Sad? Anxious? Really, It’s All in Your Head!

People pose for photo

NAMI Executive Director Heather Turner with Stephen Strakowski, MD. Photo by Cindy Starr / Mayfield Clinic.

Shake it off … Everybody goes through bad patches … Chin up … It’s all in your head!

Sound familiar? Stephen M. Strakowski, MD,  a leading psychiatrist and researcher, knows that for those who  struggle with mental illness, dark thoughts and cloudy moods really are  all in their head. But – and here’s the catch – they’re biologically  based and not a sign of moral failing or personal weakness. “The brain,”  he said Wednesday, “is vulnerable to going awry.”

Dr. Strakowski, Senior Associate Dean for Research at the University  of Cincinnati, the Dr. Stanley & Mickey Kaplan Professor and  Chairman of Psychiatry and Behavioral Neuroscience, and head of UCNI’s  Mood Disorders Center, discussed mental illness in an evolutionary  context and condemned stigmatizing attitudes at the 2011 Annual  Celebration of NAMI Hamilton County. The organization is one of more than a hundred local branches of the National Alliance on Mental Illness.

Like a new automobile or the latest computer model, the part of our  brain that houses the newest and most complex machinery is most apt to  have a bug in it, Dr. Strakowski said. “Our big foreheads – the  prefrontal cortex – is what makes us human,” he said. “We’ve only had  these big foreheads for 50,000 years, whereas we’ve been walking around  for 4 million years. The newest part of the brain is the least tested  over time.”

The new brain, he added, “has matured late, and it’s the seat of most, if not all, mental illness.”

Dr. Strakowski said problems arose with a breakdown of feedback loops  between the newer prefrontal cortex and two very old parts of the human  brain. The older parts involved in this misfiring are 1) the striatum,  which drives us for reward and pleasure, and 2) the amygdala, which  drives our “fight or flight” response. In the modern world, the amygdala  fires when we argue, become emotional or experience stage fright.

“These deep brain structures are closely connected to the prefrontal  cortex,” Dr. Strakowski said. “The prefrontal cortex modulates and  manages primitive impulses. Ninety-five percent of our decisions are  based on how we feel, but as human beings we are able to nuance our  feelings so that eventually our emotions make good decisions for us.”

Functional MRI, a medical test that produces images of the brain in  action by revealing electrical activity, shows that in people with  bipolar disorder, the amygdala is overactive even in situations when the  brain is processing a simple task. This results in serious mood swings,  from abnormally elevated or energized moods (mania) to depression.

Looking out over a packed dining room at the Hyde Park Country Club,  Dr. Strakowski said that the audience – a record 225 for NAMI’s annual  celebration — showed that “people are finally starting to get it.”  Mental illness, which accounts for five of the 10 most disabling  conditions in the world, is vitally important, he said. The world’s most disabling conditions, according to “The Global Burden  of Disease” (Harvard University Press, 1998), are: 1. major depression;  2. iron-deficiency anemia; 3. falls; 4. alcohol abuse; 5. chronic  obstructive pulmonary disorder; 5. bipolar disorder; 7. congenital  anomalies; 8. osteoarthritis; 9. schizophrenia; and 10.  obsessive-compulsive disorder.

In summary, people who pejoratively dismiss depression or other  mental illness as being “all in your head,” are uneducated about the  biological mechanisms underlying the disease. “Stigma is always based on  ignorance,” Dr. Strakowski said. “Typically, the most stigmatizing  people know the least about what they’re talking about.”

Dr. Strakowski encouraged his audience to continue working to “spread knowledge and help people understand these illnesses.”

*  *  *

Among those receiving 2011 Awards of Excellence at the NAMI event were:

  • Scott Bullock, MSW, LISW-S, Lindner Center of HOPE, “Exemplary Therapist”
  • James Curell, MD, Associate Professor of Clinical Psychiatry at UC, “Lucille Pederson Hardgrove Exemplary Educator”

Save the date: NAMI Walks at Sawyer Point, May 12, 2012.

— Cindy Starr

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