell. The sac swells as a reflex of their limbic system.

Families and friends of people with functional brain illnesses affecting the limbic system feel confused because many of the functions of the limbic system seem like functions of the soul. In other words, some of what Christians attribute to a person's soul is the limbic system functioning in a physical way.

For example, when you pray and you feel God is hearing your prayer, it's your limbic system that handles that experience. If your limbic system were to become defective, you might pray and feel God doesn't hear. You might think, "I must have committed the unpardonable sin" or "I must have been a fraud my whole life because there is no God. I pray and it doesn't go anywhere." Or you might feel God is giving you a special mission: "God has given me a message that if I kill myself, China will become free of communism." Changes in the limbic system don't change God, but they do change your ability to have a normal sense of connection with God.

The limbic system is the part of the brain that holds all our deep beliefs. Deep beliefs usually include religion, emotional bonding, and politics. When the limbic system becomes diseased, these beliefs are affected. People may suddenly switch beliefs or reject them. These changes are difficult for families.

The limbic system also holds the "affective vocabulary." These are arousing, emotional words: swear words, sexual words, political words, religious words. The rest of our vocabulary--the everyday words--is stored in the cognitive brain, the cerebral cortex. Vocabulary comes from different parts of your brain depending on the situation. If you're pounding a nail and you hit yourself, your immediate response is probably not, "I hit my finger." You probably had a more "colorful" response because it came from your limbic system.

Stroke patients may lose their ability to speak from their cognitive cortex, but keep their limbic system. That may leave people with their positive or negative affective vocabulary. If you go to a nursing home that has several stroke victims, you may hear people swearing and others singing about Jesus.

Understanding the limbic system helps friends and family of a person with a functional brain disorder. However, the help may seem minimal when someone you love is ill. You may have tried everything you know to help the person and he or she keeps saying such things as: "My children don't love me anymore" or "It'd be better if I were out of the way" or "My wife loves the neighbor more than she loves me." If you're a child, spouse, or friend who constantly tells the person about your love, statements like these are discouraging. Remember--when the limbic system isn't working, the words don't register. People hear the words with their ears, but the message stops there.

When a person gets treatment for the brain illness, it's important for the psychiatrist to know these symptoms. Major depression is going to be different in different people based on their personality and character. Psychiatrists use symptoms to know how to treat the illness. It's also important for family members to be honest with the therapist about how they've dealt with the illness. Often before the illness is diagnosed as a brain illness, people try everything. They move, change jobs, pray, anoint with oil, go to confession. Every time they try something, they have new hope that is followed by disillusionment.

Sometimes when I work with families I use an experiment to help them understand how the limbic system is involved in their family member's illness. I remind them the limbic system responds to emotions--both positive and negative. Then I move toward a family member and say words that carry emotional meaning, but are empty of actual content. For example, I might tenderly say, "You are a very special person." As I speak, the person's lacrimal sac (under the eye) will swell--the physical evidence that the limbic system has responded to the affirmation. We've bonded or connected affectively.

Family members easily see that physical change. As the individual comments on how it felt to be affirmed, I point out that my affirmation was empty of content.

This experience can be profound because it clearly demonstrates to family members there is an actual chemical reflex to feelings.

This experiment is just like the knee jerk reflex. Even if I tell the person before I begin speaking what I plan to do, it will still work. The words that made him or her feel good caused an uncontrollable physical reaction. As a person with a functional brain illness gets sick, the positive messages don't get through. We can see that physically because the lacrimal sac doesn't swell easily. We no longer connect affectively with them. We lose our "affective relatedness." This is the sense of closeness we have with people with whom we've affectively bonded.

People with a brain illness experience changes in their affective relatedness. We tend to view that as the person changing rather than as the brain changing. For example, we think of Donna talking to Cindy, not Donna's brain reflexly responding to Cindy's brain. We want to think of it more holistically. But when there's a brain illness, that changes. The affective relatedness is aborted. It's not because Donna has changed or Cindy has changed. It's because Donna's brain is sick.

We're used to naturally relating to each other and bonding affectively. When that doesn't happen, we think, "Something's wrong with me, I can't get through to her" or "Something's wrong with him" or "Why is she rejecting me?" or "Why won't he listen?" We don't think, "Your brain is sick." We begin to have negative feelings towards the person rather than saying, "It's a shame her brain won't let this through right now. I long for a time when her brain will do this."

That's one reason why divorce is high in this illness--people who don't have the illness will begin to feel unmarried. They're no longer connected and begin to attribute it to the relationship rather than to their spouse's brain not working correctly.

If the family understands the illness, it may help them understand some of the behavior. Many victims may proclaim undue familiarity with God or practice indiscriminate sexuality. Sinful behavior such as sexual sin may be part of the picture. Understanding the illness is not designed or intended to excuse sin. The Christian who sins has confession and forgiveness ahead before relationships are restored. However, this usually can't take place until the mood swing is at least partially under control by medication to regulate the limbic transmission.

By far the most common functional brain illness is chemical depression or melancholia. People may feel as if there is a glass wall around them so they can see others, but they feel emotionally cut off or separated. God may seem equally distant.

In this situation, it's important family members understand the disease. They often feel frustrated because they've affirmed their love so often and it doesn't get through. They may have repeatedly told the person God is hearing his/her prayer. But, as long as the limbic system isn't working, none of these words help.

I sometimes refer family members to Asaph, a writer of some of the Psalms. He may well have experienced melancholia, yet God used him to write many songs. Asaph writes:

I cried out to God for help;

I cried out to God to hear me. When I was in distress, I sought the Lord;

at night I stretched out untiring hands and my soul refused to be comforted.

