Is it just really all in your head?

“Intellectually impaired” was the classification in the PWD (“Persons with Disability”) ID that my close friend “Clara” saw in her own ID card. She applied for one as she is bipolar and depends on medication to be stable. When she showed me her card, we both could not help but laugh so hard since it was only a few weeks before that she got accepted into a PhD program abroad. Clara and I, including her university abroad all know she obviously is not “intellectually impaired”. But she has a condition that needs to be treated for her to pursue her intellectual gifts. But for some reason, the government agency tasked to issue PWD IDs, could not find the words to classify her “mental disability” because it had to do largely with her emotional state. They had to assume that it had to be “intellectual” – that it has to do with academic learning and therefore, public functioning. Most people still think that if you cannot manage your own emotions, then it is not a disability but your own private failing or “it is just in your head.”

“It is just in your head” is a common expression that people say when they think you are just making things up – that it has no basis in reality. This is especially true when people think of mental conditions. People who have mental conditions are mostly perceived by the general population as just not having enough willpower, do not pray or do not pray enough or just making up medical excuses for their own “failings”. I think it is quite ironic since it is really because it is in your head that it should be taken seriously. Where else do they think it should occur to be considered serious or even “just” real?

Most people do not realize that biology, which they do not readily see, is a core reality. It is like having a picture of your house and not acknowledging that it is on planet Earth.  Having a skull which presupposes a brain is not enough to make you function. That brain will function according to the way it is wired, which in turn, is a result of your genes and your experiences as a child and as you grow older.  With about 100 billion neurons that would connect in your brain, why is it so difficult to imagine how different each person could be, even in dispensing the most basic of functions such as sensing, thinking, moving and even in dealing with their own emotions across a lifetime of experiences?

If we had brain scan apps and use them like we do social media apps, maybe we would be able to enlarge what we consider “reality” because it would include a picture of our own inner biologies and that of others’. When people who suffer from Parkinson’s disease move uncontrollably, it is because they do not produce dopamine in parts of the brain that need to regulate the way they move. So why is it more difficult to understand that when people who suffer from depression, are bipolar, schizophrenic or other mental conditions, their brains too suffer from a surplus, a shortage, absence or presence of certain connections or hormones?

“Emotions” are a particularly tricky thing for people to judge. This is because we humans are generally so skilled at identifying, classifying and expressing and even analyzing our own emotions. We consider it our “core competency” as humans relative to other life forms. We have even made an extravaganza out of our emotions that we invented an art form for it – drama! We dispense that art form in plays, musicals, literature and of course, those daily emotional watersheds – teleseryes. That is why when people fall short of the skill, we get offended or judge the other as being cold or insensitive or even uncreative. We think emotions are so basic to being human so how could anyone mess that up?

But it would be very clear how, if you realize that emotions are not spirits that float around. They have basis in our biology – organs, hormones, blood flow etc. In fact there are people, who, even if they can feel emotions, cannot make sense of those feelings on their own. Scientists estimate that about 10% of humans have “no words for feelings”. This condition is called alexithymia and people who have it, in varying degrees just can’t identify, express, and mull over their own emotions. They do feel emotions but they just do not know how to internally negotiate with these emotions. This naturally will affect how they behave and judge other’s emotions.

Studies have shown that brain scans of people with alexithymia show that they have a weak processing of facial expressions (a window to emotions) in the emotional regulatory parts of their brain but have hypersensitive areas in the brain to physical sensations. Scientists say that this makes sense because the control of sensations has a lot to do with emotional regulation.

In a recent study of alexithymia, scientists followed their noses. Science has long established the connection between smell and emotions so the study wanted to see how smell (in a range, from unpleasant to neutral to pleasant), is judged by people with alexithymia. They found that people with medium to high level of alexithymia had stronger physiological (stress response such as sweat rate, heart rate) reaction to various odors compared to low-level or non-alexithymic ones. They also found that alexithymia has different dimensions in terms of how they process smell. Those whose alexithymia made it difficult for them to identify, express and distinguish emotions, had a different reaction to the smells than those who had alexithymia that impaired their sensations, imagination and creativity.

So yes, of course emotions are in your head. They are not in your knees, your elbows or shoulders. So when people call out a mental illness as just being “in your head”, they are overstating the obvious but still somehow gloriously manage to miss the point. The “head” is part of one’s biology just like joints are part of your knees and when they ache, they could lack lubricants or have too much deposits that impair their movement. Our own minds are our most intimate “machinery” that it is easy for each of us to think that our experience of our own sanity is the standard for everyone else’s.  But clearly, just witnessing another human being, even your own children, slightly differ in the way s/he lives in the world, will overthrow the standard that you think you are.

Mental conditions are as real as the planets revolving around the sun. They have a biological basis – which means it has a parallel story inside your brain which deserves attention and treatment. Saying to people who have mental conditions that “it is just in your head” is just doing the opposite. It is insensitive, unkind and “intellectually impaired” to do so.  – Rappler.com