Humans are both biological and social beings, that is we are both nature and nurture. Frequently in therapy, the biological contributors to our mental health and general well being are not considered, as it is assumed that our client’s doctor of psychiatrist are looking after these elements. Even when this does happen, often our clients/patients have poor understandings about what those effects are, such as medication, diet, exercise and co-occurring health conditions. Here we will cover important aspects of your Medical Biology and link you to articles that further expand on each topic.
Medical Advice and Informed Consent
This is not a way to diagnose or treat yourself, this here to help inform you about each of these aspects, and either provide a guide to help you speak more knowledgeably with your professional, or give you some ideas about what you may need to look into.
It is important to have informed consent when agreeing to medical interventions. To have informed consent, your expert should give you enough useful information about the medical condition and treatment that you understand what you are choosing to do.
You should be informed about:
- Probability and Risk: What the reasonable (more common) risks are and how likely that is and how likely this intervention will give a positive outcome and what that is defined as.
- Scientific Why: Why this intervention is what is being suggested, what it is supposed to do, and what it likely informs you and the expert if it doesn’t work.
- Side Factors: If there are co-occurring conditions, how this intervention may effect those other conditions.
Generally, either listen to your expert and take their advice, or find an expert that is listening and discussing the above with you.
Medical Biology can be broken down into a few larger sections. This is not a complete text.
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Neurology (Brains)
All of mental health occurs in the brain. Our brain is an organ that is a part of our body. It is affected by what happens to our body, the health of our body and it can affect the health of our body.
Our consciousness is an emergent property of how our brain is wired and how we evolved to be more reliant on what we learn through our life than other animals. Most of Mental Health Therapy works on affecting changes to that knowledge, skills and understanding.
However, we contain those thoughts in our brain, and many of our thoughts, impulses and feelings are directly related to what the biology of our brain. If there is a deficit or oversupply in a neurotransmitter, or our neurons are poorly connected, or we have a brain injury, then it is very hard to manage our thoughts, feelings and decisions.
Our Neurology section breaks down much of what is happening for our brain biology, how that affects our lives, and what we can do about it.
Hormones
Hormones are a series of chemicals that our bodies use as a major body regulatory mechanism. Some of these hormones are used by our brains as direct neurotransmitters, while others regulate other aspects of our bodies. When our hormones are out of kilter, it can have complex biological consequences and can be a major factor behind poor mental ill health.
Diabetes
Diabetes Melitus comes in two major forms: Type 1 (often what people mean when they say diabetes) and Type 2 (sometimes called adult onset or acquired diabetes).
Diabetes is a group of endocrine diseases that are characterised by sustained high blood sugar, generally because either the pancreas cannot produce enough of the hormone Insulin to counteract the sugar in the blood, or the cells of the body becoming unresponsive to the effects of Insulin.
Maintaining good blood sugar levels that reflect your current situation is a very important part of Mental Health. Low blood sugar, also fairly common in diabetes, can leave you feeling lethargic and poorly able to respond to change, while high blood sugar can lead to impulse control problems.
ADHDers (people with ADHD) will often have high blood sugar as they use this body hack to compensate for low brain Dopamine, Noradrenaline and Adrenaline. Another mechanism common to ADHDers is using stress to elevate Adrenaline. The combination of sustained high blood sugar due to diet and high blood adrenaline due to stress can be a factor in developing Type 2 diabetes.
Sex Hormones
That two largest groups of humans, XX people (often referred to as female) and XY people (often referred to as male) have some distinct levels of certain hormones based on their XX or XY chromosomes. These hormones have an effect on how some of the brain’s neurotransmitters work, which can lead to depression, anxiety and impulse control problems. These particular hormones, such as testosterone, oestrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone, are referred to as Sex Hormones.
Hormone treatments are common and standard treatments.
ADHD, PMDD and Oestradiol
Premenstrual Dysphoric Disorder is where just prior to menstrual flow, a person has a strong cognitive and mood dysfunction which can lead to odd behaviours. This is compounded in people with both ovaries and ADHD. We cover this in detail here.
