The next "big thing" to help us better understand mental health
Happy world mental health day!
Today, I want us to look forward into the future of mental health!
It's generally accepted that social determinants of health play an important role on mental health. From the WHO, "mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live."
This seems obvious today, but that wasn't always the case. Our understand of the interplay between the social determinants of health and mental health comes from years of scientific research. It seems as though this pattern is repeating for the interaction between gut microbes and mental health!
[This figure shows the number of research articles per year on "mental health and social determinants of health" (blue) and "mental health and gut microbes" (orange).]
No area of psychiatry is as hot, or controversial today as the idea of manipulating the gut to alter the mind. The trillions of bacteria living in the human gut have been shown to play a crucial role in gut-brain communication, researchers write in the Canadian Journal of Psychiatry. The hope is that enhancing good gut microbes — whether with probiotics, fecal transplants or capsules filled with donor stool, or by adding sauerkraut or other fermented foods to the diet — may be the answer to intractable depression, the kind conventional treatments can’t touch. It could also fundamentally alter the way we conceptualize mental illness. “We now think mental illness is essentially a brain illness, and it may be that it isn’t,”. (National Post)
What do you think will help shape our understand of mental health in the next decade?
One Chinese way to describe a wicked (full of wicked ideas) person is having a 'full belly / gut of bad water' (满肚子坏水). Does it count as a realization of brain-gut connection? I added fermented bean curd, a chinese staple, back to my diet 2 years ago and it seemed helping my health in many ways.
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Yes, I think we will continue to better understand that mental illness is always mind/body illness and requires mind/body interventions. In addition it is socially embedded and I think future work will be in integrating more treatment into meaningful setting (with nature and community as perhaps the primary intervention), with more somatic therapies, more attachment-based therapies and nutritional interventions and far less dependence on over-hyped interventions like manualized talk therapies and medications. Also probably more electricity, but thinking here of neurofeedback and neurostim etc, and new modalities along these lines. And for the spiritual component and the greater recognition of early developmental trauma and neglect at the root of most mental illness, more direct focus here through models like the Comprehensive Resource Model, perhaps in combination with somatic trauma therapies and the judicious and effective use of psychedelics. And the final frontier, more focus on the ongoing well-being of psychotherapists, because when we are well, our patients do much, much better.
I think we desperately need to help people understand how incredibly capable they are of advocating for themselves and how important it is for individuals to engage in our collective wellbeing.
Our social determinants of health are all influenced by people. Why don't we ever discuss that the world is a reflection of our collective insides? By changing ourselves we ultimately change the environment around us.
Trying to balance and navigate this complex paradox is super difficult, and I hope that we pay more attention to it over the next decade and to come up with creative and meaningful approaches that get underneath the surface of the issues rather than just talk about them.