Health, Human Health and Mental Health
Our health and our environmental health are our most valuable asset. It is often taken for granted until it is lost.
Health and disease are concepts that are only relevant to biological systems. Organisms require a balanced ratio of resources for survival. A failure to achieve a resource causes a deficiency, while a surplus of any resource results in toxicity. A primary function of any biological system is an adaptive maintenance of a state of balance between the internal and external environment. In more complex mobile organisms, the nervous system coordinates this function of maintaining balance, even when the internal and external environments are constantly changing. In a state of health there is the pursuit of the beneficial and defenses against harmful aspects of the environment.
Every process, including mental processes, correlates with environmental circumstances and simultaneous physiological and biochemical events within the body and the brain. Within the brain, functioning can be conceptualized as the activity of a network of nerve cells, with simultaneous complex biochemical events and gene expression. The nature of this functioning is a result of evolution, development, learning, current perception, and judgment. The capacity to adapt correlates with the mental flexibility to adapt with the specificity that is needed for the current life situation. The greater the flexibility and the specificity of response, the greater the capacity to adapt. As a more complex life forms evolved, equally more complex systems have evolved to maintain balance. However, many of the lower more primitive systems remain. We can compare it to an ancient city where there is new construction built on top of older structures. The newer and older functions are redundant and interconnected with each other. The final result is a hierarchy of more complex adaptive systems existing over the lower more primitive adaptive systems.
Human health has been defined as soundness, or balance of the mind, body, spirit and soul. Although we live in a society that values extremes, health is, instead a state of balance (or peace). This goal can be concisely stated as:
Balance:
within ourselves
with each other
with our environment
Healthy mental functioning helps achieve this balance. Theories to explain human mental functioning have existed for millennia and knowledge of human anatomy has existed for centuries. However, knowledge of brain physiology has mostly evolved during recent decades. 2500 years ago Plato described a model of human functioning that is surprisingly accurate. It has similarities to both Freudian theory and our current view of brain physiology. He recognizes both the concept of hierarchy as well as the constant struggle to reconcile simultaneous opposing forces within us:
“In the case of the human soul, first of all it is a pair of horses that the charioteer dominates; one of them is noble and handsome and of good breeding, while the other is the very opposite, so that our charioteer necessarily has a difficult and troublesome task.”
Michelangelo demonstrates a remarkable insight into the anatomy of the human brain in The Creation of Adam (see addendum):
The Creation of Adam (1508-1512) on the ceiling of the Sistine Chapel has long been recognized as one of the world's great art treasures. In 1990 Frank Lynn Meshberger, M.D. described what millions had overlooked for centuries - an anatomically accurate image of the human brain was portrayed behind God. On close examination, borders in the painting correlate with sulci in the inner and outer surface of the brain, the brain stem, the basilar artery, the pituitary gland and the optic chiasm. God's hand does not touch Adam, yet Adam is already alive as if the spark of life is being transmitted across a synaptic cleft.* Below the right arm of God is a sad angel in an area of the brain that is sometimes activated on PET scans when someone experiences a sad thought. God is superimposed over the limbic system, the emotional center of the brain and possibly the anatomical counterpart of the human soul. God's right arm extends to the prefrontal cortex, the most creative and most uniquely human region of the brain.
*Frank Lynn Meshberger, M.D., The Interpretation of Michalangelo's Creation of Adam Basilar Neuroanatomy, JAMA #14 October 1990
It has long been questioned whether the human mind is able to understand itself. The brain is clearly the most complex organ. Until recently, most of the brain was considered a mysterious black box, since we could not visualize the anatomy and physiology of the living brain. With new technology, we can now better understand the functioning of the brain. It is a very complex organ consisting of 100 billion nerve cells of thousands of different types, which communicate with over 100 different transmitters with a much greater number of different receptor sites at 100 trillion synapses. The functioning of the brain is regulated by approximately 40,000 genes, which are expressed to different extents depending upon the current life situation.
