​​​​Image of Dr. Jonathan Downar
Dr. Jonathan Downar says what makes mental illness so challenging is that the very brain circuits a person needs to access to get over the illness are the ones that are affected by the illness. (Photo: UHN)​

Twenty per cent of Canadians will personally experience a mental illness in their lifetime.

Three million Canadians are currently living with depression.

Bell Let's Talk Day is a day for Canadians to join a national conversation on mental health in an effort to reduce stigma towards psychiatric illnesses. Although society has made great strides in its understanding and treatment of mental illness, there still exist misconceptions and misunderstandings about these disorders – including for those who may be trying to help a loved one in this situation.

Although coping with mental illness can be specific to each individual, Dr. Jonathan Downar, a psychiatrist at Toronto Western Hospital (TWH) and co-director of the repetitive Transcranial Magnetic Stimulation (rTMS) Clinic at University Health Network, says there is general information about these disorders that can help others understand them better.

Mental illness is the result of malfunctioning brain circuits

Just like neurological illnesses, mental illnesses are disorders affecting specific parts of the brain, and causing certain symptoms such as anxiety or depression.

Research is starting to link many psychiatric illnesses to abnormal activity in a few specific circuits in the brain:  One circuit is related to motivations and incentives, and another is related to self-control.

"We need these circuits running properly to guide us through our daily activities," says Dr. Downar. "If they develop abnormal 'blips' of activity, or if they fail to activate at all, then it becomes hard to control our thoughts, feelings, and behaviour. 

"But if we can restore normal activity in these circuits, then the person can recover."

Mental illness isn't a question of 'just get over it'

Everyone can feel sad or have a bad day every now and then, but they eventually move past those feelings.

Occasionally, people suffering from mental illness are perceived to be acting this way on purpose, or as though they don't "want" to get better. It can be frustrating at times for that person's loved ones who just want them to "snap out of it."

However, mental illness preys upon the motivation and self-control areas of the brain. The circuitry for motivation is what individual's need to access for things they want to focus on or achieve each day. Furthermore, a person can't shake off their illness when their circuitry for self-control is affected.

"What makes mental illness so challenging is that the very circuits that you need to get over the illness are the ones that are affected by the illness." explains Dr. Downar. "Telling a person with depression to 'just get over it' is a bit like asking a person with a stroke to 'just lift your arm' – there's a part of the brain that you need to do that function, and if it's offline, then you can't do it unless you get it back online.  That's where the treatments come in."

There isn't one therapy that works for everyone

There are a lot of ways to get self-control back online or reset someone's motivation. However, some treatments work better for some than for others.

  • Many people find benefit from regular therapy sessions such as cognitive behavioural therapy (CBT), psychoanalysis, or meditation.
  • Medication can work well for some people. Sometimes, it is difficult to go to therapy before the brain circuits are online, and prescribed medication can help to boost these circuits.
  • For one out of three people with mental illness, the above don't work. This is where patients can be considered for non-invasive brain stimulation such as rTMS.

And there are also things all of us can do to help ensure our own good mental health such as get regular exercise, eat a healthy diet, limit alcohol intake, get enough rest, create social interactions with others, and find purpose and meaning in our lives.

Be supportive but don't be pushy

A lot of stigma remains around mental illness, and the best way to help people overcome these disorders is to be supportive.

"People talk openly about having a heart problem or a broken arm, but when it comes to mental illness there can be a strong feeling of embarrassment," says Dr. Downar. "When we have a heart problem, we say we have heart failure.  When we have a kidney problem, we say we have kidney failure. But when we have a brain problem, we act like it's 'me failure'.  With the brain, it feels personal."

So the first step is to help the person see the illness as a health issue, and not as a personal failure.

"We definitely want to create more environments that are safe for people to be open about how they're feeling without judgment," he explains.

However, it's important to make the distinction between being supportive and being pushy. With these types of illnesses, the person affected has to be willing to get help – and any effort to force them to before they are ready can leave everyone frustrated.

"Family and friends want nothing more than to help their loved one, which is understandable," says Dr. Downar. "But you can't want it for them, they have to want help themselves. So my advice to people in this situation is to be encouraging and assure their loved one that they will be there for them – when they're ready to take that first step."

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