• There is no definite idea of what constitutes a brain disorder.
  • We adopt the decision of the National Institute of Mental Health to use the term “brain disorder” when we refer to conditions which cause impairing or debilitating behavior.
  • Current ideas of brain disorders are based on ideas rather than objective evidence.
  • In the United States, brain disorders are defined in the Diagnostic and Statistical Manual (DSM). Diagnosis with one of these classifications is necessary to access insurance coverage, school accommodations and government services.
  • No major research breakthroughs have occurred under the current diagnostic classification system.
  • New research tells us that our brains function in a way that is at odds with how “mental disorders” are currently conceptualized.
  • A problem in any part of the brain is likely to produce a wide variety of behavioral changes rather than just a group of similar ones.
  • In the short run, the inevitable transition into a more accurate, evidence based way of measuring and treating impairments related to brain function will add more chaos to an already confusing situation.
  • Eventually we will end up with a system of diagnosis and treatment that is reliable and targeted because the cause and characteristics of the conditions will be known and objective.

It’s Not Black and White

Atypical, problematic or unexplainable behavior has always been present. For most of time, it has been considered onerous, shameful and/or willful. In some cultures and times it has been regarded as mystical and special.

Over the past 40 years in western culture, there is growing acceptance that much of this type of behavior is a direct product of brain function (as opposed to life’s influences) and that it deserves the same type of objective consideration and help that physical problems receive.

While it may be easy to recognize when someone is seriously affected in this way, it is much less clear when, along a spectrum of wellness, a person has a condition which qualifies for a diagnosis and/or requires treatment. Both behavior and the culture in which it is measured can have such a wide range of acceptability, variability and adaptability, that it is very hard to place an exact definition on what is healthy (or healthy enough), and what represents a  pathological condition which may need therapeutic and/or medical attention.

At JBRF, we consider a brain disorder to be a condition in which brain activity produces behavior which causes a person to have a significantly reduced ability to function well in his or her life or to pose a threat to his/her well-being and/or the well-being of others. Sometimes the condition derives primarily from functional problems in the brain whereas other conditions may derive from psychological patterns and habits which, over time, cause a secondary effect on brain activity.

What Name Should Be Used to Refer to These Conditions?

The most commonly used term is today is probably “mental disorder”. Indeed, this country’s manual from which all mental health diagnoses are made is called the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the term “mental disorder” prompts notions of the mind… and that suggests a level above biology.

The near future of brain research will be dictated largely by the National Institute of Mental Health (NIMH). They have chosen to refer to brain-based behavioral syndromes as “brain disorders”. So we will too. It is logical to associate the problem with the organ that creates it; the brain. It would have been tempting to adopt the term “neurological disorder”, however NIMH reserves this for conditions in which actual damage has occurred to the brain.

Brain Disorders in the US today

You are probably familiar with many of the classifications of disorders listed in the DSM: depression, bipolar disorder, attention deficit disorder, separation anxiety, obsessive compulsive disorder etc. These and other classifications provide the diagnoses recognized by educational systems, medical and social services, and insurance.

Over the 30+ years of the DSM’s existence, experts periodically re-convene to incorporate new knowledge into the manual; classifications which may have seemed quite plausible at one time may be eliminated, others may be changed, and new classifications may appear. The most recent version of the DSM; DSM 5, was released in May of 2013. One of the most notable changes in it affects the diagnosis of bipolar disorder as it has been applied to children. For more about that, click here.

Over the 30+ years of the DSM’s existence, experts periodically re-convene to incorporate new knowledge into the manual; classifications which may have seemed quite plausible at one time may be eliminated, others may be changed, and new classifications may appear. The most recent version of the DSM; DSM 5, was released in May of 2013. One of the most notable changes in it affects the diagnosis of bipolar disorder as it has been applied to children. For more about that, click here.

There has been quite a degree of controversy over the changes proposed by the new manual. This is to be expected with a system still based on concepts rather than proof. To read a commentary by the Director of the NIMH regarding DSM5, click Research Domains, Director’s Blog 3/13. To read a New York Times editorial on the state of diagnoses and DSM5 click here.

What Will a Brain Disorder be Tomorrow?

Clearly the field of psychiatry has begun to enter a phase of transition.  Advances in genetics, neuroimaging, and neurology have made possible substantial progress in the knowledge of how the brain creates behavior.  Contrary to popular ideas, behaviors like mania and depression are not created by distinct parts of the brain, nor are they the result of the absence of specific chemicals or mutations of specific genes. The picture is much more complicated than that.

Our brains rely upon exquisitely complex functional networks which stretch across the brain and even through the body. Each network sends signals back and forth within itself as well as to other networks. And conversely, those other networks send signals to it. The whole arrangement results in a highly integrated and efficient dance of information.

From this new model, it is easy to understand why a problem in any one brain area or system could produce a broad range of symptoms and behavioral changes rather than just a group of similar behavioral symptoms as currently grouped in classifications such as depression or OCD. So even though the current classification system continues to be recognized and relied upon, and diagnoses like bipolar disorder will continue to be used for quite some time, new information is chipping away it their legitimacy.

An important new program which will help to usher in this new era is a comprehensive research initiative by the National Institute of Mental Health. The initiative is called Research Domain Criteria (RDoC) and its mission is to promote research which explores everything from genes to complex behaviors.  Presumably, from this foundation of evidence based information, new and predictable diagnoses and treatments can emerge.  (see Toward a New Classification Framework for Research on Mental Disorders).

The Transition

Like most major transitions, this one will be slow and not without some resistance and a fair amount of confusion. Within the professional community, it will take a while for new ideas to be developed, accepted and used.  Even after the professional community starts to shift it will take some time for the popular language to catch up. The old names bring instant recognition of an idea. A perfect example can be seen right here! Even though research sponsored through JBRF has led us to abandon the concept of bipolar disorder as a useful construct, we continue to be called the Juvenile Bipolar Research Foundation; if at this point we eliminated the word Bipolar from our name, many people looking for help regarding their child’s illness would not find us. (see: The Obstacles Created by Familiar Psychiatric Words)

There is much to be learned…an unlearned. We are getting closer to the day when we will stop thinking of ourselves as existing from the neck down or from the neck up –but rather as the whole beings that we are. In this future, the stigma that today is reserved for mental health will naturally dissolve and we will be able to take better care of ourselves.

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