Mental health needs to be defined in the context of the current external and internal environmental situation. In a state of mental health, mental functioning facilitates, rather than impedes healthy adaptation. These concepts can be incorporated with a systems approach to define mental health as:
Behavior, cognition, emotions, vegetative functioning, neuronal architecture, neural chemistry and gene expression reflect the life situation and maintain balance, by facilitating an adaptive allocation of resources, resulting in the capacity to experience pleasure, well being, fulfilling relationships and productive activities; the mental flexibility to adapt to change and the ability to recognize and contend appropriately with adversity.
As a result of new discoveries in the field of mental health, the social and environmental sciences, there is a rapid explosion of advances on the fields related to the understanding of mental functioning. Subsequently, we are flooded with information that is difficult to organize. To acquire a truly valid theory of human functioning, we need to first define health by integrating information into the hierarchy of the many systems that effect and are affected by human mental processes. Refer to the sections that describe each of these systems:
Individual
“I believe in the supreme worth of the individual and in the right to life, liberty and pursuit of happiness. Every right implies a responsibility, every opportunity, an obligation and every possession, a duty.”
-John D Rockefeller
The recognition of the value, rights and uniqueness of the individual are a fundamental part of healthy mental functioning and modern society.
The Individual impacts and is impacted by his/her internal and external environment to maintain balance (homeostasis).
As members of many different groups, there is a constant process to maintain a dynamic balance between our individual needs and the needs of the group(s) to which we belong.
Our identity is how we perceive ourselves. Observing ego is an imagery function, which allows us to draw an image of how we appear to others. Self-esteem and self-worth are perceptions of our value as individuals. Self-doubt occurs when we question our adaptive capabilities, which may, then, motivate us to learn and expand these capabilities, but excessive self-doubt may impede adaptation. Self-esteem is very dependent upon our ability to recognize the validity of our emotions and to respond to them appropriately. Empathy is dependent upon our ability to recognize and validate the emotions of others.
Effective social functioning is also dependent upon our capacity to recognize and appropriately respond to the emotions of others and ourselves. There needs to be an adaptive balance between our simultaneous attentiveness to the emotions of others as well as to ourselves.
Personality is unique to each individual and is molded by the interactions of many systems. We all possess a hierarchy of adaptive (or coping) mechanisms. These coping mechanisms are, in part, instinctual but are also impacted by development, learning, and environment. A large, diverse repertoire of coping mechanisms, well integrated with our emotions, gives us insight and facilitates our ability to appropriately adapt to many situations.
Coping mechanisms help us to make predictions of time and space in various systems, thereby facilitating adaptation. In many respects, our non-human environment is easier to predict but interpersonal predictions, particularly trust assessment, is the most challenging.
Since we are highly social by nature, we lead our lives with complex interdependencies on others. As a result we are constantly attempting to predict whom we can trust, under what circumstances and to what extent. Is someone a nurturing or parental figure? Perhaps they are an ally, a competitor, a predator or some combination of all of these under different circumstances? Emotional judgment is critical in the development of this ability. Ability in this area and confidence in this ability is critical in our social functioning and self-esteem, fostering our motivation and our human spirit.
If our capacity in this area is impaired, we may behave in a manner that would hamper rather than facilitate adaptation. This occurs when we implement counter-adaptive mechanisms that create a self-fulfilling prophecy causing a pathological vicious cycle in our interpersonal relationships. Thorough assessment and treatment helps in this area.
A healthy society is dependent upon preserving the integrity of the individual and constantly perfecting our individual judgment. In an unhealthy societal state, there is a loss of the integrity of the individual. We become spectators and fantasizers instead of active participants. In our current society, there are many groups, individuals and organizations, which threaten the integrity of our individuality. In the presence of these pressures to conform, we must adapt by developing our unique potential at the same time. In so doing, this healthy development will improve our individual capacity for emotional maturation, judgment and development of our personal beliefs. This, in turn, strengthens the societal group structures to which we belong.
