In my New Jersey town, there was a homeless woman seen daily on the streets. Some called her The Mud Lady.
Before her mind turned against her, she must have been very accomplished.
She was striking. She wore her clothes well, carried a stuffed old designer bag. She was tall and slender with a long neck, and very careful about her appearance. Her face was tinted orange, probably from overuse of tanning products, her eyes rimmed with dark eyeliner, and her hair was short, neatly clipped, and fashionably tousled using a product that looked like mud.
She mostly kept to herself, with a rare outburst. Her mind had been abducted long ago by paranoid schizophrenia.
The story went that she had once been a successful marketing executive with an MBA, until her mind chose to concoct demons and sinister plotters against her. It was said that her family tried desperately to help her. She refused treatment or confinement, convinced that all of them were poisons.
The local eateries gave her food, the coffee houses supplied her with her coffee. The soup kitchens provided the rest. When the New Jersey winters got too frigid, local churches and public institutions would open their hallways. She never thanked them.
Mental illness is probably the greatest health crisis we face. Here are the numbers. Almost 50% of the population will suffer from some mental illness during their lifetime, usually depression or anxiety. At any time, 20% of the population is suffering from serious mental illness. Almost 5% are psychotic or seriously ill. Suicides, murders, drug abuse, homelessness…mental illness makes its presence felt in society.
Many of us suffer some temporary or manageable mental illness: depression, bipolar disorder, anxiety, obsessive-compulsive disorders, or ADHD.
In my lifetime, I have seen the emergence of medications. When I was an undergraduate psychology major, only a few drugs, such as Thorazine for schizophrenia (which caused most patients to lose effect), lithium for bipolar disease (good for manic moods, not for depression) were available.
At that time, the mental health profession was in the grip of Freudian psychotherapies which promoted talk therapy as a cure. Somehow learning about your early childhood sexual development would cause the neurons and neurotransmitters to magically be recalibrated.
But medicine, like science, is limited by its ability to measure. At that time, there were no tools for measuring brain chemistry or brain imagery. All that they had were people’s experiences, their voices, and from these and their own experiences, they developed theories and treatment. Therapies were a product of their times. Freud developed his theories during a time when sexuality was repressed. Other protégées, like Jung, expanded it beyond sexuality, but they remained limited by the technology. Sadly, the legacy resulted in treatment that was destructive to the LGBTQ community, women, and mothers in particular. Women’s diseases that did not display obvious physical symptoms were attributed to hysteria, women’s frailties. Homosexuality was considered a mental illness.
Lacking measurements, many professionals chose blame. It has taken decades to mitigate damage on homosexuality and female dominated diseases such as fibromyalgia, lupus, autoimmune diseases, and anxiety.
Stigma, blame, shame, and guilt have shrouded mental illness long before Freud. Brain chemistry abnormalities were the victim’s fault.
We have come a long way. Mostly because of basic research and the emergence of measuring tools that can teach us about brain activity.
Researchers believe that depression may be due to serotonin, dopamine, and norepinephrine imbalances. People with clinical depression often have increased levels of monoamine oxidase A (MAO-A), an enzyme that breaks down key neurotransmitters, resulting in abnormally low levels of serotonin, dopamine, and norepinephrine.
Despite progress, depression remains a very complex and enigmatic illness. In some cases, treatments replace the need for medication. Quality sleep, exercise, diet, music, meditation, and nature can boost dopamine levels. Talk therapy especially cognitive treatments offer non medication solutions, by providing techniques to control impulses and thwart brain chemistry.
Anxiety is more complex, similar neurotransmitters are considered suspect; but scientists have added others including another neurotransmitter, GABA, the thyroid hormone, and abnormal secretions by the adrenal gland.
Schizophrenia, on the other hand, is much more elusive. It was originally believed to be caused by high levels of dopamine, but recent research hasn’t confirmed that. For now, schizophrenia is associated with changes in the structure and functioning of a number of key brain systems, including prefrontal and medial temporal lobe regions involved in working memory and declarative memory. Since paranoid schizophrenia emerges primarily in men during adolescence and early adulthood, research suggests that low estrogen levels may leave the brain vulnerable while it is still developing. They suspect there is some type of toxicity that causes permanent brain damage. Unfortunately, these structural changes in the brain suggest that for now, it is a disease that can only be managed, not cured. Current imaging of the brain hints that this damage may worsen over time. But again, we are limited by our measurements.
Stigma, blame, shame, guilt. Those have been the hallmarks of mental illness.
Even today, mental illness remains an invisible disease, often attributed to a lack of discipline, a personality defect, a lazy person, a bad parent. A shame or blame disease. Hidden within a family, lest family deficiencies be discovered. It is only now being recognized for what it is, a plethora of diseases for which we have poor measurement and little treatment.
We have made progress, to be sure, but it is only a rudimentary beginning. As we get better measurement tools, our current theories and hypotheses will likely be seen as archaic as some types of psychotherapy do today.
I have faith that basic science will someday unlock these mysteries. For now, all we can do is advocate for more money spent on research, and, of course, compassion.
And the hope that someday there will be no more mud ladies.
Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.