I remembered you, a God, and I groaned;

I mused, and my spirit grew faint. You kept my eyes from closing;

I was too troubled to speak.

I thought about the former days, the years of long ago;

I remembered my songs in the night. My heart mused and my spirit inquired;

"Will the Lord reject us forever?

Will God never show favor again? Has the Lord's unfailing love vanished forever?

Has God's promise failed for all time? Has God forgotten to be merciful?

Has the Lord in anger withheld his compassion?"

Psalm 77:1-9

The sense of separation from God and the eternal quality of the separation come through clearly in this song. Sometimes people with a functional brain illness and their families feel reassured when they realize the experience is found in scripture.

It also helps to clarify that in the usual situation, when a person feels separated from God and family, he or she usually has other symptoms that point to a dysfunction in the limbic system. These include losing his or her appetite, waking up too early, or feeling bad in the morning and finally feeling good when it's time to go to bed in the evening.

Another important aspect of the illness is loss of insight. The person with the functional brain illness won't recognize the presence of the illness. He or she may realize that something is wrong, but won't really have insight to the problem because the brain has taken the data and rearranged it. The brain does this with other illnesses, too.

When I started in medical practice, a farmer came in asking for an injection for his left shoulder so he could continue harvesting. He was ashen and sweating, but it was difficult to convince him that his problem was in his heart, not his shoulder. It didn't make sense to him--it was his shoulder that hurt, not his heart. Actually the pain coming from the shoulder was coming from nerve cells in his heart that had never sent pain messages, so the brain didn't know where to project this new pain. It assumed the pain must be near the left shoulder and communicated that to the conscious mind. A person may intellectually know the pain is from a heart attack, but will still feel it in the shoulder. Individuals can learn intellectual insight, but not feeling insight.

Let's consider another example. If you set the thermostat in a room at 95 degrees, the heat would come on, and when the I room reached 95 degrees everyone would say it was hot. However, if we could ask the thermostat if the room was hot or cold, it would say the temperature was just right because the temperature agreed with its setting.

Remember the last time you got a fever? Most people feel chilled because their brain has reset the temperature in the limbic system. Many germs can't live above 102 degrees, and fever is the natural antibiotic God placed in our bodies. If the limbic thermostat center resets the body temperature to 104 degrees, a normal temperature of 98.6 degrees would feel cold. You say you have a chill. Knowing that you're getting a fever doesn't change those chilled feelings to warm ones. You have lost affective insight and will feel cold.

The same happens to people with a functional brain disease. They cannot affectively realize their brain has changed. They can intellectually learn it. They say, "This is what happens when the doctor says I have melancholia. When I take pills I feel better for reasons that don't make any sense to me." That's the best a patient can do.

Eighty-five percent of those who have a functional brain illness will get better. We have no idea how the healing occurs. That leaves 15 percent whose brain never really corrects itself. These people have to continue medication.

The brain of a person with a functional brain disease is not making enough neurotransmitters. The medication doesn't make more neurotransmitters; it simply protects the meager amount the brain is making from further destruction. Medication doesn't cure the illness; it relieves the symptoms. Like high blood pressure, the pills only work as long as people take them.

The first bout of functional brain illness in an individual is usually related to a significant stressor. Occasionally the disease comes "out of the blue," but most frequently the first episode occurs with a psychological trauma.

Many people with melancholia have the disease precipitated by getting divorced, being fired, going bankrupt, or other stressful events. People naturally assume these may cause depression. For the vulnerable person, this triggers a biological illness.

If this seems confusing, consider that it's the same for other parts of the body, too. It may take a major stressor to cause the first ulcer, but once the first one arrives, others may happen quite easily.

This seems to be true of the brain. The first break has a psychological factor. This is one of the confusing aspects of getting an accurate diagnosis because all of the depression is attributed to the psychological problem. It may be a while before anyone recognizes the physical element.

If the illness is cyclical--as in a bipolar disorder or major depression, melancholia--further bouts occur more and more spontaneously. It's as if the major stressor cracked the stability of the brain. The brain never fully heals and remains vulnerable to future disruptions.

There's a similarity to diabetes. Diabetes is a functional illness of the pancreas. Between 1940 and 1945 in England there were almost no new cases of diabetes. The absence of sugar in the diet, caused by war rationing, protected those people who were genetically predisposed to diabetes.

This is comparable to a person who is genetically predisposed to a functional illness of the brain. If there is no excess emotional "sugar" or stress, they're more protected.

Another example is dental cavities. Individuals are more likely to have cavities if their parents have susceptible teeth. We have some control over cavities by brushing, using fluoride, and watching what we eat. But we all know people who neglect their teeth and never have a cavity while others use careful dental hygiene and still get them.

Once a cavity appears, however, all the brushing in the world won't make it disappear. It must be filled. This is the parallel to medication for the functional limbic system illness. Even if we can identify poor mental hygiene as what caused the illness, it is now an illness. It must be treated by "filling the cavity" with medication.

If you or someone you know has a loved one or family member with a functional brain illness, education is key. They are probably frustrated that nothing they've tried has worked and all their prayers seem unanswered. God is as capable of the miraculous healing of chemical imbalances as of replacing amputated legs. But think how differently we treat people with these problems.

Since people can't see a brain illness, they don't quite believe it's an illness. They may say the victim should pray for restoration. In fact, some say if prayers for healing aren't answered, the person didn't have faith. Would they say that to someone who's had a leg amputated? No, they would encourage the amputee to get an artificial leg and the physical therapy necessary to learn to use it. For a family affected by a functional brain illness, this disruption may seem unfair. They may wonder why God won't fix it. We can help by assisting them to understand God often allows us to experience illnesses of all kinds. God wants us to use the hardships in ourselves and our families as weakness that will allow us to turn to God strength.