Other attributes of the individual, the mind, the spirit and the soul are frequently discussed in many disciplines such as the humanities, ethics and religion.
The mind is not synonymous with the brain. Clearly, the brain is needed for the mind to function. The brain is an anatomical component of the body while the mind is a functional component of the individual. The functioning of the mind extends beyond the physical boundaries of the brain, experiencing life and finding meaning in that experience. What is the meaning of the universe? Or the meaning of a flower? The mind experiences the rapture associated with being alive.
The human spirit is linked with motivation, striving to fulfill the emotional needs of existence. Spirit can be suppressed as well as spontaneously restored. The Preamble of the U.S. Constitution points to the spirit behind our right to life, liberty and the pursuit of happiness. Throughout existence, mankind has embraced the spiritual elements of rituals in fulfilling our emotional existence. Marriage, for example, is viewed not only as a social arrangement but a spiritual exercise of the reunion of the self to the self or two becoming one.
The soul is generally regarded as unique as it is the core of a person's individuality. The body, the mind and sometimes the spirit can be enslaved and controlled by another but the soul, unique to each individual, is considered to always be free. An area of intense debate is centered on when an individual's life begins and ends. Is the beginning of life abrupt or is it a gradual transition? At what point does life begin? Likewise, is the end of life a gradual transition? If the soul is infused in our individuality at the beginning of life, what happens to it at death?
Nervous System
The Voluntary Nervous System controls muscles. The Autonomic Nervous System modulates vegetative functioning. Feelings are experienced by signals from the brain through the Enteric Nervous System where they are experienced in the viscera as feelings. The Endocrine System also modulates through the blood stream. Compared to the Autonomic Nervous System, the Endocrine Nervous System is generally slower to respond.
The nervous system maintains balance by being both proactive and reactive. Memory, instinct and complex processing are systems which give the ability to predict time and space, thereby facilitating adaptation. There is a redundancy of positive and negative feedback/feed forward effects, which facilitate balance in spite of change in other systems, thus maintaining a dynamic balance. (See diagram: Nervous System)
Brain
“How does the meat of the brain give rise to the spirit of the mind?"
-Dr. Rodolfo Llinas*
The brain is a proactive system allowing us to learn from the past, assess the present and predict future time and space. The inherent abstract capabilities of the brain enable us to be more adaptive in our world.
The brain has evolved with an improved adaptive capacity. In this process, newer structures have evolved upon older, lower functions. The final result is a hierarchy of more complex, adaptive systems existing over a lower, more primitive system. The lowest, most basic function is the Brain Stem and Hypothalamus that modulates vegetative functioning. The next level is the Limbic System, which modulates emotional functioning. The Para Limbic areas facilitate emotional association functioning. The Cerebral Cortex controls processing or association. Three basic functions are Perceptual (afferent) Processing, Motor (efferent) Processing and Complex Processing (executive functioning).
Humans possess unique, creative adaptive capabilities. The most advanced, most complex-associative, most creative, most adaptable to novel situations and the most uniquely human part of our nervous system is in the tip and most forward portion of the brain-the tip of the pre-frontal cortex.
A part of the basic wiring of the brain is a stimulus-response model. The stimulus from the internal and/or external environment elicits a response toward the internal and/or external environment. The more advanced portions of the brain allow for more complex adaptations. All of the different adaptive systems act together with a hierarchy of simultaneous inputs leading to a hierarchy of simultaneous responses.
The brain and nervous system, as Plato describes in his metaphor, operate on a push-pull basis. There is a simultaneous stimulation of opposing circuits. Different functions are stimulated and inhibited at the same time. The degree of balance between two or more opposing pathways determines the final outcome.