A primary component of making Dopamine is Oestradiol. This not only extracts the Tyrosine amino acid from protein, it directly regulates how much Dopamine a person makes. Low primary sex hormones (Testosterone or Oestrogen/ Progesterone) can interfere with and bottle neck Dopamine Synthesis in your brain, making ADHD worse. These hormones, Testosterone, Oestrogen and Progesterone, break down into Oestradiol, also referred to medically as E2. Oestradiol is one of the 4 forms of Oestrogen (E4, Estetrol is only made during pregnancy).
Transgender Affirming Care
Transgender is a real thing. We talk about it in our primer Understanding Transgender.
The risk to Trans folk is high, with high representations in Anxiety, Depression, Self-Harm and Suicide.
As such, we strongly advocate for Transgender Affirming Care. Many studies have shown that Trans Affirming Care can significantly reduce Anxiety, Depression, Self-Harm and Suicide.
Menopause
Menopause is a process where a person with ovaries’ body naturally stops menstruating. This occurs typically between 45 and 50, but can be earlier or later. The person’s body decreases Oestrogen and Progesterone productions the ovaries no longer mature and release eggs.
As noted above, Oestradiol is a key component for making Dopamine, so this can affect people’s cognition and mood. This can be compounded by ADHD, BPAD (Bipolar Affective Disorder) and a history of PD (Postnatal Depression). We cover this in more detail here.
Depression and Anger in Men
While rare, low testosterone (more common) or high testosterone can cause mood dysregulation such as fatigue, depression, anxiety and anger. Testosterone levels affect neuronal serotonin, dopamine and noradrenaline [Source], which can affect focus and mood. Testosterone has also been hypothesised to affect the efficacy of antidepressant medication such as SSRIs, however that connection is poorly studied and has weak evidence [Source].
While the level of testosterone can be a problem, this is considered to be fairly rare and is a treatment that is considered when other treatments don’t work in conjunction with relevant tests to confirm that testosterone is irregular.
Thyroid
The Thyroid is an endocrine gland found at the bottom of your neck, between your voice box and your chest, near your clavicle.
Endocrine glands, such as the thyroid, pituitary gland, pineal gland, pancreas, ovaries, testicles, hypothalamus, adrenal glands and parathyroid gland, create and secrete hormones. Your thyroid secretes three kinds of hormone, triiodothyronine (T3), thyroxine (Tf) and calcitonin (a peptide hormone). The first two adjust your metabolic rate and protein synthesis, the third maintains the balance of calcium.
Metabolic rate (alertness and sleep) which can affect your heart rate,
Nutrition and Diet
We are made of chemicals, our process of being alive uses chemicals and we excrete chemicals once they are no longer useful enough for our bodies (generally). Our bodies use a large amount of some elements and a small amount of most elements. The elements are bound together with other elements to form molecules. The easiest method of replacing the chemicals that we need to operate well is, to quote Michael Pollan, to “Eat food, not too much, mostly plants”.
Most Australians have a poor diet. This isn’t just a question of risking heart attacks, or risking brittle bones, which are legitimate risks, but it is also woefully misunderestimating how complex our brains are. When we feed our body, we feed our brain. Our brain is very complex, using many of the small amounts of most elements. It relies on a healthy body for housing it, and passing the necessary ingredients along to power it.
Poor diet leads to poor mental health. Think of it this way, if you get a normally healthy well adjusted person, and you strip out vitamin C from their diet, after a few days their focus and ability to initiate tasks will diminish, their impulse control will struggle, they will become quite moody and will get seem like they are a very different person. Soon after that, signs of scurvy will appear.
With poor mental health, it becomes very difficult to push ourselves to eat properly, which further exacerbates poor mental health.
To be clear, most of what we call “mental illness” is not caused by malnutrition, where you haven’t eaten enough of the right ingredients to properly feed your body, but most mental illness is exacerbated by poor nutrition. By fixing your diet, you fix most of your nutrition problems, which is decreases how much you have to overcome to remain happy and functional.
Further, some people are poor at digesting certain nutrients despite having a good and supportive diet. This can come in the form of allergies, intolerances, varying genetics and some very complicated biology. This can result in malnourishment even with the best optimised diet.
