This article was taken from the March 2014 issue of Wired magazine. Be the first to read Wired's articles in print before they're posted online, and get your hands on loads of additional content by subscribing online.
Do you know the story of Jane Eyre? On the eve of her hasty marriage to the mysterious Mr Rochester, Jane's wedding veil is torn up. She doesn't know that the enraged perpetrator is Rochester's mentally ill wife, secretly confined upstairs in rambling Thornfield Hall.
Had Rochester been poor, the wife would have been chained up at Bedlam rather than hidden upstairs (and we'd have no plot twist).
Even today, the rich receive their psychiatric treatment in private settings, whereas the poor are sequestered in overcrowded public "asylums" called jails, shelters and single-room-occupancy hotels.
Despite the discovery of successful medications and psychotherapies half a century ago, we still mostly treat mental illnesses behind closed doors.
What's worse, treatment is essentially unchanged since those early discoveries. Faced with a 19-year-old who's left college because of suicidality or psychosis, I can: select a descriptive label (depression, schizophrenia); prescribe meds to reduce symptoms; try psychotherapy (if the patient can afford it). Same options as 50 years ago. Yes, we've seen astonishing neuroscience breakthroughs in recent decades, but we still do not have treatments that directly target the brain-system dysfunction of mental illness.
This is about to change. Brain information-processing networks - the wiring for our thoughts, feelings and behaviour - are under active study. We've learned that brain networks operate along a probabilistic distribution of efficiency and connectivity in healthy individuals and those with mental illness. We understand that they are not fixed, but rather are malleable in response to critical events. The information-processing distortions in the brain that contribute to hallucinations or to impulsivity could potentially arise in all of us, influenced by our genes, experiences and current context.
This means two things. First, the closed door separating normal from pathological now swings open. Adaptive behaviour requires complex interactions linking our brain's multiple information-processing systems to environmental, social and developmental demands. We can identify our own individual flavours and stages of cognitive and emotional capacities. As my teenage daughter said: "I can't be expected to make future plans... my prefrontal cortex isn't wired yet." Second, we can harness the inherent plasticity of the brain - its capacity to change in response to experience -- to correct distortions in its information-processing networks. Recent studies show that precisely engineered "exercises" can train an ageing brain or a brain with schizophrenia to rewire itself, resulting in more efficient information processing and behaviour. These brain-training exercises can be embedded in a game-like wrapper and delivered using interactive technology.
Even if intensive brain training via a video game can't induce a complete "cure" in persistent mental illness, it may have an important public-health role. The brain dysfunction of mental illness is often present in mild form before a person hears voices or has suicidal impulses. We can intervene to help young people at high risk of illness, before they experience frightening symptoms.
And we can do so without medication. Brain training does not appear to cause problematic side effects, although training the brain to rewire itself, even to enhance adaptive information processing, may carry unforeseen consequences (perhaps a brain that becomes more efficient in certain areas loses ground in others).
Not only does this field offer the exciting possibility of directly targeting and maybe preventing the brain-network dysfunction of mental illness, it can be delivered using mobile technology that is highly scalable and non-stigmatising, that permits widespread social connectedness, and is available across demographic and geographic sectors. The choice is not Bedlam or the attic of Thornfield Hall. It is between which programme and which device.
Sophia Vinogradov is professor in residence, associate chief of staff for mental health at San Francisco VA Medical Center, and vice-chair of the Department of Psychiatry
This article was originally published by WIRED UK