Modulation coordinates multiple stimulatory, inhibitory functions, thereby, facilitating complex adaptation. It alters the state an organism is in just as the control knobs of a TV set alter brightness, contrast, volume, etc. Biological modulations can be very complex. To modulate the body, besides the peripheral nervous system, the autonomic and endocrine systems are also involved. For example, when a threat is perceived, there is a modulation to perceive relevant cues to prepare for a fright, flight or fight response. Different parts of the brain, the autonomic and endocrine systems all modulate in synchrony to help adapt to this current environmental condition. Resources are allocated from one group of functions and shifted towards other functions as when systems functioning during periods of quiescence are reduced and stress system functioning is increased. Modulation, therefore, can be reduced to a complex form of stimulation and inhibition.
There are many different types of modulation, most of which are poorly understood. All of us possess a different modulation capability; some of us allocate more energy to introspection vs. vigilant scanning, for example. The more complex the modulation, the greater the capacity to adapt to unique situations.
Besides hierarchy, stimulus-response, simultaneous stimulation-inhibition and modulation, another concept is memory. Memory is a significant function in both the nervous system and the immune system. In the nervous system, memory creates a long-term potential similar to ruts in the road. The more strongly an associative network is stimulated, the stronger the long-term potential, or memory.
Memory is the result of a sequence of positive and negative feedback events. Emotional memory is a particularly strong function. The current effect of prior emotional learning often is stronger than our cognitive learning or our capacity for current cognitive or emotional processing. Since memory constantly changes, the brain is in a constant state of change or it is considered to be plastic.
As we place these concepts into a psychodynamic model, we see five basic components to the nervous system:
Afferent or sensory systems
Modulation systems:
-The greater limbic system
-The lower level centers modulating basic vegetative functioning
Processing centers
Efferent or output systems
There is a hierarchy of systems within each one of these five components. At the top is the conscious, creative process which considers and balances emotional, cognitive, internal perceptions (enteroreceptive), external perceptions (enteroreceptive), instinctual and memory inputs and outputs.
We can compare the brain to a symphony orchestra. Many components are acting in synchrony to hopefully achieve a harmonious end result. We would like to see ourselves as having total conscious control over our behavior. However, our responses are strongly influenced by instinct, memory, environmental influence and various pathological states.
Which is more powerful in influencing our behavior, higher powers or lower powers? Is there a top-down hierarchy or a bottom-up hierarchy? Is the pre-frontal cortex more powerful than the hypothalamus and limbic system or is the opposite true? Pathways from the cortex to the amygdala are less well developed than pathways from the amygdala to the cortex. The lower powers have been present in evolution for a much longer period of time, leading us to believe they are much more powerful thus causing more of a bottom-up hierarchy (i.e.: emotions drive thoughts more so than thoughts drive emotions). Lower life forms can function with emotional reactivity, without logic or language. Emotional reactivity is a much more basic, vital function than is the higher power of logic and language.
This view may, however, conflict with the manner in which we would like to view ourselves. Once we use this framework, we can better understand that altered emotional states often drive the thought content in that direction. For example, a spontaneous panic attack creates an emotional state that then causes higher powers to entertain thoughts of imminent harm. With a failure of counter-regulatory systems, these thoughts then intensify the emotional and physical state, causing a vicious cycle that results in a full-blown panic attack. In this instance, there is a bottom-up hierarchy with lower powers being more powerful.
True, higher powers impact and sometimes direct lower powers as described in Plato's model of the charioteer, but are the lower powers more powerful? This is, of course, a question for endless debate.
The human body and brain have evolved with a large number of adaptive capabilities. We all have a different endowment of our adaptive potential, stronger in some capabilities and weaker in others. Possessing a trait that is extreme may be adaptive in one environmental situation and maladaptive in another. The environment, life experiences and maturation impact our memory and further mold our hierarchy of adaptive systems.
Neural Network
Different neurotransmitter systems and pathways are associated with different functions. Most neural networks function with a sequence and combination of neurotransmitter systems (i.e.: serotonin, norepinephrine, dopamine, etc.). In this discussion, I shall organize neural networks according to function.