Check out our section on Nutrition, Health in Body and Mind, Eating Disorders and also ARFID Neurodivergence and You.
Exercise
TLDR: Exercise is good, lots of positive from 2 hours per week, less after that; however, minimal effect to weight.
For mental and physical wellbeing, there is a big difference between sedentary and fit. In logistical terms, that is 2 hours of exertion activity that increases your heart rate and breathing rate. For good bone condition, some of this should include mild skeletal jarring (impact), such as a fast walk, small jumps or higher – this sends a signal to your brain that your bones need to be strong, so your skeletal bones are reinforced with calcium, which reduces your risk of osteoporosis.
From sedentary (mostly not moving) to fit has profound positive effects on your heart, risk of cancer, muscle tone, ability to focus, concentrate and positive mood. This transition also has some positive effect on weight, where slim people will gain a bit, and larger people will lose a bit
Exercise beyond basically being fit has minimal effect on weight (for that you need to look at diet, hormones and GPL1), but does have continuing moderate positive effects on body and mind health. That is, you won’t get as much from a second 2 hours of exercise per week as you did from the first, but it will generally be an improvement in your body and mind health.
It is very important to note that some conditions require changes in exercise. For example, injuries require modification to not further damage them, chronic pain may require different types of exercise, heart conditions need to not overly stress the heart, and Fibromyalgia, Chronic Fatigue, Myalgic Encephalomyelitis can be made worse with exercise – so check with your specialists for these conditions.
Medication
Medication is any substance that is added to your body that changes some biological chemistry, and by extension, your biological system. Medications can be topical (placed on the skin), intravenous (directly injected into your bloodstream), ingested (swallowed) or inhaled (breathed in). The most common medication delivery method is ingested.
We have an ever evolving section on medications for you to consider [LINK]. To repeat the warning above, this isn’t about recommending for you specifically which medications to take, this is to supplement your knowledge of what medications do (to the best of our knowledge) to further help your informed consent when talking to your medical professional.
Sleep
Every biological entity we know about does some form of diurnal change in its biological process, where the entity will be more active and another where it is less active. When the biological entity is an animal, we refer to the less active part as sleep. In humans, we enter a different state of consciousness during this essential part of our diurnal process.
On average, people in Western Civilisation average 1 hour less sleep than is optimal for them. That does not mean 7 hours, as the 8 hour sleep for everyone is a myth created by people not being good at understanding mathematics and statistics.
We have an article on Beating Insomnia and Beating Pre-Sleep Anxiety that expands on this and gives so much more information.
Specifics on Complicated Conditions
ADHD, Attention Deficit Hyperactivity Disorder
ADHD is a congenital neurological condition that affects roughly 1 in 10 people worldwide. In some areas that number can increase up to 4 in 10. In Australia, it the ABS (Australian Bureau of Statistics) reports that the prevalence of ADHD here is about 1 in 10.
Primarily ADHD is a condition that affects Dopamine in the preFrontal Cortex, where not enough Dopamine is able to get to the Synapses to allow you to understand, think, plan and do things. ADHD often affects Noradrenaline, as Noradrenaline is made from Dopamine. Most ADHDers (people with ADHD) have too little Noradrenaline, a few have too much. Noradrenaline affects your mood, recognition of safety, how well you connect ideas and initiate tasks. Noradrenaline being out of the Goldilocks Zone is the primary reason why people experience long term mood disorders such as Anxiety and Depression.
Autism
Autism is a congenital neurological condition that affects roughly 1 in 30 people, although we suspect that this is higher than previously thought.
Autism describes a spectrum of presentations and is more of an umbrella term for a range of neurological differences that affect how people behave, learn, and interact with other people. Autistic people often have difficulties socialising with non-Autistic people, or other Autistic people who are far away from themselves in the various spectrums that Autism has.
Autism is often co-occurring with a host of other conditions, which can result in Autism being a disability. Many Autistic people are not disabled, although they may struggle in select environments and benefit from making accommodations.
Fibromyalgia, Chronic Fatigue Syndrome and Myalgic Encephalomyelitis
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