Translation introduction:
Why and how does mental illness occur? Does it have organic causes? Why do some people suffer from mental illness and not others? When it comes to mental illness in particular, there are still many incomplete answers. This article presents an interesting theory about the physiological/immunological origins of many mental disorders, by examining the case of the child Sacha Egger who developed violent psychological symptoms overnight, although he, or any of his family members, had never suffered from any form It is a known form of mental disorder.
Translation text:
One day in February 2009, a 13-year-old boy named “Sasha Egger” thought people were coming to harm his family. His mother, Helen, watched him anxiously that evening, especially after her healthy son forgot the rules of his favorite card game. The next morning, the mother began making phone calls for help, by that time Sasha was up and wandering aimlessly in the yard, tearing paper and stuffing his pockets. Helen later described her son’s condition: “My son looked like an old man with dementia.”
That afternoon, Sasha was admitted to the hospital to be seen by a group of specialists, one of whom thought the child might have bipolar disorder, so he was given a course of antipsychotics, but the drugs did not help him get better. At this time, his mother, Helen, a child psychiatrist at Duke University, realized that his condition was worsening. The strange thing is that these symptoms appeared on Sasha almost overnight, and some of them – such as dilated pupils and stuttering in speech – do not indicate a mental illness, but rather a dysfunction in the nervous system, and this is what the parents suggested, but the doctors believed that the parents’ psychological condition made them deny the disease their son.
Meanwhile, Sasha’s condition grew increasingly restless, and he refused to eat food that he thought tasted like sewage. Only five days after the start of his strange behavior, he moved to the intensive care unit, and he was under the influence of severe sedatives, and he lives on solutions. None of the doctors knew the reason behind what was happening. His parents thought that there was a possibility that their son’s condition would get worse, and he might eventually die, but one of his mother’s classmates, Helen, a neurologist named “Mohammed Mikati”, listened to their story and did some simple tests by asking them:
Can Sasha touch his nose?
– He does it with difficulty.
Can he draw a watch?
Yes, but without scorpions.
Mikati witnessed a similar case to Sasha several years ago, in an 11-year-old boy, who had been suffering for three months, but later recovered automatically. Mikati thought the cause was encephalitis, suspecting that Sasha might have a similar illness, so he ordered a test to monitor electrical activity in the brain. Daniel Egger, Sasha’s father, watched the needle dance on the instrument all night, presumably a sign of brain malfunction. Daniel hoped this would be a guide to diagnosing the condition and prescribing appropriate treatment.
If Sasha suffers from encephalitis, why is that? Scientists have long concluded that hallucinations and delusions can appear if an infection affects the brain and causes inflammation, but Mikati ruled out the possibility of infection. On the other hand, Mikati was aware that there are types of encephalitis that arise due to autoimmunity (autoimmunity is a pathological condition that occurs as a result of the failure of the body’s immune system to recognize its own internal organs and parts, so it treats them as if they are alien to it and starts attacking them).
Only two years before that incident, scientists discovered one case when the immune system, possibly due to infections common elsewhere in the body, mistakenly attacked important and vital receptors in the brain. The symptoms of this condition were similar to those caused by schizophrenia, but the correct treatment was not to put the patient on antipsychotics, but instead to take therapies that target the immune system. Reviewing these conclusions, Mikati decided to inject Sasha with a set of antibodies that could calm autoimmune attacks, and the boy actually immediately improved, the color in his face again, he regained his focus and calmness again, and he began craving and asking for food.
Finally, the child’s parents were very relieved, but when they remembered the amount of justifications and their attempts to convince the doctors of their conclusions, they were saddened by the great resistance they had encountered, and wondered what had happened to the patients whose parents were more submissive in the face of the doctors, or who did not have a child psychiatrist in the family. Commenting on this, Helen says: “If I had not been a child psychiatrist, besides my contacts and relationships, my son would be dead by now, my God! Just imagining it frightens me.” The experiment also raised a much deeper question: Could an autoimmune disorder affecting the brain be the root cause of many mental illnesses? And what are these diseases?
Madness and insanity
The idea that insanity might have a biological cause separate from being just a malfunction in your head dates back to at least the late nineteenth century, when psychiatric clinics in Europe were filled with delusional, mentally ill (or demented) patients suffering from Neurosyphilis (a complication of a late stage venereal disease). It does not stop there. The idea that targeting the immune system or focusing on and treating its diseases can cure insanity also has a history.
In 1927, the Austrian psychiatrist, Julius Wagner Jaurge, was awarded the Nobel Prize for his “heat therapy” by which he deliberately infected patients with malaria to cause them to have a fever. Operations lead to relieving pain and reducing inflammatory reactions, and muscle spasms). His treatment worked for some patients, but in return a few of them died of malaria.
Nearly a century later, this idea has resurfaced, partly spurred on by observations linking immune system disorders with psychological states. Scientists have found, for example, that activating people’s immune systems as if they were fighting a viral infection can cause They have a feeling of deep despair, and stimulates suicidal thoughts. For many years, scientists have believed that the brain is isolated or often separated from the immune system by the so-called blood-brain barrier (a barrier between blood vessels in the brain and other cells of brain tissue, providing protection for the brain from pathogens and toxins that may be present in the blood).