Let's look at some neural networks which regulate mental functions in greater detail. In a state of health, emotions accurately reflect our current life situations and are fast and approximate adaptive modulations. Cognition is slower and weaker but more able to adapt to unique situations. In the awake state there is a constantly changing allocation of resources between the following functions:
Afferent (Sensory)
AlertnessEnvironment scanning (vigilance) Prioritizing Attention
-Allocating greater attention to different sensory inputs
-Differentiating the most significant from the loudest input
Focused attention on a specific input:
-Sensory modalities
-Content: Emotional perception of self and of others
-Specific tasks
-Threat perception
-Reward perception (sex, feeding, bonding)
Processing (Introspection)
Processing current tasks
Processing future tasks - Anticipation (Cognitive)
Prioritizing multiple tasks
Memory encoding-Emotional, cognitive, polymodal
Memory reorganization
Memory access-working, recent, remote
Emotional significance (feelings) to self and others
Imagery
Creativity
Modulation
Anticipation (Emotional)
Afferent vs. efferent processing (alertness to environment vs. focus on output vs. introspection)
Emotional modulations
Emotional vs. cognitive focus
Motivation
Other modulators
Efferent (Motor, response, output, behavior)
Focused attention on performing current task(s)
Memory directed responses
Emotional directed responses
Cognitive directed responses
To define a few of the more complex functions:
Processing
Processing is the association or organization of information. It may be a fairly simple, unimodal association such as associating something that unites two perceptions in the same sensory modality. It may also be complex such as a complex multimodal or polymodal association: the other driver's face, the sound of screeching brakes, breaking glass, the smell of gasoline, the feeling of intense fear, a bodily pain, a perception of imminent harm and helplessness.
Learning is processing that occurs over time as we sensitize or desensitize memory associations. Creative processing is making new associations beyond those that were drawn from experience and memory. Processing occurs simultaneously with both cognition and feelings.
When an event occurs, that experience is processed or integrated with existing information. If an experience can not be processed immediately, that memory is then repressed to be processed at a later time. If there is an inability to process emotionally significant information, the memory is either consciously suppressed or imagery is implemented to repress the memory from consciousness. The memory may, however, keep returning to consciousness at times of decreased activity and free association, or at times when certain cues trigger recall.
To keep such memories suppressed and repressed requires a disassociation from any cues (emotions and other perceptions) which evoke recall. While adaptation occurs when these memories are integrated with other information, conversely, pathology occurs when these memories become increasingly disassociated at the sacrifice of increased impairment in adaptive capability.
Emotions
Emotions are modulations, which alter functioning, thereby facilitating adaptation. In a state of health, both the intensity and type of emotions reflect the current life situation. The emotional state is constantly changing in response to changing life events and is a blend of different arousal levels of different emotions. It is unclear which emotions could be considered primary with distinct neural centers and which emotions are a blend of other primary emotions. A focal point of emotional functioning is the limbic system. Emotions alter perception, processing, physiological functioning, and behavior. Emotions are primarily instinctual and are impacted by emotional memory, cognitive memory, cognition, somatic factors and other systems. Apathy is a lack of emotional reactivity. Lability is an excessively rapid shift of emotions.
Individual differences in basic emotional temperament and learning results in different basic emotional set points and different capacities to shift appropriately in response to life events.
Mood is the external appearance of the emotional state, while feelings are the internal perception of the emotional state. Emotions appear to originate in the limbic system and are transmitted to the viscera where they are perceived as feelings.
Alexithymia is an inability to recognize, experience and describe feelings. Anhedonia is an inability to recognize, experience and describe pleasurable feelings. There may be partial degrees of both alexithymia and anhedonia.
Since the capacity to feel emotions is a critical component of empathy, alexithymia can result in a decline in the capacity for empathy. A number of conditions can cause alexithymia including autism, Asperger's Syndrome, developmental failures, PTSD and injuries from encephalopathies
Anticipation
Anticipation is a complex emotional perception of the future and is experienced as a feeling about the future.
