Mental Illness: Let’s Call It What It Is... A Physical Disease

Millions of Canadians suffering from mental illness could benefit from one simple change. Instead of describing it as a disease of the mind, we need to accept and call it what it really is: a disease of the brain.

While that may seem like simple wordplay, it would signify a truly revolutionary approach to dealing with mental disorders. Evidence from decades of scientific research suggests this is the way to go.

With some diseases that severally impact mental functioning, this has been the case for decades. Consider how we view Alzheimer's disease. While it creates behavioural challenges– memory loss, misplacing things, becoming disoriented–it has long been accepted as a neurological disease. But scientific advances, in particular in the fields of brain imaging and genetics, have produced strong evidence that many other diseases such as anxiety and depression aren't so much mental ailments as they are health problems with cause by malfunctioning of the brain. At their root are physical causes: Mix-ups in genetic sequencing, underperformance of neurotransmitters in the brain such as serotonin, and the environment can all play a part in mental diseases. In short, while their symptoms are often more behavioural than physical, these conditions are just as "real" as cancer or cardiovascular disease.

Unfortunately, almost half of Canadians still believe that a diagnosis of mental illness is merely an "excuse for poor behaviour and personal failing", and one in ten think those with mental illness could just "snap out of it" if they wanted to, according to a recent survey commissioned by the Canadian Medical Association.

If we as a society accept the physical basis for such so-called "mental" illnesses, it's difficult to overstate the positive impact this would have on those who suffer from them. The less stigma mental illnesses carry, the more those with diseases such as anxiety or depression will seek treatment, which would be a major health-care achievement. Currently, it's estimated that, at most, just 20 to 25 per cent of people suffering from a mental illness seek help.

Increasing the willingness to request and undergo treatment would also have positive ramifications for the country as a whole. With proper care, those with mental illnesses will have more stable home lives, find it easier to perform well at work, and generally be more positive, happier members of society. While we joke about taking "mental health" days, mental illness accounts for a stunning forty per cent of disability claims and sick leaves in Canada. Overall, according to a Centre for Addiction and Mental Health study, the annual cost of mental health to the economy each year is a staggering $51-billion.

An important step towards increasing our understanding of the physical nature of mental health was the creation of the Mental Health Commission of Canada. Established by the federal government in August, 2007, the Commission is developing a national mental health strategy and a long-term stigma-reduction campaign. As Commission Chair Michael Kirby has said, the stigma faced by people living with mental health problems such as depression, bipolar disorder and schizophrenia is often worse than the mental illness itself. Here, we are following in the successful path of other large-scale campaigns to reduce the stigma surrounding these disorders, including Beyond Blue in Australia and See Me in Scotland.

Still, there are important leadership roles to be played by everyone from the medical community itself to educators. Health care professionals not only need to be made more aware of the scientific work underscoring the physical nature of mental illness, but also enlisted to help break down the artificial wall between mental and physical diseases. In fact, some of the worst discrimination and stigma faced by those with mental illness comes from their health-care providers, according to Mr. Kirby. We also need to start talking early on to our children about the problem. Introducing primary school students to the physical roots of mental illness and the many treatment options available may help them respond more effectively when they encounter symptoms in themselves, their families, or their friends. And while some politicians, athletes, and writers have begun to talk openly about their own battles with mental illness, we still need more well-known personalities, from actors to hockey players, to speak out and to champion research and public awareness efforts.

We don't yet have a cure, but tools such as genetic profiling and brain scanning, combined with better drugs and psychotherapy, are greatly advancing our ability to treat conditions such as depression and anxiety in much the same way we do hypertension or diabetes. The more we accept and embrace the fact that such conditions are not just "in your mind", but real diseases with real biological causes, the more we'll be able to help all those dealing with mental illnesses live productive and happy lives.

Dr. Rémi Quirion
Inaugural Scientific Director
CIHR's Institute of Neurosciences, Mental Health and Addiction