Mental Health

I have lately been delving into substance abuse, suicide, and mental health in general. This past weekend, I used an AI-based platform to digest 250 journal articles on these topics.  The resulting panorama of mental health is really astounding.

I have earlier focused on hypertension, diabetes, heart disease and, most recently, cancer. My sense is that we understand these diseases far better than mental health. What are the biological and physiological sources of Alzheimer’s, anxiety, bipolar disorder, depression, personality disorder, and schizophrenia?

It does seem that we understand the biological and physiological sources of addiction in terms of reward pathways in the brain. Drugs may impede these pathways and at least help overcome the overdoses that could result. But, we cannot fix these problems by surgery.

Talk therapy seems to help with mental illness. The goal is to get the patient to take agency over their treatment and recovery.  But I wonder if you cure mental illness or just learn how to manage it.

It seems like our overall approach is premised on stratifying people into two or more bins — normal, other than normal, and really abnormal.  However, this stratification is driven by desires to match treatment protocols to bins.  Bins have no meaning to diseases.  Cancer does not realize that it has transitioned from stage 3 to 4.

This is all complicated by the need to address whole people who have substance abuse issues, cardiovascular and pulmonary challenges, and employment, housing, and poverty issues. Each silo fixing one problem at a time simply does not work.

There is also the issue of how much one can count on the patient, family, and friends to help. They are likely addressing their own issues of employment, housing, and poverty. We need to provide holistic health and well being, but we are not organized and resourced to do this.

I have long advocated the goal of fostering a healthy, educated, and productive population that is competitive in the global marketplace. We know a lot about how to achieve each piece of this, but we are not very good at putting the pieces together. In light of the current crisis and likely emerging crises, we need to get much better at putting the pieces together.

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