Mental Health: A Report by the Surgeon General

Progress in understanding depression and schizophrenia offers exciting examples of how findings from different disciplines of the mental health field have many common threads (Andreasen, 1997). Despite the differences in terminology and methodology, the results from different disciplines have converged to paint a vivid picture of the nature of the fundamental defects and the regions of the brain that underlie these defects. Even in the case of depression and schizophrenia, there is much to be uncovered about etiology, yet the mental health field is seen as poised“to use the power of multiple disciplines.” The disciplines are urged to link together the study of the mind and the brain in the search for understanding mental health and mental illness (Andreasen, 1997).

This linkage already has been cemented between cognitive psychology, behavioral neurology, computer science, and neuroscience. These disciplines have knit together the field of “cognitive neuroscience” (Kosslyn & Shin, 1992). This new and joint discipline has carved out its own professional society, journals (Waldrop, 1993), and textbooks (Gazzaniga et al., 1998). There is movement toward integration of other disciplines within the field. To promote linkages between psychiatry and the neurosciences, neuroscientist Eric R. Kandel has furnished a novel approach. His essay,“A New Intellectual Framework for Psychiatry,” supplies a set of biological principles to forge a rapprochement—conceptual as well as practical—between the two disciplines (Kandel, 1998). Integrated approaches are seen as vital to tackle the monumental complexity of mental function.

⁵ Chapter 4 contains a fuller discussion of the relationship between stress and depression. In common parlance, stress refers either to the stressful event or to the individual’s response to the event. However, mental health professionals distinguish the two by referring to the external events as the “stressor” (or stressful life event) and to the individual’s response as the “stress response.”

⁶ Other types of information used to establish cause and effect relationships are the strength and consistency of the association, time sequence information, dose-response relationships, and disappearance of the effect when the cause is removed.

⁷ Anxiety and depression may in some cases be caused by hormonal changes related to the tumor itself.

⁸ Establishing that a disorder runs in families could suggest environmental and/or genetic influences because families share genes and environment. Comparing identical versus fraternal twins assumes that their shared environments are about equal, thereby providing insight about genetic influences. Such comparisons are further enhanced by studies of twins (identical vs. fraternal) separated at birth and adopted by different families.

⁹ The median concordance rate for identical twins is only 14 percent (NIMH, 1998).

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