Imagery
Imagery is the capacity to experience what does not currently exist. It allows us to recount and process a memory from the past to create our own view of the present and imagine and plan what may be in the future. Neither creativity nor delusion could exist without this function.
Our imagination is always active. In the wakeful state it is partially suppressed by current perceptions but during REM sleep, this function is disinhibited. Our imagination is most effective when it is well integrated with an accurate assessment of our life experiences. It is sometimes difficult to differentiate past imagination from past memory, current imagination from current situation, and our image of the future from true possibilities.
Imagery is significant in a number of processes relevant to interpersonal functioning. Object constancy is a psychoanalytic term describing the ability to recognize a person exists even when they are not seen. Observing ego is our capacity to imagine how others may perceive us. Empathy is our capacity to imagine the emotional perspective of others.
In psychiatric illness, there are impairments in the ability to integrate imagery with reality and unique patterns have been demonstrated on brain imaging tests.
A deficiency of imagery inhibits creativity. A mild deficiency in the ability to differentiate between imagery and reality causes distorted perceptions and beliefs while a more severe degree of impairment causes hallucinations and delusions.* Some degrees of reality testing are seen in many psychiatric conditions including post-traumatic stress disorder, complex partial seizure disorder, encephalopathy and psychotic disorders.
Arousal
Arousal is the intensity of a mental function. Sleep-wakefulness arousal is a gradation from deep sleep to a high level of alertness. Emotional arousal is the intensity of an emotional state, i.e.: states such as fear, libido, anger, hunger, jealousy, dysphoria, etc.
Motivation
Motivation is an emotional modulation, which prepares us to behave in a particular direction. While anticipation is an afferent emotion, motivation is an efferent emotion. Apathy is a diminished capacity for motivation.
Hopefully we can rapidly shift the allocation of mental resources in response to current adaptive needs but we all allocate our mental resources in different ratios. Attention Deficit Disorders as well as many other traits and pathological states can be conceptualized from such a perspective.
Adversive Pathway
One group of pathways is best described as the adversive or harm-avoidance pathways. These pathways modulate functions that allow us to be repelled from something perceived to have a potential for harm. Another group of pathways, reward or pleasure seeking which includes sexual, feeding and bonding functions, attracts us towards people and things that we perceive as pleasurable. Whether repelled or attracted these two major pathways have similar attributes. Harm perception is associated with negative internal perceptions while the reward pathway is associated with pleasurable, internal perceptions.
A simple perception of harm is the perception of pain. More complex perceptions of harm take the form of the more complex emotions in the harm-perception pathways. Likewise, the perception of pleasure takes both a simple and a highly complex form. For example, euphoriais an extreme of an emotionally pleasurable sensation and dysphoria is an unpleasant emotional state. When we are acquiring pleasurable feedback, we may feel some degree of euphoria, which motivates us to further pursue activities associated with this emotion. We may then respond to this by projecting ourselves into our environment, a function that is associated with increased activity of the serotonin system of the brain. Contrary to euphoria, dysphoria is an unpleasant emotional state where we experience negative feedback. This is associated with behavior inhibition and decreased serotonin activity. Mild degrees of both euphoria and dysphoria guide and mold our behavior and learning on a daily basis.
Different mental functions and emotions recognize harm based on a dimension of time. (See diagram below) In looking at harm avoidance, we notice several components to this pathway - perception of harm, modulation, processing and the motor pathway of harm avoidance.
Let us first look at the diagram showing the Sequence of Normal Mental Functioning, then the basic Fear Sequence, Threat Awareness Processing, Response to Threat Recognition, Threat Perception, Threat Processing, Threat Modulation-Emotional, Fast and Slow, Threat Avoidance-Efferent.
Adaptation requires a constant shift in the allocation of resources to adapt to constant changes in the internal and external environments. We all have different genetic endowments resulting in different abilities to adapt to environmental fluctuations and extremes. Traits that are adaptive in some situations are maladaptive at other times. When an individual possesses extreme traits and/or is in an extreme environment, a pathological vicious cycle may be triggered.