Scientists then failed to understand a clear mechanistic (or to understand the details) of how the immune system causes behavioral disturbances. But in 2007, a neurologist at the University of Pennsylvania, Joseph Dalmau, described a condition he called “antibody encephalitis” or “NMDA,” as these infections stimulate the immune system to attack a vital and active receptor in the brain; This results in serious neurological and psychological symptoms.
Scientists previously noted that some autoimmune diseases, such as lupus erythematosus, are linked to psychosis (a serious mental disorder that causes hallucinations and delusions all the time, in which a person is completely disconnected from reality). They began to suspect that some infections, through activation of the immune system, contributed to psychological symptoms. Dalmau has provided rigorous evidence that the immune system can attack the brain, and the development of tests for psychiatric disorders and the fact that patients can recover with treatment has sparked a wave of interest in autoimmune diseases of the central nervous system.
In all, scientists have identified many immune-related mental illnesses, including dementia-like conditions, epilepsy, and “stiff person syndrome”, a rare neurological disorder of unknown causes characterized by progressive immobility and stiffness of the patient, similar to Parkinson’s disease (known as Parkinson’s disease), and many experts suspect there will be more of these disorders. She and her co-workers are the ones people abandoned ten years ago. Van Matter continues, “We can improve their psychological state with our discoveries so far, and I think this is the greatest reward we can give them.”
Some scientists are now wondering whether symptoms of illnesses such as depression, schizophrenia and bipolar disorder are somehow linked to problems with the immune system, and they have found evidence to support this idea. Robert Yulkin, a scientist at Johns Hopkins University in the United States, believes that about a third of people with schizophrenia show signs of an overactive immune system (although this may be linked to other factors, such as smoking and obesity). Autoimmune diseases are more common in schizophrenia patients and their families than in the general population, and this may indicate a common genetic weakness. Scientists also note that patients with bipolar disorder and depression have immune disorders.
In the same context, a recent study conducted by scientists at the American Research Center “Mayo Clinic”, which specializes in neurological problems related to autoimmunity, revealed that when comparing mental patients to a group of healthy people, they discovered that they are more likely to harbor antibodies that target brain tissue. One implication of this is that some of these patients’ psychological symptoms may be due to autoimmune problems, and perhaps these patients could benefit from immunotherapy.
Scientists are also becoming increasingly interested in the relationship between depression and “systemic inflammation” that occurs as a result of the release of inflammatory cytokines from immune-related cells, the immune system’s response to infection, or other possible causes such as a poor diet, obesity, or stress. Chronic stress, or trauma.
Studies show that about a third of people with depression have high levels of inflammatory markers in their blood. Scientists have hypothesized that the malaise, anxiety, and lethargy caused by depression might really be a pathological behavior, a calm instinct for recovery, meaning that if we look at infection or disease in their proper context, we will discover that they help us survive. But problems start to arise if the immune system remains active for a long time, and this may lead to clinical depression (the most severe form of depression).
This new understanding of the immune system’s role in determining how we feel and behave suggests new avenues for treating mental illness. In 2013, Emory University scientists noticed signs of improvement in depressed patients who had high levels of systemic inflammation — and the usual treatments didn’t work — when they were given an immunosuppressant. Surprisingly, other researchers have found that aspirin, perhaps the oldest anti-inflammatory drug, may be useful as an additional treatment for schizophrenia.
Hold on to hope
Scientists have discovered cases similar to that of Sasha, who relapsed a year and a half after his recovery. This was the first of five major relapse cases, two of which required a months-long hospital stay. Although Sacha has been diagnosed with autoimmune encephalitis, a type of encephalitis that can occur as a result of a range of autoimmune diseases, scientists have not yet identified the antibodies that cause the disruptions in his brain.
Sasha is now 21 years old, and describes feeling as if he has a burning ember in his brain and needs cooling, to relieve that feeling he uses powerful drugs originally developed for cancer, which suppress the activity of the immune system. Although his memory stopped working during setbacks, and he had to miss high school for months over the years, he nevertheless managed to graduate with honors, go to college, and write on his college application: “If I could write a book, I would call it Shattered Memories.” Because after every hospitalization I had to rebuild my life from scratch.”
Sasha’s parents are hoping to get a treatment for their son that will help his immune system function normally. “I just hope he sticks together,” says mum Helen. She and her husband, Danielle, co-founded a nonprofit coalition for encephalitis, which can occur as a result of a range of autoimmune diseases. After this long journey they have gone through, one of the goals of the Iger family is simply to raise awareness about this disease, and they have questions about other psychological conditions that may originally be disorders of the immune system, but are hidden. Ultimately, their larger goal became to correct misconceptions between psychiatry and neuroscience. Commenting on this, Helen says: “The problem is that psychosis is often seen as an illness in itself, while psychosis, like a fever, is a symptom of many different diseases.”
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This article was translated from The Atlantic and does not necessarily represent the Meydan website.
Translation: Somaya Zaher.
